Petties v. Carter
| Decision Date | 23 August 2016 |
| Docket Number | No. 14–2674,14–2674 |
| Citation | 836 F.3d 722 |
| Parties | Tyrone Petties, Plaintiff–Appellant, v. Imhotep Carter and Saleh Obaisi, Defendants–Appellees. |
| Court | U.S. Court of Appeals — Seventh Circuit |
Rami Naji Fakhouri, Attorney, Goldman Ismail Tomaselli Brennan & Baum LLP, Chicago, IL, for Plaintiff–Appellant.
Robert L. Larsen, Attorney, Cunningham, Meyer & Vedrine, Warrenville, IL, Michael R. Slovis, Attorney, Cunningham, Meyer & Vedrine, Chicago, IL, for Defendants–Appellees.
Before Wood, Chief Judge, and Posner, Flaum, Easterbrook, Kanne, Rovner, Williams, Sykes, and Hamilton, Circuit Judges.
, Circuit Judge.
Tyrone Petties suffered a debilitating rupture in his Achilles tendon
, which caused him extreme pain and impeded his mobility over the course of three years. He brought a lawsuit under 42 U.S.C. § 1983 against his doctors at Stateville Correctional Facility, alleging they failed to alleviate his suffering and to enable his recovery from the injury. We heard this case en banc to clarify when a doctor's rationale for his treatment decisions supports a triable issue as to whether that doctor acted with deliberate indifference under the Eighth Amendment. We conclude that even if a doctor denies knowing that he was exposing a 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. Because we find that Petties has produced sufficient evidence for a jury to conclude that the doctors knew the care they were providing was insufficient, we reverse the district court's grant of summary judgment to the defendants.
Petties was walking up the stairs of his cell house at Stateville in January 2012 when he heard a loud pop and felt excruciating pain and weakness in his left Achilles tendon. It was not the first time he had suffered such an injury. In 2010 he suffered a partial rupture
in his right Achilles tendon at the prison which had not fully healed.
An Achilles tendon rupture
is a tear in the tendon which impedes the ability of the foot to point downward, causing pain and limiting mobility. Walking around on a ruptured tendon exacerbates the injury, increasing the gap between the torn edges of a tendon because of the way that muscles contract in the foot and calf. Immobilizing the injured foot prevents stretching of the tear and allows the torn edges of the tendon to sit together, and scar tissue to form, rejoining the edges. When an Achilles rupture is not immobilized, the stretching apart of the torn tendon edges when the injured foot hits the ground causes severe pain and weakness.
Petties went to Stateville's health clinic and eventually saw Dr. Imhotep Carter, the medical director of Stateville (though his actual employer was Wexford Health Sources, a private contractor of medical services to correctional facilities). Before Petties, Dr. Carter had seen approximately ten Achilles tendon ruptures
in his twenty-year career. As the prison's medical director, Dr. Carter was in charge of implementing Wexford's medical policies and procedures, among which was a specific treatment protocol for patients with ruptured Achilles tendons. The protocol advised that patients receive a splint, crutches, and antibiotics if there were lacerations to the site of injury, and then be sent to a specialist for further treatment.
Dr. Carter's notes reflect that he thought Petties had an Achilles tendon rupture
, and that he followed some of Wexford's protocol, but not all of it. He gave Petties crutches, ice, and Vicodin. He also authorized one week of “lay-in” meals, which meant that Petties did not have to walk to the cafeteria, but could eat in his cell. Finally, he referred Petties to a specialist, but that appointment did not happen for almost six weeks. In the meantime, Dr. Carter did not provide Petties with a splint, boot, cast, or other device that would immobilize his foot. About a month later, after Petties reported to the infirmary that his tendon was “killing him” and keeping him from climbing stairs, Petties saw Dr. Carter again and received a renewed prescription for crutches, pain medication, lay-in meals, and assignment to a lower bunk to keep pressure off his foot. But he still did not receive a splint.
In March 2012, Petties had an MRI taken which showed an Achilles tendon rupture
. There was a gap between the torn ends of the tendon that measured approximately 4.7 centimeters. About a week later, Petties met with Dr. Anuj Puppala, an orthopedic specialist, who noted that the lack of “any sort of cast” was potentially creating the gapping at the tendon rupture site. He recommended an orthopedic boot to prevent further gapping and to alleviate pain, and gave one to Petties. Finally, he thought that surgery might be necessary due to the gapping, and referred Petties to an ankle specialist. When Petties returned to Stateville, Dr. Carter authorized use of the boot, along with crutches, ice, and assignment to a lower bunk. Petties asserts that Dr. Carter said he would not order surgery because it was too costly.
In July 2012, Petties finally saw an ankle specialist, Dr. Samuel Chmell, who ordered a second MRI after noting weakness in Petties's ankle. Dr. Chmell also ordered physical therapy, gentle stretching exercises, and follow-up treatment. In August 2012, Dr. Carter was replaced as the medical director of Stateville by Dr. Saleh Obaisi, another Wexford employee. Dr. Obaisi approved the order for a second MRI, but did not authorize physical therapy. According to Petties, he also said that surgery was too expensive.
That September, Petties had his second MRI, which showed a partial tear in his tendon, indicating some healing. But he continued to complain of pain, and Dr. Obaisi gave him Tylenol
, approved a low bunk permit, and continued his use of the boot. Dr. Obaisi renewed the low bunk permit and use of the boot in November, and again the following June. Petties experienced pain, soreness and stiffness as late as March 2014, over two years after the injury.
In November 2012, Petties filed a lawsuit under 42 U.S.C. § 1983
against Dr. Carter and Dr. Obaisi for deliberate indifference in violation of the Eighth Amendment. The district court granted summary judgment to Dr. Carter and Dr. Obaisi. Petties appeals.
We review the district court's grant of summary judgment de novo , viewing the record in the light most favorable to Petties, and drawing all inferences in his favor. Pagal v. TIN Inc ., 695 F.3d 622, 624 (7th Cir. 2012)
.
“The Constitution does not mandate comfortable prisons, but neither does it permit inhumane ones.” Farmer v. Brennan , 511 U.S. 825, 832, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994)
(internal citations and quotation marks omitted). Every claim by a prisoner that he has not received adequate medical treatment is not a violation of the Eighth Amendment. Estelle v. Gamble , 429 U.S. 97, 105, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). But the Eighth Amendment safeguards the prisoner against a lack of medical care that “may result in pain and suffering which no one suggests would serve any penological purpose.” Id . at 103, 97 S.Ct. 285.1 To determine if the Eighth Amendment has been violated in the prison medical context, we perform a two-step analysis, first examining whether a plaintiff suffered from an objectively serious medical condition, and then determining whether the individual defendant was deliberately indifferent to that condition. Farmer , 511 U.S. at 834, 114 S.Ct. 1970
; see also
Berry v. Peterman , 604 F.3d 435, 440 (7th Cir. 2010).
In evaluating an Eighth Amendment claim, we start by determining if the medical condition the plaintiff suffered was objectively serious. Farmer , 511 U.S. at 834, 114 S.Ct. 1970
; see also
Walker v. Peters , 233 F.3d 494, 498 (7th Cir. 2000). Here, the parties agree that an Achilles tendon rupture is an objectively serious condition, but they dispute whether in responding to the rupture, the defendants acted with deliberate indifference.
To determine if a prison official acted with deliberate indifference, we look into his or her subjective state of mind. Vance v. Peters , 97 F.3d 987, 992 (7th Cir. 1996)
(citing Farmer , 511 U.S. at 842, 114 S.Ct. 1970 ). For a prison official's acts or omissions to constitute deliberate indifference, a plaintiff does not need to show that the official intended harm or believed that harm would occur. Id. at 992. But showing mere negligence is not enough. Estelle , 429 U.S. at 106, 97 S.Ct. 285 (); McGee v. Adams , 721 F.3d 474, 481 (7th Cir. 2013) (). Even objective recklessness—failing to act in the face of an unjustifiably high risk that is so obvious that it should be known—is insufficient to make out a claim. Farmer, 511 U.S. at 836–38, 114 S.Ct. 1970. Instead, the Supreme Court has instructed us that a plaintiff must provide evidence that an official actually knew of and disregarded a substantial risk of harm. Id. at 837, 114 S.Ct. 1970. Officials can avoid liability by proving they were unaware even of an obvious risk to inmate health or safety. Id . at 844, 114 S.Ct. 1970.
The difficulty is that except in the most egregious cases, plaintiffs generally lack direct evidence of actual knowledge. Rarely if ever will an official declare, “I knew this would probably harm you, and I did it anyway!” Most cases turn on circumstantial evidence, often originating in a doctor's failure to conform to basic standards of care. While evidence of medical malpractice often forms the basis of a deliberate indifference claim, the Supreme Court has determined that plaintiffs must show more than mere evidence of malpractice to prove deliberate indifference....
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