Carey Hixson v. Michael Moran
1 F.4th 297
| 4th Cir. | 2021Background:
- Hixson, an inmate diagnosed with Type 2 diabetes and previously prescribed insulin, was jailed at Harrisonburg-Rockingham Regional Jail for ~5 months in 2016.
- Jail staff initially lacked medical records confirming his insulin prescription; Dr. Moran placed Hixson on a diabetic diet and ordered daily blood‑glucose testing (later increased to twice daily when readings varied).
- Hixson’s glucose readings fluctuated (normal to >400 mg/dL); Dr. Moran reviewed readings weekly and declined to prescribe insulin or oral hypoglycemics citing risk of hypoglycemia from variable readings.
- Hixson repeatedly asked nursing staff for insulin informally but did not report diabetic symptoms, formally grieve, or submit medical requests for diabetes care while incarcerated.
- Hixson sued under 42 U.S.C. § 1983 (Eighth Amendment deliberate indifference) and state medical malpractice/gross negligence; the district court granted summary judgment for Dr. Moran, and Hixson appealed.
- The Fourth Circuit affirmed, finding no deliberate indifference or gross negligence and concluding the district court’s order was final.
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Finality / Jurisdiction | District court failed to rule on separate claim re: non‑insulin medication, so order not final | District court addressed central component and encompassed all medication claims | Order was final; appellate jurisdiction proper |
| Eighth Amendment — deliberate indifference for failing to prescribe insulin/non‑insulin meds | Dr. Moran knew of Hixson’s diabetes and should have prescribed insulin or oral meds; expert says standard of care violated | Dr. Moran monitored glucose, used diet and increased testing, and reasonably withheld meds due to variable readings and hypoglycemia risk | No deliberate indifference: reasonable medical judgment and monitoring defeated § 1983 claim |
| State law — gross negligence / medical malpractice | Failure to medicate amounted to gross negligence under Virginia law | Some degree of care was shown (diet, monitoring, testing), so not gross negligence | Not grossly negligent as a matter of law; summary judgment proper |
Key Cases Cited
- Coopers & Lybrand v. Livesay, 437 U.S. 463 (final-judgment rule description and scope)
- Firestone Tire & Rubber Co. v. Risjord, 449 U.S. 368 (practical construction of final-judgment rule)
- Porter v. Zook, 803 F.3d 694 (4th Cir. 2015) (finality when district court fails to address claims)
- Farmer v. Brennan, 511 U.S. 825 (prison officials must respond reasonably to known serious risks)
- Iko v. Shreve, 535 F.3d 225 (4th Cir. standard: objective and subjective elements of deliberate indifference)
- Miltier v. Beorn, 896 F.2d 848 (4th Cir. deliberate indifference requires treatment so grossly inadequate it shocks the conscience)
- Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (summary judgment and genuine-issue standard)
- Elliot v. Carter, 292 Va. 618 (Virginia law: gross negligence requires indifference, not mere inadequacy)