In September, 2012, the MA Department of Corrections was ordered by a federal judge to provide sex-reassignment surgery for a transsexual prison inmate to meet 8th amendment rights to treatment to meet serious medical need. The inmate had been diagnosed with Gender Identity Disorder (GID) and had failed other, more conservative, options such as hormonal therapy and psychotherapy. This court case and the current appeal provide an example of the type of correctional health care cases involving the civil rights of our patients.
More than other nursing specialties, correctional nurses need to understand the legal implications of health care in our delivery environment and the implications for our participation. Our patients not only bring malpractice cases before the courts, they also bring forward civil rights claims based on the 8th and 14th amendments to the constitution. In the landmark 1976 Supreme Court case of Estelle v. Gamble, justices determined that it was a violation of the 8th amendment clause of ‘cruel and unusual punishment’ for correctional health care providers to show ‘deliberate indifference to serious medical needs of prisoners.’ In an earlier post I discussed the concept of ‘deliberate indifference’. This post will take up the issue of ‘serious medical need’ as defined by the courts.
In the judgment of this original case, the concept of serious medical need was not clearly defined. It took several other cases to provide insight into the definition of this concept; in particular, Duran v. Anaya, 1986; Ramos v. Lamm, 1980; Dean v. Coughlin, 1985b. According to civil rights attorney, William J. Rold, these cases define serious medical need as:
- Diagnosed by a physician as mandating treatment
- Obvious enough to even a layperson as needing attention
- Causing pain, discomfort, or threat to good health
- Needing not to be life-threatening
When determining if the defendant was deliberately indifferent to a serious medical need, the courts have also taken into account these factors (again from Rold):
- Is the patient’s condition amenable to treatment: Was there a treatment available that was withheld from the patient?
- Consequences to the patient if they do not receive the treatment: What is the potential mortality or morbidity without the medical care?
- Likelihood of favorable outcome: Will the treatment actually help the patient?
- The patient’s anticipated incarceration: Will the patient be in custody long enough to complete the treatment or need the treatment?
Based on this information, do you agree with the MA court ruling that the patient’s serious medical need was not met without the requested surgery? Share your thoughts about the indicators of serious medical need in the comments section of this post
Photo Credit: © Matthew Benoit – Fotolia.com
dawn says
No this should not be allowed. If this person was not incarcerated he would have to pay for this himself not the taxpayers.
K says
While I have to agree as I would not see this as a serious medical need, it is informative as the law might, especially if there isn’t any legal precedence.
If people are not happy that their tax dollars might pay for a gender reassignment operation because it is not addressed, then it is their obligation to lobby their appointed electorate against it and not blame the people that have to broadly interpret the law to protect the current interpretation.
Marsha says
I was dissapointed to hear this ruling. I don’t believe this is a community standard of care. Would anone’s PPO or HMO prescribe this surgery as a standardized treatment? That is what I wonder about. And the burden it places on prisons as a precedent is outrageous.
I know of plenty of people who would be willing to do a little time, to save that kind of a dime.