overview of legal issues related to inmate health care n.
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    David Sasser Senior Counsel Legal Advisor-Idaho Sheriff’s Association & Idaho Chiefs of Police Association Naylor & Hales, P.C. Attorneys at Law 950 W. Bannock, St., Suite 610 Boise, ID 83702 208-383-9511 (main) 208-947-2083 (direct) 208-870-9733 (cell) 208-383-9516 (fax) Email:
  2. This information/presentation is intended to promote consideration and discussion of significant issues related to inmate health care. This information/presentation is NOT intended to be legal advice, and participants/attendees should not rely upon it or take any action based upon it. There is a significant body of law related to the topic of this presentation and participants/attendees should consult with their attorneys prior to taking any actions related to these issues. Disclaimer
  3. If you provide services to inmates in the detention setting, chances are high that you WILL get sued. . . sooner or later, HOWEVER The deck is stacked in favor of health care providers by statutes, professional standards and court decisions, including State law malpractice cases and in actions based on the United States Constitution. Courts’ willingness to defer to providers’ (particularly physicians’) medical judgment is a BIG factor This presentation will focus primarily on inmates’ constitutional right to “adequate” medical care. Preliminary Observations
  4. Some of the most important cases are: Estelle v. Gamble, 429 U.S. 97 (1976) Bell v. Wolfish, 441 U.S. 520 (1979) Parratt v. Taylor, 451 U.S. 527 (1981) West v. Atkins, 487 U.S. 42 (1988) Washington v. Harper, 494 U.S. 210 (1990) Farmer v. Brennan, 511 U.S. 825 (1994)
  5. Parrattheld that: In order for a plaintiff to state a claim under Title 42 U.S.C., Section 1983 (constitution-based) He/she must allege the violation of a right secured by the Constitution and law’s of the United States – and, Must show that the alleged deprivation was committed by a person who was acting under color of state law
  6. West informed us that: A physician who is under contract with the state to provide medical services at a state-prison hospital, even on a part-time basis Acts “under color of state law” within the meaning of Section 1983 The facts that the state employed respondent (the defendant physician) pursuant to a contractual arrangement that did not generate the same benefits or obligations applicable to other “state employees” does not alter the analysis. Nor does the fact that Doctor Atkins’ employment contract did not require him to work exclusively for the prison make him any less a state actor than if he performed those duties as a full-time, permanent member of the state prison medical staff.
  7. Estelle established the “deliberate indifference” standard, including the following: The 8th Amendment protects sentenced inmates from cruel and unusual punishment. All claims of inadequate medical care DO NOT violate the 8th Amendment. Medical malpractice (negligence) does not “become a constitutional violation” just because the victim is an inmate. To establish an 8th Amendment violation, an inmate must prove: the provider was aware that the inmate had “serious medical needs” (Objective Component) The provider knew of the serious need and understood their acts/omissions would constitute an excessive risk to the inmate’s health or safety.
  8. Bell held that: Pre-trial detainees are entitled to adequate health care Pursuant to the due process requirements of the 14th Amendment Failure to provide such care constitutes impermissible punishment of persons not convicted of a crime Although some courts have articulated distinctions between the protections afforded sentenced and pre-trial detainees Most courts apply the same “deliberate indifference” standard to both groups
  9. Farmer clarified that officials/providers are not liable under the 8th Amendment unless they: know facts that indicate there is excessive risk to the inmate’s health or safety, AND believe the inmate’s health is in danger ... but proceed anyway, without taking reasonable steps to limit the risk
  10. In determining whether “serious” medical needs exist, some courts have considered: Chronic or substantial pain Would reasonable physician or patient think issue warrants treatment Condition significantly affects patient’s daily activities or quality of life If delay in providing care is an issue – what are “effects” of delay “Seriousness” is subject to case-by-case analysis Courts have held that jails/prisons cannot determine “seriousness” based on rigid lists of circumstances ?? Serious Medical Need ??
  11. Courts have found medical staff deliberately indifferent where they: Ignored obvious serious conditions – i.e. broken bones, cuts requiring treatment, patient with history of chest pain, etc. Failed to treat diagnosed conditions – particularly if diagnosed by a specialist or ER physician Failed to investigate to extent needed to make informed judgment – i.e. failure to consult treating physician before stopping medication or changing treatment, failure to order diagnostic tests or send to specialist
  12. Delayed treatment resulting in serious, detrimental consequences Failure to take serious action while inmate lost weight over several months Several days delay where inmate is in pain, nauseated and vomiting- resulting in ruptured appendix Interfered with access to treatment – often involves staff and/or medical staff denying access to specialists Allowing access to specialists, but not providing access to prescribed treatment Ignoring or refusing to carry out medical orders Used non-medical factors to make medical decisions Inadequate staffing or communication barriers Retaliation or punishment Financial limitations or budget constraints Inmate scheduled for release Make medical decisions so incompetent they are medically unacceptable.
  13. Dental Care Inmates have a right to adequate dental care under circumstances where. . . Their dental problems are deemed to be “serious” medical needs and/or cause serious problems. MISCELLANEOUS HEALTH CARE ISSUES
  14. Factors courts have relied on include: Severe toothache or persistent pain Significant unwarranted delay or refusal to get inmate to dentist or specialist Swollen, bleeding gums interfering with eating, sleeping and other activities Failure to provide serious treatments such as fillings and crowns – especially where prescribed by dentist Consideration of non-medical factors – i.e. cost, personal dispute, retaliation
  15. Farmer also established that: “The (8th) Amendment also imposes duties on these officials who must provide humane conditions of confinement; prison officials must ensure that inmates receive adequate food, clothing, shelter and medical care and must take reasonable measures to guarantee the safety of the inmates” This duty is not without boundaries – but courts have had a difficult time agreeing on “reasonable measures” Mental Health Care, Suicide Prevention & the Duty to Protect Inmates
  16. Focus on Questions: 1. Were officials or providers “deliberately indifferent” to the rights, health or safety of the inmate? 2. Did they have knowledge of a substantial risk of harm? 3. What did they do – did they proceed, without taking “reasonable measures” and cause serious harm?
  17. Common issues in inmate mental health and/or suicide cases include: Were proper policies & procedures in place? Was proper training provided to staff? What did the provider know? When did the provider know it? Was there proper screening and classification? Were appropriate notices provided to appropriate staff? Was there timely follow-up action? Was/Is there proper documentation?
  18. Informed consent is a matter of state law Generally speaking inmates must be informed of: Enough information about proposed treatment options To make an informed decision whether to accept or refuse the treatment offered, with knowledge of the risks associated with the treatment options Inmate’s Right to Informed Consent and to Refuse Medication
  19. May be based on state law, or The 8th Amendment In Washington the Supreme Court held that: Some deprivations are so important that states must establish processes to avoid unfair deprivations Antipsychotic drugs can be administered without the patient’s consent Only if “a mental disorder exists which is likely to cause harm if not treated” – AND If one psychiatrist has prescribed the treatment and another has reviewed and concurred in the treatment Inmate’s Right to Refuse Medication
  20. Clear, Written Agreement re: the services you are/are not providing and all terms, conditions, costs, etc. Insurance coverage for malpractice, acts, omissions, violations of rights – ALL aspects of ALL services you have agreed to provide Policies & Procedures (Internal) Personnel Policies Operations Policies Policies & Procedures (External) Of prisons or jails you serve Training Plan/Program Risk Management Plan (Jacqueline Moore has excellent material) Risk Management Suggestions ForHealth Care Providers
  21. Keep it professional – arms length Hazards of “familiarity” Importance of Policy Ethical Implications Confidentiality Keeping personnel “drama” separate Provider’s role in grievance process Your Relationship With Jail/Prison Management & Staff
  22. Shackling/Restraining Pregnant Inmates Disabled/Wheelchair-Bound Inmates MRSA Infections in Detention Inmate Diets Inmates with HIV/AIDS Transexual Inmates OTHER ISSUES – IF TIME PERMITS