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Edwards v. Snyder

October 20, 2008


The opinion of the court was delivered by: Frazier, Magistrate Judge


Before the Court is the remaining defendants' combined motion for summary judgment (Doc. No. 167). Responses and replies are on file (Doc. Nos. 174, 175, 176). With respect to Count I, against defendant Ruiz, plaintiff is proceeding on a § 1983 claim. He challenges the conditions of his former confinement at Big Muddy Correctional Center in December, 2000, and January, 2001. Plaintiff claims that defendant Dr. Ruiz violated his Eighth Amendment right to be free from cruel and unusual punishment by responding to his serious medical need for diagnosis and treatment of a finger injury with deliberate indifference. Specifically, he claims that an important diagnostic test (X-ray) was delayed and that another important test (MRI) was never ordered or performed. He also claims that Dr. Ruiz did not refer him to a specialist for evaluation or treatment and delayed the initial evaluation and subsequent surgery. In Count II, plaintiff asserts a claim of negligent supervision and training against defendants Bochantin, Laurent, and Wexford Health Services. Specifically, he claims that these defendants failed to override Dr. Ruiz' poor treatment decisions and/or failed to train their co-workers and employees to do so.

Summary judgment is proper where "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(c); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). To determine whether there is a genuine issue of material fact, courts construe all facts in the light most favorable to the non-moving party and draw all reasonable and justifiable inferences in favor of that party. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986).

I. Deliberate Indifference -- Dr. Ruiz

In Estelle v. Gamble, 429 U.S. 97 (1976), the Supreme Court held that the Eighth Amendment's prohibition against cruel and unusual punishment imposes a duty upon states to provide adequate medical care to inmates. Failure to provide medical care violates the Eighth Amendment when there is "deliberate indifference" to a substantial risk of harm. Farmer v. Brennan, 511 U.S. 825, 834 (1994); Sherrod v. Lingle, 223 F.3d 605, 610 (7th Cir. 2000). This standard requires the plaintiff to establish an objective element that he faced a substantial risk of harm and a subjective element that the defendant was aware of and disregarded an excessive risk to the inmate's health. Wynn v. Southward, 251 F.3d 588, 593 (7th Cir. 2001). When considering whether an inmate's medical care demonstrates deliberate indifference to his serious medical needs, the Court evaluates the inmate's medical care as a whole. Gutierrez v. Peters, 111 F.3d 1364, 1374 (7th Cir.1997). Deliberate indifference is "a state of mind more blameworthy than negligence" and "requires more than ordinary lack of due care for the prisoner's interests or safety." Farmer v. Brennen, 511 U.S. 825, 835 (1994). A medical professional shows deliberate indifference to an inmate's serious medical need when he or she makes a treatment decision representing a substantial departure from accepted medical judgment, practice, or standards. In those circumstances, the Court may infer that the decision was not based on the exercise of medical judgment. Sain v. Wood, 512 F.3d 886, 895 (7th Cir. 2008).

Viewed in plaintiff's favor, the relevant evidence shows that he suffered a traumatic finger injury causing a painful knuckle deformity on December 31, 2000, at approximately 9:30 a.m. At least two individuals glanced at the injured finger and quickly formed the impression that plaintiff needed a doctor's attention.

Plaintiff was promptly transported to the prison's health care unit, which has an infirmary. The infirmary has patient beds but is not equipped for surgical procedures other than minor procedures such as toenail removal or simple laceration and wound repair. Although a physician was not physically present in the unit when plaintiff arrived, he received prompt attention from the nursing staff. The nurses assessed the nature of plaintiff's injury and observed that tissue and bone were exposed through his skin and were contaminated with debris. They also observed some bleeding from the wound. They checked plaintiff's vital signs, removed some of the debris from the wound, and wrapped plaintiff's hand. Cori Reid, a staff nurse, prepared an injury report indicating that plaintiff was being referred off-site for treatment.*fn1 During this process, Dr. Ruiz, a licensed physician, was contacted by telephone two times. Dr. Ruiz had experience in the field of emergency medicine and had performed numerous complex hand surgeries. He gathered information about plaintiff's condition, considered the treatment options available, and gave the nursing staff verbal instructions. He declined to send plaintiff to an off-site medical facility for emergency care. In making that assessment, he considered the nature of the care that would likely be available at Good Samaritan Hospital. He directed the nurses to admit plaintiff to the prison infirmary and prescribed medication (an oral antibiotic dosed four times a day for five days, a pain reliever dosed every four to six hours as needed, and a pain reliever/fever reducer dosed three times a day). He also ordered imaging of the finger by x-ray and immobilization, specifying a bulky, sterile dressing. In following these instructions, the nursing staff found that the extent of the deformity made it difficult to immobilize plaintiff's finger.

Following the second telephone call, defendant Dr. Ruiz decided to drive to the prison. At approximately 12:45 p.m. -- more than 3 hours after plaintiff first presented with his injury -- defendant Dr. Brian Ruiz arrived at the prison health care unit. He conducted a brief examination of plaintiff's injured finger and checked for signs of circulation deficits and/or neurological damage. He formed the impression that plaintiff had an open fracture/dislocation which could be repaired with hand surgery. Dr. Ruiz continued the treatment initiated by phone and formulated a diagnostic procedure and therapeutic plan. He ordered that images of plaintiff's finger be taken prior to 8 a.m. on January 2, 2001, and directed the nursing staff to soak plaintiff's hand in a solution for 15 minutes prior to 8 a.m. on January 2, 2001. He planned to repair the injury at that time. In making this plan, Dr. Ruiz relied on his medical belief that a short delay with antibiotic therapy would reduce the risk of infection.

On January 2, 2001, Dr. Ruiz administered a local anesthetic and surgically repaired plaintiff's injury in the prison infirmary. During the surgery -- a complex procedure requiring retraction of a tendon and multi-layer closure -- he removed a foreign body from the wound and repaired the dislocation. Subsequently, Dr. Ruiz provided follow-up care and determined that infection had been prevented. After the surgical incision healed, Dr. Ruiz ordered physical therapy.

Dr. Ruiz did not order immediate transport to an off-site hospital for emergency attention or treatment and did not immediately drive to the prison and perform surgery. He did not order additional imaging tests (an MRI), and did not refer plaintiff to a surgeon or another specialist for consultation, assistance, or treatment.

At Dr. Elyea's request, the treatment provided by Dr. Ruiz was reviewed by Dr. Cleveland Rayford. Dr. Rayford read plaintiff's records and conferred with the director of nursing and the health care unit administrator. He referred plaintiff to Dr. Gupta, an orthopedic specialist, for an off-site evaluation. Dr. Gupta recommended supervised physical therapy for the injury, which he described as a "dorsal dislocation with tiny chip avulsion fracture."

Plaintiff has pain, limited range of motion in his finger, disfigurement, and sensitivity. He is not able to fully perform his usual activities.

Dr. Ruiz argues that plaintiff has not presented evidence sufficient to satisfy the objective element of his claim. This argument is rejected. Construing the evidence in plaintiff's favor, he has proved that he presented with a finger injury that was ultimately diagnosed as an open dislocation with a fracture. This particular injury required care from trained medical professionals and was treated with complex hand surgery and physical therapy. Medical professionals and lay persons alike easily would (and did) recognize that the injury required a doctor's attention. This evidence satisfies the objective element of plaintiff's Eighth Amendment claim. Gutierrez v. Peters, 111 F.3d 1364, 1373 (7th Cir. 1997); Wynn v. Southward, 251 F.3d at 593.

Dr. Ruiz also argues that the evidence is not sufficient to show that he responded to plaintiff's need for medical treatment with deliberate indifference. The materials on file show that when Dr. Ruiz assessed, diagnosed, and treated plaintiff's injury, he made some choices that differ from the approach some other medical professionals would have followed. Notations on Cori Reid's report permit the inference that she expected to transfer plaintiff to an outside hospital for care. Dr. Gupta, a general and orthopedic surgeon, believes orthopedic surgeons should evaluate and treat displaced open fractures. In his work outside the prison setting, x-ray imaging is used as an initial diagnostic tool. Dr. Gupta would have cleansed the wound and performed a surgical repair without delay or with minimal delay. Also, he would have used an external cast or splint to stabilize the fracture. Dr. Gupta believes delay in treating a fractured ...

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