Armond Norfleet v. Thomas Webster and Alejandro Hadded

Citations: 439 F.3d 392; 2006 U.S. App. LEXIS 5398; 2006 WL 508700Docket: 05-1237

Court: Court of Appeals for the Seventh Circuit; March 3, 2006; Federal Appellate Court

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Armond Norfleet, diagnosed with arthritis, was transferred from a federal prison in Milan, Michigan, to Terre Haute, Indiana, on May 22, 2002. At Terre Haute, medical staff determined that his previous treatments, including the provision of soft-soled shoes and pain medications, were unnecessary, leading to a reduction in his medication. Norfleet subsequently filed a lawsuit against five prison officials, claiming a violation of the Eighth Amendment due to deliberate indifference to his serious medical needs. The district court granted summary judgment to three of the defendants but denied it for Dr. Thomas Webster, Clinical Director, and physician assistant Alejandro Hadded. The government appealed this decision.

Norfleet's medical history reveals a long-standing need for specific treatments for his arthritis, including a prescription for soft-soled shoes since 1994 to alleviate pain aggravated by standard footwear. Despite periods of improvement, evaluations indicated fluctuating severity of his condition, with indications of rheumatoid arthritis as early as 1998. A significant assessment in February 2002 by Dr. Eugene Y. Su recommended an increase in his pain medication and better footwear, which led to a temporary allowance of soft-soled shoes while still at Milan. The appeal process highlighted a disagreement between the appellate court and the district court regarding the adequacy of medical care provided to Norfleet at Terre Haute.

Norfleet was transferred to Terre Haute on May 22, 2002, where prison authorities confiscated his soft-soled shoes due to lack of authorization. Dr. Webster reviewed Norfleet's medical history, noting past rheumatoid arthritis and toe deformities, but ultimately diagnosed him with minimal arthritis, concluding he did not need soft-soled shoes. Consequently, Norfleet was required to wear uncomfortable prison-issued shoes, and Dr. Webster also reduced his medications. Despite this, Norfleet continued to receive Naprosyn for pain, with a pharmacist confirming it was authorized by Dr. Webster. On February 12, 2003, Norfleet sought a refill for Naprosyn, but Hadded, a Health Services employee, scheduled an appointment thirteen days later instead of refilling the prescription immediately, resulting in Norfleet going twelve days without medication. A new policy implemented on January 17, 2003, required inmates to wait ten to fourteen days for Naprosyn refills to address potential abuse and side effects.

In analyzing the case, the district court's ruling on summary judgment was reviewed de novo, with all disputed facts viewed favorably to Norfleet. The appeal concerned the government's claim of qualified immunity, focusing on whether Norfleet's constitutional claim had merit. To establish a violation of the Eighth Amendment for deliberate indifference, Norfleet needed to demonstrate both a serious medical need and that a defendant was deliberately indifferent to it. While there was no dispute regarding the seriousness of Norfleet's medical condition, the key issue was the subjective determination of deliberate indifference by prison officials.

A prison official is considered to have a culpable state of mind if they are aware of a substantial risk of harm to an inmate and act with disregard for that risk. Negligence or medical malpractice does not constitute a constitutional violation, even if the victim is a prisoner, as established in Estelle v. Gamble. A mere disagreement among physicians regarding an inmate's treatment does not indicate deliberate indifference. To establish deliberate indifference based on a physician's treatment decision, the choice must significantly diverge from accepted medical standards, indicating a lack of genuine medical judgment. Evidence may suggest that a prison official was aware of a substantial risk if the risk was obvious.

In the case of Norfleet, the facts do not support a finding of deliberate indifference by Dr. Webster or Hadded regarding Norfleet's medical needs. Dr. Webster's assessment of the seriousness of Norfleet's arthritis reflects a difference of opinion rather than deliberate indifference, as he reviewed Norfleet's medical history and determined that soft-soled shoes were unnecessary. Despite previous prescriptions for such shoes, subsequent medical evaluations indicated improvement in Norfleet's condition. The differing medical opinions available to Dr. Webster were not inconsistent enough to suggest a serious departure from accepted medical judgment, as he acknowledged Norfleet's minimal pain and prescribed medication accordingly. Thus, Dr. Webster's decision, grounded in medical records and not indicative of deliberate indifference, is upheld.

The record does not support a violation of the Eighth Amendment by Hadded, a low-level prison employee, as deliberate indifference requires a culpable state of mind akin to criminal recklessness, where the defendant must be aware of and disregard an excessive risk of harm to an inmate. Hadded followed the prison policy mandating a ten-day wait for refills of the pain reliever Naprosyn, which is designed to protect inmates from harmful side effects. His actions do not indicate a basis for deliberate indifference, contrasting with a case where a nurse denied medication based on personal belief. Consequently, adherence to the policy by Hadded cannot be interpreted as deliberate indifference. The conclusion reverses the district court's ruling, directing judgment in favor of Dr. Webster and Hadded. Additionally, while Norfleet highlights facts regarding the revocation of his soft-soled shoes and discontinuation of his Plaquenil prescription and eye exams, these do not alter the determination of lack of deliberate indifference by the defendants. Norfleet has not claimed that the policy itself is unconstitutional.