United States District Court, E.D. Michigan, Southern Division
DAVID L. RHINEHART and LEWIS RHINEHART, Joint Personal Representatives of the Estate of KENNETH A. RHINEHART, Deceased, Plaintiffs,
DEBRA SCUTT, et al., Defendants.
OPINION AND ORDER GRANTING DEFENDANTS' SECOND
MOTION FOR SUMMARY JUDGMENT  AND FINDING OTHER MOTIONS
STEPHEN J. MURPHY, III UNITED STATES DISTRICT JUDGE
the Court is Defendant's second motion for summary
judgment. The first was referred to the magistrate judge, who
issued a report and recommendation ("Report")
suggesting the Court deny the motion. ECF 273. The Court
adopted the Report over Defendants' objections, ECF 284,
and preparations for trial commenced. Extensive motion
practice ensued and at least one additional deposition was
taken. Also during that time, the Court of Appeals for the
Sixth Circuit issued an opinion that addressed one of the
central legal theories in this case. See Mattox v.
Edelman, 851 F.3d 583 (6th Cir. 2017),
reh'g denied (Apr. 6, 2017). Subsequent
to the decision, Defendants filed a motion for leave to file
a second motion for summary judgment in light of the
appellate decision and new testimony. The Court granted leave
and laid out the discrete issues that needed to be addressed.
Both parties filed briefs and the Court held a hearing. The
Court must grant Defendants' motion.
judgment is proper if 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 fact is material
for purposes of summary judgment if its resolution would
establish or refute an "essential element of a cause
of action or defense asserted by the parties[.]"
Kendall v. Hoover Co., 751 F.2d 171, 174 (6th Cir.
considering a motion for summary judgment, the Court must
view the facts and draw all inferences in the light most
favorable to the non-moving party. Stiles ex rel. D.S. v.
Grainger Cty., Tenn., 819 F.3d 834, 848 (6th Cir. 2016).
The Court must then determine "whether the evidence
presents a sufficient disagreement to require submission to a
jury or whether it is so one-sided that one party must
prevail as a matter of law." Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 251-52 (1986). And although
the Court may not make credibility judgments or weigh the
evidence, Moran v. Al Basit LLC, 788 F.3d 201, 204
(6th Cir. 2015), a mere "scintilla" of evidence is
insufficient to survive summary judgment; "there must be
evidence on which the jury could reasonably find for the
plaintiff, " Anderson, 477 U.S. at 252.
facts of the case have been fully set forth several times.
See, e.g., ECF 273. In very brief summary: Kenneth
Rhinehart was an inmate at a state prison in Munising,
Michigan when he was first diagnosed with End-Stage Liver
Disease (ESLD). Prison medical personnel began treating him
for the condition, but in September 2009, a CT scan revealed
some abnormal liver findings that suggested Rhinehart might
have cancer, so he was transferred to the JCF facility in
Jackson, Michigan that October to be seen by a liver
specialist or cancer specialist. The case concerns the
treatments he did and did not receive from the time of his
transfer until his death in February 2013 following hip
The Standard for Deliberate Indifference Claims
Eighth Amendment to the United States Constitution prohibits
cruel and unusual punishment and applies to the States
through the Fourteenth Amendment. Estelle v. Gamble,
429 U.S. 97, 101-02 (1976). The Supreme Court has held that
deliberate indifference to the serious medical needs of a
prisoner constitutes "unnecessary and wanton infliction
of pain" and therefore violates the Eighth Amendment.
Id. at 104. Still, this does not transform medical
malpractice claims into constitutional violations
"merely because the victim is a prisoner."
Id. at 106. Rather, "[i]n order to state a
cognizable claim, a prisoner must allege acts or omissions
sufficiently harmful to evidence deliberate indifference to
serious medical needs." Id.
prevail on a claim of deliberate indifference, a plaintiff
must satisfy objective and subjective components. Farmer
v. Brennan, 511 U.S. 825, 834 (1994). The objective
component requires the existence of a "sufficiently
serious" medical need, while the subjective component
requires that prison officials had "a sufficiently
culpable state of mind in denying medical care."
Blackmore v. Kalamazoo Cty., 390 F.3d 890, 895 (6th
Sixth Circuit "recognizes two theories under which a
plaintiff can demonstrate the objective component of an
Eighth Amendment deliberate indifference claim."
Mattox, 851 F.3d at 598. One is to show that the
medical need "has been diagnosed by a physician as
mandating treatment." Id. When proceeding under
that theory, a plaintiff must show that prison officials
either entirely failed to treat the condition, or treated it
inadequately. Blackmore, 390 F.3d at 898. In the
latter case, a plaintiff must introduce "medical
proof" that a delay in treatment caused a serious
medical injury or that "the provided treatment was not
an adequate medical treatment of his condition[.]"
Santiago v. Ringle, 734 F.3d 585, 591 (6th Cir.
2013). The other route is to show that the claimed injury or
illness was "so obvious that even a lay person would
easily recognize the necessity for a doctor's
attention[.]" Id. at 590. In those cases, the
plaintiff must simply show that he "actually experienced
the need for medical treatment, and that the need was not
addressed within a reasonable time frame." Id.
question now before the Court is whether any of the alleged
shortcomings in Rhinehart's treatment satisfy the
objective component under any theory. Plaintiffs have made
clear that they are not arguing about delays in treatment,
see ECF 349, PgID 8849, and Plaintiffs' counsel
stated flatly at oral argument that they do not claim
Rhinehart had an obvious medical need that any lay person
would recognize. So Plaintiffs have one option: they must
show that Rhinehart's needs were diagnosed by physicians
as mandating treatment and that Defendants failed to treat
him or so inadequately treated him that he suffered a
verified medical injury.
theories of liability have vacillated. But at the hearing,
Plaintiffs clarified their eight theories of liability:
Stevenson failed to make accommodations to receive Rhinehart.
Stevenson failed to ensure that Rhinehart was seen by a
specialist after he became aware of Rhinehart's arrival
Stevenson failed to create a meaningful plan of care for
Rhinehart's ESLD, including portal hypertension, ascites,
Stevenson failed to order monitoring by a gastroenterologist
after his June 2010 EGD.
Stevenson failed to request any specialist consultations
after Rhinehart's June 30th discharge.
Edelman failed to act after learning, in February 2010, that
Rhinehart had not seen the recommended specialists.
Edelman failed to approve a TIPS procedure.
Edelman failed to approve Rhinehart's requests to be seen
by a hepatologist for evaluation and treatment of his liver
disease, including consideration for a possible liver
in their case is a claim based on a delay in cancer diagnosis
or Rhinehart's fear of cancer. While the cancer claims
were a central component of the magistrate judge's
analysis on the initial summary judgment motion and in the
Court's adoption of the Report, Plaintiffs have decided
to no longer pursue them. The Court therefore considers the
claims abandoned and will review Defendants' second
motion in light of what Plaintiffs' case actually is.
Stevenson failed to make accommodations to receive Rhinehart
argue that "Stevenson was the physician assigned as
primary provider for Mr. Rhinehart" and was
"responsible for developing the initial treatment
plan" for Rhinehart after his transfer. ECF 349, PgID
8856-57. They also argue that Rhinehart was supposed to be
seen right away, since he was transferred on an
"expedited" basis. Accordingly, they fault
Stevenson for failing to make arrangements for Rhinehart to
see specialists shortly after his arrival. Defendants dispute
that Stevenson was Rhinehart's assigned physician, and
that there were "assigned physicians" at all. But
even so, they argue that Plaintiffs' claim fails because
Rhinehart was treated for his diagnosed conditions and
suffered no harm from any delay or treatment choice.
the Sixth Circuit has rejected "the notion that a prison
doctor who delays treatment may escape liability simply
because the treatment was recommended rather than prescribed,
" Santiago, 734 F.3d at 590, the court has also
emphasized that "where a prisoner has received some
medical attention and the dispute is over the adequacy of the
treatment, federal courts are generally reluctant to second
guess medical judgments and to constitutionalize claims that
sound in state tort law." Graham ex rel. Estate of
Graham v. Cty. of Washtenaw, 358 F.3d 377, 385 (6th Cir.
2004) (quoting Westlake v. Lucas, 537 F.2d 857, 860
n.5 (6th Cir. 1976)). Thus, when a deliberate-indifference
claim is "based on the prison's failure to treat a
condition adequately . . . medical proof is necessary to
assess whether the delay caused a serious medical
injury." Blackmore, 390 F.3d at 898 (citing
Napier v. Madison Cty., 238 F.3d 739, 742 (6th Cir.
2001)). When, therefore, medical personnel recommend a
specialist referral in the ongoing treatment of a diagnosed
condition, the verifying-medical-evidence requirement
applies. To conclude otherwise would undermine the body of
established case law permitting prison doctors to accept or
reject recommendations in their medical judgment. See,
e.g., Estelle, 429 U.S. at 107 (holding that
the decision not to order "additional diagnostic
techniques or forms of treatment . . . is a classic example
of a matter for medical judgment.") and Howze v.
Hickey, No. 10-CV-094-KKC, 2011 WL 673750, at *9-10
(E.D. Ky. Feb. 17, 2011) (finding no Eighth Amendment
violation when treating doctor rejected the treatment
recommendation of outside specialists).
was being treated for longstanding ESLD and Hepatitis C
before his transfer to JCF. A suspicion of cancer arose in
the course of that treatment when a CT scan revealed
"abnormal liver findings." See ECF 259-1,
PgID 4601, 4606. Rhinehart was then transferred to JCF to
allow for a further "work up" of the findings.
Id. at 4606. The medical providers' suspicion of
cancer, however, was not a new diagnosis, and their
recommendations that Rhinehart see an oncologist or
hepatologist were not "mandated treatments."
Rhinehart in ...