Plaintiff John Andrew Cuoco brought a pro se action claiming that she was denied estrogen treatments while incarcerated as a pre-trial detainee in the all-male Federal Correctional Institution at Otisville, New York (“FCI Otisville”) in violation of, inter alia, her Fifth, Eighth and Fourteenth Amendment rights. The defendants and their employment at the time suit was instituted are:
J. Michael Quinlan Director, Federal Bureau of Prisons
Kenneth Moritsugu, D. Medical Director, Federal Bureau of Prisons
Gregory L. Hershberger Warden, FCI Otisville
Donald Moore Health Services Administrator, FCI Otisville
Robert D. Barraco, M.D. Chief Medical Officer and Chief of Health Programs, FCI Otisville
Muhamad Malik, M.D. Psychiatrist, FCI Otisville
Martin Salamack, Ph.D. Chief Psychologist, FCI Ot-isville
The United States District Court for the Southern District of New York (Lawrence M. McKenna, Judge) granted a motion to dismiss the complaint as to defendants Hershberger, Moore, Malik, and Salamack. The court declined to grant a motion to dismiss or for summary judgment brought by the remaining three defendants, Barra-co, Moritsugu, and Quinlan (collectively the “Defendants-Appellants”). We conclude that all of the defendants enjoyed either qualified or absolute immunity from suit and were thus entitled to summary judgment. We therefore reverse in part, vacate in part, and remand to the district court for it to enter judgment for all the defendants.
BACKGROUND
According to her detailed, carefully drafted amended pro se complaint, from which we draw the facts for purposes of this appeal, Cuoco was a pre-trial detainee at FCI Otisville beginning September 5, 1991. She was a preoperative male to female transsexual.
When Cuoco entered FCI Otisville, she told a physician’s assistant about her condition. She also explained that she had been taking estrogen at dosages that were to be lowered three months later when she was to be operated on to remove her testicles. Cuoco was allowed to keep for self-administration the ten tablets of the hormone she had with her when admitted to the prison.
On September 10, Cuoco left her cell in administrative segregation to meet with
The Bureau of Prisons Health Services Manual contains a paragraph devoted to treatment of transsexuals.
It is the policy of the Bureau of Prisons to maintain the transsexual inmate at the level of change existing upon admission to the Bureau. Should responsible medical staff determine that either progressive or regressive treatment changes are indicated, these changes must be approved by the [Bureau of Prisons] Medical Director prior to implementation. The use of hormones to maintain secondary sexual characteristics may be continued at approximately the same levels as prior to incarceration, but such use must be approved by the Medical Director.
Bureau of Prisons Health Services Manual, Program Statement 6000.3, § 6803.
A week after the interview, on September 17, Barraco told Cuoco that she would not get any synthetic estrogen because, not yet having undergone surgery, she was not a “true or genuine transsexual.” He said that the Bureau of Prisons policy applied only to “true transsexuals.” He told her that if she wanted hormones nonetheless, she would have to file an administrative remedy form.
In response, Cuoco threatened suicide. The defendant Salamack, chief psychologist at the prison, was then summoned. He attended to Cuoco’s suicide threat but told Cuoco that because he was a psychologist and not a medical doctor, there was nothing he could do about her medication.
Cuoco began to suffer psychological and physical withdrawal symptoms resulting from the termination of the estrogen treatment. On September 20, Cuoco made further suicide threats, in response to which she was placed in a cell in the prison hospital furnished only with a stained mattress on a concrete slab. She was stripped to her underwear and forced to sleep with the lights on in the cold. When she complained of a resulting sore throat, she was told she would spend another day in the cell.
Cuoco had two brief meetings with the defendant Malik, a prison staff psychiatrist, during this period. He refused to discuss her medical problem with her and indicated that he could do nothing about the denial of the estrogen tablets.
Also on September 20, Cuoco filed an informal grievance. Barraco called Bureau of Prisons Medical Director Mori-tsugu to ask for authorization to deny Cuoco’s request for hormone treatment. Moritsugu denied Cuoco’s request by telephone even though, according to Cuoco, he knew or should have known of the withdrawal symptoms that would result.
On September 23, Cuoco complained in writing to Health Services Administrator Moore about the denial of her medication and its implications. Moore did not respond.
On September 24, Barraco told Cuoco that Moore and Warden Hershberger had been apprised of the situation. The following day Cuoco spoke to Hershberger. He refused to hear Cuoco’s complaints, remarking that Cuoco “should act like a man the way God intended.”
After a flurry of legal activity, a disciplinary hearing officer said he would talk to both Hershberger and Barraco about
Cuoco then filed her complaint. The defendants moved to dismiss it, or, in the alternative, for summary judgment, arguing that they were entitled to absolute immunity or qualified immunity and that the complaint failed to allege their personal involvement in the conduct at issue. They also claimed that there was no evidence in the record to support the assertion that Cuoco was a transsexual, rather than a homosexual who took estrogen for aesthetic purposes. Cuoco did not respond to the motion.
In a November 19, 1992 memorandum and order, the district court, construing the lawsuit’s § 1983 claims as claims under Bivens v. Six Unknown Fed. Narcotics Agents,
On December 30, 1992, the Defendants-Appellants moved for reargument. At their request, the district court issued a memorandum endorsement dated January 15, 1993 that vacated the November 19, 1992 memorandum and order for the limited purpose of providing the district court with an opportunity to decide the reargument motion prior to the expiration of the defendants’ time to appeal. Meanwhile, on January 11, 1993, Cuoco moved for reconsideration of the November 19 memorandum and order pursuant to Fed.R.Civ.P. 60(b). In support of her motion, Cuoco filed a carefully drafted, seventeen-page affirmation setting forth her version of the facts. Her appellate counsel characterizes the affirmation as “containing] a graphic and detailed factual account of her claim.” The affirmation was generally consistent with, if somewhat more detailed than, the amended complaint.
The district court did not rule on the reargument motions for nearly six years. On September 29, 1998, however, it denied Cuoco’s motion for reconsideration and the Defendants-Appellants’ motion for reargument, vacated its previous vacatur, and reinstated the November 19, 1992 memorandum and order. This appeal and cross-appeal from the 1992 and 1998 orders followed.
DISCUSSION
I. The Appeal
A. Appellate Jurisdiction
Because “this appeal is taken from the denial by the district court of a motion for summary judgment rather than from a final judgment, it is interlocutory.” Rohman v. New York City Transit Auth.,
Ordinarily, only final judgments may be appealed under 28 U.S.C. § 1291. But under the collateral order doctrine, interlocutory appeals may be taken from determinations of “claims of right separable from, and collateral to, rights asserted in the action, too important to be denied review and too independent of the cause itself to require that appellate consideration be deferred until the whole case is adjudicated.”
Id. (quoting Cohen v. Beneficial Indus. Loan Corp.,
B. The Deliberate Indifference Standard
Cuoco was in pre-trial detention at the time of the alleged incidents of which she complains. Because as a pretrial detainee she was not being “punished,” the “cruel and unusual punishment” proscription of the Eighth Amendment to the Constitution does not apply. The district court correctly concluded that Cuoco’s claims arise under the Due Process Clause of the Fifth Amendment instead. See Weyant v. Okst,
Because we apply the Fourteenth Amendment test developed in Weyant, a § 1983 action, to this Bivens action under the Fifth Amendment, it follows that Cuoco’s action lies if the defendants denied her, an unconvicted detainee, “treatment needed to remedy a serious medical condition and did so because of [their] deliberate indifference to that need.” Weyant,
We assume for purposes of this appeal that transsexualism constitutes a serious medical need.
Courts have repeatedly held that treatment of a psychiatric or psychological condition may present a “serious medical need”.... There is no reason to treat transsexualism differently than any other psychiatric disorder. Thus ... plaintiffs complaint does state a “serious medical need.”
Meriwether v. Faulkner,
To establish the second element, deliberate indifference, “a plaintiff must show ‘something more than mere negligence’; but proof of intent is not required, for the deliberate-indifference standard ‘is satisfied by something less than acts or
C. Appeals of Moritsugu and Barraco
It is undisputed that Moritsugu and Barraco are doctors and members of the Public Health Service. They argue that as such they enjoy absolute immunity from Cuoco’s suit, and that they therefore are entitled to summary judgment regardless of whether questions of fact exist as to the merits. “[T]he denial of a substantial claim of absolute immunity is an order appealable before final judgment, for the essence of absolute immunity is its possessor’s entitlement not to have to answer for his conduct in a civil damages action.” Mitchell,
1. Statutory Immunity. Moritsugu and Barraco claim that they are absolutely immune under the terms of the Public Health Service Act, 42 U.S.C. § 233(a)(1998). Section 233(a) makes the Federal Tort Claims Act the exclusive remedy for specified actions against members of the Public Health Service:
The remedy against the United States provided by sections 1346(b) and 2672 of Title 28 [the Federal Tort Claims Act], or by alternative benefits provided by the United States where the availability of such benefits precludes a remedy under section 1346(b) of Title 28, for damage for personal injury, including death, resulting from the performance of medical, surgical, dental, or related functions ..., by any commissioned officer or employee of the Public Health Service while acting within the scope of his office or employment, shall be exclusive of any other civil action or proceeding. ...
42 U.S.C. § 233(a) (emphasis added). The question is therefore whether the injury for which Cuoco seeks compensation was one “resulting from the performance of medical ... or related functions” by Barraco and Moritsugu while acting within the scope of their offices or employment. Id.
“In construing the terms of a statute, we look first to its language to ascertain its plain meaning.” Cheung v. United States,
Cuoco alleges that Barraco and Mori-tsugu were inexperienced doctors (i.e., they lacked expertise about transsexualism), that they misdiagnosed Cuoco (i.e., they did not think she was a true transsexual), and that that explains why they prescribed the wrong course of treatment (i.e., they stopped estrogen treatments when they should have renewed Cuoco’s prescription). The complained of behavior of these defendants thus occurred within the scope of their offices or employment and during the course of their “performance of medical ... or related functions,” 42 U.S.C. § 233(a). Cuoco’s exclusive remedy for injuries caused by that behavior is therefore against the United States under the Federal Tort Claims Act.
The district court relied on Mendez v. Belton,
Of course Congress could not, by the simple expedient of enacting a statute, deprive Cuoco of her constitutional due-process rights, but that is not what § 233(a) does. It protects commissioned officers or employees of the Public Health Service from being subject to suit while performing medical and similar functions by requiring that such lawsuits be brought against the United States instead. The United States thus in effect insures designated public health officials by standing in their place financially when they are sued for the performance of their medical duties. Cfi 42 U.S.C. § 233(f) (listing alternative forms of insurance government can procure for public health officials when remedies against United States are likely to be precluded). The statute may well enable the Public Health Service to attract better qualified persons to perform medical, surgical and dental functions in order better to serve, among others, federal prisoners. “[W]hen defendants show that Congress has provided an alternative remedy which it explicitly declared to be a substitute for recovery directly under the Constitution and viewed as equally effective” the plaintiff is barred from bringing a Bivens action. Carlson v. Green,
Cuoco’s response is to assert that the Federal Tort Claims Act is an inadequate alternative remedy because it does not provide for the declaratory or injunctive relief she seeks. Whatever the strength of that argument in the abstract, by the time the motions at issue in this appeal were made in the district court, Cuoco was no longer a pre-trial detainee and was no longer incarcerated in FCI Otisville. Her estrogen problem had also been resolved and she makes no claim that there is a danger that Moritsugu will again deny her necessary estrogen treatment. There is thus no basis for us to conclude that Cuoco had any claim against either Barraco or Moritsugu at the time the district court considered her complaint beyond a claim for compensation for her past treatment at FCI Otisville, which was entirely amenable to resolution under the Federal Tort Claims Act.
2. Inappropriate statements. Cuoco also alleges that she overheard Barraco asking a prison official, “Did you bring the HE/SHE?” Whether or not covered by § 233(a), this sort of rudeness and name-calling does not rise to the level of a constitutional violation. See Purcell v. Coughlin,
D. Appeal of Quinlan
1. Principles of Qtialified Immunity. A government official is entitled to qualified immunity from suit for actions taken as a government official if (1) the conduct attributed to the official is not prohibited by federal law, constitutional or otherwise; (2) the plaintiffs right not to be subjected to such conduct by the official was not clearly established at the time of the conduct; or (3) the official’s action was objectively legally reasonable in light of the legal rules that were clearly established at the time it was taken. See Rohman,
2. Quinlan’s Qualified Immunity. The claim against Quinlan does not make it past the first criterion for qualified immunity. There is no conduct at all attributed to Quinlan in either the amended complaint or in Cuoco’s affirmation except for his service as Director of the Bureau of Prisons. That conduct, if conduct it may be said to be, is obviously not prohibited by federal law.
The district court allowed the case against Quinlan to proceed because he was “the federal prisons’ policy maker.” “A supervisory official may be liable because he or she created a policy or custom under which unconstitutional practices occurred, or allowed such a policy or custom to continue,” or “if he or she was grossly negligent in managing subordinates who caused the unlawful condition or event.” Williams v. Smith,
Indeed, Cuoco makes no allegation that Bureau of Prisons policies or customs were unconstitutional — to the contrary, she argues that Bureau policy mandated that she receive estrogen treatments. And there is no evidence or allegation that Quinlan knew about Cuoco’s dispute with FCI Otis-ville officials or that he was personally involved in the decision to deny Cuoco estrogen. Finally, there is no allegation or evidence that Quinlan had supervisory authority over medical decisions made by doctors in federal prisons.
Quinlan is plainly immune from Cuoco’s lawsuit.
II. Cuoco’s Cross-Appeal
A. Appealability
While the district court allowed Cuoco’s suit to proceed against Barraco,
The district court offered no explanation for entering a partial final judgment here, stating conclusorily that it “perceives no just reason for delay in the entry of judgment of dismissal in favor of those defendants.” Ordinarily, this insufficiency would prevent us from exercising appellate jurisdiction over this cross-appeal. See L.B. Foster Co.,
B. Qualified Immunity
Cuoco cross-appeals from the district court’s dismissal of her claims against Hershberger, Moore, Malik, and Salamack. She argues that dismissal was inappropriate and that material questions of fact exist that should have precluded summary judgment in their favor. In the alternative, she asserts that as a pro se litigant she should have been afforded the opportunity to revise her complaint in the district court. These arguments are without merit.
The district court dismissed the claims raised on appeal as to defendants Hersh-berger, Moore, Malik, and Salamack for failure to state a claim under Fed.R.Civ.P. 12(b)(6). It did so because these defendants were not involved in the decision to deny estrogen treatments to Cuoco.
Defendant Moore was the Health Services Administrator at FCI Otisville at the time of the allegations; defendant Hershberger was the Warden. The district court held that “[t]he absence of a factual predicate for the allegations against defendants Hershberger and Moore leads to the conclusion that these defendants are named in the action solely because of their supervisory positions. In a Bivens action, such a respondeat superi- or theory will not suffice.” On appeal, Cuoco claims that these defendants were named not in their supervisory capacity, but because “each of the defendants was in a position to intervene” in the denial of estrogen, and, instead of doing so, “treated her with deliberate indifference.”
Although it was error to dismiss the complaint for failure to state a claim, we nevertheless affirm the judgment in favor of the defendants because they each were entitled to have their motions for summary judgment granted on qualified immunity grounds. There is no evidence that Hershberger or Moore, neither one a medical doctor, had the authority to intervene in an admittedly medical decision made by Drs. Barraco and Moritsugu. Nor on the undisputed facts could either have prescribed estrogen treatments for Cuoco, no matter how attentive to her problems and symptoms they were. They are therefore entitled to summary judgment on qualified immunity grounds both because (a) the conduct attributed to them is not prohibited by federal law, see section I.D.l, above, and (b) these defendants were non-doctors whose failure to intercede in the medical treatment of an inmate was, if wrongful, not objectively unreasonable, see section I.D., above.
Cuoco was under medical treatment. Cuoco suggests no basis on which to conclude that Moore or Hershberger should have challenged the responsible doctors’ diagnosis. One can imagine the repercussions if non-medical prison officials were to attempt to dictate the specific medical treatment to be given to particular prisoners — for whatever reason. It was, as a matter of law, objectively reasonable for Moore and Hershberger not to have done so with respect to Cuoco.
Defendant Malik’s
Cuoco’s allegations against Sala-mack are more extensive. When Cuoco first met him, Salamack, a psychologist without a medical doctor’s ability to prescribe drugs, told her that there was nothing he could do about her medication and warned her not to attempt to “manipulate the system.” Then, after being notified that Cuoco was contemplating suicide, Sa-lamack placed Cuoco on suicide watch.
According to Cuoco, Salamack “callously disregarded” her requests for estrogen and eventually had her restrained after she had “started being disruptive ... by making noise and requesting medical treatment.” Cuoco apparently argues that because Salamack witnessed the withdrawal symptoms that she was experiencing first hand he was deliberately indifferent to her needs by denying her estrogen or not explaining to the other defendants that she needed estrogen. But Salamack, having no medical degree, had no authority to decide what medical treatment was appropriate for Cuoco. He could, of course, have suggested a course of estrogen treatment assuming he knew enough medicine to do so and thought it the better course.
C. Leave To Replead,
Cuoco argues on appeal that the district court should not have dismissed her complaint for failure to state a claim without granting leave to replead. “A pro se complaint is to be read liberally. Certainly the court should not dismiss without granting leave to amend at least once when a liberal reading of the complaint gives any indication that a valid claim might be stated.” See Gomez v. USAA Fed. Sav. Bank,
Cuoco asserts, finally, that under the rule of McPherson v. Coombe,
CONCLUSION
For the foregoing reasons, we reverse the order of the district court insofar as it denied summary judgment to defendants
Notes
. We therefore refer to the plaintiff using female pronouns.
. We limit this jurisdictional ruling to cases in which our resolution of the interlocutory appeal obviates the need to dismiss the appeal of the partial judgment.
. It is not clear from the record whether Malik and Salamack were Public Health Service officials. If they were, absolute immunity under 42 U.S.C. § 233(a) would protect them. See section I.C., above.
. Cuoco argues in passing that the district court's dismissal was "especially wrong in light of the fact that the District' Court had stayed discovery.” Cuoco br. at 54. Cuoco is apparently complaining that she was prevented from obtaining all the discovery she sought prior to the district court’s adjudication of the defendants’ motion to dismiss and for summary judgment. This single, conclusory, one-sentence argument is insufficient to preserve any issue for appellate review. See Norton v. Sam’s Club,
Even if this issue had been fairly presented, moreover, we see no reason to expect that discovery would have helped Cuoco establish a triable issue of material fact. And we are particularly reluctant to remand for unnecessary discovery because this case revolves around questions of absolute and qualified immunity. One of the purposes of conferring immunity on public officials is to avoid the substantial "social costs” that litigation can impose on them, see Anderson v. Creighton,
