Cruel and unusual or adequate healthcare: Looking at the circuit split

In 1976, the United States Supreme Court handed down a landmark decision where the Court interpreted the Eighth Amendment’s “cruel and unusual” punishment clause to incorporate denying incarcerated persons adequate care for their serious medical needs. Scholars have broken down the so-called Estelle test into two prongs. The first prong requires that a plaintiff show she has an objective “serious medical need.” This objective prong assesses the seriousness of the medical condition and whether it is sufficiently severe to be actionable under the Eighth Amendment. The second prong, the subjective prong, requires that a plaintiff show that prison officials acted deliberately indifferent towards her health or safety.

In Estelle v. Gamble, the Supreme Court did not give clear directions regarding what constitutes deliberate indifference. As a partial remedy, the Court revised and clarified the test in Farmer v. Brennan. The Court, acknowledging that it never explained the meaning of deliberate indifference, stated that it is more than negligence: it is acts or omissions with the purpose of causing harm or having knowledge that harm could result. Even with this new guidance from the Supreme Court, lower courts still have a lot of latitude in defining deliberate indifference, which is reflective in inconsistent case law, ultimately leading to a circuit court split.

Currently, there are two different standards of deliberate indifference used within the lower courts. One standard, the medically unacceptable standard, states that deliberate indifference occurs when a doctor’s decision regarding medical treatment does not conform to accepted professional standards, which raises an inference that it was not actually based on medical judgment. The other standard, the grossly inadequate care standard, states that deliberate indifference occurs when the need for treatment is obvious, but the medical care is so minimal that it is equivalent to no treatment at all.

An example of the medically unacceptable standard in action is in Arnett v. Webster, where Kevin Arnett had rheumatoid arthritis (RA), and for over 10 months, prison officers did not provide him with the necessary medication to treat his condition. The Seventh Circuit, in holding for Arnett, stated that prison officials acted with deliberate indifference when they knew about Arnett’s RA but did not provide medication to treat his condition.

In contrast, an example of the grossly inadequate care standard can be seen in Santiago v. Ringle, where Oscar Santiago had a serious skin condition but was not given the recommended treatment after seeing a specialist. The Sixth Circuit found that prison officials were not deliberately indifferent to Santiago’s serious medical need because they provided him some treatment and there was no proof it was inadequate.

These cases emphasize the need to create a uniform standard for deliberate indifference because the lack of unification creates case law that negatively impacts the most marginalized communities within the prison system—transgender and mentally incapacitated incarcerated folks. Incarcerated persons have a right to adequate healthcare while in prison, and the current jurisprudence strips incarcerated folks of that fundamental right.