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Liability for Prison and Post-release Health Care - Lugo v. Senkowski, 114 F.Supp.2d 111 (N.D.N.Y. Sep 25, 2000)

This case deals with two interrelated issues: what is the standard of care for prison physicians; and does the prison owe any duty of continuing care to inmates who have been released or paroled?  The second issue is becoming critically important as the prison population ages due to 'three strikes" laws that prevent parole and needs ever more medical care, plus the mandatory sentencing provisions for drug use that have imprisoned many persons with HIV who will need medical care as they become symptomatic.  Many prisons have found the cheapest way to deal these problems is to parole or discharge the prisoner on a "compassionate" release.  Since most prisoners have no money, insurance, or community resources, the effect is often to deny them care or at least delay it.  This is an important case with a substantial review of precedent.

Plaintiff in this case filed a 42 U.S.C. 1983 claim, alleging violations of his Eighth and Fourteenth Amendment rights. Plaintiff alleges that Defendants were deliberately indifferent to his serious medical needs. Specifically, Plaintiff alleges that he was denied timely and adequate treatment for a kidney stone while incarcerated at Clinton and Coxsackie Correctional Facilities; that he was wrongfully paroled while he was awaiting surgery; and that he was denied contact with his doctor while out on parole by defendant Edwards, his parole officer.  This opinion arose from the defendants motion to dismiss, which argues that Plaintiff has failed to state a claim upon which relief may be granted.

In order to establish an Eighth Amendment claim arising out of inadequate medical care, as made applicable to states by the Fourteenth Amendment, a prisoner must prove "deliberate indifference to serious medical needs." Estelle v. Gamble, 429 U.S. 97, 104 (1976). This standard includes both subjective and objective components. "First, the alleged deprivation must be, in objective terms, 'sufficiently serious." ' Hathaway v. Coughlin, 37 F.3d 63, 66 (2d Cir.1994). Second, subjectively, the defendant "must act with a sufficiently culpable state of mind." An official acts with deliberate indifference when he "knows of and disregards an excessive risk to inmate health or safety; the official must both 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." In this case, the court found that plaintiff must also establish that a parolee is entitled to 8th amendment protection for the claims that are based on post-release conduct. 

As discussed in DeShaney v. Winnebago Cty. Dep't of Soc. Servs., 489 U.S. 189 (1989), the key issue is the extent that the state has limited the individual's right or ability to  care for himself.  Thus the state has broad obligations to provide services to prisoner because they cannot provide for themselves: "[W]hen the State takes a person into its custody and holds him there against his will, the Constitution imposes upon it a corresponding duty to assume some responsibility for his safety and general well-being."  The court looked to a previous case on providing parolees with medication: "In Wakefield v. Thompson, 177 F.3d 1160 (9th Cir.1999), the Ninth Circuit addressed this issue in holding that a parolee requiring medication beyond his release was owed an affirmative duty by the state. The court held that 'a prisoner's ability to secure medication 'on his own behalf' is not restored the instant he walks through the prison gates and into the civilian world.' The court reasoned that, because it could take parolees a number of days or even weeks to obtain new medication, 'the period of time during which prisoners are unable to secure medication 'on their own behalf' may extend beyond the period of actual incarceration.'"

Here, plaintiff had surgery to remove his kidney stones shortly before his release on parole from Clinton Correctional Facility and was told by his treating physician that follow up surgery within several weeks was needed to remove a metal stent from his kidney.  He was released on parole several weeks later with the stent still inside his body. The court saw this as being released in the middle of a surgical procedure:  "In other words, Plaintiff was released in the midst of an ongoing surgical process, at approximately the time that the second leg of the procedure was to be completed." Five days after his parole, Plaintiff was admitted to the hospital with severe pain. Defendants allegedly provided Plaintiff no assistance in obtaining the medical treatment he needed. Moreover, Plaintiff alleges that defendant Edwards prevented him from returning to Albany to have the follow up surgery performed by his treating physician. The court found that:

"The facts as alleged by Plaintiff here support a claim that he was unable to obtain the necessary treatment "on his own behalf" and that the state had a continuing duty to protect him for a reasonable amount of time. This is particularly true here because the medical procedure needed by Plaintiff involved the completion of a course of treatment started while the plaintiff was incarcerated. Under the circumstances alleged in this case, where Defendants were aware that Plaintiff needed additional medical attention almost immediately upon his departure, this duty could have entailed allowing Defendant to return to Albany for treatment or forwarding his medical records to a facility in New York to facilitate the performance of the operation there. Taking the facts as alleged by Plaintiff as true, he was owed a limited duty of protection beyond his period of incarceration which was not satisfied by the state."

The court found that defendants' disregarding of plaintiff's treating physician's recommendations, without any independent medical evaluation or rationale satisfied the second prong of the test -  deliberate indifference to the prisoner's medical needs.  The court also found that removal of the stent was a serious medical need, another necessary element.  Defendants argued that were entitled to qualified immunity, which "shields public officials from liability for their discretionary acts that do not violate clearly established statutory or constitutional rights of which a reasonable person would have known. . . if it was objectively reasonable for the public official to believe that his acts did not violate those rights." The court found that plaintiff's facts, if proved at trial, established that defendants' conduct was not objectively reasonable and would not be entitled  to qualified immunity.

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