United States Court of Appeals

For the Eighth Circuit

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No. 17-3786

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Timothy Barr

lllllllllllllllllllllPlaintiff - Appellant

v.

Rebecca Pearson, Nurse, Corizon, SECC; Brandi Juden, BSN, RN, Corizon,

SECC; Dana Degens; David Helman, RN, Corizon, SECC; Jewel Cofield; Mina

Massey, Medical Director; MD G. Babich; Kimberly Birch, N.P.; Nina Hill, N.P.

lllllllllllllllllllllDefendants - Appellees

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Appeal from United States District Court 

for the Eastern District of Missouri - Cape Girardeau

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Submitted: September 26, 2018

Filed: November 27, 2018

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Before SMITH, Chief Judge and MELLOY, Circuit Judge.1

MELLOY, Circuit Judge. 

This case was originally assigned to a three-judge panel consisting of Chief 1

Judge Smith, Judge Melloy, and Judge Stras. Judge Stras recused himself. This

opinion is filed by Chief Judge Smith and Judge Melloy under Eighth Circuit Rule

47E. 
Missouri Department of Corrections inmate Timothy Barr filed suit under

42 U.S.C. § 1983 alleging that various state-contracted health care providers

(“Defendants”) violated the Eighth Amendment when they stopped administering his

multiple sclerosis (“MS”) medication. The district court granted summary judgment

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in favor of Defendants, finding that their actions did not violate the Eighth

Amendment. We affirm. 

I. Background

The following information comes from a portion of Barr’s medical record that

was submitted to the district court. On May 21, 2014, neurologist Dr. Sudhir Batchu

diagnosed Barr with MS and prescribed Avonex for his symptoms. Barr began

receiving Avonex injections on June 10. He regularly received these injections until

October 2014. On October 10, 2014, Nurse Dana Degen noted that Barr refused his

Avonex injection because the “side effects [were] getting the best of [him].” A

separate October 10 entry by Nurse Practitioner Nina Hill indicatesthat Hill met with

Barr to discuss his MS diagnosis and his refusal of Avonex. Hill referred Barr to

mental health services for depression related to his diagnosis. On October 23, 2014,

Barr saw Dr. Kimberly Birch. During that session, they discussed his MS diagnosis. 

Dr. Birch noted that Barr’s case was “very complex.” She also noted that Barr had

refused Avonex due to its adverse side effects and that he felt “much better” while off

of the drug. At the conclusion of the session, Dr. Birch noted that she planned to

speak with her colleagues about Barr’s case and that she was going to request a

second opinion from a different neurologist. She also prescribed Aspirin and

requested an echocardiogram, which was performed on November 5. On November

11, Barr met with optometrist Dr. Lee Browning because he had been experiencing

blurry vision. After meeting with Barr, Dr. Browning noted that Barr was being

 The Honorable Abbie Crites-Leoni, United States Magistrate Judge for the

2

Eastern District of Missouri. 

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followed “for high suspicion of multiple sclerosis” but had discontinued taking

Avonex “on his own due to undesirable side effects.” That is the most recent entry

in the portion of Barr’s medical record that was submitted. 

Barr contests parts of his medicalrecord in his sworn affidavit. In the affidavit,

Barr admits that he had been experiencing “negative side effects” but states that he

never refused his Avonex injection. Rather, he states that “Defendants stop[ped]

giving [him] and prescribing medication to [him], on October 8, 2014.” He also

states that Hill and Dr. Birch told him that they did not think he had MS. Regardless,

both parties agree that after October 10, Barr stopped receiving Avonex injections. 

II. Standard of Review

This Court reviews a district court’s grant of summary judgment de novo.

Rooney v. Rock-Tenn Converting Co., 878 F.3d 1111, 1115 (8th Cir. 2018). 

Summary judgment is appropriate if “there is no genuine dispute as to any material

fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). 

In assessing whether a genuine dispute exists, the facts are viewed in the light most

favorable to the nonmoving party. Rooney, 878 F.3d at 1115. 

III. Analysis

The Eighth Amendment requires that inmates be provided with adequate

medical care. See Schaub v. VonWald, 638 F.3d 905, 914 (8th Cir. 2011). To

establish that a denial of medical care rises to the level of an Eighth Amendment

violation, an inmate must show that a defendant acted with deliberate indifference.

Id. The test for deliberate indifference consists of two prongs. Id. First, an inmate

must show that he “suffered from an objectively serious medical need.” Id. Second,

an inmate must show that the defendant knew of and deliberately disregarded that

need. Id. Deliberate disregard is a mental state “equivalent to criminal-law

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recklessness, which is ‘more blameworthy than negligence,’ yet less blameworthy

than purposely causing or knowingly bringing about a substantial risk ofserious harm

to the inmate.” Id. at 914–15 (quoting Farmer v. Brennan, 511 U.S. 825, 835, 839–40

(1994)). Showing medical malpractice is not enough: “[A] complaint that a physician

has been negligent in diagnosing or treating a medical condition does not state a valid

claimof medical mistreatment.” Estelle v. Gamble, 429 U.S. 97, 106 (1976). Rather,

an inmate must show that the provider disregarded “a known risk to the inmate’s

health.” Gordon ex rel. Gordon v. Frank, 454 F.3d 858, 862 (8th Cir. 2006). 

Significantly, while inmates have a right to adequate medical care, they have

no “right to receive a particular or requested course of treatment.” Dulany v.

Carnahan, 132 F.3d 1234, 1239 (8th Cir. 1997). Indeed, “doctors remain free to

exercise their independent medical judgment.” Id. Thus, “[a] prisoner’s mere

difference of opinion over matters of expert medical judgment or a course of medical

treatment fail[s] to rise to the level of a constitutional violation.” Meuir v. Greene

Cty. Jail Emps., 487 F.3d 1115, 1118–19 (8th Cir. 2007) (second alteration in

original) (citation omitted). 

Viewing the record in the light most favorable to Barr, Defendants’ decision

to halt Barr’s Avonex injections did not rise to a level akin to criminal recklessness.

See Farmer, 511 U.S. at 835. In fact, the decision was probably not even negligent. 

First, even assuming that Barr did not refuse his Avonex injections, Defendants still

had good reason to end them. Three different health care providers wrote in Barr’s

medical record that he had complained to them about Avonex’s side effects. Barr

does not dispute these facts. Indeed, Barr himself stated in his affidavit that he “was

taking treatment of Avonex for months, with all of it’s [sic] negative side effects.” 

Given these undisputed negative side effects, it was well within Defendants’

independent medical judgment to stop administering Avonex. Second, Barr does not

allege that any harm occurred after the injections ended. As noted, mere

disagreement with the course of treatment is not enough. Finally, even after Barr’s

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injections were halted, Appellees continued to provide medical care—prescribing

other medication, scheduling follow-ups, and requesting additional diagnostic tests. 

Ultimately, no rational trier of fact could find that Defendants were deliberately

indifferent. 

IV. Conclusion

We affirm the district court’s order granting summary judgment in favor of

Defendants. 

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