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Prisoner’s Request for Medical Care after Signing Refusal Form Precludes Summary Judgment

Prisoner’s Request for Medical Care after Signing Refusal Form Precludes Summary Judgment

by David M. Reutter

The Eleventh Circuit Court of Appeals has reversed a summary judgment order for the defendants in a former prisoner’s civil rights suit that alleged he was denied medical care after prison staff “materially altered” a refusal form he had signed.

Jeffery Kuhne was incarcerated at the Jackson Correctional Institution (JCI) in Malone, Florida on a probation violation. Shortly after his arrival at JCI, he experienced a “dramatic loss of vision.” Upon his June 2008 intake, Kuhne had vision of 20/40 in his right eye and 20/30 in his left eye. By mid-September 2008 his vision had deteriorated to 20/70 in his right eye and 20/50 in the left eye.

He was diagnosed by optometrist Dr. Paul Harman on October 21, 2008 as having proliferative diabetic retinopathy, a progressive condition that can lead to permanent blindness if left untreated. The next day, Kuhne was scheduled for an “urgent” follow-up consultation with a retinal specialist on November 18. However, he never had a follow-up before his release from prison in March 2009, and was left permanently blind in his left eye.

Kuhne filed a civil rights complaint, which the U.S. District Court dismissed on summary judgment. The court said Kuhne could “not be forced to undergo medical treatment he does not want, but ‘he cannot refuse medical treatment, and then claim he was denied medical care.’”

On October 28, 2008, five days after signing a consent form to see the retinal specialist, Kuhne had met with JCI nurses Olivia Williams and Paula Bryson. He asked them to remove certain lifting and walking restrictions placed on him due to medical reasons, because he “no longer needed those restrictions.” They told him to sign a refusal form, and he did so.

What the form stated was in dispute. Williams and Bryson said it included both the lifting and walking restrictions as well as the follow-up eye consult. Kuhne argued he was not advised the form included refusal of the eye consult, and he had followed Bryson’s order “to sign the refusal form and get out of the office.” The next day, Kuhne learned the form contained a refusal for the follow-up consultation with the retinal specialist, even though, “at the time he signed the refusal form, he ‘did not see anything written [on the form] about an eye consult.’”

Because the “validity and scope of the refusal form” was in question, the Eleventh Circuit held it could not serve as the basis for granting summary judgment. Further, the appellate court noted that Kuhne went to “a number of sick calls” in an attempt to obtain treatment for his eyes after signing the refusal form in October 2008, indicating he had not intended to refuse the eye consult. Additionally, his attorney wrote a letter to the prison concerning Kuhne’s eye problems, and Kuhne continued to file grievances and requests for medical treatment.

“A reasonable jury could find that Mr. Kuhne did not refuse the consultation with the ophthalmologist on October 28, 2008, and that either Nurse Williams or Nurse Bryson (or someone else) wrote in the words ‘eye consult’ after Mr. Kuhne signed a blank refusal form he believed would only remove his lifting and walking restrictions,” the Eleventh Circuit wrote.

The Court of Appeals also found that even if Kuhne had signed the form that included a refusal for the eye consultation, “There are genuine issues of material fact as to whether Mr. Kuhne renewed his request for medical treatment on multiple occasions thereafter.”

Accordingly, the summary judgment order for the defendants was reversed. See: Kuhne v. Florida Department of Corrections, 745 F.3d 1091 (11th Cir. 2014).

Following remand, on August 14, 2014 the district court again entered summary judgment against Kuhne, dismissing the case. The court found he had failed to meet his burden of proving deliberate indifference, and had presented no evidence “besides a self-serving assertion that there was no informed consent” with respect to the refusal form.

The court noted that Kuhne had testified during a deposition that he could read and write, and the form clearly stated he was refusing the follow-up eye consultation. Further, other evidence indicated that Kuhne refused the consult so he could get a job driving a tractor at the JCI Work Camp, and that he planned to obtain treatment for his eyes after his release. Kuhne has since filed another appeal to the Eleventh Circuit, which remains pending.


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Related legal case

Kuhne v. Florida Department of Corrections