Opinion ID: 1917662
Heading Depth: 1
Heading Rank: 4

Heading: Maintaining Prison Security, Order, and Discipline

Text: The State's interest in maintaining orderly prison administration is a consideration in this case, but was not a consideration in Mack, 329 Md. 188, 618 A.2d 744, because the facts in that case did not involve prisons or prisoners. The United States Supreme Court has said: The interest in preserving order and authority in the prisons is self-evident. Prison life, and relations between the inmates themselves and between the inmates and prison officials or staff, contain the ever-present potential for violent confrontation and conflagration. Responsible prison officials must be permitted to take reasonable steps to forestall such a threat, and they must be permitted to act before the time when they can compile a dossier on the eve of a riot. Jones v. North Carolina Prisoners' Labor Union, Inc. 433 U.S. 119, 132-33, 97 S.Ct. 2532, 2541, 53 L.Ed.2d 629, 643 (1977). In Jones, 433 U.S. at 125, 97 S.Ct. at 2537-38, 53 L.Ed.2d at 638, the Supreme Court recognized that [t]he fact of confinement and the needs of the penal institution impose limitations on constitutional rights, [to the extent that those rights] are implicit in incarceration. [4] Despite their incarceration, inmates do not forfeit all constitutional protections. Bell v. Wolfish, 441 U.S. 520, 545, 99 S.Ct. 1861, 1877, 60 L.Ed.2d 447, 472 (1979). Inmates retain certain common law and constitutional protections. See Pell v. Procunier, 417 U.S. 817, 822, 94 S.Ct. 2800, 2804, 41 L.Ed.2d 495, 501 (1974) ([A] prison inmate retains those First Amendment rights that are not inconsistent with his [or her] status as a prisoner or with the legitimate penological objectives of the corrections system.); Cruz v. Beto, 405 U.S. 319, 92 S.Ct. 1079, 31 L.Ed.2d 263 (1972). For example, generally a convicted person retains the freedom of speech and religion and may claim the protection of the Due Process Clause to prevent additional deprivation of life, liberty, or property without due process of law. Bell, 441 U.S. at 545, 99 S.Ct. at 1877, 60 L.Ed.2d at 472. Furthermore, a competent person has a constitutional right to refuse unwanted medical treatment. See Cruzan, 497 U.S. at 277, 110 S.Ct. at 2851, 111 L.Ed.2d at 241 (noting that the doctrine of informed consent is viewed as generally encompassing the right to refuse treatment and that this principle is firmly established in law); but see Washington v. Harper, 494 U.S. 210, 221-22, 110 S.Ct. 1028, 1036-37, 108 L.Ed.2d 178, 197-98 (1990) (holding that forcing the injection of medication into a non-consenting individual's body represents a substantial interference with that individual's liberty, although this interest may be outweighed by the State's interest in maintaining prison security). Maryland common law and statutory law also protect a patient's right to make informed choices about medical care and [do] not allow a physician to substitute his judgment for that of the patient in the matter of consent to treatment. McQuitty v. Spangler, 410 Md. 1, 20, 976 A.2d 1020, 1031 (2009) (recognizing the well-settled principle of informed consent and that personal autonomy and personal choice were the primary foundation of the informed consent doctrine) (internal citation omitted); Williams v. Wilzack, 319 Md. 485, 508, 573 A.2d 809, 820 (1990) (pointing out that under the provisions of Md.Code (1982, 1988 Supp.), § 10-708 of the Health-General Article, the General Assembly intended to create a justifiable expectation that ... drugs will not be administered to an inmate unless he is mentally ill and a danger to himself or others); Sard, 281 Md. at 439, 379 A.2d at 1019 (acknowledging that under common law principles a physician, treating a mentally competent adult under non-emergency circumstances, cannot properly undertake to perform surgery or administer other therapy without the prior consent of his patient). In the prison context, an inmate's exercise of constitutional and common law rights must be balanced against the interests of corrections officials. Youngberg v. Romeo, 457 U.S. 307, 321, 102 S.Ct. 2452, 2461, 73 L.Ed.2d 28, 40-41 (1982) ([W]hether [an individual's] constitutional rights have been violated must be determined by balancing his [or her] liberty interests against the relevant state interests.); Pell, 417 U.S. at 822, 94 S.Ct. at 2804, 41 L.Ed.2d at 501. Although due deference should be accorded the corrections authorities' informed assessment of their penological objectives and administrative needs, the court will intervene where prison regulations or practices imperil constitutional rights. Procunier v. Martinez, 416 U.S. 396, 405-06, 94 S.Ct. 1800, 1807-08, 40 L.Ed.2d 224, 236 (1974) (When a prison regulation or practice offends a fundamental constitutional guarantee,... courts [must] discharge their duty to protect constitutional rights.). Where there is a reasonable connection between a prison regulation or policy imposed and the penological objective at issue, the prison regulation or policy will be considered valid. Turner v. Safley, 482 U.S. 78, 89, 107 S.Ct. 2254, 2261, 96 L.Ed.2d 64, 79 (1987). Ordinarily, courts defer to prison officials to make difficult judgments concerning institutional operations. Id. In determining whether a regulation, policy, rule or restriction impermissibly burdens the exercise of a constitutional right, the United States Supreme Court, in Turner, directs the court to assess the overall reasonableness of the institutional restriction on the exercise of an inmate's constitutional rights by weighing four factors. First, there must be a `valid, rational connection' between the prison regulation and the legitimate governmental interest put forward to justify it. Turner, 482 U.S. at 89, 107 S.Ct. at 2262, 96 L.Ed.2d at 79 (quotation omitted). This connection must not be so remote as to render the policy arbitrary or irrational. Turner, 482 U.S. at 89-90, 107 S.Ct. at 2262, 96 L.Ed.2d at 79. Prison regulations or policies based upon exaggerated concerns are not reasonably related to any state interest. Turner, 482 U.S. at 97-98, 107 S.Ct. at 2266-67, 96 L.Ed.2d at 84. Moreover, prison regulations and policies grounded on whims ... about prospective hypothetical situations or speculative and uncertain anxieties do not satisfy the Turner standard of reasonableness. See Campos v. Coughlin, Commissioner New York State Dep't of Correctional Services, 854 F.Supp. 194, 209 (S.D.N.Y.1994) (holding that speculation that Santeria beads would exacerbate gang violence was unfounded when Catholic rosary beads and Christian crosses caused no violence). Likewise, the possibility of an adverse impact upon a governmental interest will not justify the restriction on the exercise of a constitutional right. See Turley v. Adel Community Sch. Dist., 322 F.Supp. 402, 408-09 (S.D.Iowa 1971) (holding that the possibility of disruption due to negative reaction to longhaired students does not sustain a school policy on hair length). Second, Turner requires that a court consider whether inmates retain alternative means of exercising the circumscribed right. Turner, 482 U.S. at 90, 107 S.Ct. at 2262, 96 L.Ed.2d at 79. Third, a court must take into account the costs that accommodating the right would impose on other inmates, guards, and prison resources generally. Turner, 482 U.S. at 90, 107 S.Ct. at 2262, 96 L.Ed.2d at 79-80. And fourth, a court must consider whether there are alternatives to the regulation that fully accommodate[ ] the prisoner's rights at de minimis cost to valid penological interests. Turner, 482 U.S. at 90-91, 107 S.Ct. at 2262, 96 L.Ed.2d at 80. The Court of Special Appeals, in the present case, pointed out correctly that the Turner analysis does not assist us in `balancing the competing interests' of [Reid] and [the State] because Turner involved a facial challenge to a prison regulation. Stouffer, 184 Md.App. at 289, 965 A.2d at 108. In other words, the United States Supreme Court, in Turner, provided the framework for determining whether a prison regulation or restriction was reasonable on its face. Here, however, we are reviewing a challenge to a specific prison directive as applied to Reid. See McNabb v. Dep't of Corr., 163 Wash.2d 393, 180 P.3d 1257, 1264-65 (2008) (acknowledging that  Turner delineates the State's ... compelling interest in maintaining security and orderly administration in its prison system and the due deference [given correctional authorities] regarding the manner in which the officials carry out their mandate to provide medical services to incarcerated individuals). Nonetheless, we agree with the Supreme Court of Washington, in McNabb, that the State's interest in maintaining security and order in prison and due deference given to prison officials should be considered in addition to the four established compelling state interests implicated by refusal of medical treatment, as adopted by this Court in Mack v. Mack, 329 Md. 188, 618 A.2d 744 (1993), when determining whether the right of an incarcerated individual to refuse [medical treatment] outweigh[s] the State's interests. McNabb, 163 Wash.2d 393, 180 P.3d 1257, 1264-65. Unlike the present case, in Polk there was evidence in the record from which the court could reasonably infer that Brown's motives for refusing medical treatment were manipulative and that his refusing medical treatment would disrupt the day-to-day management of the jail. Polk, 594 N.W.2d at 431. Thus, the court in that case was justified in deferring to the professional expertise of correctional authorities, in the absence of any substantial evidence in the record that the correctional officials exaggerated their response to preserve internal order and discipline. See Polk, 594 N.W.2d at 430. Furthermore, in Polk, the appellate court explained, on the basis of the record before the court, that the chief jailer's concerns that other inmates would `copycat' Brown's actions as an excuse to get out of jail were reasonable and that there was no substantial evidence that the chief jailer's application to the district court was an exaggerated response to Brown's refusal to submit to dialysis treatment. Id. The court in Polk acknowledged that a State's interests in [m]aintaining security and preserving internal order and discipline `are essential goals that may require limitation or retraction of the retained constitutional rights of ... prisoners.' Polk, 594 N.W.2d at 430 (quoting Bell, 441 U.S. at 546, 99 S.Ct. at 1878, 60 L.Ed.2d at 473; Procunier v. Martinez, 416 U.S. at 412, 94 S.Ct. at 1811, 40 L.Ed.2d at 239-40 (noting the governmental interests in a prison setting are the preservation of internal order and discipline, the maintenance of institutional security and the rehabilitation of prisoners)). In Myers, 399 N.E.2d at 457, the Supreme Judicial Court of Massachusetts pointed out that, when balancing the governmental interests and the individual's, wide-raging deference [must] be accorded the decisions of prison administrators, in the absence of substantial evidence in the record to indicate that the officials have exaggerated their response. (Internal citations omitted.) Specifically, as to the facts in Myers, the court emphasized that the correctional needs in [that] case [were] urgent and ought to be given considerable weight, because the prisoner's refusal of life-saving treatment [was] predicated on an attempt to manipulate his placement within the prison system. Myers, 399 N.E.2d at 457-58. Quoting the United States Supreme Court in Jones, 433 U.S. at 126 n. 4, 97 S.Ct. at 2538 n. 4, 53 L.Ed.2d at 639 n. 4 (1977), the court in Myers noted that the purpose for exercising a constitutional right is a factor which prison officials may legitimately consider in determining whether [that exercise] is likely to be a disruptive influence, or otherwise detrimental to the effective administration of the ... prison system. Myers, 399 N.E.2d at 458 n. 4. Unlike the situation in Myers, there is no evidence in the present case that Reid's refusal of dialysis treatment is predicated on an attempt to manipulate his placement within the prison system. The trial judge, in the present case, found that the Commissioner showed proper concern for the negative impact Reid's choice [ i.e., refusing to submit to kidney dialysis] could have upon the prison community. Nonetheless, the trial judge found that there has been no evidence presented that Reid has made any attempt to disrupt the order of the prison, and that there was no evidence suggesting that the actions of Reid would cause disruption to the prison community. Although the State's interest in upholding orderly prison administration in Myers and in the present case is a valid consideration, as the court pointed out in Myers, the fact of the [inmate's] incarceration does not per se divest him of his right of privacy and interest in bodily integrity. Myers, 399 N.E.2d at 457; see also Thor v. Superior Court, 5 Cal.4th 725, 21 Cal.Rptr.2d 357, 855 P.2d 375, 388 (1993) (upholding a prison inmate's right to refuse or demand the withdrawal of medical treatment of any form in the absence of evidence demonstrating a threat to institutional security, public safety or prison officials); Singletary v. Costello, 665 So.2d 1099, 1109 (Fla.Dist.Ct.App.1996) (holding that there was no evidence adduced that the inmate's conduct undermined the security, safety or welfare of the prison). The Commissioner contends that the professional expertise of the Commissioner and Assistant Commissioner as to the detrimental effects of Reid's refusal to receive dialysis treatment should be given deference by the courts. Particularly, the Commissioner maintains that [w]here ... there is an absence of substantial evidence in the record to indicate that the officials have exaggerated their response to these considerations, the courts should ordinarily defer to their expert judgment in such matters. Through testimony before the trial court, Commissioner Stouffer expressed concern that Reid's injury or death as a result of his refusal to receive medical treatment may increase `angst' within the general population. This the Commissioner predicted would lead to disruption and disorder through peaceful protests or potentially through acts of violence. In addition, according to Assistant Commissioner Watson's affidavit, filed in these proceedings, Reid's actions require a `substantial and disproportionate utilization of limited case management, medical and psychological resources.' According to the Commissioner, in the Assistant Commissioner's view, as Reid's health deteriorates, the demand upon institutional resources will increase and morale of staff will diminish. Further, Commissioner Watson predicted that if Reid is allowed to manipulate resources by refusing medical care, his condition will create a perception that the administration is not in control of the inmate population. No testimony was presented, however, as to why the concerns expressed by the Commissioner and Assistant Commissioner would be any different if Reid were compelled to submit to weekly dialysis treatment. Thus, in our view, if the court is to defer to the expert judgment of correction officials, that judgment must be reasonable and informed. See Turner, 482 U.S. at 93, 107 S.Ct. at 2264, 96 L.Ed.2d at 82 (holding that the standard is whether the actions of prison officials were reasonably related to valid corrections goals and not an exaggerated response to those objectives); Jones, 433 U.S. at 128, 97 S.Ct. at 2539, 53 L.Ed.2d at 640 (holding that regulations prohibiting inmates from soliciting other inmates to join a prisoner's union were reasonable and consistent with legitimate operational considerations of the prison). In this case, the evidence presented was merely speculative, which is insufficient under Turner to present a valid, rational connection between the infringement on Reid's right to refuse medical treatment and the legitimate governmental interests asserted. Here, the trial judge noted that consideration of the impact on institutional operations was an appropriate penological objective of the corrections system; however, the evidence presented at the hearing did not persuade the court that the correction officials' conclusions were reasonable and supported by the evidence. In effect, the trial court determined that, based upon the evidence presented, or lack thereof, the correctional officials exaggerated their response to Reid's refusal to submit to dialysis treatment.