Santiago v. Ringle

• Decision Date: 05 November 2013
• Docket Number: No. 12–4075.,12–4075.
• Parties: Oscar SANTIAGO, Plaintiff–Appellant, v. Dr. Kurt RINGLE and Dr. Constance Mosher, individually, Defendants–Appellees.
• Court: U.S. Court of Appeals — Sixth Circuit

734 F.3d 585

Oscar SANTIAGO, Plaintiff–Appellant,

v.Dr. Kurt RINGLE and Dr. Constance Mosher, individually, Defendants–Appellees.

No. 12–4075.

United States Court of Appeals, Sixth Circuit.

Argued: Oct. 3, 2013.

Decided and Filed: Nov. 5, 2013.

ARGUED: Rickell Howard, Ohio Justice & Policy Center, Cincinnati, Ohio, for Appellant. Debra Gorrell Wehrle, Office of the Ohio Attorney General, Columbus, Ohio, for Appellees. ON BRIEF: Rickell Howard, David Singleton, Ohio Justice & Policy Center, Cincinnati, Ohio, for Appellant. Debra Gorrell Wehrle, Office of the Ohio Attorney General, Columbus, Ohio, for Appellees.

Before: COLE, KETHLEDGE, and STRANCH, Circuit Judges.

OPINION

COLE, Circuit Judge.

After a delay in receiving dermatologist-recommended treatments for a painful skin condition, inmate Oscar Santiago sued his prison doctors under 42 U.S.C. § 1983. He claimed violation of the Eighth Amendment's prohibition of cruel and unusual punishment. The district court initially denied the doctors' motion for summary judgment, but on a motion to reconsider the court entered summary judgment in favor of the doctors. The court also granted a second motion for summary judgment, finding the doctors entitled to qualified immunity. Santiago now challenges the district court's grants of summary judgment on the merits and on the basis of qualified immunity. Because Santiago has not proved that the delay in his treatment caused a serious medical need, nor that the doctors acted with deliberate indifference, we affirm.

I. BACKGROUND

A. Relevant Facts

Plaintiff–Appellant Oscar Santiago is an inmate of the Marion Correctional Institute (“MCI”) in Marion County, Ohio. Defendant–Appellants Kurt Ringle and Constance Mosher were MCI's Medical Director and Assistant Medical Director. Because Dr. Ringle and Dr. Mosher moved for summary judgment, we consider the evidence and draw all reasonable inferences in the light most favorable to Santiago. See Tysinger v. Police Dep't of Zanesville, 463 F.3d 569, 572 (6th Cir.2006).

Complaining of severe pain, swelling, and a rash, Santiago was seen by Dr. Mosher on January 31, 2008. Notes in Santiago's medical chart from that day state the following: “Bilateral leg pain, knee pain, ankle pain onset approx. 2 wks ago. Progressively worse over last 3–days. Unable to walk to infirmary or climb into top bunk. ‘Feels like hot razors over Achilles tendons and the bones of my knees are gonna pop out.’ ” Dr. Mosher prescribed Tylenol to treat Santiago's pain and antibiotics to treat what she thought might be Methicillin-resistant Staphylococcus aureus (MRSA).

Santiago was seen the next day by Dr. Ringle, who diagnosed him with erythema nodosum (“EN”), a skin inflammation disorder. Dr. Mosher's affidavit characterizes EN as “an uncomfortable but non-dangerous skin condition with symptoms that typically disappear in about six weeks but may recur.” Dr. Mosher's affidavit also states that because there is no known cure for EN, the “standard treatment” is to prescribe bed rest, an anti-inflammatory medication, and various treatments to alleviate the discomfort and risks of the underlying symptoms. Dr. Ringle prescribed an anti-inflammatory medication and an antibiotic.

Four days later, on February 5, Santiago complained of increased pain and swelling. He was transferred to The Ohio State University (“OSU”) Medical Center. Doctors there diagnosed Santiago with EN and arthralgias, a severe joint-pain condition, and prescribed an anti-ulcer agent and a different anti-inflammatory medication. Santiago was discharged after two days, and he eventually returned to MCI on February 11. A nursing note from that day stated that he “denies any discomfort at this time.” Still, Dr. Ringle prescribed a wheelchair and cane, the OSU-prescribed anti-inflammatory medication, a different anti-ulcer agent, Tylenol, and Benadryl. Dr. Ringle also ordered a dermatology consult.

Santiago was seen on February 20 by an OSU dermatologist, who recommended treating Santiago's condition with a topical steroid ointment, compression hose, and a saturated solution of potassium iodide, also known as SSKI. Dr. Mosher's affidavit states that SSKI may help treat EN but is not part of the standard treatment. The recommendations were transcribed into Santiago's medical chart that day, but they were not signed and ordered. Dr. Ringle told Santiago later that evening that he would prescribe the dermatologist's recommendations.

Each day on February 22, 23, 24, and 25, Santiago asked the MCI nursing staff about the recommended treatments. The nursing staff denied knowledge of the treatments until, on the 25th, two nurses found Santiago's unsigned chart under paperwork on Dr. Ringle's desk. Apparently, Dr. Ringle had been on vacation since February 21. On February 26, a nurse told Santiago that the treatments were “being taken care of.” Dr. Mosher, who was covering Dr. Ringle's duties while he was away, signed the order for the three recommended treatments on February 27. Santiago received the topical steroid ointment on February 29 and the compression stockings on March 10.

Santiago waited longer for the SSKI. Because SSKI is a non-formulary drug, the Ohio Department of Rehabilitation and Correction does not stock it, and a correctional institute's medical director must obtain approval to order the drug. Though Dr. Mosher had ordered SSKI on February 27, apparently without approval, Dr. Ringle signed an order discontinuing SSKI on March 3. The next day, Santiago's mother called various prison officials to complain that Santiago had not received all of his treatments. On March 5, Dr. Ringle sought and received approval to purchase SSKI, examined Santiago, prescribed SSKI for him, and recommended a rheumatology consult. Santiago received the SSKI on March 17. Before receiving SSKI, Santiago remained in pain and continued to rely on a wheelchair. Shortly after he began SSKI, his pain and other symptoms improved. Santiago continued to receive the anti-inflammatory medication, anti-ulcer agent, Tylenol, and Benadryl that Dr. Ringle and Dr. Mosher had previously prescribed while he waited for the dermatologist's recommended treatments.

B. Procedural History

Santiago filed a pro se complaint against Dr. Ringle and Dr. Mosher in their individual capacities under 42 U.S.C. § 1983. He alleged violations of his Eighth and Fourteenth Amendment rights, claiming that the doctors were deliberately indifferent to his serious medical needs when they delayed the treatments recommended by the dermatologist on February 20, 2008. The doctors moved for summary judgment, arguing that Santiago could not substantiate his deliberate indifference claim, and the district court denied summary judgment. In genuine dispute, the court found, were facts about the delay of Santiago's medical treatment and the seriousness of his suffering that could support the subjective and objective components of Santiago's Eighth Amendment claim.

The doctors moved for reconsideration and filed a second motion for summary judgment, this one based on qualified immunity. The district court granted both motions and entered summary judgment in favor of the doctors. On reconsideration, the court found it had “mis-apprehended the facts regarding the dermatologist's treatments,” which were recommendations and not part of a prescribed plan. While “interruption of a prescribed plan of treatment could constitute a constitutional violation” under Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976), the court found that the doctors' delay in implementing the dermatologist's recommendations could not violate the Eighth Amendment. To “prevent manifest injustice,” the court reconsidered its initial ruling and entered summary judgment for the doctors. The court then held that because Santiago could not show a constitutional violation, the doctors were also entitled to qualified immunity.

Santiago timely appealed. We have jurisdiction under 28 U.S.C. § 1291.

II. ANALYSIS

A. Standard of Review

This court reviews de novo a grant of summary judgment, including one based on qualified immunity. Wallace v. Midwest Fin. & Mortg. Servs., Inc., 714 F.3d 414, 418 (6th Cir.2013); Dickerson v. McClellan, 101 F.3d 1151, 1157 (6th Cir.1996). A court must grant summary judgment “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). A genuine dispute of material fact exists when there is sufficient evidence, considered in the light most favorable to the nonmoving party, for a reasonable jury to find for the nonmoving party. Tysinger, 463 F.3d at 572. Once the moving party has identified what it believes shows an absence of a genuine dispute of material fact, the nonmoving party must “go beyond the pleadings and by her own affidavits, or by the depositions, answers to interrogatories, and admissions on file, designate specific facts showing that there is a genuine issue for trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 323–24, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (quoting Fed.R.Civ.P. 56) (internal quotation marks omitted).

Santiago brings his claims under 42 U.S.C. § 1983. To succeed on such a claim, Santiago must demonstrate that a person acting under color of state law “deprived [him] of rights, privileges or immunities secured by the Constitution or laws of the United States.” Bennett v. City of Eastpointe, 410 F.3d 810, 817 (6th Cir.2005). Dr. Ringle and Dr. Mosher do not dispute that they acted under color of state law, so we assess whether the doctors violated Santiago's constitutional rights.

B. Eighth Amendment Claim

A prison doctor violates the Eighth Amendment when she exhibits “deliberate indifference to [the] serious medical needs” of a prisoner. Estelle, 429 U.S. at 104, 97 S.Ct. 285. An Eighth Amendment claim has an objective component and a subjective component. Comstock v. McCrary,...