Inmates and Detainees Have a Constitutional Right to Medical Care
Inmates Deserve Medical Care.
I. Constitutional Right to Medical Care
Whether in jail or prison, inmates and detainees have a constitutional right to medical care. When a prison or jail deprives an inmate of medical care, they may be violating the Eighth Amendment. Sealock v. Colorado, 218 F.3d 1205, 1209 (10th Cir. 2000) (citing Estelle v. Gamble, 429 U.S. 97, 105 (1976)) (“A prison official’s deliberate indifference to an inmate’s serious medical needs violates the Eighth Amendment.”).
II. Types of Deprivations
In New Mexico, the Tenth Circuit U.S. Court of Appeals has recognized two types of medical conduct constituting deliberate indifference. Paugh v. Uintah Cnty., 47 F.4th 1139, 1154 (10th Cir. 2022). “The first applies when medical professionals fail to treat a serious medical condition properly.” Id. (internal quotes and cite omitted). The second applies to medical professionals failing in their gatekeeper role by delaying or denying access to healthcare an inmate. Id. The Court has identified the following examples of deliberate indifference under both types of misconduct: (1) failing to treat a condition so obvious even a layperson would recognize it, (2) recognizing the inability to treat and declining or unnecessarily delaying a referral, (3) completely denying treatment or access to medical care, and/or (4) responding to an obvious risk with treatment that is patently unreasonable. Id.; see also Lucas, 58 F.4th at 1139.
III. Proving a Constitutional Violation
To establish that a prison official was deliberately indifferent to an inmate’s medical needs, “there is both an objective and a subjective component.” Estate of Beauford v. Mesa Cty., 35 F.4th 1248, 1262 (10th Cir. 2022). “[T]he focus of the objective component is the seriousness of the plaintiff’s alleged harm, while the focus of the subjective component is the mental state of the defendant with respect to the risk of that harm.” Prince v. Sheriff of Carter Cnty., 28 F.4th 1033, 1044 (10th Cir. 2022).
a. Objective Component
“To satisfy the objective component, the plaintiff must produce evidence that the prisoner’s medical need was ‘sufficiently serious.’” Beauford, 35 F.4th at 1262 (internal quotation and citation omitted). A medical need is serious if it is “one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.” Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir. 1980) (internal quotation marks and citation omitted). A medical need is further serious if “resulted in substantial harm.” Beauford, 35 F.4th at 1262 (internal quotation and citation omitted). “The substantial harm requirement may be satisfied by lifelong handicap, permanent loss, or considerable pain.” Id. The Tenth Circuit has held a plaintiff can also satisfy the objective component if the plaintiff can show that the delay resulted in “substantial harm” to essential organs, loss of parts of fingers, and hours of pain. See Beauford, 35 F.4th at 1262; see also Mata, 427 F.3d at 753-755 (finding substantial harm when evidence supported that delay caused permanent and irreversible heart damages); Oxendine v. Kaplan, 241 F.3d 1272, 1278 (10th Cir. 2001) (finding that substantial harm when evidence supported that delay caused loss of a part of finger to gangrene and rot); Al-Turki v. Robinson, 762 F.3d 1188, 1193-94 (10th Cir. 2014) (finding substantial harm when evidence supported that inmate suffered pain for approximately five hours).
a. Subjective Component
To satisfy the subjective component, a plaintiff must establish that the defendant knew of and disregarded an excessive risk to the inmate’s health or safety’” Paugh, 467 F.4th at 1156. Plaintiff does not need to show that the medical provider “acted or failed to act believing the harm actually would befall an inmate.” Id. (internal quotations and citations omitted). “Rather it is enough that an official merely refused to verify underlying facts that he strongly suspected to be true, or declined to confirm inference of a risk that he strongly suspected to exist.” Id. (internal quotations and citations omitted). “Whether a prison official had the requisite knowledge of a substantial risk is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence.” Id. (internal citations and quotations omitted). The Tenth Circuit has “equated deliberate indifference to recklessness, in which a person disregards a risk of harm of which he is aware.” Id. at 1154 (internal quotation s and citations omitted).
To show that defendant knew that plaintiff faced a substantial risk of harm, plaintiff may present evidence that the medical emergency was obvious. Lucas v. Turnkey Health Clinics, LLC, 58 F.4th 1127, 1139 (10th Cir. 2023). “When a risk is obvious, it is circumstantial evidence of an official’s awareness of serious medical need.” Id. Obviousness in terms of the subjective prong is not the same as the objective prong. Id. In considering with a medical emergency was obvious to a medical provider, the fact finder may consider the medical providers’ heightened knowledge and training to support that the provider knew of and disregarded a substantial risk. Id.
To show a medical provider disregarded an obvious risk does not require a showing that the inmate was completely denied any medical care. Id. at 1138-39. The Tenth Circuit explained in Lucas, the inquiry is not whether healthcare worker “provided some care but rather whether they fulfilled their sole obligation to refer or otherwise afford access to medical personnel capable of evaluating a patient's treatment needs when such an obligation arises.” Id. at 1139. The Tenth Circuit explained “doing nothing in the face of serious medical needs is obviously sufficient to state a claim under both theories.” Id. “However, merely doing something (with no reference to the underlying condition) does not necessarily insulate one from liability.” Id. Instead, “a court may need to determine whether there was the functional equivalent of a complete denial of care in light of the specific circumstances.” Id.
IV. Examples of Deprivations
Failing to assess an inmate or send an inmate to the hospital when a medical provider knows the inmate is suffering a medical emergency satisfies the subjective component of deliberate indifference. See Paugh, 47 F. 4th at 1154 (Providing examples of deliberate indifference such as “when a medical professional fails to treat a medical condition so obvious that even a layman would recognize the condition,” “completely denies care although presented with recognizable symptoms which potentially create a medical emergency," "responds to an obvious risk with treatment that is patently unreasonable,” or “prevent[s] an inmate from receiving treatment or deny[s] him access to medical personnel capable of evaluating the need for treatment.").
Thus, in Smith v. Allbaugh, the Tenth Circuit found that medical providers’ failure to send an inmate to the hospital when the inmate presented with severe abdominal pain, bloody vomit, bloody stool, weight loss, elevated heart rate, elevated blood pressure, and difficulty breathing over a two-week period was sufficient to establish deliberate indifference. 987 F.3d 905, 910-911 (10th Cir. 2021).
Similarly, in Kikumura v. Osagie, the Tenth Circuit overturned the granting of a motion to dismiss when it found that the plaintiff pled sufficient facts to support that a physician assistant was deliberately indifferent by not providing adequate treatment or sending the inmate to a higher level of care despite numerous signs that the inmate was suffering a medical emergency. 461 F.3d 1269, 1274-76, 1293-95 (10th Cir. 2006).
Again, in Jensen v. Clyde, the Tenth Circuit refused to grant qualified immunity to a nurse who refused to obtain a higher level of care for an arrestee suffering severe withdrawals even though the nurse provided some intervention, including placing the arrestee in medical observation and providing fluids. 989 F.3d 848, 859-60 (10th Cir. 2021).
Most recently, in Lucas v. Turn Key Health Clinics, the Tenth Circuit overturned the granting of a motion to dismiss when it found sufficient evidence of deliberate indifference when a physician failed to provide adequate treatment to lessen the inmate’s symptoms and failed to send the inmate to the hospital for a higher level of care. 58 F.4th 1127, 1143 (10th Cir. 2023).