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D.C. Circuit Reverses Dismissal of Deliberate Indifference Gallstone Claim

The U.S. Court of Appeals for the D.C. Circuit reversed the dismissal of a prisoner’s civil rights action alleging inadequate medical care.

Herbert Brown, a prisoner in the District of Columbia (District), was incarcerated at the notorious Lorton Correctional Facility from 1991 to 1997. While at Lorton he had numerous health problems that included headaches, constipation, loss of appetite, yellowed eyes, and pain in his chest, stomach, lower back and penis. Medical staff improperly diagnosed Brown or ignored his requests for treatment. As a result, he suffered an inflamed liver, jaundice and a “medley of other maladies.”

Brown was finally diagnosed by a doctor as having gallstones; he was ordered transferred immediately to a hospital for surgery. However, for the next sixty days prison officials refused to comply with the doctor’s order, even in spite of Brown’s continued complaints of pain. Instead, prison officials sent him to the hospital only after he was again diagnosed with gallstones and ordered transferred immediately. At the hospital, surgeons removed 18 gallstones from Brown’s urinary tract.

Upon his return to Lorton, Brown continued to complain of similar problems. Nevertheless, over the next several months medical staff refused to provide treatment or misdiagnosed him. In one instance, Brown was diagnosed with food poisoning and ordered transferred to the hospital, but prison officials refused.

In 1997, Brown was sent to the Northeast Ohio Correctional Center, a private prison owned by Corrections Corporation of America (CCA). There he continued to receive inadequate medical care. At one point, a CCA physician prescribed diabetes medication for Brown without examining him. After suffering several months from the medication’s negative effects, Brown learned he did not have diabetes. He filed numerous grievances at both Lorton and Youngstown complaining about his lack of adequate medical treatment.

In December 2004, Brown filed suit in the U.S. District Court for the District of Columbia under 42 U.S.C. § 1983 against the District, CCA and several District and CCA prison officials for failing to provide adequate medical care in violation of the Eighth Amendment.

On August 1, 2005, the district court dismissed Brown’s case in its entirety. According to the court, Brown had failed to state an Eighth Amendment claim against the District because his complaint alleged only “delays” in receiving treatment, “displeasure” as to the quality of treatment, and “disagreement” about the course of treatment. The district court reasoned that because Brown had in fact received some medical care, his complaint alleged only negligence, if anything.

Further, assuming Brown’s allegations did state an Eighth Amendment claim, the district court refused to find municipal liability against the District, holding that Brown’s allegations, at best, were based on respondeat omissions not sufficiently harmful to evidence deliberate indifference to his serious medical needs. Brown appealed.

The D.C. Circuit Court of Appeals explained that one example of “deliberate indifference” is when a prison doctor or official “intentionally denies or delays access to medical care or interferes with the treatment once prescribed.” Applying this standard to Brown’s case, the appellate court did not hesitate to conclude he had alleged an Eighth Amendment violation.

First, the D.C. Circuit easily found that Brown’s gallstone condition was a “serious medical need,” noting the “intense and often relentless pain that accompanies” the condition and “the complications that can follow.” Likewise, the appellate court found that Brown’s allegations rose to the level of “deliberate indifference” based on the District’s refusal to send him to a hospital for sixty days after a doctor ordered his “immediate hospitalization.”

The D.C. Circuit also disagreed with the district court on the issue of municipal liability, finding that Brown had sufficiently alleged a custom or policy of deliberate indifference by the District. Brown’s numerous grievances put the District on notice of the alleged inadequate medical care he was receiving, yet the District “sat by idly” while Brown’s serious medical needs were ignored.

Finally, the appellate court rejected the district court’s sua sponte dismissal of the District and CCA employees for failure to perfect service. The district court was required to give Brown notice prior to the dismissal, the D.C. Circuit held, given Brown’s pro se status, his incarceration, and his resultant “limited ability to ensure proper service.”

Accordingly, the judgment of the district court was reversed and the case was remanded for further proceedings. The case is still pending. See: Brown v. District of Columbia, 379 U.S. App. D.C. 370 (D.C. Cir. 2008).

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Related legal case

Brown v. District of Columbia