Oscar Santiago v. Kurt Ringle, 2013 U.S. App. LEXIS 22406

Inmate Oscar Santiago, housed at Marion Correctional Institute, sues Dr. Ringle (Medical Director) and Dr. Mosher (Assistant Medical Director) under 42 U.S.C. § 1983 for Eighth Amendment cruel and unusual punishment claims.
Santiago complained of severe pain, swelling, and a rash, with EN diagnosed on January 31, 2008; he was treated with Tylenol, antibiotics, and an anti-inflammatory regimen.
February 20, 2008 dermatologist recommended topical steroid, compression hose, and SSKI, but these were not promptly signed/ordered.
Between February 20 and March 17, Santiago continued receiving prior prescriptions; the dermatologist’s recommendations remained unsigned until February 27 (signed by Mosher) and SSKI order later discontinued on March 3.
The district court initially denied summary judgment, granted reconsideration, and eventually awarded summary judgment to defendants, including on qualified immunity grounds; Santiago appeals.
The Sixth Circuit analyzes whether the delay in implementing dermatologist recommendations violated the Eighth Amendment, focusing on objective and subjective components and then on qualified immunity.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether delay in dermatologist-recommended treatment violated the Eighth Amendment.	Santiago alleges delay created a serious medical need and showed deliberate indifference.	Ringle/Mosher argue delay alone does not prove deliberate indifference; not a violation without evidence of substantial risk.	No constitutional violation; delay not shown to involve deliberate indifference given ongoing treatment.
Whether Santiago had a sufficiently serious medical need during the delay period.	Pain and EN constitute a serious medical need needing dermatologist treatment.	Ongoing treatment sufficed; dermatologist recommendations were not proven essential during the period.	Not shown: no verifiable evidence that delay caused a serious medical injury.
Whether the doctors acted with a sufficiently culpable state of mind (subjective component).	Delayed signing/approval demonstrated reckless indifference to risk.	Delays due to desk/administrative issues were not deliberate disregard; no evidence of awareness of substantial risk.	Insufficient showing of subjective recklessness for either doctor.
Whether the doctors are entitled to qualified immunity given lack of constitutional violation.			Qualified immunity affirmed because no constitutional violation occurred.

Estelle v. Gamble, 429 U.S. 97 (U.S. 1976) (establishes Eighth Amendment deliberate-indifference standard)
Boretti v. Wiscomb, 930 F.2d 1150 (6th Cir. 1991) (delay in treatment can show deliberate indifference when tied to serious need)
Napier v. Madison Cnty., 238 F.3d 739 (6th Cir. 2001) (medical proof needed to show detrimental effect of delay)
Blackmore v. Kalamazoo Cnty., 390 F.3d 890 (6th Cir. 2004) (claims involving failure to treat require proof of serious medical need and impact of delay)
Comstock v. McCrary, 273 F.3d 693 (6th Cir. 2001) (deliberate indifference standard articulated; intentional or reckless disregard)
Miller v. Calhoun Cnty., 408 F.3d 803 (6th Cir. 2005) (negligence alone not sufficient for Eighth Amendment claim)
Lane v. Wexford Health Sources, 510 F. App’x 385 (6th Cir. 2013) (two-week delay insufficient to show deliberate indifference where not personal involvement shown)
Dixon v. Clem, 492 F.3d 665 (6th Cir. 2007) (affirmative standard: may affirm on any basis supported by record)
Reilly v. Vadlamudi, 680 F.3d 617 (6th Cir. 2012) (mere delay must be tied to deliberate indifference evidence)
Alspaugh v. McConnell, 643 F.3d 162 (6th Cir. 2011) (continued treatment and monitoring undermines claim of deliberate indifference)