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Healthcare Law--Intentional Inmate Discrimination: The Overlooked Connection Between Eighth Amendment Claims and Title VII Cases--Richmond v. Huq, 885 F.3d 928 (6th Cir. 2018).

Under the Eighth Amendment of the Constitution, an individual is protected from cruel and unusual punishment by the federal government. (1) This fundamental right extends to prison inmates who are deprived of necessary medical care and access to mental health services and psychiatric medication. (2) In Richmond v. Huq, (3) the United States Court of Appeals for the Sixth Circuit, considered whether the Plaintiff raised a dispute of material fact regarding an alleged Eighth Amendment violation by doctors, nurses, and psychiatric social workers at Wayne County Jail for deliberate indifference. (4) After reviewing the record and the common application of the Eighth Amendment to claims involving prison inmates, summary judgment, and qualified immunity, the Court of Appeals for the Sixth Circuit reversed the District Court's grants of summary judgment to Defendants Myftari, Hawk, Lonberger, Allen, and Wayne County; the court also reversed the grants of summary judgment to Defendants Huq, Clafton, Fowler, and Shoulders. (5) Ultimately, the court affirmed the grants of summary judgment to Defendants Rucker, Williams, and Coleman and then remanded the case. (6)

On December 25, 2012, Melissa Richmond, the Plaintiff, attended a family gathering in Wyandotte, Michigan when an altercation occurred between some of her family members. (7) As the police arrived in response to the family fight, Richmond saw her son get into a verbal and physical altercation with the officers and witnessed the officers use a taser to subdue him. (8) When Richmond tried to stop the officers from using the taser on her son, the officers arrested her and took her into custody. (9) In between Richmond's arrest and booking, she suffered self-inflicted burn wounds on her right breast and torso after setting her seatbelt on fire with a lighter in a failed attempt to escape the police cruiser. (10) Richmond was then taken to a hospital, where she received routine medical treatment for second-degree burn wounds to prevent infection and further skin damage in the form of dressing changes and Lortab, a pain medication often used to treat burn wounds. (11)

Following her arraignment on December 26, 2012, Richmond had medical and mental health screenings at Wayne County Jail, where the on-call doctor prescribed Richmond dressing changes on her wound once a day and a psychiatric social worker determined that Richmond did not need psychiatric medication until her psychiatric appointment on January 11, 2013. (12) Richmond, who was scheduled for mental health and medical screenings on January 11, objected to the jail's failure to provide her with psychiatric medication and adequate medical care. (13) As a result of her objection, she was evaluated by another psychiatric social worker and received the same mental health diagnosis and medical treatment that she received on the day of her arraignment. (14) After her mental health evaluation, the prison had no record that Richmond's wound dressing was changed between January 13-15 and January 17-18. (15) In fact, Richmond's complaints on January 23 and 24 of inadequate medical care for her burn wounds directly conflicted with the jail's internal records that Richmond received the dressing for her burn wounds prescribed by the prison medical staff. (16) Subsequent to her February 13 release, Richmond received a referral to the Detroit Medical Center's Burn Center where the medical staff informed her she would need a skin graft because part of her wound would not heal on its own. (17)

In the fall of 2013, Richmond sued Wayne County Jail for cruel and unusual punishment under the Eighth Amendment. (18) Richmond's claim rested on allegations that the medical staff at Wayne County Jail was deliberately indifferent to her medical needs because they did not order the number of dressing changes prescribed by the hospital and the psychiatric staff failed to give her psychiatric treatment and medication for the first three weeks of her incarceration. (19) In response to her claims, the United States District Court for the Eastern District of Michigan, Southern Division granted summary judgment in favor of Wayne County Jail. (20) In its opinion, the court found that Richmond failed to present an Eighth Amendment violation due to a lack of evidence that any member of the prison staff subjectively perceived a risk of harm to Richmond and disregarded it. (21) Additionally, the court found that Richmond failed to provide a plausible constitutional violation against each of the defendants individually. (22)

The U.S. Constitution's protection against cruel and unusual punishment originates from British colonial rule in America. (23) Prior to the American Revolution, the British government enforced a legal system known as the "Bloody Code" where scores of offenses both minor and major were punishable by death. (24) Following the removal of British rule, the remaining laws and the "Bloody Code" were seen as corrupt remnants of English rule and served as a reminder of the brutal legal system that the colonists fought against, one that gave murderers the same punishments as petty thieves. (25) Using the framework of the 1689 English Bill of Rights, and the writings of Enlightenment scholars such as Cesare Beccaria and Voltaire, the United States of America ratified the Eighth Amendment in 1791, which created the fundamental right of protection from cruel and unusual punishment by the government. (26)

While the Eighth Amendment most ties into protection from barbarous torture from the government, the cruel and unusual punishment clause also applies to medical care for inmates when prison officials neglect prisoners' medical needs. (27) This conversation gained momentum in the 1960s, when courts started to take a less deferential role when dealing with prison problems involving inmates' care. (28) The debate over inmates' access to adequate healthcare has continued into the twenty-first century and remains a hot-button issue for many advocates of prison reform. (29) As to common law decisions, in 1976, the Supreme Court held in Estelle v. Gamble that deliberate indifference to a prisoner's serious medical needs constitutes cruel and unusual punishment under the Eighth Amendment of the Constitution. (30) Likewise, in 1981, the court reasoned in Rhodes v. Chapman that when prison conditions deprive inmates of life's necessities, those acts by prison officials violate the Eighth Amendment of the Constitution. (31) Ten years later, Earner v. Brennan laid out the test for a deliberate indifference claim, a test still in effect today. (32) First, a plaintiff must prove that the deprived medical care involved a sufficiently serious condition, the objective component. (33) Second, the official must subjectively disregard the substantial risk to the inmate's health. (34)

Regarding the circuit courts, the Sixth Circuit's objective-subjective test for deliberate indifference claims is largely indicative of the other circuit courts in the country. (35) The Sixth Circuit follows the objective-subjective test for deliberate indifference claims. (36) A plaintiff must be able to prove that the government officials in question knew of and then disregarded an excessive risk to an inmate's safety or health. (37) The Sixth Circuit has similarly held that a plaintiff alleging deliberate indifference needs to demonstrate more than mere negligence or a misdiagnosis of an ailment to establish a prerequisite for this claim under the Eighth Amendment. (38) Therefore, if the plaintiff can establish the criteria above, a plaintiff must then demonstrate a causal link between each defendant's conduct and the resulting injury. (39)

Moreover, another subset of law that has underlying ties to Eighth Amendment cases and the ongoing obstacles prisoners face is employment discrimination, a form of intentional discriminatory conduct where legislation was implemented to protect classes of people vulnerable to intentional discrimination. (40) This protective legislation was created under Title VII of the 1964 Civil Rights Act, which prohibited discrimination by employers on the basis of race, color, sex, national origin, and religion (five protected classes). (41) In McDonnell Douglas Corp. v. Green, the Supreme Court laid out a four-part test for pleading a claim of employment discrimination. (42) This four-part test became known as the McDonnell Douglas test and this analysis considers both direct and circumstantial evidence in a plaintiff's case. (43) Courts tend to view the test as an evidentiary roadmap in deciding the merits of a case, particularly when the plaintiffs case primarily relies on circumstantial evidence. (44)

In the case-in-chief, the United States Court of Appeals for the Sixth Circuit reviewed the trial court's grant of summary judgment for the defendants de novo. (45) Next, the court in the case-in-chief examined whether or not there were any disputes of material fact in Richmond's case. (46) The court's focus then shifted to examining the claim under the Eighth Amendment of the United States Constitution. (47) After examining the general test for deliberate indifference claims under the Eighth Amendment, the court looked at precedent for when a plaintiff claims that the prison medical staff has failed to adhere to the prescribed course of medical treatment. (48)

The court then considered the standard for medical care when a prison doctor meets with an inmate in order to assess Richmond's claims that during her follow-up appointment on January 11, Dr. Thomas Clafton did not address the inadequate dressing changes and lack of Lortab dosages prescribed by the jail's medical staff. (49) The court then explored whether a Plaintiff'still has a cause of action for deliberate indifference if the wound healed without infection. (50) Similarly, the court took under consideration the defendants' claim that a court should be reluctant to second guess a jail staff's medical judgments in light of Richmond's claims against Dr. Thomas Clafton and Dr. Rubab Huq for insufficient treatment. (51) Additionally, the court examined Richmond's claims that the jail medical staff were in possession of documents that listed her prescriptions for Prozac and Xanax before entering custody. (52) Next, the court considered whether Richmond had proved she suffered from a serious medical need when she met with psychiatric social worker Agron Myftari to discuss her mental health needs. (53) Then, the court brought its attention to Richmond's claim that psychiatric social worker Patricia Rucker acted with deliberate indifference for failure to provide Richmond with psychiatric medication. (54) In a similar fashion, the court examined Richmond's claims that Nurse Lonberger intentionally scrubbed her burn wound hard to inflict pain in violation of the Eighth Amendment. (55) Next, the court looked at Richmond's claims that nurse Fowler, Shoulders, and Hawk were aware of her mental illness history and did not make an effort to verify Richmond's list of medications with an outside physician or pharmacy. (56) After focusing on Richmond's claims against the defendants individually, the court considered the doctrine of qualified immunity. (57) Likewise, the court considered the standard for municipal liability claims in relation to Richmond's claim that the county prison was liable for her injuries. (58) Finally, the court examined Richmond's claim that Wayne County's practices violated the Eighth Amendment because it relied on psychiatric social workers to determine whether an inmate needed medication, the jail did not provide medication for weeks to inmates known to suffer mental illnesses, and jail physicians did not verify the inmate's current medication with an outside physician. (59)

After reviewing the precedent on Eighth Amendment claims, the court determined that based on Richmond's burn wounds and mental health history, Richmond's physical and mental ailments satisfied the objective component of a deliberate indifference claim. (60) Next, the court found the district court's grant of summary judgment regarding the subjective disregard by Defendant Dr. Clafton for deliberate indifference was inappropriate for Richmond's medical needs and found sufficient evidence for Richmond's claim that Clafton neglected her mental health needs. (61) Then, the court determined the district court's grant of summary judgment for Dr. Huq for treatment of the burn was incorrect and the district court improperly granted summary judgment to Huq for deliberate indifference to Richmond's mental health needs. (62) The court then found that the district court incorrectly granted summary judgment to Defendant Agron Myftari. (63) After looking at Richmond's final claim against a psychiatric social worker, the court found the district court correctly granted summary judgment to Defendant Patricia Rucker. (64)

In a similar fashion, the court focused on Richmond's claims against the nursing staff. (65) The court found that the district court inappropriately granted summary judgment to Nurse Lonberger. (66) Next, the court determined that the district court properly dismissed Richmond's claims against Nurses Williams and Coleman. (67) Comparatively, the court found that the district court improperly granted summary judgment to Nurses Hawk and Shoulders for inadequate medical treatment. (68) Similarly, the court found that the district court inappropriately granted summary judgment to Medical Assistant Allen. (69) Regarding Richmond's deliberate indifference claim against Nurses Hawk, Shoulders, and Fowler, the court found that the district court correctly granted summary judgment to Shoulders, but not to Fowler and Hawk. (70) Then, the court closed its analysis by holding the district court incorrectly granted summary judgment to Wayne County for municipal liability. (71) Overall, the court reversed the District Court's grants of summary judgment to Defendants Myftari, Hawk, Lonberger, Allen, and Wayne County, reversed in part the grants of summary judgment to Defendants Huq, Clafton, Fowler, and Shoulders, and affirmed the grants of summary judgment to Defendants Rucker, Williams, and Coleman and remanded the case. (72) However, one important question that remains is whether the McDonnell Douglas test could have been applied to the facts of Richmond's case to bring about a more efficient ruling because prison inmates often experience similar intentional discrimination to statutory protected classes when inmates are deprived of necessary medical care. (73)

While the court in the case-in-chief correctly ruled on the district court's grant of summary judgment, the court's methodology confused the real issue of the case, how Richmond's status as an inmate led to her victimization from intentional discrimination similar to the disparate treatment that members of protected classes under Title VII experience in the workplace. (74) The court in the case-in-chief became inundated with issues of summary judgment with multiple defendants, and because of Richmond's numerous claims against Wayne County jail and its personnel, the focus centered on the liability of each defendant for deliberate indifference and ignored the fact that Richmond fell victim to the prison's assembly line style of administering healthcare. (75) Richmond was left with one option while in jail, she had to receive the substandard medical treatment provided by the prison and suffer as a result of the power dynamics that systematically disadvantage inmates who fail to receive their prescribed healthcare. (76) Despite its predominate use in employment discrimination litigation, the McDonnell Douglas test provides a useful blueprint for a court to handle claims by plaintiffs who are seeking protection against intentional discrimination, especially when taking into account the inability of many prisoners to obtain direct evidence due to their isolation from society. (77) While prison inmates are not a statutorily protected class, this same analysis could be applied to deliberate indifference cases because inmates are often intentionally victimized due to their status as incarcerated people, a group that has been looked down upon throughout history and has repeatedly been mistreated by prison staff members. (78) Under the McDonnell Douglas framework, a plaintiff first has to meet multiple criteria to create a prima facie case of intentional discrimination. (79) In the event that a plaintiff establishes a prima facie case, the defendant must provide a legitimate nondiscriminatory reason for the adverse action. (80) If the court finds that the defendant has successfully rebutted the plaintiffs prima facie case, the plaintiff has the chance to show that the defendant's legitimate nondiscriminatory reason was a pretext, or a smokescreen for intentional discrimination. (81)

Under the McDonnell Douglas test, a plaintiff must establish that (i) they belong to a protected class; (ii) they applied for and were qualified for a job for which the employer sought applicants; (iii) despite their qualifications, the plaintiff was rejected, and (iv) after the plaintiffs rejection, the position remained open and the employer continued to seek similarly qualified applicants. (82) This test can be applied to deliberate indifference cases, matters which often involve intentional discrimination against inmates with serious medical needs who are deprived of adequate medical care because of their status as prison inmates. (83) In addition to incidents of physical and psychological abuse, prison inmates experience intentional discrimination when prison staff members knowingly deprive inmates of proper healthcare, an act which robs prisoners of their humanity. (84) Thus, applying the McDonnell Douglas test to Richmond's case, the first prong would be (i) that the plaintiff is part a group of people who are frequent victims of intentional discrimination. (85) Regarding the second prong of the McDonnell Douglas test, (ii) Richmond suffered injuries requiring medical treatment during her incarceration and received a prescription for treatment. (86) A key similarity between a person applying for a job and a plaintiff requiring medical treatment for injuries while in jail is that both situations involve a person's qualifications. (87) Therefore, applying the second part of McDonnell template to Richmond's case, Richmond established that she suffered injuries requiring treatment during her incarceration and was prescribed medical treatment. (88)

Correspondingly, as to the third portion of the McDonnell framework (iii), although Richmond had a clearly designated prescription that needed to be given to her during her incarceration, the prison medical personnel gave her inadequate treatment and in some instances no treatment at all. (89) An analogy can be made between a qualified job applicant getting rejected despite their qualifications for the position and an inmate failing to receive prescribed treatment from medical professionals required to treat a lingering condition while in prison. (90) Both involve a person failing to receive something despite their eligibility for it. (91) Furthermore, under the third part of McDonnell Douglas applied to Richmond's case, a plaintiff must establish that despite their prescribed treatment for injuries to be administered in prison, they did not receive the prescribed treatment. (92) Finally, (iv) Richmond had to receive further medical treatment following her incarceration to heal her injuries. (93) Here, there is not much of an analogy to make between a former inmate needing to receive additional medical care and an employer continuing to accept job applications after rejecting a qualified applicant. (94) At the same time, because the other three applications of the McDonnell Douglas test easily relate to Richmond's case and because the McDonnell analysis is known for its malleability, the final part of the analysis can be adapted to Richmond's need for treatment after her imprisonment. (95) With this in mind, applying the final prong of McDonnell Douglas test to Richmond's case, a plaintiff must establish that the inmate or former inmate needed medical care outside prison to heal their injuries. (96)

Moreover, under the McDonnell Douglas test, when a plaintiff establishes a prima facie case, a rebuttable presumption of intentional discrimination is created and the defendant has the opportunity to provide a legitimate nondiscriminatory reason for the employment action. (97) In relation to Richmond's case, this template could be applied to Eighth Amendment cases so that once an inmate or former inmate establishes a prima facie case of intentional discrimination by the prison, it creates a rebuttable presumption of intentional discrimination and the burden shifts to the prison staff defendant(s) to provide a legitimate, nondiscriminatory reason why the plaintiff's prescribed medical care did not get implemented in jail. (98) The final component of the McDonnell Douglas test is that once a defendant provides a legitimate reason for the adverse employment action, the plaintiff has the opportunity to show that the defendant's nondiscriminatory reason was in fact a pretext or smokescreen for intentional discrimination. (99) With the McDonnell Douglas test applied to Richmond's case, once the defendant provides a legitimate reason for inadequate medical treatment, the plaintiff has the opportunity to show that the defendant's reason for inadequate treatment is a pretext for intentional discrimination. (100)

Melissa Richmond suffered self-inflicted second degree burn wounds following her arrest after she tried to set her seatbelt on fire, an episode exhibiting severe mental illness. Afterwards, Richmond did not receive the routine treatment prescribed by the hospital and was delayed psychiatric medication by members of the prison staff despite her pronounced history of mental illness. Rather than focus on Richmond's membership in a group routinely subjected to intentional discrimination, the court became engulfed in the technicalities of summary judgment in deliberate indifference cases and reached its decision in a tortuous manner. The court could have reached a just result by applying the McDonnell Douglas test to each of the defendants Richmond filed lawsuits against and treating the facts in the case-in-chief as an intentional discrimination case. Richmond established a prima facie case of intentional discrimination because she (1) was a member of a group frequently subjected to intentional discrimination, (2) suffered injuries requiring treatment in jail and got prescribed medical treatment, (3) despite her prescribed treatment to be administered in jail, Richmond did not receive the prescribed treatment that was easy to implement, and (4) following the inadequate treatment, Richmond needed further medical care outside of prison to heal the injuries. Of the defendants, Wayne County jail had multiple employees who failed to provide a legitimate reason for providing Richmond with inadequate medical care and others who could have successfully rebutted a presumption of intentional discrimination towards Richmond. By applying the McDonnell Douglas test, the court could have avoided the complexities of a deliberate indifference claim and instead focused on an efficient method to ensure the protection of inmates from intentional discrimination, one of this country's most victimized populations. One of the most rampant forms of intentional discrimination prison inmates experience is when jails fail to provide them with adequate healthcare despite the existence of prescriptions provided by outside hospitals and past medical conditions. Unlike other citizens who can seek alternative healthcare options, prison inmates have little choice but to accept substandard medical treatment offered to them by prisons. It is this very type of intentional discrimination stemming from power dynamics that the McDonnell Douglas test was created to protect against.

George Barclay, J.D. Candidate, Suffolk University Law School, 2020; Vanderbilt University, 2013. Mr. Barclay may be contacted at gbarclay@suffolk.edu.

(1) See U.S. CONST, amend. VIII. "Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted." Id.; see, e.g., Gregg v. Georgia, 428 U.S. 153, 182 (1976) (discussing the need to determine whether punishment "comports with the basic concept of human dignity"); Richmond v. Huq, 885 F.3d 928, 937 (6th Cir. 2018) (highlighting cases that give examples of applying the Eighth Amendment).

(2) See id. A prisoner's Eighth Amendment rights are violated when prison officials or doctors show deliberate indifference towards prisoners' serious medical needs. Id.; see also Estelle v. Gamble, 429 U.S. 97,104 (1976) (stating the same).

(3) Richmond, 885 F.3d 928.

(4) See id. at 937 (noting that the plaintiff's claims consisted of deliberate indifference and municipal liability claims). The District Court granted summary judgment on behalf of Wayne County Jail and Richmond appealed. Id. at 934.

(5) Id. at 949. The court in the case-in-chief reversed five summary judgment rulings of the District Court outright, reversed four summary judgment rulings in part, and affirmed three summary judgment rulings. Id.

(6) Id.

(7) See Richmond, 885 F.3d. at 934. It is unclear whether the police were notified by neighbors about the altercation or were just in the area and overheard the altercation when it took place. See id.

(8) See id.

(9) See id.

(10) See id.

(11) See also Richmond v. Huq, No. 14-14892, 2016 U.S. Dist. LEXIS 138215, at *1-2 (E.D. Mich. Oct. 5, 2016) (noting that the plaintiffs wounds were on her right breast and torso).

(12) See Richmond, 885 F.3d at 934-35. The on-call doctor prescribed dressing once a day instead of to the dressing changes twice a day prescribed by the hospital, as well as Lortab instead of the silvadene cream prescribed by the hospital. Id. at 935. During the mental health screening with Agron Myftari, a psychiatric social worker, Richmond discussed her history of bipolar disorder as well as her Prozac and Xanax medications that Richmond took regularly prior to her arrest. Id. at 935. Richmond also alleged that on December 29 Nurse Jacqueline Lonberger intentionally scrubbed her wound hard, leading to unnecessary pain. Id.

(13) See id.

(14) See id. Jim Gilfix, the third psychiatric social worker who saw Richmond also knew of Richmond's history of taking Prozac and Xanax prior to her arrest. Richmond, 885 F.3d at 936. When Richmond finally saw Dr. Lisa Hinchman, she was prescribed medication to treat her mental health ailments but not Prozac and Xanax, despite Hinchman's diagnoses of bipolar disorder, depression, and Post Traumatic Stress Disorder. Id.

(15) See id. The record indicates that the nurses changed Richmond's dressing on January 16, 19, 20, 21, and 22. Id. at 936-37. The jail records indicate that Richmond received medical supplies on January 21 and January 27. Id. at 937.

(16) See id. In her grievances, Richmond noted that medical staff failed to change her dressing and provide her medication, and she feared her wound was infected. See Richmond, 885 F.3d at 937.

(17) See id. Dr. Katychev, who examined the wound informed Richmond that while the wound was not infected, it did not fully heal. Id. Richmond had the skin grafting surgery on February 22, 2013. See id.

(18) See id. Richmond's claim stems from the time of her incarceration between December 26, 2012 and February 13, 2013; see also Richmond v. Huq, No. 14-14892, 2016 U.S. Dist. LEXIS 138215, at *1. Richmond listed physicians Rubab Huq and Thomas Clafton as defendants, as well as nurse practitioner Marie Shoulders, resident nurses Jacqueline Lonberger, Shevon Fowler, April Williams, Felecia Coleman, and Maxine Hawk, medical assistant Danielle Allen, and psychiatric social workers Agron Myftari and Patricia Rucker. Id.

(19) See Richmond, 885 F.3d at 937. Another claim Richmond made concerned the liability of Wayne County for the Jail's alleged practice of psychiatric social workers delaying prisoner's access to psychiatric medication. Id.

(20) See Richmond, 2016 U.S. Dist. LEXIS 138215, at *14. The court found that the plaintiff failed to show how any of the individual defendants were indifferent to her medical and mental health needs. Id.

(21) See id. at *13. The district court concluded that Richmond was not denied necessary medical treatment, but rather told that she could wait for it, a reasonable medical judgment that courts usually avoid second guessing. Id. Generally, courts are hesitant to second guess medical judgments that are within the general standard of care. Id; see also Marc J. Posner, Article, The Estelle Medical Professional judgment Standard: The Right of Those in State Custody to Receive High-Cost Medical Treatments, 18 Am. J.L. AND Med. 347, 353 (1992). Once an inmate's condition is determined to be serious, the inmate is constitutionally entitled to receive adequate treatment based on the professional judgment of the medical professionals. Id. But see Nina Garcia, Note, Starting with the Man in the Mirror: Transsexual Prisoners and Transitional Surgeries Following Kosilek v. Spencer, 40 Am. J.L. AND MED. 442, 455 (2014). The right of an inmate patient to treatment is not absolute however and does not entitle a plaintiff to the finest treatment available. Id; see also Maggert v. Hanks, 131 F.3d 670 (7th Cir. 1997). The Maggert court held that "[withholding from a prisoner an esoteric medical treatment that only the wealthy can afford does not strike [the court] as a form of cruel and unusual punishment." Id. at 672.

(22) See Richmond, 2016 U.S. Dist. LEXIS 138215, at *11. The district court noted that the plaintiff failed to name each individual responsible for changing her dressings on a given day and any failures in that regard appeared to be negligence rather than deliberate indifference. Id. at 14. The district court granted all of the defendants' motions for summary judgment. Id.

(23) See John D. Bessler, The Italian Enlightenment and the American Revolution: Cesare Beccaria's Forgotten Influence on American Imw, 37 Hamline J. Pub. L. & Pol'y 1, 34 (2017) (discussing the Italian scholar's influence on the colonial legal system after the American Revolution).

(24) See id. In English colonial American, even petty offenses such as theft could lead to death sentences as punishment. Id; see also Joshua E. Kastenberg, An Enlightened A ddition to The Original Meaning: Voltaire And the Eighth Amendment's Prohibition Against Cruel and Unusual Punishment, 5 TEMP. Pol. & Civ. RTS. L. Rev. 49, 54 (1995). Following the 1689 Bill of Rights, the English legal system had a very loose interpretation of what constituted cruel and unusual punishment.

(25) See Erin E. Braatz, The Eighth Amendment's Milieu: Penal Reform in the IMte Eighteenth Century, 106 J. Crim. L. & Criminology 405, 420, 453 (2016). The founding fathers were also concerned about the introduction of torture implemented in other countries such as the stake, flaying someone alive, and mutilation. Id. at 440.

(26) See BESSLER, supra note 23 and accompanying text. Beccaria's work, On Crimes and Punishments, written in 1764, opposed both torture and capital punishment and was known to James Madison, Benjamin Franklin, and Benjamin Rush. Id. at 18, 34. See generally KASTENBERG, supra note 23 and accompanying text. Voltaire was another strong opponent of torture and capital punishment and Voltaire had a great deal of contact with Benjamin Franklin during his life. Id. at 51, 67. James Madison, who wrote the Bill of Rights, owned most of Voltaire's works. Id. at 68.

(27) See Russell W. Gray, Wilson v. Seiter: Defining the Components of and Proposing a Direction for Eighth Amendment Prison Condition Imw, 41 Am. U.L. Rev. 1339, 1347 (1992).

(28) Id. at 1345.

(29) See John V. Jacobi, Article, Prison Health Public Health: Obligations and Opportunities, 1 Am. J. L. & Med. 447, 461 (2005) (noting that the Supreme Court recognizes the Eighth Amendment right of prisoners to adequate healthcare). See id. at 447, 451-452. Scholars and prison reform advocates have argued that the Eighth Amendment protections granted to prisoners do not go far enough to ensure sanitary conditions and that the conditions of prisons often strip inmates of access to adequate healthcare and leave them to suffer from ailments such as, but not limited to, communicable diseases, sexually transmitted diseases, chronic illnesses, and mental illness. Id. at 453. Mental illnesses can be so prevalent among prison inmates that prisons are sometimes referred to as the "new asylums." Id. For example, prison inmates in state prisons are three to five times more likely to develop schizophrenia than citizens in the general population. Id. Additionally, over the years, prisons have been found to have substandard systems in place to treat chronic health conditions as well as poor intake systems for prisoners requiring mental health treatment. Id. at 457, 460-461. Due to a long ingrained societal perception that prisoners should not experience comfort or compassion during their time behind bars and a lack of government funding towards improving prison conditions, inmates are often left at the mercy of prison staff members who have treated them inhumanely and intentionally deprived them of medical care.

(30) See Estelle v. Gamble, 429 U.S. 97, 104 (1976) (noting that deliberate indifference can occur as a result of both guard and doctor actions).

(31) See Rhodes v. Chapman, 452 U.S. 337, 347 (1981).

(32) See Farmer v. Brennan, 511 U.S. 825, 834 (1994).

(33) Id. The medical condition alleged cannot be one of mere discomfort. Id.', see Wilson v. Seiter, 501 U.S. 294, 298 (1991); Rhodes, 337 U.S. at 347, 349. The court in Wilson referred to their decision in Rhodes, highlighting the argument that "[t]he Constitution, we said, 'does not mandate comfortable prisons,'... and only those deprivations denying 'the minimal measures of life's necessities,'... are sufficiently grave to form the basis of an Eighth Amendment violation." Wilson, 501 U.S. at 298 (quoting Rhodes, 337 U.S. at 347, 349).

(34) See Farmer, 511 U.S. 834. The prison official must know and disregard an excessive risk to inmate safety. Id. at 843. "The question under the Eighth Amendment is whether prison officials, acting with deliberate indifference, exposed a prisoner to a sufficiently substantial 'risk of serious damage to his future health.'" Id. (quoting Helling v. McKinney, 509 U.S. 25, 35 (1993)).

(35) See Clark-Murphy v. Foreback, 439 F.3d 280, 286 (6th Cir. 2006). For a plaintiff to establish deliberate indifference, an inmate must present objectively serious mistreatment and subjective ignorance by the defendants to the inmate's medical or safety needs based on the mistreatment. See MacLeod v. Kern, 424 F. Supp. 2d 260, 265-66 (Mass. Dist. Ct. 2006). The First Circuit holds that a mere disagreement about medical treatment is not enough for a deliberate indifference claim and that the denial of medical treatment needs to shock the conscience of the court. See Johnson v. Maurer, Civil Action No. 3:18-cv-694 (CSH), 2018 U.S. Dist. LEXIS 206012, at *16 (Conn. Cir. Ct. 2018) (referencing Hilton v. Wright, 673 F.3d 120, 127 (2d Cir. 2012)). In the Second Circuit, the courts use language similar to the standard for criminal negligence and hold that a plaintiff must show that a defendant knew of and disregarded an excessive risk to the prisoner's health. Id. With regard to a defendant, it must be shown '"that he not only was aware of facts from which a reasonable person would conclude [plaintiff] faced an excessive risk, but that he personally actually drew that inference.'" Stewart v. Wenerowicz, No. 12-4046, 2015 U.S. Dist. LEXIS 114307, at *24 (E.D. Pa., 2015); see also Bistrian v. Levi, 696 F.3d 352, 367 (3d Cir. 2012) (citing Farmer, 511 U.S. at 834). The Third Circuit holds that the plaintiff alleging deliberate indifference must show (1) that they were incarcerated under conditions imposing substantial risk of serious harm, (2) the defendant was deliberately indifferent to the substantial risk to the prisoner and, (3) the defendant's deliberate indifference caused the alleged harm. See Hendrick v. Booth, Civil Action No. TDC-14-4021, 2015 U.S. Dist. LEXIS 163247, at *13 (D. Md. Dec. 3, 2015) (referencing Farmer, 511 U.S. at 837). Fourth Circuit courts in a similar vein have held that to constitute deliberate indifference, the defendant's actions must be so grossly inadequate or excessive as to shock the conscience of the court and that mere disagreement over course of treatment is insufficient for deliberate indifference. Id. "Deliberate indifference is an 'exacting standard' that requires more than a showing of 'mere negligence or even civil recklessness, and as a consequence, many acts or omissions that would constitute medical malpractice will not rise to the level of deliberate indifference." Hinojosa v. Livingston, 807 F.3d 657, 689 (5th Cir. 2015). The Fifth Circuit holds that an incorrect diagnosis by medical personnel does not suffice to state a claim of deliberate indifference under the objective-subjective test of Farmer. Id. To succeed in presenting this claim, a plaintiff must show "that the officials 'refused to treat him, ignored his complaints, intentionally treated him incorrectly, or engaged in any similar conduct that would clearly evince a wanton disregard for any serious medical needs.'" Arnett v. Webster, 658 F.3d 742, 753 (7th Cir. 2011). As to what constitutes a sufficiently serious medical condition, courts in the Seventh Circuit have held that a delay in treating non-life threatening but particularly painful conditions may constitute deliberate indifference if the delay exacerbated the injury or unnecessarily prolonged the inmate's pain. See id. Specifically, in this case Arnett the prisoner was prescribed Enbrel for his RA before arriving at Terre Haute. See id. Upon arrival, Arnett repeatedly asked for the medication and obtained a letter from his prescribing physician urging the doctor at Terre Haute to place him back on the medication. See id. The Seventh Circuit held that medical personnel cannot stand idly by for a number of months while the inmate's condition worsens and causes permanent damages, but must explore alternative treatments to aid the inmate. See id. at 753-54. See Arnett v. Webster, 658 F.3d 742, 753 (7th Cir. 2011); see also Starbeck v. Linn Cty. Jail, 871 F. Supp. 1129, 1143 (N.D. Iowa 1994). Eighth Circuit courts have held that deliberate indifference is shown if prison officials deliberately deprive a prisoner of a serious medical need or act recklessly in the face of such a need. See id. The Court has determined that recklessness relative to a serious medical need occurs if the prison officials ignore a substantial risk of danger that they are aware of or would be apparent to a reasonable person in the officials' position. See Gress v. Smith, No. 2:13-cv-0328 TLN KJN P, 2018 U.S. Dist. LEXIS 206503, at *13 (E.D. Cal. 2018). The Ninth Circuit has held that a prison official acts with deliberate indifference when they ignore the instructions of the prisoner's treating physician or surgeon. See Winton v. Bd. of Comm'rs, 88 F. Supp. 2d 1247,1262 (N.D. Okla. 2000). Tenth Circuit defines that in order for a prisoner's medical needs to be objectively serious, the risk of harm needs to be so obvious that the government entity should have known about it. See Visage v. Woodall, No. 3:16-cv-1077-J-34PDB, 2018 U.S. Dist. LEXIS 178132, at *15 (M.D. Fla. Oct. 16, 2018); see also Carter v. Galloway, 352 F.3d 1346, 1349 (11th Cir. 2003). The Eleventh Circuit defines the factors to survive a summary judgment motion, a plaintiff alleging a deliberate indifference claim must (1) produce evidence of substantial risk of serious harm, (2) the defendant's deliberate indifference to that risk and, (3) causation. See Majhor v. Kempthorne, 518 F. Supp. 2d 221, 238 (D.C. 2007); see eg Baker v. District of Columbia, 326 F.3d 1302, 1306 (D.D.C. 2003). Likewise, the D.C. Circuit has held that officials need to have knowledge of the serious medical need and recklessly disregard the excessive risk to the prisoner's health or safety to constitute deliberate indifference. See Farmer, 511 U.S. at 837. The subjective element requires that "ft]he officialjs] must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and [they] must also draw the inference." See Moore v. United States, No. 2016-2092, 2017 U.S. App. LEXIS 8088, at *2 (Fed. Cir. May 4, 2017). Lasdy, the Federal Circuit follows the deliberate indifference standards set forth in Fstelle and Farmer with no variations. Id.

(36) See Clark-Murphy, 439 F.3d at 286.

(37) Id. The official must be aware of a situation where such an inference could be drawn about substantial risk to health and safety and the official must also draw that inference. Id. at 290.

(38) Id.; see e.g. Farmer, 511 U.S. at 834.

(39) See Clark-Murphy, 439 F.3d at 293.

(40) See generally Title VII of the Civil Rights Act of 1964, 42 USCS [section] 2000e-2 (1964).

(41) See id. An employer may not engage in employment practices that discriminate on the basis of race, color, sex, national origin, and religion. Id.

(42) See McDonnell Douglas Corp. v. Green, 411 U.S. 792, 802 (1973). For a plaintiff to establish a prima facie case, a plaintiff must establish that "(i) that they belong to a protected class; (ii) that they applied and were qualified for a job for which the employer sought applicants; (iii) despite their qualifications, the plaintiff was rejected, and (iv) after the plaintiffs rejection, the position remained open and the employer continued to seek applicants with similar qualifications." Id. A rebuttable presumption of discrimination is created and the burden shifts to the defendant to provide a legitimate nondiscriminatory reason for the adverse employment action. Id. at 804. The plaintiff then has the opportunity to show that the defendant's legitimate nondiscriminatory reason was in fact a pretext for discrimination. See Tide VII of the Civil Rights Act of 1964, 42 U.S.C. [section] 2000e-2 (1964). An employer may not engage in employment practices that discriminate on the basis of race, color, sex, national origin, and religion. Id.; see Sandra F. Sperino, Article, justice Kennedy's Big New Idea, 96 B.U. L. Rev. 1789, 1826 (2016). The McDonnell Douglas test has become one of the most important "key analytical devices" courts use to determine the strength of intentional discrimination cases. Id. at 1826; see also Henry L. Chambers, Jr., Article, Recapturing Summary Adjudication Principles in Disparate Treatment Cases, 58 SMU L. REV. 103, 105 (2005). Due to the ability of the McDonnell Douglas test to consider both direct and circumstantial evidence in a plaintiff's case, courts tend to view the test as an evidentiary roadmap in deciding the merits of the case, particularly when the plaintiff's case primarily relies on circumstantial evidence. Id.; see also Sandra F. Sperino, Article, Bethinking Discrimination Law, 110 MICH. L. REV. 69, 77 (2011). Courts have routinely modified the McDonnell Douglas test in order to apply it to different factual scenarios when looking at plaintiffs' prima facie cases because the facts will necessarily vary with each case. Id.; see also Mikaela Shaw, Comment; The Resurgence of the Maternal Wall: Revisiting Accommodation under the Pregnancy Discrimination Act, 2014 U. CHI. LEGAL F. 565, 578 (2014) (noting that each circuit applies the test with "slight variations in the language").

(43) See Chambers supra text accompanying note 42.

(44) Henry L. Chambers, Jr., Article, Recapturing Summary Adjudication Principles in Disparate Treatment Cases, 58 SMU L. Rev. 103, 105 (2005). Due to the ability of the McDonnell Douglas test to consider both direct and circumstantial evidence in a plaintiffs case, courts tend to view the test as an evidentiary roadmap in deciding the merits of the case, particularly when the plaintiffs case primarily relies on circumstantial evidence. Id.

(45) See Richmond, 885 F.3d at 937; see also Watson v. Cartee, 817 F.3d 299, 302. (6th Cir. 2016). When a district court grants summary judgment, an appellate court reviews the judgment de novo and does not defer to the original findings of fact by the trial court. Id.

(46) See Fed R. Civ. P. 56(a). In order for a court to grant summary judgment, there must be no dispute of material fact. Id.

(47) See U.S. CONST, amend. VIII. Inmates are provided the right to be free from cruel and unusual punishment. See generally, Estelle v. Gamble, 429 U.S. 97 (1976) the court found that the Eighth Amendment forbids "punishments which are incompatible with the evolving standards of decency that mark the progress of a maturing society" and held that "deliberate indifference to serious medical needs of prisoners" violated the Eighth Amendment. But see JACOBI, supra text accompanying note 29 at 461-62. Since Estelle, the Supreme Court has been hesitant to expand upon the notion of what constitutes adequate healthcare beyond treating serious medical conditions; see also Comstock v. McCrary, 273 F.3d 693, 702 (6th Cir. 2001). When prison doctors or officials are deliberately indifferent to a prisoner's serious medical needs, that prisoner's Eighth Amendment rights are violated. Id. at 703. A plaintiff alleging deliberate indifference needs to demonstrate more than mere negligence or a misdiagnosis of an ailment to establish a deliberate indifference claim under the Eighth Amendment. See Clark-Murphy v. Foreback, 439 F.3d 280, 286 (6th Cir. 2006). In order to establish a deliberate indifference claim, a plaintiff must prove that the alleged mistreatment by prison officials was objectively serious and that the defendants subjectively ignored the medical needs of the plaintiff. See Blackmore v.

Kalamazoo Cty., 390 F.3d 890, 897 (6th Cir. 2004). A medical need is objectively serious when a lay person can easily recognize the necessity of treatment. See Farmer v. Brennan, 511 U.S. 825, 837 (1994). For the subjective component of the deliberate indifference test, the plaintiff must prove that the official knew of an excessive risk to inmate health or safety and disregarded the risk. Id. The prison official needs to both be aware of facts that an inference could be drawn from that a substantial risk of serious harm exists and the official must draw the inference from those facts. Id.

(48) See Boretti v. Wiscomb, 930 F.2d 1150, 1154-55 (6th Cir. 1991). When a prisoner suffers pain needlessly and relief is readily available, that prisoner has a cause of action against the officials who may have caused the suffering.

(49) See Lemarbe v. Wisneski, 266 F.3d 429, 439 (6th Cir. 2001). A doctor must provide the patient with medical treatment without consciously exposing the inmate to treatment that creates an "excessive risk of serious harm." See Richmond No. 14-14892, 2016 U.S. Dist. LEXIS 138215, at *1-2. Lortab is a pain medication often used to treat burn wounds.

(50) See Boretti, 930 F.2d at 1155-56 (6th Cir. 1991). A plaintiff who brings evidence of a lack of a provision of care can still bring a claim of deliberate indifference even if the wound healed without an infection. Id.

(51) See Alspaugh v. McConnell, 643 F.3d 162, 169 (6th Cir. 2011). Federal courts are reluctant to second guess medical judgments for treatment unless the medical treatment in question is so inadequate that it is equivalent to no treatment at all. Id.

(52) See Comstock v. McCrary, 273 F.3d 693, 702 (6th Cir. 2001). A prison official alerted to a prisoner's serious medical needs has an obligation to offer medical care to a prisoner and the obligation extends to psychiatric needs and medication. Id.

(53) See generally Blackmore, 390 F.3d 899-900. When a plaintiff' shows that they are suffering from mental illness that a physician diagnoses as mandating treatment, a plaintiff has met their burden that they are suffering from a serious medical need. Id.

(54) See Comstock 273 F.3d at 710. An official does not act with deliberate indifference when they choose one medically reasonable form of treatment instead of another form of treatment. Id.; see also Rouster v. Cty. of Saginaw, 749 F.3d 437, 449 (6th Cir. 2014). An official has taken appropriate steps to protect an inmate's healthcare when they rely on other jail staff to evaluate the inmate's condition. Rouster, 749. F.3d at 449.

(55) See Estelle, 429 U.S. at 104. The infliction of unnecessary suffering is inconsistent with contemporary standards of decency and constitutes a claim under the Eighth Amendment. Id.

(56) See Comstock, 273 F.3d at 706. An official may be liable for deliberate indifference if their actions fall below what their training indicates as necessary to help an inmate patient. Id.

(57) See Pearson v. Callahan, 555 U.S. 223, 231 (2009). Qualified immunity protects government officials from civil liability if the official's conduct does not violate clearly established constitutional rights that a reasonable person would know. Id.; see also Estate of Carter v. City of Detroit, 408 F.3d 305, 310-11. (6th Cir. 2005) (defining qualified immunity). An analysis for qualified immunity has two steps, (1) whether a constitutional right was violated and (2) whether the constitutional right violated was clearly established. Id,; see Comstock v. McCrary, 273 F.3d at 702. When a right is clearly established, the right must be clear enough so that a reasonable official understands that their actions in the moment violate that right. Comstock, 273 F.3d at 702; see Parsons v. Caruso, 491 F. App'x 597, 602 (6th Cir. 2012) (noting that deliberate indifference to a prisoner's medical needs has been well established since 1976). The protection of prisoners from deliberate indifference to psychological needs is also well established. Id.

(58) See Connick v. Thompson, 563 U.S. 51, 60-1 (2011). A municipality of government can be liable for a [section]1983 claim if the government body subjects a person to a deprivation of rights or causes a person to suffer such a deprivation. Id. A plaintiff must prove that the action in the scope of municipal policy caused their injury. Id.; see also Blackmore, 390 F.3d at 900. Deliberate indifference can be proved with evidence that the city or county knew that an inmate faced a substantial risk of serious harm and disregarded the risk be failing to take reasonable measures to reduce it. Blackmon, 390 F.3d at 900.

(59) See Okla. City v. Tuttle, 471 U.S. 808, 823-24 (1985). In order for a plaintiffs Eighth Amendment claim regarding a specific municipality to pass muster, a plaintiff must prove that their injury was arguably caused by an existing, unconstitutional municipal policy. Id.

(60) See Richmond, 885 F.3d at 938-39 (finding that Richmond's burn wounds displayed objectively serious medical and mental health conditions). Richmond's second-degree burn wounds required an eventual skin graft and were the product of self-harm caused by Richmond's decision to set her seatbelt on fire. Id. Richmond also had an attempted suicide in her record, which the prison staff knew about because Richmond reported the attempt to the prison medical staff. Id.

(61) See Farmer, 511 U.S. at 837 (describing the Eighth Amendment's "subjective component"); Richmond, 885 F.3d at 939. The court found that a reasonable jury could find Clafton knew and disregarded risk of inadequate care implementation. Id. The court determined that no excessive harm risk existed with Clafton's inability to provide Richmond with psychiatric medication because he could not have provided the medication any sooner than Dr. Hinchman, who Richmond went to see on the same day. Id. at 941.

(62) See Richmond, 885 F.3d at 941. The court found no evidence existed that Huq implemented the burn treatment or was aware of its implementation. Id. The court found no facts in the record to suggest that I Iuq was aware the burn treatment was not been implemented as prescribed by the jail medical staff. Id. The court found that a jury could find Huq was aware and disregarded Richmond's psychiatric condition because there was a question of fact as to Huq's awareness that Richmond took both Prozac and Xanax for her mental health needs prior to her incarceration. Id. at 942.

(63) See id. at 942-43. The court held that Myftari disregarded his obligation to offer psychiatric medication to stop Richmond's suffering because he was aware of Richmond's past prescriptions of Xanax and Prozac as well as the risk that symptoms of bipolar disorder and depression can return within two weeks or less when a patient is not taking psychiatric medication. See id.

(64) See Comstock, 273 F.3d at 710. The court found that a mental health evaluation referral was a reasonable form of treatment instead of medication because it showed a professionally sound response to Richmond's claim that she required psychiatric medication. See Richmond 885 F.3d at 943-44. Mental health evaluation referrals show a concern for patients' needs rather than deliberate indifference because a patient has the potential to be prescribed the necessary treatment at a mental health evaluation. Id.

(65) See id. at 944. The court looked at Richmond's claims against nurse practitioner Marie Shoulders, resident nurses Jacqueline Lonberger, Shevon Fowler, April Williams, Felecia Coleman, and Maxine Hawk, and medical assistant Danielle Allen. Id. To parse out liability, the court went through the nursing staff one by one. Id.

(66) See Estelle, 429 U.S. at 104. The court noted that a reasonable jury could find intentional scrubbing of a wound as unnecessary pain infliction. Id.; see Richmond, 885 F.3d at 944. The infliction of unnecessary pain while implementing medical treatment is the type of conduct that the Eighth Amendment forbids. Estelle, 429 U.S. at 104.

(67) See Earner, 511 U.S. at 837. The court found no evidence existed Williams or Coleman disregarded a risk to Richmond's health. See Richmond, 885 F.3d at 945. Both nurses had limited interactions with Richmond while preparing her for examinations by a superior medical party. Id.

(68) See Earner, 511 U.S. at 837. The court noted that a reasonable jury could find Hawk and Shoulders disregarded risk of improper dressing changes. See Richmond, 885 F.3d at 945. There was a genuine question of fact from the record as to Hawk and Shoulders' awareness that Richmond's prescription for burn treatment was not being properly implemented. Id.

(69) See Farmer, 511 U.S. at 837. The court found that a reasonable jury could find Allen knew and disregarded risk of inadequate dressing changes. See Richmond, 885 F.3d at 946. There is no evidence that Allen did anything to address Richmond's dressing changes between January 5-20 2013, a time when Allen frequently provided dressing changes for Richmond as well as a time period where Richmond specifically alleged that her dressing changes were inconsistently implemented. Id.

(70) See Farmer, 511 U.S.at 837. The court noted that a reasonable jury could find Hawk and Fowler knew and disregarded the risk of Richmond needlessly suffering from going without her psychiatric medication. Id.; see Richmond, 885 F.3d at 946-47. The court found there was no excessive harm risk present with Shoulders inability to provide Richmond psychiatric medication because there was no evidence Shoulders could have provided Richmond with access to psychiatric medication than Dr. Hinchman, who Richmond saw on the same day. Richmond, 885 F.3d. at 947.

(71) See Estate of Carter, 408 F.3d at 310-11. The court found a dispute of material fact whether Wayne County prison staff violated Richmond's Eighth Amendment rights. See Richmond 885 F.3d at 948. The question of material fact stems from Wayne County Jail's practice of not verifying a patient's outside medication before determining whether the individual needs immediate medical treatment constitutes deliberate indifference. Id.

(72) See Richmond, 885 F.3d at 949. The ruling reversed five grants of summary judgment, reversed four grants of summary judgment in part, and affirmed three grants of summary judgment, leaving little of the District Court's holding intact. See id.

(73) See McDonnell Douglas Corp., 411 U.S. at 802; see also Sperino, supra note 42 at 77 and accompanying text. The malleability of the McDonnell Douglas test remains a crucial evidentiary tool in cases where a plaintiff alleges intentional discrimination by one or more defendants. See id.

(74) See Richmond, 885 F.3d. at 928. According to the McDonnell Douglas case, a complainant must first establish a prima facie case of discrimination by establishing they belong to a protected class before the burden can switch to the respondent to show they did not discriminate against the individual. See McDonnell Douglas Corp., 411 U.S. at 802.

(75) See JACOBI supra note 29 and accompanying text.

(76) See 'Richmond, 885 F.3d at 937. Although Richmond was supposed to receive one dose of medication every eight hours, for a total of three doses a day, it was jail policy to not wake a sleeping inmate when they were receiving pain medications. See id. at n.2.

(77) See McDonnell Douglas Corp., 411 U.S. at 802. The court provides four different ways a complainant may establish they have a prima facie case of discrimination. Id; see also Chambers, Jr. supra note 42 and accompanying text. The McDonnell Douglas test was designed so that a plaintiff could still make out a case even if the case relies solely on circumstantial evidence.

(78) See JACOBI supra note 29 and accompanying text at 447. Beginning with the founding of the United States, advocates for prison reform have been arguing for better health care for prisoners. See id.

(79) See McDonnell Douglas Corp., 411 U.S. at 802. The complainant must establish they belong to a protected class, they applied to, and were qualified for, a job where the employer was seeking applicants, they were rejected despite qualifications, and that following the rejection the position remained open and the employer continued to seek applicants. See id. at 802.

(80) See id. at 802. The court chose not to create a detailed list of legitimate reasons that an employer could have for refusing to hire a job applicant. Id. at 802-3.

(81) See McDonnell Douglas Corp., 411 U.S. at 803. The court stated that the employer must find an objective reason for refusing to hire an applicant since subjective criterion "carries] little weight in rebutting charges of discrimination." See id. at 803 (quoting Green v. McDonnell Douglas Corp., 463 F.2d 337, 352 (8th Cir. 1972).

(82) See McDonnell Douglas Corp., 411 U.S. at 802. The McDonnell Douglas test is used to remove "artificial, arbitrary and unnecessary barriers to employment when the barriers operate ... to discriminate on the basis of racial ... classification." See id. at 801 (quoting Griggs v. Duke Power Co., 401 U.S. 424, 430-31 (1971). The test is also used to balance societal and personal interests, such as promoting "efficient and trustworthy workmanship assured through fair and racially neutral employment and personnel decisions." See McDonnell Douglas Corp., 411 U.S. at 801.

(83) See Comstock, 273 F.3d at 702.

(84) See JACOBI supra text accompanying note 29 at 453-455. Prisons routinely are overcrowded, fail to have basic sanitation for inmates in need of healthcare and often leave inmates without the means to treat chronic health conditions or serious illnesses. See id.

(85) See McDonnell Douglas Corp., 411 U.S. at 802.

(86) See Richmond v. Huq, No. 14-14892, 2016 U.S. Dist. LEXIS 138215, at *1-2.

(87) See McDonnell Douglas Corp., 411 U.S. at 802.

(88) See ids, see also Richmond, 2016 U.S. Dist. LEXIS 138215, at *1-2.

(89) See Richmond, 885 F.3d at 934-35. The dressings were not changed in the prescribed time frame and there were missed doses of medication. Id.

(90) See McDonnell Douglas Corp., 411 U.S. at 802.

(91) See id. The employer did not dispute the respondent's qualifications despite rejecting the plaintiff for the job, which is similar to a medication being prescribed and a different treatment being given. Id.

(92) See id.

(93) See Richmond, 885 F.3d at 937.

(94) See McDonnell Douglas Corp., 411 U.S. at 802.

(95) See Richmond, 885 F.3d at 937. See Sperino, supra note 42 at 77.

(96) See McDonnell Douglas Corp., 411 U.S. at 802.

(97) See id. at 804.

(98) See id.

(99) See id at 802.

(100) See id.
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Date:Sep 22, 2019
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