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

Heading: The Jail Doctor

Text: Dr. Butler is not entitled to summary judgment. Neither medical malpractice nor mere disagreement with a doctor's medical judgment is enough to prove deliberate indifference in violation of the Eighth Amendment. See Estelle, 429 U.S. at 106, 97 S.Ct. 285; Estate of Cole v. Fromm, 94 F.3d 254, 261 (7th Cir.1996). But a prisoner also is not required to show that he was literally ignored. Sherrod v. Lingle, 223 F.3d 605, 611 (7th Cir.2000). Although the doctor did not completely ignore plaintiff's pain, a doctor's choice of the easier and less efficacious treatment for an objectively serious medical condition can still amount to deliberate indifference for purposes of the Eighth Amendment. Estelle, 429 U.S. at 104 & n. 10, citing Williams v. Vincent, 508 F.2d 541 (2d Cir.1974); Johnson v. Doughty, 433 F.3d at 1013 (stating that medical personnel cannot simply resort to an easier course of treatment that they know is ineffective); Greeno, 414 F.3d at 655 (noting that persistence in a course of treatment known to be ineffective violates the Eighth Amendment). A significant delay in effective medical treatment also may support a claim of deliberate indifference, especially where the result is prolonged and unnecessary pain. Grieveson v. Anderson, 538 F.3d 763, 779 (7th Cir.2008) (reversing summary judgment for defendants where plaintiff did not receive treatment for painful broken nose for nearly two days), citing Gutierrez v. Peters, 111 F.3d 1364, 1371-72 & n. 6 (7th Cir.1997) (collecting cases). Also, as we explained in Grieveson, a non-trivial delay in treating serious pain can be actionable even without expert medical testimony showing that the delay aggravated the underlying condition. 538 F.3d at 779, distinguishing Langston v. Peters, 100 F.3d 1235, 1240 (7th Cir.1996) (one-hour delay in responding to claim of injury by rape in prison did not rise to level of constitutional violation). In this context, courts may consider the cost of treatment alternatives [when] determining what constitutes adequate, minimum-level medical care, Johnson, 433 F.3d at 1013, citing Ralston v. McGovern, 167 F.3d 1160, 1162 (7th Cir.1999), but medical personnel cannot simply resort to an easier course of treatment that they know is ineffective. Johnson, 433 F.3d at 1013, citing Kelley v. McGinnis, 899 F.2d 612, 616 (7th Cir. 1990). On the summary judgment record, a jury could reasonably conclude that Dr. Butler knowingly adhered to an easier method to treat Berry's pain that she knew was not effective. She had not identified an effective pain medication, nor could she explain Berry's pain, yet she rejected the obvious alternative of referring Berry to a dentist. A jury could find that she simply concluded that Berry could endure his pain until his transfer back to the DOC several weeks later, when Berry would be the DOC dentist's problem, not hers. It is hard to imagine that a doctor seeing a civilian patient, or a doctor in a prison having on-site dental staff, would respond in this way to persistent complaints of severe dental pain over a period of weeks, even in the absence of a dental emergency. A basic dental examination is not an expensive or unconventional treatment, nor is it esoteric or experimental. See Ralston, 167 F.3d at 1162. Such examinations are inexpensive and commonly sought immediately to address severe dental pain. Thus, Dr. Butler's refusal to permit Berry such a basic treatment option could be characterized as a gratuitous cruelty forbidden by the Eighth Amendment. See id. Where Berry made a modest request for treatment by a dentist, Dr. Butler's obdurate refusal to alter [Berry's] course of treatment despite his repeated reports that the medication was not working and his condition was getting worse, see Greeno, 414 F.3d at 654, is sufficient to defeat her motion for summary judgment. [2] We are troubled by the evidence that Dr. Butler would not refer Berry to a dentist unless and until he presented either a dental emergency or infection. For a physician to wait to treat a patient until an infection occurs seems counterintuitive. Medical science has long tried to prevent infections from occurring in the first place. The record does not explain just what is included in the term dental emergency, but such emergencies are certainly not the only serious dental conditions that demand reasonably prompt professional attention. Berry could have required emergency treatment if an infection had spread from his afflicted tooth into his bloodstream, but a doctor could not conscionably wait until that late point to finally provide effective treatment, particularly when confronted with persistent complaints of severe dental pain that was not responding to medication. Dr. Butler's refusal to refer Berry to a dentist resulted in a substantial and unnecessary delay in the treatment of his decaying tooth. The medical records and Berry's steady complaints of escalating pain indicate that the delay unreasonably prolonged Berry's suffering, making summary judgment inappropriate. See, e.g., Grieveson, 538 F.3d at 779-80 (evidence of one-and-a-half day delay before treating painful broken nose was sufficient to survive summary judgment); Williams v. Liefer, 491 F.3d 710, 716 (7th Cir.2007) (affirming denial of judgment as a matter of law; jury could conclude that the delay in treatment unnecessarily prolonged and exacerbated prisoner's pain). Of course, we do not suggest that a minor delay in treatment constitutes deliberate indifference. See, e.g., Knight v. Wiseman, 590 F.3d 458, 466 (7th Cir.2009) (noting that two-and-a-half hour delay in treatment of plaintiff's shoulder injury was minimal and had no adverse consequences). Anyone who has ever visited a doctor's office knows that some delays in treatment are inevitable, particularly absent a life-threatening emergency. Such delays are even more likely in the prison environment. See, e.g., id. at 467 (noting that delay was result of guards' inability to leave prison work gang unattended). The delay in this case, however, was neither minimal nor justified by Berry's status as a prisoner. Berry was forced to endure nearly two months of serious pain despite the availability of an obvious treatmenta simple dentist visitthat Berry had specifically requested numerous times. The only apparent reason for that delay was that he had the misfortune of being transferred to a jail without an on-site dentist.