Kevin Darrah v. Dr. Krisher, 865 F.3d 361

Background

Plaintiff Kevin Darrah, an inmate with severe palmo-plantar hyper-keratoderma (HPK), had previously been successfully treated with Soriatane at a different Ohio prison before transfer to Madison Correctional Institution (MCI).
Ohio Department of Rehabilitation and Correction (ODRC) maintains a drug formulary; Soriatane was non-formulary while Methotrexate was the formulary psoriasis drug. Non-formulary medications required prior authorization from review officials regulated by the Ohio Department of Mental Health (ODMH).
After transfer to MCI in January 2011, Darrah went nearly three months without any HPK medication; when treatment began, staff prescribed Methotrexate (and monitoring) after requests for Soriatane were denied by the Review Board.
Darrah repeatedly complained that Methotrexate was ineffective and that he remained in severe pain and at risk of infection; he eventually obtained Soriatane from a non-ODRC source and improved after beginning it in February 2012.
Darrah sued under 42 U.S.C. § 1983 alleging Eighth Amendment deliberate indifference against Drs. Krisher, Eddy, Weil, and Nurse Stanforth; the district court granted summary judgment to defendants, and the Sixth Circuit reversed and remanded.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether a 3-month delay in providing any HPK medication amounts to Eighth Amendment deliberate indifference	Darrah: known serious condition; multiple complaints; no treatment for ~3 months; interruption of prescribed care	Defendants: delay caused by formulary/prior-authorization rules and plaintiff’s misstatements about prior authorization	Reversed; triable issue exists — jury could find deliberate indifference to the untreated period
Whether prescribing Methotrexate (formulary) instead of previously effective Soriatane constituted deliberate indifference	Darrah: Soriatane was the only effective drug for him; Methotrexate was less efficacious and risky, chosen for formulary/cost reasons	Defendants: medical judgment and formulary compliance; some treatment was provided	Reversed; reasonable jury could find choice was a non-medical-based, less efficacious treatment amounting to deliberate indifference
Whether continuing Methotrexate despite lack of improvement created deliberate indifference	Darrah: continued complaints and lack of response made continued use effectively no treatment	Defendants: ongoing monitoring and dosage adjustments, dispute over symptoms and compliance	Reversed; material fact disputes preclude summary judgment — jury could find continued ineffective care amounted to indifference
Whether supervisory/administrative failures by Nurse Stanforth and Review-Board members can be Eighth Amendment violations	Darrah: Stanforth failed to ensure continuity and escalation of care; Krisher/Eddy denied prior authorization and kept treatment plan despite photos/complaints	Defendants: limited authority (nurse), reliance on formulary/regulations, and medical discretion	Reversed; factual disputes exist as to abdication of duties and non-medical decisionmaking, so claims survive summary judgment

Key Cases Cited

Estelle v. Gamble, 429 U.S. 97 (1976) (deliberate indifference to serious medical needs violates the Eighth Amendment)
Farmer v. Brennan, 511 U.S. 825 (1994) (subjective deliberate-indifference standard requires awareness of substantial risk)
Comstock v. McCrary, 273 F.3d 693 (6th Cir. 2001) (plaintiff must show official perceived and disregarded substantial risk)
Boretti v. Wiscomb, 930 F.2d 1150 (6th Cir. 1991) (interruption of prescribed treatment can state an Eighth Amendment claim)
Terrance v. Northville Regional Psychiatric Hospital, 286 F.3d 834 (6th Cir. 2002) (short delays can constitute deliberate indifference when risk is known)
Blackmore v. Kalamazoo County, 390 F.3d 890 (6th Cir. 2004) (test focuses on substantial risk of serious harm; actual harm not required)
Pearson v. Callahan, 555 U.S. 223 (2009) (qualified immunity framework)