Source: https://www.prisonlegalnews.org/news/1996/sep/15/limited-interlocutory-appeals-in-medical-cases/
Timestamp: 2019-04-21 09:05:53+00:00

Document:
Filed under: Cardiovascular, Transplants, Civil Procedure, Appeals, Expert Witnesses, Qualified Immunity. Location: Missouri.
The court of appeals for the eighth circuit held that the law is clearly established that a heart transplant patient is entitled to reasonable medical care. Whether he actually received that care was a factual question it lacked jurisdiction to answer. In 1985 Edward Miller received a heart transplant. In 1989 he began serving a long sentence for the state of Missouri. Miller filed suit claiming that prison doctors did not provide him with the specialized and ongoing medical care he required as a heart transplant patient. The defendants sought summary judgment claiming that Miller had not produced evidence from which a jury could conclude that he was deprived of the necessary medical care, or that if he was, that they were responsible. They also claimed that Miller was not harmed by any neglect on their part, because he had not rejected the heart and was still alive. They also claimed that they were entitled to summary judgment on qualified immunity grounds. The district court rejected these arguments and the defendants filed an interlocutory appeal.
As a preliminary matter the court noted that it lacks jurisdiction to hear interlocutory appeals that challenge the sufficiency or adequacy of the evidence in the lower court, i.e., it cannot rule on factual disputes. Interlocutory appeals can only be filed by government defendants claiming they are entitled to qualified immunity from money damages. "That some issues must be reviewed in a qualified immunity appeal does not mean that we have jurisdiction to review all of the points addressed in the summary judgment motion. Only those issues that concern what the official knew at the time the alleged deprivation occurred are properly reviewed in this type of interlocutory appeal. We have jurisdiction to review these issues because their review is necessary in order to determine whether a reasonable state actor would have known that his actions, in light of those facts, would violate the law."
The court clarified this. "The question of what was known to a person who might be shielded by qualified immunity is reviewable, to determine if the known facts would inform a reasonable actor that his actions might violate an established legal standard--the right to speak freely, the right to be free from unreasonable searches and seizures, a prisoner's right to adequate medical care, for example. Conversely, if the issues relate to whether the actor actually committed the act of which he is accused, or damages, or causation, or other similar matters that the plaintiff must prove, we have no jurisdiction to review them in an interlocutory appeal of a denial of a summary judgment motion based on qualified immunity." The court held it could not rule on the bulk of the defendants' appeal in this case.
To succeed on an eighth amendment claim for medical indifference a prisoner must show that he had an objectively serious medical need and that prison officials knew about and disregarded that need. "Facts relating to the subjective component of the claim, unlike facts relating to the objective component of the claim, would inform a reasonable prison official whether his actions violated the Eighth Amendment's mandate that the State 'provide medical care for those whom it is punishing by incarceration....' We thus have jurisdiction to review whether sufficient evidence exists that the defendants actually knew of a need for specialized medical care and acted reasonably in light of that knowledge, the subjective component of the claim."
Analyzing the evidence presented in this case, including a medical expert retained by Miller, the court held that there was "ample evidence that Miller needed the care he claims he was denied." The court discussed the specific care required by heart transplant patients. The key question was whether the defendants had provided Miller with the care he needed at the time he needed it, not whether his medical care needs had changed over time. The court held that Miller had produced sufficient evidence to convince a jury that the defendants had been deliberately indifferent to his serious medical needs. Thus, the defendants were not entitled to qualified immunity. See: Miller v. Schoenen, 75 F.3d 1305 (8th Cir. 1996).
 On Appeal from the United States District Court for the Western District of Missouri.
 Edward Miller is an inmate at the Jefferson City Correctional Center in Missouri. In this lawsuit, brought under 42 U.S.C. Section(s) 1983 (1988), he alleges that the defendants deprived him of the care he required as a heart-transplant patient. This deprivation, in turn, it is said, deprived him of his Eighth Amendment right to be free from cruel and unusual punishment. The District Court,*fn1 adopting the report and recommendation of a Magistrate Judge,*fn2 held that Miller's evidence was sufficient to survive a summary-judgment motion, and that the defendants were not shielded from his claim by qualified immunity. The defendants now appeal that order. We lack jurisdiction to hear a portion of the appeal, and dismiss as to that portion. To the extent that we do have jurisdiction, we affirm the order of the District Court.
 We must first address the issue of our jurisdiction over this appeal. Ordinarily, we have no jurisdiction of an appeal challenging the denial of a motion for summary judgment. Johnson v. Jones, 115 S. Ct. 2151, 2154-55 (1995). Such orders are not final orders in the traditional sense. Ibid.; 28 U.S.C. Section(s) 1291 (1993). One exception to this rule occurs when a summary-judgment order denies a motion based on qualified immunity. Mitchell v. Forsyth, 472 U.S. 511, 530 (1985); Reece v. Groose, 60 F.3d 487, 489 (8th Cir. 1995). Qualified immunity shields state actors from liability in civil lawsuits when "their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known." Reece, 60 F.3d at 491 (quoting Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982)). As we discussed in Reece, however, the qualified-immunity question involves more than merely determining whether the law governing a plaintiff's claim is "clearly established." We must examine the information possessed by the government official accused of wrongdoing in order to determine whether, given the facts known to the official at the time, a reasonable government official would have known that his actions violated the law. Id. at 489; Anderson v. Creighton, 483 U.S. 635, 640 (1987).
 By way of example, whether an inmate has alleged sufficient facts to allow a jury to conclude that the inmate faces a risk of assault from other inmates, prison officials know of the risk, and the reasonableness of their actions in light of a known risk are all reviewable in an appeal of a denial of qualified immunity at the summary-judgment stage. Reece, 60 F.3d at 490. That much is so because prison officials must protect inmates from violence at the hands of other inmates, if they are aware of a substantial risk that such violence will occur. See Farmer v. Brennan, 114 S. Ct. 1970, 1984 (1994). That is the "clearly established" law. Examination of the facts known to the prison officials is necessary in order to determine whether a reasonable official would have known that his failure to take some particular action to protect the inmate would violate that law.
 On the other hand, if police officers who are accused of violating a plaintiff's rights by using excessive force when they arrested him move for summary judgment on the ground that they were not involved in the incident, we may not review that portion of the appeal as part of an appeal of a denial of qualified immunity. See Johnson, 115 S. Ct. at 2156. We have no jurisdiction over that portion of an appeal because whether the officers were actually involved is a factual question that does nothing to inform us about whether, given the facts known at the time, reasonable officers would have known that the level of force they employed was excessive. Such orders "determine only . . . question[s] of `evidence sufficiency,' i.e., which facts a party may, or may not, be able to prove at trial." Ibid.
 We are thus left with the following distinction. The question of what was known to a person who might be shielded by qualified immunity is reviewable, to determine if the known facts would inform a reasonable actor that his actions violate an established legal standard -- the right to speak freely, the right to be free from unreasonable searches and seizures, a prisoner's right to adequate medical care, for example. Conversely, if the issues relate to whether the actor actually committed the act of which he is accused, or damages, or causation, or other similar matters that the plaintiff must prove, we have no jurisdiction to review them in an interlocutory appeal of a denial of a summary-judgment motion based on qualified immunity.
 Applying these principles to the case before us, we hold that we lack jurisdiction over much of the defendants' appeal. Initially, the defendants argue that Miller has failed to identify evidence that these defendants were the doctors who actually deprived Miller of adequate care. This argument is no different from the one rejected by the Supreme Court in Johnson v. Jones. In Johnson the officers said that, even if the plaintiff had been subjected to excessive force, they did not do it. Id. at 2153. Here, the defendants are saying that, according to the evidence Miller has produced, if Miller's right to adequate medical care was abridged, someone else did it. The Supreme Court held that no jurisdiction existed in Johnson, id. at 2156, and we must do the same here.
 The defendants also argue that Miller has failed to put forth "verifying medical evidence" of a severe deprivation of medical care, as required by Beyerbach v. Sears, 49 F.3d 1324, 1326 (8th Cir. 1995). We held in Reece, however, that the Supreme Court's opinion in Johnson v. Jones overturned that portion of Beyerbach that held that we have jurisdiction to hear such an argument. Reece, 60 F.3d at 492. Whether there is verifying medical evidence that Miller failed to receive the treatment he desired, and, if he did not, whether there is verifying medical evidence that the failure to treat him was sufficiently serious, are questions beyond our jurisdiction in this interlocutory appeal.
 We do, however, have jurisdiction to hear a portion of the defendants' appeal. Miller asserts that the defendants violated his Eighth Amendment rights by failing to provide him with adequate medical care. In order to succeed, he must show that he had an objectively serious medical need, Estelle v. Gamble, 429 U.S. 97, 105 (1976), and that the defendants knew of and disregarded that need, Farmer, 114 S. Ct. at 1979. Facts relating to the subjective component of the claim, unlike facts relating to the objective component of the claim, would inform a reasonable prison official whether his actions violated the Eighth Amendment's mandate that the State "provide medical care for those whom it is punishing by incarceration." Estelle, 429 U.S. at 103. We thus have jurisdiction to review whether sufficient evidence exists that the defendants actually knew of Miller's need for specialized care and acted reasonably in light of that knowledge, the subjective component of the claim.
 Summary judgment is appropriate when there is no genuine issue of material fact that would allow a reasonable jury to find in favor of the non-moving party. Anderson v. Liberty Lobby, 477 U.S. 242, 247-48 (1986). In order to survive summary judgment in this case, Miller must point to evidence, admissible at trial, that would allow a reasonable jury to conclude that he had a particular medical need, and the defendants knew of this need. Fed. R. Civ. P. 56(c). The defendants may show that they acted without deliberate indifference in light of their knowledge of Miller's condition. Farmer, 114 S. Ct. at 1983. Those are the "material facts" in this appeal because they are the facts relevant to the defendants' qualified-immunity defense.
 Moreover, Miller points to specific incidents, involving infections that went untreated, where his medical needs were ignored. What he describes as a chronic ear infection was never treated.*fn3 Following surgery in 1993, he asserts, the area around his incision became infected. Several months passed before this infection was treated. One record actually indicates that this infection progressed to the point of swelling up and bursting before any action was taken.
 *fn1 The Hon. Scott O. Wright, United States District Judge for the Western District of Missouri.
 *fn2 The Hon. William A. Knox, United States Magistrate Judge for the Western District of Missouri.
 *fn3 The defendants claim that Miller never had an ear infection. Whether he did or not is a question of fact for the jury.

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