Opinion ID: 539921
Heading Depth: 3
Heading Rank: 2

Heading: Delay in Medical Treatment

Text: 29 Within a few days after the confiscation of Wood's sling, the pin in Wood's shoulder broke--as might reasonably have been anticipated. 3 Wood promptly notified prison officials that he was in pain and sought medical help, but he was not seen by a physician until March 22, 1983, eleven days after the sling was confiscated and, according to the district court, anywhere from a week to ten days after his complaints were made known. Dr. McLennan, a physician working at NSP under contract with the State, took X-rays of Wood's shoulder and correctly diagnosed his problem, noting that a piece of the broken pin was floating in Wood's shoulder. Dr. McLennan recommended that Wood be seen by Dr. Schnaser, an outside orthopedic specialist. However, Wood was not taken to Dr. Schnaser until May 4, some fifty-four days after the initial confiscation and some forty-three days after Dr. McLennan determined that Wood's condition required treatment by a specialist. Once Wood was taken to Dr. Schnaser, the floating pin was surgically removed that same day. 30 Wood contends that these facts show a delay in treatment so unreasonable as to constitute an instance of deliberate indifference that is distinct from the confiscation of the sling. The defense, however, advanced two possible excuses for the delay. First, Dr. McLennan testified that he was unable to treat Wood when he first saw him because Wood's medical records were not in his file. The district court apparently believed the need for medical records excused the delay, noting, No doubt a newly received prisoner would be subject to a period of processing and settling in before other than emergency or life or health threatening complaints could be attended to. However, this observation fails to account for the delay of nearly eight weeks here. Whatever the maximum reasonable duration of a period of processing and settling in may be, it must be substantially fewer than fifty-four days. 4 31 The second excuse offered by the defendants is that Wood spent some of the eight-week period outside NSP. The district judge found that on March 30, 1983, Wood was taken from NSP to the Clark County jail for hearings in connection with his criminal conviction, and that he was not returned until April 14, 1983. 5 Practically, the court asserted, treatment had to await his return to NSP where he could be seen by Dr. Schnaser. 32 However, this two-week absence also fails to excuse the delay, for several reasons. As a preliminary matter, it is not at all clear that the absence is relevant, for the State may well have been obligated to treat Wood even before his March 30 removal. That, after all, was nineteen days after his arrival (ample time for processing and settling in) and eight days after Dr. McLennan's diagnosis. The district judge thought it fair to say that it might take a week or so for a free citizen to be able to make an appointment and see a family physician ... or to see a specialist such as Dr. Schnaser. I am less confident that a private citizen experiencing pain from a broken metal shaft in his shoulder would wait a week to have it repaired or removed. Next, it is not at all clear why the NSP authorities could not have arranged for Wood to see an orthopedic specialist--possibly even the surgeon who inserted the pins--during the two weeks he spent at the Clark County jail. 6 33 In any event, the more fundamental problem with the tendered excuse is that Wood's physical absence from the prison cannot possibly be thought sufficient reason for the prison authorities to delay arranging for Wood's visit to Dr. Schnaser. Even if the State need not have treated Wood prior to March 30, it certainly should have arranged for treatment immediately upon his return. Instead, it waited another eight days after his return before sending Wood to Dr. McLennan again, then furnished Wood with a form for the release of his medical records, and then waited twelve more days before taking Wood to Dr. Schnaser. Surely, even if the State gets a week or so to arrange for treatment, it does not get a fresh week or so at every step of the way. 34 Judge Farris offers a different rationale for rejecting Wood's argument. He cites Shapley v. Nevada Board of State Prison Commissioners, 766 F.2d 404, 407 (9th Cir.1985), for the proposition that a delay in treatment is not actionable unless it causes substantial harm. He appears to take the position that Wood's medical needs were not serious enough to give rise to a violation of his rights under the eighth amendment because his injury did not threaten his life or health. However, any such assertion is foreclosed by Estelle. There, the Court explicitly stated that the eighth amendment applies not only to cases which actually produce physical 'torture or a lingering death,' [quoting In re Kemmler, 136 U.S. 436, 446, 10 S.Ct. 930, 933, 34 L.Ed. 519 (1890) ], but also to less serious cases, [in which] denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose. Estelle, 429 U.S. at 103, 97 S.Ct. at 290. As Dr. Schnaser noted pithily in his testimony, [I]t hurts to have a pin back out through your skin. This pain, while undoubtedly in Estelle 's less serious category, was nonetheless substantial enough to constitute a serious medical need. 7 For the same reasons, any assertion that Wood must allege some sort of permanent physical damage is equally untenable. 35 Moreover, the proposition advanced by Judge Farris is not supported by the authorities he cites. In Broughton v. Cutter Laboratories, 622 F.2d 458 (9th Cir.1980), we held that a six-day delay in the treatment of hepatitis, during which time the inmate was in the prison hospital, might constitute deliberate indifference; surely the fifty-four day delay in the treatment of Wood's shoulder caused more pain and showed less concern by prison officials. In Hunt v. Dental Dep't, 865 F.2d 198 (9th Cir.1989), an inmate who had lost his dentures in a prison riot alleged that prison officials waited three months before placing him on a soft-food diet, during which time his teeth were breaking and his gums were bleeding. We held that his allegations were sufficient to state a claim under section 1983. Hunt involved less pain and only slightly more delay than Wood suffered. Certainly, neither Hunt nor Broughton supports a requirement of lasting injury or a threat to life or health. 36 In summary, Wood notified prison authorities of his condition on March 11, 1983 when he was admitted. On March 22, they themselves belatedly concluded that he was in need of medical treatment. Once the authorities were aware of Wood's serious medical needs, their foot-dragging response to those needs, evidenced by the delay of nearly eight weeks between complaint and treatment, cannot be characterized as anything other than deliberate and wilful indifference.