Opinion ID: 2761209
Heading Depth: 2
Heading Rank: 1

Heading: The Eighth Amendment and Medical Care in Prison

Text: Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. U.S. Const. amend. VIII. From this brief amendment, courts have derived the principles that govern the permissible conditions under which prisoners are held and that establish the medical treatment those prisoners must be afforded. See Farmer v. Brennan, 511 U.S. 825, 832 (1994). Where society takes from prisoners the means to -36- provide for their own needs, the failure to provide such care may actually produce physical torture or a lingering death. Brown v. Plata, 131 S. Ct. 1910, 1928 (2011) (internal quotation marks omitted). Undue suffering, unrelated to any legitimate penological purpose, is considered a form of punishment proscribed by the Eighth Amendment. Estelle v. Gamble, 429 U.S. 97, 103 (1976). The Eighth Amendment is meant to prohibit unnecessary and wanton infliction of pain, which is repugnant to the conscience of mankind. Id. at 105-06 (internal quotation marks omitted). The Amendment's focus on punishment means that not all shortages or failures in care exhibit the intent and harmfulness required to fall within its ambit. See Farmer, 511 U.S. at 837 (reasoning that the Eighth Amendment's prohibition of punishment implies an act done with intentionality). Therefore, to prove an Eighth Amendment violation, a prisoner must satisfy both of two prongs: (1) an objective prong that requires proof of a serious medical need, and (2) a subjective prong that mandates a showing of prison administrators' deliberate indifference to that need. See Estelle, 429 U.S. at 106 (holding that inadequate treatment must be sufficiently harmful to evidence deliberate indifference to serious medical needs); Sires v. Berman, 834 F.2d 9, 12 (1st Cir. 1987) (A plaintiff must satisfy two elements to present a viable [Eighth Amendment] claim: he must show a serious medical need, and he must prove the defendant's purposeful indifference thereto.). -37- First, a medical need must be serious. Id. This objective prong requires that the need be one that has been diagnosed by a physician as mandating treatment, or one that is so obvious that even a lay person would easily recognize the necessity for a doctor's attention. Gaudreault v. Municipality of Salem, Mass., 923 F.2d 203, 208 (1st Cir. 1990). This prong does not impose upon prison administrators a duty to provide care that is ideal, or of the prisoner's choosing. See United States v. Derbes, 369 F.3d 579, 583 (1st Cir. 2004) (stating that prison administrators are by no means required to tailor a perfect plan for every inmate; while [they are] constitutionally obligated to provide medical services to inmates, these services need only be on a level reasonably commensurate with modern medical science and of a quality acceptable within prudent professional standards (internal quotation marks and citations omitted)); United States v. DeCologero, 821 F.2d 39, 43 (1st Cir. 1987) (same); Ferranti v. Moran, 618 F.2d 888, 891 (1st Cir. 1980) ([A]llegations [that] simply reflect a disagreement on the appropriate course of treatment . . . fall[] short of alleging a constitutional violation.). Rather, the Constitution proscribes care that is 'so inadequate as to shock the conscience.' Torraco v. Maloney, -38- 923 F.2d 231, 235 (1st Cir. 1991) (quoting Sires, 834 F.2d at 13)).7 Second, even if medical care is so inadequate as to satisfy the objective prong, the Eighth Amendment is not violated unless prison administrators also exhibit deliberate indifference to the prisoner's needs. Estelle, 429 U.S. at 105-06. For purposes of this subjective prong, deliberate indifference defines a narrow band of conduct, Feeney v. Corr. Med. Servs. Inc., 464 F.3d 158, 162 (1st Cir. 2006), and requires evidence that the failure in treatment was purposeful. See Estelle, 429 U.S. at 105 (holding that an inadvertent failure to provide adequate medical care is not a constitutional violation);8 id. at 106 (Medical malpractice does not become a constitutional violation merely because the victim is a prisoner.); Watson v. Caton, 984 F.2d 537, 540 (1st Cir. 1993) (The courts have consistently refused to 7 Although these cases address the second, subjective prong of the Eighth Amendment analysis, we have recognized that the subjective deliberate indifference inquiry may overlap with the objective serious medical need determination and that similar evidence . . . may be relevant to both components. Leavitt v. Corr. Med. Servs., Inc., 645 F.3d 484, 498 (1st Cir. 2011) (internal quotation marks and brackets omitted); see also DesRosiers v. Moran, 949 F.2d 15, 18-19 (1st Cir. 1991). As the adequacy of care is germane both to Kosilek's objective need for surgery and to the DOC's alleged deliberate indifference to that need, the principles of these cases are relevant to both steps of our analysis. 8 Although this case does not involve an inadvertent failure to provide adequate medical care, see Estelle, 429 U.S. at 106, that fact alone does not elevate the DOC's choice among alternative treatments to deliberate indifference for purposes of the Eighth Amendment analysis. -39- create constitutional claims out of disagreements between prisoners and doctors about the proper course of a prisoner's medical treatment, or to conclude that simple medical malpractice rises to the level of cruel and unusual punishment.). The obvious case would be a denial of needed medical treatment in order to punish the inmate. Watson, 984 F.2d at 540. While deliberate indifference may also be exhibited by a wanton disregard to a prisoner's needs, Battista v. Clarke, 645 F.3d 449, 453 (1st Cir. 2011), such disregard must be akin to criminal recklessness, requiring consciousness of 'impending harm, easily preventable.' Watson, 984 F.2d at 540. When evaluating medical care and deliberate indifference, security considerations inherent in the functioning of a penological institution must be given significant weight. Battista, 645 F.3d at 454 ([S]ecurity considerations also matter at prisons . . . and administrators have to balance conflicting demands.). [W]ide-ranging deference is accorded to prison administrators in the adoption and execution of policies and practices that in their judgement are needed to . . . maintain institutional security. Whitley v. Albers, 475 U.S. 312, 321-22 (1986) (quoting Bell v. Wolfish, 441 U.S. 520, 547 (1979)) (internal quotation marks omitted). In consequence, even a denial of care may not amount to an Eighth Amendment violation if that decision is based in legitimate concerns regarding prisoner safety -40- and institutional security. Cameron v. Tomes, 990 F.2d 14, 20 (1st Cir. 1993) (requiring courts to embrace security and administration, . . . not merely medical judgments in assessing claims of deliberate indifference); Sires, 834 F.2d at 13 ([S]afety factors are properly included in the evaluation of the medical needs of an inmate.). Importantly, prison administrators need only have 'responded reasonably to the risk.' Giroux v. Somerset Cnty., 178 F.3d 28, 33 (1st Cir. 1999) (quoting Farmer, 511 U.S. at 844).