the end result, the total health care made available to and received by the plaintiff class which is subject to constitutional scrutiny by this court. 437 F.Supp. at 315. In determining the adequacy of the system, it appears that there are no set formulas which may be used. The courts which have ordered additional medical staff have not relied upon the ratios of staff to inmates, which, unlike here, were sometimes truly shocking. Instead, the underlying concept is that inmates are entitled to qualified medical coverage at all times, sufficient to meet both their routine and emergency health care needs. 437 F.Supp. at 312. The court was influenced by the following factors in concluding that the medical system was inadequate: [N]evertheless, plaintiffs have 437 F.Supp. at 312. A claim is stated for relief when a series of incidents closely related in time cumulatively show a pattern of deliberate indifference to medical needs, Bishop v. Stoneman, 508 F.2d 1224 (2d Cir. 1974), and when the prison's system of medical care is so inadequate that it causes unwarranted suffering, Cruz v. Ward, 558 F.2d 658 (2d Cir. 1977), cert. denied. 153 Constitutional standards are violated when persons with contagious or communicable diseases are incarcerated without medical attention with other inmates. There is also a constitutional right to be confined in an environment which does not threaten mental or physical well-being. Battle v. Anderson, 564 F.2d 388 (10th Cir. 1977). In Williams v. Edwards, 547 F.2d 1206 (5th Cir. 1977), the court of appeals found no error in the district court's determination that medical care in the state penitentiary violated constitutional rights. Most of the medical system was staffed by inmates who served as x-ray attendant, emergency room attendant, physician assistant, lab assistant, and physical therapy assistant. Two-thirds of these inmates had only an eighth grade education; none had formal medical training; and some could barely read and write. No adequate supervision was maintained, and narcotics were freely dispensed without adequate record keeping. 547 F.2d at 1216. The injunctive relief ordered by the district court was found to be valid and not barred by the Eleventh Amendment, even though compliance would require expenditure of state funds. Improvements in the medical system were affirmed on appeal in Todaro v. Ward, 565 F.2d 48 (2d Cir. 1977). Female prison inmates alleged denial of access to medical care by arbitrary procedures and misadministration. The district court found that the nurse responsible for initial screening and dispensing medicine spent only fifteen to twenty seconds with each patient, barely sufficient time for her to describe her symptoms. A delay of two weeks to two months in seeing a physician meant inmates suffered unnecessary pain. Patients in the sick wing were often placed in locked rooms. The nearest officer could close a solid door which prevented observation of sick patients and made it impossible to hear cries for help. Poor record keeping caused substantial delays in medically ordered follow-up 153. See also Todaro v. Ward, 565 F.2d 48 (2d Cir. 1977). appointments and diagnostic procedures. Repeated noncompliance with medical orders resulted in the failure to properly treat illnesses. The court recognized: [W]hile a single instance of 565 F.2d at 52. The court further noted: Not all medical systems complained of have been found to be constitutionally infirm. Lack of thorough intake exams for pretrial detainees was found not to be cruel or unusual punishment in Collins v. Schoonfield, 344 F. Supp. 257 (D. Md. 1972). A medical staff consisting of a medical doctor and nurses with semi-weekly sick call and facilities for emergency care was found adequate. Chapman v. Rhodes, 434 F. Supp. 1007 (S.D. Ohio 1977). Six inmates who alleged particular prisoners were denied medical care on particular occasions did not sufficiently show deliberate indifference. Cotton v. Hutto, 540 F.2d 412 (8th Cir. 1976). Adequate medical services in the segregated confinement area were provided by two medical technicians who visited the cell block three times each day. Sweet v. South Carolina Department of Corrections, 529 F.2d 854 (4th Cir. 1975). Noting that some essential medical care must be available for inmates, although there is not any consensus as to the precise amount, Coxson v. Godwin, 405 F. Supp. 1099, 1101 (W. D. Va. 1975) found that the following allegations were insufficient: (1) Doctor assigned to the unit will not examine inmates after certain hours on Monday and Thursday. (2) No sick room for recovery from illness. (3) No nurse on duty. (4) Certain non-prescription drugs are not stocked. (5) Twenty to thirty minute wait before obtaining medication. (6) No night emergency facilities. 154 The requirements for preliminary injunctive relief were not sufficiently established in Tate v. Kassulke, 409 F.Supp. 651 (W.D. Ky. 1976). There the court found the jail maintained a sick call, available to all inmates, which was staffed by paramedics, practical nurse, and a military medic. The jail furnished at least one doctor each day and a psychiatrist and dentist one day per week. Although specific instances of denial of medical treatment were alleged by inmates, the court found that the records indicated the inmates were referred to a physician, and found testimony of the prisoner witnesses to be biased. The Tentative Draft of Standards Relating to the Legal Status of Prisoners 155 recommends that each 154. See Owens-El v. Robinson, 442 F.Supp. 1368, 1385, 1390 (W.D. Pa. 1978) (no claim stated by allegation that no nurses or physicians were available after midnight but absence of nurses trained in psychiatric care creates problems). 155. 14 American Criminal Law Review 387, 466-72 (1977). institution should have an adequate plan to insure immediate emergency treatment; to permit transfer of those who cannot be adequately treated at the correctional institution; to prevent a correctional official from denying or interfering with medical treatment; that upon request a prisoner will be seen by a licensed health care provider within twenty-four hours; that prisoners need not waive a right or privilege in order to secure medical treatment. These standards also advocate periodic medical exams, intake exam for communicable diseases or emergency care, a thorough medical exam within forty-eight hours of admission, and thorough medical exams periodically and prior to release. f. Dental and Psychiatric Care Nearly all cases recognize the rights of a prisoner to adequate dental care; however, the most recent trend is the widespread recognition of the right to psychiatric treatment. In Stokes v. Hurdle, 393 F.Supp. 757 (D. Md. 1975), plaintiff alleged that routine dental treatment was denied to inmates in segregation. The policy of the institution to perform only emergency work on inmates in segregation. The court recognized the right to dental treatment, but noted that for the claim to reach constitutional dimensions, a total denial of necessary treatment or substantial harm was necessary. 156 A convicted child molester sought a writ of habeas corpus in Fielding v. LeFevre, 548 F.2d 1102 (2d Cir. 1977). Plaintiff, who had undergone extenseive psychotherapy before trial, claimed that imprisonment would cause him to regress. He alleged that continuing psychiatric treatment was essential to maintaining his cure and that it would be impossible to receive this care in prison. The court, after noting that a section 1983 action and not habeas corpus was proper, stated that while the psychiatric care offered in the prison was not of the same quality that plaintiff now received, it did not constitute a constitutional violation. In Vinnedge v. Gibbs, 550 F.2d 926 (4th Cir. 1977), plaintiff complained that he was not granted psychiatric 156. See also Blakey v. Sheriff of Albemarle County, 370 F.Supp. 814 (W.D. Va. 1974). |