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The Eleventh Circuit Court of Appeals Affirmed the Grant of Summary Judgment in Favor of a Physician Medical Director of a Correctional Facility on a Claim for Deliberate Indifference Brought Pursuant to 42 U.S.C. 1983 – A Health Law and Regulation Update Blog Post by Darshan Patel

October 24, 2019

Health Law and Regulation Update Blog Post by Darshan Patel.

When Plaintiff arrived at the correctional facility in December 2012, he suffered from a “hammer toe” that he had managed for over twenty years by wearing “oversized shoes with extra pads.” When issued the standard footwear at the correctional facility, Plaintiff began to experience pain due to the hammer toe, so he was allowed to wear flip flops instead. In December 2013, Plaintiff consulted with a podiatrist who recommended he undergo surgery. The surgery had to be approved by the Medical Director. In January 2014, the Medical Director denied the request, and instead recommended conservative treatment of prosthetic shoes and pain medication, which have been known to improve pain related to hammer toe. In June 2014, the Medical Director denied another request by Plaintiff to undergo surgery. In doing so, he made a reference to the correctional facility’s coverage for the procedure, which allowed for coverage if the procedure was required based on the Director’s medical opinion. Between July 2014 and October 2014, Plaintiff began to be fitted with orthopedic shoes until they found the right fit. The shoes provided Plaintiff with relief. In June 2015, Plaintiff was transferred to another correctional facility, at which he ultimately underwent surgery on his hammer toe. He filed suit against the medical director alleging that the denial of the recommended surgery constituted deliberate indifference to his medical needs. The trial court granted summary judgment in favor of the Medical Director.

Summary judgment was proper because nothing the Medical Director did rose to the standard necessary to demonstrate an Eighth Amendment violation. The Director was not deliberately indifferent in denying the first request because conservative treatments have been known to help hammer foot, and it was the same manner in which Plaintiff had managed his pain for over twenty years. Further, Plaintiff was allowed to wear flip flops soon after experiencing pain. After that point, his pain was no worse than before incarceration. The denial of the second request did not constitute deliberate indifference because the request came before the Medical Director’s earlier recommendation to fit Plaintiff with orthopedic shoes had even been pursued or deemed unsuccessful. Ultimately, even though there was a delay in Plaintiff getting his surgery between his first request and the date of his procedure, there was no evidence that Plaintiff’s condition was in such an urgent need for surgery that more conservative measures could not be pursued first.

The Court of Appeals also found no error in the Medical Director’s referencing of the correctional institution’s insurance coverage because there was no evidence his decision was made solely on the availability of coverage for the procedure. To be sure, coverage was available if, in the Medical Director’s judgment, it was necessary. Additionally, the mere fact that the Medical Director chose a different course of treatment than Plaintiff’s podiatrist is not grounds for liability under the Eighth Amendment.

The takeaway is that a correctional physician may exercise his/her medical judgment in exhausting conservative courses of treatment before resorting to surgery, where there is no urgent need for invasive treatment and where there is no indication the patient is experiencing increased pain as a result of the conservative treatment.

The case is: CHRISTOPHER STEWART, Plaintiff-Appellant, v. SHARON LEWIS, Defendant, WAYNE WELLS, Defendant – Appellee, No. 18-10892, ___ Fed. Appx. ___, 2019 WL 5395797 (11th Cir. October 22, 2019).