Opinion ID: 145553
Heading Depth: 2
Heading Rank: 3

Heading: The Jail Nurse

Text: We also conclude that Nurse Reich was not entitled to summary judgment. The district court concluded that Reich was entitled to defer to Dr. Butler regarding Berry's treatment. Here, however, the record shows that Dr. Butler last saw Berry on April 24th, six weeks before he was transferred to the DOC facility where he finally received the needed root canal. During much of that time, Nurse Reich was aware of Berry's ongoing pain and the ineffectiveness of the recommended pain medications, yet he apparently never consulted Dr. Butler again regarding whether a dentist's examination was necessary. Rather, Nurse Reich continued to respond personally to Berry's complaints (including one complaint directed to defendant Peterman), telling Berry that he could not see a dentist until his next DOC placement and asking if Berry needed to see Dr. Butler about an infection. Given the substantial passage of time after Dr. Butler last examined Berry and Nurse Reich's continued responses to Berry's complaints during that time, a jury could conclude that Reich acted independently rather than on Dr. Butler's instructions and was therefore personally responsible for delaying Berry's dental treatment, at least after he last saw Dr. Butler on April 24th. A jury could conclude that the imposition of this delay constituted deliberate indifference to Berry's serious pain. To the extent that Nurse Reich did in fact consult with Dr. Butler over the course of Berry's last weeks at the Waushara County Jail, though, a jury could question whether he could justifiably defer to Dr. Butler's opinions regarding Berry's dental complaints. Although a medical care system requires nurses to defer to treating physicians' instructions and orders in most situations, that deference may not be blind or unthinking, particularly if it is apparent that the physician's order will likely harm the patient. See Frank J. & Nancy M. Cavico, The Nursing Profession in the 1990's: Negligence and Malpractice Liability, 43 Clev. St. L.Rev. 557, 613-16 (1995) (discussing cases). As an ethical matter, a nurse confronted with an inappropriate or questionable practice should not simply defer to that practice, but rather has a professional obligation to the patient to take appropriate action, whether by discussing the nurse's concerns with the treating physician or by contacting a responsible administrator or higher authority. American Nurses Ass'n, Code of Ethics for Nurses With Interpretive Statements, Provision 3.5 (2001), available at http://nursingworld.org/ethics/code/ protected_nwcoe813.htm (last visited April 9, 2010). We do not suggest that these professional standards are part of the Eighth Amendment, but they are relevant in evaluating whether Nurse Reich can rely on the general supervision by Dr. Butler to excuse his responses to Berry's continuing complaints of pain in a way that otherwise could reasonably be deemed to show deliberate indifference to his pain. Also, a jury could find that Nurse Reich's deference was less justifiable than usual because this was a case of dental pain rather than a medical problem clearly within Dr. Butler's professional expertise. Nothing in the record indicates that Dr. Butler had any dental training or experience to which Nurse Reich could or should defer. As a matter of simple common sense, few people would turn to a general practitioner physician for the treatment of a cavity or gum disease. We are not persuaded, at least as a matter of law, by Nurse Reich's argument that he cannot be held liable because he lacked the authority to refer Berry to a dentist without further approval. Nurse Reich always had the ability to contact Peterman or other supervisory personnel to voice any concerns about Dr. Butler's treatment of Berry's condition. See American Nurses Ass'n, Code of Ethics for Nurses With Interpretive Statements, Provision 3.5. In sum, Berry has offered sufficient evidence to defeat Nurse Reich's motion for summary judgment. The extent to which Nurse Reich relied on Dr. Butler's medical judgment and the reasonableness of any such reliance require further exploration at trial, particularly given the regime of individual liability under section 1983, under which the defendants might try to blame each other for Berry's suffering. Accordingly, we AFFIRM the judgment of the district court as to defendant Peterman, REVERSE as to defendants Reich and Butler, and REMAND this matter for further proceedings consistent with this opinion. Thus far, Berry has pursued this case without a lawyer, and he has presented the evidence and his legal arguments well. If this matter proceeds to a trial on the merits, however, the district court will want to consider the possibility, pursuant to the standards set forth in Pruitt v. Mote, 503 F.3d 647 (7th Cir.2007) ( en banc ), of requesting counsel to represent him at trial if Berry is receptive to the idea. See 28 U.S.C. § 1915(e)(1).