UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 17-7424
JEFFREY A. PERRY,
Plaintiff - Appellant,
v.
BARBRA MEADE, Medical Department; JOHN DOE, Nurse Practitioner; JOHN
DOE, Nurse Practitioner; JANE DOE, Nurse Practitioner,
Defendants - Appellees,
and
RAPPAHANNOCK REGIONAL JAIL, Medical Department; JOSEPH HIGGS,
Superintendent,
Defendants.
Appeal from the United States District Court for the Eastern District of Virginia, at
Alexandria. Anthony John Trenga, District Judge. (1:17-cv-00588-AJT-TCB)
Submitted: March 15, 2018 Decided: March 27, 2018
Before NIEMEYER, MOTZ, and DUNCAN, Circuit Judges.
Vacated and remanded by unpublished per curiam opinion.
Jeffrey Allen Perry, Appellant Pro Se.
Unpublished opinions are not binding precedent in this circuit.
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PER CURIAM:
Jeffrey Allen Perry appeals the district court’s order dismissing his second
amended 42 U.S.C. § 1983 (2012) complaint for failure to state a claim, pursuant to 28
U.S.C. § 1915A(b)(1) (2012). For the reasons that follow, we vacate the district court’s
dismissal of Perry’s claims against John Doe (one), Jane Doe, and John Doe (two)
(collectively, “Defendants”) and remand for further proceedings on those claims. 1
“We review de novo a district court’s dismissal under 28 U.S.C. § 1915A for
failure to state a claim, applying the same standards as those for reviewing a dismissal
under Fed. R. Civ. P. 12(b)(6).” De’lonta v. Johnson, 708 F.3d 520, 524 (4th Cir. 2013).
We “must construe all factual allegations [in the complaint] in the light most favorable to
the plaintiff.” Wilcox v. Brown, 877 F.3d 161, 166-67 (4th Cir. 2017). “A plaintiff has
stated a claim when he alleges facts allowing the court to draw the reasonable inference
that the defendant is liable for the misconduct alleged.” Id. at 166. (internal quotation
marks omitted); see Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007) (holding that
complaint must contain “only enough facts to state a claim to relief that is plausible on its
face”).
1
Although the district court also dismissed claims against the remaining
defendants, Perry does not argue in his informal brief that the district court erred in
dismissing those claims. See 4th Cir. R. 34(b) (recognizing that we limit our review to
issues raised in informal brief); Jackson v. Lightsey, 775 F.3d 170, 177 (4th Cir. 2014).
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In his second amended complaint, Perry alleged that, while he was incarcerated at
the Rappahannock Regional Jail from 2015 to 2016, Defendants, who are medical
professionals, were deliberately indifferent to his serious medical needs, in violation of
the Eighth Amendment. Perry specifically alleged that he repeatedly complained of
intense pain and rectal bleeding and dizziness, but that Defendants either ignored his
requests for medical treatment or prescribed ineffective courses of treatment without
conducting medical examinations. Perry further alleged that he informed Defendants that
the prescribed treatment was ineffective and that his condition had worsened, yet
Defendants persisted in that course of treatment. Eventually, Perry was diagnosed with
internal hemorrhoids and required a five-day hospitalization and a blood transfusion due
to blood loss. 2 The district court dismissed Perry’s claims because Defendants met with
Perry and offered advice or prescribed medication.
“A prison official’s deliberate indifference to an inmate’s serious medical needs
constitutes cruel and unusual punishment under the Eighth Amendment.” Jackson, 775
F.3d at 178. “The plaintiff must demonstrate that the [defendant] acted with ‘deliberate
indifference’ (subjective) to the inmate’s ‘serious medical needs’ (objective).” Iko v.
Shreve, 535 F.3d 225, 241 (4th Cir. 2008) (quoting Estelle v. Gamble, 429 U.S. 97, 104
(1976)). The objective element of a deliberate indifference claim is satisfied by a serious
medical need, and a medical condition is serious when it has “been diagnosed by a
2
According to Perry, his treating physician at the hospital stated that the
medication prescribed by John Doe (one) and John Doe (two) was “useless” for treating
his condition.
4
physician as mandating treatment or is so obvious that even a lay person would easily
recognize the necessity for a doctor’s attention.” Scinto v. Stansberry, 841 F.3d 219, 225
(4th Cir. 2016) (alteration and internal quotation marks omitted), cert. denied sub nom.
Phillip v. Scinto, 138 S. Ct. 447 (2017). The subjective element of an Eighth Amendment
claim is satisfied by showing that a defendant was “deliberately indifferent,” which
means that the defendant knew of and disregarded “the risk posed by the serious medical
needs of the inmate.” Iko, 535 F.3d at 241. “[M]ere negligence” does not constitute
deliberate indifference; rather, “the plaintiff must show that the [defendant] was aware of
facts from which the inference could be drawn that a substantial risk of serious harm
exist[ed], and . . .dr[ew] th[at] inference.” Scinto, 841 F.3d at 225 (internal quotation
marks omitted); see Johnson v. Quinones, 145 F.3d 164, 167 (4th Cir. 1998).
We conclude that Perry alleged plausible deliberate indifference claims against
Defendants. First, objectively, the medical condition Perry alleged constitutes a serious
medical need. As to the subjective element, while Defendants prescribed medication or
offered advice to Perry, that alone does not foreclose Perry’s claims. See De’lonta, 708
F.3d at 526 (holding that, even if defendants “provided [plaintiff] with some treatment
. . . , it does not follow that [defendants] have necessarily provided constitutionally
adequate treatment”). Indeed, Perry alleged that he repeatedly informed Defendants that
the treatment plan was ineffective and that his bleeding and pain had worsened, but
Defendants failed to change course. See Cesal v. Moats, 851 F.3d 714, 723 (7th Cir.
2017) (“Continuing an ineffective treatment plan . . . may evidence deliberate
indifference.”); White v. Napoleon, 897 F.2d 103, 109 (3d Cir. 1990) (recognizing same).
5
Significantly, while under Defendants’ care or immediately thereafter, Perry’s condition
deteriorated to the point that he required hospitalization for five days and a blood
transfusion. See Greeno v. Daley, 414 F.3d 645, 655 (7th Cir. 2005) (recognizing that
treatment later received may be considered in determining whether medical professional
continued ineffective treatment plan). These facts are sufficient to plausibly allege the
subjective element of a deliberate indifference claim. See Arnett v. Webster, 658 F.3d
742, 754 (7th Cir. 2011) (“[Plaintiff’s] allegations that the medical defendants knowingly
ignored his complaints of pain by continuing with a course of treatment that was
ineffective and less efficacious without exercising professional judgment are sufficient to
state a claim.”).
Accordingly, we vacate the district court’s dismissal of Perry’s deliberate
indifference claims against John Doe (one), Jane Doe, and John Doe (two), and we
remand for further proceedings on those claims. We express no opinion on the ultimate
disposition of Perry’s claims. We dispense with oral argument because the facts and
legal contentions are adequately presented in the materials before this court and argument
would not aid the decisional process.
VACATED AND REMANDED
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