A summary judgment was granted for defendant in Wester v. Jones, 554 F.2d 1285 (4th Cir. 1977). During a physical exam given on his initial entry into prison, plaintiff complained of an injury in his left eye. During a three month period he made several complaints concerning pain and loss of vision in his left eye, and contended that the prison doctor cursorily examined him after the initial complaint and never re-examined him. A specialist who examined the plaintiff found him suffering from a detached retina; and although he was treated for this condition, his full sight was never restored. The majority applied the standards of Estelle and found no constitutional violation: "It is undisputed that the doctor examined Wester and found no medical problem Even if the doctor were negligent in examining Wester and in making an incorrect diagnosis, his failure to exercise sound professional judgment would not constitute deliberate indifference to serious medical needs." 554 F.2d at 1286. Justice Winters, however, dissented, feeling that the plaintiff asserted more than medical malpractice. He felt it was crucial that the prison doctor never re-examined him after he repeatedly complained: "A refusal to conduct another medical examination of a prisoner who has a known pre-existing injury despite his repeated complaints of pain and fading vision is, in my view, the deliberate indifference which Estelle holds a violation of the eighth amendment. 554 F.2d at 1287. An action against a prison superintendent and an ophthalmogist was dismissed in Parilla v. Cuyler, 447 F.Supp. 363 (E.D. Pa. 1978) for failure to state a constitutional violation. Plaintiff claimed a doctor examined his eyes and determined that his vision would be lost unless an operation was performed. The doctor later decided that nothing could be done and treated plaintiff, who lost vision in one eye, with eyedrops. The court found that one aspect of Estelle was satisfied by the showing that the medical needs were serious. However, the complaint which named the prison superintendent did not allege that he personally participated in the medical treatment or acted on it in any way. The court observed that the determinative issue was whether a claim of deliberate indifference was set forth and concluded that: On the face of this complaint, however, no set of facts appear which show deliberate indifference to plaintiff's medical needs on the part of Cuyler or Robinson. Instead, as in Estelle, . it appears that these supervisory officials are named "more on respondeat superior principles in line with their official capacities." The allegations therefore fail to state a claim. 447 F.Supp. at 366-67. Although a single incident may be insufficient to state a constitutional violation, it is possible that a series of incidents which are closely related in time may show a pattern of conduct. The cumulative effect of these incidents may rise to the level of deliberate indifference. Bishop v. Stoneman, 508 F.2d 1224 (2d Cir. 1974). The standards promulgated by Estelle were the subject of further elaboration in Laaman v. Helgemoe, 437 F.Supp. 269, 311 (D. N.H. 1977). The court noted that in a section 1983 action the following must be shown: a callous indifference to medical needs, that the medical needs were serious, and that the failure to treat them has resulted in considerable harm. A serious medical need was defined as one that has been diagnosed by a physician as mandating treatment, or one that is so obvious that a lay person would recognize the need for treatment. Thus, even elective treatments may be constitutionally mandated. The court also noted that one need not wait until the harm suffered is so egregious as to shock the conscience; failure to fulfill an affirmative duty also violates the Eighth Amendment. Many complaints which appear to allege a denial of medical care are in reality concerned with situations in which some medical care is provided but is alleged to be inadequate. When this is the case, the allegations must rise above the malpractice or difference of judgment standard which was previously discussed. This section focuses primarily on complaints which allege a total denial of medical care despite plaintiff's request. The cases are in accord that a constitutional violation exists if there has been total denial of medical care with an intent to harm the inmate, or where the injury is so severe and obvious that medical treatment is clearly required. A complaint against prison authorities which does not allege personal involvement in the decision to deny medical treatment or severe and obvious injuries may be dismissed for failure to state a claim. Mathis v. Pratt, 375 F.Supp. 301 (N.D. Ill. 1974). In that case, the doctor refused to renew the prisoner-plaintiff's prescription for Thorazine after he admitted he was a drug addict. 144 A federal pretrial detainee alleged denial of medical care in Hampton v. Holmesburg Prison Officials, 546 F.2d 1077 (3d Cir. 1976). The court of appeals found no constitutional violation and vacated the district court's award of damages. Plaintiff had been assaulted and suffered injuries to his jaw, head, face, and right hand. Two days after the incident he asked for medical attention, and submitted sick call slips on the following day. Five days later he saw a prison nurse, seven days after his request he saw a prison doctor, and four days later was taken to a Philadelphia hospital for out-patient treatment. The court noted that the constitutional standard was not satisfied since the record failed to support the charge that the guards deliberately or intentionally prevented plaintiff from receiving medical treatment, nor was it shown they prevented his sick call slips from proceeding through established channels. At most the court felt a pattern of neglect in providing prompt medical attention was established which was insufficient to impose tort liability on the guards. A district court dismissal of a claim was reversed and remanded in West v. Keve, 571 F.2d 158 (3d Cir. 1978). A state prisoner who was serving a life sentence had varicose vein surgery postponed for seventeen months during which time he allegedly suffered great pain. The court stated that constitutional standards would be violated if deliberate indifference caused an easier and 144. The requirement that there be an intent to harm or failure to treat severe and obvious injuries is imposed in Roach v. Kligman, 412 F.Supp. 521 (E.D. Pa. 1976). See also Page v. Sharpe, 487 F.2d 567 (1st Cir. 1973); Bartling v. Ciccone, 376 F.Supp. 200 (W.D. Mo. 1974); Donahue v. Maynard, 437 F.Supp. 47 (D. Kan. 1977) (medical records which showed constant care and attention refuted claim of denial of medical care). less effective treatment to be used. 145 A refusal to allow an inmate in solitary confinement access to medical care may be actionable depending on the nature, extent, seriousness of the injury, the need for medical treatment, and the defendant's conduct. The plaintiff in Mathis v. DiGiacinto, 430 F.Supp. 457 (E.D. Pa. 1977) alleged that repeated requests for the skin medication he was receiving prior to solitary were denied. Defendants requested a summary judgment, contending that only a minor condition was involved. The court declined to hold as a matter of law that no constitutional deprivations had taken place and noted that the claim may be actionable since a factual dispute was involved, 146 A district court's dismissal was held erroneous in Westlake v. Lucas, 537 F.2d 857 (6th Cir. 1976), where a county jail inmate alleged he was denied a special diet and ulcer medication. Six days after his incarceration he started to vomit blood and was told he could receive no medical treatment for two days. The court noted a section 1983 claim is stated where there is a denial of an obvious need for medication and a prisoner is needlessly allowed to suffer pain when relief is readily available. 147 145. See also Sanabria v. Village of Monticello, 424 F.Supp. 402 (S.D. N.Y. 1976) (suit brought by arrested individual against village stated cause of action where plaintiff was paralyzed as a result of failure to allow medical treatment for broken neck). 146. See also Fitzke v. Shappel, 468 F.2d 1072 (6th Cir. 1972) (nine hour delay in receiving medical attention after arrest and incarceration where prisoner limped and complained of pain and numbness in leg actionable). But see Arroyo v. Schaefer, 548 F.2d 47 (2d Cir. 1977) (no callous or shocking disregard where inmates were forced to remain in cells for two hours without showers or other medical treatment after inmate in adjoining cell was tear-gassed). 147. See also Williams v. Vincent, 508 F.2d 541, 544 (2d Cir. 1974); Scharfenberger v. Wingo, 542 F.2d 328, 331 (6th Cir. 1976); Thomas v. Pate, 493 F.2d 151, 158 (7th Cir.), cert. denied sub nom. Thomas v. Cannon, 419 U.S. 879, 95 S.Ct. 143, 42 L. Ed. 2d 119 (1974). A jury verdict in favor of the prisoner plaintiff was set aside in McCracken v. Jones, 562 F.2d 22 (10th Cir. 1977). The warden and director of the department of corrections successfully argued on appeal it was error to deny their motion for judgment n. o. v. Plaintiff had injured his back and been examined by prison doctors who prescribed exercises he refused to follow. Although plaintiff did not have a constitutional right to be examined by his own doctor, his doctor later performed surgery. 148 The court stated: [M]uch of the trial was taken up 562 F.2d at 24. d. Denial of Prescribed Medical Treatment Although it is difficult to satisfactorily show deliberate indifference in cases involving inadequate medical care, there is little doubt that a refusal to follow a prescribed course of medical care is actionable. Most of the cases in this area name as defendants non-medical personnel who refuse or interfere with the physician's guidelines. The leading case dealing with interference with a prescribed course of medical treatment is Martinez v. Mancusi, 443 F.2d 921 (2d Cir. 1970), cert. denied, 401 U.S. 983, 91 S. Ct. 1202, 28 L. Ed. 2d 335 (1971). this action against the warden, prison doctor, and guards, plaintiff, who was suffering from infantile In 148. See also Smart v. Villar, 547 F.2d 112 (10th Cir. 1976) (deliberate indifference not shown by alleging failure to allow medical tests at facility outside prison). |