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Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 

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In the 

United States Court of Appeals 

For the Seventh Circuit ____________________

No. 14‐3549

RYAN K. MATHISON,

Plaintiff‐Appellant,

v.

SCOTT MOATS, et al.,

Defendants‐Appellees.

____________________

Appeal from the United States District Court for the

Central District of Illinois.

No. 12 C 1319 — Joe Billy McDade, Judge.

____________________

SUBMITTED JANUARY 19, 2016— DECIDED FEBRUARY 8, 2016

____________________

Before POSNER, EASTERBROOK, and SYKES, Circuit Judges.

POSNER, Circuit Judge. Ryan Mathison, an inmate at the

Federal Correctional Institution in Pekin, Illinois, brought

this Bivens suit against members of the prison staff and now

appeals from the district court’s grant of summary judgment

in favor of the defendants.

At 3 a.m. one morning Mathison, who suffers from

chronic high blood pressure, was awakened by excruciating

Case: 14-3549 Document: 23 Filed: 02/08/2016 Pages: 8
2 No. 14‐3549

pain in his chest and left arm and other symptoms of a heart

attack. He summoned a guard (defendant Wickman), to

whom he explained his symptoms. The guard immediately

summoned the supervising lieutenant (defendant Omelson),

who in turn called the nurse on call (defendant Wall), who

told the lieutenant that Mathison’s condition was not an

emergency. Having decided there was no emergency, Wall

instructed Mathison (via Omelson) to go to the infirmary in

the morning. Mathison went at 6:45 a.m.—almost four hours

after he had suffered what was indeed a heart attack. The

lieutenant had deferred to Wall’s decision that there was no

emergency.

Upon Mathison’s arrival at the prison infirmary, howev‐

er, the medical staff realized he had a serious problem, and

after giving him tests and some drugs had him transported

by ambulance to the nearest hospital emergency room,

which was in Pekin but didn’t have the necessary equipment

or expertise to treat a serious heart attack and so had him

taken immediately to a Peoria hospital to receive advanced

cardiac care. There he received a stent placement and was

diagnosed with a heart attack. He remained in the hospital

for two days and then was returned to the prison.

His suit is against the guard he first summoned, the su‐

pervising lieutenant, the nurse on call, and the doctor who

treated him in the prison infirmary. He charges them with

deliberate indifference to a serious medical condition, the

indifference consisting both of confining him to his cell for

almost four hours after he awoke with severe pain and

spoke to the guard on duty, and of not treating him in the

infirmary until 8 a.m.—five hours after the onset of his heart

attack. (He also sued the United States, under the Federal

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No. 14‐3549 3

Tort Claims Act, but he has not appealed from the district

judge’s dismissal of his FTCA claim.)

Defendant Moats, the prison doctor, declared in discov‐

ery that the delay in treating Mathison’s heart attack had not

caused damage to his heart. But he based this opinion main‐

ly on what he’d been told by a doctor at the Peoria hospital,

rather than on medical records.

Blood contains an enzyme called troponin; an elevated

level of troponin signifies damage to the heart muscle. There

are several tests for determining the level of troponin in a

person’s blood. See, e.g., Vinay S. Mahajan & Petr Jarolim,

“How to Interpret Elevated Cardiac Troponin Levels,” 124

Circulation 2350 (2011). The range in a healthy person, ac‐

cording to the test that was used to measure the level of tro‐

ponin in blood drawn from the plaintiff in the emergency

room at the Pekin hospital the morning he arrived, is zero to

.07 ng/ml (nanograms per milliliter). The plaintiff’s blood

was found to contain .32 ng/ml of troponin that morning,

which 9 hours later peaked at 33.8 ng/ml and about 9 hours

after that dropped to 18.9 ng/ml.

In granting summary judgment in favor of the defend‐

ants, the judge remarked that as a prisoner Mathison was

entitled only to “minimal care,” as distinct from the medical

care “he would receive if he were a free person, let alone an

affluent free person.” That may be true in general, but not in

life and death situations. A prison inmate has a right to re‐

ceive prompt medical treatment of a heart attack. Williams v.

Leifer, 491 F.3d 710, 716 (7th Cir. 2007). Yet against the evi‐

dence that the normal range of troponin in a healthy heart

does not exceed .07 ng/ml, the judge relied on Dr. Moats’s

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4 No. 14‐3549

unsupported opinion that a level of .32 ng/ml is within the

normal range.

Moats had made no effort through tests or an examina‐

tion to determine whether Mathison’s heart attack, exacer‐

bated by the delay in treating it, had caused significant heart

damage. That was excusable, however, because Moats is not

a cardiologist—that is why an ambulance should have been

summoned by Lieutenant Omelson given her suspicion that

Mathison indeed was having a heart attack, and she doubt‐

less would have summoned one had Wall advised her to do

so when Mathison first complained of excruciating pain in

his chest and left arm. But the fact that Moats is not a cardi‐

ologist is also a reason why the judge should not have cred‐

ited his testimony that Mathison’s troponin level was within

the normal range. Cf. Rowe v. Gibson, 798 F.3d 622, 627 (7th

Cir. 2015). And a further reason was that the .32 ng/ml tro‐

ponin level was discovered in a test conducted six hours af‐

ter the heart attack, though the level peaks on average 24

hours after the first symptoms of a heart attack. E.g., Brian P.

Shapiro, et al., “Cardiac Biomarkers,” Mayo Clinic Cardiology

773, 774 (2007).

The defendants’ lawyer thus was not justified in holding

out Moats as an expert on cardiology and during discovery

submitting an “expert report” by him stating that Mathison

had suffered no damage to his heart. Moats was not quali‐

fied to offer such an opinion as evidence—and a medical re‐

port from a nurse practitioner who examined Mathison de‐

termined his troponin level to have been 18 ng/ml after the

heart attack, contradicting Moats’s statement that there

could not have been damage to Mathison’s heart because he

hadn’t had an elevated level of troponin.

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No. 14‐3549 5

As for the five hours during which (the defendants do

not deny) Mathison experienced excruciating pain while

awaiting treatment—pain that could have been alleviated by

giving him oxygen, aspirin, and nitroglycerin (for his pain

was quickly alleviated when Dr. Moats gave him those palli‐

atives)—the judge ruled as a matter of law that the failure of

treatment could not be evidence of deliberate indifference to

a serious medical condition. The ruling had no basis in law

or medicine. Delay in treating a heart attack “is a strong pre‐

dictor for short‐term survival rate and a surrogate for the

amount of damaged myocardial [heart] tissue.” Jerry Avorn,

et al., “Therapeutic Delay and Reduced Functional Status Six

Months After Thrombolysis for Acute Myocardial Infrac‐

tion,” 94 Am. J. Cardiology 415, 419 (2004). We held in Wil‐

liams v. Leifer, supra, that a six‐hour delay in administering

nitroglycerin to treat an inmateʹs severe chest pain could

create liability for deliberate indifference to an acute medical

need.

Although the prison’s treatment of Mathison’s heart at‐

tack was incompetent, the guard whom Mathison sum‐

moned to his cell when the attack began (defendant Wick‐

man) can’t be thought to have exhibited deliberate indiffer‐

ence to Mathison’s condition. For he immediately notified

his superior, the supervisory lieutenant, as protocol re‐

quired; he had no medical training that would have enabled

him to do more for Mathison. Dr. Moats, though he should

not have been allowed to testify as an expert witness, cannot

be thought to have exhibited deliberate indifference to

Mathison’s plight either. He was not made aware of

Mathison’s condition until 8 a.m., and proceeded to give him

emergency treatment and promptly summoned an ambu‐

lance to take him to the nearest hospital emergency room.

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That leaves the supervisory lieutenant (Omelson) and the

nurse (Wall). Wickman, the guard, had summoned Omelson

to Mathison’s cell when Mathison first alerted the guard to

the excruciating pain in his chest and arm, and she talked to

Mathison (without entering the cell) and told him it sounded

as if he were having a heart attack. She then spent 20

minutes trying unsuccessfully to reach Nurse Wall. A heart

attack is a life‐endangering event, and Omelson had the au‐

thority to call 911 and summon an ambulance. She’d inferred

from talking to Mathison that he was having a heart attack

(“I do believe you’re having a heart attack”), and that infer‐

ence was a sufficient basis for making such a call given the

difficulty she was having locating Wall. But if in doubt as to

what to do, she should one imagines have called a doctor or

a hospital emergency room for advice. Her failure to make

such a call left Mathison in agony for almost five more

hours. Cf. Farmer v. Brennan, 511 U.S. 825, 842 (1994); Cava‐

lieri v. Shepard, 321 F.3d 616, 622 (7th Cir. 2003).

Wall claims to have concluded from Omelson’s report

(when Omelson finally reached him in the course of the

night) of Mathison’s symptoms that Mathison was not hav‐

ing a heart attack, even though Omelson told him that

Mathison was experiencing acute pain in his chest and his

left arm, which are classic symptoms of a heart attack. Wall

could have told Omelson to call 911, or called Moats himself,

but instead he relied on impressions that he gleaned from

Omelson, who was not medically trained and who had

learned of Mathison’s symptoms only from talking to

Mathison from outside his cell. Wall’s behavior was thor‐

oughly unprofessional—especially since, unlike Omelson, he

was aware of Mathison’s medical history, which included

the fact that he was in the prison’s chronic care program for

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No. 14‐3549 7

treatment of his chronic high blood pressure, a condition

that creates an increased risk of a heart attack. See William B.

Kannel, ʺCoronary Risk Factors: An Overview,ʺ Cardiovascu‐

lar Medicine 1809, 1815–17 (1995).

There is more. Wall testified that after Omelson told him

that Mathison was experiencing acute chest and arm pain, he

asked Omelson some unspecified questions. Whether a

nurse could accurately diagnose a heart attack on the basis

of a second‐hand account by a person with no medical train‐

ing may be doubted, but in any event Wall has not explained

what questions he asked; nor did he instruct Omelson to

gather more information to help him ascertain whether

Mathison needed immediate treatment. And just as with re‐

gard to Omelson, a professionally responsible reaction by

Wall to Mathison’s plight would have imposed no cost or

risk on Wall. Cf. Gayton v. McCoy, 593 F.3d 610, 623 (7th Cir.

2010); Sain v. Wood, 512 F.3d 886, 894–95 (7th Cir. 2008).

And when Mathison arrived at the infirmary Nurse Wall

remarked that he must be the inmate having the heart attack.

This implies that Wall had concluded from talking with

Lieutenant Omelson during the night that Mathison was hav‐

ing a heart attack. Yet Wall had nevertheless chosen to do

nothing—further evidence of deliberate indifference.

The district judge said that Omelson’s and Wall’s inac‐

tion had not “denied Plaintiff the minimal civilized measure

of life’s necessities.” We think that civilization requires more

in a life and death situation, and are left to wonder what the

judge thinks the minimum level of care is to which a prison‐

er who is suffering a heart attack is entitled.

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8 No. 14‐3549

We affirm the dismissal of the claims against Wickman

and Moats, but reverse the dismissal of the claims against

the other two defendants and remand the case for further

proceedings consistent with this opinion.

AFFIRMED IN PART, REVERSED IN PART, AND REMANDED

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