# U ni te d S ta te s Co ur t of A pp ea ls

For the Eig hth Circu it

__ __ __ __ __ __ __ __ __ __ __ __ __ _

No. 1 4- 10 87

__ __ __ __ __ __ __ __ __ __ __ __ __ _

Jo hn Ru ss el l Al la rd

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff - App el la nt

v.

Ton ia Bal dwi n, M D; Del or es Green ; Pa m el a Ale xa nd er

ll ll ll ll ll ll ll ll ll ll l Defe nd

an ts - App el le es

__ __ __ __ __ __
App eal fro m

Uni te d S ta te s Di st ric t Co ur t fo r th e So ut he rn Dis tri ct of I owa - Des M oi ne s

__ __ __ __ __ __

Su bm it te d: Decem

be r 9, 2 01 4
Fil ed : M arch 5, 2 01 5

__ __ __ __ __ __

Befo re LOKEN, BYE, an d S MITH, Ci rcu it Ju dg es

.

__ __ __ __ __ __

BYE, Cir cu it Ju dg e.

Io wa in m at e Jo hn Ru ss el l All ard br ou gh t th is 42 U.S.C

. § 19 83 co m pl ai nt

ag ai ns t pr is on st aff al l e g i ng vi ol at io ns of hi s co ns ti tu ti on al rig ht s ba se d on th ei r

al le ge d fai lu re to tre at hi s se rio us m ed ic al co nd it io n. The di st ric t co ur t gr an te d 1

The Hon or ab le Ro na l d Lon gs ta ff, Uni te d St at es Dis tri ct Ju dg e fo r th e 1

So ut he rn Dis tri ct of I owa

.su m

m ary jud gm en t to th e pr is on st aff. All ard f i l e d t h e in st an t ap pe al

, arg ui ng

m at eri al qu es ti on s of fact ex is t reg ard in g th e ap pr op ria te ne ss of th e care he rece iv ed

. W e aff irm.

I

All ard was a pr is on er at th e Cl ari nd a Co rrec ti on al Faci li ty ("C CF" ) of th e Io wa Dep art m en t of Co rrec ti on s ( " I D O C " ) at th e ti m e of th e ev en ts gi vi ng ris e to th is

la wsu it

. All cl ai m s ari se ou t of a bo wel ob st ru ct io n and pe rfo rat io n Alla rd su ffer ed

an d th e al le ge dl y de fic ie nt m ed ic al care pr ov id ed by Ton ia Bal dwi n, M.D., Delo res

Green , and Pam el a Ale xa nd er (" CCF He al th Serv ic es st aff" ). 2

On Feb ru ary 5, 20 11

, All ard se nt a m ed ic al co m pl ai nt to CCF Heal th Serv ic es

to rep or t pa in in hi s ab do m en an d fai lu re to ha ve a bo wel m ov em en t fo r ov er a week

. All ard was di ag no se d at th at ti m e wit h c on st ip at io n, an d tre at m en t of th e co nd it io n
be ga n. Dur in g th e fir st th ree da y s of hi s tre at m en t fo r c o n s t i p a t i o n by CC F Heal th

Serv ic es , All ard rece iv ed Mi lk of Mag ne si a, was to ld to in crea se hi s flu id in ta ke

, was gi ve n a Lim it ed Acti vi ty Not ic e fo r wor k, was to ld to in crea se hi s act iv it y le ve ls

, was gi ve n a Doc us at e So di um cap su le

, was ad m in is te red an en em a, was gi ve n m ag ne si um
ci tra te

, an d rece iv ed a co m pl et e bl oo d co un t whi ch in di cat ed All ard ha d no in fect io n.

All ard al so rep or te d pa ss in g so m e ga s an d CCF Heal th Serv i c e s s ta ff no te d
hypera ct iv e b owe l s ou nd s.

On Fe br ua ry

8, 2 01 1, All ard rep or te d h e h ad st il l n ot ha d a bo wel m ov em en t

an d hi s bo wel so un ds were hypo act iv e an d sl ug gi sh

. All ard was pu t on a li qu id di et

at th e ti m e whi ch rem ai ne d in effe ct un ti l hi s bo wel pe rfo rat ed

. St oo l so fte ne rs were

Dur in g th e ti m e pe rio d rel ev an t to th is su it

, m ed ic al care was al so pr ov id ed to 2

All ard by ot he r CCF Heal th Serv ic es st aff mem be rs who ha ve no t be en na m ed as de fen da nt s i n t hi s s ui t.

-2

-or de red

. The ne xt da y All ard pr es en te d with m or e act iv e bo wel so un ds an d a sl ig ht

fev er. On Feb ru ary 10

, All ard ag ai n pr es en te d wit h a so ft ab do m en an d bo wel so un ds

in al l fo ur qu ad ran ts

. On th at da y All ard rep or te d n o b o w e l mo ve m en t an d All ard

was refe rred of

f-s it e fo r an x- ray of hi s ab do m en

. The x- ray was ta ke n at th e Cl ari nd a

R e gi on al Heal th Cen te r ("C RHC" ) in Cl ari nd a, Io wa, on Feb ru ary 10

, an d C C F

Heal th Serv ic es st aff rece iv ed a rep or t fro m CRHC in di cat in g All a r d ' s b o w el

co nt ai ne d a lar ge qu an ti ty of st oo l, b ut th ere was no ob st ru ct iv e p at te rn

.

On Fe br ua ry

11 , All ard rep or te d a sm al l b owe l m ov em en t, b ut st il l fe lt si ck

. All ard pr es en te d wit h a so ft ab do m en an d hypo act iv e to no rm al bo wel so un ds

. All ard

co nt in ue d to be tr e a t e d fo r co ns ti pa ti on , in cl ud in g an ot he r bo tt le of m ag ne si um
ci tra te

. On Feb ru ary 12

, All ard rep or te d a sm al l bo wel m ov em en t fro m th e pr io r da y ,

cram pi ng in hi s lo w e r a b d o men , an d na us ea. All ard pr es en te d wit h so m e bo wel

s ou nd s an d hi s ab do m en was no t te nd er. The ne xt da y , All ard rep or te d n a u s e a ,

vo m it in g, an d so m e ga s, bu t no bo wel m ov em en t. All ard w a s pr es cri be d th e

an ti bi ot ic Aug m en ti n. All ard was co nt in ue d on Mi raLA X a n d s to ol so fte ne rs

. A

co m pl et e b lo od co un t was ord ered

.

On Feb ru ary 14

, All ard rep or te d a sm al l bo wel m ov em en t ha d oc cu rred th e

ni gh t be fo re. Th e c o mp l e t e bl oo d co un t pe rfo rm ed on Feb ru ary 14 in di cat ed no

in fect io n. Late r on Feb ru ary 14

, All ard rep or te d th ree s mal l st oo ls

. A so ap su ds

en em a was th en or de red

, an d res ul te d in li qu id st oo l an d a sm al l so li d bo wel

m ov em en t. The so ap su ds en em a was rep eat ed

. The la xa ti v e GoLytely was th en

o r d e r e d

. On Feb ru ary 15

, ne w la xa ti ve s an d su pp os it or ie s were or de red

. Th e

su pp os it or ie s re su lt ed in ga s an d a sm al l am ou nt of s to ol

.

On Feb ru ary 16

, All ard rep or te d he ha d a bo wel m ov em en t th e ni gh t be fo re an d

pa ss ed ga s al l ni gh t. All ard rep or ts th at on Feb ru ary 16 he was ph y si cal ly un ab le to

walk be cau se of pa in an d un ab le to dr in k flu id s be cau se of vo m it in g. Mo re la xa ti ve s
were ord ered

. On Feb ru ary 17

, All ard m ad e cl ear hi s in te res t in st op pi ng la xa ti ve s,

-3

-bu t was co nt in ui ng to ha ve pa in

. Bo wel so un ds were pr es en t in al l bo wel qu ad ran ts

an d A l l ard rep or te d so m e sm al l res ul ts fro m th e tre at m en t or de red th e da y be fo re.

Late r, All ard 's whi te bl oo d co un t in di cat ed in fect io n a nd he was refe rred to th e

em e r g e n c y ro om at CRFC

. The em erg en cy ro om do ct or no te d ab do m en bo wel

so un ds , no m as se s o r m eg al y , and a so ft a bd om en . Flat an d u pr ig ht ab do m en fil m s

rev eal ed fai rly la rg e am ou nt s of ai r wit hi n th e co lo n, bu t th e CRFC em erg en cy ro om
do ct or di d no t se e an y ob st ru ct io n, an d th e CRFC rad io lo gi st

, whi le no t ex cl ud in g an

o bs tru ct io n, di d no t di ag no se on e. The rad io lo gi st at CRFC no te d di st al co l o n i c 3

ob st ru ct io ns were no t ex cl ud ed an d reco m m en de d a CT sc an if di st en ti on pe rs is te d.

A fte r hi s ret ur n fro m th e em erg en cy ro om , All ard was gi ve n th e ga s rel ie ve r
Si m et hi co ne on th e reco m m en da ti on of th e em erg en cy ro om do ct or

. No CT sc an was

or de red

.

On Feb ru ary 18 an d 19

, All ard w a s i n s tru ct ed to walk be twee n hi s cel l an d

CCF Heal th Serv ic es , whi ch he es ti m at e s h e di d ap pr ox im at el y twen ty ti m es

. On

Feb ru ary 18

, All ard as ke d fo r a ch an ge in m ed ic al di rect iv es ; th e m ed ic al di rect iv es

were no t ch an ge d. O n F e br ua ry 19

, All ard li ed by rep or ti ng th ree st oo ls an d

rep or ti ng he fel t b et te r. All ard was t ol d t o c on ti nu e wal ki ng an d d rin ki ng flu id s.

The m or ni ng of Feb ru ary 20

, All ard su ffer ed a pe rfo rat ed di ve rti cu lu m

. All ard

was se nt to a ho sp it al in Co un ci l B l u ffs

, Io wa, whe re he was tre at ed

. All ard ha d

em erg en cy su rg ery whe re a co lo st om y ba g was in st al le d an d hi s bo wel was rep ai red

.

The CRHC em erg en cy ro om ph y si ci an sa w All ard on Feb ru ary 17 an d wro te 3

th e rep or t on Feb ru ary 18

. The CRHC rad io lo gi st read th e x- ray on Feb ru ary 17 an d

no te d a "d is ta l co lo ni c ob s t ru ct io n is no t ex cl ud ed " by th e fil m s. The Io wa Dep art m en t of Co rrec ti on s di d no t rece iv e a co py of th e rad io lo gi st 's rep or t un ti l Sep te m be r. The fai lu re of th e CCF Heal th Serv ic es st aff to ob ta in th e rep or t do es no t de m on st rat e de li be rat e in di ffer en ce: th e res ul ts of th e x- ray were rep or te d to th e CCF
Heal th Serv ic es st aff an d were reco rd e d o n F eb ru ary 17 in All ard 's CCF m ed ic al

reco rd s.

-4

-All ard us ed th e co lo st om y ba g fo r te n m on th s an d no w ha s a sc ar. In Mar ch of 20 11

,

All ard rece iv ed a di sc i p l i n a ry no ti ce an d was rep rimand ed fo r fai lu re to st ric tl y
ad he re to m e d i c a l d i r ect iv es

. The rep rimand was ba se d on All ard 's refu sa l to walk

as di rect ed as p art of h is m ed ic al tre at m en t.

All a r d co m

m en ced th is la wsu it on Mar ch 12

, 20 12

, ag ai ns t Ton ia Bal dwi n, M.D.; Delo res Green ; Pam el a Alex an de r; St ev e Je nk in s; an d Mar k Lun d, cl ai m in g

hi s Eig ht h Am en dm en t rig ht to be f r e e f ro m cru el an d un us ua l pu ni sh m en t was
vi ol at ed be cau se CCF Heal t h Serv ic es st aff fai le d to tre at hi s se rio us m ed ic al

co nd it io n. The di st ric t cou rt d is m is se d J en ki ns an d Lu nd fro m th e su it an d g ran te d

su m m ary jud gm en t t o t he rem ai ni ng de fen da nt s.

II

"We rev ie w a di st ric t co ur t's de ci si on to gr an t a m ot io n fo r su m m ary jud gm en t

de no vo , ap pl y in g th e sa m e st an da rd s fo r su m m ary jud gm en t as th e di s t r i c t c o ur t."

Tu s i n g v

. Des Mo in es In de p. Cm ty. Sch . Di st ., 6 39 F.3 d 50 7, 51 4 (8 th Ci r. 20 1 1 )

. Su m m ary jud gm en t is ap pr op ria te "i f th e m ov an t sh ows th at t h e r e i s n o ge nu in e
di sp ut e as to an y

m at eri al fact an d t he m ov an t i s en ti tl ed to jud gm en t as a m at te r of

la w." Fed

. R. Ci v. P. 56 (a). In co ns id eri ng su m m ary jud gm en t m ot io ns , th e bu rd en

of de m on st rat in g th ere are no ge n u i n e is su es of m at eri al fact res ts on th e m ov in g

pa rty, an d we rev ie w th e ev id en ce an d th e in fere nc es whi ch reas on ab ly m ay be dr awn

fro m th e ev id en c e i n t h e l i gh t m os t fav or ab le to th e no nm ov in g pa rty. Dav is v.

Je ffer so n Hos p. Ass'n

, 68 5 F.3d 67 5, 68 0 (8 th Ci r. 20 12 ). "'Where th e reco rd ta ke n

as a who le co ul d no t le ad a rat io na l tri er of fact to fin d fo r th e no nm ov in g pa rty, th ere
is no ge nu in e is su e fo r tri al .'" Torg ers on v. Ci ty of Ro ch es te r, 64 3 F.3 d 10 31

, 10 42
(8 th Cir . 20 11 ) (q uo ti ng Ric ci v. DeSt efan o, 5 57 U.S. 55 7, 5 85 (20 09 )).

The Eig ht h Am en dm en t pr oh ib it s cru el an d un us ua l pu ni sh m en ts

. U.S. Co ns t.

am en d. VIII. The go ve rn m en t ha s an "o bl ig at io n to pr ov id e m ed ic al care fo r th os e

-5

-who m it is pu ni sh in g by in carc erat io n." Est el le v. Gam bl e, 42 9 U.S. 97

, 10 3 (1 97 6)

. "An Eig ht h Am en dm en t cl ai m th at pr is on of fic ia ls were de li be rat el y in di ffer en t to th e

m ed ic al ne ed s of in m at es in vo lv es bo th an ob jecti ve a n d a su bjec ti ve co m po ne nt

. The pl ai nt iff

s m us t d e mo n st rat e (1 ) th at th ey su ffer ed ob jecti ve ly se rio us m ed ic al

ne ed s an d (2) th at th e p ris on off ic ia ls act ua ll y

kn ew of bu t d el ib erat el y

di sr eg ard ed

th os e n e e d s ." Dul an y v. Carn ah an , 13 2 F.3 d 12 34

, 12 39 (8 th Ci r. 19 97 ) (in te rn al

ci ta ti on s om it te d)

. All ard ha s de m on st rat ed h e su ffer ed an ob jecti ve ly se rio us
med i c a l ne ed whe n hi s bo wel be cam e ob st ru ct ed an d th erea fte r pe rfo rat ed

, bu t

All ard 's cl ai m th e pr is on of fic ia ls act ua ll y k ne w o f bu t de li be rat el y di sr eg ard ed hi s

m ed ic al ne ed s fa il s as a m at te r of law.

A l l ard ag rees he was di ag no se d wit h co ns ti pa ti on an d gi ve n ex te n s i v e

tre at m en t fo r th at di ag no se s. Howev er, A l l a r d arg ue s hi s di ag no se s an d care were

co ns ti tu ti on al ly in ad eq ua te

. To pr ev ai l on a d el ib erat e in di ffer en ce cl ai m , All ard

m us t sh ow m or e th an ev en gr os s neg li ge nc e. Sp an n v. Ro pe r, 45 3 F.3 d 10 07

, 10 08
(8 th Ci r. 20 06 ) (p er c u r ia m ); se e al so Vau gh n v. Gray

, 55 7 F.3 d 90 4, 90 8 (8 th Ci r.

20 09 ) ("I n or de r to de m on st rat e th at a de fen da nt act ua ll y kn ew o f

, bu t de li be rat el y
di sr eg ard ed , a se rio us m ed ic al ne ed

, th e pl ai nt iff m us t est ab li sh a 'm en ta l sta te ak in

to cri m in al reck le ss ne ss : di sr eg ard in g a kn own ris k to th e in m at e's he al th .'" (q uo ti ng

Gor do n v . Fran k, 4 54 F.3d 85 8, 8 62 (8t h C ir. 2 00 6) )).

All ard fir st arg ue s hi s di a g n o s e s was co ns ti tu ti on al ly in ad eq ua te

. To sh ow
de li be rat e in di ffer en ce in a m is di ag no si s, All ard m us t sh ow de fen da nt s were m or e

th an gr os sl y ne gl ig en t. "Neg li ge nt m is di ag no si s do es no t crea te a co gn iz ab le cl ai m

un de r § 19 83 ." McR av en v. San de rs , 57 7 F.3 d 97 4, 98 2 (8 th Ci r. 20 09 ). All ard ha s

fai le d to m eet th is bu rd en

. CCF Healt h Serv ic es st aff di ag no se d All ard wit h sev ere

co ns ti pa ti on aft er he ari ng All ard 's co m pl ai nt s an d co nd uc ti ng phy sic al ex am ina tio ns.

CC F Heal th Serv ic es st aff twi ce refe rred All ard to th e em erg en cy ro om whe re th e

em erg en cy ro om ph y si ci an ex am in ed All ar d a n d di ag no se d co ns ti pa ti on

. The

di ag no se s by CCF Heal th Serv ic es st aff do es no t ari se to a le ve l of cri m in al

-6

-reck le ss ne ss

. See Vau gh n, 55 7 F.3 d at 90 8. All ard 's ex pe rt te st ifi ed th at a ph y si ci an

rev ie win g th e x- rays in li gh t of All ard 's sym pt om s sh ou ld ha ve di ag no se d All ard wit h

a bo wel ob st ru ct io n. W hi le All ard m ay ha ve es ta bl is he d a qu es ti on of m at eri al fact

s u f f ic ie nt fo r a ne gl ig en t m al pr act ic e cas e, su ch ev id en ce do es no t sh ow de li be r a t e

in di ffer en ce. CCF Heal th Serv ic es st aff re ferr ed All ard to an ou ts id e p ro vi de r who

ve rif ie d th e di ag no se s of co ns ti pa ti on

. Thu s, th e m is di ag no si s d o e s n o t r is e to th e
le ve l o f de li be rat e in di ffer en ce.

All ard ne xt ar g u e s th e care pr ov id ed was co ns ti tu ti on al ly in ad eq ua te

. A
pl ai nt iff can sh ow de li be rat e in di ffer en ce i n t h e le ve l of care pr ov id ed in di ffer en t

way s, inc lu di ng sh owi ng gr os sl y in co m pe te nt or i na de qu at e car e, Sm it h v

. Je nk in s,

91 9 F.2 d 90

, 93 (8 th Ci r. 19 90 ), sh owi ng a de fen da nt 's de ci si on to ta ke an eas ie r an d

le ss effi caci ou s co ur se of tre at m en t, id

., or sh owi ng a de fen da nt in te nt io na ll y de la y ed

or de ni ed acce ss to m ed ic al care , M el oy v . B ach m ei e r , 3 0 2 F

. 3 d 84 5, 84 9 (8 th Ci r.

20 02 ). All ard rel ie s on Sm it h, 91 9 F.2 d at 93 , t o a r g u e th e tre at m en t pr ov id ed was

co ns ti tu ti on al ly de fic ie nt

. In Sm it h, th e Eig ht h Circ ui t hel d "m ere pro of of m ed ic al

care " is in su ffi ci en t to di sp ro ve de li be rat e in di ff e r e n c e

. Id

. Thu s, in cas es whe re

so m e m ed ic al care is pr ov id ed

, a pl ai nt iff "i s en ti tl ed to pr ov e hi s cas e by es ta bl is hi ng [th e] co ur se of tre at m en t, or la ck th ereo f, so de vi at ed fro m pr of es si on al st an da rd s th at

it am ou nt ed to de li be rat e in di ffer en ce." Id.

Sm it h do es no t, as All ard co nt en ds

, m an da te a jury tri al in th is cas e. In Sm it h,

th e reco rd was no t well de ve lo pe d an d th is Co ur t was "p art ic ul arl y tro ub le d by th e
ab se nc e of Sm i t h ' s medi cal reco rd s fro m th e co ur t reco rd ." Id

. Thi s Co ur t he ld "a

rev ie w of th e m ed ic al reco rd s is req ui red be fo re a de te rm in at io n ag ai ns t Sm it h is

m ad e." Id

. In th e in st an t m at te r, th e med i c a l r e co rd s are av ai la bl e an d All ard ha s

pr ov id ed an ex pe rt who te st ifi ed to th e st an da rd of care

. The reco rd de m on st rat es th e

CCF Heal th Serv ic es st aff di d no t ig no re All ard 's co m pl ai nt s or hi s ov eral l co nd it io n.

All ard 's m ed ic al reco rd s sh ow CCF Heal th Serv ic es st aff tri ed nu m ero us tre at m en ts

an d co ns ta nt ly res po nd ed to A l l a rd 's co m pl ai nt s wit h po te nt ia l rem ed ie s to tre at

-7

-co ns ti pa ti on

. In fact

, at va rio us ti m es All ard rep or te d to hi s he al th care pr ov id ers

va rio us tre at m en ts were pr ov id in g so me rel ie f. Alt ho ug h All ard rep or te d hi s
di sp le as ur e wit h th e or de red tre at m en ts

, a he al th care pr ov id er ne ed no t acce pt as tru e

m ed ic al jud gm en ts of

fere d by th ei r pa ti en ts bu t m us t m ak e tre at m en t de ci si on s on th e
ba si s of m an y fact or s, on ly on e of whi ch is pa ti en t's in pu t. Giv en s v. Jo ne s, 90 0 F.2 d

12 29 , 1 23 2 (8 th Ci r.19 90 ); se e al so Ph il li ps v. J as pe r Cn ty. Ja il , 4 37 F.3 d 79 1, 79 5
(8 th Ci r. 20 06 ) (h ol di ng m ere di sa gr eem en t wit h tre at m en t de ci si on s do es no t ris e to

le ve l of co ns ti tu ti on al vi ol at io n)

. In to t a l, vi ewin g th e ev id en ce in th e li gh t m os t

fav or ab le to All ard

, th e tre at m en ts pr ov id ed were no t so in e ffec ti ve as to be

cri m in al ly reckl es s an d t he refo re ri se to th e le ve l o f de li be rat e in di ffer en ce.

Fi na ll y , All ard arg ue s th e di sc ip li na ry a c t io n su pp or ts hi s de li be rat e

in di f f e r e n ce cl ai m

. Alt ho ug h a reas on ab le in fere nc e can be m ad e fro m th e
di sc ip li na ry act io ns th at th e pr is on he al th of fic ia ls di d no t be li ev e All ard was as si ck

as he cl ai m ed to be

, th is do es no t crea te a qu es ti on of m at eri al fact whi ch m us t be se nt

to a jury. It is no t fo r th is Co ur t to de te rm in e whe th er th e di sc ip li na ry act io n sh ou ld

ha ve be en fil ed

. The ev id en ce in fav or of th e CCF Heal th Serv ic es st aff on All ard 's
Eig ht h Am en dm en t cl ai m is st ro ng an d All ard ha s no t sh own ho w th e CCF req ui rin g

hi m to walk ris es to th e le ve l o f de li be rat e in di ffer en ce.

III

Alt ho ug h All ard de m on st rat es th e m ed ic al st aff at CCF fai le d to pr op erl y
di ag no se hi s bo wel ob st ru ct io n, an d al th ou gh All ard de m on st rat es th e fai lu re to tre at

th e bo wel ob st ru ct io n le d to a bo wel pe rfo rat io n, All ard fai ls to pu t fo rward ev id en ce

to su pp or t a fin di ng of de li be rat e in di ffer en ce. Acco rd in gl y , we affi rm th e jud gm en t.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

-8

-