Suarez v. Sullivan
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Opinion
24-872 Suarez v. Sullivan, et al.
United States Court of Appeals For the Second Circuit
August Term 2024
Argued: March 31, 2025 Decided: March 17, 2026
No. 24-872
ELVIN SUAREZ,
Plaintiff-Appellant,
v.
ROBERT MORTON, Superintendent, Downstate Correctional Facility, in his individual capacity; ABDUL QAYYUM, Psychiatrist, Downstate Correctional Facility, in his individual capacity; PETER M. HORAN, Supervising Offender Rehabilitation Coordinator, Downstate Correctional Facility, in his individual capacity; MAURA L. DINARDO, Clinician, New York State Office of Mental Health, in her individual capacity; SAMANTHA L. KULICK, Psychology Assistant 3/Supervisor, New York State Office of Mental Health, in her individual capacity; BRANDON N. REYNOLDS, Psychiatrist, New York State Office of Mental Health, in his individual capacity; CHESNEY J. BAKER, Licensed Master Social Worker 2/Supervisor, New York State Office of Mental Health, in his individual capacity,
Defendants-Appellees, ANN MARIE T. SULLIVAN, Commissioner, New York State Office of Mental Health, in her individual capacity; NEW YORK STATE DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION; NEW YORK STATE OFFICE OF MENTAL HEALTH; ANTHONY J. ANNUCCI, Acting Commissioner, New York State Department of Corrections and Community Supervision, in his individual capacity; RYAN LAHEY, Office of Mental Health Unit Chief, Downstate Correctional Facility, in his individual capacity,
Defendants. *
Appeal from the United States District Court
for the Southern District of New York
No. 7:20CV07133,
Vincent L. Briccetti, Judge.
Before: PARK, PÉREZ, and MERRIAM, Circuit Judges.
Plaintiff-appellant Elvin Suarez brought this action against the New York State Department of Corrections and Community Supervision (“DOCCS”), the New York State Office of Mental Health (“OMH”), and several DOCCS and OMH employees pursuant to 42 U.S.C. §1983, alleging that defendants violated his Eighth Amendment right to be free from cruel and unusual punishment. Suarez asserts two Eighth Amendment claims: (1) deliberate indifference to his conditions of confinement, and (2) deliberate indifference to his medical needs.
*The Clerk’s Office is respectfully directed to amend the caption as reflected above.
2 The District Court granted defendants’ motion for summary judgment in its entirety, concluding that no triable issues of fact existed on the record before it. We disagree and conclude that, construing the evidence in the light most favorable to Suarez, there are genuine disputes of material fact on both Eighth Amendment claims as to each defendant’s knowledge of a serious risk to Suarez’s health and well-being, and each defendant’s disregard of that risk. We therefore VACATE the District Court’s grant of summary judgment to defendants and REMAND for further proceedings consistent with this opinion.
VACATED AND REMANDED.
JUDGE PARK dissents in a separate opinion.
ALEXANDRA M. AVVOCATO, Morrison & Foerster LLP, New York, NY (Jamie A. Levitt; Jocelyn E. Greer; Brian R. Matsui, Morrison & Foerster LLP, Washington, DC; Robert M. Quackenbush, The Legal Aid Society, New York, NY, on the brief), for Plaintiff-Appellant.
ANAGHA SUNDARARAJAN (Barbara D. Underwood, Solicitor General; Judith N. Vale, Deputy Solicitor General, on the brief), for Letitia James, Attorney General, State of New York, New York, NY, for Defendants-Appellees.
SARAH A. L. MERRIAM, Circuit Judge:
Elvin Suarez was diagnosed in 2014 with a schizoaffective disorder. Since
his initial diagnosis, his symptoms have fluctuated. When treated, he
experienced periods of stability. But when he stopped taking medication, his
3 symptoms worsened and he decompensated. In 2017, while serving a sentence,
Suarez was discharged from a psychiatric hospital to Downstate Correctional
Facility (“Downstate”) with a prescription for Zyprexa, an antipsychotic
medication. Shortly after Suarez’s arrival at Downstate, his assigned psychiatrist
discontinued his prescription. Over the following two months, Suarez
decompensated, had an altercation with an officer, and was placed in the Special
Housing Unit (“SHU”), where he began hallucinating. After fifteen days in the
SHU, a disciplinary hearing officer sanctioned Suarez to placement in
“keeplock,” another form of disciplinary housing, where he remained for two
additional weeks until his release from Downstate. The day after Suarez was
released, provoked by his hallucinations, he stabbed his mother multiple times.
Suarez sued the New York State Department of Corrections and
Community Supervision (“DOCCS”), the New York State Office of Mental
Health (“OMH”), and several DOCCS and OMH employees pursuant to 42
U.S.C. §1983 alleging, as relevant to this appeal, two violations of his Eighth
Amendment rights. Specifically, Suarez alleged that defendants were
deliberately indifferent to the serious risk that he would suffer significant mental
health effects and decompensation by (1) placing him in disciplinary housing
4 and (2) providing him with inadequate medical treatment. The District Court
granted summary judgment to each defendant on Suarez’s Eighth Amendment
claims, finding no triable issue of fact as to, inter alia, defendants’ knowledge that
Suarez was decompensating. The District Court rested this finding principally
on the fact that Suarez did not tell anyone that he was hallucinating.
Because we conclude that the record presents genuine disputes of material
fact on both Eighth Amendment claims as to each defendant’s knowledge of a
serious risk to Suarez’s health and well-being, and each defendant’s disregard of
that risk, we hold that the District Court erred in granting summary judgment to
defendants on Suarez’s Eighth Amendment claims. We therefore VACATE the
judgment and REMAND for further proceedings.
I. BACKGROUND
A. Suarez’s Mental Health History
The facts are drawn from the record at summary judgment and are
undisputed unless otherwise noted. Suarez has a well-documented history of
mental illness. In 2014, Suarez began hearing voices and engaging in self-harm,
after which he was diagnosed with Bipolar Disorder and prescribed anti-
psychotic medication. Following his initial diagnosis, Suarez received inpatient
5 psychiatric treatment, was diagnosed with Bipolar Disorder, Episodic Mood
Disorder, Drug-Induced Psychotic Disorder with Delusions, and Psychosis, and
was prescribed anti-psychotic medications, anti-depressants, and mood
stabilizers. After his release from inpatient care, Suarez stopped taking his
medication and decompensated, exhibiting symptoms such as hallucinations,
delusions, depression, and laughing and talking to himself.
Suarez’s symptoms fluctuated over time, with periods of relative stability
and periods of psychosis, during which he could become disoriented,
hallucinate, and sometimes attempt to harm himself. During one such period of
instability in 2015, Suarez was arrested; while in custody, he experienced
psychosis and exhibited “disruptive, confused or bizarre behavior.” App’x
at 1956-57 (citation modified). He was placed in a mental health observation unit
and prescribed psychotropic medications. After a psychiatric examination
deemed him unfit to stand trial, Suarez was committed to Kirby Forensic
Psychiatric Center (“Kirby”), a maximum-security psychiatric hospital operated
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24-872 Suarez v. Sullivan, et al.
United States Court of Appeals For the Second Circuit
August Term 2024
Argued: March 31, 2025 Decided: March 17, 2026
No. 24-872
ELVIN SUAREZ,
Plaintiff-Appellant,
v.
ROBERT MORTON, Superintendent, Downstate Correctional Facility, in his individual capacity; ABDUL QAYYUM, Psychiatrist, Downstate Correctional Facility, in his individual capacity; PETER M. HORAN, Supervising Offender Rehabilitation Coordinator, Downstate Correctional Facility, in his individual capacity; MAURA L. DINARDO, Clinician, New York State Office of Mental Health, in her individual capacity; SAMANTHA L. KULICK, Psychology Assistant 3/Supervisor, New York State Office of Mental Health, in her individual capacity; BRANDON N. REYNOLDS, Psychiatrist, New York State Office of Mental Health, in his individual capacity; CHESNEY J. BAKER, Licensed Master Social Worker 2/Supervisor, New York State Office of Mental Health, in his individual capacity,
Defendants-Appellees, ANN MARIE T. SULLIVAN, Commissioner, New York State Office of Mental Health, in her individual capacity; NEW YORK STATE DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION; NEW YORK STATE OFFICE OF MENTAL HEALTH; ANTHONY J. ANNUCCI, Acting Commissioner, New York State Department of Corrections and Community Supervision, in his individual capacity; RYAN LAHEY, Office of Mental Health Unit Chief, Downstate Correctional Facility, in his individual capacity,
Defendants. *
Appeal from the United States District Court
for the Southern District of New York
No. 7:20CV07133,
Vincent L. Briccetti, Judge.
Before: PARK, PÉREZ, and MERRIAM, Circuit Judges.
Plaintiff-appellant Elvin Suarez brought this action against the New York State Department of Corrections and Community Supervision (“DOCCS”), the New York State Office of Mental Health (“OMH”), and several DOCCS and OMH employees pursuant to 42 U.S.C. §1983, alleging that defendants violated his Eighth Amendment right to be free from cruel and unusual punishment. Suarez asserts two Eighth Amendment claims: (1) deliberate indifference to his conditions of confinement, and (2) deliberate indifference to his medical needs.
*The Clerk’s Office is respectfully directed to amend the caption as reflected above.
2 The District Court granted defendants’ motion for summary judgment in its entirety, concluding that no triable issues of fact existed on the record before it. We disagree and conclude that, construing the evidence in the light most favorable to Suarez, there are genuine disputes of material fact on both Eighth Amendment claims as to each defendant’s knowledge of a serious risk to Suarez’s health and well-being, and each defendant’s disregard of that risk. We therefore VACATE the District Court’s grant of summary judgment to defendants and REMAND for further proceedings consistent with this opinion.
VACATED AND REMANDED.
JUDGE PARK dissents in a separate opinion.
ALEXANDRA M. AVVOCATO, Morrison & Foerster LLP, New York, NY (Jamie A. Levitt; Jocelyn E. Greer; Brian R. Matsui, Morrison & Foerster LLP, Washington, DC; Robert M. Quackenbush, The Legal Aid Society, New York, NY, on the brief), for Plaintiff-Appellant.
ANAGHA SUNDARARAJAN (Barbara D. Underwood, Solicitor General; Judith N. Vale, Deputy Solicitor General, on the brief), for Letitia James, Attorney General, State of New York, New York, NY, for Defendants-Appellees.
SARAH A. L. MERRIAM, Circuit Judge:
Elvin Suarez was diagnosed in 2014 with a schizoaffective disorder. Since
his initial diagnosis, his symptoms have fluctuated. When treated, he
experienced periods of stability. But when he stopped taking medication, his
3 symptoms worsened and he decompensated. In 2017, while serving a sentence,
Suarez was discharged from a psychiatric hospital to Downstate Correctional
Facility (“Downstate”) with a prescription for Zyprexa, an antipsychotic
medication. Shortly after Suarez’s arrival at Downstate, his assigned psychiatrist
discontinued his prescription. Over the following two months, Suarez
decompensated, had an altercation with an officer, and was placed in the Special
Housing Unit (“SHU”), where he began hallucinating. After fifteen days in the
SHU, a disciplinary hearing officer sanctioned Suarez to placement in
“keeplock,” another form of disciplinary housing, where he remained for two
additional weeks until his release from Downstate. The day after Suarez was
released, provoked by his hallucinations, he stabbed his mother multiple times.
Suarez sued the New York State Department of Corrections and
Community Supervision (“DOCCS”), the New York State Office of Mental
Health (“OMH”), and several DOCCS and OMH employees pursuant to 42
U.S.C. §1983 alleging, as relevant to this appeal, two violations of his Eighth
Amendment rights. Specifically, Suarez alleged that defendants were
deliberately indifferent to the serious risk that he would suffer significant mental
health effects and decompensation by (1) placing him in disciplinary housing
4 and (2) providing him with inadequate medical treatment. The District Court
granted summary judgment to each defendant on Suarez’s Eighth Amendment
claims, finding no triable issue of fact as to, inter alia, defendants’ knowledge that
Suarez was decompensating. The District Court rested this finding principally
on the fact that Suarez did not tell anyone that he was hallucinating.
Because we conclude that the record presents genuine disputes of material
fact on both Eighth Amendment claims as to each defendant’s knowledge of a
serious risk to Suarez’s health and well-being, and each defendant’s disregard of
that risk, we hold that the District Court erred in granting summary judgment to
defendants on Suarez’s Eighth Amendment claims. We therefore VACATE the
judgment and REMAND for further proceedings.
I. BACKGROUND
A. Suarez’s Mental Health History
The facts are drawn from the record at summary judgment and are
undisputed unless otherwise noted. Suarez has a well-documented history of
mental illness. In 2014, Suarez began hearing voices and engaging in self-harm,
after which he was diagnosed with Bipolar Disorder and prescribed anti-
psychotic medication. Following his initial diagnosis, Suarez received inpatient
5 psychiatric treatment, was diagnosed with Bipolar Disorder, Episodic Mood
Disorder, Drug-Induced Psychotic Disorder with Delusions, and Psychosis, and
was prescribed anti-psychotic medications, anti-depressants, and mood
stabilizers. After his release from inpatient care, Suarez stopped taking his
medication and decompensated, exhibiting symptoms such as hallucinations,
delusions, depression, and laughing and talking to himself.
Suarez’s symptoms fluctuated over time, with periods of relative stability
and periods of psychosis, during which he could become disoriented,
hallucinate, and sometimes attempt to harm himself. During one such period of
instability in 2015, Suarez was arrested; while in custody, he experienced
psychosis and exhibited “disruptive, confused or bizarre behavior.” App’x
at 1956-57 (citation modified). He was placed in a mental health observation unit
and prescribed psychotropic medications. After a psychiatric examination
deemed him unfit to stand trial, Suarez was committed to Kirby Forensic
Psychiatric Center (“Kirby”), a maximum-security psychiatric hospital operated
by the New York State OMH, for restoration of fitness.
Suarez was evaluated at Kirby in connection with his refusal to take
psychotropic medications. During the evaluation, the examining psychologist
6 noted Suarez’s out-of-context laughter, “which suggests he is responding to
intrusive thoughts or other internal stimulation (i.e. hallucinations).” App’x
at 1445. The examiner concluded that Suarez “lacks the capacity to make
treatment decisions regarding medications for manic psychosis,” that he “has
knowledge of his diagnosis but disagrees with it and does not appreciate how
the signs and symptoms of illness apply to him,” and that his “lack of insight
interferes with [his] ability to reason about whether to take medication.” App’x
at 1446. After two months of treatment, including medication compliance,
Suarez’s symptoms improved and he was discharged. Shortly after his release,
however, Suarez stopped taking his prescribed medication and again
decompensated.
B. Suarez’s 2016 Arrest and Mental Health Treatment
Two months after his release from Kirby, Suarez was arrested and
detained. He was again found unfit to stand trial and committed to Kirby for
restoration of fitness. Upon arrival at Kirby, Suarez refused anti-psychotic
medication; treatment records reflect that he evinced a belief that he was not
mentally ill and did not need medication. On four occasions within Suarez’s first
month at Kirby, the medical staff administered emergency medication by
7 injection in response to instances of aggression or violence. After several weeks
of treatment, Suarez’s medication compliance improved, his mood stabilized,
and he stopped having incidents of aggression. He was deemed fit to participate
in the legal proceedings against him and discharged from Kirby.
Suarez’s Kirby Discharge Summary, prepared by his treatment team,
noted that he arrived at Kirby with “poor / non-compliance with his prescribed
psychiatric medications.” App’x at 1448. Under a section headed “ALERTS,” the
Discharge Summary stated: “Accepting facility to encourage medication
compliance as patient will decompensate if non-compliant.” App’x at 1448.
Suarez was sentenced to two years of imprisonment.
C. Downstate Correctional Facility
On June 22, 2017, while serving that sentence, Suarez was transferred to
Downstate Correctional Facility to serve the remainder of his prison term.
Downstate principally operates as a reception and classification center for
individuals being transferred to facilities controlled by DOCCS. We begin with
an overview of the mental health services, relevant policies, and personnel at
Downstate at the time of Suarez’s incarceration there.
1. Mental Health Services
8 Because of its status as a reception center, Downstate typically housed
individuals for between four to six weeks and lacked the longer-term mental
health treatment programming available at other facilities. Still, Downstate is
classified as a Level 1 facility and equipped with mental health services and
providers, as well as a satellite unit – the Forensic Diagnostic Unit (“FDU”) – a
residential crisis treatment program that “provide[s] observation[] cells for
individuals in acute psychiatric crisis either through self-injury, suicidal risk, or
psychiatric decompensation.” App’x at 704; see also id. at 1961, 1966.
Mental health services at DOCCS facilities, including at Downstate, are
provided by OMH. See N.Y. Mental Hyg. Law §7.07; see also App’x at 1961-62.
Level 1 facilities like Downstate are statutorily required to have OMH staff
“assigned on a full-time basis and able to provide treatment to incarcerated
individuals with a major mental disorder. The array of available specialized
services include: residential crisis treatment, residential day treatment,
medication monitoring by psychiatric nursing staff, and potential commitment to
the central New York Psychiatric Center.” N.Y. Correct. Law §2(27). At
Downstate at the relevant time, there were about 25 on-site OMH staff, including
a Mental Health Unit Chief, psychiatrists, mental health clinicians, social
9 workers, and nurses. Meetings of the full OMH treatment team were held at
least once a week to discuss concerns about specific patients.
“Each incarcerated person on the OMH roster at Downstate was assigned
to an OMH clinician, who served as the patient’s primary clinician, and a
psychiatrist, who was principally responsible for prescribing psychiatric
medication and providing medication counseling and education.” App’x at 1962.
Downstate also had a full-time SHU clinician who served as the primary care
clinician for all inmates housed in the SHU.
“By policy, within 48 hours of arrival at Downstate, every incarcerated
person underwent an initial mental health screening interview to determine his
mental health service needs.” App’x at 1965. Based on the screening, individuals
were classified by “level” indicating the need for mental health services;
designations ranged from Level 1 (those with the greatest need for mental health
services) to Level 6 (those with no need for mental health services). Individuals
receiving a Level 1 or 2 designation could also be designated as having a Serious
Mental Illness (“SMI”); such inmates were classified as a Level 1-S or 2-S.
Individuals classified as Level 1-S “were those OMH identified as having the
most serious mental health diagnosis and the greatest need for mental health
10 treatment.” App’x at 1965.
If the initial screening identified an individual as needing mental health
services, that individual would undergo an additional screening – typically by
the OMH clinician who was going to be the individual’s assigned clinician – to
determine diagnoses and treatment plans. The individual would also be
assigned a primary psychiatrist. Together, the OMH clinician and psychiatrist
would “prepare a ‘Core History’ and a treatment plan . . . within 30 days of the
initial screening,” and the primary clinician would meet with the patient to
discuss those materials. App’x at 1966. Typically, an individual under OMH
care would meet with a primary clinician and psychiatrist approximately every
30 days, during which the clinician was required by OMH policy to prepare
treatment notes. In addition to these services provided by employees of OMH,
any DOCCS employee was empowered “to write a mental health referral,
referring an inmate to OMH, at any time.” App’x at 1972.
A Joint Case Management Committee (“JCMC”) met every other Thursday
to review, monitor, and coordinate the treatment plans of Downstate inmates
under OMH care who were housed in the SHU. At these meetings, the JCMC
“reviewed and discussed each inmate with an SMI designation, going through
11 each inmate case by case.” App’x at 1974. The JCMC meeting agenda
specifically provided that the committee would review mental health treatment
needs of SHU inmates to consider whether a “reduction in confinement
sentence” or a “change in housing assignment” may be appropriate for an
inmate. App’x at 1973. The JCMC also considered “any recommendations . . .
that an inmate-patient be reevaluated by psychiatric staff with regard to current
treatment needs.” App’x at 1973.
2. Policies Regarding Imposition of Disciplinary Sanctions on Individuals with Serious Mental Illnesses
Downstate had several policies regarding disciplinary sanctions for
individuals with SMIs, including policies designed to implement the
requirements of New York law. At all relevant times, Downstate had two forms
of disciplinary sanctions: the SHU, which constituted segregated confinement in
a housing unit separate from general population, and keeplock. 1 Because
1 At the time of Suarez’s incarceration at Downstate, “segregated confinement” under New York law was defined as “the disciplinary confinement of an inmate in a special housing unit or in a separate keeplock housing unit” which are “housing units that consist of cells grouped so as to provide separation from the general population, and may be used to house inmates confined pursuant to the disciplinary procedures described in regulations.” N.Y. Correct. Law §2(23) (effective until Mar. 21, 2022). Under the current version of the statute, “segregated confinement” is defined as “the confinement of an incarcerated
12 Downstate did not have separate keeplock housing units, keeplock sanctions
were served in an inmate’s cell within the general population. However, it is
undisputed that the conditions of keeplock confinement were the same whether
served in the general population or in segregated units: individuals in keeplock
were subject to 23-hour lockdown in their cells.
When an individual is placed in segregated confinement for more than 24
hours, New York Correction Law requires that “the superintendent . . . arrange
for the facility health services director, or a registered nurse or physician’s
associate approved by the facility health services director to visit such
incarcerated individual” within the first 24 hours and, subsequently, “at least
once in every twenty-four hour period thereafter, during the period of such
confinement, to examine into the state of health of the incarcerated individual.”
N.Y. Correct. Law §137(6)(c).
The statute also provides that, with certain exceptions, “the department, in
consultation with mental health clinicians, shall divert or remove incarcerated
individuals with serious mental illness . . . from segregated confinement or
individual in any form of cell confinement for more than seventeen hours a day other than in a facility-wide emergency or for the purpose of providing medical or mental health treatment.” N.Y. Correct. Law §2(23) (currently effective).
13 confinement in a residential rehabilitation unit, where such confinement could
potentially be for a period in excess of thirty days, to a residential mental health
treatment unit.” Id. §137(6)(d)(i).
At Level 1 facilities like Downstate, an individual placed in segregated
confinement must be “assessed by a mental health clinician” within one business
day. Id. §137(6)(d)(ii)(A). Generally, an individual with an SMI “shall be
diverted or removed from segregated confinement or a residential rehabilitation
unit,” id. §137(6)(d)(ii)(C), unless (1) “the reviewer finds that removal would pose
a substantial risk to the safety of the incarcerated individual or other persons, or
a substantial threat to the security of the facility”; or (2) “the assessing mental
health clinician determines that such placement is in the incarcerated
individual’s best interests based on his or her mental condition and that
removing such incarcerated individual to a residential mental health treatment
unit would be detrimental to his or her mental condition,” id. §137(6)(d)(ii)(E).
Even if it is determined upon initial assessment that an individual with an
SMI should not be removed from segregated confinement, the statute requires
that the individual “shall be diverted to a residential rehabilitation unit and
reassessed by a mental health clinician within fourteen days of the initial
14 assessment and at least once every fourteen days thereafter.” Id. §137(6)(d)(ii)(D)
(emphasis added). Moreover, “[i]ncarcerated individuals with serious mental
illness who are not diverted or removed from a residential rehabilitation unit
shall be offered a heightened level of mental health care, involving a minimum of
three hours daily of out-of-cell therapeutic treatment and programming.” Id.
§137(6)(d)(iii). That level of care, however, is not required where “an
incarcerated individual with serious mental illness does not, in the reasonable
judgment of a mental health clinician, require the heightened level of care.” Id.
§137(6)(d)(iii)(A).
OMH policy required each OMH clinician to prepare progress notes
documenting treatment provided to a patient. Progress notes taken during an
OMH clinician’s meeting with a patient were included in the patient’s OMH
chart. As discussed infra, each defendant had access to and reviewed Suarez’s
OMH chart.
At any time, and regardless of whether an individual was housed in
general population, keeplock, or the SHU, any OMH employee could place the
individual in the FDU, even if the individual was scheduled for a disciplinary
hearing or sanction. And any DOCCS employee could request a consult with
15 OMH for an individual “to be seen immediately regardless of the day of the
week.” App’x at 711.
3. Relevant Personnel
a. OMH Staff
At all times relevant to this appeal, Ryan Lahey served as the Mental
Health Unit Chief at Downstate with ultimate responsibility for ensuring that
OMH staff at Downstate followed OMH policies and procedures. 2 Lahey’s
responsibilities included supervising and providing input on inmates’ treatment
plans; reviewing treatment plans; and reviewing, approving, and signing off on
initial mental health service level designations. Lahey also chaired the JCMC and
held OMH treatment team meetings once a week, during which OMH staff
discussed any concerns about specific patients.
OMH clinician Defendant Samantha Kulick 3 served as “Suarez’s assigned
primary clinician from his admission to Downstate on June 22, 2017, until his
placement in . . . [the] SHU on August 8, 2017.” App’x at 1964. After he was
2Suarez does not appeal the District Court’s grant of summary judgment to Lahey; Lahey is therefore not an appellee.
3 Since the events giving rise to this lawsuit, Kulick has changed her last name. For consistency with the parties’ submissions and the record on appeal, we refer to her as “Kulick.”
16 placed in the SHU, Suarez’s primary care clinician became Defendant Maura
DiNardo, Downstate’s “SHU Clinician.” App’x at 1964. Defendant Abdul
Qayyum was Suarez’s assigned psychiatrist at Downstate, when Suarez was not
housed in the SHU. Defendant Chesney Baker was an OMH social worker and
pre-release coordinator at Downstate, responsible for arranging post-release
mental health services for Suarez. Defendant Brandon Reynolds was an OMH
psychiatrist who, as relevant here, initially assessed Suarez’s eligibility for
Assisted Outpatient Treatment (“AOT”) following his release from Downstate.
b. DOCCS Non-Medical Staff
Defendants Robert Morton and Peter Horan were DOCCS employees who
were not OMH staff. Morton was the Superintendent of Downstate. As
Superintendent, Morton was responsible for the supervision and management of
Downstate, including the facility’s compliance with applicable guidelines, laws,
rules, and regulations. Morton visited the SHU weekly to ensure compliance
with policies and procedures, and to check on the wellbeing and condition of
each inmate. Morton also reviewed, noted any objections to, and signed off on
recommendations of the JCMC; reviewed and signed off on deprivation orders
(orders depriving SHU inmates of the typical one-hour-per-day of recreational
17 time) exceeding seven days; and reviewed and signed off on Tier 3 disciplinary
sanctions (the most severe disciplinary sanction).
Horan was the Supervising Offender Rehabilitation Coordinator
(“SORC”). In that capacity, he held disciplinary hearings at Downstate to
determine the appropriate sanctions for inmates accused of disciplinary
violations.
D. Suarez’s Incarceration at Downstate
1. Admission and Initial Evaluation
Suarez arrived at Downstate on June 22, 2017, received his initial mental
health screening that same day, and was referred for further OMH evaluation.
Kulick, Suarez’s assigned primary OMH clinician, conducted his OMH intake
evaluation the following day, during which she began drafting a screening
admission note and “Treatment Needs/Service Level Designation” form detailing
Suarez’s history of mental health treatment, including his diagnoses. In the
admission note, Kulick reported Suarez’s Zyprexa 4 prescription – with which he
arrived at Downstate – and his “[m]ental health history, [s]ubstance
4 Zyprexa is a branded version of the generic-named product Olanzapine, an anti-psychotic.
18 abuse/dependence history, [h]istory of psychiatric hospitalizations, [p]rior
suicide ideation/threats/gestures/attempts, [and] [i]mpulsive behavior.” App’x
at 492-93. She also noted that, at the time of his admission, “[s]uicidal/homicidal
ideation, intent, and plan are persuasively denied” and that “[n]o hallucinations,
delusions, obsessions, phobias, or over-valued ideas are elicited.” App’x at 492.
Kulick recommended a Level 1 designation for Suarez, with a preliminary
diagnosis of “[s]chizoaffective disorder, Bipolar type,” and an indication that
further diagnosis was deferred. App’x at 493. 5 Kulick testified that her initial
recommendation was based on Suarez’s active Zyprexa prescription and his two
prior hospitalizations at Kirby. On June 27, 2017, Kulick completed the initial
screening process and recommended Suarez be admitted to OMH for individual
therapy and medication. Suarez’s comprehensive suicide risk assessment, as
prepared by Kulick, noted that if the treatment team observed signs of
“suicidality and psychiatric decompensation,” then Suarez “may benefit from a
medication evaluation and/or [residential crisis treatment program] admission.”
App’x at 1440. It also identified “disciplinary sanctions” and “single [c]ell”
5 Lahey, who signed off on initial mental health service level designations, “officially designated Mr. Suarez a Level 1-S patient” on June 30, 2017. App’x at 1984.
19 housing as potential risk factors, and indicated that “loss of . . . contact with
support system or psychiatric decompensation” were possible “triggers” for self-
harm. App’x at 1440.
On June 30, 2017, Suarez met with Qayyum, his assigned OMH
psychiatrist, for his initial psychiatric evaluation. At that evaluation, Suarez
reported his history of self-harm and auditory hallucinations but told Qayyum:
“I don’t need meds.” App’x at 500. Qayyum discontinued Suarez’s Zyprexa
prescription and recommended that Suarez “cont[inue] ind[ividual] therapy”
and have a follow-up appointment with Qayyum two weeks later. App’x at 501.
Qayyum checked a box on the progress note indicating that he provided
“medication education” to Suarez, but provided no further information about
any such medication education in the narrative “comments” section. App’x at
501. 6
Suarez was next seen by OMH staff three weeks later; the record does not
6 Suarez asserted as an undisputed statement of fact: “There is no evidence that Defendant Qayyum informed anyone that he had discontinued Mr. Suarez’s medication.” App’x at 1986. Defendants did not contest the accuracy of this statement, but objected to the statement on the ground that it “argues that Dr. Qayyum had an affirmative obligation to advise others” of the discontinuation of the prescription. App’x at 1986. Pursuant to OMH policy, Qayyum’s progress notes were included in Suarez’s OMH chart, which was available to all defendants.
20 reflect a follow-up with Qayyum two weeks after their initial meeting. On July
19, 2017, Suarez had a follow-up with Kulick, during which she prepared his
Core History form to be used as a reference for Downstate staff. In it, Kulick
noted that Suarez arrived with “an active medication order for Zyprexa,” that he
“reports he is prescribed medication for mood swings,” “endorses experiencing
auditory hallucinations that ‘tell me to hurt myself,’” and “endorses compliance
with his medication and believes same are effective in treating his psychiatric
symptoms.” App’x at 1434. While the Core History form did not reflect that
Suarez’s prescription was discontinued three weeks earlier, Kulick testified that
she was aware that Suarez “did not want to take the medication anymore and the
psychiatrist [Qayyum] had discontinued it.” App’x at 816.
Two days later, on July 21, 2017, Suarez saw Qayyum again. Suarez
continued “declining med[ication]” and “den[ying] AH/VH,” or auditory and
visual hallucinations, but Qayyum’s progress notes reflect that Suarez presented
with “mood and affect slightly blunted.” App’x at 563-64. Qayyum again
checked the box on the progress note that said “medication education provided,”
but gave no details, and the handwritten notes reflect no such education. App’x
at 564. The parties dispute whether such medication education was actually
21 provided.
Also in late July 2017, Baker, in her capacity as pre-release coordinator,
began reviewing Suarez’s records to begin the pre-release planning process; she
met with Suarez on August 3, 2017, to discuss his post-release mental health care.
During that meeting, Baker noted that Suarez “endorses his medication[]
Zyprexa . . . w[as] discontinued due to his refusal, and believes ‘I don’t need
them.’” App’x at 575. Baker’s notes reflect that Suarez’s “[t]hought processes
appear logical,” “[h]is eye contact is appropriately maintained,” and “[n]o
hallucinations, delusions, obsessions, phobias, or over-valued ideas are elicited.”
App’x at 576.
2. Suarez’s detention in the SHU
On August 8, 2017, Suarez was involved in an altercation with DOCCS
officers, during which he kicked them and made verbal threats against them. An
Unusual Incident Report documenting the altercation, signed by Morton,
reported that Suarez was “arguing with staff and acting unpredictable,” and,
once he was escorted to the infirmary, he “began spitting at staff,” after which a
spit mask was placed on his face. App’x at 1739-40. The notes from the
infirmary also report that Suarez was lethargic, “off by 2 days w[ith the] current
22 date,” and that although he had been “[o]n Zyprexa in recent past,” it had been
discontinued “due to p[atient] refusing.” App’x at 1557. The infirmary
physician requested an “immediate emergency phone referral” for a mental
health evaluation. App’x at 1994.
In response to the referral, Kulick met with Suarez in the infirmary. Her
progress notes indicate that Suarez was wearing “a spit mask covering his head
and face” but that he “appear[ed] calm” with a “neutral” mood, had an affect
“within normal range and congruent to mood,” “fair” “insight and judgment,”
did not have “hallucinations, delusions, obsessions, phobias or over-valued
ideas” and denied “[p]erceptual disturbances of any kind,” but that “[h]is eye
contact [was] sporadic.” App’x at 502. Kulick noted that Suarez “denies drug
use; however, it is suspected that he may be under the influence.” App’x at 502.
On August 8, 2017, Suarez was placed in the SHU, where he remained for
fifteen days until August 22, 2017. While he was in the SHU, DiNardo became
Suarez’s primary clinician. DiNardo conducted an initial mental health
interview during which Suarez denied experiencing auditory hallucinations. For
his first seven days in the SHU, Suarez was subject to a deprivation order, which
23 prohibited him from leaving his cell for the usual one hour of recreation time. 7
Additionally, on August 11, 2017, the OMH AOT Coordinator emailed several
Downstate staff members, including Qayyum and Baker, stating that Suarez
“meets criteria [for AOT] as evidenced by hospitalizations following
noncompliance with treatment.” App’x at 2001-02. The email attached the
Discharge Plan from Kirby.
The parties dispute the level of care Suarez received while housed in the
SHU. Suarez testified in his deposition that, shortly after being placed in the
SHU, he began hearing voices saying: “When you get out of here you have to
protect yourself.” App’x at 383. He further testified that he started having
“anxiety attacks because [he] couldn’t leave [his] cell.” App’x at 383. He testified
that he did not tell anyone about those voices. Suarez contends that he was
unable to speak with a mental health clinician about the symptoms he was
experiencing in the SHU because “they didn’t offer [him] the services” while he
was there. App’x at 383. Defendants assert that DiNardo made daily weekday
“rounds” of the SHU and that Suarez appeared stable at all times, was “even-
7 The parties dispute whether Morton signed off on the initial deprivation order placed on Suarez on August 8, 2017. It is undisputed, however, that Morton discontinued the order on August 15, 2017, seven days after Suarez was placed in the SHU.
24 keeled,” and “did not display any symptom relating to his mental illness” or
“advise [DiNardo] of any concerns.” App’x at 414.
While Suarez was housed in the SHU, he had a Tier 3 disciplinary hearing
beginning on August 15, 2017, regarding his altercation with DOCCS; Horan was
the assigned hearing officer. In advance of the hearing, Horan received a hearing
packet, which included a misbehavior report, Suarez’s SMI status, and
documentation showing that Suarez was housed in the SHU. Horan had the
authority to release an incarcerated person from confinement prior to the start of
a hearing, but he did not do so for Suarez. Horan testified that Suarez “seemed
to be a little bit off” during the hearing, App’x at 1893, “lack[ed] connection,” and
was not “completely free of any signs of mental illness,” App’x at 2018. During
the hearing, “Suarez told Defendant Horan that he did not know what OMH was
and did not know whether he was being treated by them. He also indicated that
he did not understand the nature of some of the charges against him.” App’x at
2014. As a result, Horan adjourned the hearing to obtain confidential OMH
testimony regarding Suarez’s mental health.
Several events occurred after the disciplinary hearing was adjourned.
First, Suarez met with Baker to review his post-discharge plans. Baker’s
25 treatment notes report that Suarez “does not believe he has a mental health
problem,” “does not feel any different on or off medication,” and “denies
experiencing psychiatric symptoms,” but that Suarez’s “[i]nsight and judgment
are poor.” App’x at 582-83. The parties dispute whether the JCMC met on
August 17, 2017, during the disciplinary hearing hiatus. “Lahey testified that if
the JCMC meeting took place it would have taken place on August 17, 2017,” but
defendants deny that there is any evidence that such a meeting occurred. App’x
at 2003-04. Suarez asserts that, if it met as scheduled, the JCMC would have
reviewed his file and could have recommended a “time cut” from the SHU.
App’x at 2003. Finally, on August 17, 2017, Suarez met with Reynolds to evaluate
whether Suarez was eligible for AOT. Reynolds noted that Suarez presented
with a “mildly elevated” affect “with frequent and inappropriate smiling and
laughter.” App’x at 504. Reynolds reported that Suarez “does not believe he
suffers from a mental illness, . . . denies hearing any voices in a long time,” and
“otherwise denies several other elements of his mental health history, such as
taking multiple antipsychotics.” App’x at 504. He also indicated that Suarez
asserted he had been “‘lying about taking medication’ at the time of his Instant
Offense (assaulting an officer)” and admitted to using K2 while in custody.
26 App’x at 504. Reynolds noted that Suarez’s insight was “poor.” App’x at 504.
The hearing resumed on August 21, 2017, to take mental health testimony
from DiNardo. DiNardo testified: “The behaviors exhibited by [Suarez] that are
consistent with his current diagnosis include mood fluctuation and psychosis.”
App’x at 1165. She further stated that “[a]t the time of the incident, [Suarez] was
prescribed Zyprexa . . . which was discontinued due to his noncompliance.”
App’x at 1165. DiNardo concluded: “It is my clinical opinion . . . that the conduct
related to the disciplinary hearing is related to [Suarez’s] mental health
symptoms” and that Suarez “is not suitable for confinement in disciplinary
housing due to the mental illness.” App’x at 1165-66.
That same day, Morton submitted a petition for an AOT order for Suarez.
In the petition, Morton stated:
Mr. Suarez has a significant history of mental health problems. The respondent also has a history of hospitalization related to mental illness, substance abuse, and non-compliance with treatment. Due to respondent [sic] continued lack of insight into his mental illness and the need for treatment, there is nothing to indicate that the respondent will change his pattern of treatment non-compliance with resultant psychosis and high risk behaviors without the benefit of court- ordered treatment.
App’x at 1261. As part of the AOT petition, Reynolds submitted an affirmation,
in which he stated: “When non-compliant with psychiatric treatment, [Suarez]
27 experiences auditory hallucinations, mood lability, and suicidal ideation. He
also has a history of violence towards self and others.” App’x at 1265. Reynolds
also noted that “Suarez’s Zyprexa medication had been discontinued
approximately five weeks prior, due to his refusing to take medication.” App’x
at 1266.
On August 22, 2017, Horan found Suarez guilty and imposed a sanction of
fourteen days of time served in the SHU, and sixty days of keeplock time with
thirty of those days suspended. 8 The sanction imposed by Horan exceeded the
applicable DOCCS guidelines, which required that individuals with SMI
designations who received greater than 30 days of disciplinary sanctions be
referred to a special program absent exceptional circumstances. See N.Y. Correct.
Law §137(6)(d)(i). Horan testified that he imposed that sanction because he
“wanted [Suarez] out of [the] SHU as quickly as possible.” App’x at 1092. While
Horan had the authority to refer Suarez to OMH, and had made such referrals in
the past, he testified that, by 2017, “OMH was involved with every mental
hygiene case,” and therefore he did not make a referral for Suarez. App’x
at 1078, 2026.
8 Also on August 22, 2017, DiNardo met with Suarez; DiNardo documented “no signs of psychiatric decompensation” after that meeting. App’x at 414-15.
28 On August 23, 2017, Morton reviewed and approved the sanction imposed
on Suarez. In the “reason for decision” field, Morton stated simply: “This
penalty should not be reduced.” App’x at 919; see also App’x at 2028. DOCCS
Acting Assistant Commissioner Finnegan emailed Morton on August 24, 2017,
pointing out that Suarez’s punishment “exceeded the confinement sanction
guideline,” that Morton’s “review still leaves the confinement sanction OVER the
guidelines,” and “as such,” Morton needed to send “the hearing record sheet,
misbehavior report, both disposition pages, and [his] justification” to Finnegan
for his review. App’x at 918; see also App’x at 2029. The record does not reflect
whether Morton did so.
3. Time in Keeplock and Release from Downstate
On August 24, 2017, Qayyum met with Suarez, who was then in keeplock
status. Qayyum’s progress note indicates that Suarez was “coherent” but
“laughing inappropriately” and “denies AH/VH,” or auditory and visual
hallucinations, and declined medication. App’x at 565-66. The next day, Suarez
met with Reynolds and Baker for an AOT exam. Although Suarez refused
medication and denied experiencing psychiatric symptoms, Reynolds noted that
his “affect remains mildly elevated, with inappropriate smiling and laughter”
29 and “insight poor.” App’x at 506.
On August 31, 2017, “OMH obtained a court order” – the AOT – requiring
Suarez to undergo the one-year post-release treatment plan prepared by
Reynolds, App’x at 2031, which included a requirement that he “take psychiatric
medication as prescribed,” App’x at 1269.
“On September 2, 2017, Mr. Suarez’s mother and sister visited him at
Downstate.” App’x at 2032. Suarez’s sister testified in her deposition that Suarez
“was talking to himself again, and he just wasn’t physically there – no eye
contact, no talking to us” and that he was “throwing up.” App’x at 823-24.
Three days later, on September 5, 2017, Suarez was released from
Downstate and transferred to a Staten Island parole office to meet with his parole
officer and post-release mental health care coordinator, both of whom reported
that he was smiling and laughing to himself inappropriately. Suarez returned to
his mother’s home, where she “observed him ‘pacing, giggling, and carrying on
conversations when he was alone,’ and appearing angry and nonsensical.”
App’x at 2034. The next day, Suarez met with his parole officer, who reported
that Suarez “mumbled and talked to himself,” and “appeared to be in need of
medication.” App’x at 2034 (citation modified). Suarez testified: “[W]hen I got
30 home I was already hearing voices” that told him “I have to protect myself
because somebody dear to me was going to hurt me and I have to[] make sure I
stay safe.” App’x at 388.
On the evening of September 6, 2017, “Suarez attacked his mother with a
kitchen knife, stabbing her multiple times in the chest, face and arms.” App’x at
2034. He was arrested and evaluated; on October 4, 2017, Suarez was deemed
unfit “to proceed in the defense of his case.” App’x at 2035. The evaluators
noted that he appeared “suspicious and guarded” and that he “smiled in an odd
manner for no apparent reason.” App’x at 2035. One of those evaluators also
noted that Suarez’s “thinking was irrational and rigid” and that he had
“significant difficulty processing verbally conveyed information.” App’x at 2035.
At the time Suarez commenced the instant lawsuit, he was committed to Kirby.
E. Suarez’s Deposition Testimony
Suarez testified that no one at Downstate “discuss[ed] with [him] what if
anything . . . you should do if you wanted mental health treatment.” App’x at
381. He testified that he does not remember the altercation with DOCCS officials
on August 8, 2017, and does not recall the disciplinary hearing. See App’x at 382
(“I recall not having a hearing.”). Suarez further testified that he did not “recall
31 meeting with a mental health clinician,” while he was in the SHU, App’x at 382,
but that he does recall meeting with “the doctor that took me off the medication,”
that is, Qayyum, and that Suarez “asked him if [he] could get off of it,” App’x at
385. Suarez testified that while he was housed in the SHU, he “started hearing
v[o]ices again and they came and went, but they weren’t there permanently. At
the same time, . . . I had anxiety attacks because I couldn’t leave the cell.” App’x
at 383. He testified that he never asked a correction officer if he could speak to a
mental health clinician, because he “was not in the right state of mind to think of
things like that.” App’x at 383.
II. PROCEDURAL HISTORY
In September 2021, Suarez brought this action against DOCCS and OMH,
as well as certain DOCCS and OMH employees in their individual capacities:
Morton, Qayyum, Horan, Kulick, DiNardo, Reynolds, and Baker. 9 In the Second
Amended Complaint – the operative complaint – Suarez asserted six causes of
action, only two of which are before us on appeal. 10 Specifically, Suarez alleges,
9Suarez also named as defendants Anthony Annucci, the DOCCS Acting Commissioner; Ann Marie T. Sullivan, the OMH Commissioner; and Ryan Lahey, the OMH Unit Chief at Downstate. Suarez does not appeal the District Court’s grant of summary judgment to those defendants.
32 pursuant to 42 U.S.C. §1983, that each individual defendant violated his Eighth
Amendment right to be free from cruel and unusual punishment by (1) placing
him in segregated confinement despite his psychiatric needs and (2) failing to
provide him with adequate mental health treatment.
The District Court granted summary judgment to each defendant on
Suarez’s Eighth Amendment claims. See Suarez v. Annucci, No. 7:20CV07133(VB),
2024 WL 814664 (S.D.N.Y. Feb. 27, 2024). As to Morton, the District Court held
that there were no genuine disputes of material fact regarding his subjective
awareness that Suarez was actively decompensating or at substantial risk of
doing so, and that no reasonable juror could find that Morton disregarded any
risk to Suarez’s health because he “acted to protect [Suarez] from harm.” Id.
at *13. The District Court found as to Horan, although he “was indisputably
aware of [Suarez]’s serious mental illness designation,” he “subjectively intended
. . . to remove [Suarez] from segregated confinement as soon as possible” and
10 Suarez brought the following additional claims, none of which are at issue on appeal: (1) disability discrimination, in violation of Title II of the Americans with Disabilities Act against Annucci, Sullivan, DOCCS, and OMH; (2) disability discrimination, in violation of Section 504 of the Rehabilitation Act of 1973, against Annucci, Sullivan, DOCCS, and OMH; (3) violation of New York Correction Law §137, against OMH and all OMH employee defendants; [A268- 69] and (4) negligent supervision and training, against OMH and all OMH employee defendants.
33 therefore had “a subjective intent to reduce [Suarez]’s risk of harm.” Id. at *14
(citation modified). And as to each OMH defendant, the District Court held they
had no “reason to believe [Suarez] was psychologically decompensating,
notwithstanding their awareness of [his] mental illness and history,” principally
“because [Suarez] did not tell anyone at Downstate he was hearing voices.” Id.
at *15.
Suarez timely appealed.
III. DISCUSSION
A. Applicable Law
1. Summary Judgment Standard
“We review de novo a district court’s decision to grant summary judgment,
construing the evidence in the light most favorable to the party against whom
summary judgment was granted and drawing all reasonable inferences in that
party’s favor.” Unkechaug Indian Nation v. Seggos, 126 F.4th 822, 828 (2d Cir. 2025)
(citation modified).
A motion for summary judgment may properly be granted – and the grant of summary judgment may properly be affirmed – only where there is no genuine issue of material fact to be tried, and the facts as to which there is no such issue warrant the entry of judgment for the moving party as a matter of law. The function of the district court in considering the motion for summary judgment is not to resolve
34 disputed questions of fact but only to determine whether, as to any material issue, a genuine factual dispute exists.
Lara-Grimaldi v. Cnty. of Putnam, 132 F.4th 614, 633 (2d Cir. 2025) (citation
modified).
2. Eighth Amendment Deliberate Indifference
The Eighth Amendment prohibits the infliction of “cruel and unusual
punishments.” U.S. Const. amend. VIII. Cruel and unusual punishments
include “the unnecessary and wanton infliction of pain on a prisoner.” Boddie v.
Schnieder, 105 F.3d 857, 861 (2d Cir. 1997) (citation modified). “To demonstrate
an Eighth Amendment violation, a plaintiff must make two showings.”
McPherson v. Coombe, 174 F.3d 276, 280 (2d Cir. 1999). First, there is an objective
prong: that “the alleged punishment [was] ‘objectively, sufficiently serious.’” Id.
(quoting Farmer v. Brennan, 511 U.S. 825, 834 (1994)). Our precedents establish
that objectively serious punishment includes, among other things, conditions of
confinement that “pose an unreasonable risk of serious damage to . . . health,”
Vega v. Semple, 963 F.3d 259, 273-74 (2d Cir. 2020), and “deprivation of adequate
medical care,” including “mental health care,” Spavone v. New York State Dep’t of
Corr. Servs., 719 F.3d 127, 138 (2d Cir. 2013). Second, there is a subjective prong:
that “the prison official involved must have acted with a ‘sufficiently culpable
35 state of mind.’” McPherson, 174 F.3d at 280 (quoting Farmer, 511 U.S. at 834). We
have characterized the subjective prong as “a mens rea prong” or “mental element
prong,” which requires a “showing that the officer acted with at least deliberate
indifference to the challenged conditions.” Darnell v. Pineiro, 849 F.3d 17, 29 (2d
Cir. 2017).
Although they are necessarily factually intertwined, we evaluate Suarez’s
two Eighth Amendment claims – based on conditions of confinement and
inadequate medical care – separately. See Goode v. Cook, No. 23-7521-pr, 2025 WL
816302, at *4 (2d Cir. Mar. 14, 2025) (summary order) (“While a medical needs
claim and conditions of confinement claim are surely related, the Supreme Court
and our Court have treated them as distinct rights.”); McFadden v. Noeth, 827 F.
App’x 20, 27 (2d Cir. 2020) (summary order). “To state a claim under the Eighth
Amendment on the basis that a defendant has failed to prevent harm” by
subjecting a plaintiff to unlawful conditions of confinement, “a plaintiff must
plead both (a) conditions of confinement that objectively pose an unreasonable
risk of serious harm to their current or future health, and (b) that the defendant
acted with deliberate indifference.” Vega, 963 F.3d at 273 (citation modified).
And to make out an Eighth Amendment claim for deliberate indifference to
36 serious medical needs, 11 a plaintiff must show first that “the deprivation alleged
[was] objectively[] sufficiently serious” and that the defendant’s “state of mind is
one of ‘deliberate indifference’ to inmate health or safety.” Farmer, 511 U.S.
at 834 (citation modified).
Although the two claims are distinct, both require Suarez ultimately to
prove that the defendant was deliberately indifferent to the objectively serious
risk to health posed by conditions of confinement or inadequate medical care.
“Deliberate indifference under the Eighth Amendment standard means the
official must” (1) “know of . . . an excessive risk to inmate health or safety” and
(2) “disregard” that risk. Vega, 963 F.3d at 273 (citation modified).
The standard for evaluating a prison official’s knowledge is well-
established under our precedent. An official “knows of” an excessive risk to
inmate health or safety when he is “aware of facts from which the inference
could be drawn that a substantial risk of serious harm exists, and he . . . draw[s]
the inference.” Id. The Supreme Court has described the requisite mental state
as “the equivalent of recklessly disregarding [a] risk.” Farmer, 511 U.S. at 836.
11Of course, it is well-established that “psychiatric or mental health care is an integral part of medical care.” Langley v. Coughlin, 888 F.2d 252, 254 (2d Cir. 1989). It therefore “must be provided to prisoners.” Id.
37 Thus, the standard requires more than mere negligence, but less than “acts or
omissions for the very purpose of causing harm or with knowledge that harm
will result.” Lara-Grimaldi, 132 F.4th at 631 (citation modified); see also Spavone,
719 F.3d at 138 (“Officials need . . . not intend harm” to be deliberately
indifferent.). “Whether a prison official had the requisite knowledge of a
substantial risk is a question of fact subject to demonstration in the usual ways,
including inference from circumstantial evidence, and a factfinder may conclude
that a prison official knew of a substantial risk from the very fact that the risk
was obvious.” Phelps v. Kapnolas, 308 F.3d 180, 186 (2d Cir. 2002) (per curiam)
To defeat a defendant’s motion for summary judgment on the question of
knowledge, a plaintiff need only point to a genuine dispute of fact as to whether
that defendant knew of a risk. Thus, we have explained that summary judgment
is improper where, on the one hand, “[a] jury could well find that the defendants
rejected the requests to treat plaintiff . . . not because the defendants were in any
way indifferent to plaintiff’s needs, but because the defendants sincerely and
honestly believed that they were required to comply” with certain policies, but,
on the other hand, “a jury could also reasonably reach the contrary result,
38 namely, that the defendants here did subjectively know of, and disregard an
excessive risk to, plaintiff’s health,” particularly where the record gives rise to
disputes of fact as to knowledge and disregard. Johnson v. Wright, 412 F.3d 398,
404 (2d Cir. 2005). Where a jury could reach either conclusion, summary
judgment is inappropriate because there remains “a question of fact that ought to
be submitted to a jury.” Id.
In addition to knowledge, a deliberate indifference claim requires a
showing that a defendant “disregarded” a known risk. It is well-settled that one
may disregard a risk – and thus be deliberately indifferent to it – through either
action or inaction. See Lara-Grimaldi, 132 F.4th at 630; see also Spavone, 719 F.3d
at 138 (“[T]he charged official must act or fail to act.” (citation modified)). We
have held, for example, that a defendant can be deliberately indifferent where he
“knew of the health dangers and yet refused to remedy the situation, constituting
deliberate indifference.” LaBounty v. Coughlin, 137 F.3d 68, 73 (2d Cir. 1998). “[A]
deliberate indifference [to medical needs] claim can lie where prison officials
deliberately ignore the medical recommendations of a prisoner’s treating
physicians.” Johnson, 412 F.3d at 404. Relatedly, liability may be imposed on
prison staff who “discontinue[] various, significant medical treatments” that an
39 inmate was receiving before arrival at the facility, “ignoring the
recommendations of his prior physician.” Abreu v. Lipka, 778 F. App’x 28, 32 (2d
Cir. 2019) (summary order).
Even where a defendant does not outright refuse to remedy a risk, he may
exhibit deliberate indifference to a medical need by “consciously choos[ing] an
easier and less efficacious treatment plan,” Chance v. Armstrong, 143 F.3d 698, 703
(2d Cir. 1998) (citation modified), or by “intentionally denying or delaying access
to medical care,” Darby v. Greenman, 14 F.4th 124, 128 (2d Cir. 2021). And, as
particularly relevant here, deliberate indifference may be established where an
inmate was “confined to SHU despite the recommendation that he be placed in a
less-restrictive location,” and kept there, even when officials knew of “the
deleterious effect that his extended confinement in SHU-like conditions” would
have “on his preexisting mental state.” Randle v. Alexander, 960 F. Supp. 2d 457,
481 (S.D.N.Y. 2013); accord Palakovic v. Wetzel, 854 F.3d 219, 229 (3d Cir. 2017)
(plaintiff stated claim of deliberate indifference to serious medical needs against
defendants who “permitted” him to be placed in solitary confinement despite
“fragile mental health condition and history of self-harm and suicide attempts”).
Inherent in our precedent is the principle that a defendant cannot have
40 disregarded a serious risk to a plaintiff, of which he was aware, if he did not have
the ability to take some action to alleviate that risk. This principle is reflected in
our broader Section 1983 caselaw. To bring a Section 1983 claim, a plaintiff must
allege a specific defendant’s “personal involvement . . . in alleged constitutional
deprivations.” Darby, 14 F.4th at 130 (citation modified). And to establish
supervisory liability, a plaintiff must “establish the personal involvement of a
supervisory defendant in the alleged constitutional deprivations of her
subordinates,” Morgan v. Dzurenda, 956 F.3d 84, 89 (2d Cir. 2020) (citation
modified), which may be based on a showing that the supervisor was “directly
involved in the incident itself” or “failed to remedy a wrong after learning of”
that wrong, M.B v. Reyes, No. 97-2653, 1999 WL 147031, at *2 (2d Cir. Mar. 15,
1999) (summary order).
Applying these principles, we have affirmed a grant of summary judgment
to defendant correction officers on a plaintiff’s claim for denial of treatment
where there was “no evidence that [the non-medical defendants] had the
authority to intervene in an admittedly medical decision. . . . Nor on the
undisputed facts could either [defendant] have prescribed [the] treatments for
[the plaintiff], no matter how attentive to her problems and symptoms they
41 were.” Cuoco v. Moritsugu, 222 F.3d 99, 111 (2d Cir. 2000). And even where a
defendant was a medical professional, we have held that he could not have been
deliberately indifferent where “he had no responsibility for the treatment” of the
plaintiff. Id.; see also Acosta v. Thomas, 837 F. App’x 32, 36 (2d Cir. 2020)
(summary order) (holding that defendant did not “fail[] to act” for Eighth
Amendment purposes where, among other things, he “never examined or
diagnosed [the plaintiff] . . .[,] did not make medical decisions as to the
appropriate treatments for individual inmates or resolve disputes between
inmates and their doctors”).
As we have stated in a nonprecedential decision, “to be entitled to a jury
trial, [the plaintiff] must proffer evidence from which a reasonable juror could
infer that (1) [the defendant] was subjectively aware of the seriousness of [the
plaintiff’s] situation, and (2) [that defendant] had the ability to take some action
that would have significantly alleviated” the risk. Shepherd v. Hogan, 181 F.
App’x 93, 96 (2d Cir. 2006) (summary order). We embrace that principle here:
liability for deliberate indifference under the Eighth Amendment requires a
showing that the defendant had some ability to mitigate the serious risk to a
plaintiff’s health or safety. See Clark v. Valletta, 157 F.4th 201, 225 (2d Cir. 2025)
42 (Robinson, J., concurring in part, dissenting in part) (“[P]laintiffs must allege (1) a
serious medical need, and (2) that prison officials who were both aware of that
need and capable of addressing it did not do so.”).
On appeal, defendants do not dispute the objective prong of either the
conditions of confinement or medical needs claims. The objective prong was
likewise not disputed in the District Court, and therefore not adjudicated at
summary judgment. See Suarez, 2024 WL 814664, at *12 n.13. And because the
District Court concluded that defendants were entitled to summary judgment on
the merits, it did not consider whether defendants were entitled to qualified
immunity. See id. at *18 n.20. We therefore evaluate only whether there are
genuine disputes of material fact as to whether each defendant acted with
deliberate indifference to Suarez’s (1) conditions of confinement or (2) serious
medical needs. We conclude that there are. We address Suarez’s claims against
each defendant in turn.
B. DOCCS Defendants
In granting summary judgment, the District Court concluded, as a matter
of law, that the DOCCS defendants – Horan and Morton – subjectively believed
that Suarez did not face a serious risk of harm through conditions of confinement
43 or inadequate medical care. See id., 2024 WL 814664, at *13-14. But that was
insufficient to support a grant of summary judgment in their favor. As explained
above, at summary judgment, Suarez need only point to evidence – including
circumstantial evidence – from which a jury could infer that “a substantial risk of
serious harm exist[ed]” and that the defendant recklessly disregarded that risk
through affirmative acts, inaction, or inadequate action. Farmer, 511 U.S. at 837;
see also Phelps, 308 F.3d at 186. Even if the record also permits the inference that
“the defendants sincerely and honestly believed that” their actions were
adequate, or that no action was required, it is the jury, and not the court, that
must resolve the competing inferences. Johnson, 412 F.3d at 404.
Thus, defendants’ argument that “[t]here is no basis in the record to
conclude that any of the defendants intentionally delayed or denied Suarez
medical care or ignored a significant risk that his condition would deteriorate
without additional treatment,” Defendants-Appellees’ Br. at 24 (emphasis
added), misses the mark. The relevant standard for deliberate indifference is
recklessness. “Officials need only be aware of the risk of harm, not intend harm”
to be deliberately indifferent under the Eighth Amendment. Spavone, 719 F.3d
at 138.
44 1. Defendant Horan
Suarez argues that the District Court erred by concluding that Horan, the
SORC assigned to conduct Suarez’s Tier 3 disciplinary hearing, could not have
been deliberately indifferent because the evidence conclusively established (1)
that Horan had “a subjective intent to reduce [Suarez’s] risk of harm” by
removing him from the SHU after the disciplinary hearing, and (2) that Horan
had a “subjective belief that [Suarez] was not at a serious risk of harm in SHU
during the disciplinary hearing.” Suarez, 2024 WL 814664, at *14. We conclude
that genuine disputes of material fact prevent summary judgment in favor of
Horan.
a. Conditions of Confinement
First, we conclude that there are genuine disputes regarding whether
Horan knew of “an excessive risk to [Suarez’s] health or safety” posed by his
placement in disciplinary housing and “disregarded that risk.” Vega, 963 F.3d
at 273-74.
Horan, as the assigned SORC, reviewed Suarez’s hearing packet, which
described his SMI status and the basis for it. Horan testified that during the
hearing, Suarez seemed “a little bit off” and “appeared to lack connection and
45 was clearly not completely free of any signs of mental illness.” App’x at 1893,
2018 (citation modified). Indeed, Horan adjourned the hearing in response to
Suarez’s representation that he was unfamiliar with OMH and did not
understand the nature of his disciplinary proceeding in order to obtain
confidential testimony from DiNardo, the SHU clinician, during which DiNardo
opined that Suarez “is not suitable for confinement in disciplinary housing due
to the mental illness.” App’x at 1166. Because Horan personally observed
Suarez’s behavior at the hearing and heard DiNardo’s opinion that Suarez was
not suitable for disciplinary housing, a jury could reasonably conclude that
Horan knew of the risk that continued disciplinary housing would have a
negative impact on Suarez’s mental health.
The record also permits an inference that Horan disregarded that risk. As
SORC, Horan had the power to remove Suarez from disciplinary confinement
prior to the start of the hearing and the authority to impose a disciplinary
sentence at the conclusion of the hearing. Despite his ability to alleviate the
danger to Suarez, Horan did not remove Suarez from the SHU prior to the start
of the disciplinary hearing. And even after DiNardo testified that Suarez was not
suitable for disciplinary housing – testimony that Horan admitted should be
46 given “considerable” weight – Horan imposed an above-DOCCS guidelines
sanction on Suarez of 60 days in keeplock, with 30 of those days deferred. App’x
at 2015, 2020. While Horan testified that he “wanted [Suarez] out of [the] SHU as
quickly as possible,” App’x at 1092, it is undisputed that keeplock, even when
served in the general population, is a form of disciplinary housing in which an
inmate is confined to his cell for 23 hours per day. Indeed, Horan acknowledged
that keeplock is a “confined setting.” App’x at 2021. Drawing inferences in
Suarez’s favor, as is required at the summary judgment stage, a reasonable jury
could conclude that Horan was deliberately indifferent because he knew of
Suarez’s serious mental illness and witnessed signs of decompensation, and yet
affirmatively sanctioned Suarez to an additional term of disciplinary housing
despite testimony from medical professionals that it was not appropriate. See
LaBounty, 137 F.3d at 73 (defendant was deliberately indifferent where he “knew
of the health dangers and yet refused to remedy the situation”). The District
Court erred in holding to the contrary.
b. Medical Needs
Whether there are genuine issues as to Horan’s deliberate indifference to
Suarez’s medical needs is a closer call. Ultimately, we conclude that Suarez has
47 sufficiently raised triable questions of fact that must be resolved by a jury.
There is evidence that Horan had knowledge of the serious risk posed to
Suarez’s health by inadequate medical treatment and placement in disciplinary
housing. It is true that DiNardo testified at the disciplinary hearing: “No matter
the length of the sanction given, Mental Health will continue to monitor the
inmate patient closely and make referrals for special programming when
available.” App’x at 1166. But DiNardo also testified that “[a]t the time of the
incident, [Suarez] was prescribed Zyprexa . . . which was discontinued due to his
noncompliance with same,” and that “the conduct related to the disciplinary
hearing is related to the inmate patient’s mental health symptoms.” App’x
at 1165-66. And, as previously noted, DiNardo testified that Suarez “is not
suitable for confinement in disciplinary housing due to the mental illness.”
App’x at 1166. On balance, while a jury could conclude that Horan reasonably
believed OMH staff would address any medication and treatment needs, this
record would also permit an inference that Horan knew that Suarez was not
being medicated and was exhibiting symptoms of psychosis, which led to an
altercation with DOCCS staff, and that someone with his mental health profile
should not be subject to segregated housing or keeplock status. The jury is
48 entitled to weigh that competing evidence.
There are likewise genuine disputes as to whether Horan disregarded the
known risk posed by inadequate medical treatment. Horan had the authority to
refer Suarez to OMH for further mental health treatment; although he testified
that “OMH was involved with every mental hygiene case” by 2017, he conceded
that he still retained the ability to make such a referral and that he had done so in
the past. App’x at 1078, 2026. Despite his power to do so, Horan failed to refer
Suarez for further treatment and instead imposed a keeplock sanction on Suarez
that exceeded DOCCS guidelines, despite hearing testimony that Suarez should
not be kept in disciplinary housing. Drawing inferences in Suarez’s favor, as we
must, we conclude that a reasonable jury could find that Horan was deliberately
indifferent because he knew of Suarez’s serious mental illness and that he was
not taking medication, and personally witnessed signs of decompensation, yet
failed to refer Suarez for further treatment. We conclude that genuine disputes
of material fact exist sufficient to permit Suarez’s deliberate indifference to
serious medical needs claim against Horan to proceed to trial.
2. Defendant Morton
Suarez contends that there are genuine disputes of material fact as to
49 whether Morton, as Superintendent of Downstate, knew of Suarez’s serious
mental health condition and the risk of decompensation but disregarded that risk
by failing to remove him from disciplinary housing or refer him for further
medical treatment. We agree.
We begin first with Suarez’s conditions of confinement claim against
Morton – specifically, whether Morton knew of the risk to Suarez’s health posed
by subjecting him to “unlawful conditions of confinement” and consciously
disregarded that risk. Vega, 963 F.3d at 273.
There is ample record evidence from which a jury could infer that Morton
knew of the risk that placement in disciplinary housing posed to Suarez’s mental
health. Morton signed the Unusual Incident Report regarding Suarez’s
altercation with DOCCS staff, which noted, among other things, that Suarez was
“acting unpredictable” and had spit at DOCCS staff, which prompted his
placement in the SHU. App’x at 1739-40. Morton himself made weekly rounds
of the SHU, speaking with individuals housed there – including, presumably,
Suarez, who spent fifteen days in the SHU, during which time he experienced
hallucinations. And Morton personally reviewed and signed off on
50 recommendations of the JCMC, which was responsible for reviewing,
monitoring, and coordinating treatment plans for inmates in the SHU who were
assigned to OMH’s caseload, including Suarez. The parties dispute whether the
JCMC met on August 17, 2017, while Suarez was in the SHU; whether that
meeting occurred and whether Suarez’s condition was discussed is a question of
fact for the jury. If the meeting in fact occurred, it could be reasonably inferred
that Morton knew of Suarez’s condition, that he was not taking medication, and
that the SHU was detrimental to his health. Moreover, although the parties
dispute whether Morton signed the initial deprivation order on August 8, 2015,
when Suarez was placed in the SHU, it is undisputed that Morton discontinued
that order after seven days, on August 15, 2015. Based on his discontinuation
order, a jury could readily infer that Morton knew the risk posed to Suarez by 24-
hour confinement, to which Suarez had been subjected for seven days.
The record also reflects that Morton was confronted by superiors about the
risk that disciplinary confinement posed to Suarez. After Morton signed off on
Horan’s above-DOCCS-guidelines sanction of 60 days in keeplock, Morton
received an email from DOCCS Acting Assistant Commissioner Finnegan, which
expressly flagged that Morton’s “review still leaves the confinement sanction
51 OVER the guidelines” applicable to individuals with SMI status. App’x at 918;
see also App’x at 2028. The record thus permits the inference that Morton was
aware of the danger posed to Suarez by continued confinement in disciplinary
housing.
There are also genuine issues of fact as to whether Morton was deliberately
indifferent to Suarez’s health by “refus[ing] to remedy” the dangerous situation.
LaBounty, 137 F.3d at 73.
First, Morton had the power as Superintendent to alleviate the risk posed
to Suarez’s health by disciplinary housing. He testified that he could release
inmates from the SHU while a Tier III disciplinary hearing was underway –
though he chose not to in this case. And Suarez’s disciplinary hearing resumed –
and mental-health testimony was taken – on the same day (August 21, 2017) that
Morton submitted the AOT petition in which he acknowledged that Suarez had a
“significant history of mental health problems” and “non-compliance with
treatment.” App’x at 1261, 1263. In light of that evidence, the jury could infer
that by refusing to remove Suarez from the SHU, Morton consciously
disregarded a serious risk of which he was aware.
Morton also reviewed, signed off on, and had the authority to modify the
52 keeplock sanction imposed by Horan. But despite submitting an AOT petition
raising serious concerns about Suarez’s health, and despite receiving an email
from the Acting Assistant Commissioner flagging that the sanction was
excessive, there is no evidence that Morton removed Suarez from keeplock or
diverted him to the FDU. In the face of Morton’s ability to remedy Suarez’s
conditions of confinement, a reasonable jury could conclude that his failure to do
so constitutes deliberate indifference.
In granting summary judgment, the District Court concluded that “[n]o
reasonable juror would find that [Morton] was deliberate[ly] indifferen[t]”
because Morton “acted to protect [Suarez] from harm” when he “declin[ed] to
renew [Suarez]’s deprivation order at the first opportunity.” Suarez, 2024 WL
814664, at *13. While the inference drawn by the District Court may be a
permissible one, as stated above, the record evidence also permits an inference
that he should have acted sooner. How to weigh the competing evidence is
squarely within the province of the jury. See Lara-Grimaldi, 132 F.4th at 633.
Genuine disputes of material fact likewise preclude summary judgment on
Suarez’s deliberate indifference to medical needs claim against Morton.
53 The record supports an inference that Morton knew Suarez was not taking
his medication, knew of the risks that inadequate medication and disciplinary
confinement posed to Suarez’s mental health, and knew that Suarez was in fact
decompensating. Morton signed the Unusual Incident Report, which noted
Suarez’s unpredictable behavior, see App’x at 1739-40; Morton made weekly
rounds of the SHU while Suarez was housed there, during the time that,
according to Suarez’s testimony, he began hallucinating and having anxiety
attacks, see App’x at 383, 1970; and Morton was on the JCMC, which reviewed
medical records and treatment plans of SMI inmates, including Suarez, see App’x
at 1968-69. Moreover, drawing all inferences in Suarez’s favor, a factfinder could
find that the JCMC did meet on August 17, 2017, while Suarez was in the SHU,
and discussed Suarez’s condition. Taken together, these facts would permit a
reasonable jury to conclude that Morton knew that Suarez was not taking
medication, knew of the risk that lack of medication and disciplinary
confinement posed to Suarez’s health, and knew that Suarez was
decompensating.
Perhaps most significantly, on August 21, 2017, while Suarez was still in
the SHU, Morton submitted an AOT petition on his behalf, in which he expressly
54 attested that Suarez’s “history of lack of compliance with treatment for mental
illness . . . resulted in one or more acts of serious violent behavior,” that Suarez
“has a significant history of mental health problems . . . and hospitalization
related to mental illness, substance abuse, and non-compliance with treatment,”
and that Suarez had “continued lack of insight into his mental illness and the
need for treatment.” App’x at 1260-61. Indeed, without an AOT, Morton
expressed his view that Suarez would not “change his pattern of treatment non-
compliance with resultant psychosis and high risk behaviors.” App’x at 1261.
The jury could infer from this petition alone that Morton knew of Suarez’s
condition and the risk that lack of treatment posed. Morton’s own words give
rise to a triable issue of fact as to Morton’s knowledge that Suarez faced serious
mental health risks without proper treatment and that he was decompensating.
A jury could also conclude that Morton consciously disregarded the
known risk posed by lack of medication and disciplinary housing. Morton, as a
DOCCS employee, had the power to refer Suarez to OMH. Thus, not only could
Morton remove Suarez from disciplinary housing, he could also take steps to
obtain further mental health treatment for Suarez. His choice not to do so –
despite knowing that Suarez was unmedicated and that placement in
55 disciplinary confinement was a risk to his health and knowing, as demonstrated
by the AOT petition, that Suarez needed treatment – creates a genuine dispute of
material fact as to his deliberate indifference. We conclude that the District
Court’s holding that Morton “acted to protect [Suarez] from harm” as a matter of
law when he sought “an AOT order that would mandate continued mental
health treatment upon [Suarez]’s release,” Suarez, 2024 WL 814664, at *13,
impermissibly resolved disputed facts in Morton’s favor. There are sufficient
disputes of material fact to preclude summary judgment in favor of Morton.
C. OMH Defendants
Defendants contend that “[t]hough Suarez occasionally showed symptoms
of his mental illness,” none of the OMH providers – Kulick, DiNardo, Qayyum,
Reynolds, and Baker – “subjectively believed that Suarez was at significant risk
of imminently or rapidly decompensating” such that they “were deliberately
indifferent to Suarez’s need for psychotropic medication to prevent
decompensation,” and that “no reasonable juror could conclude that Suarez’s
treatment providers believed Suarez needed to be removed from disciplinary
housing.” Defendants-Appellees’ Br. at 2-3, 24-25. We are not persuaded. See
Johnson, 412 F.3d at 404 (concluding summary judgment was improper where
56 record permitted inference that defendants knew and disregarded a risk, even
where record also permitted competing inference that defendants sincerely and
honestly believed that their actions adequately addressed the risk).
Underlying our analysis as to each OMH defendant is the following
undisputed fact: “If at any time an OMH employee believes that the incarcerated
individual requires immediate mental health treatment, that staff member can
place the incarcerated individual in the FDU regardless of when the hearing is to
be conducted or the sanction imposed.” App’x at 711. Thus, each OMH
defendant indisputably had the authority to place Suarez in the FDU at any time.
Cf. Cuoco, 222 F.3d at 111 (noting lack of evidence demonstrating certain
defendants had “authority to intervene”); see also Shepherd, 181 F. App’x at 96.
And, again, the OMH defendants need not have been intentionally indifferent to
risks posed to Suarez’s health, see Spavone, 719 F.3d at 138; the question is
whether the record permits an inference that each defendant recklessly disregarded
those risks.
1. Defendant Kulick
There are genuine disputes of material fact as to whether Defendant Kulick
– Suarez’s OMH primary clinician during his time at Downstate when he was
57 not housed in the SHU – knew of risks to Suarez’s health posed by disciplinary
housing and lack of medication and knew that he was in fact decompensating,
and yet consciously disregarded those risks.
The record permits an inference that Kulick, as Suarez’s primary clinician,
knew of the risks posed to his mental health by disciplinary housing. Kulick
conducted Suarez’s intake evaluation, during which she detailed Suarez’s
medical history. That medical history included Suarez’s Zyprexa prescription,
which was active upon his arrival at Downstate, as well as his history of mood
swings, auditory hallucinations, and previous suicide attempt. Based on this
history, it was Kulick who recommended that Suarez be designated as a Level 1-
S and that he be admitted to OMH care for individual therapy and medication.
Kulick’s initial review also recommended that if the treatment team observed
signs of “suicidality and psychiatric decompensation,” then Suarez “may benefit
from a medication evaluation and/or [residential crisis treatment program]
admission.” App’x at 1440. She also identified “disciplinary sanctions” and
“single [c]ell” housing as potential “[r]isk factors.” App’x at 1440. This evidence
precludes a finding, as a matter of law, that Kulick lacked knowledge of the risk
58 that disciplinary housing posed to Suarez.
The record likewise reflects a genuine dispute as to whether Kulick knew
that Suarez was in fact decompensating. Kulick testified in her deposition that
she was aware that between June 30, 2017, and July 19, 2017, Suarez “did not
want to take the medication anymore and the psychiatrist [Qayyum] had
discontinued it.” App’x at 816. A few weeks later, on August 8, 2017, Kulick
responded to a request from the infirmary for an immediate mental health
referral after Suarez’s altercation with DOCCS staff. Shortly before Kulick’s
arrival, Suarez was unaware of the current date. When Kulick arrived, she
observed Suarez wearing a spit mask. While Kulick described Suarez as having
a neutral mood and an affect within the normal range – evidence that the District
Court credited in granting summary judgment – Kulick’s notes also reflected that
Suarez’s “eye contact [was] sporadic” and that she “suspected that he may be
under the influence.” App’x at 502. Crediting this evidence, a jury could
conclude that Kulick knew Suarez was experiencing serious mental health issues
and could be decompensating.
Kulick’s recommendation that Suarez should be admitted to a residential
crisis treatment program if he started to decompensate, her acknowledgment
59 that disciplinary sanctions and single-cell housing were risk factors for him, and
her observations of him after the immediate referral, taken together, are sufficient
to permit a reasonable jury to infer that Kulick was deliberately indifferent to
Suarez’s serious medical needs by failing to divert him from disciplinary
housing. It is undisputed that any OMH employee – Kulick included – could
place an individual in the FDU at any time, regardless of where the individual
was housed and whether there was a disciplinary proceeding underway.
Accordingly, when Kulick – who was particularly familiar with Suarez’s medical
history and the fact that he had been unmedicated for around five weeks – was
called to the infirmary after Suarez’s altercation with DOCCS officers, saw
Suarez in a spit mask, noted his sporadic eye movements, and suspected that he
was under the influence, her failure to divert him to the FDU or take any other
action to address his condition could suffice to establish that she was deliberately
indifferent to the risk posed by Suarez’s conditions of confinement.
Disputes of fact likewise prevent summary judgment in favor of Kulick on
Suarez’s deliberate indifference to medical needs claim. First, knowledge: As
discussed, Kulick was familiar with Suarez’s medical history, including mood
60 swings, auditory hallucinations, and a previous suicide attempt, and she was
aware that he arrived to Downstate with an active Zyprexa prescription.
Moreover, Kulick herself recommended Suarez’s admission to OMH for therapy
and medication. And, as noted, the evidence permits an inference that Kulick
knew Suarez was in fact decompensating.
It is true that Suarez denied on July 19, 2017, and August 8, 2017, that he
was experiencing psychiatric symptoms, specifically hallucinations. But Kulick
is a mental health professional; those denials are insufficient to establish as a
matter of law that Kulick lacked knowledge that Suarez was decompensating
and needed treatment. Kulick herself acknowledged that “a seriously mentally
ill individual may not accurately self-report their symptoms if that person is not
compliant in taking their prescribed psychiatric medication.” App’x at 1986.
Drawing inferences in Suarez’s favor, a reasonable jury could conclude that
Kulick recognized that Suarez would decompensate without medication, knew
his medication had been discontinued, and witnessed signs of decompensation.
There are also disputed factual issues as to whether Kulick disregarded the
risk Suarez faced from inadequate medical treatment and disciplinary
confinement. Kulick, as Suarez’s primary care clinician from June 22, 2017, until
61 August 8, 2017, certainly had the power to seek further mental health treatment
for him. In her role, Kulick prepared Suarez’s treatment plan and examined him
on a monthly basis. After the August 8, 2017, altercation with correctional
officers, Kulick responded to an infirmary referral and made notes indicating
that she knew Suarez was no longer on medication. See App’x at 972. A jury
could reasonably infer that Kulick had the ability to recommend treatment, even
if she could not write prescriptions – particularly after she learned that Qayyum
had discontinued Zyprexa. And, as discussed, Kulick had the authority to send
Suarez to the FDU at any time including when he was in the SHU or serving a
keeplock sanction. Accordingly, just as with the conditions of confinement claim,
a jury could infer that, when Kulick – who was intimately familiar with Suarez’s
medical history and the fact that he had been unmedicated for around five weeks
– was called to the infirmary after Suarez’s altercation with DOCCS officers, saw
Suarez in a spit mask, noted his sporadic eye movements, and suspected that he
was under the influence, her failure to divert Suarez to the FDU or take any other
action with regard to his medical needs constituted deliberate indifference.
The District Court therefore erred in granting summary judgment in favor
of Kulick.
62 2. Defendant DiNardo
The record gives rise to genuine disputes of material fact as to whether
Defendant DiNardo, the SHU clinician responsible for Suarez’s care while he was
housed there, was subjectively aware of the severity of Suarez’s mental illness,
that he was decompensating without medication, and that his housing in the
SHU and lack of medication posed a serious risk to his health. There likewise are
disputed factual issues regarding whether, in spite of that knowledge, DiNardo
disregarded the risks posed to Suarez by the conditions of confinement and lack
of medical treatment.
The record contains ample evidence from which a jury could infer that
DiNardo knew of the risk disciplinary confinement posed to Suarez’s health and
that Suarez was in fact decompensating. DiNardo, Suarez’s primary clinician
upon his entry in the SHU, made daily weekday rounds to observe the inmates
in the SHU, including Suarez. Suarez testified that during that time, he began
experiencing hallucinations and anxiety attacks. Although it is undisputed that
Suarez did not expressly tell DiNardo that he was experiencing hallucinations,
DiNardo testified in her deposition that she knew that “placement in [the] SHU
63 can cause a person to decompensate,” App’x at 416, and she testified at Suarez’s
disciplinary proceeding that it was her medical opinion that the DOCCS
altercation resulted from Suarez’s mental illness. Specifically, she observed that
his behaviors, including “mood fluctuation and psychosis” were “consistent with
his current diagnosis.” App’x at 1165. She also testified that Suarez had been
discontinued from Zyprexa due to noncompliance, and she opined that he was
“not suitable for confinement in disciplinary housing due to the mental illness.”
App’x at 1165-66. Additionally, DiNardo served on the JCMC, which reviewed
the files and treatment plans of individuals housed in the SHU – including
Suarez. Assuming that the JCMC met while Suarez was housed in the SHU, the
committee members would have discussed Suarez’s mental health and whether
to remove him from the SHU.
There is likewise a dispute of material fact as to whether DiNardo
disregarded the risk posed by disciplinary confinement. DiNardo, as an OMH
employee, had the capability to remove Suarez from the SHU and send him to
the FDU, even during the pendency of his disciplinary hearing. And as Suarez’s
primary clinician, DiNardo was principally responsible for his mental health
treatment while he was in the SHU. DiNardo testified at the disciplinary hearing
64 that Suarez “did not display any symptoms relating to his mental illness” during
her rounds or “advise [her] of any concerns,” App’x at 414, and her treatment
notes from August 22, 2017, reported no signs of psychiatric decompensation.
But DiNardo knew that disciplinary confinement could lead to decompensation
and testified that Suarez specifically was not suited for disciplinary housing and
that his behavior was consistent with the absence of anti-psychotic medication.
The jury is entitled to weigh this competing evidence and find that DiNardo was
deliberately indifferent to Suarez’s serious medical needs by failing to remedy
the risk posed by the conditions of confinement in disciplinary housing.
Disputed issues of fact likewise preclude summary judgment on Suarez’s
deliberate indifference to serious medical needs claim against DiNardo. As
discussed, the record evidence supports a conclusion that DiNardo knew that
Suarez was decompensating and that the decompensation was exacerbated by
disciplinary housing and lack of medication. Indeed, DiNardo testified at
Suarez’s disciplinary hearing about Suarez’s mental illness and that he was not
suited for disciplinary housing. See App’x at 1165-66. And, as mentioned,
drawing inferences in Suarez’s favor that the JCMC met and reviewed Suarez’s
65 file on August 17, 2017, while he was in the SHU, DiNardo would have discussed
Suarez’s mental health status and his disciplinary sanction. Accordingly, a jury
could infer that DiNardo knew of the serious risk that Suarez was
decompensating without medication while housed in the SHU.
On this record, a jury could also conclude that DiNardo consciously
disregarded Suarez’s serious medical needs. As mentioned, DiNardo had the
capability to divert Suarez to the FDU for further mental health treatment while
he was under her care. And as Suarez’s primary clinician, DiNardo was
principally responsible for his mental health treatment while he was in the SHU.
The record reflects genuine disputes of material fact as to whether
DiNardo was deliberately indifferent to Suarez’s medical needs, in spite of the
measures she claimed she did take. While DiNardo testified that she would “say
hi” to Suarez through his cell door during rounds, Suarez testified that he did not
receive treatment while in the SHU. Even crediting DiNardo’s testimony of her
daily check-ins on Suarez, which we need not do at the summary judgment
stage, a jury could find that level of care constitutionally inadequate. This is
particularly so because New York law mandated that “[i]nmates with serious
mental illness who are not diverted or removed from segregated confinement
66 shall be offered a heightened level of care, involving a minimum of two hours
each day, five days a week, of out-of-cell therapeutic treatment and
programming,” unless a contrary recommendation is made and documented.
N.Y. Correct. Law §137(6)(d)(iii) (effective until Dec. 17, 2017).
Moreover, as noted, DiNardo’s failure to exercise her authority to divert
Suarez to the SHU supports Suarez’s deliberate indifference to serious medical
needs claim. Although DiNardo stated in progress notes and at Suarez’s
disciplinary hearing that Suarez did not exhibit or tell her about his mental
health symptoms, she also testified that Suarez was not suited for disciplinary
housing and that his behavior was consistent with unmedicated psychosis. In
light of DiNardo’s failure to send Suarez to the FDU or otherwise treat him in
accordance with the level of care mandated by Downstate policy and New York
law, the record does not support a finding, as a matter of law, that DiNardo was
not deliberately indifferent to Suarez’s serious medical needs.
3. Defendant Qayyum
As with the other OMH defendants, disputed issues of fact preclude
summary judgment on Suarez’s claims against Defendant Qayyum, Suarez’s
psychiatrist at Downstate.
67 a. Conditions of Confinement
The evidence is sufficient to permit an inference that Qayyum knew of the
substantial risk posed to Suarez’s mental health by placement in disciplinary
housing. From the beginning of Suarez’s time at Downstate, Qayyum was
familiar with his medical history, including his history of hallucinations and his
Zyprexa prescription. As Suarez’s primary psychiatrist, Qayyum was
responsible for formulating a treatment plan and working with Suarez’s primary
clinician, Kulick, to prepare Suarez’s Core History form and other intake
paperwork. That paperwork expressly noted that OMH should monitor Suarez
for signs of “suicidality and psychiatric decompensation,” observed that he “may
benefit from a medication evaluation and/or [residential crisis treatment
program] admission,” and that “disciplinary sanctions” and “single [c]ell”
housing posed a risk to Suarez. App’x at 1440. From this evidence, a reasonable
jury could certainly infer that Qayyum knew of the risk posed to Suarez by
disciplinary confinement.
A jury could also find that Qayyum was aware that Suarez was in fact
decompensating. Qayyum met with Suarez intermittently between June 30, 2017,
and August 24, 2017 – both before he was serving any disciplinary sanction and
68 after he was released from the SHU but subject to a keeplock sanction. About a
month after Qayyum first terminated Suarez’s prescription for Zyprexa, the two
met again. While Suarez denied hallucinations, Qayyum noted that his mood
and affect were “slightly blunted.” App’x at 563. And when Qayyum met with
Suarez on August 24, 2017, almost two months after he discontinued the Zyprexa
prescription, and after Suarez had spent several weeks in the SHU, Qayyum
reported that Suarez was “coherent” but “laughing inappropriately,” despite
Suarez’s continued denial of hallucinations. App’x at 565. While the District
Court recognized that Qayyum observed inappropriate laughter, it held that the
record established, as a matter of law, that Qayyum lacked knowledge that
Suarez was decompensating because Suarez denied hallucinations and exhibited
fair insight and judgment. See Suarez, 2024 WL 814664, at *15. That conclusion
impermissibly weighed the evidence in Qayyum’s favor. We conclude that there
are genuine disputes of material fact precluding a finding that Qayyum lacked
knowledge of Suarez’s condition.
There are also genuine disputes of material fact that preclude summary
judgment as to whether Qayyum was deliberately indifferent to the risk posed by
Suarez’s conditions of confinement. Like other OMH staff members, Qayyum
69 had the authority to send Suarez to the FDU for further mental health treatment
at any time, including when Suarez was in the SHU or keeplock confinement.
His failure to do so, despite being aware that Suarez was likely to decompensate
without medication and that disciplinary sanctions and single-cell housing were
documented risk factors to Suarez, and despite observing signs of
decompensation (including inappropriate smiling and laughter) after Suarez had
been off Zyprexa for almost two months and in disciplinary housing for over two
weeks, permits an inference that Qayyum acted with deliberate indifference to
the risk posed by Suarez’s conditions of confinement.
The evidence is even stronger in support of Suarez’s claim that Qayyum
was deliberately indifferent to his serious medical needs.
Qayyum was Suarez’s primary psychiatrist at Downstate and met with
him on several occasions. In this capacity, Qayyum was responsible for
prescribing psychiatric medication and providing medication counseling and
education to Suarez. Qayyum was also uniquely familiar with Suarez’s medical
history and his Zyprexa prescription. In response to Suarez’s claim that he did
not need medication, Qayyum discontinued Zyprexa and recommended
70 continued individual therapy; he did this even though he knew full well that
some individuals with mental illness “believe they do not need medication, but
once they stop taking it they begin to decompensate.” App’x at 445-46. This
alone might be sufficient to support an inference of knowledge of the risk posed
to Suarez by lack of medication. But then, on August 11, 2017, Qayyum received
the Kirby Discharge Summary, which specifically noted Suarez’s hospitalizations
due to treatment noncompliance and indicated that Downstate should
“encourage medication compliance as [Suarez] will decompensate if non-
compliant.” App’x at 1448; App’x at 2001-02. Accordingly, a reasonable jury
could readily conclude that, by August 11, 2017, at the latest, Qayyum knew that
Suarez was at risk of decompensating without medication.
Moreover, for many of the reasons discussed above, the record supports an
inference that Qayyum recognized signs that Suarez was in fact decompensating.
One month after Suarez stopped taking Zyprexa, Qayyum observed Suarez’s
mood and affect as “slightly blunted.” App’x at 563. Two months after Qayyum
stopped Suarez’s medication, Qayyum reported that Suarez was “coherent” but
“laughing inappropriately.” App’x at 565. Even crediting Qayyum’s assertion
that Suarez denied hallucinations, the evidence at minimum creates a genuine
71 dispute as to Qayyum’s knowledge that Suarez was experiencing serious
symptoms of psychosis.
A jury could also find that Qayyum’s failure to provide medical treatment
or divert him from disciplinary confinement, in the face of Suarez’s
decompensation, constituted deliberate indifference to Suarez’s serious medical
needs. As stated, Qayyum was principally responsible for Suarez’s medication
management at Downstate, knew that doctors at Kirby warned that medication
compliance was essential, knew that disciplinary housing was a risk factor for
Suarez, and yet Qayyum discontinued the Zyprexa prescription and did not
reinstate it or seek more aggressive care (by, for example, diverting him to the
FDU) despite observing signs of decompensation while Suarez was in
disciplinary confinement. And although Qayyum attested that he discussed
Zyprexa with Suarez and the need for him to take medication, Suarez disputes
that medication education was actually given. Instead, Suarez contends that
Qayyum merely checked the “medication education provided” box on progress
notes but did not actually provide any education. The fact that Qayyum left
blank the narrative “comments” section about medication education on his
progress notes supports Suarez’s version of events.
72 Accordingly, we conclude that genuine disputes of material fact exist as to
whether Qayyum was deliberately indifferent to Suarez’s serious medical needs.
4. Defendant Reynolds
The record gives rise to genuine disputes of fact as to whether Reynolds,
an OMH psychiatrist who assessed Suarez’s eligibility for AOT, knew that
Suarez was decompensating but failed to divert him from disciplinary housing
or take steps to get him additional medical treatment.
First, the record supports an inference that Reynolds knew of the risk
posed to Suarez’s health by disciplinary confinement and knew that Suarez was
decompensating, yet failed to divert him to the FDU.
With respect to knowledge, Reynolds attested that AOT applies to those
who require “mandatory treatment” due to “a history of noncompliance with
treatment and have had multiple hospitalizations and/or have engaged in
violence.” App’x at 455. To evaluate Suarez’s eligibility for an AOT order,
Reynolds was required to exercise his “clinical judgment, based on a review of
records, consulting with [Suarez’s] treatment team, and” meeting with him.
App’x at 456. While Reynolds claimed that he did not have a “basis to seek civil
73 commitment” of Suarez after his August 17, 2017, review, he in fact sought an
AOT order after his August 25, 2017, meeting with Suarez. App’x at 456-57. The
record establishes that Reynolds was aware of Suarez’s history of mental illness,
including the risk of decompensation without medication, that disciplinary
sanctions and single-cell housing were risk factors for him, and that he had not
been taking Zyprexa for over a month at the time of their first meeting.
There is also a genuine dispute of material fact as to Reynolds’s knowledge
that Suarez was in fact decompensating in disciplinary housing. Reynolds first
met with Suarez while he was housed in the SHU, during his disciplinary
hearing. At both that meeting and Reynolds’s second meeting with Suarez on
August 25, 2017, after Suarez had spent several weeks in disciplinary housing
and was serving a keeplock sanction, Reynolds’s notes indicated that Suarez had
a mildly elevated affect and was inappropriately smiling and laughing.
Although Suarez denied hearing voices, Reynolds noted that his insight was
“poor.” App’x at 504. While the District Court recognized that Reynolds
observed Suarez’s inappropriate smiling and laughter, it weighed that
information against Reynolds’s other observations that Suarez was “alert and
properly oriented” and that he “denied experiencing hallucinations or homicidal
74 ideations” to hold that “the record does not raise an inference that [he] [was]
subjectively aware [Suarez] was or would psychologically decompensate.”
Suarez, 2024 WL 814664, at *15. In so doing, the District Court improperly
resolved disputed issues of fact in Reynolds’s favor. See Lara-Grimaldi, 132 F.4th
at 633.
There are also genuine disputes of fact as to whether Reynolds consciously
disregarded the risk posed to Suarez by placement in disciplinary housing.
Reynolds was an OMH employee who, like the others, had the authority to send
Suarez to the FDU for further mental health treatment at any time, including
when Suarez was in the SHU during the August 17, 2017, meeting and when he
was in keeplock housing during the August 25, 2017, meeting. A reasonable jury
could infer that Reynolds knew that Suarez was decompensating and that he
consciously disregarded the risk to Suarez’s health and well-being by failing to
exercise his ability to remove Suarez from the SHU by referring him to the FDU.
The District Court found that, as a matter of law, Reynolds did not disregard a
risk to Suarez because he “advocated for [Suarez] to be issued the AOT order”
and thus “took affirmative steps to protect [Suarez] from any harm his poor
insight into his mental health condition posed after his release.” Suarez, 2024 WL
75 814664, at *15. But Suarez’s claims are based on the conditions of his confinement,
not his release, and it is undisputed that Reynolds did nothing to address those
conditions. The record is sufficient to preclude summary judgment in favor of
Reynolds on this claim.
The same evidence creates triable issues as to whether Reynolds knew of
the risk posed to Suarez by disciplinary confinement and a lack of medication
and consciously disregarded that risk. The very fact that Reynolds assessed
Suarez for AOT establishes his knowledge that Suarez was noncompliant with
treatment, and that treatment was necessary for Suarez’s own safety and the
safety of others. Reynolds’s own affirmation seeking the AOT order stated that
“[w]hen non-compliant with psychiatric treatment, [Suarez] experiences auditory
hallucinations, mood lability, and suicidal ideation,” and that Suarez “has a
history of violence toward self and others.” App’x at 1265. Reynolds also noted
that “Suarez’s Zyprexa medical had been discontinued approximately five
weeks” before he assaulted and threatened to kill an officer at Downstate. App’x
In light of his authority to send Suarez to the FDU for further mental
76 health treatment at any time, a jury could reasonably infer that Reynolds
consciously disregarded Suarez’s serious medical needs by failing to divert him
for further medical attention. The District Court’s conclusion that, as a matter of
law, Reynolds acted only to benefit Suarez overlooked material evidence to the
contrary. Accordingly, Reynolds is not entitled to summary judgment on this
claim.
5. Defendant Baker
Finally, there are genuine disputes of material fact as to whether Baker, an
OMH social worker who coordinated Suarez’s post-release mental health
treatment, was deliberately indifferent to Suarez’s conditions of confinement and
medical needs.
The record supports an inference that Baker knew that disciplinary
housing posed a risk to Suarez’s health. Baker began her pre-release work in
July 2017 by requesting Suarez’s records, which documented his medical history,
including that disciplinary sanctions and single-cell housing were “[r]isk
factors.” App’x at 1440. A jury could also infer that Baker knew that Suarez was
decompensating. Baker received an email from the OMH AOT Coordinator on
77 August 11, 2017, with Suarez’s Discharge Plan from Kirby, which expressly
flagged Suarez’s likelihood of decompensating without medication. That
warning came over a week after Baker’s first meeting with Suarez, during which
Baker noted that “Zyprexa . . . w[as] discontinued due to [Suarez’s] refusal.”
App’x at 575. Then, at the August 16, 2017, meeting between Suarez and Baker
shortly after the email with the Kirby records, and while Suarez was housed in
the SHU, Baker noted that, although Suarez maintained appropriate eye contact
and lacked symptoms, his “[i]nsight and judgment [were] poor.” App’x at 583.
Later, on August 25, 2017, after Suarez was released from the SHU but subject to
keeplock, Baker and Reynolds met with Suarez; at that meeting, Suarez had a
mildly elevated affect and was smiling and laughing inappropriately. From this,
a jury could infer that Baker knew that Suarez faced a risk of decompensating,
that he was decompensating, and that disciplinary housing was a risk factor to
him.
Given the evidence of Baker’s knowledge, a reasonable jury could
conclude that Baker was deliberately indifferent to Suarez’s conditions of
confinement. While Baker had a more limited role in Suarez’s treatment than the
other OMH defendants, she was an OMH employee with the undisputed
78 authority to divert Suarez to the FDU when she witnessed signs of
decompensation. Whether her failure to do so constituted deliberate indifference
to the serious risk to Suarez’s well-being posed by his conditions of confinement
is a determination that must be left to the ultimate trier of fact.
The evidence likewise supports Baker’s knowledge of the risk posed to
Suarez’s health by his placement in disciplinary confinement and by the lack of
medication. Not only did Baker review Suarez’s medical records before their
first meeting, which detailed his medical history and risk of decompensation,
but, as mentioned, when Baker met with Suarez on August 3, 2017, while he was
in disciplinary confinement, to discuss his mental health care upon release, Baker
herself noted the discontinuation of Zyprexa due to Suarez’s noncompliance.
Then, on August 11, 2017, Baker received, by email, Suarez’s Kirby Discharge
Summary, which stated: “Accepting facility to encourage medication compliance
as patient will decompensate if non-compliant.” App’x at 1448; 2001-02. From
this evidence, a jury could infer that Baker knew Suarez was at risk of
decompensating without medication.
Moreover, as discussed, record evidence supports an inference that Baker
79 knew that Suarez, who was not taking medication, was in fact decompensating in
disciplinary confinement. While Suarez denied “experiencing psychiatric
symptoms” when the two met on August 16, 2017, Baker noted Suarez’s poor
insight and judgment. App’x at 582-83. And on August 25, 2017, while Suarez
denied hallucinations or needing medication, Reynolds’s notes from the same
meeting (which Baker attended) noted Suarez’s inappropriate smiling and
laughter.
A jury could likewise infer that Baker was deliberately indifferent because
she failed to take any action to address Suarez’s serious medical needs while he
was incarcerated. While Baker did encourage Suarez to seek treatment after his
release from Downstate and scheduled an appointment for him at a clinic near
his mother’s house, Baker did not exercise her undisputed authority as an OMH
staff member to divert him for further treatment in the FDU while he was housed
at Downstate, in spite of the concerning behaviors she witnessed. That evidence
is sufficient to raise a triable issue of fact.
* * *
We note, in closing, that the dissenting opinion suggests that our holding
faults defendants for failing to “continue[] Suarez’s medication over his
80 objection.” Dissenting Op. at 14. Not so. Suarez has not argued, and we do not
conclude, that the only way defendants could have provided him with
constitutionally adequate medical care would be to require him to continue his
medication against his will. As described at length above, see supra Section I.C.1,
defendants had a wide range of health treatment options available, including
medication education and transfer to the FDU. The fact that Suarez was not
taking Zyprexa undoubtedly increased his risk of decompensation, but that does
not mean that the only available means of mitigating that risk was forcibly
medicating him. By reducing the issue of adequate medical treatment to the
single question of whether Suarez was receiving one medication, the dissenting
opinion distorts the record and misconstrues our holding.
IV. CONCLUSION
For the foregoing reasons, the District Court erred in granting summary
judgment to defendants on Suarez’s Eighth Amendment deliberate indifference
claims. We VACATE the judgment and REMAND for further proceedings
consistent with this opinion.
81 24-872 Suarez v. Morton
PARK, Circuit Judge, dissenting:
Elvin Suarez served a two-year sentence for assaulting a police officer. The day after he was released from prison, he stabbed his mother repeatedly with a kitchen knife. He blamed his actions on his medical team and prison officials from when he was imprisoned. He sought money damages, claiming that they violated the Eighth Amendment by honoring his request to discontinue his medication and by placing him in solitary confinement after he attacked corrections officers. The district court sensibly granted summary judgment to Defendants, concluding that they were not deliberately indifferent to Suarez’s condition. Everyone on Suarez’s medical team had observed that he was calm and not decompensating while in disciplinary housing. 1 And the prison officials had relied on the medical team’s assessments in making disciplinary decisions, which were unusually lenient due to Suarez’s mental-health needs. But the majority’s decision concludes otherwise by misreading the record and misapplying Eighth Amendment doctrine. I respectfully dissent.
I
“In order to establish a violation of his Eighth Amendment rights, an inmate must show (1) a deprivation that is objectively, sufficiently serious that he was denied the minimal civilized measure
1 Psychiatric decompensation is “a breakdown in an individual’s defense mechanisms, resulting in progressive loss of normal functioning or worsening of psychiatric symptoms.” Decompensation, APA Dictionary of Psychology, Am. Psych. Ass’n, https://dictionary.apa.org/decompensation (last visited Mar. 13, 2026). of life’s necessities, and (2) a sufficiently culpable state of mind on the part of the defendant official, such as deliberate indifference to inmate health or safety.” Gaston v. Coughlin, 249 F.3d 156, 164 (2d Cir. 2001) (quotation marks omitted). The Eighth Amendment thus has “both objective and subjective components.” Walker v. Schult, 45 F.4th 598, 610 (2d Cir. 2022). A plaintiff must satisfy both to establish an Eighth Amendment violation but only the latter is at issue here. 2
Suarez failed to present evidence that would permit a reasonable jury to find deliberate indifference as to any Defendant. Start with Suarez’s medical team. The majority concludes that a jury could find that five care providers—two psychiatrists, two clinicians, and a social worker—were all deliberately indifferent on the theory that they knew of but disregarded the risk of Suarez decompensating. But the undisputed facts tell a different story. Each provider exercised good-faith diligence in caring for Suarez and independently concluded that he remained stable throughout his three-month incarceration. Even if those conclusions proved wrong in hindsight, “negligence is not deliberate indifference.” Brock v. Wright, 315 F.3d 158, 164 (2d Cir. 2003).
A
Suarez claims that his treating psychiatrist, Dr. Abdul Qayyum, acted with deliberate indifference by discontinuing his prescription for Zyprexa, an antipsychotic medication. According to Suarez, Dr.
2 The majority correctly recognizes that the objective prong was “not adjudicated at summary judgment,” ante at 43, so the district court may consider that issue on remand.
2 Qayyum made that decision based on Suarez’s self-reporting and despite knowing that “some people believe they do not need medication, but once they stop taking it they begin to decompensate.” Appellant’s Br. at 33. That narrative distorts Dr. Qayyum’s testimony.
Dr. Qayyum first examined Suarez on June 30, 2017. During that session, he concluded that Suarez appeared “coherent,” “logical and future oriented,” and that Suarez “was not experiencing delusions.” App’x at 445. After Suarez refused his medication, Dr. Qayyum detailed the benefits of Zyprexa, discussed alternative medications, and discouraged Suarez from stopping the medication. He warned that “some people believe they do not need medication, but once they stop taking it they begin to decompensate.” Id. at 445- 46. Still, he believed that “if the individual is stable, not showing any signs of psychosis, the individual has the right to decline medication.” Id. at 445.
Two more sessions followed. On July 21, Dr. Qayyum again found Suarez “coherent,” with his “insight and judgment . . . fair.” App’x at 447. Though he encouraged Zyprexa, Dr. Qayyum noted that Suarez cogently “exercised his right to decline medication.” Id. And on August 24, Dr. Qayyum again discussed the benefits of medication and confirmed that, in the absence of “psychotic symptoms,” he could not involuntarily administer the drug. Id. at 448. 3
To be clear, Suarez insisted on stopping the medication he now says 3
he should have been given even after being informed of these risks. The majority suggests that Dr. Qayyum’s knowledge that “some individuals
3 So on three different occasions, Dr. Qayyum assessed Suarez to be stable, largely asymptomatic, and entitled to decline medication. His clinical opinion was that the signs to which Suarez now points— inappropriate laughter, kicking a guard—were isolated events, “not evidence of psychiatric [decompensation].” App’x at 448. And all the while, he monitored Suarez’s progress, encouraged him to keep taking his medication, and made sure that he continued with individual therapy.
Suarez’s discontinuation of Zyprexa was thus based on his desire to stop taking the medication, as well as Dr. Qayyum’s belief that Suarez “did not show any signs of psychosis” and that the circumstances did not warrant a court order for involuntary medication, which would have required that Suarez first decompensate, spend time in the Forensic Diagnostic Unit, 4 and still display psychotic symptoms. App’x at 447. Suarez now faults Dr. Qayyum, but a “complaint that a physician has been negligent in diagnosing or treating a medical condition does not state a valid claim
with mental illness ‘believe they do not need medication, but once they stop taking it they begin to decompensate’” “alone might be sufficient to support an inference of knowledge of the risk posed to Suarez by lack of medication.” Ante at 71. If that were correct, it is difficult to see how any inmate prescribed medication for mental illness could ever stop taking it, no matter how coherent or cogent he is. 4 The Forensic Diagnostic Unit houses prisoners “in need of emergency mental health care.” App’x at 361. Prisoners transfer into that unit at their care providers’ request, “regardless of whether [they were] housed in [the Special Housing Unit] or in general population.” Id.
4 of medical mistreatment under the Eighth Amendment.” Estelle v. Gamble, 429 U.S. 97, 106 (1976).
The majority’s view is that the Eighth Amendment required Dr. Qayyum to disregard his own observations as well as Suarez’s representations that he was not experiencing symptoms because Qayyum also saw Suarez smile and laugh “inappropriately” and his mood was “slightly blunted.” Ante at 69. But Dr. Qayyum explained that “[l]aughing inappropriately or talking to oneself is not considered a significant sign of decompensation.” App’x at 448. 5 The majority disagrees with Dr. Qayyum’s medical judgment, but a disagreement about an issue of medical judgment “cannot form the basis of a deliberate indifference claim.” Hernandez v. Keane, 341 F.3d 137, 147 (2d Cir. 2003).
5 The majority argues that a jury could conclude that Dr. Qayyum knew Suarez was at the risk of decompensating because he received the Kirby Discharge Summary, which expressed that Suarez risked decompensating if unmedicated. See ante at 71. But the fact that over a year earlier, a different physician observing different symptoms made the conclusory statement that Suarez “will decompensate if non-compliant” with his medication does not permit the inference that Dr. Qayyum knew Suarez was decompensating in August 2017. App’x at 1448. In any event, the fact that different doctors may have disagreed about Suarez’s treatment does not establish a violation of the Eighth Amendment. See White v. Napoleon, 897 F.2d 103, 110 (3d Cir. 1990) (“[N]o claim is stated when a doctor disagrees with the professional judgment of another doctor.”).
5 B
Suarez next claims that Samantha Kulick—his primary clinician until his placement in the Special Housing Unit (“SHU”)— “took no action” even after “witness[ing] signs of Mr. Suarez’s decompensation.” Appellant’s Br. at 36. That too blinks the record.
During her intake session, Kulick recommended Zyprexa, although she could not prescribe it. On June 27 and July 19, Kulick observed that Suarez lacked any signs of distress and explained to him how to access mental-health services between appointments. And in examining Suarez directly after his disciplinary incident, Kulick found him to be “calm” and not “actively decompensating,” so she believed that “there was no justification for removing him from SHU.” App’x at 424; see id. (“[We are] only able to remove an individual from SHU if they are decompensating.”). Kulick did not fail to act in the face of a clear risk of decompensation—to the contrary, she recommended medication, tracked Suarez’s progress, and confirmed his stability.
Here too, the majority assigns an unsupportable amount of weight to the slimmest of evidence. It argues that even though Kulick observed Suarez as “having a neutral mood and an affect within the normal range,” a jury could conclude that Kulick must have known that Suarez was decompensating because he had sporadic eye contact and seemed as though “he may be under the influence.” Ante at 59. But the majority points to nothing in the record establishing that these are symptoms from which an observer should know that Suarez was “experiencing serious mental health issues and could be decompensating.” Id. Although Kulick prepared a “Clinical
6 Assessment of Suicide Risk” form noting that Suarez’s “disciplinary sanctions” and “single [c]ell” housing were potential risk factors for him, this same form also noted that Kulick “did not observe an increased risk for self-harm” following Suarez’s disciplinary sanctions, and that Suarez was not experiencing current suicidal ideation or intent. App’x at 1440. Worse, the majority faults Kulick for recommending that Suarez be admitted to a residential treatment program if he started to decompensate. Ante at 59-60. But such a statement is not evidence from which a jury could conclude that Kulick was deliberately indifferent to the risk of Suarez decompensating; rather, it reflects her consistent belief that Suarez was not decompensating while she was treating him.
C
Suarez also claims that Maura DiNardo—his SHU clinician— was deliberately indifferent because she allowed Suarez to “remain in SHU and keeplock for a month and failed to offer any meaningful treatment during that time.” Appellant’s Br. at 39. But DiNardo lacked disciplinary authority, so it was not her decision to place or to keep Suarez in confinement. Indeed, she advised against moving Suarez to SHU, though only out of “an abundance of caution,” not because he “was in such a state that he needed to be removed.” App’x at 416. 6
6 Although the majority asserts that DiNardo had “authority to divert Suarez,” ante at 67, DiNardo was authorized to remove a person from SHU only “if the person was in crisis [or] if they were suicidal or w[ere] experiencing psychiatric decompensation,” App’x at 414. Her evaluation
7 Nor did DiNardo shirk her treatment duties. She met with Suarez when he arrived in SHU and found “no medical basis” to remove him. App’x at 414. She conducted another formal evaluation on August 22 and again detected no “signs of psychiatric decompensation.” Id. at 415. And she continued monitoring him while doing rounds in SHU, making certain that he did not exhibit “any symptoms relating to his mental illness.” Id. at 414. The majority reduces the uncontroverted evidence that DiNardo continued to monitor Suarez while he was in SHU to testimony that DiNardo “would ‘say hi’ to Suarez through his cell door during rounds.” Ante at 66. That mischaracterizes her testimony. DiNardo testified that she saw Suarez “Monday through Friday when [she] made rounds in SHU” and that he was “stable at all times that [she] saw him.” App’x at 414. She further testified that some days all Suarez (not DiNardo) wanted to do was “say hi,” but on other days he would engage her in conversation. Id. Further, she offered Suarez a private interview “which he declined.” Id. There is thus no basis from which a jury could conclude that DiNardo was deliberately indifferent to Suarez’s medical needs.
D
Suarez claims that Dr. Brandon Reynolds—the psychiatrist who prepared his discharge order—also acted with deliberate indifference by allowing Suarez to remain unmedicated and to leave the prison. But Dr. Reynolds was not Suarez’s treating physician. And he too found that Suarez “never demonstrated any signs nor
of Suarez was that he was neither decompensating nor suicidal, so she lacked the authority to make such a referral.
8 symptoms that would lead to the conclusion that [he] lacked the capacity to make [the] decision . . . whether to take medication.” App’x at 455 (emphasis added). So Dr. Reynolds believed that Suarez retained “the right” to refuse Zyprexa and arranged for post-release treatment—including medication “as clinically indicated”—at an outpatient clinic.
Suarez tells a different tale, arguing that there is “no real question Reynolds knew Mr. Suarez was decompensating.” Appellant’s Br. at 41. To be sure, Dr. Reynolds found Suarez’s affect “mildly elevated” and at times noticed “inappropriate smiling and laughter.” App’x at 456. But even accounting for these isolated symptoms, Dr. Reynolds’s clinical view was that Suarez “was able to survive safely in the community” and “did not pose a threat of danger to himself or others.” Id. at 459; see also id. (noting that the fact that Suarez stabbed his mother after he was released “does not negate the fact that he was clinically stable at the times I met with him”).
The majority says that this “inappropriate smiling and laughter” creates a genuine dispute of material fact as to whether Dr. Reynolds was required to disregard both his own clinical observations and Suarez’s representations about his mental health and to conclude instead that Suarez was decompensating. Ante at 74. But as Dr. Reynolds explained, such a conclusion would be medically unsound “because such symptoms, by themselves, would neither meet criteria for a mood episode nor indicate clinical instability.” App’x at 456. So there is no basis for concluding that he was deliberately indifferent to Suarez’s medical needs.
9 E
Finally, Suarez claims that Chesney Baker—a social worker responsible for his discharge plan—was deliberately indifferent because she failed to provide necessary treatment despite knowing that he would decompensate without medication. But that argument also fails. Baker played “no role” in the decision to place Suarez in SHU and worked only to encourage Suarez to discuss his medication status and mental-health needs with a physician. App’x at 406. Indeed, Baker arranged for him to be seen by a clinic immediately after his release, even though such appointments often take weeks to secure.
What is more, Suarez cannot establish that Baker ignored decompensation warnings. Baker testified that “[o]n every occasion when I met with Mr. Suarez[,] he never presented as being in a state of decompensation” and was instead “able to engage and participate in the discussions regarding his release plan.” App’x at 408-09 (emphasis added). Finding “no evidence of formal thought disorder,” “hallucinations, delusions, obsessions, phobias or over- valued ideas,” she deemed Suarez “mentally stable” and saw “no basis on which to transfer him to the Forensic Diagnostic Unit.” Id. at 409. Contrary to Suarez’s claims, Baker believed that she and other members of the treatment team took “all the necessary actions” in caring for Suarez and facilitating his safe release. Id. at 410.
In sum, no reasonable jury could find that any of the five treatment providers operated with “a state of mind equivalent to the familiar standard of recklessness as used in criminal law.” Smith v. Carpenter, 316 F.3d 178, 184 (2d Cir. 2003) (quotation marks omitted).
10 All five repeatedly evaluated Suarez, discovered no signs of decompensation, played no role in the decision to discipline him, and identified no need to transfer him from SHU. The majority relies mainly on isolated instances of “inappropriate” laughter or smiling along with the fact of confinement and Suarez’s medical history, but it points to nothing from which a jury could conclude that these symptoms made the treatment providers aware of the risk that Suarez was decompensating. Even with the inappropriate benefit of hindsight, see Parrish ex rel. Lee v. Cleveland, 372 F.3d 294, 303-04 (4th Cir. 2004) (noting that the subjective awareness prong is concerned with “the risk as [the Defendants] perceived it,” “not as it now may be perceived enlightened by the benefit of hindsight”), these symptoms on their own are not considered significant signs of decompensation, and none of the five treatment providers viewed them as signs that Suarez was in fact decompensating.
II
Suarez’s arguments as to the two prison officials fare no better. Suarez first claims that Superintendent Robert Morton was deliberately indifferent because he failed to refer Suarez for treatment and to remove him from SHU. But Morton carried “no authority to evaluate whether an incarcerated individual required medication.” App’x at 358. Still, he “knew that at any time if the penalty aggravated [Suarez’s] mental health condition,” the treatment providers “would remove him” and provide “immediate mental health treatment.” Id. at 363. And Morton confirmed that Suarez’s confinement in SHU—already “partially suspended” in recognition of his mental-health history—accounted for Suarez’s condition and
11 was not “excessive.” Id. at 347. Suarez’s treatment providers also uniformly observed that Suarez was not in fact decompensating while he was in disciplinary housing, and it was not deliberate indifference for Morton to credit their medical opinions. See Brock, 315 F.3d at 164 (no deliberate indifference where superintendent deferred to treating physician’s recommendation).
Suarez next argues that Peter Horan—the prison official who conducted the disciplinary hearing—was deliberately indifferent because he “simply ignored DiNardo’s treatment advice” in sentencing Suarez to disciplinary confinement. Appellant’s Br. at 44. When Suarez threatened to kill people, he “posed a threat to the safety of staff or other inmates” with his “verbal threats coupled with physical contact with staff,” so Horan ordered that Suarez be confined to disciplinary housing to incapacitate him and to deter future assaults. App’x at 347. But nothing about this sanction shows that Horan ignored DiNardo’s treatment advice or was deliberately indifferent to Suarez’s mental-health needs.
Horan accounted for Suarez’s “mental health status” by “basically giv[ing] him the lightest disposition I have eve[r] given on an assault on staff in my career” and removing Suarez from SHU “as quickly as possible.” App’x at 1069, 1092. Horan’s notes from the disciplinary hearing memorialized that Suarez’s “mental health issues were taken into consideration” and that a portion of the sanctions were “suspended” as a result. Id. at 344. And Horan was “aware that should Mr. Suarez begin to suffer mental-health issues, [the treatment providers] could and would have him removed to the
12 Forensic Diagnostic Unit.” Id. at 338. 7 What is more, Horan testified that “[a]t no time during the hearing [] did I believe that Mr. Suarez was decompensating or at the risk of becoming violent.” Id. In fact, Horan explained that “I would not have sentenced Mr. Suarez to keeplock if I believed that keeplock would cause him harm.” Id. Deliberate indifference in this context means that a prison official “must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Tangreti v. Bachmann, 983 F.3d 609, 619 (2d Cir. 2020) (emphasis added) (quotation marks omitted). But nothing in the record would permit a jury to conclude that Horan actually drew the inference that this “light” punishment posed a serious risk to Suarez’s health.
Suarez has thus failed to establish a genuine dispute of fact as to either Morton or Horan. Neither played a role in his mental-health treatment or “deliberately def[ied] the express instructions of [Suarez’s] doctors.” Johnson v. Wright, 412 F.3d 398, 404 (2d Cir. 2005) (quotation marks omitted). Both took steps to assure themselves that Suarez was stable, receiving adequate care, and capable of SHU
7 The majority’s citation to Vega is thus inapposite. Ante at 45 (quoting Vega v. Semple, 963 F.3d 259, 273-74 (2d Cir. 2020)). In Vega, we concluded that there was a triable issue regarding deliberate indifference where plaintiffs alleged that defendants knew that inmates “faced substantial risk of serious harm from indoor radon exposure and that Defendants disregarded that risk by failing to take reasonable measures to abate it.” 963 F.3d at 274 (emphasis added). But Horan took “reasonable measures” to abate the risk that disciplinary housing posed to Suarez by partially suspending Suarez’s sentence in consideration of his mental- health needs.
13 confinement. And both relied on the fact that the treatment providers monitoring Suarez’s disciplinary confinement would intervene if necessary. Suarez thus fails to show that Morton and Horan knew of and disregarded an excessive risk to inmate health or safety. Morgan v. Dzurenda, 956 F.3d 84, 89 (2d Cir. 2020).
III
In the majority’s view, Defendants (1) should have continued Suarez’s medication over his objection, despite the unanimous opinion of the medical team that he was stable; and (2) should not have confined Suarez to disciplinary housing, despite the danger he posed to others. The Eighth Amendment does not compel this result. 8
For a plaintiff to prevail on a deliberate indifference claim, the defendant “must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Darby v. Greenman, 14 F.4th 124, 128
8 Indeed, forcing Suarez to continue his medication may have raised other concerns. See, e.g., Washington v. Harper, 494 U.S. 210, 221-22 (1990) (recognizing “a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment”). Although the majority disclaims this implication of its decision, ante at 80-81, it states elsewhere that a Defendant’s awareness that some people who discontinue medication begin to decompensate “alone might be sufficient to support an inference of knowledge of the risk posed to Suarez by lack of medication,” id. at 71 (emphasis added). And the majority repeatedly concludes that Defendants were deliberately indifferent to Suarez’s medical needs because they knew about the risk posed by the “lack of medication,” even though Suarez affirmatively requested to discontinue that medication. Id. at 55, 58, 63, 71, 76, 79.
14 (2d Cir. 2021) (quotation marks omitted). The majority satisfies itself that a jury could find Defendants were “aware of facts from which the inference could be drawn.” Id.; see, e.g., ante at 47 (concluding that there is a triable issue on deliberate indifference because Defendant “knew of Suarez’s serious mental illness and witnessed signs of decompensation”). What is missing from the majority’s analysis is evidence from which a jury could conclude that Defendants actually knew Suarez was decompensating. The majority repeatedly concludes that because something is possible, a reasonable jury could conclude it happened. See, e.g., ante at 61 (“a reasonable jury could conclude that Kulick recognized that Suarez would decompensate without medication, knew his medication had been discontinued, and witnessed signs of decompensation”). That is unsound logic and distorts the summary judgment standard.
Every physician who observed Suarez agreed that he was not decompensating. And there is no suggestion that Defendants based their medical and disciplinary decisions on an “improper motive” rather than their “sound medical judgment.” Chance v. Armstrong, 143 F.3d 698, 704 (2d Cir. 1998). Instead, Suarez simply believes that Defendants should have drawn a different inference from the one that they did about the risk that he would decompensate.
The majority’s decision faults prison officials for failing to predict that Suarez would decompensate upon release and brutally stab his mother. It incentivizes officials to assume that mentally ill patients showing any signs of decompensation are actually decompensating. And it warns prison officials that someone with Suarez’s “mental health profile should not be subject to segregated
15 housing or keeplock status” even when his behavior threatens staff and other inmates. Ante at 48.
I respectfully dissent.
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Cite This Page — Counsel Stack
Suarez v. Sullivan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/suarez-v-sullivan-ca2-2026.