Rouse v. Plantier, 98-5139

• Decision Date: 14 January 1999
• Docket Number: No. 98-5139,98-5139
• Citation: 182 F.3d 192
• Parties: (3rd Cir. 1999) DARRYL LEON ROUSE v. WILLIAM PLANTIER, ACTING SUPERINTENDENT OF A.D.T.C.; SALLY S. SCHEIDEMANTEL, RESIGNING SUPERINTENDENT OF A.D.T.C.; WILLIAM H. FAUVER, COMMISSIONER OF N.J. DEPARTMENT OF CORRECTIONS; GOVERNOR JIM FLORIO, STATE OF NEW JERSEY; DR. ROBERT CARDINALE, MEDICAL DIRECTOR OF A.D.T.C.; DR. NARSHIMA REDDY, ATTENDING PHYSICIAN OF A.D.T.C.; MS. ELAINE MARTIN, CHIEF NURSE OF A.D.T.C.; CAPTAIN HELMKIN, HOUSING; MIKE ZELL, DIRECTOR OF SOCIAL SERVICES; DR. SANDOVAL, ATTENDING PSYCHOLOGIST OF A.D.T.C.; DR. CATTONE, M.D., ST. FRANCIS HOSPITAL; SCOTT FAUNCE; DR. TARLIAN, M.D.; DR. O'BRYNE, M.D.; DR. TODD, M.D., ST. FRANCIS HOSPITAL; CHARLES BROOKS, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED; STEPHEN JANKOWSKI, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED; JULIO BAEZ, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED; ROBERT KAMMERER, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED v. ELAINE ALLEN; JOHN DOE; JANE ROE WILLIAM PLANTIER; ROBERT CARDINALE; NARSHIMA REDDY; ELAINE ALLEN, APPELLANTS Argued:
• Court: U.S. Court of Appeals — Third Circuit

Page 192

182 F.3d 192 (3rd Cir. 1999)

DARRYL LEON ROUSE v. WILLIAM PLANTIER, ACTING SUPERINTENDENT OF A.D.T.C.; SALLY S. SCHEIDEMANTEL, RESIGNING SUPERINTENDENT OF A.D.T.C.; WILLIAM H. FAUVER, COMMISSIONER OF N.J. DEPARTMENT OF CORRECTIONS; GOVERNOR JIM FLORIO, STATE OF NEW JERSEY; DR. ROBERT CARDINALE, MEDICAL DIRECTOR OF A.D.T.C.; DR. NARSHIMA REDDY, ATTENDING PHYSICIAN OF A.D.T.C.; MS. ELAINE MARTIN, CHIEF NURSE OF A.D.T.C.; CAPTAIN HELMKIN, HOUSING; MIKE ZELL, DIRECTOR OF SOCIAL SERVICES; DR. SANDOVAL, ATTENDING PSYCHOLOGIST OF A.D.T.C.; DR. CATTONE, M.D., ST. FRANCIS HOSPITAL; SCOTT FAUNCE; DR. TARLIAN, M.D.; DR. O'BRYNE, M.D.; DR. TODD, M.D., ST. FRANCIS HOSPITAL; CHARLES BROOKS, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED; STEPHEN JANKOWSKI, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED; JULIO BAEZ, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED; ROBERT KAMMERER, ON BEHALF OF A CLASS OF THEMSELVES AND OTHERS SIMILARLY SITUATED v. ELAINE ALLEN; JOHN DOE; JANE ROE WILLIAM PLANTIER; ROBERT CARDINALE; NARSHIMA REDDY; ELAINE ALLEN, APPELLANTS

No. 98-5139

U.S. Court of Appeals, Third Circuit

Argued: January 14, 1999

June 29, 1999

ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY (D.C. No. 90-cv-03511) (District Judge: Honorable Stephen M. Orlofsky)

Peter Verniero Attorney General of New Jersey Joseph L. Yannotti Assistant Attorney General Mary C. Jacobsen (argued) Assistant Attorney General Jayroe Wurst Deputy Attorney General William P. Flahive Deputy Attorney General Office of Attorney General, Trenton, New Jersey, Counsel for Appellants

Lawrence S. Lustberg Mark A. Berman (argued) Gibbons, Del Deo, Nolan, Grigginger & Vecchione One Riverfront Plaza Newark, New Jersey 07102-5497 Counsel for Appellees

Before: Nygaard, Alito, and Lewis, Circuit Judges

OPINION OF THE COURT

Alito, Circuit Judge

Plaintiffs are a class of past, present, and future insulin-dependent diabetic inmates ("plaintiffs") who filed suit claiming that various corrections officials and employees were deliberately indifferent to the plaintiffs' serious medical needs, in violation of the Eighth Amendment. In this appeal, defendants challenge the District Court's refusal to grant summary judgment in their favor on the grounds of qualified immunity. For the reasons discussed below, we vacate the District Court's decision and remand for further proceedings in accordance with this opinion.

I.

In 1990, Darryl Rouse, an insulin-dependent diabetic then incarcerated at the Adult Diagnostic and Treatment Center ("ADTC"), a correctional facility in New Jersey, filed this § 1983 action. Named as defendants were: William Fauver, Commissioner of the New Jersey Department of Corrections; William Plantier, Acting Superintendent of the ADTC; Doctor Robert Cardinale, former Medical Director of ADTC; Doctor Narshima Reddy, former physician at ADTC; and Nurse Elaine Allen, former Chief of Nursing at ADTC. Rouse alleged that the defendants had subjected him to cruel and unusual punishment by failing to provide him with adequate medical care.

In 1994, Rouse amended his complaint and sought class certification, declaratory and injunctive relief for the class members and monetary relief for present insulin-dependent diabetic inmates. See Supp. App. at 18-19 (Amended Complaint).¹ The amended complaint alleged that "[t]he defendants have provided class members with medical care for their diabetes and diabetes-related conditions that is so uniformly and grossly inadequate as to constitute deliberate indifference to serious medical needs in violation of the Eighth Amendment to the United States Constitution." See Id. at 18.

In 1996, the District Court certified a class consisting of all former, present, and future insulin-dependent diabetics incarcerated at the ADTC, pursuant to Federal Rule of Civil Procedure 23(a) and 23(b)(2). For the purpose of classwide damages, the District Court also certified a class consisting of all former and present insulin-dependent diabetics incarcerated at the ADTC, pursuant to Federal Rules of Civil Procedure 23(a) and 23(b)(3).

Defendants moved for summary judgment on the merits of plaintiffs' claim and, alternatively, on the grounds of qualified immunity. In support of their respective arguments, both parties submitted the reports of medical experts. None of the experts disputed that plaintiffs suffer from insulin dependent diabetes mellitus, which all agree is a serious illness.

Plaintiffs proffered an expert report by Dr. Michael D. Cohen. See App. at 123-46. Basing his report primarily on the American Diabetes Association Clinical Practice Recommendations issued in 1995, Dr. Cohen explained that a characteristic of insulin-dependent diabetes is an abnormally high amount of sugar in the blood due to insulin deficiency, see id. at 123, and that a primary goal of disease management, therefore, is to lower the amount of sugar in the blood to normal or near-normal physiological levels. See Id. at 125. Achieving this goal, Dr. Cohen stated, requires diabetics to engage in a comprehensive daily care plan. See Id. at 123 ("Daily management requires close attention to medication, dietary intake and activity, with frequent monitoring of the blood sugar."). Failure to do so, Dr. Cohen asserted, can cause short-term complications, including excessive urination, constant thirst and hunger, weakness, confusion, dizziness, and seizures, as well as severe long-term problems, including blindness, amputation of feet and legs, renal failure, and nerve damage. See Id.

Dr. Cohen noted several components necessary for proper diabetes management. First, he said, diabetics require daily injections of insulin, the frequency of which depends upon the severity of the illness. See Id. at 125-26. Second, he asserted that in order to determine the amount of insulin required, diabetics must monitor their blood-sugar levels at least three to four times each day. See Id. at 126; see also id. at 155 (Report of Plaintiffs' Expert, Dr. Mathew J. Miller) ("Dr. Miller's report") (asserting that "all insulin-requiring diabetics should monitor their blood glucose levels on a daily basis" and that the ability to test one's blood-sugar level three to four times each day "is a reasonable standard to which we should aspire"). Third, he stated that, in addition to snacks and low-sugar sweets, diabetics must be given individualized diet plans tailored to their specific medical needs. See Id. at 127-30; see also Id. at 156 (Dr. Miller's Report) ("Appropriate food should be provided to each diabetic, the portions and composition individualized to needs, size, activity level and so forth."). Fourth, Dr. Cohen opined that diabetics must be educated about their disease and the steps necessary to maintain their health. See Id at 130; see also id. at 155 (Dr. Miller's Report) ("[E]ducation is the sine qua non of good diabetic management."). Fifth, Dr. Cohen stated that timely and effective measures must be taken to prevent long-term and chronic complications, such as blindness and loss of limbs. See Id. at 131-39. For instance, Dr. Cohen noted that the American Diabetes Association recommends an "[a]nnual comprehensive dilated eye and vision examination by an opthamologist." See Id. at 134. And finally, he stated, clinical and follow-up evaluations must be conducted on a regular basis to monitor the progression of the diabetic's illness. See Id. at 139-46; id. at 139 ("Special primary care needs of diabetics include: comprehensive initial evaluation, regular follow-up, access to aggressive care for acute illnesses and injuries, attention to prevention of lung infections[,] and dental care.").

Dr. Cohen evaluated the level of care provided to the plaintiffs and opined that the defendants had failed to treat plaintiffs' illness adequately in all material respects. See Id. at 146 ("Essential components of necessary care for prisoners with diabetes are missing or inadequate at ADTC."). Dr. Cohen faulted defendants for giving plaintiffs one insulin shot per day, despite suggestions from medical consultants that some of the plaintiffs required more than one daily injection. See Id. at 126. Dr. Cohen noted that plaintiffs were not provided the opportunity to monitor their blood-sugar levels on a daily basis and that, in some cases, blood sugar levels had been tested only 20 times per year. See Id. at 125-27. In addition, Dr. Cohen stated that, among other deficiencies, defendants had not provided plaintiffs with individualized meals and had not furnished diabetes-appropriate snacks or low-sugar sweets. See Id. at 128-30. Dr. Cohen noted further that, other than scheduling one education session several years ago, the defendants had not educated the plaintiffs about their illness. See Id. at 130. Last, Dr. Cohen asserted that defendants had no comprehensive plan for preventing long-term complications (e.g., inmates are not permitted to visit an eye doctor annually), see id. at 134-35, and that the defendants had not established an adequate evaluation and follow-up program to monitor the progression of the inmates' illness. See Id. at 139-46. He concluded:

"The care and treatment provided to prisoners with diabetes at ADTC is unacceptable by current standards of care. . . . As medical and nursing staff at ADTC are or ought to be aware of the current standards of care for management of diabetes and the harm that results from inadequate care and treatment, they have shown deliberate indifference to the pain and suffering of prisoners with diabetes."

App. at 124-25.

In response, defendants commissioned a report from Dr. William E. Ryan. Id. at 158-74. Dr. Ryan agreed with plaintiffs' expert that diabetes care must be "individualized," but he disputed most of Dr. Cohen's other assertions. See Id. at 163. Dr. Ryan noted that diabetics whose blood-sugar levels are "known" and "stable"...