West v. Atkins

Incident Summary & Facts

In 1983, Quincy West, an inmate at Odom Correctional Center in North Carolina, tore his left Achilles tendon playing volleyball. He was sent for orthopedic consultation to Central Prison Hospital in Raleigh, the State’s acute-care facility for more than 17,500 inmates. The hospital had one full-time staff physician and filled its other needs through “Contracts for Professional Services” with area doctors. One of those doctors was Dr. Samuel Atkins, a private orthopedist paid about $52,000 a year to run two clinics a week at the hospital, plus fees for surgery. Over several months, Dr. Atkins treated West’s injury with a series of casts. West alleged that although the doctor acknowledged surgery would be necessary, he refused to schedule it and discharged West while the ankle was still swollen and painful and his movement still impeded. Because West was in “close custody,” he could not choose to see a different physician.

This case did not involve a use-of-force encounter. It concerns who counts as a state actor under 42 U.S.C. § 1983.

Procedural posture: West sued pro se under § 1983, alleging that Dr. Atkins’s deliberate indifference to his serious medical needs violated the Eighth Amendment. Relying on Calvert v. Sharp, the district court granted summary judgment on the ground that a contract physician does not act “under color of state law.” A Fourth Circuit panel vacated that ruling, but the en banc court affirmed. It reasoned that professionals exercising professional judgment do not act under color of state law unless they exercise custodial or supervisory authority. The Supreme Court granted certiorari to resolve a split with the Eleventh Circuit.

Core Legal Issue

Does a private physician under part-time contract with the State to treat prison inmates act “under color of state law” for purposes of § 1983 when he treats an inmate?

The Holding

Yes. Dr. Atkins’s medical treatment of West was state action “fairly attributable to the State,” so he acted under color of state law. The Fourth Circuit’s judgment was reversed and the case remanded.

The Court’s Analysis:

• Traditional test: A defendant acts under color of state law when exercising power “possessed by virtue of state law and made possible only because the wrongdoer is clothed with the authority of state law” (United States v. Classic). “[A] public employee acts under color of state law while acting in his official capacity or while exercising his responsibilities pursuant to state law.”
• Polk County distinguished: A public defender is not a state actor because he is “the State’s adversary.” A prison doctor’s relationship with prison authorities is “cooperative,” and professionals are not exempt “simply because they are professionals acting in accordance with professional discretion and judgment.”
• Custodial or supervisory role is irrelevant: Estelle v. Gamble implicitly treated a prison doctor’s medical treatment as state action. The Fourth Circuit’s custodial/supervisory test “cannot be reconciled” with Estelle.
• Function, not contract terms: “It is the physician’s function within the state system, not the precise terms of his employment,” that controls. Contracting out care “does not relieve the State of its constitutional duty” to provide adequate care to those in custody. The State delegated that duty, and Dr. Atkins voluntarily assumed it.
• Custody matters: West could get medical care only through the State, so any deliberate indifference was caused by the State’s exercise of its right to incarcerate him.
• Concurrence (Scalia, J.): Agreed that Atkins acted under color of state law. He doubted that a doctor without penological duties can inflict Eighth Amendment “punishment,” and viewed such a claim as arising under Fourteenth Amendment due process.
• The Court did not decide whether West’s allegations amounted to deliberate indifference rather than malpractice.