### -1- 

# United States Court of Appeals

FOR THE EIGHTH CIRCUIT

____________ No. 96-1351

____________ Gloria Coleman, * * Appellee, * * v. * Appeal from the United States * District Court for the Nurse Ruth Rahija, Nurse at * Southern District of Iowa IMCC - Oakdale, * * Appellant. *

____________ Submitted: October 22, 1996 Filed: June 5, 1997

____________ Before RICHARD S. ARNOLD, Chief Judge, and FLOYD R. GIBSON and McMILLIAN, Circuit Judges.

____________ McMILLIAN, Circuit Judge.

Gloria Coleman brought this action in the United States Distric t Court for the Southern District of Iowa, pursuant to 42 U.S.C. § 1983 , claimi ng that Ruth Rahija was deliberately indifferent to her seriou s medical needs in violation of her Eighth Amendment right to be free from cruel and unusual punishment. Rahija now appeals from the district court’ s final order, following a bench trial, holding th at Rahija was deliberately indifferent to Coleman’s serious medical needs a nd awarding Coleman $1,000 in compensatory damages and $3,500 in punitive damages. Coleman v.

### In her answer, Rahija asserted qualified immunity as a n 1 

### affirmative defense but failed to argue it in the district court. She also failed to make a qualified immunity argument to thi s court.
-2- Rahija , No. 4-91-CV-50260 (S.D. Iowa Jan. 2, 1996) ( Coleman ). Fo r reversal, Rahija argu es that the district court erred in finding that (1) Coleman had a serious medical need; (2) Rahija h ad sufficient knowledge of Colema n’s serious medical need to justify a finding of deliberat e indifference; (3) Coleman suffered actual harm as a consequence of Rahija’ s actions; and (4) Rahija’s conduct was sufficiently callous to support an award of punitive damages. For the reasons disc ussed below, we vacate the award of punitive damages and affirm the order of the district court on th e remaining issues.

I. Background The factual background is primarily based on the findings of th e district court. Id. at 1-10. On January 15, 1991, Coleman, an inmate, wa s transferred from the Iowa Correctional Facility for Women in Mitchellville , Iowa, to the Iowa Medical and Classification Center (IMCC) in Oakdale , Iowa. At that time, Coleman was twenty-eight years old and approximately
seven months pregnant. She was transferred to IMCC to facilitate closer monitoring of her pregnancy. Rahija was a registered nurse employed b y IMCC. 1

Upon Coleman’s arriv al at IMCC, the IMCC Health Services Department (Hea lth Services) conducted a “health screen” and documented Coleman’ s health history, including the fact that Coleman had five prior pregnancies

. Dr. Ti mothy Pflederer, a Health Services physician, conducted a routin e physical e xamination of Coleman on January 23, 1991, and noted in hi s examination notes

### -3-

that Colem an had a long history of problematic pregnancies. In 1980 , Colema n prematurely delivered twins who were either stillborn or die d shortl y after birth. Of Coleman’s subsequent four pregnancies, thre e involved precipitous labors lasting less than on e hour and one resulted in
a premature delivery. Based on this information, Dr. Pflederer referred Coleman to the University of Iowa Hospitals and Clinics Obstetrical Unit (the University) for an evaluation. On January 30, 1991, Dr. Katherin e Stevenson, a University resident physician, examined Coleman and discovere d that her cervix was one to two centimeters dilated. She reported tha t Coleman’s obstetric history was “significant” an d recommended that Coleman remain at IMCC due to its proximity to the University and Coleman’s histor y of pre-term deliveries.

On January 31, 1991, a notation was made in the Health Service s records that Coleman had been examined at the Un iversity and was to remain at IMCC until after the baby was born. On February 2, 1991, a t approx imately 8:45 a.m., Coleman awoke and went to Health Services , comp laining that her “water” was “leaking.” A Health Services nurs e examin ed Coleman and determined that Coleman’s amnion had not ruptured

. Instead, the nurse de termined that Coleman was experiencing normal mucous vagina l discharge which commonly occurs during the later stages o f pregnancy. The nurse gave Coleman sanitary napkins and instructed her to notify Health Services if her condition worsened. On February 14, 1991, Coleman returned to Health Services complainin g that she “had a bloody show.” At that time, Health Services transferred Coleman to the University for an examination. The University physicians determined that Colem an was not in active labor but noted that her cervix

was dilated one to two centimeters and she was having minimal contractions

. The University physic ians instructed Health Services to return Coleman to the University if

### U nder IMCC’s policy, a pregnant woman is transferred to th e 2 

### University when she is in active labor. Brief for Appellant at 10.
-4- her contractions beca me painful, regular, and separated by ten minutes or less. 2

On February 15, 1991, Coleman awoke early in th e morning and noticed
some spotting of blood. She complained of bleeding, back pain, and stomac h pain to a guard, who sent her to Health Services. She notified Healt h Servi ces of the spotting and decided not to attend her required schoo l classes that day. At approximately 10:30 a.m., Coleman again reported to Health Services complaining of more bleeding and back pain. Althoug h Co leman denied being terribly uncomfortable, Coleman’s symptoms wer e recogn ized signs of labor and led the IMCC nursing staff to call th e University. Dr. Alvina Driscoll, a University resident physician , determined that the bleeding was likely due to cervical changes and was no t
a concern unless it increased or was associated with cramping o r contractions. The IM CC nursing staff recorded in Coleman’s medical chart that she was to be monitored for increased bleeding or signs of labor. Th e bleedi ng was to be monitored by inspecting Coleman’s sanitary napkins

. Coleman returned to Health Services at approxima tely 2:00 p.m. to complain of more b leeding and show a nurse a sanitary napkin with blood on it

. After looking at the sanitary napkin, the nurse threw it in the garbage.

At approximately 7:00 p.m., Coleman was watchin g television when she stood t o use the bathroom and felt an extreme pain in her lower abdome n causing her to double over. Coleman’s pain began to subside when another inmate , Felicia Allen, attempted to comfort her. Sometime thereafter , Coleman went to Health Services and was seen by Rahija, who had come o n duty at 3: 00 p.m. Without taking Coleman’s vital signs, performing a vaginal examination, or

### Health Services did not have any equipment to monito r 3 

### Coleman’s contractions, and Rahija was not qualified to perform a vaginal examination of Coleman to monitor any cervical changes. Notably, at no time prior to her transfer to the Universit y 4 

### at approximately 11:45 p.m. on February 15, 1991, did Colema n receive the assistance of a wheelchair.
-5- attempting to monitor the baby’s heart tones, Rahija sent Coleman back to her living unit and told her to return when the contractions were six to seven minutes apart.

At approximately 9:30 p.m., Coleman’s pain worsened. She returned to Health Services and reported to Rahija that s he was still bleeding, she hurt “down there,” po inting to her abdomen, and her contractions were six minu tes apart. Rahija placed her hands on the exterior of Coleman’ s abdom en and noted that she was unable to feel any contractions. Rahij a 3 monitored the baby’s heart tones, which were 142 beats per minute. At tha t time, Coleman denied experiencing low back pain or rupturing of her amnion

. Despite concluding that Coleman was in “possible early labor,” Rahija sent Coleman back to her living unit and instructed her to return to Healt h Servic es if the bleeding increased or the contractions increased i n severity or regularity. Fol lowing Rahija’s instructions, Coleman returned to her livin g unit. C oleman sat on the edge of her bed in increasing pain until 11:25

4 p.m., whe n she began to scream from the intense pain and moved to th e cement floor, where s he laid in a fetal position. A correctional officer allowed Allen and another inmate to enter Colema n’s living unit to attempt to calm her by talking to her and rubbing her back and stomach.

At tha t point, a correctional officer called Health Services t o summon Rahija and Grace Schwickerath, also a registered nurse,

### The district court recognized that Coleman wa s 5 

### “understandably uncooperative” because she believed that her child was about to be born yet was unable to obtain any assistance from the nursing staff. See Colema n v. Rahija , No. 4-91-CV-50260, slip op. at 9 n.6 (S.D. Iowa Jan. 2, 1996).
-6- to attend to Coleman. When they arrived, Coleman stated that she was in pain and felt “like pushing.” The nurses observed that Coleman appeared to be “bearing down.” Both nurses placed their hands on the exterior of Coleman’s abdomen and were unable to feel any contractions. One of th e
nurses monitored the baby’s fetal heart tones, which were 120 beats pe r minute. The nurses asked Coleman to stand to allow them to inspect he r sanita ry napkin. As Coleman stood, she “grunted” and expelle d approximately 15cc of dark red blood. Coleman’s sanitary napkin indicated that she had been spotting previously. Coleman stated that she “should go ahead [and] just have this baby [and] that would teach you for no t listen ing.” Id. at 9. At that point, the nurses agreed that Colema n 5 should be transported to the University and Schwickerath went to make the necessary arrangements. Rahija stayed with Cole man and noted that Coleman was probably in premature labor. However, Schwi ckerath noted that Coleman was in “questionable labor.” Id.

At approximately 11:45 p.m., Coleman was transported from IMCC to th e Uni versity. While transporting Coleman, the attending medica l professionals repeatedly called Coleman’s name t o prevent her from falling asleep. Coleman constantly felt the urge to pus h and, sometime during the ride , expelled another 20cc of blood. Shortly after arriving at th e University, Coleman delivered a premature baby boy at 12:20 a.m. o n February 16, 1991, although she was later unable to remember the delivery. Neithe r Coleman nor the baby suffered any complications during th e delivery. Coleman

### -7-

returned to IMCC on February 18, 1991, and the baby was later released fro m the hospital to the care of Coleman’s mother.

On March 3, 1991, Coleman completed a form complaint used b y prisoners to file complaints under the Civil Rig hts Act, 42 U.S.C. § 1983, alleging that Rahija violated Coleman’s Eighth Amendment right to be free from c ruel and unusual punishment by being deliberately indifferent t o Coleman’s complaints that she was in labor, which caused her to suffer bot h physically and emotionally. Coleman’s complaint was filed in the United States District Court for the Southern District of Iowa on April 29, 1991.

On Sept ember 27-28, 1994, this matter was tried to the distric t
cou rt, sitting without a jury. The case remained open for furthe r depositions and was c ompleted on April 10, 1995. The district court held that Rahija’s conduct deprived Coleman “‘of the minimal civilized measure of life’s necessities’ afforded her by the Eighth Amendment,” id. at 19-20 , quoting Whitnack v. D ouglas County , 16 F.3d 954, 957 (8th Cir. 1994), and awarde d Coleman $1,000.00 in actual damages and $3,500.00 in punitiv e damages, id. at 24. The district court held that, while some evidenc e suggested that Coleman should have been taken to the University at 7:0 0 p.m. on February 15, 1991, the greater weight of the evidence indicate d that, at 9:30 p.m., a reasonable person would have concluded that Coleman
was in labor and in need of proper medical attention provided by th e Univer sity. Id. at 21. The district court held that Rahija wa s accountable for Coleman’s pain and suffering between 9:30 p.m. and 11:30 p.m., whe n Coleman was finally transferred to the University. Id. Th e distri ct court further held that Rahija’s conduct in delaying Coleman’ s transfer to the Unive rsity rose to the level of callousness and warranted punitive damages to p revent such an occurrence in the future. Id. at 23- 24. This appeal followed.

### -8- II. Discussion

To prevail on an Eighth Amendment claim, an inm ate must show both an object ive element, that the deprivation was sufficiently serious, and a subjective element, t hat the defendant acted with a sufficiently culpable state of mind. Choate v. Lockhart , 7 F.3d 1370, 1373 (8th Cir. 1993) , citing Wilson v. Seiter , 501 U.S. 294, 302-03 (1 991). In a deprivation of medical c are case, an inmate must show that the prison official wa s deliberately indiffer ent to the inmate’s serious medical needs. Camberos

v. Br anstad , 73 F.3d 174, 175 (8th Cir. 1995). In order to succeed, a n inmate mu st show both that he or she had an objectively serious medica l need and that the def endant knew of and disregarded that need. Miller v. Schoenen , 75 F.3d 1305, 1309 (8th Cir. 1996), citing Estelle v. Gamble , 42 9 U.S. 9 7, 105 (1976), and Farmer v. Brennan , 511 U.S. 825, 837 (1994 ) ( Farmer ). Each step of this inquiry is fact-intensive, and we review the district court’s factual conclusions for clear error. Jensen v. Clarke , 94 F.3d 1191, 1197-98 (8th Cir. 1996).

A. Serious Medical Need
The initial question presented in this case is whether the district court’s finding that Coleman had a serious medical need is clearl y
erroneo us. A serious medical need is “one that has been diagnosed by a physician as requiring treatment, or one that is so obvious that even a layperson would easil y recognize the necessity for a doctor’s attention.” Camberos v. Branstad , 73 F.3d at 176. When an i nmate alleges that a delay in medical treatment constituted a constitutional deprivation, “th e object ive seriousness of the deprivation should also be measured b y reference to the effect of delay in treatment.” Crowley v. Hedgepeth , 109

### -9-

F.3d 500, 502 (8th Cir. 1997). An inmate’s failure to place verifyin g medical evidence in the record to establish the detrimental effect of dela y in med ical treatment precludes a claim of deliberate indifference t o medical needs. Id.

In this case, the district court found that Col eman was experiencing pre-termlabor and concluded that her condition was sufficiently serious to constitute a serious medical need. Specifically, the district cour t found that Coleman’s medical records indicated that she had a propensity of rapid labor and delivery; she was exhibiting some sign of possible labo r in the early afternoon on February 15, 1991; Rah ija noted that Coleman was in “possible early labor” at 9:30 p.m.; and Coleman believed the matte r sufficiently serious to continue seeking medical treatment. Coleman at 13

- 14. The district court also recognized six factors which might signal pre

term labor, five of w hich could be determined by an external examination, and found that Coleman had four of the five observable factors. Id. at 16

- 17. These four factors included: (1) an increase in vaginal discharge; (2 )
a “b loody show”; (3) uterine contractions six minutes apart; and (4 ) abdominal pain possibly attributable to a tightening of her pelvis an d earlier complaints of lower back pain. Id. The district court was also persuaded that had Rahija performed a vaginal examination of Coleman, ther e would have been evidence of progressive dilatation and effacement of the cervix. Id. at 17. Rahija argues that the district court’s finding that Coleman had a serious medical need is clearly erroneous. Rahi ja cites Boxwell v. County of Sherbur ne , 849 F.2d 1117 (8th Cir. 1988), for the proposition tha t pregnancy alone is no t necessarily a serious medical need and claims that Coleman failed to present evidence of unusual ci rcumstances related to her pregnancy to raise it to the level of a serious medical need. Rahij a contends that Coleman was

### -10-

not in active labor u ntil 11:25 p.m. on February 15, 1991, because, based
on Coleman’s previous precipitous deliveries, had she been in labor at 9:3 0 p.m., the baby would have been born before 12:20 a.m. Rahija also claims that the district court clearly erred in finding that Coleman complained of back pa in at approximately 10:30 a.m. that day because the medica l records indicate that Coleman reported “[b]leeding again - bac k uncomfortable but no pains.” Brief for Appellan t at 5, citing Appendix at 325.

Based on t he evidence presented at trial and relied upon by th e distric t court, we conclude that the relevant factual findings of th e distr ict court, as outlined above, are not clearly erroneous. While a woman’s pregnancy is generally not, alone, a ser ious medical need, Coleman presented evidence of her previous rapid labors and premature deliveries to establish a substa ntial risk of pre-term labor. See Boxwell v. County of Sherburne , 849 F.2d at 1122 (risk of miscarriage where pretrial detaine e
was six and one-half months into problem pregnancy, was bleeding, ha d previously fainted, and had history of rapid labor). A layperson woul d have recognized the necessity for a doctor’s attention at 9:30 p.m. See Camberos v. Branstad , 73 F.3d at 176 (a serious medical need is one that is so obvious that a layperson would recognize the necessity for a doctor’ s attent ion). Also, based on the district court’s factual findings , Coleman’s symptoms satisfied the requirements fo r transfer as set forth by the University physicians. See id. (a serious medical need is one that ha s been diagnosed by a p hysician as requiring treatment). We therefore hold that the district court did not clearly err in concluding that Coleman’s physical condition constituted a serious medical need. We also hold that Coleman presented sufficient “verifying medica l evidence” that Rahija “ignored a critical or escalating situation or that the delay posed a substantial risk of serious

### Dr. Paul Loeffelholz, the clinical director for IMCC an d 6 

### medical director for the Iowa Department of Corrections, testified that “bearing down” is a voluntary activity to help expel th e fetus once the cervix is fully dilated. Appendix at 48.
A lthough Farmer v. Brennan , 511 U.S. 825 (1994), is a 7 

### conditions-of-confinement case, the analytical model it provide s applies equally to deprivation of medical care cases. Beyer bach v. Sears , 49 F.3d 1324, 1326 n.1 (8th Cir. 1995).
-11- harm” for her claim to succeed. See Beyerbach v. Sears , 49 F.3d 1324, 132 7 (8th C ir. 1995) (inmate’s failure to present verifying medical evidenc e constituted failure to establish objective component of claim); see also Cro wley v. Hedgepeth , 109 F.3d at 502. Specifically, Coleman presente d expert testimony that the urge to push during the delivery process is an involuntary reaction, see Coleman at 18, indicat ing that Coleman, in fact, had been in labor, see Appendix at 48 (deposition testimony of Dr. Pau l Loeffelholz), and that the delay in her treatment posed a subs tantial risk 6 of serious harm.

B. Deliberate Indifference
Having held that the district court did not clearly err in finding that Coleman’s condition constituted a serious medical need, we now addres s the qu estion whether the district court’s finding that Rahija wa s deliber ately indifferent to Coleman’s serious medical need is clearl y
errone ous. This question, like the first step in our analysis, is a question of fact reviewed for clear error. Jensen , 94 F.3d at 1198. To satisf y this subjective element, Farmer requires a finding of actua l knowledge on the part of the defendant. Jensen v. Clarke , 94 F.3d at 1195 7 (f ailure-to-protect case applying same two-step analysis). A priso n official may be held liable under the Eighth Amendment if he or she knows that an inmate faces a substantial risk of serious harm and

### -12-

disregards that risk by failing to take reasonable measures to abate it. Farmer , 511 U.S. at 847. “[T]he failure to trea t a medical condition does not constitute punishment within the meaning of the Eighth Amendment unles s prison officials knew that the condition created an excessive risk to the inmate’s health and then failed to act on that knowledge.” Long v. Nix , 86 F.3d 761, 765 (8th Cir. 1996). Moreover, “an Eighth Amendment claimant need not show that a prison official acted or fa iled to act believing that harm actually would befall an inmate; it is enou gh that the official acted
or failed to act despite his [or her] knowledge of a substantial risk of serious harm.” Farmer , 511 U.S. at 842. The factual determination that a prison official had the requisite knowledge of a substantial risk may be inferred from circums tantial evidence or from the very fact that the risk was obvious. Id.

For e xample, if an Eighth Amendment plaintiff present s eviden ce showing that a substantial risk [to th e inmate’s health] was longstanding, pervasive, well

docu mented, or expressly noted by prison officials i n the pa st, and the circumstances suggest that th e defe ndant-official being sued had been exposed t o information concerning the risk an d thus must have known abou t it, then such evidence could be sufficient t o permit a trier of fact to find that the defendant

official had actual knowledge of the risk.

Id. at 842-43 (internal quotations omitted). The district court, in this case, concluded that Rahija had actual knowledge of Coleman’s serious medical need. Th e district court based its finding on the docume ntation in Coleman’s medical records of her previous precipitous labors, the IMCC officials’ election to keep Coleman at IMCC until after delivery because of her medical history, Rahija’s notation tha t Coleman might have been in possible early labor, and Coleman’s objective symptom s that she was experiencing pre-term labor. Coleman at 14-15 , citing Farmer ,

### -13-

511 U.S. at 842 (“a factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious”).
Rahija argues that t he district court clearly erred in finding that she had the requisite knowledge to constitute deliberate indifference

. Rahija claims that Coleman did not have painful, regular contractions less than t en minutes apart, increased heavy bleeding, or bleeding wit h contra ctions until 11:25 p.m., at which point Rahija determined tha t Coleman should be sen t to the University. Thus, Rahija contends that she

was n ot deliberately indifferent to Coleman’s condition because he r treatment of Coleman was consistent with the University physician’s (Dr. Driscoll’s) advice.

In this case, the di strict court’s conclusion that Nurse Rahija had actual knowledge based on the obviousness of Coleman’s serious medical nee d is not clearly errone ous. Coleman’s propensity for precipitous labor and pr emature delivery was well-documented and expressly noted by priso n officials in Coleman’ s medical records, to which Rahija had been exposed, and constituted the sole reason for Coleman’s placement at IMCC. From thi s evidence, a trier of fact could have found that Rahija had actual knowledg e of the risk of pre-term labor. See Farmer , 511 U.S. at 842-43; Jensen , 94 F.3d at 1198. We therefore hold that the district court did not clearly err in finding that R ahija’s unnecessary delay in transferring Coleman to the U niversity constituted deliberate indifference to Coleman’s seriou s medical need. See Jo hnson-El v. Schoemehl , 878 F.2d 1043, 1055 (8th Cir. 1989) (“Delay in the provision of treatment or in providing examinations
can vi olate inmates’ rights when the inmates’ ailments are medicall y serious or painful in nature.”).

### -14-

C. Compensatory Damages

Comp ensatory damages may include not only out-of-pocket loss an d other monetary harms, but also such injuries as impairment of reputation, personal humiliation, and mental anguish and suf fering. Memphis Community Sch. Dist. v. Stachura , 477 U.S. 299, 307 (1986) ( Stachura ). Specifically , mental and emotional distress, which include mental suffering and emotiona l anguish, constitute compensable injury under § 1 983. Carey v. Piphus , 435 U.S. 247 , 264 & n.20 (1978). While such injuries are essentiall y subjective, they may be evidenced by the plaintiff’s conduct and observed by others. Id. at 26 4 n.20. Additionally, evidence of physical pain and suffering may support an award of compensatory damages in excess of an y actual out-of-pocket medical expenses. Jackson v. Crews , 873 F.2d 1105, 1109 (8th Cir. 1988).
Rahija argues that t he record does not support the district court’s finding that Coleman was subjected to pain and suffering from 9:30 p.m

. until 11:30 p.m. Instead, Rahija suggests that Coleman experienced nothin g dif ferent from what women endure during childbirth and that Coleman ha d
acc ess to a television and a bed as if she was in a hospital. Sh e concludes that had she transferred Coleman to th e University at 9:30 p.m.,

as suggested by the district court, Coleman would have experienced the sam e labor in the hospital as she did in her living u nit, and, therefore, there was nothing unconstit utional about where Coleman experienced labor or how Rahija treated her. We disagree and hold that the evidence supports the district court’s award of compensatory damages for Coleman’s physical pain and suffering an d mental anguish and suffering. Fortunately, neither Coleman nor her baby suffered any complications during the delivery at the University. However , the fact remains that,

### -15-

because of Rahija’s unnecessary delay, Coleman was subjected to “a great dea l of fear and physical suffering [which] accompanied the prospect o f having a baby on the floor of a penal institution,” Coleman at 21, withou t the appropriate medical attention. We therefore hold that the distric t court did not clearly err in finding that Coleman suffered a compensable injury under § 1983.

D. Punitive Damages

In a § 1 983 case, both compensatory and punitive damages ar e avail able upon proper proof. Cunningham v. City of Overland , 804 F.2 d 1066, 1069 (8th Cir. 1986), citing Stachura , 477 U.S. at 306 & n.9. But unlike compensatory damages, which are mandatory and are awarded as a matter of right once liability is found, punitive damages are awarded or rejected in a particular case at the discretion of the fact finder onc e sufficiently serious misconduct by the defendant is shown. Smith v. Wade , 461 U.S. 30, 52 (1983); McKinnon v. Kwong Wah Re staurant , 83 F.3d 498, 508 (1st Cir. 1996) (Title VII case). Punitive dama ges are awarded to “punish the defendant for his [or her] willful or malicious conduct and to deter others from similar behavior.” Stachura , 477 U. S. at 306 n.9. The focus, in determining the pr opriety of punitive damages, is on the intent of the defendant, Cunningham v. City of Overland , 804 F.2d at 1070, and whether the defendant’s conduct is of the sort that calls for deterrence an d punishment over and a bove that provided by compensatory awards. Smith v. Wade , 461 U.S. at 54. Punitive damages are appropriate in a § 1983 case “‘when the defendant’ s conduct is shown to be motivated by evil motive or intent, or when it involves reckless or callous indifference to th e federally protected rights of others.’” Walters v. Grossheim , 990 F.2d 381 , 385 (8th Cir. 1993), quoting Smith v. Wade , 461 U.S. at 56.

### -16- To impose a punitive award in this case, the district court wa s required to find not only that Rahija’s conduct met the callousnes s threshold, which is a question of ultimate fact, but also that her conduct merited a punitive aw ard of $3,500 in addition to the compensatory award, which is a discretionary moral judgment. Smith v. Wade , 461 U.S. at 52. Applyi ng this standard, the district court awarded Coleman $3,500.00 i n puniti ve damages “so that prison officials recognize the seriousness o f this lack of action and guard against it in the future.” Coleman at 24.

A finding of deliberate indifference to a serious medical need, whil e establishing liability under § 1983, does not necessitate a finding o f callous indifference warranting punitive damages. See Standley v

. Chilhowee R-IV Sch. District , 5 F.3d 319, 323 (8th Cir. 1993) (defendant was liable under § 19 83 for violating plaintiff’s First Amendment rights, but there was insufficient evidence that defendant’s conduct rose to the lev el of “evil motive” or “reckless or callous indifference” to justif y punitive damages); see also Cornell v. Woods , 69 F.3d 1383, 1391 (8th Cir. 1995) (prison officials’ conduct in punishing inmate for exercising hi s First A mendment rights established liability under § 1983 but did no t warrant imposition of punitive damages); Ivey v. Wilson , 832 F.2d 950, 956 (6th C ir. 1987) (prison officials’ acts violated prisoner’s due proces s rights and gave rise to § 1983 liability, but punitive damages award was improper because there was no evidence that defe ndants “were acting in bad faith” or “harbored any ill will” towards plaintiff); Walters v. City of Atl anta , 803 F.2d 1135, 1147 (11th Cir. 1986) (upholding jury’s findin g that “defendants were responsible for the racial discrimination” plaintiff suffered, but vacating punitive damages award because the record did not show that defendants “acted with either the requisite ill will or callous disregard of [plaintiff’s] federally protected rights”); Lavicky v

. Burnett , 758 F.2d 468, 477

### -17-

(10th Cir. 1985) (unlawful search and seizure and taking of plaintiff’s property without a hearing gave rise to § 1983 liability, but punitive damages award was properly set aside because “there was n o evidence of malice, wantonness, or oppressivenes s”), cert. denied 474 U.S. 1101 (1986); Soderbeck v. Burnett County , 752 F.2d 285, 289 (7th Cir. ) (plaintiff’s showing of political dismissal was sufficient for compensator y damages, but not punitive damages), cert. denied 471 U.S. 1117 (1985) ; Hernandez-Terado v. Artau , 874 F.2d 866, 872 (1st Cir. 1989) (same). Afte r reviewing the evidence presented at trial, we hold that Rahija’s conduct in this case was not sufficiently egregious to justify the imposition of punitive damages. Se e Cornell v. Woods , 69 F.3d at 1391. Coleman admits that Rahija testified that she relied on, and attempted to follow, th e University physicians ’ instructions in caring for Coleman. See Brief for Appellee at 27, 28 n.12. While Rahija is liable under § 1983 for her dela y in treati ng Coleman, her conduct does not rise to the level calling fo r punishment and deterrence over and above that pr ovided by the compensatory award. See Smith v. Wade , 461 U.S. at 54; see also Stachura , 477 U.S. at 310 (“Section 1983 presupposes that damages that compensate for actual har m ordina rily suffice to deter constitutional violations.”). The facts o f this case illustrate the difference between conduct justifying mer e li ability under the Eighth Amendment and conduct justifying punitiv e damages under § 1983. Because the district cour t abused its discretion in awarding punitive damages over and above the com pensatory award, we vacate the punitive damages award.

III. Conclusion

Accordingly, the pun itive damages award is vacated and the order of the district court is affirmed in all other respects.

### -18-

FLOYD R. GIBSON, Circuit Judge, concurring in part and dissenting in part.

Though I am in full accord with the Court's decision to affirm the imposi tion of compensatory damages against Nurse Ruth Rahija, I canno t agree that the district court's award of punitive damages should b e reversed. In my view, the rather startling and disturbing facts of this
case reve al the district court did not commit clear error when it foun d that R ahija acted with "callous indifference to the federally protecte d rights of others." Smith v. Wade , 461 U.S. 30, 56 (1983). Furthermore, I beli eve the district court correctly determined that Nurse Rahija' s behavior was "simply inexcusable" and of a type that "must be punished in

an appropriate way so that prison officials recognize the seriousness of this lack of action and guard against it in the future." Coleman v

. Rahija , No. 4-91-CV-50260, at 24 (S.D. Iowa Jan. 2, 1996); see also Smith , 461 U.S. at 54 ("The focus is on the character o f the tortfeasor's conduct -- whether it is of the sort that calls for dete rrence and punishment over and above that provided by compensatory awards."). As a result, I a m unable to conclude that the district court abused its discretion when it deemed punitive damages appropriate. For these reasons, I respectfull y dissent from that portion of the Court's opinion vacating the distric t court's punitive damages award.

A true copy.
Attest: CLERK, U.S. COURT OF APPEALS, EIGHTH CIRCUIT.