In the Case of Dudley Lee v Minister for Correctional Services, the issue on causation and the unlimited liability of the state has been invoked in the arguments that led to the decision of the Constitutional Court to overturn the Supreme Court of Appeal ruling that discharges the respondent Minister for Correctional Services from tort liability. As can be gleaned from the facts of the case, plaintiff Lee was arrested for various charges that led to his detainment in prison for more than four years. He contracted pulmonary tuberculosis (TB) while confined in prison which prompted him to file for damages to the respondent contending that the latter is liable with its negligence being the cause of contracting TB by the plaintiff. By admission of the parties, it has been well established that prior to confinement in prison, the plaintiff is negative for TB. The respondent is also aware of the risks about inmates contracting TB considering the correction’s congested environment and overcrowding of inmates. Moreover, it has also been admitted that the correction's authorities rely on a system of self reporting of inmates about their symptoms upon their admission to prison to serve their sentence.
The Supreme Court of Appeal ruled in favor of the respondent by absolving it from liability on tort. Its ruling provides that the plaintiff failed to provide a causal link between contracting TB and the negligent conduct of the respondent. Upon appeal, the Constitutional Court overturned this ruling discussing on two main issues on causation and state liability. Causation under tort law is described by Nelson as the sufficient causal link between the act or omission of one party and the resulting harm caused to another (55). The court usually applies the element of but-for element in tort law which refers to the actual or factual causation. Green explained that the but-for element is the standard legal test in determining whether or not the proscribed conduct is the factual cause of the outcome in question (8). To satisfy this element in tort, it is necessary for the plaintiff to show that the defendant's act or omission is one of the causes resulting to the damage or injury.
As has been justified by the Supreme Court of Appeal, the plaintiff failed to establish the but-for element on the alleged systemic omission of the prison authorities to safeguard the constitutional rights of the plaintiff that resulted to Lee’s contraction of TB. However, the Constitutional Court explained that the law allows the flexible approach using the test within the common sense view on causation. Indeed, the but-for element in tort law is taken into consideration when the cause-in-fact are not too attenuated as legally sufficient proximate cause of the event. While there is no direct evidence that will point out that the cause of contraction of the disease by Lee was due to the negligence of the prison authorities, the but-for element in tort law may be applied in determining the contributing causes-in-fact of a loss or the proximate cause of the loss that have legal consequences, so long as one is not so intervening and superseding as to cut the causal chain from the event in dispute (Stempel and Knutsen 7). The flexible approach in establishing the but-for element has been founded on the rule that the court will not allow a wronged plaintiff to be at the disadvantaged position by its failure to meet the formal requirements of proving the cause (David, McCague and Yaniszewski 226). The court has the responsibility of providing a just solution to render justice to the victim of tortuous acts. The court also justified that there is the difficulty in drawing the line between the positive act and omission.
It was the higher court’s contentment that the Court of Appeal erred in applying the strict rule on substitution of reasonable alternative measures to identify the factual causation because the law allows the flexible application of the but-for test. When the flexibility rule is applied, the plaintiff is no longer bound to present further evidence as the court will only evaluate the presented evidence by the plaintiff. The common sense view on causation is usually applied where the causality raises difficult legal questions that strict adherence to logic cannot be answered. As in the case of Lee, it has been fully established that he has no TB before he was admitted to the prison. By applying the flexible rule on causation, the higher court made an inquiry on what the authorities could have done to prevent the condition of spreading the TB infection under the prevailing prison condition. Under this premise, the court affirmed that the prison authorities were indeed negligent on preventing the spread of infection that resulted to Lee's contraction of TB during his imprisonment. Thus, the higher court ruled that the probable causation has been sufficiently proven by the plaintiff.
The higher court also emphasized the constitutional rights of inmates to health and access to health care facilities which the state is mandated to uphold. Lines demonstrated the right of prisoners to health as part of the international human rights law with the state obligation to provide primary health care to restore the health of ailing prisoners and to provide proactive preventive measures to preserve the health status of inmates (4). Every prison must have an acceptable medical infrastructure, hygienic environment, and sick inmates should be isolated from the healthy ones. The Supreme Court upheld the constitutional rights of the prisoners to adequate health care. There are different principles under the international law upholding the rights of prisoners to quality health care. One of these rights is to enjoy good health, mental and physical, and to be entitled to access the standard health care that is equivalent to those available to the wider community without discrimination (Moller and Stover 7). According to Paris, the deprivation of health care to prisoners constitutes cruel and unusual punishment as enunciated in the Supreme Court ruling in Estelle v Gamble (113).
Considering the factual admission of the prison authorities that they are aware of the potential risk of contagion of TB infection inside an overcrowded prison cell, they showed negligence by their failure to implement preventive measures. It should be noted that the spread of TB infection in prison is considered to be a growing public health problem and its prevention and the eradication of such problem should form part of the public health policy of the state (United States Agency International Development 2). It is the state’s duty to legislate policies and laws that should uphold the rights of prisoners on access to public health and to provide enough practitioners to monitor the health of inmates during their incarceration. Local and state laws should include the surveillance of the health of the inmates as part of public health policies and providing testing and screening for infectious diseases, provision for medical examination and treatment and vaccination (The Centers for Law and the Public Health 16).
These policies are among the important state responsibilities that the prison authorities failed to implement within the corrections that may have caused the incidence of contracting the TB infection by the plaintiff Lee. There was no health care program that is being implemented in the correctional facility as established by the fact that the determination of the existing illness and medical condition of the inmates are made solely dependent upon self-reporting of the inmates. There are no preventive measures that were also imposed to prevent the spread of the TB infection. There was also the failure to isolate inmates with TB which exacerbates the risks of contagion among healthy prisoners. Thus, considering these conditions existing at the prison at the time of Lee's imprisonment who was in good health prior to being detained, it is easier for the court to infer that based on poor implementation of state policy upholding the rights of prisoners to health care, there is a high probability to establish the causation resulting to Lee’s becoming ill with TB. The state’s accountability on the rights of prisoners to good health is unlimited and unconditional, being a constitutional right guaranteed to the prisoners. The state is liable for its failure to address its constitutional and statutory obligation to the people of providing equal access to health care without any discrimination. Placing Lee in an environment where the risk of contracting TB is high is a plain negligence on the part of the state to provide him protection against illness in violation of his human dignity and the right to be placed on detention under a humane living condition with adequate medical treatment, proper medication and nutrition. It is thus the state’s responsibility to provide inmates a safe custody with adequate health care services and facilities that will improve their health condition and prevent further contagion of communicable disease, which the respondent failed to address that becomes the causal link to the damage suffered by Lee.
References
David, Hillel, McCague, Paul and Yaniszewski, Peter. Proving Causation Where The But For Test Is Unworkable. 22 July 2005. Web. 7 April 2016.
Green, Sarah. Causation in Negligence. Oxford: Heart Publishing, 2015. Print.
Lines, Rick. “The right to health of prisoners in international human rights law.” International Journal of Prisoner Health, 4.1 (2008): 353. Web. 7 April 2016.
Moller, Lars and Stover, Heino. Health in Prisons: A WHO Guide to the Essentials in Prison Health. Switzerland: WHO. 2007. Print.
Nelson, Brian. Law and Ethics in Global Business: How to Integrate Law and Ethics Into Corporate Governance Around the World. New York: Routledge, 2006. Print.
Paris, J. “Why Prisoners Deserve Health Care.” AMA Journal of Ethics. 10.2 (2008): 113-115. Web. 7 April 2016.
Stempel, Jeffrey and Knutsen, Erik. Stempel and Knutsen on Insurance Coverage. New York: Wolters Kluwer, 2015. Print.
The Centers for Law and the Public Health. Tuberculosis Control Laws and Policies: A Handbook for Public Health and Legal Practitioners. 1 October 1999. Web. 7 April 2016.
United States Agency International Development. Tuberculosis in Prisons: A Growing Public Health Challenge. n.d. Web. 7 April 2016.
