Opinion ID: 2761209
Heading Depth: 3
Heading Rank: 1

Heading: The DOC's reliance on medical experts

Text: The subjective element of an Eighth Amendment claim for injunctive relief requires not only that Kosilek show that the treatment she received was constitutionally inadequate, but also that the DOC was -- and continues to be -- deliberately indifferent -58- to her serious risk of harm. See Farmer, 511 U.S. at 844-45.13 On the record presented, this is a burden Kosilek cannot meet. Even if the district court had been correct in its erroneous determination that SRS was the only medically adequate treatment for Kosilek's GID, the next relevant inquiry would be whether the DOC also knew or should have known this fact, but nonetheless failed to respond in an appropriate manner. See Wilson v. Seiter, 501 U.S. 294, 298 (1991). In answering this question, it is not the district court's own belief about medical necessity that controls, but what was known and understood by prison officials in crafting their policy. Id. at 300 (requiring a showing of purposefulness or intent on the part of prison administrators). In this case, the DOC solicited the opinion of multiple medical professionals and was ultimately presented with two alternative treatment plans, which were each developed by different medical experts to mitigate the severity of Kosilek's mental distress. The choice of a medical option that, although disfavored by some in the field, is presented by competent professionals does 13 Although the DOC has not specifically argued that the conflicting medical opinions preclude a finding of subjective deliberate indifference, we do not find this argument waived. As we have explained above, the subjective and objective analyses overlap. See supra note 7; see also Leavitt, 645 F.3d at 498. The DOC's contention that the district court erred in deeming SRS medically necessary and in rejecting Dr. Schmidt's approach as imprudent necessarily entails the DOC's subjective belief that SRS was unnecessary. The contrary position -- i.e., that SRS is not objectively necessary but that the DOC did not disagree as to the need for SRS -- would be wholly illogical. -59- not exhibit a level of inattention or callousness to a prisoner's needs rising to a constitutional violation.14 Cf. Torraco, 923 F.2d at 234 ([T]his court has hesitated to find deliberate indifference to a serious need '[w]here the dispute concerns not the absence of help, but the choice of a certain course of treatment,' [but] deliberate indifference may be found where the attention received is 'so clearly inadequate as to amount to a refusal to provide essential care.' (internal citations omitted)). Moreover, a later court decision -- ruling that the prison administrators were wrong in their estimation of the treatment's reasonableness -- does not 14 If the prison itself should have been aware that some of the medical advice it was receiving was imprudent -- that is, if any layperson could have realized that the advice was imprudent -- then the decision to still follow that advice may qualify as deliberate indifference. See Farmer, 511 U.S. at 846 n.9 (If, for example, the evidence before a district court establishes that an inmate faces an objectively intolerable risk of serious injury, the defendants could not plausibly persist in claiming lack of awareness . . . .); Hadix v. Johnson, 367 F.3d 513, 526 (6th Cir. 2004) (If [the challenged prison conditions] are found to be objectively unconstitutional, then that finding would also satisfy the subjective prong because the same information that would lead to the court's conclusion was available to the prison officials.). The facts of this case, however, are highly distinct from such a scenario. Nor did the district court's conclusion render the DOC's continued refusal to provide SRS deliberately indifferent. On the contrary, the evidence was conflicting as to the medical need for SRS. The choice between reasonable medical views was not for the district court to make, and the DOC remained entitled to reasonably rely on Schmidt's and Osborne's expert opinions. Moreover, even assuming arguendo that the DOC was on notice that its treatment was insufficient, the DOC's continued refusal also rested on valid security concerns, discussed below, such that its actions did not amount to deliberate indifference in any event. -60- somehow convert that choice into one exhibiting the sort of obstinacy and disregard required to find deliberate indifference. Cf. Nadeau v. Helgemoe, 561 F.2d 411, 417 (1st Cir. 1977) (refusing to substitute the values and judgment of a court for the values and judgment of the . . . prison administration).