Proving Deliberate Indifference in Denial of Medical Care Cases

While it's black-letter law that a prisoner has a constitutional right to medical attention, it's the law of reality that prisoners denied medical care will rarely win their lawsuits.  This is because a prisoner must prove that prison guards were deliberately indifferent to his serious medical needs.  In the prison context, this means that the guards must have been subjectively aware of a serious risk to the prisoner's health.

Excuse the rant, but in criminal cases, mens rea is always easily proven.  Rarely are cases dismissed pre-trial (or reversed on appeal), for an inability to establish the criminal defendant's mental state.  In prisoner's rights cases, however, federal judges go all Wittgenstein: How can we know what any person was subjectively aware of?  Case dismissed, due to the beetle in the box problem.

The double standards are a bit much - even to someone like me, who isn't especially sympathetic to the plight of prisoners.  I do care about the rule of law; and intellectual and judicial integrity requires judges to apply legal standards equally.  Prison guards should not be treated more favorably than criminal defendants.

Indeed, given the Bill of Rights, one would say that prison guards in a civil case - where there exists no presumption of innocence - should be treated worse than criminal defendants.  Yet our current legal system flips the script: Civil defendants in Section 1983 cases have more rights and are treated more favorably than criminal defendants.  What's up with that?

Anyhow, in Marlita v. Cook County, No. 08-2232 (7th Cir. Dec. 1, 2009) (here), a pre-trial detainee's estate (this means he died in jail, even though he had never been convicted, and thus was presumed innocent) was able to establish deliberate indifference where:

A brief overview of the record reveals testimony describing in detail Smith’s condition on the days leading up to his death. A number of witnesses reported that Smith was vomiting, coughing and exhibiting other signs of serious illness including nausea and lethargy. A fellow inmate reported that on April 29, 2004, the day when all three officer defendants were working, Smith was “coughing a lot, running back and forth to the bathroom, throwing up, just laying on the floor, not moving, not eating . . . .” . Another inmate reported that Smith was lying on the floor in front of the cell—which would have placed him in the direct path of the officials when performing their rounds. Inmates testified that they complained or heard others complain to officers aboutSmith’s condition during all three shifts: 7a.m.-3p.m., 3p.m-11p.m., and 11p.m.-7a.m., that were covered by Officers Facundo, Toomey, and Sanchez respectively. Finally, Officer Toomey testified that he saw Smith that day, and, at one point, saw him lying in front ofhis cell.
Slip op. at 10.  Thus, deliberate indifference was established.  Id. at 11. ("The evidence suggests that the officers wereaware of the risk to Smith’s health, either from the inmates’complaints, or from his visible symptoms ... and their failure to act could have led a jury tofind that they ignored this risk.")