# U ni te d S ta te s Co ur t of A pp ea ls For the Eig hth Circu it

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No. 1 7- 37 86

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Tim ot hy Barr

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

ff - App el la nt

v.

Reb ecca Pear so n, Nu rs e, Co riz on , SECC; Bran di Ju de n, BS N, RN, Cori zo n, SECC; Dana Dege ns ; Dav id Helm an , RN, Cor iz on , SECC; Jewe l Co fie ld ; M in a Mas se y , Med ic al Dire ct or ; M D G. Babi ch ; Ki m be rly Birch , N.P.; Nin a Hil l, N.P.

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 Eas te rn Dis tri ct of M is so ur i - C ap e Gir ard eau

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Su bm it te d: Sep te m

be r 26 , 20 18 Fi le d: Nov em

be r 27 , 20 18

__ __ __ __ __ __ Befo re SM ITH, Chi ef J ud ge an d M ELLOY, Cir cu it Ju dg e. 1

MELLOY, Circu it Ju dg e.

Thi s case was or ig in al ly ass ig ne d to a th ree- jud ge pa ne l con si st in g of Chi ef 1 Ju dg e Sm it h, Ju dg e Mel lo y , an d Ju dg e St ras

. Ju dg e St ras recu se d hi m se lf. Thi s op in io n is fil ed by Ch ie f Ju dg e Sm it h a n d J u dg e Mel lo y un de r Eig ht h Ci rcu it Ru le 47 E.Mi ss ou ri Dep art m en t of Co rrec ti o n s in m at e Tim ot hy Barr fil ed su it un de r

42 U.S.C. § 19 83 a l l e g i ng th at va rio us st at e-co nt ract ed he al th care pr ov id ers (“ Defen da nt s” ) vi ol at ed th e Eig ht h Am en dm en t whe n th ey st op pe d ad m in is te rin g hi s

m ul ti pl e sc le ro si s (“ MS” ) m ed ic at io n. The di st ric t co ur t gr an te d su m m ary jud gm en t 2
in fav or of Defen da nt s, fin di ng th at th ei r act io ns di d no t vi ol at e th e Ei gh th
Am en dm en t. We affir m

.

I. Back gr ou nd

The fo ll owi ng in fo rm at io n co m es fro m a po rti on of Barr ’s m ed ic al reco rd th at

was su bm it te d to th e di st ric t co ur t. On May 21
, 20 14
, ne ur ol og is t Dr. Su dh ir Bat ch u di ag no se d B a r r wit h MS an d pr es cri be d Avo ne x fo r hi s sym pt om s. Barr be ga n

rece iv in g Avo ne x in

jecti on s on Ju ne 10

. He reg ul arl y rece iv ed th es e in jecti on s un ti l
Octo be r 20 14

. On Octo be r 10
, 20 14
, Nur se Dan a Deg en no te d th at Barr refu se d hi s Avo ne x in

jecti on be cau se th e “ si de effe ct s [were ] ge tt in g th e be st of [h im ]. ” A

se pa rat e Octo be r 10 en try by Nur se Prac ti ti on er Nin a Hil l in di cat es th at Hil l m et wit h
Barr to di sc us s hi s MS di ag no si s an d hi s refu sa l of Avo ne x. Hil l refe rred Barr to

m en ta l he al th se rv ic es fo r de pr es si on rel at ed to hi s di ag no si s. On Octo be r 23
, 20 14
, Barr sa w Dr. Kim

be rly Bi rch

. Dur in g th at se ss io n, th ey di sc us se d hi s MS di ag no si s. Dr. Bi rch no te d th at Barr ’s c as e was “ ve ry co m pl ex .” Sh e al so no te d t ha t Barr ha d refu se d Avo ne x du e to it s ad ve rs e si de effe ct s an d th at he fel t “ m uc h be tt er” whi le of

f of t h e d r u g

. At th e co nc lu si on of th e se ss io n, Dr. Bi rch no te d th at sh e pl an ne d to
sp eak wit h he r c o l l e a g ue s ab ou t Barr ’s cas e an d th at sh e was go in g to req ue st a

se co nd o p i n i o n fro m a di ffer en t ne ur ol og is t. Sh e al so pr es cri be d Asp iri n an d

req ue st ed an ech oc ard io gr am , whi ch was pe rfo rm ed on Nov em be r 5. On Nov em

be r 11 , Barr m et wit h o pt om et ris t Dr. L ee Br own in g b ecau se he ha d b een ex pe rie nc in g bl ur ry vi si on

. Afte r m eet in g wit h Barr
, Dr. Bro wni ng no te d th at Bar r w a s be in g

The Ho no rab le Abb ie Cri te s- Leo ni , Uni te d S ta te s M ag is tra te Ju dg e fo r th e 2 East ern Dis tri ct of M is so ur i.

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-fo ll owe d “ fo r hi gh su sp ic io n of m ul ti pl e sc le r o s is ” bu t ha d di sc on ti nu ed ta ki ng Avo ne x “ on hi s o wn d ue to un de si rab le si de effe ct s.” Th at is th e m os t rece nt en try in th e p or ti on of B arr’s m ed ic al reco rd th at was s ub m it te d.

Barr co nt es ts pa rts of hi s m ed ic al reco rd in hi s swo rn affi da vi t. In th e affi da vi t, Barr ad m it s th at he ha d b een ex pe rie nc in g “ ne ga ti ve si de effe ct s” bu t st at es th at he

ne ve r refu se d hi s Avo ne x in jecti on

. Rat he r, he st at es th at “ Defen da n t s st op [p ed ] gi vi ng [h im ] an d pr es cri bi ng m ed ic at io n to [h im ], on Octo b e r 8
, 20 14 .” He al so
st at es th at Hil l an d Dr. Bi rch to ld hi m th at th ey di d no t th in k he ha d MS. Reg ard le ss , bo th pa rti es ag ree th at aft e r Octo be r 10 , B arr st op pe d rece iv in g Avo ne x in jecti on s.

II. St an da rd of R ev ie w

Thi s Co ur t rev ie ws a di st ric t co ur t’s gr an t of su m m ary jud gm en t de no vo

. Ro on ey v. Ro ck -Ten n Co nv ert in g C o

. , 87 8 F.3 d 11 11
, 11 15 (8 th Ci r. 20 18 ).
Su m m ary jud gm en t is ap pr op ria te if “ th ere is no ge nu in e d is pu te as t o a ny m at eri al fact an d th e m ov an t is 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 as se ss in g wh et he r a ge nu in e di sp ut e ex is ts , th e fact s are viewe d in th e li gh t m os t fav or ab le to th e n on m ov in g p art y . Roo ne y , 87 8 F .3d at 1 11 5.

III. An al y si s

The Eig ht h Am en dm en t req ui res th at in m at es be pr ov id ed wit h ad eq ua te med i c a l c a r e

. See Sch au b v. Von W al d, 63 8 F.3 d 90 5, 91 4 (8 th Ci r. 20 11 ). To

es ta bl is h th at a de ni al of m ed ic al care ris es to th e le ve l of an Eig h t h A men dm en t vi ol at io n, an in m at e m

us t s h o w t ha t a de fen da nt act ed wit h de li be rat e in di ffer en ce. Id . The t es t fo r de li be rat e in di ffer en ce co ns is ts of t wo p ro ng s. Id. Fi rs t, an inm at e

m us t sh ow th at he “ su ffer ed fro m an ob jecti ve ly se rio us m ed ic al ne ed .” Id

. Seco nd
,
an in m at e m

us t sh o w th at th e de fen da nt kn ew of an d de li be rat el y di sr eg ard ed th at

ne ed

. Id

. Deli be rat e di sr eg a r d is a m en ta l st at e “ eq ui va le nt to cri m in al -la w

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-reck le ss ne ss , whi ch is ‘m or e bl am ewo rth y th an ne gl ig en ce,’ y et le ss bl am ewo rth y

th an pu rp os el y cau si ng or kn owi ng ly br in gi ng ab ou t a su bs ta nt ia l ris k of se rio us ha rm
to th e in m at e.” Id

. at 91 4– 15 (q uo ti ng Farm er v. Bren na n, 51 1 U.S. 82 5, 83 5, 83 9– 40 (1 99 4) ). Sh owi ng m ed ic al m al pr act ic e is no t en ou gh : “ [A] co m pl ai nt th at a ph y si ci an ha s be en ne gl ig en t in di ag no si ng or tre at in g a m ed ic al co nd it io n do es no t st at e a va li d cl ai m of m ed ic al m is tre at m en t.” Est el le v. Gam bl e, 42 9 U.S. 97
, 10 6 (1 97 6)

. Rat he r,

an in m at e m

us t sh ow th at th e pr ov id er di sr eg a r d e d “a kn own ris k to th e in m at e’s he al th .” Gord on ex rel . Gord on v. Fra nk , 45 4 F .3d 85 8, 8 62 (8t h C ir. 2 00 6)

.

Si gn ifi can tl y , whi le in m at es ha ve a ri gh t t o a de qu at e m ed ic al care , th ey ha ve

no “ rig ht to rece i v e a pa rti cu la r or req ue st ed co ur se of tre at m en t.” Dul an y v. Carn ah an , 13 2 F.3 d 12 34
, 12 39 ( 8 t h C i r. 19 97 ). In de ed
, “ do ct or s rem ai n free to

ex erci se t h e i r in de pe nd en t m ed ic al jud gm en t.” Id

. Thu s, “ [a] pr is on er’s m ere di ffer en ce of op in io n ov er m at te rs of ex pe rt m ed ic al jud gm en t or a co ur se of m ed ic al

tre at m en t fai l[s ] to ris e to th e le ve l of a co ns ti t u t i o n a l vi ol at io n.” Meu ir v. Green e Ct y

. Ja il Em

ps ., 48 7 F.3 d 11 15
, 11 18 –1 9 (8 th Ci r. 20 07 ) (s eco nd al te rat io n in

or ig in al ) (ci ta ti on om it te d)

.

Viewi ng th e reco rd in th e li gh t m os t fav or ab le to Barr
, D e fen da nt s’ d eci si on
to ha lt Barr ’s Avo ne x in

jecti on s di d no t ris e to a le ve l ak in to cri m in al reck le ss ne ss

. See Farm er, 511 U.S. at 83 5. In fact
, th e de ci si on was pr ob ab ly no t even ne gl ig en t. Fi rs t, ev en as su m in g th at Barr di d no t refu se hi s Avo ne x in jecti on s, Defen da nt s st il l ha d g oo d re as on to en d t he m . Three di ffer en t h eal th care pro vi de rs wrot e in Barr ’s

m ed ic al reco rd th at he ha d co m pl ai ne d to th em ab ou t Avo ne x’s si de effe ct s. Barr do es no t di sp ut e th es e fact s. In de ed
, Barr hi m se lf st at ed in hi s affi da vi t th at he “ was
ta ki ng tre at m en t of Avo ne x fo r m on th s, wit h al l of it ’s [s ic ] ne ga ti ve si de effe ct s.” Giv en th es e un di sp ut ed ne ga ti ve si de effe ct s, it was wel l w i t h i n Defen da nt s’ in de pe nd en t m ed ic al jud gm en t to st op ad m in is te rin g Avo ne x. Seco nd
, Barr do es no t al le ge th at an y ha rm oc cu rred aft er th e i n jecti on s en de d. As no te d, m ere di sa gr eem en t wi th th e co ur se of tre at m en t i s n ot en ou gh . Fin al ly, ev en aft er Ba rr’s

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-in

jecti on s were ha lt ed
, App el le es co nt in ue d to p ro vi de m ed ic al care —p res cri bi ng
ot he r m ed ic at io n, sc he du li ng fo ll ow- up s, an d req ue st in g ad di ti on al di ag no st ic te st s. Ult im at el y , n o r a ti on al tri er of fact co ul d fin d th at Defen da nt s were de li be rat el y in di ffer en t.

IV. Co nc lu si on

W e affi rm th e di st ric t co ur t’s or de r gr an ti ng su m m ary jud gm en t in fav or of Defen da nt s.

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