Todaro v. Ward

• Decision Date: 31 October 1977
• Docket Number: D,No. 337,337
• Citation: 565 F.2d 48
• Parties: Louise TODARO, Ernestine Davis, Deidra Plair, Phyllis Klippel, Sylvia Davis, Cleo Bacon, Iris Capella, Naomi Bostick, Mary Reed, Alice Taver, Carol Lewin, Tammy Goldston, Margaret Gatling, Tonya Jackson, Tracye Craig, Beverly Massey, Carmen Garcia, Helen LaVore, Gloria Taggart, Marta Hardee, Althea McDaniel, Ruth Dobson, Madeline Pineda, Judy Wheat, Bernadette Brown, and Evelyn Thorpe, on behalf of themselves and all other persons similarly situated, Plaintiffs- Appellees, v. Benjamin WARD, Commissioner of the New York State Department of Correctional Services, Ian Loudon, Assistant Commissioner for Health Services of the New York State Department of Correctional Services, David Frost, Southern Regional Director of Health Services of the New York State Department of Correctional Services, Frances Clement, Superintendent of Bedford Hills Correctional Facility, Henry Williams, Health Services Director of Bedford Hills Correctional Facility, Robert Tschorn, Surgical Consultant at Bedford Hills Correctional Facility, and Marie Daly, Nurse Administrator at Bedford Hills Correctional Facility, Individually and in their official capacities, Defendants-Appellants. ocket 77-2095.
• Court: U.S. Court of Appeals — Second Circuit

Page 48

565 F.2d 48

Louise TODARO, Ernestine Davis, Deidra Plair, Phyllis Klippel, Sylvia Davis, Cleo Bacon, Iris Capella, Naomi Bostick, Mary Reed, Alice Taver, Carol Lewin, Tammy Goldston, Margaret Gatling, Tonya Jackson, Tracye Craig Beverly Massey, Carmen Garcia, Helen LaVore, Gloria Taggart Marta Hardee, Althea McDaniel, Ruth Dobson, Madeline Pineda Judy Wheat, Bernadette Brown, and Evelyn Thorpe, on behalf of themselves and all other persons similarly situated Plaintiffs- Appellees, v. Benjamin WARD, Commissioner of the New York State Department of Correctional Services, Ian Loudon, Assistant Commissioner for Health Services of the New York State Department of Correctional Services, David Frost, Southern Regional Director of Health Services of the New York State Department of Correctional Services, Frances Clement, Superintendent of Bedford Hills Correctional Facility, Henry Williams, Health Services Director of Bedford Hills Correctional Facility, Robert Tschorn, Surgical Consultant at Bedford Hills Correctional Facility, and Marie Daly, Nurse Administrator at Bedford Hills Correctional Facility, Individually and in their official capacities, Defendants-Appellants.

No. 337, Docket 77-2095.

United States Court of Appeals, Second Circuit.

Argued Oct. 6, 1977.

Decided Oct. 31, 1977.

Arlene R. Silverman, Asst. Atty. Gen. of the State of New York, New York City (Louis J. Lefkowitz, Atty. Gen. of the State of New York, Samuel A. Hirshowitz, First Asst. Atty. Gen. of the State of New York, New York City), for defendants-appellants.

Eric Neisser, New York City (William E. Hellerstein, Ellen J. Winner, The Legal Aid Society Prisoners' Rights Project, New York City), for plaintiffs-appellees.

Before KAUFMAN, Chief Judge, GURFEIN and MESKILL, Circuit Judges.

KAUFMAN, Chief Judge:

The sad often desperate plight of many incarcerated in our nation's prisons is most dramatically revealed by the all too frequent petitions of inmates who have been denied access to basic medical services.

It is too late in the day to argue that penal incarceration reduces an individual's humanity. Although the public may only become aware of the demeaning reality of prison life when frustrations explode into riot, it is important to accord the basic amenities of human existence to those whom we expect one day will assume a productive role in society. The evolving standards of decency embodied by the Eighth Amendment have been refined in response to these vital needs, and courts have critically scrutinized alleged deprivations suffered by the incarcerated beyond those inherent in the very structure of prison life. When inhuman or barbaric conditions are discovered, judges will not hesitate to enter the breach and order remedial measures.

In the instant case we are called upon to decide, as have other courts in recent years, whether several important aspects of a correctional institution's overall health care system meet constitutional requirements. We agree with the able district judge that they do not. While the physician staff and physical facilities at the Bedford Hills Correctional Facility may be adequate, all too often an inmate in need of treatment has been denied access to medical help by arbitrary procedures and misadministration so gross that it must be deemed willful. Faced with this deliberate denial of basic health care, we have little difficulty affirming the moderate remedial measures ordered by the district court.

I.

The facts are set out in great detail in the district judge's thorough opinion. ¹ Accordingly, we need review them only briefly.

Bedford Hills is a medium security facility confining the approximately 380 female prisoners committed to the custody of the New York Department of Corrections. At the time of trial in January and February 1976, the medical staff at Bedford Hills consisted of one full-time physician, the prison's Health Services Director, Dr. Henry D. Williams, one part-time gynecologist, and four outside consultants who, in combination, practiced general medicine at the prison clinic three hours a day, six days a week. In addition, dermatology, neurology, podiatry, and optometry clinics were held on an irregular basis several times a year. Hospital services were provided by community facilities near the prison.

The existence of this structure for the administration of health care was of little avail to many prisoners for, as Judge Ward noted, certain procedures employed by the appellants significantly impeded inmate access to medical services at Bedford Hills and caused doctor-prescribed treatments and tests not to be administered promptly. As a result, essential medical services were denied, or unreasonably delayed and inmates forced to suffer needless pain. For the sake of clarity we will briefly outline the prison's major deficiencies.

1. The Lobby Clinic

Of the many hurdles confronting an inmate seeking adequate medical care, the first, almost insuperable, obstacle stood at the point of intake, in the operation of the "lobby clinic," a screening device which inmates must use to secure an appointment with a physician. During the clinic's one-hour sessions, held twice daily in one of the prison's residence halls, a single nurse both listened to requests for care and dispensed medication. Since she was locked in a small room to prevent the theft of drugs, the nurse's contact with the many inmates seeking help was minimal, no more than a cursory glance from inside a locked and barred cashier's window. This procedure, of course, precluded any opportunity for a physical examination to determine the nature and extent of the patient's ailment. Moreover, the trial court estimated that the nurse spent an average of only 15 to 20 seconds with each prisoner. During that brief span hardly time for the inmate to even describe her ailment the nurse made cryptic notes of complaints (e. g., "throat," "stomach"), which were later transmitted to another nurse who, on the basis of this scanty record, assigned priorities in scheduling appointments with doctors.

Appellees' experts testified that these screening procedures, the gateway to all medical services at Bedford Hills, did not even approach the barest minimum standard of effectiveness. Yet neither Dr. David Frost, the regional Director of Health Services for the Department of Corrections, nor Dr. Williams were sufficiently concerned about its efficacy to observe the clinic in operation.

The effects of the screening procedure were, on occasion, devastating. Analysis of the medical records in evidence and the testimony of five inmate witnesses revealed that delays of two weeks to two months in achieving access to a physician were not uncommon. Judge Ward cited five specific instances in which women inmates had been forced to endure unnecessary pain as a result of delay, including the case of one, with a recent history of permanent eye damage from a parasitic infection, who waited two weeks before a doctor attended to her complaint of impaired vision.

To correct these glaring instances of maladministration, the district court directed state officials either to place a physician in the lobby clinic, a common practice in other correctional institutions, or, to substantially improve the screening procedure. ²

2. Sick Wing

The sick wing, consisting of nineteen rooms, is used to house women suffering from severe fevers, elevated blood pressure and epilepsy, or whose maladies are sufficiently dangerous to warrant bed rest and observation. But, as the testimony of appellees' experts made clear, the operation of the sick wing was substandard and, to describe its faults modestly, was marked by a serious lack of communication and medical observation. In the sick wing, patients were often placed in locked rooms, denied even the opportunity to make verbal requests for assistance. Moreover, the closest officer was inconveniently located in a station across a lobby from the sick wing corridor. And, to make matters worse, even this inadequate access could be blocked, at the officer's discretion, by closing a solid door which prevented observation of the rooms and made it impossible to hear the inmates' cries for aid. Even if such a plea for emergency help were answered, adequate medical assistance might be delayed since the medical staff and supplies were located in the ambulatory care clinic on the other side of another solid, continuously-locked door. These inadequacies but reflected others, equally severe. Medical equipment or emergency supplies were not to be had either on the sick wing corridors or in the officer's station closest to the infirmary. And, nights often passed without even a single nurse on duty.

The court cited two instances in which inadequate provision for communication and observation in the sick wing seriously endangered the health of inmates. The judge cogently commented that he "need not wait until an epileptic chokes to death on her tongue," in the absence of proof that such a catastrophe had actually occurred. He held correctly, we believe, that these deficiencies subjected inmates to grave and unnecessary risks. Accordingly, the judge ordered that the wooden door be removed and that a nurse be stationed in a position to observe the sick wing between the hours of 4 p. m. to 8 a. m. The judge also appropriately directed that a nurse make rounds every two hours at night, that appellants install a nurse buzzer call system and that inmate-patients be locked in their rooms only under extraordinary circumstances and then only if observed at regular 1/2 hour intervals by a nurse.

3. Follow-Up Procedures

Even those inmates who found a doctor at the end of Bedford's medical labyrinth were still not free of the system's misadministration. Poor recordkeeping and inadequate notice procedures caused substantial delays, in some cases extending several months, in scheduling doctor-ordered follow-up appointments and diagnostic tests....