Last Friday, the Eighth Circuit Court of Appeals closed the book on a case thatâÄôs been lingering in federal courts for more than 35 years. Depending on how much you value the health of our stateâÄôs prisoners, the decision either represents a step forward or a step back. The case Hines v. Anderson was first filed in 1973. The plaintiff was Howard Lansing Hines, an inmate in the Minnesota state prison system, who filed a suit in federal court on behalf of a whole class of similarly situated prisoners. Hines was suing Wendell Anderson, then-governor of Minnesota. The inmates alleged that the health care they were receiving in Minnesota prisons was so poor that it was a violation of the 8th AmendmentâÄôs prohibition against âÄúcruel and unusual punishment.âÄù In the end, the suit didnâÄôt go to trial. Instead, the two sides reached an agreement in 1977. The state, for its part, was allowed to deny any actual wrongdoing. They also didnâÄôt have to pay the inmates any money for their allegations of medical mistreatment. The prisoners were granted an extensive health care guarantee, one that promised to provide to all the inmates in the Minnesota prison system the full protections of what was then known as the Minnesota âÄúPatientsâÄô Bill of Rights.âÄù The 1977 settlement decree describes the medical guarantees in great detail, all grounded in the notion that âÄúevery patient and resident shall have the right to considerate and respectful care,âÄù and âÄúto every consideration of his privacy and individuality as it relates to his social, religious and psychological well being.âÄù Every inmate received an extensive physical and psychological checkup, with extra preventive tests for prisoners older than 40. The settlement also guaranteed that âÄúan indigent inmate shall be furnished, free of charge, prosthetic devices such as artificial limbs, eyeglasses, false eyes, dentures, braces, casts and crutches.âÄù If they requested one, inmates could receive a physical exam before they were discharged from the system. The agreement also called for adequate medical staffing and provided for any extensive medical procedures to be carried out at a specially designated room at a St. PaulâÄôs Ramsey Hospital. The agreement made special provisions for the psychological health of inmates in 24-hour lockup. For better or worse, the federal government sounded the death knell for this statewide agreement when President Clinton signed the Prison Litigation Reform Act into law in 1996. The law stated that âÄúrelief âĦ with respect to prison conditions shall extend no further than necessary to correct the violation of the Federal right of a particular plaintiff.âÄù Essentially, the law required that the only remedy for a prisonerâÄôs lawsuit is to ensure that his/her constitutional rights stop being violated. Nothing more, nothing less. The new law applied retroactively, and for the Minnesota prisoners, this meant that the days of the negotiated Hines health care plan were likely numbered. In 2002, the old decree was dredged up. A U.S. magistrate judge was placed in charge of determining whether the old Hines decree was too generous to fit within the scope of the Reform Act. Part of the investigation involved taking statements from inmates about their health care treatment while in prison. Some of the tales are harrowing. One inmate cut his left arm with a staple and inserted an ink pen under the skin. After it was discovered by a nurse, the resident doctor decided not to remove the pen for more than two weeks because, in his judgment, it was an infection risk to remove it. Other inmates testified to erratic dialysis treatments, lack of medication for hepatitis C and general hygienic problems in the medical areas of the prison. A medical expert hired by the state testified to âÄúseveral examples of substandard care.âÄù But the report by the magistrate went on to conclude that none of the violations were sufficient to be âÄúcruel and unusualâÄù for 8th Amendment purposes. The report also found that the overall health care plan instituted in the Hines settlement in 1977 was too âÄúbroad and comprehensiveâÄù for the federal law and recommended that the decree be terminated. The district court followed the recommendations of the magistrate and terminated the plan. The prisoners appealed, arguing that they there should be additional investigations and court hearings before the Hines decree could be thrown out. The appeals court didnâÄôt agree, and they upheld the termination of the Hines settlement on November 21. They cited previous Supreme Court and Eighth Circuit precedent that said that, while prison officials are required to provide medical care to prison inmates, no Eighth Amendment violation exists unless officials deliberately disregard âÄúobjectively serious medical needs.âÄù The court said that while the allegations of the prisoners were serious, they were not âÄúcruel and unusualâÄù enough to violate the Constitution. Barring an appeal to the Supreme Court, there is nothing left to be done, unless the federal laws are re-written. Should they be? How much should a convicted criminal be allowed to complain about health care? What sort of standards do these prisoners deserve? Maybe part of the rehabilitative nature of a prison sentence should involve more than the barest essentials of medical care. Maybe a comprehensive health care package is simply a fundamental human right. WhatâÄôs fair in this situation, and whatâÄôs ethical? For three judges on the Eighth Circuit last week, the answer was clear: The law had spoken, and the Hines decree was simply too generous. Jake Parsley welcomes comments at [email protected].