Case: 21-60320 Document: 00516740277 Page: 1 Date Filed: 05/05/2023
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
FILED
May 4, 2023
No. 21-60320
Lyle W. Cayce
Clerk
Chaz Pinkston,
Plaintiff—Appellee,
versus
Doctor Hendrick Kuiper, Medical Director,
Defendant—Appellant.
Appeal from the United States District Court
for the Northern District of Mississippi
USDC No. 4:17-CV-39
Before Higginbotham, Jones, and Oldham, Circuit Judges.
Per Curiam:
A medical doctor ordered that a distressed prisoner receive
medication. Afterward, the prisoner sued, arguing that the doctor violated
the prisoner’s due process rights. The district court agreed. We do not, and
we reverse.
I.
Chaz Pinkston is a Mississippi state inmate. Dr. Hendrick Kuiper is a
physician, and at relevant times was the medical director at the state facility
where Pinkston was housed. Because Pinkston suffers from a complex
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No. 21-60320
psychiatric profile that includes narcissistic personality disorder and a history
of hunger strikes, Pinkston’s cell was inside the facility’s medical unit.
The genesis of this litigation occurred one morning in September
2016. Pinkston complained of a skin problem on his leg. Dissatisfied with a
prison nurse’s response, Pinkston began yelling, imitating animal noises, and
kicking against his cell door. Pinkston continued for more than three hours.
He also threatened violence against medical staff. As a result of Pinkston’s
incitement, other prisoners, many of whom were also psychiatric patients,
began to act similarly.
Dr. Kuiper heard this disturbance from his position one floor below
Pinkston. Kuiper went to the scene, as did as many as nine other staff
members. There, Kuiper asked Pinkston to desist several times. Pinkston did
not. Kuiper then ordered that Pinkston receive two injections: Haldol, an
antipsychotic, and Benadryl, an antihistamine intended as a prophylactic
against any complication from Haldol. Pinkston went to sleep following the
injections, and nearby inmates quieted down.
Afterward, Pinkston filed a 42 U.S.C. § 1983 suit alleging that Dr.
Kuiper’s decision to forcibly medicate Pinkston violated Pinkston’s civil
rights. The district court, relying on Fourteenth Amendment substantive due
process jurisprudence and out-of-circuit opinion, agreed.
Dr. Kuiper timely appealed. We have jurisdiction to review the district
court’s final judgment. See 28 U.S.C. § 1291. We review the district court’s
legal conclusions de novo and its factual findings for clear error. See Adkins v.
Kaspar,
393 F.3d 559, 563 (5th Cir. 2004).
II.
When a plaintiff files a 42 U.S.C. § 1983 suit alleging a constitutional
infraction, the “first inquiry” is to “isolate the precise constitutional
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violation with which the defendant is charged.” Graham v. Connor, 490 U.S.
386, 394 (1989).
We first (A) explain why Pinkston’s claim is best understood as an
Eighth Amendment claim. Then we (B) resolve that claim.
A.
The Eighth Amendment protects federal prisoners from “cruel and
unusual punishments.” U.S. Const. amend. VIII. That means prisoners
are protected from “the unnecessary and wanton infliction of pain.” Gregg v.
Georgia, 428 U.S. 153, 173 (1976).
The “wanton infliction of pain” standard provides the bridge between
the Eighth Amendment’s cruel and unusual punishment guarantee and a
prisoner’s right to medical care. Because the Supreme Court considers
“deliberate indifference to serious medical needs” functionally equivalent to
the “wanton infliction of pain,” the Court has held that the Eighth
Amendment prohibits such indifference. Estelle v. Gamble, 429 U.S. 97, 104
(1976) (quotation omitted).
This “deliberate indifference” standard applies to claims based on a
defendant’s acts, not just his omissions. Id. at 106. We have held that the
decision to provide treatment is “a classic example of a matter for medical
judgment” and subject to Eighth Amendment resolution. Gobert v. Caldwell,
463 F.3d 339, 346 (5th Cir. 2006) (quotation omitted). We have repeatedly
applied the Eighth Amendment in other cases where prisoners challenged
providers’ affirmative acts. See Davis v. Lumpkin,
35 F.4th 958, 963 (5th Cir.
2022) (indicating deliberate indifference applies when a prisoner claims
officials “intentionally treated him incorrectly”); Bias v. Woods,
288 F.
App’x 158, 162 (5th Cir. 2008) (applying deliberate indifference to a
provider’s decision to order medical transport).
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Dr. Kuiper’s decision to medically intervene falls within the Eighth
Amendment’s ambit. In an alternative world where Dr. Kuiper decided
against intervention, claims for resulting injury would be reviewable under
the deliberate indifference standard. The standard for evaluating Dr.
Kuiper’s decision and its consequences does not change merely because in
this world, Dr. Kuiper made that decision differently.
The parties and the district court resist this conclusion and instead
frame this dispute as a matter of Fourteenth Amendment substantive due
process. They rely on the Supreme Court’s statement in Washington v.
Harper, 494 U.S. 210 (1990), that individuals possess “significant liberty
interest in avoiding the unwanted administration of antipsychotic drugs.”
Id.
at 221. In Harper, the Supreme Court held that the State must afford a
prisoner minimal procedural protection before subjecting him to a forcible,
long-term regimen of antipsychotic injections.
Id. at 228–31. The Supreme
Court later relied on Harper when it recognized a pre-trial detainee’s
Fourteenth Amendment interest in avoiding repeated injections over a sixmonth interval. See Riggins v. Nevada,
504 U.S. 127, 130–31, 135 (1992). And
in this case, the district court held that Harper and Riggins required Dr.
Kuiper to hold a hearing before providing care to a plainly distressed
Pinkston.
But neither Harper nor Riggins articulated constitutional standards
governing the isolated administration of a single dose of an antipsychotic in a
threatening, time-sensitive prison situation. Moreover, the Supreme Court
has instructed us not to apply the Fourteenth Amendment’s substantivedue-process catchall when another, more specific constitutional provision
applies. United States v. Lanier, 520 U.S. 259, 272 n.7 (1997) (“[I]f a
constitutional claim is covered by a specific constitutional provision, such as
the Fourth or Eighth Amendment, the claim must be analyzed under the
standard appropriate to that specific provision, not under the rubric of
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substantive due process.”); Albright v. Oliver, 510 U.S. 266, 273 (1994)
(“Where a particular Amendment ‘provides an explicit source of
constitutional protection’ against a particular sort of government behavior,
‘that Amendment, not the more generalized notion of substantive due
process, must be the guide for analyzing these claims’” (quoting Graham,
490 U.S. at 395)).
Harper and Riggins therefore do not apply.1
B.
Under the Eighth Amendment, Pinkston’s claim fails. The Eighth
Amendment requires Pinkston to satisfy an “extremely high” deliberate
indifference standard. See Gobert, 463 F.3d at 346 (quotation omitted).
Negligence or even medical malpractice does not independently support a
prisoner’s Eighth Amendment deliberate indifference claim. Estelle, 428
U.S. at 105–06. Rather, a deliberate indifference plaintiff must show that the
defendant
(1) was aware of facts from which the inference could be drawn
that substantial risk of serious harm exists; (2) subjectively
drew the inference that the risk existed; and (3) disregarded the
risk.
Cleveland v. Ball, 938 F.3d 672, 676 (5th Cir. 2019) (quoting Farmer v.
Brennan,
511 U.S. 825, 837 (1994)).
1
Nor can Pinkston contend that bodily integrity claims are somehow different. We
long ago foreclosed that contention. See Austin v. Johnson, 328 F.3d 204, 210 n.10 (5th Cir.
2003) (deciding that, where custodial plaintiff brought a bodily integrity claim, the Eighth
Amendment “defines the limits of government action” and “controls over the more
generalized notion of substantive due process” (quotations omitted)).
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The record is devoid of evidence that Dr. Kuiper subjectively
disregarded significant risk to Pinkston. That alone disposes of this case. Far
from showing deliberate indifference, the record instead suggests that Dr.
Kuiper believed medicating Pinkston was necessary to avoid danger to both
Pinkston and others. The fact that Dr. Kuiper prescribed Benadryl as
prophylaxis against any risk from Haldol further supports our conclusion that
Dr. Kuiper believed his actions consistent with Pinkston’s medical need.
The district court, leveraging hindsight, might disagree with Dr.
Kuiper about the objective necessity of medicating Pinkston. But post hoc,
objective determinations are irrelevant. The deliberate indifference standard
asks only whether the defendant’s subjective, ex ante choices reflect
deliberate indifference. See Cleveland, 938 F.3d at 676. Dr. Kuiper’s did not.
III.
Even if we did apply the Fourteenth Amendment, the result would not
change.
Because the parties raise it, we consider the example set by our sister
circuit in Hogan v. Carter, 85 F.3d 1113 (4th Cir. 1996). That case considered
a medical practitioner’s choice to administer an emergency dose of
antipsychotic Thorazine to an enraged inmate who, like Pinkston, was
kicking against his door and behaving aggressively toward staff over a period
of several hours.
Id. at 1114. Like Pinkston, the plaintiff in Hogan argued that
he was entitled to a hearing before medication.
Id. at 1115.
In Hogan, the en banc Fourth Circuit appeared to frame the question
presented as one of procedural due process. See id. at 1117 (“Due process . . .
calls for such procedural protection as the particular situation demands.”
(quotation omitted)). The Fourth Circuit decided that the Supreme Court in
Washington v. Harper “did not have before it, and did not address,” what
procedure might be required in Hogan’s emergency circumstances.
Id. at
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1116. The Fourth Circuit then concluded that the Constitution does not
require “adversary proceedings at any hour of the night” while “the very
inmates for whose protection the state is constitutionally responsible remain
in danger of injury at their own hands.” Id. at 1117.
The Fourth Circuit’s decision comports with the law in this Circuit,
which similarly recognizes that emergency circumstances justify the
abbreviation or elimination of pre-deprivation procedures like hearings. See
Caine v. Hardy, 943 F.2d 1406, 1412 (5th Cir. 1991) (en banc) (“Not even an
informal hearing, however, must precede a deprivation undertaken to protect
the public safety.”). That’s in part because the procedure due in each case
varies with the circumstances of that case and the competing interests
involved. See Harper,
494 U.S. at 229 (citing Mathews v. Eldridge,
424 U.S.
319, 335 (1976)); Hogan,
85 F.3d at 1117; Caine, 943 F.3d at 1412. So, if we
were to resolve Pinkston’s claims using a Fourteenth Amendment
procedural due process framework, we would consider not only his liberty
and medical interests, but also the significant government interest in
“maintaining institutional security and preserving internal order” within his
penitentiary. Bell v. Wolfish,
441 U.S. 520, 546 (1979). Here, Pinkston
received more than the procedure he was due.
Pinkston’s principal counterargument is that he received no process
at all. We disagree. It’s not as if Dr. Kuiper suddenly and arbitrarily injected
Pinkston. Rather, Dr. Kuiper injected him only after Pinkston precipitated a
disturbance that subjectively appeared imminently dangerous, only after
multiple rounds of verbal persuasion failed, and only after a licensed medical
professional determined that medication was appropriate.
…
The district court erred when it declined to apply an Eighth
Amendment framework to Pinkston’s dispute over medical treatment. And,
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even if a Fourteenth Amendment framework were apposite, Pinkston
received all the process he was due. We REVERSE the judgment of the
district court and render judgment for Dr. Kuiper.
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