ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA D.C.C.A. No. 77-1399
Before Seitz, Chief Judge, Adams and Rosenn, Circuit Judges.
One of the most persistent problems in the administration of the criminal justice system is how to treat those individuals who have been charged with a crime but not yet convicted. In order to guarantee their presence at trial, the state may imprison citizens before their guilt or innocence is determined, but their status during this waiting period has been questioned ever since the time of Blackstone, who described the wait between arrest and trial as "this dubious interval."*fn1 It has been asserted that pretrial detainees have often fared worse than convicts in our prisons,*fn2 but in recent years many courts, through application of the due process clause, have sought to extend to them protection as great or greater than that afforded convicted prisoners.*fn3
In the present case we are confronted with the question of the state's authority to discontinue a medically accepted course of treatment for drug addiction that had previously been prescribed for a pretrial detainee. The district court decided, after hearing expert medical testimony, that plaintiff's loss of access to methadone maintenance dosages at best constituted a medical malpractice claim, and did not amount to the violation of his constitutional rights necessary to support a suit under 42 U.S.C. § 1983. We conclude that under the circumstances here the refusal to allow Norris to continue to receive methadone operates to deprive him of a liberty interest without due process of law, unless the state can demonstrate that a legitimate security concern, or a genuine fear of substantial administrative disruption, warrants this interference with plaintiff's medical care. Because the record does not demonstrate a connection between the security interest justifying the incarceration of a pretrial detainee and the deprivation of liberty complained of here, the case must be remanded to the district court.
Appellant Tyrone Norris was arrested for a drug-related offense on April 23, 1975. Bail was set at $150,000,*fn4 but Norris was unable to post that amount. He was then taken to the Chester County Farms Prison, where he was to be detained while awaiting trial. For approximately seven months prior to his arrest, Norris had been receiving prescribed daily dosages of methadone from the Chester-Crozier Methadone Clinic in Chester, Pennsylvania, a facility licensed to dispense the drug pursuant to federal and state regulations.
On his arrival at the prison, Norris immediately informed Sergeant Mazzi, a guard, that he was participating in the Chester-Crozier program, presented his identification card, and requested that he be supplied with methadone. The next day he repeated his request to Dr. Kistler, the prison physician. Methadone was not regularly dispensed at the prison, and although Dr. Kistler and Warden Frame sometimes arranged for the transfer of prisoners with drug problems to facilities where different treatment was available,*fn5 Dr. Kistler concluded that that procedure was unnecessary in Norris' case. Instead, he treated Norris with thorazine, a tranquilizer, which Norris claims provided little help in dealing with the pain of withdrawal from methadone addiction.
Norris returned to the infirmary on April 28, and Dr. Kistler testified that he did not find Norris to be exhibiting the usual symptoms associated with withdrawal from addiction to drugs. The doctor also testified that Norris' failure to return with more serious symptoms and complaints indicated the stability of his condition, and justified the decision not seek outside help.*fn6 Norris, on the other hand, testified that he was reluctant to go to Dr. Kistler because the doctor had told him there was nothing he could do.*fn7
Whatever the prison authorities knew or should have known about the severity of his condition, Norris testified that the pain was sufficient to drive him to slash his left wrist on May 2, 1975, whereupon he was hospitalized and his wrist was bandaged. Thereafter he attempted to tear out the stitches, and, as a result, the wrist became infected. Norris was returned to the Chester County Farms Prison, where he received treatment and considerable medication, including librium, valium and benadryl. He remained incarcerated at the prison for several months thereafter, but at no time did he receive permission to continue the methadone medication he had been receiving before his arrest.
Norris brought this action under 42 U.S.C. § 1983 against Chester County,*fn8 Warden Frame, Dr. Kistler and seventeen other named defendants, alleging that their refusal to allow him to continue to receive methadone while he was detained before trial constituted a denial of liberty without due process of law. He sought to bring suit as a member of a class, as well as individually. However, the district court refused to certify the class, ruling that it did not meet the requirements of Rule 23 of the Federal Rules of Civil Procedure. Norris also set forth a state law claim of negligence, but the trial judge declined jurisdiction over any pendent claim after he had rejected the federal cause of action.
The district court, sitting without a jury, concluded that the facts alleged established, at most, medical malpractice, which alone does not amount to the constitutional violation necessary to proceed under § 1983. In adopting an eighth amendment analysis to evaluate Norris' claim, the trial court said:
While we are sympathetic to the plight of an individual such as Mr. Norris who undergoes drug withdrawal while incarcerated, we feel that his legal claims rise no higher than alleging inadequacy or impropriety of treatment. It is not alleged that the plaintiff was denied medical attention; both the plaintiff and Dr. Kistler testified that he received considerable medical attention during his incarceration at Chester County Farms. Neither did his medical treatment consist of acts which were either intentionally injurious, callous, grossly negligent, shocking to the conscience, unconscionable, intolerable to the fundamental fairness or barbarous. We adhere to the standard enunciated by Judge Luongo in Roach v. Kligman, 412 F. Supp. 521, 525 (E.D.Pa.1976) wherein he held: "Where the plaintiff has received some ...