• The Line Between a Medical Slip-Up and Deliberate Indifference for Section 1983 Liability
  • October 4, 2016 | Author: Bide Akande
  • Law Firm: Heyl, Royster, Voelker & Allen Professional Corporation - Chicago Office
  • How bad does an inmate’s care have to be to create a reasonable inference that a doctor did not just slip up, but was aware of, and disregarded, a substantial risk of harm? This was the issue decided by the Seventh Circuit Court of Appeals in their August 23, 2016 en banc decision Petties v. Carter, No. 14-2674 2016 U.S. App. LEXIS 15524. (7th Cir. Aug. 23, 2016). In that case, the plaintiff brought a 42 U.S.C. § 1983 deliberate indifference action against two doctors at Statesville Correctional Facility, Dr. Carter and Dr. Obaisi, regarding treatment associated with a ruptured Achilles tendon. Petties, 2016 U.S. App. LEXIS 15524, at *1-4. Both parties agreed that the plaintiff’s Achilles tendon rupture constituted an objectively serious condition, but they disputed whether defendants acted with deliberate indifference in responding to the rupture. The en banc court aimed to clarify when a doctor’s rationale for his or her treatment decisions supports a triable issue as to whether that doctor acted with deliberate indifference under the Eight Amendment. To constitute a triable issue, plaintiff had to provide evidence that defendants actually knew of and disregarded a substantial risk of harm to the plaintiff. Id. at *6-7 (citing Farmer v. Brennan, 511 U.S. 825, 837 (1994)) (emphasis added).

    The court found a triable issue regarding plaintiff’s deliberate indifference claims pertaining to Dr. Carter. The court reasoned that: 1) plaintiff’s condition required immobilization to properly heal and prevent further damage; 2) Dr. Carter knew this and could have provided such treatment immediately via a splint; 3) Dr. Carter never explained why plaintiff’s ruptured Achilles tendon did not warrant emergency treatment; and 4) Dr. Carter inexplicably failed to immobilize plaintiff’s ankle or send plaintiff to a specialist or emergency doctor for six weeks, causing unnecessary pain to plaintiff and worsening his medical condition. Id. at *18-22. From this circumstantial evidence, the court held that a jury could also reasonably conclude that Dr. Carter knowingly caused plaintiff substantial harm. Id. The court also held that plaintiff provided a triable issue of fact as to whether Dr. Obaisi was deliberately indifferent by presenting evidence that Dr. Obaisi refused to order physical therapy treatment in accordance with the specialist’s order. Id. at *22-24.

    In presenting its holding, the court stated that “even if a doctor denies knowing that he was exposing plaintiff to a substantial risk of serious harm, evidence from which a reasonable jury could infer a doctor knew he was providing deficient treatment is sufficient to survive summary judgment.” Id. at *2. In its holding, the court emphasized that they have repeatedly rejected the notion that “the provision of some care” automatically meant that the doctor’s medical treatment met the basic standards of the Eighth Amendment. Id. at *15. Instead, the context surrounding a doctor’s medical treatment decisions can potentially override his or her claimed ignorance of the risks arising from that decision. Id. at *15-16.

    When a doctor says he did not realize his treatment decisions (or lack thereof) could cause serious harm to a plaintiff, a jury is entitled to weigh that explanation against certain clues that the doctor did know.... [W]here evidence exists that the defendants knew better than to make the medical decisions that they did, a jury should decide whether or not the defendants were actually ignorant to risk of the harm that they caused. Id. at *15-17.

    The dissent argued that Estelle v. Gamble, 429 U.S. 97 (1976), shielded doctors from liability so long as those doctors provide palliative care to prisoners; however, the majority rejected this argument. Instead, the majority established that Estelle explicitly held that a violation of the Eighth Amendment can be established whether “the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed.” Petties, 2016 U.S. App. LEXIS 15524, n.1 (citing Gamble, 429 U.S. 97, 104-05). “Regardless of how evidenced, deliberate indifference to a prisoner’s serious illness or injury states a cause of action under § 1983.” Petties, 2016 U.S. App. LEXIS 15524, n.1 (citing Gamble, 429 U.S. 97, 104-05). The majority opinion stated that the dissent collapsed “these distinct avenues to proving deliberate indifference into one” to argue, incorrectly, that any response by a physician, so long as it is not harmful, satisfies the Eighth Amendment. Petties, 2016 U.S. App. LEXIS 15524, n.1. The majority opinion also rejected the dissent’s characterization of plaintiff’s claims as a challenge to the quality of his medical care. Id. at n.3. Instead, the majority determined that plaintiff argued that his doctors’ treatment decisions and the resulting harmful consequences supported an assertion that the defendants deliberately refused to provide care they knew that plaintiff required. Id.

    This holding clarifies that §1983 defendants cannot defeat a claim on summary judgment by simply pointing out that the plaintiff received some form of medical treatment. Defendants must give some reasonable rationale for why their treatment decisions do not substantially depart from accepted professional standards. Thus, defendants must be cautious when refusing to follow the instructions of specialists, when failing to follow existing treatment protocols, inexplicably delaying treatment when doing so would exacerbate plaintiff’s pain/medical condition, and/or pursuing easier and less efficacious forms of treatment without exercising professional judgment. See Id. at *13. Factors such as these imply that the doctor knew that the plaintiff required certain treatment and rejected administration of this treatment due to reasons other than reasonable difference in their medical opinions. As such, great care should be taken to ensure that medical providers act according to company treatment policies and that those treatment providers clearly document legitimate justifications for delaying treatment, disregarding a specialist’s instructions, and delaying emergency medical treatment when legitimately warranted.