The media typically seizes on the most sensational or politically controversial aspects of a court decision, but shrewd risk management requires looking beyond headlines. “Hot-button” cases often impact scenarios far removed from political controversy. The Seventh Circuit’s recent decision in Mitchell v. Kallas fits that description.
The facts are simple. Plaintiff Mitchell was an inmate in Wisconsin who identified as transgender, was diagnosed with gender dysphoria, and sought hormone therapy. But six months passed between Mitchell’s request for that treatment and the first interview with the defendant physicians. Six more months followed while the physicians were allegedly developing their treatment plan. But then, Dr. Kallas decided that Mitchell was not eligible for treatment because Mitchell “was scheduled to be released that month.” The Seventh Circuit reversed in part a grant of summary judgment in defendants’ favor. While activists will likely be quick to celebrate (or denounce) the court’s discussion of gender dysphoria and related questions of transgender rights, Mitchell deserves attention because it turns on a far more banal question, and one that arises often in inmate denial-of-medical-care cases: when does a delay in providing medical care to an inmate cross the line into unconstitutional denial of medical care?
Mitchell acknowledged that because prisons have limited medical resources, some delay is inevitable. Thus, courts “weigh the seriousness of the condition against the difficulty of providing care.” In this case, Mitchell effectively alleged that the defendants, especially Dr. Kallas, dragged their feet with an eye towards delaying Mitchell’s prescribed treatment until Mitchell’s sentence was almost up, thus avoiding entirely any obligation to provide Mitchell treatment (and, more importantly, the cost of providing such treatment). Looking at the record, the Seventh Circuit saw a question of fact whether Dr. Kallas carefully “balanced the pros and cons” of Mitchell’s treatment, or “looked at the calendar and reflexively dismissed her request” and remanded that claim for trial.
Mitchell teaches that while prison medical staff do not have to provide instant care, and while, as other cases have recognized, they may consider the cost of a procedure as one of many factors in their medical opinion, they may not delay care simply to “run out the clock” on an inmate’s sentence and thereby avoid the cost of care. Prison medical staff who find it necessary to delay providing a significant course of treatment should minimize their liability risk by thoroughly explaining how they balanced all relevant factors in making that choice. That point may not grab headlines, but it applies far more broadly than the specific facts in Mitchell, and thus should be the case’s main lesson for prison medical staff.