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Standard for Deliberate Indifference to Inmate Safety and Medical Needs

Ciara N. Cannoy, Brie Pileggi and Jacob X. Chavez
Journal of the American Academy of Psychiatry and the Law Online June 2024, 52 (2) 262-264; DOI: https://doi.org/10.29158/JAAPL.240030-24
Ciara N. Cannoy
Fellow in Forensic Psychology
PhD
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Brie Pileggi
Forensic Psychologist
PsyD, LP
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Jacob X. Chavez
Forensic Psychology Fellowship Director and Forensic PsychologistForensic Psychology DepartmentDirect Care and Treatment Forensic ServicesMinnesota Department of Human ServicesSt. Peter, Minnesota
PsyD, LP
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  • deliberate indifference
  • qualified immunity
  • inmate safety
  • failure to protect
  • civil rights

Prison Employees Are Protected by Qualified Immunity When Making Minimal but Good-Faith Efforts to Protect Inmate Safety and Medical Needs

In King v. Riley, 76 F.4th 259 (4th Cir. 2023), three deliberate indifference claims were raised following the murders of four inmates by two fellow prisoners. The Fourth Circuit Court of Appeals ruled there was no constitutional right for properly conducted security checks, nor were prison officials required to deliver medical services in an emergency if they attempted to obtain services. The court determined prison officials were entitled to qualified immunity.

Facts of the Case

John King was an inmate housed on the Immediate Care Services Unit (ICSU), a mental health ward of the Kirkland Correctional Facility in South Carolina. The unit held inmates with significant mental health difficulties that did not rise to the level of inpatient hospitalization. Inmates were employed as janitors, known as ward keepers. Ward keepers were recommended by mental health counselors and granted special privileges such as unit access and allowing peers in their cells.

In April 2017, two head ward keepers, Jacob Philip and Denver Simmons, lured Mr. King into Mr. Simmons’s cell, strangled him, placed his body beneath the bed, and murdered three other inmates over the course of two and a half hours. On duty was Sergeant DeWaun McKan, who was required to conduct 30-minute security checks. He completed security checks but did not look inside the cells, despite training to do so. Thus, the murders went uninterrupted and undiscovered. Afterward, Mr. Philip and Mr. Simmons approached an administration building and suggested officers look in Mr. Simmons’s cell. Sergeant McKan and Officer Damien Jones discovered the four bodies. Medical aid was requested but not personally administered.

Mr. King’s estate sued Sergeant McKan and Officer Jones, their supervisors, and the warden and associate wardens at Kirkland, alleging correctional staff showed deliberate indifference to Mr. King’s safety and need for medical intervention, violating his Eighth Amendment rights. Three deliberate indifference claims were raised. First, Sergeant McKan was deliberately indifferent to Mr. King’s safety by failing to complete proper security checks. Second, Officer Jones and Sergeant McKan showed deliberate indifference to Mr. King’s medical needs by requesting medical personnel but not personally administering care. Third, their immediate and extended supervisors were deliberately indifferent to Mr. King’s safety under a theory of supervisory liability. The magistrate judge held the defendants were not deliberately indifferent and had qualified immunity on the three claims. Mr. King’s estate appealed, and the matter was brought before the Fourth Circuit Court of Appeals.

Ruling and Reasoning

Unless an official knowingly violated the Eighth Amendment, the official would be entitled to a two-pronged qualified immunity analysis when a deliberate indifference claim is raised. The two prongs are objective and subjective as articulated in Farmer v. Brennan, 511 U.S. 825 (1994). A significant risk of harm must be demonstrated to satisfy the objective prong. The subjective prong is concerned with whether prison officials were aware of the substantial risk and understood their response was insufficient. Thus, even if a prison official knew of the risk of harm, if the response was reasonable, the official cannot be held liable.

Regarding the first claim of deliberate indifference concerning failure to protect, Mr. King’s estate asserted Sergeant McKan’s conduct was constitutionally deficient because, despite allegedly knowing about the risk of inter-inmate violence, he did not visually inspect cells during rounds. The court noted that government workers who are sued as individuals are protected by qualified immunity. To surmount qualified immunity, a complainant must show a statutory or constitutional right was violated and that right was indisputable during the alleged incident. The Fourth Circuit determined there was no constitutional right dictating that Sergeant McKan look inside cells to reduce the risk of violence. Further, while Sergeant McKan was trained to look inside cells during security rounds, there was no institutional policy requiring this practice. Regardless, qualified immunity is concerned with the violations of “clearly established constitutional law” (King, p 268) not prison policy. Thus, Sergeant McKan was protected by qualified immunity.

Regarding the second claim related to medical needs, Mr. King’s estate referenced four cases from other jurisdictions where prison officials were found deliberately indifferent for failing to provide first aid to unconscious or dead prisoners. They proposed these cases constituted a consensus that failure to provide medical aid was unconstitutional. The Fourth Circuit disagreed. Regarding the cases referenced, the court stated two of the cases were concerned with total failure to act, which is distinguishable from Mr. King’s estate’s claims. While the other two cases were similar to Mr. King’s, the court stated two cases from other jurisdictions did not constitute consensus. The court ruled Sergeant McKan and Officer Jones put forth good-faith efforts to obtain medical assistance, thus negating deliberate indifference. Again, the officers did not violate a clearly established right and were thus entitled to qualified immunity.

Regarding the third claim connected to supervisory liability, Mr. King’s estate alleged the officer’s immediate supervisor, warden, and associate wardens all showed deliberate indifference within their supervisory roles. In Ashcroft v. Iqbal, 556 U.S. 662 (2009), the Supreme Court ruled government officials are only liable for their own misconduct, not for the unconstitutional conduct of their subordinates. Because the complaint did not contain specific allegations of each individual supervisor’s conduct, this claim was rejected. On all three deliberate indifference claims, the Fourth Circuit affirmed the summary judgment rulings.

Dissent

Regarding the failure-to-protect claim, the dissenting judge asserted Sergeant McKan knowingly failed to protect prisoners from inter-inmate violence and should not be entitled to qualified immunity. He said prison officials knew the nature of serious psychological problems experienced by inmates on the ICSU and that intensive monitoring was required by prison policy. Based on the nature of the unit and the prior violent offenses committed by the ward keepers involved, the dissent argued sufficient evidence existed to establish officials were aware of the risk of harm because of its obvious nature. Because Sergeant McKan admitted to knowingly conducting improper security checks, the dissent argued he was at minimum subjectively aware his actions were inadequate considering the risk. The majority was further criticized for not providing additional guidance regarding what would constitute an Eighth Amendment violation upon a prison official’s dereliction of duty and for presenting officials with a future liability avoidance blueprint.

Discussion

The current case repeatedly refers to Farmer v. Brennan. In Farmer, the Supreme Court said that for a violation of an inmate’s Eighth Amendment rights to have occurred, prison officials must be deliberately indifferent to the conditions of incarceration, which pose a substantial risk of serious harm. Second, there must be evidence of a prison official’s knowledge of the risk, which the Court indicated need not require that the prison employee believed harm would come to an inmate based on their action or inaction. Rather, it is enough for prison officials to have knowledge of the risk of serious harm and disregard that risk to be held accountable for their action or inaction. In King, the Fourth Circuit concluded that no claims met the standard for deliberate indifference, because of the failure to establish a constitutional right violation. Thus, Sergeant McKan and Officer Jones were protected by qualified immunity. This doctrine can afford government officials performing discretionary duties immunity from individual lawsuits when damage occurs.

In correctional settings, regardless of one’s specific discipline, employees are correctional officers first and are thus responsible for maintaining the safety and security of the institution (Federal Mediation and Conciliation Services, In the Matter of the Arbitration between American Federation of Government Employees, Council of Prisons Locals Union and U.S. Department of Justice Federal Bureau of Prisons Employer, Opinion and Award, 2017). While conducting security checks may not typically fall under the purview of all correctional employees, the matter of deliberate indifference to medical needs is worth consideration. It is necessary for all correctional employees to consider the unique, environment-specific needs of a correctional setting, while maintaining awareness of their discipline-specific ethics. Individuals working within specific disciplines, such as medical personnel, psychologists, and social workers, may be called upon to provide some degree of medical care in a situation like the current case. For physicians, this is consistent with the American Medical Association (AMA) Code of Medical Ethics, which indicates that physicians can largely choose their patients and place of care except in emergencies. (American Medical Association. AMA principles of medical ethics. Opinion 1.1.2. 2016). It is important for all correctional employees, though, to consider personal safety as well as the safety and security of the facility. The findings in King indicate, at least within the Fourth Circuit’s jurisdiction, that employees who make a good-faith effort to obtain medical assistance in an emergency will be protected by qualified immunity even if medical care is not personally delivered.

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Journal of the American Academy of Psychiatry and the Law Online: 52 (2)
Journal of the American Academy of Psychiatry and the Law Online
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1 Jun 2024
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Standard for Deliberate Indifference to Inmate Safety and Medical Needs
Ciara N. Cannoy, Brie Pileggi, Jacob X. Chavez
Journal of the American Academy of Psychiatry and the Law Online Jun 2024, 52 (2) 262-264; DOI: 10.29158/JAAPL.240030-24

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Standard for Deliberate Indifference to Inmate Safety and Medical Needs
Ciara N. Cannoy, Brie Pileggi, Jacob X. Chavez
Journal of the American Academy of Psychiatry and the Law Online Jun 2024, 52 (2) 262-264; DOI: 10.29158/JAAPL.240030-24
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