Court Opinion

ID: 9700286
Source: CourtListenerOpinion
Date Created: 2023-08-25 21:18:37.387169+00
Date Added: 2024-06-11T18:21:06.684404
License: Public Domain

TERRY, Associate Judge,
with whom Chief Judge WAGNER and Associate Judge REID join, dissenting:
The principal issue in this case, one of first impression in this court, is whether the trial court was correct when it ruled that the District of Columbia could delegate to a contractor its duty to provide necessary and appropriate medical care to prisoners incarcerated in its prison system. I believe this ruling was erroneous, and thus I would reverse the judgment in favor of the District and remand this case for further proceedings.
In her motion for summary judgment, appellant argued that the District had a non-delegable duty to provide her with necessary medical care while she was confined in the D.C. Jail. In ruling on the motion, the court noted initially that the cases appellant cited in support of her position merely defined the duty owed by the District, but did not say whether it was delegable or non-delegable. The court then ruled that “the District of Columbia has a non-delegable duty only insofar as the plaintiff has suffered a constitutional deprivation.” Because appellant had not raised any such constitutionally based claim, the court denied her motion.1
In challenging this and similar rulings during the trial, appellant contends that the *202District does indeed have a non-delegable duty to provide appropriate medical care for inmates within its custody. She cites D.C.Code § 24-442 (1996), as well as case law from other jurisdictions, to support her argument that the District must be held liable when one of its prisoners is injured as a result of malpractice committed by prison health care providers, regardless of whether they are District employees or independent contractors. I agree with appellant and would hold that the District’s duty to provide reasonable, non-negligent medical care for prisoners in its custody is non-delegable.
A. The District’s Limited Constitutional Duty
The Supreme Court has held that federal and state governments have a non-delegable duty, based on the Eighth Amendment to the Constitution, to provide adequate medical care to persons incarcerated within their prison systems. West v. Atkins, 487 U.S. 42, 54, 108 S.Ct. 2250, 101 L.Ed.2d 40 (1988). Further, the Court has held that a private physician treating prison inmates under a contract with a state is a government agent, acting under color of authority sufficient to hold the state liable under federal civil rights statutes, such as 42 U.S.C. § 1983, for damages resulting from the physician’s “deliberate indifference” to the serious medical needs of the inmates. Id. at 55-56, 108 S.Ct. 2250. Such “deliberate indifference ... constitutes the ‘unnecessary and wanton infliction of pain’ ... proscribed by the Eighth Amendment.” Estelle v. Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976) (citation omitted). The existence of such indifference may be “manifested by prison doctors in their response to the prisoner’s needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed.” Id. at 104-105, 97 S.Ct. 285 (citations omitted).
With respect to medical treatment, however, “an inadvertent failure to provide adequate medical care cannot be said to constitute [a violation of the Eighth Amendment].” Id. at 105, 97 S.Ct. 285. Although a state has a constitutional duty to provide for the “basic human needs” of anyone whose liberty it has restrained, and although medical care is included among those “basic human needs,” De Shaney v. Winnebago County Dep’t of Social Services, 489 U.S. 189, 200, 109 S.Ct. 998, 103 L.Ed.2d 249 (1989), the state also “has considerable discretion in determining the nature and scope of its responsibilities.” Youngberg v. Romeo, 457 U.S. 307, 317, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982). What these and similar cases say, in essence, is that an allegation of medical malpractice alone will not support a claim that a prisoner’s Eighth Amendment rights have been violated. Thus, to prove a constitutional violation in providing medical services, a prisoner must show conduct so extreme that it surpasses simple negligence. See Ancata v. Prison Health Services, Inc., 769 F.2d 700, 705 (11th Cir.1985); Henderson v. Harris, 672 F.Supp. 1054, 1063 (N.D.Ill.1987) (“Contracting with private health services agencies will not relieve the federal government from its constitutional obligation” (citations omitted)).2
Although appellant occasionally refers in her brief to a possible constitutional duty on the part of the District, she makes no substantial Eighth Amendment claim, nor did she do so in the trial court. Instead, she appears to contend that the District has only a general, non-delegable duty to prevent the commission of simple medical malpractice on prisoners in its custody. If such a duty exists, therefore, it must be found outside the confines of the Constitution.
B. The District’s Non-Constitutional Duty
This court has held that the District, its agents and employees are subject to ordinary negligence standards requiring them to exercise reasonable care in the protection and safekeeping of inmates in its correctional facilities. Matthews v. District of Columbia, *203887 A.2d 731, 734 (D.C.1978); Gaither v. District of Columbia, 338 A.2d 57, 60 (D.C.1975). These duties are codified in D.C.Code § 24 — 442, which states that the Department of Corrections is “responsible for the safekeeping, care, protection, instruction, and discipline of all persons committed to [its] institutions.” However, even though prison personnel have a duty to exercise reasonable care, they are not insurers of an inmate’s safety. Hughes v. District of Columbia, 425 A.2d 1299, 1302 (D.C.1981). Rather, in order to establish liability, a prisoner “must establish by competent evidence a standard of care; that the defendant violated that standard; and that such violation proximately caused injury to the [prisoner].” Id. With respect to medical care, we have held that physicians owe the same duty of care to prisoners in the District’s custody that they owe to non-incarcerated patients. Thus, when treating prisoners, physicians are subject to ordinary negligence standards requiring them to exercise reasonable care. District of Columbia v. Mitchell, 533 A.2d 629, 648 (D.C.1987).
The delegability of the District’s duty to provide prison inmates with medical care and its potential liability when an independent contractor commits malpractice are questions unresolved in this jurisdiction until now. Indeed, there appear to be very few reported cases anywhere that address the delegability issue.3 In at least two instances, however, courts have held governments hable for negligent medical care provided to prisoners by independent contractors on the ground that the government’s duty to provide medical care to its prisoners is not delegable.4
In Medley v. North Carolina Dep’t of Correction, 330 N.C. 837, 412 S.E.2d 654 (1992), the North Carolina Supreme Court held that the state was liable under its Tort Claims Act, N.C.G.S. § 143-291 (1990), for injuries resulting from malpractice committed by its agents when providing medical care to inmates. In that case a private physician, acting as an independent contractor for a state prison, misdiagnosed an inmate’s affliction as an ingrown toenail when in fact he was suffering from diabetic gangrene in his left big toe. The toe was later amputated after another doctor discovered the gangrene, but the wound did not heal properly, and the prisoner’s leg eventually had to be amputated above the knee.
On appeal, the court held that because of the state’s position as the sole health care provider for its prisoners, and because the state had a duty to provide them with medical services, a duty imposed by both the United States and North Carolina Constitutions as well as a state statute,5 the duty was of such importance as to make it non-delega-ble:
We hold that the duty to provide adequate medical care to inmates ... is such a fundamental and paramount obligation of the state that the state cannot absolve *204itself of responsibility by delegating it to another.
Id. at 844, 412 S.E.2d at 659. Consequently, the court said, “one with whom the [state] contracts to perform that duty is as a matter of law an agent for purposes of applying the doctrine of respondeat superior.” Id. (citations omitted). The court concluded that this rale “applies to the definition of ‘agent’ under the State Tort Claims Act” and thus held the state liable for the medical malpractice of an independent contractor who had been hired to provide medical services to state prisoners.
Although the District is statutorily required by D.C.Code § 24-442 to provide for the medical care of its prisoners, there is no District of Columbia tort claims act under which the District may be held liable as a principal for the negligence of its agents. However, the rationale of the Medley court is similar to that found in a case from the State of Washington that does not involve a tort claims act.
In Shea v. City of Spokane, 17 Wash.App. 236, 562 P.2d 264 (1977), aff'd, 90 Wash.2d 43, 578 P.2d 42 (1978), a prisoner suffered a serious spinal cord injury when he fell in his jail cell. He sued the city of Spokane for damages resulting from negligent medical treatment by a doctor who, under contract with the city, had examined him at the jail but failed to detect the severity of his injury. The Washington Court of Appeals held that the city had a non-delegable duty to provide prisoners in its jail with adequate health care, and that the negligence of the doctor in treating the prisoner must therefore be imputed to the city. Because the prisoner, by being arrested, had been deprived of his ability to care for himself, the city had a duty to provide health care for him. That duty, the court held, was non-delegable because the city had “complete control” over the prisoner:
[T]he nature of the relationship [between the city and the prisoner] is such as to render non-delegable the duty of providing for the health of a prisoner. Stated another way, the duty is so intertwined with the responsibility of the City as custodian that it cannot be relieved of liability for the negligent exercise of that duty by delegating it to an “independent contractor” physician.
Id. at 242, 562 P.2d at 268 (citations omitted).6
I agree with the rationale of the Medley and Shea cases and would adopt it for the District of Columbia. In my view, the District has a duty, imposed both by the Constitution7 and by statute,8 to provide medical care to prisoners incarcerated in its correctional system. Such confinement creates what the Shea court called a “special relationship,” based on the fact that the District has “complete control over a prisoner deprived of liberty.” Shea, supra, 17 Wash.App. at 242, 562 P.2d at 268; see West v. Atkins, supra, 487 U.S. at 57 n. 15, 108 S.Ct. 2250 (“prisons and jails are inherently coercive institutions that for security reasons must exercise nearly total control over their residents’ lives”). A prisoner in need of medical care cannot choose the physician who will provide it; the prisoner must accept such care from the physician made available by the District or go without medical care entirely. The plain fact is that, once incarcerated, a prisoner’s choice of a health care provider is forfeited to the District. “An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met.” Estelle, supra, 429 U.S. at 103, 97 S.Ct. 285. Because the District has thus assumed the absolute right to make decisions about providing health care for the prisoner, it should also be obliged to accept the consequences when those decisions go awry.
I conclude, as did the Shea court, that “the nature of the relationship” between the District and the prisoner — specifically, the prisoner’s- total dependency on the District to provide medical care — makes the District’s *205duty non-delegable.9 It “cannot be relieved of liability for the negligent exercise of that duty by delegating it to an ‘independent contractor’ physician.” 17 Wash.App. at 242, 562 P.2d at 268 (citations omitted); accord, Medley, supra, 330 N.C. at 844, 412 S.E.2d at 659 (“the duty to provide adequate medical care to inmates ... is [so] fundamental ... that the state cannot absolve itself of responsibility by delegating it to another”). I would hold, therefore, that the trial court erred in ruling that the District could delegate its duty to an independent contractor, and hence that it also erred in directing a verdict for the District. A corollary holding would be that PDC and its employees are, “as a matter of law,” agents of the District “for purposes of applying the doctrine of respondeat superior.” Medley, supra, 330 N.C. at 845, 412 S.E.2d at 659 (citations omitted).10
Because my colleagues in the majority see this case differently, I respectfully dissent.

. The court also rejected appellant’s argument that the District was liable on a theory of negligence per se. Appellant does not contest that ruling.

. Appellant, citing Henderson v. Harris, suggests that the District’s duty to provide her with "appropriate” or "sufficient” medical care is not only non-delegable but constitutionally based. A careful reading of Henderson reveals, however, that it is a case of "deliberate indifference,” as that term is used in Estelle v. Gamble, 429 U.S. at 104, 97 S.Ct. 285, rather than simple negligence as in the case at bar. See Henderson, 672 F.Supp. at 1058-1059.

. As the District points out, Estelle v. Gamble, supra, does not answer this question. It suggests that a prisoner who receives negligent medical care may sue for malpractice, 429 U.S. at 107 & n. 15, 97 S.Ct. 285, but it does not say whether the state or the negligent physician is the proper party defendant, or whether the prisoner may elect to sue either (or both).

. There is at least one case to the contrary. Rivers v. State, 159 A.D.2d 788, 552 N.Y.S.2d 189 (1990). My colleagues in the majority endorse its reasoning, but I do not find it persuasive. They also cite Logue v. United States, 412 U.S. 521, 93 S.Ct. 2215, 37 L.Ed.2d 121 (1973), which strikes me as clearly distinguishable. The decision in Logue depended in large part on a federal statute, 28 U.S.C. § 2671, which defined the term "federal agency” as excluding "any contractor with the United States.” An employee of such a contractor was thus held not to be a federal employee, so that the United States was not liable under the Federal Tort Claims Act. Because there is no comparable statute involved in this case, Logue is of little or no assistance here.

.N.C.G.S. § 148-19(a) (1991) provides in relevant part:
The general policies, rules and regulations of the Department of Correction shall prescribe standards for health services to prisoners, which shall include preventive, diagnostic, and therapeutic measures on both an outpatient and a hospital basis, for all types of patients. A prisoner may be taken, when necessary, to a medical facility outside the State prison system. The Department of Correction shall seek the cooperation of public and private agencies, institutions, officials and individuals in the development of adequate health services to prisoners.

.The Supreme Court of Washington later adopted in full "the analysis, rationale, and conclusion of the Court of Appeals” on this issue. 90 Wash.2d at 44, 578 P.2d at 42.

. De Shaney, supra, 489 U.S. at 200, 109 S.Ct. 998; West, supra, 487 U.S. at 54, 108 S.Ct. 2250.

. D.C.Code § 24-442.

. The Supreme Court in West v. Atkins, supra, likewise focused on this same relationship, not on whether the physician was a state employee or an independent contractor, in holding that the physician was acting "under color of state law" within the meaning of a federal civil rights statute:
Whether a physician is on the state payroll or is paid by contract, the dispositive issue concerns the relationship among the State, the physician, and the prisoner. Contracting out prison medical care does not relieve the State of its constitutional duty to provide adequate medical treatment to those in its custody.... [The doctor was] fully vested with state authority to fulfill essential aspects of [that] duty.... [The doctor] must be considered to be a state actor.
487 U.S. at 56-57, 108 S.Ct. 2250 (emphasis added). Although West does not decide the precise issue presented in this case, its reasoning is parallel to that of the Medley and Shea cases, which are directly in point.

. The District, of course, would not be without a remedy against PDC or any such agent, either under common law principles of contribution or indemnity or, presumably, under the contract.