Ramos v. Patnaude
2011 U.S. App. LEXIS 10356
| 1st Cir. | 2011Background
- Ramos, a pre-trial detainee, was committed to Worcester County House of Correction (April 4, 2003) and subjected to withdrawal from heroin.
- Dr. Patnaude, medical director, treated Ramos with a three-day protocol to mitigate withdrawal, repeated twice over nine days, with hospital visits for dehydration and chest issues.
- Clinical notes described severe medical conditions (dehydration, renal failure, respiratory distress, pneumothorax, etc.).
- Ramos sued under 42 U.S.C. § 1983 for due process deliberate indifference and, for some defendants, failure to train; state-law claims for intentional infliction of emotional distress were added.
- District court granted summary judgment to appellees on merits and exhaustion, holding exhaustion under § 1997e(a) and state-law exhaustion were lacking; on de novo review, the First Circuit affirmed.
- Remaining defendants were Dr. Patnaude and Worcester Internal Medicine; Worcester Internal Medicine disposed for lack of evidentiary support; the parties briefed exhaustion and merits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the district court erred in granting summary judgment on the § 1983 deliberate indifference claim against Patnaude | Ramos contends Patnaude acted with deliberate indifference during withdrawal treatment. | Patnaude followed a long-standing protocol and did not disregard substantial risk. | Affirmed; no evidence of deliberate indifference given undisputed treatment decisions. |
| Whether exhaustion under § 1997e(a) is a jurisdictional prerequisite or an affirmative defense controlling reach | Ramos argues non-notification of grievance procedures voids exhaustion, affecting jurisdiction. | Exhaustion is not jurisdictional; merits may be reached notwithstanding exhaustion issues. | Not jurisdictional; merits reached on the record while bypassing exhaustion. |
| Whether Worcester Internal Medicine can be held liable given lack of contractual relationship and respondeat superior limits | Group liability through association with Patnaude; contaminated by record. | No contract and no respondeat liability; group not liable for § 1983 claim. | Affirmed dismissal; no evidentiary support for liability. |
Key Cases Cited
- Woodford v. Ngo, 548 U.S. 81 (U.S. 2006) (exhaustion under § 1997e(a) is not jurisdictional and is an affirmative defense)
- Jones v. Bock, 549 U.S. 199 (U.S. 2007) (proper exhaustion defined; not jurisdictional)
- Burrell v. Hampshire County, 307 F.3d 1 (1st Cir. 2002) (deliberate indifference standard applied to pre-trial detainee due process)
- Acosta v. U.S. Marshals Service, 445 F.3d 509 (1st Cir. 2006) (constitutional violations require more than mere negligence)
- Hathaway v. Coughlin, 37 F.3d 63 (2d Cir. 1994) (medical care must be more than perfunctory; standards of care matter)
- Warren v. Fanning, 950 F.2d 1370 (8th Cir. 1991) (mere delay or inadequacy in care not necessarily deliberate indifference)
- Sires v. Berman, 834 F.2d 9 (1st Cir. 1987) (standard for deliberate indifference in medical neglect cases)