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

Heading: analysis

Text: On appeal Murphy first argues that, contrary to the dis‐ trict judge’s determination, a reasonable jury could find that Dr. Shah was aware of his condition, recklessly disregarded its progression, and improperly delayed sending him to the hospital. He points to the testimony of his expert, Dr. Citron‐ berg, and his treating surgeon, Dr. Bailey—expert testimony that, he believes, the district court wrongly “discount[ed]” in favor of its own view of the record. (Murphy’s Br. at 23.) Deliberate indifference requires a two‐fold showing. First, the plaintiff must suffer from an “objectively serious medical condition.” Petties, 836 F.3d at 727–28 (citing Farmer v. Bren‐ nan, 511 U.S. 825, 834 (1994)). The parties agree that Murphy’s dental infection meets this requirement. But second, the No. 19‐3310 7 plaintiff must provide evidence that the defendant “actually knew of and disregarded a substantial risk of harm.” Petties, 836 F.3d at 728. The assessment here presents a close question. On the one hand, Dr. Citronberg’s report does contain statements that, in isolation, may call into question whether the risk of severe in‐ fection posed to Murphy was so obvious that a reasonable jury could infer that Dr. Shah was aware of the risk and dis‐ regarded it. See Petties, 835 F.3d at 729. For instance, Dr. Cit‐ ronberg opined that Dr. Shah “ignored the obvious risk of progression to the severe infection that [Murphy] ultimately suffered.” (Doc. 46–3 at 3.) This progression, he said, was “ap‐ parent” from the softball‐sized swelling to Murphy’s cheek that persisted despite treatment, and the presence of new swelling that had developed in his mouth and to his jaw. (Doc 46–3 at 2–3.) And this progression, he added, required a trans‐ fer to a higher level of care, which Dr. Shah did not order until days later. But portions of Dr. Citronberg’s sworn testimony require understanding these statements about shortcomings in Dr. Shah’s medical care as a difference in medical opinion about the proper course of treatment. As the district court noted, Dr. Citronberg testified that, while he disagreed with Dr. Shah’s course of treatment, Dr. Shah provided “what he thought was the right treatment.” (emphasis ours). (Murphy’s Br. App. at 19, quoting Doc. 44–2 at 10:1–4.) And Dr. Citron‐ berg agreed that Murphy’s condition remained “generally the same” during the five days from his arrival at the prison healthcare unit on May 6 until he showed his first signs of a high fever on May 10. (Doc. 44–2 at 52:1–53:15.) 8 No. 19‐3310 Murphy responds that the district court took Dr. Citron‐ berg’s testimony out of context and that a factfinder still could find deliberate indifference. He spotlights Dr. Citronberg’s statement that his condition between May 6 and May 10 “was always severe enough to require transfer to a hospital.” (Mur‐ phy’s Reply Br. at 9.) But this statement does not relate to Dr. Shah’s subjective awareness of a substantial risk, let alone the risk of progression to a severe infection. The statement reflects merely a difference of opinion over when Murphy should have been sent to a hospital, a scenario that is insufficient to support deliberate indifference. See Petties, 836 F.3d at 729 (“[E]vidence that some medical professionals would have cho‐ sen a different course of treatment is insufficient to make out a constitutional claim.”); see also Steele v. Choi, 82 F.3d 175, 179 (7th Cir. 1996). Murphy also argues that deliberate indifference can be in‐ ferred from the testimony of his treating surgeon, Dr. Bailey, who said that when a patient shows signs of trismus (reduced opening of the jaws) and infection, “[y]ou need to get imaging to find out what’s going on.” (Murphy’s Br. at 23, 25–26; Doc. 44–5 at 75:22–76:4.) But a failure to seek a particular diagnostic technique, like imaging, “is a classic example of a matter for medical judgment,” amounting to, “[a]t most,” medical mal‐ practice, Estelle v. Gamble, 429 U.S. 97, 107 (1976), which “just isn’t enough,” Steele, 82 F.3d at 179. What’s more, Dr. Bailey’s testimony says nothing about Dr. Shah’s actual knowledge of a need to order such imaging. Relatedly, Murphy argues that deliberate indifference could be inferred from Dr. Shah’s failure to alter the antibiotic treatment upon learning that he was not taking his oral peni‐ cillin. In support, Murphy references his increased swelling No. 19‐3310 9 and inability to open his mouth as of May 7, and entries in a prison medical record (to which Dr. Shah likely had access) that, he says, show he received only the first of five prescribed doses. But there is no evidence that Dr. Shah knew that Murphy was not taking the medicine. The doctor testified that he was not concerned with Murphy’s symptoms on May 7 because penicillin, which had been started only the previous day, takes 4–5 days to heal an infection. But Dr. Shah also did more than stick with the same penicillin treatment; on May 10 he gave Murphy an injection of a different antibiotic because it “works faster.” (Doc. 44–1 at 50:13–18.) And even if Murphy’s prison medical record reflects that he received only one dose of penicillin,3 it is unreasonable to infer, without more, that the particular record was both in the chart Dr. Shah reviewed and that he saw it. Finally, Murphy turns his attention to Dr. Shah’s steroid treatment, which, Murphy says, showed a “complete aban‐ donment of medical judgment”—as opined by Dr. Citron‐ berg. Norfleet v. Webster, 439 F.3d 392, 396 (7th Cir. 2006). But Dr. Citronberg’s written opinions and oral testimony do not go so far; his statements suggest only that Dr. Shah’s steroid treatment can be regarded as negligent. As he wrote in his 3 Such an assumption probably would be misplaced (even though the magistrate judge agreed with Murphy on this point). Nurse Rice testified that for an oral penicillin prescription (as opposed to injection), he typi‐ cally would issue all doses of the medication to the inmate to keep in his cell and take as directed. That testimony is consistent with Murphy’s prison medical record, which bears a set of initials alongside an entry for May 6 at 8:00 a.m. with a notation “#10 doses” (i.e., 2 pills per day for 5 days). (Doc. 46–1 at 2.) 10 No. 19‐3310 report, the use of steroids outside of an appropriate hospital setting and without appropriate antibiotics was a “deviation from the standard of care.” (Doc. 46–3 at 3.) His oral testimony was similar: Steroid treatment in this situation was “inappro‐ priate,” though he acknowledged that certain antibiotics and steroids are a “known treatment” for oral infections in “cer‐ tain situations.” (Doc. 44–2 at 40:4–13; 41:5–42:1.) The matter of steroid treatment, then, merely highlights a difference in medical opinion over the course of treatment—a standard that suggests negligence rather than deliberate indifference. See Petties, 836 F.3d at 729.