Mixed Immunity Ruling in Fourth Circuit Prisoner Failure-to-Treat Claim

The Fourth Circuit issued a mixed ruling on qualified immunity to two different doctors, with very different roles, in a prisoner's Eighth Amendment failure-to-provide-adequate-treatment claim. The court also ruled that the treating physician enjoyed sovereign immunity from the prisoner's medical-malpractice claim.

The case, Pfaller v. Amonette, arose when a prisoner died from liver cancer after prison doctors failed to treat his hepatitis C. The plaintiff alleged that one of those doctors, Amonette, designed treatment guidelines that excluded the prisoner from receiving treatment. The plaintiff alleged that the other doctor, Wang, failed to provide necessary treatment.

The court ruled that Wang did not enjoy qualified immunity, but Amonette did. The court said that Wang failed to refer the prisoner for additional testing after his blood numbers showed that he qualified. The court rejected Wang's argument that he simply made a mistake. And it rejected his argument that the constitutional right wasn't clearly established at the time. On this last point, the court said that the relevant right was the right to receive adequate medical treatment free from deliberate indifference--and not the right (as Wang claimed) to schedule a specific type of follow-up test at a particular time. The court noted that the right to receive adequate medical treatment was well established.

In contrast, the court said that Amonette didn't interact with the prisoner at all, but instead "created a system of prioritization where the sickest inmates received treatment first." The court said that this prioritization was consistent with standards of the medical community and the Federal Bureau of Prisons when resources are limited. The court also noted that "various Courts of Appeals opinions have cut different ways regarding whether similar treatment guidelines pass constitutional muster or violate clearly established law." The court said that this "gray area" itself was enough to protect Amonette.

Finally, the court held that while Wang didn't enjoy qualified immunity from the Eighth Amendment claim, he did enjoy sovereign immunity (as a government employee, doing the government's work) from the medical-malpractice claim.