Health Care

Court-Ordered Reforms

Prior to the mid-1970s, prisons were virtually closed to public scrutiny, and convicts were accorded few rights. Most health care services were provided by other inmates—usually without formal training and with only rudimentary medications and equipment. Professional health care providers were few. Many of these had licensing, competence, or sobriety problems and could not find gainful employment elsewhere. As a result, abuses abounded. Sometimes medical care was denied as a form of punishment or because of the whim of an officer.

Few gave credence to prisoners’ complaints. Judges ruled it was not the business of courts to meddle in the internal affairs of prisons and left these matters to the discretion of correctional managers. This state of affairs continued until the 1960s and 1970s, when white, middle-class, affluent, educated, and socially well-connected people were incarcerated for civil disobedience or other activities in civil rights and antiwar demonstrations. These activists generally had greater credibility than the typical inmate, whose only contact with a lawyer may have been with a public defender. Amid voters’ rights rallies and Vietnam War protests, legal defense societies were quickly mounted to provide competent defense and advocacy.

Soon class action suits were filed, grouping similarly situated inmates together as plaintiffs seeking redress. Most were filed in federal courts and sought relief under 42 U.S.C. § 1983 of the Civil Rights Act from conditions of cruel and unusual punishment prohibited by the Eighth Amendment. In 1976, the U.S. Supreme Court in Ruiz v. Estelle ruled that “deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain’ proscribed by the Eighth Amendment.”

Following Ruiz v. Estelle, an avalanche of litigation ensued. Some suits were successful. Many resulted in court-ordered consent agreements and required defendants to implement sweeping changes under the watchful eye of court-appointed monitors. Besides medical and mental health care, reforms addressed overcrowding, brutality, nutrition, and access to courts. The most fundamental health arena changes required access to professional medical evaluation and prohibited interference with ordered medical treatment.

...