Verdicts

Petties eventually saw Dr. Imhotep Carter, the medical director of Stateville, although Carter's actual employer was Wexford Health Sources, a private medical services contractor to correctional facilities. Prior to treating Petties, Dr. Carter had treated approximately 10 Achilles tendon ruptures in his 20-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. It advised that patients receive a splint, crutches, and antibiotics if there were lacerations to the site of injury, and that patients then be sent to a specialist for further treatment. Dr. Carter followed most of these protocols, but he did not splint the injured area to keep it immobile. He ordered a specialist consult, but it was not to take place for six more weeks. When Petties complained of severe pain again a month later, Dr. Carter ordered the same treatment as before, again excluding the splint or other device that would have immobilized the patient's foot. In March 2012, Petties had an MRI taken, which showed an Achilles tendon rupture with a gap between the torn ends of approximately 4.7 centimeters. About a week later, Petties was seen by orthopedic specialist Dr. Anuj Puppala, who told Petties the gap in the ruptured tendon might have been caused by failure to immobilize the foot with “any sort of cast.” Dr. Puppala gave an orthopedic boot to Petties to prevent further gapping and to alleviate pain. He then referred Petties to an ankle specialist so that surgery could be considered. Petties alleged in his suit that when he returned to the prison, Dr. Carter authorized use of the boot, along with his own previously ordered remedies, but refused to consider ordering surgery because it would be too expensive.

Petties brought suit against Dr. Carter, among others, alleging he was in extreme pain for years and his mobility was impeded by Dr. Carter's course of treatment. Under 42 U.S.C. § 1983, he also brought suit against his Stateville Correctional Facility doctors, alleging that they failed to alleviate his pain and allow him to recover from his injuries.

Citing the teachings of Farmer v. Brennan, 511 U.S. 825 (1994), the Seventh Circuit noted that, to prove a claim of deliberate indifference, “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 … . Officials can avoid liability by proving they were unaware even of an obvious risk to inmate health or safety.” The problem for plaintiffs, however, 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!'” stated the court. While blatant disregard for medical standards could support a finding of mere medical malpractice, it might also rise to the level of deliberate indifference. “[H]ow 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?” asked the court.

In this case, the court concluded that the evidence presented by Petties was enough to keep his suit alive. Dr. Carter testified that he was responsible for implementing Wexford's protocol, which stated that the primary course of treatment for an Achilles rupture included a splint, and also testified he was not aware of any shortage of splints at the facility while he was treating Petties. Dr. Carter further testified that he thought crutches would keep the patient's weight off of his foot, so a boot or other immobilizing device was not necessary. However, he and the plaintiff's other treating doctors also testified that there is a purpose to immobilization that goes beyond prevention of weight-bearing on the injured foot so a “jury could … find suspicious that Dr. Carter did not provide the boot until an outside doctor documented the importance of immobilization in writing. A reasonable inference to draw from this evidence is that Dr. Carter was aware of the need for immobilizing a ruptured tendon, but simply decided not to until he came under scrutiny.”

As to Petties' claim that Dr. Carter was responsible for the six-week delay in his seeing a specialist, he provided corroborating medical evidence through Dr. Puppala's treatment notes that the delay harmed him. Dr. Carter's counter argument that the delay was caused by a prison lock-down that barred visits to outside specialists unless the doctor issued an emergency override order did not explain why he did not issue such an order. “The harm stemming from the delay in receiving the boot would have been avoided by sending Petties to the emergency room so he could get an MRI,” said the appeals court. “And the harm from the delay in seeing a specialist would have been mitigated by splinting Petties's foot while security issues were resolved. The delay of both, without a clear justification for either, dooms Dr. Carter's argument that Petties's suffering was unavoidable. On this record, whether the delay was the result of negligence or deliberate indifference is a question for the jury to decide.”

In addition, Petties had also argued that Dr. Carter should have followed Dr. Puppala's recommendation that he be evaluated by a specialist to consider the option of surgery. The court found this allegation was not supported by any medical evidence that such surgery would have led to a better outcome for Petties. However, stated the court, the patient's contention that Dr. Carter dismissed the possibility of surgery as too expensive could be used as circumstantial evidence “that a jury could view as supporting his other claims. If a jury believes that Dr. Carter cited cost as a reason for refusing one form of treatment, then it would be reasonable to infer that Dr. Carter made other medical decisions in Petties's case — failing to splint his foot, not issuing an emergency override order so he could see a specialist — that were dictated by cost, administrative convenience, or both, rather than medical judgment.”

Prisoner's Deliberate Indifference Claim Reinstated

The U.S. Court of Appeals for the Seventh Circuit has reversed a district court's summary dismissal of a prison inmate's lawsuit, brought under 42 U.S.C. § 1983, that claimed his doctor violated his Eighth Amendment rights. The suit claimed that the doctor showed deliberate indifference to the plaintiff's medical needs; the Seventh Circuit found that the plaintiff had produced enough evidence to possibly convince a jury that the doctor knew the treatment provided was inadequate. Petties v. Carter, 2016 U.S. App. LEXIS 15524 (7th Cir., 7/23/16).

Plaintiff Tyrone Petties, a prisoner at Stateville Correctional Facility, suffered a debilitating rupture in his left Achilles tendon in January 2012 while climbing a staircase. This was the second such injury, as Petties had injured his right Achilles tendon two years earlier. As explained by the Seventh Circuit in the case: “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 eventually saw Dr. Imhotep Carter, the medical director of Stateville, although Carter's actual employer was Wexford Health Sources, a private medical services contractor to correctional facilities. Prior to treating Petties, Dr. Carter had treated approximately 10 Achilles tendon ruptures in his 20-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. It advised that patients receive a splint, crutches, and antibiotics if there were lacerations to the site of injury, and that patients then be sent to a specialist for further treatment. Dr. Carter followed most of these protocols, but he did not splint the injured area to keep it immobile. He ordered a specialist consult, but it was not to take place for six more weeks. When Petties complained of severe pain again a month later, Dr. Carter ordered the same treatment as before, again excluding the splint or other device that would have immobilized the patient's foot. In March 2012, Petties had an MRI taken, which showed an Achilles tendon rupture with a gap between the torn ends of approximately 4.7 centimeters. About a week later, Petties was seen by orthopedic specialist Dr. Anuj Puppala, who told Petties the gap in the ruptured tendon might have been caused by failure to immobilize the foot with “any sort of cast.” Dr. Puppala gave an orthopedic boot to Petties to prevent further gapping and to alleviate pain. He then referred Petties to an ankle specialist so that surgery could be considered. Petties alleged in his suit that when he returned to the prison, Dr. Carter authorized use of the boot, along with his own previously ordered remedies, but refused to consider ordering surgery because it would be too expensive.

Petties brought suit against Dr. Carter, among others, alleging he was in extreme pain for years and his mobility was impeded by Dr. Carter's course of treatment. Under 42 U.S.C. § 1983, he also brought suit against his Stateville Correctional Facility doctors, alleging that they failed to alleviate his pain and allow him to recover from his injuries.

Citing the teachings of Farmer v. Brennan , 511 U.S. 825 (1994), the Seventh Circuit noted that, to prove a claim of deliberate indifference, “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 … . Officials can avoid liability by proving they were unaware even of an obvious risk to inmate health or safety.” The problem for plaintiffs, however, 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!'” stated the court. While blatant disregard for medical standards could support a finding of mere medical malpractice, it might also rise to the level of deliberate indifference. “[H]ow 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?” asked the court.

In this case, the court concluded that the evidence presented by Petties was enough to keep his suit alive. Dr. Carter testified that he was responsible for implementing Wexford's protocol, which stated that the primary course of treatment for an Achilles rupture included a splint, and also testified he was not aware of any shortage of splints at the facility while he was treating Petties. Dr. Carter further testified that he thought crutches would keep the patient's weight off of his foot, so a boot or other immobilizing device was not necessary. However, he and the plaintiff's other treating doctors also testified that there is a purpose to immobilization that goes beyond prevention of weight-bearing on the injured foot so a “jury could … find suspicious that Dr. Carter did not provide the boot until an outside doctor documented the importance of immobilization in writing. A reasonable inference to draw from this evidence is that Dr. Carter was aware of the need for immobilizing a ruptured tendon, but simply decided not to until he came under scrutiny.”

As to Petties' claim that Dr. Carter was responsible for the six-week delay in his seeing a specialist, he provided corroborating medical evidence through Dr. Puppala's treatment notes that the delay harmed him. Dr. Carter's counter argument that the delay was caused by a prison lock-down that barred visits to outside specialists unless the doctor issued an emergency override order did not explain why he did not issue such an order. “The harm stemming from the delay in receiving the boot would have been avoided by sending Petties to the emergency room so he could get an MRI,” said the appeals court. “And the harm from the delay in seeing a specialist would have been mitigated by splinting Petties's foot while security issues were resolved. The delay of both, without a clear justification for either, dooms Dr. Carter's argument that Petties's suffering was unavoidable. On this record, whether the delay was the result of negligence or deliberate indifference is a question for the jury to decide.”

In addition, Petties had also argued that Dr. Carter should have followed Dr. Puppala's recommendation that he be evaluated by a specialist to consider the option of surgery. The court found this allegation was not supported by any medical evidence that such surgery would have led to a better outcome for Petties. However, stated the court, the patient's contention that Dr. Carter dismissed the possibility of surgery as too expensive could be used as circumstantial evidence “that a jury could view as supporting his other claims. If a jury believes that Dr. Carter cited cost as a reason for refusing one form of treatment, then it would be reasonable to infer that Dr. Carter made other medical decisions in Petties's case — failing to splint his foot, not issuing an emergency override order so he could see a specialist — that were dictated by cost, administrative convenience, or both, rather than medical judgment.”