Case: 20-10049 Date Filed: 09/04/2020 Page: 1 of 20
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT ________________________
No. 20-10049 Non-Argument Calendar ________________________
D.C. Docket No. 5:18-cv-00178-TKW-MJF
FALLON CHRISTINA PAULK,
Plaintiff - Appellant,
versus
TOMMY FORD, Sheriff Bay County Florida, RICK ANGLIN, JEROLD DERKAZ, MD, DAVID SASSER,
Defendants - Appellees. ________________________
Appeal from the United States District Court for the Northern District of Florida ________________________
(September 4, 2020) Case: 20-10049 Date Filed: 09/04/2020 Page: 2 of 20
Before ROSENBAUM, GRANT, and LUCK, Circuit Judges.
PER CURIAM:
Fallon Paulk nearly died due to complications of Crohn’s disease while in
pretrial detention at the Bay County Jail (the “jail”). After undergoing life-saving
emergency surgery upon her release, she filed this lawsuit alleging that Defendants-
Appellees—Tommy Ford, the Bay County Sheriff; Rick Anglin, the jail’s warden;
Dr. Jerold Derkaz, the jail’s Chief Medical Officer and Paulk’s primary doctor at the
jail; and David Sasser, the jail’s Health Services Administrator—were deliberately
indifferent to her serious medical needs, in violation of her constitutional rights. The
district court granted summary judgment to the defendants, concluding that they did
not act with deliberate indifference. Because genuine issues of material fact remain
in the record, we vacate and remand for further proceedings.
I.
In January 2014, Paulk was arrested for drug possession and booked into the
Bay County Jail, where she remained until her release on July 7, 2014. Immediately
after her release, Paulk was rushed to the emergency room and underwent surgery.
According to the surgeon, Paulk had been septic and malnourished for seven days
and was “lucky to be alive.” Had she stayed in jail any longer, the surgeon told her,
she would have been dead.
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Paulk’s near-death experience stemmed from complications of Crohn’s
disease, a chronic inflammatory bowel disease that affects the lining of the
gastrointestinal tract. Symptoms of Crohn’s disease include abdominal pain and
cramping, diarrhea, fatigue, weight loss, and malnutrition. Crohn’s disease is
characterized by active symptomatic periods—sometimes called “flare-ups”—and
periods of remission. Flare-ups can also lead to more serious complications like
bowel obstructions or perforations, which require immediate medical attention and
potentially surgery. Because there is no cure for Crohn’s disease, treatment is
focused largely on reducing the inflammation that causes flare-ups and relieving the
symptoms that arise. To those ends, a variety of medications may be prescribed,
including steroids, immunosuppressants, and antibiotics.1
During her approximately six-month stay at the jail, Paulk experienced
multiple flare-ups of Crohn’s disease and submitted numerous written requests for
medical treatment. With some fluctuation, her symptoms increased in severity over
the course of her pretrial detention. The jail knew that Paulk suffered from Crohn’s
disease from the outset because during intake at the jail she disclosed it and a prior
bowel resection surgery.
1 See Crohn’s disease – Diagnosis and treatment, MAYO CLINIC, https://www.mayoclinic. org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309 (last visited Aug. 13, 2020). 3 Case: 20-10049 Date Filed: 09/04/2020 Page: 4 of 20
Paulk began experiencing intermittent Crohn’s symptoms in mid-March,
starting with abdominal pain. In April, she twice requested a low bunk due to pain
and inflammation, but these requests were denied. In late April, she reported
vomiting and severe abdominal cramping for three days. She was seen on May 2 by
Waneda Wolfe, an advanced registered nurse practitioner (“ARNP”), who
prescribed medications to treat her cramps, nausea, and vomiting.
From May through June 16, Paulk submitted numerous sick-call requests
complaining of abdominal cramping of increasing severity, an inability to use the
restroom, and heartburn. In response to these requests, ARNP Wolfe and Dr. Derkaz
examined Paulk on multiple occasions, prescribed a variety of medications to treat
her symptoms, ordered X-rays to be taken on May 29, June 2, and June 10; and
collected blood samples for tests on June 10. The X-rays on May 29 and June 2
found “no evidence for obstruction,” but the X-ray from June 10 noted “[f]indings
consistent with an intermittent or partial small bowel obstruction.”
On June 16, Wolfe ordered Paulk sent to the emergency room. According to
Wolfe, Paulk appeared “ill, pale & in pain” and her abdomen was distended and
tender. Paulk was admitted to the hospital and underwent a CT scan, x-rays, a
colonoscopy, and other tests. The CT report noted mild constipation and findings
that were consistent with Crohn’s disease and a “possible early or partial small bowel
obstruction.” The X-ray report noted a possible “inflammatory distal small bowel
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stricture”—a narrowing of the intestine—but “[n]o signs of bowel perforation or
other acute process.” Finally, Dr. Finlaw performed a colonoscopy with biopsy,
finding an “ileocolonic anastomosis” stricture that the scope could not pass through.
In a post-operative report, Dr. Finlaw wrote that Paulk should “[c]ontinue steroids”
and that she “will need Remicade, although this may be challenging in the fact that
she is currently incarcerated.” Dr. Finlaw also ordered a high-fiber diet.
The hospital discharged Paulk on June 20 in stable condition with a diagnosis
of a small-bowel obstruction with a fair prognosis. The discharge summary noted
that surgery had signed off and that Paulk was “not having any acute abdomen.” The
summary further noted that Paulk “plans to start Remicade in the outpatient” and
that she should return to the hospital for a follow-up appointment in one to two
weeks. Despite these discharge instructions, however, Paulk did not return to the
hospital for a follow-up appointment, nor was she prescribed Remicade. The jail
continued her treatment with steroids and other medications that she had previously
received at the jail.
Meanwhile, Paulk’s parents became increasingly worried about her health.
After her hospitalization from June 16–20, Paulk’s father called Sasser, the jail’s
Health Services Administrator, every day, speaking with him regularly. For her part,
Paulk’s mother called the jail up to five times a day. At some point after Paulk’s
discharge, Paulk’s mother spoke with Sasser and informed him that Paulk had
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previously been on Remicade when Paulk had her prior bowel surgery, and that she
(Paulk’s mother) did not think it would be a good idea for Paulk to start taking it
again.
After her discharge from the hospital, Paulk was returned to the jail’s regular
housing. Over the next two days, Paulk requested a refill for Doxepin—used to treat
depression, anxiety, and insomnia—and indicated that she was having trouble
sleeping. On June 23, Paulk also reported that her abdomen was hurting again. Dr.
Derkaz examined Paulk on June 24 and noted that she had been up the night before
with some abdominal pain, nausea, and vomiting. That same day, Dr. Derkaz
canceled the high-fiber diet ordered by Dr. Finlaw.
Dr. Derkaz saw Paulk again on June 30, two days after Paulk was moved to
the medical unit for observation. Paulk had been running a fever on June 28, and
Paulk’s family members had called the jail to say that other inmates were calling
them and stating how sick Paulk was. In his treatment notes for June 30, Dr. Derkaz
wrote that Paulk seemed to be doing much better and that she had no guarding or
distension. Paulk was returned to general population after seeing Dr. Derkaz.
On July 1, Paulk asked for “some [B]oost” and inquired whether she could
get “a full liquid diet,” writing that she was “getting weak because I can’t eat” and
had lost significant weight. A nurse disputed Paulk’s claim of weight loss and denied
the request for Boost. Paulk responded, claiming that she had dropped from 155 to
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138 pounds. On July 2, Paulk requested a higher dose of Doxepin and to see the
doctor.
On July 3, Dr. Derkaz examined Paulk and determined that she had a partial
small-bowel obstruction that was stable and not a “surgical problem” at that time. It
was not a surgical problem, according to Dr. Derkaz, because “[a] physical
examination showed her abdomen to be soft and with active bowel signs, left-sided
tenderness, no guarding or distension.” Dr. Derkaz’s treatment notes indicated that
Paulk had a bowel movement that morning and had vomited once or twice. Paulk
was given Boost. This was the last time Dr. Derkaz examined Paulk.
At around 10:00 a.m. on July 4, according to treatment notes, Paulk, in tears,
presented to medical with stomach pain, nausea, vomiting, and diarrhea. She could
not walk or sit up straight. She was given Toradol, an anti-inflammatory pain
reliever. Later that night, just after 10:00 p.m., Paulk reported abdominal pain,
nausea, and feeling faint. A nurse noted that Paulk’s abdomen was distended and
firm with hypoactive bowel sounds and that she had difficulty walking and sitting
upright. Paulk was given prescribed medications, but the nursing staff was unable
to reach Dr. Derkaz or to leave a voicemail. Paulk was reassessed approximately 40
minutes later and reported that she was feeling better.
At around 11:25 a.m. the following day, July 5, Paulk again reported
abdominal pain, nausea, vomiting. Her abdomen was distended and firm, and she
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was unable to stand or sit upright. The nursing staff contacted Dr. Derkaz, who
prescribed Toradol for pain relief and Phenergan for nausea and vomiting but took
no other action. At that time, according to Dr. Derkaz, he “probably” knew that
Paulk was going to be released soon.
The treatment notes indicate that a nurse checked on Paulk at approximately
1:30 p.m. and wrote that she was resting quietly with no apparent symptoms of
distress. The same nurse checked on Paulk at 4:05 p.m. that same day and twice the
next day, July 6, each time noting that Paulk was resting and exhibited no apparent
symptoms of distress. Her abdomen remained distended and firm, however.
Although the treatment notes indicate that Paulk was being closely monitored
from July 3–6, Paulk testified that the nurses “weren’t coming to take care of me”
and that she preferred being in general population because at least there she “had
people helping take care of me.” She elaborated,
They weren’t even wanting to bring my medication inside the medical cell. They were wanting me to come to the door just to get my medication, and I couldn’t even get up. . . . I remember being very, very sick and throwing up and couldn’t even make it to the toilet. And I was puking all over the cell and they were just letting it stay in there.
By early July, Paulk’s parents feared for her life. Based on information from
Sasser, Paulk, and other inmates, her parents were convinced that Paulk had a bowel
blockage and that she was “going septic.” Paulk’s mother kept in touch with an
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inmate housed with Paulk who was “trying to keep [Paulk] alive basically.”2 But
despite their best efforts, the jail refused to take action. In his phone calls to Sasser,
Paulk’s father tried to explain that Paulk was likely going septic due to Crohn’s
disease, that “[h]er body is swelling up and if it’s not treated, she’s going to be
septic.” Paulk’s mother testified that she conveyed similar information to jail staff,
though at some point they stopped answering her calls, likely recognizing her
number.
Two or three days before the court hearing on July 7, Paulk’s mother sent her
father to the jail because Paulk was “in really bad shape. She’s got to get to the
hospital or she’s going to die.” Paulk’s father went to the jail with his sister and
tried to persuade jail staff to call an ambulance, but they refused. Paulk’s father
responded, “well let me call an ambulance, and they said, no.” He then implored,
“listen, you people don’t understand what’s going on. . . . She is going to die.” But
jail staff refused to call an ambulance or provide any information about Paulk.
Paulk was released from jail on July 7, after her court date. Paulk testified
that she was “so sick that [she] was in a wheelchair” and was largely “unresponsive.”
2 The record contains what appears to be a letter from this inmate to Paulk’s parents. This letter provides details about events relating to Paulk at the jail from late June through Paulk’s release. The letter is unsworn, however, and Paulk has not indicated that this inmate is available to testify. Because the letter itself appears to be inadmissible hearsay, and because it is unclear at this time whether the inmate would be available to provide testimony in this case, we do not consider the letter in evaluating whether the district court correctly granted summary judgment. 9 Case: 20-10049 Date Filed: 09/04/2020 Page: 10 of 20
Her parents rushed her to the emergency room, where a CT scan showed findings of
bowel perforation, air, and abscesses. She underwent emergency surgery and had
multiple abdominal abscesses drained and small bowel strictures that were resected.
Before she was discharged, the surgeon told her that she had “gone septic” and was
“lucky to be alive.” The surgeon stated that upon her admission she had “only a 25
percent chance to live” and that she would have died if she stayed in jail any longer.
The surgeon informed Paulk’s mother that Paulk had been septic for seven days and
that her blood work indicated that she had been without food and water during that
time. That suggests Paulk had been septic and without food or water since June 30
or July 1.
II.
Paulk filed this lawsuit under 42 U.S.C. § 1983 alleging that the defendants
were deliberately indifferent to her serious medical needs, in violation of her
constitutional rights. Paulk also alleged state-law claims of negligence against
Sheriff Ford. After discovery, the defendants filed a motion for summary judgment,
which the district court granted. With regard to the federal claims, the court
concluded that the defendants were not deliberately indifferent to Paulk’s serious
medical needs because the jail’s medical staff provided frequent medical care to
address her condition, and because negligence in treatment or even medical
malpractice is not enough to give rise to a constitutional claim. The court declined
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to exercise supplemental jurisdiction over the state-law claims and remanded them
to state court. Paulk now appeals the dismissal of her § 1983 claims.
III.
“We review a district court’s grant of summary judgment de novo considering
all the facts and reasonable inferences in the light most favorable to the non-moving
party.” Mann v. Taser Int’l, Inc., 588 F.3d 1291, 1303 (11th Cir. 2009). Summary
judgment is appropriate if, based on the evidentiary materials in the record, “there is
no genuine dispute as to any material fact and the movant is entitled to judgment as
a matter of law.” Fed. R. Civ. P. 56(a). “Summary judgment is improper, however,
if the evidence is such that a reasonable jury could return a verdict for the nonmoving
party.” Guevara v. NCL (Bahamas) Ltd., 920 F.3d 710, 720 (11th Cir. 2019)
(quotation marks omitted).
IV.
Because Paulk was a pretrial detainee at the time of the alleged violations, her
claims are governed by the Due Process Clause of the Fourteenth Amendment.
Jackson v. West, 787 F.3d 1345, 1352 (11th Cir. 2015). Nevertheless, the minimum
standard allowed by the Due Process Clause for pretrial detainees is the same as that
allowed by the Eighth Amendment for prisoners. Id.
Under the Fourteenth Amendment, pretrial detainees like Paulk have the
“right to receive medical treatment for illness and injuries.” Cook ex rel. Estate of
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Tessier v. Sheriff of Monroe Cty., Fla., 402 F.3d 1092, 1115 (11th Cir. 2005). A
pretrial detainee can establish a violation of this right by showing that a jail official
displayed “deliberate indifference” to her serious medical needs. Id.; see Estelle v.
Gamble, 429 U.S. 97, 104 (1976).
A deliberate-indifference claim has both an objective component and a
subjective component. Goebert v. Lee Cty., 510 F.3d 1312, 1326 (11th Cir. 2007).
For the objective component, the plaintiff must show that she has an objectively
“serious medical need”—that is, “one that has been diagnosed by a physician as
mandating treatment or one that is so obvious that even a lay person would easily
recognize the necessity for a doctor’s attention.” Id. (quotation marks omitted).
Appellees do not dispute that Crohn’s disease and its complications present
objectively serious medical needs. The evidence shows that Paulk’s Crohn’s disease
led to complications that twice required her hospitalization and nearly resulted in her
death. This is sufficient to show that Paulk had serious medical needs.
For the subjective component, the plaintiff must “show the [jail] official’s:
(1) subjective knowledge of a risk of serious harm; (2) disregard of that risk; and
(3) by conduct that is more than mere negligence.” Bingham v. Thomas, 654 F.3d
1171, 1176 (11th Cir. 2011) (quotation marks omitted); see Farmer v. Brennan, 511
U.S. 825, 837 (1994) (explaining that the standard of deliberate indifference is
consistent with recklessness in the criminal law). “Conduct that is more than mere
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negligence includes: (1) grossly inadequate care; (2) a decision to take an easier but
less efficacious course of treatment; and (3) medical care that is so cursory as to
amount to no treatment at all.” Bingham, 654 F.3d at 1176. Additionally, an officer
“who delays necessary treatment for non-medical reasons may exhibit deliberate
indifference.” Id.; Farrow v. West, 320 F.3d 1235, 1246 (11th Cir. 2003).
However, “[m]ere incidents of negligence or malpractice do not rise to the
level of constitutional violations.” Harris v. Thigpen, 941 F.2d 1495, 1505 (11th
Cir. 1991). Deliberate indifference is about “obduracy and wantonness, not
inadvertence or error in good faith.” Whitley v. Albers, 475 U.S. 312, 319 (1986).
“It is the equivalent of recklessly disregarding a substantial risk of serious harm to
the inmate.” Cottrell v. Caldwell, 85 F.3d 1480, 1491 (11th Cir. 1996) (quotation
marks omitted). So “a simple difference in medical opinion between the prison’s
medical staff and the inmate as to the latter’s diagnosis or course of treatment [fails
to] support a claim of cruel and unusual punishment.” Harris, 941 F.2d at 1505.
Here, no reasonable jury could conclude that the defendants were deliberately
indifferent to Paulk’s serious medical needs before her hospitalization from June 16–
20.3 Before that time, Paulk regularly received medical attention and treatment for
symptoms of Crohn’s disease, in most instances within one or two days after she
3 Notably, Paulk did not sue ARNP Wolfe, who treated Paulk during this time, for deliberate indifference. 13 Case: 20-10049 Date Filed: 09/04/2020 Page: 14 of 20
requested medical assistance. She was prescribed various medications to treat her
symptoms, she underwent diagnostic procedures such as X-rays to determine the
severity of her condition, and she was taken to the hospital shortly after the jail
discovered that she may have a bowel obstruction. Whether this care was good or
negligent, it simply does not reflect the type of “reckless[] disregard[]” of inmate
health that we have found sufficient to meet the standard of deliberate indifference. 4
Cottrell, 85 F.3d at 1491; see Bingham, 654 F.3d at 1176; Harris, 941 F.2d at 1505.
But as to the events following her hospital discharge and her return to the jail,
we conclude that there are genuine issues of material fact that preclude summary
judgment. Before explaining why, we pause a moment to clarify what is at issue on
appeal. In granting summary judgment, the court found that Paulk failed to present
sufficient evidence of deliberate indifference. But the court did not go further and
address the defendants individually or their claims of qualified immunity. The
parties on appeal likewise do not address qualified immunity or the claims as to
4 Paulk asserts that laxatives were “contraindicated” for her conditions but were prescribed, anyway. But she offers no medical or expert evidence as to the use of laxatives to treat Crohn’s disease. The only supporting testimony she offers came from her mother, who believed that it was “in total disregard for Crohn’s patients to ever take a laxative” and stated that she had been “[t]old by a gastro doctor to never take a laxative or anything like that because it only aggravated the Crohn’s symptoms.” On the other hand, both Dr. Derkaz and ARNP Wolfe testified that laxatives are sometimes prescribed for Crohn’s patients. On this record, we cannot say that Paulk’s evidence on this point reflects anything more than“a simple difference in medical opinion between the prison’s medical staff and the inmate as to the latter’s diagnosis or course of treatment,” which is not sufficient to “support a claim of cruel and unusual punishment.” Harris, 941 F.2d at 1505. 14 Case: 20-10049 Date Filed: 09/04/2020 Page: 15 of 20
particular defendants. Because these inquiries require individualized assessments,5
the sole issue before us, as we see it, is simply whether a reasonable jury could find
in Paulk’s favor on any of her claims of deliberate indifference, and not the viability
of all her claims or whether qualified immunity applies. With that clarification, we
explain why Paulk could prevail on a deliberate-indifference claim at least as to Dr.
Derkaz.
The evidence reflects that Paulk returned to the jail from the hospital with a
diagnosis of a partial small-bowel obstruction and recommendations (in the jail’s
view) or orders (in Paulk’s view) to give her Remicade and a high-fiber diet and to
return her to the hospital for a follow-up appointment within two weeks. Although
her condition did not require surgery at that time, Dr. Derkaz knew it required
monitoring going forward and that life-threatening complications could result.
Dr. Derkaz testified that complications common to Crohn’s disease can lead to life-
threatening conditions, such as a complete bowel obstruction or a bowel perforation.
5 See Alcocer v. Mills, 906 F.3d 944, 951 (11th Cir. 2018) (“Because § 1983 requires proof of an affirmative causal connection between the official’s acts or omissions and the alleged constitutional deprivation, each defendant is entitled to an independent qualified-immunity analysis as it relates to his or her actions and omissions.”); Dang ex rel. Dang v. Sheriff, Seminole Cty. Fla., 871 F.3d 1272, 1280 (11th Cir. 2017) (stating that, when assessing the subjective component of a claim of deliberate indifference, we must judge each individual defendant “separately and on the basis of what that person kn[ew]” and not on “[i]mputed or collective knowledge”). 15 Case: 20-10049 Date Filed: 09/04/2020 Page: 16 of 20
Life-threatening conditions did in fact result. By July 7, Paulk was largely
“unresponsive” and close to death. According to the surgeon who performed
emergency life-saving surgery after her release from the jail, Paulk was “lucky to be
alive” and had been septic and malnourished for seven days.
And there is sufficient evidence for a jury to conclude that Dr. Derkaz was
aware that Paulk was deteriorating and developing life-threatening conditions due to
her Crohn’s disease but took no reasonable action in response. See McElligott v.
Foley, 182 F.3d 1248, 1259 (11th Cir. 1999) (finding sufficient evidence of
deliberate indifference where “the defendant was aware that plaintiff’s condition
was, in fact, deteriorating, and still did nothing to treat this deteriorating state.”);
Carswell v. Bay Cty., 854 F.2d 454, 457 (11th Cir. 1988) (finding sufficient evidence
of deliberate indifference whether the defendants were aware of the plaintiff’s
deteriorating condition but did little to ensure that the plaintiff received medical
attention).
On July 1, Paulk reported that she was “getting weak because I can’t eat.”
Two days later, she saw Dr. Derkaz, who believed that she did not have a “surgical
problem” at that time because her abdomen was “soft and with active bowel signs,
left-sided tenderness, no guarding or distension.” But the very next day Paulk
reported to medical in tears and complained of abdominal pain, nausea, and
vomiting. And that day and the next, July 4 and 5, nurses noted that Paulk’s
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abdomen was distended and firm, that she had difficulty walking and sitting upright,
and that she had hypoactive bowel sounds. Although the nursing staff was unable
to reach him on July 4, Dr. Derkaz was informed of Paulk’s condition on July 5. 6
Dr. Derkaz’s own testimony reflects that the symptoms reported by Paulk and
the nurses indicated that her condition was deteriorating and required emergency
care. In attempting to downplay the severity of Paulk’s condition, he testified that
“if she had a full bowel obstruction she would have been vomiting and would be
getting sicker,” “she wouldn’t be able to eat,” and she “would be getting
progressively worse and worse and worse.” But a reasonable jury could conclude
that Paulk did exhibit these symptoms, or symptoms of comparable severity, and
that Dr. Derkaz knew as much. As of July 5, when Dr. Derkaz was informed of
Paulk’s condition, Paulk had been in severe distress for at least two days, with
nausea, vomiting, abdominal pain, a distended and firm abdomen, hypoactive bowel
sounds, an inability to eat, and difficulty walking or standing upright. Under Dr.
Derkaz’s own testimony, these symptoms reflect a potential life-threatening
condition requiring surgery.
Despite his awareness of these facts, Dr. Derkaz took no action with regard to
Paulk’s medical needs, apart from prescribing Toradol, for pain relief, and
6 Meanwhile, Paulk’s parents repeatedly called Sasser and other jail staff and described Paulk’s condition, pleading that she likely had a bowel obstruction, was going septic, and needed emergency medical care or else she would die. 17 Case: 20-10049 Date Filed: 09/04/2020 Page: 18 of 20
Phenergan, for nausea and vomiting, the same medication she had previously
received at various times at the jail. He did not order X-rays or blood tests, as the
jail previously had done when she experienced similar but less severe symptoms in
May and June. He did not personally examine Paulk after July 3. Nor did he call a
specialist or an ambulance or direct anyone else to do those things. And Paulk
almost died as a result.
A reasonable jury could conclude from this evidence, viewed in the light most
favorable to Paulk, that Dr. Derkaz “recklessly disregard[ed] a substantial risk of
serious harm to the inmate.” See Cottrell, 85 F.3d at 1491. A jury could reasonably
conclude that in early July 2014 Paulk’s need for emergency care was obvious and
that Dr. Derkaz’s response—prescribing medication for her symptoms that did little
or nothing to ameliorate a potential life-threatening complication like a bowel
obstruction or perforation—was “grossly inadequate” or was “so cursory as to
amount to no treatment at all.” See McElligott, 182 F.3d at 1255–57 (reasoning that
“a jury could find that the medication provided to [the plaintiff] was so cursory as to
amount to no care at all” because it “was not treating the severe pain he was
experiencing”). “A jury could infer deliberate indifference from the fact that [Dr.
Derkaz] knew the extent of [Paulk’s] pain, knew that the course of treatment was
largely ineffective, and declined to do anything more to attempt to improve [her]
condition.” Id. at 1257–58 (quotation marks omitted). In other words, this case is
18 Case: 20-10049 Date Filed: 09/04/2020 Page: 19 of 20
not about a simple difference in views on appropriate treatment, which is insufficient
to show deliberate indifference. See Harris, 941 F.2d at 1505. Rather, a jury could
reasonably conclude “that the defendant was aware that plaintiff’s condition was, in
fact, deteriorating, and still did nothing to treat this deteriorating state.” McElligot,
182 F.3d at 1259.
We acknowledge that Paulk received medical care throughout her
incarceration at the jail. And courts “hesitate” to find a constitutional violation
where an inmate has received medical care. Waldrop v. Evans, 871 F.2d 1030, 1035
(11th Cir. 1989). “Hesitation does not mean, however, that the course of a
physician’s treatment of a prison inmate’s medical or psychiatric problems can never
manifest the physician’s deliberate indifference to the inmate’s medical needs.” Id.
And it remains the case that “grossly incompetent medical care or choice of an easier
but less efficacious treatment can constitute deliberate indifference.” Id. For the
reasons explained above, we conclude that there is sufficient evidence for a
reasonable jury to return a verdict against Dr. Derkaz on Paulk’s claim of deliberate
indifference.
Accordingly, the district court erred in granting summary judgment on the
ground that Paulk had not offered sufficient evidence of deliberate indifference as to
any of the defendants. We conclude that, at least as to Dr. Derkaz, summary
judgment was not appropriate because a reasonable jury could return a verdict in
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Paulk’s favor on her claim of deliberate indifference. See Guevara, 920 F.3d at 720.
But because the court (and the parties on appeal) did not go further and conduct an
individualized assessment of the evidence as to each defendant or address the
defendants’ claims of qualified immunity, we do not do so in the first instance.
Instead, we believe that the most prudent course of action is simply to vacate
the grant of summary judgment and remand for further proceedings. For the issues
that remain, the district court may choose to conduct the analysis on the basis of the
record as it currently exists, or it may allow the parties to supplement their summary-
judgment submissions in light of our opinion today.
VACATED AND REMANDED.