## Facts

- Carrie Rahat Sama, a Texas prison inmate, was diagnosed with endocervical adenocarcinoma in situ/CIN III, described as a malignant condition.
- A resident physician supervised by Dr. Edward Hannigan evaluated Sama and diagnosed a malignant neoplasm of the endocervix; the parties did not dispute that a radical hysterectomy was the appropriate treatment.
- Sama had previously had her right ovary removed and told physicians she wanted her left ovary preserved if possible, citing fertility concerns.
- Physicians advised Sama that the chance of preserving the left ovary was extremely low and that the final decision would be made during surgery based on intraoperative findings.
- During the radical hysterectomy, the surgeons found the left ovary “grossly abnormal” and removed it, along with lymph nodes.
- After surgery, Sama asserted she had not agreed to removal of the left ovary and alleged the consent form had been altered.
- Sama sued prison and contract medical personnel under 42 U.S.C. §§ 1983 and 1985, alleging (1) Eighth Amendment deliberate indifference and (2) Fourteenth Amendment substantive due process violations based on unwanted medical treatment and bodily integrity.
- The district court granted summary judgment for defendants, including on qualified immunity, rejected conspiracy and supervisory-liability theories, and denied Sama’s recusal motion as untimely and unsupported.
- Sama appealed.

## Issues

1. Whether the intraoperative removal of Sama’s left ovary and lymph nodes during a medically indicated radical hysterectomy constituted Eighth Amendment deliberate indifference.
2. Whether the alleged nonconsensual removal of the ovary violated a clearly established Fourteenth Amendment right to refuse unwanted medical treatment in the prison medical context, defeating qualified immunity.
3. Whether Sama produced sufficient evidence to support § 1985 conspiracy and § 1983 supervisory-liability claims.
4. Whether the district court abused its discretion in denying Sama’s motion to recuse.

## Decision

- The Fifth Circuit affirmed summary judgment for defendants on all claims.
- The court held Sama failed to show deliberate indifference because the record reflected medical judgment in treating a serious cancer diagnosis, including removal of tissue deemed abnormal during surgery.
- The court held defendants were entitled to qualified immunity on the Fourteenth Amendment claim because the relevant law on unwanted medical treatment in the prison context was not clearly established under the circumstances presented.
- The court affirmed dismissal of Sama’s additional statutory and supervisory-liability theories for lack of specific evidence of conspiracy, personal involvement, and causation.
- The court affirmed denial of recusal as untimely and not supported by a sufficient showing of bias requiring disqualification.

## Legal Principles

- An Eighth Amendment medical-care claim requires evidence of deliberate indifference; disagreements over treatment decisions or allegations amounting to negligence or malpractice do not establish a constitutional violation.
- Prisoners may retain a liberty interest in bodily integrity and in refusing certain medical treatment, but officials and medical providers are protected by qualified immunity unless existing precedent clearly establishes the unlawfulness of the challenged conduct in the specific context.
- When a patient consents to a medically necessary procedure and is advised of contingencies that may require additional intraoperative steps, ambiguity about the scope of refusal may weigh against finding a clearly established constitutional violation.
- § 1985 conspiracy claims require specific evidence of an actionable conspiracy; conclusory assertions are insufficient.
- Supervisory liability under § 1983 requires personal involvement or a causal connection to the constitutional violation; status or general oversight is not enough.
- Recusal requires a timely motion and a sufficient basis demonstrating actual bias or an appearance of partiality under the applicable standards.

## Conclusion

The Fifth Circuit upheld summary judgment for prison and contract physicians and officials, concluding that the challenged intraoperative removal of an ovary during medically indicated cancer surgery did not meet the deliberate-indifference standard and that qualified immunity barred the Fourteenth Amendment unwanted-treatment claim because the governing law was not clearly established in that prison medical setting.


Sama v. Hannigan, 669 F.3d 585 (5th Cir. 2012)