Thirty Years After Estelle v. Gamble: A Legal Retrospective

For more than three decades, beginning with Estelle v. Gamble in 1976, the courts have protected the constitutional right of prisoners to health care. This article explores the historical antecedents of this protection and its present application to modern correctional health care delivery. Focusing on the three basic rights guaranteed by Estelle—the right to access to care, the right to care that is ordered, and the right to a professional medical judgment—the article traces the development of case law in the hundreds of lawsuits that have influenced correctional health care over these years. The article also addresses the “state of mind” component of constitutional liability, the requirement of “serious medical needs” as a predicate to suit, and the impact of privatization on correctional health care delivery. Finally, the article describes the impact of litigation on the promulgation of standards for correctional health care services and on the accreditation of correctional health care systems.