Travis Valentino Dantzler v. Tonia Baldwin, MD

United States Court of Appeals
For the Eighth Circuit
___________________________
No. 23-3382
___________________________
Travis Valentino Dantzler
lllllllllllllllllllllPlaintiff - Appellee
v.
Tonia Baldwin, MD
lllllllllllllllllllllDefendant - Appellant
Melissa Farnsworth, NSD; Stephen Weis, Superintendent/Warden; Randy Gibbs,
Deputy Director; Blythe Larson
lllllllllllllllllllllDefendants
____________
Appeal from United States District Court
for the Southern District of Iowa - Central
____________
Submitted: September 24, 2024
Filed: April 8, 2025
____________
Before SMITH, ERICKSON, and STRAS, Circuit Judges.
____________
SMITH, Circuit Judge.

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Inmate Travis Dantzler brought suit under 42 U.S.C. § 1983 alleging, inter
alia, that Dr. Tonia Baldwin, a physician at the Clarinda Correctional Facility (CCF),
was deliberately indifferent to his complaints of knee pain by delaying an MRI and
orthopedic referral based on his parole eligibility—a nonmedical reason. Dr. Baldwin
moved for summary judgment based on qualified immunity. She argued that she was
not deliberately indifferent to Dantzler’s serious medical needs. Alternatively, she
asserted that the law was not clearly established “because no reasonable medical
professional would have believed that her treatment of [Dantzler] would amount to
a constitutional violation.” R. Doc. 21-1, at 21. The district court1 denied Dr.
Baldwin’s motion, concluding that Dantzler created a genuine issue of material fact
as to whether Dr. Baldwin was deliberately indifferent. We affirm.
I. Background
“In this interlocutory posture, we take as true the facts that the district court
found were adequately supported, as well as the facts that the district court likely
assumed, to the extent that they are not blatantly contradicted by the record. Viewed
in this manner, the facts are these.” Humes v. Jones, 109 F.4th 1112, 1115 (8th Cir.
2024) (citation omitted).
On February 17, 2020, Dantzler, an inmate at the Anamosa State Penitentiary
(ASP), first reported right knee pain. He injured his knee several days prior. A nurse
prescribed ibuprofen and issued a knee sleeve to Dantzler. On February 29, 2020, a
second nurse saw Dantzler for his knee pain and continued ibuprofen for an
additional week. On March 13, 2020, a third nurse saw Dantzler for his knee pain.
That nurse restricted Dantzler to a lower bunk, advised Dantzler to refrain from all
sports, allowed Dantzler to have a brace/walker, and scheduled Dantzler to see a
physician.
1The Honorable Rebecca Goodgame Ebinger, United States District Judge for
the Southern District of Iowa.
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On March 26, 2020, Dr. Michael Dehner examined Dantzler at ASP. Dantzler
reported that he had strained his right knee playing basketball and that his knee had
shown little improvement since the injury. Dantzler requested guidance for
rehabilitation. Dr. Dehner noted that Dantzler had “no instability, slight swelling,
[and] good ROM [range of motion].” R. Doc. 22, at 11. Dr. Dehner diagnosed
Dantzler with a “knee sprain”; ordered “rehab exercises [for] 6 weeks”; and prescribed
diclofenac, a non-steriodal anti-inflammatory drug. Id. On April 16, 2020, Dr. Dehner
reported that Dantzler was “not taking med as directed” and attributed some of
Dantzler’s continued discomfort to “[n]oncompliance with medicine regimen.” Id. at
13.
On July 6, 2020, Dantzler reinjured his knee playing basketball; he saw a nurse
that same day. The nurse reported that Dantzler limped and “was not wearing his knee
brace.” Id. at 15. The nurse noted swelling in Dantzler’s right knee. Dantzler had an
“active range of motion” but experienced pain moving the knee. Id. Dantzler “rated
his pain at a[n] 8 on a scale of 0 to 10.” Id. The nurse consulted with Dr. Dehner. Dr.
Dehner then issued the following directions for Dantzler: He should (1) wear the
issued knee brace, (2) not participate in sports for 90 days, and (3) return for a follow-
up after a week. After consulting with Dr. Dehner, the nurse passed along Dr.
Dehner’s directions and told Dantzler to put ice on his knee to treat the swelling.
On July 16, 2020, Dr. Dehner again examined Dantzler. Dr. Dehner observed
that Dantzler’s knee was “more swollen than last time,” noted that Dantzler had “[f]elt
a pop” when he reinjured his knee, and reported that Dantzler had “medial joint line
tenderness, no instability.” Id. at 18. He continued his orders for rest, ice, a non-
steriodal anti-inflammatory drug, rehabilitation, and no sports.
On December 27, 2020, Dantzler reported, “[I] have severe pain in my right
knee—it[’]s been this way since [F]ebruary. . . . [I] would like an MRI done [because]
[I] [am] certain there is some structural damage. [I] can sometimes barely walk.” Id.
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at 22. Three days later, a nurse examined Dantzler and noted that his “right knee . . .
appeared swollen” but was “not warm to the touch.” Id. at 23. She continued
Dantzler’s care plan, referred him to a doctor, and advised him to use his knee brace.
On January 6, 2021, Dantzler was transferred to CCF. Dr. Tonia Baldwin
examined Dantzler two days later. She observed that Dantzler was “not wearing the
knee[]sleeve.” Id. at 25. Dantzler attributed the lack of use of the sleeve to the prison’s
transfer protocols. He reported that his knee sleeves and ibuprofen were removed from
his possession.
During her exam, Dr. Baldwin observed “marked swelling around the knee” and
“swelling of the infrapatella bursa.” Id. She found “[n]o meniscal tear on exam.” Id.
She directed Dantzler to wear the knee sleeve and take ibuprofen for two weeks. When
she asked Dantzler “how many [ibuprofen] pills he ha[d] left, he state[d] none”
because “he did not get them back when he came to CCF.” Id. at 26. She noted that if
the swelling in Dantzler’s knee was not down after the two-week period, then she
would consider aspiration or a cortisone injection. But if the swelling was down, she
would order physical therapy. She ordered that Dantzler have a lower bunk
assignment, restricted his physical activity for one month, and advised that he may
have a “[b]race/[w]alker” and a “knee stabilized brace” in his possession. Id.
On January 22, 2021, at a follow-up appointment, Dantzler reported that his
knee “fe[lt] close to the same as the last time he was seen.” Id. at 28. But Dr. Baldwin
found “marked improvement in the knee” with only slight swelling. Id. She noted that
Dantzler was only taking ibuprofen one to two times a day because it “hurt his
stomach.” Id. She advised him to take the ibuprofen with food to aid with the
“stomach discomfort” and renewed the ibuprofen for two more weeks. Id.
On February 28, 2021, Dantzler reported injuring his knee again. He stated that
his knee “made a popping noise” while he was “walking laps” and that his knee was
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swollen again. Id. at 30. He stated his belief that his knee was more than sprained
because “it[’]s been injured since [F]ebruary of [2020].” Id. The nurse observed that
Dantzler was “ambulating with steady gait. No limping, guarding or grimacing.” Id.
She did, however, note that Dantzler’s “[r]ight knee ha[d] edema on outer aspect,” he
had “[c]repitus . . . with movement,” and his knee was “tender on outer aspect.” Id.
The nurse issued Dantzler ibuprofen, restricted his sports activity for two weeks, and
scheduled an appointment for Dantzler to see the doctor. She also commented, “Of
note [Dantzler] was not wearing knee brace today.” Id.
On March 3, 2021, Dr. Baldwin examined Dantzler. He described that, while
walking, he went to take a step, and a pain went through his knee, making him unable
to extend it. According to Dantzler, “there was a pop.” Id. at 32. He reported that his
knee had “swelled by night.” Id. Dantzler explained that it hurt to “pivot [his] leg/knee
to put on his socks” and that the pain was “a sharp stinging kind of pain.” Id. Dr.
Baldwin observed that Dantzler’s “ligaments cont[inued] to be intact” with “NO
meniscal tear on exam.” Id. But she did note “[e]dema, “[i]nflam[m]ation,” and “[j]oint
[t]enderness.” Id. Dr. Baldwin diagnosed Dantzler with “bursitis.” Id. She ordered him
to “cont[inue] with the knee[]sleeve (which he [was] wearing).” Id. She also gave him
“leg strengthening exercises to perform daily” and increased his ibuprofen dosage. Id.
On March 30, 2021, Dantzler again saw Dr. Baldwin. He advised her that his
“knee [was] not healed,” he did “not want to give back his knee brace,” and he
“shouldn’t have to return [his] knee brace if [he was] still having pain.” Id. at 37. Dr.
Baldwin noted “slight swelling on either side of the proximal patella and slight
swelling in the infrapatella bursa.” Id. She reconfirmed her diagnosis of “knee
bursitis.” Id. at 38. She observed that Dantzler was not currently wearing the knee
sleeve but “need[ed] to cont[inue] with it.” Id. Additionally, Dantzler had not been
taking the ibuprofen. He told Dr. Baldwin that he was “tired of taking [ibuprofen]
b[ecause] it is all he has been given for the past year whether he has knee pain,
toothache, etc.” Id. According to Dr. Baldwin, not taking the ibuprofen “ma[de] it
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longer to resolve the knee bursitis.” Id. Dr. Baldwin permitted Dantzler to keep the
knee brace for another month.
Dantzler disputes Dr. Baldwin’s implication that he was noncompliant with
treatment. He explains that he “took [the] knee sleeve off before going to ‘every’
[h]ealth [s]ervice[s] appointment . . . . because it was easier to show his knee/injury
if he had on jeans or sweatpants, because short[s] are not allowed to be worn in [the]
Health Service[s] Department.” R. Doc. 46, at 27. He also challenges Dr. Baldwin’s
assertion that he was not taking the ibuprofen. According to Dantzler, “It is not
possible for [Dr.] Baldwin to monitor if/when I am taking the issued [ibuprofen],
because . . . . I took it in my cell as required.” Id.
On April 29, 2021, Dantzler saw Dr. Baldwin for continued right knee pain. His
“[right] knee cont[inued] to swell off and on” and was “worse when he [went] to stand
up from sitting.” R. Doc. 22, at 40. The pain also “increase[d] when he trie[d] to do
the [physical therapy] exercises.” Id. Dantzler asked to keep the knee sleeve. Dr.
Baldwin observed that Dantzler was “not wearing the knee sleeve” but that “one is
able to see where the knee sleeve had been. W[h]en he stands, there is swelling above
the patella on the lateral side.” Id. Dr. Baldwin maintained her diagnosis of bursitis in
Dantzler’s right knee and noted his continued need for the knee sleeve and ibuprofen.
Additionally, Dr. Baldwin wrote in her notes, “[Dantzler] to kite if he gets laid down[2]
in October so that referrals to UIHC can be entered. If laid down, will order MRI and
ortho referral.” Id.
Dantzler denies ever telling Dr. Baldwin that he was due for parole in October
2021. According to Dantzler:
2The term “laid down” refers to denial of parole. See R. Doc. 21-3, at 32.
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Plaintiff did not state that he was up for parole in October. Plaintiff also
did not agree to this course of action. These comments are fictitious and
unsupported. During this encounter the defendant ([Dr.] Baldwin) said
“there [is] no way your knee is still swelling like this—I think we need
to schedule you for MRI and ortho.” After checking the plaintiff’s
chart[,] she states[,] “I see you get ran up for parole in October[.] [I]f you
get laid down[,] I’ll schedule you for MRI and ortho.” The plaintiff never
agreed to this[.] [W]hen [he] asked “why he had to wait (6) months when
it[’]s evident there[’]s a problem now[,]” [Dr.] Baldwin ignored him and
continued [to] type on her computer.
R. Doc. 46, at 28.
Dr. Baldwin responds that she “discussed [her] referring [Dantzler] to
University of Iowa Hospitals and Clinics (UIHC) for an MRI and orthopedist
appointment if he was ‘laid down’—not paroled—in October. [He] agreed to this
course of action.” R. Doc. 21-3, at 32. But Dantzler replies that he “continually asked
for an MRI” and that such action “is not consistent with an individual that agreed to
wait.” R. Doc. 46, at 55. Dr. Baldwin also states that
it did not make sense to set an appointment for him after he was
expecting to be released, as he stated he was not going to follow up at
UIHC after his release; and even if he could be seen initially before his
release he would almost certainly have to get another MRI if further
treatment was necessary, again due to his indicating he would not follow
up at UIHC.
R. Doc. 21-3, at 34–35. Dantzler, however, denies making this statement. He avers that
he was never asked whether he would follow up at UIHC and notes that there is no
notation in the medical records to support Dr. Baldwin’s statement regarding
follow-up treatment at UIHC.
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On June 2, 2021, Dantzler requested and was issued more ibuprofen.
On July 23, 2021, Dr. Baldwin did not see Dantzler but renewed his use of a
knee brace. She also noted, “If [Dantzler] got laid down from parole, need referral, see
April notes.” R. Doc. 22, at 44.
On July 29, 2021, Dantzler sent a kiosk message to Health Services, stating that
he had been called to return his knee brace even though he still had “quit[e] a bit of
fluid in [his] knee” and “excruciating pains in the morning.” R. Doc. 21-3, at 22. He
indicated that his knee pain had “been an on-going problem [for] 2 years now” and
stated that “if an MRI was done. . . all [his] pain w[ould] be clearly evident.” Id. The
following day, Dr. Baldwin replied that Dantzler could “have the knee brace through
October.” Id. She also wrote, “Per our last discussion, you wanted to wait for MRI to
be done if you did not get parole. If this has changed, let me know.” Id.
On August 18, 2021, Dantzler requested ibuprofen for his knee and back.
Dantzler was issued a seven-day supply of ibuprofen. Two days later, Dantzler made
a sick call request, stating, “The pain in my knee is getting severe. I’ve sent several
kites concerning this issue. I need an MRI done ASAP.” R. Doc. 22, at 47. According
to Dantzler, he had spoken with two other nurses informally about his pain, but
nothing was done. Dantzler asserted:
This is my final attempt at resolving this issue formally. I was told I
would get an MRI in Sept[ember] if I don’t get release[d]. My release
date shouldn’t have anything to do with receiving proper health care.
Medical staff is being deliberately indifferent to my serious medical need
as the[y] know my knee has been injured (over a year). Yet still are
denying me medical care adequately.
Id. The responding nurse commented that Dantzler’s knee brace was confiscated
because of Dantzler’s placement in administrative segregation and would not be
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returned to him until an investigation was completed. The nurse issued Dantzler a knee
sleeve until his knee brace could be returned. She also issued him ibuprofen. The nurse
also noted, “The doctor said you are to kite health services if you get laid down in
October so that referrals to UIHC can be entered. If you are laid down, the order for
an MRI and ortho referral will be made.” Id.
On August 25, 2021, a nurse saw Dantzler for “cold symptoms.” Id. at 49. He
also stated, “I really need to talk about my knee. I need an MRI. I [have] been telling
you for months. I need crutches or something.” Id. According to the examining nurse,
two other nurses had observed Dantzler as he entered and left health services and
reported “[n]o change in gait . . . . Gait steady and even.” Id. But Dantzler counters
that he could not have been observed entering or leaving health services “because he
was escorted in through the back door (by C/O Barry).” R. Doc. 46, at 33. He states
that he “didn’t encounter any medical staff until they entered the room he was placed
in.” Id. He contends that “[v]ideo evidence will show that [he] did indeed walk with
a limp.” Id.
On August 31, 2021, Dantzler filed a formal grievance. He alleged that he was
“[b]eing [d]enied [m]edical [s]ervices . . . [d]eliberately” and wanted an “‘MRI’—
asap!!!” R. Doc. 21-3, at 41 (ellipsis in original). Melissa Farnsworth, CCF Health
Services Director, was on COVID-related leave from that position for approximately
three weeks from mid-August 2021 until early September 2021. In her absence,
Dantzler sent multiple requests for medical care, noting increased pain in his right
knee. See R. Doc. 22, at 51 (“Well I sent a lot of kites and they weren’t returned. Well
they said they would fax them to you to return to me. . . . Well I still want to file a
grievance.”).
On September 9, 2021, Dantzler complained that his “pain [was] getting worse.”
Id. Farnsworth visited Dantzler in his cell. Farnsworth commented that Dantzler
agreed “in April when he saw the doctor he was ok with waiting a while for an MRI
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or to see Ortho, but now that the pain has increased he wants to be seen.” Id. But
Dantzler denies he ever agreed to wait but instead repeatedly requested an MRI. R.
Doc. 46, at 34–35 (stating that Dantzler demanded an MRI on July 29, August 20,
August 25, August 31, October 4, and November 3, 2021, and “also requested an MRI
verbally on several occasions”). Farnsworth scheduled Dantzler to see Dr. Baldwin the
following week.
On September 16, 2021, Dantzler saw Dr. Baldwin. Dr. Baldwin’s notes
indicate that Dantzler complained of “worsening [right] knee pain,” an inability to
“extend the knee out” in the morning, and an inability “to squat down” without pain
in both knees. R. Doc. 22, at 52. Dr. Baldwin noted that Dantzler was “wearing the
knee[]sleeve” and that there was “[n]o swelling in the knee today.” Id. She indicated
that Dantzler was in administrative segregation, that it was “[u]nlikely that he will
have his parole granted,” and that she would “order [an] MRI [on the] [right] knee.”
Id. She “encouraged [Dantzler] to take [ibuprofen] for the pain.” Id. Consistent with
her notes, Dr. Baldwin did order that Dantzler receive an MRI at UIHC. Dr. Baldwin
requested that Dantzler be “evaluate[d] for etiology and treatment options.” Id. at 54.
On September 21, 2021, Dantzler was transferred to the Iowa State Penitentiary
(ISP). On October 14, 2021, he was denied parole.
On September 27, 2021, Blythe Larson, CCF Treatment Director, denied
Dantzler’s August 31, 2021 grievance. She stated, “Due to the length of wait for an
MRI at UIHC, Dr. Baldwin did not schedule you until you received your BOP decision
because you would not have been able to go to the appointment due to your release.”
R. Doc. 21-3, at 46. Additionally, she stated, “It is the doctor’s determination when
someone is referred to UIHC and also regarding bunk restrictions[,] and I cannot
override that as this is her area of expertise.” Id.
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On October 4, 2021, Dantzler appealed Larson’s grievance denial. In his appeal,
he stated that he wanted “an ‘MRI’ done on both knees and hip . . . ASAP!!!” Id. at 47
(ellipsis in original). On October 18, 2021, Stephen Weis, CCF Warden, denied
Dantzler’s grievance appeal. He agreed with Larson that it was for the doctor to
determine when someone is referred to UIHC. Ten days later, Dantzler appealed this
denial to the central office and again requested an MRI on both knees and hip. This
appeal was also denied.
On November 5, 2021, UIHC Orthopedist Laura Magrane, PA-C, examined
Dantzler. An MRI revealed “MFC cartilage defect, joint effusion, [and] medial
meniscal tear (possible root).” R. Doc. 22, at 60. After discussing surgical and
nonsurgical options with Magrane, Dantzler “[c]onsented . . . for a right knee
arthroscopy, meniscal repair versus debridement and microfracture.” Id. According to
Dantzler, he also told Magrane about the pain in his left knee; however, because she
only had orders to treat his right knee, she did not order an MRI or x-ray for his left
knee. Dantzler avers that Magrane “informed [him] that looking at the present damage
the surgery was not a permanent fix, and he would like[ly] need a knee replacement
in the next 2–3 years.” R. Doc. 46, at 61.
On January 12, 2022, Dantzler had surgery on his right knee at UIHC.
On May 4, 2022, Dantzler reported having pain in his left knee. In his sick call,
he stated that his left knee was swollen and the pain was increasing “off and on.” R.
Doc. 22, at 74. Dantzler was “certain there [was] something wrong with it.” Id. He
believed that his left knee felt similar to how his right knee felt when the meniscus was
torn, describing it as “grinding, and swelling more and more with most activity and
sometimes even walking.” Id. Dantzler was already scheduled for a follow-up
appointment at UIHC on May 11, 2022. The physician at ISP prepared orders for
Dantzler to be seen for both knees at that appointment. Additionally, he ordered an
x-ray of Dantzler’s left knee for May 5, 2022.
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On May 11, 2022, Magrane examined Dantzler and observed swelling in his left
knee. She also ordered an MRI of his left knee. According to Dantzler, Magrane
“again explain[ed] to [him] that he had a torn meniscus and additional surgery [was]
needed” on his left knee. R. Doc. 46, at 17. Dantzler had surgery on his left knee on
August 10, 2022.
On August 24, 2022, two days before his left-knee, post-surgical appointment
with UIHC, Dantzler requested to have an MRI on his hip while he was there. He
reported having pain in his hip when he sat for a period of time and then stood. No
MRI was ordered because there was no documentation of any hip issue and because
it was too near the appointment.
On August 26, 2022, Magrane saw Dantzler for his follow-up appointment. He
was released with no restrictions and was scheduled to begin therapy in two weeks.
At his appointment, Dantzler told Magrane about his “‘tailbone’ pain that has been
ongoing for several years and report[ed] that likely started after a fall directly
backwards on his buttock.” R. Doc. 22, at 82. He reported “pain in the tailbone on
sitting, especially when leaning back” and “an abrupt increase in pain during the
transition from sitting to standing.” Id. Magrane discussed treatment options with
Dantzler regarding his tailbone and indicated that “[i]f symptoms persist[,] x-ray of the
coccyx should be completed and possible consideration of MRI to rule out other
pathology.” Id. at 83.
On September 15, 2022, Dantzler complained of hip, tailbone, or pelvis pain
upon standing. He attributed this pain to the fall from 2021 that he had also reported
to Magrane. Four days later, Dantzler “report[ed] right knee pain.” Id. at 88. Dantzler
told Dr. Chase Newton at ISP that “[d]ue to compensating from his right leg[,] he
started getting left knee pain. He ended up falling and landed on his tailbone. When
he sits or stands up[,] he has pain that shoots from his tailbone throughout his pelvis.”
Id. Dr. Newton ordered x-rays of Dantzler’s pelvis and tailbone and gave permission
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for Dantzler to have a donut cushion for his symptoms. On September 26, 2022, Dr.
Newton reviewed the x-rays and observed no fractures; but he did note arthritis of
Dantzler’s hip joints. He did not see any “other significant abnormalities” on the x-
rays. Id. at 90.
Dantzler filed a pro se complaint under 42 U.S.C. § 1983 against CCF prison
officials, including Dr. Baldwin, for violation of his Eighth Amendment rights. The
district court conducted an initial review of the complaint. See 28 U.S.C. § 1915A(a).
The district court narrowed Dantzler’s claims to one claim for deliberate indifference
to a serious medical need related to the delayed treatment of Dantzler’s right knee.
The CCF prison officials moved for summary judgment based on qualified
immunity. The district court granted in part and denied in part their motion.
Specifically, the court dismissed all claims asserted against the CCF prison officials,
except for Dr. Baldwin.
The court framed the issue as “whether [Dr. Baldwin’s] subsequent decision to
delay [Dantzler’s] referral was based on nonmedical considerations, namely, whether
Dantzler would be paroled.” R. Doc. 52, at 21. The court concluded that “Dantzler has
created a material fact issue as to whether [Dr.] Baldwin was deliberately indifferent
to his knee pain by delaying the MRI and orthopedic referral based on his parole
eligibility.” Id. The district court further concluded that Dr. Baldwin was not entitled
to qualified immunity because “cases clearly establish [that] the intentional denial or
delay of access to medical care may violate the Eighth Amendment” and “that a delay
in care based on nonmedical considerations may also violate the Eighth Amendment.”
Id. at 24–25. According to the court, “a reasonable official in [Dr.] Baldwin’s shoes
would have understood that a delay in referring Dantzler for an orthopedic
consultation and MRI based on whether he was eligible for parole would be a
violation of his Eighth Amendment rights.” Id. at 25.
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II. Discussion
Dr. Baldwin argues that the district court erred in denying her motion for
summary judgment based on qualified immunity. She asserts that she “is entitled to
qualified immunity primarily for two reasons”: (1) her “actions were not deliberately
indifferent to any serious medical need,” and (2) “neither the district court nor
Dantzler identified any case clearly establishing that Dr. Baldwin’s conduct was
deliberately indifferent.” Appellant’s Br. at 20–21.
We review de novo the district court’s denial of qualified immunity. Fisherman
v. Lauderville, 100 F.4th 978, 980 (8th Cir. 2024). “We have limited interlocutory
review in qualified-immunity cases, meaning we lack jurisdiction to decide factual
issues, including whether the pretrial record sets forth a genuine issue of fact for trial.”
Id. (internal quotation marks omitted). As a result, we must affirm “when it is apparent
that, if the plaintiff’s version of the facts is right, the officer violated a clearly
established right.” N.S. v. Kan. City Bd. of Police Comm’rs, 933 F.3d 967, 969 (8th
Cir. 2019).
We have jurisdiction to determine pure issues of law. Fisherman, 100 F.4th at
980. “Two arise frequently. First, accepting the district court’s factual findings as true,
did the defendant violate a constitutional right? And second, was the right clearly
established at the time? If either answer is no, then qualified immunity applies.” Id.
(cleaned up). In other words, reversal of the district court’s denial of qualified
immunity is warranted when, “under the plaintiff-friendly version of the facts, there
was no constitutional violation or the underlying right was not clearly established.”
N.S., 933 F.3d at 969.
A. Constitutional Violation
Dantzler’s deliberate-indifference claim is based on the Eighth Amendment.
“The Eighth Amendment requires state prison officials to provide inmates with needed
medical care.” Cullor v. Baldwin, 830 F.3d 830, 836 (8th Cir. 2016). “[D]eliberate
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indifference to serious medical needs of prisoners constitutes the unnecessary and
wanton infliction of pain proscribed by the Eighth Amendment.” Redmond v. Kosinski,
999 F.3d 1116, 1120 (8th Cir. 2021) (alteration in original) (quoting Estelle v.
Gamble, 429 U.S. 97, 104 (1976)). “Deliberate indifference is more than negligence,
more even than gross negligence. It may be found where medical care is so
inappropriate as to evidence intentional maltreatment.” Presson v. Reed, 65 F.4th 357,
366 (8th Cir. 2023) (internal quotation marks omitted); see also Redmond, 999 F.3d
at 1120 (stating that the plaintiff “must show grossly incompetent or inadequate care
so inappropriate as to evidence intentional maltreatment or a refusal to provide
essential care” (internal quotation marks omitted)). “The level of culpability required
to demonstrate deliberate indifference on the part of prison officials is equal to
criminal recklessness.” Holden v. Hirner, 663 F.3d 336, 343 (8th Cir. 2011).
“Deliberate indifference has both an objective and a subjective component.”
Cheeks v. Belmar, 80 F.4th 872, 876 (8th Cir. 2023) (internal quotation marks
omitted), cert. denied sub nom. Jakob v. Cheeks, 144 S. Ct. 1030 (2024). To prevail
on a deliberate-indifference claim, “[t]he plaintiff must show (1) an objectively serious
medical need, and (2) that the defendant knew of and disregarded that need.”
Redmond, 999 F.3d at 1120 (internal quotation marks omitted).
1. Serious Medical Need
Dr. Baldwin argues that Dantzler failed to show that he suffered from an
objectively serious medical need because, “[a]t the time of the alleged delay in medical
care, Dantzler’s right knee was not diagnosed by a physician as requiring treatment.
It was diagnosed as inflammation requiring conservative management, including
anti-inflammatory medication, rehab exercises, a knee sleeve and restrictions.”
Appellant’s Br. at 29. According to Dr. Baldwin, “A layperson would not have
identified the necessity for a doctor’s attention. Nothing showed that Dantzler’s right
knee [had something] seriously wrong [with it].” Id. Dr. Baldwin also argues that “to
the extent Dantzler’s allegations rely on a theory of delays in treatment having caused
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him harm, he has not provided verifying medical evidence sufficient to support his
claims.” Id. at 31.
“A serious medical need is one that has been diagnosed by a physician as
requiring treatment, or one that is so obvious that even a layperson would easily
recognize the necessity for a doctor’s attention.” Cheeks, 80 F.4th at 878 (internal
quotation marks omitted). But where, as here, an inmate “alleges that a delay in
medical treatment constituted a constitutional deprivation, the objective seriousness
of the deprivation should also be measured by reference to the effect of delay in
treatment.” Id. (internal quotation marks omitted). “To establish this effect, the inmate
must place verifying medical evidence in the record to establish the detrimental effect
of delay in medical treatment.” Jackson v. Riebold, 815 F.3d 1114, 1119–20 (8th Cir.
2016) (cleaned up); see also Cheeks, 80 F.4th at 878 (“In other words, if a plaintiff is
relying on a delay in treatment theory, there is an additional requirement to place
verifying medical evidence in the record to show there was a detrimental effect caused
by the delay.”); Presson, 65 F.4th at 366–67 (stating that the inmate “must present
verifying medical evidence that the prison officials ignored an acute or escalating
situation or that these delays adversely affected his prognosis” (quoting Redmond, 999
F.3d at 1121)).
An inmate’s “failure to place verifying medical evidence in the record to
establish the detrimental effect of delay in medical treatment precludes a claim of
deliberate indifference to medical needs.” Cheeks, 80 F.4th at 878; see also Laughlin
v. Schriro, 430 F.3d 927, 929 (8th Cir. 2005). But “what constitutes verifying medical
evidence”? Williams v. Liefer, 491 F.3d 710, 715 (7th Cir. 2007). “Clearly, expert
testimony that the plaintiff suffered because of a delay in treatment would satisfy the
requirement.” Id. (citing Coleman v. Rahija, 114 F.3d 778, 785 (8th Cir. 1997)
(concluding that expert testimony satisfied the verifying medical evidence
requirement)). By contrast, “self-reported assertions of pain are insufficient” to
“constitute . . . verifying medical evidence” in the absence of “corroborating evidence
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of symptoms.” Hancock v. Arnott, 39 F.4th 482, 487 (8th Cir. 2022). Additionally,
“evidence of a plaintiff’s diagnosis and treatment, standing alone, is insufficient if it
does not assist the jury in determining whether a delay exacerbated the plaintiff’s
condition or otherwise harmed him.” Williams, 491 F.3d at 715 (emphasis added).
An inmate’s failure to “introduce expert testimony stating that his medical
condition worsened because of the delay . . . does not mean [the inmate] offered no
verifying medical evidence.” Grieveson v. Anderson, 538 F.3d 763, 779 (7th Cir.
2008) (citing Williams, 491 F.3d at 715). An inmate may satisfy this requirement by
“suppl[ying] medical records.” Id.; see also Miranda v. County of Lake, 900 F.3d 335,
347 (7th Cir. 2018) (“While expert testimony could be used as ‘verifying medical
evidence,’ medical records alone could suffice.” (citing Grieveson, 538 F.3d at 779;
Williams, 491 F.3d at 715)). For example, in Williams, the inmate alleged that an
hours-long delay in proper medical care unnecessarily prolonged his pain and high
blood pressure. 491 F.3d at 712–13. The inmate had awakened with chest pain, arm
numbness, dizziness, nausea, and vomiting. Id. at 712. He complained several times
about his pain and symptoms to three prison officers, none of whom granted his
request for medical treatment. Id. at 712–13. In the afternoon, while carrying a heavy
box up a flight of stairs, the inmate blacked out and fell backwards down the stairs.
Id. at 713. He was sent to the prison emergency room. Id. When seen there, he had
high blood pressure, an elevated pulse, and an abnormal heart rate. Id. He remained
in the prison infirmary for six days. Id. Thereafter, he filed a deliberate-indifference
claim against the prison officers. Id. at 714.
The prison officers’ medical expert, who was the inmate’s examining physician,
“testified that any delay in treatment ‘[did not] appear to have had any significant
adverse effect’ on [the plaintiff’s] condition.” Id.(first alteration in original). The
inmate did not introduce expert testimony in support of his deliberate-indifference
claim; instead, he relied on the medical records from when he arrived at the hospital.
Id. at 715. The medical records and examining physician’s testimony “showed that
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when [the inmate] arrived at the hospital, he had elevated blood pressure, had an
abnormal EKG, was sweating, and complained of severe pain.” Id. Additionally, the
medical records demonstrated “that with treatment, [the inmate’s] symptoms,
including his pain and high blood pressure, quickly subsided.” Id. “The only testimony
from a medical expert, [the examining physician], was that the delay did not appear
to have adversely affected [the inmate’s] condition.” Id.
The Seventh Circuit held that “a reasonable jury could have concluded from the
medical records that the delay unnecessarily prolonged and exacerbated [the inmate’s]
pain and unnecessarily prolonged his high blood pressure.” Id. at 716. The court noted
that “[t]he medical records indicate that the nitroglycerin almost immediately relieved
his pain and lowered his blood pressure, so a jury could find that the defendants’ delay
caused [the plaintiff] six extra hours of pain and dangerously elevated blood pressure
for no good reason.” Id.; see also Grieveson, 538 F.3d at 779 (holding that although
pretrial detainee did not provide expert testimony, he produced verifying medical
evidence by “suppl[ying] medical records indicating that he had a nasal fracture, that
he could experience further bleeding, and that he may need to see a specialist”).
In the present case, Magrane diagnosed Dantzler’s knee condition on November
5, 2021. The MRI showed that Dantzler had an “MFC cartilage defect, joint effusion,
medial meniscal tear (possible root).” R. Doc. 22, at 60. He underwent knee surgery
to repair the meniscal tear on January 12, 2022. But Dr. Baldwin argues that
Dantzler’s right knee injury was not objectively serious at the time of the alleged delay
in medical care—April 29, 2021. The district court found a genuine issue of material
fact based on Dantzler’s testimony. He testified that, on that date, Dr. Baldwin told
him, “there [is] no way your knee is still swelling like this—I think we need to
schedule you for MRI and ortho.” R. Doc. 46, at 28. Additionally, Dantzler avers that
he “described every symptom of a [t]orn [m]eniscus to her,” id. at 65, including pain,
swelling, a popping sensation, and difficulty standing and pivoting, id. at 65–66. And
he maintains that “there was only one month” during a nine-month period when he did
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not complain about his knee. Id. at 56. Under Dantzler’s version of the facts, Dr.
Baldwin was aware that Dantzler’s knee injury was objectively serious enough to
warrant an MRI as of April 29, 2021.
Additionally, we conclude that Dantzler produced verifying medical evidence
that the delay in medical treatment adversely affected his condition. As in Williams
and Grieveson, the evidence “falls somewhere in between a bare recitation of
treatment received and expert testimony about the delay’s effect.” Grieveson, 538 F.3d
at 779 (quoting Williams, 491 F.3d at 715). Like the plaintiffs in those cases, Dantzler
“relies on the existing medical records to corroborate his claims that the delay in
treatment caused him prolonged pain as well as the need to have surgery on his left
knee.” R. Doc. 52, at 22. Dr. Baldwin told Dantzler, at his April 29, 2021 examination,
that he needed an MRI based on his knee’s continued swelling. See R. Doc. 46, at 28.
Afterwards, the medical records show that Dantzler consistently complained of
worsening knee pain and renewed his requests for an MRI; in response, the CCF
medical staff treated his condition with knee braces and ibuprofen. See, e.g., R. Doc.
22, at 43 (June 2, 2021); id. at 44 (July 23, 2021); id. at 46 (August 18, 2021); id. at
47 (August 20, 2021); id. at 49 (August 25, 2021); id. at 51 (September 9, 2021); id.
at 52 (September 16, 2021); see also R. Doc. 21-3, at 22 (July 29, 2021). Ultimately,
he was referred for an MRI and underwent surgery on his right knee but only after he
was denied parole.
The medical records also show that, after the surgery on his right knee, Dantzler
complained of increased swelling and pain in his left knee on May 4, 2022. R. Doc.
22, at 74. He was referred to UIHC for an x-ray and to have both knees examined. Id.
He had surgery on his left knee on August 10, 2022. Id. at 80. Following that surgery,
Dr. Newton saw Dantzler at ISP for tailbone pain on September 19, 2022; Dr.
Newton’s notes indicate:
[Dantzler] reports right knee pain. He had torn meniscus and
microfracture of his right femur. Due to compensating from his right leg
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he started getting left knee pain. He ended up falling and landed on his
tailbone. When he sits or stands up he has pain that shoots from his
tailbone throughout his pelvis.
Id. at 88 (emphasis added).
2. Deliberate Disregard
“We now turn to the subjective prong of the inquiry. Under the subjective
prong, to show deliberate indifference, the official must know of and disregard the
inmate’s serious medical need.” Presson, 65 F.4th at 367 (internal quotation marks
omitted). The plaintiff must show “that the [defendants] recognized that a substantial
risk of harm existed and knew that their conduct was inappropriate in light of that
risk.” Id. (alteration in original) (internal quotation marks omitted).
“[A] complaint that a physician has been negligent in diagnosing or treating a
medical condition does not state a valid claim of medical mistreatment.” Barr v.
Pearson, 909 F.3d 919, 921 (8th Cir. 2018) (alteration in original) (quoting Estelle,
429 U.S. at 106). An “exercise of professional judgment, even if negligent, falls well
short of deliberate indifference.” A.H. v. St. Louis County, 891 F.3d 721, 727 (8th Cir.
2018) (emphasis added). Thus, it “is not enough” for an inmate to “[s]how[] medical
malpractice.” Barr, 909 F.3d at 921. Instead, the “inmate must show that the provider
disregarded a known risk to the inmate’s health.” Id. (internal quotation marks
omitted); see also Perez v. Fenoglio, 792 F.3d 768, 777 (7th Cir. 2015) (“Prison
physicians will be liable under the Eighth Amendment if they intentionally disregard
a known, objectively serious medical condition that poses an excessive risk to an
inmate’s health.” (internal quotation marks omitted)). “As long as this threshold is not
crossed, inmates have no constitutional right to receive a particular or requested course
of treatment . . . .” Redmond, 999 F.3d at 1120 (internal quotation marks omitted).
“[N]othing in the Eighth Amendment prevents prison doctors from exercising their
independent medical judgment . . . .[, and] [p]rison officials do not violate the Eighth
Amendment when, in the exercise of their professional judgment, they refuse to
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implement a prisoner’s requested course of treatment.” Long v. Nix, 86 F.3d 761, 765
(8th Cir. 1996) (emphasis added); see also Holloway v. Del. Cnty. Sheriff, 700 F.3d
1063, 1074 (7th Cir. 2012) (stating that prison doctor “is free to make his own,
independent medical determination as to the necessity of certain treatments or
medications, so long as the determination is based on the physician’s professional
judgment and does not go against accepted professional standards” (emphases added)).
“A plaintiff can show deliberate indifference in the level of care provided in
different ways, including showing grossly incompetent or inadequate care, showing
a defendant’s decision to take an easier and less efficacious course of treatment, or
showing a defendant intentionally delayed or denied access to medical care.” Allard
v. Baldwin, 779 F.3d 768, 772 (8th Cir. 2015) (emphases added) (citations omitted).
We have previously held that “‘mere proof of medical care’ is insufficient to disprove
deliberate indifference.” Id. (quoting Smith v. Jenkins, 919 F.2d 90, 93 (8th Cir.
1990)). “[E]ven where medical care is ultimately provided, a prison official may
nonetheless act with deliberate indifference by delaying the treatment of serious
medical needs, . . . though the reason for the delay and the nature of the medical need
is relevant in determining what type of delay is constitutionally intolerable.” Farrow
v. West, 320 F.3d 1235, 1246 (11th Cir. 2003) (emphasis added) (internal quotation
marks omitted); see also Allard, 779 F.3d at 772 (“[I]n cases where some medical care
is provided, a plaintiff is entitled to prove his case by establishing the course of
treatment, or lack thereof, so deviated from professional standards that it amounted to
deliberate indifference.” (cleaned up)); Langford v. Norris, 614 F.3d 445, 460 (8th Cir.
2010) (“[A] total deprivation of care is not a necessary condition for finding a
constitutional violation . . . .”).
If this case concerned only the physician’s medical judgment in delaying
treatment, deliberate indifference could not be shown. This record, however, also
involves the physician’s nonmedical reasons for delay. We have recognized that a
prison official “delaying medical treatment for ‘nonmedical reasons’ may amount to
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deliberate indifference.” Cannon v. Dehner, 112 F.4th 580, 591 (8th Cir. 2024)
(emphases added) (quoting Hartsfield v. Colburn, 371 F.3d 454, 457 (8th Cir. 2004));
see also Morris v. Cradduck, 954 F.3d 1055, 1059 (8th Cir. 2020) (“Delaying access
to prescribed medical care for non-medical reasons may constitute deliberate
indifference in certain circumstances.”). For example, in Hartsfield, we reversed
summary judgment in favor of a jail doctor who had withheld treatment of a pretrial
detainee’s3 toothache for six weeks “for nonmedical reasons—[the detainee’s]
behavioral problems.” 371 F.3d at 457. When the detainee initially requested treatment
for “a severe toothache and three loose teeth,” the jail doctor “prescribed ibuprofen but
was hesitant to send [the detainee] to a dentist right away because [j]ail records
showed that [the detainee] had previously exhibited threatening and argumentative
behavior.” Id. at 456. Approximately six weeks later, the detainee “finally received
treatment from a dentist who told [the detainee] that the delay had caused a bad
infection in his mouth.” Id. In a verified statement, the detainee stated “that he did not
receive ibuprofen and that while he was awaiting treatment, blood seeped from his
gums, his mouth became swollen, an infection developed, and he had difficulty eating
and sleeping.” Id. Additionally, he claimed that “he encountered [the jail doctor] in a
hallway and requested treatment, but when he identified himself, [the jail doctor]
walked away and said, ‘I can’t talk to you.’” Id.
We held that there was a question of material fact regarding “whether . . . [the
jail doctor] w[as] deliberately indifferent to [the detainee’s] serious medical needs
when [he] failed to arrange for dental treatment until about six weeks after [the
detainee’s] written request for it, causing him to suffer further pain and infection.” Id.
at 457. We concluded that the jail doctor’s “statement . . . demonstrated that [the jail
doctor] was made aware of [the detainee’s] pain when he reviewed the medical
request, but he withheld dental treatment for nonmedical reasons—[the detainee’s]
behavioral problems.” Id.; see also Chance v. Armstrong, 143 F.3d 698, 704 (2d Cir.
3Hartsfield, 371 F.3d at 457 (“Pretrial detainees are entitled to at least as much
protection under the Fourteenth Amendment as under the Eighth Amendment.”).
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1998) (“[The inmate] has also alleged that [the treating doctors] recommended
extraction not on the basis of their medical views, but because of monetary incentives.
This allegation of ulterior motives, if proven true, would show that the defendants had
a culpable state of mind and that their choice of treatment was intentionally wrong and
did not derive from sound medical judgment.”).
Similarly, in Delaughter v. Woodall, the Fifth Circuit reversed summary
judgment for a prison medical administrator where it was “not clear that [an
orthopedic doctor’s] cancellation of [the inmate’s] surgery” and a medical center’s
refusal to accept the inmate as a patient were “medical-judgment decisions.” 909 F.3d
130, 138 (5th Cir. 2018). In that case, the inmate sued a prison medical administrator
for deliberate indifference after the orthopedic doctor that the inmate was referred to
cancelled the inmate’s hip replacement and reconstructive surgery. Id. at 135. The
inmate claimed that the doctor “told him ‘they’—presumably [the prison]—would not
pay for his surgery, and [the inmate’s] medical records reflect[ed] that [the doctor] told
[the inmate] that [the inmate’s] insurance would not pay for a CT scan or custom
components.” Id. at 139. At the time that the inmate filed suit “[b]ased on the delay in
surgery,” the inmate had yet to receive surgery. Id. at 135. But he had received some
medical care both before and after the surgery was cancelled. See id. (stating that a
prison doctor “treated [the inmate] with pain medication and steroid injections on at
least four separate occasions” prior to the inmate’s consultation with the orthopedic
doctor and that, after the surgery’s cancellation, the prison doctor “continued to treat
[the inmate] with medication and steroid injections”).
The Fifth Circuit held that “[f]actual disputes about the reason for the delay
prevent[ed] [the court] from determining whether [the prison administrator] violated
[the inmate’s] constitutional rights,” and as a result, the district court erroneously
granted summary judgment in favor of the prison administrator. Id. at 139. The inmate
produced evidence that the orthopedic doctor cancelled the inmate’s surgery and the
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medical center failed to accept the inmate as a patient “because [the prison] refuse[d]
to pay for his surgery.” Id. at 138.
Dr. Baldwin argues that Dantzler has failed to show that she acted with
deliberate indifference. According to Dr. Baldwin, the record clearly shows that she
“did not ignore Dantzler” because “[s]he saw him at multiple appointments and issued
treatment plans to ameliorate his knee pain. She gave him ibuprofen and knee sleeves
several times.” Appellant’s Br. at 30. She maintains that Dantzler’s “non-compliance
with his treatment plan makes it difficult to determine whether the issue would resolve
with conservative treatment or if further intervention was necessary.” Id. Dr. Baldwin
also asserts that she did refer “Dantzler to UIHC for further treatment as soon as he
requested that, following the disciplinary event that made his parole less likely.” Id.
She further argues that “to the extent there was a delay in moving to an alternative
treatment, that decision was made in consultation with Dantzler.” Id. at 30–31. She
maintains that “Dantzler himself explained that he was not going to continue with
treatment if he was released, and because he believed he would be released[,] Dr.
Baldwin exercised medical judgment to remain on the conservative treatment plan.”
Id. at 31.
Proper summary judgment analysis requires that we construe the facts in
Dantzler’s favor. See N.S., 933 F.3d at 969. Crediting Dantzler’s version of the facts,
we conclude that Dr. Baldwin did not “exercise” her “professional judgment” in
deciding to delay Dantzler’s MRI. See A.H., 891 F.3d at 727; Long, 86 F.3d at 765;
see also Holloway, 700 F.3d at 1074. Dr. Baldwin did provide “some medical care,”
but that fact does not foreclose Dantzler’s deliberate indifference claim. See Allard,
779 F.3d at 772. Subject to a contrary determination at trial, Dr. Baldwin delayed
Dantzler’s MRI for a nonmedical reason—the possibility that he would be paroled. See
Cannon, 112 F.4th at 591; Hartsfield, 371 F.3d at 457. As the district court explained:
Dantzler adamantly disputes Baldwin’s version of events. He avers
he never volunteered or otherwise stated he would be considered for
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parole in October 2021. ECF No. 46 at 28. Moreover, he avers he never
agreed to this course of action. Id. According to Dantzler, “[d]uring this
encounter, [Baldwin] said, ‘there is no way your knee is still swelling like
this. I think we need to schedule you for MRI and ortho.’” Id. Dantzler
avers Baldwin then checked his chart and saw he was scheduled for a
parole review in October. Id. Baldwin told Dantzler if he is denied
parole, she would schedule him for an MRI and an orthopedic
appointment. Id. Dantzler contends he asked why he had to wait six
months when the need for an MRI was immediate. Id. He avers Baldwin
did not reply but “continued to type on her computer.” Id. He argues it
would have been inconsistent to agree to a delay in treatment given his
repeated complaints of pain and requests for an MRI. Id. at 55.
Also according to Baldwin, “it did not make sense to set an
appointment for him after he was expecting to be released, as he stated
he was not going to follow up at [the University of Iowa] after his
release.” ECF No. 21-3 at 34–35. Dantzler disputes he declined to be
treated at the University of Iowa after he was released. ECF No. 46 at 54.
He avers he was never asked whether he would follow up at the
University of Iowa, and argues there is no notation in the medical records
to support Baldwin’s statement regarding follow-up treatment at the
University of Iowa. Id. at 53–54.
R. Doc. 52, at 20 (alterations in original). Additionally, Dantzler disputes Dr.
Baldwin’s implication that he was noncompliant with treatment. See R. Doc. 46, at 27
(explaining that he “took [the] knee sleeve off before going to ‘every’ [h]ealth
[s]ervice[s] appointment . . . . because it was easier to show his knee/injury if he had
on jeans or sweatpants, because short[s] are not allowed to be worn in [the] Health
Service[s] Department”); id. (explaining that “[i]t [was] not possible for [Dr.] Baldwin
to monitor if/when [Dantzler was] taking the issued [ibuprofen]” because it was issued
to him to take in his cell as needed).
Based on Dantzler’s account, Dr. Baldwin was aware of Dantzler’s knee pain,
recognized that his knee was still swelling and not improving yet “withheld [the MRI]
for [a] nonmedical reason[]”— the possibility of Dantzler’s parole. See Hartsfield, 471
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F.3d at 457. In light of the conflicting accounts, it is “not clear” that Dr. Baldwin’s
decision to delay the MRI was a “medical-judgment decision[].” See Delaughter, 909
F.3d at 138.
B. Clearly Established
“Proving the Eighth Amendment violation itself, however, is only half the
battle. To overcome qualified immunity, [Dantzler] must show that every reasonable
official in [Dr. Baldwin’s] position would have understood that [delaying an MRI for
the nonmedical reason of an inmate’s possibility of parole] violated that right.”
Fisherman, 100 F.4th at 981 (cleaned up). In other words, Dantzler bears the burden
of showing that the law is clearly established. See Dean v. Bearden, 79 F.4th 986, 989
(8th Cir. 2023).
A plaintiff can show that law is clearly established in three ways.
First, a plaintiff may identify existing circuit precedent involving
sufficiently similar facts that squarely governs the situation. Second, a
plaintiff may point to a robust consensus of cases of persuasive authority
establishing that the facts of her case make out a violation of clearly
established right. We do not consider a consensus based on the decision
of a single circuit and a handful of lower courts to be robust. Finally, a
plaintiff may show, in rare instances, that a general constitutional rule
applies with obvious clarity to the facts at issue and carries the day for
her.
Hovick v. Patterson, 37 F.4th 511, 517 (8th Cir. 2022) (cleaned up).
No matter how the plaintiff shows clearly-established law—existing circuit
precedent, robust consensus of cases of persuasive authority, or an obvious case—that
law must “clearly prohibit the [official’s] conduct in the particular circumstances
before him [or her]. The rule’s contours must be so well defined that it is clear to a
reasonable official that his [or her] conduct was unlawful in the situation he [or she]
confronted.” Id. (cleaned up). We undertake this inquiry “in light of the specific
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context of the case, not as a broad general proposition.” Id. (internal quotation marks
omitted). “We must not define clearly established law at a high level of generality,
since doing so avoids the crucial question whether the official acted reasonably in the
particular circumstances that he or she faced.” Id. (internal quotation marks omitted).
Applying these principles, we hold “that every reasonable official in [Dr.
Baldwin’s] position would have understood that [delaying an MRI for the nonmedical
reason of an inmate’s possibility of parole] violated” Dantzler’s Eighth Amendment
rights. See Fisherman, 100 F.4th at 981 (cleaned up). First, circuit precedent clearly
establishes that an inmate can prove deliberate indifference by showing that a prison
official “intentionally delayed . . . access to medical care.” Allard, 779 F.3d at 772.
Second, circuit precedent put Dr. Baldwin on notice that providing “some
medical care” to Dantzler would not immunize her from a deliberate-indifference
claim; Dantzler “is entitled to prove his case by establishing the course of treatment,
or lack thereof, so deviated from professional standards that it amounted to deliberate
indifference.” Id. (cleaned up). Thus, a prison doctor who fails to exercise
“professional judgment” in making a medical care decision may be liable for
deliberate indifference. See A.H., 891 F.3d at 727.
Third, circuit precedent, as well as a robust consensus of cases from our sister
circuits, establish that a prison official “delaying medical treatment for ‘nonmedical
reasons’ may amount to deliberate indifference.” Cannon, 112 F.4th at 591 (quoting
Hartsfield, 371 F.3d at 457); see also Morris, 954 F.3d at 1059.4 We acknowledge that
4Our sister circuits agree. See, e.g., Delaughter, 909 F.3d at 138 n.7 (“We have
previously suggested that a non-medical reason for delay in treatment constitutes
deliberate indifference, and several of our sister circuits have held so explicitly.”);
Perez, 792 F.3d at 777 (“Deliberate indifference may occur where a prison official,
having knowledge of a significant risk to inmate health or safety, . . . delays a
prisoner’s treatment for non-medical reasons, thereby exacerbating his pain and
suffering.”); Blackmore v. Kalamazoo County, 390 F.3d 890, 899 (6th Cir. 2004)
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the “word ‘may’ leaves room for consideration of the specific facts and circumstances
of the case.” Leonard v. St. Charles Cnty. Police Dep’t, 59 F.4th 355, 363 (8th Cir.
2023). But we have no trouble concluding that Hartsfield put Dr. Baldwin on notice
that delaying medical treatment for the nonmedical reason of an inmate’s possibility
of parole would rise to the level of deliberate indifference. In Hartsfield, we held that
evidence a prison doctor “withheld dental treatment for nonmedical reasons—[the
detainee’s] behavioral problems”—generated a “question of material fact . . . as to
whether . . . [the jail doctor] w[as] deliberately indifferent.” 371 F.3d at 457. Like the
jail doctor in Hartsfield, Dr. Baldwin “was made aware of [Dantzler’s] pain . . . , but
[she] withheld [scheduling the MRI] for nonmedical reasons—[Dantzler’s possibility
of parole].” Id.
Leonard does not undermine our conclusion that the law was clearly
established. In that case, a nurse failed to provide a pretrial detainee with medication
for his mental illness and eye inflammation. 59 F.4th at 358. But once the detainee
“began showing suicidal tendencies, she placed him in the Suicide Prevention Unit,
which had procedures in place to prevent inmates from harming themselves.” Id. at
363. Thus, the nurse “dealt with his psychosis,” id. at 362, by taking a “precautionary
measure[],” id. at 363. We compared the nurse’s action to “what happened in Dadd v.
Anoka County.” Id. (citing Dadd v. Anoka County, 827 F.3d 749, 755 (8th Cir. 2016)).
“There, the nurse refused to provide an inmate with a prescription painkiller following
dental surgery. Later, despite knowing that he could not sleep due to the pain, she still
did nothing. And even after a doctor prescribed an over-the-counter pain medication,
(“When prison officials are aware of a prisoner’s obvious and serious need for
medical treatment and delay medical treatment of that condition for non-medical
reasons, their conduct in causing the delay creates the constitutional infirmity.”);
Farrow, 320 F.3d at 1246 (“For example, a defendant who delays necessary treatment
for non-medical reasons may exhibit deliberate indifference.”); Rouse v. Plantier, 182
F.3d 192, 197 (3d Cir. 1999) (“We have found ‘deliberate indifference’ . . . where the
prison official . . . delays necessary medical treatment based on a non-medical
reason . . . .”).
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she refused to administer it.” Id. The “clearly established principle” that we discerned
from Dadd “is that a complete failure to treat an extremely painful (or other serious)
condition displays a reckless indifference to a serious medical need.” Id. (citing Dadd,
827 F.3d at 757). We held that Dadd did not place the nurse in Leonard on “‘fair
notice’ that her failure to take further action violated clearly established law.” Id.
Although we distinguished Dadd from Leonard on the complete-failure-to-treat
principle, that is not the only ground upon which Leonard is distinguishable from
Dadd. In Leonard, we never said that the nurse’s decision to place the pretrial detainee
in the Suicide Prevention Unit to monitor his mental illness instead of giving him his
medication was not a “medical judgment”; by contrast, in Dadd, the nurse’s refusal to
give the inmate his medication was not based on a “medical judgment” but on
“indifference.” Dadd, 827 F.3d at 756. In summary, the nurse in Leonard exercised
medical judgment, while the nurse in Dadd failed to act based on a nonmedical
reason—indifference. For the same reason, Leonard is distinguishable from the
present case. Based on Dantzler’s version of the facts, Dr. Baldwin delayed his MRI
for a nonmedical reason (the possibility of parole) instead of based on her medical
judgment.
In summary, we conclude that the law was clearly established. Crediting
Dantzler’s version of the facts, we hold that Dr. Baldwin was on notice that despite
providing some care to Dantzler, her delay in scheduling him for an MRI based on the
nonmedical reason of his possibility of parole supports a finding of deliberate
indifference.
III. Conclusion
We affirm the judgment of the district court.
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STRAS, Circuit Judge, dissenting.
Dr. Baldwin made the wrong decision about how to treat Travis Dantzler’s
injured knee. But “[d]eliberate indifference is a difficult standard to meet,” which is
why she should receive qualified immunity “[e]ven under a plaintiff-friendly version
of the facts.” Leonard v. St. Charles Cnty. Police Dep’t, 59 F.4th 355, 360–61 (8th
Cir. 2023) (citations omitted). Maybe she committed medical malpractice, but the
treatment she provided did not reflect a criminally reckless state of mind. See id. at
360.
“[T]his is not one of those cases in which there was a complete and unjustifiable
lack of treatment.” Id. at 361. Dantzler received ibuprofen and a knee brace/sleeve
from the moment he reported having pain until a doctor surgically repaired his knee.
Although getting the surgery took longer than it should have, criminal recklessness
requires more than just being wrong about the right medical treatment. See Phillips
v. Jasper Cnty. Jail, 437 F.3d 791, 795 (8th Cir. 2006) (holding that mere
disagreement with a treatment decision is not enough); Dulany v. Carnahan, 132 F.3d
1234, 1240 (8th Cir. 1997) (“[A]n inmate is not entitled to any particular course of
treatment.”).
Even if waiting to see if Dantzler received parole crossed the constitutional line,
Dr. Baldwin still did not violate a clearly established right. See Morgan v. Robinson,
920 F.3d 521, 523 (8th Cir. 2019) (en banc). Our cases establish only that delaying
non-emergency medical care may be unconstitutional. See Leonard, 59 F.4th at 363
(“The word ‘may’ leaves room for consideration of the specific facts and
circumstances of [each] case . . . .”). That is, “complete[ly] fail[ing] to treat an
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extremely painful (or other serious) condition” can lead to liability. Id. But not
treating a painful knee with ibuprofen and a brace, the right approach for the injury she
thought he had. See Brosseau v. Haugen, 543 U.S. 194, 198 (2004) (per curiam)
(requiring “fair notice” before an official loses qualified immunity).
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