Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-08-02187/USCOURTS-ca7-08-02187-0/pdf.json

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

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The Honorable William T. Lawrence, United States District

Court Judge for the Southern District of Indiana, sitting by

designation.

In the

United States Court of Appeals

For the Seventh Circuit

No. 08-2187

LESTER GAYTON,

Plaintiff-Appellant,

v.

MICHAEL D. MCCOY, et al.,

Defendants-Appellees.

Appeal from the United States District Court 

for the Central District of Illinois.

No. 04 CV 1354—Byron G. Cudmore, Magistrate Judge.

ARGUED MAY 7, 2009—DECIDED JANUARY 28, 2010

Before FLAUM and WILLIAMS, Circuit Judges, and

LAWRENCE, District Judge.

WILLIAMS, Circuit Judge. India Taylor, a thirty-four-yearold recent college graduate, entered Peoria County Jail

on October 15, 2003 complaining of chest pain. Despite

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knowledge that Taylor had a serious heart condition and

elevated blood pressure, she was never provided with

any medication and, against the jail’s written protocol, a

doctor was never contacted to examine her. Less than

three days later, she was dead due to non-specific heart

failure brought on by an elevated pulse. Her estate’s

executor brought suit against the three nurses who examined Taylor, claiming that they violated her due

process rights by failing to provide her with adequate

medical care. The plaintiff also brought suit against a

variety of prison officials, claiming that inadequate

prison medical policies contributed to Taylor’s untimely

death.

The district court excluded the plaintiff’s expert

witness, Dr. Corey Weinstein, finding that he was unqualified and that his opinions were not reliable. It also

granted summary judgment to the defendants after

determining that none of them exhibited a deliberate

indifference to a serious medical need of Taylor’s.

Because Dr. Weinstein conceded that he has no specific

training or education regarding the short-term efficacy of

Taylor’s heart medications, we affirm the district court’s

exclusion of his opinion that she might have survived

if prison officials had provided her with these medications in the days before her death. However, Dr.

Weinstein’s medical training, examination of Taylor’s

medical records, and use of differential diagnosis

support his conclusion that the nurses’ failure to

quell Taylor’s vomiting could have led to her

tachycardia, and his opinion on this issue should have

been admitted. Likewise, his examination of the record

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No. 08-2187 3

in this case coupled with being one of the leading experts

on prison medical care support his conclusion that the

jail officials did not provide Taylor with the minimum

standard of prison medical care expected in this country,

and to the extent that it remains relevant at trial, it

should be admitted.

The district court was correct that, as the plaintiff

conceded at oral argument, the prison’s medical policies

were adequate and therefore did not contribute to

Taylor’s death. So, the district court properly awarded

summary judgment to Peoria County, Advanced Correctional Healthcare, Inc., and the individual defendants

who did not have contact with Taylor during her incarceration. As to the nurses, although she failed to follow

prison protocol in treating Taylor, Nurse Olivia Radcliff

took steps to obtain Taylor’s cardiac medications and

put a note in Taylor’s file to have her seen by a doctor if

the medications were not delivered. So, it cannot be

said that she acted with deliberate indifference, and the

district court correctly granted summary judgment

in her favor. Taylor visited Nurse Patricia Mattus complaining of nausea, and, because she thought Taylor

was drug seeking, Nurse Mattus did not provide Taylor

with any medication, put her on the sick call list, and sent

her back to her cell. Because Taylor did not complain

of chest pain during the visit, however, Nurse Mattus

was not faced with a serious medical need that required

immediate treatment. So, the district court properly

granted summary judgment in her favor.

On the other hand, Nurse Pam Hibbert was presented

with ample evidence that Taylor needed medical treatCase: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
4 No. 08-2187

ment. While participating in a video-bond hearing, Taylor

began to vomit. The guards were so concerned about

Taylor’s condition that they collected her vomit in a bag

and immediately called Nurse Hibbert requesting that

she examine Taylor. Nurse Hibbert knew about Taylor’s

heart condition, and if per prison protocol, she examined

Taylor’s chart, she would have seen that her cardiac

medications should have been delivered, that she had

recently complained of chest pain, that she had high

blood pressure less than twenty-four hours earlier, and

that she should have already been examined by a doctor. But instead of calling a doctor or examining Taylor,

Nurse Hibbert concluded that Taylor was drug seeking,

and told the guards that her shift was coming to an end.

Based on these facts, a jury could find that Nurse

Hibbert was deliberately indifferent to Taylor’s serious

medical need, and that Nurse Hibbert’s inaction caused

Taylor to suffer harm. Therefore, we reverse and

remand this matter for trial against Nurse Hibbert.

I. BACKGROUND

In April 2003, thirty-four-year-old India Taylor’s

doctors diagnosed her with congestive heart failure

(“CHF”). CHF is a serious heart condition characterized

by a swelling on the lining surrounding the heart,

which weakens the heart and impairs the heart’s ability to

pump blood to the body’s organs. Taylor’s doctors prescribed a regimen of six medications, generally consisting

of diuretics and ACE inhibitors. They also informed

her that she had a mortality risk of forty to sixty percent

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No. 08-2187 5

if she failed to take her medications on a consistent

basis, but less than ten percent if she took them as instructed. Over the course of the next few months, Taylor

took her medications sporadically and missed several

doctors’ appointments.

On July 1 and July 17, 2003, respectively, Taylor was

arrested. During both arrests, Taylor complained of chest

pain and was transported to the emergency room. Both

times, doctors provided her with her prescribed CHF

medications, after which she was taken to Peoria County

Jail (“PCJ”). When Taylor arrived at PCJ on July 2, 2003,

Nurse Patricia Mattus made contact with Taylor’s

doctors to ascertain her medical history. This history and

a list of Taylor’s necessary medications became a part of

Taylor’s medical records at PCJ. During her second incarceration, Taylor vomited violently as a result of heroin

withdrawal. The medical staff treated her with Donnatal

(to calm her nausea) and Vistaril (a sleep aid).

On July 20, 2003, the day after she was released from

her second detention at PCJ, Taylor went to the emergency room complaining of chest pain. She presented

with an elevated blood pressure, and her doctors prescribed thirty days’ worth of CHF medications with an

additional refill. Walgreens’s records show that she

filled these prescriptions shortly after she was released

from the emergency room.

On August 2, 2003, Taylor was arrested again. This

time she had her medications with her. Dr. Norman

Johnson, a prison physician, examined her and recommended that she continue taking her CHF medications

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6 No. 08-2187

while incarcerated. Dr. Johnson is employed as president

and CEO of Advanced Correctional Healthcare, Inc., a

private, for-profit company that provides medical care

in prisons, including PCJ. During Taylor’s monthlong incarceration at PCJ, she did not suffer from heroin

withdrawal and did not vomit. She was released on

August 28, 2003.

October 15, 2003, Taylor was arrested again and

detained at PCJ. During the booking process, she complained of chest pain. After she was processed, the guards

took her to medical intake. During intake, Nurse Olivia

Radcliff examined Taylor. Taylor completed a medical

questionnaire, on which she listed her treating physician

and medications. Nurse Radcliff acknowledged that the

jail had copies of Taylor’s medical records and knew of

the medications that she was prescribed to treat her

CHF. The back of the form, on which the nurse was

supposed to record her observations and findings, has

never been found.

Nurse Radcliff checked Taylor for head lice but did not

take her vital signs. Taylor called her brother, Lester

Gayton, and asked him to refill her medications and

bring them to PCJ. Nurse Radcliff made a note on

Taylor’s chart that if the medications were not brought

to the prison by the following day, Taylor was to be seen

by Dr. Johnson.

Gayton could not retrieve Taylor’s prescriptions due

to complications with her insurance, but failed to

inform the jail that he would not be delivering the medications. Around 4:30 A.M. the next morning (October 16),

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No. 08-2187 7

Taylor complained to the guards of nausea and told them

that she was suffering from heroin withdrawal. The

guards saw her vomit and took her to see Nurse Mattus.

Taylor requested drugs to help her stop vomiting, but

Nurse Mattus concluded that Taylor must have forced

herself to vomit in order to receive drugs and refused

to provide her with medication to reduce her vomiting.

Nurse Mattus also claimed that she was unable to take

Taylor’s vitals and sent her back to her cell after putting

her on the sick call list to be seen later that morning.

Around 9 A.M. that same morning, Nurse Pam Hibbert

saw Taylor during PCJ’s sick call. Taylor’s blood pressure

was elevated and she complained of nausea. Nurse

Hibbert sent Taylor back to her cell. During Taylor’s

video-bond hearing at 3 P.M., Taylor vomited violently.

The guards were worried about her condition. They

collected her vomit in a plastic bag and called Nurse

Hibbert. Nurse Hibbert told the guards that she thought

Taylor was seeking drugs, refused to allow the guards

to bring Taylor in for an examination, and stated that

Taylor should just fill out a sick request form in order to

be seen by the next nurse because Hibbert’s shift was

almost over (Nurse Mattus took over at 8 P.M.). The

officers took the sick request form to Taylor and helped

her fill it out. Taylor said she was feeling better, but

she completed the form, which the guards submitted

for her at 7:40 P.M. This request form was also never

found. One of the officers filed a jail incident report

against Nurse Hibbert because she thought that Nurse

Hibbert ignored a significant medical complaint.

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8 No. 08-2187

Taylor was on the list of prisoners to be seen by

Dr. Johnson the next morning. However, sometime before

3:40 A.M. on the morning of October 17, Taylor died.

Taylor’s brother and administrator of her estate, Lester

Gayton, initiated this wrongful death action pursuant to

42 U.S.C. § 1983 against the Sheriff who administers

PCJ, PCJ’s superintendent, Advanced Correctional

Health Care, the three nurses who examined Taylor, and

Dr. Johnson.

There are three medical opinions at issue in this case.

Dr. Brian Mitchell, a pathologist at the coroner’s office,

concluded that Taylor died of heart failure. The defendants’ expert, Dr. Kreigh Moulton, a board-certified

cardiologist, testified that Taylor died of heart failure as

a result of “sustained ventricular tachyarrhythmia in the

setting of a chronic nonischemic cardiomyopathy.”

“Tachyarrhythmia” or “tachycardia” simply refers to a

pulse that reaches over 100 beats per minute. Essentially,

Dr. Moulton concluded that Taylor had a weak heart,

her pulse elevated while in prison, and her heart failed for

non-specific reasons. Dr. Corey Weinstein, the plaintiff’s

expert, adopted the other two experts’ cause of death

findings and opined that: (1) had Taylor been given her

cardiac medications while in prison, she might still

be alive; (2) the combination of Taylor’s vomiting

and diuretic medications could have caused electrolyte

imbalances (due to depleted potassium levels), which

could have led to her tachycardia and then her heart

failure; and (3) prison medical officials departed from

accepted standards of prison medical care in their treatment, or lack thereof, of Taylor. Dr. Moulton refuted

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No. 08-2187 9

Dr. Weinstein’s findings and concluded that: (1) Taylor’s

cardiac medication would not have prevented her death;

and (2) although severe vomiting could contribute

to tachyarrhythmia, it would take almost a full day of

vomiting before her electrolyte levels were sufficiently

depleted to do so.

The district court excluded Dr. Weinstein’s testimony

and entered summary judgment for the defendants,

finding that the plaintiff failed to show proximate causation or that any defendant acted indifferently to a

serious medical need. The plaintiff now appeals.

II. ANALYSIS

A. The Exclusion of Dr. Weinstein’s Testimony

Federal Rule of Evidence 702 allows an expert witness

to testify about a relevant scientific issue in contention

if his testimony is based on sufficient data and is the

product of a reliable methodology correctly applied to the

facts of the case. Under the Daubert framework, the

district court is tasked with determining whether a

given expert is qualified to testify in the case in question

and whether his testimony is scientifically reliable.

Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 592-93

(1993). “Whether a witness is qualified as an expert can

only be determined by comparing the area in which the

witness has superior knowledge, skill, experience, or

education with the subject matter of the witness’s testimony.” Carroll v. Otis Elevator Co., 896 F.2d 210, 212 (7th

Cir. 1990). In determining reliability, Daubert sets

forth the following non-exhaustive list of guideposts:

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10 No. 08-2187

Dr. Weinstein’s qualifications include, among other things: a 1

medical degree from the University of Illinois College of

(continued...)

(1) whether the scientific theory can be or has been tested;

(2) whether the theory has been subjected to peer review

and publication; and (3) whether the theory has been

generally accepted in the scientific community. Daubert,

509 U.S. at 593-94. The court should also consider the

proposed expert’s full range of experience and training in

the subject area, as well as the methodology used to

arrive at a particular conclusion. Smith v. Ford Motor Co.,

215 F.3d 713, 718 (7th Cir. 2000). We give the district court

latitude in determining not only how to measure the

reliability of the proposed expert testimony but also

whether the testimony is, in fact, reliable, Jenkins v.

Bartlett, 487 F.3d 482, 489 (7th Cir. 2007), but the court

must provide more than just conclusory statements of

admissibility or inadmissibility to show that it adequately

performed its gatekeeping function. Naeem v. McKesson

Drug Co., 444 F.3d 593, 608 (7th Cir. 2006). Determinations

on admissibility should not supplant the adversarial

process; “shaky” expert testimony may be admissible,

assailable by its opponents through cross-examination. See

Daubert, 509 U.S. at 596. We review de novo whether the

court correctly applied Daubert’s framework, and we

review the court’s decision to admit or exclude expert

testimony for abuse of discretion. Kunz v. DeFelice, 538

F.3d 667, 675 (7th Cir. 2008).

In this case, the district court found that:

(1) Dr. Weinstein was not qualified to testify regarding 1

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No. 08-2187 11

(...continued) 1

Medicine (1969), treating patients as a general practitioner for

over thirty years, spending a significant amount of his time

consulting on medical care in prisons, many prior legal consultations regarding prison medical care, certification by the

National Commission on Correctional Health Care, membership in the American Public Health Association, being

Chairman of the Jail and Prison Health Committee, and membership in the International Human Rights Committee.

Taylor’s “cause of death”; and (2) the methodology he

used to arrive at his conclusions was not sufficiently

reliable. The district court reasoned that Dr. Weinstein

was not qualified to opine on Taylor’s cause of death

because he was neither a cardiologist nor pharmacologist,

had no specific expertise on heart disease, and did not

possess any training regarding the interactions of Taylor’s

prescriptions and tachycardia. In its analysis, the district

court made a fundamental mistake in characterizing

Dr. Weinstein’s testimony as “cause of death” testimony.

Dr. Weinstein did not testify as to what caused Taylor’s

death. All three experts agreed that Taylor died as a

result of nonspecific heart failure due to an increased

heart rate, the cause of which cannot be known for certain. Dr. Weinstein did not dispute this. Instead, he offered

his opinion that Taylor’s death could have been prevented

if: (1) she had been given her CHF medications; (2) she had

been treated to stop her vomiting; or (3) she had received

adequate medical treatment from the medical professionals

at PCJ. Dr. Weinstein’s qualifications for making, and

methodology in reaching, each of these conclusions must

be separately examined.

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12 No. 08-2187

Before turning to Dr. Weinstein’s individual conclusions, it is important to address the district court’s assumption that Dr. Weinstein needed to have specific cardiac

training to testify as an expert in a case involving a

heart-related death. True, simply because a doctor has a

medical degree does not make him qualified to opine on

all medical subjects. See Carroll, 896 F.2d at 212. That

said, courts often find that a physician in general practice

is competent to testify about problems that a medical

specialist typically treats. 29 Wright & Gold, Federal

Practice and Procedure, § 6265 (1997); see Doe v. Cutter

Biological, Inc., 971 F.2d 375, 385 (9th Cir. 1992) (“The

fact that the experts were not licensed hematologists

does not mean that they were testifying beyond their

area of expertise. Ordinarily, courts impose no requirement that an expert be a specialist in a given field, although there may be a requirement that he or she be of a

certain profession, such as a doctor.”); see also Dickenson

v. Cardiac & Thoracic Surgery of E. Tenn., 388 F.3d 976,

978-79 (6th Cir. 2004); United States v. Viglia, 549 F.2d 335,

336 (5th Cir. 1977) (holding that a pediatrician who

had degrees in medicine and pharmacology but no experience in treating patients for obesity had sufficient

knowledge, training, and education to testify regarding

drug’s effect on obese persons). The question we must

ask is not whether an expert witness is qualified

in general, but whether his “qualifications provide a

foundation for [him] to answer a specific question.” Berry

v. City of Detroit, 25 F.3d 1342, 1351 (6th Cir. 1994); see

Meridia Prod. Liab. Litig. v. Abbott Lab., 447 F.3d 861, 868 (6th

Cir. 2006) (district court did not abuse its discretion by

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No. 08-2187 13

permitting qualified pharmacologist to testify as to drug

temporarily elevating blood pressure of some patients,

but not as to effects of high blood pressure on the

human body.); Dura Auto. Sys. of Ind., Inc. v. CTS Corp.,

285 F.3d 609, 613 (7th Cir. 2002). So, the fact that

Dr. Weinstein is not a cardiologist does not prevent him

from testifying regarding Taylor’s death; instead, we

must look at each of the conclusions he draws

individually to see if he has the adequate education, skill,

and training to reach them.

Here, Dr. Weinstein makes three separate conclusions.

With respect to his first conclusion, that Taylor

would not have died if PCJ had given her her cardiac

medications, the district court did not abuse its

discretion in finding him unqualified because of his lack

of specific knowledge of cardiology and pharmacology.

Aside from the fact that these drugs treat heart disease

and that they were prescribed for Taylor’s CHF,

Dr. Weinstein gives no basis for his opinion that if

prison officials had obtained and administered these

medicines to her during the two days prior to her death

she would have survived. Dr. Weinstein does not

contend that he has any specific knowledge regarding

how these drugs function, whether they are efficacious

in the short term as well as the long term, or how they

prevent CHF from reaching a critical stage. Moreover,

Dr. Weinstein cannot state what effect, if any, these

medications would have had given that the record

reveals that Taylor had not been taking them consistently nor as instructed by her prescribing physician.

Because he does not have specialized cardiac or pharmacoCase: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
14 No. 08-2187

logical knowledge upon which to base his conclusion

that these drugs had a reasonable probability of saving

her life if taken in the days before her death, the

district court did not err in excluding it.

On the other hand, Dr. Weinstein’s second conclusion,

that Taylor’s vomiting combined with her diuretic medications may have contributed to her tachycardia and

subsequent death, should not have been excluded. The

effects of vomiting on potassium and electrolyte levels

in the body is not specialized knowledge held only by

cardiologists, and as Dr. Weinstein opined, it is knowledge that any competent physician would typically

possess. So, the district court erred when it concluded

that Dr. Weinstein was not qualified to testify that

Taylor’s vomiting may have hastened her death.

The district court did not address Dr. Weinstein’s third

conclusion, that the care given to Taylor did not meet the

acceptable standards of prison medicine and that the

standard level of care may have prevented her death. It is

undisputed that Dr. Weinstein is an expert in the area

of prison healthcare. So, to the extent that it remains

relevant, given that Dr. Weinstein’s testimony regarding

PCJ’s or the individual defendants’ failure to provide

an adequate standard of medical care to Taylor resulted

in an injury to her could “assist the trier of fact to understand the evidence or to determine a fact in issue,” it

should be admitted. See Fed. R. Evid. 702.

The district court also excluded Dr. Weinstein’s testimony because it found it to be unreliable. Specifically,

the court took issue with the fact that: (1) Dr. Weinstein

simply adopted the cause of death proffered by the

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No. 08-2187 15

other physicians; and (2) he did not specifically rule out

any other possible contributing factors to Taylor’s death.

As stated above, none of the experts in this case can

definitively say that one specific factor caused Taylor’s

heart to stop. Dr. Weinstein simply posited that a large

amount of vomiting was one factor that increased the

likelihood that Taylor’s heart would fail. To the extent

that this amounts to “adopting the cause of death”

finding of another expert, we see no problem with it.

In terms of his methodology, Dr. Weinstein, like

Dr. Moulton, had to arrive at his conclusions based

solely on an examination of a cold record, consisting of

Taylor’s autopsy report, her medical records, and the

testimony of the prison guards and other witnesses. Cf.

Cooper v. Carl A. Nelson & Co., 211 F.3d 1008, 1020 (7th

Cir. 2000) (“[I]n clinical medicine, the methodology of

physical examination and self-reported medical history

employed by [the physician] is generally appropriate.”). In

reviewing the record, Dr. Weinstein used the same type

of equally reliable analysis as Dr. Moulton—differential

diagnosis based on Taylor’s medical history and the

facts surrounding her incarceration. Dr. Weinstein,

based on his medical experience, provided a sufficient

scientific basis for his position that, among other things,

Taylor’s vomiting could have exacerbated her heart

condition and hastened her death. Cf. Bass by Lewis v.

Wallenstein, 769 F.2d 1173, 1183 (7th Cir. 1985) (finding

that expert’s testimony that chance of survival would

have been 10-30% if advanced cardiac life support had

been timely administered was sufficient to uphold jury

verdict).

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16 No. 08-2187

The district court also took issue with the fact that, aside

from lack of medication and the nurses’ failure to treat

Taylor’s vomiting, Dr. Weinstein did not posit any

possible alternative causes of Taylor’s heart failure.

Aside from failing to account for the inefficiencies of

requiring an expert to list each and every possible cause

of a given outcome, this analysis misinterprets Dr.

Weinstein’s testimony as being directly related to

Taylor’s “cause of death.” Dr. Weinstein did not

conclude that Taylor’s vomiting was a one-hundred

percent certain cause of her death. As we have held on

many occasions, an expert need not testify with

complete certainty about the cause of an injury; rather

he may testify that one factor could have been a contributing factor to a given outcome. See Walker v. Soo Line R.

Co., 208 F.3d 581, 587-88 (7th Cir. 2000). The possibility

that a cause other than Taylor’s vomiting was ultimately

responsible for her injury is properly left for exploration

on cross-examination. See id.; Cooper, 211 F.3d at 1021

(“The possibility of Mr. Cooper’s [chronic pain syndrome]

being attributable to a factor other than the fall is a

subject quite susceptible to exploration on cross-examination by opposing counsel. Similarly, the accuracy and

truthfulness of the underlying medical history is subject

to meaningful exploration on cross-examination and

ultimately to jury evaluation. Therefore, Nelson’s contention that other conditions of Mr. Cooper’s might have

caused his CPS goes to the weight of the medical testimony, not its admissibility.”). Further, whether the cause

put forth by a qualified expert actually proximately

caused the injury at issue is a question for the jury at trial;

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No. 08-2187 17

a district court should only evaluate whether an expert’s

conclusion on causation was reasoned and based on a

reliable methodology. Cooper, 211 F.3d at 1015 (“Although the existence of a duty must be determined as a

matter of law, the question of whether there was a breach

of that duty and an injury proximately caused by

that breach are questions of fact for the jury.”). Last, the

plaintiff need not show that the defendants’ failure to

treat her vomiting ultimately caused her death, but

merely that it exacerbated her medical problems, because

the constitutional violation in question here is the failure

to provide adequate medical care to Taylor in response

to a serious medical condition, and not “causing her

death”. See Grieveson v. Anderson, 538 F.3d 763, 779 (7th

Cir. 2008) (“A delay in the provision of medical treatment

for painful conditions—even non-life-threatening conditions—can support a deliberate-indifference claim so

long as the medical condition is ‘sufficiently serious or

painful.’ ”) (citations omitted); see also Williams v. Liefer, 491

F.3d 710, 716 (7th Cir. 2007) (“[A] jury could find that the

defendants’ delay caused [the inmate] six extra hours of

pain and dangerously elevated blood pressure for no

good reason.”). For these reasons, the district court

abused its discretion in finding that Dr. Weinstein’s

testimony regarding the link between Taylor’s vomiting

and her death was unreliable.

In summary, given that none of the medical experts in

this case can determine the exact cause of Taylor’s untimely death, aside from non-specific heart failure, the

jury should hear testimony, backed by accepted medical

science, about factors that could have exacerbated her

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18 No. 08-2187

heart condition. After hearing from all of the experts, and

after vigorous cross-examination, it will be up to the

jury to determine which of these factors, if any, proximately caused an injury to Taylor. Dr. Weinstein’s testimony regarding the interaction between Taylor’s

vomiting and her heart condition as well as his testimony

regarding the standard of medical care in prisons and the

effects of delaying care are admissible, but his testimony

regarding the role that PCJ’s failure to provide Taylor

with her CHF medications may have played in her death

is not. As always, on remand the district court retains

the discretion to exclude portions of Dr. Weinstein’s

testimony that are inconsistent with any of the other

Federal Rules of Evidence.

B. Deliberate Indifference to a Serious Medical Condition

In order to sustain a § 1983 claim for violation of

Taylor’s Fourteenth Amendment due process right to

adequate medical care, the plaintiff must show that:

(1) Taylor had an objectively serious medical condition;

(2) the defendants knew of the condition and were deliberately indifferent to treating her; and (3) this indifference

caused her some injury. See Hayes v. Snyder, 546 F.3d

516, 522 (7th Cir. 2008); Qian v. Kautz, 168 F.3d 949,

955 (7th Cir. 1999). An objectively serious medical condition is one that “has been diagnosed by a physician as

mandating treatment or one that is so obvious that even

a lay person would perceive the need for a doctor’s attention.” Hayes, 546 F.3d at 522. A medical condition

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need not be life-threatening to be serious; rather, it could

be a condition that would result in further significant

injury or unnecessary and wanton infliction of pain if

not treated. See Reed v. McBride, 178 F.3d 849, 852 (7th

Cir. 1999).

With regard to the deliberate indifference prong, the

plaintiff must show that the official “acted with the

requisite culpable state of mind.” Id. This inquiry has two

components. The official must have subjective knowledge of the risk to the inmate’s health, and the official also

must disregard that risk. Collins v. Seeman, 462 F.3d 757,

761 (7th Cir. 2006). Evidence that the official acted negligently is insufficient to prove deliberate indifference. See

Payne for Hicks v. Churchich, 161 F.3d 1030, 1040 (7th Cir.

1998). Rather, “ ‘deliberate indifference’ is simply a synonym for intentional or reckless conduct, and that ‘reckless’ describes conduct so dangerous that the deliberate

nature of the defendant’s actions can be inferred.” Qian,

168 F.3d at 955. Simply put, an official “must both be

aware of facts from which the inference could be drawn

that a substantial risk of serious harm exists, and he

must also draw the inference.” Higgins v. Corr. Med. Serv.

of Ill., Inc., 178 F.3d 508, 510 (7th Cir. 1999); see also Hudson

v. McHugh, 148 F.3d 859, 864 (7th Cir. 1998). Even if a

defendant recognizes the substantial risk, he is free from

liability if he “responded reasonably to the risk, even if

the harm ultimately was not averted.” Farmer v. Brennan,

511 U.S. 825, 843 (1994). Whether a medical condition

is “serious” and whether a defendant was “deliberately

indifferent” to it are fact questions, to be resolved by a

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20 No. 08-2187

jury if a plaintiff provides enough evidence to survive

summary judgment. See Hayes v. Snyder, 546 F.3d 516, 523

(7th Cir. 2008). The district court granted summary judgment to the defendants because it found that they did not

show a deliberate indifference to a serious medical need

of Taylor’s; we review this decision de novo, viewing all

facts in the light most favorable to the plaintiff. Williams

v. Rodriguez, 509 F.3d 392, 398 (7th Cir. 2007).

1. Objectively Serious Medical Condition

The district court found that Taylor’s CHF, but not her

vomiting, was a serious medical condition. There is no

dispute that Taylor had a serious heart condition, CHF,

which was diagnosed by a doctor. Taylor’s prison medical

records reflected this and noted that she was required

to take six different medications to manage this condition. So, Taylor’s CHF was a serious lifelong medical

condition, and a jury could find that Taylor’s complaints

of chest pain during her incarceration at PCJ made the

defendants aware that she had an “objectively serious

medical condition” that required medical intervention.

Vomiting, in and of itself, is not an uncommon result

of being mildly ill, and, absent other circumstances (e.g.,

vomiting continuously for a long period of time, having

blood in one’s vomit, or the like), does not amount to

an objectively serious medical condition. However, given

that PCJ and its medical staff were on notice of Taylor’s

CHF, they should have been more concerned about her

vomiting than that of the average ill inmate. When Taylor

Case: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
No. 08-2187 21

arrived at PCJ she complained of chest pain. Subsequently, she complained of nausea and vomited enough

to make several prison guards very concerned for her

health. There is no need to parse the two conditions and

call one serious and the other not. As Dr. Weinstein

testified, excessive vomiting could exacerbate Taylor’s

heart condition. The seriousness of her vomiting is highlighted by the fact that several prison guards thought

it prudent to collect her vomit in a bag and call the

nurse to see if Taylor could be examined immediately.

At minimum, a jury could find that, although not life

threatening, Taylor’s vomiting could have led to increased pain or injury as a result of her heart condition,

allowing the plaintiff to survive the defendant’s motion

for summary judgment on the issue of whether she exhibited a serious medical condition. See Farmer, 511 U.S.

at 843.

2. Deliberate Indifference

The district court did not find that any of the defendants’ actions extended beyond mere negligence into the

realm of deliberate indifference because it found that

Taylor’s complaints were not indicative of “crushing chest

pain” or “chest pain that signaled an emergency.” Given

this conclusion, the district court found that the nursing

staff was reasonable in assuming Taylor was drug seeking

and responded appropriately to Taylor’s complaints by

putting her on the list to be seen by a doctor three days

after her initial complaints of chest pain. In reaching

these conclusions, the analysis weighed the evidence

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22 No. 08-2187

and neglected to view the facts in the light most

favorable to the plaintiff as the non-moving party. The

record reflects that Taylor’s CHF was a life threatening

condition known to the defendants through Taylor’s

medical records. Her specific complaints of chest pain

while she was incarcerated at PCJ, either alone or in

conjunction with her serious vomiting, could certainly

lead a jury to believe that she had a serious medical

condition. Whether a reasonable jury could possibly find

for the plaintiff depends on the knowledge each

individual defendant had regarding Taylor’s condition,

and how each defendant responded to her requests for

medical attention. So, we must examine the defendants’

knowledge and actions individually.

a. Dr. Johnson, Sheriff McCoy, and Superintendent Smith in Their Individual Capacities

Dr. Norman Johnson, Sheriff Michael McCoy, and

Superintendent Steven Smith did not have contact with

Taylor during the days immediately preceding her

death. So, in order to sustain a due process claim

against them, the plaintiff needs to show that they had

knowledge of Taylor’s condition and somehow ratified

the deliberate indifference of those persons who were

directly responsible for Taylor’s care. See Hudson, 148

F.3d at 863. Given that the record reveals no evidence

that they knew of Taylor’s incarceration, condition, or

requests for medical attention, summary judgment in

their favor is appropriate.

Case: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
No. 08-2187 23

b. Advanced Correctional Healthcare, Inc., Peoria

County, Illinois, and Defendants in Their

Official Capacities

It is well established that there is no respondeat superior

liability under § 1983. See Horwitz v. Bd. of Educ. of Avoca

Sch. Dist. No. 37, 260 F.3d 602, 619-20 (7th Cir. 2001). A

“private corporation is not vicariously liable under § 1983

for its employees’ deprivations of others’ civil rights.”

Iskander v. Vill. of Forest Park, 690 F.2d 126, 128 (7th Cir.

1982). Generally, to maintain a viable § 1983 action

against a municipality, a government agent (such as

Advanced Correctional Healthcare, Inc.), or individual

policymaking defendants in their official capacities

(such as Johnson, McCoy, and Smith), a plaintiff must

demonstrate that a constitutional deprivation occurred

as the result of an express policy or custom promulgated

by that entity or an individual with policymaking authority. See Latuszkin v. City of Chicago, 250 F.3d 502, 504

(7th Cir. 2001).

So, in order to maintain an action against Advanced

Correctional Health Care, Inc. or Peoria County, the

plaintiff must show that PCJ’s healthcare policy was a

“moving force” behind Taylor’s death or needless suffering. Latuskin, 250 F.3d at 505. Here, the plaintiff

cites two policies which he contends contributed to Taylor’s death. First, he claims that the jail’s policy did not

permit the guards to directly contact Dr. Johnson when

they felt that a prisoner needed a doctor’s attention.

Second, he argues that when a prisoner is “very sick”

guards should check on her every half hour.

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24 No. 08-2187

At PCJ, a doctor is present to take appointments on

Mondays, Wednesdays, and Fridays. The doctor is

on call twenty-four hours a day, seven days a week, for

any medical emergency. Prison policy dictates that a

doctor is supposed to be contacted if a prisoner complains of a serious medical condition, specifically

including chest pain. At all other times there is a nurse

or nurse practitioner on site to handle minor emergencies

and other ailments. Although mandating a doctor’s visit

or constant prisoner checks would likely reduce the

number of illness-related deaths or injuries, it is neither

economically prudent nor feasible to put such policies

in place. As the plaintiff conceded at oral argument,

the policies that were in place were sufficient to

provide Taylor with adequate medical care; instead, the

plaintiff alleges that the harm to Taylor resulted from

the nurses’ failure to follow these policies. So, any type

of Monell claim fails. See Monell v. City of New York, 436

U.S. 658 (1978). As such, summary judgment for all

non-nurse defendants is appropriate.

We now turn to the defendants that actually had

contact with Taylor prior to her untimely death.

c. Nurse Radcliff

Nurse Radcliff was the first medical professional to

“treat” Taylor upon her arrival at PCJ. Taylor complained

of chest pains. Nurse Radcliff failed to follow PCJ’s protocol which requires her to contact a doctor when an

inmate complains of chest pains. She also failed to take

Taylor’s vital signs.

Case: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
No. 08-2187 25

Instead, Nurse Radcliff responded to Taylor’s

complaints by putting her on the list to have her vitals

checked each morning, and, according to her own statements, asked Taylor about the severity of her chest pain.

More importantly, she had Taylor call her brother to

bring her CHF medication to PCJ and put a specific note

on Taylor’s chart to call the doctor if the medication

was not delivered by the next day. “[D]eliberate indifference may be inferred based upon a medical professional’s erroneous treatment decision only when the

medical professional’s decision is such a substantial

departure from accepted professional judgment, practice,

or standards as to demonstrate that the person responsible did not base the decision on such a judgment.”

Estate of Cole by Pardue v. Fromm, 94 F.3d 254, 261-62

(7th Cir. 1996). If this standard is not met, the deliberate

indifference question may not go to the jury. Id. Here,

although she did not have Taylor immediately examined

by a doctor, given that she took reasonable measures to

ensure that Taylor would get her medication, and put a

notation in her chart to have her seen by a doctor if

they did not arrive, it cannot be said that Nurse

Radcliff’s judgment departed so substantially from the

professional norm that she acted deliberately indifferent

to Taylor’s health. Nor can it be said that her actions

were “so dangerous” that the deliberate nature of her

conduct can be inferred. Qian, 168 F.3d at 955. So,

summary judgment in Nurse Radcliff’s favor is appropriate.

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26 No. 08-2187

d. Nurse Mattus

Nurse Mattus examined Taylor after she complained of

nausea. During this examination, Taylor neither vomited

nor complained of chest pain. In response, Nurse Mattus

put Taylor on the morning sick call list, but refused to

give her any medication to quell her nausea. Certainly

Nurse Mattus should have checked Taylor’s chart and

ascertained whether Taylor’s CHF medications had been

delivered, and in response to finding that they had not

been, immediately followed up with Dr. Johnson. But,

her failure to do so was not a deliberate indifference

to a serious medical condition, but mere negligence—

Taylor neither vomited nor complained of chest pain

during the visit; had she done so, our analysis might be

different. But since she did not, and negligence is not

actionable as a due process violation, summary judgment in favor of Nurse Mattus is appropriate. See Steele

v. Choi, 82 F.3d 175, 178 (7th Cir. 1996) (courts must

“distinguish between deliberate indifference to serious

medical needs of prisoners, on the one hand, and

negligen[ce] in diagnosing or treating medical condition, on the other,” and “only the former” violates the

Eighth Amendment (citations omitted)).

e. Nurse Hibbert

Later that morning, Taylor again went to PCJ’s infirmary

complaining of nausea. Nurse Hibbert examined her

and found that her blood pressure was high. Taylor

asked for anti-nausea medication but did not vomit.

Nurse Hibbert did not give Taylor this medication, but she

Case: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
No. 08-2187 27

testified that had she seen Taylor vomit, protocol

would have dictated that she administer anti-nausea

medication to her. She also testified that she knew of

Taylor’s CHF, and that the prison policy stated that a

nurse should retrieve a prisoner’s medical chart before

examining her. Had she done so, she would have seen

that Taylor was supposed to have been examined by

a doctor because her brother failed to bring her CHF

medications to the prison, and that Taylor had complained of chest pain during intake.

Later that day, Taylor vomited while attending a court

proceeding via video. The prison guards were so concerned about Taylor’s health that they felt it necessary

to collect her vomit in a trash bag. Admirably, they immediately called Nurse Hibbert and told her that Taylor

needed to be examined as soon as possible. (Nurse Hibbert

disputes the guards’ version of events, but for our purposes we accept it as true). Despite clear indications

that Taylor was in serious medical need—she had complained of chest pain, exhibited high blood pressure hours

earlier, and vomited during a video hearing—Nurse

Hibbert refused to see Taylor, and instead told the

guards to have her fill out a sick request form. See Walker

v. Benjamin, 293 F.3d 1030, 1037 (7th Cir. 2002) (quoting

Farmer, 511 U.S. at 842) (“[A] factfinder may conclude

that a prison official knew of a substantial risk from the

very fact that the risk was obvious.”). Nurse Hibbert

herself admitted that if she had seen Taylor vomit, she

would have given her anti-nausea medication. But faced

with the guards’ concern and a bag full of vomit, she did

not. In fact, the record reveals that the reason she did

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28 No. 08-2187

nothing was, because, according to the guards’ testimony,

it was approaching the end of her shift and she wanted

to let the next nurse handle the situation. As a result of her

inaction, Officer Browning, one of the guards that told

Nurse Hibbert to examine Taylor, thought that Nurse

Hibbert violated prison protocol, and filed a complaint

against her. And all three of the guards present at the

video hearing testified for the plaintiff in this matter.

Given that Nurse Hibbert refused to treat or even see

Taylor in spite of her serious medical condition, a jury

could easily find that her actions surpassed mere negligence and entered the realm of deliberate indifference.

In fact, the guards’ testimony regarding Taylor’s condition, and the various acts that they took to try to help

her, shows that even a layperson would believe that

Taylor’s condition was serious. See Hayes, 546 F.3d at

522. Therefore, we reverse the district court’s grant of

summary judgment in favor of Nurse Hibbert.

3. Proximate Causation

The district court also found that none of the nurses’

actions was the proximate cause of Taylor’s death. See

Berman v. Young, 291 F.3d 976, 982 (7th Cir. 2002) (noting

that plaintiff must “produce evidence that she sustained

actual injury and that her injuries had a causal connection

with the alleged [Section 1983] due process violation”)

(citations omitted). The district court concluded Gayton

needed to show, through expert testimony, that the

nurses’ inaction necessarily caused Taylor’s death. And

without such testimony, the district court found he

could not establish proximate cause.

Case: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
No. 08-2187 29

Because Dr. Weinstein’s testimony concerning the

possible connection between Taylor’s vomiting and her

tachycardia should not have been excluded, the plaintiff

now has expert evidence to establish causation. Moreover, even if the plaintiff could not proffer expert testimony in this case, he still would have adequate causation

evidence to reach trial against Nurse Hibbert. Proximate

cause is a question to be decided by a jury, and only in

the rare instance that a plaintiff can proffer no evidence

that a delay in medical treatment exacerbated an

injury should summary judgment be granted on the issue

of causation. See Grieveson, 538 F.3d at 779; Cooper, 211

F.3d at 1015. Expert testimony is not always necessary

to establish causation in a case where an inmate alleged

that prison employees violated his due process rights

by failing to provide him with adequate medical care:

Clearly, expert testimony that the plaintiff suffered

because of a delay in treatment would satisfy the

requirement. On the other hand, evidence of a

plaintiff’s diagnosis and treatment, standing alone,

is insufficient if it does not assist the jury in determining whether a delay exacerbated the plaintiff’s

condition or otherwise harmed him.

Grieveson, 538 F.3d at 779 (citing Liefer, 491 F.3d at 715).

But if the plaintiff offers evidence that allows the jury

to infer that a delay in treatment harmed an inmate,

there is enough causation evidence to reach trial.

Grieveson, 538 F.3d at 779. In Grieveson, an inmate alleging prison officials violated his due process rights

by failing to provide him with adequate medical care

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30 No. 08-2187

did not introduce expert testimony that the delay in

medical care caused him to suffer. Id. Nonetheless,

because he introduced the medical records relating to his

injury, which could have led a jury to infer that a delay

in treatment could have unnecessarily prolonged and

exacerbated his injury, we concluded he had enough

evidence to survive summary judgment. Id. The same

is true here. The plaintiff has offered evidence that Taylor

had a serious medical condition, the guards thought her

condition serious enough that she needed medical attention, and Nurse Hibbert actively ignored her requests

for treatment. This is enough for a jury to find that

Taylor incurred “many more hours of needless suffering

for no reason” as a result of Nurse Hibbert’s inaction.

Id. This is especially true because the constitutional deprivation at issue is a failure to provide Taylor with due

process in the form of adequate medical treatment; the

plaintiff need not prove that Nurse Hibbert’s inaction

necessarily led to Taylor’s death, but rather that her

suffering was exacerbated by Nurse Hibbert’s failure to

provide her with adequate medical care. See id.; see also

Liefer, 491 F.3d at 715-16.

III. CONCLUSION

Therefore, we AFFIRM IN PART and REVERSE IN PART

the district court’s exclusion of Dr. Weinstein’s testimony. The district court properly excluded Dr. Weinstein’s testimony as it relates to the effects of PCJ’s failure

to provide Taylor with her CHF medications. However,

his testimony regarding the adequate standard of medCase: 08-2187 Document: 49 Filed: 01/28/2010 Pages: 31
No. 08-2187 31

ical care in prisons and the effect that Taylor’s vomiting

may have had on her heart condition should not have

been excluded. We AFFIRM the district court’s grant of

summary judgment to Dr. Johnson, McCoy, Smith, Advanced Correctional Healthcare, Inc., Peoria County, Nurse

Mattus, and Nurse Radcliff because no reasonable jury

could conclude that their actions amounted to deliberate

indifference to a serious medical need. Because a jury

could find that Nurse Hibbert’s inaction amounted to

deliberate indifference to a serious medical need of Taylor’s, we REVERSE the district court’s grant of summary

judgment in her favor, and remand for trial on the plaintiff’s § 1983 claim against her. Because the plaintiff has

failed to develop any argument relating to the district

court’s award of summary judgment to the defendants on

his state law claims, he has waived any objection to the

court’s decision on those claims, and therefore we AFFIRM

on those claims. See Argyropoulos v. City of Alton, 539

F.3d 724, 738 (7th Cir. 2008).

1-28-10

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