Constitutional Rights of Inmates Chapter 10 Right to Rehabilitation Programs Right to Medical Aid, and Right to Life

1. Constitutional Rights of Inmates Chapter 10 Right to Rehabilitation Programs Right to Medical Aid, and Right to Life

2. Right to Rehab • U.S. Supreme Court in Pell v. Procunier stated rehabilitation was one of three primary purposes of punishment • American Correctional Association • Prison serves to protect society from crime. • When its emphasis is on rehabilitation. • Many states have statutes that encourage rehabilitation of inmates.

3. Court Decisions • Courts have refused to hold there is an absolute right to rehabilitation.

4. Right to Rehab • Padgett v. State, 406 F.Supp. 287 (M.D.Pa. 1976) • Inmates sued claiming failure to provide meaningful rehab programs was cruel and unusual punishment. • Court held no constitutional duty on government to rehabilitate prisoners. • Question as to whether state should try to rehabilitate inmates in view of issue of effectiveness of rehabilitation programs. • Public policy issue best left to legislatures.

5. Does Rehab Work? • 1970s trend among researchers was that “nothing works” • If programs are ineffective, no reason to require states to attempt rehabilitation.

6. Does Rehab Work? • Recent research indicates that treatment programs do reduce recidivism. • Drug treatment courts (DTCs) • Offenders who complete DTC have statistically significantly lower recidivism rates

7. Rehab in Prison • Prison and the “inmate culture” not conducive to effective treatment. • Inmates who sign up for rehab or educational programs just to build their parole file. • Treatment works best in a “therapeutic community”. • But research does support use of rehab programs in prison.

8. Right to Rehab • Lack of meaningful rehabilitation programs has been one factor that courts have cited in finding state prison systems unconstitutional. • But only an element, not the sole element of determination.

9. Right to Rehab • Penal system cannot be operated in manner that impedes ability of inmates to attempt their own rehabilitation. • Harris County, Texas jail ordered to provide educational and vocational programs. • But inmates had no right to attend rehab programs outside institution.

10. Rehab Without Consent • Aversion therapy (Clockwork Orange treatment) held unconstitutional. • Inmates given nauseating injections for infraction of rules. • Attempt to produce Pavlovian aversion to bad behavior. • 8th Circuit held this cruel and unusual punishment. • It was not treatment regardless of what they called it.

11. Rehab Without Consent • Courts held institutions could require educational programs. • Arkansas inmates sued to enjoin mandatory literacy programs. • Court held state had sufficient interest in eliminating illiteracy among inmates, and could require participation. • More than mere attendance can be required. • States can require meaningful participation, and impose sanctions for failure. • Completion of educational/vocational programs can be a factor for parole release.

12. Consent to Experiments • Is inmate’s consent voluntary or coerced? • Scientists need volunteers to conduct experiments. • Parole boards can reward volunteers for experiments. • Is it truly voluntary?

13. Consent to Treatment • Inmate has right to refuse drug treatment • The right is adequately protected by hospital regulations that provide informal consultations and interviews to determine whether compelled administration of drugs is necessary. • Decision is made from a medical standpoint.

14. Type of Treatment • Scope of rehabilitation is left to institution • Court held that it within administration discretion to reject inmates for x-ray technician training program • Absent arbitrary or capricious selection, court will not intervene • Court has held pre-trial detainees entitled to continue methadone treatment program they were in prior to arrest

15. Mental Health Cases • District Court D.C. held persons who had been involuntarily committed to mental institution after acquittal on basis of insanity had right to treatment • Minnesota D.C. has held that persons who were committed after involuntary civil commitment hearing were entitled to at least minimal treatment • NYDC held that persons who had been committed were entitled to treatment regardless of whether commitment was civil or criminal

16. Mental Health Cases • O’Connor v. Donaldson, 422 U.S. 563 (1975) • 5th Circuit had held that mental patient who had been involuntarily committed to state hospital was entitled to rehabilitative treatment, or at least to adequate habilitation if treatment was impossible. • Non-dangerous person could not be held in custody if he could survive on his own or with help of family or friends. • Superintendent of hospital entitled to defense of qualified immunity to civil damages because there was state law that authorized continued confinement of person like P. • U.S. Supreme Court reversed the 5th Circuit and remanded for determination of liability in light of qualified immunity defense. • Supreme Court refused to decide whether mental patients have constitutional right to treatment as result of their detention by the state.

17. Mills v. Rogers, 457 U.S. 291 (1982)

18. Youngberg v. Romeo, 457 U.S. 307 (1982)

19. Juveniles and Treatment • District of Columbia Juvenile Court Act mandates treatment • Morales v. Turman, US District Court (E.D. Texas) held that incarcerated juvenile had to be placed in treatment program that had been designed to suit needs of juvenile. • These cases could indicate a trend that could eventually expand to adults and treatment.

20. Sex Offenders and Treatment • California enacted indeterminate sentence for sex offenders (1 day to life) • Calif. Supreme Court held that confinement for this sentence without treatment was cruel and unusual punishment • Indeterminate sentence implied that inmate could be released if he got better and no longer a danger • Only way to get better was through treatment

21. Sex Offenders and Treatment • New York modified its sex offender statute to eliminate a right to treatment • Ohlinger v. Watson, 9th Circuit ruled Oregon sex offender statute requires treatment for sex offenders • Research on effectiveness of treatment of sex offenders – mixed results

22. Right to Treatment • If state confines a man for purpose of helping him; • Right to withhold freedom depends on whether help is provided • When legislature justifies confinement on promise of treatment, it commits state to provide resources to fulfill promise

23. Administrative Review • Supreme Court held that administrative review (rather than court review) was most effective way to determine whether or not inmates should be required to take antipsychotic drugs

24. Administrative Review • Washington State Prison had special unit for felons with severe mental disorders • Some inmates refused to take medication prescribed

25. Administrative Review • State Prison administration established review board to conduct administrative hearing to determine whether inmates should be required to take drugs • Hearing conducted by review board • Psychiatrist • Psychologist • Associate warden of unit

26. Administrative Review • None of board members were involved in treatment of inmates • Hearing complied with Turner v. Safley • State had interest in safety and security which may exceed rights of inmate to refuse treatment • Inmate had right to be present at hearing • Right to present evidence • Right to counsel substitute • Any decision to medicate was subject to periodic review

27. Right to Medical Care • Common complaint is inadequate medical care • Inmate cannot provide for own medical care • Inmates are restrained • Cannot select treatment provider • Cannot control treatment from open market

28. Right to Medical Care • Inmates have greater need for medical care than general public • Many inmates have mental problems • 70% inmates have drug or alcohol problems • AIDS, hepatitis and TB • Overcrowding, poor nutrition, lack of exercise aggravate problems • Incarceration intensifies concern over physical symptoms due to boredom

29. Inmate Suits Over Medical Care • Inadequate medical care • Denial of medical care • Improper medical care

30. Federal Jurisdiction Over Medical Care Issues • Inmate must allege existence of a federally protected right. • Due process under 5th and 14th Amendments • Right to be free from abuse of discretion regarding life and health • Right to be free from cruel and unusual punishment under 8th Amendment • Intentional denial of needed medical care • Official’s conduct indicates deliberate indifference to medical needs of inmate

31. Federal Tort Claims Act 42 USC §2674 • Provides cause of action against US government for negligence, including medical negligence • Applies to medical treatment of federal prisoners

32. Americans With Disabilities Act 42 USC §12101 • Prevents discrimination against persons with disabilities • Applies to persons in any federally funded “program or activity” • Can apply to federal prisoners

33. Right to Medical Care - Remedies • Constitutional guarantee against cruel and unusual punishment do not mean inmate will be cured of any real or imagined medical problems • Inmate only entitled to medical care through diagnosis and treatment as is reasonably available under the circumstances of his confinement and medical condition

34. Adequacy of Medical Care • Gates v. Collier, 501 F.2d 1291 (5th Cir. 1974) • Medical treatment at Mississippi State Penitentiary • 1800 inmates • One full-time physician and several inmate assistants • Substandard hospital • Court ruled services and conditions inadequate

35. Adequacy of Medical Care • Gates v. Collier, 501 F.2d 1291 (5th Cir. 1974) • State ordered to employ three full-time physicians, including one psychiatrist; two full-time dentists; two full-time physicians assistants; six full-time RNs or LPNs; one medical records librarian; two medical clerical personnel; consultant services of a radiologist and pharmacist. • Upgrade hospital and equipment • Comply with American Correctional Association standards regarding medical care for inmates

36. Adequacy of Medical Care • Gates v. Collier, 501 F.2d 1291 (5th Cir. 1974) • Not punish inmates for seeking medical care unless superintendent finds the inmate was malingering • Not use inmates to fill above positions, but may use inmates to supplement this staff

37. Adequacy of Medical Care • Lack of funds is not a defense • When institution reaches the level that care is “adequate” courts again back off to the old “hands off” position

38. Adequacy of Medical Care • Individual treatment • Generally, court will find a constitutional violation only if the medical condition was serious and not attended to • The “deliberate indifference” standard

39. Estelle v. Gamble, 429 U.S. 97 (1976)

40. Deliberate Indifference • Elements • Objective element- must be “sufficiently serious” • Subjective element - Official must act with “sufficiently culpable state of mind”

41. Deliberate Indifference • More than negligence, but less than intentional conduct • Knows of and disregards a substantial risk of serious harm

42. Deliberate Indifference • What is “sufficiently serious”? (need not be life-threatening) • Mandates treatment • Even lay person would recognize condition needs doctors attention • Causes pain • Condition significantly affects persons daily activities • Possibility of life-long handicap or serious loss if untreated.

43. Pre-Trial Detainees • Supreme Court has not ruled on what standard applies • Lower courts have held same standards of medical care of Estelle v. Gamble that apply to prison inmates apply to pretrial detainees

44. Initial Screening • Several cases have held adequate medical system requires medical screening of all inmates within reasonable time after entering the prison • Determine whether inmate has a condition that requires treatment • Whether inmate has any contagious disease

45. HIV Inmates • Acquired Immune Deficiency Syndrome • Disease where immune system fails • Viral agent is human immunodeficiency virus (HIV) • If virus is in person’s blood they are HIV positive • If virus develops into AIDS, it is fatal

46. HIV Inmates-Litigation • Testing/Screening • Tests became available in 1985, but not fully reliable • Delay between infection and when test will show positive • Suits to require testing for AIDS • Courts usually defer to judgment of prison • Suits to prohibit mandatory testing-grounds that it violates right to privacy • Courts usually defer to prison • Held that prison has reasonable basis for testing inmates

47. HIV Inmates-Litigation • Segregation • Uninfected inmates have sued to force segregation of HIV positive inmates. Courts have refused to require prisons to segregate • Infected inmates have sued to prevent being segregated. Courts have refused to prevent segregation when prison deems it necessary.

48. HIV Inmates-Litigation • Reasons given for upholding segregation are prevention of spread of disease; protection of infected inmates from hostile uninfected inmates and diagnostic and treatment ease.

49. HIV Inmates-Litigation • Confidentiality • Some courts have found that unnecessary disclosure of HIV status violates right to privacy • Crucial factor is whether disclosure is necessary • disclosure to doctor will always be necessary • disclosure to another inmate usually not necessary

50. HIV Inmates-Litigation • Treatment • AIDS inmates entitled to treatment just like any other disease • Failure to treat will be 8th Amendment violation • Inmate only entitled to minimally adequate treatment • Negligence is not enough for a valid claim-must be deliberate indifference • Education on spread of AIDS is essential element of AIDS treatment programs