Achilles Tendon Injury: A Jury Will Get to Decide if Doctor Was Deliberately Indifferent
Filing a deliberate indifference claim for a serious medical need is difficult. The standard is much higher than typical negligence and requires close to intentional conduct on behalf of prison guard and/or healthcare provider.
The burden on the prisoner is to show that they have an (1) objective serious medical condition; and the more difficult burden is showing that the doctor or nurse (2) appreciated the risk of not treating condition and still did nothing. This requires getting into a healthcare providers head.
Fortunately, we can use circumstantial evidence to meet the burden, and one of the ways that we do this is find cases that are factually similar to your case, and see how the courts have ruled on the issue.
Recently, the Seventh Circuit Court of Appeals in Chicago found that a prisoner could go forward on his Achilles tendon injury claim.
The Achilles Tendon
The Achilles or Calcaneal tendon runs from the bottom of the calve muscle to the heel. A tendon attaches muscle to bone. So here the Achilles tendon attaches the gastrocnemius and soleus muscles to the calcaneus or heel bone. The calve muscles allow us to plantar flex (go up on our tip toes).
If the Achilles Tendon is torn off the heel bone it is called a rupture. This condition hurts like the dickens and the patient cannot walk correctly.
The key to treating his injury is immobilizing the lower leg because if the leg isn't immobilized every time the calve muscles contract it will pull more tendon away from the heel.
Like I said earlier, the key to being successful in deliberate indifference cases is having supporting facts and trying to fit the facts of your case into a case that has already been reported.
Here is the story:
The patient tears his Achilles Tendon climbing some stairs. He goes to the medical department and the doctor doesn't immobilize (splint) his ankle. The doctor also doesn't get the patient into specialist for six weeks. The first doctor ends up leaving the facility and a second doctor doesn't order physical therapy that was recommended by a foot and ankle specialist.
The prisoner claimed that the first doctor showed deliberate indifference because he failed to immobilize the ankle, waited six weeks before getting the patient to a specialist, and refused to order surgery. The prisoner claimed that the second doctor didn't send him to physical therapy like the specialist recommended.
The trial court dismissed the case on summary judgment and the prisoner appealed. The Seventh Circuit framed the issue like this and asked the question. How bad does an inmate's care have to be to create a reasonable indifference that a doctor did not just slip up, but was aware of, and disregarded a substantial risk of harm? Both sides agreed that a ruptured Achilles tendon was a serious medical need - so the issue was what was in the doctors' head.
In finding that the inmate should tell his story to a jury, the Seventh Circuit found regarding the first doctor:
- The Dr. testified that appropriate treatment for a complete rupture of the tendon is to immobilize the ankle - which he didn't do.
- His employer had a protocol that called for immobilization of the ankle.
- The Dr. was aware of the need to immobilize the ankle but simply decided not to do so until he came under scrutiny.
- The Court also took issue with the 6-week delay.
- Regarding the second doctor and physical therapy, the court said a jury can hear the claim because:
- The Dr. testified that he always follows a specialist's recommendation; and the reason he didn't on this patient is because this patient had physical therapy in the past.
What Lessons Do We Learn?
If an inmate ruptured their Achilles tendon and the doctor didn't immobilize the ankle, get a timely referral, and follow the specialist's recommendations, the inmate has a chance to have a successful outcome.
As you can see, these cases turn on the specific facts.