In 2005 three inmates with serious mental illness and Protection and Advocacy for People with Disabilities, Inc., www.pandasc.org, filed suit against the South Carolina Department of Corrections. [link to complaint already on site] Plaintiffs allege that SCDC has failed to provide adequate mental health treatment, resulting in their being harmed or placed at risk of harm. The case is brought under two provisions of the South Carolina Constitution: Article II § 15 is essentially similar to the Eighth Amendment of the United States Constitution prohibiting cruel and unusual punishment; Article XII § 2 requires the state to establish a correctional system. Plaintiffs voluntarily dismissed their Article XII claim.
After several years of motions and discovery, on September 29, 2010, Circuit Court Judge Michael Baxley issued an Order Setting Forth Applicable Constitutional Standards. This order sets out what Plaintiffs, the class of inmates with serious mental illness, in the custody of the South Carolina Department of Corrections (SCDC), must show to win their case.
Plaintiffs’ case is based on many years of law setting out the standards for similar claims. The United States Supreme Court first considered the issue of prisoner health care over thirty five years ago in Estelle v. Gamble, 429 U.S. 97 (1976). Estelle addressed the prohibition against cruel and unusual punishment in the United States Constitution’s Eighth Amendment in the context of prison medical services. While this case is brought under the South Carolina Constitution, Judge Baxley ruled that the same standards set by Estelle and the many cases interpreting Estelle control this case.
Estelle states the “elementary principles” that establish the government’s Eighth Amendment obligation to provide medical care to prisoners:
The Amendment embodies “broad and idealistic concepts of dignity, civilized standards, humanity and decency…,: against which we must evaluate penal measures. Thus, we have held repugnant to the Eight Amendment punishments which are incompatible with “the evolving standards of decency that mark the progress of a maturing society”…or which “involve the unnecessary or wanton infliction of pain.”
Estelle ruled that to establish liability under the Eighth Amendment in a prison conditions case, plaintiffs must prove that defendants acted with “deliberate indifference to a serious medical need of prisoners.” The Supreme Court further held that this deliberate indifference standard contains both an objective and a subjective component. See Farmer v. Brennan, 511 U.S. 825, 834-37 (1994).
Plaintiffs have the burden of demonstrating that SCDC’s conduct creates a substantial risk of serious harm, referred to in Farmer as “an objectively intolerable risk of harm.” The risk must involve an extreme deprivation, such as withholding a basic human need like food, clothing or medical care. The likelihood of harm must be substantial and the anticipated injury must be serious: routine discomfort arising simply from the fact of being confined is not enough. A medical need is sufficiently serious under the Eighth Amendment only if the failure to treat it adequately could result in a further significant injury or wanton infliction of pain. Judge Baxley, following the law established in many cases, recognized that treatment for mental illness is as important as treatment for physical illness.
Plaintiffs may demonstrate the objective component of serious harm by showing either a pattern of negligent conduct (meaning in this setting deliberate indifference) or by such systemic and gross deficiencies in staffing, facilities, equipment, or procedures that the inmate population is effectively denied access to adequate medical care. Evidence of harm to individual inmates is presented as representative of systemic harm to the class.
Six factors are commonly assessed to determine whether a prison mental health system is minimally adequate:
- A systematic program for screening and evaluating inmates to identify those in need of mental health care;
- A treatment program that involves more than segregation and close supervision of mentally ill inmates;
- Employment of a sufficient number of trained mental health professionals;
- Maintenance of accurate, complete, and confidential mental health treatment records;
- Administration of psychotropic medication only with appropriate supervision and periodic evaluation; and
- A basic program to identify, treat, and supervise inmates at risk for suicide.
Judge Baxley’s order establishes these six factors as “relevant and probative, not as bright line standards, but rather as an organizational framework – broad areas into which the parties’ evidence concerning the adequacy of SCDC’s mental health system may be funneled and considered.”
Plaintiffs also must establish the subjective component of deliberate indifference, similar to criminal recklessness, which makes a person liable when he or she consciously disregards a substantial risk of serious harm. Farmer held that a defendant has a sufficiently culpable state of mind when the defendant knows that inmates face a substantial risk of serious harm and disregards that risk by failing to take reasonable measures to abate it. A comparable standard would be the behavior of a drunk driver who is aware of driving dangerously but continues to do so.
Deliberate indifference may be shown through direct evidence, such as testimony of prison officials or internal documents, or through circumstantial evidence. Failure to verify to underlying facts that suggest risk of serious harm or ignoring reports of harm may constitute deliberate indifference. As Judge Baxley’s order states:
“…[S]uch proof as is required to show a constitutional violation cannot be inconclusive or speculative, or merely arousing suspicion, and cannot related to individual or isolated circumstances, but must relate to systematic and gross deficiencies that detail a broad pattern of deprivation...there must be a showing that defendants are knowingly and unreasonably disregarding substantial risks of serious injury, or turning a blind eye to inferences of serious risk that defendants reasonable should strongly expect to exist.”
Judge Baxley also ruled that Article XII, § 2 of the South Carolina Constitution creates an enforceable affirmative duty on SCDC to provide mental health care to inmates. He compared the section to a similar constitutional provision requiring the state to provide an education to school children, interpreted in Abbeville County School District, et al. v. State of South Carolina, et al., 334 S.C. 58, 515 S.E.2d 535 (1999). He ruled that Plaintiffs must show that SCDC has not provided minimally adequate mental health care for the class, using the six factors above as a benchmark for measuring adequacy.