Opinion ID: 780359
Heading Depth: 3
Heading Rank: 3

Heading: Defendant Wright

Text: 29 Dr. Wright has been the Chief Medical Officer of DOCS for over seven years. His primary responsibility at DOCS is to set the overall direction for [DOCS'] provision of health care. It is Wright's promulgation of DOCS' policy on prevention and treatment of keloids that Brock alleges resulted in a violation of his Eighth Amendment rights. 30 In particular, item # 1.43 of the DOCS manual declares keloids to be among the [c]onditions and services which, absent the existence of collateral symptoms, are considered prima facie medically unnecessary (emphasis added). Although Wright mentioned at his deposition that this part of the manual predated his appointment, the current policy bears a revision date of January 1996 and is signed on behalf of DOCS by Wright. 31 Wright may be held liable if a jury could reasonably find that he created a policy or custom under which unconstitutional practices occurred or [that he] allowed the continuance of such a policy or custom. Colon v. Coughlin, 58 F.3d at 873. While liability may not be established against a defendant simply because that defendant was a policy maker at the time unconstitutional acts were committed, see Cuoco v. Moritsugu, 222 F.3d 99, 109 (2d Cir.2000), where unconstitutional acts are the result of a policy promulgated by the defendant, a valid § 1983 action may lie. It is not seriously in dispute that Wright is responsible for DOCS policy # 1.43. 32
33 The district court held and the defendants argue, however, that DOCS' policy is a constitutionally valid one. In particular, the defendants contend that [i]t is not a blanket ban on specialty consultations for treatment of keloids. If there is a reason, aside from a cosmetic, non-medical one, a request to see a dermatologist may be granted. 34 As an initial matter, it is not at all clear what DOCS policy # 1.43 means. Is the sort of pain Brock has allegedly suffered and that we have identified as constituting a serious medical condition a collateral symptom within the meaning of the policy? Wright's own understanding of the policy is ambiguous on this point. He stated at deposition that treatment for keloids is allowed only to the extent that the treatment is performed for functional rather than aesthetic reasons. And by functional, he indicated that the treatment would have to make some difference in the functioning of a body part. 35 Given these statements, a jury could well find that the policy was intended to bar the treatment of a keloid for purposes of alleviating moderate, but persistently chronic, pain in a body part. Wright gave two examples in which treatment would be allowed. The first was that of a prisoner with a keloid near the eye that interfered with the opening of the eyelid. The second was that of a prisoner whose mental health was so severely impacted by the scar that it was adversely affecting [his or her] ability to function in society. The giving of two cases of this sort, and no others, itself constitutes evidence from which a jury could conclude that the policy meant to bar from treatment someone with the symptoms Brock allegedly has. 36 Moreover, along with the other defendants, Wright has argued that both O'Connell and Cetin properly implemented the policy. 5 Both doctors in effect stated that Brock had no collateral symptoms, sufficient under the policy, to justify an outside consultation, despite the fact that Brock had, according to Cetin, complained of pain. Since both have cited the policy as the reason for their actions and since Wright concedes that O'Connell and Cetin followed the policy, the question before us is whether following the policy resulted in deliberate indifference to Brock's medical needs. If so, summary judgment may not be granted in favor of Wright, since unconstitutional acts would then have occurred as the result of a policy promulgated by Wright. 37 On this issue, we simply note the presence of facts in dispute that could be resolved by a jury in a way that would entitle Brock to relief. It is not controverted that Cetin was aware that Brock was suffering some pain from his scar. The defendants sought to cast doubt on the truthfulness of Brock's claims about the extent of the pain he was suffering and, also, to put into question DOCS' awareness of Brock's condition. But at most, defendants' arguments and evidence to these effects raise issues for a jury and do not justify summary judgment for them. 38 In summary, looking at all the facts in the record, we think that a reasonable jury, if it fully credited Brock's and Farooq's testimony, could find that it is more likely than not that Cetin (1) knew Brock was experiencing chronic pain, (2) understood that the keloid could cause this sort of pain in the facial area, and (3) recognized that either steroid injections or perhaps other therapies a dermatologist might provide were superior treatments to those provided in the prison. A jury could also conclude, based on the admissions of the defendants and other evidence, that Cetin refused to appeal O'Connell's denial of a dermatological consultation and treatment because he reasonably believed that chronic pain of the type Brock alleged he was suffering was not a collateral symptom within the meaning of the DOCS policy. And a jury could also find that Wright both intended the policy he established to be so read and should have known the consequences for people situated like Brock of such a reading. 39
40 Brock has also adduced facts sufficient for a jury to find that the DOCS policy was deliberately indifferent to Brock's receiving necessary medical care to prevent his scar from keloiding. In his affidavit, Farooq stated that, given Brock's history, it was a virtual certainty that his facial laceration would keloid. Farooq further indicated that the sort of pain Brock claims to be experiencing is not surprising given the location of the scar. Moreover, still according to Farooq, relatively inexpensive steroid injections could have prevented the keloid. Finally, Farooq stated that because preventive steps were not taken, [r]evision [now] will not correct the damage caused by the keloid formation, although it may reduce it. 41 At summary judgment, we are bound to credit Farooq's viewpoint that a denial of treatment is nowhere near as efficacious as steroid injections in preventing keloid formation in at-risk individuals. Moreover, a jury could well conclude that steroid injections were not given, not because of a medical judgment — at most negligent — that such prevention was not worthwhile, but because the DOCS policy established by Wright forbade preventative measures in cases such as Brock's. That is, a jury could find — if it credited Farooq's testimony — that the policy precluded steroid shots even when the formation of keloids was nearly certain and where those keloids could produce the sort of chronic pain Brock claims to have. If this is the case, then the policy, the jury may conclude, represents a conscious choice by DOCS to prescribe `easier and less efficacious' treatment plan[s] for prisoners who are either at risk for or who have begun to develop keloids in areas where the keloids will likely cause pain and other medical problems. Chance, 143 F.3d at 703 (quoting Williams v. Vincent, 508 F.2d 541, 544 (2d Cir.1974)). Such a choice violates the Eighth Amendment. See id. 42 On this ground too summary judgment should not have been granted to Wright. 43 Accordingly, we VACATE the order of the District Court granting summary judgment to defendant Wright and AFFIRM the grant of summary judgment to defendants Berbary and Eagan. We REMAND the case to the district court for further proceedings consistent with this opinion.