Document: 429 U.S. 97 S.Ct. 285 50 L.Ed.2d 251 W. J. ESTELLE, Jr., Director, Texas Department of Corrections, et al., Petitioners,v.J. GAMBLE. No. 75-929. Argued Oct. 5, 1976. Decided Nov. 30, Rehearing Denied Jan. 17, 1977. See 1066, 798. Syllabus Respondent state inmate brought this civil rights action under 42 U.S.C. § 1983 against petitioners, the corrections department medical director (Gray) and two correctional officials, claiming that he was subjected to cruel unusual punishment in violation Eighth Amendment for inadequate treatment a back injury assertedly sustained while engaged prison work. The District Court dismissed complaint failure claim upon which relief could be granted. Appeals held alleged insufficiency required reinstatement complaint. Held: Deliberate indifference by personnel prisoner's serious illness or constitutes contravening Amendment. Here, however, respondent's claims Gray do not suggest such indifference, allegations revealing other saw respondent on 17 occasions during 3-month span treated his problems. perform an X-ray use additional diagnostic techniques does constitute but is at most malpractice cognizable courts. question whether has stated constitutional Director Corrections warden prison, separately evaluated should considered remand. Pp. 101-108. 516 F.2d 937, reversed remanded. Bert Pluymen, Austin, Tex., pro hac vice, special leave Court. Daniel K. Hedges, Houston, respondent, Mr. Justice MARSHALL delivered opinion 1 Gamble, injured November 9, 1973, performing work assignment. On February 11, 1974, instituted 1983,1 complaining received after injury. Named as defendants were Estelle, H. Husbands, Dr. Ralph Gray, chief officer hospital. Court, sua sponte granted.2 remanded with instructions reinstate 937 (C.A.5 1975). We granted certiorari, 424 907, 96 1101, 47 311 (1976). 2 * Because claim, we must take true its handwritten, se allegations. Cooper v. Pate, 378 546, 84 1733, 12 1030 (1964). According complaint, Gamble when bale cotton3 fell him unloading truck. He continued four hours became stiff pass unit At hospital assistant, "Captain" Blunt, checked hernia sent cell. Within pain so intense returned where given pills nurse then examined doctor. following day, Astone who diagnosed lower strain, prescribed Zactirin (a reliever) Robaxin muscle relaxant),4 placed "cell-pass, cell-feed" status days, allowing remain cell all times except showers. 12, again medication cell-pass, cell-feed another seven days. also ordered moved from upper bunk one week, authorities did comply directive. Astone. doctor relaxant new reliever, Febridyne, cell-pass permitting meals 26, Astone, put original reliever five days week. 3 December 3, despite Gamble's statement hurt much it had first took off thereby certifying capable light same time, Febridyne went Major Muddox told too "administrative segregation."5 taken before disciplinary committee, apparently because refusal When committee heard high blood pressure, directed seen 4 6, petitioner performed urinalysis, test, pressure measurement. drug Ser-Ap-Es more pain. week 30 prescription filled staff lost it. twice December; both Captain Tiognolos (described relaxant). For December, remained administrative segregation. 5 In early January, would "farm" if return refused, nonetheless, January 7, requested go sick call migraine headaches. After initial refusal, Blunt sodium salicylate 25, renewals times. Throughout month, kept 6 31, January. severe pressure. testified "first class" condition. no further examination testimony, solitary confinement. 7 Four later, 4, 8 a. m., asked see chest pains "blank outs." It until 7:30 night assistant hospitalized. day Heaton electrocardiogram; later Quinidine irregular cardiac rhythm experienced chest, left arm, guards refused. next day. Finally, allowed Heaton, three swore out II gravamen petitioners have Amendment, made applicable States Fourteenth.6 Robinson California, 370 660, 82 1417, 758 (1962). therefore base our evaluation those Amendments decisions interpreting them. 9 history prohibition "cruel punishments" been recounted length prior opinions need repeated here. See, e. g., Gregg Georgia, 428 153, 169-173, 2909, 2923, 49 859 (1976) (joint Stewart, Powell, Stevens, JJ. (hereinafter joint opinion)); Granucci, Nor Cruel Unusual Punishment Inflicted: Original Meaning, 57 Calif.L.Rev. 839 (1969). suffices note primary concern drafters proscribe "torture(s)" "barbar(ous)" methods punishment. Id., 842. Accordingly, applied comparing challenged execution concededly inhuman Wilkerson Utah, 99 130, 136, 25 L.Ed. 345 (1879) ("(I)t safe affirm punishments torture . others line unnecessary cruelty, are forbidden amendment ."); re Kemmler, 136 436, 447, 10 930, 933, 34 519 (1890) ("Punishments they involve lingering death ."). Our recent cases, proscribes than physically barbarous punishments. supra, 171, 2924 opinion); Trop Dulles, 356 86, 100-101, 78 590, 597, 598, 630 (1958); Weems United States, 217 349, 373, 544, 551, 54 793 (1910). embodies "broad idealistic concepts dignity, civilized standards, humanity, decency ," Jackson Bishop, 404 571, 579 (C.A.8 1968), evaluate penal measures. Thus, repugnant incompatible "the evolving standards mark progress maturing society." 101, 598; 172-173, 2925 378, 553, "involve wanton infliction pain," 173, Louisiana ex rel. Francis Resweber, 329 459, 463, 67 374, 376, 91 422 (1947); 136.7 11 These elementary principles establish government's obligation provide care whom punishing incarceration. An rely treat needs; fail so, needs will met. worst may actually produce physical "torture death," evils immediate less denial result suffering suggests serve any penological purpose. Cf. 2924-25 opinion). inconsistent contemporary manifested modern legislation8 codifying commonlaw view "(i)t just public prisoner, cannot reason deprivation liberty, himself."9 conclude deliberate prisoners "unnecessary 182-183, opinion), proscribed This doctors their response needs10 intentionally denying delaying access care11 interfering once prescribed.12 Regardless how evidenced, states cause 1983. 13 conclusion mean, every prisoner adequate accident, although added anguish, basis alone characterized (1947), example, concluded unconstitutional force undergo second effort electrocute mechanical malfunction thwarted attempt. Writing plurality, Reed reasoned violate attempt "unforeseeable accident." 464, 376. Frankfurter's concurrence, based solely Due Process Clause Fourteenth since failed "an innocent misadventure," id., 470, 379, " 'repugnant conscience mankind,' 471, 380, quoting Palko Connecticut, 302 319, 323, 58 149, 150, 288 (1937).13 14 Similarly, context, inadvertent said pain" "repugnant mankind." physician negligent diagnosing treating condition valid mistreatment Medical become merely victim prisoner. order allege acts omissions sufficiently harmful evidence needs. only can offend "evolving decency" Amendment.14 III 15 Against backdrop, now consider claim. handwritten document liberally construed. As unanimously Haines Kerner, 519, 92 594, 652 (1972), "however inartfully pleaded," "less stringent formal pleadings drafted lawyers" appears 'beyond doubt plaintiff prove set facts support entitle relief.' 520-521, 596, Conley Gibson, 355 41, 45-46, 99, 80 (1957). 16 Even applying these liberal capacity Department, spanning period: times; twice; unidentified injury; six They injury, heart disclaimed objection provided problem; "based lack diagnosis injury." Response Pet. Cert. 4; Brief 19. strain bed rest, relaxants relievers. contends done way treatment, number options pursued. agreed, stating: "Certainly x-ray (Gamble's) might tests conducted led appropriate daily experiencing." F.2d, 941. But forms indicated classic example matter judgment. A decision X-ray, like measures, represent malpractice, proper forum court Tort Claims Act.15 error holding reversal That portion judgment affirmed.16 focused primarily actions doctors, action. Although reverse director, remand case allow opportunity consider, conformity opinion, officials. 18 ordered. 19 BLACKMUN concurs 20 STEVENS, dissenting. 21 Most what Court's entirely consistent federal courts processing inmates prohibited I disagreement area law developed thus far, probable impact opinion. Nevertheless, there reasons why am unable join First, insofar orders dismissal faithful rule normally construing pleading prepared uncounseled inmate. Second, adequately explain certiorari case. Third, describes State's duty ambiguous terms incorrectly relate subjective motivation persons accused violating rather standard Constitution. 22 represents crude challenge system administering confined. Fairly construed, alleges disabling responsible indifferent needs, mistreated worsened. 23 allegedly manifested, diagnose properly, conduct staff. confinement prolonged periods refusing assigned perform.1 presented first-class condition, fact sprain Prison refused permit sleep assigned. least occasion personnel. suffered blackouts solitary, forced wait clearance obtained warden. His draws into character attention attempts obtain However, apart twice, sued individuals occasions. short, complains whole inadequate. 24 impossible assess quality received. points out, even true, guilty nothing negligence malpractice. hand, surely inconceivable overworked, undermanned crowded prison2 expedient course routinely prescribing killers thorough disclose obvious remedial treatment.3 Three fine judges sitting Fifth Circuit4 thought enough require some inquiry actual facts. If meant 652, clearly right.5 test relief. Rather, say assurance that, beyond doubt, proved relief.6 manifest. provides unsatisfactory foundation deciding merits important questions typically drawn, unclear, equivocal, pleadings, affidavits, possibly evidentiary hearing usually bring simplify make naked complaint.7 26 Admittedly, tempting eliminate meritless stage. Unfortunately, "is instance judicial haste long run makes waste," Dioguardi Durning, 139 774, 775 (C.A.2 1944) (Clark, J.), cited approval U.S., 521, S.Ct., 596. instant case, resisted temptation premature dismissal, ended filing records affidavits demonstrating treatment. Likewise, Circuit reinstating stand normal course, litigation probably come end without review wrongly decided issue, great harm requiring State move summary Instead, stages appellate review, still over: proceed, disposed finality.8 27 principal beneficiaries today's judges, very little whose time saved, "writ-writers" within walls, semiprofessional services greater demand. about ability embellish conclusory good faith foreclose State. unfortunate increase prisoners' dependence writ-writers. Cruz Beto, 405 327 n. 1079, 1084, 31 263 (Rehnquist, J., dissenting). 28 Like dismiss hear practice interlocutory R. Stern & E. Gressman, Supreme Practice 180 (4th ed. 1969), ill serves interest economy. 29 Frankly, was, am, puzzled grant certiorari.9 misapplied Kerner reading liberally, inexplicable. instead question, prisoners, kind factual basis10 requires predicate adjudication novel see, Rescue Army Municipal 331 549, 568-575, 1409, 1419-1423, 1666; Ellis Dixon, 349 458, 75 850, 854, 1231; Wainwright City New Orleans, 392 88 2243, 1322 (Harlan, concurring).11 Moreover, notes, Courts reached substantially adopts. Ante, 292 14. Since seldom takes reaffirm settled law, understand chosen exception practice. By reference accidental unsuccessful 422, ante, 105, references "deliberate indifference" "intentional" care, believe improperly attaches significance defendant criterion determining inflicted.12 Subjective well determine what, any, remedy particular defendant. violated turn individual inflicted it.13 Whether conditions Andersonville product design, negligence, mere poverty, inhuman. sum, convinced petition denied. having granted, Appeals. Title provides: "Every person who, color statute, ordinance, regulation, custom, usage, Territory, subjects, causes subjected, citizen jurisdiction thereof rights, privileges, immunities secured Constitution laws, shall liable party suit equity, proceeding redress." petitioner-defendants aware Tr. Oral Arg. 13-15. resulted simultaneously granting file forma pauperis. weighed "6.00 pound." interpreted mean 600 pounds. 938 (CA5 names descriptions drugs administered App. A-5 A-11, brief, 19-20. There meaning unclear and, answer State, so. segregation" never defined. deemed equivalent 939. note, "32A-7 building" "32A20 building," "solitary confinement," "3102 building." "Excessive bail required, nor excessive fines imposed, inflicted." oral argument, counsel agreed 42-43. grossly disproportionate severity crime, 367, 549 (1910), imposes substantive limits criminal punished, Neither involved Ala.Code Tit. 45, 125 Alaska Stat. 33.30.050 (1975); Ariz.Rev.Stat.Ann. 31-201.01 (Supp.1975); Conn.Gen.Stat.Ann. 18-7 Ga.Code Ann. 77-309(e) (1973); Idaho Code 20-209 (Supp.1976); Ill.Ann.Stat. c. 38, 103-2 (1970); Ind.Ann.Stat. 11-1-1.1-30.5 Kan.Stat.Ann. 75-4249 Md.Ann.Code Art. 698 (1976); Mass.Ann.Laws, 127, 90A (1974); Mich.Stat.Ann. 14.84 (1969); Miss.Code 47-1-57 (1972); Mo.Ann.Stat. 221.120 (1962); Neb.Rev.Stat. 83-181 (1971); N.H.Rev.Stat.Ann. 619.9 N.M.Stat.Ann. 42-2-4 Tenn.Code §§ 41-318, 41-1115, 41-1226 Utah 64-9-13, 64-9-19, 64-9-20, 64-9-53 (1968); Va.Code 32-81, 32-82 W.Va.Code 25-1-16 Wyo.Stat.Ann. 18-299 (1959). Many adopted regulations specify, varying degrees detail, prisoners. Comment, Rights Prisoners Care Implications Drug-Dependent Pretrial Detainees, U.Chi.L.Rev. 705, 708-709 (1975). Model legislation proposed minimum accord. American Law Institute, Penal 303.4, 304.5 National Advisory Commission Criminal Standards Goals, Offenders, Standard 2.6 Council Crime Delinquency, Act Protection Prisoners, 1(b) Sheriffs' Association, Inmates' Legal Rights, Right Fourth Nations Congress Prevention Treatment Minimum Rules 22-26 (1955). foregoing found Dept. Enforcement Assistance Administration Compendium Correctional Legislation (2d Spicer Williamson, 191 N.C. 487, 490, 132 S.E. 291, 293 (1926). Williams Vincent, 508 541 1974) (doctor's choosing "easier efficacious treatment" throwing away ear stitching stump attributable exercise professional judgment"); Thomas 493 151, 158 (C.A.7), cert. denied sub nom. Cannon, 419 879, 95 143, 119 (1974) (injection penicillin knowledge allergic, allergic reaction); Jones Lockhart, 484 1192 1973) (refusal paramedic treatment); Martinez Mancusi, 443 921 1970), denied, 401 983, 1202, 335 (1971) (prison refuses administer killer renders leg surgery contrary surgeon). Westlake Lucas, 537 857 (C.A.6 1976); 158-159; Fitzke Shappell, 468 1072 1972); Hutchens Alabama, 466 507 Riley Rhay, 407 496 (C.A.9 1969); Edwards Duncan, 993 (C.A.4 1966); Hughes Noble, 295 495 1961). Wilbron Hutto, 509 621, 622 1975); Campbell 460 765 supra ; Tolbert Eyman, 434 625 1970); supra. noted, "a series abortive attempts" single, cruelly willful attempt" present different 380. essential agreement standard. All agree terminology regarding sufficient varies, results indifference. Page Sharpe, 487 567, 569 (C.A.1 1973); 541, 544 (uses phrase indifference"); Gittlemacker Prasse, 1, (C.A.3 Russell Sheffer, 528 318 Newman 503 1320, 1330 1974), 421 948, 1680, 44 102 (1975) ("callous 860 ("deliberate 158; 626; Dewell Lawson, 489 877, 881-882 (C.A.10 1974). Tex.Rev.Civ.Stat., 6252-19, (Supp.1976). Petitioners assured argument statute used assert claims. Contrary STEVENS' assertion dissent, signals retreat (1972). contrast general Haines, detailed accounting exhaustive description speculation unnecessary. apparent extensive segregation through affidavit filed 8, infra, up date affidavit. legislative report quoted Appeals, various 17,000 occasional part-time help. 940-941, poorly describe resemble reported systems. instance, study Pennsylvania reported: "When ill, point contact prison's health program sick-call line. Access barred guard, give convict whimsy prejudice, undiagnosed complaints. commonly sees civilian paraprofessional nurse, placebo examination, history-taking recorded diagnosis. seeing prisons produces aspirin symptoms, dizziness fainting, persisted years." Health Project, University Pennsylvania, Conditions Pennsylvania's Prisons, Bar Association Facilities Services, Jails, Other Facilities: Compilation Materials, 71, 81-82 (Aug. California found: "By greatest problem (at major prison), perhaps hospitals, abusive doctor-patient relationship. M.T.A.s (medical technical assistants) toward complaints unique Folsom, continuously elsewhere, calloused frequently hostile attitude exhibited uniquely reprehensible. "Typical (one doctor) patient ." Assembly Select Committee Reform Rehabilitation, Examination California's Hospitals, 60-61 statements observers demonstrate far fanciful read alleging provided. panel included Clark, retired member designation, Judges Goldberg Ainsworth. unanimous admonished judiciary especially solicitous problems uneducated seeking litigate own behalf. said: "Whatever scope internal administration prisons, asserted petitioner, however pleaded, offer supporting evidence. hold lawyers, 101-102, 774 1944)." 595-596. Under without, minimum, defendants. record February, causing served Fed.Rule Civ.Proc. Clerk referred magistrate June procedures commenced. service improper, Nichols Schubert, 499 946 (C.A.7 disposition endorsement raised parties. reinstated, expressly "intimate(d) whatever petitioner's allegations," significant approach being pressed decide merits. argued forcefully amount violation. (Only footnote 51-page brief discuss Respondents 22-23, 20, 70-5025, O.T. 1971.) Yet, devoted single word answering alleged. teaches postponed ascertained. Polk Co. Glover, 305 59 15, 83 intimating issues, "(t)he salutary principle determined passing grave 10, 17. Borden's Baldwin, 194, 213, 55 187, 193, 79 281 (Cardozo Stone, JJ., concurring result). potentially avoids necessity ever issue remove question. Alternatively, concrete available issues. generally 574-575, 1422, 1423, 1666. involved, conceptual legal theories explored assayed facts, pleader's supposition," avoid "elucidating responsibilities be." Shull Pilot Life Ins. Co., 313 445, 447 1963). transferred confinement, all. continuing allegations, shown (Gamble) spent months stands chance remaining intervention," Presumably bar pursuing charges, necessary officials doctor's bunk, claimed work, solitary. relevant produced testimony elicited care. show amend reassert doctors. "The remarkable thing presence involves application well-settled familiar situation, respondent. Why mystery me particularly many burdened heavy caseload." Butz Glover Livestock Comm'n 411 182, 189, 93 1455, 1460, 36 142 (Stewart, 100 unclear. writ improvidently clear parties disagreed 48. dissenting Justices Resweber pointed out: intent executioner lessen excuse result. statutory sure failure." 477, 382 (Burton, joined Douglas, Murphy, Rutledge, JJ.). indicates "by prescribed." 104-105. indicate part violation, disagree. elects impose imprisonment custody meets minimal adequacy. basic obligation, agents affirmative reasonable competent, diligent personnel, ensure delivered. nations crime. Of improper violates rest us, risk error. Such rise tort necessarily adds risk, providing meet competence diligence caseload facilities, suffer breach duty.

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