Opinion ID: 2972579
Heading Depth: 2
Heading Rank: 3

Heading: deliberate indifference claims against

Text: CAPTAIN BIGCRAFT, NURSE GILBERT, AND DEPUTY WARDEN HOWELL
Qualified immunity is not merely a defense to be raised in response to a plaintiff’s claims. Rather, where it applies, qualified immunity shields government officials from enduring a lawsuit 11 No. 03-2446 / 03-2461 in the first instance. Thus, when the district court rejects an official’s assertion of qualified immunity, it makes a purely legal determination, which we review de novo. See Solomon v. Auburn Hills Police Dept., 389 F.3d 167, 172 (6th Cir. 2004); Scott v. Churchill, 377 F.3d 565, 569 (6th Cir. 2004); Tucker v. City of Richmond, Ky., 388 F.3d 216, 219 (6th Cir. 2004); Virgili v. Gilbert, 272 F.3d 391, 392 (6th Cir. 2001).
Qualified immunity “is conceptually distinct from the merits of the plaintiff’s claim.” Mitchell v. Forsyth, 472 U.S. 511, 527 (1985). It is “an entitlement not to be forced to litigate the consequences of official conduct.” Id. “The entitlement is an immunity from suit rather than a mere defense to liability; and like an absolute immunity, it is effectively lost if a case is erroneously permitted to go to trial.” Id. at 526. In defining this entitlement, the Supreme Court has held that “government officials performing discretionary functions generally are shielded from liability for civil damages insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). In 2001, the Court established a two-part test for determining whether qualified immunity applies. Saucier v. Katz, 533 U.S. 194, 201 (2001). In the initial inquiry, we must consider whether, “[t]aken in the light most favorable to the party asserting the injury, . . . the facts alleged show the officer’s conduct violated a constitutional right.” Id. If the facts as alleged by the claimant fail to establish a constitutional violation, then immunity applies. On the other hand, if the alleged facts sufficiently 12 No. 03-2446 / 03-2461 demonstrate a constitutional violation, we must then determine “whether the right was clearly established.” Id. Captain Bigcraft, Nurse Gilbert, and Deputy Warden Howell all concede that it is “clearly established” that deliberate indifference to an inmate’s serious medical needs violates the Eighth Amendment’s protection against cruel and unusual punishment. Further, these Defendants do not contest the district court’s determination that Cook had a serious medical need. Thus, on appeal this court need only decide whether pursuant to the alleged facts these Defendants’ conduct demonstrates deliberate indifference. The Supreme Court has clearly held that “deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain proscribed by the Eighth Amendment.” Estelle v. Gamble, 429 U.S. 97, 104 (1976) (internal quotations and citation omitted). Deliberate indifference takes many forms. A plaintiff can show such indifference when prison guards intentionally deny or delay access to medical care or when prison doctors fail to respond appropriately to the prisoner’s needs. Id. The Supreme Court discussed deliberate indifference in prison-conditions cases in Farmer v. Brennan, 511 U.S. 825 (1994), stating that deliberate indifference “describes a state of mind more blameworthy than negligence,” id. at 835, but also that it constitutes “something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result,” id. Thus, the Court set forth the following subjective recklessness test for deliberate indifference: a prison official cannot be found liable under the Eighth Amendment for denying an inmate humane conditions of confinement unless the official knows of and disregards an excessive risk to inmate health or safety; the official must both be aware of facts 13 No. 03-2446 / 03-2461 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. Finally, [w]hether a prison official had the requisite knowledge of a substantial risk is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence . . . and a factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious. Id. at 842.
Construing the facts in the light most favorable to Cook, the district court held that Cook had established that Captain Bigcraft “recognized [Cook’s] need [for medical attention], but failed to act in a timely or appropriate fashion.” J.A. at 559. Captain Bigcraft contests the holding of the district court on the theory that he acted reasonably by summoning Nurse Gilbert, relying on her medical training and expertise, and having Cook transferred to the prison hospital. Although Captain Bigcraft alleges that he took these actions “in a timely fashion,” the facts alleged by Cook contradict Bigcraft’s representation of timeliness. When MDOC officers first escorted Cook to Captain Bigcraft, Captain Bigcraft quickly noted that Cook’s behavior was peculiar, and that Cook appeared dizzy, weak, and disoriented. In fact, during this first encounter, Captain Bigcraft so appreciated Cook’s obviously unhealthy condition that he saw a need to stand behind Cook to keep Cook from falling. Captain Bigcraft further recorded in his report that in response to his commands Cook gave affirmative answers to commands, followed immediately by irrational responses. Although Captain Bigcraft summoned Nurse Gilbert on the basis of Cook’s actions, he simultaneous ordered other officers to shackle Cook, to strap him into a restraining chair, 14 No. 03-2446 / 03-2461 and to mask him. While Captain Bigcraft contends that the restraining chair and mask resulted from Cook’s attempt to “escape” and his spitting at the officers, the district court, after viewing the videotape, came to a different conclusion. Upon observing the tape, the district court opined that a reasonable jury could conclude that Cook’s need for serious medical treatment was obvious and that his attempt to run out of the door was related to his clearly disoriented state. Further, the district court observed from the videotape that Cook was not attempting to spit on the officers because Cook spat primarily in a forward motion, yet the officers were mainly positioned behind him. Captain Bigcraft also acknowledges that Cook became immediately unresponsive once he was placed in the restraining chair. Despite Cook’s obvious unresponsive state, Captain Bigcraft delayed for several hours before taking any steps to have Cook transported to DWH. The district court concluded that “reasonable jurors could find that Bigcraft’s claim that he did not believe that [Cook] was in need of medial attention until he had been strapped in the chair for several hours is contrary to his admitted observations of [Cook].” J.A. at 561. We agree. Viewing all of the above evidence in the light most favorable to Cook, we conclude that a reasonable jury could find that Cook has demonstrated that Captain Bigcraft was deliberately indifferent to his serious medical needs and that Captain Bigcraft’s responses were objectively unreasonable under these circumstances.
The district court also determined that Cook could establish deliberate indifference by Nurse Gilbert. On appeal, Nurse Gilbert contends that the district court erred in denying her qualified immunity because “there are no facts to support that she drew the inference that her conduct posed 15 No. 03-2446 / 03-2461 a substantial risk of serious harm to Cook,” Defs.-Appellant’s Br. at 22, and she merely “exercised her professional judgment in treating Cook,” id. at 25. In sum, Nurse Gilbert’s claim is that she cannot be liable for deliberate indifference where the facts alleged prove, at most, that she acted negligently in failing to diagnose Cook’s condition. Negligence, Gilbert says, is an insufficient basis upon which to ground an Eighth Amendment violation of cruel and unusual punishment. We agree with Nurse Gilbert that Cook must show something more than mere negligence in his attempt to hold her liable in the instant case. A plaintiff may establish deliberate indifference, however, by a showing of grossly inadequate medical care. Terrance v. Northville Regional Psychiatric Hosp., 286 F.3d 834, 843 (6th Cir. 2002) (“‘deliberate indifference may be established by a showing of grossly inadequate care as well as a decision to take an easier but less efficacious course of treatment’”); see also Tate v. Coffee County, Tennessee, 48 Fed. Appx. 176, 180 (6th Cir. 2002) (“a medical professional’s failure to perform any of the tests that would be routinely conducted under similar circumstances rises above the level of simple negligence and can support a finding of deliberate indifference”); Comstock v. McCrary, 273 F.3d 693, 711 (6th Cir. 2001) (finding that doctor’s evaluation of inmate was “grossly inadequate” where doctor failed to review suicidal inmate’ psychological records and failed to comply with department of corrections policies on suicide prevention). In the present case, Cook has asserted facts from which a fact finder could reasonably conclude that his urgent need for medical care was obvious, and Nurse Gilbert failed to respond in an objectively reasonable manner. Cook has pled facts from which a reasonable jury could find that Gilbert acted with deliberate indifference by providing grossly inadequate medical care. 16 No. 03-2446 / 03-2461 More specifically, Cook has produced evidence demonstrating that Gilbert had a responsibility, as the on-duty nurse at the time of his arrival at boot camp, to complete a health history form on him, prepare an intake history and screening form, and take his vital signs. Gilbert concedes that she did not take these actions upon Cook’s arrival at the Cassidy Lake boot camp. Had Gilbert fulfilled her duties in this regard, she likely would have discovered that Cook first became ill in the Manistee County Jail. After Captain Bigcraft summoned Gilbert to examine Cook, she was made aware that he had been unable to complete the three-mile run. A jury could also reasonably conclude that Gilbert was aware of the high temperature outside on the day in question. (Cook has alleged that the temperature was approximately ninety-five degrees.) Gilbert observed him in the restraint chair for more than an hour. In fact, she made cursory checks on him, often at the request of other officers, during which she limited her “examinations” to taking his pulse, checking his fingers for capillary refill, and perfunctory inspections of his restraints. Gilbert also noted that Cook’s heart rate was elevated, and remained elevated despite his lethargic and possibly unconscious state in the restraining chair. Perhaps more important are the obvious actions Gilbert failed to take in her various “examinations” of Cook. While the officers later reported to DWH personnel that Cook received a wound on his forehead when he tried to “escape,” Gilbert never examined or treated that wound. Although Cook’s entire face was covered by a mask, a jury could conclude that Gilbert failed to respond reasonably because she never removed Cook’s mask during all of her “examinations” of him. Despite his elevated heart rate and lethargic or unconscious state, Gilbert apparently never examined Cook’s eyes. Considering all of the above facts together, we believe that a jury could 17 No. 03-2446 / 03-2461 reasonably conclude that Nurse Gilbert was deliberately indifferent to Cook’s obvious serious medical needs.
The district court similarly determined that Deputy Warden Howell was not entitled to the protections of qualified immunity. Howell contends on appeal primarily that he cannot be held liable for the actions of his subordinates and that he had no personal involvement in Cook’s treatment on the day in question. Although Howell correctly states that a supervisor may not be made liable for the acts of his subordinate, this circuit has held that supervisors may be liable where they “implicitly authorized, approved, encouraged, condoned or knowingly acquiesced in” the actions of their subordinates. Taylor v. Mich. Dept. of Corrections, 69 F.3d 76, 81 (6th Cir. 1995). In the present case, Cook has presented evidence that Howell had a responsibility to authorize or deny the use of the restraint chair. The evidence further demonstrates that Captain Bigcraft ordered Cook into the restraining chair without waiting for proper authorization from Howell, and that Bigcraft informed Howell of his use of the restraint chair on at least two occasions on the evening in question. Despite being advised that Bigcraft had used the restraint chair without proper authorization, there is no evidence that Howell took any steps to personally assess Bigcraft’s actions or the efficacy of continuing to use the restraint chair. On this record, Cook has alleged facts and produced evidence sufficient to establish that Howell was made aware of his placement in the restraint chair, but that Howell acquiesced in Captain Bigcraft’s use of the chair. Howell’s failure 18 No. 03-2446 / 03-2461 to properly supervise his subordinates, especially where he has a clear obligation to do so, subjects him to potential liability in the present case.