## Facts

- Jane Doe, a late-term pregnant inmate at Taycheedah Correctional Institution, had a due date in mid-to-late April 2001.
- After she refused a scheduled labor induction on April 18 but agreed to reschedule, prison officials placed her in segregated confinement on April 20.
- In segregation on April 21, Doe reported a large fluid discharge and escalating pain and repeatedly requested medical attention.
- Nursing staff examined Doe multiple times and concluded she was in “false labor,” did not transport her to a hospital, and at least once relied on an abdominal “soft/hard” assessment informed by a phone call with hospital personnel.
- Doe alleged that some security staff ignored her repeated cries for help and made dismissive or derogatory remarks about her condition.
- In the early morning of April 22, after staff were unable to reach an on-call physician, Doe pressed her emergency button but was again assessed as not in labor.
- Doe delivered her baby alone in her segregation cell; she and the newborn were transported to a hospital only after delivery.
- After returning to the institution, Doe alleged she was placed in maximum security and did not receive postpartum supplies (e.g., ice or sanitary pads) until the next morning.
- Doe sued ten prison employees under 42 U.S.C. § 1983, alleging deliberate indifference to serious medical needs in violation of the Eighth Amendment; defendants sought summary judgment and qualified immunity.

## Issues

1. Whether childbirth and the onset of labor constituted a sufficiently serious medical need under the Eighth Amendment.
2. Whether the evidence, viewed in Doe’s favor, could support a finding that nursing and security staff knew of and disregarded a substantial risk to Doe’s health by failing to respond adequately to signs of labor.
3. Whether Nurse Supervisor Holly Meier could be liable under § 1983 for failure to train nursing staff.
4. Whether the defendants were entitled to qualified immunity at summary judgment.

## Decision

- The court granted summary judgment to Nurse Supervisor Meier on the failure-to-train claim.
- The court denied summary judgment to the remaining defendants, holding that material factual disputes existed on deliberate indifference.
- The court denied qualified immunity for the remaining defendants at the summary-judgment stage, because the right to be free from deliberate indifference to serious medical needs was clearly established and the alleged conduct could be found unconstitutional.

## Legal Principles

- An Eighth Amendment medical-care claim requires (1) an objectively serious medical need and (2) a subjective showing that officials knew of and disregarded an excessive risk to inmate health or safety (more than negligence or malpractice).
- Childbirth and active labor constitute a serious medical condition requiring timely medical attention.
- Repeated failure to respond to obvious signs of labor, refusal or delay in obtaining outside care, and failure to provide assistance during an emergent delivery can permit an inference of deliberate indifference when a jury could find conscious disregard rather than mere misdiagnosis.
- Security staff may be liable where they ignore repeated pleas for help and fail to take reasonable steps to obtain medical care for an inmate in apparent medical distress.
- Supervisory liability for failure to train requires evidence of constitutionally deficient training and deliberate indifference, such as a pattern of violations or an obvious need for additional training.
- Qualified immunity is unavailable at summary judgment when, taking the plaintiff’s version of disputed facts, the alleged conduct violates clearly established Eighth Amendment standards governing serious medical needs.

## Conclusion

The court held that a reasonable jury could find deliberate indifference where a late-term pregnant inmate repeatedly reported symptoms consistent with labor yet was not timely transported or assisted and ultimately gave birth alone in segregation; only the nurse supervisor received summary judgment because the failure-to-train theory lacked sufficient evidentiary support.


Doe v. Gustavus, 294 F. Supp. 2d 1003 (E.D. Wis. 2003)