Opinion ID: 3062064
Heading Depth: 2
Heading Rank: 2

Heading: claims against defendant nafziger

Text: Defendant Nafziger presented evidence, uncontroverted by competent evidence from plaintiff, establishing the following material facts. He was clinical director at Florence from January 2007 through February 2008. R. Vol. 1 at 306. In July 2007 he noted that plaintiff, who had chronic Hepatitis C, was due for blood testing. Id. at 308-09. Most persons with chronic Hepatitis C remain healthy, but a small number develop serious liver disease. Id. at 309. Thus, they are typically monitored by testing, id. at 309-10, and may be treated with antiviral medication depending on the physician’s judgment about the appropriateness and optimal timing for such treatment, which is not always effective, carries adverse risks, and may be superseded by better treatments in the future, id. at 310. When the initial test results were suggestive of advancing liver disease, id. at 308, defendant Nafziger recommended that plaintiff be seen in the prison’s -11- Chronic Care Clinic, id. at 309. Such clinics are used to monitor inmates with ongoing medical needs like chronic hepatitis, which require periodic evaluation at clinically appropriate intervals. Id. at 308. Plaintiff had refused to go to the clinic in 2003, 2004, 2005. Id. This time he went to the clinic and defendant Nafziger ordered more testing. Id. In addition, he was sent for a psychological consultation required before starting treatment with Interferon and Ribavirin due to adverse side effects. Id. at 310. Shortly thereafter, in October 2007, defendant Nafziger recommended to the Medical Director at the BOP Central Office that plaintiff be approved for treatment. Id. at 310-11. He did not have authority to approve the treatment himself, id. at 311, and there was nothing more he could do to speed up the process, id. The delay awaiting approval was typical for such a request, id. at 312, and at the time he terminated his employment with BOP a few months later, “[p]laintiff had not and did not face a substantial risk of harm from the lack of Interferon/Ribavirin treatment in [his] medical opinion,” id. A. Failure to Obtain Interferon/Ribavirin Treatment The standard for Eighth Amendment claims of deliberate indifference to prisoner health and safety needs was clarified in Farmer v. Brennan, 511 U.S. 825 (1994). In Farmer, the Court specified a two-pronged inquiry, with an objective component concerned with the seriousness of the need at issue and a subjective component concerned with the defendant’s culpable state of mind. Id. at 834. -12- The district court’s disposition in the instant case turned on the subjective component, so that is where we will focus our analysis. The Farmer Court made it clear that the subjective component is not satisfied “unless the [prison] official knows of and disregards an excessive risk to inmate health or safety; the official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Id. at 837. The Court likened the subjective component to “recklessness in the criminal law,” in that the defendant “must consciously disregard a substantial risk of serious harm.” Id. at 837, 839 (internal quotation marks omitted). The Supreme Court had already emphasized in its initial decision recognizing deliberate indifference claims, Estelle v. Gamble, 429 U.S. 97 (1976), that “a complaint that a physician has been negligent in diagnosing or treating a medical condition does not state a valid claim of medical mistreatment under the Eighth Amendment,” since “[m]edical malpractice does not become a constitutional violation merely because the victim is a prisoner.” Id at 106. As our cases reflect, when medical judgment is involved “the subjective component is not satisfied, absent an extraordinary degree of neglect.” Self v. Crum, 439 F.3d 1227, 1232 (10th Cir. 2006). We agree with the district court that plaintiff has not demonstrated the existence of a triable case under these principles. The facts recited above show a medically reasonable course of conservative treatment, followed by a prompt -13- response by defendant Nafziger when tests he ordered indicated a possible acute turn in plaintiff’s hitherto chronic condition. Further testing and evaluation led to his recommendation for the treatment plaintiff seeks. The required authorization remained pending when he left the employ of BOP four months later, and he averred without contradiction that this limited delay was neither unusual nor, in his medical judgment, a matter giving rise to a substantial risk of harm to plaintiff. Whether or not other medical professionals would have followed the same course with a similar patient (and there is no basis in the record to conclude they would not), we see no reasonable basis for a jury to infer that defendant Nafziger knew of and deliberately disregarded a substantial risk of harm to plaintiff. If there has been any constitutional violation with regard to plaintiff’s medical treatment during his ongoing federal confinement, it was not at the hands of defendant Nafziger during the fairly short period of time at issue here. B. Exhaustion of New Claims Asserted in Amended Complaint Plaintiff interjected three new claims against defendant Nafziger in his amended complaint, alleging that he failed to (1) vaccinate plaintiff, leading to plaintiff’s contraction of Hepatitis B; (2) ensure that plaintiff received proper medical care after defendant Nafziger left the BOP; and (3) provide adequate medical care generally. The district court dismissed these claims without prejudice for lack of exhaustion. -14- Congress has directed that no suit over prison conditions may be brought “until such administrative remedies as are available are exhausted.” 42 U.S.C. § 1997e(a). This requirement applies to federal prisoners. Garrett v. Hawk, 127 F.3d 1263, 1265 (10th Cir. 1997), abrogated on other grounds as explained in Yousef v. Reno, 254 F.3d 1214, 1216 n.1 (10th Cir. 2001). As the magistrate judge discussed, defendants submitted an affidavit from an attorney employed at Florence who is familiar with its administrative remedy process and who has access to the database that tracks inmates’ complaints and appeals. See R. Vol. 1 at 314-17; see also id. at 321-33 (attached printout from database). The attorney notes that plaintiff exhausted his original claim about the Interferon/Ribavirin treatment, see id. at 317, but not any of the newly asserted claims, id. at 318. As plaintiff has not presented any competent evidence to controvert this showing, the dismissal of these claims under § 1997e(a) for failure to exhaust was correct. -15- The district court’s judgment is AFFIRMED in all respects except that the claim against defendant Lappin is REMANDED to be modified to a dismissal without prejudice. Appellant’s motion to proceed on appeal without prepayment of fees is GRANTED. He is reminded of his continued obligation to continue making partial payments until the filing fee is paid in full. Entered for the Court Stephen H. Anderson