Opinion ID: 4517132
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Wrobel

Text: We are hesitant to conclude that a doctor was deliberately indifferent when a prisoner receives medical care. Waldrop v. Evans, 871 F.2d 1030, 1035 (11th Cir. 9 Case: 19-11230 Date Filed: 03/17/2020 Page: 10 of 16 1989). But for some emergency injuries, such as broken bones, even a few hours delay in receiving treatment can constitute deliberate indifference. Harris v. Coweta Cty., 21 F.3d 388, 393–94 (11th Cir. 1994). “The tolerable length of delay in providing medical attention depends on the nature of the medical need and the reason for the delay.” Id. Clark argues that Dr. Wrobel’s course of treatment was beyond grossly negligent because the emergency physician allegedly said Clark should see the specialist “a.s.a.p” and Dr. Wrobel’s recommendation did not come until two weeks later. But Clark sued only Dr. Wrobel, not Stewart, not SCM, and not Dr. Rosenbaum. We look to what Dr. Wrobel knew, when he knew it, and how he responded. See Burnette, 533 F.3d at 1331. The record reflects that Dr. Wrobel first gained subjective knowledge of Clark’s knee injury when he examined Clark on May 26, 2015. Dr. Wrobel examined Clark and the x-rays, he confirmed the hospital diagnosis, and he immediately referred Clark to an orthopedic specialist. The specialist, Dr. Rosenbaum, examined Clark two days later. Clark contends that the emergency physician said he needed to see a specialist immediately, but his medical records and discharge paperwork do not 10 Case: 19-11230 Date Filed: 03/17/2020 Page: 11 of 16 indicate that there was an immediate need to see a specialist.2 We have previously held that a difference of opinion between a medical professional and a prisoner concerning the proper diagnosis or course of treatment is usually insufficient to support a claim of deliberate indifference. Harris v. Thigpen, 941 F.2d 1495, 1505 (11th Cir. 1991). In any event, Dr. Wrobel acted in the manner that Clark contends was the appropriate course of action—he referred Clark to an orthopedic specialist at the time of his examination, and instructed Clark to stop taking his blood pressure medications and ibuprofen to prepare for the consultation. Clark fails to demonstrate how the two-day “delay” between Dr. Wrobel’s examination and Dr. Rosenbaum’s examination was “so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness.” Id. Clark also argues that Dr. Wrobel’s staff provided constitutionally deficit medical care. Supervisory officials, however, are not liable for the unconstitutional acts of their subordinates “on the basis of respondeat superior or vicarious liability.” Hartley v. Parnell, 193 F.3d 1263, 1269 (11th Cir. 1999) (quoting Belcher v. City of Foley, 30 F.3d 1390, 1396 (11th Cir.1994)). To be liable under a supervisory theory, the supervisor must personally participate in the 2 The only other evidence regarding the applicable standard of care or appropriate course of treatment comes from Dr. Wrobel’s affidavit, which stated that “Mr. Clark received standard of care at all times.” 11 Case: 19-11230 Date Filed: 03/17/2020 Page: 12 of 16 alleged constitutional violation or there must be a causal connection between the supervisory official’s actions and the alleged deprivation. Id. As explained above, Dr. Wrobel immediately referred Clark to Dr. Rosenbaum when he became aware that Clark had a possible knee fracture. Even if Dr. Wrobel had been subjectively aware of Clark’s injury based on Clark’s prebooking hospital visit, Clark has failed to provide evidence that the course of treatment during that two-week period amounted to “more than gross negligence.” Goebert, 510 at 1327. Stewart examined Clark’s knee on May 13 and May 18, ordered and reviewed his x-rays, maintained his pain medications, and scheduled Clark to meet with Dr. Wrobel on the doctor’s next visit to the Jail. This course of action is consistent with Clark’s discharge instructions from the hospital. We have previously held that medical care need not be “perfect, the best obtainable, or even very good.” Thigpen, 941 F.2d at 1510. Even though Clark maintains that more should have been done or more should have been done faster, he fails to demonstrate how that is anything other than a difference of opinion. See id. We find that Clark’s complaints regarding the speed at which he was referred to a specialist are insufficient to support his claim of deliberate indifference for his knee injury. 12 Case: 19-11230 Date Filed: 03/17/2020 Page: 13 of 16