Section 1983 civil liability of prison officials for denying and delaying medication and drugs to prison inmates.

• Author: Vaughn, Michael S.

Not much is known about prison health care, except that prisons are required to provide adequate care for the "serious medical needs" of inmates.(1) Historical depictions of prison health care portray an ineffectual system plagued by ineptness and callousness.(2) Even worse than poor management, the checkered past of prison health care is tainted by corruption, brutality, and human experimentation.(3) At one time, for example, prison researchers praised the beneficial effects of tranquilizers, calling the mind- and mood-altering effects of medication beneficial treatment.(4) Although federal guidelines currently protect inmates from harmful research(5) and contemporary prison health care is demonstrably improved,(6) the delivery of quality health care to prisoners continues to be hampered by custody and security issues(7) and by the problems associated with prison crowding.(8)

The medication distribution system in correctional facilities has been, at best, at the periphery of past research.(9) The recent attack by President Clinton on pharmaceutical manufacturers increased scrutiny on the drug industry,(10) but this focus is primarily directed at corporate managers accused of price gouging.(11) Thus, the problems associated with prescribing and dispensing medication to inmates remain elusive. The limited research on this issue reports tightly controlled access to routine medication,(12) even though inmates may need more medication than the general public.(13) Other research points to the difficulty of implementing a medication distribution system that meets the diverse medical needs of inmates.(14) Although these problems in allocating inmate medication coincide with an explosion of prisoner suits, the literature lacks an accounting of civil liability jurisprudence in this important area of corrections.

This article focuses on potential civil liabilities for prison and medical officials under Title 42, U.S.C. Section 1983 (hereinafter "[sections] 1983").(15) It analyzes the Supreme Court's standard of "deliberate indifference" as interpreted by the United States Courts of Appeals in the context of civil liability involving the denial and delay of medication to inmates. The article analyzes the federal cases occurring before and after the United States Supreme Court's 1976 decision in Estelle v. Gamble.(16) The post-Gamble analysis builds a legal/conceptual framework around which case law and the factors necessary to establish a viable [sections] 1983 claim are delineated and explored. The article concludes by identifying the conditions and circumstances involving denial or delay of inmate medication that most likely lead to civil liability of prison officials.

Prison Medication Cases in the United States Circuit Courts of Appeals

Before Estelle v. Gamble

Prior to Gamble, the federal courts debated the appropriate culpable mental state required to bring a [sections] 1983 claim of improper medical care under the eighth amendment. Although there was some confusion between terms such as deliberate indifference, gross negligence, intentional neglect, and deprivation of basic medical treatment, courts were in general agreement that, to raise a viable civil rights claim under the eighth amendment, prison inmates must show more than "simple negligence." The nine cases below represent the early litigation in the circuits pertaining to denying and delaying medication to inmates with serious medical needs. In this narrow area of prison law, from 1957 to 1976, six different circuits decided nine cases and used five different legal standards to assess inmate challenges brought under [sections] 1983. This resulted in little continuity in the law and much confusion over the level of culpability and scienter required to bring an inmate claim under [sections] 1983. The pre-Gamble analysis organizes the cases by the various standards articulated by the lower courts.

Exceptional Circumstances

For a court assessing the constitutional validity of an inmate's claim alleging impropriety in a prison medication case, the threshold question was whether to abandon the hands-off doctrine and address the merits of the claim. In an early case illustrating the hands-off doctrine, the Seventh Circuit affirmed the dismissal of a [sections] 1983 claim of an inmate who alleged that prison officials had violated his civil rights by placing him in an isolation cell without benefit of medication. In United States v. Ragen,(17) the Seventh Circuit said that only under "exceptional circumstances" was it proper for the federal courts to intervene in the operational aspects of a prison. In dismissing the inmate's claim, the court added that decisions of maintaining and managing prisons are for the states, not the federal courts. This case illustrates the problems inmates faced in bringing a claim into the federal judiciary. Over time, however, courts became more amenable to inmate claims as more inmates sued over medication denial and delays.(18)

Knowingly and Intentionally

In an early case involving denial of medical care and medication, the Seventh Circuit reversed the district court's motion to dismiss a [sections] 1983 allegation of violation of the fourteenth amendment. In Coleman v. Johnston,(19) Coleman was detained in a Chicago jail with a leg gunshot wound. Plaintiff alleged that the jail authorities "knowingly and intentionally" neglected his injuries, denying him medical care and medication for three days. Without addressing the merits of the inmate's claim, the court said that the plaintiff should have the opportunity to prove the allegations at trial; thus, as early as 1957, the Seventh Circuit held that prison officials who "knowingly and intentionally" neglected an inmate's serious injuries may be subject to a civil rights suit under [sections] 1983.

Deliberate Infliction of Pain

In another case involving the denial of medications,(20) the plaintiffinmate filed a federal civil rights claim under [sections] 1983, alleging a violation of the fourteenth amendment because prison officials refused to administer pain medication for five days following surgery to remove hemorrhoids. The Ninth Circuit reversed an order granting a motion to dismiss, saying that the "deliberate infliction of pain through a calculated withholding of medication" was equivalent to an assault.(21)

Deprivation of Basic Medical Treatment

Some courts decided medication cases without clearly articulating a legal standard, adding to the confusion. In Campbell v. Beto,(22) an inmate with a heart condition was forced to perform manual labor and to work without prescribed heart medication, contrary to doctor's orders. The inmate brought a [sections] 1983 claim after suffering a heart attack. Without articulating a legal standard for the district court to use on remand, the Fifth Circuit reversed the district court's dismissal of the inmate's claim, holding that only "practices which result in the deprivation of basic elements of adequate medical treatment" violate the Constitution.(23)

Deliberate Indifference

Before Gamble, the Second, Sixth, and Eighth Circuit Courts of Appeals used deliberate indifference as a legal standard to assess inmate challenges in prison medication cases. Under this standard, courts consistently found constitutional violations on the part of prison officials for denying inmates medication for serious medical conditions. For example, the Second Circuit used the deliberate indifference standard when prison authorities refused to treat a known medical ailment. In Corby v. Conboy,(24) the Court of Appeals reversed the district court's dismissal of the inmate's [sections] 1983 claim that prison officials denied the inmate treatment of a serious nasal problem, holding that "a charge of 'deliberate indifference' to a prisoner's request for essential medical treatment is sufficient to state a claim."(25)

The Sixth Circuit also used deliberate indifference before it was adopted by the Supreme Court in Gamble. In 1976, in Westlake v. Lucas,(26) jail authorities refused to administer an inmate's medication even though they knew the inmate had a bleeding ulcer. After the inmate vomited blood, jail authorities gave the inmate a mild antacid. The inmate brought a [sections] 1983 action, alleging a violation of his eighth and fourteenth amendment rights. under the deliberate indifference standard by showing that he suffered severe pain for long periods and that "analgesic relief" was withheld.(27) The Sixth Circuit said that, to show deliberate indifference under a "totality of the conditions" analysis, there was no need to demonstrate an intent to inflict pain. Rather, the inmate had to show that prison officials denied "repeated requests for medical treatment in the face of an obvious need."(28)

In a case decided two weeks before the Supreme Court's Gamble decision, the Eighth Circuit used deliberate indifference in an inadequate medication claim. In Massey v. Hutto,(29) an inmate claimed that prison authorities failed to administer sufficient medication. In the first claim, the evidence showed that the inmate was receiving pain medication for a disabled hand. The Eighth Circuit rejected the inmate's [sections] 1983 claim, saying that a mere disagreement over medical treatment did not indicate deliberate indifference to the inmate's serious medical needs.(30) In the second claim, the inmate alleged that he was not receiving medication for his bleeding ulcer. In remanding this claim to the district court for reconsideration, the Eighth Circuit said that the allegations, if true, might be sufficient to show deliberate indifference.(31) Hence, the Eighth Circuit clearly distinguished between medication that inmates receive but believe to be inadequate and that which is denied altogether, saying that providing no medication for significant medical needs is deliberate indifference--enough to state a federal civil rights claim under [sections] 1983.

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