Smith v. Smith

PUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

ROY L. SMITH, 

Plaintiff-Appellant,

v.  No. 08-7139

AMY L. SMITH, Nurse,

Defendant-Appellee.



Appeal from the United States District Court

for the District of South Carolina, at Beaufort.

Henry F. Floyd, District Judge.

(9:07-cv-00275-HFF)

Argued: October 27, 2009

Decided: December 28, 2009

Before MICHAEL and GREGORY, Circuit Judges,

and Benson E. LEGG, Chief United States District Judge

for the District of Maryland, sitting by designation.

Reversed and remanded by published opinion. Judge Gregory

wrote the opinion, in which Judge Michael and Judge Legg

joined.

COUNSEL

ARGUED: Jamal Malik Edwards, KIRKLAND & ELLIS,

LLP, Chicago, Illinois, for Appellant. Samuel F. Arthur, III,

2 SMITH v. SMITH

AIKEN, BRIDGES, NUNN, ELLIOTT & TYLER, PA, Flor-

ence, South Carolina, for Appellee. ON BRIEF: William E.

Devitt, P.C., Naima Garvin, Rebecca P. Piper, KIRKLAND &

ELLIS, LLP, Chicago, Illinois, for Appellant.

OPINION

GREGORY, Circuit Judge:

Roy L. Smith ("Smith"), an inmate at the Evans Correc-

tional Institute in Bennettsville, South Carolina, filed a com-

plaint under 42 U.S.C. § 1983 alleging the defendant, Amy L.

Smith ("Nurse Smith"), exhibited deliberate indifference to

Smith’s serious medical need in violation of his Eighth

Amendment rights. The district court adopted the magistrate

judge’s report and recommendation ("R&R"), dismissing the

complaint for failure to state a claim and holding the defen-

dant had qualified immunity.

Because we find the district court erred in concluding that

Smith failed to state a claim for relief, we reverse the order

dismissing his complaint and remand the case to the district

court for further proceedings.

I.

A.

The following facts were alleged in Smith’s complaint,

which attached his prison grievance forms and medical

records. On May 18, 2006, Smith received an Order to Report

Slip ("OTR") issued by Dr. Pravin Patel for the use of gentian

violet, an antifungal agent, to treat a foot infection. Smith had

complained of bleeding and peeling of both his left and right

feet. The OTR prescribed that he should receive treatment

once a week for the next three weeks for the condition. When

SMITH v. SMITH 3

Smith went to receive treatment two days later on May 20, he

was told by a member of the prison staff that Nurse Smith, a

registered nurse at the prison, tore up the OTR which autho-

rized treatment for his condition. He did not receive the pre-

scribed medication that day. He next reported to sick call on

May 30, complaining of dry scalp and sinus problems, and

again on June 6, complaining of his continuing foot pain. He

was treated for the foot infection on June 6, but on June 13

he signed a waiver refusing to receive further treatment for

that condition.

On June 6, 2006, Smith filed a Step 1 Inmate Grievance

Form with the prison alleging that Nurse Smith tore up his

OTR and caused him to be denied the medication ordered by

Dr. Patel for fifteen days. The prison warden found that the

OTR was destroyed because it was expired and therefore

Nurse Smith had not committed any misconduct in the case.

In response to a second grievance form, the prison determined

that because Smith had refused medical treatment by a signed

waiver on June 13, he had not been denied medical care and

therefore was not entitled to relief. The prison’s institutional

grievance process was exhausted on August 29, 2006.

B.

Smith filed a pro se § 1983 complaint against Nurse Smith

in the District Court for South Carolina alleging negligence

and deliberate indifference to his medical needs on January

25, 2007. In response to the complaint, Nurse Smith filed a

motion to dismiss pursuant to Federal Rule of Civil Procedure

12(b)(6), alleging that Smith failed to exhaust his administra-

tive remedies in the prison and that she was entitled to quali-

fied immunity. She argued that even if Smith had a serious

medical condition, there was no allegation or proof that she

exhibited deliberate indifference in tearing up the OTR or that

it resulted in a denial of medical care or injury to Smith. On

June 20, 2007, the magistrate judge issued an R&R proposing

that Nurse Smith’s motion to dismiss be granted on the basis

4 SMITH v. SMITH

of qualified immunity.* The district court adopted the R&R

in its entirety on January 22, 2008. This appeal followed.

II.

This Court reviews a district court’s order granting a

motion to dismiss de novo. Schatz v. Rosenberg, 943 F.2d

485, 489 (4th Cir. 1991). A complaint should be dismissed "if

it does not allege ‘enough facts to state a claim to relief that

is plausible on its face.’" Giarratano v. Johnson, 521 F.3d

298, 302 (4th Cir. 2008) (quoting Bell Atl. Corp. v. Twombly,

550 U.S. 544, 570 (2007)). The facts alleged must be suffi-

cient "to raise a right to relief above the speculative level."

Twombly, 550 U.S. at 555. In evaluating the complaint, this

Court will "construe the factual allegations ‘in the light most

favorable to the plaintiff.’" Schatz, 943 F.2d at 489 (quoting

Battlefield Builders, Inc. v. Swango, 743 F.2d 1060, 1062 (4th

Cir. 1984)). However, "[l]iberal construction of the pleadings

is particularly appropriate where, as here, there is a pro se

complaint raising civil rights issues." Loe v. Armistead, 582

F.2d 1291, 1295 (4th Cir. 1978) (citing Haines v. Kerner, 404

U.S. 519, 521 (1972); Gordon v. Leeke, 574 F.2d 1147, 1151

(4th Cir. 1978); (additional citations omitted)).

III.

Smith argues that the district court erred in dismissing his

pro se complaint for two reasons. First, his complaint, prop-

erly construed, states a claim of deliberate indifference to his

medical needs under the Eighth Amendment. Second, the dis-

trict court improperly applied the standard in evaluating Nurse

Smith’s motion to dismiss by construing the facts in a light

most favorable to her rather than to him, the pro se plaintiff.

We agree with both rationales and discuss each in turn.

*The magistrate judge found Nurse Smith’s failure-to-exhaust argument

was without merit.

SMITH v. SMITH 5

A.

In order to state a claim under the Eighth Amendment, a

prisoner must allege that "the prison official acted with a suf-

ficiently culpable state of mind and . . . [that] the deprivation

suffered or injury inflicted on the inmate was sufficiently seri-

ous." Iko v. Shreve, 535 F.3d 225, 238 (4th Cir. 2008) (quot-

ing Williams v. Benjamin, 77 F.3d 756, 761 (4th Cir. 1996)).

The district court did not make a finding regarding whether

or not the medical need at issue was sufficiently serious to

meet the Eighth Amendment standard, and Nurse Smith con-

ceded that she did not dispute this issue in her motion before

the district court, her brief before this Court, or at oral argu-

ment. We are, therefore, only left with the task of evaluating

whether or not Smith adequately alleged deliberate indiffer-

ence on the part of Nurse Smith to satisfy the second prong

of the Eighth Amendment analysis.

The Supreme Court articulated the standard to state a claim

of deliberate indifference to serious medical needs of prison-

ers in violation of the Eighth Amendment in Estelle v. Gam-

ble, 429 U.S. 97, 104 (1976). The Court found that deliberate

indifference can be manifested in at least the following three

manners: "by prison doctors in their response to the prisoner’s

needs or by prison guards in intentionally denying or delaying

access to medical care or intentionally interfering with the

treatment once prescribed." Id. at 104-05 (citations omitted).

Smith alleged in his complaint that he was prescribed treat-

ment by Dr. Patel for his foot infection and that when he

sought to receive that treatment, he was unable to do so

because Nurse Smith ripped up the OTR, which authorized

his treatment. Under the standard outlined in Estelle, Smith

argues that this conduct meets all three of the scenarios.

Because we find that Smith has pled deliberate indifference in

the form of delay or interference with treatment once pre-

6 SMITH v. SMITH

scribed, the other form of indifference under Estelle is inap-

plicable.

In Estelle, the Supreme Court endorsed the Sixth Circuit’s

finding in Westlake v. Lucas, 537 F.2d 857 (6th Cir. 1976)

that delayed medical treatment can constitute a manifestation

of deliberate indifference. 429 U.S. at 104-05 n.11 (citing

Westlake, 537 F.2d 857). In that case, the inmate alleged that

"[a]lthough jail officials were aware of his condition [bleed-

ing ulcer] . . . they refused to grant Appellant’s requests until

ordered to do so by a doctor." Westlake, 537 F.2d at 859. The

Sixth Circuit reversed the district court’s dismissal of the

complaint, finding that the inmate had "adequately stated a

cause of action for deprivation of needed medical care . . . ."

Id. at 861.

Smith similarly stated a claim for deprivation of needed

medical care. His complaint stated that he was prescribed

medicine by Dr. Patel, and that the OTR enabling him to

receive the ordered treatment was destroyed by Nurse Smith,

ultimately depriving him of care. In pleading that Nurse Smith

destroyed the means for him to access the medical treatment

ordered by the doctor, Smith alleged facts sufficient to consti-

tute intentional denial of treatment because mere delay or

interference can be sufficient to constitute a violation of the

Eighth Amendment. Estelle, 429 U.S. at 104-05. Taking the

pleadings as true, as we are compelled to do when considering

a 12(b)(6) motion to dismiss, it is clear that Smith made out

a claim for deliberate indifference and the district court erred

in finding that Smith failed to state a claim under the Eighth

Amendment.

B.

In her motion to dismiss, Nurse Smith alleged she was enti-

tled to qualified immunity from Smith’s action, citing Harlow

v. Fitzgerald, 457 U.S. 800 (1982). Harlow held that a gov-

ernment official is entitled to qualified immunity from suit

SMITH v. SMITH 7

where "their conduct ‘does not violate clearly established stat-

utory or constitutional rights of which a reasonable person

would have known.’" Slattery v. Rizzo, 939 F.2d 213, 216 (4th

Cir. 1991) (quoting Harlow, 457 U.S. at 818). The Supreme

Court has held that where qualified immunity is at issue, a

court must first determine "whether a constitutional right

would have been violated on the facts alleged; [and] . . . sec-

ond . . . whether the right was clearly established." Saucier v.

Katz, 533 U.S. 194, 200 (2001). But see, Pearson v. Callahan,

___ U.S. ___, 129 S. Ct. 808, 818 (2009) (holding that the

rigid Saucier procedure mandating the order of inquiry is not

required in all cases).

In evaluating Nurse Smith’s motion to dismiss and her

claim to qualified immunity, the district court found that "the

general Eighth Amendment right at issue was clearly estab-

lished at the time of the events alleged in the Complaint—in

the longstanding principle that a prisoner may not be sub-

jected to deliberate indifference of a serious medical need."

Smith v. Smith, No. 9:07-cv-275, 8-9 (D.S.C. June 20, 2007)

(Kosko, Mag. J.). The district court went on to find that Smith

failed to identify where his constitutional rights were violated

based on the facts that he alleged. Specifically, the court

stated in taking all of his allegations to be true, Smith failed

to allege deliberate indifference sufficient to survive Nurse

Smith’s motion to dismiss. As previously outlined, Nurse

Smith did not contest the seriousness of Smith’s medical need

in her motion to dismiss or her brief before this Court and

conceded the point in oral argument. Nurse Smith argues that

because Smith received treatment for his condition on June 6,

and signed a waiver refusing treatment on June 13, her actions

could not have denied him medical care.

The district court erred in examining these issues of fact

articulated by Nurse Smith in her motion to dismiss because

they fall outside Smith’s complaint. Even if those facts were

contained within his medical records in their entirety, the dis-

trict court incorrectly drew an inference against Smith in find-

8 SMITH v. SMITH

ing that his refusal to receive treatment on June 13 illustrates

that Nurse Smith did not deny him care. Smith, at a minimum,

alleged that by destroying the OTR, Nurse Smith delayed his

medical care from May 20 when he sought treatment, to June

6, when he received the medication ordered by the doctor.

The length of the delay, or the institution’s role in causing the

delayed medical care are all questions of fact. Because the

court was evaluating a motion to dismiss, it should not have

looked beyond his complaint in determining whether or not

Smith stated a claim under the Eighth Amendment, and for

that reason, we find that the district court erred.

Furthermore, because the district court premised both the

grant of the motion to dismiss and qualified immunity on its

finding that Smith failed to allege deliberate indifference in

his complaint, the immunity analysis was prematurely con-

cluded on the erroneous basis that Smith did not plead facts

sufficient to indicate Nurse Smith had deliberate indifference

to his medical need. As the district court provided no addi-

tional reasoning to support qualified immunity, we reverse

that holding as well.

IV.

In light of the foregoing, we reverse the district court’s

order dismissing Smith’s complaint and granting qualified

immunity. We remand the case to the district court for further

proceedings based on Smith’s complaint.

REVERSED AND REMANDED