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

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. …