California Civil Jury Instructions (CACI) (2017)

3041. Violation of Prisoner’s Federal Civil Rights—Eighth Amendment—Medical Care (42 U.S.C. § 1983)

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3041.Violation of Prisoner’s Federal Civil Rights—Eighth
Amendment—Medical Care (42 U.S.C. § 1983)
[Name of plaintiff] claims that [name of defendant] provided [him/her]
with inadequate medical care in violation of [his/her] constitutional
rights. To establish this claim, [name of plaintiff] must prove all of the
following:
1. That [name of plaintiff] had a serious medical need;
2. That [name of defendant] knew that [name of plaintiff] faced a
substantial risk of serious harm if [his/her] medical need went
untreated;
3. That [name of defendant] consciously disregarded that risk by not
taking reasonable steps to treat [name of plaintiff]’s medical need;
4. That [name of defendant] was acting or purporting to act in the
performance of [his/her] official duties;
5. That [name of plaintiff] was harmed; and
6. That [name of defendant]’s conduct was a substantial factor in
causing [name of plaintiff]’s harm.
A serious medical need exists if the failure to treat a prisoner’s
condition could result in further significant injury or the unnecessary
and pointless infliction of pain.
Neither medical negligence alone, nor a difference of opinion between
medical personnel or between doctor and patient, is enough to establish
a violation of [name of plaintiff]’s constitutional rights.
[In determining whether [name of defendant] consciously disregarded a
substantial risk, you should consider the personnel, financial, and other
resources available to [him/her] or those that [he/she] could reasonably
have obtained. [Name of defendant] is not responsible for services that
[he/she] could not provide or cause to be provided because the necessary
personnel, financial, and other resources were not available or could not
be reasonably obtained.]
New September 2003; Revised December 2010; Renumbered from CACI No. 3012
December 2012; Revised June 2014, December 2014, June 2015
Directions for Use
Give this instruction in a case involving the deprivation of medical care to a
prisoner. For an instruction on the creation of a substantial risk of serious harm, see
CACI No. 3040, Violation of Prisoner’s Federal Civil Rights—Eighth
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0059
Amendment—Substantial Risk of Serious Harm. For an instruction involving the
deprivation of necessities, see CACI No. 3043, Violation of Prisoner’s Federal
Civil Rights—Eight Amendment—Deprivation of Necessities.
In prison-conditions cases, the inmate must show that the defendant was
deliberately indifferent to his or her health or safety. In a medical-needs case,
deliberate indifference requires that the prison officials have known of and
disregarded an excessive risk to the inmate’s health or safety. Negligence is not
enough. (Farmer v. Brennan (1994) 511 U.S. 825, 834–837 [114 S.Ct. 1970, 128
L.Ed.2d 811].) Elements 2 and 3 express deliberate indifference.
The “official duties” referred to in element 3 must be duties created by a state,
county, or municipal law, ordinance, or regulation. This aspect of color of law most
likely will not be an issue for the jury, so it has been omitted to shorten the
wording of element 3.
The Ninth Circuit has held that in considering whether an individual prison medical
provider was deliberately indifferent, the jury should be instructed to consider the
economic resources made available to the prison health care system. (See Peralta v.
Dillard (9th Cir. 2014) 744 F.3d 1076, 1084 [en banc].) Although this holding is
not binding on California courts, the last optional paragraph may be given if the
defendant has presented evidence of lack of economic resources and the court
decides that this defense should be presented to the jury.
Sources and Authority
• Deprivation of Civil Rights. Title 42 United States Code section 1983.
“[D]eliberate indifference to serious medical needs of prisoners constitutes the
‘unnecessary and wanton infliction of pain,’ proscribed by the Eighth
Amendment. This is true whether the indifference is manifested by prison
doctors in their response to the prisoner’s needs or by prison guards in
intentionally denying or delaying access to medical care or intentionally
interfering with the treatment once prescribed. Regardless of how evidenced,
deliberate indifference to a prisoner’s serious illness or injury states a cause of
action under section 1983.” (Estelle v. Gamble (1976) 429 U.S. 97, 104–105
[97 S.Ct. 285, 50 L.Ed.2d 251], internal citation and footnotes omitted.)
• “Our cases have held that a prison official violates the Eighth Amendment only
when two requirements are met. First, the deprivation alleged must be,
objectively, ‘sufficiently serious.’ For a claim . . . based on a failure to prevent
harm, the inmate must show that he is incarcerated under conditions posing a
substantial risk of serious harm. The second requirement follows from the
principle that ‘only the unnecessary and wanton infliction of pain implicates the
Eighth Amendment.’ To violate the Cruel and Unusual Punishments Clause, a
prison official must have a ‘sufficiently culpable state of mind.’ In prison-
conditions cases that state of mind is one of ‘deliberate indifference’ to inmate
health or safety . . . .” (Farmer, supra, 511 U.S. at p. 834, internal citations
omitted.)
• “ ‘To set forth a constitutional claim under the Eighth Amendment predicated
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upon the failure to provide medical treatment, first the plaintiff must show a
serious medical need by demonstrating that failure to treat a prisoner’s
condition could result in further significant injury or the unnecessary and
wanton infliction of pain. Second, a plaintiff must show the defendant’s
response to the need was deliberately indifferent.’ The ‘deliberate indifference’
prong requires ‘(a) a purposeful act or failure to respond to a prisoner’s pain or
possible medical need, and (b) harm caused by the indifference.’ ‘Indifference
may appear when prison officials deny, delay or intentionally interfere with
medical treatment, or it may be shown in the way in which prison [officials]
provide medical care.’ ‘[T]he indifference to [a prisoner’s] medical needs must
be substantial. Mere “indifference,” “negligence,” or “medical malpractice” will
not support this [claim].’ Even gross negligence is insufficient to establish
deliberate indifference to serious medical needs.” (Lemire v. Cal. Dep’t of Corr.
& Rehab. (9th Cir. 2013) 726 F.3d 1062, 1081–1082, internal citations omitted.)
• “Indications that a plaintiff has a serious medical need include ‘[t]he existence
of an injury that a reasonable doctor or patient would find important and worthy
of comment or treatment; the presence of a medical condition that significantly
affects an individual’s daily activities; or the existence of chronic and
substantial pain.’ ” (Colwell v. Bannister (9th Cir. 2014) 763 F.3d 1060, 1066.)
• “We hold . . . that a prison official cannot be found liable under the Eighth
Amendment for denying an inmate humane conditions of confinement unless
the official knows of and disregards an excessive risk to inmate health or safety;
the official must both be aware of facts from which the inference could be
drawn that a substantial risk of serious harm exists, and he must also draw the
inference.” (Farmer, supra, 511 U.S. at p. 837.)
• “The subjective standard of deliberate indifference requires ‘more than ordinary
lack of due care for the prisoner’s interests or safety.’ The state of mind for
deliberate indifference is subjective recklessness. But the standard is ‘less
stringent in cases involving a prisoner’s medical needs . . . because “the State’s
responsibility to provide inmates with medical care ordinarily does not conflict
with competing administrative concerns.” ’ ” (Snow v. McDaniel (9th Cir. 2012)
681 F.3d 978, 985, internal citations omitted.)
• “[D]eliberate indifference ‘may appear when prison officials deny, delay or
intentionally interfere with medical treatment, or it may be shown by the way in
which prison physicians provide medical care.’ . . . . ‘[A] prisoner need not
show his harm was substantial.’ ” (Wilhelm v. Rotman (9th Cir. 2012) 680 F.3d
1113, 1122, internal citation omitted.)
• “[A]llegations that a prison official has ignored the instructions of a prisoner’s
treating physician are sufficient to state a claim for deliberate indifference.”
(Wakefield v. Thompson (9th Cir. 1999) 177 F.3d 1160, 1165.)
• “[A] complaint that a physician has been negligent in diagnosing or treating a
medical condition does not state a valid claim of medical mistreatment under
the Eighth Amendment. Medical malpractice does not become a constitutional
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violation merely because the victim is a prisoner.” (Estelle, supra, 429 U.S. at
p. 106.)
• “ ‘A difference of opinion between a physician and the prisoner—or between
medical professionals—concerning what medical care is appropriate does not
amount to deliberate indifference.’ Rather, ‘[t]o show deliberate indifference, the
plaintiff “must show that the course of treatment the doctors chose was
medically unacceptable under the circumstances” and that the defendants “chose
this course in conscious disregard of an excessive risk to plaintiff’s health.” ’ ”
(Colwell, supra, 763 F.3d at p. 1068.)
• “It has been recognized . . . that inadequate medical treatment may, in some
instances, constitute a violation of 42 United States Code section 1983. In Sturts
v. City of Philadelphia, for example, the plaintiff alleged that defendants acted
‘carelessly, recklessly and negligently’ when they failed to remove sutures from
his eye, neck and face. The court concluded that although plaintiff was alleging
inadequate medical treatment, he had stated a cause of action under section
1983: ‘. . . where a prisoner has received some medical attention and the
dispute is over the adequacy of the treatment, federal courts are generally
reluctant to second guess medical judgments. In some cases, however, the
medical attention rendered may be so woefully inadequate as to amount to no
treatment at all, thereby rising to the level of a § 1983 claim. . . .’ ” (Ochoa v.
Superior Court (1985) 39 Cal.3d 159, 176–177 [216 Cal.Rptr. 661, 703 P.2d 1],
internal citations omitted.)
• “Because society does not expect that prisoners will have unqualified access to
health care, deliberate indifference to medical needs amounts to an Eighth
Amendment violation only if those needs are ‘serious.’ ” (Hudson v. McMillian
(1992) 503 U.S. 1, 9 [112 S.Ct. 995, 117 L.Ed.2d 156], internal citation
omitted.)
• “[T]here is a two-pronged test for evaluating a claim for deliberate indifference
to a serious medical need: First, the plaintiff must show a serious medical need
by demonstrating that failure to treat a prisoner’s condition could result in
further significant injury or the unnecessary and wanton infliction of pain.
Second, the plaintiff must show the defendant’s response to the need was
deliberately indifferent. This second prong . . . is satisfied by showing (a) a
purposeful act or failure to respond to a prisoner’s pain or possible medical
need and (b) harm caused by the indifference.” (Akhtar v. Mesa (9th Cir. 2012)
698 F.3d 1202, 1213.)
• “A prison medical official who fails to provide needed treatment because he
lacks the necessary resources can hardly be said to have intended to punish the
inmate. The challenged instruction properly advised the jury to consider the
resources [defendant] had available in determining whether he was deliberately
indifferent.” (Peralta,supra, 744 F.3d at p. 1084.)
• “[T]rial judges in prison medical care cases should not instruct jurors to defer to
the adoption and implementation of security-based prison policies, unless a
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party’s presentation of the case draws a plausible connection between a
security-based policy or practice and the challenged medical care decision.”
(Chess v. Dovey (9th Cir. 2015) 790 F.3d 961, 962.)
• “We now turn to the second prong of the inquiry, whether the defendants were
deliberately indifferent. This is not a case in which there is a difference of
medical opinion about which treatment is best for a particular patient. Nor is
this a case of ordinary medical mistake or negligence. Rather, the evidence is
undisputed that [plaintiff] was denied treatment for his monocular blindness
solely because of an administrative policy, even in the face of medical
recommendations to the contrary. A reasonable jury could find that [plaintiff]
was denied surgery, not because it wasn’t medically indicated, not because his
condition was misdiagnosed, not because the surgery wouldn’t have helped him,
but because the policy of the [defendant] is to require an inmate to endure
reversible blindness in one eye if he can still see out of the other. This is the
very definition of deliberate indifference.” (Colwell, supra, 763 F.3d at p. 1068.)
• “A ‘serious’ medical need exists if the failure to treat a prisoner’s condition
could result in further significant injury or the ‘unnecessary and wanton
infliction of pain.’ The ‘routine discomfort’ that results from incarceration and
which is ‘part of the penalty that criminal offenders pay for their offenses
against society’ does not constitute a ‘serious’ medical need.” (Doty v. County of
Lassen (9th Cir. 1994) 37 F.3d 540, 546, internal citations and footnote
omitted.)
• “The Supreme Court has interpreted the phrase ‘under “color” of law’ to mean
‘under “pretense” of law.’ A police officer’s actions are under pretense of law
only if they are ‘in some way “related to the performance of his official
duties.” ’ By contrast, an officer who is ‘ “pursuing his own goals and is not in
any way subject to control by [his public employer],” ’ does not act under color
of law, unless he ‘purports or pretends’ to do so. Officers who engage in
confrontations for personal reasons unrelated to law enforcement, and do not
‘purport[] or pretend[]’ to be officers, do not act under color of law.” (Huffman
v. County of Los Angeles (9th Cir. 1998) 147 F.3d 1054, 1058, internal citations
omitted.)
Secondary Sources
3 Witkin, California Criminal Law (4th ed. 2012) Punishment, § 244
8Witkin, Summary of California Law (10th ed. 2005) Constitutional Law, § 826
Schwarzer, et al., California Practice Guide: Federal Civil Procedure Before Trial,
Ch. 2E-10, Special Jurisdictional Limitations—Eleventh Amendment As Limitation
On Actions Against States, ¶ 2:4923 (The Rutter Group)
3 Civil Rights Actions, Ch. 11, Deprivation of Rights Under Color of State
Law—Prisons, ¶ 11.09 (Matthew Bender)
11 California Forms of Pleading and Practice, Ch. 114, Civil Rights: Prisoners’
Rights, § 114.15 (Matthew Bender)
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19A California Points and Authorities, Ch. 196, Public Entities, § 196.183
(Matthew Bender)
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