Pabon v. Wright, Docket No. 04-2896-RP(L);
| Decision Date | 03 August 2006 |
| Docket Number | Docket No. 04-2896-RP(L);,Docket No. 04-2901-RP(CON). |
| Citation | 459 F.3d 241 |
| Parties | WILLIAM PABON, Plaintiff-Appellant, Felix Manuel Ruiz a/k/a Pedro Ruiz,<SMALL><SUP>1</SUP></SMALL> Plaintiff, v. Dr. Lester WRIGHT, Dr. Norman Selwin, Dr. Charles Bendheim, Dr. Vincent Marrone, Dr. Harry Mamis, Andrew Miller, Dr. Charles Rush, Dr. Bharat Dasani, Dr. Ravi Hotchandani, Dr. Robert Rosenzweig, Dr. Koenigsmann, Dr. Chakarvorty, Dr. Phillip Marrone, Jacqueleine A. Bodzak, and Catherine Metzler, Defendants-Appellees.<SMALL><SUP>2</SUP></SMALL> |
| Court | U.S. Court of Appeals — Second Circuit |
William Pabon, Stormville, NY, pro se.
David Lawrence III, Assistant Solicitor General (Eliot Spitzer, Attorney General of the State of New York, Michael S. Belohlavek, Senior Counsel, on the brief), New York City, NY, for State Defendants-Appellees.
Nancy A. Breslow, Martin Clearwater & Bell LLP (John L.A. Lyddane, on the brief), New York City, NY, for Private Defendants-Appellees.
Before WALKER, Chief Judge, NEWMAN and KATZMANN, Circuit Judges.
William Pabon, an inmate at Green Haven Correctional Facility ("Green Haven"), was diagnosed with Hepatitis C. Under the care of physicians both at Green Haven and at a private clinic, he underwent a liver biopsy to verify the diagnosis and then was treated with both Interferon and Ribavirin. Pabon complains that his Hepatitis treatment was conditioned on his submission to a liver biopsy and that the Interferon treatment resulted in serious side effects about which he was not warned. He further claims that, had he known of the side effects associated with liver biopsies and Interferon, he would have refused treatment. Pabon contends that these facts amount to a violation of a Fourteenth Amendment right to medical information.
For the reasons that follow, we hold that Pabon is correct that the Fourteenth Amendment's recognized liberty interest in an individual's right to refuse medical treatment carries with it a concomitant right to such information as a reasonable patient would deem necessary to make an informed decision regarding medical treatment. To establish a violation of this right, a prisoner must show that (1) government officials failed to provide him with such information; (2) this failure caused him to undergo medical treatment that he would have refused had he been so informed; and (3) the officials' failure was undertaken with deliberate indifference to the prisoner's right to refuse medical treatment. We also recognize, however, that prison officials may administer treatment to an inmate despite that inmate's desire to refuse treatment if, in the exercise of their professional judgment, the officials reasonably determine that providing such treatment furthers a legitimate penological interest. Because this right was not clearly established in this circuit when Pabon was diagnosed with and treated for Hepatitis C, we affirm the district court's grant of summary judgment to all Defendants on qualified-immunity grounds.
In October 1996, a laboratory test indicated that Pabon may have contracted Hepatitis C, a chronic viral liver disease that can increase the risk of liver cancer and can lead to inflammation, scarring, and cirrhosis of the liver. Cirrhosis ultimately can lead to liver failure and death.
The physicians at Green Haven referred Pabon to Dutchess Gastroenterologists, P.C. ("Dutchess") for additional testing. In May 1997, a doctor at Dutchess saw Pabon and, according to Defendants, recommended that Pabon undergo additional testing to confirm the preliminary Hepatitis C diagnosis. Pabon contends that he was forced to undergo these tests. In any event, the additional tests were performed, and they confirmed the initial diagnosis.
Pabon returned to Dutchess in July 1997 for further evaluation. Defendants maintain that, at that time, the doctors at Dutchess provided Pabon with information about Hepatitis C and Interferon, a medication used for the treatment of Hepatitis C, and discussed with Pabon the need for a liver biopsy. They also maintain that the prevailing standard of care in treating Hepatitis C includes performing a liver biopsy to assess the state of a patient's liver before prescribing Interferon.
According to Pabon, he was told that he must undergo a liver biopsy in order to receive treatment for his condition but was never informed of the possible complications or risks associated with liver biopsies. He maintains that the prevailing standard of care does not call for a biopsy and that had his treatment not been made contingent on undergoing the biopsy, he would have refused to submit to that procedure.
In October 1997, the liver biopsy was performed, and the following month, Dr. Bharat Dasani evaluated Pabon and prescribed Interferon. While Dr. Dasani does not recall a specific conversation with Pabon about Interferon's side effects, he claims that it is his custom and practice to have such a conversation with all patients being treated with Interferon. Pabon contends that he was never informed of Interferon's possible side effects.
Pabon began Interferon treatment in November 1997. Because his response to the Interferon therapy was incomplete as of October 1998, Dr. Thomas Rush, the consulting infectious-disease specialist at Green Haven, recommended the addition of Ribavirin, also used to treat Hepatitis C, to Pabon's treatment. Pabon claims that Dr. Rush failed to inform him of the possible side effects of Ribavirin treatment.
Pabon complained of gastric pain soon after his Interferon treatment began. As a result, he was examined at Dutchess on two occasions where Dr. Dasani recommended that Pabon take Zantac along with his Interferon. Pabon also maintains that he experienced numerous additional side effects of the biopsy and the Interferon/Ribavirin treatment, including dizziness, vomiting, abdominal pain, severe headaches, chronic depression, pain, suicidal thoughts, and impotence, and that these adverse effects led to marital problems.
By late 1999, Pabon exhibited a complete response to Hepatitis C therapy and the medications were discontinued. Since that time, Pabon's liver enzymes have remained normal, and his Hepatitis C viral load is undetectable. According to Pabon's doctors, this sustained response is the best outcome that could have been expected.
Despite this successful result, Pabon brought this § 1983 suit seeking damages for violations of his rights under the United States Constitution. The complaint names two groups of defendants: Pabon's doctors at Dutchess and his doctors and nurses at Green Haven. The district court construed Pabon's complaint to implicate only his Eighth Amendment rights and, finding no evidence of deliberate indifference, granted Defendants' summary judgment motion. This timely appeal followed.
We review a district court's grant of summary judgment de novo. Anderson v. Recore, 446 F.3d 324, 328 (2d Cir.2006). Summary judgment is appropriate where, construing all evidence in the light most favorable to the non-moving party, id., "there is no genuine issue as to any material fact and ... the moving party is entitled to a judgment as a matter of law," Fed.R.Civ.P. 56(c).
The district court considered only whether Pabon had submitted evidence sufficient to show a disputed issue of material fact with respect to an Eighth Amendment violation. To make out such a violation, an inmate must show that state officials acted with deliberate indifference to his serious medical needs. Estelle v. Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). Defendants do not dispute that Hepatitis C qualifies as a serious medical condition, but the district court found that Pabon had failed to put forth evidence that Defendants acted with deliberate indifference and therefore granted their summary judgment motion.
On appeal, Pabon fails to challenge this determination. Because Pabon's brief to this court does not contend that the district court erred in dismissing his Eighth Amendment claim, we consider that claim abandoned. Cruz v. Gomez, 202 F.3d 593, 596 n. 3 (2d Cir.2000) (). We therefore will not review the dismissal of Pabon's Eighth Amendment claim.
Pabon's complaint also indicated that at least some of his claims arose under the Fourteenth Amendment. According to the district court, the Fourteenth Amendment is relevant to Pabon's claim only insofar as it makes the Eighth Amendment's ban on cruel and unusual punishment applicable to the states, and Defendants agree with this analysis. Pabon asserts that he raised a Fourteenth Amendment due process claim independent of the Eighth Amendment.
We construe complaints filed by pro se litigants liberally and "interpret them to raise the strongest arguments that they suggest." Burgos v. Hopkins, 14 F.3d 787, 790 (2d Cir.1994). Pabon's appellate brief is wholly devoted to the argument, new to this court, that Defendants' alleged failure to inform him of the side effects of Interferon treatment and refusing to provide treatment pending a liver biopsy constitute violations of his Fourteenth Amendment substantive due process right to refuse medical treatment. Because this argument is based on facts that are alleged in Pabon's complaint, we conclude that Pabon did raise an independent Fourteenth Amendment claim in his complaint. The viability of the Fourteenth Amendment claim is thus the issue before us on appeal.
Even if Pabon's complaint states a Fourteenth Amendment claim, we must consider whether Defendants are entitled to summary judgment on qualified-immunity grounds. Determining this question is a two-step process. First, we must consider whether, viewed in the light...
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