The real lethal punishment: the inadequacy of prison health care and how it can be fixed.

AuthorWallace, G. Nicholas
  1. INTRODUCTION

    There are over two million people incarcerated around the country in local, state, and federal jails and prisons. (1) Although prisoners do not have the full slate of constitutional rights as most American citizens, they do have some. (2) Prisoners have the right to due process, to be free from discrimination, to have access to parole, and to be free from cruel and unusual punishment. (3) However, inmates also have one right that no other American citizen enjoys: the right to health care. (4) Therefore, it is up to the Government to fund, staff, and administer health care for all incarcerated individuals. However, most of the health care provided at correctional facilities can hardly be considered adequate. (5) Many facilities are understaffed, poorly funded, and severely overcrowded. (6) Thus, the question becomes whether the health care provided to prisoners is adequate and, if not, whether prisoners are entitled to relief under the U.S. Constitution, particularly the Eighth Amendment. (7)

    However, the problems that plague the prison health care system can likely be improved without much intervention from the legislature. First, physicians can be encouraged to work in prisons with steadier pay and more flexible hours. Second, funding for prisons has been a perennial problem for many years. Privatization of health care can reduce costs while providing better health care to prisoners. Finally, overcrowding is a problem that has recently arisen due to a "crack down" on crime across the country. Governments can alleviate this problem without jeopardizing criminal enforcement by instituting various measures of sentencing reform.

    Part I of this article focuses on the quality of health care that is to be provided to prisoners and reasons why the health care that is currently being provided is inadequate. Part II examines the issue through an ethical lens and summarizes Kantian ethics and how that theory shapes this issue. Part III focuses on exactly what quality of health care prisoners are entitled to and what their remedies are if the health care is found to be inadequate. Part IV focuses on three primary reasons prison health care is considered inadequate: understaffing, underfunding, and overcrowding. Additionally, each of these problems will be analyzed and possible solutions to the problems will be offered. Lastly, Part V will examine a particular group of prisoners: the mentally ill. This focus provides a more detailed view on a specific group of individuals in prison, how the inadequacies directly affect them, and what the Government has done to fix the inadequacies of the care provided to them in prison.

  2. WHY SHOULD INMATES RECEIVE ADEQUATE HEALTH CARE?

    Although people in prison need to be punished for their wrongdoing, they still deserve respect as living people. Immanuel Kant is famous for his "Categorical Imperative," which placed moral demands on all persons to perform. (8) Kant also believed that all human beings possess dignity because of their rational autonomy and because they follow various moral laws. (9) Kant's theory "demands equal respect for all persons and forbids the use of another person merely as a means to one's own ends." (10) Thus, regardless of a person's appearance or past acts, that person should be treated with the same respect and dignity as everyone else.

    Kant's theory serves as the basis on which most of this article is founded. Murdering or raping another individual does not waive the right to be treated and respected as a person. Richard Jaffe, a prominent criminal defense attorney in Birmingham, Alabama, wrote, "no one is as bad as his worst acts or as good as his best. We are all human beings with relative coping skills, flaws and imperfect personalities." (11) Providing medical care to inmates may seem nominal, but in reality, it is usually not implemented in a manner that promotes Kantian respect. Too often, judges, politicians, and other community leaders believe that the guilty should be punished by inhumane and barbaric treatment. More often than not, inmates have only made one mistake that cost them severely; yet, they are punished as if they are some kind of creature rather than a human being. Kantian ethics places someone who runs a red light on the way to work in the same category as a serial rapist, because ultimately, both are still people who deserve respect.

    Rehabilitation and deterrence are the main focuses of the prison system. People need to be punished; nevertheless, they also need to be rehabilitated so, in theory, they will not commit the same acts that led them to prison. Additionally, inmates should not be afforded the same rights that they are entitled to on the outside; however, the list of deprived rights should not include respect and dignity. Those rights, as Kant believes, are unconditional.

  3. INMATES' ABILITY TO CHALLENGE HEALTH CARE AND THE STANDARD THEY MUST MEET

    While the Eighth Amendment prohibits unjust punishment, 42 U.S.C. [section] 1983 allows a prisoner to challenge unjust punishment on a civil rights basis. The standard an inmate must meet to succeed on such a claim was not clear until an inmate's guaranteed right to health care was first recognized in 1976 by the U.S. Supreme Court's holding in Estelle v. Gamble. (12) While the right was deemed fundamental, the extent as to the quality of care was largely left undecided. Therefore, the progeny of Estelle has had the difficult task of deciding exactly what prisoners are afforded in regards to health care and what their remedy should be if there is a finding of inadequate care.

    A. How Can a Prisoner Challenge the Health Care Provided to Him/Her?

    Any American citizen, including incarcerated individuals, enjoys the right to be free from "cruel and unusual punishment." (13) A proper challenge for infringement on one's Eighth Amendment rights should be made through 42 U.S.C. [section] 1983. A [section] 1983 petition is a civil action for the deprivation of rights. (14) [section] 1983 affords any citizen, including prisoners, the right to challenge a government actor who has denied them any rights, privileges or immunities as set forth by the U.S. Constitution. (15) Individuals who succeed on a [section] 1983 petition are entitled to any remedy available at law that will adequately redress the harm. (16) The Prison Litigation Reform Act demands that the prisoner exhaust all other administrative remedies prior to filing a [section] 1983 petition. (17)

    B. The Kind of Health Care Prisoners are Afforded: The Deliberate Indifference Standard

    Prior to the late 1960s, the few documented accounts of prison conditions and health care are barbaric. (18) It wasn't until the late 1960s when courts began taking notice of the deplorable health care being provided in American jails and prisons. (19) While there was a growing concern for prisoners' rights, no action was taken by the U.S. Supreme Court until 1976. (20)

    1. Estelle v. Gamble

      J.W. Gamble brought a civil rights action under 42 U.S.C. [section] 1983 complaining about the medical care he received after he suffered a back injury while on a prison work assignment. (21) For many weeks, Mr. Gamble was repeatedly misdiagnosed and mistreated. (22) Mr. Gamble was prescribed blood pressure medicine and was repeatedly required to go back to work or he would be placed on "administrative segregation." (23) After refusing to return to work, Mr. Gamble was brought before the prison disciplinary committee where a correctional officer testified that he was in "first class medical condition." (24) The disciplinary committee placed Mr. Gamble in solitary confinement where he experienced black outs and severe chest pains for four days until he was finally cared for by a doctor. (25)

      Ultimately, the United States Supreme Court reviewed Mr. Gamble's petition and the Court acknowledged that the government had an "obligation to provide medical care for those whom it is punishing by incarceration." (26) The Court held that a "deliberate indifference to serious medical needs of prisoners constitutes the 'unnecessary and wanton infliction of pain' proscribed by the Eighth Amendment" and thus, there is a cause for action. (27) The Court further held that any intentional denial of access to health care or interference with treatment by guards is also actionable under the Eighth Amendment. (28)

    2. What Must a Prisoner Prove to Succeed on a [section] 1983 Claim?

      Although the Court in Estelle established the "deliberate indifference" standard, there was not a great deal of clarity regarding what that standard encompassed. Courts did not shed light on the difficult burden a prisoner bears to succeed on a [section] 1983 claim until the 1980s and 1990s. (29)

      The "deliberate indifference" standard has both an objective and subjective prong. (30) To meet the objective prong, the prisoner must show that the deprivation of medical treatment was "sufficiently serious." (31) An inmate's injuries "must significantly decrease his quality of life, or constitute a situation where death, permanent injury, or extreme pain has occurred or appears likely." (32) Also, any "wanton and unnecessary infliction of pain" will be found to be in violation of the inmate's constitutional rights. (33)

      To succeed on the subjective prong, a prisoner must show that the prison official responsible for the harm acted with a culpable state of mind. (34) The U.S. Supreme Court has more clearly defined this subjective prong by holding that the conduct must involve "more than ordinary lack of due care for the prisoner's interests or safety" stating that "[i]t is obduracy and wantonness, not inadvertence or error in good faith, that characterize the conduct prohibited by the Cruel and Unusual Punishments Clause ..." (35) Thus, an inmate bears a heavy burden when trying to prove that the acting official acted in a culpable state of mind by proving that the official "[knew] of and...

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