Mackey v. Cook

Background

Vincent Robert Mackey, a California prisoner proceeding without a lawyer, sued doctors and administrators at San Quentin under 42 U.S.C. § 1983. He alleged that the defendants violated the Eighth Amendment by failing to provide adequate medical care for what he described as long-term failure of bowel movement through the lower bowel. He said the defendants instead diagnosed constipation or irritable bowel syndrome, prescribed laxatives and suppositories that did not work, and failed to order tests for the condition he believed he had. He sought testing, other injunctive relief, two million dollars, and an official apology.

The claims proceeded against Dr. Cook, Dr. Ramirez Batlle, Dr. Wu, N. Podolski, M. Verdier, T. Woodson, S. Gates, Warden Broomfield, and Chief Medical Officer Pachynski. The court had previously found that Mackey stated claims alleging deliberate indifference to serious medical needs, including claims against the supervisors based on alleged inadequate training, supervision, or policies.

The medical evidence described chronic constipation, prior testing, several medications and treatments, and repeated referrals to gastroenterologists. A 2021 colonoscopy was normal, and a December 2021 anorectal motility study was also normal, although it showed high-normal sphincter pressure and recommended considering nitroglycerin ointment. Dr. Cook treated Mackey several times in 2022, ordered or provided laxatives, suppositories, nitroglycerin cream, laboratory work, and referrals to gastroenterologists. Mackey declined or refused some offered gastroenterology appointments. A later gastroenterologist, Dr. McCabe, described likely idiopathic constipation and said Mackey had a neuromotor peristalsis problem requiring further testing.

Legal standard

The court applied the summary-judgment standard under Federal Rule of Civil Procedure 56. Summary judgment is appropriate when the evidence shows no genuine dispute about a fact that could affect the outcome and the moving party is entitled to judgment as a matter of law. The court viewed the evidence in the light most favorable to Mackey as the nonmoving party.

For the Eighth Amendment medical-care claim, Mackey had to show a serious medical need and that each defendant deliberately disregarded it. Deliberate indifference requires a purposeful act or failure to act by an official who knew of a substantial risk of serious harm and failed to take reasonable measures to address it. The court explained that negligence, malpractice, an inadvertent failure to provide adequate care, or a disagreement about medical treatment is not enough. For different treatment choices, the prisoner must show that the chosen treatment was medically unacceptable under the circumstances and was selected with conscious disregard of the risk.

Court’s analysis

Dr. Cook

The court held that the evidence would not allow a reasonable fact-finder to conclude that Dr. Cook was deliberately indifferent. Other doctors, including Dr. Ndu and Dr. McCabe, also diagnosed chronic or idiopathic constipation. The court said Mackey’s disagreement with that diagnosis did not create a genuine factual dispute. Dr. McCabe’s later reference to a neuromotor peristalsis problem did not establish that Dr. Cook knowingly disregarded a different condition, particularly because Dr. McCabe also described chronic idiopathic constipation.

The court also found no evidence that Dr. Cook’s treatment was medically unacceptable. Dr. Cook examined Mackey multiple times, provided or ordered several treatments, arranged laboratory work, and repeatedly referred him to gastroenterologists. The court rejected the argument that Dr. Cook should have referred Mackey directly to a motility sub-specialist, finding no evidence or cited authority showing that a general-practitioner referral to a gastroenterologist was unreasonable. The court also found that Dr. Cook ordered enemas twice but changed course when they were not readily available; the evidence did not show that this decision consciously disregarded a safety risk.

Dr. Wu and Dr. Ramirez Batlle

The court found that Mackey submitted no evidence showing when or how Dr. Wu or Dr. Ramirez Batlle treated him, apart from a reference to Dr. Ramirez Batlle’s signature on a colonoscopy report. The court considered Mackey’s verified complaint but concluded that the alleged diagnoses of constipation and irritable bowel syndrome, along with the use of laxatives, suppositories, and referrals, did not support deliberate indifference. The court found no evidence that these defendants knew of a better treatment and disregarded it.

Administrative defendants

The court also found no triable issue as to N. Podolski, M. Verdier, T. Woodson, and S. Gates, who had reviewed Mackey’s medical grievances. The court concluded that they investigated the situation, ensured that Mackey was receiving medical care, and reasonably relied on the doctors’ opinions and referrals. It found no evidence that these officials knew of, or should have known of, a substantial health risk that they disregarded.

Supervisory defendants

The court held that Warden Broomfield and Chief Medical Officer Pachynski were not liable because there was no evidence that they personally participated in Mackey’s treatment, knew about his gastrointestinal problems, implemented deficient medical policies, or inadequately trained or supervised other defendants. Because the evidence did not show that Mackey received medically unacceptable care, the court found no basis for supervisor liability.

Motion for sanctions

Mackey moved for sanctions under Rule 11 against the defendants’ attorney. He claimed that the attorney falsely told the court Mackey did not object to an extension of time to file the summary-judgment motion. The court found that the attorney had instead stated that Mackey did not agree to the extension. The court denied the sanctions motion.

Disposition

The court granted the defendants’ motion for summary judgment and denied Mackey’s motion for sanctions. It directed the clerk to enter judgment and close the file.