The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
ERIE
GALINA RYTSAR, )
)
Plaintiff ) 1:25-CV-00205-RAL
)
VS. ) RICHARD A. LANZILLO
) Chief United States Magistrate Judge
SIMEON K. OBENG, DOCTOR; )
RENEE ROCKWOOD, CRNP; AND ) MEMORANDUM OPINION ON
HARMON, (JANE) MEDICAL ) MEDICAL DEFENDANTS’ MOTION
COORDINATOR, ) TO DISMISS
Defendants RE: ECF NO. 15
Defendants have moved under Fed. R. Civ. P. 12(b)(6) to dismiss all claims of
Plaintiffs Complaint. See ECF No. 15. For the following reasons, Defendants’ motion
will be GRANTED in part and DENIED in part.
I. Relevant Procedural History
Plaintiff Galina Rytsar (“Rytsar”) is an inmate in the custody of the
Pennsylvania Department of Corrections (“DOC”) at its State Correctional Institution
at Cambridge Springs, Pennsylvania (“SCI-Cambridge Springs”). She commenced
this pro se action against Dr. Simeon, K. Obeng, PA Renee Rockwood, and Health
Services Administrator Morgan Harmon (collectively “Defendants”), three
individuals contracted to provide medical services to inmates at SCI-Cambridge
Springs. See ECF No. 6 at 1.
1 The parties have consented to the jurisdiction of a United States Magistrate Judge pursuant to 28
U.S.C. § 636(C).
Rytsar’s Complaint asserts an Eighth Amendment claim against all
Defendants based on their alleged deliberate indifference to her serious medical
needs and a Fourteenth Amendment substantive due process claim against
Defendants Obeng and Rockwood based on their alleged failure to disclose the side
effects and risks associated with medication they prescribed for her. As relief, the □
Complaint seeks nominal and punitive damages and a declaration that the
Defendants’ acts and omissions violated Rytsar’s rights under the U.S. Constitution.
The Complaint does not request compensatory damages. Defendants have moved to
dismiss all claims against them pursuant to Fed. R. Civ. P. 12(b)(6). ECF No. 15.
The motion has been fully briefed and is ripe for disposition. See ECF No. 16
(Defendants’ brief in support); ECF No. 21 (Rytsar’s brief in opposition).
Il. Standard of Review
A motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6) tests
the legal sufficiency of the complaint. Kost v. Kozakiewicz, 1 F.3d 176, 183 (8d Cir.
1993). In deciding a Rule 12(b)(6) motion to dismiss, the court must accept as true
all factual allegations of the complaint and views them in a hight most favorable to
the plaintiff. See Phillips v. Cnty. of Allegheny, 515 F.3d 224, 228 (3d Cir. 2008)
(citing Worldcom, Inc. v. Graphnet, Inc., 343 F.3d 651, 653 (8d Cir. 2003). In making
its determination under Rule 12(b)(6), the court is not opining on whether the
plaintiff is likely to prevail on the merits; rather, the plaintiff must only present
factual allegations sufficient “to raise a right to relief above the speculative level.”
Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 556 (2007) (citing 5 C. Wright & A.
Miller, Federal Practice and Procedure § 1216, pp. 235-36 (8d ed. 2004)).
Furthermore, a complaint should only be dismissed pursuant to Rule 12(b)(6) if it
fails to allege “enough facts to state a claim to relief that is plausible on its face.” Id..
at 570.
While a complaint does not require detailed factual allegations to survive a
motion to dismiss, it must provide more than labels and conclusions. Id. at 555. A
“formulaic recitation of the elements of a cause of action will not do.” Id. (citing
Papasan v. Allain, 478 U.S. 265, 286 (1986)). Moreover, a court need not accept
inferences drawn by a plaintiff if they are unsupported by the facts alleged in the
complaint. See Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). Nor must the court accept
legal conclusions disguised as factual allegations. See Twombly, 550 U.S. at 555;
McTernan v. City of York, Pennsylvania, 577 F.3d 521, 531 (8d Cir. 2009) (“The tenet
that a court must accept as true all of the allegations contained in a complaint is
inapplicable to legal conclusions.”).
Finally, because Rytsar is proceeding pro se, her Complaint will be held to “less
stringent standards than formal pleadings drafted by lawyers.” Haines v. Kerner,
404 U.S. 519, 520-521 (1972). If the Court can reasonably read his pro se pleading to
state a valid claim upon which relief can be granted, it will do so despite his failure
to cite proper legal authority, confusion of legal theories, poor syntax and sentence
construction, or unfamiliarity with pleading requirements. See Boag v. MacDougall,
454 U.S. 364 (1982); United States ex rel. Monigomery v. Bierley, 141 F.2d 552, 555
(3d Cir. 1969). But “any pleading must still contain sufficient factual allegations that,
when accepted as true, ‘state a claim to relief that is plausible on its face.” Heffley v.
Steele, 2019 WL 5092127, at *4 (W.D. Pa. Oct. 11, 2019), aff'd, 826 Fed. Appx. 227
(3d Cir. 2020) (citations omitted).
Ill. Factual Allegations and Claims
For purposes of the pending motion to dismiss, the Court accepts as true the
following factual allegations of the Complaint. In December 2019, Rytsar complained
to Defendant Rockwood that she was experiencing chest pains. ECF No. 6, { 5.?
Rockwood prescribed Coumadin, a blood thinner. He explained that Rytsar was □
experiencing chest pain “because her blood was too thick” and was preventing
adequate oxygen to her heart. Rockwood did not inform her of the side effects, risks,
or symptoms to look out for if the dosage of Coumadin was incorrect or discuss
medications that should not be taken while she was on Coumadin.
Sometime in 2023, Defendant Obeng changed the strength of her Coumadin,
allegedly without her consent and without warning her about potential side effects or
risks. On August 15, 2023, Rytsar noticed a large unexplained bruise on her thigh
area. Thereafter, Rytsar developed more bruising on her body and suffered from nose
bleeds. Rytsar then began developing joint pain in her ankles and wrists as well as
experiencing dizziness and periodic blackening in her vision. By early September
2023, Rytsar became concerned because she was experiencing extreme weakness and
pain as well as swelling to her arms and legs making it difficult for her to walk or use
her hands.
2 The relevant factual allegations are set out in paragraphs 5-21 of Rytsar’s Complaint (ECF No. 6).
Citations to the pleading are omitted except for quoted allegations.
On September 5, 2023, Rytsar went for her monthly International Normalized
Ratio or “INR” test to measure her clotting time, but the nurse could not get a
readable result despite several tries on two different machines. The nurse informed
Rytsar that her blood was too thin to allow a readable result. Rytsar then showed
the nurse the bruising on her body and notified her of the extreme weakness she was
feeling and pain she was experiencing in her ankles and wrists. The nurse attempted
to reach Obeng three times but was unsuccessful; she recommended that Rytsar
refuse her Coumadin because she believed it was causing her symptoms.
On September 6, 2023, Rytsar placed a sick call regarding the pain and
swelling she was experiencing and expressed concerns of developing blood clots. .
Defendant Harmon failed to schedule an appointment for her to be seen by medical.
By the evening of September 7, 2023, Rytsar had not heard from medical, and she
spoke to a sergeant on duty and explained her symptoms. The sergeant called
medical and sent Rytsar to be seen by two nurses on duty. The nurses stated they
were unable to do anything without the approval of Dr. Obeng, who had already left
for the evening. The nurses informed Rytsar that they would call her the following
day, however, she was not seen or called.
Rytsar conducted her own research using the library at SCI-Cambridge
Springs and discovered that Coumadin should not be taken with Zoloft, the blood
pressure medication she was currently prescribed. If Rytsar had been informed of
the risks and symptoms associated with Coumadin, she would have refused to take
and thereby avoided the suffering and discomfort she had experienced.
Based on the foregoing alleged facts, Rytsar asserts two distinct but related
constitutional claims: (1) an Eighth Amendment claim against all Defendants based
on alleged deliberate indifference to her serious medical needs; and (2) a Fourteenth
Amendment substantive due process claim against Defendants Rockwood and Obeng
_ based on their alleged failure to inform her of the risks, contraindications, and side
effects of Coumadin. In support of their motion to dismiss these claims, Defendants
argue that (1) Rytsar is barred from recovering monetary damages because she did
not request them in any of her prison grievances; (2) Rytsar’s Complaint fails to state
a claim under the Eighth Amendment because the facts alleged do not support a
finding that any Defendant acted with deliberate indifference to her medical needs;
and (3) Rytsar’s Fourteenth Amendment claim fails because federal law does not
recognize a prisoner’s right to informed consent to prescription medication.
IV. Discussion and Analysis
A. Rytsar procedurally defaulted her claims for compensatory, nominal,
and punitive damages by failing to request such relief in her grievances,
but she did raise and preserve her demand for declaratory relief.
Defendants argue that Rytsar is precluded from recovering monetary damages
in this lawsuit because she did not request such relief any administrative grievance
submitted at the prison. Under the Prison Litigation Reform Act (“PLRA”),
3 In support of this position, Defendants have attached Rytsar’s grievance history, copies of her
grievances and appeals, and an affidavit to their brief in support of their motion to dismiss. See ECF
Nos. 16-2, 16-3. This Court normally does not permit a defendant asserting an administrative
exhaustion affirmative defense in a motion under Rule 12(b)(6) to rely on materials outside the
pleadings unless the defendant moves in the alternative for summary judgment and complies with the
requirements of Western District of Pennsylvania Local Civil Rule 56.C, including the requirement
that the motion be accompanied by a concise statement of material facts. This requirement is intended
to ensure that a plaintiff has a fair and procedurally proper means to contest the factual assertions
upon which the defendant relies in support of the affirmative defense. Here, however, Rytsar has
prisoners complaining about the conditions of their confinement must exhaust
available administrative remedies before they file suit in federal court. 42 U.S.C. §
1997e(a). The PLRA requires proper exhaustion, meaning plaintiffs must
administratively grieve their claims in accordance with the procedural rules of the
prison in which they are incarcerated. Downey v. Pennsylvania Dep’t of Corr., 968
F.3d 299, 305 (8d Cir. 2020) (citing Woodford v. Ngo, 548 U.S. 81, 88 (2006)). Courts
do not have discretion to waive or excuse this statutory requirement, even in “special
circumstances,” unless administrative remedies were “unavailable” to the plaintiff.
See Ross v. Blake, 578 U.S. 632 (2016). Failure to exhaust administrative remedies
is an affirmative defense that the defendant plead and prove. Jones v. Bock, 549 U.S.
199, 216 (2007). When properly raised, exhaustion presents a threshold issue that
the Court must resolve before addressing the merits of a prisoner's claims. See
Rinaldi v. United States, 904 F.3d 257, 265 (8d Cir. 2018).
The DOC’s general grievance policy, DC-ADM 804, applies to most inmate
complaints and concerns regarding prison conditions. Among other requirements, it
specifies that “lijf the inmate desires compensation or other legal relief normally
available from a court, the inmate must request the specific relief sought in his/her
initial grievance.” DC-ADM 804 (A)(11)(d). An inmate who fails to request monetary
relief in her grievance in accordance with this provision has procedurally defaulted
conceded that she did not request monetary damages in any of her grievances. See ECF No. 21 § 7.
Accordingly, the Court will address Defendants’ failure-to-exhaust defense despite their having relied
upon outside material to support their motion to dismiss.
her claim as to such damages and may not recover them in a subsequent lawsuit. See
Spruill v. Gillis, 372 F.3d 218, 233-235 (3d Cir. 2004).
Rytsar acknowledges that she did not request compensatory damages in any
of her prison grievances and that she is therefore precluded from recovering such
damages in this case. See ECF No. 21, 7. Indeed, her Complaint does not request
compensatory damages. See ECF No. 6 at 6. But her Complaint does demand
nominal and punitive damages. Jd. “The primary purpose of nominal damages in
[civil rights] cases is thus to guarantee that a defendant’s breach of these duties will
remain actionable regardless of their consequences in terms of compensable
damages.” Amato v. City of Saratoga Springs, 170 F.3d 311, 318 (2d Cir. 1999). They
satisfy the redressability element of Article III standing “even if [the plaintiff] cannot
or chooses not to” seek other damages. Uzuegbunam v. Preczewski, 592 U.S. 279, 290-
93 (2021). The Court of Appeals for the Third Circuit has yet to address whether an
inmate’s failure to request nominal damages in a grievance precludes their recovery
in a subsequent lawsuit. But several district courts within the Third Circuit have
addressed the issue and held that nominal damages are not recoverable absent a
request for monetary relief in an applicable grievance. See e.g., Zhinin v. Booher,
2026 WL 2280767, at *3 n.5 (M.D. Pa, Aug. 7, 2026) (collecting cases). As the court
in Zhinin observed, “[t]o permit an unexhausted, stand-alone claim for nominal
damages could invite plaintiffs to sue in federal court without completing exhaustion □
in any form or even attempting to do so” and thereby “frustrate the purposes of the
PLRA’s exhaustion requirement, which include giving the responding agency “an
opportunity to correct its own mistakes ... before it is haled into federal court.” Id.
(citing Woodford, 548 U.S. at 88-90). The same applies to Rytsar’s claim for punitive
damages. See Brown v. Caison, 2026 WL 701562, at *3 (M.D. Pa. Mar. 12, 2026);
Young v. Walters, WL 2970241, at *5 (W.D. Pa. Aug. 5, 2025), report and
recommendation adopted, 2025 WL 2970237 (W.D. Pa. Oct. 21, 2025). Because
Rytsar failed to request monetary relief in any form during the administrative
grievance process, she did not properly exhaust a claim for compensatory, nominal,
or punitive damages and is precluded from recovering any such damages in this case.
In Grievance No. 1054371, Rytsar did request “a change in medication” and
changes to medical department procedures regarding her care. See ECF 16-3 at 6.
These requests are essentially demands for declaratory relief that Rytsar exhausted
them through the grievance process. Rytsar has therefore preserved her right to
demand declaratory relief in this action. Thus, while Rytsar may not pursue claims
for compensatory, nominal, or punitive damages in this action, her surviving claim
for declaratory relief necessitates that the Court address the merits of her Eighth and
Fourteenth Amendment claims.
B. The Complaint fails to state a claim under the Eighth Amendment.
The Eighth Amendment’s prohibition of cruel and unusual punishment
extends to prison officials’ “deliberate indifference” to inmates’ “serious medical
needs.” See Estelle v. Gamble, 429 U.S. 97 (1976) (stating that “deliberate indifference
to serious medical needs of prisoners constitutes the unnecessary and wanton
infliction of pain proscribed by the EHighth Amendment”) (internal quotation omitted).
To state a claim for violation of her Eighth Amendment right to medical care, Rytsar
must allege facts to support findings that: (1) she had a serious medical need, and (2)
the Defendant prison officials acted with deliberate indifference to that need. See
Rouse v. Plantier, 182 F.3d 192, 197 (8d Cir. 1999). A serious medical need is “one
that has been diagnosed as requiring treatment or one that is so obvious that a lay
person would easily recognize the necessity for a doctor’s attention.” Walker v.
Brooks, 2009 WL 3183051 (W.D. Pa. Sept. 30, 2009) (citing Monmouth County
Correction Institute Inmates v. Lanzaro, 834 F. 2d 326,347 (3d Cir. 1987)). See also
Colburn v. Upper Darby Township, 946 F.2d 1017, 1023 (8d Cir. 1991) (observing that
a serious medical need exists when “a failure to treat can be expected to lead to
substantial and unnecessary suffering, injury, or death”). A prison official acts with
deliberate indifference to a prisoner’s medical need when he or she “knows of and
disregards an excessive risk to inmate health or safety.” Farmer v. Brennan, 511 U.S.
825, 837 (1994). Such indifference may be manifested by an intentional refusal to
provide care, delayed medical treatment for non-medical reasons, denial of prescribed
medical treatment, a denial of reasonable requests for treatment that results in
suffering or risk of injury, Durmer v. O’Carroll, 991 F.2d 64, 68 (8d Cir. 1993), or
“persistent conduct in the face of resultant pain and risk of permanent injury.” White
v. Napoleon, 897 F.2d 1038, 109 (8d Cir. 1990).
The Complaint alleges facts sufficient to support the “serious medical need”
element of Rytsar’s Eighth Amendment claim. It alleges that in 2019, Rytsar
presented to Dr. Rockwell with chest pains that he diagnosed as having been caused
10
by a blood condition. To treat this condition, Dr. Rockwell prescribed Coumadin, a
medication that Rytsar continued to take until at least 2023, when Dr. Obeng
adjusted her dosage. Rytsar’s allegations thus support that she presented with and
continued to have a medical condition that required ongoing medical treatment.
Defendants do not appear to contest this element of the claim.
Defendants’ principal challenge is the sufficiency of the allegations to support
a plausible inference that any Defendant acted with the deliberate indifference to
Rytsar’s medical need. Allegations of deliberate indifference must satisfy “a high
threshold.” Anderson v. Bickell, 2018 WL 5778241, at *2 (8d Cir. Nov. 2, 2018).
“[P]rison authorities are accorded considerable latitude in the diagnosis and
treatment of prisoners,” Durmer, 991 F.2d at 67, and “it is well-settled that an
inmate’s dissatisfaction with a course of medical treatment, standing alone, does not
give rise to a viable Eighth Amendment claim,” Tillery v. Noel, 2018 WL 3521212, at
*5 (M.D. Pa. June 28, 2018) (collecting cases), report and recommendation adopted,
2018 WL 3518459 (M.D. Pa. July 20, 2018). Similarly, “the mere misdiagnosis of a
condition or medical need, or negligent treatment provided for a condition, is not
actionable as an Eighth Amendment claim because medical malpractice standing
alone is not a constitutional violation.” Tillery, 2018 WL 3521212, at *5 (citing
Estelle, 429 U.S. at 106). Based on these principles, “courts have consistently rejected
Eighth Amendment claims where an inmate has received some level of medical care.”
Clark v. Doe, 2000 WL 1522855, at *2 E.D. Pa. Oct. 13, 2000).
11
As to each of the Defendants, the allegations of the Complaint fail to meet the
high bar necessary to support an inference of deliberate indifference. As to Defendant
Harmon, Rytsar alleges only that she failed to schedule her to be seen after she
submitted a sick-call request on September 6, 2023. ECF No. 6, §{ 16-17. Harmon,
however, is a healthcare services administrator, not a medical provider. Non-medical
prison officials generally are entitled to rely upon the professional judgment of
treating medical personnel and cannot be held liable under the Eighth Amendment
merely because they fail to intervene in an inmate’s medical treatment. Durmer, 991
F.2d at 68; Spruill v. Gillis, 372 F.3d 218, 236 (8d Cir. 2004). Liability attaches only
where the non-medical official has actual knowledge or reason to believe that medical
staff are mistreating or refusing to treat the inmate. Spruill, 372 F.3d at 236. The
Complaint acknowledges that Rytsar was consistently under the care of prison
medical staff. Although Rytsar alleges that Harmon did not promptly schedule an
appointment after she submitted a sick-call request, this allegation does not support
an inference that Harmon interfered in her treatment or consciously disregarded a
substantial risk to health or safety. The Complaint therefore fails to state an Eighth
Amendment claim against Harmon.
The allegations of the Complaint also fail to state an Eighth Amendment
deliberate indifference claim against Defendants Rockwood and Obeng. Rytsar
alleges that Rockwood prescribed Coumadin in 2019 for chest pain and that Obeng
later adjusted the medication’s dosage without her consent. She further alleges that
neither physician adequately warned her about Coumadin’s risks, potential side
12
effects, or interactions with other medications, and that after the dosage change, she
developed bruising, nosebleeds, weakness, joint pain, dizziness, and swelling. Rytsar
alleges that she would have refused the medication had she been informed of its risks.
As a threshold matter, these allegations belie any denial of care by Rockwell
or Obeng. The allegations support that Rockwell and Obeng treated Rytsar’s
condition by prescribing anticoagulation medication and that they or other medical
personnel periodically monitored the effects of that medication through INR testing.
Instead, Rytsar faults both Rockwell and Obeng for not explaining the potential side
effects, risks, and drug interactions associated with Coumadin and, perhaps, for
inadequate monitoring of her condition and calibration of her dosage. But these are
allegations of negligent care, not deliberate indifference, and as such, they are
insufficient to support an Eighth Amendment claim. See Estelle, 429 U.S. at 106
(“Medical malpractice does not become a constitutional violation merely because the
victim is a prisoner.”); Brown v. Borough of Chambersburg, 903 F.2d 274; 278 (8d Cir.
1990) (“[A]s long as a physician exercises professional judgment his behavior will not
violate a prisoner’s constitutional rights.”); James v. Pa. Dep’t of Corr., 230 Fed. Appx.
195, 197 (8d Cir. 2007) (holding that disagreement with the course of treatment does
not establish deliberate indifference).
Because the Complaint alleges, at most, negligence or medical malpractice in
prescribing and monitoring Rytsar’s Coumadin, it fails to state an Eighth
Amendment claim against Rockwood or Obeng.
13
C. The Complaint states a Fourteenth Amendment substantive due
process claim for declaratory relief.
Rytsar bases her Fourteenth Amendment claim on Rockwell and Obeng’s
alleged failure to inform her of the potential side effects, risks, and drug interactions
associated with Coumadin. In support of dismissal of this claim, Defendants argue
that “[t]here is no federal informed consent statute or requirement.” ECF No. 16,
p. 10. This position, however, ignores federal precedent holding that under the Due
Process Clause of the Fourteenth Amendment, prisoners “retain a limited right to
refuse treatment and a related right to be informed of the proposed treatment and
viable alternatives.” White v. Napoleon, 897 F.2d 103, 112-114 (8d Cir. 1990)
(discussing that pursuant to the Due Process Clause of the Fourteenth Amendment,
“[p]risoners have a right to such information as is reasonably necessary to make an
informed decision to accept or reject proposed treatment, as well as a reasonable
explanation of the viable alternative treatments that can be made available in a
prison setting”); see also Benson v. Terhune, 304 F.3d 874, 884-885 (9th Cir. 2002)
(discussing the Third Circuit's recognition of the right to medical information as set
forth in Napoleon and describing it as a “reasonable application of Supreme Court
precedent”); Pabon v. Wright, 459 F.3d 241, 246 (2d Cir. 2006) (discussing 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”). This precedent recognizes that a prison medical provider's
14
failure to provide such information and obtain informed consent to treatment may
support a substantive due process claim.4 __
To state an informed consent substantive due process claim, the plaintiff must
allege “(1) [she] was deprived of information that a reasonable patient would deem
necessary to make an informed decision about [her] medical treatment, (2) the
defendant(s] acted with deliberate indifference to [her] right to refuse treatment, and
(8) if [she] had received the information, [she] would have refused the treatment.”
Farmer-Shaw v. Wetzel, 2026 WL 101475, at *6 (W.D. Pa. Jan. 14, 2026) (quoting
Knight v. Grossman, 942 F.3d 336, 344 (7th Cir. 2019)). If the plaintiff establishes
that her right to informed consent has been violated, the court must then “take the
second and final step of balancing the prisonev’s right to informed consent against
countervailing state interests.” Id. “Liability arises only if, in the end, the prisoner’s
right outweighs the state interests.” Id.
As previously discussed, Rytsar’s allegations do not support an Eighth
Amendment cruel-and-unusual-punishment claim. But this does not foreclose an
informed consent substantive due process claim because the elements of the two
claims differ materially. The District Court for the Eastern District of Pennsylvania
explained these differences as follows:
4 The Supreme Court held that “[w]here a particular Amendment provides an explicit textual source
of constitutional protection ... that Amendment, not the more generalized notion of substantive due
process, must be the guide for analyzing these claims.” County of Sacramento vu. Lewis, 523 U.S. 833,
842 (1998) (citing Graham v. Connor, 490 U.S. 386, 395 (1989)). While recognition of a substantive
due process claim based on lack of medical informed consent may appear to be at odds with this holding
given the applicability of the Eighth Amendment to most prison medical claims, a lack of informed
consent claim has been found to be sufficiently distinct and grounded in due process to stand on its
own. See Quarles v. Bontempo, 2025 WL 1822675, at *7 (H.D. Pa. July 2, 2025), reconsideration
denied, 2025 WL 2837737 (B.D. Pa. Oct. 7, 2025).
15
When considering inmate medical claims premised upon
an alleged failure to inform, as well as deliberate
indifference to medical needs, it is important to note that
the contours of these two constitutional rights differ, and
conduct which may not violate the Eighth Amendment
might still deny an inmate his substantive due process
right to refuse certain forms of treatment. For example, an
inmate suffering from cancer may be presented with a
series of treatment options, some of which involve invasive
surgery and removal of body organs, while other forms of
treatment may be less radical and invasive. A
disagreement between the prisoner and his doctors
regarding which treatment option to pursue, standing
alone, may not constitute an Eighth Amendment violation.
See e.g., Gause v. Diguglielmo, 339 F. App'x 132 (8d Cir.
2009) (dispute over choice of medication does not rise to the
level of an Eighth Amendment violation). However, if
prison doctors unilaterally took it upon themselves to_
conduct surgery without ‘the inmate's knowledge or
consent, that action might still violate the substantive due
process rights of the prisoner, even if the surgery fell
within the range of medical treatment options permitted
under the Eighth Amendment. Pabon v. Wright, 459 F.3d
241, 250 (2d Cir. 2006); White v. Napoleon, 897 F.2d 103,
111 (8d Cir. 1990). Yet, while the contours of these two
constitutional claims differ, both claims share a common
element of intent, and require a showing of deliberate
indifference to establish liability. Further, cases construing
the reach of both the Eighth Amendment and substantive
due process protections in a prison setting consistently hold
that mere negligence cannot be equated with deliberate
indifference.
Mercaldo v. Fisher, 2017 U.S. Dist. LEXIS 14769 at *22-23 (M.D. Pa. Feb. 1, 2017).
Rytsar alleges that Rockwell and Obeng failed to inform her of the side effects
and risks associated with Coumadin, including unusual or excessive bruising, nose
bleeds, dizziness or weakness, and vision changes.5 She further alleges that she
5 Manufacturer and government disclosures list bleeding as the most common and serious potential
side effect of taking Coumadin (warfarin). See e.g., https:/www.google.com/search?g=Bristol-
Myers+Squibb+Coumadin+tside+effects+disclosure&rlz=1C1GCHU_enUS887US887&o0q=Bristol-
16
developed joint pain in her ankles and wrists, dizziness, extreme weakness and pain
and swelling in her arms and legs, and periodic “blackening” in her vision. Rytsar’s
allegations plausibly support that the side effects and risks associated with
Coumadin represented information that a reasonable patient would deem necessary
to make an informed decision about whether to take the medication. And Rytsar
alleges that had she received this information, she would have refused Coumadin.
The critical question presented by Defendants’ motion is whether the facts
alleged in the Complaint support a plausible inference that Rockwell or Obeng “acted
with deliberate indifference to [Rytsar’s] right to refuse treatment.” Knight, 942 F.3d
at 344. -Ultimately, their conduct must be sufficiently egregious that it “shocks the
conscious of the court.” County of Sacramento v. Lewis, 523 U.S. 833, 847 n.8 (1998).
“The context of the Government’s conduct is essential to determine whether it shows
the requisite deliberate indifference that ‘shocks the conscience’ for a substantive due
process violation.” Hope v. Warden York Cnty. Prison, 972 F.3d 310, 330 (8d Cir.
2020) (quoting Lewis, 523 U.S. at 486). Relevant here, a prison official is deliberately
indifferent to a prisoner’s right to refuse treatment if the official “subjectively knows
... that the [prisoner] would want to know the medical information being withheld in
order to decide whether to refuse the treatment.” Knight, 942 F.3d at 343. In other
words, the prisoner must show the official “acted with the intent to induce [the
Myers+Squibb+Coumadin+side+effects+disclosure&gs lerp=EgZiaHJvbWUyBegAEEUYOdIBCTI50
DQ0ajBqOagCALACAQ &sourceid=chrome&ie=UTF-8 . Consistent with Rytsar’s allegations,
bleeding risk is reported to manifest in various ways, including excessive bruising, nose bleeds,
dizziness or weakness, and vision changes. Id.
17
prisoner] to undergo treatment that he otherwise might have declined.” Pabon, 459
F.3d at 254.
According to the Complaint, neither Rockwell nor Obeng disclosed to Rytsar
the potential side effects, risks, or adverse drug interactions associated with
Coumadin or advised her to the physical signs that would alert her to an adverse
reaction to the medication. The Complaint supports a plausible inference that
Rockwell and Obeng, as physicians, knew of the drug’s potential side effects, risks,
and adverse drug interactions and knew that a reasonable patient would need to
know this information in making an informed decision regarding the drug. And the
Court accepts, as it must, Rytsar’s allegation that she would have declined the drug
had she known this information.* Although Obeng is not alleged to have had any
involvement in the initial prescribing of Coumadin to Rytsar in 2019, he is alleged to
have increased her dosage in 2023. The same need for information underlying a
patent’s initial decision to take a medication would apply to her decision whether to
accept an increased dosage of the same medication. Based on these alleged facts, the
Complaint supports a plausible inference that both Rockwell and Obeng acted with
deliberate indifference to Rytsar’s right to refuse Coumadin. This conclusion is not
inconsistent with the Court’s prior holding that neither Rockwell nor Obeng acted
6 The Court acknowledges that, according to the Complaint, Rockwell prescribed Coumadin in 2019
based on Rytsar’s complaints of chest pains and that Rytsar apparently continued the medication for
almost four years before she experienced any adverse side effects. The Complaint does not allege any
facts to indicate that the drug failed to address the condition that caused her chest pains. It was only
after her dosage was adjusted in 2023, that she experienced side effects. Thus, it appears that the
drug served its intended therapeutic purpose and only caused adverse side effects after the dosage was
adjusted. The Court also notes that the Complaint acknowledges that medical personnel periodically
tested the coagulation factor of Rytsar’s blood, apparently as a precaution based on her use of
Coumadin.
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with deliberate indifference to Rytsar’s serious medical need. The deliberate
indifference element of a Fourteenth Amendment substantive due process claim
focuses on the patient’s right to decline treatment. In contrast, the deliberate
indifference inquiry under the Eighth Amendment focuses on the patient’s overall
care for her serious medical need. Although the decision to prescribe Coumadin for
Rytsar’s condition was a legitimate exercise of Defendants’ medical judgment,
Rockwell and Obeng’s alleged failure to advise her of the risks of the drug may still
be found to have been deliberately indifferent to her right to decline to take it.
The Court’s finding that Rytsar’s allegations are adequate to support the
deliberate indifference element of her Fourteenth Amendment claim against
Rockwell and Obeng does not end the inquiry. A prisoner’s right to informed consent
must still be balanced “against countervailing state interests.” Knight, 942 F.3d at
344. But the Court presently lacks information necessary to balance these interests.
The Complaint does not disclose the seriousness of the condition that prompted
Rockwell to prescribe Coumadin or Obeng to alter its dosage. Such information and
other factors may be relevant to the balancing element of the claim. Based on the face
of the Complaint alone, the Court cannot say that the Commonwealth’s interests
outweigh Rytsar’s right to informed consent.
Accordingly, Defendants’ motion to dismiss will be denied as to Rytsar’s
Fourteenth Amendment substantive due process claim. As previously explained,
however, Rytsar’s only potential remedy based on this claim is declaratory relief.
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V. Conclusion
For the foregoing reasons, Defendants’ motion to dismiss will be granted in
part and denied in part. The motion will be granted to the extent Rytsar’s Complaint
seeks any form of monetary damages, including nominal or punitive damages, and to
the extent it asserts an Eighth Amendment claim against the Defendants based on
deliberate indifference to Rytsar’s serious medical needs. The motion will be denied
only to the extent the Complaint asserts a substantive due process claim and seeks
declaratory relief based on Defendant Rockwell and Defendant Obeng’s alleged
failure to inform Rystar of the side effects, risks, and adverse drug interactions
associated with their prescribing of Coumadin. .
A separate Order will follow.
DATED this 28th day of August, 2026.
BY THE COURT:
CHIEF UNITED STATES MAGISTRATE JUDGE □
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