Opinion ID: 788501
Heading Depth: 3
Heading Rank: 2

Heading: Sufficiently serious medical need

Text: 20 As to the objective component, a serious need for medical care, Farmer requires only that the inmate show that he is incarcerated under conditions posing a substantial risk of serious harm; 511 U.S. at 834, 114 S.Ct. 1970, so as to avoid the unnecessary and wanton infliction of pain. Id. This Court defined this objective factor as evidence of serious medical needs, Brooks v. Celeste, 39 F.3d 125, 128 (6th Cir.1994) and later noted the evidence need only show that the medical need at issue is sufficiently serious. Comstock v. McCrary, 273 F.3d 693, 702-03 (6th Cir.2001) (quoting Farmer, 511 U.S. at 834, 114 S.Ct. 1970) (emphasis added). 21 Most other circuits hold that a medical need is objectively serious if it 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. Gaudreault v. Municipality of Salem, 923 F.2d 203, 208 (1st Cir.1990) (emphasis added) (citing Monmouth County Corr. Inst'l Inmates v. Lanzaro, 834 F.2d 326, 347 (3d Cir.1987)); see also Wynn v. Southward, 251 F.3d 588, 593 (7th Cir.2001); Aswegan v. Henry, 49 F.3d 461, 464 (8th Cir.1995); Hill v. Dekalb Reg'l Youth Det. Center, 40 F.3d 1176, 1187 (11th Cir.1994); Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir.1980); accord Harden v. Green, 27 Fed.Appx. 173, 2001 WL 1464468, at  3 (4th Cir. Nov.19, 2001). As the Eleventh Circuit observed, [c]ases stating a constitutional claim for immediate or emergency medical attention have concerned medical needs that are obvious even to a layperson because they involve life-threatening conditions or situations where it is apparent that delay would detrimentally exacerbate the medical problem [whereas] delay or even denial of medical treatment for superficial, nonserious physical conditions does not constitute a [constitutional] violation. Hill, 40 F.3d at 1187-88. 22 In unpublished opinions, this Court has evaluated the seriousness of a prisoner's medical needs by this obviousness approach. See, e.g., Taylor v. Franklin County, 104 Fed.Appx. 531, 2004 WL 1595203, at  (6th Cir. July 14, 2004) (Such obvious signs of recurring incontinence and debilitating immobility were clear symptoms of a serious problem, even if Defendants did not [choose] to believe Plaintiff.); Alexander v. Jones, 234 F.3d 1267, 2000 WL 1562841, at  (6th Cir. Oct.12, 2000) (holding that the plaintiff's glaucoma was not so obvious that a lay person would recognize it); Friend v. Rees, 779 F.2d 50, 1985 WL 13825, at  (6th Cir. Oct.1, 1985) (A 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.). In addition, lower courts within this Circuit have adopted this obviousness rule. See, e.g., Smith v. Franklin County, 227 F.Supp.2d 667, 677 n. 10 (E.D.Ky.2002); Bowman v. Corr. Corp. of Am., 188 F.Supp.2d 870, 885 (M.D.Tenn.2000), aff'd in part, rev'd in part, 350 F.3d 537 (6th Cir.2003); McKinney v. Compton, 888 F.Supp. 75, 77 (W.D.Tenn.1995); Meadows v. Trotter, 855 F.Supp. 217, 218-19 (W.D.Tenn.1994); Inmates, Wash. County Jail v. England, 516 F.Supp. 132, 139 (E.D.Tenn.1980), aff'd without op., 659 F.2d 1081 (6th Cir.1981). 23 This obviousness standard for determining a serious medical need is distinct from a separate branch of Eighth Amendment decisions where the seriousness of a prisoner's medical needs may also be decided by the effect of delay in treatment. Hill, 40 F.3d at 1188 (emphasis added in part); Gaudreault, 923 F.2d at 208; Monmouth County, 834 F.2d at 347. These decisions involve prisoner claims of delay in treatment that caused injury, loss, or handicap. Hill, 40 F.3d at 1188; Monmouth County, 834 F.2d at 347. Other examples involve delayed administration of medication, see, e.g., Canady v. Wilkinson, 90 Fed.Appx. 863, 2004 WL 232728 (6th Cir. Feb.2, 2004); Dozier v. Pauley, 24 Fed.Appx. 398, 2001 WL 1563602 (6th Cir. Dec.3, 2001); see also Rumsey v. Martin, 28 Fed.Appx. 500, 2002 WL 169559 (6th Cir. Jan.31, 2002); or a prisoner's refusal to take the prescribed medication, see, e.g., Lewis v. Turner, 16 Fed.Appx. 302, 2001 WL 669816 (6th Cir. June 7, 2001); or occasional missed doses of medication, Stone v. Cheboygan County, 2002 WL 507504 (E.D.Mich. Apr.4, 2002); or claims based on a determination by medical personnel that medical treatment was unnecessary. See, e.g., Smith v. Franklin County, 227 F.Supp.2d 667, 677-78 (E.D.Ky.2002). Also within this branch are decisions involving whether the prisoner was treated adequately. Bright v. Martin, 37 Fed.Appx. 136, 2002 WL 818298 (6th Cir. Apr.29, 2002); Love v. Taft, 30 Fed.Appx. 336, 2002 WL 104749 (6th Cir. Jan.24, 2002); Powell v. Messary, 11 Fed.Appx. 389, 2001 WL 303367 (6th Cir. Mar. 19, 2001) or whether any delay in providing medical care was harmless, Craw v. Gray, 159 F.Supp.2d 679 (N.D.Ohio 2001), or where the prisoner had a very minor injury for which many people outside prison would not even think of seeking outside medical treatment. See, e.g., Nickens v. Anderson, 56 Fed.Appx. 244, 245, 2003 WL 344214 (6th Cir. Feb.13, 2003); see also Wright v. Taylor, 79 Fed.Appx. 829, 2003 WL 22474614 (6th Cir. Oct.29, 2003) (decaying tooth); Lawless v. Muskingum County, 36 Fed.Appx. 192, 2002 WL 1272120 (6th Cir. June 6, 2002) (knee injury for which it was merely preferable that plaintiff receive treatment); Jennings v. Al-Dabagh, 275 F.Supp.2d 863 (E.D.Mich.2003) (foot infection from which plaintiff suffered minor discomfort). Accord Martin v. Gentile, 849 F.2d 863 (4th Cir.1988) (glass splinter in prisoner's palm and minor cuts and bruises that required neither stitches nor painkillers); Shabazz v. Barnauskas, 790 F.2d 1536 (11th Cir.1986) (shaving bumps). 24 As reflected by its facts, Napier involved a claim about the effect of the delay in receiving medical treatment. In Napier, an arrestee suffering from kidney failure was kept from his scheduled dialysis while incarcerated for twenty-nine hours. 238 F.3d at 741. The evidence showed that he missed forty-one of his thrice-weekly dialysis treatments in 1997, including a treatment session scheduled three days prior to his incarceration and the session following his release, and that he even told a prison guard that he had an appointment that day but missing it was no big deal because he had missed them before. Id. In affirming summary judgment for the defendants, this Court adopted the analytical approach of Hill, Gaudreault , and Monmouth County by examining the effect of the delay in treatment. Id. at 742. In adopting this practical and logical approach, we held that `[a]n inmate who complains that delay in medical treatment rose to a constitutional violation must place verifying medical evidence in the record to establish the detrimental effect of the delay in medical treatment to succeed.' Napier, 238 F.3d at 742 (quoting Hill, 40 F.3d at 1188). Because the plaintiff in Napier did not present medical evidence that he was harmed by the delay in treatment, and because as his doctor testified, plaintiff could have received treatment immediately upon his release yet failed to do so, we affirmed the dismissal of the action. Id. at 742-43. 25 In sum, the verifying medical evidence requirement is relevant to those claims involving minor maladies or non-obvious complaints of a serious need for medical care. Napier, which was relied upon by the district court, falls within this branch of decisions. In a word, Napier does not apply to medical care claims where facts show an obvious need for medical care that laymen would readily discern as requiring prompt medical attention by competent health care providers. Napier applies where the plaintiff's deliberate indifference claim is based on the prison's failure to treat a condition adequately, or where the prisoner's affliction is seemingly minor or non-obvious. In such circumstances, medical proof is necessary to assess whether the delay caused a serious medical injury. Napier, 238 F.3d at 742. 26 In dismissing this action, the district court noted that Blackmore's appendix did not burst, and that there was no evidence of any medical complications or consequences arising from the delay of treatment ... [or] that the delay contributed to the size or appearance of his surgical scar. There simply is no medical verification that his condition worsened as a result of the delay. (J.A. 222). A determination that Blackmore's appendix ruptured is not a prerequisite for his Eighth Amendment right to avoid the pain from the officers' deliberate indifference to his obvious need for medical care. 27 Defendants were not preventing Blackmore from attending a regularly-scheduled treatment. In Napier, the prisoner did not complain about missing treatment; told prison guards that missing a treatment was no big deal; missed over forty treatment sessions of his own accord; and neither sought immediate medical attention upon his release nor even attended his next scheduled treatment. The facts of this case differ greatly from those in Napier, where the injury to the prisoner's kidney condition could not be discerned without competent medical proof. 28 The facts here are further distinguishable from Napier in that Blackmore's claim falls under the obviousness line of decisions. Here, Blackmore did not suffer from a long-term and well monitored illness, but rather exhibited obvious manifestations of pain and injury. Blackmore complained of sharp and severe stomach pains for an extended period of time. Significantly, Blackmore vomited — a clear manifestation of internal physical disorder. The jailers deemed Blackmore's condition sufficiently serious to place him in an observation cell. Blackmore complained orally and in writing for over two days before receiving medical treatment. With these facts, a jury could reasonably find that Blackmore had a serious need for medical care that was so obvious that even a layperson would easily recognize the necessity for a doctor's attention. Gaudreault, 923 F.2d at 208. 29 As the Supreme Court has held, the test for deliberate indifference is whether there exists a  substantial risk of serious harm, Farmer, 511 U.S. at 837, 114 S.Ct. 1970 (emphasis added), and does not require actual harm to be suffered. See also Smith v. Carpenter, 316 F.3d 178, 189 n. 15 (2d Cir.2003) (observing that actual physical injury is not necessary in order to demonstrate an Eighth Amendment violation and declining to adopt a per se rule that such injury is required) (citing in part Helling v. McKinney, 509 U.S. 25, 35, 113 S.Ct. 2475, 125 L.Ed.2d 22 (1993)). Where the seriousness of a prisoner's needs for medical care is obvious even to a lay person, the constitutional violation may arise. This violation is not premised upon the detrimental effect of the delay, but rather that the delay alone in providing medical care creates a substantial risk of serious harm. When prison officials are aware of a prisoner's obvious and serious need for medical treatment and delay medical treatment of that condition for non-medical reasons, their conduct in causing the delay creates the constitutional infirmity. In such cases, the effect of the delay goes to the extent of the injury, not the existence of a serious medical condition. Blackmore was suffering from appendicitis, and it is sufficient that the officers' delay in treatment of an obvious medical emergency posed a substantial risk of serious harm to Blackmore by subjecting him to unnecessary infliction of pain. 30 To the extent our previous opinions would benefit from clarification, we hold today that where a plaintiff's claims arise from an injury or illness so obvious that even a layperson would easily recognize the necessity for a doctor's attention, Gaudreault, 923 F.2d at 208, the plaintiff need not present verifying medical evidence to show that, even after receiving the delayed necessary treatment, his medical condition worsened or deteriorated. Instead, it is sufficient to show that he actually experienced the need for medical treatment, and that the need was not addressed within a reasonable time frame. This is precisely what occurred here — after Blackmore suffered for two days, making unrelenting complaints and vomiting, a nurse identified classic signs of appendicitis and doctors performed an appendectomy. 31 In sum, we conclude that Blackmore presents sufficient evidence from which a jury can infer that his obvious need for medical care was sufficiently serious and that the Officers had a sufficiently culpable state of mind. Accordingly, summary judgment on this claim is reversed.