Pre-Trial Detainees, Denial of Medical Care, and Deliberate Indifference

As one often finds when studying or litigating civil rights cases, the law takes many odd turns.

For example, a convicted prisoner who is denied medical treatment must file suit under the Eighth Amendment, which prohibits "cruel and unusual punishment."  A pre-trial detainee (usually someone who cannot afford to post bail) must file suit under the Fourteenth Amendment.  The rationale is that a pre-trial detainee, unlike a prisoner, is not being "punished."  It's an unpersuasive distinction.

A pre-trial detainee who has been held in jail 8 months pending trial is identically situated to someone who has been sentenced to jail.  It's not as if pre-trial detainees are put into the first-class section of the jail.  Jail is equally miserable for everyone.  Nevertheless, the cases distinguish between pre-trial detainees and prisoners - at least when the source of law for a Section 1983 action is involved.

A prisoner who gets sick and dies in prison, however, must show more than mere negligence on the part of prison officials in order to state an Eighth Amendment/Section 1983 claim.  Instead, the prisoner must prove deliberate indifference.  Deliberate indifference is a subjective standard.  It requires knowledge and disregard.  Farmer v. Brennan, 511 U.S. 825 (1994) (defining deliberate indifference as knowledge that an inmate faced a substantial risk of serious harm, and disregard for that risk).

Since pre-trial detainee's claims are treated differently than a convicted prisoner's, there was some controversy over whether Farmer v. Brennan's subjective standard applied.  Today, in Caiozzo v. Koreman, No. No. 05-4002 (2d Cir. Sep. 22, 2009) (here), a unanimous three-judge panel held that a pre-trial detainee must establish subjective knowledge of a substantial risk of harm.

In Koreman, a pre-trial detainee who had been arrested for first-degree harassment died after going into alcoholic shock.  His estate sued, alleging that jail officials were deliberately indifferent to his serious medical needs.  According to the allegations, the jail's intake nurse did a poor job of diagnosing the decedent before processing him into jail.  Had the estate been suing for medical malpractice, the case would have been a slam dunk.

The Second Circuit panel held, however, that showing gross incompetence - even amounting to a objective recklessness - is not enough:

There are two elements to a claim of deliberate indifference to a serious medical condition: "[The plaintiff] must show that she [or he] had a 'serious medical condition' and that it was met with 'deliberate indifference.'" Cuoco, 222 F.3dat 106. Here, there is no dispute that Caiozzo had a serious medical condition. The question is therefore whether a reasonable juror could show that Cummins was deliberately indifferent to that condition, which, under the Farmer test, means that she "kn[ew] of and disregard[ed] an excessive risk to [Caiozzo's] health or safety" and that she was "both . . . aware of facts from which the inference could be drawn that a substantial risk of serious harm exist[ed], and . . . also dr[e]w the inference." Farmer, 511 U.S. at 837.
Most of the evidence offered by the plaintiff was in support of the argument that Cummins should have been aware that Caiozzo was in immediate danger of alcohol withdrawal. A reasonable juror might have concluded that this was the case.  There is virtually no evidence, however, to support a conclusion by a reasonable juror that Cummins was actually aware of that immediate danger. The evidence is clear that she thought, wrongly it turned out, that Caiozzo was intoxicated and therefore not in danger of an imminent severe alcohol withdrawal reaction.  No reasonable juror could conclude that the Farmer test has been met.
Slip op at *18.  Prisoners rights cases have just gotten much harder to win.  Some will no doubt applaud the result.  It's become a cute past time of even many lawyers to decry prisoners' rights.  "Another lawsuit or denial of cable television," the ignorant who don't even know what volume Section 1983 contained in, guffaw.

Others might wonder whether a person presumed innocent shouldn't be entitled to greater medical attention than Caiozzo's standard will encourage.  Caizzo's standard is almost identical to that used in homicide cases.  See M.P.C. § 210.1(1): "A person is guilty of criminal homicide if he ... recklessly or negligently causes the death of another human being."  Id. at 2.02(c) ("A person acts recklessly with respect to a material element of an offense when he consciously disregards a substantial and unjustifiable risk that the material element exists or will result from his conduct.")

Can it really be that courts are requiring civil rights litigants to prove that they were murdered by prison officials?  Caizzo seems to suggest so.