## Facts

- George O. Mitchell, a civilly committed “sexually violent predator,” was confined at Washington’s Special Commitment Center (SCC) and had been diagnosed with hepatitis C before commitment.
- From roughly 2003–2005, an outside consulting physician discussed interferon–ribavirin therapy but could only recommend, not order, treatment; Mitchell agreed to postpone treatment to lose weight because the drugs were weight-based.
- In May 2009, Mitchell met with SCC Medical Supervisor Dr. Thomas Bell, requested interferon–ribavirin therapy, and discussed biopsy results.
- Dr. Bell declined to recommend the therapy at that time, citing (1) biopsy findings indicating the disease had not progressed enough to justify severe side effects and (2) race-related efficacy data indicating the therapy was “largely unsuccessful on African–American males” with Mitchell’s genotype.
- Mitchell later received interferon–ribavirin therapy in November 2012, without clinical success.
- Mitchell sued under 42 U.S.C. § 1983 for damages and injunctive relief, alleging constitutionally inadequate medical care and an Equal Protection violation based on the use of race in the 2009 treatment decision.
- The district court granted summary judgment to defendants; Mitchell appealed.

## Issues

1. Whether a state medical-treatment decision that explicitly relies on race-related treatment-outcome data constitutes a racial classification subject to strict scrutiny under the Equal Protection Clause.
2. Whether Dr. Bell and other state officials were entitled to qualified immunity for considering race-related treatment-outcome data in refusing Mitchell’s requested therapy in 2009.

## Decision

- The Ninth Circuit affirmed summary judgment for the defendants.
- The court held that explicitly incorporating race-related treatment outcomes into a government medical-treatment decision constitutes a racial classification triggering strict scrutiny.
- The court nonetheless held Dr. Bell and other officials were entitled to qualified immunity because, in 2009, it was not clearly established that such reliance on race-stratified outcome data violated equal protection.
- The court also rejected Mitchell’s inadequate-medical-care claim on the summary-judgment record, concluding the refusal was supported by professional medical judgment (including disease-stage and side-effect considerations) and did not show a constitutional violation.

## Legal Principles

- Government action that classifies individuals by race is subject to strict scrutiny, including when race is used in medical-treatment decisions made by state officials.
- The use of race-stratified clinical outcome data in a state treatment decision is not insulated from equal-protection review merely because it is presented as medically motivated.
- Qualified immunity bars damages unless existing precedent makes the constitutional rule clearly established at the time of the conduct; close factual novelty can defeat clearly established notice.
- For civilly committed persons’ medical-care claims, decisions grounded in professional judgment and risk–benefit assessment generally do not establish unconstitutional denial of care on summary judgment absent evidence of a sufficiently serious constitutional departure.

## Conclusion

The Ninth Circuit held that state medical decisions explicitly relying on race-related outcome data are racial classifications subject to strict scrutiny, but affirmed for defendants because qualified immunity applied and the record did not support liability on the medical-care claim.


Mitchell v. Washington, 818 F.3d 436 (9th Cir. 2016)