The First Circuit Court of Appeals reversed the grant of summary judgment to a physician assistant at the York County Jail (YCJ) in Maine, concluding that a material dispute existed as to whether the physician assistant acted with deliberate indifference to the serious medical needs of an HIV-positive detainee.

In April 2008, Raymond D. Leavitt, a Maine state prisoner, filed suit pursuant to 42 U.S.C. § 1983 and the Americans with Disabilities Act (ADA), seeking injunctive relief and monetary damages against various correctional officials and healthcare providers. He alleged that he was denied HIV treatment for the entirety of his 167-day stay at YCJ and for the first 17 months of his incarceration at the Maine State Prison (MSP), where medical care was provided by Correctional Medical Services (CMS).

Leavitt, who had been taking HIV medications before he was incarcerated, claimed that the delay in reinitiating his antiretroviral therapy for HIV resulted in short- and long-term negative consequences to his health.

Initially proceeding pro se, Leavitt eventually obtained the services of an attorney. In March 2010, the district court granted summary judgment in favor of the defendants, finding insufficient evidence that they had acted with deliberate indifference to Leavitt’s serious medical needs.

On appeal, Leavitt dropped his ADA claim. With respect to the 17-month delay in reinitiating Leavitt’s antiretroviral therapy at MSP, the Court of Appeals noted an acknowledgement by MSP’s healthcare providers that “the care [Leavitt] received ultimately fell short of the mark,” and the Court therefore urged “[t]hose responsible for the operation of the Maine correctional healthcare system ... [to] focus on the troubling implications of that acknowledgment.”

The First Circuit concluded, however, that because the medical department at MSP operates on a clinic model where no particular healthcare provider is charged with following any particular patient, Leavitt could not carry his burden of demonstrating that any individual provider was sufficiently aware of his circumstances to actually draw the inference that he faced a substantial risk of serious harm. Thus, the grant of summary judgment to the MSP and CMS defendants was affirmed.

By contrast, with respect to Leavitt’s treatment at YCJ, the First Circuit observed that physician assistant Alfred Cichon was the president of ARCH, the corporation that provided healthcare services at the jail, and that, as its largest shareholder, a jury could infer that Cichon had a financial incentive to keep treatment costs low. Such an incentive could explain Cichon’s “unfortunate” overlooking of a medical report that would have alerted him to the need to “precipitously” refer Leavitt to an infectious disease specialist.

The Court of Appeals therefore reversed the grant of summary judgment in favor of Cichon, and remanded the case for further proceedings. See: Leavitt v. Correctional Medical Services, Inc., 645 F.3d 484 (1st Cir. 2011).

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