On November 4, 2016, a federal appeals court in Richmond, Virginia issued a significant opinion in favor of a Cohen Milstein client in a case involving the quality of medical care inmates receive in federal prisons.  In a published, unanimous opinion, the U.S. Court of Appeals for the Fourth Circuit overturned a lower court’s summary judgment ruling throwing out Paul Scinto’s Eighth Amendment claims against a prison doctor and a prison camp administrator for intermittently failing to provide him – an inuslin-dependent diabetic – with his supplemental insulin, and for failing to provide him with a medical assessment after he called in an emergency due to gallstone-related pain.  The Eighth Amendment prohibits cruel and unusual punishment.

Case Background

Mr. Scinto was a 54 year-old federal prison inmate in North Carolina.  He suffered from insulin-dependent diabetes, hepatitis C, anemia, gallstones, and hypertension.  He sued his prison doctor, prison camp administrator, and the prison warden for failing to provide him with adequate medical care in violation of the Eighth Amendment’s prohibition on cruel and unusual punishment: in particular, Mr. Scinto alleged that his prison doctor denied him his supplemental doses of insulin even after his blood sugar went too high, that the prison warden denied his request for a diet that would not exacerbate his diabetes, and that the prison doctor and prison camp administrator failed to provide him with a medical assessment after he called in an emergency related to his gallstones.

The district court entered summary judgment against Mr. Scinto, ruling that no reasonable jury could return a verdict in his favor.  The court ruled that Mr. Scinto needed to show not only that he had a serious medical condition to which the defendants were deliberately indifferent, but that – using expert medical testimony – their deliberate indifference caused him substantial medical harm.

In a published, unanimous opinion, the Fourth Circuit reversed the district court’s ruling and revived two of Mr. Scinto’s claims: his claim against the prison doctor for denying him supplemental insulin, and his claim against the prison doctor and camp administrator for not providing him a medical assessment after he called in an emergency because of gallstone-related pain and vomiting.  The court made several important rulings for prisoners:

  • First, with respect to Mr. Scinto’s claim against the prison doctor for denying him supplemental insulin, the court ruled that denying Mr. Scinto even a single dose of such insulin “may be sufficient alone to meet the” Eighth Amendment cruel and unusual punishment standard, that “the act of withholding insulin from an insulin-dependent diabetic alone creates a serious injury or a substantial risk of such injury” as a matter of law, that expert medical testimony on a serious injury or a substantial risk of such injury is not necessary in an insulin denial case, and that Mr. Scinto’s evidence of an increase in his blood sugar – marked in his medical records – was enough to satisfy the legal requirements of the Eighth Amendment.
  • Second, with respect to Mr. Scinto’s claim against the prison doctor and camp administrator regarding their refusal to provide him any medical assessment after he called in an emergency, the court ruled that “[a] juror could reasonably infer that failing to treat, for two to five days, an inmate who is vomiting blood and experiencing evident physical distress creates a substantial risk that serious bodily injury will result or has already occurred,” and that Mr. Scinto’s evidence of certain “outward signs” of his need for medical attention – his cell had an odor, he was vomiting gastric fluid and blood, he was in pain – gave rise to “to an inference of deliberate indifference sufficient for” establishing an Eighth Amendment cruel and unusual punishment claim.
  • Third, with respect to Mr. Scinto’s claim regarding a diet for managing his diabetic condition, the court held that Mr. Scinto did not have enough evidence to establish an Eighth Amendment claim.  But the court provided valuable guidance for future cases, holding for the first time in its circuit that, under the Eighth Amendment, prison officials must provide inmates with a special diet if such an accommodation is medically necessary.  The court further ruled that a prison official could be held liable under the Eighth Amendment if an inmate could show that no combination of foods offered to him in his prison meal plan “would have provided him adequate sustenance without causing adverse medical consequences.”
  • Finally, the court rejected the defendants’ qualified immunity defense.  Qualified immunity is the primary defense in constitutional cases: it protects government officials from liability if their conduct did not at the time violate a clearly established constitutional right.  The court ruled that the prison doctor and camp administrator committed a violation of Mr. Scinto’s constitutional right “to receive adequate medical care and to be free from officials’ deliberate indifference to [his] known medical needs,” and that those rights were clearly established at the time of the events giving rise the lawsuit.

The Fourth Circuit held that Mr. Scinto could present his claim to a jury, and it remanded the case to federal court in North Carolina for trial.  Adam Farra, an associate in Cohen Milstein’s Securities Litigation & Investor Protection practice, briefed and argued the appeal.