949 F.2d 15 (1st Cir. 1991), 90-2121, DesRosiers v. Moran
|Citation:||949 F.2d 15|
|Party Name:||Steven M. DesROSIERS, Plaintiff, Appellant, v. John J. MORAN, et al., Defendants, Appellees.|
|Case Date:||November 15, 1991|
|Court:||United States Courts of Appeals, Court of Appeals for the First Circuit|
Submitted Sept. 6, 1991.
[Copyrighted Material Omitted]
Steven M. DesRosiers, on brief pro se.
Anthony A. Cipriano, Deputy Chief, Legal Services, Rhode Island Dept. of Corrections, on brief for appellees.
Before BREYER, Chief Judge, and SELYA and CYR, Circuit Judges.
SELYA, Circuit Judge.
Plaintiff-appellant Steven M. DesRosiers is an inmate at the Adult Correctional Institutions (ACI), Cranston, Rhode Island (a state prison). Invoking 42 U.S.C. § 1983 (1988), DesRosiers sued eight state actors in the United States District Court for the District of Rhode Island. 1 His principal contention was that the defendants failed to furnish him adequate medical care during his incarceration, thereby violating the Eighth Amendment (applicable to state actors by means of the Fourteenth Amendment). After a bench trial at which DesRosiers represented himself, the district court entered judgment for the defendants. DesRosiers appeals. We affirm.
The trial testimony revealed that, in 1987, DesRosiers was a maximum-security inmate at the ACI. In April, he underwent surgery at Rhode Island Hospital (RIH) to remove a pilonidal cyst from his lower back and buttocks. Following the operation, DesRosiers was transferred to the ACI and placed in a high-security infirmary ward. The parties agree that DesRosiers' stay at RIH and the prison infirmary was unremarkable. They likewise agree that he was doing reasonably well when he returned to the ACI's maximum-security facility on May 12, 1987 (after a check-up at RIH). At that time, RIH physicians recommended to the ACI's medical staff that DesRosiers--who, once back in maximum security, was immediately shunted to the punitive segregation unit (PSU) in order to fulfill a previous disciplinary sanction--should shower thrice daily and have the dressing on his wound changed at like intervals.
DesRosiers asserted that this prescribed regimen was thwarted because the defendants either denied, or interfered with, the recommended course of treatment. He testified to a pattern of callousness and neglect. Specifically, he criticized members of the ACI's nursing staff for refusing to assist him in changing his bandages. He also accused the guards of preventing him from taking the suggested number of showers. In a contrary vein, the defendants contended that literal compliance with the RIH recommendations was not constitutionally mandated; that DesRosiers was allowed to perform sufficient ablutions; and that the medical staff effectively fulfilled the rest of the regimen by helping DesRosiers on some occasions and, on other occasions, giving him supplies with which to change his own dressings. Specifically, ACI nurses testified that the plaintiff's condition was closely monitored by
doctors and nurses alike, both before and during his confinement in the PSU; that DesRosiers had been given an ample supply of sterile dressings and cleansing solution to conduct self-care during the nurses' busiest shift (3:00-11:00 p.m.); and that the plaintiff's dressings were regularly checked and changed by medical personnel on less frenetic shifts. Nurse Stephenson testified that there was nothing in the plaintiff's treatment protocol that contradicted the use of self-care to change dressings. Moreover, she said that the plaintiff was entirely capable of assisting himself in this regard. Nurse Wilburn testified along the same lines. In her testimony, the plaintiff's surgeon confirmed that, with some initial tutelage, post-surgical patients should normally be able to change their own dressings. The plaintiff's contention that he was denied the specified number of showers was undermined by testimony from correctional officer Ricci.
The plaintiff was released from segregation after eighteen days. It is uncontradicted that, while at the PSU, he developed a nasty infection in his surgical wound. Medical evidence about the cause of the infection was inconclusive. Documentary proof was scant; in point of fact, the evidence was scattershot as to whether, and if so, to what extent, the prison's medical staff was required to document the delivery of routine services. Lack of adequate prophylactic care could, of course, have brought about such a condition. There were, however, several other possibilities. For example, DesRosiers' surgeon admitted that surgical wounds of this type are highly susceptible to infection even if good hygienic practices are assiduously followed.
On this pleochroic record, the district court found that the defendants made an honest, good-faith effort to provide DesRosiers with the best care possible in light of prison conditions characterized by limited staffing and precarious safety. The court determined that, while DesRosiers did not always receive three daily showers, he was invariably afforded the opportunity to shower at least once a day. The court found that DesRosiers was provided with a satisfactory supply of bandages and kindred materials and that he was capable of changing his dressings without assistance. The court also found, in substance, that the level of care which DesRosiers received was adequate, if not ideal. Based on these findings, the court concluded that DesRosiers had failed to prove an Eighth Amendment violation. 2
Having reviewed the record with care, we believe that the district court's findings and conclusions are supportable both legally and factually. We elaborate, albeit briefly.
The Eighth Amendment, by its terms, prohibits the infliction of "cruel and unusual punishment." When, as here, a convict claims that state prison officials violated the Eighth Amendment by withholding essential health care, he must prove that the defendants' actions amounted to "deliberate indifference to a serious medical need." Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 292, 50 L.Ed.2d 251 (1976). Deliberate indifference is conduct that offends evolving standards of decency in a civilized society. See Rhodes v. Chapman, 452 U.S. 337, 347, 101 S.Ct. 2392, 2399, 69 L.Ed.2d 59 (1981); Estelle, 429 U.S. at 102-03, 97 S.Ct. at 290-91. As such, it has both an objective component (was there a sufficiently serious deprivation?) and a subjective component (was the deprivation brought about in wanton disregard of the inmate's rights?). See Wilson v. Seiter, --- U.S. ----, 111 S.Ct. 2321, 2324-25, 115 L.Ed.2d, 271 (1991). In practice,
as this case illustrates, these components may overlap or merge.
In evaluating the quality of medical care in an institutional setting, courts must fairly weigh the practical constraints facing prison officials. See id. 111 S.Ct. at 2326. Moreover, inadvertent failures to provide medical care, even if negligent, do not sink to the level of deliberate indifference. Whitley v. Albers, 475 U.S. 312, 319, 106 S.Ct. 1078, 1084, 89 L.Ed.2d 251 (1986); Layne v. Vinzant, 657 F.2d 468, 471 (1st Cir.1981); Ferranti v. Moran, 618 F.2d 888, 890-91 (1st Cir.1980). In order to establish deliberate indifference, the complainant must prove that the defendants had a culpable state of mind and intended wantonly to inflict pain. See Wilson, 111 S.Ct. at 2324-25; Steading v. Thompson, 941 F.2d 498, 500 (7th Cir.1991). The requisite state of mind may be manifested by the officials' response to an inmate's known needs or by denial, delay, or interference with prescribed health care. Estelle, 429 U.S. at 104-05, 97 S.Ct. at 291-92. While this mental state can aptly be described as "recklessness," it is recklessness not in the tort-law sense but in the appreciably stricter criminal-law sense, requiring actual knowledge of impending harm, easily preventable. See Wilson, 111 S.Ct. at 2324-26; McGill v. Duckworth, 944 F.2d 344, 347 (7th Cir.1991).
Next, we consider the supportability of the district court's factual findings. In performing this task, our standard of review is highly respectful. Under Fed.R.Civ.P. 52(a), we assay findings of fact in a bench trial only for clear error. 3 See, e.g., Jackson v. Harvard...
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