Easter v. Powell

• Decision Date: 05 October 2006
• Docket Number: No. 04-11332.,04-11332.
• Citation: 467 F.3d 459
• Parties: John Edward EASTER, also known as Stephen Easter, Plaintiff-Appellee, v. Gayla POWELL, Defendant-Appellant.
• Court: U.S. Court of Appeals — Fifth Circuit

467 F.3d 459

John Edward EASTER, also known as Stephen Easter, Plaintiff-Appellee, v. Gayla POWELL, Defendant-Appellant.

No. 04-11332.

United States Court of Appeals, Fifth Circuit.

October 5, 2006.

John Edward Easter, Iowa Park, TX, pro se.

Harold Joseph Liller, Jr., Austin, TX, for Powell.

Appeal from the United States District Court for the Northern District of Texas.

Before HIGGINBOTHAM, DeMOSS and OWEN, Circuit Judges.

PER CURIAM:

John Edward Easter, a prison inmate acting pro se, brought a 42 U.S.C. § 1983 claim against prison nurse Gayla Powell, alleging deliberate indifference to his serious medical needs in violation of the Eighth Amendment. The only issue in this interlocutory appeal is whether Powell is entitled to qualified immunity as a matter of law. We hold that Powell was not entitled to summary judgment on her immunity defense because Easter alleged the violation of a clearly established constitutional right and Powell failed to establish that her conduct was objectively reasonable as a matter of law. Therefore, we affirm the district court's judgment and remand the case for further proceedings consistent with this opinion.

I

Easter, a prison inmate who has a history of serious heart problems, was taken to the prison infirmary for chest pain and vomiting. A prison doctor prescribed oxygen and nitroglycerin, a medication used to prevent chest pain by relaxing the blood vessels to the heart. The label on Easter's nitroglycerin bottle included instructions to "dissolve 1 tablet under [his] tongue every 5 minutes as-needed for chest pain; after 3 tablets or 15 minutes call doctor if no relief has been obtained." Approximately fifteen minutes after receiving nitroglycerin, Easter's chest pain ceased and he returned to his cell.

Two days later, Easter went back to the prison infirmary, again complaining of severe chest pain. At the infirmary, Easter informed Nurse Powell that he had been experiencing severe chest pain for approximately twenty minutes. Powell took Easter's blood pressure and sent him to the prison pharmacy to have his nitroglycerin prescription refilled. Because the pharmacy was closed, Easter returned to the infirmary and repeated his request that Powell provide him with nitroglycerin. Powell accused Easter of being argumentative, stated that his blood pressure was normal, and ordered him to leave. After reminding Powell that he was there for chest pain and not blood pressure, Easter requested an electrocardiogram¹ and nitroglycerin. Powell refused Easter's requests and had security escort him to his cell. After four hours of severe pain, Easter returned to the infirmary and was given nitroglycerin by a different medical professional. Easter alleges that by the time his pain ceased, blood vessels in his left eye had burst, causing it to fill with blood.

Easter sued Powell pursuant to 42 U.S.C. § 1983, alleging that Powell violated his Eighth Amendment rights by denying him medical treatment and refusing to perform an EKG. Powell moved for summary judgment, arguing that (1) she did not violate Easter's Eighth Amendment rights and (2) she was entitled to qualified immunity from Easter's suit. The district court granted Powell's motion for summary judgment as to Easter's claim that Powell violated his Eighth Amendment rights by delaying medical treatment because Easter did not allege that the delay resulted in substantial harm.² The court concluded, however, that Easter stated an Eighth Amendment claim for damages for the pain he allegedly suffered during the several hours he was denied treatment and Powell failed to establish as a matter of law that her actions in delaying treatment were objectively reasonable. The court therefore denied Powell's motion for summary judgment on that claim and her qualified immunity defense.

Powell has pursued this interlocutory appeal.

II

A district court's order denying qualified immunity is immediately appealable only to the extent that it turns on an "issue of law."³ A district court's decision to deny qualified immunity on a motion for summary judgment is "not appealable if [it is] based on a claim regarding the sufficiency of the evidence."⁴ Thus, we only have jurisdiction to determine whether, viewing the facts in the light most favorable to Easter, Powell is entitled to qualified immunity as a matter of law;⁵ we do not have jurisdiction to determine whether the evidence is sufficient to support either party's version of the facts.⁶ We review the denial of Powell's motion for summary judgment de novo.⁷

"[G]overnment officials performing discretionary functions generally are shielded from liability for civil damages insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known."⁸ When assessing whether a defendant is entitled to qualified immunity, we engage in a bifurcated analysis.⁹ First, we determine whether, under current constitutional standards, the plaintiff has alleged a violation of a clearly established constitutional right.¹⁰ If so, we then decide if the defendant's conduct was objectively reasonable in light of the clearly established law at the time of the incident.¹¹ A government official is entitled to qualified immunity if either (1) the plaintiff failed to state a constitutional claim or (2) the defendant's conduct was objectively reasonable in light of the clearly established law.¹²

Easter alleges that Powell violated his Eighth Amendment right to be free from cruel and unusual punishment. Although the Eighth Amendment "does not, by its precise words, mandate a certain level of medical care for prisoners[,]"¹³ the Supreme Court has interpreted it as imposing a duty on prison officials to "ensure that inmates receive adequate ... medical care."¹⁴ A prison official violates the Eighth Amendment's prohibition against cruel and unusual punishment when his conduct demonstrates deliberate indifference to a prisoner's serious medical needs, constituting an "unnecessary and wanton infliction of pain."¹⁵ The mere delay of medical care can also constitute an Eighth Amendment violation but only "if there has been deliberate indifference [that] results in substantial harm."¹⁶

The "deliberate indifference" standard requires "a showing that the official was subjectively aware of the risk [of serious harm to the inmate]."¹⁷ "[A] prison official cannot be found liable under the Eighth Amendment ... unless the official knows of and disregards an excessive risk to inmate health or safety; the official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference."¹⁸ However, a prison official's knowledge of a substantial risk of harm may be inferred if the risk was obvious.¹⁹ For example,

[I]f an Eighth Amendment plaintiff presents evidence showing that a substantial risk of inmate attacks was longstanding, pervasive, well-documented, or expressly noted by prison officials in the past, and the circumstances suggest that the defendant-official being sued had been exposed to information concerning the risk and thus must have known about it, then such evidence could be sufficient to permit a trier of fact to find that the defendant-official had actual knowledge of the risk.²⁰

Taking Easter's allegations as true, as we must,²¹ Powell knew that Easter (1) had a heart condition, (2) was experiencing severe chest pain, and (3) did not have his prescribed heart medication. The record evidence indicates that Easter's prior heart problems were well-documented in his medical chart, which indicated that he had heart disease and had suffered a heart attack, and that Powell had been exposed to the information. Therefore, it can be inferred from the circumstances that Powell was subjectively aware of a substantial risk of harm to Easter's health.

Although Powell was aware of that substantial risk, she did nothing more than direct Easter to the pharmacy to obtain a refill of his nitroglycerin prescription. When Powell learned that the pharmacy was closed, she sent Easter back to his cell without providing him any treatment. There is no indication in the record that Powell did not have access to nitroglycerin or that she was unable to offer Easter any other treatment options. Accepting Easter's allegations as true, Powell was aware of a serious risk to Easter's health, yet turned a deaf ear to his request for medical treatment.

Powell argues that Easter alleges only a disagreement about the nature of the treatment provided, not an actionable deliberate indifference claim. Although mere disagreement with the treatment provided is not sufficient to state a claim for deliberate indifference,²² Easter is not alleging mere disagreement with the course of treatment Powell provided to him. Rather, Easter alleges that Powell failed to follow a prescribed course of treatment that called for the administration of nitroglycerin when he experienced chest pain.²³ A prison inmate can demonstrate an Eighth Amendment violation by showing that a prison official "`refused to treat him, ignored his complaints, intentionally treated him incorrectly, or engaged in any similar conduct that would clearly evince a wanton disregard for any serious medical needs.'"²⁴ According to Easter's allegations, Powell refused to provide any treatment to, and ignored the complaints of, a patient suffering from severe chest pain that she knew had a history of cardiac problems. Powell's alleged conduct meets the "deliberate indifference" threshold.²⁵

"[D]elay in medical care can only constitute an Eighth Amendment violation if there has been deliberate indifference [that] results in substantial harm."²⁶ The district court determined that Easter made no claim of any lasting complications resulting from the delay in receiving nitroglycerin, and thus failed to show an Eighth Amendment violation as to the...