CONSTITUTIONAL LAW: Denial of Medical Care for an Inmate Was Cruel and Unusual Punishment
The Lawletter Vol 40 No 7
John Stone, Senior Attorney, National Legal Research Group
It is no easy task for a prisoner to succeed on a claim that he was denied medical care in circumstances that violated his federal constitutional rights. Such a cause of action is not simply a prisoner's version of a medical malpractice case but, rather, requires a more demanding showing by the plaintiff. Mere negligence in diagnosis or treatment will not suffice. To state an Eighth Amendment claim for cruel and unusual punishment based on deficient medical care, a prisoner must allege an objectively serious medical condition and an official's deliberate indifference to that condition. Estelle v. Gamble, 429 U.S. 97 (1976). "Deliberate indifference" to a prisoner's serious medical needs occurs when a defendant realizes that a substantial risk of serious harm to a prisoner exists but then disregards that risk.
In a recent case, a prisoner appearing on his own behalf, and perhaps benefiting from the relative leniency afforded pleadings from pro se litigants, convinced a federal appeals court to reinstate his claim under 42 U.S.C. § 1983 for denial of medical care after his claim had been dismissed by a federal district court. Perez v. Fenoglio, No. 12-3084, 2015 WL 4092294 (7th Cir. July 7, 2015). While an inmate at a state prison, Perez was injured during a prison basketball game. He suffered a torn ligament in his right hand, dislocation of his thumb, tissue damage, and a "gaping wound" between his thumb and right index finger. What ensued was a succession of failures by medical personnel and prison officials to see to it that Perez received adequate treatment for his serious injuries. The recurring theme was unnecessary delays, prison red tape, some outright indifference to Perez's condition, and, at least as to some of the defendants, a desire to retaliate against Perez. The result was permanent damage to his hand and a diminished ability to use it.
Not only did Perez's complaint state a violation of his Eighth Amendment right to medical care, but a succession of persons or entities who made contact with him after his injury were found by the Seventh Circuit to be culpable, assuming that Perez could support his allegations with proof. The prison physician determined that the wound was so serious that it required a specialist's care, but then Perez had to wait four days and file a grievance before he was sent to the specialist, by which time it was too late for the wound to be sutured. Then Perez had to wait seven months and file another grievance before he was sent to the specialist for follow-up care. The prison physician also ignored recommendations of the specialist. Altogether, Perez was forced to wait 10 months from the time of his injury until receipt of meaningful treatment in the form of surgery, despite his complaints of ongoing symptoms, including pain, bleeding, swelling, and loss of function.
A prison nurse had knowledge of the severe injury yet failed to provide adequate treatment to Perez herself, such as by suturing his wound, or to ensure that others did, such as by contacting supervisory personnel to voice any concerns about the treatment being provided to him. The private corporation that served as the prison's health-care provider also could be found liable on allegations that the prison nurse told Perez that she could not stitch his wound or prescribe medication without a "doctor there" and that a doctor was not "there" because of the provider's policy or practice of not having a full-time doctor stationed at the prison at all times or on call to suture open wounds as necessary. The prison's health-care administrator also contributed to the violations, as he was the individual responsible for approving requests for inmates to be seen by outside doctors. Furthermore, despite the prison physician's determination that Perez's gaping wound and open dislocation were so serious that he should see a specialist, the administrator, without explanation, refused to grant the referral request for four days, causing Perez needless pain and suffering and worsening the injury.
Even some nonmedical personnel at the prison were subject to being held liable. Grievance officials, who had been made aware of Perez's predicament by way of his grievances and other correspondences, obtained actual knowledge of the serious medical condition and inadequate medical care through coherent and highly detailed grievances and other correspondences from Perez. Each of these officials failed to exercise his or her authority to intervene on behalf of Perez to rectify the situation, suggesting that they either approved of, or turned a blind eye to, his allegedly unconstitutional treatment.
According to Perez's handwritten complaint, the suffering experienced from the neglected injuries to his hand was compounded by the fact that the defendants were retaliating against him over an earlier series of events. He sufficiently alleged that because he had brought a previous grievance against prison officials for the withholding of his prescribed depression medication, members of the prison's medical staff, including the prison physician and the prison's health-care administrator, denied him adequate care when he severely injured his hand. This constituted a separate, additional violation, this time of his rights under the First Amendment. To state a First Amendment claim for retaliation, a plaintiff must allege that (1) he engaged in activity protected by the First Amendment; (2) he suffered a deprivation that would likely deter First Amendment activity in the future; and (3) the First Amendment activity was at least a motivating factor in the defendants' decision to take the retaliatory action. Bridges v. Gilbert, 557 F.3d 541 (7th Cir. 2009).