Medical Care for Prisoners – A Brief Look at the Legal Standard and Current Litigation
By Joel Schneider
The Alabama Department of Corrections (ADOC) has had a particularly bad year in the news: a Federal investigation confirmed rampant sexual abuse and harassment at Tutwiler Correctional Facility,[i] a string of inmate murders at St. Clair Correctional Facility,[ii] occupancy rates of prisons around the state remain close to double their design capacity,[iii] and the few programs that are points of pride for the ADOC are struggling to maintain funding.[iv] Predictably, especially in light of the overcrowding issue, the ADOC has also failed to provide adequate medical care for its inmates and is now facing a class action law suit. Initially filed in June of this year by the Southern Poverty Law Center (SPLC) on behalf of over forty plaintiffs representing the class, the complaint alleges the ADOC has violated the 8th Amendment’s prohibition on “cruel and unusual punishment” (among other constitutional violations) by “failing to provide constitutionally adequate medical care…[and] mental health care.”[v] And although the complaint and the facts alleged make for an intuitively strong case against the ADOC, the plaintiffs and the cause they further face real challenges in maintaining this suit.
The first and most daunting of these challenges is the fairly unforgiving legal standard the plaintiffs must meet in order to prove a violation of the 8th Amendment. The jumping off point is the case Estelle v. Gamble, wherein the Court upheld the logical conclusion that incarceration must include medical care for inmates, as the inmates have no ability to independently seek out medical care, and the denial of which would lead to the “unnecessary and wanton infliction of pain” the 8th Amendment is designed to prevent.[vi] The Court went on to establish a constitutional floor of acceptable levels of medical care, stating that a “deliberate indifference to serious medical needs of” a prisoner would violate the 8th Amendment.[vii] Essentially, the Estelle test is two-fold: the plaintiff must meet the objective requirement of a “serious medical need” and must also meet a subjective requirement by showing the defendant “acted with an attitude of ‘deliberate indifference’ to that…need.”[viii] The Court in Estelle was very clear, however, that the focus of this constitutional protection was not the quality of the medical care – neither mistake nor even medical negligence can form the basis of a claim of “medical mistreatment.”[ix]
The threshold question then for medical mistreatment claims is whether or not the medical need of the inmate is a serious one. A serious medical need, at least in the 11th Circuit, is defined as “one diagnosed by a physician as mandating treatment” or a need that is “so obvious that a lay person” would recognize the need for treatment.[x] Furthermore, the ailment must present a “substantial risk of serious harm” if left unattended.[xi] Case law has filled in the blanks of the definition with a discernible spectrum of what can and can not be a serious medical need, with broken bones and severe, symptomatic asthma on one end and shaving bumps on the other.[xii] The second prong of the Estelle test is noticeably more complicated. To meet the requirement of deliberate indifference, the plaintiff must satisfy three “components” by showing the defendant had a “subjective knowledge” of the “risk of serious harm,” that he disregarded that risk, and did so in a manner that exceeds negligence.[xiii] The court has held that a variety of scenarios satisfy the the deliberate indifference requirement: where the prison official flat out refuses to address an inmate’s serious medical need, delays the treatment, (although the court tempers this by noting the reason for the delay and extent of need are relevant), offers treatment “so grossly inadequate” or “cursory as to amount to no treatment at all,” or where the prison official chooses a “less efficacious” form of treatment.[xiv]
A brief look at the complaint filed by the SPLC yields the impression that the plaintiffs have satisfied the first prong of the Estelle test. Embedded in the formal language of the complaint are stories of inmates who are grossly under-treated or never treated at all. The subjective requirement, on the other hand, is likely to be the more intensely litigated issue in the SPLC suit. However, given the systemic nature of the ADOC’s failure to provide adequate medical care as alleged in the complaint, it seems, at the very least, plausible the SPLC could win on this issue as well.
This possible outcome introduces the second, more puzzling challenge the class of plaintiffs (and any interested Alabamian) must face: even if the lawsuit is won, will the relief be effectual? The SPLC complaint states the plaintiffs seek a declaratory judgment and injunctive relief. It has been roughly forty years since a class of Alabama prisoners has sought the same relief on the same grounds in Newman v. State of Ala., a case in which the plaintiffs did prevail.[xv] The Court of Appeals upheld the district court’s grant of injunctive relief and extensive decree aimed at remedying the constitutional violation,[xvi] and that injunction remained in effect for a decade.[xvii] Nevertheless, a generation later, the prisoners of the State of Alabama are again required to turn to the courts in an effort to secure their right to adequate medical care. If the court awards an injunction in the current lawsuit, what will stop the Alabama Department of Corrections from returning to its unconstitutional ways?
[i] Kim Severson, Troubles at Women’s Prison Test Alabama, The New York Times (March 1, 2014), http://www.nytimes.com/2014/03/02/us/troubles-at-womens-prison-test-alabama.html?_r=0
[ii] Casey Toner, Prison reform group calls for new St. Clair warden, citing third inmate homicide in 10 months, al.com (June 12, 2014), http://www.al.com/news/index.ssf/2014/06/top_alabama_prison_reform_grou.html
[iii] The Research and Planning Div., Monthly Statistical Report for June 2014, Alabama Department of Corrections (June 6, 2014), http://www.doc.state.al.us/docs/MonthlyRpts/2014-06.pdf
[iv] Dan Carsen, Budget Cuts Threaten a Unique Alabama Prison Program, NPR (August 23, 2014), http://www.npr.org/2014/08/23/342249911/budget-cuts-threaten-a-unique-alabama-prison-education-program
[v] First Amended Complaint at 2, Joshua Dunn, et al. v. Kim Thomas, et al, Civil Action No. 2:14-cv-00601-WKW-TFM, available at http://www.splcenter.org/sites/default/files/downloads/case/first_amended_complaint.pdf
[vi] Estelle v. Gamble, 429 U.S. 97, 103 (1976)
[viii] Farrow v. West, 320 F.3d 1235, 1243 (11th Cir. 2003)
[ix] 429 U.S. 97 at 105-106.
[x] Farrow, 320 F.3d at 1243
[xii] Id. at n.14.
[xiii] McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir. 1999)
[xv] Newman v. State of Ala., 349 F. Supp. 278, 286 (M.D. Ala. 1972) vacated in part, 522 F.2d 71 (5th Cir. 1975) and aff’d in part, 503 F.2d 1320 (5th Cir. 1974)
[xvi] Newman v. State of Ala., 522 F.2d 71 (5th Cir. 1975)
[xvii] Sterling v. Riley, 2:10-CV-117-TMH, 2010 WL 921067 (M.D. Ala. Mar. 11, 2010)