Over a span of days, Joshua England's pleas for help became more desperate.

"I've been puking all night, and now I'm puking what looks like blood," he wrote to his medical providers on May 22, 2018. "My stomach hurts so, so bad." At the medical clinic that day he clutched his abdomen and described his pain as sharp and intense — an 8 out of 10. But he was seen by a lesser-trained licensed practical nurse, who didn't give him a complete abdominal exam or send him for any lab work. Instead he was given Pepto-Bismol and told to drink water and eat fibrous food.

The Pepto-Bismol didn't help. The next day England wrote that his pain was so bad he could barely breathe. He couldn't eat or sleep. He again went to the clinic, where he said he'd had bloody stool and his pain was now a 10 out of 10. The physician assistant found that his pulse was racing but didn't conduct an abdominal exam. Instead, he chalked up England's symptoms to constipation and prescribed a laxative.

At that point someone with England's symptoms might seek out a new clinic, to get a more thorough workup, or even head straight to an ER. But Joshua England didn't have that option. He was inmate No. 775261 at Joseph Harp Correctional Center, a medium-security facility in central Oklahoma. He'd been sentenced to 343 days in prison after he and some buddies set some hay bales on fire one drunken night. This reconstruction of the events of those days in May 2018 is based on prison and medical records obtained by Business Insider in collaboration with The Frontier, a nonprofit newsroom in Oklahoma.

Four days after he first requested help, England submitted his fourth sick call — a one-page form that prisoners at Joseph Harp used to request medical attention. He again wrote down how it was hard to breathe or even lie down. This time the licensed practical nurse who saw him consulted with the prison's supervising physician, Robert Balogh. Balogh prescribed ibuprofen over the phone. He, and the physician assistant who saw England earlier, each had marks on their records: Balogh had been fined and put on probation for a time by the Oklahoma narcotics bureau, and the license of the PA had once been revoked for prescription fraud.

As medical professionals downplayed England's symptoms, he continued to deteriorate. He couldn't work or eat or shower; instead he remained in his cell, curled up on the floor in tears. Other prisoners reported that he had lost weight, his skin color had changed, and he no longer seemed fully cognizant.

On May 29, 2018, a corrections officer discovered England slumped over on the floor next to his cell. The Choctaw Nation kid who loved fishing and cattle ranching had died, just weeks after turning 21. Autopsy records show that the cause of death was a ruptured appendix.

Appendicitis is easily treated with minimally invasive outpatient surgery. Even treating a ruptured appendix is considered routine as long as the patient is immediately hospitalized. In this case, the PA was notified of his declining condition the morning of his death; he later told investigators he didn't believe England's condition had been life-threatening. A licensed practical nurse who saw England a few days earlier said she suspected he was in withdrawal and seeking painkillers.

Five years after England's death, the Oklahoma legislature approved a $1.05 million settlement with his mother, Christy Smith, to resolve a claim under the Eighth Amendment, which bars "cruel and unusual punishments." During litigation, the Oklahoma attorney general maintained that the prison's course of treatment was legitimate; in settling, the state admitted no wrongdoing.

Balogh, who no longer works for the department, confirmed the probation and said he was cleared to work without monitoring in 2015. He said he worked remotely for Joseph Harp so was reliant on information provided over the phone by the nurse, who he said did not mention that England had been having symptoms over a span of days. "You had a system where, many times, the physician was not there," Balogh said. "There were some ways that information could fall through the cracks."

A spokesperson for the Oklahoma Department of Corrections declined to comment about the case, as did Joan Kane, a clerk for the Western District Court of Oklahoma, on behalf of Judge Charles Goodwin, who presided. "It is atypical for federal judges to speak publicly about specific legal situations or cases," she said. No other judge on a case mentioned in this story agreed to comment.

Few cases win outright

Business Insider analyzed a sample of nearly 1,500 federal Eighth Amendment lawsuits — including every appeals court case with an opinion we could locate filed from 2018 to 2022 and citing the relevant precedent-setting Supreme Court cases and standards — and found that a settlement like Smith's was exceedingly rare.

The cases in BI's sample overwhelmingly detailed serious claims of harm, including sexual assault, retaliatory beatings, prolonged solitary confinement, and untreated cancers. Prisoners lost a vast majority of them — 85%.

Roughly three-quarters of civil suits filed in the United States settle, and nearly half of nonprisoner civil-rights suits do. In BI's sample of Eighth Amendment cases, just 14% settled. Many of the settlements were sealed. Of the rest, none involved an admission of wrongdoing by prison officials. BI was able to identify just six cases that settled for $50,000 or more; half of those, including the England case, involved prisoner deaths.

Many of the cases settled for modest amounts: An Oregon prisoner received $251 over a claim that she was sexually assaulted by another prisoner and then pepper-sprayed by a guard. A Nevada prisoner got $400 on a claim that guards beat and pepper-sprayed him while he was in restraints. A New York prisoner won $2,000 for claims that he suffered debilitating pain while prison officials delayed treating his degenerative osteoarthritis.

In 11 cases — less than 1% of the sample — the plaintiffs won relief in court.

Seven of these plaintiffs won damages, the result of six jury trials and one default judgment; plaintiffs in the other four cases, including two class actions, were granted motions for injunctive relief, such as being freed from a prolonged stint in solitary. In one of these cases, a plaintiff in Wisconsin was granted access to gender-affirming surgery to treat her gender dysphoria after a seven-year delay. Along the way, the 7th Circuit granted the officials qualified immunity, which protects the conduct of public officials in the line of duty, so the plaintiff was denied damages. Beth Hardtke, the director of communications for the Wisconsin Department of Corrections, said the department updated its transgender-care policy in response to the ruling.

Litigants without lawyers

Another pattern jumped out: In every case in BI's sample in which a prisoner prevailed, the plaintiff was represented by legal counsel. They were outliers.

In the vast majority of cases, 78%, prisoners litigated pro se — without counsel — in large part because a Clinton-era law, the Prison Litigation Reform Act, tightly capped attorney fees, making it prohibitive for lawyers to take prisoner cases. BI interviewed 10 attorneys who represented prisoners or their families in cases that prevailed; they all said the cases would have struggled to succeed without counsel.

"Pro se litigants do not win cases in federal court," said Victor Glasberg, one of a team of attorneys who successfully proved in 2018 that conditions on Virginia's death row violated prisoners' Eighth Amendment rights. "When faced with abysmal anti-plaintiff litigation and jurisprudence, the chance of a pro se litigant getting to first base is about as good as my flying to the moon."

Even lawyers struggle to master the convoluted standards that now guide Eighth Amendment claims, said Chris Smith, a Mississippi attorney who won a constitutional claim over inadequate medical care in 2021.

Smith told BI that his team's ability to access documents was critical for winning the case; he and his colleague spent days combing through 5-inch binders containing years of medical records to prove the corrections department was responsible for treatment delays.

But prisoners face a litany of hurdles, he said, starting with the difficulty they face obtaining records.

They don't have experience in the rules of civil procedure, he said. They don't know how to plan a litigation strategy, or draft jury instructions, or take depositions.

In England's case, because he had died, his mother was the plaintiff in a 2019 lawsuit alleging that corrections and medical staff had failed to treat his appendicitis. Since she was not incarcerated, she was able to secure legal counsel free from the PLRA's fee caps.

The settlement, reached after a four-year legal battle, did not require the defendants to admit to any wrongdoing. State taxpayers, rather than the named defendants, footed the bill.

"The people that actually were responsible for it," England's stepfather, Darren Smith, said, "have no accountability whatsoever."

Prisoners succeed more before juries

One federal judge, Lawrence Piersol of the South Dakota District Court, said that in his experience, jurors are not generally sympathetic to imprisoned plaintiffs. BI's data indicates that plaintiffs actually fare somewhat better before juries than before judges. Of the 1,488 cases in BI's sample, prisoners prevailed more often before juries. Just 2% of the cases BI reviewed were decided by a jury. Yet more than half of the 11 prisoners who won their suits had jury trials.

Glasberg, the Virginia attorney, said he suspected that if more cases were decided by jurors, it would "significantly improve the plight of people in prisons and jails." Many prisoners, he said, see their cases dismissed preemptively by a judge, before a jury has the chance to hear evidence.

One Louisiana prisoner, Tony Johnson, was awarded $750,000 in 2020 after a jury found that a guard at Angola had sexually assaulted him. The guard denied the allegations.

Johnson's lawyer, Joseph Long, told BI that the verdict was the result of years of litigation, including obtaining dozens of depositions and spending nearly $40,000 on the case. The underlying Eighth Amendment claim, he said, entailed abuse with the potential to infuriate even jurors sympathetic to law enforcement.

"Prison isn't supposed to be good, but when they get raped by a guard even the most hard-bitten conservative has to admit that's wrong," Long said. The guard resigned from the prison in 2014 and was never criminally charged; four years after the verdict, Long said, his client has yet to receive his money from the state. The Louisiana Department of Public Safety & Corrections declined to comment on the record.

Chris Smith's client, a Mississippi prisoner named Thad Delaughter, had complained for years about severe hip pain caused by rheumatoid arthritis. Eventually, in 2011, he was allowed to see an outside specialist who found that he needed surgery to reconstruct his hip. The operation was scheduled, only to be abruptly canceled; one of Smith's arguments in court was that prison officials didn't want to foot the substantial bill.

The treatment kept getting delayed as his condition deteriorated. At trial, jurors found that Gloria Perry, the department's chief medical officer, had violated Delaughter's constitutional rights by delaying the procedure; he was awarded $382,000 in damages and, in 2022, had the operation.

Perry denied any wrongdoing, saying in court filings that her actions didn't rise to the level of a constitutional violation; her motion for a new trial was denied. A representative of the Mississippi Department of Corrections said Perry no longer worked for the department and declined to comment on litigation matters; her attorney did not respond to queries.

'I want him to live'

Among the jury wins for prisoners in BI's sample were two cases filed against doctors who worked for Wexford Health, the private correctional healthcare company. In one case, an Illinois prisoner named William Kent Dean convinced a jury that his kidney cancer had metastasized after healthcare providers failed to diagnose and adequately treat his symptoms over a span of seven months. At one point, email records showed, Wexford employees discussed admitting him into hospice in lieu of paying to treat his illness. "He's the love of my life," Dean's wife, Cynthia Dean, said during the trial, "and I want him to live."

In 2019, Dean won $11 million in damages at trial against Wexford and two of its medical providers. Appeals court judges of the 7th Circuit then sent the case back, after finding that Dean hadn't proved the defendants were "deliberately indifferent" to his suffering, as the Supreme Court requires.

One 7th Circuit judge, Diane Wood, dissented, writing, "Wexford directly learned of the lack of significant medical intervention and the arc of Dean's cancer's progression, yet still did not act efficiently or effectively."

Dean died of kidney cancer in 2022 at the age of 61.

Wexford and the Illinois Department of Corrections did not respond to requests for comment.

In August, a new jury again found in favor of Cynthia Dean, who had taken over as plaintiff. This time the award was $155,100. Wexford, in a court filing, denied all of the allegations.

BI's database is packed with cases that also allege significant harm — but the plaintiffs lost.

One was another Illinois prisoner under the care of Wexford, who sued his doctor for waiting over a year to test for an abdominal hernia — prolonging his pain and delaying corrective surgery. Another involved an Oklahoma man who filed suit saying that a prison doctor had improperly discontinued his medication to treat chronic nerve pain from tongue cancer. Both cases were dismissed when judges found the prisoners could not prove their doctors were deliberately indifferent.

A woman in California sued after doctors persistently misdiagnosed a growing lump that, years later, was diagnosed as Stage 4 breast cancer. Even then, she said, doctors denied and delayed chemotherapy as the cancer spread.

The US District Court for the Eastern District of California dismissed her case when she died. There was nobody to take over for her as plaintiff.

Terri Hardy, a spokesperson for the California Department of Corrections and Rehabilitation, declined to comment on the breast cancer case and said the department works to ensure that its complaint process is fair, thorough, and timely. A spokesperson for the Oklahoma Department of Corrections declined to comment on the tongue cancer case.

Large settlements for prisoner deaths

One way for a plaintiff to win a large settlement, BI found, is to end up dead.

Of the six lawsuits BI identified that settled for $50,000 or more, half of those were filed by family members such as Josh England's mother, Christy Smith, whose sons or brothers died behind bars. Unlike prisoner plaintiffs, these surviving relatives didn't have to overcome the PLRA's hurdles.

"Somebody has lost their life, so there should be a lot of money," said Paola Armeni, a Las Vegas attorney. "They're not getting their loved one back."

Armeni's case is one of a handful in our sample in which a lawsuit forced substantive change. She represented the family of Carlos Perez Jr., a Nevada prisoner who was killed in 2014 at Nevada's High Desert State Prison by a trainee officer named Raynaldo-John Ruiz Ramos. Ramos shot Perez multiple times with birdshot, a kind of ammunition used to hunt small game. "They lit him up," Armeni told BI. "The birdshot was from his waist up. It was a murder."

Six months later, a prisoner named Stacey Richards was permanently blinded when a corrections officer shot him with birdshot at another Nevada prison, Ely State.

After an eight-year legal battle, the state settled last year with Perez's family for $1.6 million. That same year, a case filed by Richards settled for $2.25 million. In exchange, Richards' attorney agreed that his client wouldn't talk to the press about the case. Ramos maintained in court that firing his weapon was a reasonable use of force to break up a fight between prisoners.

As a result of Perez's death, the state corrections commissioner was forced out and the department commissioned an external review of its use-of-force policies, ultimately agreeing, in 2015, to phase out the use of birdshot, which prison guards had deployed for decades.

In reaching a settlement with the Perez family, the state did not accept liability for Perez's death, even though the Clark County coroner's office had ruled it a homicide.

The Nevada Department of Corrections declined to comment; Ramos' attorneys did not respond to requests for comment.

Ramos was charged with involuntary manslaughter. In 2019, he entered a plea deal. In exchange for community service and a mental-health evaluation, he avoided prison.

Over the past decade, Minnesota's prisons have experienced officer assaults, lockdowns, and chronic staffing shortages. They have faced allegations of substandard medical care, inhumane living conditions, sexual abuse by guards, and retaliation against prison employees who have sounded the alarm. "It's a very sick system," one former lieutenant told Business Insider. Officers "have each other's back," she said, "even if that means lying."

Within this troubled system, officers and prisoners said one facility has stood out: Minnesota Correctional Facility–Rush City.

A former Rush City therapist described it as one of the state's most dangerous prisons, and a former corrections officer there recalled near-daily fights. "The staff up there are a bunch of cowboys," a former Rush City lieutenant said. Officers there "go hands-on much quicker than they would at any other facility," he added. "It was a culture that was just ingrained from the day it opened."

The first lieutenant, who spent a year at Rush City, described the place as a "time bomb."

The routine brutality earned Rush City a moniker: Gladiator School.

Despite the frequent violence, Dario Bonga, a longtime Rush City prisoner, said one assault, in particular, had stuck with him. It was the day a prisoner bashed in James Vandevender's head.

Bonga was one of six prisoners and officers who said the attack was so brutal they still remembered it over a decade later.

A methodical attack

On June 8, 2012, Vandevender, then 25, had only a few months left on his yearlong sentence over assaulting someone during a fight. He and Bonga were working that day in the prison's industry area, folding balloons, when Bonga was startled from his work by a loud thud. A prisoner had swung at Vandevender's head with a four-by-four wooden post. Bonga watched in shock as the man, later identified as Mark Latimer, continued his methodical attack.

Surveillance footage obtained by BI corroborates Bonga's account. It shows Latimer pick up an unsecured wooden board from a shelf in the woodworking area, drop it, and walk away. A few seconds later he's back, and this time he quickly pulls out a wooden post. No officers are visible in the video; the unguarded woodshop wasn't operating that day.

In the surveillance footage, Latimer saunters several hundred feet across the workshop with the four-by-four. No one tries to stop him — no corrections officer; no one from Minncor Industries, the corrections division that oversees prison labor — as he approaches Vandevender's worktable, hoists the post over his shoulder, and begins to swing.

Only after the sixth blow — after Vandevender has collapsed onto the table, bleeding from his nose and mouth, and after Latimer has slipped into the crowd of panicked men — do officers come running.

Later, at the hospital, a doctor told Vandevender's mother, Peggy Vandevender, that her son had a 20 to 30% chance of survival. He spent 45 days in a coma and woke up 40 pounds lighter. His face was numb, and he couldn't speak or read. He thought he had a prison softball game that weekend, not processing that he had been in the hospital for a month and half.

Years later, the effects of Vandevender's traumatic brain injury persist. Tests indicated a decline in cognitive function. Seizures have forced him to take epilepsy medication. Deep depression sent him in search of meth, which landed him at Rush City again.

When Vandevender arrived back, about four years later, Bonga thought he was seeing a ghost. No one thought he could have survived that beating.

'Unacceptable' risks

In 2018, Vandevender filed a lawsuit alleging that prison officials, by failing to protect him from the attack that day, had violated his Eighth Amendment rights to be free from "cruel and unusual punishments." His attorneys argued that officials had been aware of the risks: For several months before the assault, officials had specifically instructed prisoners to pile and store the boards in an unsecured area that was accessible to prisoners, against prison policy. Vandevender's complaint said that in the weeks before the attack, a prisoner had warned a guard that "the open pile of wood was a threat to the health and safety of all of the inmate population and could be used as a weapon against him and other inmates." The prisoner said the guard told him it was none of his business and "not to worry about it."

There was reason for concern: Vandevender's complaint cited an incident in which, he said, one Rush City prisoner had assaulted another with the wooden handle of a pitchfork, "causing serious head injuries." When, six years after Vandevender's assault, a corrections officer named Joseph Gomm was killed by a prisoner wielding a sledgehammer taken from a work area at another Minnesota prison, Gomm's family sued, alleging a "long-standing culture" in which Minncor's revenue was prioritized over safety.

"Had there been more staff, had there been more cameras out there, absolutely Officer Gomm would not have been killed," a former Rush City corrections officer told BI. "Same thing with Vandevender."

Aaron Swanum, an information officer for the Minnesota Department of Corrections, said that among Minncor staff, only production supervisors are required to receive security training. At Rush City, he said, there is just one.

After reviewing the circumstances surrounding Vandevender's attack for his case, Tim Gravette, a corrections consultant, concluded that Rush City staffers were negligent for failing to properly follow state correction policies, and that if they had, Latimer couldn't have attacked Vandevender in the way he did. "I find the lack of work material accountability to be unacceptable practice," he wrote.

Paul Schnell, Minnesota's corrections commissioner, said that while he couldn't comment on Vandevender's case because it predated his tenure, "obviously we want to be in a place where we're trying to take the steps to keep people safe."

He said that since he became commissioner in 2019, he'd established an Office of Professional Accountability to address employee complaints, revived an independent ombudsman office to address internal grievances, started a body-camera pilot program, and, in the wake of Gomm's murder, increased the number of staff and cameras in the industry area of the prison where he died. The department confirmed that there have been no such changes at Rush City.

Whether a prisoner wins or loses a lawsuit, Schnell said, "we're certainly looking at our practices no matter what."

He said that "everything's incremental" when it comes to corrections reform.

"The challenge is that we were struggling to get our staffing complement up in general, so while we may have put more bodies in Minncor, we were shorter elsewhere," he said. "It's always give-and-take."

A guardrail against cruelty

From its beginnings, the Eighth Amendment was understood as a guardrail against unabashed cruelty; by the mid-20th century it was also being used to push back against inhumane prison conditions, violence, and medical neglect. Then, in the 1980s and 1990s, as mass incarceration was on the rise, the Supreme Court issued a series of opinions that shifted the focus away from these underlying abuses to the question of prison officials' intent.

In practice, these decisions made it difficult for prisoners to assert their constitutional rights.

One of those pivotal cases was 1994's Farmer v. Brennan. The court unanimously ruled that prison officials were liable for Eighth Amendment violations only if they acted with "deliberate indifference" to a prisoner's suffering. To meet this standard, Justice David Souter wrote, prisoners must show that officers were aware of and disregarded a serious risk of harm, saying this approach "comports best with the text of the Amendment." Officials were now on the hook only if they had the knowledge that a particular harm would occur if they didn't act.

While Souter said a court could infer awareness if the risk was obvious, the standard still required incarcerated plaintiffs to marshal proof of something ineffable — a prison official's inner thoughts.

Business Insider's analysis of a sample of nearly 1,500 Eighth Amendment cases — including every appeals court case with an opinion we could locate filed from 2018 to 2022 citing the relevant precedent-setting Supreme Court cases and standards — shows that mindset has become an extremely difficult standard to meet. For the vast majority of prisoners in BI's database who filed their suits without counsel, proving mindset can be almost impossible — 85% of their cases decided under the deliberate indifference standard lost.

All of the remaining pro se cases settled, often for modest amounts.

"However obvious the circumstances, people may at times remain oblivious," Sharon Dolovich, a law professor at UCLA, wrote in an anthology on the Eighth Amendment. "And when this is true of prison officials, no constitutional liability may lie, however 'soul-chilling' the conditions."

Deference to officials, coupled with "the long and troubling history of unspeakable maltreatment against incarcerated people by the very actors charged with their protection," she wrote, has created a landscape where "the power that prison officials have over incarcerated persons is sure to be abused."

In BI's sample, a few attorneys successfully proved mindset, sometimes by obtaining explicit circumstantial evidence, such as email exchanges introduced in the case of one Illinois prisoner that show prison healthcare providers floated the possibility of sending him to hospice care after his oncologist recommended treatment that would cost $15,000 a month. But such cases were rare.

Few sitting judges would comment to BI about the deliberate-indifference standard; some did not respond to interview requests, while others declined to comment. One who did, Lawrence Piersol, a federal judge in South Dakota, decided a case under the standard filed in 2020 by a prisoner named Jason Dunkelberger. While incarcerated at the South Dakota State Penitentiary, Dunkelberger said, the tips of his fingers were severed by a metal shear in the prison machine shop that he'd never been trained to use; in a deposition, he said he was told he'd be sent to solitary if he refused the assignment, given to him by a fellow prisoner put in charge by the machine shop's supervisor. He said he waited 90 minutes before being sent to the hospital, where the fingers were amputated.

The South Dakota Department of Corrections did not respond to requests for comment.

In his lawsuit, Dunkelberger argued that prison staff had violated his constitutional rights by failing to keep him safe. Because the directive to use the machine had come from a prisoner, and not an officer, Piersol ruled that officials couldn't be considered deliberately indifferent. Piersol said his decision spoke for itself, but he agreed to comment on Eighth Amendment cases generally.

"It's difficult for a prisoner to succeed," Piersol said. "But sometimes there are some decent settlements."

Dunkelberger's claim couldn't meet that high bar. Vandevender's didn't either.

Donovan Frank, a federal judge with the District of Minnesota, granted the prison officials qualified immunity in the Vandevender case, finding that he had failed to prove they "were subjectively aware of a substantial risk posed by the wooden boards." Even if they should have known that leaving them unsecured violated Rush City's tool policy, Frank wrote, that "does not satisfy the subjective-culpability requirement."

He dismissed the case before Vandevender could take discovery.

After Vandevender appealed, the 8th Circuit agreed with Frank, deciding that Vandevender was the victim of a surprise attack and that corrections officers therefore could not have violated his rights by failing to protect him. The court determined that the prior assault with a wooden pitchfork handle hadn't signaled a "pervasive risk."

When BI spoke with Mark Bradford, Vandevender's attorney, two years after he lost the case, he seemed defeated.

"I'm not sure what more you could possibly do to show deliberate indifference," he said. "It really is a troubling standard that the 8th Circuit has employed here."

Appended to the appeals court's judgment is a separate opinion, authored by Judge Jane Kelly, who wrote that she concurred only because she was bound by 8th Circuit precedent. "Our caselaw may set the bar too high for the typical inmate to sufficiently plead prison officials were deliberately indifferent to a substantial risk of serious harm in a case like this one."

'The easiest lie to tell'

The Eighth Amendment cases BI reviewed include claims of untreated cancers and heart disease, retaliatory beatings, sexual assaults, limb amputations, and prisoners wasting away in squalid cells littered with feces and dead flies. There was a New York teenager who said he was put in a vermin-infested cell in late 2021 where he was attacked by a bat and bitten by a poisonous spider, an Arizona prisoner who said in 2020 he was given only Tylenol to treat a broken jaw, and a Michigan man who filed a complaint in 2019 saying his eyesight deteriorated because prison doctors refused to conduct cataract surgery. Again and again, courts dismissed these cases, finding that prisoners had failed to meet the deliberate-indifference standard. The standard introduced three decades ago by the Supreme Court — and its interpretation by federal courts in the years since — has created formidable obstacles to accountability in this country's prisons.

The Arizona Department of Corrections, Rehabilitation & Reentry did not comment on the broken-jaw claim but said that Gov. Katie Hobbs had appointed a new corrections director, Ryan Thornell, in January 2023 "to make needed changes to the correctional system" and that he was ensuring "high-quality, patient-centered care and wellness are becoming standard practice." The New York and Michigan corrections departments did not respond to requests for comment.

Of the cases in BI's sample, 1,361 were argued under the deliberate-indifference standard. Only 10 plaintiffs prevailed in court; another 164 cases settled without the prison admitting liability. All 10 of the successful plaintiffs were among the minority in the sample who were represented by counsel.

David Fathi, the director of the National Prison Project at the ACLU, told BI the standard has been "an enormous barrier to justice for incarcerated people." If prisoners encounter conditions that are "inhumane, unhealthy, dangerous, or even lethal," he argued, "that should be enough to violate the Eighth Amendment — you shouldn't have to go looking for someone who was thinking bad thoughts."

David Shapiro, the executive director of the Chicago Lawyers' Committee for Civil Rights, has litigated dozens of Eighth Amendment cases on behalf of prisoners.

"I didn't know this person was going to get attacked by another incarcerated person," he said of defenses under the deliberate-indifference standard. "I didn't know that this person was having chest pains because they were experiencing a heart attack."

As long as prison officials assert that they didn't know about the risk, he said, a federal court will rarely find an Eighth Amendment violation.

"What is the easiest lie to tell?" he said. "I didn't know."

'A dark and evil world'

For generations, the federal courts took a mostly hands-off approach to conditions in America's prisons. That changed in the wake of the Civil Rights Movement, as judges began to issue Eighth Amendment rulings that secured key rights for prisoners.

In 1970, for instance, a federal judge put every Arkansas prison under court order, calling the state system "a dark and evil world completely alien to the free world." Six years later, another federal judge found prisons in Alabama "wholly unfit for human habitation" in violation of the Constitution.

About this time, a Texas prisoner named J.W. Gamble sued his facility over inadequate medical care, arguing that officers had failed to treat his intense pain after a 600-pound cotton bale fell on him during a work assignment. While the Supreme Court found that Gamble's constitutional rights hadn't been violated, the 1976 decision, written by Thurgood Marshall, established that prisoners have a right to medical care under the Eighth Amendment.

"Deliberate indifference to serious medical needs of prisoners constitutes the 'unnecessary and wanton infliction of pain,'" Marshall wrote. "An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met."

It was a consequential decision. It was also, fatefully, the court's introduction of the phrase "deliberate indifference."

"There it sat," John Boston, the former director of the Prisoners' Rights Project of the New York City Legal Aid Society, said, "extremely vulnerable to a more conservative court coming along and trying to define it downward in ways disadvantageous to prisoners."

That shift occurred quickly. As President Ronald Reagan ramped up the war on drugs, legislators from both parties, committed to a tough-on-crime agenda, began to pass a raft of criminal-justice measures. The impact of these policies is now well known. In less than 30 years the country's penal population grew sixfold to a peak of more than 2 million, leaving the US incarcerating more people than any other country.

The critical Farmer v. Brennan case came when Dee Farmer, a transgender woman, filed a claim saying federal prison officials had failed to protect her from sexual assault. In an interview, she described how, after being raped by another prisoner at knifepoint, she was sent to segregation for over a year.

When Farmer won her case before the Supreme Court, it was hailed as a major victory for transgender rights. The decision also cemented the current deliberate-indifference standard.

Farmer's lead attorney, the ACLU's foremost prison expert, Elizabeth Alexander, argued that the standard should hinge on what officials had the professional responsibility to know. The solicitor general, Drew Days III, disagreed, contending that officials should be held liable only for risks they were aware of. "Petitioner's 'should have known' approach ignores the 'deliberateness' requirement of the 'deliberate indifference' standard," he wrote in his brief.

The Supreme Court agreed with Days, finding that officials were liable only if they personally knew of and disregarded the risk, regardless of the gravity of the harm to the prisoner.

Some issued warnings at the time. Michelle Alexander, the noted civil-rights lawyer and author, who was then a clerk for Justice Harry Blackmun, suggested that the majority opinion "would allow a prison official to argue to the jury that although a particular risk of harm was plainly obvious, and a reasonable prison official would have been aware of it, he wasn't."

In his own concurring opinion, Blackmun described the new standard as fundamentally misguided. "A punishment is simply no less cruel or unusual because its harm is unintended," he wrote.

Alexander, in a recent email, described the decision as one of many during that period that created what she called "unconscionable obstacles to meaningful relief for people ensnared by our criminal injustice system."

Vandevender is one of hundreds of prisoners in BI's sample for whom those obstacles were insurmountable. Prisons are inherently dangerous places, the 8th Circuit concluded in his case, and "inmates bent on assaulting other inmates will use even the most harmless objects as weapons."

Judge James Loken, who authored the majority opinion, wrote that, for Vandevender, "the outcome was tragic, and an assault with this weapon was, in hindsight, no doubt avoidable."

Still, he concluded by quoting the Farmer decision, writing, "an official's failure to alleviate a significant risk that he should have perceived but did not, while no cause for commendation, cannot under our cases be condemned as the infliction of Eighth Amendment punishment."

A fiancée's warning

Six years after Latimer's assault on Vandevender, Rush City experienced another violent attack. This time, officials were repeatedly warned of the risk.

Trina Murray was at home in bed one night when she got the call. She was confused; her daughter never phoned that late. She listened with a rising panic as she learned that her only son, David Hodges, had been assaulted at Rush City.

Hodges is a large man, tall and broad-shouldered, with the word "family" inked onto his right forearm. But Murray still worried about his exposure to violence when, in 2011, he was sent to prison for sexual assault. She knew what Minnesota's prisons could be like, having worked in two of them.

She tells one story from when she was an officer at Minnesota Correctional Facility–Lino Lakes, a medium-security prison outside Minneapolis, in the 1990s. There, in her telling, she witnessed a group of officers placing bets on how many prisoners they could send to solitary confinement. When she reported the behavior, she became the target of a campaign of retaliation. The officers, all men, followed her to her car. They called her the N-word, she said, and told her to go back to Africa. Later someone threw a rock through the window of her home. Eventually, she quit.

After the call that evening in September 2018, she scrambled to learn what had happened to her son. In incident and investigative reports, Hodges claimed that another prisoner, Courtney Osgood, had entered his cell with a shank, angry that Hodges had refused to pay off a debt owed by Hodges' cellmate. Osgood grabbed Hodges' locs, ripping some out, and attempted to stab him. Hodges, who had been making coffee on a small hotplate, threw the boiling water at Osgood, who raced out of the cell.

Prison officials weren't aware of the altercation, according to an incident report, until Hodges' then-fiancée called the prison, concerned about his safety. Once alerted, Hodges' subsequent civil complaint said, they sentenced Osgood to 20 days in segregation — and gave twice that to Hodges. Gene Olson, a prison lieutenant who investigated the incident, said in a deposition that he couldn't prove Hodges' account of the attempted stabbing because officials couldn't track down the shank. Osgood also denied Hodges' account in a message to BI, calling it a "fabricated narrative."

In segregation for about six weeks, locked in a tiny cell, the lights on 18 hours a day, Hodges said, he obsessed about one thing: what was waiting for him when he got out.

"It's prison politics 101, if I assault you and I hurt you real bad, you're looking to get your lick back," he said. "Needless to say, I'm a big guy, and I know this time he was coming with help."

Hodges begged officers to move him to a different unit, verbally and in writing. Murray, his mother, along with his fiancée, his sister, and his grandmother, called and wrote over a period of six weeks to the prison and to state corrections headquarters, imploring officials to take action because they feared for his life. "What exactly must he do to get a transfer to another facility for his safety?" his fiancée asked in a late-October email to the warden at the time, Jeffrey Titus. "Why must something really bad happen before he is taken seriously."

Every prison in Minnesota has an incompatibility-review committee composed of prison staff that meets to decide whether particular prisoners pose a risk to each other and need to be separated. Their deliberations, a former corrections staffer at Rush City told BI, are usually documented in great detail. Rush City's panel, which included Olson, had met in late September 2018 and decided that Hodges and Osgood didn't need to be separated. Ashlee Berts, a corrections program director who oversaw the committee, said in a deposition two years later that no notes were kept to explain their rationale. She said she didn't remember who was on the committee, whether it had convened in person or over email, and what was discussed. Olson said under oath that, despite the pleas from Hodges and his family, he didn't believe Hodges faced any threats.

Schnell, the corrections commissioner, said he expected his staffers to fully document incompatibility reviews. "It's news to me that there wasn't that information," he said of Berts' claim that no records were kept. "We want to be in a position where we can say that we have documentation that we did that and the basis for it."

In early November, just hours after Hodges was released from segregation, Osgood and a fellow prisoner assaulted him in the living unit, throwing a mixture of hot water and capsaicin, a chili-pepper extract, in his face. Surveillance video shows Hodges trying to escape as the two men come toward him. They land a series of punches as Hodges waves his arms in a futile attempt to make contact with his assailants. His eyes were blinded and burning, he told BI, saying it felt like an eternity before officers arrived. Medical records show he suffered a nasal fracture, second-degree burns, and an eye injury.

Ten days after the assault, the committee made a new determination: Hodges and Osgood were incompatible, and Hodges' transfer request was granted.

Almost five years later, Hodges discussed the incident while sitting in an empty visitors' room at Minnesota Correctional Facility–Moose Lake, a state hospital turned prison an hour north of Rush City. The window blinds concealed a barbed-wire fence just outside. He wears wire-framed glasses now, to help with the blurred vision he's lived with since the attack. "I had a lot of sleepless nights," he said. "Every time I think about the situation, I'll have flashbacks." In a July 2019 incident report, an officer described finding him crying in the midst of an anxiety attack.

Like Vandevender before him, Hodges filed a lawsuit alleging that prison officials at Rush City failed to keep him safe.

With Vandevender, the court's ruling hinged on the fact that he'd experienced a surprise attack. But the attack on Hodges came after a campaign of urgent warnings that he feared for his life.

The defendants argued that launching the incompatibility review was itself proof they hadn't been deliberately indifferent to Hodges' welfare. A federal judge, Wilhelmina Wright, accepted the officers' claim that they had determined in good faith that Osgood no longer posed a threat.

"The fact that this conclusion proved to be incorrect does not demonstrate that Defendants recklessly or intentionally ignored an obvious risk," Wright wrote in deciding in the officers' favor. The 8th Circuit — the same appeals court that decided Vandevender's case — agreed with Wright on appeal, finding that the officials had simply "predicted incorrectly." Hodges' claim failed.

A modern-day 'Lord of the Flies'

The sample BI analyzed is full of cases in which officers failed to act on warnings that prisoners were at risk.

Marc Bakambia, another Rush City prisoner, said that after a group of prisoners beat him up and threw him over a railing, he was placed in their same unit and assaulted again, leaving him with bone fractures and a traumatic brain injury. Craig Shipp claimed he had sought orthotic shoes for his diabetes and degenerative joint disorder but Arkansas prison and medical staff denied his repeated requests; he said he eventually developed an infection severe enough to result in the amputation of his right foot. Mitchell Marbury claimed he requested a transfer after a friend warned him that a fellow prisoner was out to get him; he said an Alabama corrections officer laughed and told him to get a shank. Less than a week later, he said, he was stabbed in the facility's day room.

The Arkansas and Alabama corrections departments did not respond to requests for comment; the Minnesota corrections department did not comment on the Bakambia case.

"Marbury's argument is essentially that every prisoner who tells prison officials about an unspecified threat from an unspecified inmate without more is entitled to protective custody or a transfer," 11th Circuit judges wrote in the majority opinion. "Our caselaw establishes a higher standard for deliberate indifference."

"The Eighth Amendment does not allow prisons to be modern-day settings for Lord of the Flies," Judge Robin Rosenbaum wrote in a scathing dissent. By not holding officials responsible, she said, "the Majority Opinion condones this behavior and ensures it will occur again."

In reviewing Hodges' appeal, Kelly, the 8th Circuit judge, wrote her own opinion, as she had in the Vandevender case. She disagreed with how her colleagues assessed the question of mindset, writing that a committee finding alone should not release prison officials from liability. She also noted that "the absence of documentation regarding prison decisions or prison officials' inability to remember events central to their decision-making process may be relevant," raising the question of whether those gaps could have been deliberate.

Many corrections officers are made aware of the mindset standard. BI requested officer training materials from every state prison system and obtained them from 37 — most of which explicitly trained on deliberate indifference. Taken together, the documents indicate that the standard, as interpreted by federal courts, could encourage prison staff to remain incurious about what goes on in their facilities.

As Oregon's training materials say, "basically, deliberate indifference is a cognitive choice to do what you did."

Fathi, of the ACLU, reviewed a sample of the training materials BI obtained and said the guidance might lead officers "to act in ways that violate people's rights and that harm people very severely."

Many of the materials, he said, appear to train officers to treat prisoner complaints with suspicion. In a 2021 Mississippi slide deck, for instance, corrections officials were told prisoners try to compromise their integrity "as entertainment and for their amusement" or "to facilitate an escape, assault, rape or murder." A slide in a 2018 Utah training PowerPoint displayed the header "inmates do crazy things… then sue YOU for it."

"It's good to train them on the law," Fathi said. "But they should also make clear that we expect more than the absolute minimum that's required to avoid violating the Constitution."

Memory issues

On a muggy June morning in 2023, as the sun was just beginning to peak out in Euless, Texas, James Vandevender was already up in his father's modest one-story house in the Dallas suburb, pouring himself a cup of coffee. He had moved there from Minnesota, after his last prison stint, looking for a fresh start.

He was dressed in khakis for his job installing high-end appliances. A tattoo of his son's name showed below his shirt sleeve, and a scar cut across his cropped brown hair.

He moved through the same routine as every morning: packing his lunchbox, scarfing down breakfast, and swallowing an array of anti-seizure pills and antidepressants.

Still, that day, he forgot to put the ice pack in his lunchbox and had to redo it. When he headed outside to toss out the trash, he couldn't remember where he stowed the garbage bins. By the time he and his coworkers gassed up and headed off to the first house, Vandevender had misplaced his phone.

As they wrapped up their first job and headed back to their truck, Vandevender realized he'd left his tool bag inside.

At the next house, the men were tasked with installing a mounted range hood they'd never encountered before. It was a tricky job, Vandevender said. By late afternoon, visibly frustrated, he called the installation a "fucking joke."

His coworker Mike, in a black baseball cap to protect from the sweltering sun, took a breather in the driveway, away from the tension inside. "He's been having memory issues all day long. It's an everyday thing," he said of Vandevender. "That's when he gets frustrated."

Ashley Christen, the mother of Vandevender's 20-year-old son, said that when the two of them were growing up in rural Minnesota, Vandevender was smart and quick-witted, known for delivering the best one-liners. As a kid, he loved to hunt and spend time on his grandfather's dairy farm; his mother, Peggy, said he was fun and lovable, always offering to help out around the house.

But since the assault, they both said, he's struggled to communicate. He's forgetful, irritable, and prone to snap. Peggy said he relied on scribbled notes to get through the day.

"It shouldn't have happened," she said. "It was because of their lack of watching the people," she added. "It was due to their negligence."

On a recent fall afternoon, 12 years after Latimer bludgeoned him with the wooden post, Vandevender sat down with a friend to watch surveillance footage of the attack for the first time. He doesn't remember anything from that day; his first recollection is waking up weeks later, confused and shackled, in a hospital bed flanked by corrections officers.

"I just want to make sure you're mentally prepared to see it," the friend told him, before pressing play. "I want to," Vandevender said.

When the video finished, there was a long silence.

Eventually, he started talking. He said the footage took him back to his time in prison — the smell, the barbed wire, the disrespect. He said that he noticed Latimer picked up the post from an unauthorized part of the industry area, where prisoners weren't allowed, and that any unused lumber should have been disposed of. He said he felt the weight of what it must have been like for his mother, when she got the call every parent of an incarcerated child dreads.

When asked about the life he could have had, the one where he got out of prison at age 25 without the burdens of a traumatic brain injury, he struggled to respond.

"I don't want to talk about it," he said.

Nearly three years into Bill Clinton's first term as president, US senators took to the floor to tackle an urgent concern. Prisoners across the country were filing too many lawsuits.

"The vast majority of these suits are completely without merit," Sen. Orrin Hatch, the Republican chair of the Judiciary Committee, said in September 1995. "It is time to lock the revolving prison door and to put the keys safely out of reach of overzealous federal courts."

Sen. Harry Reid, who would go on to become the Senate Democratic majority leader, ticked off a litany of ridiculous cases he said were clogging up the nation's courts. There was the Missouri prisoner who sued because his facility didn't have salad bars on the weekends. And the Nevada prisoner who said his constitutional rights had been violated when he received chunky peanut butter — not smooth — from the prison canteen.

"And to think, we, the taxpayers, are paying for all of this," Reid said.

Reid and Hatch were speaking in support of the Prison Litigation Reform Act, introduced by the most powerful man in the Senate at the time, the Republican Bob Dole. Dole, then the majority leader, had pitched it as a common-sense reform that would sharply curb such "frivolous lawsuits." Hatch insisted it wouldn't affect prisoners who raised legitimate claims.

The National Association of Attorneys General helped craft the legislation and circulated top-10 lists of "frivolous" prisoner lawsuits, including the complaints about salad bars and peanut butter, to garner support. A few attorneys general — from red and blue states alike — took their case to The New York Times. "We feel strongly that convicted criminals should not be granted unlimited free access to our courts to conduct their costly and most often frivolous lawsuits," they wrote.

"It was about resources," a former attorney general who backed the legislation said. "You are just struggling to run what was then the state's largest law office. So to me it was a question of degrees. Let's find some balance and look at cases that need to be looked at and get rid of steak and wine and peanut butter cases."

Some elected officials issued warnings. Sen. Ted Kennedy of Massachusetts called the bill "patently unconstitutional," and Joe Biden, then a Delaware senator, said it placed "too many roadblocks to meritorious prison lawsuits." But it passed easily, buried in an omnibus appropriations bill, with little legislative debate about its potential repercussions.

In April 1996, Clinton signed the PLRA into law.

A separate system of justice

While it had never been easy to file a lawsuit from prison, the rules of play had been roughly the same as for any other indigent person seeking redress in court. The PLRA changed that, effectively carving out a separate and unequal system for prisoners.

Prisoners could now win monetary damages only if the harm they endured was physical, rather than mental or emotional. Strict caps on attorney fees discouraged lawyers from representing prisoners, leaving the vast majority of plaintiffs, many without a high-school diploma, to file on their own.

Many prisoners would no longer get their day in court: A judge or staff attorney would screen cases before any evidence could be presented or any motions could be made. If the screener deemed a case frivolous or decided it had failed to clearly state a constitutional claim, the judge could simply dismiss the case. A prisoner who had three suits dismissed in this way — the "three strikes" rule — would be barred from filing another without paying prohibitive court fees.

Crucially, any claims that made it to court would be dismissed if a prisoner could not show they had exhausted their prison's internal grievance process — procedures that a number of state corrections departments have turned into arcane, highly technical affairs.

"In a busy court, there's a template to get rid of the cases," Nancy Gertner, a former federal district judge in Massachusetts, said of the PLRA, "and invariably they're gotten rid of."

The senators were right that there had been an uptick in prisoner lawsuits. But that increase closely tracked the rise of the prison population as the war on drugs and punitive sentencing laws more than doubled incarceration rates from 1986 to 1996, the year the PLRA became law.

Reid had compared prisoners to "an alcoholic locked inside a liquor store," abusing the nation's legal system with easy access to the courts. But legal scholars have found that the rate of prisoner legal filings had actually stayed relatively consistent.

In fact, Margo Schlanger, a law professor at the University of Michigan, found that in the year before the PLRA was signed into law, prisoners filed a similar number of lawsuits per capita as people on the outside.

Within five years of its passage, prisoner suits dropped by 43%, even as the prison population continued to grow, according to Schlanger's research. Schlanger examined prisoner filings again in 2022 and found that the filing rate never rebounded.

Cases that prisoners have filed since the law's passage, she found, have struggled to succeed. To understand why, Business Insider analyzed a sample of nearly 1,500 federal cases alleging "cruel and unusual punishments" in violation of the Eighth Amendment, including every appeals court case we could locate with an opinion filed from 2018 to 2022 citing the relevant Supreme Court cases and standards.

Some were filed by former prisoners after their release, or by their families, who were not bound by the PLRA. But in an examination of the roughly 1,400 cases filed by people while they were imprisoned, the impact of the PLRA jumped out — 27% of those cases failed because of the law's requirements.

In BI's district court sample, the PLRA's effects were more dramatic — 35% failed because of the law.

A few dozen of the claims BI examined appeared to center on minor matters: For instance, an Indiana prisoner claimed he developed a rash after he wasn't allowed to shave, an Alabama prisoner said he was served undercooked food, and a Michigan prisoner sued saying he'd been denied shoes while being held in a dirty shower. But the vast majority clearly involved claims of substantive harm. Among them were dozens of claims that prisons had allowed retaliatory beatings, stabbings, sexual assaults, and egregious forms of medical neglect.

These include the case of Kenneth Coleman, a Florida prisoner. He said prison officials put him in the same cell as an "enemy" who later assaulted him, leaving his left eye with a sag. He lost his case for failing to complete the prison's grievance process before filing suit. They include a case out of Colorado, in which the plaintiff said she began self-mutilating after medical providers failed to dispense the hormone blockers that had been prescribed to treat her diagnosed gender dysphoria; her case was dismissed because the court ruled that self-harm didn't count as a physical injury. And they include the case of Benjamin Gottke in Louisiana, whose left leg was amputated below the knee after, he said, corrections officials failed to protect him from being assaulted. His case was dismissed at screening for failure to properly state his legal claim.

The Louisiana and Colorado corrections departments declined to comment on the record. A spokesperson for the Florida Department of Corrections did not comment on the Coleman case but said, "We ensure the safety and healthcare of our inmate population in accordance with Florida law."

When prisoners' cases are knocked out by the PLRA, they rarely succeed on appeal. Such appeals, BI found, failed nine out of 10 times.

Victor Glasberg, a civil-rights attorney in Virginia, has represented prisoners for decades and successfully litigated an Eighth Amendment case about conditions on the commonwealth's death row. "The Prison Litigation Reform Act is the worst piece of federal legislation to have been enacted in my lifetime, and I was born in 1945," he said. "It is malicious, vindictive, and grossly unfair."

An undiagnosed tumor

Kevin Harrison Jr. was 24 years old and not long into a life sentence for murder when he first noticed lumps on the left side of his chest. In July 2011, he saw Michael Hakala, a doctor at Southeast Correctional Center in Missouri who worked for a prison healthcare company called Corizon Health, now YesCare, which was then contracted to provide healthcare to the state's prisoners. In a civil complaint he would later file, Harrison said Hakala assured him that the lump was benign without ordering a biopsy.

Two years later, the lumps had grown considerably, Harrison's complaint said. During shirtless basketball games, he said, other prisoners told him he looked as if he'd been shot.

Harrison said Hakala again assured him that nothing was wrong.

More than seven years after his first appointment, in November 2018, Harrison said he was granted a visit with another doctor; that doctor also worked for Corizon. Concerned by what had become a gnarled mass, the doctor ordered a biopsy. At 31 years old, Harrison was told he had a rare form of skin cancer.

He underwent what he described as a grueling, invasive surgery that required doctors to cut deep into his pectoral muscle to remove the tumor. He wore a bandage for months as his chest slowly healed, and he lived with debilitating pain. Several years later, the muscle pain and spasms have barely abated, he said, and with his follow-up appointments often delayed he worries the cancer will return.

In March 2022 he filed suit against Hakala and other medical staff alleging that they had violated his constitutional rights by failing for years to biopsy his tumor.

His case was dismissed during screening.

Patricia Cohen, a magistrate judge for the Eastern District of Missouri, found that his handwritten complaint, filed without counsel, had failed to make a clear Eighth Amendment claim: He hadn't shown he could prove the defendants had intentionally delayed his treatment.

As in many claims dismissed at screening, the judge gave Harrison 30 days to file an amended complaint. In this case, a court clerk, Nathan Graves, said Cohen had provided Harrison with "clear instructions" for how to do so. Harrison, whose request for an attorney was denied by the judge, told BI he missed the deadline because he was locked in solitary confinement for assaulting two corrections officers. He refiled the case last year, which is still pending; the defendants have yet to respond to the underlying claims.

Tad Eckenrode, Hakala's attorney, declined to comment on the pending litigation but noted that Harrison's claims remained unproven allegations; the Missouri Department of Corrections declined to comment. A YesCare spokesperson declined to speak about Harrison's case but said by email, "Our industry is filled with mission driven professionals who are committed to serving incarcerated individuals, many of whom have never received healthcare in their life, within a challenging prison environment," adding that "ignoring the many successes and positive advancements in our industry only serve to make it more difficult to retain and recruit medical professionals to serve incarcerated populations."

Of the 376 cases in BI's sample disqualified by the PLRA, 75% were dismissed at screening, denying the plaintiffs the chance to argue their case in court — or seek discovery. Over half of those cases involved allegations of inadequate medical care, including several for potentially fatal illnesses, such as Harrison's cancer.

"As a result of the PLRA, people who have suffered horrific harm, people who have extremely meritorious and compelling cases, get thrown out of court for reasons that have nothing to do with the merits of their case," said David Fathi, the director of the National Prison Project at the ACLU. "It just tilts the playing field against prisoners across the board."

Several cases in BI's sample dismissed at screening involved claims that negligence had left prisoners with permanent disabilities. A Kansas plaintiff said one of his feet was amputated after an infection was allowed to fester; a prisoner in California said he was left with persistent migraines and dizziness after a guard, while trying to quell a fight between two other prisoners, shot him in the head. Eight prisoners who alleged that they'd been sexually assaulted had their cases dismissed at screening.

The Kansas Department of Corrections declined to comment; a spokesperson for the California Department of Corrections and Rehabilitation did not address the shooting claim but said the department had "fundamentally reformed its approach to addressing allegations of staff misconduct to enhance staff accountability and improve transparency."

A ticking clock

Prisons are hierarchical systems, largely insulated from the outside world, where corrections officers control every aspect of a prisoner's life. The PLRA effectively requires prisoners experiencing abuse or neglect to confront those officers directly, mandating that they pursue grievances internally before they have the right to seek redress in court. Prisoners in multiple cases said that requirement came with consequences.

In the spring of 2016, a Texas prisoner named Juanita Ornelas began a prolonged battle with the prison bureaucracy. Ornelas, a transgender woman who said she presents as masculine in prison for safety reasons, said she was being repeatedly sexually and physically abused by another prisoner at the William R. Boyd Unit in East Texas.

Ornelas, who was serving time on weapons charges, was required by Texas corrections policy to try to resolve the issue informally and then to submit a formal grievance, on a specified form, all within 15 days of the incident. The unit's grievance coordinator would then have at least 40 days to respond, at which point, if Ornelas wasn't satisfied, she would have another 15 days to file an appeal.

In a complaint that she would later file in the Western District of Texas, Ornelas said she had been terrified her attacker would kill her if she filed a grievance. She said that she had witnessed attacks on other people who had filed grievances and that it was common knowledge that officers at Boyd often ratted out prisoners who disclosed sexual abuse. When Ornelas finally asked an officer for a grievance form, she said in a memorandum she introduced in court, the officer refused and instead told her to stop snitching.

Desperate for help, she said, she instead submitted several I-60s — a form Texas prisoners use for routine transfer requests — to Alexander Hamilton, an investigator in the criminal justice department's office of the inspector general who had once visited the unit. Ornelas thought if she reported the assaults directly to Hamilton, she would have a better chance at getting moved out of danger.

But her I-60s to Hamilton went unanswered and the abuse continued, she said.

Amanda Hernandez, a spokesperson for the Texas Department of Criminal Justice, said that Ornelas' claims were investigated and could not be substantiated and that "the agency takes all allegations of abuse seriously," promptly forwarding them to the appropriate authorities. The office of the Texas attorney general, which represented Hamilton, did not respond to queries.

In early June 2016, officials moved Ornelas to a different prison. It had nothing to do with the rape allegations, she told BI; she'd been accused of housing a weapon in her cell, though she said it wasn't hers. There, 200 miles away, she submitted a series of grievances to document the abuse she said she experienced at Boyd. Even then, Ornelas said in her memorandum, officials repeatedly refused to process the forms or said they hadn't received them. In January 2017, she said — nine months after she had sent her first I-60 to Hamilton and four months after she went on a hunger strike — a grievance form was finally processed.

"I couldn't believe it was so hard to report something like that," Ornelas said. "They just completely ignored and disregarded the sexual-abuse report."

A year later, Ornelas filed a pro se lawsuit alleging that Hamilton had violated her Eighth Amendment rights by failing to protect her from repeated sexual assaults. Though Ornelas said the rapes were so violent they left her bloodied, the attorney general never weighed in on the underlying claims in court, focusing on Ornelas' failure to meet the deadline for submitting a prison grievance before filing suit; a district judge, Alan Albright, agreed with that assessment and dismissed her case. On appeal, the 5th Circuit ruled that even if Ornelas had followed prison protocols, she'd still lose the case: She had offered no proof that Hamilton ever saw or received the letters.

The offices of Albright and the other federal judges who presided over cases decided in this story declined to comment, didn't respond to interview requests, or, in the case of Cohen, the judge in Missouri, said the decisions spoke for themselves.

'Byzantine grievance processes'

The requirement to exhaust a prison's internal grievance system before filing suit is one of the PLRA's most significant obstacles. Of the prisoner cases knocked out by the law in BI's sample, nearly one in four failed because judges decided the plaintiff had not fully complied with the grievance process.

"The exhaustion-of-remedies requirement definitely incentivizes prison systems to create Byzantine grievance processes," Corene Kendrick, the deputy director of the ACLU National Prison Project, told BI. "If you fail to meet a single deadline, or if you worded something in a way that wasn't quite specific enough, the courts will often just throw the cases out."

Legal scholars have described prison grievance procedures as something out of Kafka.

In Colorado, for instance, a grievance can be denied if the handwriting is deemed illegible or if the prisoner uses more than "one line of dialogue" to describe the abuse allegation. In Florida, a grievance can be rejected if more than one issue is discussed in a single form. In West Virginia, only one staple may be used to attach the pages.

Many states require prisoners to use an official grievance form, which prisoners sometimes depend on corrections officers to supply. Once filed, the form may go into oblivion.

"A lot of times, especially in segregation, you give the grievance to an officer," one West Virginia prisoner told BI. "Nine times out of 10 it's going in the garbage."

Andy Malinoski, a representative of the West Virginia Department of Commerce, responding on behalf of the state corrections division, said the agency "adamantly denies" the prisoner's claim and "is committed to the safety, quality of life, and well-being of those in the care of the legal system in our state."

Tiffany Yang, an assistant law professor at the University of Maryland, authored a study last year finding that the PLRA had effectively provided a playbook to prison systems on how to narrow the pathway to judicial relief. She documented instances in which state corrections departments had responded to a successful prisoner lawsuit by amending their grievance requirements to make the rules more complex. She called this cycle the "prison pleading trap."

"Each prison system can define its own internal grievance procedure, and that decision has created a system that is designed to fail the very people that it should protect," Yang told BI. "Even if an incarcerated person is successful in overcoming administrative exhaustion, what prison officials can do with that defeat is to transform it into a blueprint for how to amend the grievance policy to make it more difficult for future litigants."

In her study, Yang discussed a 2005 case in Arkansas in which the courts allowed a prisoner to move his case forward against medical staffers he said had denied him dental treatment, ruling that they were identifiable even though his grievance listed only their job titles, not their names. The state corrections department then updated its procedures to require all Arkansas prisoners to specify, in their first grievance, the full names of each individual involved. As Yang wrote, that alone can prove to be an impossible hurdle in situations in which officials don't wear name badges, hide their badges, or refuse to provide their names to prisoners.

The Arkansas Department of Corrections did not respond to queries.

In a 2022 legal brief, the ACLU joined with other civil-rights groups in arguing that because prison administrators design the procedures that prisoners must follow before suing them, there is "a perverse incentive to make grievance processes as impenetrable as possible."

The statute of limitations for civil suits is typically measured in years. But most prisoners must file a grievance on a much tighter timeline. In Louisiana, prisoners are encouraged to seek an informal solution and then have three months to file a grievance. In Arizona, they have 10 days to make an informal complaint and then five days after that to file the formal grievance. In Michigan, they have two days to resolve the issue informally and then five days after that to submit a grievance form. If they don't file on time, they can't win in court later.

Even when an incident has left a prisoner consigned to the hospital or solitary confinement, the clock can continue to tick.

A former Minnesota prison lieutenant told BI that, at the facilities where she worked, "a fairly high percentage" of prisoners had no idea how to navigate the grievance process. She said that prisoners were alerted to its existence, but only through a "two-second conversation" during intake. Prisoners at facilities in several states told BI they were never instructed by staff on how to properly complete these forms, and instead relied on rare visits to the library or on fellow prisoners — untrained jailhouse lawyers — for guidance.

Paul Schnell, Minnesota's corrections commissioner, said the department continually tries to improve its grievance system. He expressed surprise at the lieutenant's claim, "given the number of grievances we get."

"If the door is closed for people, that's not OK," he said. "We want to make sure people have a mechanism" for exercising their due-process rights.

In any case, filing a grievance comes with risks. The risk of retaliation from other prisoners and staff, as Ornelas feared in Texas. Or the risk of formal punishment. In some states, such as Alaska, officials can hand down disciplinary action if they believe a prisoner has abused the grievance system.

Again and again, a law meant to end frivolous prisoner lawsuits has halted Eighth Amendment claims on technicalities regardless of the underlying merits of their case. Many were thrown out over missed grievance deadlines; others because a prisoner failed to provide the full name of a staffer or use the proper terminology in stating their claim.

Unintended consequences

From the moment it was enacted, the PLRA faced intense criticism. In testimony before the Senate Judiciary Committee in September 1996, an advocate for incarcerated teenagers warned that the law "contains several provisions that hinder efforts to protect children from danger and abuse" in juvenile institutions; the American Bar Association admonished Congress for passing a law that it said contained "unconstitutional" provisions.

David Keene, as chair of the American Conservative Union, called for the law to be reformed, saying in a 2008 op-ed article that "it had the unintended consequence of virtually insulating prison officials from external oversight." In 2014, the United Nations' Committee Against Torture expressed concern that the law was "curbing prisoner lawsuits at the expense of inmates' rights."

One of the most sustained efforts at reform coalesced in 2007, more than a decade after the PLRA was signed into law. The bipartisan SAVE Coalition rallied behind a bill introduced by Rep. Bobby Scott of Virginia that sought to ease some of the law's most onerous requirements. "It needed reform because there's so many instances where legitimate claims couldn't be heard," Scott told BI. "On the meritorious cases, prisoners just don't have rights."

Those who testified on behalf of the bill included a retired federal judge who said the PLRA "unnecessarily constrains the judge's role, limiting oversight and accountability"; a former director of the California prison system, who said the legislation created "often-insurmountable obstacles" for prisoners; and a former Republican attorney general who, after himself spending time in prison for mail fraud, called the PLRA a "deeply flawed" law that "undermines the protection of constitutional rights that all Americans, including prisoners, share."

Sarah Hart, as an assistant district attorney in Philadelphia, had assisted Congress in drafting the PLRA and testified against the proposed reforms, arguing that "the current system allows corrections managers to learn of serious problems in the prison, take prompt action to stop them, and remedy past problems."

Keene, who went on to serve as president of the National Rifle Association, told BI that one of the reasons he took up criminal-justice reform was that his son had spent time in a federal prison. During testimony before the House Judiciary Committee in 2007 in support of Scott's bill, Keene said it was impossible for his son to properly file grievances, accusing prison officials of intentionally giving him the wrong forms and of reading his confidential legal mail. "The process is broken," he said, quoting a letter his son wrote from prison. "It feels like I'm playing poker in a rigged game."

In their March 1995 letter in The New York Times, the state attorneys general insisted that the PLRA wouldn't block meritorious cases, that "no reasonable individual would accept that cases of sexual assault by prison guards or unchecked and rampant tuberculosis within the prison population should be dismissed or disregarded as nonmeritorious."

On the contrary, in the decades since the law was enacted, many prisoners accusing guards of assault have had their cases blocked by the PLRA. In BI's sample, PLRA technicalities likewise knocked out cases involving allegations of sexual harassment by a corrections officer, delayed treatment for hepatitis C, and prolonged stints in solitary confinement.

Just months after the PLRA became law, Jon O. Newman, a federal judge on the 2nd Circuit Court of Appeals, authored an article in the Brooklyn Law Review. In it, he examined the three lawsuits attorneys general cited as frivolous in their New York Times op-ed, at least two of which made their way onto the Senate floor. He found that the Nevada prisoner hadn't filed suit because he preferred chunky peanut butter over creamy. He sued because he said that the commissary had charged him $2.50 for the jar — nearly a week's wages for a prisoner — and that he never received the item. "I readily acknowledge that $2.50 is not a large sum of money," Newman wrote. "But such a sum is not trivial to the prisoner whose limited prison funds are improperly debited."

The Missouri prisoner who was ridiculed for wanting a salad bar, meanwhile, had filed suit with dozens of other prisoners alleging major deficiencies at their facility, including insufficient food, meals contaminated by rodents, a lack of proper ventilation, and dangerous overcrowding that the plaintiffs said had resulted in the housing of healthy people together with those with contagious diseases.

"The prisoners' reference to salads was part of an allegation that their basic nutritional needs were not being met," Newman wrote. "The complaint concerned dangerously unhealthy prison conditions, not the lack of a salad bar."

Decades later, it was as if Newman's article had never appeared. In a 2015 brief before the Supreme Court, Michigan's attorney general at the time, Bill Schuette, pulled out the peanut-butter anecdote again to argue that a prisoner's case should be dismissed under the PLRA.

His brief used the word "frivolous" 48 times.