Amicus Brief: Court access needed to address inadequate medical care

by Aleks Kajstura, October 1, 2026

Yesterday, the Prison Policy Initiative, in partnership with the Roderick and Solange MacArthur Justice Center, filed an Amicus Curiae brief in support of Kekai Watanabe, who was injured and denied medical care while incarcerated at FDC Honolulu. Mr. Watanabe was assaulted and severely injured (suffering what was later found to be a broken tailbone). The staff nurse, however, only gave Mr. Watanabe over-the-counter painkillers. Several months passed before the facility staff allowed Mr. Watanabe to get X-rays revealing the broken tailbone—which, by that point, had splintered into the surrounding soft tissue. Then the Bureau of Prisons procrastinated on addressing the broken bone until releasing Mr. Watanabe several years later—still without ever providing treatment.

Mr. Watanabe sued the FDC Honolulu officials for violations of the Eighth Amendment (prohibiting cruel and unusual punishment), but the prison officials argued that Mr. Watanabe wasn’t allowed to sue, and his recourse was limited to filing a complaint through the Bureau of Prisons’ dysfunctional grievance system, known as the Administrative Remedy Program (ARP).

Our Amicus brief shows why incarcerated people, like Mr. Watanabe, need to retain access to the courts in order to maintain accountability for violations of medical care in prisons. For the brief, the MacArthur Justice Center did a deep-dive into the historical context of the ARP and how it was never meant to supplant access to the courts (and submitted an appendix of documents from the National Archives). And we relied on our previous research on the ARP to show that:

• Despite systemically inadequate medical care, fewer than 1% of grievances submitted through the ARP over the course of a decade result in relief.

• The ARP does not function as designed. The system is, officially, supposed to be flexible to address complaints efficiently and thereby decrease the need for incarcerated people to rely on courts to address routine issues. But in practice, the Bureau of Prisons denies complaints based on rigid enforcement of labyrinthine rules and stonewalls any progress.
• Even if the ARP rules were applied flexibly —as intended— the time limits built into the system are detached from the realities of incarceration and prevent many people from obtaining relief. The ARP starts the filing clock at the time of the relevant incident. This creates several problems:
  • For evolving injuries, like those of Mr. Watanabe, the clock begins running before the full extent of the injury is discovered.
  • Frequent transfers between facilities make it difficult to fit medical issues neatly into the confines of the ARP time limits.
  • Officials simply wait out the problem until the injured person is released, eliminating any possible remedy. In this case, for example, medical care was denied until Mr. Watanabe was released and thus was never provided. This kind of stalling is a common tactic used by medical providers in prisons.

We hope that the Supreme Court will make the right decision in this case and continue to allow incarcerated people to access the courts to seek remedies for constitutional violations when they are denied medical care. Medical care in prisons is already routinely inadequate and shutting off this safety valve would have dire consequences.