Document: 487 U.S. 42 108 S.Ct. 2250 101 L.Ed.2d 40 Quincy WEST, Petitionerv.Samuel ATKINS. No. 87-5096. Argued March 28, 1988. Decided June 20, Syllabus Respondent, a private physician under contract with North Carolina to provide orthopedic services at state-prison hospital on part-time basis, treated petitioner for leg injury sustained while was incarcerated in state prison. Petitioner barred by law from employing or electing see of his own choosing. Alleging that he given inadequate medical treatment, sued respondent Federal District Court U.S.C. § 1983 violation Eighth Amendment right be free cruel and unusual punishment, relying Estelle v. Gamble, 429 97, 97 285, 50 251. The court entered summary judgment respondent, holding that, as "contract physician," not acting "under color law," jurisdictional prerequisite action. Appeals ultimately affirmed. Held: A who is the State inmates basis acts within meaning 1983, when treats an inmate. Pp. 48-57. (a) If defendant's alleged infringement plaintiff's constitutional rights satisfies state-action requirement Fourteenth Amendment, conduct also constitutes action law" 1983's purposes, since it "fairly attributable State." Lugar Edmondson Oil Co., 457 922, 935, 937, 102 2744, 2752, 2753. Thus, employee generally when, performing official capacity exercising responsibilities, abuses position him State. Polk County Dodson, 454 312, 445, 70 509, distinguished. 49-50. (b) erred concluding defendants are removed purview if they professionals accordance professional discretion may liable only custodial supervisory authority. court's analogy between public defender County, supra, unpersuasive. 50-54. (c) Respondent's treating fairly has obligation, law, adequate care those whom incarcerated. Estelle, U.S., 104, S.Ct., 291; Spicer Williamson, 191 N.C. 487, 490, 132 S.E. 291, 293. delegated function physicians such defers their judgment. This analysis altered fact paid payroll nor required work exclusively It physician's system, precise terms employment, determinative. 54-57. 815 F.2d 993 (CA4 1987) reversed remanded. BLACKMUN, J., delivered opinion Court, which REHNQUIST, C.J., BRENNAN, WHITE, MARSHALL, STEVENS, O'CONNOR, KENNEDY, JJ., joined. SCALIA, filed concurring part judgment, post, p. ---. Adam Stein, Raleigh, N.C., petitioner. Jacob L. Safron, respondent. Justice BLACKMUN Court. 1 case presents question whether 2 * Petitioner, West, tore left Achilles tendon playing volleyball Odom Correctional Center, Jackson, prison examined directed transferred Raleigh consultation Central Prison Hospital, acute-care facility operated its more than 17,500 inmates. Hospital one full-time staff physician, obtains additional assistance "Contracts Professional Services" area physicians. 3 Samuel Atkins, M.D., provided pursuant contract. Under it, Doctor Atkins approximately $52,000 annually operate two "clinics" each week amounts surgery.1 Over period several months, West's placing series casts. West alleges although doctor acknowledged surgery would necessary, refused schedule eventually discharged ankle still swollen painful, movement impeded. Because prisoner "close custody," employ elect different choosing.2 4 Pursuant 1983,3 proceeding pro se, commenced this against Atkins4 United States Eastern punishment.5 deliberately indifferent serious needs, failing treatment. 5 Relying decision controlling Calvert Sharp, 748 861 1984), cert. denied, 471 1132, 105 86 283 (1985), granted Atkins' motion In Calvert, Fourth Circuit held specialist, employed nonprofit corporation Maryland House Corrections Penitentiary, did act requisite concluded he, too, injury. App. 37. 6 panel vacated Court's 799 923 (1986). Rather considering could distinguished, remanded assessment record permitted finding deliberate indifference need, showing necessary prevail claim. See 251 (1976). 7 On en banc rehearing, however, divided affirmed dismissal complaint. (1987). declining overrule majority concluded: 8 "Thus clear practicable principle enunciated Supreme [in [Dodson,] 509 (1981) ], followed professional, bounds traditional does even where, state. Where exercises authority, say capacity, then claim can established, nexus proved." F.2d, 995 (footnote omitted). 9 rule limits "the range subject action." Ibid.6 10 dissent offered three grounds service rendered doctor—whether permanent member staff, limited prison—constitutes purposes 1983. First, doctors much "state actors" other employees, no significant difference physician-employees assumed actors O'Connor Donaldson, 422 563, 95 2486, 45 396 (1975). 997-998. Second, "public function" rationale applied because, context, exclusive prerogative State," obligated complete control over circumstances sources prisoner's Id., 998-999, citing Blum Yaretsky, 991, 1011, 2777, 2789, 73 534 (1982). Finally, reasoned integral role plays system qualifies actions law. 999, Price, 383 787, 794, 1152, 1157, 16 267 (1966) ("[W]illful participant joint activity agents" 1983); 931-932, 2750-2751, 482 (1982); Tower Glover, 467 914, 104 2820, 81 758 (1984). 11 Circuit's ruling conflicts decisions Eleventh Circuit, Ancata Health Services, Inc., 769 700 Ort Pinchback, 786 1105 (1986), effect contracts inmates, entity, 1983.7 We certiorari resolve conflict. 484 912, 256, 98 214 II 12 To plaintiff must allege secured Constitution laws States, show deprivation committed person Parratt Taylor, 451 527, 535, 1908, 1913, 68 420 (overruled grounds, Daniels Williams, 474 327, 330-331, 106 662, 88 662 (1986)); Flagg Bros., Inc. Brooks, 436 149, 155, 1729, 1733, 56 185 (1978). sought fulfill first alleging There guard, prohibited Amendment. 104-105, 291. adequacy allegation sufficiency element cause contested here.8 issue before us established second essential element—that acted A. 13 definition requires defendant have exercised power "possessed virtue made possible because wrongdoer clothed authority law." Classic, 313 299, 326, 61 1031, 1043, 85 L.Ed. 1368 (1941). Accord, Monroe Pape, 365 167, 187, 473, 484, 492 (1961) (adopting Classic standard 1983) Monell New York City Dept. Social 658, 695-701, 2018, 2038-2041, 611 (1978)); 317-318, 449, (1981); id., 329, 455-456 (dissenting opinion). "that [is] will support suit 1983." 2752. Rendell-Baker Kohn, 830, 838, 2764, 2769, 418 n. 7, 7. circumstances, federal Lugar, 14 constitute action, caused exercise some privilege created . responsible," party charged said actor." Ibid. "[S]tate employment sufficient render 936, 18, 2753, 18; 2754. firmly 172, 476. generally, responsibilities See, e.g., 535-536, 1913; Adickes S.H. Kress & 398 144, 152, 90 1598, 1605-1606, 26 142 (1970). 157, 5, 1734, 5. 15 Indeed, relied upon Appeals, determined abusing performance assigned tasks "a lawyer's functions counsel criminal proceeding." 325, 453. noted, differs typical government actor. While duties, retains all attributes attorney, including, most importantly, "professional independence," constitutionally obliged respect. 321-322, 451. ethical obligations require independent opposition 318-319, 320, 450. accordingly representing indigent proceeding, "is behalf State; State's adversary." 323, 13, 452, 13. 18. B disagree dictates conclusion providing treatment contrast defender, obligation make judgments set conflict authorities. relationship authorities cooperative. "Institutional assume mission State, through institution, attempts achieve." Manual governing health Carolina's institutions, observe, declares: "The provision effort correctional administrators providers, achieved mutual trust cooperation."9 Similarly, American Medical Association Standards Services Prisons (1979) personnel officials cooperation coordination" "joint effort." Preface, i; Standard 102, Discussion. certainly oblige thus find proffered 17 Of course, perceive adversarial defense lawyer our justice decisive factor decision. court, instead, appears misread establishing general do capacities. considered unless "custodial supervisory" 995. extent "professional" engaged turned particular attorney adversary independence integrity applicable class. Appeals' reading inconsistent cases, decided either identified actors, see, (1984) (state defenders), suits, (1976) (medical director physician). Youngberg Romeo, 307, 322-323, 30, 2452, 2461-2462, 30 (1982) (establishing standards determine regarding involuntarily create liability due process violation). Defendants simply judgment.10 18 approach determining wholeheartedly embraced cannot reconciled demonstrates irrelevant challenged performed inmate's brought physician-employee, Dr. Gray, both system. 107, 292-293. Gray sued, solely allegedly substandard plaintiff; were issue. suggest had inmate.11 contrary, inference drawn explicitly "indifference manifested response needs states 10, 291 (citing approval Courts claims without mention duties). sharply undermine holding.12 C 19 now explicit what implicit Estelle: undertaking duties petitioner's Such 20 recognized "An inmate rely treat needs; fail so, met." 103, 290. light this, 293 (1926) (common inmates), cited 9, 9. employs physicians, order obligation. By relationship, effected authorized West.13 He so "clothed 1043. turn. receive misused demonstrating resultant caused, sense relevant inquiry, punish incarceration deny venue obtain needed care. 21 contractual arrangement generate same benefits employees" alter analysis. determines attributed Whether contract, dispositive concerns among prisoner. Contracting out relieve duty custody, deprive prisoners means vindicate rights.14 bore affirmative West; Atkins; voluntarily 22 Nor any less actor full-time, staff. working amount time spends others perform similar law.15 employ, worked fully vested aspects duty, placed III 23 For reasons stated above, we conclude respondent's delivery therefore Accordingly, reverse remand further proceedings consistent opinion. 24 ordered. 25 I agree believe lacks penological inflict "punishment" term Cf. Johnson Glick, 481 1028, 1031-1032 (CA2) (Friendly, J.), denied sub nom. John Johnson, 414 1033, 94 462, 38 324 (1973). am view, attention custody (in elsewhere) prevented otherwise obtaining causes physical harm indifference, violates Amendment's protection liberty process. 315, 324, 2457-2458, 2462-2463 (dictum); 331, 665, (1986); Ingraham Wright, 430 651, 672-674, 41, 1401, 1413-1414, 41 (1977); Rochin California, 342 165, 169-174, 72 205, 208-210, 96 183 (1952); 1032-1033. note se complaint merely claimed rights, courts specified confers rights. included following: clinics per week; neurological referrals; scheduled; rounds often surgical patients; coordinate Physical Therapy Department; request neurosurgical consultants spinal cases; emergency on-call hours day. His furnish days fulfillment these duties. 24-25. Department Correction nurses assistants, orders. 28. Apparently, maintained practice apart submissions reflect nonprison depended livelihood. bars but minimum-security option go outside choice expense funded family resources insurance. Division Care Procedure §§ 710.1-710.2 (1980), Brief 15a-16a (promulgated N.C.Admin.Code 02E.0203 (1987) N.C.Gen.Stat. 148-11, 148-19 (1987)). Section provides part: "Every who, statute, ordinance, regulation, custom, usage, Territory Columbia, subjects, subjected, citizen jurisdiction thereof privileges, immunities laws, shall injured equity, proper redress." represented here Attorney General Carolina. representation 143-300.7 informed them indemnification malpractice actions. named James B. Hunt, Governor Carolina, Rae McNamara, Director Correction. Hunt McNamara appeal. 993, 996 1987). pursued addition, rejected contention "exclusive function." explained: "Decisions day-to-day rendering kind traditionally sovereign public." 996, 2, 1012, 2790, resolution implicitly persons. Miranda Munoz, 770 255 (CA1 1985) (upholding jury verdict eight jail); Norris Frame, 585 1183 (CA3 1978) (pretrial detainee's against, others, physician); Murrell Bennett, 615 306 (CA5 1980) (reinstating Byrd Wilson, 701 592 (CA6 including penitentiary); Duncan Duckworth, 644 653 (CA7 1981) (allowing administrator proceed until identity responsible members determined); Kelsey Ewing, 652 (CA8 prison). brief oral argument, insisted failed Estelle. maintains allegations "amount malpractice" negligence based claim," which, 105-106, 292, punishment. No undertaken factfinding, let alone passed decline address instance, particularly settled doctrine avoid questions whenever possible. Spector Motor Service, McLaughlin, 323 101, 105, 65 154, 89 (1944); Jean Nelson, 472 846, 854, 2992, 2997, 664 (1985). 100.5. 8a. entirely inquiry. controlled standards, where normally coercive encouragement, overt covert, deemed 1004, 2786 (decisions privately owned nursing home transfer Medicaid patients action); 840, 2770-2771, (discharge school action). Rendell-Baker, entities received funding regulation not, more, convert into 2785-2786; 840-843, 2770-2772. suggested party's satisfy responsible. found, direction. "nexus" absent. determination transformed proposition "[T]he judgment," suggested, primary test." 995, 1. And argument obligations, renders obligations. misunderstood discussion (1975), observed involved psychiatrist served superintendent mental hospital, Texas chief officer hospital. 450-451. observations, context contrasting under-color-of-state-law requirement. 319-320, discussed facts "in highlight cooperative absence akin existing defenders state." ("Institutional achieve"). Nothing stands Furthermore, greatly diminish right, few likely directly patient available respondeat superior. 690-695, 2035-2038, prisoners. compliance regulations charge Director, Prisons, responsibility maintain basic health. 02E.0201 administrator, designate specific "who facility." 02E.0202. provisions, As explained, delimiting liability, leave citizens vindication whose been 'private' denied." 998. Contrary intimations, employee's parallels sector itself, reason former "If individual possessed purports might taken purely capacity. ." Griffin Maryland, 378 130, 135, 84 1770, 1773, 754 (1964). Moreover, individuals, performs (quite source remuneration) distinguishes ordinary physician-patient relationship. 318, 449-450. Respondent carried That setting, specifically designed community, inevitably affects Unlike situation confronting patients, nonmedical life influence nature, timing, form West. matters involving clinical "sole province." Admin.Code 02E.0204 These regulations, keeping security undeveloped limitations But studies care, simple common sense, unaffected thing, financial limited. Further, prisons jails inherently institutions nearly total residents' lives activities confines; schedules strictly regulate work, exercise, diet. factors can, do, impact prisons. Neisser, Is Joint? Search Constitutional Care, 63 Va.L.Rev. 921, 936-946 (1977) (describing institutional effects prisons); M. Wishart N. Dubler, Jails Detention Centers: Some Legal Ethical Dilemmas (1983) ("[T]he nation's beset problems virtually unknown services").

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