The United States Court of Appeals for the Eleventh Circuit (“Federal Appellate Court”) held in its unpublished opinion filed on October 3, 2017 that the U.S. District Court erred in dismissing an inmate’s complaint before any of the defendants filed a response or the parties had conducted any discovery in the case because the inmate’s allegations plausibly suggest that at least some of the prison officials knowingly delayed or interfered with the provision of his prescribed medication and, in doing so, displayed deliberate indifference to his serious medical needs.
The inmate had filed his federal complaint pro se and in forma pauperis in the U.S. district court, alleging that medical personnel at Broward County Main Jail (“Jail”) acted with deliberate indifference to his serious medical needs, in violation of the Eighth Amendment, when they delayed or denied the provision of necessary medication. The U.S. district court found that the inmate’s allegations were insufficient to establish a claim of deliberate indifference.
The inmate’s second amended pro se complaint alleged that he first experienced severe chest pains and shortness of breath in February or March of 2015 at which time he was seen by the medical director at the Jail, who performed an electrocardiogram (“EKG”) and diagnosed that the inmate had suffered a “slight heart attack,” for which the medical director prescribed hydrochlorothiazide and clonidine to treat the inmate’s high blood pressure.
The inmate was supposed to take the blood-pressure medication twice per day: once in the morning and once in the afternoon. However, starting in April or May of 2015, he regularly did not receive his morning medication until 1:00 p.m., only three hours before he received his second dose at 4:00 p.m. The inmate alleged that he experienced chest pain and shortness of breath when his morning medication was late, which in turn led him to believe for months that he was going to have a heart attack or stroke. In addition, the inmate alleged that on at least four occasions, the morning nurse failed to deliver his medication at all. The inmate alleged that these problems persisted despite numerous attempts on his part to get the Jail to fix them.
A magistrate judge issued a report and recommendation (“R&R”) after sua sponte screening the inmate’s second amended complaint under 28 U.S.C. §1915(e)(2) and as to the deliberate-indifference claim, the magistrate judge narrowly construed the inmate’s allegations as claiming that he had regularly “received his prescribed medications in [a] timely manner except on four occasions” – specifically August 29, 2015, August 30, 2015, September 27, 2015, and October 22, 2015. But apart from those dates, the magistrate judge stated that the inmate’s “allegations show that he has regularly been receiving medical care” at the Jail, and the grievance log indicated that “the authorities at the jail recognized the problem and attempted to correct it.” The magistrate judge concluded that the fact that the inmate “may have received his medication late on four occasions” amounted to no more than negligence, which was insufficient to show deliberate indifference to his medical needs.
The inmate filed objections to the R&R, asserting that the magistrate judge had misconstrued the allegations in his second amended complaint: the inmate explained that his claim was not that he received late medication on four occasions, but rather that the problems of delayed medication went on for four or five months. Further, the inmate asserted that the dates the magistrate judge cited were the dates on which no morning medication was provided.
The U.S. district court judge overruled the inmate’s objections and adopted the magistrate judge’s R&R. Therefore, the U.S. district court dismissed the inmate’s complaint for failure to state a claim, pursuant to § 1915(e)(2)(B)(ii), before service of process to the defendants. The inmate appealed.
United States Court of Appeals for the Eleventh Circuit (“Federal Appellate Court”) Decision
The Federal Appellate Court stated that deliberate indifference to an inmate’s serious medical needs violates the Eighth Amendment of the U.S. Constitution. A serious medical need is considered one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention. To prove a claim for deliberate indifference under the Eighth Amendment, a prisoner must show (1) that he had an objectively serious medical need and (2) that the prison official subjectively acted with deliberate indifference to that need.
The Federal Appellate Court stated that deliberate indifference has three components the plaintiff must satisfy: he must show a prison official’s (1) subjective knowledge of a risk of serious harm; (2) disregard of that risk; (3) by conduct that is more than mere negligence. Conduct that is more than mere negligence includes: (1) grossly inadequate care; (2) a decision to take an easier but less efficacious course of treatment; and (3) medical care that is so cursory as to amount to no treatment at all.
The Federal Appellate Court stated that a prison official who delays necessary treatment for non-medical reasons may exhibit deliberate indifference; an Eighth Amendment violation may also occur when state officials knowingly interfere with a physician’s prescribed course of treatment.
The Federal Appellate Court held that the inmate’s allegations, accepted as true and construed in the light most favorable to him, were sufficient to state a viable claim under the Eighth Amendment for deliberate indifference: his allegations indicate that he had an objectively serious medical need. Specifically, the inmate had presented to medical at the Jail complaining of chest pains and shortness of breath, and a subsequent EKG revealed that he had suffered a slight heart attack. A doctor prescribed medication for high blood pressure, which the inmate was supposed to take twice per day. When he did not take his medication at the right times, the inmate experienced chest pain and shortness of breath, and he believed that he was going to have a heart attack or a stroke. The Federal Appellate Court held that the inmate’s allegations plausibly establish that he had a serious medical need that had been diagnosed by a physician as mandating
The Federal Appellate Court further held that the inmate’s allegations indicate that prison officials acted with deliberate indifference to his medical needs by regularly failing to provide his blood-pressure medication as prescribed: prison officials were subjectively aware of the inmate’s serious medical needs because he repeatedly complained about not receiving his medication on time or at all and explained that he experienced chest pains and shortness of breath as a result. The inmate’s allegations also show that prison officials disregarded that risk by failing to ensure that his medication was distributed as prescribed: the inmate first complained about problems with the Jail’s provision of medication in June 2015, but, despite his repeated complaints, the problems persisted at least through October 2015.
The Federal Appellate Court held that because the Jail waited several months to meaningfully respond to the inmate’s repeated complaints about the provision of his medication and that prison officials never acknowledged, much less addressed, the alleged late delivery of the medication, the Federal Appellate Court could not say at this early stage of proceedings that the inmate’s allegations fail to plausibly show that prison officials’ conduct went beyond negligence (the inmate’s allegations, liberally construed, reflect that his medication was late on more than just a “handful of occasions,” as the U.S. district court stated: the inmate first complained about the late delivery of medication in June 2015. By October 2015, and despite numerous complaints in the meantime, the inmate still regularly was not receiving his medication on time and occasionally did not receive his morning medication at all).
The Federal Appellate Court ruled that from the limited record, the U.S. district court erred in dismissing the inmate’s complaint before any of the defendants filed a response or the parties had conducted any discovery in this case: the inmate’s allegations plausibly suggest that at least some of the prison officials knowingly delayed or interfered with the provision of the inmate’s prescribed medication and, in doing so, displayed deliberate indifference to his serious medical needs. Therefore, the Federal Appellate Court held that the U.S. District court erred by sua sponte dismissing the inmate’s claim under § 1915(e)(2)(B)(ii), and the Federal Appellate Court vacated and remanded the case to the U.S. district court for further proceedings.
Source Carter v. Broward County Sheriff Office, Case No. 16-11649
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