This is a classic jail health case. Plaintiff, who is suffering advanced AIDS and is on a multi-drug protease cocktail, was arrested on a bench warrant. He told the arresting officers and the jailers that he must have his medications on schedule, and that his family could bring the medication to the jail. Despite this information, he was denied his medicine for at least two days. Due to this delay, plaintiff alleges that he became resistant to the drugs and that his viral load has climbed dramatically. He brought this claim under 42 USC 1983 against the county, the jail health physician, the jail health services manager, and other prison personnel. The district court dismissed, finding that delay in treatment did not meet the constitutional standard for liability, and that the jail personnel were entitled to qualified immunity.
The Ninth Circuit accepted the case for review and reversed. The court first reviewed the "deliberate indifference" standard for liability for prison health related claims, as articulated in Estelle v. Gamble, 429 U.S. 97 (1976):
"In general, 'officials are deliberately indifferent to a prisoner's serious medical needs when they deny, delay, or intentionally interfere with medical treatment.' . . . As this Circuit has held, '[a] determination of deliberate indifference involves an examination of two elements: the seriousness of the prisoner's medical need and the nature of the defendant's response to that need .' . . . (footnote text) In general, serious medical need exists where the failure to treat a condition could result in further significant injury or the unnecessary and wanton infliction of pain. '[T]he more serious the medical needs ..., and the more unwarranted the defendant's actions in light of those needs, the more likely it is that a plaintiff has established 'deliberate indifference' on the part of the defendant.'" (citations omitted)
The testimony in this case established the jail health personnel knew the importance of assuring strict compliance with AIDS medication, knew that the jail pharmacy did not have the necessary medications, and still did not exercise their authority to turn him away from the jail. Once admitted, the jail health physician saw no reason he needed to be treated urgently, and, despite notes in the medical chart that the prisoner's medications needed to be started, it was two days before an effort was made to contact his family to obtain the medications. The court found that this raised a legitimate issue of fact as regards whether the jail was deliberately indifferent to the prisoner's medical needs and reversed the summary judgment. The appeals court reversed the district court's finding that the jail personnel were entitled to qualified immunity, holding that such immunity is predicated on reasonable behavior and that showing deliberate indifference to the prisoner's medical needs was not reasonable. The court also rejected the defendant's claim that the county could not be held liable without some evidence of an official custom or policy that caused the prisoner's injuries. The court found that a previously settled class action, in which the county admitted that prison health services were substandard, was evidence of the necessary custom or policy.
This is an important case. Frustratingly, it is unpublished and thus of limited direct presidential value, but its analysis should be valuable in other cases involving improper management of HIV medications. I cannot post it because it is only available on sources that do not allow educational use on WWW sites.
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