Photo of medical professional in scrubs taking an inmate's blood pressure with an blood pressure cuff through a slightly larger opening in a jail cell gate

Are We in a Jail Health Care Crisis?

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By: Savannah Pelfrey
Member, American Journal of Trial Advocacy

            Telemedicine is a phenomenon within the health care world that is presumed to have started within the last decade; however, its history within the prison industry started much earlier.[1]  Telemedicine, or telehealth, “allow[s] health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology.”[2]  Telemedicine within the prison industry began to pick up speed in the 1980s when prisons began outsourcing health care to private for-profit companies, which was during the time the prison industry began privatization as a whole.[3]  The private health care companies quickly incorporated the telemedicine system into prison health care because of its cost benefits, rather than to improve health care for inmates.[4]

            Today’s prison health care system consists of private for-profit companies negotiating multiyear contracts with each jail and prison they serve.[5]  According to an article from The New Yorker, “the companies receive a per-diem, per-individual rate, so profits depend on holding costs below that amount.”[6]  Everyday correctional-care companies treat inmates in the prison or jail for minor complaints, such as headaches; however, if it is a more than a minor complaint, such as a complex procedure or injury, “correctional-care companies are supposed to send patients to a hospital.”[7]  However, the article further states that “[m]edical staff, prescription drugs, and outside services such as hospital stays constitute major costs” which could affect the companies’ profits.[8] 

            Although low cost is the central concern for prison health care, prison officials cannot act with deliberate indifference towards an inmates’ injuries or it can be constituted as cruel and unusual punishment in violation of the prisoners’ Eighth Amendment rights.[9]  In Estelle v. Gamble,[10] the respondent filed a civil suit under 42 U.S.C § 1983 against the prison medical staff and other prison officials, alleging that he was subjected to cruel and unusual punishment in violation of his Eighth Amendment right.[11]  The allegations stem from a back injury the respondent suffered while unloading a truck during his prison work assignment.[12]  The respondent was seen seventeen times by medical personnel; however, the medical treatment was inconsistent and only consisted of prescriptions for pain medications and bed rest.[13]  The Supreme Court held that although deliberate indifference to serious medical needs of a prisoner is the “unnecessary and wanton infliction of pain,”[14] and thus can constitute cruel and unusual punishment, the respondent’s claims against the prison medical staff were not sustainable and did not amount to deliberate indifference.[15]  The Court stated  that “a complaint that a physician has been negligent in diagnosing or treating a medical condition does not state a valid claim of medical mistreatment under the Eighth Amendment. Medical malpractice does not become a constitutional violation merely because the victim is a prisoner.”[16]  

             Estelle paved the way for recognition of Eighth Amendment violations in prison health care, requiring prisons to provide adequate medical care to prisoners.[17]  Consequently, the federal legal standards for prison medical care were raised significantly with the enaction of the Prisoners Litigation Reform Act in 1997.[18]  The Prisoners Litigation Reform Act has two major requirements for prisoners who wish to file suit against prison medical staff or prison officials and states there must be a physical injury, and the prisoner must exhaust all available administrative remedies before filing suit.[19] 

             Although this helped slow prisoner litigation for the time being, the increasing number of incarcerated individuals coupled with the high percentage of incarcerated individuals with chronic illnesses or poor health has continuously fueled prisoner litigation.[20]  In addition, the opioid epidemic has put increased pressure on the reliance of prison health care.[21]  With these stresses comes the need for more specialized care within the prison health care system that some are concerned is not provided with the increased use of telemedicine.[22]   

            Prisoners claiming Eighth Amendment violations have numerous hoops to jump through in order to have their voices heard.  Not only must the inmate adhere to the requirements of the Prisoner Litigation Reform Act, but they also must overcome the common belief across the judicial system that substantial deference must be given to the judgement of prison administrators since their responsibility is so substantial.[23]   

            However, within the last two months numerous prisoners have filed claims of Eighth Amendment violations, although the next obstacle has been overcoming the defendant’s motions for summary judgement, and all have failed.[24]  In January, the United States District Court of Connecticut held in Perry v. Furey[25]defendant’s motion for summary judgement was granted because the plaintiff did not admit sufficient evidence of any deliberate indifference by prison officials, but he only alleged that he was unhappy with his treatment which is insufficient.[26] 

            Next, on February 12th, 2020, the United States District Court for the Eastern District of California heard Miner v. Smiley,[27] which involved an inmate claiming his prison doctor was deliberately indifferent to his rheumatoid arthritis, and the medications he was taking when he performed a procedure that resulted in an infection.[28]  The court held the defendants’ motion for summary judgement was granted because there was insufficient evidence presented that the prison doctor was aware of an unreasonable risk in order to be deliberately indifferent.[29]  On the following day, the United States District Court for the District of Maryland held in Pevia v. Pierce[30] that the defendants’ motion for summary judgement was granted because no evidence existed of conduct that amounted to deliberate indifference on behalf of any of the prison officials or medical staff.[31]

             Lastly, on February 20th, 2020, the United States District Court for the Middle District of Louisiana heard the plaintiffs’ claims for a motion for summary judgement in Peters v. Singh.[32]  Plaintiffs were current and former inmates in the State of Louisiana and alleged their Eighth Amendment rights were violated by the prison’s “If-Reducible-No-Surgery” hernia policy and the cataract policy.[33]  The plaintiffs’ contended that the cataract policy unconstitutionally delayed necessary cataract surgeries.[34]  The court denied the plaintiffs’ motion for summary judgement  because the plaintiffs failed to establish sufficient evidence of the defendants’ deliberate indifference.[35]  Thus, the defendants’ motion for summary judgement was granted because the defendants evidenced ongoing treatment given to the plaintiffs and a showing of disagreement between an inmate and the medical treatment provided is insufficient to prove a constitutional violation.[36]   

            What these recent decisions tell us is that inmates wishing to file claims of Eighth Amendment violations for deliberate indifference of medical care are going to have difficulty in proving the subjective element that the defendant was aware of the need for medical attention but failed either to provide it or to ensure that the needed care was available.[37]  In order to overcome this burden, inmates are going to have to have substantial evidence that they received hardly any medical treatment, if any.  Although these recent 2020 decisions seem discouraging, it is likely inmates are going to continue to file Eighth Amendment violations for inadequate medical care because telemedicine has become a staple in health care, and the prison population is continuously growing while inmates health continuously declines.

[1] Lux Alptraum, Telemedicine Is Revolutionizing Prison Health Care, Elemental (Jan. 3, 2020),

[2] Telemedicine Defined, AMD Global Telemedicine, (last visited Mar. 26, 2020).

[3] Steve Coll, The Jail Health-Care Crisis, New Yorker (Feb. 25, 2019),

[4] Id.

[5] Id.

[6] Id.

[7] Id.

[8] Id.

[9] Estelle v. Gamble, 429 U.S. 97, 104-05 (1976).  

[10] 429 U.S. 97 (1976).

[11] Id. at 99-101; 42 U.S.C. § 1983 (2018) states the following:

Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State or Territory or the District of Columbia, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities, secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress . . . .


[12] Estelle, 429 98-99.

[13] Id. at 107.

[14] Id. at 104 (quoting Gregg v. Georgia, 428 U.S. 153, 173 (1976)).

[15] Id. at 107-08.

[16] Id. at 106.

[17] Jonathan Rosenfeld, The Origin of Prisoner’s Rights: Estelle v. Gamble, 429 U.S. 97; 75-929 (1976), Nat’l L. Rev. (Sept. 16, 2016),

[18] Daniel E. Manville, Federal Legal Standards for Prison Medical Care, Prison Legal News (May 15, 2003),

[19] 42 U.S.C. § 1997e(a) (2018) (“No action shall be brought with respect to prison conditions under section 1983 of this title, or any other Federal law, by a prisoner confined in any jail, prison, or other correctional facility until such administrative remedies as are available are exhausted.”); 42 U.S.C. § 1997e(e) (2018) (“No Federal civil action may be brought by a prisoner confined in a jail, prison, or other correctional facility, for mental or emotional injury suffered while in custody without a prior showing of physical injury or the commission of a sexual act.”).

[20] Incarceration, Healthy People, (last visited Mar. 29, 2020) (“Studies have shown that when compared to the general population, jail and prison inmates of both genders are more likely to have high blood pressure, asthma, cancer, arthritis, and infectious diseases, such as tuberculosis, hepatitis C, and HIV.”).

[21] Coll, supra note 3.

[22] Alptraum, supra note 1.

[23] Id.

[24] See Perry v. Furey, No. 3:18cv1709 (KAD), 2020 WL 59941, at *7 (D. Conn. Jan. 6, 2020) (granting defendant’s motion for summary judgement); Miner v. Smiley, No. 2:17-cv-1896-MCE-EFB P, 2020 WL 704551, at *9 (E.D. Cal. Feb. 12, 2020) (granting defendants’ motion for summary judgement); Pevia v. Pierce, No. ELH-18-3902, 2020 WL 758158, at *29 (D. Md. Feb. 13, 2020) (holding defendants’ motion for summary judgement was granted); Peters v. Singh, No. 16-842-SDD-RLB, 2020 WL 853517, at *17 (M.D. La. Feb. 20, 2020) (holding defendants’ motion for summary judgement was granted).

[25] No. 3:18cv1709 (KAD), 2020 WL 59941 (D. Conn. Jan. 6, 2020).

[26] Id. at *6.  

[27] No. 2:17-cv-1896-MCE-EFB P, 2020 WL 704551 (E.D. Cal. Feb. 12, 2020).

[28] Id. at *7-8.

[29] Id.

[30] No. ELH-18-3902, 2020 WL 758158 (D. Md. Feb. 13, 2020).

[31] Id. at *15.

[32] No. 16-842-SDD-RLB, 2020 WL 853517, at *2 (M.D. La. Feb. 20, 2020).

[33] Id.

[34] Id.

[35] Id. at *11-13.

[36] Id. at *10-14.  

[37] See DePaola v. Clarke, 884 F.3d 481, 486 (4th Cir. 2018) (“To state a claim . . . for deliberate indifference to serious medical needs, a prisoner must show that he had a serious medical need, and that officials knowingly disregarded that need and the substantial risk it posed.”).

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