United States District Court, Eastern District of Pennsylvania
December 10, 2002
CHARLES ISELEY, SR., ET AL., PLAINTIFFS,
MARTIN DRAGOVICH, ET AL., DEFENDANTS.
The opinion of the court was delivered by: Eduardo C. Robreno, United States District Judge
MEMORANDUM AND ORDER
Plaintiff Charles Iseley, Sr. ("plaintiff") is an inmate at the
Pennsylvania State Correctional Institution at Green. Plaintiff suffers
from Hepatitis C, a common viral infection of the liver which can cause
liver cancer. Plaintiff asserts that for over four years he has
repeatedly requested from prison officials to be treated for Hepatitis
C, but has yet to receive such treatment.
In response to plaintiff's request, the Department of Corrections
("DOC") directed that he submit to a psychological evaluation and sign a
Mental Health Informed Consent Document ("consent form")*fn1 before his
requested treatment could proceed. As part of plaintiff's psychological
evaluation, plaintiff is required to complete a Beck Depression Inventory
("BDI questionnaire"), which consists of a series of questions designed
to help evaluate whether plaintiff suffers from depression, and to sign a
consent form authorizing the release of certain medical and personal
The DOC asserts that plaintiff's treatment cannot proceed without
plaintiff first undergoing the psychological evaluation. This is so,
according to the DOC, because medicinal treatment for Hepatitis C can
cause severe psychological side effects, and the likelihood that
plaintiff will experience these side effects must be assessed before
treatment can be administered. The DOC contends that, without a
psychological evaluation, the proper course of treatment cannot be
ascertained. Moreover, defendants*fn2 refuse to treat plaintiff without
first obtaining a signed consent form. According to defendants, the
consent form authorizes the DOC to release plaintiff's medical and
personal information in order to protect other inmates and staff, and to
insure the orderly operation of the prison facility.
Plaintiff, on the other hand, refuses to submit to the psychological
evaluation as a condition for receiving treatment for Hepatitis C and
also refuses to sign the consent form.
Plaintiff brings this action under 42 U.S.C. § 1983 claiming that
defendants have acted with deliberate indifference towards his serious
medical needs. Before this court is plaintiff's pro se request for a
preliminary injunction. The parties have made extensive and highly
detailed written submissions (see doc. nos. 96, 97, 102, 103, 104 for
plaintiff and doc. No. 100 and non-commonwealth defendants' response to
plaintiff's motion, which has yet to be docketed, for defendants) and the
court heard argument. For the reasons that follow, plaintiff's request
for injunctive relief will be denied.
The Third Circuit recently restated the factors a court must consider
and the burden a party must meet in order to obtain injunctive relief:
[t]o obtain an injunction, the plaintiff [has] to
demonstrate (1) that [he is] reasonably likely to
prevail eventually in the litigation and (2) that [he
is] likely to suffer irreparable injury without
If these two threshold showings are made[,] the
District Court then considers, to the extent
relevant, (3) whether an injunction would harm the
[defendant] more than denying relief would harm the
plaintiff and (4) whether granting relief would
serve the public interest.
Tenafly Eruv Assoc., Inc. v. Borough of Tenafly, 309 F.3d 144, 2002 WL
31388923 at *6 (3d Cir. October 24, 2002) (citing S. Camden Citizens in
Action v. N.J. Dep't of Envtl. Protection, 274 F.3d 771, 777 (3d Cir.
2001) and Adams v. Freedom Forge Corp., 204 F.3d 475, 484 (3d Cir. 2000))
(internal citations omitted). In other words, the movant must establish a
likelihood of success on the merits and a likelihood that he will suffer
irreparable injury if the requested relief is not granted before the
court can even consider public interest and the balance of hardships.
For the purpose of deciding the instant motion, the court will assume
that plaintiff can show that he will suffer irreparable harm if he is not
treated for Hepatitis C. More problematic, however, is the likelihood
that plaintiff will ultimately succeed on the merits of the instant
To state a claim under 42 U.S.C. § 1983 for deprivation of medical
violation of the Eighth Amendment, a plaintiff must show
that the defendant acted with "deliberate indifference to serious medical
needs." Estelle v. Gamble, 429 U.S. 97, 104 (1976). The defendants
acknowledge that medical treatment for Hepatitis C constitutes a serious
medical need under Estelle. They contend, however, that they did not act
with deliberate indifference towards plaintiff's need for treatment.
To prove deliberate indifference, plaintiff must establish that
defendants knew that plaintiff faced a "substantial risk of serious
harm," but disregarded "that risk by failing to take reasonable measures
to abate it." Farmer v. Brennan, 511 U.S. 825, 847 (1994); see Singletary
v. Pa. Dept. of Corrections, 266 F.3d 186, 193 n. 2 (3d Cir. 2001)
(stating that the general standard for a § 1983 deliberate
indifference claim is set forth in Farmer). For the purpose of deciding
whether injunctive relief is appropriate at this stage of the
litigation, the court will assume that defendants knew of the
"substantial risk of serious harm" to plaintiff. Accordingly, the precise
issue before the court is whether plaintiff has established a reasonable
likelihood that he will ultimately prevail on the issue of whether
defendants took reasonable measures to abate the risk posed to plaintiff
as a result of his need for Hepatitis C treatment.
A. The Requirement that Plaintiff Submit to a Psychological Evaluation
before he can Receive Medicinal Treatment for Hepatitis C is
Reasonably Related to a Legitimate Penological Interest.
It is uncontested that plaintiff has sought medical treatment for a
significant period of time. Defendants explain, however, that they agreed
to provide the requested treatment, but informed plaintiff that he would
have to undergo a psychological evaluation and sign a consent form before
medicinal treatment could begin. Plaintiff refused. Accordingly,
defendants contend that, it is plaintiff who has delayed treatment by
refusing to submit to the psychological evaluation, which includes
completion of the BDI questionnaire, and by refusing to sign the consent
Defendants further explain that DOC policy requires that all treatment
of Hepatitis C begin with a psychological evaluation of the patient.*fn3
The purpose of this
requirement is to enable medical personnel to
determine if there is a risk that the patient will suffer certain
psychological side effects from receiving Hepatitis C medication,*fn4
and, in turn, to calibrate the course of treatment accordingly. The DOC
further asserts that it cannot make an exception to this policy because
the administration of Hepatitis C treatment without first conducting a
psychological evaluation would put plaintiff and other inmates and staff
at risk. Finally, concern for the integrity of a fair and uniform policy
that applies to all inmates, given the reported outbreak of Hepatitis C
among prison populations, is particularly relevant to this case.*fn5
Plaintiff, on the other hand, contends that the DOC's requirement that
he complete the BDI questionnaire is unreasonable and unlawful because:
1) it requires plaintiff to involuntary submit to unwanted mental health
treatment and 2) it forces plaintiff to submit to unwanted treatment in
order to receive required treatment.
• Plaintiff's right to decline unwanted medical treatment.
While plaintiff is correct in his assertion that a prisoner "possesses
a significant liberty interest in avoiding the unwanted administration
of" mental health treatment, Washington v. Harper, 494 U.S. 210, 221-22
(1990),or, for that matter, any other type of medical treatment, White
v. Napolean, 897 F.2d 103, 113 (3d Cir. 1990), a prisoner's right to
refuse such treatment is limited.*fn6 See id. As stated by the Third
Circuit, "a prison may compel a prisoner to accept treatment when prison
officials, in the exercise of professional judgment, deem it necessary to
carry out valid medical or penological objectives." Id. The proper
inquiry is "whether the regulation [at issue] is reasonably related to
legitimate penological interests." Washington, 494 U.S. at 223 (internal
In answering this question, the Supreme Court has instructed that
courts should weigh the following four factors, commonly referred to as
the Turner factors, see Turner v. Safley, 482 U.S. 78, 89 (1987): 1)
whether there is "a rational connection between the prison regulation and
the legitimate governmental interest put forward to justify it," so that
the policy is not rendered "arbitrary or irrational;" 2) "whether inmates
retain alternative means of exercising the prescribed right;" 3) "the
costs that accommodating the right would impose on other inmates,
guards, and prison resources;" and 4) "whether there are alternatives to
the regulation that fully accommodate the prisoner's rights at de minimis
cost to valid penological interests." Doe v. Delie, 257 F.3d 309, 317 (3d
Cir. 2001). (citing Dehart v. Horn, 227 F.3d 47, 51 (3d Cir. 2000) (en
With regards to the first Turner factor, defendants have offered
evidence to support a medically legitimate justification for the policy,
i.e., the need to enforce an appropriate medical protocol which protects
inmates from the psychological side effects that can be caused by
medicinal treatment of Hepatitis C. In turn, plaintiff presents no
evidence to refute defendants' assertion that treatment for Hepatitis C
can cause severe psychological side effects, and that therefore, a
psychological evaluation is necessary to determine the best course of
treatment for that individual.*fn7 Accordingly, and in light of the
deference that is to be given to the professional judgment of prison
medical personnel, see White, 897 F.2d at 113, the court finds that the
requirement that plaintiff undergo a psychological evaluation prior to
receiving treatment for Hepatitis C, is reasonably related to a
legitimate penological interest.
The second Turner factor, regarding alternative means that are
available to the prisoner for exercising the constitutional right
in question, i.e., the right to decline medical treatment, is not
applicable to these facts.
Under the third Turner factor, the court finds that accommodating
plaintiff would indeed impose significant costs on both, prison resources
and the plaintiff. Plaintiff himself has provided the court with
information concerning the severe psychological side effects that can
result from medical treatment of Hepatitis C. See Hepatitis C Patient
Handout at 5-6, attached to Plaintiff's letter to the court dated
November 14, 2002 (describing psychological risks associated with
treatment of Hepatitis C). The purpose of the psychological evaluation is
to help determine the likelihood that plaintiff may, in fact, develop one
of these side effects. The actual risks to the inmate —
depression, confusion, psychosis, aggression, etc. — and to other
inmates and staff are indeed substantial. Should these side effects
materialize, the correctional authorities would be forced to bear the
cost of treating plaintiff not only for Hepatitis C, but also for the
psychological side effects that may have been avoided through proper
With regards to the fourth factor, the court concludes that there
are no alternative courses of action that would fully accommodate
the plaintiff's right to avoid unwanted medical treatment without
substantially affecting the penological interests involved herein.
After giving due consideration to the Turner factors, the court
concludes that the requirement that prisoners submit to a psychological
evaluation before being treated for Hepatitis C is reasonably related to
legitimate penological interests.
2. Plaintiff's right to avoid submitting to unwanted medical treatment in
order to receive required treatment.
Plaintiff's argument that he cannot be forced to submit to unwanted
treatment in order to receive required treatment, see Harrison v.
Barkley, 219 F.3d 132, 138-140, (2d Cir. 2000), also fails. First, it
fails for the same reasons stated above regarding plaintiffs right to
medical treatment. Secondly, reliance on Harrison is
misplaced. In this case, unlike in Harrison, where the medical procedures
in question were two distinct and separate procedures and where there was
no legitimate penological reason for requiring one procedure to be done
before the other,*fn8 the requirement that plaintiff submit to a
psychological evaluation is part and parcel of the treatment that
plaintiff is requesting. Absent evidence from the plaintiff that the
treatment prescribed by the DOC protocol is either unreasonable or in
error, the court will not second-guess the professional judgment of
prison medical personnel.*fn9 See White, 897 F.2d at 113.
B. Plaintiff's Right to Privacy in His Medical Records.
Plaintiff also contends that the DOC requirement that plaintiff sign a
consent form before he can be treated for Hepatitis C is unreasonable and
unlawful because: 1) plaintiff has a right to his medical privacy and 2)
prison officials cannot refuse necessary medical treatment by first
requiring plaintiff to sign a waiver.
Plaintiff correctly asserts that prisoners have a constitutional right
to privacy in their medical information. See Delie, 257 F.3d at 315-17.
This right protects the prisoner's interest in keeping certain medical
information confidential. See id. As a corollary, however, the Third
Circuit has cautioned that "a prisoner does not enjoy a right of privacy
in his medical information to the same extent as a free citizen." Id. at
317. In short, a prisoner's constitutional right to privacy, including
the preservation of the confidentiality of medical information, "is
subject to substantial restrictions and limitations in order for
correctional officials to achieve legitimate correctional goals and
maintain institutional security." Id.
Specifically, an inmate's constitutional right may be curtailed by a
policy or regulation that is shown to be "reasonably related to legitimate
penological interests." Turner v. Safley, 482 U.S. 78, 89  (1987).
Courts must respect the administrative concerns underlying a prison
regulation, without requiring proof that the regulation is the least
restrictive means of addressing those concerns.
Delie, 257 F.3d at 317.
In the instant action, defendants are attempting to limit plaintiff's
privacy in his medical information by requiring plaintiff, as a
precondition to receiving medical treatment, to consent to the disclosure
of information obtained from plaintiff's psychological evaluation under
three circumstances. First, defendants seek to require plaintiff to
consent to disclosure of certain non-confidential information. Thus, the
information for which plaintiff is required to consent to disclosure is,
by definition, not confidential. Accordingly, such information could be
disclosed by prison officials with or without plaintiff's consent and
requiring plaintiff to consent to its disclosure can not be said to
infringe upon his privacy.
Second, defendants seek to require plaintiff to consent to disclosure
of his medical information if it is believed that plaintiff poses a
threat to his own health and safety, the health and safety of others or
the orderly operation of the prison facility. This requirement is
specifically the type of institutional regulation contemplated and
approved by the Third Circuit in Delie as a proper basis for infringing
upon a prisoner's right to privacy in his medical information. See Delie,
257 F.3d at 317 (an inmate's right to privacy "is subject to substantial
restrictions and limitations in order for correctional officials to
achieve legitimate correctional goals and maintain institutional
security"). Accordingly, the court finds that requiring plaintiff to
consent to disclosure of his medical information under these
circumstances is reasonably related to a legitimate penological
Finally, defendants seek to require plaintiff to consent to disclosure
of his medical information, to the extent necessary, "to prepare reports
or recommendations, or to make decisions, regarding any aspect of
[plaintiff's] current or future custody, including, but not limited to,
[plaintiff's] housing, work or program status, pre-release or parole."
Under the relevant Turner factors, the court concludes that this
requirement is reasonably related to legitimate penological interests.
First, in order for prison officials to provide safe and appropriate
conditions of confinement, they have a legitimate need to gather and
evaluate information that is relevant to an inmate's psychological
condition. Based on the language of the form itself, it appears that this
information plays an important role in designating the type of
confinement a particular prisoner requires and to ascertain the
circumstances under which it would be safe to allow that prisoner to
interact with other inmates and prison staff.
Second, given the substantial deference afforded to penological
decisions made by prison personnel, see White, 897 F.2d at 113, and the
limited circumstances under which courts may consider alternatives to
prison regulations, see Delie, 257 F.3d at 317, the court will not second
guess prison authorities and devise alternatives to the regulation at
Under these circumstances, the court concludes that the requirement
that plaintiff sign the consent form is reasonably related to a
legitimate penological interest.
For the reasons set forth above, the court finds that plaintiff has
failed to establish a reasonable likelihood that he would eventually
prevail on the issue of whether defendants took reasonable measures to
abate the risk posed to plaintiff as a result of his need for Hepatitis C
Given that plaintiff has not established a reasonable
likelihood of success on the merits, plaintiff's Motion for Temporary
Restraining Order and/or Preliminary Injunction (doc. no. 96) is denied.
An appropriate order follows.
AND NOW, on this 10th day of December, 2002, upon consideration of
plaintiff's Motion for Temporary Restraining Order and/or Preliminary
Injunction (doc. no. 96) and all replies and responses thereto, it is
hereby ORDERED that plaintiff's Motion for Temporary Restraining Order
and/or Preliminary Injunction (doc. no. 96) is DENIED.
AND IT IS SO ORDERED.