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Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 

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In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 19-2225 

DARRYL TURNER, 

Plaintiff-Appellant, 

v.

REENA D. PAUL, et al., 

Defendants-Appellees. 

____________________ 

Appeal from the United States District Court for the 

Northern District of Illinois, Eastern Division. 

No. 17 C 2434 — Matthew F. Kennelly, Judge. 

____________________ 

ARGUED FEBRUARY 19, 2020 — DECIDED MARCH 26, 2020 

____________________ 

Before WOOD, Chief Judge, and FLAUM and RIPPLE, Circuit 

Judges. 

WOOD, Chief Judge. Darryl Turner suffered a broken nose 

during an altercation with another inmate while in pre-trial 

detention at the Cook County Jail. The injury left him with 

pain and shortness of breath. A doctor determined that he 

needed surgery to treat his problems, but to Turner’s great 

Case: 19-2225 Document: 32 Filed: 03/26/2020 Pages: 10
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frustration, the surgery was repeatedly rescheduled and postponed. Over a year after the initial injury, he finally received 

the surgery following his release from custody. 

Claiming that his treatment was unconstitutionally deficient under the Eighth and Fourteenth Amendments to the 

U.S. Constitution, Turner sued a number of administrators 

and medical professionals at the Cook County Health and 

Hospitals System and at Cermak Health Services, a countyoperated clinic located in the jail. He also sued Cook County 

itself. The district court granted summary judgment with respect to all defendants, and Turner appealed. We affirm the 

district court’s grant of summary judgment. 

I 

A 

In October 2015, while Turner was in pre-trial detention, 

another inmate punched him in the face and broke his nose 

during a fight. A few days later, he saw an ear, nose and throat 

(ENT) specialist at Cermak’s urgent care clinic. The doctor 

recommended that Turner follow up with the plastic surgery 

clinic at Stroger Hospital for a nasal fracture evaluation. On 

November 10, Dr. Stefan Szczerba (an assistant clinical professor of surgery at Stroger) determined that Turner needed a 

septorhinoplasty and turbinate reduction to treat the nose, 

but he noted that the surgery should wait for six to twelve 

months, until after Turner’s bone injury had healed and the 

swelling in his nose had subsided. Szczerba scheduled Turner 

for pre-operation clearance on November 19. 

On November 19, Dr. Reena Paul saw Turner at Cermak. 

She noted that he had missed his pre-operation appointment, 

and so she contacted the scheduling department to make sure 

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No. 19-2225 3

he got another appointment. This effort was successful. 

Turner’s pre-operation clearance was rescheduled and he was 

seen for that purpose the next day. Soon after, Turner had an 

appointment with Dr. Stamatia Richardson, who scheduled 

him for another appointment on January 12, 2016. 

As these events transpired, Turner appeared in state court 

twice, first on November 9 and second on December 14. On 

each of these occasions, Turner complained that his nose was 

broken and that he had not been treated. On both occasions, 

the judge issued orders requiring that a doctor see Turner. At 

the December 14 hearing, Turner misleadingly claimed that 

his surgery had been scheduled for November 9 or 10 and that 

it had been cancelled. The judge ordered that Turner “should 

be seen by an ENT as soon as possible and that any surgery 

that is needed be performed as soon as possible.” The Department of Corrections forwarded these orders to Dr. Connie 

Mennella, chair of correctional health at Cermak, and to Sandra Navarro, deputy director of risk management at the Cook 

County Health and Hospitals system. 

On December 22, Turner’s attorney sent a letter to Nneka 

Jones Tapia, the executive director of the Cook County Department of Corrections, demanding that Turner receive surgery. Jones Tapia forwarded the letter to Elizabeth Feldman, 

division chair for clinic operations at Cermak, and to Navarro. 

Navarro and Feldman followed up on the letter with administrators at Stroger Hospital and ascertained that Turner had 

another appointment scheduled for January 12. 

Turner saw Dr. Szczerba again at his January 12 appointment. Szczerba recommended that Turner return in one to 

two weeks to evaluate the timing of his surgery. The doctor 

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also wrote in his notes “unclear why so delayed in scheduling.” At a deposition, Szczerba testified that this referred to 

Turner; that is, Turner was unclear why it was taking so long 

for him to get the surgery. Dr. Paul saw Turner the next day 

and noted that his appointment with plastic surgery would 

take place the following week. 

On January 19, Michael Gart, a medical resident, saw 

Turner and scheduled him for surgery on January 21. However, Gart cancelled the operation after consulting with 

Szczerba, who believed that it should wait on account of 

Turner’s continuing complaints of nasal pain. Turner was rescheduled for a follow-up appointment on February 9. On 

February 2, Turner’s attorney lodged another complaint with 

Cook County’s administrators. Navarro followed up on the 

complaint and learned of the February 9 appointment. 

At the February 9 appointment, the clinic scheduled 

Turner’s surgery for February 25. This surgery was cancelled, 

but the record does not reveal why. Deposition testimony indicates, however, that when a surgery does not take place it is 

usually because the surgeon rescheduled or because another 

patient had a more urgent case. A medical resident rescheduled Turner’s operation for March 31. On March 22, Gina 

Chung, a physician’s assistant, saw Turner. Chung observed 

in her notes that Turner’s nasal fracture was not acute and that 

he was breathing normally. 

Turner’s March 31 surgery was also cancelled, for reasons 

unknown. On April 25, Turner had a follow-up appointment 

where the physician noted that his surgery had been cancelled. In June, Turner was moved from pre-trial detention to 

imprisonment at the Stateville Correctional Center. In August, 

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No. 19-2225 5

he was released from prison and in November, he received 

his septorhinoplasty and turbinate reduction at Cermak. 

B 

After he finally managed to have his surgery, Turner sued 

nine administrators and medical professionals who had 

worked on his case over the preceding year. As the case developed, Turner and the defendants stipulated to the dismissal of three of the defendants, leaving Feldman, Mennella, Navarro, Paul, Richardson, and Chung in the case. Turner also 

sued Cook County under a Monell theory of liability. 

After discovery, the district court granted summary judgment in favor of the defendants. It found that Turner had not 

introduced enough evidence to permit a reasonable jury to 

conclude that any of the individual defendants acted objectively unreasonably in Turner’s case. Because none of the individual defendants had the authority to schedule surgeries, 

the court reasoned, Turner could not prove that any of them 

engaged in objectively unreasonable conduct that caused his 

surgery to be delayed. The court also granted summary judgment to Cook County, on the ground that there was no evidence that the County’s practices or policies caused his injury. 

II 

A 

At all times relevant to this lawsuit, Turner was a pre-trial 

detainee. His section 1983 claim against Cook County’s doctors and administrators is thus analyzed under the Fourteenth 

Amendment, rather than under the Eighth Amendment 

standard applied to prisoners. See Miranda v. Cnty. of Lake, 900 

F.3d 335, 352 (7th Cir. 2018). For a pre-trial detainee to prevail 

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on a claim of deficient medical treatment, he must demonstrate two things. First, he must show that the defendants 

acted “purposefully, knowingly, or ... recklessly.” Id. at 353. 

A showing of only “negligence or even gross negligence will 

not suffice” to meet this standard. McCann v. Ogle Cnty., Illinois, 909 F.3d 881, 886 (7th Cir. 2018). Second, he must proffer 

evidence showing that the course of treatment he received 

was “objectively unreasonable.” Id. at 886 (“This standard requires courts to focus on the totality of facts and circumstances faced by the individual alleged to have provided medical care and to gauge objectively - without regard to any subjective belief held by the individual - whether the response 

was reasonable.”). 

Turner has not met these burdens. His basic theory of liability against all six defendants is that they failed to ensure 

that he received his surgery in a timely manner. But Turner 

presented no evidence that would allow the trier of fact to 

conclude that the allegedly unreasonable conduct of any of 

the named defendants caused his surgery to be delayed. The 

unrebutted evidence showed that none of the defendants had 

the authority to schedule or to perform the relevant surgery. 

Additionally, the evidence shows that each time any of the 

individual defendants encountered Turner, his surgery or another appointment was on the plastic surgery schedule. As a 

result, a reasonable jury could not conclude that the defendants’ conduct was objectively unreasonable. 

Taking a closer look, we see that Turner proceeds against 

two categories of individual defendants. First, he sues Paul, 

Richardson, and Chung, each of whom served as his primary 

care physician at some point. Each of the medical defendants 

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No. 19-2225 7

was a primary care provider who could refer him to the plastic surgery clinic for additional treatment, but none was authorized to perform nasal surgeries. Second, he sues Mennella, Feldman, and Navarro, administrators who worked on 

his case. It is undisputed that none of these defendants was 

employed at Stroger Hospital and none had the direct authority to schedule operations at the plastic surgery clinic. 

Turner claims nonetheless that the medical defendants 

failed to meet the standard of care by failing to follow up with 

the plastic surgery clinic to make sure that he had received his 

surgery. This argument fails. The medical defendants contacted the plastic surgery clinic for scheduling each time they 

saw Turner. According to the unrebutted evidence, none of 

these defendants had the independent authority to schedule 

surgeries at the plastic surgery clinic. That duty fell instead on 

the medical residents at the clinic, who made their decisions 

in consultation with the doctors at the hospital. Because the 

medical defendants had no control over the scheduling of the 

appointments, Turner cannot claim that their failure to schedule him for surgery, or their failure to nag the residents, constituted objectively unreasonable conduct. See Walker v. Benjamin, 293 F.3d 1030, 1038 (7th Cir. 2002) (holding that summary judgment in favor of a defendant doctor was warranted 

where the plaintiff “presented no evidence that ... delays 

were even within [the doctor’s] control”). We are aware of no 

rule of law that would impose a duty on the medical defendants to continue calling the clinic, after they had properly contacted the proper schedulers. 

As for the defendant administrators, Feldman, Mennella, 

and Navarro, Turner has likewise failed to show that their 

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conduct was objectively unreasonable. Like the medical defendants, the administrative defendants had no authority to 

schedule surgeries themselves. In each instance where they 

were contacted about Turner’s case, they followed up with the 

clinic and saw that he had another appointment scheduled, 

either to see a doctor or to have the surgery performed. Turner 

charges that the administrative defendants had an additional 

duty to follow up on his appointments at the hospital to ensure that he actually received his surgery. Once again, we are 

aware of nothing that places the bar of “objectively reasonable” behavior that high. The administrators’ responsibility 

was satisfied by their follow-ups with the clinic. 

Because Turner has not presented evidence sufficient for a 

reasonable juror to conclude that any of the individual defendants’ actions were objectively unreasonable, we affirm 

the district court’s grant of summary judgment in their favor. 

B 

We now turn to Turner’s claim against Cook County. In 

order to prevail on a claim against a municipality under section 1983, a plaintiff must show that “an official policy, widespread custom, or action by an official with policy-making authority was the moving force behind a constitutional injury.” 

McCann, 909 F.3d at 888 (cleaned up). The central question 

under Monell is “always whether an official policy, however 

expressed[,] ... caused the constitutional deprivation.” Glisson 

v. Ind. Dep’t of Corr., 849 F.3d 372, 378 (7th Cir. 2017). 

Turner offers three theories of Monell liability against Cook 

County. First, he argues that the County had a widespread 

practice of failing to follow through on scheduling. Second, 

he argues that the County failed to have adequate procedures 

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No. 19-2225 9

in place for responding to court orders and grievance requests. Finally, he argues that Drs. Mennella and Feldman 

were final policymakers and that their actions caused his constitutional deprivation. 

Turner’s argument that the County’s alleged policy of failing to follow up delayed his treatment fails on its face. Because there was no evidence that the physicians at Cermak 

had any part in scheduling surgery, the evidence does not 

support a finding that the County is liable for the delay. 

Turner points to a report prepared by a court-appointed monitor that found that Cermak failed to enter orders received 

from off-site clinics in a consistent manner. He cannot base his 

theory of liability on this “policy,” however, because the report covered only orders that Cermak received from the specialty clinics, rather than orders from Cermak to the clinics. 

The report provides no evidence that Cermak was deficient in 

requesting appointments for its patients at the specialty clinics. The evidence thus does not support a finding that the 

County’s policies caused Turner’s deprivations. 

Turner cannot rely upon gaps in the County’s policies for 

similar reasons. Turner complains that the County failed to 

act upon his repeated grievances and the court orders filed 

late in 2015 and attributes this failure to inadequate policies 

for following up on such requests and orders. It is true that 

“in situations that call for procedures, rules or regulations, the 

failure to make policy itself may be actionable.” Glisson, 849 

F.3d at 381. However, Turner’s arguments are again unavailing, because he cannot show that a different policy would 

have led to faster treatment. Nor does he show how the delay 

in his own treatment was an obvious consequence of the 

County’s actions. As discussed above, all the evidence shows 

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10 No. 19-2225 

that the County’s administrators were diligent in contacting 

the clinic to ensure that Turner had appointments with the 

clinic’s doctors. They were responsive to his grievances and 

to the court’s orders. That record precludes any finding of an 

actionable gap in the County’s policies. 

Finally, Turner cannot claim liability against Cook County 

on the ground that Mennella and Feldman were final policymakers whose actions led to a constitutional deprivation. A 

county can be liable under the final policymaker theory only 

if we are dealing with a real policymaker and that policymaker acted “with deliberate indifference as to [the] known –

or obvious consequences” of her conduct. Board of Cnty. 

Comm’rs of Bryan Cnty., Okl. v. Brown, 520 U.S. 397, 407 (1997) 

(quotation marks omitted); see also Doe v. Vigo Cnty., Ind., 905 

F.3d 1038, 1045 (7th Cir. 2018). It is not at all clear that either 

Mennella or Feldman meets the criteria for a final policymaker. See, e.g., Milestone v. City of Monroe, Wis., 665 F.3d 774, 

780–81 (7th Cir. 2011). But, like the district court, we do not 

need to resolve that issue here. Turner has pointed to no evidence showing that Mennella and Feldman were deliberately 

indifferent to his medical needs. Turner has not even provided enough evidence to conclude that they acted unreasonably. Thus, Turner’s argument based on the final policymaker 

theory also fails. 

Because all of Turner’s arguments to the contrary are unavailing, the district court properly granted summary judgment in the County’s favor on Turner’s Monell claim. 

III 

We AFFIRM the judgment of the district court. 

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