Opinion ID: 3066199
Heading Depth: 2
Heading Rank: 5

Heading: B.1 (June 18, 2008).

Text: 13 I have not been able to locate exact rules for Hawaii, Idaho and Montana. Idaho has a general rule that “[a]ny extraordinary treatment shall be approved by the health authority prior to treatment.” Idaho Admin. Code 06.01.01.302.05.c (2014). Montana has a different approach: “All residents [at community correctional centers] shall pay for their own . . . medical and dental expenses.” Mont. Admin. R. 20.7.204(1) (1982). Similarly, inmates incarcerated in Hawaii are responsible for a medical co-payment for many types of treatment, and must pay the full cost of elective procedures. Hawaii Dep’t of Public Safety, Policy No. COR.10.1A.13 (2010). 46 COLWELL V. BANNISTER Colwell’s case evidences the fact that NDOC makes individualized, case-by-case assessments, as required by Medical Directive 106, because Colwell received cataract removal surgery on his left eye in 2000 despite the fact that he had vision in both eyes. Nevada’s policy,14 which is consistent with that of other jurisdictions, both federal and state, is not a blanket “one good eye” policy. B If NDOC does not have a policy of not treating cataracts, then we need to consider the facts of Colwell’s case. In Estelle, the Supreme Court held that “a prisoner must allege acts or omissions sufficiently harmful to evidence deliberate indifference.” 429 U.S. at 106. We have held that deliberate indifference requires a showing that failure to treat an inmate’s condition “could result in further significant injury or the unnecessary and wanton infliction of pain.” Jett, 439 F.3d at 1096 (internal quotation marks omitted). Judged by that standard, prison officials have not been deliberately indifferent to Colwell’s condition. Colwell has been blind in his right eye since 2002, and his condition has not worsened since then. During the time that he had the cataract, Colwell declined medical treatment—that is, he decided to live with the condition—for five years. It is undisputed that Colwell’s cataract is not painful and that the cataract has not—and will not—cause irreversible damage. His monocular vision can be corrected by surgery in the 14 Nevada urges us to adopt a test for “overall visual acuity” to determine who has a “serious medical need” and is entitled to cataract surgery. That standard, although not articulated in Medical Directive 106, is closest to the BOP’s and the State of Washington’s guidelines. COLWELL V. BANNISTER 47 future, and NDOC has said that it will revisit the question of surgery should anything change in Colwell’s condition.15 Alternatively, the majority cites “the other harms and dangers that flow from” monocular blindness as evidence of deliberate indifference. Maj. Op. at 14. But as I discussed above, these harms and dangers cannot support a finding of deliberate indifference. To the extent that there are future dangers that may be caused by monocular blindness, there is no evidence that such unidentified dangers pose an “unreasonable risk of serious damage to his future health.” Helling, 509 U.S. at 35. Given Colwell’s history, it is probable that these future “dangers” include unfortunate, but minimally harmful, cuts and scrapes. Such potential injuries are not enough to show that NDOC’s denial of surgery poses an unreasonable risk of serious damage to Colwell’s future health. Accordingly, I would hold that Colwell cannot prove “harm caused by the indifference,” as required by Jett. See 439 F.3d at 1096. NDOC, like all prisons, must make difficult decisions about inmate medical care and control costs wherever possible, consistent with the Eighth Amendment. See Peralta, 744 F.3d at 1084 (“A prison medical official who fails to provide needed treatment because he lacks the necessary resources can hardly be said to have intended to punish the inmate.”). I assume that NDOC would prefer to treat Colwell’s cataract. But, given his individual circumstances, NDOC made a reasonable medical decision 15 The majority states that monocular blindness “is harm in and of itself.” Maj. Op. at 14. This reasoning begs the question. Were the majority’s reasoning correct, any injury or condition would qualify because the injury would be harm in and of itself. 48 COLWELL V. BANNISTER that Colwell would receive regular evaluations to monitor his condition, and if it worsens, would consider a new medical request. Although NDOC’s administrators and physicians may have a different perspective from that of Colwell’s treating physicians, monitoring a cataract, rather than performing surgery, is a legitimate medical decision. See Am. Optometric Ass’n, Care of the Adult Patient with Cataract 17 (2010), available at www.aoa.org/documents/ optometrists/CPG-8.pdf (“If the patient has few functional limitations as a result of the cataract and surgery is not indicated, it may be appropriate to follow the patient at 4 to 12-month intervals to evaluate eye health and vision.”). And such differences of opinion do not evidence deliberate indifference. Jackson, 90 F.3d at 332 (“[W]here a defendant has based his actions on a medical judgment that either of two alternative courses of treatment would be medically acceptable under the circumstances, plaintiff has failed to show deliberate indifference, as a matter of law.”); see also Cobbs, 475 F. App’x at 582–83 (finding that a directive to monitor an inmate’s cataract closely was “the product of considered medical judgment”); Samonte, 264 F. App’x at 636 (holding that refusal to authorize cataract surgery after a doctor recommended surgery was a difference of medical opinion). Indeed, this is not a case where “an individual sat idly by as another human being was seriously injured,” McGuckin, 974 F.2d at 1060, because NDOC provided Colwell with regular eye care. As the majority states, Colwell received cataract surgery on his left eye, yearly physicals, and consultations with an opthamologist and an optometrist. See Maj. Op. at 5–7. Such routine eye care “belies the notion that [NDOC] acted with deliberate indifference.” Cobbs, 475 F. App’x at 583; see also Estelle, 429 U.S. at 107 (finding inmate’s claim noncognizable where he received medical treatment on seventeen occasions.); COLWELL V. BANNISTER 49 Hummer, 407 F. App’x at 113 (upholding summary judgment where inmate “failed to present evidence showing that the defendants’ denial of cataract surgery in his right eye has caused or will cause further injury”).16 NDOC’s treatment was reasonable. Colwell is not in any pain and he is able to engage in many activities. The alternative course of treatment that NDOC selected—wait and see—did not cause life-threatening injury. Because of Colwell’s functionality, NDOC’s decision not to authorize cataract removal surgery was consistent with Medical Directive 106. Instead, this case is most like Samonte and Layton, where this court and the District of Nevada found that NDOC’s refusal to authorize cataract removal surgery did not violate the Eighth Amendment. See Samonte, 264 F. App’x at 636 (“Dr. Bauman’s refusal to authorize cataract surgery after another doctor determined that such surgery was an option was a difference of medical opinion, insufficient by 16 The panel cites Snow, 681 F.3d 978, as an example where prison officials rejected the recommendations of outside specialists and unreasonably denied the inmate surgery for two years. Maj. Op. at 15. The majority’s reliance on Snow is misplaced. In Snow, the inmate was in “excruciating and unbearable pain.” 681 F.3d at 983. Snow’s hips had degenerated to the point where he was barely able to walk, could not kneel, and required assistance with everyday activities such as getting out of bed and putting on his socks. Id. at 982–83. The state even conceded that Snow had a serious medical need. Id. at 985. But after Snow’s treating physicians indicated that he needed bilateral hip replacement surgery, NDOC authorized only pain relievers and anti-inflammatories. Id. at 983. In turn, the medications made Snow’s creatinine levels skyrocket, causing a potentially life-threatening situation. Id. at 984. We observed that the inmate’s medical condition interfered with his ability to function. Id. And we questioned whether it was a reasonable medical decision to adopt a medication only approach, where doing so long-term caused additional serious medical problems. Id. at 988. 50 COLWELL V. BANNISTER itself to raise a triable issue of deliberate indifference.”) (internal quotation marks omitted); Layton, 2012 WL 6969758 at  (finding no deliberate indifference where “[d]efendant’s decision to deny Layton’s request for cataract surgery on the grounds that Layton’s condition did not meet the prison’s medical criteria amounts to a difference of opinion regarding the appropriate course of treatment.”). Finally, NDOC could not have been deliberately indifferent to Colwell’s serious medical needs if it did not know why Colwell required cataract removal surgery or whether surgery was necessary for Colwell to complete the required activities of daily living. Farmer, 511 U.S. at 837–38 (clarifying that deliberate indifference is comparable to a reckless mens rea in that recklessness is the disregard of a known risk of harm). His annual physicals—at least those to which Colwell consented—ask the physician to report whether he had any “functional limitation/disability.” There are no comments in these sections. In a 2009 Consultation Report, Dr. Scott checked “yes” to the question “[d]oes this condition significantly affect qualify of life?”, but he did not explain how the condition affected Colwell, and he wrote on the front of the report that he had discontinued the report altogether. In sum, neither Colwell’s requests nor the discontinued consultation report provided information that put prison officials on notice that Colwell’s cataract rendered him unable to perform the required tasks of daily living. I would hold that the respondents were not deliberately indifferent to Colwell’s alleged “serious medical needs,” because Colwell did not meet the difficult legal burden of showing “a purposeful act or failure to respond to a prisoner’s pain or possible medical need and [ ] harm caused by the indifference.” Jett, 439 F.3d at 1096. COLWELL V. BANNISTER 51