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Legally Speaking: Diabetes care in a correctional facility

If you work as a nurse in a correctional facility, you know all too well that an inmate has a constitutional right to be free from cruel and unusual punishment under the Eighth Amendment. Likewise, you also know that you cannot be “deliberately indifferent” to the inmate’s serious medical needs. And, the right to adequate medical care, not the best care possible, is the normal standard by which your practice is evaluated should an inmate injury or death occur.

Inmates also have rights under Section 1983 of the Civil Rights Act of 1871 that protect their right to medical treatment. This protection is afforded any prisoner who is incarcerated in a state-run facility. Briefly, the act affords all the protections of the U.S. Constitution, federal statutory and administrative rights. In short, it allows the inmate to initiate a civil action against any governmental conduct that violates a federal right and allows a request for damages or equitable relief (e.g., an injunction).

One inmate in a prison in Virginia believed he was not receiving adequate medical care for his diabetes and filed a suit under Section 1983 for relief.1

One day, the inmate complained to a nurse on duty in the prison that he needed to have his blood sugar checked. The nurse informed the prisoner that she did not have an order requiring daily blood sugar testing but he could ask the doctor for such an order. The inmate did so and the doctor ordered the glucose checks.

The nurse checked the inmate’s blood sugar the next day and found it to be low, as was his blood pressure. The nurse placed the inmate on the doctor list. The inmate was examined and he told the doctor that the nurse told him there were no orders for regular blood sugar tests.

Based on his assessment and the patient’s medical history, the doctor informed the inmate that his blood sugar only needed to be checked every three months and that the doctor was going to try to discontinue his oral diabetic medication for a few days. The doctor told the inmate to tell the nurse if he was having serious headaches. He also wanted to have blood drawn for three glucose levels. When the nurse came in to draw blood, the inmate refused.2

When the doctor visited the inmate in his cell, he asked why he had refused the blood draw. The inmate informed the doctor that blood draws were not necessary and the finger stick method was adequate enough to check his blood sugar levels. The physician informed him that if he refused the blood draws, he could not prescribe his oral diabetic medication and would note in his medical record that he refused medical care.

All nurses refused to provide the finger sticks for glucose levels because they had no orders to do so. When the inmate filed a grievance about the entire situation, other correctional officers allegedly failed to comply with his filed grievance.

The inmate filed his Section 1983 action, naming the doctor, two nurses, the warden and the two officers who failed to comply with his grievances.3

The court carefully discussed all of the applicable laws when an inmate alleges a violation of Section 1983 and the right of the prisoner to medical treatment. It opined that the inmate did not allege that anyone in the prison ignored his serious medical condition. Rather, the inmate disagreed with the manner in which the medical staff treated his condition. The court stated that the nurses were correct in not doing daily finger checks without a physician’s order and that the physician’s treatment plan was offered but not accepted by the inmate.

The inmate’s “mere belief that he should receive different treatment for different ailments does not demonstrate that the doctor’s treatment plan was an unreasonable response to the risks” of the inmate’s medical condition.4 Moreover, the court continued, had the doctor misdiagnosed his medical condition, that is not the basis for a legal case alleging “deliberate indifference.”

The court also held that a prisoner does not have a constitutional right to a grievance procedure. The correctional officers’ alleged failure to comply with his request was based on the physician’s treatment plan and therefore does not give rise to a Section 1983 violation.

This case illustrates how applicable law is analyzed and applied to an inmate’s allegations of a violation of constitutional and civil rights. In this instance, no violation was found. The nurse and nurses involved in the inmate’s care listened to his concerns about his diabetes, informed him of how he could see the physician, the physician provided medical oversight and suggested treatment, and the nurses did not overstep their role by taking blood sugar checks without an order.

[accordion load=”hide”]As a nurse working in a correctional facility, you never want to be successfully sued for violating an inmate’s right to healthcare. This is especially important when an inmate has a chronic condition such as diabetes. So, it is essential that you:

1.Never know of yet disregard an excessive risk of harm to an inmate’s health by failing to take reasonable steps to abate any risk of harm to the inmate5;
2. Never deny or delay an inmate’s access to a physician or other medical personnel;
3. Never fail to carry out medical orders;
4. If you need an order from a physician before initiating treatment or carrying out a test, request that order;
5. Never fail to solicit as much information as you can about an inmate’s symptoms;
6. Quickly place an inmate on the sick call or doctor’s call when you in your professional judgment believe it is necessary; and
7. Keep your clinical skills up to date so that you can competently examine, diagnose and treat an inmate or refer the inmate to the physician or to another treatment facility used by the prison. [/accordion]


1. Spencer v. Williams, Civil Action No. 7:05-cv-00627 (W.D. Va.), October 19, 2005, 1-5.
2. Id., at 2.
3. Id.
4. Id., at 4-5.
5. Farmer v. Brennan, 511 U.S. 825, 836 (1994).

By | 2015-08-17T20:45:55-04:00 August 17th, 2015|Categories: Nursing Careers and Jobs, Nursing News|0 Comments

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

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