Case Information
*2 Before MURPHY, SMITH, and BENTON, Circuit Judges.
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BENTON, Circuit Judge.
Thomas J. Ingrassia, a civilly-committed individual, sued Carol A. Dickneite, Jay W. Englehart, Alan W. Blake, Beth Weinkein and Mary Beth Rowe, alleging a violation of his constitutional right to adequate nutrition under 42 U.S.C. § 1983. The district court denied defendants qualified immunity. They appeal. Having jurisdiction under 28 U.S.C. § 1291, this court affirms in part, reverses in part, and remands.
I.
Ingrassia was civilly committed to the Missouri Sexual Offender Rehabilitation and Treatment Services (SORTS) facility. In 2001, he escaped. Apprehended in 2003, he was convicted of property damage related to the escape. After serving a prison sentence, Ingrassia returned to SORTS in August 2008. He then weighed 150 pounds, although he alleges this was lower than normal due to recent back surgery.
Returning to SORTS, Ingrassia was placed on Total Ward Restriction (TWR), which included not eating in the dining room. Based on his height, weight, and age, SORTS determined he required a 2000-calorie per day diet. The TWR lasted until March 15, 2009, when he began eating in the dining room. By May 27, Ingrassia weighed 163 pounds.
Under SORTS policies, if a patient refuses to attend meals in the dining room or to comply with meal procedures, SORTS provides two 300-calorie meal- replacement drinks or, if medically necessary, a regular meal tray in the patient’s room. On July 12, for unknown reasons, Ingrassia received two meal-replacement shakes instead of a regular meal. In protest, he microwaved the shakes in a styrofoam cup, put them on a desk in the nurse’s station, and smashed a book on top of them, spilling them all over the desk.
The following day, Rowe, a registered nurse, ordered that Ingrassia be provided a bag lunch and no drinks until further notice. Later that day, Blake, the chief operating officer, discontinued that order, directing that he receive regular meal trays but no hot liquids. Between July 22, 2009, and March 4, 2010, an additional order directed no liquids except water. On September 17, Ingrassia again smashed a meal- replacement shake in protest. Thereafter, he received only bag lunches and finger foods.
According to Ingrassia, during this period of restrictions, his bag lunches often lacked key items. Each sack lunch normally had a sandwich, bag of chips, pack of cookies, and one piece of fruit. Ingrassia also received a 200-calorie night-snack. He alleges that, due to the missing items, he sometimes consumed only 1200 calories per day. In August 2009, shortly after the food restrictions began, Ingrassia weighed 165 pounds. Three months later, it was 151 pounds. Throughout the period of restrictions, Ingrassia made several formal and informal complaints to defendants. On March 4, 2010, he started receiving regular meals, ending the dietary restrictions.
Ingrassia sued the defendants under 42 U.S.C. § 1983, alleging a Fourteenth Amendment claim for denial of adequate nutrition. Defendants moved for summary judgment on the basis of qualified immunity. The district court denied the motion. Defendants appeal.
II.
The defendants argue that the district court should have granted them qualified
immunity. “[A]n order denying qualified immunity is immediately appealable even
though it is interlocutory.”
Scott v. Harris
, 550 U.S. 372, 376 n.2 (2007). “‘A
defendant, entitled to invoke a qualified immunity defense, may not appeal a district
court’s summary judgment order insofar as that order determines whether or not the
pretrial record sets forth a genuine issue of fact for trial’; the appealable issue is a
purely legal one.”
White v. McKinley
,
This court reviews de novo the district court’s denial of qualified immunity.
Id.
at 813. The defendants bear the burden to establish the relevant facts supporting
qualified immunity, while Ingrassia receives the benefit of all reasonable inferences.
See
Wallingford v. Olson
,
“Qualified immunity may protect government officials from liability under 42
U.S.C. § 1983, but not if their conduct violated clearly established statutory or
constitutional rights of which a reasonable person would have known.”
Nelson v.
Corr. Med. Servs.
,
Reviewing the denial of qualified immunity, this court views the facts most
favorably to Ingrassia and draws all reasonable inferences in his favor.
Nance v.
Sammis
,
III.
Although Ingrassia is civilly committed—not imprisoned—his confinement is
subject to the same safety and security concerns as that of a prisoner.
Revels v.
Vincenz
,
Civilly-committed individuals have a constitutional right to nutritionally
adequate food.
See
Wishon v. Gammon
, 978 F.2d 446, 449 (8th Cir. 1992). A
plaintiff may demonstrate violation of his constitutional rights by evidence “that the
food he was served was nutritionally inadequate or prepared in a manner presenting
an immediate danger to his health, or that his health suffered as a result of the food.”
Id.
See also
Berry v. Brady
, 192 F.3d 504, 508 (5th Cir. 1999) (suggesting that
inmate claiming inadequate diet must allege losing weight, suffering adverse physical
effects, or being denied nutritionally or calorically adequate diet),
cited with approval
in
Davis v. Missouri
, 389 F. Appx. 579, 579 (8th Cir. 2010). To demonstrate a
constitutional violation, Ingrassia must show that the defendants were deliberately
indifferent to his nutritional needs, that is, “failed to act despite . . . knowledge of a
substantial risk of serious harm.”
See
Farmer v. Brennan
,
A.
According to defendants, Ingrassia was not denied adequate nutrition because (1) any inadequate nutrition was due to his own behavioral choices, and (2) as a matter of law, he had adequate nutrition because objective measures such as Body Mass Index (BMI) and labwork were within the normal range.
Defendants first contend that Ingrassia’s failure to follow SORTS dining-room
procedures led to the replacement meals and shakes. Defendants emphasize cases
where courts hold that prisoners have no constitutional claim if inadequate nutrition
stems from failure to comply with safety procedures during meals.
See, e.g.
,
Talib v.
Gilley
,
Defendants also note that Ingrassia’s BMI was at all times within the “normal” range of 18.9 to 24.9. According to defendants, they cannot be liable for withholding adequate nutrition because the objective evidence—his BMI—demonstrates adequate nutrition. While certainly favoring defendants, the normal BMI does not as a matter of law foreclose an inadequate-nutrition claim. As Ingrassia points out, at his height, a weight drop from 174 to 131 pounds might be considered “normal” BMI. This court has held that a far less precipitous weight loss states a claim for inadequate nutrition. See Davis , 389 F. Appx. at 579 (finding allegation of 19-pound weight loss in 8 months sufficient to state a constitutional violation).
Likewise, although defendants contend that Ingrassia’s labwork was at all times within normal ranges, the evidence shows four indicators outside the normal range. The district court properly found that the lab results remained contested issues of material facts. The objective measures of the “normal” range BMI and lab results do not foreclose a claim for inadequate nutrition.
Rather, as the district court explained, there is ample evidence from which a jury—crediting Ingrassia’s evidence—could find that he proved a constitutional violation: (1) he lost 11 pounds in less than two months (and 14 pounds in three months), (2) his bag lunches often lacked items as punishment for behavioral violations, (3) at times he received only 1200 calories per day instead of the recommended 2000, and (4) food—including oatmeal and mashed potatoes–was *8 improperly withheld under the “no liquids” order. The evidence, taken most favorably to Ingrassia, demonstrates a violation of his constitutional right to adequate nutrition.
B.
The defendants, save Englehart, assert they did not have the requisite
knowledge to be liable for deliberate indifference to Ingrassia’s dietary needs.
Defendants Dickneite, Blake, Weinkein and Rowe argue that they did not have
knowledge of his weight loss or the authority to change his meal plans.
See
Farmer
v. Brennan
,
Blake and Weinkein each knew of Ingrassia’s complaints and had authority to change his meals. Blake, the chief operating officer, received a complaint from Ingrassia in 2009 about the health shakes. Blake conceded in his response to a request for admissions that he “may have been aware” of Ingrassia’s weight loss. Blake had authority to enter orders about nutrition, having reversed Rowe’s 2009 no-liquid order.
Likewise, Weinkein, a registered dietitian, acknowledged she was aware of Ingrassia’s weight loss, responding to one of his complaints by writing (under her signature) that a registered dietitian had calculated his nutritional needs and found his diet adequate. Weinkein noted proposed changes to Ingrassia’s nutrition plan, including progress notes that he had nutritional risks and should be receiving Slim Fast bars to meet his nutritional needs. At this stage in the proceedings, Ingrassia has shown that Blake and Weinkein each potentially had the requisite knowledge and authority for his deliberate-indifference claim.
Rowe and Dickneite, however, did not have knowledge or authority. Although Rowe, a registered nurse, entered the nutritional order after Ingrassia first smashed the shake in 2009, Ingrassia has adduced no evidence that she was aware of and ignored his weight loss, as required for a claim of deliberate indifference. Similarly, Dickneite, in the State Office of Consumer Safety, had neither knowledge of Ingrassia’s weight loss nor the authority to change his meal plans. The evidence against Rowe and Dickneite is insufficient to support a claim for deliberate indifference. The district court erred by denying summary judgment to them.
C.
Defendants contend that, even if questions of material fact remain whether Ingrassia was denied adequate nutrition, the right to adequate nutrition was not clearly established, warranting qualified immunity. Defendants argue that appellate courts have not clearly defined adequate nutrition in the civil commitment context. At the time of the alleged violations, however, it was clearly established that a prisoner may properly allege a constitutional violation by demonstrating significant weight loss or other adverse physical effects from lack of nutrition. See Davis v. Missouri , 389 F. Appx. 579, 579 (8th Cir. 2010) (citing cases for proposition that “inmate claiming inadequate diet under Eighth Amendment must allege he lost weight or suffered adverse physical effects, or was denied nutritionally or calorically adequate diet”). While there are contested issues of fact about Ingrassia’s weight loss and caloric intake, his evidence established a significant weight loss tied to nutrition. Because the law was settled, the district court properly denied summary judgment to Englehart, Blake and Weinkein.
* * * * * * *
The order of the district court denying qualified immunity is affirmed in part, reversed as to Rowe and Dickneite, and remanded for proceedings consistent with this opinion.
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