Nevada prisoners have an Eighth Amendment right to adequate medical care, dental care, and mental health care. Inmates suffering from healthcare neglect or medical malpractice may be eligible to bring a Section 1983 lawsuit against their jail or prison for violating their civil rights.
In this article, our Nevada personal injury attorneys discuss:
- 1. Inmate Healthcare
- 2. Injuries
- 3. Suing for Medical Neglect
- 4. Who can I sue?
- 5. Remedies
- 6. Defenses
- 7. Statute of Limitations
- Additional Reading
Inadequate health care for inmates qualifies as “cruel and unusual” punishment.
1. Inmate Healthcare
The Eighth Amendment of the U.S. Constitution obligates jails and prisons to provide adequate health care.1 This comprises regular medical and dental care as well as mental health care (when necessary).2
Note that inmates are entitled to adequate care no matter whether the providers are government employees or private practitioners under contract with the government.3
Nevada City and County Jail Policies
NRS 211 delegates the administration of jail inmates’ health care to county sheriffs. Jails are required to provide treatment to inmates for:
- injuries incurred during arrest or while in custody;
- treatment for infectious, contagious, or communicable diseases; and
- examinations as required by law or by court order.
Inmates must pay for their own treatment if their injuries occurred:
- while they committed a public offense,
- while they were arrested (if convicted),
- if they self-inflicted their injuries, or
- if their injuries or illnesses were preexisting before being in custody.4
The CCDC has faced allegations of inadequate health care.
CCDC Policies
The biggest jail in Clark County is the Clark County Detention Center (CCDC) in downtown, Las Vegas. The CCDC contracts with NaphCare, Inc. to provide medical and mental health services at both the CCDC’s main facility and its North Valley Complex (NVC).
NaphCare is paid to provide:
- medical and medication management,
- mental health care, and
- drug detoxification treatment.
It also coordinates women’s health care, emergency and radiological services, dialysis, and other services.
NaphCare is required to complete a thorough health assessment of any inmate who is in custody for 10 days. They must supply inmates who are discharged with a reasonable amount of medication and information on community resources to continue their health care.5
Nevada State Prison Policies
NRS 209 delegates the administration of prison inmates’ health care to Nevada’s Department of Corrections Medical Division. The Division’s Medical Director and Medical Administrator manage the department’s:
- medical services,
- dental services,
- clinical mental health services, and
- pharmacy services.
The Medical Division also has a Nursing department and Central Pharmacy. Nevada’s larger prisons have medical clinics, dental clinics, and infirmaries. Two prisons have on-site acute care infirmaries.
Primary care is provided in the prisons. Outside surgeons, cardiologists, and gastroenterologists periodically go to the prisons to provide care there. When off-site care is necessary, inmates are taken to community hospitals.
On average, the prisons’ healthcare staff have 600 patient care contacts each day.6
2. Injuries
Medical care is especially vital in jail and prison since statistics indicate that inmates have higher-than-average rates of illness as compared to the general population.7 However, Nevada’s jail and prison healthcare is woefully inadequate:
- In 2015, Nevada spent less than $3,500 on healthcare per inmate, which pales next to the $5,720 per inmate average.
- Of the 43 states surveyed in a recent Pew research study, Nevada ranks the fourth-lowest in healthcare staffing, with only 24.5 full-time staff for every thousand inmates. (Inadequate medical staffing is most pressing in rural areas.)8
- Nevada prison inmates pay a copay of $8 for healthcare, making Nevada second only to Texas as the most expensive state for inmates.9
A recent audit of the CCDC shows that its medical provider NaphCare often failed to provide medications to inmates being discharged and did not provide sufficient mental health treatment.10
Jail and prison inmates may file grievances about inadequate medical care. However, many inmates face retaliation by prison workers as well as doctors for filing grievances to begin with. So many inmates suffer without seeking medical care for fear of being:
- assaulted,
- sequestered, or
- denied food.11
Nevada prisons pay below-average health care costs per inmate.
3. Suing for Medical Neglect
Nevada inmates who have suffered medical neglect can bring a Section 1983 lawsuit claiming they were denied their Eighth Amendment constitutional right to adequate medical care. In order to prove medical neglect, the inmate (“plaintiff”) would need to show the following:
- The inmate has a serious medical need,
- The prison/jail acted with deliberate indifference to the inmate’s medical need12
The plaintiff has the burden to prove these elements by a “preponderance of the evidence.” This is the legal way of saying that it is more likely than not that the jail/prison committed medical neglect.13
Serious Medical Need
A medical condition qualifies as a “serious medical” when the failure to treat the condition can cause the inmate further significant injury or the unnecessary or wanton infliction of pain. A condition does not have to be life-threatening to be a serious medical need: Substantial pain, injury, or function loss is sufficient.14
Examples of serious medical needs may include:
- broken bones
- torn ligaments
- infection disease
- cancer
- deep cuts
- chronic disease
- chronic pain
- an infected tooth that needs extraction
- suicide attempts
Note that mild injuries or discomfort do not rise to the level of a serious medical need. Plaintiffs’ attorneys often rely on expert medical witnesses to testify as to the seriousness of the plaintiff’s medical needs.
Deliberate Indifference to the Inmate’s Serious Medical Need
Once the detention facility becomes aware that an inmate may have a serious medical need, it is obligated to investigate the matter further and provide treatment if necessary. A jail/prison acts with “deliberate indifference” when it is aware of the inmate’s medical situation and recklessly disregards the substantial risk of harm that the inmate faces.15
Examples of deliberate indifference to an inmate’s serious healthcare needs may include:
- delaying or denying access to health care
- denying access to a specialist when necessary
- failing to follow doctors’ orders, such as administering medicine
- failing to fully examine the inmate and review the healthcare records in order to formulate the most appropriate treatment
- the jail/prison deciding on treatment by considering only non-medical factors, such as money or convenience16
Note that defendant(s) cannot be held liable for medical neglect merely for being negligent. The plaintiff has to show that the defendant(s) acted recklessly, which is a higher standard than negligence.17
4. Who can I sue?
Depending on the facts of the case, inmates may sue some or all of the following parties for health care neglect:
- The jail/prison
- The individual guards or other detention officials who showed deliberate indifference to the inmate’s condition
- The medical staff showed deliberate indifference to the inmate’s condition
- The medical group that employed the doctors who showed deliberate indifference to the inmate’s condition
5. Remedies
Plaintiffs who suffered healthcare neglect while in jail or prison may try to recover compensatory damages to pay for their:
- doctors’ bills (that are not covered by the jail or prison),
- pain and suffering,
- lost wages (if applicable), and/or
- loss of future earnings (if applicable).
If the court finds the actions of the jail or prison officers to be particularly egregious, the court may order punitive damages. The court may also order that the defendants pay the plaintiff’s attorneys’ fees.
Finally, the court can order the jail or prison to provide the necessary medical treatments the inmate requires.18
6. Defenses
Defendants in a 1983 lawsuit for healthcare neglect may try to advance the following arguments to avoid liability:
- The plaintiff did not have a serious healthcare need;
- The defendant(s) did not know – and reasonably could not have known – that the plaintiff had a serious medical need;
- The defendant(s) did not demonstrate deliberate indifference; and/or
- The medical treatment – or lack of treatment – that the plaintiff received falls within acceptable professional standards of care
Defendants may try to argue that they have “qualified immunity” that protects them from liability from Section 1983 claims. Though if the plaintiff can show that the defendant did not act in good faith, then any immunity privileges should not apply.19
7. Statute of Limitations
Inmates usually have a statute of limitations of two (2) years following the injury to bring a Section 1983 lawsuit in Nevada. If they wait after two years to file, the lawsuit can be dismissed for being stale.20
Additional Reading
For more in-depth information, refer to these scholarly articles:
- Marginality or Neglect – Women & Criminal Justice.
- Women in Prison – Women & Therapy.
- Causes and correlates of prison inmate misconduct: A systematic review of the evidence – Journal of Criminal Justice.
- A Right without a Remedy: Sexual Abuse in Prison and the Prison Litigation Reform Act – Harvard Civil Rights-Civil Liberties Law Review.
- Differences in inmate-inmate and inmate-staff altercations: Examples from a medium security prison – The Social Science Journal.
Legal References:
- U.S. Constitution’s Eighth Amendment (“Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.”); Estelle v. Gamble, 429 U.S. 97, 103 (1976).
- Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982); see NRS 211.140 & NRS 209.4889.
- West v. Atkins, 487 U.S. 42, 57-58 (1988); Richardson v. McKnight, 521 U.S. 399 (1997).
- NRS 211.
- Audit Report Clark County Detention Center Inmate Medical Care Contract April 2016.
- State of Nevada Department of Corrections Medical Division.
- Id.
- Ben Botkin, Nevada gets low marks for inmate health spending, Las Vegas Review-Journal (November 6, 2017).
- Nick Wing, Prisons And Jails Are Forcing Inmates To Pay A Small Fortune Just To See A Doctor, Huffington Post (August 19, 2017)
- Audit Report Clark County Detention Center Inmate Medical Care Contract April 2016.
- Nevada Prisoner Abuse Documentation Nevadacure.org; see Doty v. County of Lassen, 37 F.3d 540 (9th Cir. 1994)(“Doty’s mild stress-related ailments are the type of routine discomfort that may result merely from incarceration and the concomitant separation from one’s family. A serious medical need requires an ailment of a greater magnitude or with a cause separate from confinement. Since Doty was not suffering from a serious medical need, no constitutional violation occurred.”).
- Estelle v. Gamble, 429 U.S. 97 (1976). (“An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death, the evils of most immediate concern to the drafters of the Amendment. In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose. The infliction of such unnecessary suffering is inconsistent with contemporary standards of decency as manifested in modern legislation codifying the common law view that it is but just that the public be required to care for the prisoner, who cannot, by reason of the deprivation of his liberty, care for himself. We therefore conclude that deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain, proscribed by the Eighth Amendment. This is true whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed.”) Note that although the Estelle decision set out the “deliberate indifference” standard, the majority did not feel that Gamble’s particular claim could stand against medical staff (as opposed to prison administration). The court noted that medical negligence and malpractice was not tantamount to constitutional violation and that those claims were covered by state tort law.”).
- Martin A. Schwartz, George Cheny Pratt, Section 1983 Litigation: Jury instructions, Volume 4, 2017 Supplement.
- Clement v. Gomez, 298 F.3d 898, 904 (9th Cir. 2002).
- Farmer v. Brennan, 511 U.S. 825, 836 (1994). There are several ways detention facilities may become aware of an inmate’s healthcare emergency, including: The ailing inmate informs a jail/prison employee or doctor; a fellow inmate informs a jail/prison employee about the patient’s condition; a doctor discovers the medical need during an examination or by reviewing health records; a jail/prison employee observes the sick inmate in distress or deteriorating health.
- See, for example, Estelle v. Gamble, 429 U.S. at 104; Toussaint v. McCarthy, 801 F.2d 1080, 1112 (9th Cir. 1986); Jones v. Johnson, 781 F.2d 769, 771 (9th Cir. 1986).
- Estelle v. Gamble, 429 U.S. 97 (1976).
- 42 U.S.C. § 1988.
- See, for example, Harlow v. Fitzgerald, 457 U.S. 800 (1982).
- NRS 11.190.