Medical Malpractice in Correctional Facilities: State Tort Remedies for Inappropriate and Inadequate Health Care Administered to Prisoners

• Published date: 01 December 2004
• DOI: 10.1177/0032885504269347
• Date: 01 December 2004
• Author: Sue Carter Collins,Michael S. Vaughn
• Subject Matter: Articles

10.1177/0032885504269347
THE PRISON JOURN
V
AL / December 2004
aughn, Collins / MALPRACTICE IN CORRECTIONAL FACILITIES
MEDICAL MALPRACTICE IN
CORRECTIONAL FACILITIES: STATE
TORT REMEDIES FOR INAPPROPRIATE
AND INADEQUATE HEALTH CARE
ADMINISTERED TO PRISONERS
MICHAEL S. VAUGHN
SUE CARTER COLLINS
Georgia State University
This article reviews state tort remedies assessed against correctional personnel for
inappropriate and/or inadequate health care administered to prisoners. It reviews
medical malpractice and negligence law generally and then applies these legal pre-
cepts to jail and prison health care legal actions. Through an inductive process, the
cases from various state courts are divided into four categories: administration of
inadequate or inappropriate medication, performance of inappropriate medical pro-
cedures, inappropriate diagnosis of serious medical conditions, and undertreatment
of serious medical problems. The article concludes by calling for more research on
health care within correctional settings.
Keywords: malpractice; prison; health; litigation; inmate
The Institute of Medicine within the National Academy of Sciences
(Kohn, Corrigan, & Donaldson, 2000) reported that medical errors kill
44,000 to 98,000 patients a year in the United States. These estimates reflect
deaths attributed to mistakes in the practice of free-world medicine. Negative
health outcomes within incarcerated populations—where it has been alleged
that substandard personnel are often employed—could be potentially much
higher (Dabney & Vaughn, 2000). Because the types of medical errors to
An earlier version of this article was presented at the 2001 meeting of the American Society
of Criminology in Atlanta, Georgia. Correspondence concerning this article should be addressed
to Michael S. Vaughn,Ph.D., Departmentof Criminal Justice, Georgia State University, P.O. Box
4018, Atlanta, GA 30302-4018; phone: (404) 651-3688; fax: (404) 651-3658; e-mail: mvaughn@
gsu.edu.
THE PRISON JOURNAL, Vol. 84 No. 4, December 2004 505-534
DOI: 10.1177/0032885504269347
© 2004 Sage Publications
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THE PRISON JOURNAL / December 2004
which inmates are subject are generally unknown, the area of prison health
care is in dire need of social inquiry, research, and study (Ford & Wobeser,
2000).
It has been well documented that prison inmates are generally in poorer
health than is the nonincarcerated population (Marquart, Merianos, Cuvelier,
& Carroll, 1996) and represent one of the largest identifiable underserved
groups with respect to the quality of medical care they receive (Maeve,
1997). Inmates are sent to prison to deprive them of their liberty and freedom.
Any additional injuries that they receive at the hands of government employ-
ees are considered excessive and beyond the scope of the state’s authority
(Peters, 1992; Wilson, 1993). Thus, negative health outcomes suffered by
inmates at the hands of correctional medical personnel or custodial officials
can result in civil liability (Maeve & Vaughn, 2001).
This article focuses on the harm that can befall prisoners who seek correc-
tional medical services during their incarceration. Under most state laws,
inmates who suffer negative health outcomes by virtue of medical malprac-
tice or negligence are entitled to tort remedies for their injuries. The article
analyzes civil actions in state courts where correctional medical personnel
and prison officials are found liable for providing inadequate and/or inappro-
priate health care to prisoners. Forming the core of the analysis are cases
involving the administration of inadequate or inappropriate medication, per-
formance of inappropriate medical procedures, inappropriate diagnosis of
serious medical conditions, and undertreatment of serious medical prob-
lems. The article also describes the circumstances and situations under which
state tort liability attaches for negative health outcomes suffered by prisoners
and calls for more research on correctional health care systems.
MEDICAL MALPRACTICE AND
NEGLIGENCE: A DEFINITION
Medical malpractice occurs whenever the level and quality of services
provided by a doctor, nurse, technician, or other health care official “departs
from the standard of care [provided by] those with similar training and expe-
rience [and results] in harm to a patient or patients” (American Bar Associa-
tion, 2002). In other words, medical malpractice is medical negligence com-
mitted by health care professionals that results in physical and/or emotional
damage to patients.1
The concept of negligence comes from British common law and has been
defined as “the omission to do something which a reasonable [person],
guided upon those considerations which ordinarily regulate the conduct of
human affairs, would do, or doing something which a prudent and reasonable

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Vaughn, Collins / MALPRACTICE IN CORRECTIONAL FACILITIES
507
[person] would not do” (Blyth v. Birmingham Water Works, 1856, p. 784).
Under negligence law, “an honest mistake or blunder does not absolve the
[medical practitioner] from liability, so long as a reasonable [medical offi-
cial] would anticipate that the injury might occur” (Shiffman, 1990, p. 5).
Central to negligence law is the concept of duty, which is defined by state
statutes and is usually based on community standards. Historically, many
jurisdictions adopted the “locality rule, where the standard of care is that care
a [medical care provider] would exercise practicing in the same or similar
community under the same or similar circumstances” (Shiffman, 1990, p. 4).
As a result, medical care providers were only required to “possess and apply
the knowledge and use the skill that is ordinarily used by reasonably well-
qualified [medical care providers] in the locality, or similar localities, in
which [they] practiced” (American Bar Association, 2002). In recent years,
because of increased uniformity of medical training, there has been a grow-
ing trend toward the adoption of national standards, requiring that all medical
care providers within the same class be judged by the same criteria.
Medical negligence occurs when the medical official commits a breach of
a duty that is both the actual and proximate or legal cause of the inmate’s
injury (Shiffman, 1990). To establish legal causation, the prisoner must dem-
onstrate a reasonable nexus between the act or omission of the prison medi-
cal official and the injuries. When ruling on issues of causation, some courts
employ the so-called but for rule, which requires the prisoner to prove that
but for the medical official’s conduct the injury would not have occurred
(Morreim, 2001). Other courts follow the substantial factor rule, which says
the medical official’s conduct is the cause of the prisoner’s injury if it was a
“material element and substantial factor in bringing it about” (Shiffman,
1990, p. 6). Where the inmate succeeds in establishing causation, the medical
care provider’s liability extends to all directly foreseeable risks associated
with and flowing from his or her conduct (Danhauer v. Youth Development
Center, 2001). Because medical malpractice cases typically involve a variety
of complex issues, expert testimony is commonly required to establish the
existence of acceptable standards of care and to show that a breach of duty
occurred.
TORT REMEDIES FOR PRISONERS SUFFERING
MEDICAL MALPRACTICE AND NEGLIGENCE
Administrators of a correctional facility have a duty to investigate the
qualifications and competencies of medical employees and to ensure that
they are proficient in rendering the services for which they were hired
(Morreim, 2001). They also have a duty to maintain medications and equip-

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THE PRISON JOURNAL / December 2004
ment for the health and safety of the inmates with whose custody they have
been entrusted. Physicians have a duty to practice due diligence in diagnos-
ing and treating inmates’ medical problems. Nurses have a duty to inform
physicians of potentially dangerous or serious medical problems that a rea-
sonable medical official would expect to arise. All medical care providers
have a duty to exercise due care in implementing the treatment regimens
ordered by physicians (Sharpe, 1999). In other words, both prison officials
and health care practitioners are required to maintain a certain standard of
care when rendering professional medical services to inmates. Although the
standard may vary depending on the jurisdiction in which the facility is
located, in many cases it is the so-called reasonable person standard, which
dictates that medical officials providing health care services to similarly situ-
ated prisoners under similar circumstances must act prudently when carrying
out their duties (Kappeler, 2001).
To date, there has been little research assessing correctional medical
workers’civil liability under state tort law. This article attempts to expand our
knowledge by focusing on state tort remedies available to prisoners who sue
correctional health care providers for negative health outcomes. Using the
Westlaw online database, we identified correctional health care personnel
who were sued in state courts between January 1, 1976, and December 31,
2001. In the Westlaw allstates database, our search strategy identified the
terms prison or jail within the same paragraph as the word medical and linked
those terms to the word liability. This produced over 553 cases, including
hundreds that either (a) did not pertain to a prison...