On July 20, 2010, the Eighth Circuit Court of Appeals affirmed in part a district court’s denial of summary judgment to prison officials on the medical claims of two Arkansas state prisoners.

Arkansas Department of Corrections (ADOC) prisoner Mack Langford, who is in his eighties, “suffers from a variety of physical maladies and shows signs of mild mental retardation and dementia.”

In April 2003, Langford’s repeated complaints of severe stomach pain, vomiting blood and other symptoms were dismissed as “gas” and “treated” with antacid tablets. After he was found unconscious, Langford was hospitalized and “doctors discovered a problem with [his] gallbladder, ... and found cysts in both his kidneys.” After he was released from the hospital he continued to experience back and stomach pain.

“Starting in November 2004, Langford was examined at least sixteen times by Dr. Nnamdi Ifediora, an employee or contractor of Correctional Medical Services, Inc. (‘CMS’), the company that provides medical services in Arkansas prisons. Dr. Ifediora ... referred Langford to specialists, from whom he sought diagnostic recommendations.”

In August 2005, imaging tests “revealed a possible mass in one of Langford’s kidneys and cysts in both kidneys.” Langford again complained of stomach pain on November 28, 2005 but was not treated. After passing out a second time, he was again hospitalized.
“There, doctors diagnosed him with pancreatitis and again found cysts in both his kidneys.” Prison officials failed to treat his cysts or “possible renal failure.”

John Hardin, a 66-year-old insulin-dependent diabetic ADOC prisoner, broke his ankle in February 2004. He was prescribed a wheelchair but never received one. Dr. John Lytle, a private orthopedic surgeon, surgically repaired Hardin’s ankle; however, within three months Hardin felt severe pain in the ankle. A prison doctor admitted in July 2004 that “there was something seriously wrong” with Hardin’s “misshapen and deformed” ankle.
Several months later, Dr. Ifediora noted Hardin’s ankle deformity, severe pain and difficulty walking. Ifediora again ordered a wheelchair and referred Hardin for an “orthopedic consult” with Lytle.

In October 2004, Dr. Lytle diagnosed Hardin with “Charot foot,” a sudden softening of the bones experienced by people who have significant nerve damage (neuropathy). “The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk.”

Dr. Lytle noted “significant deterioration” in Hardin’s bones and determined that reconstructive surgery may not be an option. He “suggested that amputating Hardin’s leg below the knee might give him the best chance to regain mobility.” In February 2005, “Lytle noted his concerns about ‘progressive deformity’ in Hardin’s ankle and about Hardin’s inability to bear weight on the injured leg.” He “prescribed a padded tennis shoe and a cane, and suggested that Hardin might need a brace for his foot.” However, Hardin did not receive a brace or a properly fitting padded shoe. He became wheelchair-bound and was denied other treatment options.

Langford and Hardin filed suit against several ADOC and CMS defendants, alleging deliberate indifference to their serious medical needs in violation of the Eighth Amendment. They also alleged violations of the due process and equal protection clauses, the Americans with Disabilities Act (ADA), the Rehabilitation Act and state law torts.

The district court rejected the defendants’ argument that the plaintiffs had failed to exhaust their administrative remedies, “finding that Hardin had exhausted and that there was a genuine issue of material fact about whether Langford had exhausted available remedies.” The court denied qualified immunity and “found that there were genuine issues of material fact concerning the plaintiffs’ deliberate indifference claims.” It also “found that genuine issues of material fact precluded summary judgment on the plaintiffs’ claims under the ADA and the Rehabilitation Act, as well as the state law negligence and outrage claims.” The district court denied statutory immunity to the defendants on the state law claims.

The defendants filed an interlocutory appeal on the exhaustion and qualified immunity rulings. The Eighth Circuit dismissed the appeal as to exhaustion and issues raised by the CMS defendants, for lack of jurisdiction. The appellate court found, however, that it could address the qualified immunity and statutory immunity arguments because they were “purely legal” issues.

Turning to the qualified immunity ruling, the Court of Appeals applied the “adverse inference rule” to prison officials who failed to produce letters that the plaintiffs had sent them. Under that rule, the “failure to produce the letters ... permitted the district court to infer that the evidence contained in those letters would undermine” the defense.
Ultimately, the Eighth Circuit affirmed the denial of qualified immunity on the plaintiffs’ deliberate indifference claims.

The appellate court then analyzed the district court’s ruling that the defendants were not entitled to statutory immunity on the plaintiffs’ state law claims. Noting that the “plaintiffs ignore the issue, and the state defendants treat it as an afterthought,” the Court of Appeals reversed, finding the plaintiffs had failed to offer allegations or factual support of the requisite “willful, wanton, or otherwise malicious conduct” of the defendants. The case was remanded for further proceedings. See: Langford v. Norris, 614 F.3d 445 (8th Cir. 2010).

Following remand, on September 20, 2011 the district court adopted a magistrate’s report and recommendation to grant summary judgment to Dr. Ifediora and the CMS defendants with respect to the ADA and Rehabilitation Act claims. This case remains pending. See: Langford v. Ifediora, 2011 WL 4369359 (E.D.Ark. 2011).

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