News

Potential Legal Liabilities for the Medical Care of Inmates in North Carolina Jails

23 Jul 2019 10:34 AM | Jennifer Edwards (Administrator)

By Jay C. Salsman and Christina J. Banfield,
Harris, Creech, Ward & Blackerby, P.A.

“[I]t 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.”

Local jails and state prisons in North Carolina have an obligation to provide medical care to inmates and prisoners, who inherently rely on jail authorities to obtain treatment for their medical needs as they are not free to seek medical care on their own.  When inmates believe that they have been denied or given inadequate medical care by health care providers at these institutions, they have the right to seek monetary relief for such under 42 U.S.C. § 1983. 

Civil rights cases brought by state prisoners and county inmates are governed by 42 U.S.C. § 1983, and allow prisoners to seek relief in federal court when they believe their civil rights have been violated.   42 U.S.C. § 1983 states that a person acting under color of state law, such as a state prison employee or county correctional employee, may be liable for the violation of a right protected by the United States Constitution or created by a federal statute.

An individual, private health care provider working at a state prison or county detention center can be deemed to be acting under color of state law.  However, a private health care corporation cannot be held vicariously liable under § 1983 for any acts by an individual health care provider.  A private health care corporation can only be held liable under § 1983 for a claim demonstrating that an official policy or custom of the corporation caused an alleged violation of a right.

Common § 1983 claims against health care providers are (1) claims that prison or jail conditions cause harm to the health or safety of the inmate, in violation of the Eighth Amendment protection against cruel and unusual punishment, and (2) claims that the providers are deliberately indifferent to an inmate’s serious illness or injury, in violation of the Eighth Amendment protection against cruel and unusual punishment.  “In order to make a prima facie case that prison conditions violate the Eighth Amendment, a prisoner must show both ‘(1) a serious deprivation of a basic human need; and (2) deliberate indifference to prison conditions on the part of prison officials.’”  In order to establish that a health care provider’s actions constitute deliberate indifference to a serious medical need in violation of the Eighth Amendment, the prisoner must show that the medical treatment is so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness.”

Deliberate indifference further requires that a health care provider “actually know of and disregard an objectively serious condition, medical need, or risk of harm.”  A health care provider’s failure to alleviate a significant risk that he should have perceived, but did not, cannot establish deliberate indifference.  Additionally, mere negligence or medical malpractice is not sufficient to constitute deliberate indifference to a serious medical condition.  Further, a mere disagreement between an inmate and a health care provider regarding the appropriate form of treatment does not state a constitutional claim.

Qualified immunity may apply to shield a health care provider from liability for civil monetary damages under a § 1983 suit if the provider’s conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known.  The crucial question in a qualified immunity inquiry is whether the provider’s conduct would strike an objective observer as falling within the range of reasonable judgment.  A health care provider is entitled to qualified immunity unless a reasonable person in her position would have known, based on the information possessed by her at the time, that her actions would constitute deliberate indifference to a serious medical need.

Pursuant to 28 U.S.C. § 1367, an inmate may also allege a related supplemental state law claim for medical malpractice against a health care provider.  Where an inmate’s federal complaint also alleges a state law claim for medical malpractice against a health care provider working at a jail, Rule 9(j) of the North Carolina Rules of Civil Procedure applies, and the inmate must allege that all medical care and all medical records have been reviewed by a person reasonably expected to qualify as an expert and willing to testify that the medical care did not meet the standard of care.

Inmates may not immediately file a § 1938 action after any alleged deliberate indifference to a serious medical need; instead, an inmate must exhaust all administrative remedies available to him, thereby completing the entire administrative remedy process for any such claim.  Once administrative remedies have been exhausted, an inmate can file his § 1983 suit in federal court.  Because § 1983 does not have its own statute of limitations, it is considered “deficient” within the meaning of 42 U.S.C. § 1988.  Therefore, the forum state’s personal injury statute of limitations governs the time in which the inmate may file his suit.  In North Carolina, the statute of limitations for personal injury is three years.

After the inmate files his suit, a judge will conduct a frivolity review of the plaintiff’s complaint.  If the court determines that the complaint is (1) frivolous, malicious, or fails to state a claim upon which relief may be granted, or (2) seeks monetary relief from a defendant who is immune from such relief, then the court can dismiss the complaint at a very early stage, prior to issuing summons to the named defendants.  If the suit moves forward, an inmate may file a motion for appointment of counsel with the court, as inmates have no constitutional right to counsel in a civil action.

            In defending against a complaint brought by an inmate, it is important to note that deliberate indifference is an extremely high standard that the inmate has the burden of proving.  In supporting a motion for summary judgment on such claims, medical records of sick calls, examinations, diagnoses, and medications may rebut an inmate’s allegations of deliberate indifference.  Further, the motion may, and should, be supported by a detailed affidavit from the defendant health care provider, outlining and detailing all medical care given.  In addition, expert witnesses who are familiar with the standard of care in county jails or in state prisons may be helpful to outline the standard of care that would have applied to the medical care given to the inmate. 

            42 U.S.C. § 1983 is an important vehicle that allows inmates to seek relief against private health care providers when they have actually been deprived of a right to adequate medical care during their incarceration.  However, there is and will continue to be ample statutory and case law support to assist health care providers with successfully defending against civil rights claims that are baseless or do not allege facts showing deliberate indifference to a serious medical need. 

Spicer v. Williamson, 191 N.C. 487, 490, 132 S.E. 291, 293 (1926).

Estelle v. Gamble, 429 U.S. 97, 103 (1976).

Monell v. Dep’t of Social Servs., 436 U.S.C. 658, 690 (1978).

42 U.S.C. § 1983.

42 U.S.C. § 1983.

West v. Atkins, 487 U.S. 42, 50-51 (1988).

Rodriguez v. Smithfield Packing Co., 338 F.3d 348, 355 (4th Cir. 2003); Austin v. Paramount Parks, Inc., 195 F.3d 715, 727-28 (4th Cir. 1999).

Monell v. Dep’t. of Social Servs., 436 U.S. 658, 690 (1978); see also City of Canton v. Harris, 489 U.S. 378, 385 (1989).

Strickler v. Waters, 989 F.2d 1375, 1379 (4th Cir. 1993).

Miltier v. Beorn, 896 F.2d 848, 851 (4th Cir. 1990), overruled in part on other grounds by Farmer v. Brennan, 511 U.S. 825, 837 (1994).

Short v. Smoot, 436 F.3d 422, 427 (4th Cir. 2006).

Farmer v. Brennan, 511 U.S. 825, 838 (1994).

Estelle v. Gamble, 429 U.S. 97, 106 (1976).

Id. at 105-06.

Wiley v. Doory, 14 F.3d 993, 995 (4th Cir. 1994).

Gooden v. Howard County, Maryland, 954 F.2d 960, 965 (4th Cir. 1992).

Anderson v. Creighton, 483 U.S. 635, 639-40 (1987).

Estate of Williams-Moore v. Alliance One Receivables Mgmt., 355 F. Supp. 2d 636, 649 (M.D.N.C. 2004); Moore v. Pitt Cty. Mem’l Hosp., 139 F. Supp. 2d 712, 713 (E.D.N.C. 2001).

42 U.S.C. § 1997e.

Wilson v. Garcia, 471 U.S. 261, 280 (1985).

N.C. Gen. Stat. §1-52(16).

28 U.S.C. § 1915A.

28 U.S.C. § 1915A.

See Lassiter v. Dept. of Social Servs., 452 U.S. 18, 26-27 (1981).

See Grayson v. Peed, 195 F.3d 692, 695 (4th Cir. 1999).

Banuelos v. McFarland, 41 F.3d 232, 235 (5th Cir. 1995).


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