Nunes v. MA Dept. of Corrections, 1st Cir. (2014)

7/26/2019 Nunes v. MA Dept. of Corrections, 1st Cir. (2014)

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United States Court of AppealsFor the First Circuit

No. 13- 2346

RI CHARD NUNES; CARL COE; J OHN DOE; PETER POE; RI CHARD ROE, onbehal f of t hemsel ves and ot her s si mi l ar l y si t uat ed,

Pl ai nt i f f s , Appel l ant s,

v.

MASSACHUSETTS DEPARTMENT OF CORRECTI ON;THOMAS GROBLEWSKI ; MARK WAI TKEVI CH,

Def endant s, Appel l ees,

UMASS CORRECTI ONAL HEALTH; LEONARD MCGUI RE;WARREN FERGUSON; J UDI TH STEI NBERG,

Def endants.

APPEAL FROM THE UNI TED STATES DI STRI CT COURTFOR THE DI STRI CT OF MASSACHUSETTS

[ Hon. Rya W. Zobel , U. S. Di st r i ct J udge. ]

Bef or eKayat t a, Bal dock, * and Sel ya,

Ci r cui t J udges.

J oel H. Thompson, wi t h whom Tat um A. Pr i t char d andPr i soner s' Legal Ser vi ces wer e on br i ef , f or appel l ant s.

Tor y A. Wei gand, wi t h whom J ames A. Bel l o and Mor r i sonMahoney LLP were on br i ef , f or appel l ee Thomas Gr obl ewski .

Nancy Anker s Whi t e, Speci al Assi st ant At t orney Gener al ,and Sher yl F. Gr ant on br i ef f or appel l ees Massachuset t s Depart ment

of Corr ect i ons and Mark Wai t kevi ch.

September 12, 2014

* Of t he Tent h Ci r cui t , si t t i ng by desi gnat i on.


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KAYATTA, Circuit Judge. Massachuset t s pr i sons pr ovi de

i nmat es wi t h semi - mont hl y or mont hl y suppl i es of some medi cat i ons,

whi ch t he pr i soner s t hen st or e i n t hei r cel l s and t ake on t hei r

own. Ot her medi cat i ons ar e di spensed i n si ngl e doses t o pr i soner s,

t o be i ngest ed at t he di spensi ng wi ndow. Fi ve pr i soner s wi t h HI V

chal l enge t he deci si on of pr i son of f i ci al s t o di spense HI V

medi cat i on onl y i n si ngl e doses at t he di spensi ng wi ndow. The

pl ai nt i f f s cl ai mvi ol at i ons of t he Ei ght h and Four t eent h Amendment s

t o t he Uni t ed St at es Const i t ut i on, t he Amer i cans wi t h Di sabi l i t i es

Act, and t he Rehabi l i t at i on Act. We af f i r m t he di st r i ct cour t ' s

gr ant of summar y j udgment agai nst t he pl ai nt i f f s on each of t hei r

cl ai ms.

I. Background

Because t he di st r i ct cour t gr ant ed summary j udgment , we

"descr i be t he f acts gi vi ng r i se t o t hi s l awsui t i n a l i ght as

f avor abl e t o [ t he pl ai nt i f f s] as t he r ecor d wi l l r easonabl y al l ow. "

Tr avers v. Fl i ght Servs. & Sys. , I nc. , 737 F. 3d 144, 145 ( 1st Ci r .

2013) .

The pl ai nt i f f s i n t hi s case ar e i nmat es i n t he

Massachuset t s st at e pr i son syst em who suf f er f r om HI V. They sue,

among ot hers, t he Massachuset t s Depar t ment of Cor r ect i ons, whi ch

admi ni st er s t he st at e' s pr i sons. Because i t makes no di f f er ence t o

our anal ysi s, we r ef er t o t he depar t ment as i f i t wer e t he sol e

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def endant and t he sol e ent i t y r esponsi bl e f or t he st at e' s act s at

i ssue her e.

Thi s case ar ose when t he depar t ment changed t he manner by

whi ch i nmat es recei ve medi cat i on f or HI V. Pr i or t o t he change,

many i nmat es coul d r ecei ve t hei r HI V medi cat i on t hr ough t he "Keep

on Per son" pr ogr am, whi ch we wi l l r ef er t o as t he "KOP pr ogr am. "

When r ecei vi ng medi cat i on t hr ough t he pr ogr am, i nmat es pi ck up

packages of medi ci ne once or t wi ce a mont h, t hen st ore the medi ci ne

i n t hei r cel l s and t ake i t on t hei r own i ni t i at i ve. [ App. at 66. ]

I n cont r ast , HI V medi cat i on i s now avai l abl e onl y thr ough t he

"dai l y med l i ne, " wher e i nmat es r epor t f or each dose t o a

di spensi ng wi ndow, t hen i ngest t he medi cat i on at t he wi ndow whi l e

pr i son st af f obser ve. [ App. at 65. ] Bot h t he dai l y med l i ne and

t he KOP pr ogr amare common ways f or i nmat es t o r ecei ve medi cat i ons

i n Massachuset t s pr i sons, dependi ng on what medi cat i on t hey ar e

r ecei vi ng and whet her t hey sat i sf y var i ous el i gi bi l i t y

r equi r ement s.

A. The Department's Decision to Remove HIV Medication from the

Program

The depar t ment f i r st announced i t s deci si on t o r emove HI V

medi cat i on f r om t he pr ogr am i n August 2008 and i mpl ement ed the

change i n Febr uary 2009. [ App. at 77, 83- 84. ] The part i es agr ee

t hat t he depar t ment ' s pr i mar y ai m i n i ni t i at i ng t he change i n

di spensi ng pr act i ces f or HI V medi cat i on was t o save money.

Medi cat i on f or HI V i s expensi ve, occupyi ng more than 40 per cent of

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t he depar t ment ' s pharmacy budget , al t hough f ewer t han 3 percent of

t he pr i soner s have HI V. [ App. at 266. ] Faced wi t h budget cuts i n

2008, t he depar t ment exami ned i t s expenses and det ermi ned that some

of t he cost of HI V medi cat i ons ar ose f r om "wast ed" medi cat i on:

medi cat i on t hat was di spensed t o an i nmat e t hrough t he KOP pr ogr am,

but not used by t hat i nmat e whi l e i n pr i son. [ App. at 269- 271. ]

Such medi cat i on cannot be r eused because i t has l ef t t he hands of

l i censed medi cal st af f . [ App. at 270. ] Medi cat i on schedul ed t o be

di spensed t hr ough t he dai l y med l i ne, however , can be r eused i f not

pi cked up by t he pat i ent . [ App. at 270- 71. ] The depart ment

t heref ore concl uded t hat i t coul d reduce wast e and save money by

di st r i but i ng al l HI V medi cat i on t hr ough t he dai l y med l i ne. [ App.

at 271. ]

The par t i es agree t hat t here ar e several sources of

wast ed HI V medi cat i on, but di sagr ee on t hei r r el at i ve i mpor t ance,

and on whet her t he depar t ment chose t he best approach to mi t i gat e

wast e. Wast e can ar i se when a pr i soner si mpl y chooses not t o t ake

medi cat i on t hat he has recei ved t hr ough t he KOP pr ogr am. [ App. at

73. ] I t can al so ar i se when an i nmate i s gi ven t oo much medi cat i on

when he pi cks up hi s ref i l l s. [ App. at 275- 76. ] I n addi t i on, wast e

can r esul t when an i nmat e i s r el eased f r om pr i son, i s t r ansf er r ed

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wi t hi n t he syst em, di es, or has hi s t r eatment r egi men changed. 1

[ App. at 73, 274- 76. ]

When t he depar t ment announced t he change i n August 2008,

i t r ecei ved compl ai nt s f r om medi cal st af f er s concer ned about t he

ef f ect on i nmates wi t h HI V. Two doctors who t r eat ed i nmates wi t h

HI V, Davi d St one and J ames Qui r k, obj ect ed t o t he change and have

cont i nued t o oppose i t . Thei r chi ef concern has been t hat some

i nmat es wi l l be unwi l l i ng or unabl e t o t ake t hei r medi cat i on

consi st ent l y due t o t he t i me and ef f or t r equi r ed t o wai t at t he

di spensi ng wi ndow, whi ch some i nmat es woul d have to do mor e t han

once per day. [ App. at 281- 83, 97. ] The par t i es agr ee t hat i t i s

ver y i mpor t ant f or HI V pat i ent s t o be "adher ent " ( or "compl i ant " ) ,

meani ng that t hey t ake t hei r medi cat i on consi st ent l y as prescr i bed.

When a pat i ent mi sses doses, t he vi r us can devel op r esi st ance t o

t he medi cat i on, f or whi ch t her e wi l l be f ew al t er nat i ves. [ See,

e. g. , App. at 255. ] St one and Qui r k al so wor r i ed t hat t he change

woul d exacer bat e t he si de ef f ect s of HI V medi cat i on, as i nmat es

woul d have l ess f l exi bi l i t y i n t i mi ng t hei r doses t o coi nci de wi t h

meal s or sl eep. [ See, e. g. , App. at 1408- 09. ]

As a r esul t of t hese compl ai nt s, t he depar t ment i ni t i al l y

put t he change on hol d t o st udy i t s pot ent i al i mpact s. The

depart ment t hen r evi ewed data i ndi cat i ng t hat 93 per cent of HI V-

1 The r ecor d does not i l l umi nat e exact l y why wast e can ar i sei n each of t hese scenar i os, but t he par t i es agr ee t hat such wast eoccur s. [ App. at 73. ]

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posi t i ve i nmat es al r eady repor t ed t o the dai l y med l i ne f or ot her

medi cat i ons. The depar t ment al so consi der ed dat a i ndi cat i ng t hat

44 per cent of i nmat es wi t h HI V r equest ed r ef i l l s of t hei r HI V

medi cat i on l ate or not at al l under t he KOP pr ogr am. Gi ven t he

pr ocedur al post ur e of t he case, we do not assume t hat t hi s

par t i cul ar dat a was accur at e. Rat her , because t he pl ai nt i f f s do

not ci t e any evi dence to t he cont r ary, we assume that t he

depar t ment bel i eved the data t o be accur ate as a product of a

si ncer e ef f or t t o gauge t he ef f ect s of t he pol i cy change. Af t er

r evi ewi ng t hi s i nf or mat i on, t he depar t ment deci ded t o adopt t he

change.

B. The Effects of the Policy Change

Si nce t he new pol i cy was i mpl ement ed, t he depar t ment has

moni t or ed i t s ef f ect s. I t has col l ect ed dat a showi ng t hat pat i ent

out comes have hel d st eady or i mproved si nce t he change. The

pl ai nt i f f s do not di sput e t he r aw number s col l ect ed by t he

depar t ment , t hough t he par t i es di f f er on t hei r si gni f i cance.

A common measur e of heal t h f or HI V pat i ent s i s " vi r al

l oad. " Doct or s ai m t o achi eve an "undet ect abl e vi r al l oad, "

meani ng t hat t he pat i ent has such a l ow l evel of HI V i n hi s bl ood

t hat st andar d t est s cannot det ect i t . I n t he l ast r epor t i ng per i od

bef ore the pol i cy change, 83 per cent of i nmates wi t h HI V had

undet ect abl e vi r al l oads. That r at e r ose t o 87 per cent i mmedi at el y

af t er t he change and has been document ed most r ecent l y at

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95 per cent . Whi l e accept i ng t hi s dat a as accur at e, t he pl ai nt i f f s

cont end t hat i t cannot be used t o est abl i sh t hat t he pol i cy has

act ual l y i mpr oved heal t h out comes because t he i mpr ovement i n t he

f i r st si x mont hs of t he new pol i cy was not l arge enough t o be

st at i st i cal l y si gni f i cant and t he event ual l ar ger i mpr ovement may

be t he pr oduct of ot her f act or s. [ App. at 365- 66. ]

The depar t ment has al so moni t or ed l at e r ef i l l s as a

measur e of nonadher ence. 2 Lat e r ef i l l s have r emai ned mor e or l ess

st eady si nce bef or e t he pol i cy change, st ar t i ng at 30 per cent i n

December 2008, and f l uct uat i ng bet ween 25 per cent and 35 per cent

( wi t h one out l i er mont h at 39 per cent ) af t er t he change. [ App. at

2020, 2036. ] The pl ai nt i f f s accept t hese f i gur es as accur at e, and

admi t t hat l at e r ef i l l s ar e a "pr oxy" t hat "pot ent i al l y r ef l ect

nonadher ence. " [ App. at 306- 07. ] They never t hel ess argue t hat

cur r ent adher ence f al l s bel ow accept abl e st andar ds, wi t hout

of f er i ng any evi dence that r et ur ni ng HI V medi cat i on t o t he KOP

pr ogr am woul d i ncr ease adherence. 3 [ App. at 364- 65. ]

2Medi cat i ons, whet her del i ver ed thr ough the dai l y med l i ne ort he KOP pr ogr am, are or dered f r om a pharmacy on behal f of eachi nmate r ecei vi ng t hem. When an i nmate' s suppl y i s cl ose t o r unni ngout , t he pr i son or der s a r ef i l l on behal f of t hat pat i ent . Thepr i son can t hen t r ack t he r at e at whi ch t hese r ef i l l r equest s occurbehi nd schedul e. [ App. at 305- 06. ]

3 As a mat t er of l ogi c, an exami nat i on of l at e r ef i l l s woul dseem more pr one to over st ate adher ence f or medi cat i on pr ovi dedt hr ough t he KOP pr ogr am, where pr i soners coul d r etur n f or moremedi cat i on even wi t hout f i ni shi ng t hei r l ast pack, t han f ormedi cat i on pr ovi ded t hr ough t he dai l y med l i ne, wher e pr i son st af fobser ve al l doses.

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The pl ai nt i f f s of f er no al t er nat i ve quant i t at i ve met r i c

f or assessi ng t he heal t h of i nmat es wi t h HI V, f or det er mi ni ng t hei r

adher ence, or f or ot her wi se gaugi ng t he ef f ect s of t he pol i cy

change. I n sum, t he undi sput ed dat a t hat exi st s pr ovi des cr edi bl e

suppor t f or t he depar t ment t o concl ude t hat t he di spensi ng pol i cy

cont r i but ed t o a mat er i al i mpr ovement i n t he heal t h of HI V

pr i soner s as a gr oup, and pr ovi des no basi s t o cl ai m t hat t he

change wor sened t he heal t h of t hat gr oup of pr i soner s. I t i s al so

undi sput ed t hat t he change l ed t o si gni f i cant cost savi ngs. [ App.

at 293, 317- 319. ]

C. The Plaintiffs' Situations

The pl ai nt i f f s present r el at i vel y l i t t l e evi dence

r egar di ng t hei r own si t uat i ons, f ocusi ng i nst ead on t he br oader

popul at i on of pr i soner s wi t h HI V. No medi cal pr of essi onal or

expert t est i f i ed speci f i cal l y about any pl ai nt i f f ' s s i t uat i on. I n

descr i bi ng t he consequences of t he pol i cy change f or t he

pl ai nt i f f s, we can t her ef or e r ef er onl y t o t he pl ai nt i f f s' own

t est i mony, al ong wi t h wr i t t en compl ai nt s t hey submi t t ed t o t he

pr i son.

Pl ai nt i f f Ri char d Nunes has not t aken any HI V medi cat i on

si nce t he change, cont endi ng t hat he cannot wai t on t he dai l y med

l i ne. He ci t es a pai nf ul l ower back condi t i on t hat makes i t

di f f i cul t f or hi m t o move or st and, chr oni c di ar r hea, and ot her

si cknesses. [ App. at 2351. ] Nunes r equest ed as an accommodat i on

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of hi s condi t i on t hat hi s medi cat i on be r ei nst at ed t o t he pr ogr am.

The depar t ment i nst ead of f er ed several al t er nat i ve accommodat i ons:

i t woul d pr ovi de Nunes wi t h a r ol l i ng wal ker , and al l ow hi m t o use

bat hr oom f aci l i t i es and si t on a bench whi l e wai t i ng on l i ne

wi t hout l osi ng hi s pl ace. Al t er nat i vel y, t aki ng hi s cl ai ms

r egar di ng t he sever i t y of hi s condi t i on at f ace val ue, t he

depar t ment of f er ed t o admi t hi m t o the medi cal uni t t o recei ve

medi cat i on f or as l ong as he i s t oo i l l t o go t o t he di spensi ng

wi ndow. [ App. at 2224- 26. ] Nunes has not accepted t hese

accommodat i ons, and now mai nt ai ns t hat he wi l l not at t end t he dai l y

med l i ne no mat t er what t he depar t ment does t o accommodate hi m.

[ App. at 113. ]

The ot her f our pl ai nt i f f s have at t ended t he dai l y med

l i ne consi st ent l y si nce t he pol i cy change. Thr ee have compl ai ned

t hat , i n t he cour se of at t endi ng t he l i ne, t hei r HI V st at us has

been di scl osed t o ot her i nmat es. [ App. at 2457, 2487, 2510. ]

These compl ai nt s i nvol ve i nadver t ent di scl osures by medi cal st af f ,

occur r i ng spor adi cal l y, and somet i mes unconnect ed t o t he

depar t ment ' s pol i cy change. For exampl e, t he pl ai nt i f f s compl ai n

about a post er i n t he medi cal uni t i dent i f yi ng HI V medi cat i ons, but

t hey admi t t hat t he post er has si nce been t aken down. [ App. at

140. ]

Pl ai nt i f f Car l Coe has al so compl ai ned about si de ef f ect s

ar i si ng f r omnot bei ng abl e t o take medi cat i on bef or e bed. [ App. at

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2405. ] Hi s t r eatment r egi men has si nce been changed, i n part t o

l i mi t si de ef f ect s. [ App. at 1029, 2405. ] Pl ai nt i f f J ohn Doe has

compl ai ned about havi ng to wai t i n l i ne f or a l ong t i me and havi ng

hi s medi cat i on unavai l abl e t her e on t wo consecut i ve days, whi l e

pl ai nt i f f Pet er Poe has compl ai ned t hat on one occasi on he was t ol d

t o l eave t he med l i ne and r et ur n l at er . [ App. at 131, 2501. ] The

r ecor d does not demonst r at e t hat t he pl ai nt i f f s exper i enced such

i nci dent s any more t han a handf ul of t i mes i n t he f our and a hal f

year s bet ween t he pol i cy change and t he di st r i ct cour t ' s deci si on.

Nor , wi t h t he possi bl e except i on of Nunes, does any pl ai nt i f f of f er

compet ent evi dence that hi s vi r al l oads or heal t h wor sened

mat er i al l y dur i ng t hat per i od.

D. Procedural History

The pl ai nt i f f s i ni t i at ed t hi s case i n November 2010,

seeki ng t o enj oi n t he pol i cy change and r est or e HI V medi cat i ons t o

t he KOP progr am. They do not seek damages. Two years l at er , af t er

di scover y, t he def endant s moved f or summary j udgment . The di st r i ct

cour t gr ant ed t he mot i on, and t he pl ai nt i f f s appeal ed.

II. Standard of Review

We consi der de novo t he quest i on whether summar y j udgment

i s appr opr i at e, t r ai ni ng our at t ent i on not on t he di st r i ct cour t ' s

opi ni on, but r at her on whet her t he r ecor d ent i t l es t he movi ng

par t y- - her e t he def endant s- - t o j udgment as a mat t er of l aw.

Mesni ck v. Gener al El ec. Co. , 950 F. 2d 816, 822 ( 1st Ci r . 1991) .

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See al so Tr aver s v. Fl i ght Ser vs. & Sys. , I nc. , 737 F. 3d 144, 145

( 1st Ci r . 2013) . Under Feder al Rul e of Ci vi l Pr ocedur e 56( a) ,

" [ t ] he cour t shal l gr ant summary j udgment i f t he movant shows t hat

t her e i s no genui ne di sput e as t o any mater i al f act and t he movant

i s ent i t l ed t o j udgment as a mat t er of l aw. " Gener al l y speaki ng,

a par t y cannot r ai se a genui ne di sput e mer el y "by r el yi ng on the

hope t hat t he j ur y wi l l not t r ust t he credi bi l i t y of t he wi t ness, "

but must i nst ead pr esent "some af f i r mat i ve evi dence" on t he poi nt ,

except per haps wher e t he t est i mony i s " i nher ent l y unbel i evabl e. "

McGr ath v. Tavar es, 757 F. 3d 20, 28 n. 13 ( 1st Ci r . 2014) .

III. Analysis

A. The Eighth Amendment

The pl ai nt i f f s cl ai m t hat t he change i n t he met hod of

di spensi ng HI V medi cat i ons vi ol at ed t hei r r i ght t o be f r ee of

"cr uel and unusual puni shment [ ] " under t he Ei ght h Amendment . To

pr ove an Ei ght h Amendment vi ol at i on, t he pl ai nt i f f s must f i r st show

t hat t hey f aced an "obj ect i vel y i nt ol er abl e" r i sk of har mr esul t i ng

f r om t he depar t ment ' s deci si on t o make HI V medi cat i ons avai l abl e

onl y t hr ough t he dai l y med l i ne. Laki n v. Barnhart , 2014 WL

3036303 ( 1st Ci r . J ul y 7, 2014) ( quot i ng Far mer v. Br ennan, 511

U. S. 825, 846 ( 1994) ) . I n cases based on a pr i soner ' s medi cal

t r eatment , a pr i soner must show t hat t he medi cal care pr ovi ded i s

not "adequate, " as measur ed agai nst "pr udent pr of essi onal

st andar ds. " Uni t ed St at es v. DeCol oger o, 821 F. 2d 39, 43 ( 1st Ci r .

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1987) ; see al so Leavi t t v. Cor r . Med. Ser vs. , I nc. , 645 F. 3d 484,

497 ( 1st Ci r . 2011) .

A pl ai nt i f f must t hen show t hat st at e of f i ci al s "kn[ ew]

of and di sr egar d[ ed] " t he r i sk of har m. Far mer , 511 U. S. at 837.

To sat i sf y t hi s "del i berat e i ndi f f er ence" r equi r ement , a pl ai nt i f f

must show t hat st at e of f i ci al s wer e "awar e of f act s f r om whi ch t he

i nf er ence coul d be dr awn t hat a subst ant i al r i sk of ser i ous har m

exi st s, and . . . dr [ ew] t he i nf er ence. " I d.

The pl ai nt i f f s' evi dence woul d not al l ow a r easonabl e

j ury t o f i nd t hat t hey had sat i sf i ed ei t her r equi r ement . As t o t he

obj ect i ve r equi r ement , t he pl ai nt i f f s r el y pr i mar i l y on t he

t est i mony of St one and Qui r k, t he t wo doct ors who work i n t he

pr i son syst em, and on t he af f i davi t of an out si de exper t , Dr . Davi d

Bangsber g. Yet , none of t hese wi t nesses t est i f i ed speci f i cal l y

about t he pl ai nt i f f s' si t uat i ons. Bangsber g di d not exami ne t he

pl ai nt i f f s, r evi ew t hei r medi cal r ecor ds, or of f er any anal ysi s of

t hei r par t i cul ar si t uat i ons. [ App. at 362- 66. ] I ndeed, he di d not

concl ude t hat t he depar t ment had pr ovi ded i nadequat e medi cal care

t o any i nmat e, al t hough he i dent i f i ed, i n t he abst r act , cer t ai n

pr act i ces as "subst andar d. " [ App. at 362, 366. ] Meanwhi l e, t he

t est i mony of St one and Qui r k est abl i shes, at best , t hat cer t ai n

i nmat es- - not i dent i f i ed as any of t he pl ai nt i f f s- - have suf f er ed

pr obl ems r esul t i ng f r om t he pol i cy change, but t he t est i mony does

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not at t empt t o measur e t hese pr obl ems agai nst medi cal st andards.

[ See, e. g. , App. at 1420, 1455. ]

Even vi ewed i n t he l i ght most f avor abl e t o t he

pl ai nt i f f s, none of t hi s t est i mony est abl i shes t hat any pl ai nt i f f

has act ual l y r ecei ved medi cal car e f al l i ng bel ow pr of essi onal

st andards. Nor does t he r emai ni ng evi dence make possi bl e such a

f i ndi ng. The pl ai nt i f f s pr esent t hei r own wr i t t en compl ai nt s, but

t hese compl ai nt s ar e unaccompani ed by medi cal anal ysi s and document

onl y occasi onal medi cal pr obl ems ar i si ng f r om t he pol i cy change:

t empor ar y si de ef f ect s f or one pl ai nt i f f , and a handf ul of mi ssed

doses f or t wo ot her s. 4 As t o t he st at i st i cs pr esent ed by t he

par t i es, t hey f ur t her under mi ne t he pl ai nt i f f s' case: on t he whol e,

mor e pat i ent s have undet ect abl e vi r al l oads s i nce t he change, and

l at e r ef i l l s have r emai ned st eady. Even f ul l y accept i ng t he

pl ai nt i f f s' cr i t i ci sms of t he dat a, one woul d be bound t o concl ude

t hat t he pol i cy change di d not make out comes any worse, even i f i t

di d not make t hem any bet t er .

The pl ai nt i f f s' probl ems onl y mul t i pl y on t he i ssue of

del i ber at e i ndi f f er ence. As demonst r at ed above, t he r ecor d i s so

devoi d of evi dence of act ual medi cal r i sk to t he pl ai nt i f f s as t o

make i t unr easonabl e to concl ude that t he depar t ment knowi ngl y

4 Al t hough anot her pl ai nt i f f , Nunes, has not t aken hi smedi cat i on si nce t he pol i cy change, we expl ai n bel ow i n part C t hatt he pr i son has made reasonabl e ef f or t s t o accommodat e t he probl emst hat he says pr event hi m f r om doi ng so.

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di sr egar ded such a r i sk. Even i f t he pl ai nt i f f s' evi dence r ai sed

a possi bi l i t y of har m t o t he gr oup of HI V- posi t i ve pr i soner s as a

whol e, t hat possi bi l i t y i s so uncer t ai n and unsuppor t ed by bef or e-

and- af t er evi dence as t o pr ecl ude a r easonabl e f act f i nder f r om

i nf er r i ng t hat t he depar t ment i s now knowi ngl y di sr egar di ng a har m

t o t hese pr i soner s. On t he cont r ar y, t he undi sput ed f act s show

t hat t he depar t ment engaged i n f aci al l y reasonabl e ef f or t s, wel l

bef or e t hi s l i t i gat i on commenced, t o assess t he ef f ect s of a pol i cy

change, and t hen concl uded, wi t h ampl e basi s, t hat t he change woul d

not harm i nmates.

B. The Right to Avoid Disclosure of Personal Information

Cl ai mi ng t hat t he pol i cy change exposed t hem t o

di scl osur es of t hei r HI V st at us t o ot her i nmat es, t he pl ai nt i f f s

asser t a vi ol at i on of a r i ght t o pr i vacy under t he Four t eent h

Amendment . The Supreme Cour t has i mpl i ed t hat t he Const i t ut i on

mi ght pr ot ect i n some ci r cumst ances " t he i ndi vi dual i nt er est i n

avoi di ng di scl osur e of per sonal mat t er s" f r om gover nment

i nf r i ngement . Whal en v. Roe 429 U. S. 589, 599 ( 1977) . But cf .

Nat i onal Aer onaut i cs & Space Admi n. v. Nel son, 131 S. Ct . 746, 751

( 2011) ( assumi ng, but decl i ni ng t o conf i r m, " t hat t he Const i t ut i on

pr ot ect s a pr i vacy r i ght of t he sor t ment i oned i n Whal en" ) . For

t hose i n pr i son, however , any r i ght t o pr i vacy i s i nevi t abl y

di mi ni shed. For exampl e, pr i son of f i ci al s may sear ch an i nmat e' s

cel l wi t hout r egard t o t he Four t h Amendment pr ohi bi t i on on

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unr easonabl e searches. See Hudson v. Pal mer , 468 U. S. 517, 526

( 1984) . See al so Sanchez v. Per ei r a- Cast i l l o, 590 F. 3d 31, 42- 44

( 1st Ci r . 2009) . St i l l , whi l e we have never consi der ed t he i ssue,

t hr ee ot her ci r cui t s have f ound t hat pr i soner s have at l east a

l i mi t ed const i t ut i onal r i ght agai nst gr at ui t ous di scl osur es of

medi cal i nf or mat i on. 5

We need not deci de i n thi s case whether pr i soner s have a

const i t ut i onal r i ght t o keep medi cal i nf or mat i on pr i vat e. Rat her ,

because t he i nadver t ent and spor adi c di scl osur es her e occur r ed i n

t he cont ext of a r easonabl e gover nment pol i cy, t he pl ai nt i f f s

cannot pr evai l even i f t he depar t ment i nf r i nged on a pr i vacy

i nt er est pr ot ect ed by t he Const i t ut i on. I n r eachi ng t hi s

concl usi on, we r el y on a r ecent Supr eme Cour t case r ej ect i ng a

pr i vacy cl ai mbr ought by appl i cant s f or empl oyment wi t h gover nment

cont r act or s. See Nel son, 131 S. Ct . at 759- 61. Ther e, appl yi ng

t he same pr ecedent s r el i ed upon by the pl ai nt i f f s her e, t he Cour t

f ound no basi s t o enj oi n a pol i cy t hat r equi r ed col l ect i ng

sensi t i ve medi cal i nf or mat i on about t he appl i cant s unl ess t he

pl ai nt i f f s est abl i shed t hat t he pol i cy was not " r easonabl e. " See

i d. At l east t he same bar shoul d appl y when pl ai nt i f f s chal l enge

5 See Powel l v. Schr i ver , 175 F. 3d 107, 112 ( 2d Ci r . 1999)( hol di ng t hat "grat ui t ous di scl osur e of an i nmat e' s conf i dent i almedi cal i nf or mat i on as humor or gossi p" vi ol at es t he Const i t ut i on) ;Doe v. Del i e, 257 F. 3d 309, 317 ( 3d Ci r . 2001) ( f ol l owi ng Powel l ) ;Moor e v. Pr evo, 379 F. App' x 425, 428 ( 6t h Ci r . 2010) ( f ol l owi ngPowel l and Del i e) . Bot h Del i e and Moor e were accompani ed bydi ssent s.

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t he gover nment ' s admi ni st r at i on of pr i sons, wher e st at e of f i ci al s

f ace pr obl ems " not suscept i bl e to easy sol ut i ons" and t her ef or e

r ecei ve "wi de- r angi ng def er ence. " Bel l v. Wol f i sh, 441 U. S. 520,

547 ( 1979) .

Our pr ecedi ng anal ysi s of t he Ei ght h Amendment cl ai m

demonst r ates t hat t he pr i son' s pol i cy was not unr easonabl e, and

t hat t he i nj unct i on sought by t he pl ai nt i f f s woul d t hr eat en t o

el i mi nat e si gni f i cant cost savi ngs whi l e qui t e possi bl y posi ng a

r i sk t hat gai ns i n over al l heal t h woul d al so be l ost . The

pl ai nt i f f s r et or t t hat t he depar t ment coul d have adopt ed a nar r ower

pol i cy t hat woul d have subst ant i al l y mat ched t he benef i t s of i t s

cur r ent pol i cy whi l e bet t er pr ot ect i ng t hei r pr i vacy:

i ndi vi dual i zed det er mi nat i ons of how medi ci ne i s di st r i but ed t o

each pr i soner . [ Repl y Br . at 26. ] Yet , t he Supr eme Cour t i n

Nel son squarel y r ej ect ed t he cl ai mt hat t he gover nment must empl oy

t he "l east r est r i ct i ve means of f ur t her i ng i t s i nt er est " i n or der

t o avoi d di scl osur es of per sonal i nf or mat i on. 131 S. Ct . at 761.

On t hese f act s, t he use of an ot herwi se reasonabl e and cust omary

di spensi ng pr act i ce does not vi ol at e any const i t ut i onal pr i vacy

r i ght s mer el y because ot her pr i soner s may i nf er what medi cat i ons a

pr i soner i s t aki ng and what di sease he suf f er s f r om.

C. Americans with Disabilities Act and Rehabilitation Act

I n addi t i on t o t hei r const i t ut i onal cl ai ms, t he

pl ai nt i f f s pr ess st at ut or y cl ai ms based on t he Amer i cans wi t h

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Di sabi l i t i es Act ( "ADA") , 42 U. S. C. 12132, and t he Rehabi l i t at i on

Act , 29 U. S. C. 794. The par t i es agr ee t hat we need make no

di st i nct i on bet ween t he t wo st at ut es f or pur poses of our anal ysi s

i n t hi s case. [ BB at 18 n. 7; RB at 30 n. 9. ] Bot h st at ut es

pr ovi de, i n near l y i dent i cal l anguage, t hat "no qual i f i ed

i ndi vi dual wi t h a di sabi l i t y shal l , by r eason of such di sabi l i t y,

be excl uded f r om par t i ci pat i on i n or be deni ed t he benef i t s of t he

ser vi ces, pr ogr ams, or acti vi t i es of a publ i c ent i t y, or be

subj ect ed t o di scr i mi nat i on by any such ent i t y. " 42 U. S. C.

12132; see al so 29 U. S. C. 794( a) . The pl ai nt i f f s cor r ect l y

ar gue t hat t hei r condi t i on qual i f i es as a di sabi l i t y under t he

st at ut es. See 42 U. S. C. A. 12102( 2) ( B) .

A pl ai nt i f f can pr ess sever al di f f er ent t ypes of cl ai ms

of di sabi l i t y di scr i mi nat i on. Fi rst , a pl ai nt i f f can assert

di spar at e t r eat ment on account of di sabi l i t y, i . e. , t hat t he

di sabi l i t y act ual l y mot i vat ed t he def endant ' s chal l enged adver se

conduct . See Rayt heon Co. v. Hernandez, 540 U. S. 44, 52- 53 ( 2003) .

Such cl ai ms ar e gover ned by t he same anal yt i c f r amework gover ni ng

cl ai ms of r aci al di scr i mi nat i on under Ti t l e VI I of t he Ci vi l Ri ght s

Act of 1964. I d. at 50- 52; see al so Regi onal Econ. Cmt y. Act i on

Pr ogr am, I nc. v. Ci t y of Mi ddl et own, 294 F. 3d 35, 48 ( 2d Ci r .

2002) . Al t er nat i vel y, i n an appr opr i at e case a pl ai nt i f f can cl ai m

t hat a gover nment pol i cy, t hough neut r al on i t s f ace, "f al l [ s] mor e

harshl y on one gr oup t han another and cannot be j ust i f i ed by

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busi ness necessi t y. " See Raytheon Co. , 540 U. S. at 52 ( i nt er nal

quot at i on mar ks omi t t ed) ; 28 C. F. R. 35. 130( b) ( 3) ( I ) ( est abl i shi ng

t hat t he ADA pr ohi bi t s publ i c ent i t i es f r omadopt i ng pol i ci es t hat

"have t he ef f ect of subj ect i ng qual i f i ed i ndi vi dual s wi t h

di sabi l i t i es t o di scr i mi nat i on on t he basi s of di sabi l i t y") .

Fi nal l y, a pl ai nt i f f can pur sue a t hi r d pat h, cl ai mi ng t hat a

publ i c ent i t y has r ef used t o af f i r mat i vel y accommodat e hi s or her

di sabi l i t y where such accommodat i on was needed t o pr ovi de

"meani ngf ul access t o a publ i c ser vi ce. " 6 Henr i et t a D. v.

Bl oomberg, 331 F. 3d 261, 273- 76 ( 2d Ci r . 2003) . Al t hough such

cl ai ms can be seen as bear i ng many of t he i ndi ci a of di spar at e

i mpact or di spar at e t r eat ment , 7 a pl ai nt i f f pur sui ng such a cl ai m

need not di r ect l y addr ess and sat i sf y the el ement s or met hods f or

pr ovi ng such t heor i es. See

i d. at 275.

6 The r egul at i ons under t he r el evant por t i on of t he ADA r ef ert o "r easonabl e modi f i cat i on, " 28 C. F. R. 35. 130( b) ( 7) , whi l e t hecoor di nat i ng r egul at i ons under t he Rehabi l i t at i on Act use t he ter m"r easonabl e accommodat i on, " 28 C. F. R. 41. 53, but t her e i s nomat er i al di f f erence between t he t erms. See Wong v. Regent s ofUni v. of Cal i f or ni a, 192 F. 3d 807, 816 n. 26 ( 9t h Ci r . 1999) .

7When a di sabl ed per son i s deni ed a r easonabl e accommodat i on,t hat per son l acks oppor t uni t i es possessed by si mi l ar non- di sabl edpeopl e on account of di sabi l i t y. Such deni al can of t en be seen ascreat i ng a di spar at e i mpact , whi ch under Ti t l e VI I r out i nel y

i nvol ves t he unj ust i f i ed f ai l ur e t o avoi d per pet uat i ng a bur denar i s i ng f rom hi story or t radi t i on. Si mi l ar l y, a deni al of r easonabl e accommodat i on can r esembl e di sparat e t r eat ment i f somedi scr i mi nat or y ani mus i s i nvol ved. For exampl e, a hei ght t est maycr eate an adver se i mpact on women i n t he same way t hat a mobi l i t yt est may create an adver se i mpact on peopl e wi t h cer t ai ndi sabi l i t i es, absent accommodat i on.

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Her e, f our of t he pl ai nt i f f s pur sue onl y a c l ai m of

di spar at e t r eat ment . They argue t hat t he depar t ment r emoved t hei r

medi cat i ons f r om t he KOP pr ogr am si mpl y because t hey have HI V,

whi l e al l owi ng pr i soner s wi t h ot her i l l nesses t o cont i nue ut i l i zi ng

i t . These f our pl ai nt i f f s expr essl y di savow any cl ai m f or

r easonabl e accommodat i on. [ BB at 21. ] They al so make no ment i on

of a di spar at e i mpact t heor y.

Whi l e t hese pl ai nt i f f s asser t di spar at e t r eat ment i n t he

f or m of "excl usi on . . . f r om t he KOP Pr ogr am, " t hat asser t i on i s

not l i t er al l y cor r ect. [ Repl y Br . 5. ] They can st i l l use t he

pr ogr am t o recei ve t he same medi cat i ons t hat ot her pr i soner s can

r ecei ve t hr ough t he pr ogr am. The pl ai nt i f f s, of cour se, need t o

access HI V medi cat i ons t hat ot her pr i soner s do not need. But t hey

have not been si ngl ed out i n t hi s respect : many other medi cat i ons

ar e al so excl uded f r om t he pr ogr am. Mor eover , t he dai l y med l i ne

pr ovi des f ul l access t o t hei r HI V medi cat i on. Al t hough t he

pl ai nt i f f s r egard t hi s as a more bur densome means of access, we see

no evi dence of any i nt ent by t he depar t ment t o i mpose t hat bur den

on t he pl ai nt i f f s because t hey have HI V. See Rayt heon Co. , 540

U. S. at 52 ( "Li abi l i t y i n a di spar at e- t r eat ment case [ under t he

ADA] depends on whet her t he pr otect ed t r ai t actual l y mot i vat ed t he

empl oyer ' s deci si on. " ( i nt er nal quot at i on mar ks, al t er at i ons

omi t t ed) ) . Rat her , t he pr i son has of f er ed non- di scr i mi nat or y

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gr ounds f or i t s deci si on, t he r easonabl eness of whi ch t he

pl ai nt i f f s have been unabl e t o ef f ect i vel y chal l enge.

I n sum, even vi ewed f avor abl y to t he pl ai nt i f f s, t he

r ecor d shows t hat t he depar t ment pr ovi des meani ngf ul access t o HI V

medi cat i ons t hr ough t he dai l y med l i ne; and i t s deci si on t o pr ovi de

access i n t hat manner i s dr i ven by cost savi ngs backed up by data

suggest i ng a posi t i ve, or at wor st neut r al , i mpact on t he heal t h of

t he HI V- posi t i ve pr i son popul at i on. On such a r ecor d, no j ur y

coul d f i nd f or pl ai nt i f f s on t hei r di spar at e t r eat ment cl ai m.

We next t ur n t o t he cl ai m br ought by one pl ai nt i f f ,

Ri char d Nunes, f or deni al of r easonabl e accommodat i on. Nunes

cl ai ms t hat he cannot at t end t he dai l y med l i ne due t o back pai n,

chr oni c di ar r hea, and ot her i l l ness. He cont ends t hat he i s unabl e

t o do so even t hough t he depar t ment has of f ered several

accommodat i ons: t he use of a r ol l i ng wal ker and t he abi l i t y t o si t

on a bench or use t he bat hr oomwhi l e mai nt ai ni ng hi s pl ace i n l i ne.

Nunes of f er ed no medi cal evi dence support i ng t hi s cl ai med

i nabi l i t y. The absence of such evi dence i s especi al l y per t i nent

because t he r ecord i s undi sput ed t hat Nunes r egul ar l y wal ks t o and

f r omt he pr i son caf et er i a and engages i n exer ci se, [ App. at 155- 56]

and t hat he r ecent l y had j obs wal ki ng wi t h a bl i nd pr i soner and

cl eani ng cor r i dor s [ App. at 153- 154] . I n t he event Nunes

never t hel ess becomes so i l l t hat he cannot l eave hi s cel l , t he

depar t ment has extended a st andi ng of f er t o move hi mt o t he medi cal

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uni t wher e he can r ecei ve hi s medi cat i ons dai l y i n accor d wi t h

nor mal depar t ment pr ocedur es appl i cabl e t o al l ser i ousl y i l l

i nmat es. 8 Hi s onl y r ej oi nder i s t hat he does not act ual l y get

qui t e i l l enough t o need t he medi cal uni t , and he woul d not want t o

move t o t he uni t because he woul d l ose hi s cur r ent cel l and not

have as much access t o hi s pr oper t y. [ BB at 41- 42. ]

But Nunes has pr ovi ded no evi dence t hat t her e even

exi st s, much l ess t hat he l i ves wi t hi n, a medi cal no man' s l and

bet ween bei ng unabl e t o go t o t he dai l y med l i ne and war r ant i ng

t r ansf er t o t he medi cal uni t . On such a r ecor d, no r easonabl e

f act f i nder coul d f i nd the depart ment ' s accommodat i ons wer e not a

r easonabl e means of pr ovi di ng Nunes wi t h meani ngf ul access t o hi s

medi cat i on. The st at ut es ent i t l e Nunes t o r easonabl e

accommodat i ons, not t o opt i mal ones f i nel y t uned t o hi s

pr ef er ences. See J . D. ex r el . J . D. v. Pawl et Sch. Di st . , 224 F. 3d

8 The pl ai nt i f f s' br i ef i mpl i es t hat Nunes was oncedi sci pl i ned f or at t empt i ng t o use t he accommodat i on. [ BB at 42. ]Nunes' s af f i davi t , however , makes cl ear t hat he was act ual l ydi sci pl i ned f or mi ssi ng a schedul ed medi cal appoi nt ment , anent i r el y di f f er ent mat t er . [ App. at 2253- 2257. ]

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60, 71- 72 ( 2d Ci r . 2000) ; Cor r i gan v. Per r y, 139 F. 3d 888, *8- 9

( 4t h Ci r . 1998) ( unpubl i shed) . 9

IV. Conclusion

Al t hough t he pl ai nt i f f s have r ai sed quest i ons about t he

wi sdom of t he depar t ment ' s pol i ci es, t hey have not pr oduced

adequat e evi dence of any const i t ut i onal or st at ut or y vi ol at i on.

Consequent l y, and f or t he r easons out l i ned above, we af f i r m t he

gr ant of summary j udgment t o t he def endant s on al l cl ai ms.

So order ed.

9 Li ke many cases appl yi ng t he empl oyment prong of t he ADA,see Schmi dt v. Met hodi st Hosp. of I ndi ana, I nc. , 89 F. 3d 342, 344-45 ( 7t h Ci r . 1996) , Cor r i gan hol ds t hat under t he Rehabi l i t at i on

Act an empl oyer need not pr ovi de the pl ai nt i f f ' s r equest edaccommodat i on so l ong as i t provi des some r easonabl e accommodat i on.The same l ogi c appl i es here. Cf . Ansoni a Bd. of Educ. v.Phi l br ook, 479 U. S. 60, 68 ( 1986) ( r eachi ng t he same concl usi on i nanal yzi ng empl oyer s' obl i gat i on t o r easonabl y accommodat e r el i gi ouspr acti ces under Ti t l e VI I ) .

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Nunes v. MA Dept. of Corrections, 1st Cir. (2014)

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