Indiana Supreme Court 2024 commentary on “deliberate indifference” standard in correctional litigation

Courts are inundated with lawsuits by incarcerated individuals who allege their prison-based medical providers violated the 8th Amendment under the United States Constitution when they failed to provide adequate health care. While the vast majority of these claims proceed through federal court, many proceed through the Indiana state court system.

To prevail on an 8th Amendment claim, the offender must prove, among other things, that the medical provider was “deliberately indifferent” to a “serious medical need.” This requires an inmate to prove 1) an objectively “sufficiently serious” medical need that has either been diagnosed by a physician as mandating treatment or is so obvious that a lay person would perceive the need for a doctor’s attention, and 2) that the defendant knew of a substantial risk of harm to the inmate and disregarded the risk.

The Indiana Supreme Court recently addressed the deliberate indifference standard and the burden on an inmate- to overcome a motion for summary judgment in Zaragoza v. Wexford of Ind., LLC, 225 N.E.3d 146 (Ind. 2024). Plaintiff Edward Zaragoza brought claims of medical malpractice and deliberate indifference for the care he received at Wabash Valley Correctional Facility. Plaintiff suffers from hypothyroidism and was prescribed Synthroid® in prison, which caused side effects. He claimed that the denial of his requests for alternative medications was a violation of his 8th Amendment rights.

Defendants – three providers and their employer – moved for summary judgment. All three providers claimed that they prescribed Synthroid^®, which Plaintiff refused to take. They opined that Plaintiff’s complaints were symptoms of his under-medicated condition, not adverse reactions attributable to the Synthroid^®. All three testified, as medical experts, that they provided appropriate treatment within the standard of care.

Plaintiff countered this motion for summary judgment with an affidavit from an independent family medicine physician, who reviewed his records and testified that Plaintiff’s hypothyroidism was a “serious medical condition,” and that the Synthroid® caused “severe adverse effects,” including headaches, neck pains, blurry vision, and hip pain. According to Plaintiff’s expert, the “severity and longevity” of these effects meant that Defendants should have discontinued the medication and tried an alternative designed for patients allergic to Synthroid^®. Plaintiff’s expert faulted one defendant doctor for persisting in the “ineffective and harmful” treatment, one defendant doctor for advising Plaintiff to take a week’s worth of Synthroid^® at once “despite knowing the dangers,” and the third defendant doctor for making “little or no effort” to treat Plaintiff.

The trial court granted summary judgment for Defendants, and the Indiana Court of Appeals upheld this decision. However, the Indiana Supreme Court unanimously reversed this ruling, finding Plaintiff’s expert’s affidavit admissible and sufficient to present triable issues of fact.

The Supreme Court found “some evidence of deliberate indifference by each doctor,” which precluded summary judgment. As to the defendant doctor alleged to have persisted in “ineffective and harmful” treatment, it was noted that Plaintiff had testified that he always reported his adverse effects, making the doctor “fully aware” of his complaints, which were “disregarded.” The Supreme Court also noted there was evidence that the doctor knew of alternative drugs, as he documented consideration of other options. Accordingly, the Supreme Court found that a factfinder could find that the defendant doctor acted “contrary to his professional judgment by failing to prescribe an alternative drug that he knew might treat [Plaintiff’s] hypothyroidism without the severe effects of the cheaper and easier Synthroid^®,” which would amount to deliberative indifference to a serious medical need.

As for the defendant doctor who allegedly advised Zaragoza to take seven days’ worth of Synthroid^® at once, despite the adverse effects previously caused just by a low dose, the Court said this could be “interpreted as blatantly inappropriate care and disregard of a substantial risk of harm” and that a factfinder could accordingly infer that this doctor was acting contrary to his professional judgment.

Finally, the third defendant doctor (accused of making “little or no effort” to treat the patient) had discussed an alternative option, Tirosint^®, with Plaintiff; however, the doctor still only offered Synthroid^®. The Court found that a factfinder could infer that the doctor knew about Tirosint^® but refused to offer it as an alternative.

Because there was some evidence that each of the three defendant doctors offered Synthroid® as the only option to treat Zaragoza’s hypothyroidism, despite knowing of its adverse effects and potential safer alternatives, the Supreme Court concluded that a factfinder could interpret the evidence as showing an “obdurate refusal” to move on from plainly inadequate medication, forcing the patient to choose between the intolerable side effect of Synthroid® or untreated hypothyroidism. The Court was concerned that the inmate “may have been denied a basic standard of care that a civilian could expect to receive,” and was persuaded that Plaintiff had met his burden to show a genuine issue for trial.[1]

This new opinion will have a strong impact on future deliberate indifference claims brought by inmates, particularly in cases of alleged failure to prescribe alternate medications to treat a serious condition, when the typically-prescribed medication causes severe adverse side effects. The Indiana Supreme Court has opened the door to more such cases surviving summary judgment and making it to trial if there is evidence that the defendant doctor(s) acted contrary to their professional judgment and kept the inmate on the original (and often cheaper and/or easier) medication, despite knowing of possible alternatives.

[1] The Court found this case to be similar to Greeno v. Daley, 414 F.3d 645 (7th Cir. 2005), and Berry v. Peterman, 604 F.3d 435 (7th Cir. 2010). The Court also differentiated this case from the facts of Zingg v. Groblewski, 907 F.3d 630 (1st Cir. 2018), and Pyles v. Fahim, 771 F.3d 403 (7th Cir. 2014).

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Posted March 26, 2024, by Beau Browning