Zaya v. Sood

• Decision Date: 06 September 2016
• Docket Number: No. 15–1470,15–1470
• Citation: Zaya v. Sood, 836 F.3d 800 (7th Cir. 2016)
• Parties: Joni Zaya, Plaintiff–Appellant, v. Kul B. Sood, Defendant–Appellee.
• Court: U.S. Court of Appeals — Seventh Circuit

836 F.3d 800

Joni Zaya, Plaintiff–Appellant,

v.Kul B. Sood, Defendant–Appellee.

No. 15–1470

United States Court of Appeals, Seventh Circuit.

Argued October 26, 2015

Decided September 6, 2016

Hall Adams, III, Attorney, LAW OFFICES OF HALL ADAMS LLC, Chicago, IL, for Plaintiff–Appellant.

Andrew M. Ramage, Attorney, BROWN, HAY & STEPHENS, LLP, Springfield, IL, for Defendant–Appellee.

Before Wood, Chief Judge, Bauer and Sykes, Circuit Judges.

Sykes, Circuit Judge.

Joni Zaya broke his wrist while he was an inmate at the Henry Hill Correctional Center in Galesburg, Illinois.The prison physician, Dr. Kul B. Sood, sent Zaya to an off-site orthopedic surgeon who took x-rays, fitted Zaya with a cast, and sent him back to the prison with instructions that he return in three weeks for a follow-up exam and additional x-rays.Dr. Sood didn't follow those instructions.Instead he waited nearly seven weeks to send Zaya back to the orthopedic surgeon.By that time Zaya's wrist had healed at an improper angle, and two surgeries were required to repair the defect.Zaya then filed this action under 42 U.S.C. § 1983 claiming that Dr. Sood was deliberately indifferent to his serious medical needs in violation of the Eighth Amendment.The district court granted Dr. Sood's motion for summary judgment, holding that the doctor's decision to delay Zaya's return to the orthopedic surgeon constituted a mere difference of opinion between two medical professionals.Zaya now appeals.

It is well established that a difference of opinion between two doctors is insufficient to survive summary judgment on a deliberate-indifference claim.But when a plaintiff provides evidence from which a reasonable jury could infer that the defendant doctor disregarded rather than disagreed with the course of treatment recommended by another doctor, summary judgment is unwarranted.Because Zaya has provided such evidence, we reverse and remand for further proceedings.

I.Background

On January 14, 2012, Joni Zaya, an inmate at the Henry Hill Correctional Center, injured his left wrist while playing soccer in the prison yard.He was immediately taken to the health-care unit for x-rays and treatment.Two days later Zaya was examined by Dr. Kul B. Sood, a physician and employee of Wexford Health Services, Inc., the private corporation that contracts with the Illinois Department of Corrections to provide medical services to inmates at Henry Hill.After reading Zaya's x-rays, Dr. Sood diagnosed an undisplaced fracture of the left distal radius—in other words, a broken left wrist.Dr. Sood then arranged for Zaya to be examined by Dr. Kenneth Bussey, an off-site orthopedic surgeon.

Dr. Bussey examined Zaya on January 17 and confirmed Dr. Sood's diagnosis.He placed Zaya in a cast and sent him back to Henry Hill with instructions that he return for a follow-up exam and additional x-rays in three weeks.In his exam notes, which he forwarded to the prison, Dr. Bussey explained why the timing of the follow-up visit was important:

I will put [Zaya] in a long-arm cast for 6 weeks.I will see him back in 3 weeks and then get a recheck x-ray in the cast to make sure that it is not displaced.If it does, I could still fix it at 3 weeks rather easily.Right now he doesn't need surgical intervention so I will see him back in 3 weeks.

Dr. Sood acknowledged receipt of Dr. Bussey's notes on January 30.

Despite Dr. Bussey's instructions, Dr. Sood waited for nearly seven weeks to send Zaya back for the follow-up exam and x-rays.During that time, Dr. Sood prescribed pain medication when Zaya complained of discomfort and at one point modified Zaya's cast by cutting the fiberglass.On March 1 Dr. Sood removed the cast and x-rayed Zaya's wrist.The x-rays revealed that the fracture was healing at an improper angle.At that point Dr. Sood authorized a follow-up appointment with Dr. Bussey, who examined Zaya on March 6 and determined that surgery would be required for the fracture to heal properly.Zaya subsequently underwent two operations: one on March 14 to re-break his wrist and insert a metal plate, and another on August 14 to remove the plate.

Zaya filed this suit against Dr. Sood under § 1983, claiming that the more-than-three-week delay in sending him back to Dr. Bussey amounted to deliberate indifference to his serious medical needs in violation of the Eighth Amendment.Dr. Sood moved for summary judgment, arguing that his decision to wait the extra weeks was an exercise of medical judgment.Dr. Sood further maintained that even if his conduct did rise to the level of deliberate indifference, he was entitled to qualified immunity.The district judge accepted that Zaya's fractured wrist was a serious medical condition.However, he concluded that Zaya had not produced evidence from which a reasonable jury could find that Dr. Sood consciously disregarded a known risk by delaying Zaya's return to Dr. Bussey.Accordingly, the judge granted Dr. Sood's motion for summary judgment without reaching the question of qualified immunity.This appeal followed.

II.Discussion

We review the court's order granting summary judgment de novo, evaluating the record in the light most favorable to Zaya and drawing all reasonable inferences in his favor.Burton v. Downey , 805 F.3d 776, 783(7th Cir.2015).Summary judgment is warranted “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.”FED. R. CIV. P. 56(a).A dispute is “genuine”“if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.”Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202(1986).“As to materiality, the substantive law will identify which facts are material.”Id.

The Eighth Amendment provides the substantive law in this case.In Estelle v. Gamble, the Supreme Court held that “deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain’ proscribed by the Eighth Amendment.”429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251(1976)(quotingGregg v. Georgia , 428 U.S. 153, 173, 96 S.Ct. 2909, 49 L.Ed.2d 859(1976) )(citation omitted).“To state a cause of action, a plaintiff must show (1) an objectively serious medical condition to which (2) a state official was deliberately, that is subjectively, indifferent.”Duckworth v. Ahmad , 532 F.3d 675, 679(7th Cir.2008).The parties do not dispute that a fractured wrist is an objectively serious medical condition, so the only question is whether a reasonable jury could conclude that Dr. Sood was deliberately indifferent to that condition.

A.The Deliberate–Indifference Standard

Deliberate indifference requires that a defendant“knows of and disregards an excessive risk to inmate health or safety.”Farmer v. Brennan , 511 U.S. 825, 837, 114 S.Ct. 1970, 128 L.Ed.2d 811(1994).The standard is a subjective one: The defendant must know of facts from which he could infer that a substantial risk of serious harm exists, and he must actually draw the inference.Id.The requirement of subjective awareness stems from the Eighth Amendment's prohibition of cruel and unusual punishment ; “an inadvertentfailure to provide adequate medical care cannot be said to constitute ‘an unnecessary and wanton infliction of pain.’ ”Estelle , 429 U.S. at 105, 97 S.Ct. 285(emphasis added).Whether a prison official was subjectively aware of a 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.”Farmer , 511 U.S. at 842, 114 S.Ct. 1970(citation omitted).

Any inquiry into a defendant's mental state is fraught with difficulties, but those difficulties are often amplified when the defendant is a medical professional.We have consistently held that neither a difference of opinion among medical professionals nor even admitted medical malpractice is enough to establish deliberate indifference.See, e.g. , Petties v. Carter , No. 14–2674, ––– F.3d ––––, ––––, 2016 WL 4631679, slip op. at 8(7th Cir.Aug. 25, 2016)(en banc);Norfleet v. Webster , 439 F.3d 392, 396(7th Cir.2006);Greeno v. Daley , 414 F.3d 645, 653(7th Cir.2005).However, we have also made clear that an inmate need not show that he was “literally ignored” to prevail on a deliberate-indifference claim.Conley v. Birch , 796 F.3d 742, 748(7th Cir.2015)(quotingSherrod v. Lingle , 223 F.3d 605, 611(7th Cir.2000) ).A doctor who provides some treatment may still be held liable if he possessed a sufficiently culpable mental state .SeePetties , ––– F.3d at ––––, 2016 WL 4631679, slip op. at 12.

It is in this context that we have emphasized the deference owed to the professional judgment of medical personnel.McGee v. Adams , 721 F.3d 474, 481(7th Cir.2013);see alsoSain v. Wood , 512 F.3d 886, 894–95(7th Cir.2008)(describing the “ ‘professional judgment’ standard”).By definition a treatment decision that's based on professional judgment cannot evince deliberate indifference because professional judgment implies a choice of what the defendant believed to be the best course of treatment.A doctor who claims to have exercised professional judgment is effectively asserting that he lacked a sufficiently culpable mental state, and if no reasonable jury could discredit that claim, the doctor is entitled to summary judgment.

But deference does not mean that a defendant automatically escapes liability any time he invokes professional judgment as the basis for a treatment decision.When the plaintiff provides evidence from which a reasonable jury could conclude that the defendant didn't honestly believe his proffered medical explanation, summary judgment is unwarranted.SeePetties , ––– F.3d at ––––, 2016 WL 4631679, slip op. at 12.(“When a doctor says he did...