1999 Decisions

Opinions of the United

States Court of Appeals

for the Third Circuit

6-29-1999

Rouse v. Plantier

Precedential or Non-Precedential:

Docket 98-5139

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Recommended Citation

"Rouse v. Plantier" (1999). 1999 Decisions. Paper 176.

http://digitalcommons.law.villanova.edu/thirdcircuit_1999/176
Filed June 29, 1999 

UNITED STATES COURT OF APPEALS 

FOR THE THIRD CIRCUIT 

No. 98-5139 

DARRYL LEON ROUSE 

v. 

WILLIAM PLANTIER, Acting Superintendent of A.D.T.C.; 

SALLY S. SCHEIDEMANTEL, Resigning Superintendent of

A.D.T.C.; WILLIAM H. FAUVER, Commissioner of N.J. 

Department of Corrections; GOVERNOR JIM FLORIO, 

State of New Jersey; DR. ROBERT CARDINALE, Medical 

Director of A.D.T.C.; DR. NARSHIMA REDDY, attending

Physician of A.D.T.C.; MS. ELAINE MARTIN, Chief Nurse 

of A.D.T.C.; CAPTAIN HELMKIN, Housing; MIKE ZELL, 

Director of Social Services; DR. SANDOVAL, Attending 

Psychologist of A.D.T.C.; DR. CATTONE, M.D., St. Francis 

Hospital; SCOTT FAUNCE; DR. TARLIAN, M.D.; DR. 

O'BRYNE, M.D.; DR. TODD, M.D., St. Francis Hospital; 

CHARLES BROOKS, on behalf of a class of themselves 

and others similarly situated; STEPHEN JANKOWSKI, on 

behalf of a class of themselves and others similarly 

situated; JULIO BAEZ, on behalf of a class of themselves 

and others similarly situated; ROBERT KAMMERER, 

on behalf of a class of themselves and others 

similarly situated 

v. 

ELAINE ALLEN; JOHN DOE; JANE ROE 

WILLIAM PLANTIER; ROBERT CARDINALE; 

NARSHIMA REDDY; ELAINE ALLEN, 

Appellants 
ON APPEAL FROM THE 

UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF NEW JERSEY 

(D.C. No. 90-cv-03511) 

(District Judge: Honorable Stephen M. Orlofsky) 

Argued: January 14, 1999 

Before: NYGAARD, ALITO, and LEWIS, Circuit Judges 

(Opinion Filed: June 29, 1999) 

 PETER VERNIERO 

 Attorney General of New Jersey 

 JOSEPH L. YANNOTTI 

 Assistant Attorney General 

 MARY C. JACOBSEN (ARGUED) 

 Assistant Attorney General 

 JAYROE WURST 

 Deputy Attorney General 

 WILLIAM P. FLAHIVE 

 Deputy Attorney General 

 Office of Attorney General 

 CN 112 

 R.J. Hughes Justice Complex 

 Trenton, New Jersey 08106-0112 

 Counsel for Appellants 

 LAWRENCE S. LUSTBERG 

 MARK A. BERMAN (ARGUED) 

 Gibbons, Del Deo, Nolan, Grigginger 

 & Vecchione 

 One Riverfront Plaza 

 Newark, New Jersey 07102-5497 

 Counsel for Appellees 

 2 
OPINION OF THE COURT 

ALITO, Circuit Judge: 

Plaintiffs are a class of past, present, and future insulindependent diabetic inmates ("plaintiffs") whofiled suit 

claiming that various corrections officials and employees 

were deliberately indifferent to the plaintiffs' serious 

medical needs, in violation of the Eighth Amendment. In 

this appeal, defendants challenge the District Court's 

refusal to grant summary judgment in their favor on the 

grounds of qualified immunity. For the reasons discussed 

below, we vacate the District Court's decision and remand 

for further proceedings in accordance with this opinion. 

I. 

In 1990, Darryl Rouse, an insulin-dependent diabetic 

then incarcerated at the Adult Diagnostic and Treatment 

Center ("ADTC"), a correctional facility in New Jersey, filed 

this S 1983 action. Named as defendants were: William 

Fauver, Commissioner of the New Jersey Department of 

Corrections; William Plantier, Acting Superintendent of the 

ADTC; Doctor Robert Cardinale, former Medical Director of 

ADTC; Doctor Narshima Reddy, former physician at ADTC; 

and Nurse Elaine Allen, former Chief of Nursing at ADTC. 

Rouse alleged that the defendants had subjected him to 

cruel and unusual punishment by failing to provide him 

with adequate medical care. 

In 1994, Rouse amended his complaint and sought class 

certification, declaratory and injunctive relief for the class 

members, and monetary relief for present insulindependent diabetic inmates. See Supp. App. at 18-19

(Amended Complaint).1 The amended complaint alleged that 

_________________________________________________________________ 

1. In the amended complaint, plaintiffs also alleged that defendants had 

impermissibly discriminated against insulin-dependent diabetics because 

of their disability, in violation of the Americans with Disabilities Act, 

42 

U.S.C. S 12101 et seq. The District Court denied defendants' motion for 

summary judgment on the merits of this claim, see Rouse v. Plantier, 

997 F. Supp. 575, 582 (D.N.J. 1998), but granted their motion on the 

basis of qualified immunity, Rouse v. Plantier, 987 F. Supp. 302, 317 

(D.N.J. 1997). This issue is not on appeal. 

 3 
"[t]he defendants have provided class members with 

medical care for their diabetes and diabetes-related 

conditions that is so uniformly and grossly inadequate as to 

constitute deliberate indifference to serious medical needs 

in violation of the Eighth Amendment to the United States 

Constitution." See Id. at 18. 

In 1996, the District Court certified a class consisting of 

all former, present, and future insulin-dependent diabetics 

incarcerated at the ADTC, pursuant to Federal Rule of Civil 

Procedure 23(a) and 23(b)(2). For the purpose of classwide 

damages, the District Court also certified a class consisting 

of all former and present insulin-dependent diabetics 

incarcerated at the ADTC, pursuant to Federal Rules of 

Civil Procedure 23(a) and 23(b)(3). 

Defendants moved for summary judgment on the merits

of plaintiffs' claim and, alternatively, on the grounds of 

qualified immunity. In support of their respective 

arguments, both parties submitted the reports of medical 

experts. None of the experts disputed that plaintiffs suffer 

from insulin dependent diabetes mellitus, which all agree is 

a serious illness. 

Plaintiffs proffered an expert report by Dr. Michael D. 

Cohen. See App. at 123-46. Basing his report primarily on 

the American Diabetes Association Clinical Practice

Recommendations issued in 1995, Dr. Cohen explained

that a characteristic of insulin-dependent diabetes is an 

abnormally high amount of sugar in the blood due to

insulin deficiency, see id. at 123, and that a primary goal 

of disease management, therefore, is to lower the amount of 

sugar in the blood to normal or near-normal physiological 

levels. See Id. at 125. Achieving this goal, Dr. Cohen stated, 

requires diabetics to engage in a comprehensive daily care 

plan. See Id. at 123 ("Daily management requires close 

attention to medication, dietary intake and activity, with 

frequent monitoring of the blood sugar."). Failure to do so, 

Dr. Cohen asserted, can cause short-term complications, 

including excessive urination, constant thirst and hunger, 

weakness, confusion, dizziness, and seizures, as well as 

severe long-term problems, including blindness, 

amputation of feet and legs, renal failure, and nerve 

damage. See Id. 

 4 
Dr. Cohen noted several components necessary for 

proper diabetes management. First, he said, diabetics 

require daily injections of insulin, the frequency of which 

depends upon the severity of the illness. See Id. at 125-26. 

Second, he asserted that in order to determine the amount 

of insulin required, diabetics must monitor their bloodsugar levels at least three to four times each day. See Id. at 

126; see also id. at 155 (Report of Plaintiffs' Expert, Dr. 

Mathew J. Miller) ("Dr. Miller's report") (asserting that "all 

insulin-requiring diabetics should monitor their blood 

glucose levels on a daily basis" and that the ability to test 

one's blood-sugar level three to four times each day"is a 

reasonable standard to which we should aspire"). Third, he 

stated that, in addition to snacks and low-sugar sweets, 

diabetics must be given individualized diet plans tailored to 

their specific medical needs. See Id. at 127-30; see also Id. 

at 156 (Dr. Miller's Report) ("Appropriate food should be 

provided to each diabetic, the portions and composition 

individualized to needs, size, activity level and so forth."). 

Fourth, Dr. Cohen opined that diabetics must be educated 

about their disease and the steps necessary to maintain 

their health. See Id. at 130; see also id. at 155 (Dr. Miller's 

Report) ("[E]ducation is the sine qua non of good diabetic 

management."). Fifth, Dr. Cohen stated that timely and 

effective measures must be taken to prevent long-term and 

chronic complications, such as blindness and loss of limbs. 

See Id. at 131-39. For instance, Dr. Cohen noted that the 

American Diabetes Association recommends an "[a]nnual 

comprehensive dilated eye and vision examination by an 

opthamologist." See Id. at 134. And finally, he stated, 

clinical and follow-up evaluations must be conducted on a 

regular basis to monitor the progression of the diabetic's 

illness. See Id. at 139-46; id. at 139 ("Special primary care 

needs of diabetics include: comprehensive initial evaluation, 

regular followup, access to aggressive care for acute 

illnesses and injuries, attention to prevention of lung 

infections[,] and dental care."). 

Dr. Cohen evaluated the level of care provided to the 

plaintiffs and opined that the defendants had failed to treat 

plaintiffs' illness adequately in all material respects. See Id. 

at 146 ("Essential components of necessary care for

prisoners with diabetes are missing or inadequate at 

 5 
ADTC."). Dr. Cohen faulted defendants for giving plaintiffs 

one insulin shot per day, despite suggestions from medical 

consultants that some of the plaintiffs required more than 

one daily injection. See Id. at 126. Dr. Cohen noted that 

plaintiffs were not provided the opportunity to monitor their 

blood-sugar levels on a daily basis and that, in some cases, 

blood sugar levels had been tested only 20 times per year. 

See Id. at 125-27. In addition, Dr. Cohen stated that, 

among other deficiencies, defendants had not provided 

plaintiffs with individualized meals and had not furnished 

diabetes-appropriate snacks or low-sugar sweets. See Id. at 

128-30. Dr. Cohen noted further that, other than 

scheduling one education session several years ago, the 

defendants had not educated the plaintiffs about their 

illness. See Id. at 130. Last, Dr. Cohen asserted that 

defendants had no comprehensive plan for preventing longterm complications (e.g., inmates are not permitted to visit 

an eye doctor annually), see id. at 134-35, and that the 

defendants had not established an adequate evaluation and 

follow-up program to monitor the progression of the

inmates' illness. See Id. at 139-46. He concluded: 

 The care and treatment provided to prisoners with 

 diabetes at ADTC is unacceptable by current standards 

 of care. . . . As medical and nursing staff at ADTC are 

 or ought to be aware of the current standards of care 

 for management of diabetes and the harm that results 

 from inadequate care and treatment, they have shown 

 deliberate indifference to the pain and suffering of 

 prisoners with diabetes. 

App. at 124-25. 

In response, defendants commissioned a report from Dr. 

William E. Ryan. Id. at 158-74. Dr. Ryan agreed with 

plaintiffs' expert that diabetes care must be 

"individualized," but he disputed most of Dr. Cohen's other 

assertions. See Id. at 163. Dr. Ryan noted that diabetics 

whose blood-sugar levels are "known" and "stable" do not 

require daily glucose testing. Id. Such testing, he asserted, 

is only "designed for acute and new diabetics." Id. He noted 

that the plaintiffs' blood-sugar levels generally had 

remained constant and within normal ranges, i.e, "between 

125 and 140mg," but he recognized that "many of the

 6 
glucose values were in excess of 200mg, which is less than 

hoped for and certainly not ideal." Id. at 164. He placed the 

blame for the increased levels on the plaintiffs, who 

according to Dr. Ryan, had been "uninformed regarding 

their diabetic management when they entered the 

institution" and had "thwarted" the staff's efforts to control 

blood-sugar levels by not complying with their prescribed 

diets. Id. at 161, 164. Dr. Ryan further asserted that, 

because each patient at a minimum saw a doctor every 

three months, the care provided at ADTC was "entirely 

appropriate" under clinical recommendations. See Id. at 

163 ("[R]egular visits (diabetic) should be scheduled for 

insulin treated patients at least quarterly . . . . More 

frequent contact may also be required if the patient is 

undergoing extensive insulin therapy . . . ."). Finally, Dr. 

Ryan cited several specific instances in which some of the 

plaintiffs had received timely and effective medical 

treatment. See Id. (explaining that Rouse had received 

prompt medical treatment when his blood-sugar level

increased to an unacceptable level). In sum, he found "no 

evidence of deliberate indifference or insensitivity by the 

staff of ADTC in the care of their inmate diabetic patient 

population." Id. at 170. 

Considering the experts' reports, the District Court 

granted summary judgment to Commissioner Fauver on the 

merits of the Eighth Amendment claim and dismissed as 

moot the summary judgment motion on the grounds of 

qualified immunity, concluding that plaintiffs had failed to 

demonstrate Fauver's culpability. See Rouse v. Plantier, 987 

F. Supp. 302, 312, 315 n.13 (D.N.J. 1997) ("Rouse I"); id. 

at 312 ("Plaintiffs have not adequately responded to 

Defendants' contention that there is no evidence of

Defendant Fauver's deliberate indifference."). With respect 

to the remaining defendants, however, the District Court 

denied summary judgment on both grounds. See Id. at 312, 

315; Rouse v. Plantier, 997 F. Supp. 575, 580 (D.N.J. 1998) 

("Rouse II"). 

The District Court first held that plaintiffs had 

demonstrated the existence of material factual issues on 

whether the plaintiffs as a class had received 

constitutionally adequate medical care and constitutionally 

 7 
appropriate diabetes meals. See Rouse I, 987 F. Supp. at 

308-12. The District Court next found that plaintiffs had 

adduced sufficient evidence for summary judgment 

purposes that the defendants had been aware of the risks 

of such inadequacy but had disregarded them. See Id. at 

312. Turning to defendants' qualified immunity defense, the 

District Court held that the right at issue was clearly 

established and that the defendants had failed to 

demonstrate the reasonableness of their actions. See Id. at 

313 n.10, 314-15; see also Rouse II, 997 F. Supp. at 579- 

80. Accordingly, it refused to grant summary judgment in 

their favor. 

Defendants moved for reconsideration, and the District 

Court again rejected their qualified immunity defense. See 

Rouse II, 997 F. Supp. at 579-80. Defendants then took 

this appeal. They challenge only the District Court's 

determination that they are not entitled to qualified 

immunity on plaintiffs' Eighth Amendment claim. We have 

jurisdiction pursuant to the collateral order doctrine, see 

Mitchell v. Forsyth, 472 U.S. 511 (1985), and our review is 

plenary, see Larsen v. Senate of Cmwlth. of Pa., 154 F.3d 

82, 87 (3d Cir. 1998), cert. denied, 119 S. Ct. 1037 (1999). 

II. 

The only issue in this appeal is whether the defendants 

are entitled to summary judgment based on qualified

immunity. Under this doctrine, "government officials 

performing discretionary functions generally are shielded 

from liability for civil damages insofar as their conduct does 

not violate clearly established statutory or constitutional 

rights of which a reasonable person would have known." 

Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). "The 

contours of the right must be sufficiently clear that a 

reasonable official would understand that what he is doing 

violates that right." Anderson v. Creighton, 483 U.S. 635, 

640 (1987); see also Acierno v. Cloutier, 40 F.3d 597, 616 

(3d Cir. 1994) (en banc). In determining whether defendants 

are entitled to claim qualified immunity, we engage in a 

three-part inquiry: (1) whether the plaintiffs alleged a 

violation of their constitutional rights; (2) whether the right 

alleged to have been violated was clearly established in the 

 8 
existing law at the time of the violation; and (3) whether a 

reasonable official knew or should have known that the 

alleged action violated the plaintiffs' rights. 

A. We now turn to whether the plaintiffs alleged a 

violation of their constitutional rights. The Eighth 

Amendment prohibits the imposition of "unnecessary and 

wanton infliction of pain contrary to contemporary 

standards of decency." See Helling v. McKinney, 509 U.S. 

25, 32 (1993). In Estelle v. Gamble, 429 U.S. 97 (1976), the 

Supreme Court held that the Eighth Amendment's 

prohibition against cruel and unusual punishment requires 

prison officials to provide basic medical treatment to those 

whom it has incarcerated. The Court articulated the

standard to be used: 

 In order to state a cognizable claim, a prisoner must 

 allege acts or omissions sufficiently harmful to 

 evidence deliberate indifference to serious medical 

 needs. It is only such indifference that can offend 

 "evolving standards of decency" in violation of the 

 Eighth Amendment. 

Id. at 106. Therefore, to succeed under these principles, 

plaintiffs must demonstrate (1) that the defendants were 

deliberately indifferent to their medical needs and (2) that 

those needs were serious. Id. The defendants agree that 

insulin-dependent diabetes mellitus is a serious illness, and 

therefore only the former question is in issue here. 

It is well-settled that claims of negligence or medical 

malpractice, without some more culpable state of mind, do 

not constitute "deliberate indifference." As the Estelle Court 

noted: "[I]n the medical context, an inadvertent failure to 

provide adequate medical care cannot be said to constitute 

`an unnecessary and wanton infliction of pain' or to be 

`repugnant to the conscience of mankind.' " Id. at 105; see 

also Durmer v. O'Carroll, 991 F.2d 64, 67 (3d Cir. 1993) 

("[T]he law is clear that simple medical malpractice is 

insufficient to present a constitutional violation."); White v. 

Napoleon, 897 F.2d 103, 110 (3d Cir. 1990) (emphasis 

omitted) ("[C]ertainly no claim is stated when a doctor 

disagrees with the professional judgment of another doctor. 

There may, for example, be several acceptable ways to treat 

 9 
an illness."). "Deliberate indifference," therefore, requires 

"obduracy and wantonness," Whitley v. Albers, 475 U.S. 

312, 319 (1986), which has been likened to conduct that 

includes recklessness or a conscious disregard of a serious 

risk. See Farmer v. Brennan, 511 U.S. 825, 842 (1994) 

(stating that "it is enough that the official acted or failed to 

act despite his knowledge of a substantial risk of serious 

harm"). 

We have found "deliberate indifference" in a variety of 

circumstances, including where the prison official (1) knows 

of a prisoner's need for medical treatment but intentionally 

refuses to provide it; (2) delays necessary medical treatment 

based on a non-medical reason; or (3) prevents a prisoner 

from receiving needed or recommended medical treatment. 

See Durmer, 991 F.2d at 68 (citing Monmouth County Corr. 

Inst. Inmates v. Lanzaro, 834 F.2d 326, 346-47 (3d Cir. 

1987), cert. denied, 486 U.S. 1006 (1988)). We also have 

found "deliberate indifference" to exist where the prison 

official persists in a particular course of treatment "in the 

face of resultant pain and risk of permanent injury." 

Napoleon, 897 F.2d at 109-11 (holding that allegations of 

several instances of flawed medical treatment state a claim 

under Eighth Amendment). 

In reaching its conclusion that the plaintiffs had alleged 

a violation of their Eighth Amendment rights, the District 

Court relied on the experts' reports submitted by the 

parties. The Court first found that genuine issues of 

material fact existed on whether the plaintiffs were "served 

a meal appropriate for their diabetic condition." Rouse I, 

987 F. Supp. at 308. The Court noted the "numerous 

deficiencies" cited by plaintiffs' expert, including (1) lack of 

portion control, (2) unavailability of diabetes-appropriate 

meals, snacks, and low-sugar foods, and (3) failure to 

individualize diets. Id. Next, the Court found that genuine 

issues of material fact existed on whether the level of care 

provided to plaintiffs was constitutionally adequate. Id. at 

310. Observing that some of the plaintiffs had their bloodsugar levels tested only a minimal number of times each 

year, the Court refused to conclude, as a matter of law, that 

defendants had provided appropriate medical care. Id. at 

311-12. Noting several additional deficiencies, 2 the District 

_________________________________________________________________ 

2. Specifically, the District Court noted that genuine issues of fact 

existed on "1) the adequacy of care of Rouse and Brooks' feet; 2) the 

 10 
Court concluded that "the risks of inadequate treatment 

were obvious to a reasonably well-trained doctor, nurse, or 

prison official" and that the defendants "were subjectively 

aware of the risks . . . but did not respond reasonably." Id. 

at 312. 

On appeal, defendants contend that the evidence 

demonstrates that plaintiffs were provided with"extensive 

care" that did not "fall short of that required by the Eighth 

Amendment." Appellants' Br. at 41, 37. Specifically, 

defendants note that not "all" insulin-dependent diabetics 

require "routine daily blood-sugar testing." Id. at 33 

(emphasis in original). They point to a lack of evidence 

indicating that the number of blood-sugar tests performed 

each year and the diabetic meals provided each patient 

were inappropriate for any of the particular plaintiffs' 

diabetic condition. See Id. at 34, 37 ("[P]laintiffs cannot 

demonstrate . . . that . . . the frequency of sugar testing for 

their particular medical condition so threatened their 

health [that it] subjected them to cruel and unusual 

punishment. . . . Plaintiffs [also] have presented absolutely 

no evidence that they cannot maintain their health based 

on [the] diets [provided]."). 

Plaintiffs, on the other hand, contend that the 

defendants' systemic failure to provide a constitutionally 

adequate level of care reflected a deliberate indifference to 

the plaintiffs' serious medical needs. See Appellees' Br. at 

16. Such failure, they maintain, is evidenced by the 

defendants' refusal to provide a level of care even

approximating that required by accepted medical practices. 

See Id. They further contend that "only an official who was 

deliberately indifferent to the serious medical needs of 

diabetic inmates could have participated in, and not 

objected to, the constitutionally deficient system of diabetic 

care at ADTC." Id. at 23-24. 

_________________________________________________________________ 

adequacy of the eye care provided, particularly, whether any preventive 

care is provided; 3) the adequacy of measures to prevent other relatively 

common diabetes-specific complications, such as kidney damage, nerve 

damage, or blood vessel damage; 4) the existence of and need for diabetic 

education." Rouse I, 987 F. Supp. at 311 (citations omitted). 

 11 
Considering the principles enunciated in Estelle and its 

progeny, we find that the District Court erred in concluding 

on a wholesale basis that the plaintiffs alleged a violation of 

their Eighth Amendment rights. The experts' reports make 

clear that not all insulin-dependent diabetics require the 

same level of medical care. The reports show that there are 

at least two groups of insulin-dependent diabetic plaintiffs 

in this case. The first group consists of those insulindependent diabetics whose blood sugar levels consistently 

fluctuate to abnormal levels (i.e., the "unstable" plaintiffs). 

These diabetics require intensive medical treatment in order 

to regulate their blood sugar levels to normal or near 

normal physiological levels, which, as the experts' reports 

demonstrate, is the primary goal of diabetes management. 

The other group is comprised of those insulin-dependent 

diabetics whose blood sugar levels remain at or near 

normal physiological levels over time (i.e., the"stable" 

plaintiffs). These individuals have already achieved the 

primary goal of diabetes management and therefore do not 

require the same level of intensive medical treatment as 

their unstable counterparts. Consequently, it is possible 

that conduct that violates the Eighth Amendment rights of 

the unstable plaintiffs may not violate the constitutional 

rights of the stable plaintiffs. 

In light of the diverse medical needs of, and the different 

level of care owed to, each group of plaintiffs, the District 

Court erred in holding that all members of the plaintiff 

class alleged a violation of their Eighth Amendment rights. 

Based on the evidence in the summary judgment record, 

there may be one or more subgroups of plaintiffs as to 

whom particular aspects of the care allegedly provided was 

not consistent with Eighth Amendment requirements and 

other subgroups as to whom particular aspects of the care 

was constitutionally adequate. On remand, therefore, the 

Court should address the specific needs of each such 

group, considering, for instance, the appropriate amount of 

glucose testing, the need for a special diet, and the 

plaintiffs' general compliance with their medical 

appointments and prescribed dietary plans. Then, the 

District Court should consider the appropriate level of care 

due under the Eighth Amendment. Only after the latter 

determinations are made should the District Court 

 12 
determine whether the defendants' actions with respect to 

each of these matters and with respect to each relevant 

subgroup of plaintiffs were consistent with the requisite 

level of care owed under the Eighth Amendment at the 

times in question. 

We note that this case presents an unusual situation-- 

an Eighth Amendment class action for damages in which 

the defendants asserted the defense of qualified immunity 

-- and that prior circuit precedent did not provide the 

District Court with guidance as to how the defendant's 

qualified immunity claim should be handled in this context. 

The constitutional right asserted by the plaintiff class -- the 

Eighth Amendment right of a prisoner to be free from 

deliberate indifference to his or her serious medical needs 

-- is one that obviously varies depending on the medical 

needs of the particular prisoner. Yet here, the plaintiff class 

is a medically diverse group. Moreover, the violations for 

which damages are sought allegedly occurred over a span 

of years, during which the relevant medical standards may 

have changed. And, as we will discuss below, the 

defendants also vary, including both a lay supervisor and 

medical professionals. If this case ultimately goes forward 

as a class action for purposes of damages,3 the scope of the 

qualified immunity afforded each individual defendant 

should not be any different than it would be if that 

defendant were instead faced with separate damages 

actions filed on behalf of each member of the plaintiff class. 

Thus, if an individual damages actions by plaintiff P1 

against defendant D1 would not survive a motion for

summary judgment based on qualified immunity, either 

because D1's alleged conduct did not constitute an Eighth 

Amendment violation as to P1 or because the illegality of 

D1's conduct was not clearly established at the time in 

question, then in the class action context D1 should 

likewise be free from the burden of going to trial on the 

claims of P1 and all other similarly situated members of the 

plaintiff class. For these reasons, we remand to the District 

Court for it to consider the individual needs of each 

relevant subgroup of plaintiffs. 

_________________________________________________________________ 

3. The question of class certification for purposes of damages is not 

before us, and we express no opinion on this issue.

 13 
B. In light of the fact that we are remanding this case to 

the District Court to determine in the first instance whether 

relevant subclasses of plaintiffs have alleged violations of 

their Eighth Amendment rights, it would be premature for 

us to address the question whether, if such violations are 

ultimately found to have been alleged, the illegality of the 

defendants' conduct was clearly established. However, we 

emphasize that the District Court on remand should not 

only address the situation of each relevant category of 

plaintiffs, but it should also analyze separately the 

situation of each of the defendants who is sued for damages 

in an individual capacity. 

As previously noted, when a defendant asserts the 

defense of qualified immunity, it is necessary to determine 

whether a reasonable official in the position of that 

defendant would have known that his or her actions were 

unconstitutional in light of the clearly established law and 

the information the official possessed. See Anderson v. 

Creighton, 483 U.S. 635, 641 (1987) (determining whether 

it was objectively reasonable for an official to believe that a 

particular search was supported by probable cause requires 

consideration of the information possessed by the searching 

officials). In making this determination in this case, the 

District Court went astray in two respects. 

First, the District Court should have addressed the

specific conduct of each of the individual defendants in 

determining whether that particular defendant acted in an 

"objectively unreasonable" manner. In Grant v. City of 

Pittsburgh, 98 F.3d 116, 122 (3d Cir. 1996), we observed 

that the determination of whether a government official has 

acted in an objectively reasonable manner demands a

highly individualized inquiry. We stated: 

 [T]he question is whether a reasonable public official 

 would know that his or her specific conduct violated 

 clearly established rights . . . . Thus, crucial to the 

 resolution of any assertion of qualified immunity is a 

 careful examination of the record . . . to establish, for 

 purposes of summary judgment, a detailed factual 

 description of the actions of each individual defendant 

 . . . . 

 14 
Id. at 121-22 (emphasis in original); see also Reitz v. 

County of Bucks, 125 F.3d 139, 147 (3d Cir. 1997) (stating 

that qualified immunity analysis "requires application of the 

law to the particular conduct at issue"); Bakalis v. 

Golembeski, 35 F.3d 318, 326-27 (7th Cir. 1994) ("Qualified 

immunity is an individual defense available to each

individual defendant in his individual capacity."); Waldrop 

v. Evans, 871 F.2d 1030, 1034 (11th Cir. 1989) (evaluating 

challenged conduct individually because deliberate 

indifference standard is fact-specific). 

In the present case, the District Court determined,

without an individualized explanation, that all of the 

defendants (except Commissioner Fauver) had acted in an 

objectively unreasonable manner. The District Court simply 

stated that "[d]efendants knew what the appropriate level of 

care for a diabetic was and knew that the level of care 

provided was far short of it." Rouse I, 987 F. Supp. at 315. 

Nowhere in the District Court's opinion did it analyze the 

specific actions of each of the individual defendants. Nor is 

there any evidence in the record that allows us to make this 

determination on appeal. 

The need for an individualized analysis is apparent in 

this case because one of the individual defendants, the 

acting superintendent, is a lay administrative official. It is 

well-settled that liability under S 1983 may not be based on 

the doctrine of respondeat superior, see Durmer v. 

O'Carroll, 991 F.2d 64, 69 n.14 (3d Cir. 1993), and there is 

nothing in the record or the District Court's opinion setting 

forth the basis for the conclusion that the acting 

superintendent should have known that his conduct 

constituted an Eighth Amendment violation. 

Second, the District Court should have considered the 

reasonableness of each of the defendants' actions with 

respect to each of the relevant categories of plaintiffs. The 

District Court stated: 

 [K]nowing that glucose is normally tested at the very 

 least once a day for patients like Plaintiffs, Defendants 

 could not have reasonably believed that glucose testing 

 in many cases less than twenty times a year for these 

 particular Plaintiffs was reasonable medical care . . . . 

 15 
 Defendants could not . . . have reasonably thought that 

 Plaintiffs were among the group of insulin-dependent 

 diabetics who could tolerate such infrequent testing, 

 given . . . the substantial evidence of serious 

 fluctuations in the glucose levels of some of the 

 plaintiffs . . . . 

Rouse I, 987 F. Supp. at 315 (emphasis added) (emphasis 

in original omitted). As that paragraph demonstrates, the 

District Court recognized that not all of the plaintiffs are 

similarly situated but proceeded nevertheless to consider 

the plaintiffs' claim on a classwide basis. As discussed 

earlier, this analysis may have subjected some of the 

defendants to the possibility of personal liability even 

though the care they provided may have been 

constitutionally sufficient. 

Therefore, the District Court's determination that all of 

the defendants failed to act in an objectively reasonable 

manner in the care that they provided to all of the plaintiffs 

cannot stand. Accordingly, we remand to the District Court 

for it to determine whether each of the individual 

defendants acted in an objectively reasonable manner with 

respect to the particular needs of each relevant group of 

plaintiffs. 

III. 

For these reasons, we vacate the decision of the District 

Court and remand for the Court to reevaluate the qualified 

immunity issue in accordance with this opinion. 

A True Copy: 

Teste: 

 Clerk of the United States Court of Appeals 

 for the Third Circuit 

 16