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Fifth Circuit Holds Confessed Medical Malpractice Does Not Insulate Prison Medical Providers From Finding of Deliberate Indifference

by Matt Clarke

On August 11, 2021, the United States Court of Appeals for the Fifth Circuit held that a confession of medical malpractice by prison health care providers does not prevent a district court from finding deliberate indifference. In affirming the district court’s denial of defendants’ motion for summary judgment, the court also emphasize that giving a prisoner some treatment that is ineffective also does not prevent a finding of deliberate indifference.

Laree Spikes was incarcerated at the Rayburn Correctional Center in Angie, Louisiana, when he injured himself while lifting weights, causing a lasting sharp pain in his hip and right groin area and an inability to move his right leg. Unable to walk, he declared a medical emergency and arrived at the infirmary in a wheelchair. There he was seen by Nurse Paula Stringer.

Stringer assessed the injury as a pulled muscle in the right groin area and, in accordance with the standing orders of Dr. Casey McVea, the prison’s medical director, ordered an analgesic balm, ibuprofen and ice for Spikes.

Spikes returned to the infirmary in a wheelchair five days later, complaining of continued, intense and spreading pain and no relief from the treatments. Stringer ordered ibuprofen and a muscle rub.

Spikes was back again the next day. Another nurse documented that he was wheelchair-bound, could not walk, and had intense pain radiating from his right hip to his right knee. She discussed the case with McVea, and he ordered continuing the muscle rub and ibuprofen treatment, a bottom-bunk assignment, access to crutches for a week, and a low-priority doctor’s appointment.

Eight days later, Spikes saw Nurse Robin Bowman on sick call. She noted his complaints and observed possible swelling on his hip and increased pain when she pressed on the hip, but did not significantly change his treatment.

Spikes declared a medical emergency the next day and again saw Bowman, but she did not change his treatment. Later that day, after declaring another emergency, Spikes saw Nurse Lesley Wheat. She documented his condition, then filed a disciplinary report against him for coming to the infirmary for a complaint that had already been addressed. Spikes was found guilty.

Spikes finally saw McVea about three weeks later. McVea ordered an x-ray using a readily available x-ray machine. It showed a fractured right hip, so be was transferred to a hospital. It was necessary to refracture the improperly healed hip prior to open reduction surgery.

Spikes filed a federal civil rights lawsuit under 42 U.S.C. § 1983 against McVea and four nurses. Defendants filed a motion for summary judgment which was denied as to the preoperative claims. Defendants appealed.

The Fifth Circuit held that, although an inability to move a leg is indicative of a broken bone, not muscle strain, Stringer’s initial misdiagnosis was not deliberately indifferent. However, when Spikes returned five days later and subsequently, it should have been obvious that he did not have a muscle strain because the treatments were not working. Further, Stringer failed to properly document his condition and McVea failed to change his treatment or appointment priority despite reviewing the nurses’ assessments. Therefore, a jury could infer deliberate indifference to Spike’s serious medical needs. Defendants’ admission of malpractice did not preclude a finding of deliberate indifference, so the trial court’s denial of summary judgment was affirmed. See: Spikes v. McVea, 8 F.4th 428 (2021).

According to a report in, Dr. McVea died of COVID, most likely contracted at Raymond Laborde Correctional Center in Avoyelles Parish, Louisiana, in April 2020. On September 14, 2021, the appeals court granted the defendants petition for rehearing and noted “…the recent death of the doctor makes it all the more important that the inquiry of qualified immunity not rest on the collective action of the medical staff, but on the role of each participant.” The judgement was vacated and remanded for further proceedings. See: Spikes v. McVea, 2021 U.S. App. Lexis 27612. 

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Related legal case

Spikes v. McVea