Zingg v. Groblewski, 907 F.3d 630

Background

Jenna Zingg, a pretrial detainee at MCI‑Framingham in 2013, had a history of severe psoriasis and had been controlled on Humira prior to incarceration.
After arriving at MCI‑Framingham she missed Humira doses; prison clinicians first prescribed clobetasol (formulary) and later requested non‑formulary Humira and Dovonex from the statewide medical director.
On July 15, 2013, Dr. Thomas Groblewski (MPCH statewide medical director) approved Dovonex but denied Humira based on the non‑formulary request materials and MPCH’s psoriasis protocol.
Zingg’s condition worsened; she was sent to a dermatologist in August, diagnosed with severe psoriasis and mild psoriatic arthritis, given Humira, improved, and released in September.
Zingg sued under 42 U.S.C. § 1983 alleging Eighth/Fourteenth Amendment deliberate indifference based on Groblewski’s denial of Humira; the District Court granted summary judgment for defendants and dismissed the state negligence claim without prejudice. The First Circuit affirmed.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Groblewski’s denial of Humira amounted to Eighth Amendment deliberate indifference	Zingg: denying systemic therapy (Humira) while prescribing weaker topical (Dovonex) despite prior Humira success was tantamount to refusing essential care	Groblewski: decision followed MPCH protocol, was based only on non‑formulary requests he reviewed, and was a reasonable medical judgment to try two topicals before systemic therapy	Held: No reasonable jury could find deliberate indifference; summary judgment affirmed
Whether Groblewski had actual knowledge of severity/need for Humira	Zingg: dermatologist’s April letter and prior community treatment establish obvious need and that Groblewski should have known	Groblewski: he reviewed only Casella’s non‑formulary requests and had no record evidence showing he received the dermatologist’s assessment	Held: No evidence Groblewski knew the dermatologist’s assessment; only the non‑formulary forms informed his decision
Whether failure to seek additional records supports deliberate indifference	Zingg: failure to investigate/obtain prior records echoes Leavitt misconduct	Groblewski: his role and MPCH protocol required review of non‑formulary requests; no unusual departure from standard practice	Held: At most a failure to perceive risk, not the conscious disregard required for constitutional liability
Whether cost considerations render the denial unconstitutional	Zingg: Humira’s high cost and MPCH’s cost‑sensitivity show denial was motivated by cost, evidencing deliberate indifference	Groblewski: cost considerations alone do not establish an Eighth Amendment violation where medical judgment and protocol support the choice	Held: Considering cost is not per se unconstitutional and record does not show deliberate indifference from cost alone

Key Cases Cited

Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment deliberate indifference standard for medical care)
Feeney v. Corr. Med. Servs., Inc., 464 F.3d 158 (applying deliberate indifference framework in First Circuit)
Leavitt v. Corr. Med. Servs., 645 F.3d 484 (deliberate indifference where official ignored critical records/reports)
Farmer v. Brennan, 511 U.S. 825 (subjective deliberate indifference requires actual knowledge or recklessness)
Battista v. Clarke, 645 F.3d 449 (gives deference to professional judgment and institutional constraints in Eighth Amendment claims)