Court Opinion

ID: 9392487
Source: CourtListenerOpinion
Date Created: 2023-05-05 00:00:35.170307+00
Date Added: 2024-06-11T17:18:46.137928
License: Public Domain

Case: 21-60320        Document: 00516738468            Page: 1      Date Filed: 05/04/2023

             United States Court of Appeals
                  for the Fifth Circuit                                       United States Court of Appeals
                                                                                       Fifth Circuit

                                                                                     FILED
                                                                                  May 4, 2023
                                       No. 21-60320
                                                                                Lyle W. Cayce
                                                                                     Clerk

   Chaz Pinkston,

                                                                    Plaintiff—Appellee,

                                            versus

   Doctor Hendrick Kuiper, Medical Director,

                                                                Defendant—Appellant.

                     Appeal from the United States District Court
                       for the Northern District of Mississippi
                               USDC No. 4:17-CV-39

   Before Higginbotham, Jones, and Oldham, Circuit Judges.
   Per Curiam:*
         A medical doctor ordered that a distressed prisoner receive
   medication. Afterward, the prisoner sued, arguing that the doctor violated
   the prisoner’s due process rights. The district court agreed. We do not, and
   we reverse.

         *
             This opinion is not designated for publication. See 5th Cir. R. 47.5.
Case: 21-60320      Document: 00516738468           Page: 2    Date Filed: 05/04/2023

                                     No. 21-60320

                                          I.
          Chaz Pinkston is a Mississippi state inmate. Dr. Hendrick Kuiper is a
   physician, and at relevant times was the medical director at the state facility
   where Pinkston was housed. Because Pinkston suffers from a complex
   psychiatric profile that includes narcissistic personality disorder and a history
   of hunger strikes, Pinkston’s cell was inside the facility’s medical unit.
          The genesis of this litigation occurred one morning in September
   2016. Pinkston complained of a skin problem on his leg. Dissatisfied with a
   prison nurse’s response, Pinkston began yelling, imitating animal noises, and
   kicking against his cell door. Pinkston continued for more than three hours.
   He also threatened violence against medical staff. As a result of Pinkston’s
   incitement, other prisoners, many of whom were also psychiatric patients,
   began to act similarly.
          Dr. Kuiper heard this disturbance from his position one floor below
   Pinkston. Kuiper went to the scene, as did as many as nine other staff
   members. There, Kuiper asked Pinkston to desist several times. Pinkston did
   not. Kuiper then ordered that Pinkston receive two injections: Haldol, an
   antipsychotic, and Benadryl, an antihistamine intended as a prophylactic
   against any complication from Haldol. Pinkston went to sleep following the
   injections, and nearby inmates quieted down.
          Afterward, Pinkston filed a 42 U.S.C. § 1983 suit alleging that Dr.
   Kuiper’s decision to forcibly medicate Pinkston violated Pinkston’s civil
   rights. The district court, relying on Fourteenth Amendment substantive due
   process jurisprudence and out-of-circuit opinion, agreed.
          Dr. Kuiper timely appealed. We have jurisdiction to review the district
   court’s final judgment. See 28 U.S.C. § 1291. We review the district court’s
   legal conclusions de novo and its factual findings for clear error. See Adkins v.
   Kaspar, 393 F.3d 559, 563 (5th Cir. 2004).

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                                         II.
          When a plaintiff files a 42 U.S.C. § 1983 suit alleging a constitutional
   infraction, the “first inquiry” is to “isolate the precise constitutional
   violation with which the defendant is charged.” Graham v. Connor, 490 U.S.
   386, 394 (1989).
          We first (A) explain why Pinkston’s claim is best understood as an
   Eighth Amendment claim. Then we (B) resolve that claim.
                                         A.
          The Eighth Amendment protects federal prisoners from “cruel and
   unusual punishments.” U.S. Const. amend. VIII. That means prisoners
   are protected from “the unnecessary and wanton infliction of pain.” Gregg v.
   Georgia, 428 U.S. 153, 173 (1976).
          The “wanton infliction of pain” standard provides the bridge between
   the Eighth Amendment’s cruel and unusual punishment guarantee and a
   prisoner’s right to medical care. Because the Supreme Court considers
   “deliberate indifference to serious medical needs” functionally equivalent to
   the “wanton infliction of pain,” the Court has held that the Eighth
   Amendment prohibits such indifference. Estelle v. Gamble, 429 U.S. 97, 104
   (1976) (quotation omitted).
          This “deliberate indifference” standard applies to claims based on a
   defendant’s acts, not just his omissions. Id. at 106. We have held that the
   decision to provide treatment is “a classic example of a matter for medical
   judgment” and subject to Eighth Amendment resolution. Gobert v. Caldwell,
   463 F.3d 339, 346 (5th Cir. 2006) (quotation omitted). We have repeatedly
   applied the Eighth Amendment in other cases where prisoners challenged
   providers’ affirmative acts. See Davis v. Lumpkin, 35 F.4th 958, 963 (5th Cir.
   2022) (indicating deliberate indifference applies when a prisoner claims

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   officials “intentionally treated him incorrectly”); Bias v. Woods, 288 F.
   App’x 158, 162 (5th Cir. 2008) (applying deliberate indifference to a
   provider’s decision to order medical transport).
          Dr. Kuiper’s decision to medically intervene falls within the Eighth
   Amendment’s ambit. In an alternative world where Dr. Kuiper decided
   against intervention, claims for resulting injury would be reviewable under
   the deliberate indifference standard. The standard for evaluating Dr.
   Kuiper’s decision and its consequences does not change merely because in
   this world, Dr. Kuiper made that decision differently.
          The parties and the district court resist this conclusion and instead
   frame this dispute as a matter of Fourteenth Amendment substantive due
   process. They rely on the Supreme Court’s statement in Washington v.
   Harper, 494 U.S. 210 (1990), that individuals possess “significant liberty
   interest in avoiding the unwanted administration of antipsychotic drugs.” Id.
   at 221. In Harper, the Supreme Court held that the State must afford a
   prisoner minimal procedural protection before subjecting him to a forcible,
   long-term regimen of antipsychotic injections. Id. at 228–31. The Supreme
   Court later relied on Harper when it recognized a pre-trial detainee’s
   Fourteenth Amendment interest in avoiding repeated injections over a six-
   month interval. See Riggins v. Nevada, 504 U.S. 127, 130–31, 135 (1992). And
   in this case, the district court held that Harper and Riggins required Dr.
   Kuiper to hold a hearing before providing care to a plainly distressed
   Pinkston.
          But neither Harper nor Riggins articulated constitutional standards
   governing the isolated administration of a single dose of an antipsychotic in a
   threatening, time-sensitive prison situation. Moreover, the Supreme Court
   has instructed us not to apply the Fourteenth Amendment’s substantive-
   due-process catchall when another, more specific constitutional provision

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   applies. United States v. Lanier, 520 U.S. 259, 272 n.7 (1997) (“[I]f a
   constitutional claim is covered by a specific constitutional provision, such as
   the Fourth or Eighth Amendment, the claim must be analyzed under the
   standard appropriate to that specific provision, not under the rubric of
   substantive due process.”); Albright v. Oliver, 510 U.S. 266, 273 (1994)
   (“Where a particular Amendment ‘provides an explicit source of
   constitutional protection’ against a particular sort of government behavior,
   ‘that Amendment, not the more generalized notion of substantive due
   process, must be the guide for analyzing these claims’” (quoting Graham,
   490 U.S. at 395)).
           Harper and Riggins therefore do not apply. †
                                               B.
           Under the Eighth Amendment, Pinkston’s claim fails. The Eighth
   Amendment requires Pinkston to satisfy an “extremely high” deliberate
   indifference standard. See Gobert, 463 F.3d at 346 (quotation omitted).
   Negligence or even medical malpractice does not independently support a
   prisoner’s Eighth Amendment deliberate indifference claim. Estelle, 428
   U.S. at 105–06. Rather, a deliberate indifference plaintiff must show that the
   defendant
           (1) was aware of facts from which the inference could be drawn
           that substantial risk of serious harm exists; (2) subjectively

           †
             Nor can Pinkston contend that bodily integrity claims are somehow different. We
   long ago foreclosed that contention. See Austin v. Johnson, 328 F.3d 204, 210 n.10 (5th Cir.
   2003) (deciding that, where custodial plaintiff brought a bodily integrity claim, the Eighth
   Amendment “defines the limits of government action” and “controls over the more
   generalized notion of substantive due process” (quotations omitted)).

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          drew the inference that the risk existed; and (3) disregarded the
          risk.
   Cleveland v. Ball, 938 F.3d 672, 676 (5th Cir. 2019) (quoting Farmer v.
   Brennan, 511 U.S. 825, 837 (1994)).
          The record is devoid of evidence that Dr. Kuiper subjectively
   disregarded significant risk to Pinkston. That alone disposes of this case. Far
   from showing deliberate indifference, the record instead suggests that Dr.
   Kuiper believed medicating Pinkston was necessary to avoid danger to both
   Pinkston and others. The fact that Dr. Kuiper prescribed Benadryl as
   prophylaxis against any risk from Haldol further supports our conclusion that
   Dr. Kuiper believed his actions consistent with Pinkston’s medical need.
          The district court, leveraging hindsight, might disagree with Dr.
   Kuiper about the objective necessity of medicating Pinkston. But post hoc,
   objective determinations are irrelevant. The deliberate indifference standard
   asks only whether the defendant’s subjective, ex ante choices reflect
   deliberate indifference. See Cleveland, 938 F.3d at 676. Dr. Kuiper’s did not.
                                         III.
          Even if we did apply the Fourteenth Amendment, the result would not
   change.
          Because the parties raise it, we consider the example set by our sister
   circuit in Hogan v. Carter, 85 F.3d 1113 (4th Cir. 1996). That case considered
   a medical practitioner’s choice to administer an emergency dose of
   antipsychotic Thorazine to an enraged inmate who, like Pinkston, was
   kicking against his door and behaving aggressively toward staff over a period
   of several hours. Id. at 1114. Like Pinkston, the plaintiff in Hogan argued that
   he was entitled to a hearing before medication. Id. at 1115.

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          In Hogan, the en banc Fourth Circuit appeared to frame the question
   presented as one of procedural due process. See id. at 1117 (“Due process . . .
   calls for such procedural protection as the particular situation demands.”
   (quotation omitted)). The Fourth Circuit decided that the Supreme Court in
   Washington v. Harper “did not have before it, and did not address,” what
   procedure might be required in Hogan’s emergency circumstances. Id. at
   1116. The Fourth Circuit then concluded that the Constitution does not
   require “adversary proceedings at any hour of the night” while “the very
   inmates for whose protection the state is constitutionally responsible remain
   in danger of injury at their own hands.” Id. at 1117.
          The Fourth Circuit’s decision comports with the law in this Circuit,
   which similarly recognizes that emergency circumstances justify the
   abbreviation or elimination of pre-deprivation procedures like hearings. See
   Caine v. Hardy, 943 F.2d 1406, 1412 (5th Cir. 1991) (en banc) (“Not even an
   informal hearing, however, must precede a deprivation undertaken to protect
   the public safety.”). That’s in part because the procedure due in each case
   varies with the circumstances of that case and the competing interests
   involved. See Harper, 494 U.S. at 229 (citing Mathews v. Eldridge, 424 U.S.
   319, 335 (1976)); Hogan, 85 F.3d at 1117; Caine, 943 F.3d at 1412. So, if we
   were to resolve Pinkston’s claims using a Fourteenth Amendment
   procedural due process framework, we would consider not only his liberty
   and medical interests, but also the significant government interest in
   “maintaining institutional security and preserving internal order” within his
   penitentiary. Bell v. Wolfish, 441 U.S. 520, 546 (1979). Here, Pinkston
   received more than the procedure he was due.
          Pinkston’s principal counterargument is that he received no process
   at all. We disagree. It’s not as if Dr. Kuiper suddenly and arbitrarily injected
   Pinkston. Rather, Dr. Kuiper injected him only after Pinkston precipitated a
   disturbance that subjectively appeared imminently dangerous, only after

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   multiple rounds of verbal persuasion failed, and only after a licensed medical
   professional determined that medication was appropriate.
                                       ***
          The district court erred when it declined to apply an Eighth
   Amendment framework to Pinkston’s dispute over medical treatment. And,
   even if a Fourteenth Amendment framework were apposite, Pinkston
   received all the process he was due. We REVERSE the judgment of the
   district court and render judgment for Dr. Kuiper.

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