487 U.S. 42 (1988), 87-5096, West v. Atkins

Docket Nº:No. 87-5096
Citation:487 U.S. 42, 108 S.Ct. 2250, 101 L.Ed.2d 40, 56 U.S.L.W. 4664
Party Name:West v. Atkins
Case Date:June 20, 1988
Court:United States Supreme Court

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487 U.S. 42 (1988)

108 S.Ct. 2250, 101 L.Ed.2d 40, 56 U.S.L.W. 4664




No. 87-5096

United States Supreme Court

June 20, 1988

Argued March 28, 1988




Respondent, a private physician under contract with North Carolina to provide orthopedic services at a state prison hospital on a part-time basis, treated petitioner for a leg injury sustained while petitioner was incarcerated in state prison. Petitioner was barred by state law from employing or electing to see a physician of his own choosing. Alleging that he was given inadequate medical treatment, petitioner sued respondent in Federal District Court under 42 U.S.C. § 1983 for violation of his Eighth Amendment right to be free from cruel and unusual punishment, relying on Estelle v. Gamble, 429 U.S. 97. The court entered summary judgment for respondent, holding that, as a "contract physician," respondent was not acting "under color of state law," a jurisdictional prerequisite for a § 1983 action. The Court of Appeals ultimately affirmed.

Held: A physician who is under contract with the State to provide medical services to inmates at a state prison hospital on a part-time basis acts "under color of state law," within the meaning of § 1983, when he treats an inmate. Pp. 48-57.

(a) If a defendant's alleged infringement of the plaintiff's constitutional rights satisfies the state action requirement of the Fourteenth Amendment, the defendant's conduct also constitutes action "under color of state law" for § 1983's purposes, since it is "fairly attributable to the State." Lugar v. Edmondson Oil Co., 457 U.S. 922, 935, 937. Thus, a state employee generally acts under color of state law when, while performing in his official capacity or exercising his official responsibilities, he abuses the position given to him by the State. Polk County v. Dodson, 454 U.S. 312, distinguished. Pp. 49-50.

[108 S.Ct. 2252] (b) The Court of Appeals erred in concluding that defendants are removed from § 1983's purview if they are professionals acting in accordance with professional discretion and judgment, and that professionals may be liable under § 1983 only if exercising custodial or supervisory authority. The court's analogy between respondent and the public defender in Polk County, supra, is unpersuasive. Pp. 50-54.

(c) Respondent's conduct in treating petitioner is fairly attributable to the State. The State has an obligation, under the Eighth Amendment

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and state law, to provide adequate medical care to those whom it has incarcerated. Estelle, supra, at 104; Spicer v. Williamson, 191 N.C. 487, 490, 132 S.E. 291, 293. The State has delegated that function to physicians such as respondent, and defers to their professional judgment. This analysis is not altered by the fact that respondent was paid by contract, and was not on the state payroll, nor by the fact that respondent was not required to work exclusively for the prison. It is the physician's function within the state system, not the precise terms of his employment, that is determinative. Pp. 54-57.

815 F.2d 993, reversed and remanded.

BLACKMUN, J., delivered the opinion of the Court, in which REHNQUIST, C.J., and BRENNAN, WHITE, MARSHALL, STEVENS, O'CONNOR, and KENNEDY, JJ., joined. SCALIA, J., filed an opinion concurring in part and concurring in the judgment, post, p. 58.

BLACKMUN, J., lead opinion

JUSTICE BLACKMUN delivered the opinion of the Court.

This case presents the question whether a physician who is under contract with the State to provide medical services to inmates at a state prison hospital on a part-time basis acts "under color of state law," within the meaning of 42 U.S.C. § 1983, when he treats an inmate.


Petitioner, Quincy West, tore his left Achilles tendon in 1983 while playing volleyball at Odom Correctional Center, the Jackson, N.C., state prison at which he was incarcerated. A physician under contract to provide medical care to Odom inmates examined petitioner and directed that he be

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transferred to Raleigh for orthopedic consultation at Central Prison Hospital, the acute care medical facility operated by the State for its more than 17,500 inmates. Central Prison Hospital has one full-time staff physician, and obtains additional medical assistance under "Contracts for Professional Services" between the State and area physicians.

Respondent, Samuel Atkins, M. D., a private physician, provided orthopedic services to inmates pursuant to one such contract. Under it, Doctor Atkins was paid approximately $52,000 annually to operate two "clinics" each week at Central Prison Hospital, with additional amounts for surgery.1 Over a period of several months, he treated [108 S.Ct. 2253] West's injury by placing his leg in a series of casts. West alleges that, although the doctor acknowledged that surgery would be necessary, he refused to schedule it, and that he eventually discharged West while his ankle was still swollen and painful, and his movement still impeded. Because West was a prisoner in "close custody," he was not free to employ or elect to see a different physician of his own choosing.2

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Pursuant to 42 U.S.C. § 1983,3 West, proceeding pro se, commenced this action against Doctor Atkins4 in the United States District Court for the Eastern District of North Carolina for violation of his Eighth Amendment right to be free from cruel and unusual punishment.5 West alleged that Atkins was deliberately indifferent to his serious medical needs, by failing to provide adequate treatment.

Relying on a decision of its controlling court in Calvert v. Sharp, 748 F.2d 861 (CA4 1984), cert. denied, 471 U.S. 1132 (1985), the District Court granted Doctor Atkins' motion for summary judgment. In Calvert, the Fourth Circuit held that a private orthopedic specialist, employed by a nonprofit professional corporation which provided services under contract to the inmates at the Maryland House of Corrections

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and the Maryland Penitentiary, did not act "under color of state law," a jurisdictional requisite for a § 1983 action. Because Doctor Atkins was a "contract physician," the District Court concluded that he, too, was not acting under color of state law when he treated West's injury. App. 37.

A panel of the United States Court of Appeals for the Fourth Circuit vacated the District Court's judgment. 799 F.2d 923 (1986). Rather than considering if Calvert could be distinguished, the panel remanded the case to the District Court for an assessment whether the record permitted a finding of deliberate indifference to a serious medical need, a showing necessary for West ultimately to prevail on his Eighth Amendment claim. See Estelle v. Gamble, 429 U.S. 97, 104 (1976).

On en banc rehearing, however, a divided Court of Appeals affirmed the District Court's dismissal of West's complaint. 815 F.2d 993 (1987). In declining to overrule its decision in Calvert, the majority concluded:

Thus, the clear and practicable principle enunciated by the Supreme Court [in Polk County v. [Dodson,] 454 U.S. 312 (1981)], and followed in Calvert, is that [108 S.Ct. 2254] a professional, when acting within the bounds of traditional professional discretion and judgment, does not act under color of state law, even where, as in Dodson, the professional is a full-time employee of the state. Where the professional exercises custodial or supervisory authority, which is to say that he is not acting in his professional capacity, then a § 1983 claim can be established, provided the requisite nexus to the state is proved.

815 F.2d at 995 (footnote omitted). The Court of Appeals acknowledged that this rule limits "the range of professionals subject to an Estelle action." Ibid.6

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The dissent in the Court of Appeals offered three grounds for holding that service rendered by a prison doctor -- whether a permanent member of a prison medical staff or under limited contract with the prison -- constitutes action under color of state law for purposes of § 1983. First, the dissent concluded that prison doctors are as much "state actors" as are other prison employees, finding no significant difference between Doctor Atkins and the physician-employees assumed to be state actors in Estelle and in O'Connor v. Donaldson, 422 U.S. 563 (1975). See 815 F.2d at 997-998. Second, the dissent concluded that the "public function" rationale applied because, in the prison context, medical care is within "the exclusive prerogative of the State," in that the State is obligated to provide medical services for its inmates and has complete control over the circumstances and sources of a prisoner's medical treatment. Id. at 998-999, citing Blum v. Yaretsky, 457 U.S. 991, 1011 (1982). Finally, the dissent reasoned that the integral role the prison physician plays within the prison medical system qualifies his actions as under color of state law. 815 F.2d at 999, citing United States v. Price, 383 U.S. 787, 794 (1966) ("[W]illful participant in joint activity with the State or its agents" may be liable under § 1983); Lugar v. Edmondson Oil Co., 457 U.S. 922, 931-932 (1982); and Tower v. Glover, 467 U.S. 914 (1984).

The Fourth Circuit's ruling conflicts with decisions of the Court of Appeals for the Eleventh Circuit, Ancata v. Prison Health Services, Inc., 769 F.2d 700 (1985), and Ort v. Pinchback, 786 F.2d 1105 (1986), which are to the effect that a physician who contracts with the State to provide medical care to prison inmates, even if employed by a private entity, acts under color of state law for purposes of § 1983.7 We

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granted certiorari to resolve the conflict. 484 U.S. 912 (1987).


To state a claim under § 1983, a plaintiff must allege the violation of a right [108 S.Ct. 2255] secured by the Constitution and laws of the United States, and must show that the...

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