Court Opinion

ID: 9499787
Source: CourtListenerOpinion
Date Created: 2023-08-05 17:57:39.678672+00
Date Added: 2024-06-11T17:59:43.626262
License: Public Domain

BYE, Circuit Judge,
concurring in part and dissenting in part.
I agree the district court’s findings regarding Captain Michael McGregor were not clearly erroneous and join the Court in affirming the judgment entered in his favor. I disagree Nurse Janice Colburn and Dr. Scott Ludwig should be excused for their deliberate indifference to the undisputed serious medical needs of Napoleon Hartsfield and, therefore, respectfully dissent from the portion of the Court’s opinion affirming the judgment entered in their favor.
I
Mr. Hartsfield was required to prove two things to prevail on his Eighth Amendment claim: 1) he had an objectively serious medical need; and 2) prison officials knew of the need but deliberately disregarded it. Gordon ex rel. Gordon v. Frank, 454 F.3d 858, 862 (8th Cir.2006). With respect to the first item, Nurse Col-burn and Dr. Ludwig concede he had an objectively serious medical need. Appel-lees’ Br. 15. When he was finally examined by a dentist, he had a significant amount of decay on two molars. The decay had exposed a nerve, and there was some bone loss around the decayed teeth. He also had an impacted wisdom tooth. The dentist had to extract both of the decayed molars, as well as the impacted wisdom tooth. Because Nurse Colburn and Dr. Ludwig did not dispute the seriousness of the medical condition, the only issue left for the district court’s resolution was whether the prison officials knew of the need but nevertheless deliberately disregarded it.
The Court’s decision hinges in large part on the district court’s finding that Nurse Colburn “did not see, or otherwise know, that Hartsfield had bleeding or swelling.” Based on this fact-finding, the Court distinguishes this case from our prior decisions where the inmate or prisoner not only complained of severe tooth pain, but prison officials also observed obvious signs of serious infection such as swelling, bleeding or pus. See Moore v. Jackson, 123 F.3d 1082, 1085-87 (8th Cir.1997); Boyd v. Knox, 47 F.3d 966, 969 (8th Cir.1995); Patterson v. Pearson, 19 F.3d 439, 440 (8th Cir.1994); Fields v. Gander, 734 F.2d 1313, 1315 (8th Cir.1984). In other words, deliberate indifference is present when prison officials not only have knowledge of an inmate’s complaints of severe tooth pain, but also observe swelling, bleeding, or pus. Because Nurse Colburn “did not see, or otherwise know, that Hartsfield has bleeding or swelling,” the Court concludes the seven-week delay in his medical treatment amounted to “at most a question of negligence.” Ante at 398.
The fact that Nurse Colburn did not observe Mr. Hartsfield’s bleeding and swelling is hardly surprising, however, given her admission at the evidentiary hearing she never examined the patient:
Q. From the time that Mr. Hartsfield filed his first complaint or — sorry— his first sick call request on October 20th of '01, through the time of his surgery on December 5th, did you *400ever personally examine Napoleon Hartsfield?
A. No, I did not.
Hr’g Tr. at 51, lines 3-7.
Furthermore, it is undisputed Dr. Ludwig never examined Hartsfield at any time between October 20 and December 5. Thus, this case is distinguishable from Moore, Boyd, Patterson, and Fields, only in that the deliberate indifference exceeds that present in those four cases. Prison officials were at least responsive enough to the medical needs of inmates Moore, Boyd, Patterson, and Fields to take the most basic step of examining them to determine the severity of their condition.
Nurse Colburn and Dr. Ludwig acted pursuant to a policy of non-examination for dental complaints. The prison’s admitted policy was to prescribe ibuprofen for dental patients, wait a short period to see if the pain would recede, and if it did not, refer the inmate to a dentist. Having implemented a policy of non-examination, it is incongruous for our court to excuse the delay in Mr. Hartsfield’s dental treatment on the ground the prison officials were unaware of the severity of his condition. Under the Court’s approach, prison officials can deliberately adopt a policy which shields them from knowledge, and then deny responsibility because they lacked knowledge. This is not mere negligence, but the epitome of deliberate indifference.
Under the facts involved in this case, the district court’s finding that Nurse Colburn “did not see, or otherwise know, that Hartsfield had bleeding or swelling” is irrelevant. Pursuant to their adopted policy, Nurse Colburn and Dr. Ludwig should have referred him to a dentist as soon as they knew the ibuprofen was not working. The undisputed evidence shows both Nurse Colburn and Dr. Ludwig knew the ibuprofen was not working and yet still delayed his dental treatment for weeks.
Hartsfield testified he told Nurse Col-burn about his tooth pain “[a]lmost every day when she did her roundsf.]” Hr’g Tr. at 17, line 19. “I told her that I had severe pain in my mouth, I couldn’t eat, sleep, that I was having headaches[.]” Id. at 17, lines 10-11. He testified Nurse Colburn responded by telling him to “quit complaining and bitching and that she would, you know, see me.” Id. at 17, lines 12-13. He also testified Nurse Colburn told him complaining and “threatening to file lawsuits is not going to get me seen no quicker (sic). So I figured she was gonna, you know, talk to someone and let me see the doctor or take me to get medical treatment.” Id. at 30, lines 7-11.
Nurse Colburn’s testimony did not contradict Hartsfield’s. She testified: “After the initial sick call slip, I did make rounds every day and did go to the cell that he [Hartsfield] was in, and it was a constant verbal request, constant verbal request, and he was told to put a sick call slip in.” Id. at 47, lines 11-13. She also testified she reported on his condition to Dr. Ludwig “on average at least once a week.” Id. at 52, line 10. Thus, the record is undisputed that both Nurse Colburn and Dr. Ludwig knew the ibuprofen was not working, and yet still failed to examine Mr. Hartsfield to determine the severity of his condition, or refer him to a dentist to address his serious medical need.
The only reason given by Dr. Ludwig and Nurse Colburn for delaying treatment for Mr. Hartsfield’s serious medical condition is his failure to complete a second sick call slip. The insistence on a second sick call slip was unreasonable. Under the adopted policy, Nurse Colburn and Dr. Ludwig admit they prescribed a two-part course of treatment with respect to his first sick call slip — ibuprofen first, followed *401by a referral to a dentist if the ibuprofen did not work. Nurse Colburn and Dr. Ludwig failed to follow through with the second part of the prescribed course of treatment after they knew the ibuprofen did not work. The law does not impose upon Mr. Hartsfield the burden of giving prison officials written notice of his serious medical need; he must only prove prison officials knew of his need and deliberately disregarded it. Indeed, our cases suggest the indifference is heightened when an inmate communicates his distress directly, as he did, and prison officials fail to respond. Cf. Gordon, 454 F.3d at 863 (“A reasonable officer would know that it is unlawful for officers to delay medical treatment for an inmate with obvious signs of medical distress, especially one who communicates this distress directly to officers.”).
Even assuming arguendo prison policy required Mr. Hartsfield to complete a second sick call slip, the inmate’s medical needs should take precedence when there is tension between those needs and a prison’s alleged need to adhere strictly to prison policy. See De’Lonta v. Angelone, 330 F.3d 630, 635 (4th Cir.2003) (reversing summary judgment where the refusal to provide medical treatment was based “solely” on a policy rather than on a medical judgment concerning the plaintiffs circumstances).
II
Nurse Colburn and Dr. Ludwig did not see their patient’s serious medical need because they would not examine him. In addition, they ask us to pretend they did not hear his complaints because he would not complete a second written form. Because this shows Nurse Colburn and Dr. Ludwig deliberately disregarded Mr. Hartsfield’s serious medical needs, I respectfully dissent.