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Does Wait and See Allow Prison Officials Qualified Immunity?

The following summary involves a Nevada state court prisoner who brought federal claims against numerous prison officials under 42 U.S.C. § 1983 for violating the U.S. Constitution in acting with “deliberate indifference” to his “serious medical needs.”  Because the matter was ultimately reviewed by the U.S. Court of Appeals for the Ninth Circuit, the ruling is binding over California prisons and thus, we present it herein. 
Brief Synopsis: A “wait and see” approach toward a prisoner’s medical condition did not necessarily exclude prison officials from qualified immunity for negligent acts, but in the following case, such an approach was not eligible for such immunity and at some point becomes “deny and delay” in violation of the prisoner’s constitutional right against cruel and inhuman treatment.    
Mr. Lewis Stewart was a prisoner at the Southern Desert Correctional Center (SDCC), a state prison in Clark County, Nevada, about 25 miles northwest of Las Vegas.  While housed there, he began to feel “discomfort in his lower abdominal and back area.”  He filed numerous written requests with the prison staff for medical treatment and care.  His pain was so severe that his urination was limited to short and irregular urine flows and after he did so, he would curl up in a fetal position to alleviate his pain.  After a long delay, he was seen by two medical staff and given some generic medication and sent on his way.

However, neither the pain nor the inability to urinate went away.  Sometime between 2013 and 2015, his urethra, testicles and abdominal area grew inflamed.  More written requests for treatment were made by Mr. Stewart, but nothing changed.

In 2015, he was transferred to Warm Spring Correctional Center (WSCC).  The ride lasted eight hours.  When he arrived, he appeared “pale, flushed, sweating and unbalanced.”  The medical staff at WSCC initiated “emergency medical care,” including an immediate catheterization “to drain Stewart’s urinary retainer.”  That process drained more than six liters, or fourteen pounds, of fluid from his bladder and urinary system.

He was then seen by three urologists, including two outside specialists, and underwent surgery for a transurethral resection of his prostate.  Despite such treatment, he now has stage 3 kidney disease, erectile dysfunction due to the prostrate tissue cavity, urine build up and pain from the prostatectomy.

Mr. Stewart then filed grievances against SDCC related to his care.  Those grievances were denied, so he then brought multiple claims against prison officials at SDCC.  The U.S. District Court in Nevada screened the claims and reduced them down to just two claims of deliberate indifference to serious medical needs.  The remaining two officials then brought motions for summary judgment, arguing that they were entitled to qualified immunity.  The District Court judge disagreed.

The two SDCC employees appealed to the U.S. Court of Appeals for the Ninth Circuit in San Francisco in Lewis Stewart v. Romeo Aranas; James Cox, et al.  

The Ninth Circuit explained that for Stewart to prevail on his “deliberate indifference” to “serious medical needs claim,” he had to show that: (1) the officials violated a constitutional right; and (2) the right was clearly established at the time of the violation.  Hamby v. Hammond (9th Cir., 2016) 821 F. 3d 1085, 1090.

In this case, the Ninth Circuit noted that both sides agreed the officials violated a constitutional right, but the second prong of Hamby would be determined by whether qualified immunity applied.  Horton by Horton v. City of Santa Maria (9th Cir., 2019) 915 F.3d 592 602.

Here, prison officials claimed that no clearly established law barred their “wait and see” treatment plan for Stewart’s enlarged prostate.  The Ninth Circuit agreed that no case addresses such a wait and see approach, but noted that “deny[ing], delay[ing] or intentionally interfere[ing] with medical treatment” can violate the constitution.  Colwell v. Bannister (9th Cir., 2014) 763 F. 3d 1060, 1066.  At some point, “wait and see” becomes deny and delay. 

Indeed, Stewart’s condition worsened, but prison officials never deviated from their “wait and see” plan.  A delay in treatment can violate the constitution if it results in injury.  See Shapley v. Nev. Bd. of State Prison Comm’rs (9th Cir. 1985) 766 F. 2d 404, 407.  Besides, prison officials violate the constitution when they persist in a treatment that they know is ineffective.  See Snow v. McDaniel (9th Cir., 2012) 681 F. 3d 978, 988.
Therefore, prison officials were not entitled to qualified immunity.

The citation for the United States Court of Appeal for the Ninth Circuit ruling discussed above is Lewis Stewart v. Romeo Aranas, et al. (9th Cir., 2022) 3:17-cv-00132-MMD-CBC.

For more information about qualified immunity of government officials, please click on the following articles:
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