Stepnay v. Goff, 10th Cir. (2006)

F I L E D
UNITED STATES COURT OF APPEALS

TENTH CIRCUIT
United States Court of Appeals

Tenth Circuit
January 26, 2006

Elisabeth A. Shumaker
Clerk of Court
FRED STEPNAY, JR.,

Plaintiff-Appellant,
v.
DENNIS GOFF, ARNP, Medical Care

Provider; JANET MYERS, Health
Service Administrator; JO RENE
KERNS, Resident Agent of Correct
Care Solutions; LOUIS E. BRUCE,
Warden, Hutchinson Correctional
Facility; and KANSAS
DEPARTMENT OF CORRECTIONS,
Secretary of Corrections,
No. 05-3203
(D.C. No. 04-CV-3246-GTV)
(D. Kan.)
Defendants-Appellees.
ORDER AND JUDGMENT *
Before EBEL, McKAY, and HENRY, Circuit Judges.
After examining appellants brief and the appellate record, this panel has
determined unanimously that oral argument would not materially assist the
determination of this appeal. See Fed. R. App. P. 34(a)(2) and 10th Cir. R.
34.1(G). The case is therefore ordered submitted without oral argument. This
Order and Judgment is not binding precedent, except under the doctrines of law of
the case, res judicata, and collateral estoppel. The court generally disfavors the
citation of orders and judgments; nevertheless, an order and judgment may be
cited under the terms and conditions of 10th Cir. R. 36.3.
*
Plaintiff-Appellant Fred Stepnay, Jr., a state prisoner, brought a pro se

1983 claim against the Kansas Department of Corrections and various state
officials (Defendants) alleging they provided him with constitutionally
inadequate medical care for a skin condition. The district court dismissed the
action under 28 U.S.C. 1915(e)(2)(B)(ii) because Mr. Stepnay failed to state a
claim upon which relief could be granted. Because we cannot say that allowing
Mr. Stepnay to amend his complaint would be futile, the district court erred in
dismissing his complaint under 1915(e)(2)(B)(ii).
I. Background
In November 2003, Mr. Stepnay developed a skin condition. Defendant
Dennis Goff, a nurse practitioner, treated Mr. Stepnay a number of times. In
February 2004, after three months of treatment from Mr. Goff, Mr. Stepnay was
denied his request for a referral to a physician for persistent symptoms and told
that he had been properly diagnosed and was receiving the correct treatment for
his skin condition. He subsequently filed grievances with the Health Service
Administrator, the Resident Agent of Correct Care Solutions (C.C.S.), and the
Warden, all of whom responded that no further action would be taken because he
was being seen and treated as the health care provider deemed appropriate.
Mr. Stepnay then filed a grievance with the Kansas Secretary of
Corrections and was seen by a physician on March 9, 2004. This physician
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diagnosed Mr. Stepnay with a staph infection and prescribed a ten-day course of
antibiotics and antibiotic soap. After ten days of this treatment, Mr. Stepnay still
suffered from the same symptoms and requested follow-up care. This request was
denied. He went through the same grievance process and was again told no action
would be taken. After filing a second grievance with the Kansas Secretary for
Corrections, Mr. Stepnay was seen by another physician on May 2004. This
physician diagnosed the skin condition as Staphylococcus Aureus (M.R.S.A.)
and prescribed a twenty-day course of antibiotics.
Mr. Stepnay contends that due to the C.C.S. staffs and the Wardens
deliberate indifference toward [his] medical needs, [he has] permanent scarring
on his skin and an infectious disease that will continue to recur. Additionally, he
alleges that because he has congestive heart failure this virus (M.R.S.A.) could
result in [his] untimely death. He claims that Defendants actions in denying
him medical care violated the Eighth Amendments prohibition against cruel and
unusual punishment.
After granting Mr. Stepnays motion to proceed in forma pauperis, the
district court concluded that Mr. Stepnays allegations were insufficient to state a
claim of deliberate indifference as required to state a cognizable Eighth
Amendment violation. It therefore dismissed Mr. Stepnays claim for failure to
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state a claim upon which relief may be granted pursuant 28 U.S.C.

1915(e)(2)(B)(ii). Mr. Stepnay appeals that dismissal.
II. Discussion
In order to demonstrate a violation of clearly established Eighth
Amendment rights due to inadequate medical care, an inmate must satisfy both
objective and subjective elements. Garrett v. Stratman, 254 F.3d 946, 949 (10th
Cir. 2001). An inmate satisfies the objective component by alleging facts
indicating the deprivation of medical care is sufficiently serious. Id. The
subjective component is met if prison officials acted with the requisite
culpability; that is, deliberate indifference. Id. Finally, a delay in medical care
only constitutes an Eighth Amendment violation where the plaintiff can show that
the delay resulted in substantial harm. Id. at 950 (quotations omitted).
Although a district court may dismiss sua sponte a pro se complaint for
failure to state a claim pursuant to 1915 or Fed. R. Civ. P. 12(b)(6), see
McKinney v. Oklahoma, 925 F.2d 363, 365 (10th Cir. 1991), we have nonetheless
also held that [s]uch a dismissal is appropriate only where it is patently
obvious that the plaintiff could not prevail on the facts alleged, and allowing
[him] an opportunity to amend [his] complaint would be futile, Whitney v. New
Mexico, 113 F.3d 1170, 1173 (10th Cir. 1997) (quotations omitted; emphasis
added). Although it may be unlikely that Mr. Stepnay can sufficiently allege that
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the prison officials acted with deliberate indifference to his serious medical
needs, it is not clear that allowing Mr. Stepnay the opportunity to amend his
complaint would be futile. In order to provide guidance to the district court and
Mr. Stepnay on remand, we focus our analysis on the deficiencies in his
complaint.
A. Deprivation of Medical Care for Sufficiently Serious Medical
Condition
The deprivation of a medical need is sufficiently serious if the condition
has been diagnosed by a physician as mandating treatment or is so obvious that
even a lay person would easily recognize the necessity for a doctors attention.
Garrett, 254 F.3d at 949 (quotation, alteration omitted). Although Mr. Stepnays
skin condition was twice diagnosed by a physician as mandating treatment, he
received that treatment as soon as it was prescribed. 1 Accordingly, the only
seemingly viable deprivation claim that exists relates to the brief window of time
when Defendants allegedly denied Mr. Stepnay follow-up care after the expiration
of his ten-day course of antibiotics despite the fact that Mr. Stepnay repeatedly
told Defendants the treatment for his staph infection had not worked. See Ramos
v. Lamm, 639 F.2d 559, 575 (10th Cir. 1980) (Deliberate indifference to serious
To the extent that Mr. Stepnay is challenging the nurse practioners
treatment, we note that a prisoner who merely disagrees with a diagnosis or a
prescribed course of treatment does not state a constitutional violation. Perkins
v. Kan. Dept of Corr., 165 F.3d 803, 811 (10th Cir. 1999).
1
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medical needs is shown when prison officials have prevented an inmate from
receiving recommended treatment or when an inmate is denied access to medical
personnel capable of evaluating the need for treatment.).
Mr. Stepnay may not avoid dismissal, however, by merely asserting
conclusory allegations that his condition obviously required a doctors attention
because most skin conditions are not intuitively serious. Cf. Oxendine v. Kaplan,
241 F.3d 1272, 1278 (10th Cir. 2001) (holding that ineffectiveness of the prison
doctors reattachment and care of the inmates severed finger was so obvious a
lay person would recognize the need for a doctors attention where the inmates
finger tissue blackened and necrified). However, because we can at least imagine
some skin conditions that are sufficiently serious, and drug resistant infections in
a prison context might certainly be in that context, Mr. Stepnay may only avoid
dismissal by alleging specific facts indicating his condition at the conclusion of
his ten-day course of antibiotics was so obvious that Defendants should have
recognized that it required a referral for follow-up care. Thus, Mr. Stepnay could,
for instance, describe objective symptoms he manifested after the ten-day course
of antibiotics that are sufficient to trigger the need for additional treatment. 2
B. Deliberate Indifference
Of course, Mr. Stepnay could alternatively satisfy this element by
alleging that a physician timely diagnosed his condition as mandating treatment
after the ten days of antibiotics.
2
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The subjective component of an inmates Eighth Amendment claim is met

if the prison officials 1) were aware of facts from which the inference could be
drawn that a substantial risk of serious harm existed and 2) actually drew such an
inference. See Garrett, 254 F.3d at 949. Although Mr. Stepnay contends in a
conclusory fashion that Defendants acted with deliberate indifference, his current
factual allegations do not support this contention. Nothing in Mr. Stepnays
complaint suggests that Defendants knew of and disregarded a substantial risk to
his health or safety. To the contrary, the fact that Mr. Stepnay saw three different
health care providers, on its face, cuts against his contention and affirmatively
suggests that Defendants were not indifferent to his medical needs. At most,
then, Mr. Stepnays current factual allegations indicate that Defendants may have
been negligent in diagnosing or treating his skin condition. Negligence, however,
does not become a constitutional violation merely because the victim is a
prisoner. Fitzgerald v. Corr. Corp. of Am., 403 F.3d 1134, 1143 (10th Cir.
2005).
Here, Defendants might have been aware that Mr. Stepnay underwent a tenday course of doctor-prescribed treatment for a serious staph infection and
nevertheless refused his request for follow-up care at the expiration of that course
of treatment despite the fact that Mr. Stepnay claimed to be suffering from the
same symptoms that the nurse practitioner had already unsuccessfully attempted
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to treat on numerous occasions. Because a factfinder may conclude that a prison

official knew of a substantial risk from the very fact that the risk was obvious,
Garrett, 254 F.3d at 950, at this stage in the proceedings we refuse to conclude
that it would be futile to allow Mr. Stepnay to amend his complaint. In order to
avoid dismissal, however, Mr. Stepnay must, for example, precisely identify facts
that were called to Defendants attention by the first physician to treat Mr.
Stepnay and by Mr. Stepnay himself that make obvious a substantial risk to Mr.
Stepnay. 3 See id. (If a risk is obvious, so that a reasonable man would realize it,
we might well infer that the defendant did in fact realize it.) (quotations and
alterations omitted); see also id. (noting that J. Hall, General Principles of
Criminal Law 118 (3d ed. 1982) caution[s] against confusing a mental state with
proof of its existence) (quotation omitted). If Mr. Stepnay successfully alleges
such facts, not conclusions, then Defendants delay in procuring adequate followup care for Mr. Stepnay could be sufficient to avoid dismissal.
C. Delay Resulting in Substantial Harm
Mr. Stepnay has alleged that he was not seen for follow-up care until two
months after the first physician diagnosed him with a staph infection requiring
Such facts may include, for example, precise recital of descriptions,
complaints, or statements Mr. Stepnay told prison officials informing them of his
physicians diagnosis and prescribed treatment or calling their attention to the
inadequacy of the first treatment of his condition or perhaps statements by or
notes from Mr. Stepnays first physician.
3
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medical attention, approximately six weeks after symptoms persisted despite

prescription antibiotics, after repeated requests for a second referral, and after
filing formal grievances. Assuming the other elements are met, delay in
providing Mr. Stepnay follow-up medical care may constitute a constitutional
violation. See Sealock v. Colorado, 218 F.3d 1205, 1210 (10th Cir. 2000)
(finding several hour delay in treatment for chest pains actionable); Stack v.
McCotter, 79 F. Appx 383, 389-90 (10th Cir. 2003) (unpublished) (finding that
genuine issues of material fact existed regarding whether inmates delayed dental
care constituted Eighth Amendment violation); Boyd v. Knox, 47 F.3d 966 (8th
Cir. 1995) (finding three-week delay in treating infected wisdom tooth
actionable). Such delay, however, must have resulted in substantial harm.
Sealock, 218 F.3d at 1210.
[T]he substantial harm requirement may be satisfied by lifelong handicap,
permanent loss, or considerable pain. Garrett, 254 F.3d at 950 (quotations
omitted). Mr. Stepnay alleges that due to [Defendants] deliberate indifference
toward [his] medical needs, [he has] permanent scarring on his skin and an
infectious disease that will continue to recur. Additionally, he alleges that
because he has congestive heart failure[,] this virus (M.R.S.A.) could result in
[his] untimely death. Such facts, if later proven, would meet the substantial
harm requirement.
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III. Conclusion
We express no opinion on the merits of Mr. Stepnays claims. However,
because pro se litigants are to be given reasonable opportunity to remedy the
defects in their pleadings, Hall v. Bellmon, 935 F.2d 1106, 1110 n.3 (10th Cir.
1991), the district court erred in dismissing Mr. Stepnays complaint with
prejudice without first giving him an opportunity to amend his complaint to cure
any deficiencies. We therefore REVERSE the district courts order dismissing
the complaint with prejudice and REMAND the matter with instructions to
dismiss the complaint without prejudice to Mr. Stepnays right to reinitiate the
matter by filing a new complaint that sufficiently states a claim upon which relief
may be granted. 4 Mr. Stepnays motion to proceed on appeal pursuant to 1915
is GRANTED. We remind Mr. Stepnay that he is obligated to continue making
partial payments until the entire fee has been paid.
ENTERED FOR THE COURT
David M. Ebel
Mr. Stepnays motion for a default judgment against Defendants pursuant
to Fed. R. Civ. P. 55(a) is DENIED because Defendants were never served with
Mr. Stepnays complaint. Additionally, we DISMISS Mr. Stepnays motion
before this court to amend or alter his complaint as moot based on our remand of
this case to the district court.
4
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Circuit Judge
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F I L E D

UNITED STATES COURT OF APPEALS

United States Court of Appeals

January 26, 2006

FRED STEPNAY, JR.,

DENNIS GOFF, ARNP, Medical Care

Plaintiff-Appellant Fred Stepnay, Jr., a state prisoner, brought a pro se

state a claim upon which relief may be granted pursuant 28 U.S.C.

The subjective component of an inmates Eighth Amendment claim is met

to treat on numerous occasions. Because a factfinder may conclude that a prison

medical attention, approximately six weeks after symptoms persisted despite

ENTERED FOR THE COURT

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