In this article I will give a basic introduction of a prisoner’s right to medical care. However, this information would be of very little help without information as to the enforcement of such right. Therefore, some basic information about civil rights litigation will be covered in this article as well. Still, before a prisoner submits any civil action to enforce the denial of medical care, he or she should properly research the claim and exhaust the grievance procedure.
CONSTITUTIONAL RIGHTS IN PRISON
First, as a matter of general principle, the Supreme Court has held that “convicted prisoners do not forfeit all constitutional protections by reason of their conviction and confinement in prison.” Bell v Wolfish, 441 U.S.520, 545, 99 S.Ct. 1861,1877, 60 L. Ed.2d 447(1979). Prison walls do not separate inmates from their constitutional rights. Turner v Safley, 482 U.S.78,84,107 S.Ct.2254, 2259, 96 L.Ed.2d 64(1987). Hence, when prison regulations or practices offend fundamental constitutional guarantees, “federal courts will discharge their duty to protect constitutional rights.” Procunier v Martinez, 416 U.S.369, 405-06, 94 S.Ct.1800, 1807-08,40L.Ed.2d 224(1974), modified, Thornburgh v Abbott, 490 U.S.401,109, S.Ct.1874,104 L.Ed.2d 459(1989) see also, Sheley v Dugger, 833 F.2d 1420, 1423(11th Cir.1987)(traditional deference to prison authorities does not mean “that courts must abstain from reviewing the constitutional claims of prisoners”).
DUTY TO PROVIDE MEDICAL CARE
The Supreme Court has recognized that correctional inmates”must rely on prison authorities to treat [their] medical needs if the authorities fail to do so, those needs will not be met.” Estelle v. Gamble, 429 U.S.97, 103, 97 S.Ct.285, 290, 50 L.Ed.2d 251(1976). Federal and state governments therefore have a constitutional obligation to provide the minimal adequate medical care to those whom they are punishing by incarceration. See Id. at 104, 97 S.Ct.at 291 see also Wellman v Faulkner, 715 F.2d 269,271(7th Cir.1983)(“When a state imposes imprisonment as a punishment for crime, it accepts the obligation to provide persons in its custody with a medical care system that meets minimal standards of adequacy”). Prison personnel may not subject inmates to “acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs.” Estelle, 429 U.S.at 106, 97 S.Ct.at 292(1976) Mandel v. Doe, 888 F.2d 783, 787(11thCir.1989). The Supreme Court has declared that such “deliberate indifference” by correctional system to the serious medical needs of its prisoners constitutes the kind of “unnecessary and wanton infliction of pain” that is proscribed by the Eight Amendment. Estelle, 429 U.S.at 104, 97 S.Ct.at 291(quoting Gregg v Georgia, 428 U.S.151, 173, 96 S.Ct.2909, 2925, 49 L.Ed.2d 859(1976)). The Supreme Court has clarified the meaning of the “deliberate indifference” standard which states the culpable state of mind required of prisons in Eighth Amendment claims involving inadequate or improper medical care, also applies generally to prisoners Eighth Amendment challenges to their conditions of confinement. Wilson v Seiter, 501 U.S.294, 111S.Ct.2321, 2324, 115 L.Ed.2d 271(1991). The Eighth Amendment applies to the states through the due process clause of the Fourteenth Amendment. Robinson v California, 370 U.S. 660, 666, 82 S.Ct.1417,1420, 8 L.Ed. 2d. 758(1962).
SERIOUS MEDICAL NEED
The Federal Court of Appeal for the Eleventh Circuit has construed a serious medical need “one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctors attention.” Hill v DeKalb, Reg’l Youth Det. Ctr.,40 F.3d 1176, 1187(11thCir.1994)(quotation marks and internal citation omitted). Eleventh Circuit precedent recognizes a range of medical needs that are sufficiently serious to constitute “serious medical needs” for purposes of the Eighth Amendment and some medical needs that are not. Compare Adams v Poag, 61 F.3d 1537(11thCir. 1995)(Asthma with continual breathing problems and with intermittent wheezing, coughing, and hyperventilating, can constitute a serious medical need) Brown v Hughes, 894 F.2d 1533, 1538(11th Cir.1990)(Painful broken foot can be a serious medical need) Mandel v Doe, 888 F.2d 783, 788(11th Cir. 1989)( Evidence showing that Plaintiff’s leg collapsed under him, was deteriorating, caused pain when moved, and that he was virtually unable to walk, supported jury’s conclusion that Plaintiff had a serious medical need) Aldridge v Montgomery, 753 F.2d 970, 972-73(11th.Cir.1985)(One-and-a-half-inch cut over detainee’s eye bleeding for two and half hours was a serious medical need), with Shabazz v Barnauskas, 790 F.2d 1536, 1538(11th Cir.1986)(Inmate’s “pseudofolliculitis barbae” or “shaving bumps,” even if shaving required by prison officials when physician ordered otherwise, “does not rise to the level of the cruel and unusual punishment forbidden by the Eighth Amendment”) Dickson v Colman, 569 F.2d 1310,1311(5thCir 1978)(Inmate’s high blood pressure presented no “true danger” or “serious threat” to his health he also had full range of motion in his shoulder despite continuing pain from a three-year old injury). In certain circumstances, the need for dental care combined with the effects of not receiving it may give rise to a sufficiently serious medical need to show objectively a substantial risk of serious harm. Hunt v Dental Dept., 865 F.2d 198, 200(9th Cir. 1989) and Ramos v Lamm, 639 F.2d 559, 576(10thCir.1980).
In Harris v Prison Health Services, et al, 2017 U.S.App. LEXIS 16063 (11th Cir.2017) the court held that: To establish deliberate indifference, [Plaintiff] must prove: (1) Subjective knowledge of a risk of serious harm and (2) disregard of that risk (3)by conduct that is more than mere negligence. McElligott v Foley, 182 F.3d 1248, 1155(11thCir.1999). Subjective knowledge of the risk requires that the defendant be “aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Caldwell v Warden, FCI Talladega, 748 F.3d 1090, 1099-1100(11thCir.2014). “[I]mputed or collective knowledge cannot serve as the basis for a claim of deliberate indifference. Each individual defendant must be judged separately and on the basis of what that person Kn[ew].” Burnett v Taylor, 533 F.3d 1325, 1331(11th Cir.2008)(citations omitted). An official disregards a serious risk by more than mere negligence “when he [or she] know that an inmate is in serious need of medical care, but he [or she] fails or refuses to obtain medical treatment for the inmate.” Lancaster v Monroe Cty., Ala., 116 F.3d 1419, 1425(11th Cir.1997), overruled on other grounds by LeFrere v Quezada, 588 F.3d 1317, 1318(11th Cir.2009). Even when medical care is ultimately provided, a prison official may nonetheless act with deliberate indifference by delaying the treatment of serious medical needs. See Harris v Coweta Cty., 21 F.3d 388, 393-94(11th Cir.1994)(citing Brown v Hughes, 894 F.2d 1533, 1537-39(11th Cir.1990)). Further, “medical care which is so cursory as to amount to no treatment at all may amount to deliberate indifference.” Mandel v. Doe, 888 F.2d 789(11thCir.1989)(citations omitted). However, medical treatment violates the Constitution only when it is “so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness.” Rogers v Evans, 792 F.2d 1052, 1058(11th Cir.1986)(citation omitted). The Eleventh Circuit has provided guidance concerning the distinction between “deliberate indifference” and “mere negligence.” For example, the Court has stated that “an official acts with deliberate indifference when he knows that an inmate is in serious need of medical care, but fails or refuses to obtain medical treatment for the inmate.” Lancaster v Monroe County, 116 F.3d 1419, 1425 (11th Cir. 1997). Alternatively, “[e]ven where medical care is ultimately provided, a prison official may nonetheless act with deliberate indifference by delaying the treatment of serious needs, even for a period of hours, though the reason for the delay and the nature of the medical need is relevant in determining what type of delay is constitutionally intolerable.” McElligott, supra. at 1255(11th Cir.1999). For instance, an official who delays necessary treatment for non-medical reasons may exhibit deliberate indifference. Hill, supra, at 1190, n. 26 H.C.by Hewett v Jarrard, 786 F.2d 1080, 1086 (11th Cir.1986)(citing Ancata v Prison Health Servs., Inc., 769 F.2d 700, 704 (11th Cir. 1985)). Further, the Eleventh Circuit has acknowledged that the deliberate indifference standard also applies to inmates’ psychiatric or mental health needs. Greason v Kemp, 891 F.2d 829, 834(11th Cir 1990) Waldrop v Evans, 871 F.2d 1030, 1033(11thCir.1989)(citing Rogers v Evans, 792 F.2d 1052, 1058(11th Cir.1986). It is thus clear that prisoners are guaranteed the right under the Eighth Amendment to be free from deliberate indifference by correctional institutions to their serious physical or psychological needs. In addition, the policy of deferring to the judgment of prison officials in matters of prison discipline and security does not usually apply in the context of medical care to the same degree as other contexts. Wellman v Faulkner, 715 F.2d 269, 272 (7th Cir. 1983).
ARTICULATING THE SCOPE
In articulating the scope of inmates’ right to be free from deliberate indifference, however, the Supreme Court has also emphasized that not “every claim by a prisoner that he has not received adequate medical care treatment states a violation of the Eighth Amendment.” Estelle, 429 U.S.at 105, 97 S.Ct.at 291 Mandel, 888 F.2d at 787. Medical treatment violates the Eighth Amendment only when it is “so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness.” Rogers, 792 F.2d at 1058( citation omitted). Mere incidents of negligence or malpractice do not rise to the level of constitutional violations. Estelle, 429 U.S. at 106, 97 S.Ct.at 292 (“Medical malpractice does not become a constitutional violation merely because the victim is a prisoner”) Mandel, 888 F.2d. at 787-88(Mere negligence or medical malpractice “not sufficient” to constitute deliberate indifference) Waldrop, 871 F.2d at 1033(Mere medical malpractice does not constitute deliberate indifference. Nor does a simple difference in medical opinion between the prison’s medical staff and the inmate as to the latter’s diagnosis or course of treatment support a claim of cruel and unusual punishment). In institutional level challenges to prison health care, systemic deficiencies can provide the basis for finding of deliberate indifference. Rogers, 792 F.2d at 1058. Deliberate indifference to an inmate’s health needs may be shown, for example, by proving that there are “such systemic and gross deficiencies in staffing, facilities, equipment, or procedures that the inmate populations is effectively denied access to adequate medical care.” Ramos v Lamm, 639 F.2d 559,575(10th Cir.1980). Moreover, although incidents of malpractice standing alone will not support a claim of Eighth Amendment violation, “[a] series of incidents closely related in time may disclose a pattern of conduct amounting to deliberate indifference.” Rogers, 792 F.2d at 1058-59. Repeated examples of delayed or denied medical care may indicate a deliberate indifference by prison authorities to the suffering that results.” Id. Rogers, at 1059. See also Ramos v Lamm, 639 F.2d 559, 575 (“In class actions challenging the entire system of health care, deliberate indifference to inmates’ health needs may be shown by proving repeated examples of negligent acts which disclose a pattern of conduct by the prison medical staff.”).
CLEARLY ESTABLISHED CONSTITUTIONAL RIGHT
In determining whether a government official has violated a clearly established constitutional right, a court must consider whether contours of the right were sufficiently clear that reasonable officials, at the time of their actions, would have understood that what they were doing violated that right. Anderson v Creighton, 483 U.S. 635, 641, 107 S. Ct. 3034, 3039-40, 97 L.Ed.2d 523(1987). The nonexistence of a decision specifically addressing the alleged right is a significant consideration in determining whether the right is clearly established. Muhammad v Wainwright, 839 F.2d 1422, 1424(11th Cir.1987)(recognizing that a prisoner’s First Amendment right not to be disciplined when he failed to respond to his committed name is not clearly established based upon general rulings that prisoners retained limited First Amendment rights). In addition, the existence of Supreme Court cases or Eleventh Circuit Court cases that recognize the alleged right is particularly important in determining whether the law is sufficiently clear to a reasonable official. Muhammad, 839 F.2d at 1424-25, n.7( canvassing the cases in the Eleventh Circuit to determine whether an official violated clearly established law, and recognizing that the official’s awareness of a district court opinion recognizing the alleged right cannot, of itself, settle the law where the district court sits outside this circuit). REMEDY To remedy a violation of your rights to medical care prisoners have the Civil Rights Act. However, a prisoner must first exhaust the grievance procedure. To state a claim for relief under 42 U.S.C. Sec, stat. 1983, a prisoner must allege that an act or omission committed by a person acting under color of state law deprived him of a right, privilege, or immunity secured by the Constitution or laws of the United States. Hale v Tallapoosa County, 50 F.3d 1579, 1583(11th Cir.1995). If a litigant cannot satisfy these requirements, or fails to provide factual allegations in support of the claims, then the complaint is subject to dismissal. See Bell Atlantic Corp. v Twombly, 550 U.S. 544, 555 (2007)(noting that “[f]actual allegations must be enough to raise a right to relief above the speculative level,” and complaint “must contained something more… than…a statement of facts that merely creates suspicion [of] a legally cognizable right of action”) Ashcroft v Igbal, 129 S.Ct. 1937, 1951-53(2009)(Twomblyn “expounded the pleading standard for all civil actions,” and conclusory allegations that “amount to nothing more than a formulaic recitation of the elements of a constitutional…claim” are ” not entitled to be entitled to be assumed true,” and, to escape dismissal, complaint must allege facts sufficient to move claims “across the line from conceivable to plausible.”). EXHAUSTION REQUIREMENT-42 U.S.C.1997e(a). Section 1997e(a), of the Prison Litigation Reform Act (“PLRA”), enacted as part of the PLRA, provides that a prisoner must exhaust all available administrative remedies before bringing a federal action challenging prison conditions. Booth v Chuner, 532 U.S. 731, 738, 121 S.Ct.1819, 149 L.Ed.2d 958(2001). The PLRA seeks to eliminate unwarranted interference with the administration of prisons in order to “afford corrections officials time and opportunity to address complaints internally before allowing the initiation of a federal case.” Woodford v Ngo, 548 U.S.81, 93, 126 S.Ct.2378, 165 L.Ed.2d 368(2006)(alternation and quotations marks omitted). “Compliance with prison grievance procedures, therefore, is all that is required by the PLRA to ‘properly exhaust.’” Jones v Bock, 549 U.S.199, 218, 127 S.Ct. 910, 166 L.Ed.2d 798(2007). COMPLYING WITH FDOC GRIEVANCE PROCEDURE. The grievance procedures promulgated by the Florida Department Of Corrections (“FDOC”) require a prison to: 1. File an Informal Grievance (using FDOC Form DC6-236) to the staff member responsible for the particular area of the problem. Rule 33-103.005. FAC 2. File a Formal Grievance(using FDOC Form DC1-303) to the Warden’s Office. Id. at Rule 33-103.006, FAC and 3. Submit an appeal to the Office of the Secretary of the FDOC. Id.at Rule 33-103.007, FAC see also Writ Writing 101, FDOC Grievance Procedure by Melvin Pérez, Vol. 1, Issue 1, FPLJ. However, if a prisoner is filing a medical grievance, the initial Informal Grievance step may be omitted. Id. at Rule 33-103.006. NAMING DEFENDANTS IN GRIEVANCE NOT REQUIRED. A prisoner need not name any particular defendant in a grievance in order to properly exhaust his claims. Jones, 549 U.S. at 219 see also, Brown v Sikes, 212 F.3d 1205, 1207(11th Cir.2000)(“[W]hile s.s.1997e(a) requires that a prisoner provide as much relevant information as he reasonably can in the administrative grievance process, it doesn’t require that he do more than that.”). Section 1997e(a)’s exhaustion requirement is designed “to alert prison official to a problem, not to provide personal notice to a particular official that he may be sued…” Jones 549 U.S. at 219. END NOTE. The information provided in this article is just a basic introduction to a very complex area of law. If you would like to learn more about 1983 litigation you should review other materials that cover this area in more detail. Good luck and keep your head up.