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Ninth Circuit Tells Nevada DOC: ‘Wait and See’ Prisoner Medical Care Can’t Become ‘Deny and Delay’

by David M. Reutter

On May 4, 2022, the U.S. Court of Appeals for the Ninth Circuit affirmed denial of qualified immunity (QI) to Nevada prison officials who “never deviated from their ‘wait and see’ treatment plan” for a prisoner, leaving him to suffer “intractable pain” for years.

“Mere disagreement with a medical treatment plan is not deliberate indifference,” wrote Circuit Judge Eugene E. Siler, Jr. “But continuation of the same treatment in the face of obvious failure is.”

His opinion was issued in an appeal brought by Nevada prisoner Lewis Stewart. Arriving at Southern Desert Correctional Center (SDCC) in late 2002, he began to feel “discomfort in his lower abdominal and back area,” according to the complaint he later filed. After numerous requests for medical care, he was finally seen by prison healthcare providers, including Dr. Romeo Aranas and Dr. Francisco Sanchez.

Stewart, who was then 60, complained about problems urinating, which will sound familiar to any man suffering prostate problems; he “had to sit on the toilet to urinate,” he said, and his “short and irregular urine flows were very painful.” In fact, the pain was “so severe that he had to curl into a fetal position” to relieve it. Aranas and Sanchez took his vitals and prodded the affected areas. But they examined no further, administering only generic pain medication. For the next decade, that was all the treatment Stewart got.

Sometime between 2013 and 2015, after Stewart passed 70, he began experiencing inflammation in his urethra, testicles, and abdominal areas. He informed Aranas and Sanchez, but nothing changed in their treatment regimen.

In 2015, Stewart secured a transfer, hoping for better care. After enduring an eight-hour ride, he arrived “pale, flushed, sweating and unbalanced” at Warm Springs Correctional Center. Alarmed medical staff there immediately recognized his enlarged prostate. An emergency cauterization was performed “to drain Stewart’s urinary retention” of more than six liters — fourteen pounds — of fluid.

Stewart was then seen by three specialists at the Regional Medical Facility at Northern Nevada Correctional Facility. They submitted a surgery request, leaving Stewart with a catheter in his bladder for several months while it was approved. After surgery, he finally had relief from the years-long pain. But he was left with stage 3 kidney disease, as well as erectile dysfunction.

After exhausting his administrative remedies, Stewart filed suit pro se in federal court for the District of Nevada against the state Department of Corrections and various employees, including Aranas and Stewart. Proceeding under 42 U.S.C. § 1983, he accused them of deliberate indifference to his serious medical needs, in violation of his Eighth Amendment rights.

Defendants moved for summary judgment, claiming QI. But a magistrate judge disagreed. On his recommendation, the district court denied their motion on March 9, 2020. See: Stewart v. Aranas, 2020 U.S. Dist. LEXIS 39979 (D. Nev.). Defendants then appealed.

At the Ninth Circuit, they argued that no clearly established law barred their approach to Stewart’s treatment. The Court conceded as much but said it didn’t matter: At some point “wait and see” becomes “deny and delay,” and that is sufficient to prove deliberate indifference.

“Plaintiff’s condition sharply deteriorated during his last few years at [SDCC],” the Court recalled. Yet prison officials let Stewart suffer “intractable pain over an approximately three-year period.” Such a “delay in treatment can violate the constitution if it results in injury,” the Court continued. And “prison officials knew that they violate the constitution when they persist in a treatment known to be ineffective.” Thus Defendants were not entitled to QI, and the district court’s order was affirmed. Stewart was represented on appeal by attorneys Andre M. Lagomarsino and Cory Ford of Lagomarsino Law in Henderson. See: Stewart v. Aranas, 32 F.4th 1192 (9th Cir. 2022).

The case returned to the district court, with Stewart still represented by his counsel. They won a discovery dispute on August 23, 2022, when Defendants were ordered to produce “all medical emails sent to any named Defendant regarding the claims in this case” from 2014 to Stewart’s transfer from SDCC. The case remains open for Stewart, who is now 80, and PLN will report developments as they are available. See: Stewart v. Aranas, USDC (D. Nev.), Case No. 3:17-cv-00132. 

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Related legal cases

Stewart v. Aranas

Stewart v. Aranas

Stewart v. Aranas