Colo. Prison Nurse Can't Ignore Inmate With Severe Pain - U.S. Tenth Circuit
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Colo. Prison Nurse Can't Ignore Inmate With Severe Pain

This is not a complicated case.

Homaidan Al-Turki is an inmate at Limon Correctional Facility in Colorado. He was in pain. His pain was so severe that he was unable to stand and was vomiting. Mary Robinson, the nurse on duty at the time, refused to treat him, telling him to take it up in writing with the doctor who would be around in the morning. Eventually he passed out, woke up still in pain, and passed two kidney stones.

Crisis averted, but there was still the matter of hours of untreated pain. Hence, his lawsuit against Robinson for deliberate indifference.

Sufficiently Serious Condition

In her appeal of the district court's denial of qualified immunity, Robinson basically argues that this was no big deal -- temporary benign pain that lasted only a few hours that would have only been reduced, not eliminated, by medical treatment.

The test for actionable deliberate indifference has two prongs: the objective prong ("significant, as opposed to trivial, suffering") and the subjective prong (whether the medical professional knew about it).

Obviously, only the former is at issue here, and as anyone who has ever had a kidney stone will testify, the pain can be extremely severe. An expert testified for Al-Turki, noting that the pain could cause even a large football player to curl up into a ball on the floor. He was in so much pain that he collapsed and vomited. Multiple prison guards and officials were concerned enough to take him for treatment, and to discuss Robinson's rejection of her patient with her. (She parried the shift commander's concerns by labeling the inmate an escape risk.)

Where is the line? That's TBD, the Tenth Circuit panel explained:

We need not attempt to precisely delineate in this case the exact boundaries of the line between the trivial "twinge of pain" that will not give rise to an Eighth Amendment deliberate indifference claim and the significant "substantial" pain that will give rise to such a claim. It is sufficient for us to hold that Plaintiff's several hours of untreated severe pain in this case fall on the actionable side of the line.

No Qualified Immunity

Robinson also argued that because past cases involved more severe medical emergencies, that she should be shielded by qualified immunity -- the law wasn't clearly established.

The court responds by quoting a previous case, which stated that a deliberate indifference claim will arise when "a medical professional completely denies care although presented with recognizable symptoms which potentially create a medical emergency [...] the prison official, knowing that medical protocol requires referral or minimal diagnostic testing to confirm the symptoms, sends the inmate back to his cell."

As the panel noted, the relevant question is what facts were known to Nurse Robinson at the time -- that a guy with Type II Diabetes was in severe pain. Never mind what we know now -- this was simply some benign (albeit painful) kidney stones. 

"A medical professional may not ignore an inmate's complaints of severe pain and then escape liability because later-discovered facts about the actual cause and ultimate duration of the inmate's pain, while serious enough to give rise to an Eighth Amendment claim, do not precisely correspond with the facts of previous Tenth Circuit cases," the court concluded.

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