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9.25 Particular Rights—Eighth or Fourteenth Amendment—Prisoner’s Claim re Conditions of Confinement/Medical Care

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This chapter is being reviewed in light of comments solicited by the Committee from the public.


As previously explained, the plaintiff has the burden to prove that the [act[s]] [failure to act] of the defendant [name] deprived the plaintiff of particular rights under the United States Constitution. In this case, the plaintiff alleges the defendant deprived [him] [her] of [his] [her] rights under the [Eighth Amendment] [Fourteenth Amendment] to the Constitution when [insert factual basis of the plaintiff’s claim].

Under the [Eighth Amendment] [Fourteenth Amendment], a prisoner has the right to be free from "cruel and unusual punishments." This includes the right to [specify particular constitutional interest]. In order to prove the defendant deprived the plaintiff of this right, the plaintiff must prove the following additional elements by a preponderance of the evidence:


1. [the plaintiff faced a substantial risk of serious harm] [the plaintiff faced a serious medical need];

2. the defendant was deliberately indifferent to that [risk] [medical need], that is, the defendant knew of it and disregarded it by failing to take reasonable measures to address it; and

3. the [act[s] [failure to act] of the defendant caused harm to the plaintiff.

In determining whether the defendant violated the plaintiff’s rights as alleged, you should give deference to [jail] [prison] officials in the adoption and execution of policies and practices that in their judgment are needed to preserve discipline and to maintain internal security.


Use this instruction only in conjunction with the applicable elements instructions, Instructions 9.3–9.8, and when the plaintiff is either a pretrial detainee or a convicted prisoner and claims defendants’ deliberate indifference to a substantial risk of serious harm or serious medical needs. When a convicted prisoner claims unconstitutional use of force, use Instruction 9.24 (Particular Rights—Eighth Amendment—Prisoner’s Claim of Excessive Force).When a pretrial detainee claims unconstitutional use of force, see Instruction 9.27 (Pretrial Detainee’s Claim of Excessive Force) (Comment only).

The Eighth Amendment imposes duties on prison officials to provide humane conditions of confinement; to ensure that inmates receive adequate food, clothing, shelter, and medical care; and to "take reasonable measures to guarantee the safety of the inmates." Farmer v. Brennan, 511 U.S. 825, 832 (1994) (citing Hudson v. Palmer, 468 U.S. 517, 526–27 (1984)). This also includes a duty to protect prisoners from violence at the hands of other prisoners. Id. (internal quotation marks and citation omitted); see, e.g., Cortez v. Skol, 776 F.3d 1046, 1050-53 (9th Cir.2015) (holding that mother of prisoner who suffered severe brain damage after being attacked by two fellow inmates raised genuine issues on Eighth Amendment § 1983 claim in light of evidence that one prison official escorted three hostile, half-restrained, high-security prisoners through isolated prison passage in contravention of prison policy and practice). A prison official’s "deliberate indifference" to a substantial risk of serious harm to an inmate violates the Eighth Amendment. Farmer, 511 U.S. at 828 (citing Helling v. McKinney, 509 U.S. 25 (1993); Wilson v. Seiter, 501 U.S. 294 (1991); and Estelle v. Gamble, 829 U.S. 97 (1976)). "While Estelle establishes that deliberate indifference entails something more than mere negligence, the cases are also clear that it is satisfied by something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result." Id. at 835.

In Farmer, the Supreme Court held an Eighth Amendment claim based on deliberate indifference must satisfy both an objective and a subjective component test. Farmer, 511 U.S. at 834. 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." Id. at 837. Accord Clement v. Gomez, 298 F.3d 898, 904 (9th Cir.2002) ("The inmates must demonstrate that they were confined under conditions posing a risk of ‘objectively, sufficiently serious’ harm and that the officials had a ‘sufficiently culpable state of mind’ in denying the proper medical care . . . . Thus, there is both an objective and a subjective component to an actionable Eighth Amendment violation.").

The Ninth Circuit has rejected the argument that a plaintiff need only prove the defendant’s constructive knowledge of a substantial risk of serious harm. Harrington v. Scribner, 785 F.3d 1299, 1304 (9th Cir.2015). Similarly, with respect to claims arising under Monell v. Department of Social Services., 436 U.S. 658 (1978), a plaintiff must show the municipality’s actual knowledge of the risk and not merely constructive knowledge. Castro v. Cnty. of L.A., 785 F.3d 336, 354 (9th Cir.2015).

In Estelle v. Gamble, the Supreme Court held a prison official’s deliberate indifference to serious medical needs violates the Eighth Amendment. 427 U.S. at 106. A serious medical need is present, when, for example, the "failure to treat a prisoner’s condition could result in further significant injury or the ‘unnecessary and wanton infliction of pain.’" Clement v. Gomez, 298 F.3d at 904 (citations omitted). In addition, a prisoner who suffered from a cataract in one eye, but did not suffer from pain and retained good vision in the other eye, has a serious medical need for cataract removal surgery because "his monocular blindness caused him physical injury." Colwell v. Bannister, 763 F.3d 1060, 1067 (9th Cir.2014). The Colwell court, when considering whether there was a serious medical need, relied on the indicators set forth in McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir.1992), overruled in part on other grounds by WMX Technologies, Inc. v. Miller, 104 F.3d 1133 (9th Cir.1997) (en banc)). Those indicators are as follows:

The 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 are examples of indications that a prisoner has a "serious" need for medical treatment.

Colwell, 763 F.3d at 1066 (quoting McGuckin, 974 F.2d at 1059–60).

Although the Eighth Amendment also provides a minimum standard for protecting pretrial detainees from conditions of confinement that amount to punishment, claims by pretrial detainees challenging such conditions arise under the Fourteenth Amendment’s Due Process Clause:

In light of the Supreme Court’s rulings that conditions of confinement violate pretrial detainees’ Fourteenth Amendment rights if the conditions amount to punishment, [citing Bell v. Wolfish, 441 U.S. 520, 535 (1979)], and that failure to prevent harm amounts to punishment where detention officials are deliberately indifferent, [citing Farmer v. Brennan,511 U.S. at 834], we have concluded that the "deliberate indifference" standard applies to claims that correction facility officials failed to address the medical needs of pretrial detainees.

Clouthier v. Cnty. of Contra Costa,591 F.3d 1232, 1242 (9th Cir.2010). See also Simmons v. Sacramento Cnty. Super. Ct., 318 F.3d 1156, 1160 (9th Cir.2003). As in the case of pretrial detainees, it would appear that when the plaintiff is detained pursuant to a civil commitment, the Eighth Amendment is not the proper vehicle to challenge the conditions of commitment. Instead, the plaintiff’s rights would be analyzed under the Fourteenth Amendment. See Bell v. Wolfish, 441 U.Sat 535, n.16. ("The Court of Appeals properly relied on the Due Process Clause rather than the Eighth Amendment in considering the claims of pretrial detainees.").

In Norwood v. Vance, 591 F.3d 1062 (9th Cir.2010), the Ninth Circuit held it is error not to instruct a jury to give deference to prison officials’ expert judgments when balancing the need for internal order, discipline and security against prisoners’ rights and privileges. "Prison officials are entitled to deference whether a prisoner challenges excessive force or conditions of confinement." Id. at 1067 (citing Whitley v. Albers, 475 U.S. 312, 322 (1985)). Accordingly, the committee has added language to this instruction based on the "deference" language already included in Instruction 9.24 (Eighth Amendment—Convicted Prisoner’s Claim of Excessive Force). In Norwood, the court suggested the term "deference" need not be defined in an instruction, but if "the district judge believed the term needed further context or definition, he could have provided it." Norwood, 591 F.3d at 1067. The last sentence of the instruction pertaining to deference should not be given in the ordinary Eighth Amendment medical care case. See Chess v. Dovey, 790 F.3d 961, 974 (9th Cir.2015) (holding "that a trial judge may instruct a jury to defer to a policy or practice adopted and implemented by prison officials only when that policy or practice addresses bona fide safety and security concerns, and when there is evidence that the challenged medical decision was made pursuant to that security-based policy or practice").

When a case includes an equal protection claim involving strict scrutiny, a court must be careful in delineating the role of deference. See Harrington, 785 F.3d at 1307. In such a case, deference plays a role in assessing whether the government’s asserted interest is compelling, but deference is not considered in determining whether the defendant’s actions were narrowly tailored to serve that interest. Id. at 1308.

The issue of whether a prison official met his or her duties to an inmate under the Eighth Amendment must be considered in the context of the personnel, financial and other resources available to the official or which he or she could reasonably obtain, at least when the official lacks authority over budgeting decisions. Peralta v. Dillard, 744 F.3d 1076, 1083-84 (9th Cir.2014) (en banc), cert. denied, 135 S.Ct. 946 (2015).