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In Medical Care in California State Prisons - a Primer on Deliberate Indifference
By KAREN TRAVIS, ESQ.Estelle v. Gamble, 429 U.S. 97 (1976),
http://www.kpalawyers.com/newsletters/news_september08.html


the United States Supreme Court held that a gross and extreme departure from the standard of care in provision or denial of basic medical care to prisoners was deliberate indifference, constituting cruel and unusual punishment in violation of the Eighth Amendment of the United States Constitution. In that case, a state inmate brought a civil rights action under 42 USC Section 1983 against the state corrections department, state corrections officers, and the deputy medical director, claiming that he was subjected to cruel and unusual punishment in violation of the Eighth Amendment for inadequate treatment he received for a serious back injury sustained while engaged in prison work.
Over the more than 25 years since the landmark decision in Estelle v. Gamble, courts have seen a deluge of prisoner lawsuits alleging inadequate, delayed, and/or virtually non-existent medical care. The California Department of Corrections & Rehabilitation (CDCR) in managing California's massive state prison system has failed abysmally to comply with its mandate to provide at least basic medical care to approximately 190,000 inmates.
This failure culminated in a class action lawsuit brought by ten California state prisoners in the United States District Court (Northern District) alleging serious injuries due to CDCR's deliberate indifference to their serious medical needs in violation of the cruel and unusual punishment clause of the Eighth Amendment, as well as denial of some prisoners with disabilities access to prison programs, services and rehabilitation in violation of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. [Marciano Plata et al v. Gray Davis, Governor, et al]. The Plata plaintiffs detailed a California prison medical care system that was broken beyond repair. Their grievances included insufficient number of medical staff, lack of training and supervision of all medical personnel, disorganized and incomplete medical records that often failed to accompany prisoners when they are transferred, lack of adequate medical screening of incoming prisoners, lengthy delays in accessing care, and frequent failures to provide prisoners with access to care altogether.
A stipulation reached between the parties in 2002 provided that the CDCR would implement Health Care Division Policies and Procedures designed to meet the minimal level of care necessary to fulfill the Defendants' obligations under the Eighth Amendment and that the Defendants would make all reasonable efforts to secure funding to implement these policies. There was a schedule formulated whereby each prison was required to implement the policies and procedures sometime during the time span of 2002-2008.
On June 30, 2005, after six days of evidentiary hearings, the Court ruled that the California prison medical care system was virtually non-functional and the Honorable Thelton E. Henderson announced that the court would establish a receivership to take control of the delivery of health services to all California state prisoners confined by the CDCR. As of the date of the Court's order, not a single prison had implemented the Policies and Procedures. As the Court stated "the harm already done in this case to California's prison inmate population could not be more grave, and the threat of future injury and death is virtually guaranteed in the absence of drastic action…Indeed, it is an uncontested fact that, on average, an inmate in one of California's prisons needlessly dies every six to seven days due to constitutional deficiencies in the CDCR's medical delivery system. This statistic, awful as it is, barely provides a window into the waste of human life occurring behind California's prison walls due to the gross failures of the medical delivery system". Plata Findings of Fact and Conclusion of Law Re Appointment of Receiver, October 3, 2005.
Over the past three years, the receivership appears to have had little impact on an unwieldy prison system fraught with problems of over-crowding, lack of staffing, under-funding and a pervasive practice of making it as difficult as possible for any inmate to obtain necessary medical care in a timely manner.
Despite the appointment of a receiver, one of the areas woefully in need of attention is the lack of reasonable medical care and treatment for inmates with Hepatitis C. The prison's restrictive policies exclude large numbers of inmates from obtaining necessary testing and treatment for Hepatitis C until their disease is advanced. The recent case filed by Khorrami Pollard & Abir, LLP , (Kevin Jackson v.Robin Dezember et al), seeks an order that the CDCR implement a policy to treat inmates with Hepatitis C at earlier stages in compliance with community standards.