Opinion ID: 4542454
Heading Depth: 2
Heading Rank: 1

Heading: Dental Infection and Medical Treatment

Text: On May 4, 2016, a dentist extracted one of Murphy’s teeth, a molar in his upper‐left jaw. Two days later, a Friday, Murphy went to the prison’s healthcare unit, complaining that his left cheek had swollen significantly. Derek Rice, a prison nurse who examined Mur‐ phy, described the swelling as “softball‐size[d]” and sus‐ pected an infection. (Doc. 44–7 at 1; Doc. 44–6 at 15:12–16:4.) Rice spoke in person with Dr. Shah about the evaluation.1 Dr. Shah prescribed penicillin, one gram by mouth twice a day for five days, because it is “one of the most commonly chosen drugs by M.D.s for dental infection[s].” (Doc. 44–6 at 13:15– 23; Doc. 44–1 at 20:23–21:18.) Treatment records reflect that Murphy received penicillin that morning. Murphy contends that he received only one dose of the medicine, but a notation in the record alongside a reference to the lone disbursement 1 Neither Dr. Shah nor Nurse Rice recalled these events. They based their testimony on review of the medical records. No. 19‐3310 3 says “#10 doses.” (Doc. 46–1 at 2.) Dr. Shah, who did not ex‐ amine Murphy that day, did not recall whether Rice told him of the extent of Murphy’s swelling. The next day, Saturday, May 7, Murphy had to make sev‐ eral trips to the healthcare unit. At 1:00 a.m., Murphy com‐ plained that he was having difficulty swallowing. The nurse told him that, at that hour, she was “definitely not calling the doctor,” but he should ice his jaw and neck and come back later in the morning. (Doc. 46–4 at 34:8–13; Doc. 44–7 at 3.) Murphy returned at 9:00 a.m., noting that his tongue felt swollen; however, he was unable to open his mouth wide enough for the nurse to see it. Thinking his condition was an allergic reaction, the nurse gave him Benadryl. The nurse was unable by phone to reach Dr. Shah (who did not work at the prison on weekends) and told Murphy to return at 2:00 p.m. to be reassessed—but to return “ASAP” if he had any short‐ ness of breath. (Doc. 44–7 at 6–7; Doc. 44–1 at 7:7–10.) Shortly after, the nurse spoke with Dr. Shah and told him that Mur‐ phy’s swelling was worse than the day before. Dr. Shah was not concerned that the antibiotic was not working because penicillin takes several days to work. Dr. Shah did, however, prescribe a steroid by injection because, in his experience, the steroid “has always helped the bacteria to subside more along with the antibiotic.” (Doc. 44–7 at 7; Doc. 44–1 at 36:13–38:5.) Two days later, a Monday, Dr. Shah examined Murphy for the first time, and noted that, in addition to the swelling, he was having difficulty closing his mouth and swallowing. Dr. Shah placed Murphy under a 23‐hour2 “infirmary 2 The “23‐hour” figure appears to be the relevant duration of the prison healthcare unit’s standard order for determining treatment plans. 4 No. 19‐3310 observation,” with his vital signs to be checked every four hours, to see if the treatment was helping, and he ordered an‐ other steroid injection. (Doc. 44–1 at 38:24–40:16.) But Dr. Shah didn’t believe Murphy’s condition had worsened be‐ cause he did not have a high temperature (which would sig‐ nal infection) or respiratory difficulty (which would suggest spread of infection). Over the course of the day, Murphy’s swelling persisted, and his temperature fluctuated between 98.5 and 99.8 degrees. Dr. Shah saw Murphy again the next morning, May 10, and noted continued swelling. At the site of the tooth extrac‐ tion, the doctor noticed grayish discoloration, which indi‐ cated infection, and so he admitted Murphy to the infirmary out of concern that the infection was not healing. He gave Murphy an injection of a different antibiotic, thinking that it may work faster than penicillin, and another steroid injection. Later in the day, Murphy reported having chills; his temper‐ ature had spiked to 105 degrees. Dr. Shah prescribed Tylenol and ibuprofen, which helped reduce Murphy’s temperature that night. Just before noon on May 11, after two check‐ups that morning, the nurse noticed faint whistling when Murphy breathed. The nurse notified Dr. Shah, who wasn’t working at the prison that day, and the doctor ordered that Murphy be sent to a local hospital’s emergency room. After a CT scan showed signs of an infection and the clos‐ ing of Murphy’s airway, emergency‐room staff transferred him to another hospital. There, Dr. Jonathan Bailey, an oral and maxillofacial surgeon, diagnosed him with Ludwig’s an‐ gina—a disease that involves infections of nearly all the ana‐ tomic spaces in the neck and requires urgent surgical No. 19‐3310 5 treatment. That day, Dr. Bailey operated on Murphy, draining the involved spaces of fluid. Later that week, Murphy underwent two more surgeries to clean the incisions and drain the spaces again. He returned to the prison on May 31.