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Eighth Circuit: Severe Pain Caused by Actual Injury Satisfies PLRA Physical Injury Requirement

by Matt Clarke

On August 7, 2018, the Eighth Circuit Court of Appeals held the physical injury requirement of the Prison Litigation Reform Act (PLRA), 42 U.S.C. § 1997e(e), does not require a prisoner to show that deliberate indifference to his serious medical needs caused his injury in order to recover monetary damages for the pain he suffered due to that indifference.

Daaron McAdoo was incarcerated at the Hot Springs County Detention Center in Arkansas when he was involved in a fight with another prisoner. After McAdoo refused to stop fighting when ordered to do so, guard Ben Cash grabbed him by the waist, took him to the floor and placed a knee on his back.

McAdoo immediately began complaining of shoulder pain. Jail Sgt. Amy Martin authorized his transport to a hospital about three hours later. An emergency room physician diagnosed a dislocated shoulder and prescribed hydrocodone tablets to be taken every four hours for pain, plus a shoulder splint. McAdoo was returned to the jail; because the facility prohibited the use of narcotics, he did not receive hydrocodone but instead was offered non-prescription pain relievers.

During a follow-up examination at the hospital two days later, a CT scan revealed that the head of McAdoo’s humerus was fractured and at least three bony fragments were present in the joint. The examining physician recommended immediate surgery but refused to prescribe stronger pain medication due to the jail’s ban on narcotics.

Jail officials insisted McAdoo sign documents accepting liability for all medical expenses resulting from the shoulder injury. He refused to sign, so they refused to authorize additional medical treatment. McAdoo eventually received shoulder surgery after he was transferred to the Arkansas Department of Corrections. He then filed a pro se federal civil rights action pursuant to 42 U.S.C. § 1983 against Cash and Martin, alleging failure to protect, excessive use of force and denial of medical care.

Following a 2017 bench trial during which McAdoo testified that, despite the surgery and physical therapy, “his left arm is damaged for the rest of [his] life,” the district court granted summary judgment to the defendants on the failure to protect claim as a matter of law. It then issued a memorandum opinion concluding that the excessive force claim lacked merit but the defendants were deliberately indifferent to McAdoo’s serious medical needs when they denied him prescribed narcotic pain medication.

The jail’s policy “denies prisoners the right to narcotic pain medication even when prescribed by an emergency room physician,” the court wrote. “Defendants acted pursuant to this policy in failing to provide Plaintiff his prescription pain medication – hydrocodone. No assessment of Plaintiff’s pain level was attempted. No medical judgment was exercised. Their actions amount to deliberate indifference. Clearly, there was a causal link between the policy and the increased pain Plaintiff suffered as a result of not receiving the prescribed pain medication.”

However, the district court held it could not award McAdoo monetary damages because “severe pain” did not constitute physical injury required for recovery under the PLRA. Instead, it awarded him $1.00 in nominal damages plus $311.66 in costs.

McAdoo appealed.

The Eighth Circuit held that, “because McAdoo’s severe pain resulted from an actual physical injury, he met the PLRA’s physical injury requirement.” In doing so, it accepted the reasoning of Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000) [PLN, Feb. 2002, p.12], in which a guard ignored a prisoner’s request for medical attention while he was having a major heart attack, delaying treatment for hours. Sealock found that physical pain satisfies the PLRA’s requirements when there is a prior showing of physical injury.

The Court of Appeals affirmed the district court’s denial of punitive damages, noting the defendants were merely following jail policy in denying the narcotic medication, had not acted with evil motive or intent, and McAdoo had not challenged the constitutionality of that policy. The judgment was reversed in part, affirmed in part and remanded to the district court with instructions to calculate compensatory damages for the additional pain caused by the denial of the narcotic pain medication.

McAdoo was represented on appeal by attorneys Amir H. Ali with the law firm of Roderick & Solange and Yaira Dubin with O’Melveny & Myers. See: McAdoo v. Martin, 899 F.3d 521 (8th Cir. 2018). 


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Related legal case

McAdoo v. Martin