Eleventh Circuit: Florida’s Treatment Plan for Hepatitis C-Positive Prisoners Constitutional
The court’s August 31, 2020, opinion was issued in an appeal brought by FDC. The appeal challenged a district court’s order requiring FDC to treat all HCV-positive prisoners with direct acting antiviral (DAA) drugs within two years of their diagnosis.
HCV attacks the liver, causing scarring or fibrosis that is scored from F0 to F4. The district court, after a five-day hearing in October 2017, granted a preliminary injunction that required FDC to treat prisoners with F2 (moderate fibrosis), F3 (severe fibrosis), and F4 (cirrhosis) with DAAs. (See PLN, December 2017, p.24.)
The district court subsequently granted the prisoner class motion for summary judgment that included, but expanded upon, its preliminary injunction. The permanent injunction required FDC to treat prisoners with F0 (no fibrosis) and F1 (mild fibrosis) with DAAs within two years.
On appeal, FDC conceded that chronic HCV is a serious medical need. The Eleventh Circuit began its analysis by pointing to the “stringency of the deliberate indifference” standard to sustain an Eighth Amendment violation. It believed the district court lost track of that standard and “impermissibly evaluated” FDC’s “treatment plan against a negligence (or perhaps even more lenient) benchmark.” The proper standard required the prisoners to show FDC’s “approach to the treatment of F0- and F1-level inmates is so reckless — so conscience shocking — that it violates the Constitution.”
FDC’s plan for F0 and F1 level prisoners is to monitor their conditions and provide DAA treatment to those who have either (1) have an exacerbating illness, such as HIV, (2) exhibit signs of rapid fibrosis progression, or (3) advance to F2. The Eleventh Circuit said FDC was not denying care, it just was not providing “the particular course of treatment that they and their experts want — or as quickly as they want it.”
The court noted the experts differed on whether DAA treatment should be provided regardless of underlying condition or disease progression. As the F0 and F1-level prisoners are receiving medical care and “the adequacy treatment is the subject of genuine, good-faith disagreement between health care professionals,” the court said it was “hard-pressed” to find FDC acted recklessly and in a conscience shocking manner.
The district court’s order found FDC put forth no other reason for denying DAAs to F0 and F1-level prisoners other than cost, which it found is “per se deliberate indifference.” The Eleventh Circuit said “the Eighth Amendment does not prohibit prison officials from considering cost in determining what type (or level) of medical care inmates should receive.” Courts, correlatively, reviewing claims such those at issue cannot consider cost “considerations off-limits” in determining whether prison officials acted recklessly and in a conscience shocking manner.” Prison officials, however, cannot plead poverty as an excuse for providing minimally adequate care, the court said. As FDC’s treatment plan provides minimally adequate care for F0 and F1-level prisoners, the issue of a cost “defense” never arises.
Related legal case
Hoffer v. Secretary, Florida Department of Corrections
|973 F.3d 1263 (11th Cir. 2020)
|Court of Appeals
|Appeals Court Edition