23-b-1 Constitutional Law

• Library: A Jailhouse Lawyer's Manual (2020 Edition)

23-B-1. Constitutional Law

The Eighth Amendment of the Constitution protects prisoners from "cruel and unusual punishment."⁶ In 1976, the Supreme Court said in Estelle v. Gamble that a prison staff's "deliberate indifference" to the "serious medical needs" of prisoners is "cruel and unusual punishment" forbidden by the Eighth Amendment.⁷ Thus, if prison officials treated your serious medical needs with "deliberate indifference," they violated your constitutional right to be free from cruel and unusual punishment.

You must prove two things to show that prison officials treated your serious medical needs with "deliberate indifference" (and therefore violated your constitutional rights). You must first prove that your medical needs were sufficiently serious (the "objective" part).⁸ Second, you must prove that prison officials knew about and ignored "an excessive risk to [your] health or safety" (the "subjective" part).⁹ Since deciding

Estelle, courts have tried to clarify how prisoners can prove these two things.¹⁰ This Chapter explains each part separately below.

Note that the Constitution does not guarantee comfortable prisons; prison conditions may be "restrictive and even harsh."¹¹ However, the medical care you receive should meet an acceptable standard of care in terms of modern medicine and beliefs about human decency.¹²

(a) The Objective Part: "Sufficiently Serious" Medical Need

To establish the first part (the "objective" part) of an Eighth Amendment claim based on prison officials' deliberate indifference to your medical needs, you must show that your medical needs were sufficiently serious. Courts define "serious medical need" as "one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity of a doctor's attention."¹³ To decide if a medical need is serious, the Second Circuit (which governs New York, Connecticut, and Vermont) considers several factors including, but not limited to, the following:

(1) whether a reasonable doctor or patient would perceive the medical need in question as "important and worthy of comment or treatment,"

(2) whether the medical condition significantly affects daily activities, and

(3) whether "chronic and substantial pain" exists.¹⁴

Under the Prison Litigation Reform Act ("PLRA"), a medical need is only sufficiently serious if it involves physical injury.¹⁵ For example, in one case a patient with HIV was denied his medication for several days.¹⁶

His illness was clearly serious, but it was determined that missing a few days of medication caused him no physical harm. Generally, though, if your medical condition is extremely painful, your medical need could be considered "sufficiently serious." For example, in Hemmings v. Gorczyk, prison medical staff diagnosed a ruptured tendon as a sprain and refused for two months to send the prisoner to a specially trained doctor; however, the Second Circuit later found that the prisoner's condition was painful enough to be "sufficiently serious."¹⁷ The general trend seems to be that the courts will consider injuries to be sufficiently serious if they significantly change a prisoner's quality of life. The Second Circuit has held that the denial of care has to be objectively serious enough to create "a condition of urgency"-a situation where death, permanent injury, or extreme pain appears likely to occur or has occurred.¹⁸ Other circuits have similarly high requirements for what counts as a serious injury or denial of care.¹⁹

Recent court decisions have emphasized pain²⁰ and disability when evaluating prisoners' medical needs.²¹ Drug or alcohol withdrawal is a serious medical need.²² Transsexualism or gender identity disorder ("GID") has been recognized as a serious medical need in some cases.²³ There might also be a "serious cumulative effect from the repeated denial of care" for minor problems.²⁴ Where medical treatment is delayed, courts look at whether the effects of the delay or interruption-not the underlying medical condition-are objectively serious enough to present an Eighth Amendment question.²⁵ Whether a medical need is "serious" should be determined on a case-by-case basis and not only by a prison's "serious need list."²⁶ Prisons are not allowed to have a rigid list of serious medical needs without allowing some flexibility in individual prisoner evaluations.²⁷ In addition, a treatment that a hospital or prison considers to be elective (voluntary and non-emergency) may still be a "serious medical need."²⁸

(b) The Subjective Part (Prison Officials "Knew of and Disregarded a Risk")

After proving that your medical need was sufficiently serious, you must also prove that prison officials purposely allowed you to go without necessary medical help.²⁹ This is the second part of your Eighth Amendment claim (the "subjective" part). It is difficult to prove that prison officials knew about your serious medical need and meant to deny you necessary medical care. Part 3 of this Chapter explains the different ways you can prove that...