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The death this week of a prison inmate who did not receive his dialysis treatments has left the state exposed to potential legal action that could prove costly in front of a jury, civil rights experts say.
"It's a lay down case," said Rocky Anderson, former Salt Lake City mayor and an attorney who has previously represented Utah prisoners in lawsuits involving medical error. "These people have to be morons if they don't have the policies and procedures in place to make sure [inmates] get treatment for life-threatening illnesses."
Inmate Ramon Estrada, 62, died Sunday night after a dialysis technician from the University of Utah failed to show up to appointments April 3 and 4 at the prison. Six other inmates who missed treatments were then taken to a hospital.
The Utah Department of Corrections has not released details about the circumstances of the missed treatments.
Brooke Adams, a department spokeswoman, declined to comment on the potential of litigation in Estrada's death. She said the department is still investigating the dialysis lapse and is "cooperating to the fullest extent we can" with investigations by the Unified Police Department and the Utah Disability Law Center.
The Tribune's efforts to reach Estrada's family have been unsuccessful. No one representing his heirs or estate has announced if they intend to pursue compensation.
Unified Police and the Disability Law Center are investigating why the dialysis tech did not show up; whether the tech notified his employer, the U.'s South Valley Dialysis, or the prison; whether that message was conveyed to prison medical officials; whether prison workers noticed the tech's absence; whether Estrada or the other affected inmates told prison workers they had not received treatments, or the outcomes of those complaints; the time when Estrada began showing symptoms of distress; or whether the prison made any effort to identify another treatment provider before Sunday night, when Estrada died as medics prepared to take him to a hospital.
Those details will be instrumental in showing whether the prison showed "deliberate indifference to serious medical needs." That's the standard for claims of civil rights violations under the Eighth Amendment of the U.S. Constitution, which forbids "cruel and unusual punishment," said Stewart Gollan, a civil rights attorney in Salt Lake City.
In order to amount to "deliberate indifference" — a higher standard than negligence — the prisoner's health problem has to be known to prison workers, Gollan said. In cases where the medical problem is occurring for the first time, that can be harder to prove, said John Mejia, legal director of the American Civil Liberties Union of Utah.
But in Estrada's case, dialysis treatments had been ongoing for at least seven years, which removes the question of whether prison officials knew of the need for care.
"If I were the attorney, I would argue that prior knowledge of [Estrada's medical needs] would make indifference an easier case," Mejia said.
But whether any prison workers knew that dialysis treatments were not provided April 3 and 4 — and what they did with that information — is less clear. Also not known is the reason for the lapse: Did an employee knowingly fail to take action that would have ensured the inmates' treatments? Were mistakes made in good faith? Did an unforeseeable problem prevent messages from being relayed?
Anderson was skeptical that breakdowns in communication were unavoidable, because they would have had to prevent not one, but two likely paths of information: notification from the dialysis tech that he or she would not be at the appointments, and complaints from the inmates that they had missed treatments.
"An [innocent error] would have to happen twice," Anderson said.
While it is possible that the inmates did not alert prison staff to the missed treatments, it is unlikely, Anderson said, pointing to Estrada's own comments in a 2008 parole hearing that his life depended on dialysis.
"I'm getting very sick and very ill, and if I hadn't gotten into that program I wouldn't be here right now," Estrada said.
Gollan agreed that it will be hard for prison officials to demonstrate they didn't know about the missed appointments.
"On some level, someone would have to know dialysis wasn't provided," Gollan said. "Someone along the line must have decided they weren't going to do anything because [they] didn't care or thought it was someone else's job."
Even if an employee were confused about his or her responsibilities, the state could still be liable for not establishing a system that ensures care, Gollan said.
But the line between "deliberate indifference" and simple negligence "is not exactly clear," Gollan said. While courts have held that indifference to a prisoner's medical problem amounts to a violation of both the U.S. and Utah constitutions, prisons enjoy governmental immunity from negligence lawsuits in both federal and state courts.
That means that prisons can't be sued for simply making medical mistakes that, outside of prison, may expose providers to medical malpractice suits. Courts have ruled that it is not enough for inmates to allege that they were not given the best treatment possible.
However, courts have allowed prisoners to sue in cases where prisons denied medical care as punishment; where providers failed to correct mistakes they knew they made; where treatment was delayed despite "obvious" symptoms; and, in some cases, where needed treatment was knowingly denied because of the cost.
Although the standard for violation of the Utah Constitution is similar to that of the U.S. Constitution, most lawsuits against prisons are filed in federal court because the case law is clearer and more extensive.
Regardless of the legal outcomes of Estrada's death, Mejia said, the prison should identify needed reforms and make them.
"The community does have an obligation to make sure this is happening," he said. "If there is no compelling lawsuit to be had, that doesn't mean everyone should throw up their hands."
Anderson agreed.
"[Prisoners] are the most vulnerable people on the planet, especially with regards to medical needs," he said. "They don't have any other options."
Twitter: @erinalberty