Brown v. Monsalud: Third Circuit Reaffirms That Medical Treatment Disagreements Are Not Actionable Under ADA Title II and Do Not Constitute Eighth Amendment Deliberate Indifference

Court: United States Court of Appeals for the Third Circuit

Panel: Judges Krause, Phipps, and Scirica

Date: October 2, 2025

Disposition: Summary affirmance; no substantial question presented

Note: Not precedential (I.O.P. 5.7), but informative on recurring issues in prison medical care and ADA litigation

Introduction

This appeal arose from a prisoner civil-rights action brought by Keith S. Brown, a Pennsylvania state inmate, against Dr. Mary Joy Monsalud, Dr. Newton, and Karen Holly. Brown alleged: (1) disability discrimination under Title II of the Americans with Disabilities Act (ADA); (2) deliberate indifference to serious medical needs in violation of the Eighth Amendment; and (3) intentional infliction of emotional distress (IIED) under Pennsylvania law. The controversy centered on prison medical professionals allowing Brown to keep prescribed eye drops in his cell for self-administration, which Brown resisted on the ground that his mental-health and suicidal tendencies posed a risk that he might ingest the drops rather than use them as intended.

After removal from state court to the Middle District of Pennsylvania, the District Court dismissed certain ADA claims at the Rule 12(b)(6) stage, then granted summary judgment for all defendants on the remaining federal and state claims and denied Brown’s motion for a preliminary injunction or temporary restraining order. On appeal, the Third Circuit summarily affirmed. Although the decision is nonprecedential, it consolidates several important and commonly litigated principles:

No individual-capacity damages liability exists under Title II of the ADA.
Title II applies to “public entities,” not to individual medical providers as such.
“Purely medical decisions” and disagreements over treatment regimens generally do not state ADA discrimination claims.
A difference of opinion about medication administration, without more, does not amount to Eighth Amendment deliberate indifference.
Under Pennsylvania law, IIED requires outrageous conduct and severe distress (with physical harm) — a high bar not met here.

Summary of the Opinion

Exercising jurisdiction under 28 U.S.C. § 1291, the Third Circuit conducted plenary review of the Rule 12(b)(6) dismissals and the grant of summary judgment, and affirmed on any basis supported by the record. The Court concluded:

ADA (Title II) – Individual Capacity: The District Court properly dismissed individual-capacity ADA claims against all defendants; Title II does not permit damages suits against individual government employees.
ADA (Title II) – Official Capacity/Public Entity: Dismissal of ADA claims against Drs. Monsalud and Newton in their official capacities was proper because they are not “public entities.” As for the ADA claim allowed to proceed against Holly in her official capacity, summary judgment was properly granted because Brown’s allegations amounted to a medical treatment disagreement, not disability-based discrimination by reason of disability.
Eighth Amendment: Summary judgment was proper because the record showed, at most, a disagreement over the mode of administering prescribed eye drops (self-administration in-cell), which does not constitute deliberate indifference to serious medical needs.
IIED (Pennsylvania law): Summary judgment was warranted because defendants’ conduct was not “extreme and outrageous,” and the record did not establish the severe emotional distress (with physical harm) required for IIED.
Injunctive Relief: With summary judgment appropriately granted for defendants, the denial of a preliminary injunction/TRO followed.

Because the appeal presented no substantial question, the Court summarily affirmed under Third Circuit L.A.R. 27.4 and I.O.P. 10.6, and also denied Brown’s motion for appointment of counsel.

Analysis

Precedents Cited and Their Influence

Pleading and Summary Judgment Standards:
- Fowler v. UPMC Shadyside, 578 F.3d 203 (3d Cir. 2009), and Fleisher v. Standard Ins. Co., 679 F.3d 116 (3d Cir. 2012), applying the Twombly plausibility standard at the motion to dismiss stage.
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007): complaint must state a facially plausible claim.
- Blunt v. Lower Merion Sch. Dist., 767 F.3d 247 (3d Cir. 2014) and Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986): summary judgment appropriate when no genuine dispute of material fact exists.
- Murray v. Bledsoe, 650 F.3d 246 (3d Cir. 2011) (per curiam): appellate court may affirm on any basis supported by the record.
ADA Title II Elements and Scope:
- Haberle v. Troxell, 885 F.3d 170 (3d Cir. 2018): elements of a Title II claim (qualified individual with a disability; exclusion from/denial of services, programs, or activities; by reason of disability; by a public entity).
- 42 U.S.C. § 12131(1): definition of “public entity.”
- Garcia v. S.U.N.Y. Health Sci. Ctr. of Brooklyn, 280 F.3d 98 (2d Cir. 2001): no individual liability for damages under the ADA — cited to reinforce the widely accepted rule.
- Fitzgerald v. Corr. Corp. of Am., 403 F.3d 1134 (10th Cir. 2005); Burger v. Bloomberg, 418 F.3d 882 (8th Cir. 2005) (per curiam); Bryant v. Madigan, 84 F.3d 246 (7th Cir. 1996): “purely medical decisions” and alleged failures in medical treatment are not ordinarily actionable as ADA discrimination.
Eighth Amendment Deliberate Indifference:
- Pearson v. Prison Health Serv., 850 F.3d 526 (3d Cir. 2017): two-pronged deliberate indifference standard (serious medical need + deliberate indifference).
- Monmouth County Corr. Inst. Inmates v. Lanzaro, 834 F.2d 326 (3d Cir. 1987): what counts as a “serious medical need” and the principle that mere disagreement with a prescribed treatment regimen does not establish deliberate indifference.
- Durham v. Kelley, 82 F.4th 217 (3d Cir. 2023): deliberate indifference may be shown by intentional refusal to provide care, non-medical delays, denial of prescribed treatment, or denial of reasonable requests leading to suffering or risk of injury.
Intentional Infliction of Emotional Distress (Pennsylvania):
- Bruffett v. Warner Commc’ns, Inc., 692 F.2d 910 (3d Cir. 1982): elements of IIED in Pennsylvania.
- Reeves v. Middletown Athletic Ass’n, 866 A.2d 1115 (Pa. Super. Ct. 2004): “extreme and outrageous” standard and requirement of physical harm.

Legal Reasoning

The Court’s reasoning proceeds along three principal tracks — ADA Title II, the Eighth Amendment, and state IIED — each applying well-established rules to the undisputed contours of Brown’s claims.

1) ADA Title II

Proper defendants and capacities: Title II authorizes suits against “public entities,” not individual-capacity defendants. The District Court therefore dismissed individual-capacity ADA claims against all defendants, a conclusion the Third Circuit affirmed, citing Garcia’s widely adopted rule against individual damages liability under the ADA.
Public entity requirement and official capacity: The District Court dismissed ADA claims against Drs. Monsalud and Newton in their official capacities because they are not “public entities” under § 12131(1). It allowed the ADA claim against Holly in her official capacity to proceed, presumably because that claim could be understood as against the responsible public entity. The Third Circuit affirmed the disposition across the board and, invoking its ability to affirm on any basis, emphasized that — regardless of defendant identity — Brown’s ADA theory failed on the merits.
Medical decisions are not ADA discrimination: Brown’s allegations amounted to a disagreement with a clinical judgment: allowing in-cell access to prescribed eye drops for self-administration despite his stated risk of self-harm. The Court, aligning with Fitzgerald, Burger, and Bryant, reiterated that alleged failures in the quality or manner of medical treatment are not cognizable as ADA discrimination absent exclusion from, denial of, or disparate treatment in a program or service by reason of disability. Because Brown’s allegations sounded in medical judgment rather than discriminatory denial of services or reasonable accommodations, the ADA claims could not stand.

2) Eighth Amendment Deliberate Indifference

Serious medical need and mens rea: Under Pearson and Lanzaro, a prisoner must show a serious medical need and that officials knew of and disregarded an excessive risk to health or safety. Deliberate indifference can appear as intentional denial or non-medical delays of care, denial of prescribed treatment, or refusals leading to suffering or risk of injury (see Durham).
Application to self-administered eye drops: The record reflected that Brown was treated by medical professionals and was prescribed eye drops, with a clinical judgment permitting in-cell possession and self-administration. The gravamen of the dispute was whether — given Brown’s mental health and suicidal ideation — that modality created an excessive risk. The Court agreed with the District Court that, on this record, Brown’s challenge showed a disagreement over the proper method of administration, not deliberate indifference. Such disagreements, without evidence of knowing disregard of an excessive risk, do not satisfy the Eighth Amendment standard (Lanzaro).

3) Intentional Infliction of Emotional Distress (Pennsylvania)

High bar for “outrageousness” and severe distress: To prevail on IIED, a plaintiff must prove conduct that is “so extreme and outrageous as to go beyond all possible bounds of decency,” along with severe emotional distress typically evidenced by physical harm (Reeves).
Application: The defendants’ conduct — examining Brown, prescribing eye drops, and permitting in-cell use — did not approach “outrageousness” under Pennsylvania law. Brown’s disagreement with the treatment regimen could not transform clinical decisions into tortious, atrocious conduct, and the record did not satisfy the severe-distress-with-physical-harm requirement. Summary judgment was therefore proper.

4) Injunctive Relief

Given that the defendants were entitled to summary judgment on all claims, the District Court correctly denied Brown’s request for a preliminary injunction or TRO. Without a likelihood of success on the merits, preliminary relief was unavailable.

Impact and Practical Significance

Clarifying the ADA–medical care boundary: The decision reinforces a clear line: ADA Title II is not a vehicle to challenge the quality or clinical wisdom of medical decisions. Prisoners alleging ADA violations must show exclusion from or denial of programs, services, or activities by reason of disability, or a failure to reasonably accommodate access to such services — not simply a disagreement with how clinicians treat a condition.
Proper ADA defendants and capacities: Plaintiffs should name the “public entity” responsible (e.g., the Department of Corrections or the correctional institution) rather than individual providers. Individual-capacity damages claims under Title II are not viable.
Eighth Amendment threshold: The opinion underscores that mere disagreement with a treatment plan — even where the inmate believes a modality heightens risk — does not show deliberate indifference absent evidence that officials knew of and disregarded an excessive risk and that their conduct reflects something more than negligence or mistaken judgment.
IIED’s demanding standard: Routine or even arguably negligent medical decisions in custodial settings rarely meet Pennsylvania’s “extreme and outrageous” threshold for IIED, especially where the record shows some ongoing care and clinical judgment.
Procedural economy in prisoner litigation: The Court’s use of summary action under L.A.R. 27.4 and I.O.P. 10.6 illustrates the Third Circuit’s willingness to summarily affirm when an appeal presents no substantial question, promoting efficiency in high-volume prisoner litigation.

Complex Concepts Simplified

Title II ADA “public entity” and capacity to be sued: Title II targets discrimination by public entities (state/local governments and their instrumentalities). Individual employees are not proper damages defendants under Title II. An “official-capacity” suit is essentially a suit against the entity itself.
“By reason of disability” vs. “quality of care”: ADA claims require proof that disability was the reason for denial of access to services or failure to accommodate access. Complaints about whether a doctor chose the “right” treatment generally sound in negligence or medical malpractice, not the ADA.
Deliberate indifference (Eighth Amendment) vs. malpractice: Deliberate indifference requires proof that officials knew of and disregarded a substantial risk; mere negligence, malpractice, or a difference of opinion about how to treat a condition is insufficient.
Summary judgment standard: If, after discovery, there is no genuine dispute of material fact and the law favors the movant, the court must enter judgment without a trial.
Preliminary injunction/TRO: Interim relief requires, among other things, a likelihood of success on the merits. If the underlying claims fail on the merits, preliminary relief is unavailable.
Nonprecedential disposition: A “not precedential” opinion in the Third Circuit does not bind future panels, but it can be persuasive and is often instructive, particularly on recurring doctrinal boundaries.

Conclusion

In summarily affirming the District Court, the Third Circuit offers a concise but comprehensive reaffirmation of several settled principles at the intersection of prison medical care, the ADA, and constitutional claims:

Title II ADA claims cannot be maintained against individual defendants for damages and must target discrimination by a public entity.
Medical treatment decisions, even if disputed or arguably unwise, generally do not constitute ADA discrimination.
A mere disagreement over medication administration (here, in-cell self-administration of prescribed eye drops) is not Eighth Amendment deliberate indifference.
Pennsylvania IIED requires extreme and outrageous conduct and severe distress with physical harm — a stringent standard unmet by garden-variety treatment disputes.

Although nonprecedential, Brown v. Monsalud is an instructive reminder to litigants and courts alike: the ADA’s anti-discrimination mandate is distinct from challenges to clinical judgments; the Eighth Amendment punishes deliberate disregard, not mere error; and state tort claims demand conduct far beyond ordinary disagreements over medical care. For practitioners, the opinion underscores the importance of correctly identifying proper ADA defendants (public entities), framing ADA claims around access and accommodation rather than outcomes of medical judgment, and recognizing the high evidentiary thresholds that govern Eighth Amendment and IIED claims.