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Rhinehart v. Scutt

United States Court of Appeals, Sixth Circuit

June 28, 2018

Lewis Rhinehart and David L. Rhinehart, Joint Personal Representatives for the Estate of Kenneth A. Rhinehart, Plaintiffs-Appellants,
v.
Debra L. Scutt, Warden, Defendant, Adam Edelman, M.D.; Vernon Stevenson, M.D., Defendants-Appellees.

          Argued: May 4, 2018

          Appeal from the United States District Court for the Eastern District of Michigan at Detroit. No. 2:11-cv-11254-Stephen J. Murphy, III, District Judge.

         ARGUED:

          Paul J. Zalewski, THE ZALEWSKI LAW FIRM, Warren, Michigan, for Appellant.

          Kevin A. McQuillan, CHAPMAN LAW GROUP, Troy, Michigan, for Appellees.

         ON BRIEF:

          Paul J. Zalewski, THE ZALEWSKI LAW FIRM, Warren, Michigan, for Appellant.

          Kevin A. McQuillan, Ronald W. Chapman, Carly Van Thomme, CHAPMAN LAW GROUP, Troy, Michigan, for Appellees.

          Before: MOORE, THAPAR, and BUSH, Circuit Judges.

          OPINION

          JOHN K. BUSH, Circuit Judge.

         The Eighth Amendment bars the "inflict[ion]" of "cruel and unusual punishments." U.S. Const. amend. VIII. This case addresses how that constitutional provision applies to the medical treatment rendered by two prison doctors to an inmate who suffered from end-stage liver disease ("ESLD").

         Kenneth Rhinehart ("Rhinehart"), then a prisoner, filed this action under 42 U.S.C. § 1983, alleging that medical providers associated with the Michigan Department of Corrections ("MDOC") denied him necessary treatment for his ESLD. When he died, his brothers, Lewis and David Rhinehart (the "Rhineharts"), filed an amended complaint on behalf of his estate. After defendants filed motions to dismiss and motions for summary judgment, only the Rhineharts' Eighth Amendment claims against Dr. Adam Edelman and Dr. Vernon Stevenson (the "Defendant Doctors") remained. The district court granted summary judgment to the Defendant Doctors, and the Rhineharts appealed. For the reasons below, we AFFIRM the judgment of the district court.

         I.

         In the summer of 2009, Rhinehart was an inmate at Alger Maximum Correctional Facility ("Alger") in Munising, Michigan. He was 58 years old but in poor health. He had been suffering from many medical conditions, including liver disease, and for the past four years, he had been experiencing general malaise, weight loss, and poor appetite. In August 2009, his prison doctor, Aster Berhane, ordered a CAT ("CT") scan of his abdominal area, which revealed a suspicion of bile duct cancer. The parties agree that Rhinehart did not in fact have cancer then or at any other time before his death.

         But that was unknown in the fall of 2009, so Dr. Berhane arranged to transfer Rhinehart downstate for further investigation of this potential cancer. She contacted defendant Dr. Edelman about transferring Rhinehart to Cotton Correctional Center ("Cotton"). Dr. Edelman was the medical director for utilization management at Corizon Health Inc. ("Corizon"), [1] a company responsible for on-site medical services for all state inmates. He studied internal medicine, but his experience was mainly administrative. His job was to review requests for outside treatment, which other medical providers generally submitted on a form called a 407. Such requests were necessary for a prisoner to be referred to a specialist within Corizon's referral network.

         Dr. Berhane arranged an expedited, doctor-to-doctor transfer from Alger to Cotton.[2] She also submitted a 407 request to refer Rhinehart to an oncologist (cancer specialist) or hepatologist (liver specialist) for a biopsy of the potential cancer. Dr. Edelman approved the referral request.

         Around that same time, Dr. Berhane also contacted defendant Dr. Stevenson-a general internist doctor, Corizon employee, and the senior doctor on staff at Cotton-to inform him about Rhinehart's medical issues. During his deposition, Dr. Stevenson testified that he understood that Rhinehart had "very urgent issues" and needed to be seen by a specialist for abnormal liver findings. R.263-3, Stevenson Dep., Page ID# 5025-26.

         The Rhineharts presented evidence that the Cotton facility assigned inmates to doctors based on their prison number, and that generally, an assigned doctor was responsible for developing an inmate's treatment plan and examining that inmate (unless the doctor was unavailable to do so). Rhinehart's prison number revealed that he was assigned to Dr. Stevenson.[3]

         Rhinehart was transferred to Cotton on October 26, 2009, but saw no doctor until about two months later. This delay is attributable to a failure by the nursing staff at Cotton in processing Rhinehart's intake and scheduling him for a medical-provider visit.[4] During the time that Rhinehart had not seen a doctor, he filed complaints and grievances expressing concern about not being referred for a biopsy of his liver to determine his cancer risk. He also asked to see a doctor because of increasing pain in his liver and abdominal area and consequent difficulty in performing his porter job.

         Dr. Stevenson testified that he did not receive notifications of inmate complaints or copies of grievances. But he recalled that in mid-December 2009, Cotton's Health Unit Manager, Beth Gardon, told him that Rhinehart had been at Cotton for six weeks and had not been seen for an intake. Upon hearing this, Dr. Stevenson directed Gardon to bring Rhinehart in for an appointment. The Cotton staff scheduled Rhinehart to see Dr. Stevenson three weeks later. When it came time for Rhinehart's appointment, however, Dr. Stevenson was too busy, so he arranged for another doctor, Dr. Padmaja Vemuri, to examine Rhinehart.[5]

         From early January until the end of February 2010, Rhinehart had several appointments with prison medical providers but none with Dr. Stevenson. Dr. Vemuri first examined Rhinehart on January 4, 2010; he complained about weight loss and discomfort in his liver area.[6] Dr. Vemuri noted that a request for Rhinehart to be referred to an oncologist had already been approved, and she set forth a plan to have the oncology appointment made, to have laboratory testing conducted, and for Rhinehart to have an appointment with the gastrointestinal clinic.[7]After this appointment, Rhinehart attended several more doctor appointments in January 2010 with Dr. Vemuri and another prison doctor, Dr. Zivit Cohen.[8] On February 3, 2010, Dr. Cohen obtained approval for an ultrasound of Rhinehart's liver, which was completed about a week later.

         Rhinehart was not satisfied with the care that he had received. He filed a grievance related to his first appointment with Dr. Vemuri in which he stated that he was experiencing severe pain and she failed to prescribe him pain medication. After that, he sent letters of complaints to medical and legal officials and filed a pro se lawsuit raising his concerns about his risk for cancer and the lack of care he was receiving.

         Rhinehart's grievance for lack of pain medication was upheld on January 22, 2010. A little less than a month later, Dr. Cohen saw him for his complaints of abdominal discomfort and prescribed him pain medication.

         Shortly after that appointment, a Jackson, Michigan newspaper ran an article reporting that Rhinehart probably had cancer and was in pain but had not been given a referral to a specialist, a liver biopsy, a treatment plan, pain pills, or an explanation for the delay. The article was followed by a call from the ACLU to the Michigan Attorney General's Office. This call resulted in a few internal emails among prison medical staff that showed some confusion about whether Rhinehart's cancer risk had been ruled out.

         Three days after this exchange of emails, on February 25, 2010, Dr. Stevenson and Dr. Eddie Jenkins (the Regional Medical Director) examined Rhinehart. Rhinehart complained of abdominal pain, nausea, bilateral back and flank pain, blood in his urine, and a decreased urine stream. Dr. Stevenson "reassured" Rhinehart that he had no mass or cancer, ordered urine and laboratory tests, and scheduled a follow-up appointment in three weeks.

         After that, Dr. Cohen monitored Rhinehart. She regularly examined him, ordered laboratory tests, and treated his pain. On March 8, Dr. Cohen saw Rhinehart for his ESLD. Dr. Cohen conducted a physical exam and noted improvements, including that he presented with an "okay" appetite, stable weight, and a reduction in his pain under the prescribed pain medication. In April, Rhinehart had additional follow-up appointments. Dr. Cohen conducted another full examination, prescribed Ensure, ordered lab work, and scheduled a one-month follow-up appointment. Then in May, Dr. Cohen gave Rhinehart a detail for a "light duty" work assignment to accommodate his pain. And when Rhinehart reported increased pain, Dr. Cohen prescribed methadone for him, which, during his May follow-up appointment, Rhinehart reported was working well.

         But that summer, Rhinehart's condition took a turn for the worse. On June 20, 2010, about eight months after his transfer to Cotton, the Cotton medical staff transferred Rhinehart to the emergency room of Allegiance Hospital. The Cotton staff sent him there because he had been complaining of bloating, increased pain in his spleen/liver, general malaise, and fatigue. At the hospital, he presented with constipation, hallucinating, and abdominal pain. He was admitted and treated until his discharge on June 30, 2010.

         A brief review of the Rhineharts' medical literature and expert testimony is necessary here. Liver disease can lead to cirrhosis of the liver-the deterioration of the liver when scar tissue replaces healthy liver tissue. Cirrhosis causes increased pressure in the veins that carry blood to and from the liver. This increased blood pressure can cause the formation of dilated veins in the esophagus, esophageal varices. These varices carry the risk of bleeding, a risk that increases along with the pressure and sizes of the varices. One way for a specialist to diagnose esophageal varices is by inserting a scope into the esophagus-a procedure known in the medical field as Esophagogastroduodenoscopy ("EGD") scoping. When esophageal varices are found, "first level" treatment includes prescribing medications such as beta blockers (which decrease blood pressure), EGD scoping and ligation banding performed by a specialist (which obliterate the varices), or some combination of both.

         After Rhinehart was admitted into the hospital, he underwent a series of tests, including a CT scan of his abdomen with contrast, an MRI, and an ultrasound. These tests revealed no liver mass but extensive portal venous thrombosis (blood clotting in the vein that carries blood to the liver). His hospital records show that "no definitive intervention was felt to be indicated other than beta blockers and an EGD to rule out/assess esophageal varices." R.259-2, Discharge Summary, Page ID# 4706. Dr. Lynn Schachinger, a hospital gastroenterologist, performed an EGD, which revealed four columns of esophageal varices with no active bleeding; he successfully placed seven ligation bands to obliterate the varices.

         In his post-procedure report, Dr. Schachinger recommended that Rhinehart "followup [sic] as an outpatient with the prison gastroenterologist for additional EGD with esophageal banding as necessary." R.177, Endoscopy Report, Page ID# 2421. In his deposition, Dr. Schachinger testified that "the risk of [Rhinehart's] bleeding from [his varices] was higher because of the size of the varices" and that if he had a patient with Rhinehart's conditions under his exclusive control, he would have reevaluated Rhinehart's varices a month later. R.263-13, Schachinger Dep., Page ID# 5399-4000. He also testified that he "probably would have referred [such a patient] to a tertiary care center that performs a liver transplant to see if at some point that might become necessary," but emphasized that the decision to order a transplant would be "up to the hepatologist" as "they deem necessary." Id. at 4000. The Rhineharts' expert witness, gastroenterologist Dr. Stuart Finkel, agreed. In his deposition, he testified that in the weeks and months after Rhinehart's June 2010 hospitalization, "[i]n the private world setting, Dr. Schachinger would have recalled the patient in a timely fashion for a repeat [EGD] and banding session." R.263-14, Finkel Dep., Page ID# 5442. He also agreed with Dr. Schachinger's opinion that he would have referred Rhinehart for evaluation for a liver transplant. Id.

         The day after his discharge from the hospital, Dr. Cohen saw Rhinehart. She reviewed his hospital records, ordered lab work, prescribed a beta-blocker medication (Propranolol) to reduce his blood pressure, and scheduled a one-week follow-up appointment. Rhinehart was not referred for follow-up appointments with a gastroenterologist. Instead, Dr. Cohen continued to monitor Rhinehart that month, examining him on July 8 and again on July 19.

         The next month, August 2010, Dr. Stevenson left his employment with Corizon.[9] At that time, Dr. Edelman was still working for Corizon, but he did not become re-involved in Rhinehart's healthcare until May 17, 2011.

         In June 2011, the Cotton medical staff again sent Rhinehart to Allegiance Hospital's emergency room after he complained of increased abdominal pain. R.178, Progress Note, Page ID# 2437-40. An MRI showed "progression of disease on comparison with previous imaging from June of 2010." Id. at Page ID# 2437. A CT-guided biopsy was negative for a malignancy. The gastroenterologist's discharge plan included a repeat MRI of Rhinehart's abdomen in four weeks and, if Rhinehart's tumor worsened, an evaluation at a tertiary care center. Id. at Page ID# 2437, 2439. Dr. Edelman approved the request for Rhinehart to have an MRI of his liver on July 5, 2011. The results were unchanged in comparison to the MRI completed a month earlier. The MRI also showed blockage of the portal vein (the vein that carries blood to the liver). After Rhinehart had blood drawn, Dr. Nancy McGuire, who was now Rhinehart's medical provider, discussed his case with Dr. Edelman.

         Around this same time, Rhinehart had moved for a temporary restraining order requesting that he be seen by a hepatologist, oncologist, or qualified liver specialist to be evaluated for a liver transplant-the only curative treatment option for ESLD.[10] In responding to the motion, Dr. Edelman and Dr. Kosierowski (an oncologist and Corizon consultant) signed affidavits. They declared that they had discussed Rhinehart's case and had determined that there was no need to send Rhinehart to a specialist. R.258-4, Affidavits of Dr. Edelman and Dr. Kosierowski, Page ID# 4500-09. Both Dr. Edelman and Dr. Kosierowski stated in their affidavits that Rhinehart likely did not have cancer.[11] Id. As for a liver transplant, they avowed that Rhinehart was an unlikely candidate. Id. In his affidavit, Dr. Edelman explained how liver transplants are assigned and why Rhinehart was not realistically eligible to receive one:

Liver transplants are judged by the Model for End-State Liver Disease (MELD) system to prioritize patients waiting for a liver transplant. The range is from 6 (less ill) to 40 (gravely ill). The individual score determines how urgently a patient needs a liver transplant within the next three months. The number is calculated using the most recent laboratory tests. Mr. Rhinehart, based on his most recent laboratory tests, would likely score very low on the scale and therefore would not be considered for transplant at this time.

Id. at 4507-08.

         In his deposition years later, Dr. Finkel disputed Dr. Edelman's and Dr. Kosierowski's opinions about Rhinehart's eligibility for a liver transplant. He opined that "livers are allocated to patients who are in the worst condition. And then, if nobody is available who is a match, it goes down the line to better candidates. Maybe he would have received a liver, maybe he wouldn't have received a liver, but he would have been a candidate." R.263-14, Finkel Dep., Page ID# 5442. Dr. Finkel admitted that Rhinehart's MELD score of 7 (out of 40) "would not have placed him at the top of the list for [a] liver transplant" but opined that "contrary to Dr. Edelman's testimony, it would not have eliminated him or knocked him out of contention." Id. Dr. Finkel also testified that because Rhinehart had such a low MELD score, he "probably would have done very well with a liver transplant." Id.

         On October 12, 2011, Dr. Edelman had a telemedicine appointment with Rhinehart. During the appointment, Dr. Edelman rejected Rhinehart's request to see an outside liver specialist for evaluation for a liver transplant. He reiterated that based on Rhinehart's blood work, his liver health was too good for him to qualify, and Dr. Edelman assured Rhinehart that the prison medical staff could provide his necessary treatment.

         Two weeks later, on October 26, 2011, Rhinehart was rushed to Allegiance Hospital after he reported abdominal pain and vomiting large amounts of blood. Dr. Schachinger performed an emergency EGD, discovered four columns of severe esophageal varices that were bleeding, and successfully treated them with ligation banding. At his deposition, Dr. Schachinger testified that if Rhinehart's varices had been monitored after the first banding procedure in June 2010, and if additional banding had occurred, it was possible that this bleed could have been prevented. Dr. Finkel agreed. In his deposition, he opined that the likelihood of Rhinehart's esophagus bleeding in October 2011 "would have been reduced or eliminated entirely" if Dr. Schachinger's recommendation for follow-up gastroenterologist appointments in June 2010 were followed. R.263-14, Finkel, Dep., Page ID# 5441.

         After treating Rhinehart in October 2011, Dr. Schachinger laid out a recommended plan of care in his post-procedure report. One of his recommendations was that Rhinehart's prison doctors transfer him to a tertiary care institution to undergo a transjugular intrahepatic portosystemic shunt ("TIPS") procedure, which is used to decompress the pressure in the portal vein to decrease the risk of esophageal bleeding. R.259-2, Endoscopy Report, Page ID# 4713. He recommended that "the transfer should occur if [Rhinehart] has additional bleeding" because more banding would not be an option. Id. He summarized Rhinehart's condition: "The patient's prognosis is quite poor and guarded at this time and there is a fair chance that this is going to bleed again and he may bleed to death and I recommend that he be transferred." Id.

         In his deposition, Dr. Schachinger testified that he recommended that Rhinehart's healthcare providers "consider a TIPS procedure" because it was "medically . . . the right move," as Rhinehart had severe varices, which had bled, and a TIPS has been shown to decrease his risk of bleeding. R.263-13, Schachinger Dep., Page ID# 5403. He opined that this procedure would have stopped esophageal bleeding. Id. But he also recognized that there are serious risks in performing a TIPS, including a chance of the patient developing brain disease. Id. at Page ID# 5407.

         Dr. Finkel testified that a TIPS is the "gold standard" of treatment for patients with esophageal varices. R.263-14, Finkel Dep., Page ID# 5435. He opined that a TIPS is "a minimally invasive procedure," that a patient with Rhinehart's MELD score would "have a 100 percent chance of survival following [a] TIPS for the first year," and that Rhinehart "had the potential of living for another five years without a liver transplant" had he received the TIPS. Id. at Page ID# 5440. Dr. Finkel recognized a risk of hepatic encephalopathy-a form of brain disease-from a TIPS procedure but estimated Rhinehart's risk at "less than 20 percent." Id.

         The day after Rhinehart's esophageal banding, a hospitalist, Dr. Mohmmed Al-Shihabi, contacted Dr. Edelman and Dr. Stieve about the possibility of transferring Rhinehart to a tertiary center for an evaluation and possible TIPS procedure. R.259-2, Progress Note, Page ID# 4715- 16. In his report, Dr. Al-Shihabi wrote that Dr. Edelman "denied this transfer and he said that we just need to continue monitoring the patient here, even though Dr. Schachinger said that if the patient bleeds he cannot do to [sic] anything and the patient will be unstable to be transferred or do anything and the patient will definitely die." Id. at 4715. Dr. Al-Shihabi noted that Dr. Stieve also denied the transfer. Id.

         In his deposition, Dr. Edelman testified that he had "denied the transfer because [he] talked to Dr. Stieve about it." R.263-2, Edelman Dep., Page ID# 5001. Indeed, in an internal administrative progress note, Dr. Stieve explained that he and Dr. Edelman discussed the merits of transferring Rhinehart for a TIPS evaluation. R.259-1, Progress Note, Page ID# 4689. According to Dr. Stieve's note, the doctors recognized that a TIPS could reduce a "hypothetical" risk of re-bleed but that the procedure would not prolong Rhinehart's life and came with an increased risk of brain disease. Id.

         During his deposition, Dr. Stieve discussed his familiarity with the medical issues involved in the decision. He testified that he dealt daily with patients who had esophageal varices and that "[e]sophageal varices banding was a very common thing for me to be involved with[.]" R.340-1, Stieve Dep., Page ID# 8589. He likewise testified that he "had been involved with approving other TIPS procedures for other inmates," but considered those inmates to have "different circumstances" because "[t]hey were being released so that they could get a liver transplant." Id. at Page ID# 8590, 8589 ("I would often evaluate inmates to see whether they were a candidate for a TIPS procedure"). And although he conceded that he was not a gastroenterologist, radiologist, or hepatologist, he could explain how TIPS and banding procedures were performed and what they entailed. Id. at Page ID# 8589-90.

         Dr. Stieve testified that he and Dr. Edelman disapproved transferring Rhinehart for evaluation for a TIPS because he "was stable, hadn't rebled, and we had a treatment plan that we thought would be effective in controlling further bleeds, that giving nonspecific beta-blocker therapy and 24 hour health care surveillance, which is available in all of our prisons." Id. at Page ID# 8613. He emphasized that Dr. Schachinger recommended that the transfer occur "if he has additional bleeding, and I have no evidence that after he performed the banding there was any additional bleeding." Id. at Page ID# 8608, 8612. And he testified that he and Dr. Edelman agreed that "[i]f the patient had needed the TIPS procedure, we would have agreed on it and approved it but neither one of us thought that [a TIPS] was an appropriate procedure at that particular clinical junction." Id. at Page ID# 8590.

         In February 2012, a few months after denying the request for a TIPS-procedure consult, Dr. Edelman left Corizon. Almost a year later, in January 2013, Rhinehart slipped and fell on a wet surface and broke his hip. Rhinehart agreed to undergo surgery to repair the injury, but unfortunately, he did not survive the recovery. He died of a morphine overdose in February 2013 because his liver could not metabolize the morphine used to control his pain. He suffered no esophageal bleed between October 2011 and his death.

         II.

         This action began on March 29, 2011, when Rhinehart filed a pro se lawsuit alleging that his medical providers were ignoring his pain, fear of cancer, and his desire to receive a liver transplant. The district court denied his emergency injunctive motions, and this court affirmed. See Rhinehart, 509 Fed.Appx. at 516. Soon after, Rhinehart passed away, and his brothers (as joint personal representatives of his estate) then filed an amended complaint.

         The Defendant Doctors moved for summary judgment on the Rhineharts' claims of deliberate indifference to Rhinehart's serious medical needs. The magistrate judge issued a Report and Recommendation to deny summary judgment, and the district court adopted the Report and Recommendation in full.

         About a year later, with the case going on to trial, the Defendant Doctors raised a Daubert challenge against Dr. Finkel. They objected to Dr. Finkel's testifying about Rhinehart's alleged fear of cancer and pain and suffering from not being evaluated for a TIPS procedure. The district court granted the motion in part. It decided that Dr. Finkel could testify "consistent with his expertise," about "Rhinehart's fears" because "any emotional or physical harm he suffered as a result of their indifference is relevant to the damages Plaintiffs seek." But the court precluded testimony on whether "Rhinehart suffered physical pain due merely to hypertension" because "[n]one of the materials before the Court . . . assures the Court that [Dr.] Finkel's opinion [on that topic] is based upon sufficient facts and reliable methods." The district court ordered the Rhineharts to give "one day's notice before calling Finkel" to testify so that the court could hold "a short hearing" on "precisely what Finkel intends to offer and to make any necessary rulings that will curb impermissible testimony."

         While the Daubert motion was still pending, the Defendant Doctors filed their second motion for summary judgment. They argued that this court's decision in Mattox v. Edelman clarified the requirements for establishing a deliberate-indifference claim based on a medical need that "has been diagnosed by a physician as mandating treatment." 851 F.3d 583, 598 (6th Cir. 2017). They also relied on the de bene esse trial depositions of Dr. Stieve and Dr. Kosierowski. After the district court ruled on the Defendant Doctors' Daubert motion, it granted summary judgment in their favor. Rhinehart v. Scutt, 2017 WL 3913333, at *1 (E.D. Mich. Sept. 7, 2017).

         The district court held that because the Rhineharts' case was based on the treatments Rhinehart did and did not receive for his ESLD, they had to show "that Rhinehart's needs were diagnosed by physicians as mandating treatment and that Defendants failed to treat him or so inadequately treated him that he suffered a verified medical injury." Id. at *2. The court determined that at all relevant times Rhinehart received some treatment for his ESLD. Id. at *4- 10. It rejected the Rhineharts' claims against Dr. Stevenson because they presented no "verified medical evidence" that Rhinehart suffered a harm because of Dr. Stevenson's alleged failings. Id. at *3-7. Similarly, the court determined that the Rhineharts failed to introduce "verified medical evidence" showing harm from either Dr. Edelman's failure to ensure that Rhinehart saw a specialist in early 2010 or his failure to refer him for evaluation for a liver transplant in October 2011. Id. at *7, *10-11. Finally, in addressing Dr. Edelman's denial of a specialist's request for Rhinehart to be evaluated for a TIPS procedure, the court determined that this "amounted to a mere disagreement among medical professionals" and thus did not constitute deliberate indifference to Rhinehart's serious medical needs. Id. at *9.

         The Rhineharts appealed and challenge the district court's decisions on the Defendant Doctors' second motion for summary judgment and Daubert motion.

         III.

         We review a district court's grant of summary judgment de novo. Richmond v. Huq, 885 F.3d 928, 937 (6th Cir. 2018). Summary judgment is appropriate only when there is "no genuine dispute as to any material fact" and defendants are "entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). A genuine issue of material fact exists when "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). In determining "whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law," this Court must view all the evidence and draw all reasonable inferences in the light most favorable to the non-moving party. Id. at 251-52, 255.

         Section 1983 provides a federal cause of action against government officials who, while acting under color of state law, "deprived the claimant of rights, privileges or immunities secured by the Constitution or laws of the United States." Bennett v. City of Eastpointe, 410 F.3d 810, 817 (6th Cir. 2005) (citing McKnight v. Rees, 88 F.3d 417, 419 (6th Cir. 1996)). The Rhineharts assert that the Defendant Doctors deprived Rhinehart of his constitutional rights by acting deliberately indifferent to his serious medical needs. The Defendant Doctors do not dispute that they acted under color of state law but deny that they violated Rhinehart's constitutional rights.

         The Eighth Amendment prohibits the "inflict[ion]" of "cruel and unusual punishments" against those convicted of crimes.[12] U.S. Const. amend. VIII. Incarceration is a form of criminal punishment subject to the Eighth Amendment's protections. See generally Howard v. Fleming, 191 U.S. 126, 135-36 (1903). There is a paucity of evidence from the Founding era, however, about how the Eighth Amendment was commonly understood to operate in the prison context. Imprisonment was not a typical form of punishment in this country during the eighteenth century. "Jails were used primarily to hold for trial people who could not make bail and for debtors who could not pay off their creditors." J. Filter, Prisoners' Rights: The Supreme Court and Evolving Standards of Decency 46 (2001); see also M. Mushlin, Rights of Prisoners § 1.2, at 5-6 (5th ed. 2017). "Persons who had been convicted of crimes rarely were imprisoned; instead they were fined, whipped, placed in the stockade, banished, or hanged, depending on the seriousness of their offense." Mushlin at 5-6.[13] Because incarceration as a form of criminal punishment was not the norm, the Founding generation did not have much context in which to consider what Eighth Amendment protections, if any, existed for prisoners.

         We do know from the Founding era that "the primary concern of the drafters" of the Eighth Amendment "was to proscribe 'torture[s]' and other 'barbar[ous]' methods of punishment." Estelle v. Gamble, 429 U.S. 97, 102 (1976) (alterations in original) (citation omitted). Indeed, when the Supreme Court interpreted the cruel and unusual punishments language for the first time, it remarked that "it is safe to affirm that punishments of torture . . . and all others in the same line of unnecessary cruelty, are forbidden by that amendment to the Constitution." Wilkerson v. State of Utah, 99 U.S. 130, 136 (1878); see also O'Neil v. State of Vermont, 144 U.S. 323, 339 (1892) (Field, J., dissenting) (describing punishments that the Eighth Amendment prohibited, such as "the rack, the thumb-screw, the iron boot, the stretching of limbs, and the like, which are attended with acute pain and suffering"). The Supreme Court later interpreted the Eighth Amendment's reach to, among other things, protect prisoners from the government's imposition of "unnecessary and wanton infliction of pain." Gregg v. Georgia, 428 U.S. 153, 173 (1976).

         How do these directives apply in today's prison context and, in particular, to the medical needs of an inmate? In Estelle, the Supreme Court "first acknowledged that" the Eighth Amendment "could be applied to some deprivations that were not specifically part of the sentence but were suffered during imprisonment." Wilson v. Seiter, 501 U.S. 294, 297 (1991). But because "only the unnecessary and wanton infliction of pain implicates the Eighth Amendment," id. (internal quotation marks and citation omitted), "a prisoner advancing such a claim must, at a minimum, allege 'deliberate indifference' to his 'serious' medical needs," id. (quoting Estelle, 429 U.S. at 106). "It is only such indifference that can violate the Eighth Amendment." Id. (internal quotation marks and citation omitted). Thus, "allegations of 'inadvertent failure to provide adequate medical care, '" id. (quoting Estelle, 429 U.S. at 105), "or of a 'negligent . . . diagnos[is], '" id. (alteration in original) (quoting Estelle, 429 U.S. at 106), "simply fail to establish the requisite culpable state of mind," id.

         Why is a "requisite culpable state of mind" necessary to establish in an Eighth Amendment medical-needs case? It all goes back to the text of the Eighth Amendment. Because the provision of medical care for a prisoner is not explicitly part of the sentence imposed, that care's inadequacy constitutes a "cruel and unusual punishment[]" only if the government actor, at a minimum, knew the care provided or withheld presented a serious risk to the inmate and consciously disregarded that risk. See Wilson, 501 U.S. at 300 ("If the pain inflicted is not formally meted out as punishment by the statute or the sentencing judge, some mental element must be attributed to the inflicting officer before it can qualify."). As a result, "[a]n accident, although it may produce added anguish, is not on that basis alone to be characterized as wanton infliction of unnecessary pain." Estelle, 429 U.S. at 105. Instead, the government ...


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