Hixson v. Moran

• Decision Date: 17 June 2021
• Docket Number: No. 19-1209,19-1209
• Parties: Carey HIXSON, Plaintiff – Appellant, v. Michael MORAN, in his individual capacity and as the physician at Harrisonburg-Rockingham Regional Jail, Defendant – Appellee, and Bryan Hutcheson, in his individual capacity and in his official capacity as operator of Harrisonburg-Rockingham Regional Jail; Steven Shortell, in his individual capacity and in his official capacity as operator of Harrisonburg-Rockingham Regional Jail; John Does, nurses and employees of Southern Health Partners, Inc.; Southern Health Partners, Inc.; Rockingham County, Virginia; The City of Harrisonburg, Virginia ; Katherine Raynes, a nurse and employee of Southern Health Partners, Inc.; Janelle Seekford; John Doe #1 and John Doe #2, as nurses and employees of Southern Health Partners, Inc., Defendants.
• Court: U.S. Court of Appeals — Fourth Circuit

1 F.4th 297

Carey HIXSON, Plaintiff – Appellant,

v.Michael MORAN, in his individual capacity and as the physician at Harrisonburg-Rockingham Regional Jail, Defendant – Appellee,andBryan Hutcheson, in his individual capacity and in his official capacity as operator of Harrisonburg-Rockingham Regional Jail; Steven Shortell, in his individual capacity and in his official capacity as operator of Harrisonburg-Rockingham Regional Jail; John Does, nurses and employees of Southern Health Partners, Inc.; Southern Health Partners, Inc.; Rockingham County, Virginia; The City of Harrisonburg, Virginia ; Katherine Raynes, a nurse and employee of Southern Health Partners, Inc.; Janelle Seekford; John Doe #1 and John Doe #2, as nurses and employees of Southern Health Partners, Inc., Defendants.

No. 19-1209

United States Court of Appeals, Fourth Circuit.

Argued: May 5, 2021

Decided: June 17, 2021

ARGUED: Katherine Cantolina, NDH LLC, Atlanta, Georgia, for Appellant. Christopher Stanislaw Dadak, GUYNN WADDELL CARROLL & LOCKABY, P.C., Salem, Virginia, for Appellee. ON BRIEF: Mario B. Williams, Andrew R. Tate, NDH LLC, Atlanta, Georgia, for Appellant. Susan A. Waddell, GUYNN WADDELL CARROLL & LOCKABY, P.C., Salem, Virginia, for Appellee.

Before WILKINSON and RUSHING, Circuit Judges, and TRAXLER, Senior Circuit Judge.

Affirmed by published opinion. Senior Judge Traxler wrote the opinion, in which Judge Wilkinson and Judge Rushing joined.

TRAXLER, Senior Circuit Judge:

Carey Hixson, a former inmate at Harrisonburg-Rockingham Regional Jail, sued Dr. Michael Moran, a doctor for the jail, alleging an Eighth Amendment violation under 42 U.S.C. § 1983 and violations of state law, based on Dr. Moran's purported failure to properly treat his diabetes. The district court granted summary judgment to Dr. Moran, and Hixson appeals.^* Finding no error, we affirm.

I. Facts

Carey Hixson was an inmate at Harrisonburg-Rockingham Regional Jail ("HRRJ") for 5 months in 2016. Prior to arriving at HRRJ, Hixson had been diagnosed with type-2 diabetes

and prescribed injectable insulin and oral medication. Once at HRRJ, Hixson informed medical personnel that he had insulin-dependent diabetes ; however, the staff was initially unable to acquire the medical records necessary to confirm Hixson's diagnosis. Dr. Moran placed Hixson on a diabetic diet and ordered that Hixson's blood sugar levels be tested daily, which Dr. Moran testified he would have done even if he had reviewed Hixson's medical records. Dr. Moran checked the blood sugar readings on a weekly basis. Hixson's blood sugar levels during the first four months of his incarceration varied from normal to elevated. Towards the end of his incarceration at HRRJ, Hixson's blood sugar levels varied from as low as 174 mg/dL to above 400 mg/dL. In response to the higher readings, Dr. Moran increased Hixson's blood sugar testing to twice a day but did not prescribe oral medication or insulin. Dr. Moran stated he was concerned about an insulin overdose that could result if Hixson was prescribed insulin when he did not need it. Hixson repeatedly asked nursing staff for insulin but did not report any symptoms of elevated blood sugar to either a nurse or Dr. Moran. Additionally, Hixson did not file an official grievance or complaint asking for insulin or other medication for his diabetes.

In his court complaint, Hixson claimed that Dr. Moran failed to provide him with his "required insulin

or other prescribed medication" while he was incarcerated, despite knowledge of his diabetes diagnosis. J.A. 335. As a result, Hixson asserted, he suffered pain, discomfort, and severe impairment of his bodily functions. Specifically, he experienced clouded vision and pain and tingling in his extremities.

In support of his § 1983 deliberate indifference claims, Hixson presented expert deposition testimony from Dr. Carol Rupe. Dr. Rupe opined that Dr. Moran violated the standard of care. Dr. Rupe believed that, given Hixson's blood sugar levels, Dr. Moran should have initially prescribed oral medication. Dr. Moran's expert, Dr. Rose Suaava, stated that Dr. Moran's decision not to administer insulin

was reasonable due to the variable nature of Hixson's blood sugar readings and his weight during incarceration.

The district court granted Dr. Moran's motion for summary judgment. The court determined that Hixson failed to establish that Dr. Moran acted with deliberate indifference in treating Hixson and, thus, did not violate Hixson's Eighth Amendment rights. The court specifically concluded that,

[w]hile Dr. Moran did not prescribe insulin

or any other type of medication for Hixson, [Dr. Moran] stated rational medical reasons for not doing so. Dr. Moran stated that, because Hixson's blood sugar readings varied, an insulin prescription could have led to hypoglycemia if taken while levels were low. This reasoning, combined with the diabetic diet and daily blood testing [ordered by Dr. Moran], is sufficient to show that Dr. Moran was not deliberately indifferent to Hixson's condition.

J.A. 619. The court additionally found no violation of state law because Hixson could not establish that Dr. Moran was grossly negligent in treating him. Hixson timely appealed.

II. Jurisdiction

Before addressing the merits, we pause to consider whether we have jurisdiction over Hixson's appeal. Federal courts of appeals may only exercise jurisdiction over final orders. 28 U.S.C. § 1291. A final, appealable decision "ends the litigation on the merits and leaves nothing for the court to do but execute the judgment." Coopers & Lybrand v. Livesay , 437 U.S. 463, 467, 98 S.Ct. 2454, 57 L.Ed.2d 351 (1978) (internal quotation marks omitted). The final judgment rule "serves the important purpose of promoting efficient judicial administration." Firestone Tire & Rubber Co. v. Risjord , 449 U.S. 368, 374, 101 S.Ct. 669, 66 L.Ed.2d 571 (1981). To effectuate this goal, the Supreme Court has continued a tradition of giving § 1291 a "practical rather than a technical construction." Id. at 375, 101 S.Ct. 669 (internal quotation marks omitted).

"Ordinarily, a district court order is not final until it has resolved all claims as to all parties." Porter v. Zook , 803 F.3d 694, 696 (4th Cir. 2015) (internal quotation marks omitted). In Porter , a death penalty habeas case, we held that the district court order was not final because there had been no ruling below on the petitioner's claim that he had not had a fair and impartial jury try his case. We noted that the lower court dismissed the petitioner's claim "without ruling on or seeming to recognize" this claim. Id. at 698. We also determined that the district court did not "acknowledge [the claim], and it never passe[d] on a central component of [the] claim." Id. at 699.

In the case before us, Hixson alleges inadequate treatment for his diabetes while in prison. He contends that his complaint raised a claim based upon his being denied insulin and a second claim based upon his being denied any other medication. Hixson contends that the district court did not rule on his claim involving Dr. Moran failing to give him a noninsulin medication, and that the order is therefore not final.

Assuming without deciding that these are indeed two separate claims, we nonetheless conclude that the order is final. We are able to discern from the district court's order that the court addressed the "central component" of Hixson's deliberate indifference claims. Id. at 698. The order displays an awareness of the second claim and the court's discussion uses language encompassing Dr. Moran's consideration of medication in addition to insulin. Indeed, in ruling on Hixson's deliberate indifference claims, the district court explained, "While Dr. Moran did not prescribe insulin or any other type of medication for Hixson, he stated rational medical reasons for not doing so." D. Ct. Order at 10 (emphasis added).

The district court acknowledged the scope of Hixson's claims, even quoting the allegation in Hixson's complaint that Dr. Moran was "deliberate[ly] indifferen[t] to [Hixson's] known serious medical need for diabetic medication (prescription or otherwise) to treat his...[diabetic condition]." D. Ct. Order at 4. Thus, unlike in Porter , here the district court recognized Hixson's claim, and even quoted the relevant language from his complaint. The district court then determined that Dr. Moran was not deliberately indifferent to Hixson's medical needs for choosing not to administer any medication.

Nothing else is required to satisfy us that the district court ruled on both claims. Requiring more would disregard the very purpose of § 1291 and the Supreme Court's tradition of giving the finality rule a practical rather than technical construction. Accordingly, the order is final, and we therefore turn to the merits of Hixson's appeal.

III. Merits

On appeal, Hixson asserts that the district court misapplied the summary judgment standard and erroneously determined that Dr. Moran was not deliberately indifferent or grossly negligent when treating Hixson. This Court "review[s] a district court's grant of summary judgment de novo," Lee v. Town of Seaboard , 863 F.3d 323, 327 (4th Cir. 2017), drawing all reasonable factual inferences in favor of the nonmoving party. See Glynn v. EDO Corp. , 710 F.3d 209, 213 (4th Cir. 2013). Summary judgment may be granted when there is "no genuine dispute as to any material fact." Fed. R. Civ. P. 56. A genuine issue of material fact exists only "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Shaw v. Stroud , 13 F.3d 791, 798 (4th Cir. 1994) (internal quotation marks omitted). "The mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment. Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 247-48, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) (emphasis in original). Additionally, all reasonable factual...