Lewis Rhinehart and David L. Rhinehart, Joint Personal Representatives for the Estate of Kenneth A. Rhinehart, Plaintiffs-Appellants,
Debra L. Scutt, Warden, Defendant, Adam Edelman, M.D.; Vernon Stevenson, M.D., Defendants-Appellees.
Argued: May 4, 2018
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.
J. Zalewski, THE ZALEWSKI LAW FIRM, Warren, Michigan, for
A. McQuillan, CHAPMAN LAW GROUP, Troy, Michigan, for
J. Zalewski, THE ZALEWSKI LAW FIRM, Warren, Michigan, for
A. McQuillan, Ronald W. Chapman, Carly Van Thomme, CHAPMAN
LAW GROUP, Troy, Michigan, for Appellees.
Before: MOORE, THAPAR, and BUSH, Circuit Judges.
K. BUSH, Circuit Judge.
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
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.
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.
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"),  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.
Berhane arranged an expedited, doctor-to-doctor transfer from
Alger to Cotton. 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.
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.
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.
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. 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.
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.
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. 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.After this appointment, Rhinehart
attended several more doctor appointments in January 2010
with Dr. Vemuri and another prison doctor, Dr. Zivit
Cohen. On February 3, 2010, Dr. Cohen obtained
approval for an ultrasound of Rhinehart's liver, which
was completed about a week later.
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
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
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.
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.
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.
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.
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.
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
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
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.
next month, August 2010, Dr. Stevenson left his employment
with Corizon. 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.
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.
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. 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. 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
Id. at 4507-08.
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.
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
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#
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."
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#
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
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.
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.
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.
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#
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.
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
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
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."
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,
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.
Rhineharts appealed and challenge the district court's
decisions on the Defendant Doctors' second motion for
summary judgment and Daubert motion.
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,
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.
Eighth Amendment prohibits the "inflict[ion]" of
"cruel and unusual punishments" against those
convicted of crimes. 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. 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.
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
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,"
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