John Colwell v. Robert Bannister
2014 U.S. App. LEXIS 15652
9th Cir.2014Background
- John Colwell, a Nevada inmate blind in his right eye from a mature cataract since ~2002, had treating providers (including an ophthalmologist and optometrist) recommend cataract removal.
- NDOC denied or discontinued requests for right-eye surgery through its Utilization Review Panel and medical officials; officials repeatedly cited that Colwell had a functioning left eye and therefore did not meet criteria for surgery.
- NDOC Medical Directive 106 requires case-by-case evaluation of cataracts, considering an inmate’s ability to function, and requires URP and Medical Director approval for surgery requests.
- Colwell alleges Eighth Amendment deliberate indifference under 42 U.S.C. § 1983 for denial of medically indicated surgery; district court found the condition serious but granted summary judgment to defendants on deliberate indifference grounds.
- The Ninth Circuit majority reversed summary judgment, holding (1) monocular blindness from cataract is a serious medical need and (2) a blanket administrative denial of medically recommended surgery solely because an inmate has one good eye can constitute deliberate indifference; remanded for trial.
- Judge Bybee dissented, arguing the record shows no pain or imminent harm, NDOC followed case-by-case policies consistent with prison practice, and the decision improperly expands the Eighth Amendment by treating ‘‘worthy of comment’’ diagnoses as per se serious.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether monocular blindness from cataract is a "serious medical need" under the Eighth Amendment | Colwell: untreated cataract causing one-eye blindness is a serious need because it impairs daily functioning and caused injuries at work and in prison | NDOC: cataract is non-urgent/elective if patient has satisfactory vision in other eye; not a serious need absent pain or risk of further injury | Held: Yes — monocular blindness from cataract qualifies as a serious medical need (majority) |
| Whether denial based on NDOC "one eye" practice amounts to deliberate indifference | Colwell: denial was categorical and refused medically indicated surgery despite specialist recommendations, showing conscious disregard | NDOC: decisions reflect medical judgment, resource/prioritization and case-by-case policy; difference of opinion not deliberate indifference | Held: A reasonable jury could find deliberate indifference where administrators overrode specialists based on policy rather than medical judgment; remand for trial |
| Whether a difference of medical opinion defeats an Eighth Amendment claim | Colwell: here it was not a mere difference of opinion because non‑specialists applied a blanket policy contrary to specialists' recommendations | NDOC: treating/administrative physicians made permissible medical decisions; disagreement is not unconstitutional | Held: If the refusal is the product of a policy-driven override of specialists (not a medically acceptable choice), it can be deliberate indifference; mere disagreement insufficient |
| Personal participation / injunctive relief eligibility for NDOC Director and Medical Director | Colwell: Medical Director denied grievance and current Director can implement injunctive relief; thus both are proper defendants | Defendants: dispute over personal involvement, particularly for former Director Skolnik | Held: Medical Director’s personal denial of grievance creates triable issue; current NDOC Director is proper defendant for injunctive relief implementation |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment deliberate indifference to serious medical needs standard)
- Snow v. McDaniel, 681 F.3d 978 (9th Cir. 2012) (non‑treating administrators overruling specialists can support deliberate indifference)
- McGuckin v. Smith, 974 F.2d 1050 (9th Cir. 1992) (indicators of "serious medical need," including conditions a doctor or patient would find worthy of comment)
- Toguchi v. Chung, 391 F.3d 1051 (9th Cir. 2004) (deliberate indifference requires subjective awareness and disregard of substantial risk)
- Farmer v. Brennan, 511 U.S. 825 (deliberate indifference requires that officials know of and disregard an excessive risk)
- Jett v. Penner, 439 F.3d 1091 (9th Cir. 2006) (failure to treat may constitute Eighth Amendment violation if resulting in further significant injury)
- Jackson v. McIntosh, 90 F.3d 330 (9th Cir. 1996) (difference of medical opinion does not alone establish deliberate indifference)
- Hamilton v. Endell, 981 F.2d 1062 (9th Cir. 1992) (relying on an inferior medical opinion over treating physician may support an Eighth Amendment claim)
- Koehl v. Dalsheim, 85 F.3d 86 (2d Cir. 1996) (vision impairment affecting depth perception and safety can be a serious medical need)