1973)], violates his right not to be subject to cruel and unusual punishment.
The practice of administering different standards of medical treatment inherently tends to promote the possibility of violation of the Eighth Amendment rights of individual inmates receiving medical treatment under the lower standard. However, on the record in this case the plaintiffs have not proved their allegations of cruel and unusual punishment. The case presents not a question of the constitutional adequacy of treatment of certain individual inmates, but the constitutionality of the policy and practice which maintains two different standards of treatment for prisoners.
The only justifications for the state’s different medical treatment of safekeepers offered in oral argument are:
(1) The safekeeper’s short time in the prison system makes it a nuisance to provide the same medical treatment provided to other prisoners.
(2) The safekeeper has to be on call to attend court.
(3) To provide the same medical treatment given all prisoners but safe-keepers is an administrative inconvenience and produces an excessive amount of paperwork.
Point (1) is belied by the facts that safekeepers average over five months in the prison system and that the overwhelming majority remain in the prison system after their safekeeper status ends.
Point (2) has no force because the prison system is on call-frequently to deliver prisoners to testify in criminal, habeas corpus, and other civil matters.
Point (3) is undermined by the fact that the average number of safekeepers is only one hundred and forty in a North Carolina Department of Correction prisoner population of several thousand. Any extra work involved is relatively marginal.
The weakness of all the suggested justifications for the discriminatory handling of the medical problems of safe-keepers is finally demonstrated by the fact that when the county pays for the medical needs designated “elective,” then the safekeeper is given the “elective” treatment just like any other prisoner.
The practice of treating prison inmates to two different standards of medical treatment merely because the bills of safekeepers are paid by the counties, whereas the bills of regular prison inmates are paid by the state, is a denial of equal protection of the laws as required by the Constitution.
The Fourteenth Amendment applies to the states, and a state may not escape its constitutional obligations simply by the manner in which it has created subdivisions or departments in order to provide public services. In fact, the United States Constitution does not even mention counties, cities, towns, county jails or state prisons; the probable existence of these entities is recognized by innuendo only, in the context of guaranties against cruel and unusual punishment, discriminatory treatment, due process of law and in other guaranties of civil rights and liberties.
There is no rational basis in giving prisoners different medical treatment just because the state has divided the responsibility of footing the bills among different governmental subdivisions. That a certain classification saves the state money has often been dismissed as a hindsight excuse insufficient to be a rational basis for an otherwise meaningless classification. Rinaldi v. Yeager, 384 U.S. 305, 86 S.Ct. 1497, 16 L.Ed.2d 577 (1966); Shapiro v. Thompson, 394 U.S. 618, 632-633, 89 S.Ct. 1322, 22 L.Ed.2d 600 (1969). Here the classification is even more tenuous, being based purely on the accident of which state instrumentality pays the bill, and as such it is arbitrary and unreasonable.
The discrimination is also an unnecessary irritant in the correctional process; unequal or otherwise unfair treatment diminishes rather than increases respect