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Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 

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In the

United States Court of Appeals

For the Seventh Circuit ____________________

No. 15-1470

JONI ZAYA,

Plaintiff-Appellant,

v.

KUL B. SOOD,

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Central District of Illinois.

No. 12-CV-1307 — Jonathan E. Hawley, Magistrate Judge.

____________________

ARGUED OCTOBER 26, 2015 — DECIDED SEPTEMBER 6, 2016

____________________

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

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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 

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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 followup 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 

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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

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(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 (1976) (quoting Gregg v. Georgia, 428 U.S. 153, 173 (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 (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 inadvertent failure to provide adequate medical care cannot be said to constitute ‘an unnecessary and wanton infliction of pain.’” Estelle, 429 U.S. at 105 

(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 

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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 (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, 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) (quoting Sherrod 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. 

See Petties, 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 also 

Sain 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 

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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. See Petties, slip op. at 12. (“When a doctor says he 

did not realize his treatment decisions (or lack thereof) could 

cause serious harm to a plaintiff, a jury is entitled to weigh 

that explanation against certain clues that the doctor did

know.”). That evidence may consist of “clues” drawn from 

the context surrounding a treatment decision. Id. And if the

defendant’s chosen “course of treatment” departs radically 

from “accepted professional practice,” a jury may infer from 

the treatment decision itself that no exercise of professional

judgment actually occurred. Pyles v. Fahim, 771 F.3d 403, 409 

(7th Cir. 2014). 

B. Dr. Sood’s Decision to Delay Zaya’s Return to 

Dr. Bussey

With these standards in mind, we turn to whether Zaya 

has put forward enough evidence to survive summary 

judgment. As we’ve noted, the parties agree that a broken 

wrist is a serious medical condition. Our only concern is 

Dr. Sood’s failure to comply with Dr. Bussey’s instructions 

that Zaya return in three weeks for a follow-up exam and 

additional x-rays. Zaya argues that Dr. Sood understood the 

risks associated with delaying treatment and disregarded 

those risks by waiting nearly seven weeks to authorize a 

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follow-up appointment. In support of this claim, Zaya points 

to Dr. Bussey’s instructions themselves.

A jury can infer conscious disregard of a risk from a defendant’s decision to ignore instructions from a specialist. 

See Petties, slip op. at 9; Gil v. Reed, 381 F.3d 649, 663–64 (7th 

Cir. 2004); Jones v. Simek, 193 F.3d 485, 490–91 (7th Cir. 1999). 

The validity of the inference rests primarily on the contemporaneity of the communication and the defendant’s decision. Instructions from a specialist are evidence that the 

defendant knew a particular course of treatment was recommended by at least one other medical professional at the 

time the defendant chose not to provide that treatment.

Dr. Bussey went a step further than simply recommending that Zaya return within three weeks; he actually described the risks of further delay. Dr. Bussey’s instructions 

explained that any displacement of Zaya’s wrist could still 

be fixed “rather easily” at the three-week mark—the clear 

implication being that it would become more difficult to 

correct as more time passed. Dr. Sood expressly acknowledged receipt of these instructions by countersigning the 

copy that was sent to Henry Hill. Given these facts, a jury 

could conclude that Dr. Sood consciously disregarded the

risks associated with delaying Zaya’s return to Dr. Bussey.

See Gil, 381 F.3d at 664 (“On summary judgment, we find 

that prescribing on three occasions the very medication the 

specialist warned against ... while simultaneously canceling ... two of the three prescribed [medications] gives rise to 

a genuine issue of material fact about [the defendant’s] state 

of mind.”). 

But Dr. Sood has offered an explanation for his decision 

to wait nearly seven weeks to send Zaya back to Dr. Bussey: 

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He claims that he disagreed with Dr. Bussey’s treatment 

plan. In his deposition Dr. Sood explained that he has treated over 500 fractures in his 22-year career and that he believes three weeks is too early to assess if a bone is healing 

properly. According to Dr. Sood, “[y]ou need up to six to 

eight weeks to find out the exact nature of the fracture.” That

explanation distinguishes this case from those in which the 

defendant either gives no explanation whatsoever for his 

failure to follow a specialist’s instructions, see, e.g., Jones, 

193 F.3d at 490–91, or provides an explanation that’s internally inconsistent or otherwise implausible on its face, see, 

e.g., Petties, slip op. at 16; Gil, 381 F.3d at 663–64. Because 

Dr. Sood has provided a cogent, medical explanation for his 

decision to delay follow-up treatment, Zaya must point to 

some evidence that would permit a reasonable jury to reject

his explanation as a post hoc rationalization. Cf. Sain, 

512 F.3d at 895 (granting summary judgment to the defendant doctor because the plaintiff provided “no evidence to 

show that [the doctor’s medical explanation] was a sham or 

otherwise impermissible”).1

1 This is not to suggest that courts should make credibility determinations or weigh evidence on a motion for summary judgment. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986); see also Jackson v. Ill. 

Medi–Car, Inc., 300 F.3d 760, 764 (7th Cir. 2002). But summary judgment 

does require courts to decide what inferences can justifiably be drawn 

from the nonmovant’s evidence. See Liberty Lobby, 477 U.S. at 249–50 (“If 

the evidence is merely colorable, or is not significantly probative, 

summary judgment may be granted.”) (citations omitted). If a defendant 

provides a facially plausible medical explanation for his decision and 

that explanation remains un-rebutted, the jury would have no reason to 

discredit it. 

 

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We think that Zaya has met this requirement—though 

just barely—by offering the report and deposition testimony

of Dr. Nathaniel R. Evans, his expert. Dr. Evans opined that 

it was unreasonable for Dr. Sood, a general practitioner, to 

disagree with instructions from Dr. Bussey, an orthopedic 

surgeon who had examined and treated Zaya: 

A reasonable physician, when faced with the 

circumstance of a patient having been treated 

by an orthopedist and having received written 

request from that orthopedist to return the patient to the orthopedist in ... three weeks, 

would have directed that the patient be returned to the orthopedist in the three week 

timeframe as specified by the orthopedist. In 

failing to do so, Dr. Sood deviated from the 

standard of care. 

From that testimony a reasonable jury could draw the 

following conclusions: Most general practitioners wouldn’t 

disagree with Dr. Bussey’s instructions. Dr. Sood is a general 

practitioner; therefore, Dr. Sood didn’t actually disagree 

with Dr. Bussey’s instructions. 

Of course doctors do sometimes act unreasonably, so the 

expert’s opinion is only weakly probative of Dr. Sood’s

mental state. By itself an expert’s assessment that a treatment 

decision was unreasonable is not enough to establish conscious disregard of a known risk. See Duckworth, 532 F.3d at 

681. But Zaya has offered more than that; he has provided 

evidence that Dr. Sood was fully apprised of the risks associated with delaying treatment at the time he made the 

decision to do so. Given that affirmative evidence of 

Dr. Sood’s mental state, the expert’s opinion is enough to 

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create a genuine factual dispute about whether Dr. Sood 

actually disagreed with Dr. Bussey’s instructions or instead 

simply ignored them, notwithstanding the attendant risks.

C. Qualified Immunity

Dr. Sood contends that even if a jury could find that he 

consciously disregarded the risks of delaying Zaya’s return 

to Dr. Bussey, he is nonetheless entitled to summary judgment on qualified-immunity grounds. The Supreme Court 

has held that employees of privately operated prisons may 

not assert a qualified-immunity defense. See Richardson v. 

McKnight, 521 U.S. 399, 412 (1997). We have construed that 

holding to extend to employees of private corporations that 

contract with the state to provide medical care for prison 

inmates. See Currie v. Chhabra, 728 F.3d 626, 631–32 (7th Cir. 

2013); see also Shields v. Ill. Dep’t of Corrs., 746 F.3d 782, 794 

n.3 (7th Cir. 2014). As an employee of Wexford, a private 

corporation that contracts with the Illinois Department of 

Corrections, Dr. Sood asks us to reconsider our earlier 

decisions. 

We need not do so because even if a qualified-immunity 

defense were available to Dr. Sood, he would not be entitled 

to summary judgment on that basis. “The doctrine of qualified immunity protects government officials ‘from liability 

for civil damages insofar as their conduct does not violate 

clearly established statutory or constitutional rights of which 

a reasonable person would have known.’” Pearson v. Callahan, 555 U.S. 223, 231 (2009) (quoting Harlow v. Fitzgerald, 

457 U.S. 800, 818 (1982)). Zaya’s deliberate-indifference claim 

turns on Dr. Sood’s mental state, and it is well established 

what the law requires in that regard. See Farmer, 511 U.S. at 

837. If Dr. Sood consciously disregarded the risks of delayCase: 15-1470 Document: 41 Filed: 09/06/2016 Pages: 12
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ing Zaya’s return to Dr. Bussey, then his conduct violates

clearly established law under the Eighth Amendment. See 

Petties, slip op. at 18. As we’ve explained, that’s a question of 

fact that needs to be resolved by a jury.

REVERSED AND REMANDED.

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