estelle gamble argued october decided november respondent state inmate brought civil rights action petitioners state corrections department medical director gray two correctional officials claiming subjected cruel unusual punishment violation eighth amendment inadequate treatment back injury assertedly sustained engaged prison work district dismissed complaint failure state claim upon relief granted appeals held alleged insufficiency medical treatment required reinstatement complaint held deliberate indifference prison personnel prisoner serious illness injury constitutes cruel unusual punishment contravening eight amendment however respondent claims gray suggest indifference allegations revealing gray medical personnel saw respondent occasions span treated injury problems failure perform use additional diagnostic techniques constitute cruel unusual punishment medical malpractice cognizable state courts question whether respondent stated constitutional claim petitioners director department corrections warden prison separately evaluated appeals considered remand pp reversed remanded marshall delivered opinion burger brennan stewart white powell rehnquist joined blackmun concurred judgment stevens filed dissenting opinion post bert pluymen assistant attorney general texas argued cause petitioners pro hac vice brief john hill attorney general david kendall first assistant attorney general joe dibrell assistant attorney general daniel hedges appointment argued cause filed brief respondent pro hac vice justice marshall delivered opinion respondent gamble inmate texas department corrections injured november performing prison work assignment february instituted civil rights action complaining treatment received injury named defendants petitioners estelle director department corrections husbands warden prison ralph gray medical director department chief medical officer prison hospital district sua sponte dismissed complaint failure state claim upon relief granted appeals reversed remanded instructions reinstate complaint granted certiorari complaint dismissed failure state claim must take true handwritten pro se allegations cooper pate according complaint gamble injured november bale cotton fell unloading truck continued work four hours became stiff granted pass unit hospital hospital medical assistant captain blunt checked hernia sent back cell within two hours pain became intense gamble returned hospital given pain pills inmate nurse examined doctor following day gamble saw astone diagnosed injury lower back strain prescribed zactirin pain reliever robaxin muscle relaxant placed respondent status two days allowing remain cell times except showers november gamble saw astone continued medication another seven days also ordered respondent moved upper lower bunk one week prison authorities comply directive following week gamble returned astone doctor continued muscle relaxant prescribed new pain reliever febridyne placed respondent seven days permitting remain cell except meals showers november respondent saw astone put respondent back original pain reliever five days continued another week december despite gamble statement back hurt much first day astone took thereby certifying capable light work time astone prescribed febridyne seven days gamble went major muddox told much pain work muddox respondent moved administrative segregation december gamble taken prison disciplinary committee apparently refusal work committee heard complaint back pain high blood pressure directed seen another doctor december respondent saw petitioner gray performed urinalysis blood test blood pressure measurement gray prescribed drug high blood pressure febridyne back pain following week respondent saw gray continued additional days prescription filled four days however staff lost respondent went unit hospital twice december times seen captain blunt prescribed tiognolos described muscle relaxant december respondent remained administrative segregation early january gamble told two occasions sent farm return work refused nonetheless claiming much pain january requested go sick call back pain migraine headaches initial refusal saw captain blunt prescribed sodium salicylate pain reliever seven days days respondent returned captain blunt january january received renewals pain reliever prescription times throughout month respondent kept administrative segregation january gamble brought prison disciplinary committee refusal work early january told committee work severe back pain high blood pressure captain blunt testified gamble first class medical condition committee medical examination testimony placed respondent solitary confinement four days later february respondent asked see doctor chest pains blank outs night medical assistant examined ordered hospitalized following day heaton performed electrocardiogram one day later respondent placed quinidine treatment irregular cardiac rhythm moved administrative segregation february respondent experienced pain chest left arm back asked see doctor guards refused asked next day guards refused finally february allowed see heaton ordered quinidine continued three days february swore complaint ii gravamen respondent complaint petitioners subjected cruel unusual punishment violation eighth amendment made applicable fourteenth see robinson california therefore base evaluation respondent complaint amendments decisions interpreting history constitutional prohibition cruel unusual punishments recounted length prior opinions need repeated see gregg georgia joint opinion stewart powell stevens jj hereinafter joint opinion see also granucci cruel unusual punishment inflicted original meaning rev suffices note primary concern drafters proscribe torture barbar ous methods punishment accordingly first applied eighth amendment comparing challenged methods execution concededly inhuman techniques punishment see wilkerson utah safe affirm punishments torture others line unnecessary cruelty forbidden amendment kemmler punishments cruel involve torture lingering death recent cases however held amendment proscribes physically barbarous punishments see gregg georgia supra joint opinion trop dulles weems amendment embodies broad idealistic concepts dignity civilized standards humanity decency jackson bishop must evaluate penal measures thus held repugnant eighth amendment punishments incompatible evolving standards decency mark progress maturing society trop dulles supra see also gregg georgia supra joint opinion weems supra involve unnecessary wanton infliction pain gregg georgia supra joint opinion see also louisiana ex rel francis resweber wilkerson utah supra elementary principles establish government obligation provide medical care punishing incarceration inmate must rely prison authorities treat medical needs authorities fail needs met worst cases failure may actually produce physical torture lingering death kemmler supra evils immediate concern drafters amendment less serious cases denial medical care may result pain suffering one suggests serve penological purpose cf gregg georgia supra joint opinion infliction unnecessary suffering inconsistent contemporary standards decency manifested modern legislation codifying view public required care prisoner reason deprivation liberty care therefore conclude deliberate indifference serious medical needs prisoners constitutes unnecessary wanton infliction pain gregg georgia supra joint opinion proscribed eighth amendment true whether indifference manifested prison doctors response prisoner needs prison guards intentionally denying delaying access medical care intentionally interfering treatment prescribed regardess regardless evidenced deliberate indifference prisoner serious illness injury cause action conclusion mean however every claim prisoner received adequate medical treatment violation eighth amendment accident although may produce added anguish basis alone characterized wanton infliction unnecessary pain louisiana ex rel francis resweber example concluded unconstitutional force prisoner undergo second effort electrocute mechanical malfunction thwarted first attempt writing plurality justice reed reasoned second execution violate eighth amendment first attempt unforeseeable accident justice frankfurter concurrence based solely due process clause fourteenth amendment concluded since first attempt failed innocent misadventure second repugnant conscience mankind quoting palko connecticut similarly medical context inadvertent failure provide adequate medical care said constitute unnecessary wanton infliction pain repugnant conscience mankind thus complaint physician negligent diagnosing treating medical condition state valid claim medical mistreatment eighth amendment medical malpractice become constitutional violation merely victim prisoner order state cognizable claim prisoner must allege acts omissions sufficiently harmful evidence deliberate indifference serious medical needs indifference offend evolving standards decency violation eighth amendment iii backdrop consider whether respondent complaint cognizable claim handwritten pro se document liberally construed unanimously held haines kerner pro se complaint however inartfully pleaded must held less stringent standards formal pleadings drafted lawyers dismissed failure state claim appears beyond doubt plaintiff prove set facts support claim entitle relief quoting conley gibson even applying liberal standards however gamble claims gray capacity treating physician medical director corrections department cognizable gamble seen medical personnel occasions spanning period astone five times gray twice heaton three times unidentified doctor inmate nurse day injury medical assistant blunt six times treated back injury high blood pressure heart problems gamble disclaimed objection treatment provided high blood pressure heart problem complaint based solely lack diagnosis inadequate treatment back injury response pet cert see also brief respondent doctors diagnosed injury lower back strain treated bed rest muscle relaxants pain relievers respondent contends done way diagnosis treatment suggests number options pursued appeals agreed stating certainly gamble lower back might order tests conducted led appropriate diagnosis treatment daily pain suffering experiencing question whether additional diagnostic techniques forms treatment indicated classic example matter medical judgment medical decision order like measures represent cruel unusual punishment medical malpractice proper forum state texas tort claims act appeals error holding alleged insufficiency medical treatment required reversal remand portion judgment district affirmed appeals focused primarily alleged actions doctors separately consider whether allegations director department corrections estelle warden prison husbands stated cause action although reverse judgment medical director remand case appeals allow opportunity consider conformity opinion whether cause action stated prison officials ordered footnotes every person color statute ordinance regulation custom usage state territory subjects causes subjected citizen person within jurisdiction thereof deprivation rights privileges immunities secured constitution laws shall liable party injured action law suit equity proper proceeding redress appears even aware suit reached appeals tr oral arg probably resulted district dismissed complaint simultaneously granting leave file forma pauperis complaint bale weighed pound appeals interpreted mean pounds names descriptions drugs administered respondent taken complaint app brief number terms complaint whose meaning unclear answer state must remain example administrative segregation never defined appeals deemed equivalent solitary confinement note however gamble stated administrative segregation five building five building solitary confinement five building eighth amendment provides excessive bail shall required excessive fines imposed cruel unusual punishments inflicted amendment also proscribes punishments grossly disproportionate severity crime gregg georgia joint opinion weems imposes substantive limits made criminal punished robinson california neither principles involved see code tit alaska stat rev stat ann supp stat ann code ann idaho code supp ann stat ind ann stat stat ann supp md ann code art mass ann laws stat ann miss code ann mo ann stat neb rev stat rev stat ann stat ann code ann utah code ann code ann code ann supp wyo stat ann many also adopted regulations specify varying degrees detail standards medical care provided prisoners see comment rights prisoners medical care implications prisoners pretrial detainees chi rev model correctional legislation proposed minimum standards accord see american law institute model penal code national advisory commission criminal justice standards goals standards rights offenders standard national council crime delinquency model act protection rights prisoners national sheriffs association standards inmates legal rights right fourth nations congress prevention crime treatment offenders standard minimum rules treatment prisoners rules foregoing may found dept justice law enforcement assistance administration compendium model correctional legislation standards ed spicer williamson see williams vincent doctor choosing easier less efficacious treatment throwing away prisoner ear stitching stump may attributable deliberate indifference rather exercise professional judgment thomas pate cert denied sub nom thomas cannon injection penicillin knowledge prisoner allergic refusal doctor treat allergic reaction jones lockhart refusal paramedic provide treatment martinez mancusi cert denied prison physician refuses administer prescribed pain killer renders leg surgery unsuccessful requiring prisoner stand despite contrary instructions surgeon see westlake lucas thomas pate supra fitzke shappell hutchens alabama riley rhay edwards duncan hughes noble see wilbron hutto campbell beto martinez mancusi supra tolbert eyman edwards duncan supra noted however series abortive attempts single cruelly willful attempt present different case courts appeals essential agreement standard agree mere allegations malpractice state claim terminology regarding sufficient varies results inconsistent standard deliberate indifference see page sharpe williams vincent supra uses phrase deliberate indifference gittlemacker prasse russell sheffer newman alabama cert denied callous indifference westlake lucas supra deliberate indifference thomas pate supra wilbron hutto supra deliberate indifference tolbert eyman supra dewell lawson tex rev civ art supp petitioners assured argument statute used prisoners assert malpractice claims tr oral arg contrary justice stevens assertion dissent case signals retreat haines kerner contrast general allegations haines gamble complaint provides detailed factual accounting treatment received exhaustive description renders speculation unnecessary apparent complaint received extensive medical care doctors indifferent needs justice stevens dissenting said opinion entirely consistent way lower federal courts processing claims medical treatment prison inmates inadequate constitute cruel unusual punishment prohibited eighth amendment serious disagreement way area law developed thus far probable impact opinion nevertheless three reasons unable join first insofar opinion orders dismissal complaint chief medical officer prison faithful rule normally applied construing allegations pleading prepared uncounseled inmate second adequately explain granted certiorari case third describes state duty provide adequate medical care prisoners ambiguous terms incorrectly relate subjective motivation persons accused violating eighth amendment rather standard care required constitution complaint represents crude attempt challenge system administering medical care prison gamble confined fairly construed complaint alleges received serious disabling back injury november responsible prison authorities indifferent medical needs result indifference mistreated condition worsened indifference allegedly manifested merely failure refusal diagnose treat injury properly also conduct prison staff gamble placed solitary confinement prolonged periods punishment refusing perform assigned work physically unable perform medical evidence presented disciplinary committee statement medical assistant condition fact suffering back sprain high blood pressure prison guards refused permit sleep bunk doctor assigned least one occasion medical prescription filled four days lost staff personnel suffered chest pains blackouts solitary forced wait hours see doctor clearance obtained warden complaint also draws question character attention received doctors inmate nurse response attempts obtain proper diagnosis treatment condition however apart medical director saw twice sued individuals saw occasions short complains system whole inadequate basis gamble handwritten complaint impossible assess quality medical attention received points even alleges true doctors may guilty nothing negligence malpractice hand surely inconceivable overworked undermanned medical staff crowded prison following expedient course routinely prescribing nothing pain killers thorough diagnosis disclose obvious need remedial treatment three fine judges sitting appeals fifth circuit thought enough alleged require inquiry actual facts meant said haines kerner judges clearly right haines test whether facts alleged complaint entitle plaintiff relief rather whether say assurance basis complaint beyond doubt set facts proved entitle plaintiff relief reasons haines test manifest pro se complaint provides unsatisfactory foundation deciding merits important questions typically inartfully drawn unclear equivocal thorough pleadings affidavits possibly evidentiary hearing usually bring facts simplify make unnecessary decision questions presented naked complaint admittedly tempting eliminate meritless complaint pleading stage unfortunately another instance judicial haste long run makes waste dioguardi durning clark cited approval haines kerner supra instant case district resisted temptation premature dismissal case might long since ended filing medical records affidavits demonstrating adequate treatment likewise decision fifth circuit reinstating complaint allowed stand case run normal course litigation probably come end without need review even fifth circuit wrongly decided pleading issue great harm done requiring state produce medical records move summary judgment instead case prolonged two stages appellate review still case two defendants may still proceed even claims prison doctors disposed finality principal beneficiaries today decision federal judges little whose time saved rather within prison walls whose semiprofessional services greater demand doubt ability semiprofessional embellish pleading conclusory allegations made good faith foreclose dismissal without response state unfortunate today decision increase prisoners dependence see cruz beto rehnquist dissenting ii like district decision dismiss complaint decision hear case violation normal practice denying interlocutory review see stern gressman practice ed ill serves interest judicial economy frankly still puzzled decision grant certiorari merely thought fifth circuit misapplied haines kerner reading complaint liberally grant certiorari inexplicable hand thought instead pleading question case presented important constitutional question state duty provide medical care prisoners crude allegations complaint provide kind factual basis normally requires predicate adjudication novel serious constitutional issue see rescue army municipal ellis dixon wainwright city new orleans harlan concurring moreover notes courts appeals consider question reached substantially conclusion adopts ante since seldom takes case merely reaffirm settled law fail understand chosen make case exception normal practice iii reference accidental character first unsuccessful attempt electrocute prisoner louisiana ex rel francis resweber see ante repeated references deliberate indifference intentional denial adequate medical care believe improperly attaches significance subjective motivation defendant criterion determining whether cruel unusual punishment inflicted subjective motivation may well determine remedy appropriate particular defendant however whether constitutional standard violated turn character punishment rather motivation individual inflicted whether conditions andersonville product design negligence mere poverty cruel inhuman sum remain convinced petition certiorari denied granted affirm judgment appeals complaint gamble alleged placed administrative segregation remained december january end january placed solitary confinement affidavit filed appeals following december see infra gamble alleged exception one day taken solitary brought disciplinary committee remained solitary date affidavit according state legislative report quoted appeals texas department corrections various times one three doctors care inmates occasional help poorly drafted complaint attempts describe conditions resemble reported prison systems instance study pennsylvania prison system reported ill prisoner point contact prison health care program line access may barred guard refuses give convict hospital pass whimsy prejudice light history undiagnosed complaints sick call convict commonly first sees civilian paraprofessional nurse may treat case placebo without actual examination recorded diagnosis even seeing doctor prisons produces aspirin symptoms dizziness fainting persisted years health law project university pennsylvania health care conditions pennsylvania state prisons american bar association commission correctional facilities services medical health care jails prisons correctional facilities compilation standards materials far area greatest problem hospital one major prison perhaps hospitals abusive relationship although indifference medical technical assistants toward medical complaints inmates unique folsom reported continuously elsewhere calloused frequently hostile attitude exhibited doctors uniquely reprehensible typical complaints one doctor adequately diagnose treat patient disciplinary problem prison assembly select committee prison reform rehabilitation examination california prison hospitals panel included justice clark retired member sitting designation circuit judges goldberg ainsworth haines unanimous admonished federal judiciary especially solicitous problems uneducated inmate seeking litigate behalf said whatever may limits scope inquiry courts internal administration prisons allegations asserted petitioner however inartfully pleaded sufficient call opportunity offer supporting evidence say assurance allegations pro se complaint hold less stringent standards formal pleadings drafted lawyers appears beyond doubt plaintiff prove set facts support claim entitle relief conley gibson see dioguardi durning test actually applied haines although ordered complaint reinstated expressly intimate view whatever merits petitioner allegations significant took approach despite pressed state decide merits case state argued forcefully facts alleged complaint amount constitutional violation one brief state discuss pleading question brief respondents yet devoted single word opinion answering argument constitutional violation alleged thus haines teaches decision merits complaint normally postponed facts ascertained approach taken polk glover reversed dismissal complaint without intimating view constitutional issues salutary principle essential facts determined passing upon grave constitutional questions see also borden baldwin cardozo stone concurring result approach potentially avoids necessity ever deciding constitutional issue since facts proved may remove constitutional question alternatively concrete record available decide constitutional issues see generally rescue army municipal even constitutional principles involved important conceptual legal theories explored assayed light actual facts pleader supposition courts may avoid elucidating legal responsibilities facts may never shull pilot life ins affidavit filed appeals gamble transferred another prison placed solitary confinement denied medical care conditions allegedly continuing december date affidavit appeals apparently considered allegations shown reference fact gamble spent months solitary confinement without medical care stands good chance remaining way without intervention presumably remand bar gamble pursuing charges necessary filing new complaint formal amendment present complaint original complaint also alleged prison officials failed comply doctor order move gamble lower bunk put solitary confinement claimed physically unable work refused allow see doctor two days solitary gamble medical condition relevant allegations therefore probable medical records produced testimony elicited gamble medical care evidence show fact sustained serious injury received pro forma care surely allowed amend pleading reassert claim one prison doctors remarkable thing case presence case involves application principles familiar situation little significance except respondent certiorari granted mystery particularly time thought many burdened heavy caseload butz glover livestock stewart dissenting notes ante even meaning terms used complaint unclear reason granting certiorari writ dismissed improvidently granted became clear oral argument parties agreed constitutional standard disagreed application allegations particular complaint see tr oral arg four dissenting justices resweber pointed intent executioner lessen torture excuse result statutory duty state officials make sure failure burton joined douglas murphy rutledge indicates eighth amendment violated prison guards intentionally denying delaying access medical care intentionally interfering treatment prescribed ante meant indicate intent necessary part eighth amendment violation disagree state elects impose imprisonment punishment crime believe obligation provide persons custody health care system meets minimal standards adequacy part basic obligation state agents affirmative duty provide reasonable access medical care provide competent diligent medical personnel ensure prescribed care fact delivered denial medical care surely part punishment civilized nations may impose crime course every instance improper health care violates eighth amendment like rest us prisoners must take risk competent diligent physician make error error may give rise tort claim necessarily constitutional claim state adds risk providing physician meet minimum standards competence diligence give adequate care excessive caseload inadequate facilities prisoner may suffer breach state constitutional duty