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Deliberate Indifference to Medical Needs in Jail
Prisoners’ Rights Attorney in Minnesota Assists Inmates with Civil Rights Claims
Prisoners, inmates, and detainees in jail and prison have a right to adequate medical care when they are awaiting trial in the pretrial stage as well as when they are serving a jail or prison sentence. The Eighth Amendment of the U.S. Constitution gives prisoners a right to adequate medical care, and many states also have specific laws in their constitutions that give prisoners a right to adequate medical care under state law. When a prisoner, inmate, or detainee has not been provided with adequate medical care and suffers an injury, that prisoner (or his or her family if the prisoner died as a result of the lack of medical care) may be able to file a claim for a constitutional violation. Generally speaking, in order to file a constitutional claim for inadequate medical care, the plaintiff must prove that the jail or prison showed “deliberate indifference toward the serious medical needs” of the prisoner.
What is the standard for deliberate medical indifference in jail?
It is important to understand that the standard of “deliberate indifference” is different from what a plaintiff needs to prove in a tort case based on a theory of negligence. To be clear, when a prisoner suffers harm due to inadequate medical care in a jail or prison, it may be possible to file a constitutional claim as well as a tort claim. The constitutional claim requires the plaintiff to prove deliberate indifference, while a tort claim typically only requires that the plaintiff prove negligence. The two standards are quite different, and we will explain in more detail how a “deliberate indifference” claim works.
Ultimately, if you have questions about filing a lawsuit for a prisoner injury resulting from the deliberate indifference to medical needs, you should speak with a Minnesota prisoners’ rights attorney for help.
Eighth Amendment Violations for Inadequate Medical Care Under the U.S. Constitution
To understand the standard of deliberate indifference to a prisoner’s medical needs, you need to know how the right to adequate medical care exists under the Eighth Amendment of the U.S. Constitution. A landmark U.S. Supreme Court case, Estelle v. Gamble (1976), clarified that jails and prisons must provide adequate medical care to prisoners under the Eighth Amendment.
In that case, a prisoner was working in a textile mill on work assignment. A 600-pound bale of cotton fell on him, but he continued to perform the work assignment tasks for several hours. Later on, he asked to go to the hospital. He went to the hospital, was given a checkup for a hernia, and was then sent to his cell. After returning to his cell, the prisoner began to experience severe pain, and he returned to the hospital. A nurse provided him with pain medication, then a hospital doctor examined him and did not provide additional treatment. The prisoner continued to experience pain that prevented him from working, and the prison placed him in solitary confinement for refusing to work. In total, he was seen 17 times by medical personnel, yet he never received a back X-ray or treatment for his back injury.
In ruling on the case, the Supreme Court clarified that a failure to provide adequate medical care to prisoners can, in some circumstances, constitute cruel and unusual punishment, which is prohibited by the Eighth Amendment. However, the Court held that the particular prisoner’s case did not rise to the level of an Eighth Amendment violation because the negligent or inadvertent failure to provide adequate medical care does not constitute cruel and unusual punishment. In order for an Eighth Amendment violation to occur, jail or prison personnel must show “deliberate indifference to serious medical needs.”
What is Deliberate Indifference to an Inmate’s Medical Needs?
After Estelle made clear that inadequate medical care only violates the Eighth Amendment when there is a “deliberate indifference to serious medical needs,” the U.S. Supreme Court explained what constitutes such deliberate indifference in a later case. In Farmer v. Brennan (1994), the Court ruled that prison officials can be liable for “deliberate indifference” as an Eighth Amendment violation if there is a substantial risk of serious harm to the prisoner, the prison official has subjective knowledge about the substantial risk of harm, and the prison official disregards it.
In Farmer, a transgender prisoner underwent estrogen therapy and sex reassignment surgery. The prisoner was kept separate from the general male population due in part to safety concerns for the prisoner. However, the prisoner was later transferred to a different prison and was placed in the general male population. In that prison, the prisoner was beaten and raped by a cellmate. The prisoner filed a claim alleging that the prison officials violated the prisoner’s Eighth Amendment rights by deliberately and indifferently failing to protect that prisoner. The key in such a case, according to the Court, is whether prison officials know about or have knowledge of risk to a prisoner and deliberately and indifferently disregard that risk.
Defining a “Serious Medical Need” in a Deliberate Indifference Case
If a plaintiff makes a deliberate indifference claim after suffering injuries due to inadequate medical care, that plaintiff needs to prove deliberate indifference to a serious medical need in order to have a valid Eighth Amendment claim. What constitutes a “serious medical need”? Various courts have considered this question. Some factors that courts consider in determining whether the prisoner had a serious medical need include the following:
- “Whether a reasonable doctor or patient would perceive the medical need in question as important and worthy of comment or treatment”;
- “Whether the medical condition significantly affects daily activities”; and
- “The existence of chronic and substantial pain.
In an Eleventh Circuit Court of Appeals case, the court looked to see whether a condition “has been diagnosed by a physician as mandating treatment or . . . is so obvious that even a lay person would easily recognize the necessity of a doctor’s attention.” The Ninth Circuit Court of Appeals has defined a serious medical need as a situation in which the “failure to treat a prisoner’s condition could result in further significant injury or the unnecessary and wanton infliction of pain.”
A number of courts have made clear that a prisoner can experience a serious medical need even if the condition is not a life-threatening one. Moreover, a prisoner can also have a serious medical condition under the Eighth Amendment even if the failure to treat the condition does not result in it getting worse, but the condition causes severe pain. Some courts have even determined that the later stages of a prisoner’s pregnancy can constitute a serious medical need.
Ultimately, the specific definition of a “serious medical need” used by a court may depend upon the location of the court and any authoritative law from the federal appeals courts. If you have questions about whether you may have a valid claim under the Eighth Amendment for cruel and unusual punishment due to deliberate indifference to a serious medical need, you should discuss the specific facts of your case with a prisoners’ rights attorney who has experiencing bringing similar constitutional law claims.
Key Information about a Deliberate Indifference Case
In sum, in order to bring a claim for a jail or prison’s deliberate indifference to a serious medical need, a plaintiff will need to be able to show the following:
- Prisoner had a serious medical need;
- Jail or prison personnel showed deliberate indifference to that serious medical need by recognizing the risk associated with the medical need and failing to seek or allow adequate medical care or treatment for the prisoner.
Accordingly, if you are wondering whether you have a claim, you should consider some of the following questions:
- Did the condition meet any of the likely definitions of a serious medical condition?
- What makes the medical condition serious?
- Did the jail or prison personnel understand that the medical condition was serious?
- If the jail or prison personnel understood that the prisoner faced a serious risk of harm as a result of the medical condition, did the jail or prison personnel disregard that risk?
It is important to remember that, even if you cannot bring a claim for an Eighth Amendment violation, it may still be possible to file a negligence claim under state law. A prisoner who suffers harm due to inadequate medical care may still be able to file a personal injury lawsuit under a theory of negligence if the jail or prison did not provide adequate medical care. With a negligence claim, the prisoner (or the prisoner’s family, if the prisoner died as a result of inadequate medical care) will not need to prove that the jail or prison personnel knew about the risk and intentionally disregarded it. Rather, the prisoner will need to show that the jail or prison was negligent in the medical care it provided or omitted. In many cases, understaffing at a jail or prison can lead to a successful negligence lawsuit.
Contact a Civil Rights Attorney Representing Injured Prisoners
THE MADIA LAW WAY
We have a process that works in getting exceptional results for our clients.
We are trial lawyers who prepare every case for trial from Day 1. Investigation and legal research are the first things we do, and we spend a lot of time on them. Because we haven’t filed the case yet, we have complete control – the defendant has no say and we want to use this time wisely. We interview witnesses that can help us prove the case. We’ll ask you for all relevant documents in your possession and review those carefully as well. We also will spend some time conducting legal research about unique issues in the case. We pull the jury instructions that the judge will ultimately charge the jury with after closing arguments at trial.
Our next step is typically to send a demand letter to the defendant. In the letter, we thoroughly lay out: the facts surrounding the defendant’s misconduct; the applicable law (including statutory and case citations) that make clear that the defendant broke the law; an analysis of your damages and the defendant’s monetary exposure; a demand for a monetary amount to settle the claim; and an instruction to preserve all relevant evidence, including electronic evidence. The point of this letter is to give the defendant a chance to do the right thing and pay a fair amount before litigation, and to give the defendant an opportunity to present any defenses or evidence it wants us to consider before moving forward. Sometimes we skip the demand letter if there are strategic reasons to move straight to filing, but we typically give defendants a chance to do the right thing.
If early negotiations fail, great – we file a Complaint and serve the defendant with it. A Complaint is a legal document that states the facts of what happened and alleges how the defendant broke the law. It formally starts the lawsuit. Many lawyers draft complaints in a general and relatively vague way, just to get it done and filed – because that’s all that’s really required. We take a different view. We view the Complaint as our first chance to tell your story to the judge, and we take it seriously. So we draft detailed complaints and include legal citations to statutory and judicial authority on unique points. Sometimes we’ll include a number of exhibits, diagrams, or other demonstrative aids to help the Court understand our claims. A secondary benefit of this approach is that defense lawyers reading the Complaint can become educated on the problems of their case and the state of the law – sometimes this leads them to reach out to us shortly after service of the Complaint to re-initiate settlement negotiations. Of course, by that time, the price for settlement has gone up.
Some lawyers view written discovery as a necessary evil – something to get done and out of the way before depositions. Not us. Written discovery is a gift and an opportunity. We spend a great deal of time crafting requests for documents and interrogatories (questions for the defendant to answer in writing) that are specific, detailed, and tailored to get what we need to prove our case. Many lawyers – even great ones – think written discovery is a waste of time because defense lawyers typically answer them on behalf of their clients and can try to stonewall with legalese and objections. We view this as a wonderful opportunity. In our experience, most defense lawyers can’t help themselves when answering discovery: they over-state their defenses and make assertions that their clients will not be able to support in testimony. So we get to commit the defendant to defenses that they can’t back up, leading to contradictions, confusion, and chaos in their depositions later on. We also use Requests for Admission – which many lawyers don’t. The Federal Rules and Minnesota Rules of Civil Procedure allow us to ask defendants to “admit” certain facts. We send them RFAs that are very difficult for them to deny. Of course, they do it anyway, but that sets them up later for cost and fee-shifting, which the Rules mandate for defendants that deny RFAs that are later proven true. And usually, we can get the defendants’ own witnesses to admit facts that their defense lawyers denied in RFA. That’s a great situation that leads to more chaos and confusion on the defense side.
One last point on written discovery – we send multiple waves of it throughout discovery. We typically send 3 or 4 sets of written discovery requests to defendants throughout discovery. This compounds the problems for them, because the defense lawyers continue to overstate their defenses, but now run into contradictions from not just the defendant witnesses’ deposition testimony, but also their own previous discovery responses. This makes for a great record that we can present to the judge at dispositive motions, and use for impeachment at trial.
This is our chance to question relevant witnesses, on the record with a court reporter (we typically videotape important depositions as well). We get to confront the defense witnesses with all of the evidence we’ve developed through written discovery and document production. By this time, the defendant put its witnesses in an impossible position through its written defenses, which are often untrue and indefensible. So the witness has to either lie to support the defense, or admit it’s not true. That’s a dilemma that works for our clients either way, no matter which option the witness takes. We use depositions to expose contradictions, create a record for dispositive motions, lock witnesses into their stories so that we can impeach them later at trial, and sometimes, to show defense lawyers how hopeless their case is. We often calls from defense counsel shortly after depositions of their clients, seeking to re-start settlement negotiations.
The defendant will usually make a motion for summary judgment after discovery, asking the Court to throw out the case without having a jury trial. Because we’ve hit discovery so hard – both through written discovery and depositions – this is a tough motion for defense counsel to write in our cases. We draft our response for the Court and now get to bring everything together: the admissions, contradictions, nonsense, and obvious fact disputes that we’ve uncovered through discovery. We tell a compelling story that wraps everything together for the Court and makes clear that the defense motion has to be denied, and the defendant needs to face a jury for its conduct.
Sometimes, we’ll even make an affirmative motion for summary judgment, asking the Court to grant judgment in favor of our client without a trial. These motions are generally rare for plaintiffs to make, because the defendant can usually point to some fact dispute on its intent or some other factor that necessitates a trial. But we make affirmative summary judgment motions significantly more than is typical for plaintiffs, and that’s because the work we put in during discovery helps build a fantastic record to do so.
After the Court denies the defense motion for summary judgment, the defendant has only 2 options: 1) do the right thing and pay you a fair amount to our client to settle your claim (usually much, much more at this point than the defendant could have paid at the beginning of the case to settle); or 2) face a jury for its conduct and risk an enormous verdict. This is the dilemma that we have been creating and forcing the defendant into for the entire case. We’ll engage in settlement negotiations at this point from a position of extreme strength, mainly because most defendants are (rightly) terrified of facing a jury to defend their conduct.
This is, candidly, our favorite part of the case – why we went to law school: to hold the powerful accountable before juries. We prepare heavily for trial, including: detailed witness preparation, focus groups, and mock trials. At this point, the potential outcomes and consequences for the defendant are much more severe than if it simply did the right thing at the beginning of the case and paid a fair amount to compensate our client for its misconduct. As we advocate to the jury for our client, we’re also mindful of protecting the record so that defendants will be unsuccessful in attacking the verdict in post-trial motions or appeal.
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