Medical Care

Medical Care in Prison

Prisoners have the right to receive adequate medical care. The Eighth Amendment of the US Constitution guarantees individuals the right to be free from cruel and unusual punishment, which the Supreme Court has determined to include the right of prisoners to have access to medical care.1 However, prisoners are not guaranteed the right to "unqualified access to health care."2 This page will help explain what kinds of medical care are required under the Eighth Amendment of the US Constitution.

The denial of medical care is a Constitutional violation only if prison officials are "deliberately indifferent" to a “substantial risk of serious harm.”3 Thus, in order for an inmate successfully to claim that inadequate medical care violated his constitutional rights, he must prove two things4: (1) that the poor treatment resulted in “sufficiently serious”5 harm (the objective standard), and (2) that the prison official responsible for the harm knew of an excessive risk to inmate health or safety and disregarded that risk by failing to attempt to minimize it6 (the subjective standard).

What types of medical problems meet the objective standard?
What types of actions meet the subjective standard?

What types of harm meet the objective standard?
What types of harm are considered "sufficiently serious"?
Generally, for an injury to be considered "sufficiently serious," the harm must significantly change the prisoner's quality of life. For example, harm would be considered "sufficiently serious" if it causes degeneration or extreme pain.7 Some examples of medical needs that the courts have considered "sufficiently serious"8:

• degenerative, painful hip condition that hindered the inmate's ability to walk
• painful, obviously broken arm
• bleeding ulcer that caused abdominal pain
• inflamed appendix
• shoulder dislocation
• painful blisters in mouth and throat caused by cancer treatment
• pain, purulent draining infection, and 100 degrees or more fever, caused by an infected cyst
• cuts, severe muscular pain, and burning sensation in eyes and skin, caused by exposure to mace
• head injury caused by slip in shower
• substantial back pain
• painful fungal skin infection
• broken jaw requiring jaw to be wired shut for months
• severe chest pain caused by heart attacks
  

Some examples of medical needs that the courts have determined NOT to be "sufficiently serious"9:

• sliver of glass in palm that did not require stitches or painkillers
• pain experienced when doctor removed a partially torn-off toenail without using anesthetic
• nausea, shakes, headache, and depressed appetite caused by family situational stress
• "shaving bumps"

What types of actions meet the subjective standard?
How can you determine whether or not a prison official "knows of and disregards an excessive risk to inmate health or safety"?

A prison official cannot be “deliberately indifferent” to a medical need if he is not aware of the medical problem. Thus, an inmate must make sure that prison officials know about his medical needs. If an inmate wants to see medical personnel, he must inform the corrections officers on his block. He must fill out sick call slips and, if these are not honored, he must file grievances. Once an inmate gets in to see a nurse or doctor, he should tell him about his symptoms and any relevant medical history. While an inmate should do all he can to make sure that medical personnel are aware of his medical problems, medical personnel can also be held responsible for knowing information in addition to what the inmate tells them. Specifically, medical personnel are responsible for information gained by examining the inmate, reviewing the inmate’s medical records, and by talking to others familiar with the inmate (guards, other doctors, and family members, for example).10

If a prison official knows of an inmate’s medical problem, he must do what is in his power to address that problem. If a prison official knows of an inmate’s substantial medical need and disregards it, he can be held accountable for violating the inmate’s constitutional rights. Listed below are some common situations in which courts have held that officials were deliberately indifferent to inmates’ medical needs.

Failure to Treat a Diagnosed Condition
If a prison doctor diagnoses an inmate with a certain medical condition and then fails to provide that inmate with treatment for this condition, courts are likely to find that that doctor has been deliberately indifferent to inmates’ medical needs. If an inmate suffers serious harm as a result of this lack of treatment, prison officials can be held liable for violating the inmate’s rights. For example, if an inmate who is diagnosed with HIV receives no drugs to inhibit the virus and as a result develops full-blown AIDS more quickly than he should have, prison medical staff can be held liable.

Similarly, prison officials other than doctors can be held liable for infringing on an inmate’s rights if the official prevents an inmate from receiving treatment recommended by a doctor. For example, the 2nd Circuit Court of Appeals held that prison officials were deliberately indifferent to an inmate’s medical needs when they removed him from a hospital without permission from the doctors.11 Prison officials without medical training do not have the right to second-guess the recommendations of doctors.

Delay in Treatment or Delay in Access to Medical Attention
Prison officials do not have to provide inmates with immediate access to medical care. Generally speaking, prison officials can delay in providing medical care if they have a legitimate reason for doing so.12 For example, security concerns can justify delaying an inmate’s access to medical care, as long as this delay does not make the medical problem significantly worse. On the other hand, unreasonable delays do violate the Constitution. A delay is considered to be unreasonable if it is medically unjustified and it is likely to make the medical problem worse or to result in permanent harm.13 For example, the 7th and 8th Circuit Courts of Appeals have ruled that 10-15 minute delays in responding to heart attacks constitute deliberate indifference.14 Also, the 4th Circuit Court of Appeals held that prison officials were deliberately indifferent when they delayed 11 hours in examining an inmate’s painfully swollen and obviously broken arm.15

Denial of Access to Medical Personnel
Prison officials cannot deny inmates access to medical personnel. If an inmate requests medical attention, non-medical staff may not decide whether or not to allow the inmate to see medical personnel. For example, in Parrish v. Johnson, the 6th Circuit Court of Appeals ruled that a guard who failed to relay an inmate’s request for medical care was deliberately indifferent to the inmate’s medical needs.16 Similarly, the 11th Circuit Court of Appeals found a physician’s assistant to be deliberately indifferent to an inmate’s medical needs when the assistant refused to x-ray an inmate with a broken hip or to send him to a doctor for examination.17

Grossly Inadequate Care
Negligent medical care does not violate the Constitution. In prison, medical malpractice does not constitute a violation of prisoners’ rights. On the other hand, excessively bad medical care can violate a prisoner’s 8th Amendment rights. For example, a jury could find that a prison official acted with deliberate indifference if he treats a patient with a serious risk of appendicitis by simply giving him aspirin and an enema.18

What should an inmate do if he feels his constitutional right to adequate medical treatment has been violated? (link to another page dealing with grievances, how to file lawsuits, etc.)

1. Estelle v. Gamble, 429 U.S. 97, 97 S. Ct. 285, 50 L. Ed. 2d 251 (1976).
2. Hudson v. Millian, 503 U.S. 1, 9 (1992). Citation from Robert E. Toone: Protecting Your Health and Safety – A Litigation Guide for Inmates. Montgomery, AL: Southern Poverty Law Center, 2002, p. 74.
3. Farmer v. Brennan, 511 U.S. 825 (1994).
4. Criteria summarized in A Jailhouse Lawyer’s Manual (JLM), 5th edition. New York: Columbia Human Rights Law Review , 2000, p. 540.
5. Wilson v. Seiter, 501 U.S. 294, 298, 115 L. Ed. 2d 271, 111 S. Ct. 2321 (1991).
6. Farmer v. Brennan.
7. Hathaway v. Coughlin, 37 F.3d 63 (2nd Cir. 1994).
8. List from Toone, p. 76-77.
9. Ebd., p. 77.
10. Ebd., p. 78.
11. Martinez v. Mancusi 443 F.2d 921, 924 (1970). In: JLM, p. 542.
12. JLM, p. 542.
13. See Toone, p. 81-2.
14. Bass by Lewis v. Wallenstein, 769 F.2d 1173, 1183 (7th Cir. 1985) and Tlamka v. Serrell, 244 F.3d 628, 633-34 (8th Cir. 2001). In: Toone, p. 81.
15. Loe v. Armistead, 582 F.2d 1291, 1296 (4th Cir. 1978). In: Toone, p. 81.
16. 800 F.2d 600, 605 (1986). In: Toone, p. 80.
17. Mandel v. Doe, 888 f.2d 783, 789-90 (1989). In: Toone, p. 80.
18. Sherrod v. Lingele, 223 F.3d 605, 611-12 (7th Cir. 2000). In: Toone, p. 84.