Snell v. NevilleSnell v. Neville
Mary Eiro-Bartevyan, Department of Correction Legal Division, Nancy Ankers White, Special Assistant Attorney General for appellees Thomas Neville, Massachusetts Department of Correction, Carol Mici, Stephanie Collins, Lois Russo, Dale Bissonnette, Douglas Demoura, Jeffrey Quick, Monserrate Quinones, and Joann Lynds.
George J. Puddister IV, with whom Victor J. Koufman and Koufam & Frederick, LLP were on brief, for appellee Patricia Ruze.
Background
In order to understand the legal issues addressed in our decision, we find it necessary to provide the reader with a detailed background of events which triggered this appeal. Therefore, we ask the reader‘s patience as we soldier through the facts.
The Accommodation Process and Two-Tiered Library at MCI-Concord
After a jury convicted Snell of the first-degree murder of his wife in 1995, he began serving a life without parole sentence in the Massachusetts prison system, eventually landing at the facility known as MCI-Concord in 2010. See Commonwealth v. Snell, 705 N.E.2d 236, 238-39 (Mass. 1999). Snell arrived there in less than stellar health. Amongst other ailments, he suffered knee and back pain, and had degenerative joint disease which limited his body‘s range of motion.4 A walking cane facilitated his mobility. In consequence, upon his confinement, he began to seek ways to better manage and endure his terms of incarceration. Therefore, before delving into the details of Snell‘s particular
During the time period relevant to this appeal, incarcerated persons like Snell had a couple of avenues to attain relief. First, inmates could seek reasonable accommodations from prison officials if they had physical or mental health disabilities which prevented them from engaging in the standard routines of prison life, such as a prison education or technical training program. See 103 DOC 620, https://www.mass.gov/doc/doc-620-special-health-care-practices/download; 103 DOC 408.07, https://www.mass.gov/doc/doc-408-reasonable-accommodations-for-inmates/download.5 For example, an individual with hearing loss could request a hearing aid or a person with walking difficulties could request a wheelchair. An inmate did not need to have a medically documented disability to apply for such a reasonable accommodation. See 103 DOC 620.
Second, inmates could also seek a “medical restriction” from a medical professional. For instance, if a prison physician advised an inmate not to climb stairs because such movement would be harmful to the person‘s health, the inmate would have a “no-stairs” medical restriction. A medical restriction traditionally
MCI-Concord followed prison regulations promulgated by the Department of Correction when deciding whether to grant a reasonable accommodation to an inmate, and Snell does not contend MCI-Concord ignored them. Inmates could request accommodations by: (1) asking any DOC staff member; (2) filling out a written accommodation request; or (3) asking medical staff for a restriction that the DOC defendants could translate into an accommodation. See 103 DOC 408.07(8). One of the DOC defendants, the facility‘s American with Disabilities Act (“ADA“)6 coordinator, reviewed such requests, filed written proof of the accommodation (if granted), and provided written proof of the accommodation directly to the requesting inmate. The regulations required the DOC defendants to “[e]nsure that appropriate documentation
For requests related to medical needs, such as not climbing stairs, the ADA coordinator almost always consulted with medical staff before providing or denying the accommodation in writing. While the DOC defendants ordinarily deferred to a medical professional‘s judgment about what inmates needed, there were limits built into the regulations. Before implementing a requested accommodation, the DOC defendants, ever mindful of their overarching responsibility to maintain order and security within the prison confines, weighed risks including ensuring accommodations did not appear to give unfair preferential treatment to any particular inmate. See 103 DOC 408.07(8).
The accommodation process mattered to Snell because of the prison layout. MCI-Concord has two libraries: the general library on the first floor, and, as mentioned, the law library on the second floor. The latter housed several Lexis Nexis terminals and typewriters for inmate use. The general library on the first floor also had the Terminal (which, recall, includes a typewriter), but DOC defendants installed that station as an accommodation for inmates with documented medical restrictions which hampered their ability to reach the second floor.7 With few exceptions, even
An Inmate‘s Litigious Medical History
Soon after arriving at MCI-Concord, Snell‘s persistent health problems caused him to complain about having to climb stairs to get to various areas within the prison, including the law library. He sought (but did not get) a reasonable accommodation from prison officials to use the first-floor Terminal.9 The denial baffled Snell because when he was housed at a prior facility, he had been given an indefinite medical restriction for bottom tier housing (meaning he could reside in rooms on the first floor). The authorizing doctor reasoned Snell needed a bottom tier
Of import here, Snell maintains DOC defendants, specifically MCI-Concord‘s ADA coordinator, did in fact grant him a reasonable accommodation to use the first-floor Terminal at some point prior to July 2013 because of his problems climbing stairs. However, Snell has never produced any documentation to verify that he ever had such an accommodation.10 The DOC defendants say that‘s because in the timeframe pertinent to this litigation, he didn‘t.
Stair mobility issues aside, Snell had other troubles. Various maladies, aches, and pains brought Snell to Dr. Ruze, his prison physician, up to fifteen times a year. By her thinking, Snell had obesity, a condition which she deemed a primary cause of his degenerative joint disease and likely a contributor to his hypertension and respiratory problems including sleep apnea. In Dr. Ruze‘s medical opinion, one with which Snell emphatically
No matter the disagreement over stair ambulation, Dr. Ruze and other medical personnel at MCI-Concord did not ignore Snell‘s medical needs; far from it. From 2010 to 2017, Snell, among other medical treatments, had x-rays of his knees and was referred to specialists for his orthopedic problems. By way of medical aids, prison medical personnel provided Snell with knee sleeves, anti-embolism stockings, back braces, medication for leg swelling, and the aforementioned cane. He was also afforded bottom bunk, in addition to bottom tier, restrictions, and given light work status. Despite all of the medical attention Snell received in those seven years, no medical or correctional personnel ever deemed a no-stairs restriction appropriate.
It was only in late 2018, about one year after Dr. Ruze had departed her MCI-Concord prison job, that a doctor provided
Inching His Way to This Litigation
We backtrack further to explain how Snell got to our court. From July 2013 to October 2015, Snell used the first-floor Terminal near daily despite not having a no-stairs restriction or documented proof of an appropriate accommodation. Apparently, Snell told the librarian, who started working at MCI-Concord in September 2013,12 that he had an indefinite lower tier or no-stairs restriction. It seems the librarian never checked the story out. Additionally, since virtually no other inmates used the Terminal
In August 2015, the prison librarian went on vacation. While he was away, the Lexis terminals throughout the facility temporarily shuttered. Also, with the librarian gone, Snell claimed he could not get to the typewriter (the librarian was the one who provided it to inmates). Claiming he had no access to needed legal resources, Snell filed a grievance with DOC defendants (citing his disability). A prison official (not one of the DOC defendants) promptly resolved Snell‘s grievance but we‘ll provide more details on how it got addressed later.
Then, on October 9, 2015, Snell, apparently disturbed by some new issue concerning the amount of time he was being allowed to spend at the Terminal, submitted a new grievance seeking restoration of meaningful access to research time.13 In it, Snell
Ten days later, the DOC defendants denied Snell‘s grievance regarding extra time, but they also noted that they were “unaware of an ADA [accommodation] granted to [Snell],” as Snell had described it, and added they “would be happy to review [Snell‘s] situation if [Snell] can provide the necessary documentation” to use the first-floor Terminal. Snell apparently did not. On October 29, 2015, the DOC defendants formally ended Snell‘s access to the Terminal. Thereafter, they denied Snell‘s string of grievances and appeals through the end of 2015 and into 2016.
Traipsing Away from the Prison Administrative Process
With his access to the Terminal blocked by administrative determinations, Snell turned outward for assistance. On June 22, 2016, Prison Legal Services, a not-for-profit Massachusetts organization, got involved, sending the DOC defendants a letter demanding they resume Snell‘s reasonable accommodation (the Terminal) given his disability and what they believed to be an indefinite no-stairs medical restriction from 1998. The DOC defendants promptly replied, reiterating the absence of such a restriction or the presence of any other indicator in Snell‘s medical record warranting such an accommodation. They further expressed they had consulted with Dr. Ruze who reported Snell should not have difficulty navigating stairs, especially with the use of a cane.
Discussion
To repeat, Snell‘s legal fight clearly centers around his loss of access to the first-floor Terminal, and he advances several arguments here as to why the district court erred by granting summary judgment to the defendants. First, Snell contends that contrary to the district court‘s preliminary determination, his appeals for injunctive and declaratory relief are not moot. Second, Snell argues the DOC defendants and Dr. Ruze retaliated against him in violation of Title V of the ADA (
The DOC defendants say the district court got it just right and appropriately denied Snell the relief he sought. They argue here, as they did below, that they never discriminated or retaliated against Snell -- anything but. Rather, they “reasonably relied upon the [then extant] clinical judgment of Dr. Ruze” and others in determining Snell could make his way to the second-floor law library. Dr. Ruze, for her part, says she provided medically adequate care, was never indifferent to Snell‘s needs, and never retaliated against him. We will first take up Snell‘s mootness claims before addressing each of Snell‘s remaining challenges.
A. Whether Snell‘s Appeals Matter Anymore (Mootness)
Delays within the legal system sometimes result in the resolution of a plaintiff‘s injuries without courts having to be significantly involved. In such circumstances, we say the
Because mootness touches upon jurisdictional issues (i.e., whether we can even hear the merits), we address it before his substantive claims, see Manguriu v. Lynch, 794 F.3d 119, 121 (1st Cir. 2015), and we review the district court‘s decision upon a clean slate, see Méndez-Soto v. Rodríguez, 448 F.3d 12, 14-15 (1st Cir. 2006).
An inmate generally loses the right to challenge “prison conditions or policies” at a particular facility when he transfers or leaves that prison because his complaints would no longer have any substantial impact on his life. Ford v. Bender, 768 F.3d 15,
However, there is a way for inmates to keep their declaratory and injunctive relief claims alive after they leave the prison in which the alleged harm occurred. If an inmate can show the challenged policies are “capable of repetition, yet evading review,” then he can escape mootness. Ford, 768 F.3d at 30. The exception applies where: (1) the challenged action did not last long enough for the parties to litigate the harm before it ended; and (2) there is a reasonable expectation that the complaining party will endure the same allegedly harmful action at some point in the future. See Barr v. Galvin, 626 F.3d 99, 105 (1st Cir. 2010) (quoting FEC v. Wis. Right to Life, Inc., 551 U.S. 449, 462 (2007)).
The problem with Snell‘s argument is that he never references evidence of problems so severe as would amount to a systemically dysfunctional review scheme. Simply because the medical review process, at times, has glitches, and because Snell‘s no-stairs restriction has expired, does not mean Snell would not, going forward, receive all appropriate restrictions and accommodations if placed in a non-accessible facility. This is so particularly given the documented degenerative changes to his physical health, which the DOC defendants have acknowledged and addressed. Further, Snell has remained at MCI-Shirley since November 2018 and any uncertainty about how Snell might be later medically evaluated or later housed does not suggest a reasonable
As for Dr. Ruze, she no longer works as a contractor for the Massachusetts Department of Correction and therefore has no further medical responsibility for Snell; injunctive and declaratory relief aimed at her would be of no avail. See, e.g., ACLU of Mass. v. U.S. Conf. of Catholic Bishops, 705 F.3d 44, 53 (1st Cir. 2013) (once contract expired, nothing to enjoin).
Accordingly, we affirm the district court‘s decision to declare moot the claims for injunctive and declaratory relief and turn now to Snell‘s remaining claims for damages against the defendants, claims which survive because his transfer out of MCI-Concord does not erase any injury he may have suffered while he was there. See Ford, 768 F.3d at 29 (quoting Incumaa, 507 F.3d at 287).
B. Standard of Review for Summary Judgment Claims
Appellants who lose at summary judgment get the benefit of what we call de novo review, which is where we examine the
C. Retaliation on Account of Litigation
Snell leans on Title V of the ADA by alleging claims which boil down to this: the DOC defendants and Dr. Ruze retaliatorily conspired to keep Snell from the first-floor
We assess whether defendants illegally retaliated against plaintiffs through a familiar burden-shifting exercise. See D.B. ex rel. Elizabeth B. v. Esposito, 675 F.3d 26, 41 (1st Cir. 2012) (citing McDonnell Douglas Corp. v. Green, 411 U.S. 792, 801-03 (1973)). Snell must present evidence that: (1) he engaged in conduct protected by the ADA, such as complaining about a lack of a reasonable accommodation; (2) the defendants subjected him to some adverse action; and (3) there was a causal connection between the protected conduct and the adverse action. Id. “An adverse action is one that might well dissuade a reasonable person from making or supporting a charge of discrimination.” Id. If Snell demonstrates evidence of all three (what lawyers call a “prima facie” case), then the burden shifts to the defendants to provide a “legitimate non-retaliatory explanation for the adverse action.” Id. at 42. If the defendants succeed, the story does not end there. Once more the burden shifts back to Snell to establish sufficient facts such that a reasonable juror could believe the defendants’ explanations were pretextual, meaning the defendants
By October of 2015, Snell had lodged a number of administrative complaints about stair climbing, and he had turned to state court litigation at least once.18 But the October 9, 2015
As for Dr. Ruze, Snell claims her participation in the retaliatory conspiracy occurred when she wrote the June 23, 2016 administrative note wherein she reiterated her opinion that Snell had no medical reason to stay on flat ground. Dr. Ruze did so, says Snell, without medically reevaluating him, and on the same day prison officials consulted her after receiving the Prison Legal Services’ demand letter asserting Snell‘s ADA rights. We first address the allegations against Dr. Ruze before moving on to the DOC defendants.
For the first prong of the test -- did Snell engage in protected ADA conduct -- we conclude that Snell‘s numerous grievances concerning losing access to the first-floor Terminal can reasonably be viewed as protected conduct. See Esposito, 675 F.3d at 41.
However, Snell can make it no further. Turning to the second step -- whether Dr. Ruze subjected Snell to any adverse action -- our scour of the record finds no evidence demonstrating she did. The June 23, 2016 note Snell points to as proof of an adverse action makes no mention whatsoever of the Terminal; it merely repeats Dr. Ruze‘s longstanding medical opinion concerning Snell‘s ability to climb stairs. In fact, the myriad administrative complaints concerning Snell‘s first-floor woes (both before and after June 23, 2016) never mention Dr. Ruze as acting adversely towards him. Rather, they focused almost solely on Snell‘s understanding of what his 1998 “indefinite” bottom tier restriction afforded him. Nor has Snell produced evidence of any specific grievances he may have filed which voiced dissatisfaction with Dr. Ruze‘s medical treatment (even as he insists he must have submitted them) or which complained to Dr. Ruze about accessing the Terminal. And although (as discussed more below) the DOC defendants’ decision to shut off Snell‘s first-floor Terminal might reasonably be considered adverse vis-à-vis the responsible
Even if Snell managed to get past prong two, his argument falters at step three because there is no evidence Snell‘s grievances caused Dr. Ruze to act adversely against Snell. Snell counters that there is indeed such evidence of causation, and he points to the timing of Dr. Ruze‘s June 23 note as such proof. That Dr. Ruze provided the note to the DOC defendants on the same day they provided Prison Legal Services with a justification for denying Snell access to the first-floor Terminal and that Dr. Ruze provided the note after the DOC defendants asked her about Snell‘s medical history is, to Snell, significant. It demonstrates, says
But not so fast. Snell also argues causation is established by the combination of two events on June 23, 2016, before Dr. Ruze filed the administrative note later in the day: (1) Dr. Ruze and the DOC defendants’ discussion of Snell‘s law library usage; and (2) Dr. Ruze‘s failure to reexamine Snell. No reasonable juror could find either action separately or in concert suspect. Dr. Ruze‘s administrative note articulated her (and other medical providers‘) long-held medical opinion that Snell did not require a no-stairs restriction -- an opinion clearly untethered to Snell‘s legal research preferences. As for entry of her note without a same-day examination, the record makes pellucid that Dr. Ruze was exceedingly familiar with Snell, considering the multiple times she treated him in 2016 and the abundance of times she saw
ii. The DOC Defendants
So we move along to Snell‘s retaliation claims against the DOC defendants. Reading the facts in the light most favorable to Snell, we will assume he has made out his prima facie case of retaliation. See Esposito, 675 F.3d at 41. We can also assume the DOC defendants countered with a legitimate, non-discriminatory explanation for keeping Snell away from the first-floor Terminal: they claim to have done so only after they became explicitly aware
“[T]here is no mechanical formula for finding pretext” and it is thus a fact-intensive inquiry to uncover the DOC defendants’ true motives. Kelley v. Corr. Med. Servs., Inc., 707 F.3d 108, 116 (1st Cir. 2013) (quoting Che v. Mass. Bay Transp. Auth., 342 F.3d 31, 39 (1st Cir. 2003)). One way for a plaintiff to survive summary judgment is by showing pretext through “weaknesses, implausibilities, inconsistencies, incoherencies, or contradictions in the [DOC defendants‘] proffered legitimate reasons for [their] action [such] that a reasonable factfinder could rationally find them unworthy of credence and hence infer that the [DOC defendants] did not act for the asserted non-discriminatory reasons.” Adamson v. Walgreens Co., 750 F.3d 73, 79 (1st Cir. 2014) (quoting Gómez-González v. Rural Opportunities Inc., 626 F.3d 654, 662-63 (1st Cir. 2010)). If the undisputed record evidence is insufficient to demonstrate pretext, then Snell
Snell asserts that the DOC defendants’ proffered explanation for shutting down his access to the first-floor Terminal was inconsistent or contradictory with the actual record because: (1) they knew about and sanctioned his use of the Terminal between 2013 and 2015; and (2) they kept him away from those legal resources for reasons other than his lack of a no-stairs restriction.
a. Whether the DOC Defendants Knew about or Sanctioned Snell‘s Use of the Terminal
Snell points to evidence which he says supports his contention that he had permission to use the Terminal. Snell testified at his deposition that the DOC defendants, specifically the ADA coordinator, granted him a reasonable accommodation to use the first-floor Terminal between July 2013 and October 2015 (though they contest having done so). Remember also that Snell says the DOC defendants knew about his use of the Terminal. If either were true, Snell might well demonstrate the existence of a genuine disputed material fact as to whether the DOC defendants’ proffered legitimate explanation for taking away Snell‘s access -- that they only found out he was using the Terminal following the October 9, 2015 grievance -- was pretextual.
With that framing in mind, we take a deeper record dive to see what contentions find support. First, we assess whether there is evidence that the DOC defendants granted Snell a reasonable accommodation. Next, we tackle whether there is record
1. Whether the DOC Defendants Granted Snell a Reasonable Accommodation
As mentioned earlier, there is no written documentation of any reasonable accommodation having been granted to Snell, despite the regulations requiring the DOC defendants to keep such paperwork. Moreover, Snell makes no claim that the DOC defendants violated their regulations or lost apt paperwork.22 Therefore, without such documentation, we will take Snell‘s argument to mean that the DOC defendants granted Snell‘s claimed reasonable accommodation in some oral off-the-books method. The DOC defendants, including the ADA coordinator, repeatedly testified Snell was never granted a reasonable accommodation for first-floor Terminal use. Had they done so, they would have used formal channels to process and to correspond about such issues. Snell does not dispute this testimony except to repeat the same refrain -- “DOC authorities permitted Mr. Snell to use the . . . [Terminal].” The only further detail he puts forward is that the ADA coordinator sanctioned his use of the legal resources because of his “orthopedic conditions and difficulty climbing stairs.”
We note that although Snell says the ADA coordinator granted him permission to use the Terminal, he puts no other meat on the bones such as when or where the conversation occurred or the context in which it arose or was supposedly granted. Without more, we find Snell‘s statement amounts to a bald, conclusory allegation insufficient to create a genuine issue of material fact as to whether the DOC defendants let him use the Terminal. Thus,
2. Whether the DOC Defendants Knew about or Permitted Snell‘s Terminal Use
Even if Snell had no formal reasonable accommodation, he could demonstrate pretext if he raised a genuine issue of material fact that the DOC defendants otherwise knew about or permitted his use of the Terminal before Snell filed the October 2015 grievance and before they stopped letting him access the first-floor resources. As Snell tells it, two scenarios in the record support his pretext claims in this manner. First, the librarian allowed Snell to use the Terminal in full view without reprimand. And, second, Snell points to the grievance he filed in August 2015 (the grievance resulting from the vacationing librarian leaving Snell high and dry), in which he pleaded for restored access to legal resources including a typewriter and a Lexis terminal. Neither asserted fact gets him very far.
Aside from that which we‘ve already rejected, Snell guides us to no other evidence disputing that it was the librarian, not the DOC defendants, who permitted him to use the Terminal without a proper medical restriction in violation of MCI-Concord‘s rules. The policy preventing the librarian free rein was in place by 2011, and Snell concedes that the librarian “understood that the” Terminal was “designated for handicap-accessible use” only.
Moreover, nowhere in his opening or his reply brief does Snell describe or point to any evidence that the responsible DOC defendants saw him using the resources “in full view” until they found him there on October 29, 2015. By using the phrase “in full view,” perhaps Snell wants us to conclude that the DOC defendants saw or should have seen him at the Terminal in the normal course of the prison day during his two-plus-year stint on the machine. But after thoroughly probing the record here, we have found no evidence to support that contention. And without more information in the record describing, for instance, what daily routine would have brought Snell into the view of the DOC defendants, the inference Snell asks us to draw amounts to speculation. That one prison librarian failed to do his job does not morph the DOC defendants’ legitimate rationale into a contradiction evidencing pretext. See Enica, 544 F.3d at 336 (speculation not enough to survive summary judgment).
From the face of the document, we fail to see why we should. In responding to Snell‘s grievance, the official explained, without embellishment, how alternative staffing had been arranged to provide access to a typewriter (and other items) in the librarian‘s absence. As for the Lexis disrepair, the prison
b. Ulterior Motive Theory
Next, Snell attacks the second half of the DOC defendants’ proffered legitimate explanation -- that they kept Snell from the first-floor Terminal because he lacked a no-stairs medical restriction that could have qualified him for the accommodation. Specifically, he urges that a reasonable jury could
Aside from Snell‘s lack of development, we note the decision came almost three years after the deprivation of Snell‘s access to the Terminal. Additionally, the DOC defendants, just as they had earlier done with Dr. Ruze, followed prison procedures by deferring to Dr. Churchville‘s updated November 2018 medical opinion that Snell, upon further examination, should no longer climb stairs and should have first-floor housing. That the DOC defendants responded to the updated 2018 medical recommendation by finding Snell an accessible prison without stairs, instead of simply letting him use the Terminal, says nothing about the DOC defendants’ motivations for their 2015 ADA response. But see Echevarría v. Astrazeneca Pharm., LP, 856 F.3d 119, 136 (1st Cir. 2017) (stating the “rock-solid premise that [a defendant‘s]
Snell‘s final attempt to show the DOC defendants’ reasoning for the adverse action against him was pretextual complains that the DOC defendants singled out Snell for punishment because they told the librarian specifically not to let him (and no one else) use the first-floor Terminal. True, the DOC defendants did tell the librarian to keep Snell away from that station. But such is not the end of the story. Although the order to enforce the “Handicapped Only” nature of the first-floor Terminal may, on the surface, appear to affect only Snell, he has pointed to no supporting evidence showing other inmates were allowed to use the Terminal without an appropriate medical restriction or without an approved accommodation once the librarian was reined in. In fact, according to the librarian, no other inmate has used the first-floor Terminal since the DOC defendants reminded him to enforce prison regulations. On this record, we cannot say that the DOC defendants acted with pretext when they, in complete accord with prison regulations and procedures and coupled with their prior denials of Snell‘s grievances, instructed the librarian to follow the rules and to
(Eighth Amendment)
The district court determined there was no triable issue of material fact that either the DOC defendants or Dr. Ruze subjected Snell to cruel and unusual punishment by withholding a no-stairs restriction and by discontinuing his reliance upon the first-floor Terminal. Snell disagrees, once more alleging the defendants’ decisions caused harm to his health.
To succeed with an Eighth Amendment claim related to medical problems, Snell must satisfy two elements against the DOC defendants and Dr. Ruze. See Estelle v. Gamble, 429 U.S. 97, 104-05 (1976).26 According to the first prong -- the objective one -- we must determine whether Snell had a “serious medical need[]” for which the defendants provided inadequate care. Id. at 104; see also Kosilek v. Spencer, 774 F.3d 63, 85 (1st Cir. 2014) (“To sustain a claim under the objective prong of the Eighth Amendment, [plaintiff] must show that she has a serious medical need for which she has received inadequate treatment.“).27 Under the second prong
i. Serious Medical Need
For the objective prong, the range of serious medical needs includes those which are either diagnosed by physicians or “‘[are] so obvious that even a lay person would easily recognize the necessity for a doctor‘s attention.‘” Id. at 82 (quoting Gaudreault v. Municipality of Salem, Mass., 923 F.2d 203, 208 (1st Cir. 1990)). As for whether the defendants provided adequate care, prison officials are not required to render ideal care, let alone cater to an inmate‘s preferred healthcare regimen. See id. They simply must provide care at “a level reasonably commensurate with modern medical science and of a quality acceptable within prudent professional standards.” United States v. Derbes, 369 F.3d 579, 583 (1st Cir. 2004) (quoting United States v. DeCologero, 821 F.2d 39, 43 (1st Cir. 1987)). Moreover, “[t]he law is clear that where two alternative courses of medical treatment exist, and both alleviate negative effects within the boundaries of modern medicine, it is not the place of our court to ‘second guess medical judgments‘. . . .” Kosilek, 774 F.3d at 90 (quoting Layne v. Vinzant, 657 F.2d 468, 474 (1st Cir. 1981)); see also Ruiz Rosa v. Rullán, 485 F.3d 150, 156 (1st Cir. 2007) (disagreement between two medical professionals regarding the proper course of treatment will generally be insufficient to establish an Eighth Amendment violation).
Even assuming Snell‘s various knee, back, and respiratory ailments were objectively serious to a layperson, let alone to a doctor, there is still no genuine issue of material fact that the defendants violated the Eighth Amendment by providing inadequate care, which, as Snell claims, “subject[ed] him to the pain and danger of being forced to climb stairs to reach the second-floor law library.”
But wait, says Snell, Dr. Churchville and an expert retained by Snell for trial, Dr. Michael G. Kennedy, MD., C.C., F.R.G.S. (C), disagreed with Dr. Ruze, her expert, and the other medical professionals about Snell‘s proper medical treatment. And, in Snell‘s telling, the competing expert opinions create, at minimum, a genuine issue of material fact that he suffers from a serious medical need. No disputing Dr. Churchville provided a no-stairs restriction in November 2018, but, remember, this was three years after the DOC defendants stopped Snell‘s first-floor Terminal use and more than two years after Dr. Ruze‘s June 23, 2016 note confirming Snell could climb stairs. In addition to Dr. Churchville, Snell‘s expert, Dr. Kennedy, also thought Snell deserved a no-stairs restriction in October 2015 because he “should, at all cost, [have] avoid[ed] climbing up and down stairs” due to his problematic knees and back. But both events are inconsequential since we have already assumed Snell suffered a serious medical need in 2015. Our task, then, is to scrutinize the record to see if evidence shows Snell received inadequate care during the relevant time frame.
To remind, where medical experts do not contend the care provided fell outside of the bounds of acceptable medical practice, disagreement among the experts over the proper course of care does
ii. Deliberate Indifference
For the sake of completeness though, we‘ll continue along the tiered levels by assuming there is a genuine issue of material fact regarding the objective prong and by turning to assess the subjective element.
Deliberate indifference appears when defendants had a “sufficiently culpable state of mind” by ignoring (or worsening) the inmate‘s serious medical need. Farmer, 511 U.S. at 834 (quoting Wilson v. Seiter, 501 U.S. 294, 297 (1991)). Deliberate
a. Dr. Ruze
For the reasons stated above, Dr. Ruze crafted the strategy to handle Snell‘s ailments based on a reasoned medical decision, which makes it difficult, to say the least, for Snell to
b. DOC Defendants
As for the DOC defendants, we similarly conclude that the record here yields no genuine issue of material fact which would support a finding of deliberate indifference. Although the DOC defendants could have independently granted Snell the accommodation he sought for first-floor Terminal access, see 103 DOC 408.07, they had no reason to expect Snell needed it given their justifiable reliance on the medical opinions of Dr. Ruze and other health care professionals who treated Snell, see Matthews v. Pa. Dept. of Corr., 613 F. App‘x 163, 170 (3d Cir. 2015) (“[N]on-medical prison officials are generally justified in relying on the expertise and care of prison medical providers. Absent a reason to believe (or actual knowledge) that prison doctors or their
Even putting aside their reasoned reliance on the opinions of medical professionals like Dr. Ruze, Snell had walked up and down stairs (even if with a cane in hand and even if with some difficulty)29 in other parts of the prison throughout his confinement, denting Snell‘s argument that the DOC defendants callously disregarded the risk he would suffer a more severe injury without the accommodation. The DOC defendants, as the record reflects, thus reasonably believed Snell could traverse stairs to the second-floor law library without suffering serious or irreparable harm. See Kosilek, 774 F.3d at 92 (finding no deliberate indifference where decision fell “within the realm of reason and made in good faith“) (quoting Battista v. Clarke, 645 F.3d 449, 454 (1st Cir. 2011)).
We thus affirm the grant of summary judgment on the Eighth Amendment claims. See Nunes, 766 F.3d at 142.
Relying upon the
Title II of the ADA requires public entities, including prisons and their officials, see Pa. Dept. of Corr. v. Yeskey, 524 U.S. 206, 210 (1998), to provide “meaningful access” to programs, such as law libraries, by taking reasonable steps to overcome barriers, like stairs, which impede access to those programs for inmates with disabilities, Theriault v. Flynn, 162 F.3d 46, 48 (1st Cir. 1998) (quoting Alexander v. Choate, 469 U.S. 287, 301 (1985)); see also Tennessee v. Lane, 541 U.S. 509, 531 (2004) (determining Title II “applies to the class of cases implicating accessibility to judicial services“). As previously detailed, MCI-Concord created a reasonable accommodation by establishing the first-floor Terminal for inmates with documented medical restrictions who could not traverse the stairs to the second-floor law library.32 The question, then, is whether there is a genuine
We start by asking whether the record reflects sufficient evidence to create a genuine issue of material fact that: (1) Snell “is a qualified individual with a disability; (2) . . . he was either excluded from participation in, or denied the benefits of a public entity‘s services, programs, or activities or was otherwise discriminated against; and (3) . . . such exclusion, denial of benefits, or discrimination was by reason of [his] disability.”34 Kiman v. N.H. Dept. of Corr., 451 F.3d 274, 283 (1st Cir. 2006) (internal quotation marks omitted) (quoting Parker v. Universidad de P.R., 225 F.3d 1, 5 (1st Cir. 2000)).35
Snell stresses that we must reverse the grant of summary judgment because the district court mistakenly analyzed his Title II ADA reasonable accommodation claim as one requiring him to show the defendants’ decisions “were based on any discriminatory animus.” Snell, 2019 WL 4303264, at *7. But Snell mistakes the district court‘s reasoning, even if the district court could have avoided some confusion by choosing a word other than “animus.” The third prong of an ADA Title II reasonable accommodation claim mandates that plaintiffs explain how the decision to deny a reasonable accommodation was discriminatory, even if the actors denying the accommodation did not have any intent to discriminate. See Kiman, 451 F.3d at 285. Without discrimination, there would be no ADA claim. The district court thus commented about animus only so far as to analyze whether the exclusion qualified as discriminatory, using the term when discussing the medical recommendations upon which the prison officials relied and whether the prison officials excluded Snell from accessing legal materials based on his disability. See Snell, 2019 WL 4303264, at *7. The district court did not improperly require Snell to demonstrate that the DOC defendants intended to discriminate against Snell.
We thus turn to the third prong (whether the DOC defendants excluded Snell on account of his disability). Unless the evidence shows that the DOC defendants’ decisions regarding the reasonable accommodation were “so unreasonable as to demonstrate that they were discriminating against [Snell] because of his disability,” we will hesitate to overturn the district court‘s summary judgment decision. Kiman, 451 F.3d at 285.
Even examining the evidence in the light most favorable to Snell, the DOC defendants did not “exclude[ Snell] from participation,”
Even putting aside the reasonable reliance upon medical advice, the record reflects only that the DOC defendants kept Snell away from the first-floor legal resources because they believed he could get to the second-floor library. Snell may have had an indefinite bottom tier restriction, but even prisoners on the bottom tier would navigate stairs from time to time. Snell himself climbed stairs to and from the law library for years, even while he claimed to have the 1998 indefinite bottom tier restriction exempting him from such an arduous feat. Although a layperson could look at Snell and, given his use of a cane, suspect he might have some difficulty traversing stairs, see Shedlock, 818 N.E.2d at 1030-31 (describing cane use as indicative of difficulty with stairs), and even acknowledging that forcing an inmate to
The DOC defendants also had interests in “maintaining security and order” within the institution when they determined whether providing the accommodation to Snell would have been reasonable, and we will defer to such rationales. Pierce v. Cnty. of Orange, 526 F.3d 1190, 1217 (9th Cir. 2008) (quoting Bell v. Wolfish, 441 U.S. 520, 540 n.23 (1979)). For security purposes, the DOC defendants refused accommodations which appeared to preference one inmate over others, such as allowing Snell access to the first-floor Terminal without a no-stairs restriction when all other would-be users would need to prove that they required an accommodation.
Conclusion
For the foregoing reasons, the district court‘s grant of summary judgment to the defendants on all counts is affirmed. Each party to bear its own costs.