Lewis Rhinehart v. Debra Scutt
894 F.3d 721
| 6th Cir. | 2018Background
- Kenneth Rhinehart, a prisoner with end-stage liver disease (ESLD), was transferred to Cotton Correctional Center in Oct 2009; he had progressive symptoms (weight loss, pain, ascites, varices) and multiple imaging studies but no cancer.
- Prison doctors (Dr. Vernon Stevenson — onsite senior clinician — and Dr. Adam Edelman — Corizon utilization-management medical director) oversaw/refused various specialist referrals and treatment requests between 2009–2011.
- June 2010: hospital EGD discovered large esophageal varices; gastroenterologist Dr. Schachinger banded the varices and recommended outpatient gastroenterology follow-up and beta-blockers.
- Oct 2011: Rhinehart rebled, received emergency banding; Dr. Schachinger recommended transfer for possible TIPS; Drs. Edelman and Stieve denied transfer; Dr. Edelman also declined a liver-transplant evaluation earlier in Oct 2011.
- Rhinehart later died in 2013 of a morphine overdose related to impaired hepatic metabolism; he suffered no subsequent esophageal bleed after Oct 2011.
- Procedural posture: district court granted summary judgment for Drs. Stevenson and Edelman on deliberate-indifference (Eighth Amendment) claims; plaintiffs appealed; Sixth Circuit affirmed in part, with Judge Moore concurring in part and dissenting in part.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Dr. Stevenson was deliberately indifferent before June 2010 by failing to ensure prompt specialist referral | Stevenson failed to secure timely specialist care after transfer and ignored inmate complaints, causing harm | Cotton staff delays caused initial wait; Rhinehart received monitoring, tests, and eventual hospital referral; no verified medical proof of harm from earlier delay | Rejected — plaintiffs failed to show specialist care was medically necessary for ESLD at that time or to present verifying medical evidence of harm |
| Whether Dr. Stevenson was deliberately indifferent after June 2010 by not ensuring gastroenterology follow-up per hospital recommendation | Failure to arrange post-hospital gastroenterology follow-up (EGD/recall) led to later bleeding; banding follow-up was medically needed | Prison clinicians prescribed beta-blockers, monitored Rhinehart, and Dr. Cohen implemented recognized post-discharge care; no evidence Stevenson knew of or ignored Schachinger’s recommendation | Rejected — insufficient evidence Stevenson had requisite subjective knowledge or that the care amounted to conscious disregard |
| Whether Dr. Edelman was deliberately indifferent in denying referral for liver-transplant evaluation (Oct 2011) | Rhinehart was an ESLD patient for whom transplant is the sole cure; expert testimony showed he could have been a candidate | Edelman relied on MELD-based allocation and concluded Rhinehart’s MELD (low) made transplant unlikely; plaintiffs failed to prove a referral would have resulted in receipt of a liver | Rejected — plaintiffs did not show it was likely Rhinehart would have received a liver or that Edelman subjectively knew he had a realistic chance |
| Whether Dr. Edelman was deliberately indifferent in denying transfer for TIPS after Oct 2011 banding | Specialist recommended TIPS to reduce re-bleeding and ameliorate ascites/pain; denial deprived Rhinehart of meaningful treatment and relief | Edelman and Dr. Stieve exercised medical judgment weighing TIPS benefits against risks (hepatic encephalopathy); reasonable medical disagreement not deliberate indifference | Rejected — record shows a medical judgment call supported by consultation; plaintiffs’ disagreement/experts raise malpractice at best, not deliberate indifference |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment deliberate indifference standard for prison medical care)
- Farmer v. Brennan, 511 U.S. 825 (1994) (objective and subjective components of Eighth Amendment deliberate indifference)
- Wilson v. Seiter, 501 U.S. 294 (1991) (deliberate indifference requires culpable mental state above negligence)
- Blackmore v. Kalamazoo Cty., 390 F.3d 890 (6th Cir. 2004) (need for "verifying medical evidence" when treatment was provided)
- Santiago v. Ringle, 734 F.3d 585 (6th Cir. 2013) (prisoner must present medical proof that alternative treatment was necessary and that provided care was inadequate)
- Mattox v. Edelman, 851 F.3d 583 (6th Cir. 2017) (framework for deliberate-indifference claims where a physician has diagnosed a need for treatment)