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UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT
DENNIS W. TATE, Plaintiff-Appellee,
v.
COFFEE COUNTY, TENNESSEE, et
al.
No. 01-6304
48 Fed. Appx. 176
October 4, 2002, Filed
NOTICE: NOT RECOMMENDED FOR FULL-TEXT PUBLICATION. SIXTH CIRCUIT RULE 28(g) LIMITS CITATION TO SPECIFIC SITUATIONS. PLEASE SEE RULE 28(g) BEFORE CITING IN A PROCEEDING IN A COURT IN THE SIXTH CIRCUIT. IF CITED, A COPY MUST BE SERVED ON OTHER PARTIES AND THE COURT. THIS NOTICE IS TO BE PROMINENTLY DISPLAYED IF THIS DECISION IS REPRODUCED.
RONALD LEE GILMAN, Circuit Judge. Dennis W. Tate, at the age of 23, suffered a stroke
while incarcerated at the [*177] local jail in Coffee County, Tennessee. He
subsequently brought suit against Sheriff Steve Graves, Jailer Paul Blackwell,
and Nurse Diana Casteel (in both their individual and official capacities), and against the
county itself. Tate alleges that the defendants were deliberately indifferent
to his serious medical needs. The individual defendants filed a motion for
summary judgment on the basis that they were entitled to qualified immunity,
which the district court denied. For the reasons set forth below, we AFFIRM the
judgment of the district court with regard to defendant Casteel, REVERSE the
judgment of the district court with regard to defendants Blackwell and Graves,
and REMAND the case for further proceedings consistent with this opinion.
I. BACKGROUND
A. Factual background
Tate was
incarcerated in the Coffee County Jail on January 22, 1999, following his conviction
for driving on a revoked license. He alleges that he repeatedly requested
medical assistance during his three-month incarceration, but that these
requests were frequently not answered in a timely manner or were ignored completely. The particular incident
giving rise to this lawsuit began with Tate's written request to see Nurse
Casteel on April 1, 1999. Tate completed the medical request form with the
assistance of a fellow inmate and described his symptoms as follows:
"Numbness and tingling feeling down the left side of the body. Can't get
out of bed. More like paralysis; can't move about properly. No feeling in hand
at present." Casteel stated in her deposition that, upon receiving Tate's
written request, she suspected that he might have had a stroke.
There is a dispute about the
length of time between Tate's medical request and when he was taken to
Casteel's office. Although Casteel's records show that he was seen on the day
of his complaint,
Tate recalls that he was
not seen by her until the next day. Tate also claims that when he finally got
to see her, she did not examine him or perform any diagnostic tests. Casteel
disagrees, maintaining that she did examine Tate. Her records reflect that Tate
was limping when he entered her office, but that his pupils were equal and
responsive to light and that his grip was equally strong with both hands. She also claims that she
checked Tate's pulse and blood pressure, both of which were within normal
ranges, performed a neurological examination, and tested him for sensory loss.
According to Casteel's notes, Tate told her that his limp was due to an
automobile accident that he had been involved in three years earlier, and that
one of his legs was shorter than the other.
Although Casteel's
examination notes state that Tate declined an offer to go to the hospital, Tate
denies that this option was presented to him that day or at any other time.
Tate similarly disputes Casteel's records showing that she saw him again on
April 5, 1999. Instead, Tate recalls that, after realizing that his release
date was only 12 days away, he decided to remain in his cell until that time.
Despite this decision, Tate submitted another written request to see Casteel a
few days before his release. Casteel's notes indicate that she received the
request on April 13, 1999. According to Casteel, she sent a corrections officer
to bring Tate to her office that day, but Tate refused to see her because he
was scheduled to be released the following day. Tate denies having any such
meeting with a corrections officer on April 13. The next day, on April 14, 1999, Tate was released from the jail.
Tate was
taken to a local hospital on the day of his release. The emergency room
physicians determined that he had suffered
[*178] a stroke during his
incarceration. Tate subsequently had a right carotid endarterectomy (a surgical
procedure in which fatty deposits are removed from one or both of the two main
arteries in the neck that supply blood to the brain) in June of 1999.
B. Procedural
background
This
lawsuit was filed in the United States District Court for the Eastern District
of Tennessee in January of 2000. Tate asserts claims under 42 U.S.C. §§ 1983
and 1988 for alleged violations of his rights under the Fourth and Fourteenth
Amendments. More specifically, the complaint alleges that the individual
defendants were deliberately indifferent to Tate's serious medical needs. With
regard to Jailer Blackwell and Sheriff Graves, Tate asserts that they failed to
(1) promulgate adequate policies to ensure the well-being of inmates in the
jail and (2) provide adequate training and supervision to their subordinates.
The individual defendants responded by filing a motion for
summary judgment, arguing that they are entitled to qualified immunity. In
August of 2001, the district court denied the defendants' motion, concluding
that genuine issues of material fact exist that preclude the grant of qualified
immunity as a matter of law. This timely interlocutory appeal followed.
II. ANALYSIS
A. Jurisdiction
"Government officials performing discretionary functions
generally are shielded from liability for civil damages insofar as their
conduct does not violate clearly established statutory or constitutional rights
of which a reasonable person would have known." Harlow v. Fitzgerald, 457
U.S. 800, 818, 73 L. Ed. 2d 396, 102 S. Ct. 2727 (1982). "In any appeal
from a denial of summary judgment based on qualified immunity, an appellate
court must first address the basic question whether jurisdiction is
proper." Wilhelm v. Boggs, 290 F.3d 822, 824 (6th Cir. 2002). The Supreme
Court has held that such denials are immediately appealable where the issue is
"not which facts the parties might be able to prove, but, rather, whether
or not certain given facts showed a violation of clearly established law."
Johnson v. Jones, 515 U.S. 304, 311, 132 L. Ed. 2d 238, 115 S. Ct. 2151 (1995). Thus, this court has jurisdiction only to
the extent that the defendants "concede to the facts as alleged by the
plaintiff and discuss only the legal issues raised by the case." Comstock
v. McCrary, 273 F.3d 693, 701 (6th Cir. 2001).
The defendants in the present case state in their brief that
they concede to all of the facts as alleged by Tate and are raising only legal
issues on appeal. Yet they ignore Tate's assertion that Nurse Casteel failed to
examine him or perform any diagnostic tests after receiving his April 1 medical
request that detailed his stroke symptoms, and instead proceed as if her
examination notes from that day are undisputed facts. To the extent that this
factual dispute underlies the defendants' appeal, we lack jurisdiction.
Id.
The only matter properly before us on appeal is whether the
defendants' actions, as alleged by Tate, constituted deliberate indifference to
Tate's serious medical needs. If so, the defendant's actions would violate the
Eighth Amendment's prohibition against the infliction of cruel and unusual
punishment, made applicable to the states through the Fourteenth
Amendment. Furman v. Georgia, 408 U.S.
238, 241, 33 L. Ed. 2d 346, 92 S. Ct. 2726 (1972) ("That the
requirements of due process ban cruel and unusual punishment is now
settled."); Terrance v. Northville
[*179] Reg'l Psychiatric Hosp.,
286 F.3d 834, 843 (6th Cir. 2002) ("It is well settled that the deliberate
indifference to serious medical needs of prisoners constitutes the unnecessary
and wanton infliction of pain . . . proscribed by the Eighth Amendment.")
(alteration in original) (internal quotation marks omitted). As this court
discussed in depth in Williams v. Mehra, 186 F.3d 685, 690 (6th Cir. 1989) (en
banc), "whether the [defendants] were deliberately indifferent is a mixed
issue of law and fact . . . . The resolution of this question requires us to
compare the [defendants'] conduct with a legal standard of deliberate
indifference . . . . This analysis is in accord with the established standards
of appellate review."
B. Deliberate
indifference
A claim premised upon deficient medical care "has two
components, one objective and one subjective." Comstock, 273 F.3d at 702.
The objective element is satisfied if the plaintiff alleges "that the
medical need at issue is 'sufficiently serious.'" Id. at 702-03 (quoting Farmer v. Brennan, 511 U.S. 825, 834, 128 L. Ed. 2d 811,
114 S. Ct. 1970 (1994)). As to the subjective component, the plaintiff must
"allege facts which, if true, would show that the official being sued
subjectively perceived facts from which to infer substantial risk to the
prisoner, that he did in fact draw the inference, and that he then disregarded
that risk." 273 F.3d at 703. A prison official is therefore not held
liable under the deliberate-indifference standard for simple negligence. Farmer,
511 U.S. at 835 (noting that deliberate indifference "describes a state of
mind more blameworthy than negligence"); Estelle v. Gamble, 429 U.S. 97,
106, 50 L. Ed. 2d 251, 97 S. Ct. 285 (1976) ("[A] complaint that a
physician has been negligent in diagnosing or treating a medical condition does
not state a valid claim of medical mistreatment under the Eighth
Amendment."). The Court in Farmer further explained that "deliberate
indifference to a substantial risk of serious harm to a prisoner is the
equivalent of recklessly disregarding that risk." Farmer, 511 U.S. at 836.
Proving that the defendant had a sufficiently culpable mental state to make him or her
liable for deliberate indifference is a burden borne by the plaintiff. Comstock, 273 U.S. at 703. This burden can
be met "in the usual ways, including inference from circumstantial
evidence, and a factfinder may conclude that a prison official knew of a
substantial risk from the very fact that the risk was obvious." Farmer,
511 U.S. at 842 (internal citation omitted).
C. Whether the facts as
alleged by Tate could support a finding that Nurse Casteel was deliberately
indifferent
In
analyzing whether Casteel's actions as alleged by Tate meet the legal standard
for deliberate indifference, we must first inquire whether the medical need at
issue was sufficiently serious. Farmer,
511 U.S. at 834. Casteel is not arguing that a stroke fails to meet this
standard; indeed, it would be difficult to do so in good faith. Turning to the
second prong of the
deliberate-indifference test, we next ask if Casteel was subjectively
aware of the facts from which the inference could be drawn that a substantial
risk of serious harm existed, and if she did in fact draw such an inference.
Id. Casteel admits in her deposition
that upon receiving Tate's medical request form reporting stroke-like symptoms,
she suspected that he might have had a stroke.
Tate
acknowledges that Casteel eventually saw him after he had complained of stroke
symptoms, but claims that she failed to examine him or conduct any
diagnostic [*180] tests at that time. Casteel's failure to
examine Tate, which we must assume to be true for the purposes of this appeal,
coupled with her admission that she suspected a stroke, supports the conclusion
that she was subjectively aware of a serious risk and disregarded that
risk. Comstock, 273 F.3d 693 (holding
that allegations of a prison psychologist's "grossly inadequate"
evaluation of an inmate who subsequently committed suicide, if proven, would
constitute deliberate indifference to the inmate's serious medical needs as a
matter of law, thus precluding summary judgment on qualified immunity
grounds).
Once we have concluded that a plaintiff has alleged facts which,
if true, would constitute the violation of a constitutional right, we must
assess whether that right was clearly established at the time the violation
occurred. Saucier v. Katz, 533 U.S.
194, 201, 150 L. Ed. 2d 272, 121 S. Ct. 2151 (2001). This inquiry requires determining whether a reasonable prison
nurse would have known that the conduct in question was unlawful. The Supreme
Court decided many years ago that the government has an "obligation to
provide medical care for those whom it is punishing by incarceration," and
that "deliberate indifference to serious medical needs of prisoners
constitutes the unnecessary and wanton infliction of pain proscribed by the
Eighth Amendment." Estelle v. Gamble, 429 U.S. 97, 103, 50 L. Ed. 2d 251,
97 S. Ct. 285 (1976) (internal citations omitted). Based upon this well-settled
principle, we conclude that a reasonable prison nurse would have been aware
that a failure to examine a patient complaining of stroke symptoms was in derogation
of the inmate's constitutional rights.
Casteel
argues that the fact that she saw Tate in her office precludes us from finding
that she was deliberately indifferent to Tate's serious medical needs. She
contends that her conduct, at worst, constituted nothing more than simple
negligence. This court has previously held, however, that a medical
professional's failure to perform any of the tests that would be routinely conducted
under similar circumstances rises above the level of simple
negligence and can support a finding of deliberate indifference. Comstock, 273
F.3d at 711.
D. Whether defendants
Blackwell and Graves were deliberately indifferent
Applying
the above analysis to defendants Blackwell and Graves, we reach the opposite
conclusion regarding their liability. Tate's allegations are insufficient to
support a finding that either defendant subjectively perceived that Tate was at
substantial risk for serious harm. He offers no evidence suggesting that they
knew about his stroke symptoms or his repeated requests for medical assistance.
Without this knowledge, there is no basis for finding that Blackwell or Graves
were deliberately indifferent to Tate's serious medical needs.
Tate also
alleges, however, that Blackwell and Graves should be held liable for his
injuries because they failed to promulgate adequate jail policies and because
they failed to properly train the jail staff. We recognize that these
defendants could be held individually liable if their failure to promulgate
adequate policies or failure to train reached the level of deliberate
indifference to Tate's serious medical needs.
Taylor v. Michigan Dept. of Corrections, 69 F.3d 76, 81 (6th Cir. 1995)
(holding that a prison supervisor can be held individually liable for failing
to adopt and implement operating procedures "in the face of actual
knowledge of a breakdown in the proper workings of the department"); Redman
v. County of San Diego, 942 F.2d 1435, 1446-47 (9th Cir. 1991) (holding that
where a [*181] supervisor implements an unconstitutional
policy, liability is direct, not vicarious). To establish such liability, Tate
would have to show subjective knowledge on the part of Blackwell and Graves
that the prison policy for responding to medical requests was inadequate and
was putting the inmates at serious risk. But there is no evidence in the record
to suggest that either defendant had the requisite subjective knowledge to hold
them individually liable. Farmer 511 U.S. at 842 (rejecting the argument that
an objective test should be established for determining whether a prison
official is liable under the Eighth Amendment).
As to the failure-to-train claim, this
court has repeatedly held that "a failure of a supervisory official to
supervise, control, or train the
offending individual officers is not actionable absent a showing that the
official either encouraged the specific incident of misconduct or in some other
way directly participated in it." Hays v. Jefferson County, 668 F.2d 869,
874 (6th Cir. 1982). Tate has submitted no evidence suggesting that either
Blackwell or Graves encouraged or directly participated in any deliberate
indifference to Tate's serious medical needs through their training
procedures.
III. CONCLUSION
For all of the reasons set forth above, we AFFIRM the judgment
of the district court with regard to defendant Casteel, REVERSE the judgment of
the district court with regard to defendants Blackwell and Graves, and REMAND
the case for further proceedings consistent with this opinion.
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