Withholding Migraine Treatment: Cruel and Unusual

Part of the Bill of Rights, the 8th Amendment to the United States Constitution, guarantees that prisoners shall not be subjected to cruel and unusual punishment. This clause prohibits torture and has been widely cited in support of abolishing the death penalty. It also forbids the withholding of medical treatment from prisoners in need of treatment. A prisoner in need of medical care has nowhere to go but the prison authorities. To withhold treatment from a prisoner would be using the medical condition of the prisoner as a part of their punishment - and this is held to be cruel and unusual in a long line of 8th Amendment cases.

Cases hold that the infliction of pain from an untreated medical condition, or indifference by prison authorities to the medical needs of the prisoner, is cruel and unusual punishment. The Federal Third Circuit Court of Appeals described the standard for 8th Amendment medical treatment cases in Iseley v. Beard.1 First, the court noted, the withholding of treatment must constitute "unnecessary andwanton infliction of pain" or "deliberate indifference to theserious medical needs" of a prisoner (_Estelle v. Gamble_2). In addition, to prove deliberate indifference,the plaintiff had to establish that he faced a "substantialrisk of serious harm," and that the defendants disregarded "thatrisk by failing to take reasonable measures to abate it." (_Farmerv. Brennan_3)

What does all this have to do with Migraines? Recently, I came across an 8th Amendment case involving a prisoner who was a Migraineur. Withholding treatment for Migraines is an 8th Amendment cruel and unusual punishment just the same as refusing to do a biopsy to test for cancer, or refusing to treat a case of hepatitis. In _Moriarty v. Neubold_4, Migraineur Michael Moriarty was incarcerated in a Bridgeport, Connecticut, correctional facility. He claimed 8th amendment cruel and unusual punishment due to:

  1. the prison doctor's delay in treating him,
  1. the prison doctor's refusal to treat him with the medications he had been prescribed before his incarceration, and
  1. to the prison health administrator's refusal to speed up the prison doctor's order for Imitrex.

The Federal District Court for the District of Connecticut held that Moriarty made an 8th Amendment claim for the delay in treatment. Before Moriarty was incarcerated, a neurologist prescribed Elavil as a Migraine preventive and Imitrex as a Migraine abortive. When Moriarty first entered the Bridgeport Correctional Center ("BCC") from another prison, he met with defendant Stein, a prison doctor. Moriarty told Stein about the medications prescribed, and Stein said that he didn't think those medications were necessary, and that his practice was to treat Migraines with Motrin.

Moriarty was transferred to another prison, and then on April 10, 2002, he was transferred back to BCC. On his return, he again told the nurse about his Migraine medications. He asked for an appointment with Dr. Stein, and eventually got one on April 24. At that appointment, Stein said he wouldn't continue the previously prescribed medications, instead he prescribed Inderal as a Migraine preventive.

On May 2, Moriarty saw Dr. Stein again and told him that the Inderal wasn't effective. Stein then prescribed Elavil. On May 9, Moriarty received his first dose of Elavil. Moriarty made numerous requests to see Stein again and finally saw him on May 22. At that time, Stein finally ordered Imitrex for Moriarty. On May 28, Moriarty went to see defendant Neubould, BCC's health services administrator, to complain that he hadn't yet received any Imitrex. When Moriarty asked Neubould whether he thought the delay was unreasonable, Neubould laughed and said, "I don't think so." During the month between his arrival back at BCC and the time he got the Elavil, Moriarty suffered two Migraines a week, lasting four to twelve hours. After getting the Elavil, he suffered only one "small Migraine."

The District Court thought that waiting from April 10th to April 24th for Migraine treatment, while suffering two untreated Migraines per week, was cruel and unusual punishment. Anyone who has suffered an untreated Migraine can understand that! The court didn't think that either a doctor's refusal to prescribe medications that had worked before, or an administrator's refusal to speed up the delivery of abortive medication, was cruel and unusual. Moriarty was given the right to see the doctor, but not the right to have the treatment actually be effective! Assuming the BCC was like most American prisons, imagine having an untreated Migraine in the harsh light and noise of a prison block. Talk about cruel and unusual!

Treatment that constitutes "cruel and unusual punishment" when applied to a prisoner is just standard operating procedure for those of us who are not incarcerated. How many Migraineurs have been told to just take a Motrin? The part of Moriarty's claim that was not dismissed by the Court was where he said he waited from April 10th to April 24th (a whole two weeks) to see the doctor, with frequent Migraines, before he was granted an appointment. On the outside, good luck getting an appointment to be seen for Migraines in under two months!

Cruel and unusual punishment gives rise to a constitutional claim for a prisoner; similar circumstances are not actionable for a free citizen. We aren't confined or forced to use only the doctor provided by the prison. Theoretically, we are free to find another doctor to treat us, free to go anywhere to get the treatment we need. We're free to take to our beds in a quiet room, rather than suffering a Migraine in a prison cell.

Here's a question to ponder:

If withholding treatment for Migraines from a prisoner for two weeks is cruel and unusual punishment, shouldn't prompt treatment be a basic right?

Shouldn't it be a right of every citizen? Imagine what our society and medical treatment might look like if everyone was guaranteed the right to prompt and effective treatment. Our society would have to prioritize medical research to make treatments effective, and to train many more doctors to provide effective treatment. We would have to have guaranteed medical coverage for every person, so that no one has to suffer cruel and unusual punishment while free!

The 8th Amendment's ban on cruel and unusual punishment is echoed in the Universal Declaration of Human Rights and is law in most civilized societies. It's designed to make sure we don't torture or humiliate those who we imprison, and that punishment for crimes is measured and rational. I have no argument with this. It is humane and makes perfect sense.

Isn't it ironic, though, that waiting two weeks for Migraine treatment is cruel and unusual punishment for a prisoner, while those of us on the outside might wait years if we don't have insurance or access to quality care? In this country, we are guaranteed a certain standard of medical care if we are incarcerated, but free citizens can die of dental abscesses in rural areas where there are no dentists, or go bankrupt paying for treatments we need. With no guarantee of medical coverage for every person, we all suffer cruel and unusual punishment without being convicted of a crime.

~ To the extent this sharepost contains legal information, it is legal education, not legal advice. No attorney-client relationship is created. ~


1 Iseley v. Beard, 200 Fed. Appx. 137 (3rd Cir. 2006)

2 Estelle v. Gamble, 429U.S. 97 (1976)

3 Farmerv. Brennan, 511 U.S. 825 (1994)

4 Moriarty v. Neubold, Case No. 3:02cv1662 (RNC) (D. Conn. 2004)