Glоria CODY, Appellant, v. Claude HILLARD; Officer Burle; Officer Hines; Dr. Robert Neumiller; Major S.V. James; Nurse Karen; Don Merritt, Appellees.
No. 96-1351
United States Court of Appeals, Eighth Circuit
June 5, 1997
139 F.3d 1197
Likewise, the District Court did not abuse its discretion in refusing defense counsel‘s request to take a five minute recess to cue the suppression hearing tape after each allegedly inconsistent statement made by Officer Burle during his trial testimony. The district court is allowed wide discretion in determining whether the introduction of evidence causes undue delay and waste of time. See United States v. Carr, 67 F.3d 171, 175 (8th Cir. 1995), cert. denied, ___ U.S. ___, 116 S. Ct. 1285, 134 L. Ed. 2d 230 (1996). The District Court did not abuse its discretion in refusing defense counsel‘s request to present evidence in this mannеr.
IV.
Finally, Cody argues that the District Court‘s limitation of her cross-examination of Officers Hines and Burle violated her Sixth Amendment right to confrontation. We disagree. “Absent a clear abuse of discretion and a showing of prejudice, we will not reverse a district court‘s ruling limiting cross-examination of a witness on the basis that it impermissibly infringed on the defendant‘s right of confrontation.” United States v. Brown, 110 F.3d 605, 611 (8th Cir. 1997). Cody was allowed to cross-examine each officer extensively regarding both the investigation that led to her arrest and the circumstances surrounding her ultimate confession. Had defense counsel obtained an official transcript of the suppression hearing, the District Court likеly would have permitted defense counsel to utilize that document to impeach the officers with any prior testimony that was inconsistent. The District Court specifically expressed its willingness to allow defense counsel to impeach both officers with the tape recording of the suppression hearing provided the tape was cued to the relevant testimony. In these circumstances, we cannot conclude that the District Court abused its discretion in limiting Cody‘s cross-examination, nor can we conclude that Cody‘s Sixth Amendment right to confrontation was violated.
V.
The judgment of the District Court is affirmed.
Gloria COLEMAN, Appellee, v. Nurse Ruth RAHIJA, Nurse at IMCC-Oakdale, Appellant.
No. 96-1351
United States Court of Appeals, Eighth Circuit
Submitted Oct. 22, 1996. Decided June 5, 1997.
114 F.3d 778
I. Background
The factual background is primarily based on the findings of the district court. Id. at 1-10. On January 15, 1991, Coleman, an inmate, was transferred from the Iowa Correctional Facility for Women in Mitchellville, Iowa, to the Iowa Medical and Classification Center (IMCC) in Oakdale, Iowa. At that time, Coleman was twenty-eight years old and approximately seven months pregnant. She was transferred to IMCC to facilitate closer monitoring of her pregnancy. Rahija was a registered nurse employed by IMCC.1
Upon Coleman‘s arrival at IMCC, the IMCC Health Services Department (Health Services) conducted a “health scrеen” and documented Coleman‘s health history, including the fact that Coleman had five prior pregnancies. Dr. Timothy Pflederer, a Health Services physician, conducted a routine physical examination of Coleman on January 23, 1991, and noted in his examination notes that Coleman had a long history of problematic pregnancies. In 1980, Coleman prematurely delivered twins who were either stillborn or died shortly after birth. Of Coleman‘s subsequent four pregnancies, three involved precipitous labors lasting less than one hour and one resulted in a premature delivery. Based on this information, Dr.
Gordon E. Allen, argued, Des Moines, Iowa, for appellant.
Jeffrey M. Lipman, argued, Des Moines, Iowa, for appellee.
Before RICHARD S. ARNOLD, Chief Judge, and FLOYD R. GIBSON and MCMILLIAN, Circuit Judges.
MCMILLIAN, Circuit Judge.
Gloria Coleman brought this action in the United States District Court for the Southern District of Iowa, pursuant to
On January 31, 1991, a notation was made in the Health Services records that Coleman had been examined at the University and was to remain at IMCC until after the baby was born. On February 2, 1991, at approximately 8:45 a.m., Coleman awoke and went to Health Services, complaining that her “water” was “leaking.” A Health Services nurse examined Coleman and determined that Coleman‘s amnion had not ruptured. Instead, the nurse determined that Coleman was experiencing normal mucous vaginal discharge which commonly occurs during the later stages of pregnancy. The nurse gave Coleman sanitary napkins and instructed her to notify Health Services if her condition worsened.
On February 14, 1991, Coleman returned to Health Services complaining that she “had a bloody show.” At that time, Health Services transferred Coleman to the University for an examination. The University physicians determined that Coleman was not in active labor but noted that her cervix was dilated one to two centimeters and she was having minimal contractions. The University physicians instructed Health Services to return Coleman to the University if her contractions became painful, regular, and separated by ten minutes or less.2
On February 15, 1991, Coleman awoke early in the morning and noticed some spotting of blood. She complained of bleeding, back pain, and stomach pain to a guard, who sent her to Health Services. She notified Health
Services of the spotting and decided not to attend her required school classes that day. At approximately 10:30 a.m., Coleman again reported to Health Services complaining of more bleeding and back pain. Although Coleman denied being terribly uncomfortable, Coleman‘s symptoms were recognized signs of labor and led the IMCC nursing staff to call the University. Dr. Alvina Driscoll, a University resident physician, determined that the bleeding wаs likely due to cervical changes and was not a concern unless it increased or was associated with cramping or contractions. The IMCC nursing staff recorded in Coleman‘s medical chart that she was to be monitored for increased bleeding or signs of labor. The bleeding was to be monitored by inspecting Coleman‘s sanitary napkins. Coleman returned to Health Services at approximately 2:00 p.m. to complain of more bleeding and show a nurse a sanitary napkin with blood on it. After looking at the sanitary napkin, the nurse threw it in the garbage.
At approximately 7:00 p.m., Coleman was watching television when she stood to use the bathroom and felt an extreme pain in her lower abdomen causing her to double over. Coleman‘s pain began to subside when another inmate, Felicia Allen, attempted to comfort her. Sometime thereafter, Coleman went to Health Services and was seen by Rahija, who had come on duty at 3:00 p.m. Without taking Coleman‘s vital signs, performing a vaginal examination, or attempting to monitor the baby‘s heart tones, Rahija sent Coleman back to her living unit and told her to return when the contractions were six to seven minutes apart.
At approximately 9:30 p.m., Coleman‘s pain worsened. She returned to Health Services and reportеd to Rahija that she was still bleeding, she hurt “down there,” pointing to her abdomen, and her contractions were six minutes apart. Rahija placed her hands on the exterior of Coleman‘s abdomen and noted that she was unable to feel any contractions.3 Rahija monitored the baby‘s
Following Rahija‘s instruсtions, Coleman returned to her living unit.4 Coleman sat on the edge of her bed in increasing pain until 11:25 p.m., when she began to scream from the intense pain and moved to the cement floor, where she laid in a fetal position. A correctional officer allowed Allen and another inmate to enter Coleman‘s living unit to attempt to calm her by talking to her and rubbing her back and stomach.
At that point, a correctional officer called Health Services to summon Rahija and Grace Schwickerath, also a registered nurse, to attend to Coleman. When they arrived, Coleman stated that she was in pain and felt “like pushing.” The nurses observed that Coleman appeared to be “bearing down.” Both nurses placed their hands on the exterior of Coleman‘s abdomen and were unable to feel any contractions. One of the nurses monitored the baby‘s fetal heart tones, which were 120 beats per minute. The nurses asked Coleman to stand to allow them to inspect her sanitary napkin. As Coleman stood, she “grunted” and expelled approximately 15cc of dark red blood. Coleman‘s sanitary napkin indicated that she had been spotting previously. Coleman stated that she “should go ahead [and] just have this baby [and] that would teach you for not listening.” Id. at 9.5 At that point, the nurses agreed that Coleman should be transported to the University and Schwickerath went to make the necessary arrangements. Rahija stayed with Coleman and noted that Coleman was probably in premature labor.
However, Schwickerath noted that Coleman was in “questionable labor.” Id.
At approximately 11:45 p.m., Coleman was transported from IMCC to the University. While transporting Coleman, the attending medical professionals repeatedly called Coleman‘s name to prevent her from falling asleep. Coleman constantly felt the urge to push and, sometime during the ride, expelled another 20cc of blood. Shortly after arriving at the University, Coleman delivered a premature baby boy at 12:20 a.m. on February 16, 1991, although she was later unable to remember the delivery. Neither Coleman nor the baby suffered any complications during the delivery. Coleman returned to IMCC on February 18, 1991, and the baby was later released from the hospital to the care of Coleman‘s mother.
On March 3, 1991, Coleman completed a form complaint used by prisoners to file complaints under the Civil Rights Act,
On September 27-28, 1994, this matter was tried to the district court, sitting without a jury. The case remained open for further depositions and was completed on April 10, 1995. The district court held that Rahija‘s conduct deprived Coleman “of the minimal civilized measure of life‘s necessities” afforded her by the Eighth Amendment, id. at 19-20, quoting Whitnack v. Douglas County, 16 F.3d 954, 957 (8th Cir. 1994), and awarded Coleman $1,000.00 in actual damages and $3,500.00 in punitive damages, id. at 24. The district court held that, while some evidence suggested that Coleman should have been taken to the University at 7:00 p.m. on Feb-
II. Discussion
To prevail on an Eighth Amendment claim, an inmate must show both an objective element, that the deprivation was sufficiently serious, and a subjective element, that the defendant acted with a sufficiently culpable state of mind. Choate v. Lockhart, 7 F.3d 1370, 1373 (8th Cir. 1993), citing Wilson v. Seiter, 501 U.S. 294, 302-03 (1991). In a deprivation of medical care case, an inmate must show that the prison official was deliberately indifferent to the inmate‘s serious medical needs. Camberos v. Branstad, 73 F.3d 174, 175 (8th Cir. 1995). In order to succeed, an inmate must show both that he or she had an objectively serious medical need and that the defendant knew of and disregarded that need. Miller v. Schoenen, 75 F.3d 1305, 1309 (8th Cir. 1996), citing Estelle v. Gamble, 429 U.S. 97, 105 (1976), and Farmer v. Brennan, 511 U.S. 825, 837 (1994) (Farmer). Each step of this inquiry is fact-intensive, and we review the district court‘s factual conclusions for clear error. Jensen v. Clarke, 94 F.3d 1191, 1197-98 (8th Cir. 1996).
A. Serious Medical Need
The initial question presented in this case is whether the district court‘s finding that Coleman had a serious medical need is clearly erroneous. A serious medical need is “one that has been diagnosed by a physician as requiring treatment, or one that is so obvious that even a layperson would easily recognize the necessity for a doctor‘s attention.” Camberos v. Branstad, 73 F.3d at 176. When an inmate alleges that a delay in medical treatment constituted a constitutional deprivation, “the objective seriousness of the deprivation should also be measured by reference to the effect of delay in treatment.” Crowley v. Hedgepeth, 109 F.3d 500, 502 (8th Cir. 1997). An inmate‘s failure to place verifying medical evidence in the record to establish the detrimental еffect of delay in medical treatment precludes a claim of deliberate indifference to medical needs. Id.
In this case, the district court found that Coleman was experiencing pre-term labor and concluded that her condition was sufficiently serious to constitute a serious medical need. Specifically, the district court found that Coleman‘s medical records indicated that she had a propensity of rapid labor and delivery; she was exhibiting some sign of possible labor in the early afternoon on February 15, 1991; Rahija noted that Coleman was in “possible early labor” at 9:30 p.m.; and Coleman believed the matter sufficiently serious to continue seeking medical treatment. Coleman at 13-14. The district court also recognized six factors which might signal pre-term labor, five of which could be determined by an external examination, and found that Coleman had four of the five observable factors. Id. at 16-17. These four factors included: (1) an increase in vaginal discharge; (2) a “bloody show“; (3) uterine contractions six minutes apart; and (4) abdominal pain possibly attributable to a tightening of her pelvis and earlier complaints of lower back pain. Id. The district court was also persuaded that had Rahija performed a vaginal examination of Coleman, there would have bеen evidence of progressive dilatation and effacement of the cervix. Id. at 17.
Rahija argues that the district court‘s finding that Coleman had a serious medical need is clearly erroneous. Rahija cites Boswell v. County of Sherburne, 849 F.2d 1117 (8th Cir. 1988), for the proposition that pregnancy alone is not necessarily a serious medical need and claims that Coleman failed to present evidence of unusual circumstances relat-
Based on the evidence presented at trial and relied upon by the district court, we conclude that the relevant factual findings of the district court, as outlined above, are not clearly erroneous. While a woman‘s рregnancy is generally not, alone, a serious medical need, Coleman presented evidence of her previous rapid labors and premature deliveries to establish a substantial risk of pre-term labor. See Boswell v. County of Sherburne, 849 F.2d at 1122 (risk of miscarriage where pretrial detainee was six and one-half months into problem pregnancy, was bleeding, had previously fainted, and had history of rapid labor). A layperson would have recognized the necessity for a doctor‘s attention at 9:30 p.m. See Camberos v. Branstad, 73 F.3d at 176 (a serious medical need is one that is so obvious that a layperson would recognize the necessity for a doctor‘s attention). Also, basеd on the district court‘s factual findings, Coleman‘s symptoms satisfied the requirements for transfer as set forth by the University physicians. See id. (a serious medical need is one that has been diagnosed by a physician as requiring treatment). We therefore hold that the district court did not clearly err in concluding that Coleman‘s physical condition constituted a serious medical need.
We also hold that Coleman presented sufficient “verifying medical evidence” that Rahija “ignored a critical or escalating situation or that the delay posed a substantial risk of serious harm” for her claim to succeed. See Beyerbach v. Sears, 49 F.3d 1324, 1327 (8th Cir. 1995) (inmate‘s failure to present verifying mеdical evidence constituted failure to establish objective component of claim); see also Crowley v. Hedgepeth, 109 F.3d at 502. Specifically, Coleman presented expert testimony that the urge to push during the delivery process is an involuntary reaction, see Coleman at 18, indicating that Coleman, in fact, had been in labor, see Appendix at 48 (deposition testimony of Dr. Paul Loeffelholz),6 and that the delay in her treatment posed a substantial risk of serious harm.
B. Deliberate Indifference
Having held that the district court did not clearly err in finding that Coleman‘s condition constituted a serious medical need, we now address the question whether the district court‘s finding that Rahija was deliberately indifferent tо Coleman‘s serious medical need is clearly erroneous. This question, like the first step in our analysis, is a question of fact reviewed for clear error. Jensen, 94 F.3d at 1198. To satisfy this subjective element, Farmer requires a finding of actual knowledge on the part of the defendant.7 Jensen v. Clarke, 94 F.3d at 1195 (failure-to-protect case applying same two-step analysis). A prison official may be held liable under the Eighth Amendment if he or she knows that an inmate faces a substantial risk of serious harm and disregards that risk by failing to take reasonable measures to abate it. Farmer, 511 U.S. at 847. “[T]he failure to treat a medical condition does not constitute punishment within the meaning of the Eighth Amendment unless prison officials knew that the conditiоn created an excessive risk to the inmate‘s health and then failed to act on that knowledge.” Long v. Nix, 86 F.3d 761, 765 (8th
For example, if an Eighth Amendment plaintiff presents evidence showing that a substantial risk [to the inmate‘s health] was longstanding, pervasive, well-documented, or expressly noted by prison officials in the past, and the circumstances suggest that the defendant-official being sued had been exposed to information concerning the risk and thus must have known about it, then such evidence could be sufficient to permit a trier of fact to find that the defendant-official had actual knowledge of the risk.
Id. at 842-43, 114 S. Ct. at 1981-82 (internal quotations omitted).
The district court, in this case, concluded that Rahija had actual knowledge of Coleman‘s serious medical need. The district court based its finding on the documentation in Coleman‘s medical records of her previous prеcipitous labors, the IMCC officials’ election to keep Coleman at IMCC until after delivery because of her medical history, Rahija‘s notation that Coleman might have been in possible early labor, and Coleman‘s objective symptoms that she was experiencing pre-term labor. Coleman at 14-15, citing Farmer, 511 U.S. at 842, 114 S. Ct. at 1981-82 (“a factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious“).
Rahija argues that the district court clearly erred in finding that she had the requisite knowledge to constitute deliberate indifference. Rahija claims that Coleman did not have painful, regular contractions less than ten minutes apart, increased heavy bleeding, or bleeding with contractions until 11:25 p.m., at which point Rahija determined that Coleman should be sent to the University. Thus, Rahija contends that she was not deliberately indifferent to Coleman‘s condition because her treatment of Coleman was consistent with the University physician‘s (Dr. Driscoll‘s) advice.
In this case, the district court‘s conclusion that Nurse Rahija had actual knowledge based on the obviousness of Coleman‘s serious medical need is not clearly erroneous. Coleman‘s propensity for precipitous labor and premature delivery was well-documented and expressly noted by prison officials in Coleman‘s medical records, to which Rahija had been exposed, and constituted the sole reason for Coleman‘s placement at IMCC. From this evidence, a trier of fact could have found that Rahija had actual knowledge of the risk of pre-term labor. See Farmer, 511 U.S. at 842-43, 114 S. Ct. at 1981-82; Jensen, 94 F.3d at 1198. We therefore hold that the district court did not clearly err in finding that Rahija‘s unnecessary delay in transferring Coleman to the University constituted deliberate indifference to Coleman‘s serious medical need. See Johnson-El v. Schoemehl, 878 F.2d 1043, 1055 (8th Cir. 1989) (“Delay in the provision of treatment or in providing examinations can violate inmates’ rights when the inmates’ ailments are medically serious or painful in naturе.“).
C. Compensatory Damages
Compensatory damages may include not only out-of-pocket loss and other monetary harms, but also such injuries as impairment of reputation, personal humiliation, and mental anguish and suffering. Memphis Community Sch. Dist. v. Stachura, 477 U.S. 299, 307 (1986) (Stachura). Specifically, mental and emotional distress, which include mental suffering and emotional anguish, constitute compensable injury under
Rahija argues that the record does not support the district court‘s finding that Coleman was subjected to pain and suffering from 9:30 p.m. until 11:30 p.m. Instead, Rahija suggests that Coleman experienced nothing different from what women endure during childbirth and that Coleman had access to a television and a bed as if she was in a hospital. She concludes that had she transferred Coleman to the University at 9:30 p.m., as suggested by the district court, Coleman would have experienced the same labor in the hospital as she did in her living unit, and, therefore, there was nothing unconstitutional about where Coleman experienced labor or how Rahija treated her.
We disagree and hold that the evidence supports thе district court‘s award of compensatory damages for Coleman‘s physical pain and suffering and mental anguish and suffering. Fortunately, neither Coleman nor her baby suffered any complications during the delivery at the University. However, the fact remains that, because of Rahija‘s unnecessary delay, Coleman was subjected to “a great deal of fear and physical suffering [which] accompanied the prospect of having a baby on the floor of a penal institution,” Coleman at 21, without the appropriate medical attention. We therefore hold that the district court did not clearly err in finding that Coleman suffered a compensable injury under
D. Punitive Damages
In a
To impose a punitive award in this case, the district court was required to find not only that Rahija‘s conduct met the callousness threshold, which is a question of ultimate fact, but also that her conduct merited a punitive award of $3,500 in addition to the compensatory award, which is a discretionary moral judgment. Smith v. Wade, 461 U.S. at 52. Applying this standard, the district court awarded Coleman $3,500.00 in punitive damages “so that prison officials recognize the seriousness of this lack of action and guard against it in the future.” Coleman at 24.
A finding of deliberate indifference to a serious medical need, while establishing liability under
III. Conclusion
Accordingly, the punitive damages award is vacated and the order of the district court is affirmed in all other respects.
FLOYD R. GIBSON, Circuit Judge, concurring in part and dissenting in part.
Though I am in full accord with the Court‘s decision to affirm the imposition of compensatory damages against Nurse Ruth Rahija, I cannot agree that the district court‘s award of punitive damages should be reversed. In my view, the rather startling and disturbing facts of this case reveal the district court did not commit clear error when it found that Rahija acted with “callous indifference to the federally protected rights of others.” Smith v. Wade, 461 U.S. 30, 56 (1983). Furthermore, I believe the district court correctly determined that Nurse Rahija‘s behavior was “simply inexcusable” and of a type that “must be punished in an appropriate way so that prison officials recognize the seriousness of this lack of action and guard against it in the future.” Coleman v. Rahija, No. 4-91-CV-50260, at 24 (S.D. Iowa Jan. 2, 1996); see also Smith, 461 U.S. at 54 (“The focus is on the character of the tortfeasor‘s conduct—whether it is of the sort that calls for deterrence and punishment over and above that provided by compensatory awards.“). As a result, I am unable to conclude that the district court abused its discretion when it deemed punitive damages appropriate. For these reasons, I respectfully dissent from that portion of the Court‘s opiniоn vacating the district court‘s punitive damages award.