Court Opinion

ID: 9488922
Source: CourtListenerOpinion
Date Created: 2023-08-05 12:59:50.457059+00
Date Added: 2024-06-11T17:53:11.501534
License: Public Domain

DIANE P. WOOD, Circuit Judge,
dissenting.
The question before the Court in this case is simple: did pro se petitioner Harold Oliver bring forward sufficient facts in this medical treatment § 1983 case to defeat the prison officials’ summary judgment motion? The majority concludes that he did not. Because I believe this conclusion is based both on a misapprehension of the governing legal standards and a failure to recognize the critical factual disputes in this record, I dissent.
Oliver’s complaint, which was typed on the form typically used for prisoner § 1983 cases in the Central District of Illinois, alleged that the named prison officials “deliberately, intentionally, knowingly, capriciously and maliciously ‘forced’ him to be celled with ‘smokers against his will’.” The complaint clearly stated that the defendants took these actions “even though the plaintiff complained and objected to being celled with smokers because the plaintiff suffers from ‘Asthma’.” Oliver asserted that he had been given a medical order that specified he was to have a non-smoking cellmate only. He alleged that cigarette smoke “has an even greater detriment to the lungs and vital organs of an ‘Asthmatic’ who has been ‘Medically Ordered’ to cell only with non-smokers.” He described the physical symptoms he suffered when he was exposed to smoke, and he repeatedly alleged that his suffering was the result of the deliberate indifference of the prison officials to his medical needs.
By the time the case was ready for summary judgment, Oliver had added a number of additional materials to the record. These included a memorandum dated February 18, 1993, from the Medical Records Director, Ronald C. Gruber, to North Cellhouse Superintendent Francis Melvin, reporting that Medical Director Owen Murray, D.O., had “issued a medical order” for Oliver “that he is to be celled only with a non-smoking cellmate.” In response to a request for admissions, Melvin confirmed that he received the memorandum. Melvin also admitted that he knew that Oliver was asthmatic, but denied knowing that Oliver had “a serious medical condition that require[d] him to be celled with non-smokers only.” The record also included correspondence between Oliver and Melvin about smoking, in which Melvin advised Oliver to “work it out” with his cellmate. Oliver offered several affidavits from other inmates, who attested that they had observed Oliver having difficulty breathing and that they had seen various prison officials laughing about his situation.
The prison officials themselves .attached the affidavit of Dr. Murray to their motion for summary judgment. Dr. Murray confirmed that Oliver’s records “note that he was diagnosed as a mild asthmatic on June 18, 1992.” He continued by stating “[wjhile asthma can be a serious medical problem, Mr. Oliver’s condition was only mild and never life threatening. His condition required no outside hospitalization.” The medical records themselves, which were attached to Dr. Murray’s affidavit, showed that Oliver had a prescription requiring him to take Theophylline, 300 milligram tablets, twice a day, and Metaprel, two puffs from an inhaler four times per day.
Oliver attached several items to his response to the summary judgment motion. First, he furnished a memorandum he had received from Dr. Murray that stated “a permit has been issued for a non-smoking cellmate.” In addition, he attached an article from the June 20, 1994, issue of Business *162Week entitled “Trying to Knock the Wind out of Asthma.” Id. at 184. The article notes in passing that “several studies have suggested links between asthma and greater air pollution, poverty, and exposure to cigarette smoke.” Id. (emphasis added). In the course of noting that asthma sufferers may not do enough to get away from the causes of their attacks, it lists as typical causes “cat hair or tobacco smoke.” Id. He also attached an article from U.S. News & World Report, June 20, 1994, entitled “The smoke next door,” which addresses the dangers of second-hand smoke more generally. Id. at 66.
As the majority notes, upon our de novo review of a decision granting summary judgment, we must view the facts in the light most favorable to the party opposing the motion, here Oliver. In order to prevail, Oliver had to satisfy the district court that his allegations stated a claim (and thus he did not lose as a matter of law), and that there were genuine issues of fact on each element of his claim. For an Eighth Amendment medical conditions claim under § 1983, this means showing (1) that he had a serious medical need, and (2) that the prison officials responded to that need with deliberate indifference, or, in the words of Farmer v. Brennan, - U.S. -, -, 114 S.Ct. 1970, 1977, 128 L.Ed.2d 811 (1994), with a sufficiently culpable state of mind.
No one disputes that Oliver’s allegations were enough to satisfy Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976), Farmer and the other Eighth Amendment cases. Both here and in the lower court the issue has been instead whether there were disputed issues of fact. Viewed in this light, it is clear that there is a material dispute of fact about the severity of Oliver’s asthma problem, which in turn raises a material dispute of fact about whether the prison officials were deliberately indifferent to his serious medical needs. See Estelle, 429 U.S. at 106, 97 S.Ct. at 292.
I begin with Dr. Murrey’s affidavit and the supporting medical records. Dr. Murrey states, in conclusory fashion, that Oliver had only a “mild” case of asthma, but that is not the only information we have about Oliver’s condition. The medical records themselves were objective evidence before the court about the seriousness of his condition, and they indicated that competent medical personnel believed Oliver required a twice daily dose of 300 mg of Theophylline, and two puffs from a Metaprel inhaler, which contains the sympathomimetic agent metaprotenerol, four times a day. According to the American Thoracic Society, Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease (1986), these prescriptions taken together indicate a relatively serious case of asthma. Mild cases respond to beta-adrenergic agonists (a class of drugs to which metaprotenerol belongs, id. at 231). However, the Society states:
Theophylline is usually given orally as sustained-release formulations for chronic maintenance therapy. Although the benefits of theophylline are difficult to prove in patients with COPD [chronic obstructive pulmonary disorder], its use is favored by most clinicians when appropriately used sympathomimetic agents fail to produce adequate bronchodilation.
Id. (emphasis added). The prescription of Theophylline is thus objective evidence that the Metaprel inhaler alone was not enough for Oliver’s asthma.
The record also contained indications readily comprehensible to a lay person that suggested Oliver’s condition was significant. In his deposition, he stated that “[m]y asthma causes me to wheeze, it causes me to be short of breath and causes me to be nauseated at times.” He also claimed to suffer from one to two asthma attacks a week during his stay at the prison. Although the prison officials argued that his failure consistently to take his medication indicates that his case was less severe than he claimed, this simply shows that the facts bear more than one interpretation.
I would be the last to claim that a panel of appellate judges, untrained in medicine, should decide how severe Oliver’s asthma was. However, that is not our task. The question for us is whether the summary judgment record before the district court, viewed in the light most favorable to Oliver, clearly indicated that there were no genuine *163issues of material fact that required a trial. At this preliminary stage, Oliver did not have the burden of refuting the prison doctor’s characterization of his case as a “mild” one; he needed only to show that the matter was disputed. In my view, particularly taking into account that he was proceeding pro se before the district court and did not have access to extensive medical or other libraries, he satisfied that burden.
There is a second reason to reject the conclusion that the undisputed facts made it clear that Oliver’s case was “mild.” The Murrey affidavit says that it was mild, “not life threatening.” But Eighth Amendment concerns arise before medical needs become literally life threatening. Nothing in Estelle v. Gamble or in any of the subsequent decisions of the Supreme Court or this Court adopts such a stringent standard. To the contrary, the Supreme Court’s decision in Helling v. McKinney, 502 U.S. 903, 112 S.Ct. 291, 116 L.Ed.2d 286 (1993), finding that an inmate stated a claim under the Eighth Amendment when he asserted that his exposure to environmental tobacco smoke (ETS) poses a serious danger to his future health, indicates that a claim exists far short of present or future life-threatening situations. This Court’s decision in Del Raine v. Willi-ford, 32 F.3d 1024 (7th Cir.1994), makes a similar point, in its rejection of the argument that an inmate complaining of being left in a bitterly cold cell should be allowed to proceed only if he alleged (and could show) that the cold caused “frostbite, hypothermia or a similar infliction.” Id. at 1035. In addition, in two recent cases that also involved the effects of ETS on inmates with breathing problems, the Eighth Circuit found that the allegations survived the defendant prison officials’ motions for summary judgment based on qualified immunity. See Weaver v. Clarke, 45 F.3d 1253, 1254 (8th Cir.1995) (ETS caused plaintiff “severe headaches, dizziness, nausea, vomiting, and breathing difficulties”), and Sanders v. Brundage, 60 F.3d 484 (8th Cir.1995) (ETS aggravated plaintiffs asthma). Based on these decisions, I believe that the district court also erred as a matter of law in granting summary judgment against Oliver.
It is worth reiterating that Oliver clearly alleged that the prison officials’ actions in forcing him to share a cell with smokers exacerbated his medical condition. To prove this point, he tried to show that ETS poses a greater and more immediate health risk for an asthmatic than for the general population. Working within the limited resources available to him, he did this in two ways: anecdo-tally, by supplying affidavits about the physical distress he endured when he was placed with smokers, and directly, through the Business Week article he furnished to the court.
Again bearing in mind that the question was whether the facts showed that a genuine issue was present, not whether Oliver’s evidence conclusively proved a medical point, I find his showing sufficient to defeat summary judgment. Common sense tells us that asthma is a breathing problem, and that people whose air passages and lungs are weak may well suffer more from environmental pollution (including ETS) than those whose air passages and lungs are strong. The Business Week article indicated as much, and, while it may not itself have been admissible evidence at a trial, it indicated the existence of admissible expert evidence. It is hardly realistic to expect a prisoner to track down medical experts and present their direct affidavits on a motion for summary judgment, especially when the prisoner is proceeding-pro se.
The majority brushes off the evidence Oliver was able to find. In essence it says “other than some evidence tending to prove his position, there isn’t any.” But this is an odd way to approach summary judgment. Either he met his burden under Celotex v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986), or he didn’t. I conclude that he did.
In fact, my own brief survey of the medical literature has turned up a number of studies that have found that ETS leads to increased morbidity in adult asthmatics. See, for example, Surinder Jindal, Dhijar Gupta and Amarjit Singh, Indices of Morbidity and Control of Asthma in Adult Patients Exposed to Environmental Tobacco Smoke, 106 Chest 746 (1994); Prem Menon, Roy J. Ran-*164do, Richard P. Stankus, John E. Salvaggio and Samuel B. Lehrer, Passive cigarette smoke-challenge studies: Increase in bronchial hyperreactivity, 82 J. Allergy Clin.Im-munol. 560 (1992). At a trial, other experts supporting this position might be called, and it is naturally possible that the prison might find experts to testify that ETS has no particularly detrimental effect on asthmatics, whether their condition is mild, serious, or severe. Both the general effect of ETS on asthmatics, and its effect on Oliver in particular, are factual questions that cannot be dismissed on summary judgment.
With respect to Oliver’s allegations of deliberate indifference to a known condition, the prison officials do not argue seriously that he failed to make an adequate showing. They dispute his interpretation of the Medical Director’s memorandum, and they dispute the “true intent” of Dr. Murrey in authorizing a non-smoking cellmate. These disputes about the prison’s actual evaluation of his condition were highly material to Oliver’s case, but the district court resolved them on the paper record. However, there is certainly no dispute that Oliver repeatedly told the officials about his asthma, that he repeatedly requested nonsmoking cellmates, that he called their attention to the fact that smoke made it more difficult for him to breathe, and that for a period of time they did not respond.
In conclusion, it is important to remember that this case is not about whether it would be a good idea if prisons banned smoking, or adopted smoking and no-smoking zones, nor is it about what generalized harms ETS may cause. With respect to the former, it is not up to the courts to decide those kinds of internal prison policy matters. With respect to the latter, this is a far narrower and easier case than Helling, and the Court’s result today therefore is in substantial tension with it. This case is about the effect of ETS on an admittedly asthmatic prisoner, and whether an institution’s conscious refusal to place that prisoner in a relatively smoke-free environment amounts to a deliberate refusal to treat a serious medical condition, thereby raising an Eighth Amendment concern. Because I believe that Oliver presented enough evidence to demonstrate that the crucial facts were disputed, I would reverse the judgment below and remand for a trial.