FILED U.S. COURT OF AP P EALS E LEVEN T HC IRC UIT JUNE 28, 2007 THOMAS K. KAH

N CLERK [ DO NO T P UB L I S H] I N THE UN I TE D STATE S C OU RT OF APPE ALS F O R T H E E L E V E N T H C IR C U IT

________________________ N o. 06- 14944 N on -A rgum entC al endar

________________________ D . C . D o c k e tN o . 0 6 - 0 0 1 1 6 - C V - J - 2 0 - MMH N I C H O L A S V . C I C C O N E , P la in tif f - A p p e lla n t, v ersu s J . S A P P , R . S O L O R Z A N O , R . F E L T N E R , D . H A L L , M . D E L A C E RN A , e t a l., D e f e n d a n ts - A p p e lle e s .

________________________ A pp ea l fr om the U ni t ed S t at es D i stri ctC ou rt f orthe M i ddl e D i s tr i c tof F l or i da

_________________________ ( Ju n e 28, 2007) B efo re B L A C K , M A R C U S an d F A Y , C i rcu i tJu d g es. P E R C U R I A M:The district cour t dismi ssed Hudgins pursuant to Fe d.R.Civ.P . 25(a) . 1 2 N i c hol a s V . C i c c one , apr i s one rpr oc e e di ng pr o s e , appe a l s the gr a ntof s u m m a ry j u d g m e n ti n f

a v o ro f p r i s o n o f

f i c i a l s i n h i s 4 2 U. S . C . § 1 9 8 3 a c t i o n . On appe a l , C i c c one a r gue s tha t , a f t e rhi s i ni t i a l tr e a tm e ntf ors c abi e s , the pr i s on o f f ic ia ls a c te d w ith d e lib e r a te in d if f e r e n c e w h e n th e yf

a ile d to r e - tr e a t h is c o n d itio n f

o r1 2 w e e k s . F o rth e r e a s o n s s e t f o rth m o r e f

u llyb e lo w , w e a f

f irm . A cc ordi ng t o the evi dence i n the re cord, sc abi es i nv ol ves asub-du ra l i nf e s t a t i on of

m i t e s a nd c aus e s i nt e ns e i t c hi ng t o the poi ntw he r e the s c r a t c hi ng r e s u lts in s c ab s a n d s o r e s . T h e p r e s c r ib e d s c ab ie s tr e a tm e n t is ac r e a m w h ic h k ills the m i t es . D r. H al l , a s t af f physi ci an atthe pri son, di agno se d C i cc on e w i th scabi es o n Ma r c h 3 , 2 0 0 5 , a n d p r e s c r i b e d P e rm e th r i n c r e a m t o tr e a tth e d i s e a s e . On M a r c h 17, D r . H a l l i nf

orm e d C i c c one tha the c oul d notbe r e - tr e a t e d s o s oon f or s c abi e s , s t a t i ng tha tC i c c one w oul d ha ve t o w a i ttw o m onths be c aus e the P e rm e th r in c r e a m w a s to x ic a n d c o u ld k ill h im . O n M a y2 6 , 2 0 0 5 , D r . H a ll a g a in di a gnos e d C i c c one w i th s c abi e s , r e - pr e s c r i bi ng P e rm e thr i n. D ur i ng the pe r i od be tw e e n hi s tw o P e rm e thr i n tr e a tm e nt s , C i c c one ’ s m e di c a l r e c or ds r e f l e c ttha the r e turne d t o the m e di c a l uni ton M a r c h 5, M a r c h 13, M a r c h 15, M a r c h 17, A pr i l 15, A pr i l 27, M a y 6, M a y 8, M a y 19, a nd M a y22. D ur i ng the s e vi s i t s , he w a s s e e n by N ur s e Z a k, N ur s e H udgi ns , D r . H a l l , orothe rm e di c a l pe r s onne l w ho w e r e not 13

na m e d a s de f

e nda nt s . T he s e vi s i t s i nvol ve d e i the rc ont i nue d c om pl a i nt s f ol l ow i ng hi s i ni t i a l tr e a tm e nt , tr e a tm e ntof apr i orm e di c a l c ondi t i on w hi c h w a s tr i gge r e d by the s c abi e s , orboth. C i cc on e des cr i bed the ef fe ctof sc abi es as causi ng : (1) are oc c urr e nc e of

am e di c a l c ondi t i on, w hi c h ha d be e n i n r e m i s s i on; ( 2) the ne e d f or m ent al heal th tre atm entdu e t o a “ st at e of c on fusi on ”; (3) i m m ense pai n; (4) an in ab ilityto s le e p a t n ig h t a n d c ry in g d u e to th e p a in ; a n d ( 5 ) s c ab s a n d s o r e s a ll o v e rh is b o d y . W e r evi ew the di stri ctcourt ’ s rul i ng on sum m ary j ud gm entde no vo . R oj as v . F lo r id a , 2 8 5 F .3 d 1 3 3 9 , 1 3 4 1 ( 1 1 th C ir . 2 0 0 2 ) . T h e m o v in g p a rtyis e n title d to s um m a ry j udgm e nt“ i f

the pl e a di ngs , de pos i t i ons , a ns w e r s t o i nt e rr oga t or i e s , a nd a dm i s s i ons on f

i l e , t oge the rw i th the a f

f i da vi t s , i f

a ny , s how tha tthe r e i s no ge nui ne i s s ue a s t o a ny m a t e r i a l f a c ta nd tha tthe m ovi ng pa rtyi s e nt i t l e d t o a j ud gm entas a m att erof l aw . ” F ed. R . C i v. P . 56 (c ). If the no n-m ov i ng party bears th e u l t i m at e b u rd en o f p ro o f reg ard i n g th e cl ai m ati ssu e i n th e m o t i o n , th atp arty, i n r e s pons e t o the m ot i on, m us tgo be y ond the pl e a di ngs a nd e s t abl i s h, thr ough com pet entevi dence, thatthere trul y i s agenu i ne, m at er i al i ss ue t o b e tri ed. C el ot ex C orp. v. C atre tt , 47 7 U . S . 31 7, 32 4, 10 6 S . C t . 25 48 , 25 53 , 91 L . E d. 2d 26 5 (19 86 ).

“ W he n de c i di ng w he the rs um m a ryj udgm e nti s appr opr i a t e , a l l e vi de nc e a nd reaso n ab l e factu al i n feren ces d raw n th erefro m are rev i ew ed i n a l i g h tm o st4

f a vor abl e t o the non- m ovi ng pa rty . ” R oj a s , 285 F . 3d a t1341- 42 ( c i t a t i on a nd q u o ta tio n m a rk s o m itte d ) . D e l i be r a t e i ndi f

f e r e nc e t o apr i s one r ’ s s e r i ous m e di c a l ne e ds vi ol a t e s the E ig h th A m e n d m e n t. F a rr o w v . W e s t, 3 2 0 F .3 d 1 2 3 5 , 1 2 4 3 ( 1 1 th C ir . 2 0 0 3 ) . D e lib e r a te in d if

f e r e n c e c o n ta in s b o th a n o b je c tiv e a n d s u b

je c tiv e c o m p o n e n t. I d . A p la in tif

f f ir s t m u s t d e m o n s tr a te a n “o b je c tiv e lys e r io u s m e d ic a l n e e d .” I d . A s e r i ous m e di c a l ne e d i s “ one tha tha s be e n di a gnos e d byaphy s i c i a n a s m a nda t i ng tre atm entor on e thati s s o o bv i ou s thateven a l aypers on w ou l d eas i l y r ec og ni ze th e n e c e s s ityf

o rad o c to r ’s a tte n tio n .” I d . ( c ita tio n a n d q u o ta tio n m a rk s o m itte d ) . F urther, the m edi ca l need m ustbe on e thatpo se s asubst ant i al ri sk of se ri ou s harm if le f t u n a tte n d e d . I d . O nc e as e r i ous m e di c a l ne e d i s s how n, apl a i nt i f f m us ts a t i s f

ythe s ubj e c t i ve in q u iry , e s tab lis h in g th a t “th e p r is o n o f f ic ia l a c te d w ith d e lib e r a te in d if f e r e n c e to tha tne e d. ” B oz e m a n v. O rum , 422 F . 3d 1265, 1272 ( 11th C i r . 2005) ( c i t a t i on a nd q u o t a t i o n m a rk s o m i tt e d ) . De l i b e r a t e i n d i f f e r e n c e r e q u i r e s th a t“ th e o f f i c i a l k n o ws o f a n d d is r e g a r d s a n e x c e s s iv e r is kto in m a te h e a lth o rs a f e ty ; th e o f

f ic ia l m u s t b o th be a w a r e of

f a c t s f r om w hi c h the i nf

e r e nc e c oul d be dr a w n tha tas ubs t a nt i a l r i s k of s e r i ous ha rm e xi s t s , a nd he m us ta l s o dr aw the i nf e r e nc e . ” F a rm e rv. B r e nna n, 511 U .S . 8 2 5 , 8 3 7 , 1 1 4 S .C t. 1 9 7 0 , 1 9 7 9 , 1 2 8 L .E d .2 d 8 1 1 ( 1 9 9 4 ) . D e lib e r a te5

i n d i f f e r e n c e r e q u i r e s “ ( 1 ) s u b j e c t i v e k n o w l e d g e o f

ar i s ko f s e r i o u s h a rm; (2) di sr egar d o f thatri sk; (3) by c on du ctthati s m ore than m er e negl i gence. ” F arrow , 32 0 F . 3d at12 45 (c i t at i on and q uo t at i on m arks om i tt ed). O ur ca se s have gi ven sub st ance t o [the] di st i nct i on betw ee n “ del i bera t e i nd i ff

er ence ” and m er e negl i gence, expl i ca t i ng ca t egori es o f a c tio n o rin a c tio n th a t m a yc o n s titu te d e lib e r a te in d if f e r e n c e . W e h a v e r e p e a te d lyf

o u n d th a t “a n o f

f ic ia l a c ts w ith d e lib e r a te i ndi f f e r e nc e w he n he ors he know s tha ta n i nm a t e i s i n s e r i ous ne e d of m e di c a l c a r e , buthe f

a i l s orr e f

us e s t o obt a i n m e di c a l tr e a tm e ntf orthe i nm a t e . ” E ve n w he r e m e di c a l c a r e i s ul t i m a t e l ypr ovi de d, apr i s on of f i c i a l m a y none the l e s s a c tw i th de l i be r a t e i ndi f f e r e nc e byde l a y i ng th e treatm en to f seri o u s m ed i cal n eed s, ev en fo r a p eri o d o f h o u rs, th o u g h th e r e a s o n f

o rth e d e la ya n d th e n a tu r e o f th e m e d ic a l n e e d is r e le v a n t in d e te rm in in g w h a t typ e o f d e la yis c o n s titu tio n a lly i nt ol e r abl e . W e ha ve a l s o he l d tha tde l i be r a t e i ndi f f e r e nc e m a ybe est ab l i sh ed b y a sh o w i n g o f g ro ssl y i n ad eq u at e care as w el l as b y a d e c is io n to ta k e a n e a s ie rb u t le s s e f f ic a c io u s c o u r s e o f

tr e a tm e n t. M oreover, “ [w ] hen the need for tre atm enti s obv i ou s, m edi ca l care w h ic h is s o c u r s o ry a s to a m o u n t to n o tr e a tm e n t a t a ll m a ya m o u n t to d e lib e r a te in d if

f e r e n c e .” M c E l l i gottv. F ol e y , 182 F . 3d 1248, 1255 ( 11th C i r . 1999) ( c i t a t i ons om i tt e d) (s ec on d al t er at i on i n o ri gi nal ). H o w e v e r , a“s im p le d if f e r e n c e in m e d ic a l o p in io n ” d o e s n o t c o n s titu te d e lib e r a te in d if

f e r e n c e . W a ld r o p v . E v a n s , 8 7 1 F .2 d 1 0 3 0 , 1 0 3 3 ( 1 1 th C ir . 1 9 8 9 ) .

“ [T ] he qu es t i on of w hether gov ernm ent al ac t ors s ho ul d h ave e m pl oyed addi t i on al di a gnos t i c t e c hni que s orf orm s of tr e a tm e nt‘ i s ac l a s s i c e xa m pl e of am a tt e rf

or m e d ic a l ju d g m e n t’ a n d th e r e f o r e n o t a n ap p r o p r ia te b a s is f o rg r o u n d in g liab ility6

un der the E i gh th A m endm ent . ” A dam s v. P oag, 61 F . 3d 15 37 , 15 45 (11th C i r. 1 9 9 5 ) ( c ita tio n o m itte d ) . “T h e in a d v e rte n t o rn e g lig e n t f a ilu r e to p r o v id e a d e q u a te m e di c a l c a r e c a nnotbe s a i d t o c ons t i tut e a n unne c e s s a rya nd w a nt on i nf l i c t i on of pai n. ” F arrow , 32 0 F . 3d at12 43 (c i t at i on and q uo t at i on m arks om i tt ed). In addi t i on , “ the offi ci al m ayes cape l i abi l i ty f or kn ow n ri sks ‘ i f [ he] re spon ded r e a s onabl y t o the r i s k, e ve n i f the ha rm ul t i m a t e l yw a s nota ve rt e d. ’ ” C ha ndl e rv. C r os by , 379 F . 3d 1278, 1290 ( 11th C i r . 2004) ( quot i ng F a rm e r , 511 U . S . a t844, 11 4 S . C t . at19 82 -83) (f oo tno t e om i tt ed) ( al t er at i on i n o ri gi nal ). T he di s tr i c tc ourta s s um e d, w i thoutde c i di ng, tha ts c abi e s w a s as e r i ous m e d ic a l n e e d . W h e n v ie w e d in th e lig h t m o s t f a v o r ab le to C ic c o n e , th e f a c ts di s c us s e d above r e ga r di ng the na tur e a nd tr e a tm e ntof s c abi e s a nd i t s e f

f e c ton C i c c one e s t abl i s h tha ts c abi e s c oul d be de e m e d obj e c t i ve l ys e r i ous . C f . A nduj a rv. R odr i gue z , N o. 05- 17162, m a nus c r i ptop. a t7 ( 11th C i r . M a y15, 2007) ( hol di ng tha tadog bi t e tha tc aus e d m or e tha n s upe r f i c i a l w ounds , i m pa i r e d w a l ki ng, a nd le f t th e p la in tif

f c ry in g in p a in c o u ld b e d e e m e d o b je c tiv e lys e r io u s ) . W e now turn t o w he the rthe r e c or d e vi de nc e c r e a t e s age nui ne i s s ue of m a te r ia l f

a c t a s to w h e th e rth e d e f e n d a n ts a c te d w ith d e lib e r a te in d if f e r e n c e . C ic c o n e ’s p r im a ry a r g u m e n t is th a t h e s h o u ld h a v e b e e n r e - tr e a te d w ith P e rm e th r in af t er14 days i nst ea d o f 12 w ee ks. H e f urther c on t ends thatthi s c as e does notturn7

on a n i s s ue of

adi f f e r e nc e of opi ni on ove rm a tt e r s of m e di c a l j udgm e nt , a s he never expres se d such an o pi ni on ; on ce he w as di agno se d w i th scabi es , m edi ca l j ud gm entw as re nd er ed and the on l y r em ai ni ng t as k w as t o p rovi de tre atm ent . In addi t i on , C i cc on e c om pl ai ns general l y of del ay s and deni al s of m edi ca l care . D ur i ng the tw o m onths f ol l ow i ng hi s i ni t i a l tr e a tm e nton M a r c h 3, 2005, N u r s e Z a ks a w C ic c o n e a n dp r e s c r ib e d h y d r o c o rtis o n e o n M a r c h 5 a n d 1 3 . A lth o u g h C ic c o n e w a s n o t p r e s c r ib e d a n ym e d ic a tio n d u r in g h is M a r c h 1 5 v is it w i th N ur s e H udgi ns , tw o da y s e a r l i e rhe w a s gi ve n 10 uni tdos e s of hy dr oc ort i s one and H ud gi ns advi se d h i m thathe coul d si gn up for s i ck ca l l i f m edi ci ne w as needed be f or e hi s doc t or ’ s appoi ntm e nt . C i c c one a l s o s a w D r . H a l l tw o w e e ks a f t e rthe i ni t i al tre atm ent . A tthi s vi si t , D r. H al l pres cr i bed m edi ca t i on for postsc abi es tr e a tm e n t a n d C ic c o n e ’s p r io rc o n d itio n , w h ic h h a d c o m e o u t o f r e m is s io n . I t is undi s put e d tha tD r . H a l l a l s o t ol d hi m tha the c oul d notbe gi ve n P e rm e thr i n f or a n o th e rtw o m o n th s d u e to th e to x ic ityo f th e m e d ic a tio n . A c c o r d in g to i n f o rma t i o n i n th e Ph y s i c i a n s ’ D e s kRe f e r e n c e o n A c t i c i n , ab r a n d n a me P erm ethri n cre am , dem on strabl e l i vi ng m i t es af t er14 days i nd i ca t e thatre tr e a tm e n t is n e c e s s a ry . C ic c o n e r e lie s u p o n th is s ta te m e n t a s e v id e n c e th a t D r . H a ll w as in co rr ec t. H o w ev er , C icco n e p ro v id es n o ev id en ce th at re fu tes D r. H all’ s m e di c a l j udgm e nttha tP e rm e thr i n c a nnotbe pr e s c r i be d m or e tha n onc e w i thi n a8

tw o - m o n th p e r io d . M a tte r s o f m e d ic a l ju d g m e n t e x te n d to w h e th e rth e d e f e n d a n ts s houl d ha ve pr ovi de d a ddi t i ona l f orm s of tr e a tm e nt . S e e A da m s , 61 F . 3d a t1545; s e e a l s o H a rr i s v. T hi gpe n, 941 F . 2d 1495, 1505 ( 11th C i r . 1991) ( s t a t i ng, “ [ n] or doe s as i m pl e di f

f e r e nc e i n m e di c a l opi ni on be tw e e n the pr i s on’ s m e di c a l s t a f f a nd the i nm a t e a s t o the l a tt e r ’ s . . . c our s e of tr e a tm e nts upportac l a i m of c rue l a nd u n u s u a l p u n is h m e n t” ) . Th e e v i d e n c e s h o w s th a tth e d e f e n d a n t s p r o v i d e d s o me tr e a tm e n t, b u t n o t th e tr e a tm e n t C ic c o n e b e lie v e s h e s h o u ld h a v e r e c e iv e d . B e c au s e C ic c o n e o n lyh a s s h o w n ad if f e r e n c e o f m e d ic a l o p in io n in th e m a n n e rin w hi ch the defendant s tre at ed hi s c on di t i on du ri ng thi s tw o-m on th p er i od , he has no tra i se d a genu i ne i ss ue of m at er i al fa ctre gardi ng del i bera t e i nd i ff er ence . S ee A d a m s , 6 1 F .3 d a t 1 5 4 5 ; H a rr is , 9 4 1 F .2 d a t 1 5 0 5 . M oreover, even i f D r. H al l w as i ncorrec tconcerni ng the l ength o f t i m e that m us te l aps e be f

or e r e - tr e a tm e nt , a tbe s t , the e vi de nc e onl ype rm i t s the c onc l us i on th a t D r . H a ll w a s n e g lig e n t, w h ic h is in s u f f ic ie n t f o rac la im o f

d e lib e r a te i nd i ff er ence . S ee F arrow , 32 0 F . 3d at12 43 . T he P hysi ci ans’ D es k R ef er ence prov i des no i nd i ca t i on thatre -tre atm entw i th P erm ethri n canno tsa fe l y occ ur for a peri od of t i m e. A l tho ug h d em on strabl e l i vi ng m i t es af t er14 days i nd i ca t e thatre tr e a tm e n t is n e c e s s a ry , th e o n lyr e c o r d e d v is its w ith th e d e f e n d a n ts d u r in g th isCiccone also claims that he made several unrec orded visits to the medical unit, during 2 which the staf

f did “a bsolutely nothing.”As Ciccone doe s not provide any evidenc e of who he saw duringthese visits or when the visits occur red, hehas not raise d a g enuine issue of material fact as to whether

any of the medic al per sonnel ac ted with deliberate indifference . 9 peri od occurre d w i thi n the fi rs t14 days af t ertre atm ent and there i s no evi dence

2 tha tl i vi ng m i t e s w e r e de t e c t e d be tw e e n M a r c h 3 a nd M a y26, 2005. C i c c one co n t i n u ed t o ex p eri en ce i t ch i n g . H o w ev er, acco rd i n g t o th e P h ysi ci an s’ D esk R e f e r e nc e , i t c hi ng c oul d c ont i nue a f t e rtr e a tm e nt , a nd i ti s r a r e l yas i gn of treatm en tfai l u re an d i s n o tan i n d i cat i o n fo r re-treatm en t . In ad d i t i o n , b ecau se p e r s is te n t itc h in g is p o s s ib le a n d r a r e lyas ig n o f tr e a tm e n t f

a ilu r e , N u r s e Z a kd id n o t act u n re as o n ab ly in p re sc rib in g h yd ro co rtiso n e w ith in tw o w ee k s o f C icco n e’s i ni t i al tre atm entand, there fore , di d n otac tw i th d el i bera t e i nd i ff er ence . S ee C ha ndl e r , 379 F . 3d a t1290. W e r e c ogni z e , how e ve r , tha tonc e thi s i ni t i a l tw o- m onth pe r i od e l aps e d, C i c c o n e wa s n o tr e - tr e a t e d wi th P e rm e th r i n u n t i l s o m e t i m e h a d p a s s e d . At C i c c one ’ s r e que s t , N ur s e Z a k r e f e rr e d hi m t o adoc t oron M a y8. A l though C i cc on e r eturned t o the m edi ca l un i t , he di d n otse e ado ct or un t i l M ay26 , atw hi ch t i m e he w a s pr om pt l y di a gnos e d w i th s c abi e s a nd pr e s c r i be d P e rm e thr i n. C i c c one w a s t ol d tha tthe de l a y w a s due t o ba c kl og. E ve n i f: ( 1) N ur s e Z a k ha d s ubj e c t i ve k n o w led g e th at C icco n e c o n ti n u ed to su ff erfr o m sc ab ies a s a re su lto f C icco n e’s pa s tdi a gnos i s and c ont i nue d c om pl a i nt s of i t c hi ng a nd ar a s h; a nd10

( 2) D r . D e l a - C e rna , a nothe rs t a f f phy s i c i a n, a nd D r . H a l l a nd ha d s uc h know l e dge a s ar e s ul tof

the i rr e vi e w of

C i c c one ’ s m e di c a l r e c or ds on M a y23 a nd 24, r e s pe c t i ve l y , a f

t e rr e vi e w i ng the r e c or d, w e c onc l ude tha tthe r e i s i ns uf f i c i e nt e v id e n c e to a llo w af

in d in g th a t th e d e la yin tr e a tm e n t w a s d u e to d e lib e r a te in d if f e r e n c e . Z a k ’s a c tio n s o f

p r e s c r ib in g h y d r o c o rtis o n e a n d m a k in g ac lin ic ia n r e f e rr a l, atbest , ar e no m ore than n egl i gent . S ee F arrow , 32 0 F . 3d at12 45 . N or ar e they

“ s o obj e c t i ve l y i na de qua t e tha tthe ys a t i s f yE s t e l l e ’ s hi gh s t a nda r d. ” T a y l orv. A d a m s , 2 2 1 F .3 d 1 2 5 4 , 1 2 5 9 ( 1 1 th C ir . 2 0 0 0 ) . M o r e o v e r , th e r e is n o e v id e n c e to s how tha tthe de l a y be tw e e n Z a k’ s M a y8 c l i ni c i a n r e f e rr a l a nd the appoi ntm e nt w a s due t o Z a k’ s de l i be r a t e i ndi f f e r e nc e . N ori s the r e a nye vi de nc e tha tZ a k, w i tho utthe as si st ance of a doct or, coul d h ave pres cr i bed P erm ethri n t o C i cc on e. F r om the t i m e the e vi de nc e w oul d a l l ow the c onc l us i on tha tD r s . H a l l a nd D el a-C ern a l earn ed o f C i cco n e’ s co n d i t i o n , tw o an d th ree d ays, resp ect i v el y, e l aps e d pr i ort o tr e a tm e nt . “ [ D ] e l a yi n m e di c a l tr e a tm e ntm us tbe i nt e rpr e t e d i n the cont extof the se ri ou snes s of the m edi ca l need, deci di ng w hether the del ay w or s e ne d the m e di c a l c ondi t i on, a nd c ons i de r i ng the r e a s on f orde l a y . ” H i l l v. D e ka l b R e g’ l Y outh D e t . C tr . , 40 F . 3d 1176, 1189 ( 11th C i r . 1994) , abr oga t e d on othe rgr ounds by H ope v. P e l z e r , 536 U . S . 730, 122 S . C t . 2508, 153 L . E d. 2d 66611

( 2 0 0 2 ) . “ D el ay ed tre atm entfor i nj uri es thatar e of al es se r degree of i m m edi ac y th an b ro k en b o n es an d b l eed i n g cu t s, b u tth atare o b v i o u s seri o u s m ed i cal n eed s, m a y a l s o gi ve r i s e t o c ons t i tut i ona l c l a i m s . ” H a rr i s v. C ow e t aC ounty , 21 F . 3d 38 8, 39 4 (11 th C i r. 19 94 ). In thi s c as e, al tho ug h C i cc on e had acc es s t o m edi ca l pe r s onne l , he w a s unabl e t o s e e adoc t ora s qui c kl ya s he w oul d ha ve l i ke d. T he on l y e xp l anat i on for the del ayoffe re d i n thi s c as e w as backl og , and C i cc on e has o f f e r e d n o e v id e n c e to th e c o n tr a ry . D u r in g th e tim e C ic c o n e w a s w a itin g f o rh is appoi ntm e nt , he ha d a c c e s s t o nur s e s , w a s pr ovi de d hy dr oc ort i s one f orhi s r a s h a nd m edi ca t i on for hi s pri or cond i t i on , and w as i nstruct ed t o t ake acool show er . O nce he f i na l l y s a w D r . H a l l , he w a s di a gnos e d w i th s c abi e s a nd pr om pt l ypr e s c r i be d the n ecessary treatm en t . U n d er th ese ci rcu m st an ces, th e tw o an d th ree d ay d el ays b e tw e e n th e tim e D r s . H a ll a n d D e la - C e rn ale a rn e d o f C ic c o n e ’s c o n d itio n a n d h is d o ct o r’ s ap p o i n tm en td o es n o trai se a g en u i n e i ssu e o f factas t o w h eth er th ese d e f e n d a n ts w e r e d e lib e r a te lyin d if f e r e n t. W e s i m i l ar l y c on cl ud e thatC i cc on e di d n otra i se a genui ne i ss ue of m at er i al f a c ta s t o w he the rW a r de n S app, C hi e f H e a l th O f

f i c e rS ol or z a no, a nd S e ni or H e a lth A d m in is tr a to rF e ltn e ra c te d w ith d e lib e r a te in d if f e r e n c e . T h e s e d e f

e n d a n ts r e s p o n d e d to C ic c o n e ’s f o u rg r ie v a n c e s , f

ile d b e tw e e n M a y1 0 a n d M a y2 6 , 2 0 0 5 . C i cc on e’ s M ay10 gri evance c om pl ai ned abo utbei ng char ged for hi s m edi ca l12

tr e a tm e nt , notthe qua l i ty of hi s c a r e . A l though C i c c one i ndi c a t e d hi s be l i e f tha the c ont i nue d t o s uf

f e rf r om s c abi e s , he a l s o s t a t e d tha the ha d be e n t o s i c k c a l l a nd w a s “p u t o v e rto s e e th e d o c to ra g a in .” B e c au s e th e g r ie v a n c e d id n o t c o m p la in abouti na de qua t e c a r e a nd i ndi c a t e d tha tC i c c one ha d r e c e i ve d m e di c a l a tt e nt i on a nd w oul d s e e the doc t or , i tdoe s notr a i s e age nui ne i s s ue of f a c ta s t o w he the rthe de f e nda nt s w ho r e vi e w e d the gr i e va nc e a c t e d w i th de l i be r a t e i ndi f f e r e nc e by f a i l i ng t o t a ke a c t i on t o e ns ur e tha tC i c c one r e c e i ve d tr e a tm e nt . C i c c one ’ s M a y16 a nd 26 gr i e va nc e s r e l a t e d onl y t o the a s s e s s m e ntof ac o- pa y m e nta nd l i ke w i s e do no tra i se a genui ne i ss ue of m at er i al fa ct . O n M ay22 , ho w ever , C i cc on e r equest ed pr ope rtr e a tm e ntf

orhi s s c abi e s , pr ovi di ng i nf orm a t i on aboutthe hi s t orya nd pr e s e nts t a t e of

hi s c ondi t i on, a nd s t a t i ng tha thi s appoi ntm e ntke ptge tt i ng pos tpone d due t o ba c kl og. C i c c one r e c e i ve d tr e a tm e nton M a y26. O n M a y31, S ol or z a no a nd S app de ni e d hi s gr i e va nc e on the gr ound tha tC i c c one s houl d ha ve al re ady s ee n a do ct or. T hi s r es po nse does notcr ea t e agenu i ne i ss ue of m at er i al fa ctas t o d el i bera t e i nd i ff er ence . I n l i ghtof

the f or e goi ng, w e hol d tha tC i c c one f a i l e d t o r a i s e age nui ne i s s ue o f m a te r ia l f

a c t a s to w h e th e rth e d e f e n d a n ts a c te d w ith d e lib e r a te in d if f e r e n c e . A cco rd i n g l y, th e d i stri ctco u rti s AF F I RME D.