Leavitt v. Correctional Medical Services, Inc.
2011 U.S. App. LEXIS 13269
| 1st Cir. | 2011Background
- Leavitt, an HIV-positive inmate, alleged deliberate indifference to medical needs at York County Jail (YCJ) and Maine State Prison (MSP).
- Cichon, YCJ's physician assistant, allegedly stated HIV meds would not be provided there for cost reasons and that MSP would treat him, delaying restart of antiretroviral therapy.
- ARCH (Cichon’s company) had a bid relationship with YCJ; CMS later became the provider at MSP.
- Cichon failed to consistently review viral-load lab results and did not refer Leavitt to an infectious disease specialist promptly.
- MSP's chronic care model meant care was provided by multiple providers rather than a single physician, complicating follow-up.
- District court granted summary judgment for CMS and related defendants; Leavitt prevailed only against Cichon on appeal and the matter was remanded for further proceedings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Deliberate indifference by CMS defendants? | Leavitt asserts CMS staff were aware of HIV risks and ignored care timelines. | CMS staff followed clinic protocols and scheduled follow-ups; no individual awareness of substantial risk. | No genuine issue for CMS individuals; summary judgment affirmed for CMS defendants. |
| Deliberate indifference by Cichon? | Cichon ignored a viral-load report and failed timely referrals, showing intent or recklessness. | Cichon had medical duties and generally acted; missteps did not amount to deliberate indifference. | Issue of material fact as to Cichon; reversal on that defendant and remand for trial. |
| Was there a serious medical need and link to harm? | Delay in restarting ART caused harm and worsened prognosis. | HIV is serious, but the delay was not proven to be deliberately indifferent by record. | There is a material dispute on serious medical need and causation against Cichon only. |
| Official-capacity CMS liability? | CMS as a private entity can be liable for policy or custom. | No underlying constitutional violation by CMS employees; no basis for municipal liability. | No municipal liability; but remand consistent with opinion for other issues. |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (deliberate indifference standard arms inmate claim to medical need)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference requires awareness of substantial risk and inference drawn)
- Burrell v. Hampshire Cnty., 307 F.3d 1 (1st Cir. 2002) (civil rights liability requires personal involvement; respondeat superior rejected)
- Ruiz-Rosa v. Rullán, 485 F.3d 150 (1st Cir. 2007) (deliberate indifference and serious medical need analysis; objective/subjective prongs)
- Monmouth Cnty. Corr. Insts. Inmates v. Lanzaro, 834 F.2d 326 (3d Cir. 1987) (delay can constitute serious harm supporting Eighth Amendment claim)
- Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986) (credibility and weighing of evidence are jury functions)
- Wilson v. Seiter, 501 U.S. 294 (1991) (wantonness standard for deliberate indifference applied to official conduct)
- Feeney v. Corr. Med. Servs., 464 F.3d 158 (1st Cir. 2006) (negligence or malpractice not enough; requires actual knowledge of impending harm)
- Gauvreau v. Municipality of Salem, 923 F.2d 203 (1st Cir. 1990) (serious medical need may be determined by effect of delay)