999 F.3d 1116
8th Cir.2021Background
- In March 2017 Elvin Redmond, an IDOC inmate with diabetes and hepatitis, reported a painful, swollen fifth toe that developed a blister and then an infection.
- Nurse practitioner Jana Hacker treated him at the prison (pain meds, topical and oral antibiotics, an injectable antibiotic) and referred him to the University of Iowa Hospitals & Clinics (UIHC) ER when his blister opened and he had a fever.
- UIHC evaluated him in early April; orthopedic surgeon Dr. Michael Willey recommended vascular consults and initially found no urgent need for operation; Redmond was discharged to a medical prison facility where Dr. Joel Kosinski provided ongoing care and documented need for toe amputation.
- Redmond’s infection progressed; Willey removed two toes May 30 and discovered the infection extended beyond the toes, such that below-the-knee amputation was indicated; acute renal issues delayed surgery and Redmond ultimately underwent below-the-knee amputation in August.
- Redmond filed a pro se § 1983 suit alleging Eighth Amendment deliberate indifference by Hacker, Kosinski, Willey, and several corrections officials; the district court granted summary judgment to all defendants; Redmond appealed summary judgment as to Hacker, Kosinski, and Willey.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether defendants were deliberately indifferent to a serious medical need (Eighth Amendment) | Redmond: delays and improper treatment caused infection to worsen and led to amputation | Defendants: provided ongoing, reasonable medical care; disagreements reflect medical judgment, not indifference | Summary judgment for defendants; no genuine dispute of deliberate indifference |
| Whether delay in treatment causally worsened prognosis and can be proven without expert evidence | Redmond: harmful effect of delay is obvious to a layperson (like Moore v. Jackson) | Defendants: infection, diabetes, hepatitis present complex medical issues requiring expert proof of causation | Court: complex medical causation requires expert testimony; plaintiff supplied none, so causation not shown |
| Whether Hacker and Kosinski improperly substituted or withheld prescribed antibiotics | Redmond: claims failure to follow UIHC’s Cephalexin order and that Kosinski withheld Ciprofloxacin | Defendants: record shows Amoxicillin was ordered by a physician and Ciprofloxacin was administered April 10–17; new antibiotic-contentions were raised on appeal | Court: new medication allegations not considered on appeal and record contradicts plaintiff’s claim |
| Whether the care amounted to grossly inadequate or intentionally maltreating treatment (beyond negligence) | Redmond: treatment delays and choices were grossly incompetent and caused severe harm | Defendants: differences in treatment reflect permissible medical judgment; negligence alone is insufficient | Court: no expert or other evidence of gross incompetence; summary judgment affirmed |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment deliberate indifference standard for medical care)
- Dulany v. Carnahan, 132 F.3d 1234 (8th Cir.) (deliberate indifference requires care so inappropriate it evidences intentional maltreatment)
- Moore v. Duffy, 255 F.3d 543 (8th Cir.) (departure from medical standards can show deliberate indifference; expert testimony often required)
- McRaven v. Sanders, 577 F.3d 974 (8th Cir.) (substantial evidentiary threshold to show deliberate indifference in medical-treatment claims)
- Crowley v. Hedgepeth, 109 F.3d 500 (8th Cir.) (prisoner must submit medical evidence that delay adversely affected prognosis)
- Laughlin v. Schriro, 430 F.3d 927 (8th Cir.) (effect of delay measured by impact on prognosis)
- Holden v. Hirner, 663 F.3d 336 (8th Cir.) (verifying medical evidence required to show officials ignored an acute or escalating situation)
- Alberson v. Norris, 458 F.3d 762 (8th Cir.) (expert testimony required to prove causation for sophisticated medical conditions)
- Moore v. Jackson, 123 F.3d 1082 (8th Cir.) (delay in dental care was sufficiently obvious to layperson to survive summary judgment)
- Coleman v. Rahija, 114 F.3d 778 (8th Cir.) (elements of Eighth Amendment medical claims: objective serious need and subjective deliberate indifference)