Nunes v. Massachusetts Department of Correction
766 F.3d 136
1st Cir.2014Background
- Massachusetts prisons dispense HIV meds either via Keep on Person (KOP) or daily med line; HIV meds were removed from KOP in Feb 2009 to be dispensed at a window under supervision.
- The department aimed to reduce costs because HIV meds are expensive and waste occurs when KOP meds are unused and cannot be reused.
- Data presented by the department suggested most HIV inmates already used the daily med line and a substantial share had late refills under KOP, supporting the change in dispensing method.
- After the change, health metrics showed undetectable viral loads rose (83% pre-change to 95% later); late refills remained around 25–35%.
- Plaintiffs, five HIV inmates, claimed privacy intrusions and health harm; one (Nunes) sought alternatives due to back pain, while others reported occasional disclosures and side effects.
- District court granted summary judgment for defendants; the First Circuit affirmatively held the policy constitutional and ADA/ Rehabilitation Act claims failed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Eighth Amendment viability | Policy creates substantial risk of harm to HIV inmates. | Policy is reasonable, data-supported, and not deliberate indifference. | No Eighth Amendment violation; policy reasonable and not deliberately indifferent. |
| Right to privacy (Fourteenth Amendment) | Disclosures at the daily med line violate privacy. | Inadvertent disclosures in a reasonable policy are permissible; Nelson standard applies. | No privacy violation; policy reasonable and disclosures tolerated under Nelson framework. |
| ADA and Rehabilitation Act coverage | Disproportionate impact and exclusion from KOP harms disabled inmates with HIV. | Access to HIV meds via daily med line provides meaningful access; policy driven by cost savings with neutral/positive health impact. | No disability discrimination; meaningful access provided; policy reasonable. |
| Reasonable accommodation under ADA/Rehabilitation Act | Need for tailored accommodations for Nunes and others not adequately met. | Offered accommodations (walker, bench, medical unit transfer) are reasonable; plaintiff bears burden to show need not supported by medical evidence. | Accommodations deemed reasonable; no failure to provide meaningful access. |
Key Cases Cited
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference standard for prison medical care)
- Whalen v. Roe, 429 U.S. 589 (1977) (privacy interest in avoiding disclosure of personal information)
- Nelson v. Narrows, 131 S. Ct. 746 (2011) (privacy/disclosures reviewed under reasonableness in government contexts)
- Bell v. Wolfish, 441 U.S. 520 (1979) (deference to prison officials; broad considerations in prison policy)
- Raytheon Co. v. Hernandez, 540 U.S. 44 (2003) (disparate treatment theory under ADA analyzed through Title VII framework)
- Corrigan v. Perry, 139 F.3d 888 (1998) (reasonable accommodation standard under Rehabilitation Act with some flexibility)