Opinion ID: 812189
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Al-Shami

Text: For the duration of Holloway’s detention in the Delaware County Jail, Dr. Al-Shami acted as Holloway’s primary care physician. After reviewing the information communicated to him by Nurse St. Myer on the day Holloway’s detention began, Dr. Al-Shami prescribed medication to treat Holloway’s Klippel-Trenauney Syndrome and other illnesses. Although Holloway took large doses of Oxycontin for pain prior to his detention, Dr. Al-Shami did not believe narcotic pain medication was necessary to treat the chronic pain and instead prescribed Ibuprofen and Extra Strength Tylenol for Holloway’s pain management. Because he was not pre- scribing Oxycontin, Dr. Al-Shami also prescribed three different drugs to treat narcotic withdrawal. With the exception of the Oxycontin, Dr. Al-Shami prescribed each of the other medications Holloway had taken prior 18 No. 12-2592 to his detention. Holloway argues that Dr. Al-Shami acted with deliberate indifference in not prescribing Oxycontin to manage his pain during the detention. He contends that the non-narcotic pain medications were not an effective substitute and that he was in pain for the duration of his detention. To demonstrate that a defendant acted with a “sufficiently culpable state of mind,” a plaintiff must put forth evidence to establish that the defendant knew of a serious risk to the prisoner’s health and consciously disregarded that risk. Johnson v. Doughty, 433 F.3d 1001, 1010 (7th Cir. 2006). This subjective standard requires more than negligence and it approaches intentional wrongdoing. Collignon v. Milwaukee Cnty., 163 F.3d 982, 988 (7th Cir. 1998). The Supreme Court has compared the deliberate indifference standard to that of criminal recklessness. Farmer, 511 U.S. at 837. Surely Holloway would have preferred to have been treated by a doctor who would have prescribed Oxycontin to treat his chronic pain rather than the nonnarcotic substitutes, but a prisoner is not entitled to receive “unqualified access to healthcare.” Hudson v. McMillian, 503 U.S. 1, 9 (1992). Instead, prisoners are entitled only to “adequate medical care.” Johnson, 433 F.3d at 1013. “There is not one ‘proper’ way to practice medicine in prison, but rather a range of acceptable courses based on prevailing standards in the field.” Jackson v. Kotter, 541 F.3d 688, 697 (7th Cir. 2008). For a medical professional to be held liable under the deliberate indifference standard, he must make a decision that is “such No. 12-2592 19 a substantial departure from accepted professional judgment, practice, or standards, as to demonstrate that the person responsible actually did not base the decision on such a judgment.” Id. (quoting Sain v. Wood, 512 F.3d 886, 895 (7th Cir. 2008)). There is no evidence that Dr. Al-Shami intended to cause Holloway pain or that he knew the Ibuprofen and Extra Strength Tylenol would be insufficient to alleviate Holloway’s symptoms. Moreover, Holloway did not present any evidence to show that Dr. Al-Shami’s decision not to prescribe Oxycontin was a substantial departure from accepted professional standards. Instead, Holloway argues that Dr. Al-Shami diverted from Holloway’s own doctor’s opinion that he needed Oxycontin to treat his chronic pain and that his decision not to prescribe the Oxycontin was based on his own personal belief rather than medical judgment. Holloway contends that Dr. Al-Shami told him, “I don’t believe in prescribing Oxycontin for pain management.” Even assuming that Dr. Al-Shami made this statement, Holloway does not offer evidence to show that Dr. Al-Shami’s belief is based on personal rather than medical reasons. Nor does Holloway show this belief represents such a substantial departure from accepted professional standards that it is reasonable to infer that Dr. Al-Shami did not base his decision on a medical judgment. Holloway cites Ralston v. McGovern, 167 F.3d 1160 (7th Cir. 1999), in support of his contention that Dr. Al-Shami’s deliberate indifference stemmed from his decision not to defer to Holloway’s physician’s orders, but he misinter20 No. 12-2592 prets this court’s reasoning in that case. In Ralston, we held that a prison guard’s refusal to give an inmate his prescribed medication after the inmate complained that he could not swallow and that he was spitting up blood constitutes deliberate indifference. Ralston, 167 F.3d at 1161-62. But we did not suggest that prison doctors must always defer to the judgment of a doctor who treated an inmate prior to his detention. Rather, the prison physician, as the inmate’s acting primary care doctor, is free to make his own, independent medical determination as to the necessity of certain treatments or medications, so long as the determination is based on the physician’s professional judgment and does not go against accepted professional standards. Cf. Arnett v. Webster, 658 F.3d 742, 753-54 (7th Cir. 2011) (concluding that a prison physician’s refusal to prescribe a substitute anti-inflammatory medication in place of an inmate’s previously prescribed Enbrel after ten months of complaints could amount to deliberate indifference); Gil v. Reed, 381 F.3d 649 (7th Cir. 2004) (concluding that an issue of material fact existed as to deliberate indifference where a prison physician prescribed Tylenol III to an inmate post-surgery without justification and against the surgeon’s explicit orders not to do so because of the potential side effects). The court in Ralston held only that once a prison physician prescribes medication, a prison guard should not refuse to give the inmate the medication when he needs it. Ralston, 167 F.3d at 1161-62. Dr. Al-Shami considered Holloway’s condition and prior treatment before prescribing his medication on the No. 12-2592 21 day Holloway arrived at the jail. For the treatment of Holloway’s chronic pain, Dr. Al-Shami prescribed two pain medications as a substitute for Oxycontin, and he prescribed additional medications to prevent Holloway from experiencing narcotic withdrawal symptoms. The two pain medications served the same purpose as Oxycontin, and there is no indication that Dr. Al-Shami prescribed these medications without exercising professional judgment. See Arnett, 658 F.3d at 754 (“[A] medical professional’s actions may reflect deliberate indifference if he ‘chooses an easier and less efficacious treatment without exercising his professional judgment.’ ” (quoting McGowan v. Hulick, 612 F.3d 636, 641 (7th Cir. 2010))). The only time Holloway reported any pain to Dr. Al-Shami was when Dr. Al-Shami visited him in the jail on October 6, the day before he was released. At that point, Holloway reported that he was experiencing pain in his leg and Dr. Al-Shami responded by ordering a test to check the clotting of Holloway’s blood. With Holloway’s release imminent, there was no display of deliberate indifference by Dr. Al-Shami between the time of Holloway’s complaint and the time of his release. Although “[a] prison physician cannot simply continue with a course of treatment that he knows is ineffective in treating an inmate’s condition,” see Arnett, 658 F.3d at 754, Holloway did not offer any evidence that Dr. Al-Shami knew before October 6 that the Ibuprofen and Extra Strength Tylenol were not alleviating Holloway’s pain. In his brief, Holloway cites to an affidavit he submitted in the district court in 22 No. 12-2592 which he stated, “I was in severe and intense pain every single day that I was in the Delaware County Jail and my pain was demonstrable because I was doubled over, I simply laid on the floor or mat, I constantly complained to guards and nurses about how much pain I was in, and I could not take Tylenol because it upset my stomach.” Holloway Aff. at 2. He also stated, “[e]very time I saw a physician or nurse at the Delaware County Jail, I complained of my chronic pain and explained how intense and severe the pain was.” Id. Even if the knowledge of the guards and nurses could be imputed to Dr. Al-Shami, this affidavit conflicts with Holloway’s earlier deposition in which he testified that he stayed quiet and did not complain to the nurses about his pain. This court has held that a party cannot “create an issue of fact by submitting an affidavit whose conclusions contradict prior deposition or other sworn testimony.” Buckner v. Sam’s Club, Inc., 75 F.3d 290, 292 (7th Cir. 1996). Holloway’s deposition testimony was not ambiguous or confusing, and thus, Holloway cannot submit an affidavit contradicting that testimony to create an issue of fact at the summary judgment stage. Id. at 292. No reasonable jury could conclude that a physician who prescribed an alternative pain medication, who prescribed additional medications to prevent withdrawal symptoms, and who responded to Holloway’s only report of pain in his leg by ordering a test to check the clotting of his blood acted with deliberate indifference to Holloway’s serious medical condition. Accordingly, we reject Holloway’s arguments and hold that the No. 12-2592 23 district court’s judgment in favor of Dr. Al-Shami was proper.