Opinion ID: 4567449
Heading Depth: 2
Heading Rank: 3

Heading: The Right to Medical Care

Text: The Supreme Court has long recognized that the government has a constitutional obligation to provide medical care to those whom it detains. See, e.g., Estelle v. Gamble, 429 U.S. 97, 104 (1976); Rhinehart v. Scutt, 894 F.3d 721, 736–37 (6th Cir. 2018); Blackmore v. Kalamazoo County, 390 F.3d 890, 895 (6th Cir. 2004). The Eighth and Fourteenth Amendments are violated “when the State by the affirmative exercise of its power so restrains an individual’s liberty that it renders him unable to care for himself, and at the same time fails to provide for his basic human needs—e.g., food, clothing, shelter, medical care, and reasonable safety.” DeShaney v. Winnebago Cty. Dep’t of Soc. Servs., 489 U.S. 189, 200 (1989); see Estelle, 429 U.S. at 103–04 (right to medical care under Eighth Amendment); Youngberg v. Romeo, 457 U.S. 307, 315–16 (1982) (medical care under Fourteenth Amendment for involuntarily committed mental patient); see also City of Revere v. Mass. Gen. Hosp., 463 U.S. 239, 244 (1983) (explaining that following arrest and before adjudication of guilt, due process rights to medical care “are at least as great as the Eighth Amendment protections available to a convicted prisoner”). “The Eighth Amendment’s prohibition on cruel and unusual punishment generally provides the basis to assert a § 1983 claim of deliberate indifference to serious medical needs, but where that claim is asserted on behalf of a pre-trial detainee, the Due Process Clause of the Fourteenth Amendment is the proper starting point.” Winkler v. Madison County, 893 F.3d 877, 890 (6th Cir. 2018) (quoting Phillips v. Roane County, 534 F.3d 531, 539 (6th Cir. 2008)); see Rouster v. County of Saginaw, 749 F.3d 437, 446 (6th Cir. 2014) (“The Eighth Amendment protection against deliberate indifference extends to pretrial detainees in state prisons by operation of the Due Process Clause of the Fourteenth Amendment.”); Blackmore, 390 F.3d at 895. This court has consistently applied the same “deliberate indifference” framework to Eighth-Amendment claims brought by prisoners as Fourteenth-Amendment claims brought by pretrial detainees. See, e.g., Rinehart, 894 F.3d at 737 (Eighth Amendment); Blackmore, 390 F.3d at 895 (Fourteenth Amendment); see also Richmond v. Huq, 885 F.3d 928, 937 (6th Cir. 2018) (“This Court has historically analyzed Fourteenth Amendment pretrial detainee claims and Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 13 Eighth Amendment prisoner claims ‘under the same rubric.’” (quoting Villegas v. Metro. Gov’t of Nashville, 709 F.3d 563, 568 (6th Cir. 2013))). This two-part framework contains both an objective component—a “‘sufficiently serious’ medical need”—and a subjective component—a “sufficiently culpable state of mind.” Blackmore, 390 F.3d at 895 (quoting Farmer v. Brennan, 511 U.S. 825, 834 (1994)).
“The objective component requires a plaintiff to prove that the alleged deprivation of medical care was serious enough to violate the [Constitution].” Rhinehart, 894 F.3d at 737. A sufficiently serious medical need “is ‘one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.’” Harrison v. Ash, 539 F.3d 510, 518 (6th Cir. 2008) (quoting Blackmore, 390 F.3d at 897). However, if the plaintiff has received medical attention and seeks redress based on the inadequacy of the care, “[t]here must be ‘medical proof that the provided treatment was not an adequate medical treatment of [the inmate’s] condition or pain.’” Rhinehart, 894 F.3d at 737 (second alteration in original) (quoting Santiago v. Ringle, 734 F.3d 585, 591 (6th Cir. 2013)). The district court found—and the parties do not dispute—that Griffith suffered from a sufficiently serious medical condition. Griffith suffered two seizures at the jail and a third after being transferred to a hospital, and he did not stabilize until he was airlifted to UK Hospital. Moreover, Griffith has introduced medical evidence that his treatment was inadequate. The expert report of Madeline LaMarre states: SHP nurses also failed to notify Dr. Waldridge or Jane Bartram APRN of his condition in accordance with SHP policy and procedures, treatment protocols, and as required by their scope of nursing practice. As a result, Mr. Griffiths’ [sic] condition deteriorated until he developed seizures and was transported emergently to the hospital. By the time he was admitted to the hospital he was in critical condition due to kidney failure and lactic acidosis. Report of Madeline LaMarre, R. 101-26 at PageID 4067. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 14 The report also states that “Mr. Griffith’s urinalysis was grossly abnormal showing proteinuria and hematuria which are indications of acute or chronic kidney injury, a potentially serious medical condition which required immediate medical evaluation and treatment.” Id. at PageID 4065. Thus, the only issue is whether Griffith satisfied the subjective component. As indicated, the district court held that pretrial detainees such as Griffith can satisfy the subjective component even without a showing of actual subjective knowledge.
To satisfy the subjective component under the Eighth Amendment, “the detainee must demonstrate that the defendant possessed a sufficiently culpable state of mind in denying medical care.” Winkler, 893 F.3d at 891 (quoting Spears v. Ruth, 589 F.3d 249, 254 (6th Cir. 2009)). Under this standard, “the plaintiff must show that each defendant acted with a mental state ‘equivalent to criminal recklessness.’” Rinehart, 894 F.3d at 738 (quoting Santiago, 734 F.3d at 591). “This showing requires proof that each defendant ‘subjectively perceived facts from which to infer substantial risk to the prisoner, that he did in fact draw the inference, and that he then disregarded that risk’ by failing to take reasonable measures to abate it.” Id. (quoting Comstock v. McCrary, 273 F.3d 693, 703 (6th Cir. 2001)); see Richmond, 885 F.3d at 939. To prove a defendant’s subjective knowledge, “[a] plaintiff may rely on circumstantial evidence . . . : A jury is entitled to ‘conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious.’” Rhinehart, 894 F.3d at 738 (quoting Farmer, 511 U.S. at 842). But “[a] doctor’s errors in medical judgment or other negligent behavior do not suffice to establish deliberate indifference.” Id. Accordingly, “[w]here the plaintiff has received some medical treatment, ‘federal courts are generally reluctant to second guess medical judgments and to constitutionalize claims which sound in state tort law.’” Burgess v. Fischer, 735 F.3d 462, 477 (6th Cir. 2013) (quoting Westlake v. Lucas, 537 F.2d 857, 860 n.5 (6th Cir. 1976)); see Rhinehart, 894 F.3d at 738 (“[W]hen a claimant challenges the adequacy of an inmate’s treatment, ‘this Court is deferential to the judgments of medical professionals.’” (quoting Richmond, 885 F.3d at 940). A plaintiff can nevertheless satisfy this standard by demonstrating that a medical professional “consciously expos[ed] the patient to an excessive risk of serious harm” in administering treatment, Richmond, 885 F.3d at 940 (quoting LeMarbe v. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 15 Wisneski, 266 F.3d 429, 439 (6th Cir. 2001)), or rendered medical care “so woefully inadequate as to amount to no treatment at all,” id. (quoting Asplaugh v. McConnell, 643 F.3d 162, 169 (6th Cir. 2011)). The text of the Eighth Amendment mandates this showing of subjective knowledge for claims brought by prisoners: “[t]he Eighth Amendment does not outlaw cruel and unusual ‘conditions’; it outlaws cruel and unusual ‘punishments.’” Farmer, 511 U.S. at 837. “[A]n official’s failure to alleviate a significant risk that he should have perceived but did not, while no cause for commendation, cannot . . . be condemned as the infliction of punishment.” Id. at 838; see Rhinehart, 894 F.3d at 736 (explaining that the requirement to establish a subjective component “all goes back to the text of the Eighth Amendment”). The Fourteenth Amendment, of course, does not contain the word “punishment.” See U.S. Const. amend. XIV. Moreover, the State does not detain individuals in order to impose “punishment” prior to a formal adjudication of guilt; the State is permitted to detain such persons before trial to “ensure[e] that persons accused of crimes are available for trials and, ultimately, for service of their sentences,” Bell v. Wolfish, 441 U.S. 520, 534 (1979), or to further other regulatory, nonpunitive interests, see United States v. Salerno, 481 U.S. 739, 746–47 (1987) (upholding Bail Reform Act because it allowed detention as an exercise of “permissible regulation” rather than “impermissible punishment”). Indeed, pretrial detainees cannot be punished at all, and there is accordingly “no need, as there might be in an Eighth Amendment case, to determine when punishment is unconstitutional.” Kingsley, 135 S. Ct. at 2475. Accordingly, the “proper inquiry” to evaluate the conditions of confinement for a pretrial detainee is “whether those conditions amount to punishment.” Wolfish, 441 U.S. at 535. The Court has instructed that “[a]bsent a showing of an expressed intent to punish on the part of detention facility officials, that determination generally will turn on ‘whether an alternative purpose to which [the challenged condition] may rationally be connected is assignable for it, and whether it appears excessive in relation to the alternative purpose assigned [to it].’” Id. at 538–39 (third alteration in original) (quoting Kennedy v. Mendoza-Martinez, 372 U.S. 144, 168–69 (1963)). Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 16 Despite these differences, we have nevertheless explained that it is appropriate to apply the Eighth Amendment standard to pretrial detainees because applying the Wolfish test would yield the same deliberate-indifference standard. See Roberts v. City of Troy, 773 F.2d 720, 724– 25 (6th Cir. 1985). In Roberts, we explained that the appropriate test under Wolfish is whether the challenged condition is reasonably related to a legitimate government objective. Id. at 723 (citing Wolfish, 441 U.S. at 535). We reasoned that this test is applied to determine whether prison officials are acting with improper punitive intent or pursuant to proper regulatory goals; thus, we concluded that “Bell v. Wolfish requires an intent to punish.” Id. at 725. Based on that straightforward logic—that the punitive intent required under Wolfish is the same “punishment” governed by the Eighth Amendment—we adopted the deliberate-indifference test wholesale for purposes of the Fourteenth Amendment. See id.; see also, e.g., Villegas v. Metropolitan Gov’t. of Nashville, 709 F.3d 563, 568 (6th Cir. 2013) (citing Roberts, 773 F.2d at 723); Daniels v. Woodside, 396 F.3d 730, 735 (6th Cir. 2005) (same); Blackmore, 390 F.3d at 895 (same). Griffith argues, and the district court held, that this approach is no longer appropriate in light of Kingsley. There, the Supreme Court held that a pretrial detainee could prevail on an excessive-force claim under the Fourteenth Amendment without proving that the defendant was subjectively aware that the force was excessive. See 135 S. Ct. at 2473. The Court divided the state-of-mind inquiry for an excessive force claim into two separate components. The first involves the state of mind as to the physical act that is alleged to be excessive. Id. at 2472. This inquiry remains subjective; the use of force itself must be deliberate, as opposed to accidental or negligent. Id. The second inquiry is the “state of mind with respect to the proper interpretation of the force,” or in other words, whether that force was excessive. Id. The Court held that this inquiry was objective, and a plaintiff need only show that the force used against him was “objectively unreasonable.” Id. at 2473. The Court also explained that an objective test is consistent with its Fourteenth Amendment jurisprudence. The Court’s precedents in this area have held that pretrial detainees cannot be subject to “the use of force that amounts to punishment.” Id. at 2473 (citing Graham v. Connor, 490 U.S. 386, 395 n.10 (1989)). The Court explained that “punishment” includes, clearly, an “expressed intent to punish.” Id. (discussing Wolfish, 441 U.S. at 540). But even Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 17 without an expressed intent to punish, “a pretrial detainee can . . . prevail by showing that the [challenged] actions are not ‘rationally related to a legitimate nonpunitive governmental purpose’ or that the actions ‘appear excessive in relation to that purpose.’” Kingsley, 135 S. Ct. at 2473 (quoting Wolfish, 441 U.S. at 561). It therefore reasoned that the Fourteenth Amendment inquiry in that context was already objective. Following Kingsley, the circuits have divided on whether an objective test similarly governs conditions-of-confinement claims brought under the Fourteenth Amendment. Compare Miranda v. County of Lake, 900 F.3d 335, 351–52 (7th Cir. 2018) (applying objective test under Kingsley); Darnell v. Pineiro, 849 F.3d 17 (2d Cir. 2017) (same); Castro v. County of Los Angeles, 833 F.3d 1060 (9th Cir. 2016) (en banc) (same), with Whitney v. City of St. Louis, 887 F.3d 857 (8th Cir. 2018) (holding that Kingsley did not modify the standard for FourteenthAmendment conditions-of-confinement claims); Nam Dang by and through Vina Dang v. Sheriff, Seminole Cnty Florida, 871 F.3d 1272, 1279 n.2 (11th Cir. 2017) (same); Alderson v. Concordia Parish Corr. Facility, 848 F.3d 415, 419 (5th Cir. 2019) (same). Our court has generally stayed out of the fray. We have found it unnecessary to answer the question each time we have confronted the issue, instead holding that the same result would obtain under either the subjective test dictated by Farmer or by a purely objective test derived from Kingsley. See, e.g., Martin v. Warren County, 799 F. App’x 329, 338 n.4 (6th Cir. 2020) (leaving the Kingsley question for another day because plaintiff could not prevail under either standard); Richmond, 885 F.3d at 938 n.3 (not addressing argument because it was not raised). The district court adopted the test from the Second Circuit and held that Griffith could prevail simply by showing that the defendants “recklessly failed to act with reasonable care to mitigate the risk that the [medical] condition posed to the pretrial detainee even though the defendant-official knew, or should have known, that the condition posed an excessive risk to health or safety.” Griffith, 2019 WL 1387691, at  (quoting Bruno v. City of Schenectady, 727 F. App’x 717, 720 (2d Cir. 2018)). It nevertheless held that Griffith failed to satisfy this lower requirement. See id. at . Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 18 We agree that Griffith cannot prevail under either test, and therefore reserve the question for another day.5 As we explain below, Griffith’s proof establishes, at most, a negligence claim sounding in state tort law. And “[w]hatever Kingsley requires, it is more than negligence.” Martin, 799 F. App’x at 338 n.4; see Kingsley, 135 S. Ct. at 2472 (“[L]iability for negligently inflicted harm is categorically beneath the threshold of constitutional due process.” (emphasis in original) (quoting County of Sacramento v. Lewis, 523 U.S. 833, 849 (1998))).6 Griffith argues that Defendants were deliberately indifferent because they failed to adequately monitor him for drug withdrawal, allowing his vomiting to progress to the point of dehydration. He argues that this dehydration led to his kidney failure which, in turn, caused his seizures. Griffith contends that RN Sherrow, LPN Trivette, and LPN Mundine are individually liable because they violated his constitutional rights. Further, Griffith contends that Dr. Waldridge and Jailer Rogers are individually liable under a theory of supervisor liability. Finally, Griffith asserts that SHP collectively and the County respectively are under a theory of Monell liability. We address the subjective component individually for each defendant. Rinehart, 894 F.3d at 738 (citing Garretson v. City of Madison Heights, 407 F.3d 789, 797 (6th Cir. 2005)). 5 Respectfully, we disagree with the dissent’s suggestion that we are “ignor[ing] Supreme Court precedent,” see Dissent at 8, by leaving the question for another day. See Martin, 799 F. App’x at 338 n.4; Richmond, 885 F.3d at 938 n.3. Instead, we simply find that Griffith could not prevail under either standard. As the Supreme Court has stated, “[i]f there is one doctrine more deeply rooted than any other in the process of constitutional adjudication, it is that we ought not pass on questions of constitutionality . . . unless such adjudication is unavoidable.” Spector Motor Serv. v. McLaughlin, 323 U.S. 101, 105 (1944); see Matal v. Tam, 137 S. Ct. 1744, 1755 (2017); Clinton v. Jones, 520 U.S. 681, 690 (1997) (“[W]e have often stressed the importance of avoiding the premature adjudication of constitutional questions.”); Burton v. United States, 196 U.S. 283, 295 (1905) (“It is not the habit of the court to decide questions of a constitutional nature unless absolutely necessary to a decision of the case.”); Torres v. Precision Indus., Inc., 938 F.3d 752, 754 (6th Cir. 2019) (“[Federal courts will not] decide questions of a constitutional nature unless absolutely necessary to a decision of the case or formulate a rule of constitutional law broader than is required by the precise facts to which it is to be applied.” (internal quotation marks omitted)). It is common practice to assume without deciding an issue—even a constitutional issue—that is unnecessary to the judgment. See, e.g., Chavez-Meza v. United States, 138 S. Ct. 1959, 1965 (2018); Nat’l Aeronautics and Space Admin. v. Nelson, 562 U.S. 134, 138 (2011). 6 It is clear that the constitutional standard must be something more than negligence. See, e.g., Martin, 799 F. App’x at 38 n.4. For that reason, we reject Griffith’s contention that even the Second Circuit’s standard the district court adopted is itself too high a burden after Kingsley because it requires the plaintiff to prove objective recklessness. Griffith essentially asks us to apply an ordinary negligence standard, and we decline to do so. See Kingsley, 135 S. Ct. at 2472. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 19