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Three-week Treatment Delay Not Deliberately Indifferent

The Sixth Circuit Court of Appeals held that an Ohio prisoner failed to prove that a three-week delay of treatment for a painful skin condition constituted deliberate indifference.

Ohio state prisoner Oscar Santiago complained of severe pain, swelling and a rash in his lower legs. On January 31, 2008, Assistant Medical Director, Dr. Constance Mosher, prescribed Tylenol for pain and antibiotics to treat what she thought may be Methicillin-resistant Staphyloccus Aureus (MRSA).

The next day, Medical Director Dr. Kurt Ringle diagnosed Santiago with erythema nodosum (EN), a skin inflammation disorder. Ringle prescribed an anti-inflammatory and antibiotic.

On February 5, 2008, Santiago was transferred to the Ohio State University (OSU) Medical Center due to increased pain and swelling. Doctors there diagnosed him with EN and arthralgias, a severe joint-pain condition.

When Santiago returned to prison on February 11, 2008, Ringle prescribed a wheelchair and cane, the OSU-prescribed anti-inflammatory, a different anti-ulcer agent, Tylenol and Benadryl. He also ordered a dermatology consult.

On February 20, 2008, an OSU dermatologist recommended treating Santiago’s condition with a topical steroid ointment, compression hose, and SSKI, a saturated solution of potassium iodide.

Ringle told Santiago that he would prescribe the dermatologist’s recommendations, but did not do so before leaving on vacation on February 21, 2008. Two nurses found Santiago’s unsigned chart under paperwork on Ringle’s desk on February 25, 2008.

Mosher signed the order for the recommended treatments on February 27, 2008. Santiago received the topical steroid ointment two days later and the compression stocking on March 10, 2008. He did not receive the SSKI until March 17, 2008, however, because it was a non-formulary drug that Ohio prisons do not stock.

Santiago brought federal suit, alleging that Ringle and Mosher were deliberately indifferent to his serious medical needs when they delayed the treatments recommended by the dermatologist between February 20 and March 17, 2008.

The district court initially denied the doctors summary judgment, finding factual disputes about the delay of Santiago’s treatment and the seriousness of his suffering. The doctors then sought reconsideration and moved for qualified immunity. The district court granted both motions.

The Sixth Circuit affirmed, concluding that “Santiago has not established a serious medical need” or deliberate indifference. Quoting Blackmore v. Kalamazoo County, 390 F.3d 890 (6th Cir. 2004), the appellate court explained that “medical proof is necessary to assess whether the delay caused a serious medical injury.” Yet, Santiago offered “no such proof.” Therefore, he “has not provided sufficient evidence for a reasonable jury to conclude that he experienced a serious medical need, and thus he has not satisfied the objective component of his Eighth Amendment claim.”

Turning to the subjective component, the Court of Appeals held that, at worst, “a reasonable jury might be able to infer negligence from the record, but it could not find that Dr. Ringle or Dr. Mosher acted with deliberate indifference.”

“Because Santiago has not shown that a constitutional violation occurred,” the Court affirmed “the district court’s award of qualified immunity.” See: Santiago v. Ringle, 734 F.3d 585 (6th Cir. 2013).

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Related legal case

Santiago v. Ringle