CACI 3041 Violation of Prisoner’s Federal Civil Rights—Eighth Amendment—Medical Care (42 U.S.C. § 1983)
California Civil Jury Instructions CACI
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/nonbinary pronoun] with inadequate medical care in violation of [his/her/nonbinary pronoun] 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/nonbinary pronoun] 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/nonbinary pronoun] 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/nonbinary pronoun] or those that [he/she/nonbinary pronoun] could reasonably have obtained. [Name of defendant] is not responsible for services that [he/she/nonbinary pronoun] 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, May 2020
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 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—Eighth Amendment—Deprivation of Necessities.
In prison-conditions cases, the inmate must show that the defendant was deliberately indifferent to the inmate’s 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 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.)
•“Consistent with that concept and the clear connections between mental health treatment and the dignity and welfare of prisoners, the Eighth Amendment’s prohibition against cruel and unusual punishment requires that prisons provide mental health care that meets ‘minimum constitutional requirements.’ When the level of a prison’s mental health care ‘fall[s] below the evolving standards of decency that mark the progress of a maturing society,’ the prison fails to uphold the constitution’s dignitary principles.” (Disability Rights Montana, Inc. v. Batista (9th Cir. 2019) 930 F.3d 1090, 1097, internal citation omitted.)
•“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 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.)
•“Where a plaintiff alleges systemwide deficiencies, ‘policies and practices of statewide and systematic application [that] expose all inmates in [the prison’s] custody to a substantial risk of serious harm,’ we assess the claim through a two-pronged inquiry. The first, objective, prong requires that the plaintiff show that the conditions of the prison pose ‘a substantial risk of serious harm.’ The second, subjective, prong requires that the plaintiff show that a prison official was deliberately indifferent by being ‘aware of the facts from which the inference could be drawn that a substantial risk of serious harm exists,’ and ‘also draw[ing] the inference.’ ” (Disability Rights Montana, Inc., supra, 930 F.3d at p. 1097, internal citations and footnote omitted.)
•“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.)
•“We recognize that prison officials have a ‘better grasp’ of the policies required to operate a correctional facility than either judges or juries. For this reason, in excessive force and conditions of confinement cases, we instruct juries to defer to prison officials’ judgments in adopting and executing policies needed to preserve discipline and maintain security. [¶] Such deference is generally absent from serious medical needs cases, however, where deliberate indifference ‘can typically be established or disproved without the necessity of balancing competing institutional concerns for the safety of prison staff or other inmates.’ ” (Mendiola-Martinez v. Arpaio (9th Cir. 2016) 836 F.3d 1239, 1254, internal citations omitted.)
•“[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 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.)
•“Although claims by pretrial detainees arise under the Fourteenth Amendment and claims by convicted prisoners arise under the Eighth Amendment, our cases do not distinguish among pretrial and postconviction detainees for purposes of the excessive force, conditions of confinement, and medical care deference instructions.” (Shorter v. Baca (9th Cir. 2018) 895 F.3d 1176, 1182, fn. 4.)
•“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.)
•“[C]laims for violations of the right to adequate medical care ‘brought by pretrial detainees against individual defendants under the Fourteenth Amendment’ must be evaluated under an objective deliberate indifference standard. Based thereon, the elements of a pretrial detainee’s medical care claim against an individual defendant under the due process clause of the Fourteenth Amendment are: (i) the defendant made an intentional decision with respect to the conditions under which the plaintiff was confined; (ii) those conditions put the plaintiff at substantial risk of suffering serious harm; (iii) the defendant did not take reasonable available measures to abate that risk, even though a reasonable official in the circumstances would have appreciated the high degree of risk involved—making the consequences of the defendant’s conduct obvious; and (iv) by not taking such measures, the defendant caused the plaintiff’s injuries. ‘With respect to the third element, the defendant’s conduct must be objectively unreasonable, a test that will necessarily “turn[ ] on the facts and circumstances of each particular case.” ’ The ‘ “mere lack of due care by a state official” does not deprive an individual of life, liberty, or property under the Fourteenth Amendment.’ Thus, the plaintiff must ‘prove more than negligence but less than subjective intent—something akin to reckless disregard.’ ” (Gordon v. County of Orange (9th Cir. 2018) 888 F.3d 1118, 1124–1125, internal citations omitted.)
•“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.)