Welcome to the HBS Correctional Healthcare Blog

Welcome to the HBS Correctional Health care Practice Group BLOG.  In this, our first entry, we offer an overview of the law that governs lawsuits brought by inmates against health care practitioners in correctional settings.

In 1976, the United States Supreme Court issued the landmark decision in Estelle v. Gamble regarding the rights of incarcerated persons related to receiving health care.  Unlike the private sector, inmate health care providers cannot refuse patients.  The health care providers in correctional facilities do not have a choice concerning the examination and treatment of inmates.  Regardless of a prisoner’s criminal history, attitude, or condition, practitioners are mandated to address the health-related issues about which inmates complain.  While practitioners in correctional facilities still maintain discretion and judgment in their diagnoses and treatment of inmates, there exist some guidelines within which practitioners should consider as they work in a correctional setting.

In suits involving claims related to health care provided by correctional practitioners, the basis upon which such claims are made are rooted in the principles of the Eighth Amendment to the U.S. Constitution which prohibits cruel and unusual punishment.  As such, it is the “deliberate indifference to serious medical need” that sets the standard upon which claims by inmates against health care practitioners are measured. Deliberate indifference can be proven in a number of ways including the failure to provide care, unreasonable delay in access to care, or interference with treatment once prescribed.

Negligence, disagreement, complaints about the quality of care, as well as disputes over the administration of medications and plan of care, cannot form the basis of a federal claim under the Eighth Amendment.  So the question remains how do courts determine whether or not the deliberate indifference standard has been met.

There are two components to a claim for deliberate indifference against a correctional practitioner that must be met in order for a case brought by an inmate to move forward-an an objective component and a subjective component. The objective component requires that the deprivation of medical care and treatment “sufficiently serious.” A serious medical need is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a layperson would easily recognize the necessity for a physician’s attention.  Examples of serious medical need under the objective component are when such medical needs are defined as those that are diagnosed by a physician as mandating treatment, such as insulin-dependent diabetes or AIDS, or conditions that are so obvious that even a lay person would see the need for medical attention, such as vomiting blood.  The subjective component requires that the official act with the requisite intent, that is, that he has a “sufficiently culpable state of mind.”  In order to satisfy the subjective component, a plaintiff must demonstrate “that the official being sued subjectively perceived facts from which to infer substantial risk to the prisoner, that he did in fact draw the inference, and that he then disregarded that risk.” Some courts have even held that a plaintiff must demonstrate “deliberateness tantamount to intent to punish.”

This overview demonstrates the unique nature of the field of correctional health care law.  Look for our next blog entry to discover some of the little-known procedures surrounding lawsuits involving prison health care litigation.

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