66
upon the Due Process Clause of the
Fourteenth Amendment. Unlike prisoners,
pretrial detainees have not been convicted of
crime and are not protected by the Eighth
Amendment. See Bell v. Wolfish, 441U.S.
520, 535 n.16 (1979) ("The State does not
acquire the power to punish with which the
Eighth Amendment is concerned until after it
has secured a formal adjudication of guilt in
accordance with Due Process of law. Where
the state seeks to impose punishment
without adjudication, the pertinent
constitutional guarantee is the Due Process
Clause of the Fourteenth Amendment.").
Applying this rationale, the Third Circuit has
agreed that the Estelle standard applies to
pretrial detainees, holding that deliberate
indifference to serious medical needs
violates the Due Process Clause of the
Fourteenth Amendment. Boring v.
Kozakiewicz,833 F.2d 468, 471-472 (3d Cir.
1987); Brown v. Borough of Chambersburg,
903 F.2d 274, 278 (3d Cir. 1990).
Before proceeding with our Estelle
analysis, it should be pointed out that the
deliberate indifference standard applies to
serious mental or emotional illnesses as well
as physical needs. See Inmates of Allegheny
County Jail v. Pierce 612 F.2d 754, 763 (3d
Cir. 1979) ("Although most challenges to
prison medical treatment have focused on
the alleged deficiencies of medical treatment
for physical ills, we perceive no reason why
psychological or psychiatric care should not
be held to the same standard.").
1. Are Prisoners’ Medical Needs
"Serious"?
According to Estelle
, only "acts or
omissions sufficiently harmful to evidence
deliberate indifference to serious medical
needs" rise to the level of an Eighth
Amendment violation. Estelle, 429 U.S. at
106. Exactly what constitutes a “serious
medical need" is determined on a case-by-
case basis. In general, a serious medical
need is defined as one that has been
diagnosed by a physician as requiring
treatment or one that is so obvious that a lay
person would easily recognize the necessity
for a doctor's attention. See
Monmouth
County Correctional Institutional Inmates v.
Lanzaro, 834 F.2d 326, 347 (3d Cir. 1987).
Applying this definition, the Third
Circuit has concluded that life-threatening
emergencies and injuries or illnesses are
indeed serious medical needs within the
meaning of Estelle. See Stewart v. Kelchner,
358 Fed. Appx. 291, 295 (3d Cir. 2009)
(MRSA skin infections are serious); Merritt v.
Fogel, 349 Fed. Appx. 742, 745 (3d Cir.
2009) (Hepatitis C virus is serious); Rouse v.
Plantier, 182 F.3d 192, 197 (3d Cir. 1999)
(insulin-dependent diabetes is serious); Kost
v. Kozakiewicz, 1 F.3d 176, 189 (3d Cir.
1993) (heatstroke is serious).
On the other hand, the Third Circuit
has found minor ailments not to be "serious"
medical needs and unworthy of Eighth
Amendment protection. See Tsakonas v.
Cicchi, 308 Fed. Appx. 628, 632 (3d Cir.
2009) (weight loss, eczema of the feet,
seborrhea of the scalp, athlete's foot,
constipation, and swollen knuckles not
serious injuries); Kost, 1 F.3d at 189 (lice
infestation not serious).
The problem with Estelle's "serious
medical needs" test concerns ailments lying
between the two extremes. For example,
while a brain tumor obviously constitutes a
serious medical need and a paper cut does
not, at what point, if ever, do ailments such
as tooth cavities, fever, neurosis, poor vision,
and obesity constitute serious medical
needs? See Harrison v. Barkley, 219 F.3d
132, 137 (2d Cir. 2000) (while tooth cavity is
not normally a serious medical needs, if left
untreated indefinitely, it is likely to produce
pain and require extraction, thereby rising to
the level of a serious medical condition).
In Boring v. Kozakiewicz
, the Third
Circuit resolved this matter by holding that in
questionable cases, expert testimony is
necessary to show that a prisoner's illness
was "serious" within the meaning of Estelle.
833 F.2d 468, 473 (3d Cir. 1987). In Boring
,
three prisoners brought suit against the
Allegheny County Jail alleging inadequate
medical treatment for a variety of minor