Document ID: ./input/supremecourt_opinions/opinions/10pdf/09-1233.pdf
Page Number: 13

Cite as:  563 U. S. ____ (2011) 

7 

Opinion of the Court 

pain died after an 8-hour delay in evaluation by a doctor;
and a prisoner died of  testicular cancer after  a “failure of 
MDs to work up for cancer in a young man with 17 months
of testicular pain.”3  California Prison Health Care Receiv-
ership  Corp.,  K.  Imai,  Analysis  of  CDCR  Death  Reviews 
2006, pp. 6–7 (Aug. 2007).  Doctor Ronald Shansky, former 
medical  director  of  the  Illinois  state  prison  system,  sur-
veyed  death  reviews  for  California  prisoners.  He  con-
cluded  that  extreme  departures  from  the  standard  of 
care  were  “widespread,”  Tr.  430,  and  that  the  proportion 
of  “possibly  preventable  or  preventable”  deaths  was  “ex-
tremely high.”  Id., at 429.4  Many more prisoners, suffer-

—————— 

3 Because  plaintiffs  do  not  base  their  case  on  deficiencies  in  care 
provided  on  any  one  occasion,  this  Court  has  no  occasion  to  consider 
whether these instances of delay—or any other particular deficiency in
medical care complained of by the plaintiffs—would violate the Consti-
tution under Estelle v. Gamble, 429 U. S. 97, 104–105 (1976), if consid-
ered  in  isolation.    Plaintiffs  rely  on  systemwide  deficiencies  in  the
provision  of  medical  and  mental  health  care  that,  taken  as  a  whole, 
subject sick and mentally ill prisoners in California to “substantial risk
of  serious  harm”  and  cause  the  delivery  of  care  in  the  prisons  to  fall
below  the  evolving  standards  of  decency  that  mark  the  progress  of  a
maturing society.  Farmer v. Brennan, 511 U. S. 825, 834 (1994). 

4 In 2007, the last year for which the three-judge court had available
statistics,  an  analysis  of  deaths  in  California’s  prisons  found  68  pre-
ventable or possibly preventable deaths.  California Prison Health Care 
Receivership  Corp.,  K.  Imai,  Analysis  of  Year  2007  Death  Reviews  18
(Nov.  2008).    This  was  essentially  unchanged  from  2006,  when  an
analysis  found  66  preventable  or  possibly  preventable  deaths.    Ibid. 
These  statistics  mean  that,  during  2006  and  2007,  a  preventable  or
possibly preventable death occurred once every five to six days.

Both  preventable  and  possibly  preventable  deaths  involve  major 
lapses  in  medical  care  and  are  a  serious  cause  for  concern.    In  one 
typical  case  classified  as  a  possibly  preventable  death,  an  analysis
revealed the following lapses: “16 month delay in evaluating abnormal 
liver  mass;  8  month  delay  in  receiving  regular  chemotherapy  . . .  ;
multiple  providers  fail  to  respond  to  jaundice  and  abnormal  liver
function tests causing 17 month delay in diagnosis.”  California Prison 
Health Care Receivership Corp., K. Imai, Analysis of Year 2009 Inmate
Death Reviews—California Prison Health Care System 12 (Sept. 2010)