A police officer of petitioner city wounded a suspect who was
attempting to flee from the scene of a breaking and entering. The
Massachusetts Supreme Judicial Court held that petitioner is liable
for the medical services rendered by respondent hospital to the
wounded person.
Held:
1. This Court does not lack jurisdiction to review the
Massachusetts court's opinion on the asserted ground that the
decision rested on an adequate and independent state ground. The
Massachusetts court's opinion premised petitioner's liability
squarely on the Eighth Amendment's prohibition of cruel and unusual
punishments. P.
463 U. S.
242.
2. Respondent has standing in the Art. III sense to raise its
constitutional claim in this Court. Moreover, invoking prudential
limitations on respondent's assertion of the rights of a third
party (the wounded person) would serve no functional purpose.
Cf. Craig v. Boren, 429 U. S. 190. Pp.
463 U. S.
242-243.
3. The relevant constitutional provision is not the Eighth
Amendment but is, instead, the Due Process Clause of the Fourteenth
Amendment. Although the Eighth Amendment's proscription of cruel
and unusual punishments is violated by deliberate indifference to
serious medical needs of prisoners, Eighth Amendment scrutiny is
appropriate only after the State has secured a formal adjudication
of guilt.
Ingrahm v. Wright, 430 U.
S. 651. Here, there had been no formal adjudication of
guilt against the wounded person at the time he required medical
care. Pp.
463 U. S.
243-244.
4. The Due Process Clause requires the responsible governmental
entity to provide medical care to persons who have been injured
while being apprehended by the police. However, as long as the
governmental entity ensures that the medical care needed is in fact
provided, the Constitution does not dictate how the cost of that
care should be allocated as between the entity and the provider of
the care. That is a matter of state law. Here, petitioner fulfilled
its constitutional obligation by seeing that the wounded person
received the needed medical treatment; how petitioner obtained such
treatment is not a federal constitutional question. Pp.
463 U. S.
244-246.
385 Mass. 772,
434
N.E.2d 185, reversed.
Page 463 U. S. 240
BLACKMUN, J., delivered the opinion of the Court, in which
BURGER, C.J., and BRENNAN, MARSHALL, POWELL, and O'CONNOR, JJ.,
joined, and in Parts I, II, III-A, and IV of which WHITE and
REHNQUIST, JJ., joined. REHNQUIST, J., filed an opinion concurring
in part and concurring in the judgment, in which WHITE, J., joined,
post, p.
463 U. S. 246.
STEVENS, J., filed an opinion concurring in the judgment,
post, p.
463 U. S.
246.
JUSTICE BLACKMUN delivered the opinion of the Court.
The issue in this case is whether a municipality's
constitutional duty to obtain necessary medical care for a person
injured by the municipality's police in the performance of their
duties includes a corresponding duty to compensate the provider of
that medical care.
On September 20, 1978, members of the police force of petitioner
city of Revere, Mass. responded to a report of a breaking and
entering in progress. At the scene, they sought to detain a man
named Patrick M. Kivlin, who attempted to flee. When repeated
commands to stop and a warning shot failed to halt Kivlin's flight,
an officer fired at Kivlin and wounded him. The officers summoned a
private ambulance. It took Kivlin, accompanied by one officer, to
the emergency room of respondent Massachusetts General
Page 463 U. S. 241
Hospital (MGH) in Boston. [
Footnote 1] Kivlin was hospitalized at MGH from September
20 until September 29. Upon his release, Revere police served him
with an arrest warrant that had been issued on September 26. Kivlin
was arraigned and released on his own recognizance.
On October 18, MGH sent the Chief of Police of Revere a bill for
$7,948.50 for its services to Kivlin. The Chief responded
immediately by a letter denying responsibility for the bill. On
October 27, Kivlin returned to MGH for further treatment. He was
released on November 10; the bill for services rendered during this
second stay was $5,360.41. [
Footnote 2]
In January, 1979, MGH sued Revere in state court to recover the
full cost of its hospital services rendered to Kivlin. The Superior
Court for the County of Suffolk dismissed the complaint. MGH
appealed, and the Supreme Judicial Court of Massachusetts
transferred the case to its own docket.
The Supreme Judicial Court reversed in part, holding that
"the constitutional prohibition against cruel and unusual
punishment, embodied in the Eighth Amendment to the United States
Constitution [as applied to the States through the Fourteenth
Amendment], requires that Revere be liable to the hospital for the
medical services rendered to Kivlin during his first stay at the
hospital."
385 Mass. 772, 774,
434
N.E.2d 185, 186 (1982). The court apparently believed that such
a rule was needed to ensure that persons in police custody receive
necessary medical attention. [
Footnote 3] In view of this rather novel Eighth Amendment
approach and the importance
Page 463 U. S. 242
of delineating governmental responsibility in a situation of
this kind, we granted certiorari. 459 U.S. 820 (1982).
II
We first address two preliminary issues.
A
MGH suggests that we lack jurisdiction to decide this case
because the state court decision rests on an adequate and
independent state ground. The Supreme Judicial Court's opinion,
however, stated unequivocally that state contract law provided no
basis for ordering Revere to pay MGH for the hospital services
rendered to Kivlin, 385 Mass. at 774, 434 N.E.2d at 186, and that
MGH had not invoked the Commonwealth's Constitution in support of
its claim,
id. at 776, n. 6, 434 N.E.2d at 188, n. 6. In a
section of its opinion entitled "Eighth Amendment," the court
premised Revere's liability squarely on the Federal Constitution.
[
Footnote 4] Because the
court's decision was based on an interpretation of federal law, we
have jurisdiction notwithstanding the fact that the same decision,
had it rested on state law, would be unreviewable here.
See
Oregon v. Hass, 420 U. S. 714,
420 U. S. 719,
and n. 4 (1975).
B
The parties submit various arguments concerning MGH's "standing"
to raise its constitutional claim in this Court.
Page 463 U. S. 243
MGH, however, clearly has standing in the Article III sense: it
performed services for which it has not been paid, and through this
action it seeks to redress its economic loss directly.
Moreover, prudential reasons for refusing to permit a litigant
to assert the constitutional rights of a third party are much
weaker here than they were in
Craig v. Boren, 429 U.
S. 190,
429 U. S.
193-194 (1976), where the Court permitted a seller of
beer to challenge a statute prohibiting the sale of beer to males,
but not to females, between the ages of 18 and 21. In this case, as
in
Craig, the plaintiff's assertion of
jus tertii
was not contested in the lower court,
see 385 Mass. at
776-777, n. 7, 434 N.E.2d at 188, n. 7, and that court entertained
the constitutional claim on its merits. Unlike
Craig, this
case arose in state court, and the plaintiff, MGH, prevailed. The
Supreme Judicial Court, of course, is not bound by the prudential
limitations on
jus tertii that apply to federal courts.
The consequence of holding that MGH may not assert the rights of a
third party (Kivlin) in this Court, therefore, would be to dismiss
the writ of certiorari, leaving intact the state court's judgment
in favor of MGH, the purportedly improper representative of the
third party's constitutional rights.
See Doremus v. Board of
Education, 342 U. S. 429,
342 U. S.
434-435 (1952). In these circumstances, invoking
prudential limitations on MGH's assertion of
jus tertii
would "serve no functional purpose."
Craig v. Boren, 429
U.S. at
429 U. S. 194.
[
Footnote 5]
III
A
The Eighth Amendment's proscription of cruel and unusual
punishments is violated by "deliberate indifference to serious
Page 463 U. S. 244
medical needs of prisoners."
Estelle v. Gamble,
429 U. S. 97,
429 U. S. 104
(1976). As MGH acknowledges, Brief for Respondent 3, on the facts
of this case, the relevant constitutional provision is not the
Eighth Amendment, but is, instead, the Due Process Clause of the
Fourteenth Amendment.
"Eighth Amendment scrutiny is appropriate only after the State
has complied with the constitutional guarantees traditionally
associated with criminal prosecutions. . . . [T]he State does not
acquire the power to punish with which the Eighth Amendment is
concerned until after it has secured a formal adjudication of guilt
in accordance with due process of law."
Ingraham v. Wright, 430 U. S. 651,
430 U. S.
671-672, n. 40 (1977);
see Bell v. Wolfish,
441 U. S. 520,
441 U. S. 535,
n. 16 (1979). Because there had been no formal adjudication of
guilt against Kivlin at the time he required medical care, the
Eighth Amendment has no application.
B
The Due Process Clause, however, does require the responsible
government or governmental agency to provide medical care to
persons, such as Kivlin, who have been injured while being
apprehended by the police. In fact, the due process rights of a
person in Kivlin's situation are at least as great as the Eighth
Amendment protections available to a convicted prisoner.
See
Bell v. Wolfish, 441 U.S. at
441 U. S. 535,
n. 16,
441 U. S. 545.
[
Footnote 6] We need not
define, in this case, Revere's due process obligation to pretrial
detainees or to other persons in its care who require medical
attention.
See Youngberg
v.
Page 463 U. S. 245
Romeo, 457 U. S. 307,
457 U. S. 312,
n. 11 (1982);
Norris v. Frame, 585 F.2d 1183, 1187 (CA3
1978);
Loe v. Armistead, 582 F.2d 1291 (CA4 1978),
cert. denied sub nom. Moffitt v. Loe, 446 U.S. 928 (1980).
Whatever the standard may be, Revere fulfilled its constitutional
obligation by seeing that Kivlin was taken promptly to a hospital
that provided the treatment necessary for his injury. And as long
as the governmental entity ensures that the medical care needed is
in fact provided, the Constitution does not dictate how the cost of
that care should be allocated as between the entity and the
provider of the care. That is a matter of state law.
If, of course, the governmental entity can obtain the medical
care needed for a detainee only by paying for it, then it must pay.
There are, however, other means by which the entity could meet its
obligation. Many hospitals are subject to federal or state laws
that require them to provide care to indigents. Hospitals receiving
federal grant money under the Hill-Burton Act, for example, must
supply a reasonable amount of free care to indigents.
See
42 U.S.C. § 291c(e). In the Commonwealth of Massachusetts now, any
hospital with an emergency facility must provide emergency services
regardless of the patient's ability to pay. Mass.Gen.Laws Ann., ch.
111, § 70E(k) (West Supp.1983-1984), added by 1979 Mass. Acts, ch.
214, and amended by 1979 Mass. Acts, ch. 720. Refusal to provide
treatment would subject the hospital to malpractice liability. §
70E. The governmental entity also may be able to satisfy its duty
by operating its own hospital, or, possibly, by imposing on the
willingness of hospitals and physicians to treat the sick
regardless of the individual patient's ability to pay. [
Footnote 7]
In short, the injured detainee's constitutional right is to
receive the needed medical treatment; how the city of Revere
obtains such treatment is not a federal constitutional question.
[
Footnote 8]
Page 463 U. S. 246
It is not even certain that mandating government reimbursement
of hospitals that treat injured persons in police custody would
have the effect of increasing the availability or quality of care.
Although such a requirement would serve to eliminate any reluctance
on the part of private hospitals to provide treatment, it also
might encourage police to take injured detainees to public
hospitals, rather than private ones, regardless of their relative
distances or ability to furnish particular services.
IV
For these reasons, the judgment of the Supreme Judicial Court is
reversed.
It is so ordered.
[
Footnote 1]
The city of Revere apparently has no municipal hospital or even
a jail of its own.
See App. 14.
[
Footnote 2]
Nothing in the record indicates that MGH ever tried to obtain
payment from Kivlin.
[
Footnote 3]
Because it ruled that Kivlin was no longer in custody when he
returned to MGH on October 27, the court concluded that Revere was
not liable to MGH for the services rendered during the second
hospitalization. 385 Mass., at 779-780, 434 N.E.2d at 189-190. That
issue is not before us.
[
Footnote 4]
The court stated:
"The hospital argues that the prohibition against deliberate
indifference to the medical needs of prisoners contained implicitly
in the Eighth Amendment,
Estelle v. Gamble, 429 U. S. 97
(1976), compels a government agency or division responsible for
supplying those medical needs to pay for them. We agree."
Id. at 776, 434 N.E.2d at 187-188 (footnotes omitted).
Later, the court observed that inadequate funding, and the fact
that payment would violate state law, were irrelevant: the Eighth
Amendment required such payment, and prevailed over contrary state
law.
Id. at 779, 434 N.E.2d at 189.
[
Footnote 5]
In addition, we could not resolve the question whether MGH has
third-party standing without addressing the constitutional issue.
To a significant degree, the case "is in the class of those where
standing and the merits are inextricably intertwined."
Holtzmann v. Schlesinger, 414 U.
S. 1316,
414 U. S.
1319 (1973) (Douglas, J., in chambers). Both the
standing question and the merits depend in part on whether injured
suspects will be deprived of their constitutional right to
necessary medical care unless the governmental entity is required
to pay hospitals for their services.
[
Footnote 6]
The due process issue, raised by respondent as an alternative
ground in support of the judgment, has been fully briefed and is
properly before us.
See Dandridge v. Williams,
397 U. S. 471,
397 U. S.
475-476, n. 6 (1970). There is no reason to believe,
moreover, that the Supreme Judicial Court's analysis of the rights
of pretrial detainees would be any different under the Due Process
Clause. No factual issues are in dispute, and there would be little
point in remanding the case merely to allow the Supreme Judicial
Court to reconsider its holding under the relevant constitutional
provision.
[
Footnote 7]
Nothing we say here affects any right a hospital or governmental
entity may have to recover from a detainee the cost of the medical
services provided to him.
[
Footnote 8]
We do not deal here, of course, with possible remedies for a
pattern of constitutional violations.
JUSTICE REHNQUIST, with whom JUSTICE WHITE joins, concurring in
part and concurring in the judgment.
I see no reason to decide in this case what requirements the Due
Process Clause may impose upon a governmental agency by way of
providing medical care to persons who have been injured while being
apprehended by the police. As the Court points out,
"[w]hatever the standard may be, Revere fulfilled its
constitutional obligation by seeing that Kivlin was taken promptly
to a hospital that provided the treatment necessary for his
injury."
Ante at
463 U.S.
245. The Court's other statements regarding the application
of the Due Process Clause in this situation,
ante at
463 U. S.
244-245 and this page, are therefore unnecessary, as
well as largely unsupported.
I concur in Parts I, II, III-A, and IV of the Court's
opinion.
JUSTICE STEVENS, concurring in the judgment.
This case raises a question of state fiscal policy. If the Mayor
of the City of Revere had paid this bill because he had been
advised by his attorney, or by the Attorney General of
Page 463 U. S. 247
the State, that it was an obligation of the municipality, we
would have had no interest in the matter, even if the legal advice
had misinterpreted federal law. If the Massachusetts Legislature
had passed a statute requiring bills of this character to be paid
by the city, the performance of a city's state statutory obligation
would give rise to no federal question. That would be true even if
the legislative history of the statute made it perfectly clear that
every lawmaker who voted for the bill did so because he believed
that the Federal Constitution required the State to allocate the
cost in this manner.
Because the Supreme Judicial Court of Massachusetts -- rather
than another branch of state government -- invoked the Federal
Constitution in imposing an expense on the City of Revere, this
Court has the authority to review the decision. But is it a
sensible exercise of discretion to wield that authority? I think
not. There is "nothing in the Federal Constitution that prohibits a
State from giving lawmaking power to its courts."
Minnesota v.
Clover Leaf Creamery Co., 449 U. S. 456,
449 U. S. 479
(1981) (STEVENS, J., dissenting). No individual right was violated
in this case. The underlying issue of federal law has never before
been deemed an issue of national significance. Since, however, the
Court did (unwisely in my opinion) grant certiorari, I join its
judgment.
*
* I agree with the Court's substantive analysis of this case,
except for its assertion that the Eighth Amendment's prohibition
against cruel and unusual punishment would not be violated by the
State's imposition of cruel and unusual punishment on a prisoner
before he has been convicted of a crime. I adhere to my views that
the statements in support of that assertion in
Ingraham v.
Wright, 430 U. S. 651
(1977), and
Bell v. Wolfish, 441 U.
S. 520 (1979), simply cannot be squared with the text or
the purpose of the Eighth Amendment.
See Ingraham, supra,
at
430 U. S.
684-692 (WHITE, J., dissenting).