Gregory Atkins v. Tony Parker, 972 F.3d 734

Background

Plaintiffs are a certified class of Tennessee prisoners with chronic hepatitis C who sued TDOC officials (including medical director Dr. Kenneth Williams) under 42 U.S.C. § 1983, alleging Eighth Amendment deliberate indifference for denying direct-acting antivirals to all infected inmates.
Direct-acting antivirals cure hepatitis C for most patients but are costly; prices declined from 2015 to trial but remained substantial; Tennessee had ~4,740 infected inmates in 2019.
TDOC’s 2016 policy limited antivirals to inmates with advanced liver scarring; in 2019 Williams promulgated new guidance: universal testing, baseline staging, six‑month chronic-care reassessments, an advisory committee (chaired by Williams) to prioritize and individualize treatment, and standardized workflows.
Plaintiffs' expert testified that community standard supports treating chronic hepatitis C as early as possible; he also acknowledged prioritization was understandable given limited resources and had used it at the VA. District court found his testimony credible but concluded 2019 guidance met constitutional requirements.
After a four-day bench trial the district court entered findings that the 2019 guidance—monitoring, diagnostics, advisory committee, and funding efforts—did not constitute deliberate indifference; the Sixth Circuit majority affirmed; Judge Gilman dissented arguing the rationing violated evolving standards of care and that cost cannot excuse constitutional violations.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Williams was deliberately indifferent by not providing antivirals to all infected inmates	Atkins: withholding antivirals from non‑severely scarred inmates denied constitutionally adequate medical care; best practice is early treatment for all chronic HCV	Williams: 2019 guidance provided comprehensive evaluation, monitoring, and individualized prioritization using finite resources; not deliberate indifference	Held: No deliberate indifference; 2019 guidance met Eighth Amendment obligations and district court findings not clearly erroneous
Whether Williams’s resource allocation (and alleged failure to obtain more funding) renders his policy unconstitutional	Atkins (dissent): cost cannot excuse withholding objectively necessary treatment; Williams failed to seek full funding to treat all inmates	Williams: repeatedly sought and obtained significant funding, spent funds on antivirals, and reasonably prioritized treatment given limited resources	Held: Majority rejects plaintiffs’ contention that failure to obtain more funds proves constitutional violation; record shows Williams sought funds and acted reasonably
Whether district court’s factual findings should be disturbed on appeal	Atkins: trial record shows delay causes substantial risk; court erred in crediting resource-based prioritization	Williams: defer to bench trial factfinding; findings are plausible	Held: Appellate court defers to district court; findings affirmed (clear‑error standard)
Whether continuous monitoring, staging, and advisory‑committee decisionmaking satisfy constitutional care requirements	Atkins: monitoring is inadequate if it results in unnecessary delay and suffering; policy lacks guidance for symptomatic patients with mild/moderate fibrosis	Williams: monitoring plus committee and workflow ensures individualized care and revisiting of priorities as conditions progress	Held: Those systems, together with funding efforts and prioritization, suffice under the Eighth Amendment in these circumstances

Key Cases Cited

Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment deliberate‑indifference standard for denial of medical care)
Farmer v. Brennan, 511 U.S. 825 (1994) (subjective component: conscious disregard of substantial risk)
Rhinehart v. Scutt, 894 F.3d 721 (6th Cir. 2018) (articulation of objective and subjective components in Eighth Amendment medical claims)
United States v. Demjanjuk, 367 F.3d 623 (6th Cir. 2004) (standard of review for bench‑trial factual findings)
Anderson v. City of Bessemer City, 470 U.S. 564 (1985) (appellate review of trial court factfinding; clear‑error standard)
King v. Zamiara, 680 F.3d 686 (6th Cir. 2012) (de novo review of legal conclusions; defer to factual findings)
Watson v. City of Memphis, 373 U.S. 526 (1963) (cost cannot justify denial of constitutional rights)
Peralta v. Dillard, 744 F.3d 1076 (9th Cir. 2014) (lack of resources not a defense to prospective injunctive relief for Eighth Amendment violations)
Williams v. Bennett, 689 F.2d 1370 (11th Cir. 1982) (courts may issue injunctive relief without regard to legislative financing in prison‑conditions cases)
Brown v. Plata, 563 U.S. 493 (2011) (population limits and remedies where overcrowding causes constitutional violations)
Finney v. Arkansas Bd. of Correction, 505 F.2d 194 (8th Cir. 1974) (release/transfer as remedy where budget shortfalls cause unconstitutional conditions)
Petties v. Carter, 836 F.3d 722 (7th Cir. 2016) (cost may factor into reasonableness, but officials cannot knowingly provide ineffective treatment to save money)
Darrah v. Krisher, 865 F.3d 361 (6th Cir. 2017) (prisons may consider cost among reasonable treatment options)
Atkins v. Parker, 412 F. Supp. 3d 761 (M.D. Tenn. 2019) (district decision discussing community standard of care and HCV treatment guidance)