Hixson v. Raynes et al, No. 5:2018cv00001 - Document 15 (W.D. Va. 2019)

Court Description: MEMORANDUM OPINION. Signed by Chief Judge Michael F. Urbanski on 1/23/2019. (jv)

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CLERK' S OFFICE U. S.DIST.COURT AT RG NOKE,VA FILED U N ITED STATE S D IST RICT CO U RT W EST ERN D ISTRICT O F VIR GIN IA H ARRISO N BU RG D IW SION JAy 23 2219 JU sv, C.DUDLEY LERK % (e j .x. C AREY H IXSO N , lalldtltiffy M. CivilAction N o.: 5:17-CV-032 5:18-CV-001 BRYAN H U TCH ESO N ,eta1., By: M ichaelF.U rbansldy ChiefU.S.DistrictJudge D efçndants. M EM O M N D U M O PIN ION PlaindffCareyHixsonrfl-lixson'),aninslllin-dependentdiabedc,allegeshewas deniedinsfplinwhileincrceratedattheHatrisonburg-Rocldngham Regionallail(fCHILRJ''), giving rise to avioladon ofllisEighth Am endm entrightsand a state-law clnim ofgross neglkence.Hixson'sSecondAmendedComplaintforMonetaryDamages,ECF No.125, raisestheseclnimsagninstDefendantDr.MichaelMoran (<fDr.Moran'),thedoctoratHRRJ dlpting H ixson'sincarceradon.Thism attercom esbefore thecotuton D z.M otan'sM odon forSllmmaryludgment.ECF No.189.Forthereasonsgiven below,thecourtGRANTS them odon. I.1 Hixson v. Raynes et al H ixson w asfttstdiagnosed with type 2 diabetesin Apdl2015 dllting a hospitalizadon Doc. 15 atRockingham MemorialHospital(<<ltMH').ECF No.199-5,at49.Dlzringthesame hospitalstay,hewasalso diagnosed with m ethamphetam ine-induced psychosis, 1Thefactsoftliscaseareslxmmazizedbelow and,consistentwiththes'ammaryjudgmentstandard,arevieweditzthe lightmostfavorabletoHixson.SeeWalkerv.Mod-u-lfraftHomes.IZC,775F.3d202,205n.1(4thCir.2014)(ddng FDICv.Casllion,720F.3d169,173(4thCir.2013)). Dockets.Justia.com polysubstance abuse,and alcoholabuse.Id.A consultadon noteby aphysician on April26, 2015 recorded thatH ixson had allistoryofinterm ittentblurryvision and patesthesiasofthe hand and feet.JIL -. Dt.M otan wastlaem edicaldoctotfotinmatesatHILRJdllting Hixson's incarceradon.ECF N o.199-3,at5.H ewasem ployed by Rockingham County to provide medicalcareto theinmates.J.Z at6.Hixson entezedHRRJon August23,2016 and was released onlanuary29,2017.ECF No.199-2,at31.Upon entry,I'Iixson wasseen bya nonpartyintake nurse.ECF N o.199-3,at7-8.H einform ed herthathehad type 1,inslllindependentdiabetes,buttheintakenursew asunableto congf'm the diagnosis,despite faving arecotd requestto Hixson'sm edicalptovider.Id.Dr.M oran tesdfied thatthem edicalteam atHRRJwasunableto obtain Hixson'smedicalhistorybecauseffwhen D xson)signed his release form ,hewrotedo notrelease m entalhealth inform aéon,''and H ixson'sdiagnosisof diabeteswasm adeduring llisstay in thepsychiatdc unitofRM H .ECF N o.199-2,at8. Policy dictated thatanurse repeattherecord tequestifahealth ptoviderfailed to respond within 24 holzrs.ECF N o.199-4,at10.Ifthe providersdlldid notrespond within 24 houts ofthe second tequest,policy tequired thatthe nutsecallthephysician forordersand docllm entthatno tecordswereeverreceived.1d.W hilethe odgm ' alrecord requestto Hixson'sproviderwasm ade,no evidencehasbeen elicited showing arepeatrequestw as m ade orthatD r.M oran wascontacted regarding tlae failureto secuterecords.LI. L D r.M oran reviewed theinform aéon taken by theintakenlzrseand placed H ixson on a diabetk diet.ECF N o.199-2,at8.H ealso ordered H ixson'sblood sugarlevelsbe tested every day.J-da.Forthe flrstfourm onthsofllisincarcetation,Hixson'sblood sugazreaflings 2 wetevatiable,with som e norm aland som e elevated scotes.zSeeECF N o.113-12,at18-22. Hixson'sSeptemberreaclingsranged from alow of94mg/x on September24,2016to a high of157mg/dL on Septembet22,2016.LdaLikewise,itlOctober,llislow readingwas 118mg/dL on October3,2016andltishighreadingwas169mg/K on October5,2016. J.Z N ovembet'szeadingscteeptdup,butzemainedve able,from a1ow of137mg/dL on N ovember25,2016to ahigh of239mg/dtaon November3,2016.LdaDecember's readings,whilehkher,stillfluctuated from 118mg/dL onDecember24,2016to277 m g/dtaonD ecember7,2016.J.Z Hixson'sblood sugarvaluesretained thisvatiabilityin Januaty 2017.idaOn threedaysthatmonth,January21,24,and 28,Hixson'sBvicedaily reaclingswetem orethan 100pointsapart.JA Hivson also began occasionally tefusing tesdng,cllim ing apptehension in interacting with N urseK atherideRaynesafteraconfrontadon with heroveritw 11in.3ECF N o.199-2,at 34.D r.M oran teviewed theblood sugarreadingson aw eeldy basis,asindicated by llis inidalsin Hixson'sm edicalrecord.ECF N o.199-4,at13.ln responseto the higherteadings, Dr.Moran ordered thatthebloodsugattestsbeperformedtwicedailyinlanuary2017,but atno pointclid D z.M oran prescribe Hixson any typeoforaldiabetesm eclicadon oritw nlitn injecdons.ECFNo.199-2,at23.W hileHixson clnimshe.repeatedlyaskednursingstafffor insulin,nothing in tlnerecord indicatesthatH ixson reported any sym ptom sofelevated blood sugarto eithera nurseorD r.M oran.Indeed,H ixson w asseen byD r.M otan on 2OfficialpolicyatHRW setanormalfastingbloodsugarrangeof60-110mg/dtz.ECFNo.112-12,at6.'I' heAmerican DiabetesAssociadon suggestsatargetrange'of80-130mg/dta.AmezicanDiabetesAssociation,Checlrin YourBlood Glucose,(lasteditedOct.9,2018),ho ://iabetes.org/ne g-Gi-iabetes/teaa ent-and-care/blood-glucoseconûol/checkl 'ng-your-blood-glucose.html. 3Nuzse Raynesvaguely rem em bersthe confrontadon butdoesnotrem em berifH ixson requested inslxlin.ECF N o.1994,at15. 3 Septem ber29,2016 and did notzelateany sym ptom sofordiscussdiabetes.E CF N o.199-2, at35.N ozdid I-lixson Slean ofik ialgrievance orcom plaintasking forinsulin ozany other form ofdiabetestreatment.JA H ixson flled hisoriginallaw suiton M atch 31,2017 againstDr.M oran and vadous otherdefendantswho havesincebeen disnaissed.4ECF N o.1.Hixson allegesthe following causesofacdonagainstDr.Moran:(1)Dt.MoranviolatedHixson'sffzighttobefreefrom deliberateindifferenceto lnisknown seriousm edicalneed forcliabeécm edicadon (pzescriptionorotherwise)totteatlaisknown,medicallydiagnosedcondidonofdiabetes,J' ECF No.125,at38;and (2)Dr.Moran commiledmedicalmalpracdce,astatelaw clnim wllich hasbeen disnnissed to the extentitsoundsin negligence,zatherthan grossnegligence. ECF N o.125,at38;ECF N o.167.H ixson also seekspurliéve dam agesand attorneys'fees, premised on theliabilityunder42U.S.C.j1983againstDr.Moran.ECF No.125,at45. II. PursuanttoFederalRuleofCivilProcedute56(a),thecourtmustffgrantsummary judgmentifthemovantshowsthatthezeisnogenllinedisputeastoanymaterialfactand themovantisendtledtojudgmentasamatteroflam''Fed.R.Civ.P.56(a);CelotexCo .v. Catrett,477U.S.317,322(1986)9Glnnv.EDO Co .,710F.3d209,213(4thCir.2013). W hen m aking thisdeterm inadon,the courtshould considettftllepleadings,deposidons, answersto interrogatodes,and adrnissionson file,togetherwith...gany)afidavits'?fzed by 4Hixson'soriginalcomplaintbroughtclnimsagainsttwoTqohnDoe''nutses.ECFNo.1.Onlanuaty3,2018,Hixson ftledHixsonv.Ranes,5:18-cv-001-MF?U,whichbroughtcllimsagainstRaynesandlanelleSeekford,anotherntuseat HRRJ.AstllissecondacdonbroughtidendcalclnimsagainstRaynesandSeekfordaswere&stbroughtagainsttheDoe nursesand alleged thesam e factsalleged in Hixson'sodgitzalcomplaint,itwascleazfrom the face oftheRa nes complaintthatRaynesand Seekford aze,in fact,theD oenursesnam ed in Fsxson'soziginalcomplaint.ECF N o.94,at6. 'Ihe cout' tthusconsolidated thetwo cases.ECF No.95.O n N ovem ber19,2018,Raynesand Seekford were clismissed asdefendants.ECF N o.198. 4 the pazdes.Celotex,477 U .S.at322.W hethera factism aterialdepends on therelevant substandvelaw.Andersonv.LibertyLobby,Inc.,477U.S.242,248(1986).ffozzlydisputes overfactsthatnzightaffecttheoutcom e ofthe stlitunderthegoverning 1aw willpropezly precludetheentc ofsummaryjudgment.Fact'ualdisputesthatareirrelevantorunnecessary willnotbecounted.''J-I. L(citaéonomitted).Themovingpartybearstheinidalbtudenof dem onstradng theabsenceofa genuineissue ofm aterialfactand m ay prevailby showing Tfan absence ofevidence to suppott''an essentialelem entofthe nonm oving pazty'scase. Celotex,477 U .S.at323.Ifthatburden hasbeen m et,thenonm oving partym ustthen com e forward with specifk m atedalfactsthatptove thereisagenliinedisputefortrial.M atsushita Elec.Indus.Co.v.ZenithRadioCor .,475U.S.574,586-87(1986). In determ ining whether agenllineissue ofm aterialfactexists,the courtviewsthe factsand dtawsallreasonableinferencesin thelightm ostfavotable to thenonm oving partp czl -y-lm,710F.3dat213(citingBondsv.Leavitq629F.3d369,380(4thCir.2011)).Although . fftheevidenceofthenonmovantistobebelieved,andalljusdhableinfetencesatetobe drawn in lnisfavor,'''M cAitlaids Inc.v.Iiim berl -clark Co .,N o.13-2044,2014 W L 2871492,at*1(4thCir.2014)(internalalteradonomitted)(citingTolanvs-cotton,134S.Ct. 1861,1863(2014)(percllri/mll,ffgtjhemereexistenceofascintillaofevidencein supportof thegnonmovant's)position willbeinsufficient''to overcomesummaryjudgment.Anderson, 477 U .S.at252.Rather,agenlxineissue ofm atetialfactexistsonly Tfifthereissuffkient evidencefavodngthenonmovingpartyforajurytoyeturnaverdictforthatpattp''Res. BanksharesCo .v.St.PaulMetc Ins.Co.,407F.3d631,635(4thCir.2005)(quodng Anderson,477U.S.at249).ffln otherwotds,to grantslxmmatyjudgmentthegclourtmust 5 deter inethatnoreasonablejtzrycolzldSndfo:thenonmovingpartyontheevidence beforeit.''Mossv.ParksCo .,985F.2d736,738(4thCir.1993)(cidngPetiniCo .v. PeriniConst,Inc.,915F.2d121,124(4thCir.1990)). 111. CountIallegesaviolaéon ofH ixson'sEighth Am endm entm ghtsputsuantto 42 U.S.C.j1983.To stateaclmim underj1983,aplaindffmustallegethevioladon ofadght secuted by the Consétution orlaw softheU nited Statesand m ustshow thatthedeprivation ofthatrightwascom m itzd by aperson acdng undercolorofstate law.Crosb v.Ci of Gastonia,635F.3d634,639(4thCir.2011)(cidngW estv.Atkins,487U.S.42,48(1988)). To prove an Eighth Am enclm entvioladon,Hixson mustshow thathe suffeted a suffkiently setiousdeprivadon and thatD r.M oran acted with Tfdelibetateindifference''to hishealth or safety.Fatmerv.Brennan,511U.S.825,834(1994)(citadonsonaitted).Thisisatwoprong test,withthefust,Tfobjecdve''prongreqllitingademonstradonofthesedousnessofthe deprivadonandthesecond,ffsubjecdve''prongreqllitingashowingofthedefendant's Tfsufhciently ctzlpable''state ofmind.Fnt-m er,511U .S.at834. A. Asastarting point,Hixsonmustmeettheobjectiveprong oftheFatmertestby raisingagenuinequeséonofmaterialfactthatfçthedeprivadonalleged gwas),objecdvely, fsufficientlyserious.'''Fnfvner,511U.S.at834 (quodngW ilsonv.Seiter,501U.S.294,298, (1991)).Ultimately,thedeprivation mustbeffextreme'7- meaningitmustposeTfaseriousor signiikantphysicaloremotionalinjuryresultingfrom thechallengedcondiéons,''or<<a substanéaldsk ofsuch seriousharm resuldng from ...exposure to the challenged 6 condidons.''De'Lontav.An elone,330F.3d630,634(4t. hCit.2003)(internalquotadon m arksand citaéononaitted).Inm edicalneedscases,likethecaseathand,theFarmertest reqlliresplaindffsdem onstrateofficials'deliberateindifference to a ffserious''m edicalneed thathaseither'fbeen diagnosed by aphysician asm andadng treau entor...isso obvious thateven a lay pezson would easilyzecognizethe necessity fota doctoz'sattendon.''lko v. Shreve,535F.3d225,241(4thCir.2008). Hixsonwasdiagnosedwithtype2diabetespriortohisincarceraéonatHILRJ.ECF N o.199-5,at48-50.A tthattim e,hewasprescribed M etfotm in,Lanm s,and H um alog to managethecondiéon.Ld.aat58.Upon l' tisarrivalatHILRJon August23,2016,Hixson inform ed theintakenurse thathewasdiabeticand had been prescdbed these m edicadons. ECF No.199-3,at9-11.Asstatedabove,thiswasnevetconf= ed.1i.Dr.M oran reviewed thisinfonnation,placed H ixson on adiabedc(Iiet,and ordered daily testing ofllisblood sugarlevels,butdid notprescribeinsulin orany othertype ofm edication used to treat diabetes.LdaDt.M oran saw Hixsoninperson onlyonceduringlnisincarceradon---on Septem ber29,2016,when Hixson requested a physician visitfortrea% entofback pain and high blood pressute.ECF N o.199-2,at48.H ixson did notcom plain ofany sym ptom s zelated to diabetes,nordid he m ention his(Iiabetesto D r.M oran duritzg the appointm ent. Onlanuary 19,2017,afterHixson'sbloodsugatlevelsbegan torise,Dz.Moran otdered Hixson'sblood sugarbe tested twice aday,butstillpresctibed llim no m edication.ECF N o. 199-3,at23. W hen aj1983 cl/im fozinadequatemedicaltzea% entinvolvesacomplicatedhealth condidon,experttestimonyisrequitedtoshow proofofcausadonofinjurp Edwatdsv. Graham Cty.Jail,No.1:16-CW 315-FDW ,2017W. L5894496,at*6(W .D.N.C.Nov.29, 2017).Hixson allegeshesuffered pain,discomfortand fearwhileincatceratedand sevete im pnit-m entoflzisffboclily funcdons''asaresultofthe m onthsspentwithoutm edicadon. ECF N o.125,at18.H ereliesupon Dr.CarolRupe ashisexpeztwitnessand assertsthather tesfim ony show she suffered sufficiently sezioushst'm . D r.Rupe testihed thatatype2 diabeécwilltypically require elevated blood sugar levelsfor 15-20 yearsbefore sustaining dam age to internalorgans,retinopathy,or neuropathy.ECF N o.199-5,at53-54.Itisundisputed thatH ixson spentonly five m onths it' lHILRJunderDr.M ozan'scate.In addiéon,therecord isunclearasto how long Hixson had suffered from diabetesbefore hisofhcialdiagnosisorto whatextentllissym ptom s predatelésincarceration.M oreover?Dr.Rupetestzed thatshecolzldnotbecertain that HixsonhassufferedorwillsuffetanydamageorinjurybecauseofthedmespentatHILRJ withoutm edicadon.ld.at47,at52-54. Atoralargtzm entaH ixson conceded thattherew asinsufficientevidence oflong-term permanentinjurybutcbimedhesufferedshort-te= seriousitjutyinthefot'm of discomfortapain,and fear.In hisdeposidon,Hixson syatçd thatwhileincatcerated atHRRJ, he had Tdclouded'?vision,neuropathy,and dngling and pain irllnisfeet,ECF N o.199-2,at14, although thereisno evidencethathevoicedthesesymptomstomedicalstaffatHRRJ. Colzrtshavefound thatpermanentphysicalimplitxnentisunnecessaty to show an injury sufhcientto consdtazte sedousharm undertheEighth Am endm ent.SeeEasterv.Powell, 467F.3d459,464-65(5thCir.2006)rfEvenifgtheplaindfflfailedtostateanEighth Am endmentvioladon with regard to thedelayin medicaltreatment...ghelclearly stated an EighthAmendmentviolationwitlazegardto theseverechestpainhesuffered...'')(holding thatpain suffered wllilewaiting fotttea% entissufhcientto state an Eighth Am endm ent violadon). A sD r.M oran pointsout,som e ofthe sym ptom sdescribed by H ixson and D r.Rupe pzedateHixson'sHmeinjailandthuswezenotcausedbytheclnimedfailuretomedicate whileatHRRJ.ECF No.199-5,at50.Also noteworthyisHixson'ssix-month delayin seekingmedicalcateafterlaisJanuary29,2017release.ECF No.199-5,at109-11.Rule56, however,doesnotrequirethatthenon-m ovant'scasebewithoutflaw ordoubt.Itrequires only thatthe facts,w hen viewed in thelightm ostfavorable to the non-m oving party,zaise a genlline queséon ofm aterialfact.W hile the factsadduced leavem any quesdonsunanswered, the colzrtfindsthatH ixson presentsenough evidence suppotting hisposidon to pet-mita reasonablejurytofindhesufferedaserious,albeitshort-lived,hnt'm. B. HavingmadeashowingsufhcienttomeettheRule56standardastotheobjecdve seriousnessofthedeptivadon suffeted,H ixson m ustnow m ake ashowing thatD t.M oran's subjectivementalstatewasthatofdeliberateindifference.Deliberateindifferencereq,lires<<a lligherdegteeofcliszegard than m ere negligence.''Fnt-m er,511 U .S.at837.A prison offkial ffm ust130th beaw ate ofthe factsfrom w hich theinfetencecould be drawn thata substandal risk ofhnl'm exists,and hem ustdraw thatinfetence.''Bricev.Vit ' 'a Beach Correcdonal Center,58F.3d 101,105 (4th Cir.1995).Thisshowing requiresffmorethan m ere negligencey''though fdlessthan actsoromissionsgdone)fortheveryptzm oseofcausing hsrm orwith knowledge thatharm V IIresult.''Fstm er,511U .S.at835.The standard fTlies somewherebetweenneglkenceandpurposeorknowledge:namely,recklessnessofthe subjecdvetypeusedincriminallam ''Bdcev.Va.BeachCoêr.Ctr.,58F.3d101,105(4th Cir.1995). D r.M oran arguesthatnothing in the record show shew asdeliberately indifferentto Hixson'sseriousmedicalcondidon.TosadsfythesubjecdvepzongoftheFntmertest, H ixson would have to show thatD r.M oran knew Hixson'sblood sugatreadings represented asubstandalrisk ofharm whileH ixson wasunderhiscare,and yettook no acéon.See Farm er,511 U .S.at837.D r.M oran arguesH ixson cannotshow this,asnothing in the record indicateseithersuch a state ofm ind orsuch inacion.The cout'tagrees. W hile Dr.M oran did notprescribeins'plin orany othertype ofm edicadon for H ixson,hestated radonalm edicalreasonsfotnotdoing so.Dr.M oran stated that,because H ixson'sblood sugarreaclingsvaded,an insulin prescripdon could have1ed to hypoglycemia iftaken while levelsw ere low .Tlnisreasoning,com bined w1t. 11thediabedc dietand daily blood tesdng,issufhcientto show thatD r.M ozan wasnotdeliberately indifferentto Hixson'sconclidon.SeePetersonv.Davis,551F.Supp.137,146(D.Md.1982)rfgtjhemete failuzeto tteatallm edicalptoblem s...even ifthatfailuream ountsto m edicalm alpracdce,is insufhcientto supportaclsim underj1983':). Dr.M otan'sexpertwitness,D :.RoseSuaava,opined thatthe decision notto aHm inisterinslzlin w asreasonable,given thevariable natute ofH ixson'sblood sugarteaclings and weightduring llisincarcetadon.ECF N o.190-9,at3.H ixson'sexperq D r.Rupe, countezsthatD r.M oran saw Hixson'szising blood sugarreadingsand took no acdon.She cbim sthatincteased testing isnottreatm entand thatHh son'sblood sugatlevelscalled for theuse ofinsulin.ECF N o.199-5,at76.In hetopinion,D r.M oran should haveprescribed insulin forHixson beginninginD ecember2016.J.daat102.Clearly,Dr.Rupe,Dr.M oran, and D z.Suaavadisagtee asto whatwastheproperway to handle Hixson'srising blood sugar.D eliberateindifference,how ever,zequiresthatthe treatm entgiven dfbe so gtossly incom petentoinadequate,ozexcessiveasto shock the conscienceoz...beintolezable to fundamentalfaitness.''Mildetv.Beorn,896F.2d848,851(4thCit.1990).NegEgence, m alpracdce,orincorrectdiagnosisdo notalone giverise to avioladon ofthe Eighth Amendment.Ld.aThataprisonerdid notreceivethettea% entdesired doesnotconsdttzte delibezateindifference,notdoesdisagreem entbetween t'wo medicalprofessionals.1d.See Iacksonv.Lightsey,775F.3d170,178(4thCir.2014)(statingthatapdsondoctor's treatm entdecisionscould be Tfgravely''m istaken and disagteew1:. 1'1a fotm erdiagnosisand prescribed treatnentplan by an outside specialistwithoutrtm ning afoulofthe Eighth Am endment).Instead,Hixson mustshow thatDr.M ozan failed toprovidecarehehimself felttobenecessary.1d.rf...adoctor'sfailtzretoprovidecarethathehimselfdeems necessary to tteatan inm ate'sseriousm edicalcondidon m ay consdtazte deliberate indifference.'). Thezecotd givesno evidence thatthisoccutred.D r.M oian reviewed H lson'sblood sugarreaclingsand found them too variable to prescribeinsulin.D r.Rupe looksatthese sam e num bersand com esto adifferentopinion.A Ending ofdeliberateindifference does notfollow from a disagteem entbetween m edicalprofessionals.The couttalso notesthatthe record providesno evidence D r.M otan wasaware Hixson wassuffedng any sym ptom sof iligh blood sugar.H ixson reportshe suffered clouded vision and pnin and dngling in lnis extremides,buthe nevercom plained ofany such sym ptom sto Dr.M otan when hem etwith him .W hileH ixson stateshe asked nurses forinslllin,there isno evidence thathe com plained to them ofsymptom sw arrandng m edicadon.Indeed,N m se Raynestestz ed in herdeposidon thatshebelieved H ixson to beasymptom atic forthe entitety ofllis incazceradon.ECF N o.199-4,at49.Fllrfhet,given thevatiability ofH xson'sblood sugaz readings,D r.M otan wasconcerned aboutan insulin overdose.Them edicalstaff'sbeliefthat Hixson wassuffering no sym ptom sofhigh blood sugatand theunpteclictability ofH ixson's bloodsugatlevelsfatallyundetnainesanyinferenceofthenecessarysubjecdvementalstate. 80thpatdeshaverefezencedScintov.Stansber ,841F.3d219(4th Cir.2016),in theirbdefs.H ivson arguesthe Scinto factsareon pointwhileD r.M oran drawsdistincdons betwqen thetwo sitazadons.In Scinto,a form erfederalpdsonerbtoughtsuitar instseveral federalprison offkialsalleging thata prison doctorviolated llisEighth Am endm entrightsby denying him insulin to treathistype 1,inslllin-dependentdiabetes.1d.at225.Upon hisentry into prison,pbintiffw asitnidally prescribed insulin accorcling to a sliding scale ofblood sugarrealings.J. i W hen thisprescripdon ptovedinsufficientto conttolplnintiff'sblood sugar,herequestedasupplementalinjecdon from theprisondoctoz.ld.at227.Because plaindffwasTfangzy''attheHm e ofthisrequest,the doctorte= inated plaindff'svisitand declined to providehim with insulin,instead lim iting hisprescripdon signihcantly.J1LAftez -. severalmoresimilarincidents,plnintifpshemoglobinA1C levelsrosefrom 7 (within the notmalrangefordiabetics)to 9.8(anunhealthyscore).Ld.zat228.Pbindffalso suffeted dam ageto lliskidneys,eyesight,nervoussystem ,and psychologicalw ellbeing.Ld=The court . ruled thatpbindffhad adduced enough factsshowing deliberateindifference to survive defendant'smodonfotslpmmatyjudgment.Ldaat230. Hixson atguesthatthe Scinto decision com pelsdenialofDr.M oran'sm odon.Scinto, how ever,wasdecided on very differentfacts.Fitst,theprison doctorin Scinto wasw ell aw are ofplaindff'ssetiousm edicalcondidon and had pzesctibed an insulin zegl 'm en under wllichplaintiffwastoteceivesupplementalitjecdonswhenllisbloodsugarreachedacertain level.1d.at229.Flzrthermore,plnindff'sTflengthypdsonmedicalrecordsshowged)thathis diabetesdiagnosiswasflongstanding,pervasive,well-doctunented,gand)exptesslynotedby prisonofficialsy'includingbygtheprisondoctotjlnimself.''1d.(quotingParrishexrel.Leev. Cleveland,372F.3d 294,303(4th Cir.2004)).Asnoted bytheFourth Circuitin Scinto,the pdson doctortheteT<diszegardgedjllisown presczipdon designed tomanagegplainéff'sq condition,''idaat229,because he wasffan angryand hostilepadent.''ld. H ere,in contrast,tlziscasebol 'lsdown to a disagreem entasto treatnentbetween H ixson and Dz.M otan.W hile H ixson allegeshe shotzld havereceived m edicadon,D r. M ozan chose to m onitorhisblood sugarand treathisvariablereadingswith diet.D r.M oran tesdûed abouttheHsksofproviclinginslllin to apadentwith such vatiable blood sugar readings.W hen H ixson'sreadingsrose,D r.M oran ordered twice dal 'ly testing,agnin recognizing signifkantvariabilityitlthedaily readings.Underthe circum stances,D r.M oran's care ofHixson and hisdecision to m onitorhisdiabetesand treathim witladietratherthan m edicaéon cannotconsém tedelibetateindifference.D r.M oran'sdaily m onitoring of H ixson'sblood sugatteadingsshow sthathew asnotdeliberately indiffezentto Hixson's meclicalcondidon.Thesefactscannotshow eithersubjecdveawatenessofasignifkantdsk oradeliberateinclifference to thattisk.5The courttherefore GR AN T S the m odon for summaryjudgmentandDISM ISSESCount1. IV. TheVirgirziaSupremeCourthasde:nedgrossneglkenceasadfdegreeofnegligence'' whichshowsffsuchindifference''astoTfconsdttzteg)anutterdisregardofprtzdence amoundngtothecompleteneglectofthesafetf'ofanother.Fer sonv.Fer son,212Va. 86,92,181S.E.2d648,653(1971).Tlzisdegzeeofnegligencemustbesuchaswouldshock fair-m inded people,though itneed notconsdttztewiIIfUIrecklessness.K offm an,574 S.E.2d at60.Gtossnegligencereqppitesanobjecûveinqtur 'y;thedefendant'sbehaviormustbe com pazed to thatofa sim ilarly sim ated,hypothedcalKfreasonable''person.Co a ev. Mann,906F.Supp.1025,1049(E.D.Va.1995).W hetherbehaviorconstitm esgross negligenceisusuallyaquesdonoffact,leftforthejurytoanswer.Geddchv.FairfaxCoun De t.ofFamil Servs.,282F.Supp.2d439,475(E.D.Va.2003). Though the standazdsofdeliberateindifferenceand gtossneghgenceare closely related,cotzttsdo draw disO céons.Gtossneghgenceisaslightlylower standard,lacldng the subjecévecomponentofdeliberateinclifference.Coppagq,906F.Supp at1049.Unlike delibetateindiffetence,grossnegligencedoesnotzequitea fincling thata defendantknew of asubstanéalrisk.Id.Itisenoughthatthedefendantshoulbhavebeenawareofthatdsk.Id. 5Inasupplem entalpleadingfollowitzgtheheadng,Hixsonasksthecourttofocuson certaitzdeposidontestim ony.ECF No.215.Thistesrimonydoesnot$verisetoagen'xineissueofmatezialfactastodeliberateitzdifference.WhileHt 'xson describesexperiencingblurryvisionandpaitzinlzisfeetwhileinHRRJ,ECFNo.199-2,at14,hedoesnotcbim tohave reported thistoanttrseorD r.M oran.Sim ilarly,Dr.Rupedesczibed Hixson'sblturyvisioninherdeposidon and idendEed thisasa symptom ofelevated blood sugarlevels,ECF N o.199-5,at50,99,butoffered no testim ony establishingthatanymemberofthemedicalstaffatHRRJwasawareofthesesymptoms.Thesefactsdonotraiseany infezence thatDr.M oran wasawaze ofa seriousdsk to H ixson'shealth. Asdiscussedabove,duringhisintakeHixsontoldthenurseatHILRJthathewasa type 1,inslllin-dependentdiabeéc.D r.M oran stated he decided notto m edicate paréally because fftheinform adon given by an inm ateisstadstically proven to som etim esbenot totally correct.''ECF N o.199-3,at10.D r.M oran thereforerequiresa confitm adon through m edicaltecozdsofaprisoner'sdiagnosisbefozepresczibing m edicadon.Id.Dz.M ozan w ent On to say: And had I have autom adcally placed M r. Hixson on the m edications he said he was on,ifw e look at his blood sugats during hisfltsyfew daysatthe jail,Ithink we wotzld be sitling here having a diffetentdeposidon when Ioverdosed M r.H ixson on insulin that lnis body didn't need. So, no, I clid not automaécally place him on medicadon justbecause he said he w as on it because I'm responsible for them bot.h for treating diseasethey haveand fornotcausing any dam age. I. I. J.Dr.M oranthereforeplaced Hixson on adiabeticdietandordered dailychecksofhis blood sugarlevel.Id. In D ecem ber2016,H ixson'sblood sugatlevelsrose;D z.Rupe teslifed thathis reaclingswereffde6nitelyon aconsistentbasiswellabovethe130matk''wllichisabovethe Am edcan D iabetesA ssociadon gaidelinesrecom m ended fasdng blood sugarreadings.ECF N o.199-5,at102.D r.M oran'sresponsewasto increase H ixson'sblood suga. rreadingsfrom once daily to twicedaily.A scliscussed above,D r.Rupeopinesthatthisw asinadequate.She arguesthatatthispoint,Hixsonshouldhavebeenzeceivinginslllitnitjections,andthatthe failureto do so caused permanentdamage.LdxDr.M otan'sexpett,Dr.Suaava,disagreesand statesin herrepottthatthe decision notto adm inisterinslxlitnw asreasonable,given the vatiable natate ofHixson'sblood sugarreadingsand weightduring hisincarcetadon.ECF N o.190-9,at3. A sw1t.14deliberate indiffetence,disagreem entsbetween m edicalprofessionalsdo not sufficetoshow grossnegligence.Justbecauseonemedicalprofessionalclnimstheother shouldhavedonemorethanhediddoesnotgiverisetoalevelofneglkenceffwlnichshows indifference to others,disregarding prudenceto the levelthatsafety ofothersiscom pletely neglected.''Wilb v.Gostel,265Va.437,445,578S.E.2d796,801(2003).W etethisclnim sounding in otdinary negligence,Hixson m ay havebeen able to arguethatD r.M oran should . havetaken m ore afflt-madve stepsto m anage hisdiabetes.D r.M ozan,how ever,hasalready shown heisenétled to sovereign im m unity,which sllieldslnim from m edicalm alpracdce suitssoundingitlordinaryneglkence.ECF No.166.Hixsonisnow requiredtoshow gross negligence,am uch highetstandard thathe cannotm eet. Thetecord cleatly show sthatD r.M otan took stepsto m onitorH ixson'scondidon. Virginialaw makesclearthatifdefendantshavetaken ffeven theslightestbitofcareg), regardlessofhow insufficientorineffecdveitm ay have been,''then therehasbeen no showingofgrossnegligence.Elliotv.Cm er,292Va.618,621,791S.E.2d730,731(2016). A ccordingly,the cotzrtGR AN T S them oion and D ISM ISSE S CountII. V. Dr.M oran also arguesthatheisendtled to quav ed immurzityon b0tlzthej1983 cbim and the state m edicalm alpracdce cbim .Thedoctrineofqualified im m unity,a federal commonlaw preceptapplicablein j1983 cases,sllieldsofhcialdefendantsfrom monetary liabilityso long astheofficial'sconductdid notviolate ffclearly established''stataztoryor constM tionaltightsofwllich areasonableperson in the defendant'sposiéon would have known.Mitchellv.Fors t. h 472U.S.511,526 (1985)9W ellerv.De 'tofSoc.Servs.forCi ofBalt.,901F.2d387,398(4thCir.1990).Theprincipleofqualihedimmunityreflectsthe concern thattheaward ofcivildamagesagainstpublicofhcialsforeveryjudiciallydeterm ined violadon ofrightswould discourageindividualsfrom seeking public em ploym ent,prove deleteriousto thetreasuty,and im paitgovernm entaldecision m aking.W eller,901 F.2d at398.Thedoctrineofqualiûed im m unity,thezefore,m andates thatofhcialsffal:enotliable forbad guessesin gray areas,''butinstead are only Tfliablefot transgeessingbtightlines.''M aciarieEov.Slxmner,973F.2d295,298(4thCir.1992). In detet-mining ifa defendantisendtled to qualihed im m unity,thecourtm ustfltst detezminewhether,taken in thelightm ostfavorable to a plaintiff,the factsaileged allow a hnding thatthe defendant'sconductviolated thepbintiff'sconstim donalrights.Ifthe answetto thisisyes,then thecouttm ustconsiderwhethetthisparticulardghtwasffcleatly established''atthetimeoftheviolaéon.Saucierv.Katz,533U.S.194,201(2001).Asthis cout' thasruled thatD r.M oran did notshow deliberateindifference to H ixson,the & ststep ofthe aboveanalysism ustbe answered in thenegaéve.Therefore,to theextentthe detetminadon isrelevant,Dr.Motanisendtledto qualihedimmunityon Hixson'sj1983 clnim .6 W . Forthe above zeasons,H ixson'sclnim sagainstD r.M ozan ate D ISM ISSED . W ithoutthese substandve underlying clnim s,Hixson'sclnim sfozpurzidve dam agesand 6' ThequaliEedimm'lnitycalculusisinapplicabletothestate1aw cllim ofgrossnegligence.lohnDoe#1v.Robinson, No.CIV. A.4:07CV84,2009W. L435097,at*4(E.D.Va.Feb.20,2009)(citingColb v.Borden,241Va.125,129,400 S. E.2d184,186(1991)). attozneys'feesaregroundlessand D ISM ISSE D .D efendant'sM odon forSllm m ary JudgmentisGRANTED. An appropriate O tderwillbeentered thisday. Entered:Tu s /+/ 4 0236d #ay oflanuary,2018 . M ichaelF. tbanski Chief 18 tedStatesDistdctludge '

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