After Lance Jett fell from his top bunk at California State Prison–Sacramento in October 2001, an emergency-room physician diagnosed a fracture at the base of Jett’s right thumb. The physician placed the thumb in a temporary SPICA splint, prescribed pain medication, and directed that Jett see an orthopedic doctor early the following week. The written aftercare instructions accompanied Jett back to the prison.
Jett saw a prison doctor three days later, but his hand was too swollen for a permanent cast. He was then not seen by a physician for most of November and December. During that period, he submitted medical slips, filed a grievance, and sent institutional-mail letters to Dr. Penner, Dr. Peterson, and later Warden Pliler explaining that his thumb was fractured and that he needed orthopedic treatment. Dr. Penner first saw Jett on December 24, nearly two months after the injury. Although x-rays and later examinations showed healing, they also documented deformity, angulation, and eventually post-traumatic degenerative changes.
Jett continued requesting orthopedic care. Dr. Penner did not submit an orthopedic-consult request until March 2002, and marked it routine. Jett eventually saw an orthopedist in April 2002, who concluded that the fracture had healed improperly and recommended referral to a hand specialist. Jett did not reach a hand specialist until May 2003, more than nineteen months after his injury.
Proceeding pro se, Jett sued under 42 U.S.C. § 1983 for deliberate indifference to serious medical needs under the Eighth Amendment and under California Government Code § 845.6 for failure to summon immediate medical care. A magistrate judge recommended summary judgment for all defendants, and the district court adopted that recommendation. The Ninth Circuit reviewed the grant of summary judgment de novo.
Issue #1
Whether Jett produced sufficient evidence for a jury to find that Dr. Penner was deliberately indifferent to Jett’s serious medical need before December 24, 2001.
Holding
Yes. Jett raised a genuine dispute of material fact over whether Dr. Penner knew of the fracture and need for orthopedic follow-up before December 24 and deliberately failed to respond.
Reasoning
An Eighth Amendment medical-care claim requires a serious medical need and deliberate indifference to that need. Deliberate indifference may be shown by a purposeful failure to respond to pain or a possible medical need, coupled with harm caused by that failure. A fractured thumb requiring reduction and casting was undisputedly a serious medical need.
Jett offered evidence that the emergency-room aftercare instructions were in his medical record; that he submitted medical slips and a formal grievance; and that he sent Dr. Penner an institutional-mail letter on December 8 explaining his fracture and need for an orthopedic doctor. At summary judgment, the evidence had to be viewed in Jett’s favor.
Although Dr. Penner denied knowing of the injury until December 24, the factfinder could infer that he received Jett’s letter and was aware of the medical records, slips, and grievance. On that view, a jury could find that Penner knew Jett required prompt follow-up to have the fracture set and cast, yet failed to ensure that Jett was seen.
Issue #2
Whether Jett produced sufficient evidence for a jury to find that Dr. Penner’s treatment after December 24, 2001, was deliberately indifferent to the need to set and permanently cast the fractured thumb.
Holding
Yes. The record permitted a jury to find that Penner unreasonably delayed orthopedic treatment and that the delay harmed Jett by allowing the fracture to heal with deformity.
Reasoning
Jett testified that at the December 24 visit, Dr. Penner assured him that prison staff knew he needed follow-up at Mercy Hospital. Yet Jett was not returned there or promptly referred to an orthopedist at another facility. Penner’s explanation that the prison generally used a contracted facility did not explain why no orthopedic referral occurred for months.
This was not simply a disagreement between doctors over alternative courses of treatment. The emergency-room physician directed prompt orthopedic follow-up, and Penner himself later recognized that an orthopedic consultation was needed. A jury could regard a failure to follow the prior physician’s treatment direction for nonmedical reasons as deliberate indifference.
Additional evidence supported that inference. Despite Jett’s continued requests, Penner’s orthopedic-consult request was delayed and designated routine. A factfinder could also infer indifference from Penner’s notation of no malalignment after he reviewed radiology findings that expressly identified deformity and angulation.
The record also supported causation and harm. Early imaging described a fracture still healing, while later imaging described a well-healed fracture with deformity and irregularity. A jury could infer that the delayed orthopedic care prevented timely reduction and casting, allowing the thumb to heal improperly and leaving Jett with pain and diminished function.
Issue #3
Whether Jett produced sufficient evidence for a jury to find that Dr. Peterson and Warden Pliler were deliberately indifferent to his serious medical need.
Holding
Yes. Jett was entitled at summary judgment to an inference that Peterson and Pliler received his institutional-mail letters and knowingly failed to respond.
Reasoning
Prison administrators may be liable under the Eighth Amendment when they knowingly fail to respond to an inmate’s requests for medical help. Peterson and Pliler stated in interrogatory responses that they did not know of Jett’s condition until this lawsuit.
Jett, however, swore that he sent Peterson and Pliler letters through institutional mail describing his fractured thumb and need for orthopedic treatment. At the summary-judgment stage, the court had to draw the reasonable inference that the letters were received. Whether they actually received the letters, and if so whether their lack of response was deliberately indifferent, were questions for the factfinder.
Issue #4
Whether Jett stated a viable claim under California Government Code § 845.6 based on the failure to obtain orthopedic treatment to set and cast his diagnosed fracture.
Holding
Yes. Section 845.6 can require officials to summon treatment, not merely diagnosis, when an inmate has an immediate need for care for a serious condition.
Reasoning
California Government Code § 845.6 imposes liability when a public employee knows or has reason to know that a prisoner needs immediate medical care and fails to take reasonable action to summon that care. The statute applies to serious and obvious conditions requiring immediate attention, but it does not create a general duty to monitor the quality of medical care already provided.
The lower court wrongly treated Jett’s claim as a challenge to the adequacy of care. Jett instead alleged that defendants did not summon the treatment required after his fracture was diagnosed: orthopedic care to reduce the fracture and apply a permanent cast once the swelling subsided.
The court construed “immediate medical care” to include both diagnosis and treatment. A continuing serious condition can create more than one immediate need for medical care; otherwise, officials could satisfy the statute through diagnosis alone while never obtaining necessary treatment. Because Jett offered evidence that defendants knew of his need for orthopedic treatment and did not timely summon it, a factfinder had to decide whether § 845.6 was violated.