The Prisoner's Right to Treatment

Facts of the Case

In 1983, Charles Iseley was convicted of several robbery and assault charges and was incarcerated. He had numerous medical problems, including hepatitis C, chronic fatigue syndrome, fibromyalgia, and rheumatoid arthritis. He had brought several earlier suits against prison officials around the question of treatment for HCV and other conditions.

In October 2002, while incarcerated at State Correctional Institute at Greene (SCI-Greene), he again brought suit against DOC and SCI-Greene employees and the medical provider at SCI-Greene and its employees. He filed the case pro se as a civil rights action in the United States District Court for the Western District of Pennsylvania. (The medical provider at SCI-Greene and its employees were referred to as “the Medical Defendants,” and the DOC and SCI-Greene employees were the “Commonwealth Defendants” in this case.) His complaint listed numerous claims: the failure of the prison authorities and doctors to treat his HCV and other conditions constituted cruel and unusual punishment in violation of the Eighth and Fourteenth Amendments; the Medical Defendants’ release of information regarding his HCV status violated his right to privacy; the denial of medical treatment was in violation of the Americans with Disabilities Act (ADA); the refusal to treat his HCV was retaliation for his failure to consent to psychological treatment and disclosure of his medical information; and the violation of various state laws.

The Medical Defendants filed a motion for summary judgment on the grounds that Mr. Iseley had not exhausted his administrative remedies as required by statute. The Commonwealth Defendants also filed a motion for summary judgment arguing that the DOC policy regarding HCV treatment did not constitute cruel and unusual punishment and that none of them was personally involved in the other alleged actions. The district court granted both motions for summary judgment. The plaintiff appealed to the United States Court of Appeals for the Third Circuit.

Ruling and Reasoning

The United States Court of Appeals for the Third Circuit upheld the summary judgment for the Medical Defendants, finding that Mr. Iseley had failed to exhaust his administrative remedies as required of prisoners bringing an action under § 1983 or other federal laws.

Addressing the claims made against the Commonwealth Defendants, the appeals court first outlined the standards by which denying medical care would constitute an Eighth Amendment violation. First, the court noted, it must constitute “unnecessary and wanton infliction of pain” or “deliberate indifference to the serious medical needs” of a prisoner (Estelle v. Gamble, 429 U.S. 97 (1976)). In addition, to prove deliberate indifference, the plaintiff had to establish that he faced a “substantial risk of serious harm,” and that the defendants disregarded “that risk by failing to take reasonable measures to abate it” (Farmer v. Brennan, 511 U.S. 825 (1994)). Finally, mere negligence or inadvertence is insufficient to show an Eighth Amendment violation. (Inmates of Allegany County Jail v. Pierce, 612 F.2d 754 (3rd Cir. 1979)).

The appeals court turned to the central question of whether Mr. Iseley in fact was denied treatment. They pointed out that his claim that he was denied treatment for HCV was “by his own admission” not true. Instead, the court decided that the plaintiff had “refused interferon treatment because he would not consent to the release of his medical records and concomitant psychological treatment as required by DOC policy” (Iseley, 200 Fed. Appx., p 9).

Regarding Mr. Iseley's objection that psychological treatment was unnecessary, the court cited the plaintiff's own materials that listed depression and suicidal thoughts as potential side effects of interferon treatment. The appeals court concluded that “the DOC's requirement that prisoners undergoing interferon treatment submit to psychological evaluation and treatment is a reasonable inclusion in the HCV drug treatment protocol” (Iseley, p 10) and that the Commonwealth cannot be held responsible for Mr. Iseley's unwillingness to comply with a legitimate treatment protocol.

Mr. Iseley argued that while the Commonwealth Defendants were not directly involved with denying him treatment for his other medical conditions, they acted with “deliberate indifference” because they were aware of these conditions and did not act to secure proper treatment for him. The court found this argument unconvincing, saying because the plaintiff was under the care of medical professionals, nonmedical personnel would be justified in believing that he was getting adequate care. Regarding Mr. Iseley's argument that the denial of treatment for his ailments violated the Americans with Disabilities Act (ADA), the court found that there was no violation, writing that Mr. Iseley argued that he was denied medical treatment for his disabilities, which the ADA does not cover. They pointed out that the ADA covers only persons discriminated against based on their disabilities.

Discussion

This case brings up several concerns that are relevant to psychiatrists working in a correctional setting. The plaintiff, working pro se, brought suit claiming that he was denied medical treatment and that such denial constituted cruel and unusual punishment and deliberate indifference. The United States Court of Appeals for the Third Circuit, however, ruled that the prisoner chose to refuse medical care by refusing certain elements of the treatment protocol. Therefore, the plaintiff's cruel and unusual punishment argument against the staff and the allegation that the employees acted with deliberate indifference were thought to be without merit.

The court pointed out that because interferon treatment increases the risk of depression and suicidality, requiring psychological interventions was a “reasonable inclusion” in the treatment protocol. The court's ruling appears to give prison personnel considerable latitude by allowing them to request testing and other adjunct interventions that can be justified as integral to medical treatment.

In this case, psychological elements of the treatment protocol assume a level of importance similar to other medical testing. For example, laboratory testing of white blood cell counts is required when patients are treated with clozapine because of the risk of agranulocytosis. Refusal to submit to such testing precludes treatment with clozapine.

In Iseley v. Beard, the court supported the view that refusal to submit to adjunctive psychological treatment and testing precludes interferon treatment for HCV.