John Allard v. Tonia Baldwin
2015 U.S. App. LEXIS 3503
| 8th Cir. | 2015Background
- John Allard, an Iowa prisoner at Clarinda Correctional Facility, experienced constipation beginning February 5, 2011, which culminated in a perforated diverticulum and emergency surgery (colostomy) on February 20, 2011.
- CCF Health Services treated Allard for constipation with multiple interventions (laxatives, enemas, stool softeners, liquid diet, antibiotics, mobility directives) and ordered an abdominal x-ray; outside ER physicians also evaluated him and diagnosed constipation.
- Radiology read suggested large stool burden and did not definitively show obstruction; a CRHC radiologist noted a distal colonic obstruction was not excluded and recommended CT if distention persisted, but no CT was performed while Allard remained at CCF.
- Allard alleges the misdiagnosis and treatment constituted Eighth Amendment deliberate indifference; he submitted an expert opinion that the x-rays, given his symptoms, should have led to a diagnosis of obstruction.
- CCF issued a disciplinary reprimand to Allard for noncompliance with medical walking directives during the treatment period; Allard sued several staff under 42 U.S.C. § 1983.
- The district court granted summary judgment for defendants; the Eighth Circuit affirmed, holding that although Allard suffered a serious medical need, he failed to show defendants acted with the required subjective deliberate indifference.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Adequacy of diagnosis (misdiagnosis) | Allard: x-rays and symptoms should have led to diagnosis of bowel obstruction | Defendants: multiple exams and outside ER corroborated constipation diagnosis; no evidence of criminally reckless misdiagnosis | Court: Misdiagnosis, even if negligent, did not rise to deliberate indifference; summary judgment for defendants |
| Adequacy of treatment (level and choices) | Allard: treatments deviated from professional standards and were inadequate, amounting to deliberate indifference | Defendants: provided repeated, varied, and responsive treatments; patient disagreement with care does not show constitutional violation | Court: Treatment was not so ineffective or grossly incompetent as to constitute deliberate indifference |
| Delay/denial of advanced imaging (CT) | Allard: failure to obtain CT despite radiologist recommendation and persistent symptoms | Defendants: x-ray results and ER evaluations were communicated; treatment decisions reasonable under circumstances | Court: Failure to obtain CT or earlier surgical referral did not establish the subjective mental state required for an Eighth Amendment claim |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (government must provide medical care to incarcerated persons)
- Dulany v. Carnahan, 132 F.3d 1234 (8th Cir. 1997) (deliberate indifference requires objective serious need and subjective knowledge and disregard)
- McRaven v. Sanders, 577 F.3d 974 (8th Cir. 2009) (negligent misdiagnosis not actionable under § 1983)
- Vaughn v. Gray, 557 F.3d 904 (8th Cir. 2009) (deliberate indifference requires mental state akin to criminal recklessness)
- Smith v. Jenkins, 919 F.2d 90 (8th Cir. 1990) (inadequate records and deviation from standards can support deliberate indifference when proven)
- Meloy v. Bachmeier, 302 F.3d 845 (8th Cir. 2002) (deliberate indifference may be shown by intentional delay or denial of access to medical care)