Opinion ID: 184722
Heading Depth: 2
Heading Rank: 3

Heading: Moritsugu's Qualified Immunity Claim

Text: 19 We turn now to the merits of Moritsugu's qualified immunity claim. We review the District Court's denial of summary judgment de novo, applying the same legal standard that governed the District Court's determination. See National Wildlife Fed'n v. Browner, 127 F.3d 1126, 1128 (D.C.Cir.1997). 20 Moritsugu is protected by qualified immunity unless Farmer's allegations could sustain a finding that his conduct violated clearly established law. See Harlow, 457 U.S. at 818, 102 S.Ct. 2727. The clearly established law upon which Farmer's contentions rest is the Eighth Amendment's proscription against deliberate indifference to serious medical needs of prisoners. Estelle v. Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). A prison official who knows of and disregards an excessive risk to inmate health or safety is deliberately indifferent for these purposes. Farmer v. Brennan, 511 U.S. 825, 837, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). The only question presently before us, then, is whether, viewing the record in the light most favorable to Farmer, Moritsugu's conduct could have constituted deliberate indifference to Farmer's medical needs. 21 In Farmer's view, Moritsugu was deliberately indifferent, because, in the face of her repeated requests for some type of treatment, he responded with only a single letter explaining the BOP's policy and finding that she had not established an entitlement to treatment thereunder. The bottom line, Farmer contends, is that Moritsugu was aware of, yet ordered no treatment for, her medical condition. See Brief of Appellee at 11. The District Court agreed, finding that Moritsugu effectively sanction[ed] the withholding of treatment from Farmer. Farmer v. Hawk, 991 F.Supp. at 28. We find, however, that Farmer's claims imply an obligation falling well outside the scope of Moritsugu's role as Medical Director, and, moreover, that Moritsugu's response to Farmer's requests comported with constitutional BOP medical policy. Thus, we conclude that Moritsugu's conduct met the standard of objective legal reasonableness required to support qualified immunity. Harlow, 457 U.S. at 819, 102 S.Ct. 2727. 22 There is no dispute here that the BOP's medical policy specifically speaks to the treatment of transsexualism. See HEALTH SERVICES MANUAL, Ch. 5, § 14, reprinted in J.A. 64. Moreover, although Farmer originally challenged both the BOP's medical policy and its application to her, the District Court found that the policy is constitutional on its face. See Farmer v. Hawk, 991 F.Supp. at 27. Farmer has not contested this finding on appeal. We deem it unnecessary to reach the question of whether or not transsexualism is a serious medical condition, therefore, because even assuming that it is, adherence to the policy would, a fortiori, be constitutional. 23 The parties agree, moreover, that, pursuant to this concededly constitutional policy, only three treatment options were potentially available in this case: hormone therapy, castration, and psychotherapy. Throughout this litigation, Farmer has recognized that she is not entitled to any particular treatment of her choosing. See Brief for Appellee at 4. At oral argument, counsel also conceded that hormone therapy and castration are not realistically at issue in this case, i.e., Farmer cannot pin a claim of deliberate indifference on Moritsugu's failure to order these treatments. We agree, and find nothing in the record to suggest otherwise. 24 The only remaining question, then, is whether Moritsugu was deliberately indifferent to Farmer's need for psychotherapy. We find that he was not, as Farmer has failed to establish any need for psychotherapy of which Moritsugu was aware and to which he was indifferent. Farmer apparently relies on the simple fact of her diagnosis to support her need for counseling. Yet, this is plainly inadequate: merely because someone is a transsexual, it does not inexorably follow that he or she needs psychotherapy. Even the fact that Farmer received some counseling in the past does not necessarily demonstrate her present need for that treatment. Indeed, it appears undisputed that, under the established BOP policy, Farmer had no guarantee of psychotherapy for transsexualism absent a demonstrated need. 25 Quite apart from whether Farmer had a need for psychotherapy, the most important point in this case is that Moritsugu is not the person within the BOP who determines whether psychotherapy is required in a given case. As Medical Director, overseeing operations in facilities nationwide from his office in Washington, D.C. , Moritsugu does not diagnose individual patients; nor does he prescribe treatments for particular patients, except insofar as he may be called upon to approve the recommendation of a treating physician. Such determinations are made at the local level, i.e., within individual BOP institutions. In short, Farmer's pleas to Moritsugu were plainly misguided. The appropriate recourse was, first and foremost, through the local medical personnel who were responsible for Farmer's treatment decisions. If Farmer was dissatisfied with local medical treatment, she had recourse to grievance and appeal procedures pursuant to which she could contest any failures in medical care. There is no claim here that these grievance procedures were legally inadequate. 26 Obviously, Farmer preferred to seek relief from the head of the operation, apparently on the mistaken assumption that the boss can cure all ills. It is unimaginable, however, that Moritsugu should be available to intervene in established processes on behalf of every BOP inmate who happens to be dissatisfied with his or her medical treatment. This is particularly true where, as here, the requests were completely unsupported by treatment records or recommendations from local medical personnel establishing a need for treatment. It is clear that Moritsugu's role as Medical Director neither required nor countenanced his involvement in Farmer's case. 27 On its face, Moritsugu's August 11 letter simply confirms the obvious. To be sure, Moritsugu did, perhaps unnecessarily, comment directly upon issues pertaining to Farmer's medical care. Implicit in his letter, however, was the strong message that Farmer's requests were misdirected. He stated that he had not received requests from local medical personnel to treat Farmer with hormones or castration, but that mental health personnel were available to assist her should she have specific needs for psychotherapy. See J.A. 52-53. The bottom line is apparent: as far as Moritsugu could tell, Farmer had not demonstrated any need for treatment, and it was not his role to ascertain this need. Under these circumstances, the letter reflected little more than Moritsugu's adherence to the BOP's medical policy, pursuant to which he was not directly involved in decisions concerning Farmer's care. Even Farmer's counsel, when questioned at oral argument, acknowledged that her client could not win an Eighth Amendment claim on the basis of Moritsugu's letter alone. 28 Thus, we find that Moritsugu is entitled to qualified immunity, for there is nothing else in the record on which to pin deliberate indifference. Farmer emphasizes that her claims rest not on any isolated occurrence, such as Moritsugu's August 11 letter, but rather on Moritsugu's persistent failure, in the face of her ongoing requests, to ensure that she receive any treatment. However, the mere fact that Farmer wrote to Moritsugu on multiple occasions does not change the outcome, because Moritsugu was never the person to whom these matters should have been addressed in the first place. Farmer's claims, unsupported by evidence of a medical need for psychotherapy, did not trigger any obligation on the part of Moritsugu to conduct an independent investigation into her medical condition and treatment. Farmer's implications in this regard, therefore, fail to appreciate Moritsugu's limited role, under the BOP's constitutional medical policy, in treatment decisions properly made by physicians in local institutions. In light of these factors, we hold that Moritsugu's conduct was objectively reasonable. 29 We add, as a final note, that exposing Moritsugu to personal liability in these circumstances would be totally at odds with the policies underlying the doctrine of qualified immunity. See Harlow, 457 U.S. at 806, 814, 102 S.Ct. 2727. If Moritsugu is liable in a case such as this, he is, in effect, liable for all alleged mistakes in the individual diagnoses of every inmate in the BOP system, simply by virtue of an inmate's complaint. Such an outcome is untenable. This is not to say that we can envision no circumstances under which Moritsugu could have been deliberately indifferent to an inmate's medical needs. However, we simply cannot imagine how the Medical Director in Washington, D.C. could be expected to formulate treatment regimes for prisoners throughout the system on the basis of essentially undocumented complaints charging inadequate care. And, if the weight of such an assignment were not problematic enough, the risk of personal liability would make it virtually impossible for the Government to fill positions such as Moritsugu's, as few qualified doctors would be willing to assume this responsibility with the accompanying risks of liability. The Government cannot be expected to operate in this way, and high government officials cannot be expected to assume this type of liability.