Orange Is the New Black has raised public awareness about the challenge that the correctional system confronts in providing proper medical care while operating under stringent budget constraints. When an inmate becomes ill or suffers injury while incarcerated, or enters prison with a preexisting medical condition, he/she is entitled to receive proper medical care. The law recognizes a variety of causes of action, from civil rights violations to state medical malpractice claims, to protect a prisoner who has received substandard medical care.
An inmate can make a constitutional claim under the Eighth Amendment of the U.S. Constitution, which protects prisoners from “cruel and inhuman punishment.” In order to prevail on a civil rights claim, a prisoner must be able to prove that the defendant was deliberate with his indifference to the inmate’s health or safety [see Estelle v. Gamble, 429 U.S. 97 (1976)]. If the treatment does not involve the defendant’s culpable state of mind and involves negligence, the appropriate avenue for recovery is through a medical malpractice claim. This article will discuss the issues that arise from medical malpractice claims involving state and local correctional facilities in Maine.
Who Is the Defendant?
The first challenge in these cases is identifying the defendant, which may not always be straightforward. A number of different actors can be involved in rendering medical care in prison. Some of these people may be employed by the state or county, or may be nurses, physicians, and mental health workers contracting with the correctional facility. The malpractice may involve a single provider, or it may involve a combination of providers. Many local and Maine state prisons have outsourced their health care to private corporations that specialize in providing medical and mental health services to correctional facilities to better control costs and gain access to expertise. These entities employ their own doctors, nurses, social workers, and counselors.
Maine Tort Claims Act Immunity
Understanding who is involved in an inmate’s negligent medical care is essential to analyzing whether the provider may be immune under the Maine Tort Claims Act (MTCA). Section 8102 of the MTCA defines an “employee” of a governmental entity as “a person acting on behalf of a governmental entity in any official capacity, whether temporarily or permanently, and whether with or without compensation from local, state or federal funds,” but further provides that “the term ‘employee’ does not mean a person or legal entity acting in the capacity of an independent contractor under contract to the governmental entity” [14 M.R.S.A. § 8102(1)]. If a provider is employed by a local or state entity and does not have insurance, then he/she will likely be immune under the MTCA. Many of his/her decisions in rendering medical care could be central to carrying out the government’s policy interest in providing adequate health care to inmates. Consequently, the employee’s actions would be construed as a discretionary function and be immune.
If a provider is employed by a private vendor who has contracted with the correctional facility, a copy of the contract should be obtained to fully understand the relationship between the two entities. If the vendor and its employees are independent contractors, they will not be afforded immunity. If the vendor has procured insurance and the policy does not specifically carve out exemptions for immunity, the vendor has waived immunity. However, even in the case of independent contractors, the defense may argue that the non-governmental employee should be an “employee” as defined by § 8102 because their role is central to effectuating the State’s responsibilities.
In cases involving governmental employees, a 180-day MTCA notice of claim must be filed, and the case is subject to a two-year statute of limitations.
Privatized Correctional Healthcare Services
As more local and state governments attempt to find ways to save tax dollars and address their public health responsibility in prisons, they may increasingly turn to companies that specialize in providing prison health care. These vendors employ medical and mental health personnel who are trained to deal with the special health-care needs of inmates.
Organizations such as the American Correctional Association, the National Commission on Correctional Health Care, the American Medical Association, and the American Public Health Association have developed standards and policies to address clinical issues, treatment protocols, and safety and emergency procedures, to assist in the delivery of appropriate health care in correctional facilities. Reviewing the relevant standards from these organizations will be useful in understanding the level of service required in prison. Additionally, the contract may include provisions setting the standard of care. The vendor may also have their own internal policies and procedures to address matters such as medication reconciliation and sick/emergency calls.
Despite the challenges of balancing financial limitations with providing medical care to inmates, prisoners are protected under the law if they are denied adequate medical care. Navigating through prison medical malpractice can present unique difficulties. The decision to represent a prisoner in a medical malpractice case involves identifying defendants, investigating immunity, and understanding the applicable standards of care.