Issues Arising in Institutional Litigation, part 2 of 8: Health

Health

Medical and dental care

Inmates are constitutionally entitled to medical care, including both screening and direct service. Institutions may not interfere with access to medical care or interfere with prescribed treatment for illness. Deliberate indifference to the serious medical needs of adult inmates violates the eighth amendment (see Estelle v. Gamble and Boretti v. Wiscomb). For example, the medical care system violated constitutional standards in Ramos v. Lamm, in which there were fewer than 10 hours per week of onsite physician care for an entire prison, overuse of physicians' substitutes, and use of inmates to deliver medical services. Budgetary constraints may not be used to justify a denial of necessary medical care (see Jones v. Johnson). Similarly, a substantial delay in medical treatment may result in a finding that medical care was constitutionally inadequate (see Durmer v. O'Carroll).

Each facility should have a screening mechanism for inmates. The screening should be done by a doctor or another professional who has had medical training. Many jails and lockups have a nonmedical person performing this task. This situation is not satisfactory and may result in a medical tragedy. Also, someone on staff must have the authority to transfer a seriously ill inmate to another medical facility (see Colle v. Brazos County, Texas). In addition to screening, facilities must provide adequate medical services and access to medical supplies such as eyeglasses (Williams v. I.C.C. Committee), prescription medicines (Gerakeris v. Champagne), wheelchairs (Weeks v. Chaboudy), special diets (Coades v. Jeffes), and dental care (Boyd v. Knox). In the adult system, cases have involved health-related claims that facilities have failed to make reasonable modifications to serve inmates with disabilities pursuant to the Americans With Disabilities Act of 1990 and claims that inmates have been denied the benefits of institutional programs because of a handicap under the Rehabilitation Act of 1973.

Mental health care

Children and adult inmates are constitutionally entitled to adequate mental health care. For the components of a minimally adequate mental health system see Ruiz v. Estelle. Ramos v. Lamm found that mental health services in an adult prison were grossly inadequate where 5 to 10 percent of inmates were mentally ill and 10 to 25 percent needed mental health treatment; a psychiatrist visited the prison only twice in the year before trial, and there was a 2- to 5-week wait for services from mental health staff. Similarly, Coleman v. Wilson found constitutional violations where a prison system failed to provide a systematic program for screening and evaluating inmates' mental health needs; a treatment program that involved more than segregation and close supervision of mentally ill inmates; access to a sufficient number of trained mental health professionals; maintenance of accurate, complete, and confidential mental health records; administration of psychotropic medication with appropriate supervision and periodic evaluation; and a basic program to identify, treat, and supervise inmates at risk for suicide (see Madrid v. Gomez for components of adequate institutional mental health services).

Many detained youth are mentally ill or suffer from severe emotional disturbances. Sometimes confinement adds to their disturbance. Therefore, facilities must screen minors for mental health problems, provide emergency psychological services, establish procedures for dealing with suicidal youngsters, make sure that medications are prescribed and administered by qualified medical personnel, establish provisions for children to request psychological care, and make sure that there is adequate staff for ongoing psychological services.

Juvenile cases addressing mental health needs of detained children include Thomas v. Mears, Gary W. v. State of Louisiana, Morales v. Turman, Martarella v. Kelley, Morgan v. Sproat, and Ahrens v. Thomas. The use of drugs for behavior control is constitutionally prohibited (see Nelson v. Heyne and Pena v. New York State Division for Youth). Jackson v. Fort Stanton State Hospital & Training School includes a discussion of the Youngberg v. Romeo standard in relation to developmentally disabled adults.

Apart from cases involving general mental health care in institutions, there are cases involving suicides and other harm to prisoners based on the indifference of officials to known mental health needs. Many cases involve suicides. Buffington v. Baltimore City deals with the liability of two police officers who knew that a detainee was on the verge of suicide but failed to follow department policy for the care of suicidal inmates; Simmons v. City

of Philadelphia addresses holding the city liable for indifference to the medical needs of an intoxicated adult detainee who committed suicide; Hare v. City of Corinth, Mississippi treats refusing qualified immunity to jail officials for placing a suicidal inmate in an isolated cell that was not visually monitored despite a recent suicide and failing to have onsite staff with a key who could open the door once the inmate was seen hanging; Heflin v. Stewart County, Tennessee holds that the jury should have been permitted to decide whether the jail staff's failure to cut down a hanging inmate until photos had been taken (when evidence suggested that the inmate may have been alive) was deliberate indifference; Hall v. Ryan reverses the dismissal of a case in which evidence suggested that the defendants knew of the inmate's suicidal condition because of past encounters with the police department or were recklessly indifferent in failing to consult his file after observing his wild behavior; and Cabrales v. County of Los Angeles holds that a county could be liable for deliberate indifference when its policy of understaffing institutional mental health services contributed to the suicide of an inmate placed in isolation after a suicide attempt.

Again, the suicide cases demonstrate the need for thorough mental health screening by trained staff, policies governing the supervision and treatment of suicidal and at-risk inmates, and the availability of mental health services, particularly for detained children.