Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-14-03316/USCOURTS-ca7-14-03316-0/pdf.json

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

---

In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 14-3316 

JEFFREY ALLEN ROWE, 

Plaintiff-Appellant, 

v.

MONICA GIBSON, et al., 

Defendants-Appellees. 

____________________ 

Appeal from the United States District Court for the 

Southern District of Indiana, Indianapolis Division. 

No. 1:11-cv-00975-SEB-DKL — Sarah Evans Barker, Judge. 

____________________ 

SUBMITTED MAY 26, 2015 — DECIDED AUGUST 19, 2015 

____________________ 

Before POSNER, ROVNER, and HAMILTON, Circuit Judges. 

POSNER, Circuit Judge. An Indiana prison inmate named 

Jeffrey Rowe, the plaintiff in this suit under 42 U.S.C. § 1983, 

charges administrators and prison staff (actually employees 

of Corizon, Inc., which provides medical services to the inmates at Pendleton Correctional Facility, Rowe’s prison) 

with deliberate indifference to a serious medical need—that 

is, with knowing of a serious risk to inmate health or safety 

but responding ineffectually (as by departing substantially 

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2 No. 14-3316 

from accepted professional judgment) or not at all. See, e.g., 

Farmer v. Brennan, 511 U.S. 825, 837 (1994); Sain v. Wood, 512 

F.3d 886, 894–95 (7th Cir. 2008). Such conduct was held in 

Farmer to violate the cruel and unusual punishments clause 

of the Eighth Amendment, deemed applicable to state action 

by interpretation of the due process clause of the Fourteenth 

Amendment. Rowe charges gratuitous infliction of physical 

pain and potentially very serious medical harm—cogent examples of cruel and unusual punishment. He has a subsidiary claim of having been retaliated against for filing this 

lawsuit, a claim we discuss briefly toward the end of our 

opinion. The district judge granted summary judgment in 

favor of the defendants on both claims, dismissing Rowe’s 

suit and precipitating this appeal. 

In 2009, already an inmate at Pendleton, Rowe was diagnosed with reflux esophagitis, also known as gastroesophageal reflux disease (GERD). See National Institutes of Health, 

“Gastroesophageal reflux disease,” www.nlm.nih.gov/

medlineplus/ency/article/000265.htm (visited August 17, 

2015, as were the other websites cited in this opinion). The 

Mayo Clinic explains that “a valve-like structure called the 

lower esophageal sphincter usually keeps the acidic contents 

of the stomach out of the esophagus. If this valve opens 

when it shouldn’t or doesn’t close properly, the contents of 

the stomach may back up into the esophagus (gastroesophageal reflux). ... [GERD] is a condition in which this backflow 

of acid is a frequent or ongoing problem. A complication of 

GERD is chronic inflammation and tissue damage in the 

esophagus.” Mayo Clinic, “Diseases and Conditions, Esophagitis: Reflux Esophagitis,” www.mayoclinic.org/diseasesconditions/esophagitis/basics/causes/con-20034313. As we 

explained in a recent case in which, as in this case, a prison 

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No. 14-3316 3 

inmate complained of failure to treat his GERD (and we reversed the grant of summary judgment in favor of the prison 

staff), “GERD can ... produce persistent, agonizing pain and 

discomfort. It can also produce ‘serious complications. 

Esophagitis can occur as a result of too much stomach acid 

in the esophagus. Esophagitis may cause esophageal bleeding or ulcers. In addition, a narrowing or stricture of the 

esophagus may occur from chronic scarring. Some people 

develop a condition known as Barrett's esophagus. This 

condition can increase the risk of esophageal cancer.’ 

WebMD, Heartburn/GERD Health Center, “What Are the 

Complications of Long–Term GERD?” www.webmd. 

com/heartburn–gerd/guide/reflux–disease–gerd–1?page=4.” 

Miller v. Campanella, 2015 WL 4523799, at *2 (7th Cir. July 27, 

2015). Rowe complains of pain based on neglect of his need 

for symptomatic relief; continued neglect will endanger him 

more profoundly. 

The prison physician who diagnosed Rowe with GERD 

told him to take a 150-milligram Zantac pill twice a day. 

Zantac inhibits the production of stomach acid and is commonly used to treat esophagitis (as we’ll abbreviate the 

name of Rowe’s disease). Although technically “Zantac” is 

merely the trade name for ranitidine manufactured by GlaxoSmithKline (in prescription strengths) and Boehringer 

Ingelheim (in over-the-counter strengths), it is often used as 

a synonym for ranitidine, see Wikipedia, “Ranitidine,” http://

en.wikipedia.org/wiki/Ranitidine, because Glaxo was the 

first, and remains the best-known, manufacturer. “Zantac” is 

the only word for the drug that appears in the briefs, and so 

we too will call the drug that Rowe received “Zantac.” 

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After the diagnosis Rowe was given Zantac pills and was 

permitted to keep them in his cell and take them when he 

felt the need to. This regimen continued for more than a 

year. But in January 2011 his pills were confiscated and he 

was told that he would be allowed to take a Zantac pill only 

when a prison nurse gave it to him, and that would be at 

9:30 a.m. and then at 9:30 p.m. He complained that he needed to take Zantac with his meals, which were, oddly enough, 

scheduled by the prison for 4 a.m. and 4 p.m. (why these 

times, we are not told). The prison had decided that inmates 

such as Rowe who take psychiatric medications should not 

be allowed to keep any pills in their cells—yet the head of 

health care at the prison told Rowe that he could keep in his 

cell (and thus take whenever he wanted) any Zantac pills 

that he bought at the prison commissary—which, however, 

as we’re about to see, he couldn’t afford. No reason has been 

articulated for forbidding him to keep Zantac given him by 

prison staff while permitting him to keep Zantac that he 

bought at the commissary and take it whenever he needs to 

in order to prevent or alleviate pain. There is no suggestion 

that Zantac is a narcotic or otherwise consumed for nonmedical as well as medical reasons. 

The defendants question Rowe’s inability to pay for the 

pills. They point out that in one 13-month period he spent 

approximately $60 at the commissary. But the prison commissary charges $3.28 for just four 75-mg Zantac pills (and 

recall that Rowe was to take two 150-mg pills daily), meaning that he would have to pay almost $1300 for a 13-month 

supply. And he was forbidden to buy more than eight days’ 

worth of Zantac a month from the commissary, which was 

only about a quarter of the amount that he needed.

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No. 14-3316 5 

To continue the narrative of what seems a senseless series 

of decisions by the prison’s medical staff, as well as heartless 

given what the staff knew about the disease and Rowe’s continuous claims of severe pain: at the beginning of July 2011, a 

month after he filed suit, he ceased receiving Zantac because 

his “prescription” (that is, his authorization to receive overthe-counter Zantac free of charge on a continuing basis) had 

lapsed. He made a series of requests for the drug beginning 

on July 3, but the nurse defendants denied all of them because he had no prescription. When he complained he was 

told by the administrative director of the medical staff: 

“Your chronic care condition does not warrant the continued 

use of Zantac. The continual use of over-the-counter medications can create further health problems in many instances. 

You will have to purchase this off of commissary if you wish 

to continue taking it.” Notice the contradiction (illustrating 

the run around to which Rowe was continually subjected) in 

denying Rowe free Zantac because it could create “further 

health problems” but permitting him to buy and use it at 

will, though he couldn’t afford to buy it. Nor is there any 

suggestion that Zantac is one of the over-the-counter medications that can create health problems if taken daily for a 

protracted period of time. And finally, if over-the-counter 

medicines are to be barred, why wasn’t Rowe given a prescription for 300-mg Zantac pills; these are not only prescription rather than over-the-counter drugs but one such pill a 

day may be sufficient to control one’s GERD, compared to 

two or more when an over-the-counter strength Zantac is 

prescribed.

On July 13, 2011, in response to Rowe’s continued requests for a renewed prescription for Zantac, a physician 

who works at the prison (though employed by Corizon) 

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6 No. 14-3316 

named William H. Wolfe, whose professional specialty is 

preventive medicine, about which see American College of 

Preventive Medicine: Physicians Dedicated to Prevention, 

www.acpm.org/, rather than gastroenterology, see 

healthgrades, “Dr. William H. Wolfe, MD.,” www.health

grades.com/physician/dr-william-wolfe-2fgkl/backgroundcheck, and who is a frequent defendant in prisoner civil 

rights suits, reviewed Rowe’s medical records and opined 

that his condition didn’t require Zantac at all—this despite 

the fact that Rowe had been continuously prescribed Zantac 

for almost two years and that Wolfe himself had been the 

prescribing doctor for a quarter of that period. But though 

initially refusing to provide a new prescription for Zantac, 

Wolfe later relented and on August 2 prescribed it though he 

later stated in an affidavit that he had done so as a “courtesy” to Rowe and not out of medical necessity. (Prescribing 

drugs for prison inmates as a “courtesy” seems very odd; it 

is not explained.) The upshot was that Rowe had no access 

to Zantac for more than a month (between July 1 and August 

3)—a significant deprivation. Even after Zantac was restored 

to him, he continued to be allowed to take it only at 9:30 a.m. 

and 9:30 p.m., both times being many hours distant from his 

meals. 

In another affidavit Wolfe stated that “it does not matter 

what time of day Mr. Rowe receives his Zantac prescription. 

Each Zantac pill is fully effective for twelve hour increments. 

Zantac does not have to be taken before or with a meal to be 

effective.” However, according to Boehringer Ingelheim, the 

manufacturer of over-the-counter Zantac, while Zantac can 

be taken at any time “to relieve symptoms,” in order “to 

prevent symptoms” it should be taken “30 to 60 minutes before eating food or drinking beverages that cause heartCase: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 7 

burn.” Zantac, “Maximum Strength Zantac 150,” www.zan

tacotc.com/zantac-maximum-strength.html#faqs, and this 

advice is repeated on the labels of the boxes in which overthe-counter Zantac is sold. Were Zantac equipotent whenever taken, the manufacturer would not tell consumers to take 

it 30 to 60 minutes before eating, for having to remember 

when to take a pill adds a complication that the consumer 

would rather do without. There is thus no reason for the 

manufacturer to be lying, and it would be absurd to think 

that Dr. Wolfe, a defendant who is not a gastroenterologist, 

knows more about treatment of esophagitis with Zantac 

than the manufacturer does. 

Rowe’s aim was pain prevention, so having to take Zantac six and a half hours before a meal did not do the trick. It 

left him in pain for five and a half hours during and after the 

meal, until he got his next Zantac pill. Wolfe’s statement that 

“each Zantac pill is fully effective for twelve hour increments” is also contradicted by the Zantac website, which 

states that one 150-mg pill “lasts up to 12 hours” (emphasis 

added). Thus a pill taken six and half hours before a meal 

might not be effective in alleviating the pain caused by acid 

secretions stimulated by the meal. 

It might be thought that a corporate website, such as that 

of the Zantac manufacturer, would be a suspect source of 

information. Not so; the manufacturer would be taking 

grave risks if it misrepresented the properties of its product. 

In any event, the Mayo Clinic’s website, as we’ll see in a 

moment, confirms the manufacturer’s claims. 

Wolfe’s affidavit states that Rowe was complaining just 

of “alleged heartburn [that] was not a serious medical condition warranting a prescription for Zantac”—but if so why 

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did he prescribe Zantac for Rowe during the very period in 

which, according to the affidavit, Rowe’s condition was not 

serious? (The affidavit fails to mention that it was Wolfe who 

had prescribed Zantac for Rowe, but that’s conceded.) 

It’s true that the Mayo Clinic’s website, at “Drugs and 

Supplements: Histamine H2 Antagonist (Oral Route, Injection Route, Intravenous Route),” www.mayoclinic.

org/drugs-supplements/histamine-h2-antagonist-oral-routeinjection-route-intravenous-route/proper-use/drg-20068584, 

after listing various drugs (including ranitidine) for treatment of the cluster of ailments that includes esophagitis, 

states that “for this class of drugs ... patients taking two 

doses a day are instructed: ‘Take one in the morning and one 

before bedtime.’” But this dosing, Mayo goes on to state, is 

appropriate “only for patients taking the prescription 

strengths of these medicines.” The 150-mg pills that Rowe 

was taking are available over the counter; a prescription is 

required only for the 300-mg version. Both the Boehringer 

Ingelheim and Mayo websites also say that the patient 

shouldn’t take Zantac for more than two weeks unless directed by a doctor—but Rowe was of course directed by 

Wolfe, as well as by other doctors earlier, to take Zantac on a 

continuing basis. 

Not only wasn’t Rowe allowed to take Zantac with his 

meals; he was not, as the Mayo website recommends, allowed to take it with water a half hour or an hour before eating a meal or drinking beverages that might cause him 

esophageal pain. As the Mayo website explains, for “adults 

and teenagers—150 mg with water taken thirty to sixty 

minutes before eating a meal or drinking beverages you expect 

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No. 14-3316 9 

to cause symptoms. Do not take more than 300 mg in twenty-four hours” (emphasis added).

Stomach acid is of course integral to the digestion of 

food, and indeed thirty percent of total gastric acid secretion 

is stimulated by the anticipation, smell, and taste of food, 

before the food ever reaches the stomach. Thomas A. Miller, 

Modern Surgical Care: Physiologic Foundations and Clinical Applications 344-45 (2006). “The foods you eat affect the amount 

of acid your stomach produces,” and “many people with 

GERD find that certain foods trigger their symptoms.” 

Healthline, “Diet and Nutrition for GERD,” www.healthline.

com/health/gerd/diet-nutrition#Overview1. So it is no surprise that Rowe experiences painful symptoms when he eats 

without having been allowed to take a Zantac pill shortly 

before the meal. 

The Physicians’ Desk Reference, “PDR Search: Full Prescribing Information: Zantac 150 and 300 Tablets,” www.

pdr.net/full-prescribing-information/zantac-150-and-300-tabl

ets?druglabelid=241, states that a 150-mg dose of Zantac inhibits 79 percent of food-stimulated acid secretion for up to 

three hours after it’s taken. This implies that the drug’s efficacy decreases over time and so supports Rowe’s claim that 

a 150-mg dose does not suppress his food-stimulated acid 

secretions when taken six and a half hours before a meal. 

The Physicians’ Desk Reference also says that “symptomatic 

relief commonly occurs within 24 hours after starting therapy with ZANTAC 150 mg twice daily,” which could be misread to mean that it does not matter what time of day the 

pills are taken, but which actually means that it takes a day 

for the body to recognize Zantac as a source of relief from 

esophageal distress. This interpretation is confirmed by 

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10 No. 14-3316 

Mayo, which states (at the website cited earlier): “It may take 

several days before this medicine begins to relieve stomach 

pain.”

The evidence that Rowe was in pain for five and a half 

hours after eating is his repeated attestation—in his verified 

federal complaint and his declarations—that he experienced 

pain for that length of time when he was not allowed to take 

Zantac with or shortly before his meals. For purposes of 

summary judgment his attestations of extreme pain must be 

credited. See 28 U.S.C. § 1746; Fed. R. Civ. P. 56(c). There 

was no plausible contrary evidence. The affidavits of the only expert witness on the proper times at which to take Zantac, defendants’ witness Wolfe, were highly vulnerable. 

Wolfe is not a gastroenterologist. He says that Rowe didn’t 

need Zantac yet prescribed Zantac for him. He opined with 

confidence about what Rowe needed or didn’t need—yet 

never examined him—and offered no basis for his off-thecuff medical opinion. A court should not “admit opinion evidence that is connected to existing data only by the ipse dixit of the expert.” General Electric Co. v. Joiner, 522 U.S. 136, 146 

(1997); see also Finn v. Warren County, 768 F.3d 441, 452 (6th 

Cir. 2014) (“the ‘knowledge’ requirement of Rule 702 requires the expert to provide more than a subjective belief or 

unsupported speculation”); Guile v. United States, 422 F.3d 

221, 227 (5th Cir. 2005) (“we look to the basis of the expert’s 

opinion, and not the bare opinion alone. A claim cannot 

stand or fall on the mere ipse dixit of a credentialed witness”); McClain v. Metabolife International Inc., 401 F.3d 1233, 

1242 (11th Cir. 2005). 

Remember that Rowe had been diagnosed with esophagitis back in 2009 and that for the ensuing two years physiCase: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 11 

cians had prescribed Zantac to treat his condition. Furthermore, the Indiana Department of Correction permits such 

continuous treatment only to treat a serious health condition, 

so presumably the prescribing physicians thought Rowe’s 

condition serious. None of this evidence or inference is undermined by Dr. Wolfe’s evidence. 

A member of a prison’s staff is deliberately indifferent 

and thus potentially liable to an inmate if he “knows of and 

disregards an excessive risk to inmate health,” Williams v. 

O'Leary, 55 F.3d 320, 324 (7th Cir. 1995), quoting Farmer v. 

Brennan, supra, 511 U.S. at 837; see also Miller v. Campanella, 

supra, at *2. Rowe makes two distinct claims of deliberate indifference; the evidence that we’ve reviewed tends to substantiate both. There is both evidence that defendants Wolfe, 

Deborah Dotson, Melissa Bagienski, Chris Deeds, and Lisa 

Gibson were deliberately indifferent to his pain when they 

denied him access to free Zantac for thirty-three days, and 

that defendants Mary Mansfield, Gibson, and Dr. Michael 

Mitcheff were deliberately indifferent to his pain when they 

insisted—for many months—on giving him Zantac only at 

9:30 a.m. and 9:30 p.m., instead of at his prescribed 

mealtimes. Regarding the first claim, if the nurse defendants 

to whom Rowe complained about reflux pain were not authorized to give him the free Zantac they should have 

promptly referred the matter to a doctor. 

The evidence of Wolfe’s deliberate indifference to Rowe’s 

pain and resulting need for Zantac is, as we’ve shown, substantial, and likewise the evidence that limiting Rowe’s taking Zantac to 9:30 a.m. and 9:30 p.m. for a protracted period 

exhibited deliberate indifference to a serious medical need. 

Wolfe never told anyone, so far as appears, when would be 

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12 No. 14-3316 

the best times for administering Zantac to Rowe. In very 

large doses Zantac will remain in your blood stream long 

enough to affect the stomach acid produced by meals eaten 

many hours later, but the Mayo and Boehringer Ingelheim 

timing recommendations suggest that this isn’t true for 150-

mg doses. Wolfe’s assertion that “it does not matter what 

time of day Mr. Rowe receives his Zantac prescription” is 

implausible as well as vigorously contested. Rowe’s pain 

and the Mayo Clinic’s timing recommendations suggest that 

giving 150-mg doses of Zantac five and a half hours after 

one meal and six and a half hours before the next (and only 

other) meal of the day may be a substantial departure from 

accepted professional practice, preventing summary judgment for defendants regarding Rowe’s claim of deliberate 

indifference to avoidable pain caused by the timing of his 

medication. See Sain v. Wood, supra, 512 F.3d at 894–95. Since 

Rowe’s pain strongly indicated that he was experiencing reflux, the reflux could have had serious medical consequences (up to and including cancer) in addition to inflicting 

chronic pain on him. Prisoners aren’t supposed to be tortured. 

In citing even highly reputable medical websites in support of our conclusion that summary judgment was premature we may be thought to be “going outside the record” in 

an improper sense. It may be said that judges should confine 

their role to choosing between the evidentiary presentations 

of the opposing parties, much like referees of athletic events. 

But judges and their law clerks often conduct research on 

cases, and it is not always research confined to pure issues of 

law, without disclosure to the parties. We are not like the 

English judges of yore, who under the rule of “orality” were 

not permitted to have law clerks or other staff, or libraries, or 

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No. 14-3316 13 

even to deliberate—at the end of the oral argument in an appeal the judges would state their views seriatim as to the 

proper outcome of the appeal. 

We don’t insulate judges like that, but we must observe 

proper limitations on judicial research. We must 

acknowledge the need to distinguish between judicial web 

searches for mere background information that will help the 

judges and the readers of their opinions understand the case, 

web searches for facts or other information that judges can 

properly take judicial notice of (such as when it became dark 

on a specific night, a question we answered on the basis of 

an Internet search in Owens v. Duncan, 781 F.3d 360, 362 (7th 

Cir. 2015), citing WeatherSpark, “Average Weather On September 22 For Chicago, Illinois, USA: Sun,” https://weather

spark.com/averages/30851/9/22/Chicago-Illinois-United-Stat

es), and web searches for facts normally determined by the 

factfinder after an adversary procedure that produces a district court or administrative record. When medical information can be gleaned from the websites of highly reputable 

medical centers, it is not imperative that it instead be presented by a testifying witness. Such information tends to fall 

somewhere between facts that require adversary procedure 

to determine and facts of which a court can take judicial notice, but it is closer to the second in a case like this in which 

the evidence presented by the defendants in the district 

court was sparse and the appellate court need only determine whether there is a factual dispute sufficient to preclude 

summary judgment. 

Rule 201 of the Federal Rules of Evidence makes facts of 

which judicial notice is properly taken conclusive, and therefore requires that their accuracy be indisputable for judicial 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
14 No. 14-3316 

notice to be taken of them. We are not deeming the Internet 

evidence cited in this opinion conclusive or even certifying it 

as being probably correct, though it may well be correct 

since it is drawn from reputable medical websites. We use it 

only to underscore the existence of a genuine dispute of material fact created in the district court proceedings by entirely 

conventional evidence, namely Rowe’s reported pain. 

There is a high standard for taking judicial notice of a 

fact, and a low standard for allowing evidence to be presented in the conventional way, by testimony subject to crossexamination, but is there no room for anything in between? 

Must judges abjure visits to Internet web sites of premier 

hospitals and drug companies, not in order to take judicial 

notice but to assure the existence of a genuine issue of material fact that precludes summary judgment? Are we to forbear lest we be accused of having “entered unknown territory”? This year the bar associations are busy celebrating the 

eight hundredth anniversary of Magna Carta. The barons 

who forced King John to sign that notable document were 

certainly entering unknown territory, and risking their lives 

to boot. Shall the unreliability of the unalloyed adversary 

process in a case of such dramatic inequality of resources 

and capabilities of the parties as this case be an unalterable 

bar to justice? Must our system of justice allow the muddled 

affidavit of a defendant who may well be unqualified to be 

an expert witness in this case to carry the day against a pro 

se plaintiff helpless to contest the affidavit? 

This is not the case in which to fetishize adversary procedure in a pure eighteenth-century form, given the inadequacy of the key defense witness, Dr. Wolfe. Let’s review: Wolfe 

refused to continue Rowe’s Zantac prescription in July 2011 

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No. 14-3316 15 

while Rowe was being kept waiting for three weeks before 

being seen by a doctor. Wolfe knew Rowe had esophagitis: 

he reviewed Rowe’s medical records, which contained the 

2009 diagnosis and revealed nearly two years of physicians’ 

having prescribed Zantac for him continuously. Wolfe had 

personally prescribed Zantac for Rowe for six months of those 

two years and must have known that the Department of 

Correction authorizes such treatment only for a serious

health condition. Rowe was complaining of continuing reflux pain; and while Wolfe denied a prescription renewal on 

July 13, he demonstrated his awareness that Rowe might 

need treatment by scheduling him for a later appointment 

(the August 2 appointment) to evaluate his request to resume taking Zantac. 

Against this background, to credit Wolfe’s evidence that 

it doesn’t matter when you take Zantac for relief of GERD 

symptoms (evidence that may well have failed to satisfy the 

criteria for the admissibility of expert evidence that are set 

forth in Fed. R. Evid. 702) just because Rowe didn’t present 

his own expert witness would make no sense—for how 

could Rowe find such an expert and persuade him to testify? 

He could not afford to pay an expert witness. He had no 

lawyer in the district court and has no lawyer in this court; 

and so throughout this litigation (now in its fourth year) he 

has been at a decided litigating disadvantage. He requested 

the appointment of counsel and of an expert witness to assist 

him in the litigation, pointing out sensibly that he needed 

“verifying medical evidence” to support his claim. The district judge denied both requests, leaving Rowe unable to offer evidence beyond his own testimony that he was in extreme pain when forbidden to take his medication with his 

meals. 

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16 No. 14-3316 

The web sites give credence to Rowe’s assertion that he 

was in pain. But the information gleaned from them did not 

create a dispute of fact that was not already in the record. 

Rowe presented enough evidence to call Dr. Wolfe’s assessment into question—Rowe claims that after his medication 

was switched to the 12-hour schedule he was in extreme 

pain and Dr. Wolfe, without examining Rowe or disclosing 

the basis for his opinion (as we require experts to do), stated 

cursorily that the medicine would be effective for 12 hours. 

It will be up to the factfinder to decide, on a better developed record, who is right. 

Nor is pain the only concern. Esophageal reflux disease 

can lead to serious damage of the stomach or esophagus, 

and even to cancer. 

It is heartless to make a fetish of adversary procedure if 

by doing so feeble evidence is credited because the opponent 

has no practical access to offsetting evidence. To say for example that however implausible Dr. Wolfe’s evidence is, it 

must be accepted because not contested, is to doom the 

plaintiff’s case regardless of the merits simply because the 

plaintiff lacks the wherewithal to obtain and present conflicting evidence. Rowe did not move to exclude Wolfe as an expert witness on the ground that Wolfe neither qualified to 

give expert evidence in this case (because he is not a gastroenterologist) nor, as a defendant, was likely to be even minimally impartial. But Rowe does not have the legal 

knowledge that would enable him to file such a motion. 

We have decided to reverse the judgment. We base this 

decision on Rowe’s declarations, the timeline of his inability 

to obtain Zantac, the manifold contradictions in Dr. Wolfe’s 

affidavits, and, last, the cautious, limited Internet research 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 17 

that we have conducted in default of the parties’ having 

done so. We add that the judge erred not only by giving undue weight to Wolfe’s internally contradictory affidavit but 

also by relying on a defendant (Wolfe) as the expert witness. 

There are expert witnesses offered by parties and neutral 

(court-appointed) expert witnesses, but defendants serving as 

expert witnesses?—and in cases in which the plaintiff 

doesn’t have an expert witness because he doesn’t know 

how to find such a witness and anyway couldn’t afford to 

pay the witness? And how could an unrepresented prisoner 

be expected to challenge the affidavit of a hostile medical 

doctor (in this case really hostile since he’s a defendant in the 

plaintiff’s suit) effectively? Is this adversary procedure? 

Esophagitis is a common disease for which Zantac is a 

common treatment, and it makes common sense as well as 

medical sense that a drug for treating symptoms of stomach 

acid backing up into the esophagus would be administered 

shortly before or shortly after meals unless the massive 300-

mg pill was being administered to the patient, and it was not 

in this case. Rowe claimed that the Zantac he took became 

ineffective in treating his esophagitis pain symptoms when 

the prison staff decided to give it to him only long before his 

meals. His pain and the timing recommendation of the Mayo 

Clinic that we mentioned earlier suggest that giving 150-mg 

doses of Zantac six and a half hours before and five and a 

half hours after meals may be a substantial departure from 

accepted professional practice. But without his own expert, 

Rowe couldn’t counter Wolfe’s assertion that Zantac does 

not need to be taken shortly before, or with or shortly after, a 

meal in order to be effective. As Rowe explained in his brief, 

while he “provided evidence that Zantac does not ‘prevent’ 

reflux during its 12 hours of effectiveness, and that it was 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
18 No. 14-3316 

not effective at relieving Rowe’s symptoms, the district court 

accepted the word of a defendant [i.e., Dr. Wolfe], who was 

speaking as an ‘expert,’ that the treatment Rowe received 

was adequate and effective. Had an expert been appointed, 

the expert would have confirmed Rowe’s factual representations, and would have supported Rowe’s objection that the 

defendant lacks personal knowledge about the condition(s) 

Rowe had because Wolfe never physically examined Rowe 

or had diagnostic testing done on Rowe” (citations omitted). 

Rowe’s allegations alone were sufficient to preclude 

summary judgment, and were enhanced by the defendants’ 

own evidence, which included both Wolfe’s contradictory 

evidence (among other things, he asserted that Rowe does 

not need Zantac and yet prescribed it for him) and the absurd opinion by the medical director that over-the-counter 

medications should not be provided to prisoners. Allowing 

Wolfe to be an expert witness in the case despite his being a 

defendant and not practicing the medical specialty at issue 

was another boost to the plaintiff’s case, though again not 

one that an unrepresented, indigent prisoner could exploit. 

We are coming to the end of this long opinion but we 

need to change gears for a moment: Besides arguing deliberate indifference to a serious medical need, Rowe accuses 

several of the defendants, in particular Dr. Wolfe and Nurse 

Bagienski, of retaliating against him for filing a lawsuit. He 

says they told him that going without Zantac for a month 

would make him “think twice about bringing lawsuits about 

inadequate medical care.” If indeed they said this—an issue 

that cannot be determined without a trial—Rowe has a solid 

claim of retaliation. The retaliation claims against the other 

defendants were properly dismissed, however, and likewise 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 19 

the deliberate-indifference claims against the following defendants, who the district court correctly found were not responsible for the failure to treat Rowe’s medical condition 

competently—Rose Vaisvilas, Wayne Scaife, and Kenneth 

Hysell. But we reverse with regard to the remaining defendants and remand the case for further proceedings consistent 

with this opinion. 

Although reversing, we are not ordering that judgment 

be entered in Rowe’s favor. As we’ve explained, we are not 

invoking Fed. R. Evid. 201 and thus not taking judicial notice 

of any facts outside the district court record. The remaining 

defendants are entitled to try to rebut any evidence whether 

or not presented in the district court, including any evidence 

found on the Internet. Like the conventional forms of evidentiary inquiry, Internet research must be conducted with 

circumspection. In particular it must not be allowed to extinguish reasonable opportunities for rebuttal. 

Pure adversary procedure works best when there is at 

least approximate parity between the adversaries. That condition is missing in this case, in which a pro se prison inmate, incapable of retaining an expert witness (expert witnesses usually demand to be paid—and how would this inmate even find an expert witness?), confronts both a private 

law firm and the state attorney general. 

Because of the profound handicaps under which the 

plaintiff is litigating and the fact that his claim is far from 

frivolous, we urge the district judge to give serious consideration to recruiting a lawyer to represent Rowe, see Miller v. 

Campanella, supra, at *2; Perez v. Fenoglio, 2015 WL 4092294, at 

*11 (7th Cir. July 7, 2015); appointing a neutral expert witness, authorized by Fed. R. Evid. 706, to address the medical 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
20 No. 14-3316 

issues in the case; or doing both. We are mindful that district 

courts don’t have budgets for paying expert witnesses. But 

the medical issues in the case are not complex; there should 

be no difficulty in the judge’s persuading a reputable gastroenterologist to speak to Rowe and some of the prison medical personnel (Rowe’s prison is only 30 miles from Indianapolis, and there are 128 gastroenterologists in or near Indianapolis, healthgrades, www.healthgrades.com/gastroentero

logy-directory/in-indiana/indianapolis), to sit for a deposition, and, if necessary, to testify. Rule 706(c)(2) states that a 

court-appointed expert “is entitled to a reasonable compensation, as set by the court,” and that “the compensation is 

payable ... in any ... civil case [not involving just compensation under the Fifth Amendment] by the parties in the proportion and at the time that the court directs—and the compensation is then charged like other costs.” In light of 

Rowe’s indigency, the court if it appoints its own expert 

witness will have to order the defendants to pay the expert a 

reasonable fee if the expert is unwilling to work for nothing. 

Most prisons are strapped for cash, and this is something for 

the district court to bear in mind in deciding on whether and 

how large a fee to order the defendants to pay a courtappointed expert witness in a case (such as this case) that 

has sufficient merit to warrant such an appointment. 

A substantial academic literature identifies serious deficiencies in the provision of health care in American prisons 

and jails. See, e.g., Andrew P. Wilper et al., “The Health and 

Health Care of US Prisoners: Results of a Nationwide Survey,” 99 Am. J. Public Health 666 (2009), and the studies posted by the Academic Consortium on Criminal Justice Health, 

www.accjh.org/. On the quality of treatment problems of 

Corizon, the employer of Dr. Wolfe and the other medical 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 21 

staff members sued by Rowe, see David Royse, “Medical 

Battle Behind Bars: Big Prison Healthcare Firm Corizon 

Struggles to Win Contracts,” April 11, 2015, www.mod

ernhealthcare.com/article/20150411/MAGAZINE/304119981; 

also Human Rights Defense Center, Prison Legal News, 

“Corizon Needs a Checkup: Problems with Privatized Correctional Healthcare,” March 2014, www.prisonlegalnews.

org/news/2014/mar/15/corizon-needs-a-checkup-problems-w

ith-privatized-correctional-healthcare/. The present case illustrates the problems that this literature has identified. 

AFFIRMED IN PART, REVERSED IN PART, AND REMANDED

APPENDIX

We respectfully suggest that the dissenting opinion is 

misleading in certain respects that require a response; page 

references are to pages in the dissent. 

Page 29: The dissenting opinion states that "the reversal 

is unprecedented, clearly based on ‘evidence’ this appellate 

court has found by its own internet research. ... When the 

opinion is read as a whole, the decisive role of the majority’s 

internet research is plain.” No, the majority opinion endeavors to make clear that Rowe’s allegations alone, coupled 

with the affidavit of Dr. Wolfe and other defense evidence, 

would be enough without any reference to the Internet to 

preclude summary judgment for the defendants, and doubtless would have precluded summary judgment had Rowe 

been represented. The dissent ignores this part of the majority opinion. 

Page 29: The reader is told that “the majority writes that 

adherence to rules of evidence and precedent makes a ‘heartCase: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
22 No. 14-3316 

less ... fetish of adversary procedure.’” That is not what the 

majority opinion says; it says: “It is heartless to make a fetish 

of adversary procedure if by doing so feeble evidence is 

credited because the opponent has no practical access to offsetting evidence” (emphasis added). Nowhere does the majority opinion deny the validity of the federal rules of evidence or of procedure. 

Page 32: The proposition in the dissent that the prison’s 

response was adequate as long as it “provided at least some 

treatment for pain” overlooks the fact that a 150-mg Zantac 

pill given six and a half hours before one’s next meal provides, according to Rowe, no alleviation of pain caused by 

stomach acid backing up into the esophagus, which is the 

pain of which Rowe complains. Also, it can’t be correct that 

providing “some” treatment of pain always gets a prison 

doctor off the hook. Suppose Rowe were in agony from a 

slipped disk; would it be enough for Dr. Wolfe to give him 

an aspirin? To tell him, if he broke his leg, that it would heal 

by itself, in time? 

Page 35: The statement that the majority opinion “holds 

in essence that the district judge erred by not doing such independent factual research” is mistaken. There is no such 

holding or suggestion in the opinion. The opinion merely 

suggests that the district judge should have appointed, and 

on remand should appoint, an expert witness who is a gastroenterologist (as Dr. Wolfe, the defendants’ principal witness, is not) and who also is not a defendant. 

Pages 35-36: The dissent’s citation of Daubert v. Merrell 

Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993), as a celebration 

of traditional adversary procedure misses the significance of 

Daubert, which is that it enlarged the role of the judge in poCase: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 23 

licing expert testimony. The district judge in this case failed 

to play the role envisaged in Daubert by treating Dr. Wolfe as 

an expert on GERD despite his being a defendant accused of 

neglecting Rowe’s GERD and also his not being a gastroenterologist. A Daubert hearing would doubtless have led to 

his exclusion from an expert-witness role. 

Page 39: The dissent says that “when a prisoner brings a 

pro se suit about medical care, the adversary process that is 

the foundation of our judicial system is at its least reliable. 

Few prisoners have access to lawyers or to expert witnesses 

needed to address medical issues.” Right on! (And Rowe is 

not one of the few who does have the necessary access.) But 

affirmance of a quite possibly incorrect decision cannot be 

the correct solution to the problem thus correctly stated by 

the dissent. The majority opinion offers a modest solution—

a remand to enable a competent, impartial evidentiary exploration of Rowe’s claim. 

Page 40: On this page the dissent repeats its contention 

that the majority is insisting that district judges conduct Internet research: “The majority clearly implies, while denying 

it is doing so, that the district judge herself should have done 

the independent factual research the majority has done on 

appeal, questioning an unchallenged expert affidavit ... .” 

No; the district judge should have recognized the existence 

of a substantial issue of material fact, barring summary 

judgment. Rowe’s evidence of pain contradicted Dr. Wolfe’s 

affidavit. 

Page 41: The dissent expresses concern that the defendants may have to pay most or all of an expert witness’s fee in 

a case brought by an indigent prisoner, such as Rowe. But it 

seems unlikely that a gastroenterologist would charge more 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
24 No. 14-3316 

than a nominal fee merely to testify that—what appears to 

be obvious—in order to prevent serious esophageal pain 

(and the even more serious consequences that can ensue 

from untreated GERD) a 150-mg Zantac pill should be taken 

no more than an hour before eating—not six and a half 

hours. One has only to read the label on a box of 150-mg 

Zantac pills to learn when the pill should be taken to prevent 

pain—30 to 60 minutes before eating. In addition, an expert’s 

fee, if any, would in a case such as this, with its numerous 

defendants, be split many ways or, more likely, be paid for 

by the Indiana Department of Correction, the State of Indiana, Corizon or its liability insurer, or individual defendants’ 

malpractice insurance (depending on the contractual arrangements between Corizon and the state, as well as the 

parties’ insurance arrangements), or some combination of 

these well-heeled entities. 

Page 42: The dissent states: “Without an expert witness 

qualified to present the facts and opinions the majority finds 

persuasive, that information does not come into evidence.” 

This implies that without an expert witness, a party cannot 

defeat a motion for summary judgment. That isn’t true. If a 

jury believed Rowe, he would win. It would be more likely 

to believe him than to believe Dr. Wolfe. 

Page 42: The parade of horribles on this and other pages 

of the dissent (such as page 35, discussed earlier in this Appendix) is based on a belief that the majority is ordering that 

the district judge on remand do her own Internet research. 

Not so. It is unlikely that any Internet research by anyone 

will be necessary. All that should be necessary is testimony 

by a qualified, impartial expert witness who is a gastroenterologist and is not a defendant in this litigation. 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 25 

Page 43: The dissent again states that we are requiring 

judges to conduct their own factual research. No. We are 

even accused by the dissent of trying to turn judges into 

substitutes for physicians. Again no. 

Page 45: The dissent appears to misunderstand the Mayo 

Clinic’s advice to “take one [Zantac pill] in the morning and 

one before bedtime.” As pointed out in the majority opinion, 

this advice is intended “only for patients taking the prescription strengths,” whereas Rowe was taking the 150-mg 

strength that is available over the counter. The Mayo Clinic 

provides different advice for the 150-mg pill: that it should 

be taken 30 to 60 minutes before meals to prevent heartburn 

symptoms (the mildest GERD symptoms). The dissent does 

not mention Boehringer Ingelheim’s advice, also quoted in 

the majority opinion, that while Zantac can be taken at any 

time “to relieve symptoms,” in order “to prevent symptoms” 

it should be taken “30 to 60 minutes before eating food or 

drinking beverages that cause heartburn.” That is, if you 

have pain, you take a pill right away to alleviate the pain; if 

you foresee pain as a result of eating or drinking, you take 

the pill before you eat or drink—but not six and a half hours 

before. 

Page 45: The dissent’s reference to taking Zantac for more 

than “two weeks” without a doctor’s permission is irrelevant 

to the case because Rowe had a doctor’s permission—indeed 

Dr. Wolfe’s permission—to take Zantac and had begun taking it long ago, always with permission. 

Page 45: The reference to symptomatic relief beginning 

“24 hours” after taking Zantac could be understood to mean 

that Zantac can prevent pain that far in advance. Not so. As 

explained in the majority opinion, “24 hours” is the time it 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
26 No. 14-3316 

takes for Zantac when first taken to begin to have a therapeutic effect. 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 27

ROVNER, Circuit Judge, concurring. 

A disagreement about the outcome of this relatively simple

case has morphed into a debate over the propriety of appellate

courts supplementing the record with Internet research. To be

clear, I do not believe that the resolution of this case requires

any departure from the record: as the majority opinion makes

patently clear, Rowe has consistently maintained that he

experiences hours of severe pain if he does not take Zantac

with his meals, and at this stage of the proceedings his assertions of extreme pain must be credited. See Catalan v. GMAC

Mortg. Corp., 629 F.3d 676, 696 (7th Cir. 2011). Given that, I

think this case can be decided on the fundamental and unremarkable rule that we give Rowe the benefit of all conflicts and

draw all reasonable inferences in his favor as the nonmoving

party. E.g., Keller v. United States, 771 F.3d 1021, 1022 (7th Cir.

2014). Dr. Wolfe, himself a defendant, cursorily asserted that

the timing ought not to matter. But Dr. Wolfe’s self-interested

“expert” opinion on this fact is disputed by Rowe’s own

personal experience with the timing of the medication, as the

majority makes clear. If he informed prison officials that he

was in severe pain because he could not take his medication at

particular times and they did nothing about it because they did

not care about his pain, that is the very definition of deliberate

indifference. See Greeno v. Daley, 414 F.3d 645, 653-54 (7th Cir.

2005); Walker v. Benjamin, 293 F.3d 1030, 1039-40 (7th Cir. 2002).

Treating the competing claims of Dr. Wolfe and Rowe as

disputed at the summary judgment stage is hardly holding that

a prisoner’s dissatisfaction with his treatment is always enough

to require a jury trial on whether the prison’s medical staff

were deliberately indifferent to his pain (dissent at 32). Instead,

I believe it falls more comfortably into the category the dissent

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
28 No. 14-3316

itself recognizes (dissent at 32-33)—those cases in which

prisoners have shown that medical staff persisted in an

obviously inadequate course of treatment. E.g., Arnette v.

Webster, 658 F.3d 742, 754 (7th Cir. 2011) (prescribing inadequate pain medication for condition causing pain and swelling

in joints); Berry v. Peterman, 604 F.3d 435, 441-42 (7th Cir. 2010)

(prescribing over-the-counter medications that did not relieve

pain of severe toothache ultimately necessitating root canal);

see also Greeno, 414 F.3d at 649-54 (continuing to provide

ineffective antacid treatment for severe heartburn). Rowe

argued in the district court that he needed an expert precisely

because his medical condition is “complicated” and “can

appear to be non-serious to a lay person.” The district court

denied Rowe’s motion to appoint an expert, which left Rowe

with only his own testimony to counter Dr. Wolfe. That the

manufacturer's website and other reputable medical web sites

support the plausibility of his testimony merely illuminates the

factual dispute that exists within the record as we received it;

they are not necessary to the outcome. Although the standard

for deliberate indifference is high, I have no trouble at this

stage of the litigation giving Rowe the benefit of the doubt.

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 29

HAMILTON, Circuit Judge, concurring in part and dissenting in part. 

I agree with the majority’s disposition of most claims and 

issues: affirming summary judgment for defendants on several claims and reversing on Rowe’s retaliation claim and his 

claim for complete denial of his Zantac medicine for 33 days 

in July and August 2011. 

I must dissent, however, from the reversal of summary 

judgment on Rowe’s claim regarding the timing for administering his medicine between January and July 2011 and after 

August 2011. On that claim, the reversal is unprecedented, 

clearly based on “evidence” this appellate court has found 

by its own internet research. The majority has pieced together information found on several medical websites that seems 

to contradict the only expert evidence actually in the summary judgment record. With that information, the majority 

finds a genuine issue of material fact on whether the timing 

of Rowe’s Zantac doses amounted to deliberate indifference 

to a serious health need, and reverses summary judgment. 

(The majority denies at a couple of points that its internet 

research actually makes a difference to the outcome of the 

case, see ante at 14, 16, but when the opinion is read as a 

whole, the decisive role of the majority’s internet research is 

plain.) 

The majority writes that adherence to rules of evidence 

and precedent makes a “heartless ... fetish of adversary procedure.” Yet the majority’s decision is an unprecedented departure from the proper role of an appellate court. It runs 

contrary to long-established law and raises a host of practical problems the majority fails to address. 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
30 No. 14-3316

To explain my disagreement, Part I reviews the facts in 

the record before us and shows that the majority has actually 

based its decision on its internet research. Part II explains 

why the majority’s reliance on its own factual research is 

contrary to law. Part III addresses the practical problems 

posed by the majority’s decision to do its own factual research. Finally, Part IV points out problems with the reliability of the majority’s factual research and shows that the enterprise of judicial factual research is unreliable when it loses 

the moorings to the law of judicial notice. 

I. The Facts in the Record 

On Rowe’s claim that the timing of his Zantac doses 

showed deliberate indifference to his health, the evidence in 

the record consists of two items. First, plaintiff Rowe asserts 

in his verified complaint and in several affidavits that he believes the prison’s schedule for giving him two 150 mg Zantac pills each day left him in unnecessary and avoidable pain 

for hours every day after meals. Second, defendants filed an 

affidavit from defendant Dr. William Wolfe, who was a career physician in the United States Air Force and is now a 

contract physician for the Indiana Department of Correction. 

Dr. Wolfe testified: “It does not matter what time of day Mr. 

Rowe receives his Zantac prescription. Each Zantac pill is 

fully effective for twelve hour increments. Zantac does not 

have to be taken before or with a meal to be effective. 

Providing Mr. Rowe with Zantac twice daily as the nursing 

staff makes their medication rounds, whatever time that may 

be, is sufficient and appropriate to treat his heart burn symptoms.” 

The record thus shows a prisoner’s diagnosed disease 

and complaints of pain that prison staff treated with an apCase: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 31

propriate medicine. The prisoner is not satisfied with details 

of the treatment’s timing, but a physician testified that the 

timing change the prisoner wanted was not called for because the medicine was equally effective as long as he was 

receiving two doses per day. This evidence does not support 

a reasonable inference of deliberate indifference. 

Proof of deliberate indifference is much more demanding 

than proof of even medical malpractice. E.g. Petties v. Carter, 

— F.3d —, 2015 WL 4567899 (7th Cir. July 30, 2015); Ray v. 

Wexford Health Sources, Inc., 706 F.3d 864, 866 (7th Cir. 2013); 

Duckworth v. Ahmad, 532 F.3d 675, 679 (7th Cir. 2008); see 

generally Estelle v. Gamble, 429 U.S. 97 (1976). This record evidence would not let a reasonable jury find that the prison’s 

schedule for giving Rowe his medicine departed so far from 

professional standards to find that any prison staff acted 

with deliberate indifference to his health. The district court 

therefore properly granted summary judgment for defendants on this claim. See, e.g., Norfleet v. Webster, 439 F.3d 392, 

396 (7th Cir. 2006) (reversing denial of summary judgment), 

citing Estate of Cole v. Fromm, 94 F.3d 254, 262 (7th Cir. 1996) 

(affirming summary judgment); see also, e.g., Pyles v. Fahim, 

771 F.3d 403, 409 (7th Cir. 2014) (affirming summary judgment; physician’s refusal to order MRI for prisoner’s back 

pain did not show deliberate indifference). 

As noted above, the majority claims twice that its decision does not actually depend on its independent factual research, at pages 14 and 16. See also ante at 27–28 (Rovner, J., 

concurring). These denials contradict the rest of the majority 

opinion. If they were accurate, the majority’s long discussion 

of its research and its justifications for it would amount to a 

long essay not necessary to the court’s decision. If the denials 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
32 No. 14-3316

were accurate, moreover, the majority decision would 

amount to a significant rewriting of the Eighth Amendment 

law governing health care for prisoners. 

Where prison medical staff just refuse to treat serious 

pain or disease, a prisoner may well have a viable claim that 

should go to trial. E.g., Miller v. Campanella, No. 14-1990,— 

F.3d —, 2015 WL 4523799 (7th Cir. July 27, 2015) (no treatment of prisoner’s GERD); Hayes v. Snyder, 546 F.3d 516, 524–

26 (7th Cir. 2014). Where the evidence shows, however, that 

medical staff have provided at least some treatment for pain 

we almost always hold that the prisoner is not entitled to a 

jury trial on a claim for deliberate indifference based on a 

claim that the pain treatment was not adequate. E.g., Pyles v. 

Fahim, 771 F.3d 403, 409, 411 (7th Cir. 2014); Holloway v. Delaware County Sheriff, 700 F.3d 1063, 1073–76 (7th Cir. 2012). 

If the majority decision did not depend on its own factual 

research, then the majority would be holding that the prisoner’s dissatisfaction with pain treatment is enough to require a jury trial on whether the prison’s medical staff were 

deliberately indifferent to his pain. We have not found before this case that such evidence is sufficient to infer deliberate indifference. But we will see a lot more cases like this 

one. As the average age of the prison population increases, 

so will the incidence of painful, chronic conditions that cannot be treated to the complete satisfaction of the prisoners. 

The fact that a treatment for pain is not as effective as the 

prisoner would like should not be enough to support an inference that the prison staff are deliberately indifferent to his 

pain. 

In fact, the majority’s reversal on this claim is based on a 

small but important category of cases in which prisoners 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 33

have shown that medical staff persisted in obviously inadequate courses of treatment. In those cases, we have found 

triable issues of deliberate indifference. E.g., Arnett v. Webster, 658 F.3d 742, 754 (7th Cir. 2011); Berry v. Peterman, 604 

F.3d 435, 441–42 (7th Cir. 2010); Greeno v. Daley, 414 F.3d 645, 

654 (7th Cir. 2005) (treatment prisoner received was “blatantly inappropriate”). As we explained in Pyles, these decisions 

were based on evidence showing that the need for specialized expertise or different treatment was either known by 

the treating physicians or would have been obvious to a lay 

person. 771 F.3d at 411. 

The problem for the majority here is that Rowe himself 

has made no comparable showing. Only by relying on its 

independent factual research can the majority establish an 

arguable basis for applying this theory that the course of 

treatment was so clearly inadequate as to amount to deliberate indifference. The majority decision to reverse summary 

judgment on this claim thus depends on that independent 

factual research. 

II. The Law on Judicial Research into the Facts 

The ease of research on the internet has given new life to 

an old debate about the propriety of and limits to independent factual research by appellate courts.1 To be clear, I do not 

 1 See, e.g., Layne S. Keele, When the Mountain Goes to Mohammed: The 

Internet and Judicial Decision-Making, 45 N.M. L. Rev. 125 (2014); Allison 

Orr Larsen, The Trouble with Amicus Facts, 100 Va. L. Rev. 1757 (2014); 

Richard A. Posner, Judicial Opinions and Appellate Advocacy in Federal 

Courts—One Judge’s Views, 51 Duq. L. Rev. 3 (2013); Frederick Schauer, 

The Decline of “The Record”: A Comment on Posner, 51 Duq. L. Rev. 51 

(2013); Elizabeth G. Thornburg, The Lure of the Internet and the Limits on 

Judicial Fact Research, Litig., Summer 2012, at 41; Brianne J. Gorod, The 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
34 No. 14-3316

oppose using careful research to provide context and background information to make court decisions more understandable. By any measure, however, using independent factual research to find a genuine issue of material, adjudicative 

fact, and thus to decide an appeal, falls outside permissible 

boundaries. Appellate courts simply do not have a warrant 

to decide cases based on their own research on adjudicative 

facts. This case will become Exhibit A in the debate. It provides, despite the majority’s disclaimers, a nearly pristine 

example of an appellate court basing a decision on its own 

factual research. 

The majority’s factual research runs contrary to several 

lines of well-established case law holding that a decisionmaker errs by basing a decision on facts outside the record. 

If a district judge bases a decision on such research, we 

reverse for a violation of Rule 201. E.g., Pickett v. Sheridan 

Health Care Center, 664 F.3d 632, 648–51 (7th Cir. 2011) (district court erred by relying on independent internet research 

on attorney fees without giving parties opportunity to address information). 

If jurors start doing their own research during a trial, a 

new trial is likely. United States v. Thomas, 463 F.2d 1061, 

1062–65 (7th Cir. 1972); see also United States v. Blagojevich, 

612 F.3d 558, 564 (7th Cir. 2010) (noting concern that messag-

 

Adversarial Myth: Appellate Court Extra-Record Factfinding, 61 Duke L.J. 1 

(2011); Elizabeth G. Thornburg, The Curious Appellate Judge: Ethical Limits 

on Independent Research, 28 Rev. Litig. 131 (2008); Coleen M. Barger, On 

the Internet, Nobody Knows You’re a Judge: Appellate Courts’ Use of Internet 

Materials, 4 J. App. Prac. & Process 417 (2002). 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
No. 14-3316 35

es to jurors would tempt them to engage in “forbidden research and discussion”). 

If an immigration judge or administrative law judge bases a decision on facts without record support, we reverse it. 

See, e.g., Huang v. Gonzales, 403 F.3d 945, 948–50 (7th Cir. 

2005) (reversing immigration decision based on alien’s answers to questions based on judge’s personal beliefs about 

alien’s religion); Nelson v. Apfel, 131 F.3d 1228, 1236–37 (7th 

Cir. 1997) (ALJ’s reliance on evidence outside record was erroneous but harmless). 

We are in no better a position to go outside the record for 

decisive facts. Our job is to reverse in cases where the decision-maker has gone outside the record. The majority in this 

case, however, not only does what we treat as reversible error when others do it; it holds in essence that the district 

judge erred by not doing such independent factual research. 

What was forbidden is now required. 

In addition to the case law holding that a decision-maker 

is not permitted to base a decision on evidence outside the 

record, another body of law is relevant to this issue: Federal 

Rule of Evidence 201 and the law of judicial notice. The majority opinion runs contrary to that law and misunderstands 

how Rule 201 and judicial notice fit together with the ordinary, adversarial presentation of facts. 

The vast majority of facts that courts consider when deciding cases comes from the familiar, adversarial presentations of evidence by opposing parties. The foundation of our 

legal system is a confidence that the adversarial procedures 

will test shaky or questionable evidence: “Vigorous crossexamination, presentation of contrary evidence, and careful 

Case: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
36 No. 14-3316

instruction on the burden of proof are the traditional and 

appropriate means of attacking shaky but admissible evidence.” Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 

579, 596 (1993). Those protective procedures are not available 

when a court decides to do its own factual research and bases its decision on what it finds. 

The law of evidence allows a narrow exception permitting some judicial research into relevant facts, under Federal 

Rule of Evidence 201 and the concept of judicial notice. Judicial notice “substitutes the acceptance of a universal truth for 

the conventional method of introducing evidence,” and as a 

result, courts must use caution and “strictly adhere” to the 

rule before taking judicial notice of pertinent facts. General 

Elec. Capital Corp. v. Lease Resolution Corp., 128 F.3d 1074, 1081 

(7th Cir. 1997); see also Hennessy v. Penril Datacomm Networks, 

Inc., 69 F.3d 1344, 1354 (7th Cir. 1995) (“In order for a fact to 

be judicially noticed, indisputability is a prerequisite.”). 

The majority says twice it is not taking judicial notice of 

all the cited medical information from the internet. Ante at 

13–14, 19. I agree it could not properly take judicial notice of 

this information under Evidence Rule 201(b) and (e). The 

proper timing of a patient’s doses of Zantac is not “generally 

known within the trial court’s territorial jurisdiction” and is 

not beyond “reasonable dispute,” nor can it be “accurately 

and readily determined from sources whose accuracy cannot 

reasonably be questioned,” as Rule 201(b) requires. And the 

majority has made no effort to comply with the procedural 

requirements of Rule 201(e), essential to basic fairness, of 

giving the parties an opportunity to be heard on the evidence. 

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No. 14-3316 37

If the majority is not taking judicial notice, what exactly 

is it doing? It seems to have created an entirely new, third 

category of evidence, neither presented by the parties nor 

properly subject to judicial notice. The majority writes: 

When medical information can be gleaned 

from the websites of highly reputable medical 

centers, it is not imperative that it instead be 

presented by a testifying witness. Such information tends to fall somewhere between facts that 

require adversary procedure to determine and facts 

of which a court can take judicial notice, but it is 

closer to the second in a case like this in which 

the evidence presented by the defendants in 

the district court was sparse and the appellate 

court need only determine whether there is a 

factual dispute sufficient to preclude summary 

judgment. 

Ante at 13 (emphasis added). In other words, the majority 

acknowledges that its “evidence” neither comes from adversarial presentation by the parties nor meets the strict substantive and procedural standards for judicial notice under 

Rule 201. 

Before this decision, American law has not recognized 

this category of evidence, which might be described as “nonadversarial evidence that the court believes is probably correct.” Compare the comments of the authors of Rule 201, the 

Advisory Committee Notes from 1972: 

The usual method of establishing adjudicative 

facts is through the introduction of evidence, 

ordinarily consisting of the testimony of witCase: 14-3316 Document: 22 Filed: 08/19/2015 Pages: 47
38 No. 14-3316

nesses. If particular facts are outside the area of 

reasonable controversy, this process is dispensed with as unnecessary. A high degree of indisputability is the essential prerequisite.

In other words, the Federal Rules of Evidence allow no room 

for the majority’s innovation. Adversarial evidence and judicial notice are not opposite poles on a wide spectrum, with a 

middle ground for the majority’s evidence that has neither 

been subjected to adversarial testing nor a proper subject of 

judicial notice. These are two distinct categories. To be admissible, evidence must fall within one or the other. “Close” 

to judicial notice does not count. 

The majority has not offered any precedent from the law 

of evidence to support its reliance on its own factual research. Instead, it tries to downplay the unprecedented step 

it takes, including its emphasis that it is “not ordering that 

judgment be entered in Rowe’s favor” and that defendants 

will be entitled to rebut the majority’s factual research on 

remand. Ante at 19. The majority’s modest demurrer loses 

sight of the stakes. The issue on summary judgment is 

whether the evidence in the record would allow a reasonable 

jury to find in favor of the non-moving party. See Reeves v. 

Sanderson Plumbing Products, Inc., 530 U.S. 133, 149–50 (2000); 

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251–52 (1986). By 

reversing, the majority is necessarily finding that this record 

is sufficient to support a jury verdict for Rowe. I disagree. 

The majority also points out that “judges and their law 

clerks often conduct research on cases without disclosure to 

the parties.” Ante at 12. Such research has long been understood to involve only legal research. The majority’s effort to 

compare long-accepted judicial research into case law and 

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No. 14-3316 39

statutes to its independent factual research shows the majority has entered unknown territory. 

To justify this venture, the majority asks a number of rhetorical questions and invokes the courage of the barons at 

Runnymede in 1215. Ante at 14. With respect, we are an intermediate appellate court. The Federal Rules of Evidence 

and Federal Rules of Civil Procedure that we apply are 

adopted and amended through processes established by the 

Rules Enabling Act, 28 U.S.C. § 2071 et seq. We simply do 

not have authority on our own to take the law into this unknown territory. 

III. The Practical Problems 

The majority points out correctly that prisoners must depend entirely on the government for their health care. If they 

turn to the federal courts for help, the combination of the 

constitutional standard under the Eighth Amendment, deliberate indifference to a serious health need, and the system 

of personal liability under 42 U.S.C. § 1983 can make it very 

difficult for a prisoner to hold anyone accountable for serious wrongs. See, e.g., Shields v. Illinois Dep’t of Corrections, 

746 F.3d 782 (7th Cir. 2014). When a prisoner brings a pro se 

suit about medical care, the adversary process that is the 

foundation of our judicial system is at its least reliable. Few 

prisoners have access to lawyers or to expert witnesses 

needed to address medical issues. 

These conditions pose important challenges to federal 

courts doing their best to decide these cases fairly. Yet the 

majority’s solution—to research available medical information on its own and find a genuine issue of material fact 

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40 No. 14-3316

on that basis—raises problems much more serious than a 

possible error in the resolution of one prisoner’s case. 

The majority’s approach turns the court from a neutral 

decision-maker into an advocate for one side. The majority 

also offers no meaningful guidance as to how it expects other judges to carry out such factual research and what standards should apply when they do so. Under the majority’s 

approach, the factual record will never be truly closed. This 

invites endless expansion of the record and repetition in litigation as parties contend and decide that more and more information should have been considered. 

In addition to the abandonment of neutrality, consider 

the problems from the district judge’s point of view. The majority clearly implies, while denying it is doing so, that the 

district judge herself should have done the independent factual research the majority has done on appeal, questioning 

an unchallenged expert affidavit by looking to websites of 

the drug manufacturer, the Mayo Clinic, the Physician’s 

Desk Reference, and Healthline. 

The practical questions are obvious: When are district 

judges supposed to carry out this independent factual research? How much is enough? What standards of reliability 

should apply to the results? How does the majority’s new 

category of evidence fit in with a district judge’s gatekeeping responsibilities under Rule 702 and Daubert? The 

majority offers no answers. 

The majority essentially orders the district judge on remand to find an expert witness on the medical issues, either 

for plaintiff or as a neutral expert under Rule 706. That 

might well be helpful, but as the majority concedes, district 

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No. 14-3316 41

courts do not have budgets for that purpose. Even if a few 

experts might be willing to volunteer in unusual cases, the 

demand of prisoners for free medical or other expert witnesses will far exceed the supply, especially in the rural areas 

where so many prisons are located and smaller towns where 

the nearest district courts are located. 

The majority’s solution for this problem is to have the district court use Federal Rule of Evidence 706 to order defendants, and only the defendants, to pay for an expert witness 

for the plaintiff or the court. See ante at 19–20. That approach 

is not foreclosed by the language of Rule 706, and there is 

some case law supporting it. See Ledford v. Sullivan, 105 F.3d 

354, 360–61 (7th Cir. 1997). Nevertheless, the majority’s reliance on this solution in this ordinary case further threatens 

the neutrality of the courts. It is worth recalling that damages under 42 U.S.C. § 1983 must be sought from state employees only in their individual capacities. Will v. Michigan Dep’t 

of State Police, 491 U.S. 58 (1989). Indemnification by their 

employer is a matter of state law and policy, and sometimes 

grace. See Ind. Code § 34-13-4-1; Estate of Moreland v. Dieter, 

576 F.3d 691, 694–96 (7th Cir. 2009). Is it fair to impose on individual guards, prison administrators, staff, nurses, and 

doctors the cost of finding evidence to build a case against 

them? At the very least, such one-sided burdens should be 

imposed only in extraordinary cases.2

 2 I share the concerns expressed by the district court in Martin v. 

Cohn, 1999 WL 325054, at *1 (N.D. Ind. April 5, 1999), about the fundamental fairness of imposing this financial burden on one side solely because the opposing party is indigent. The defendants will end up having 

to foot the bill for the expert even if they win the case. One partial but 

creative solution to this problem can be found in Goodvine v. Ankarlo, 

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42 No. 14-3316

Further, if the case goes to trial, how is the district judge 

supposed to present to a jury the information the majority 

has found? My colleagues and I agree it is not suitable for 

judicial notice because it is not indisputable, as required under Rule 201(b). Without an expert witness qualified to present the facts and opinions the majority finds persuasive, 

that information does not come into evidence. On appeal 

would the majority’s approach lead us to remand for a new 

trial with instructions to look harder for the right evidence? 

Or what should we do if the district judge did not find or 

rely on the information that our research turns up? As long 

as the factual record remains open for judicial supplements, 

parties will try to use the quest for the perfect record to keep 

any loss in litigation from being final. 

Then consider the problems parties and their lawyers 

will face. If we permit such independent factual research by 

district judges—even expect such research from them—

parties will need to plan for it. Responding to the evidence 

actually offered by the other side is often the biggest challenge and expense in a lawsuit. Now parties need to anticipate the evidence the judge might turn up on her own and 

prepare to meet it. The time and expense devoted to such 

preventive measures will be substantial and should be unnecessary. And if the district judge does her own research 

and gives the parties an opportunity to respond to it, the majority’s approach here is an open invitation for parties to add 

to the record on appeal. The parties will also need to anticipate on appeal that our court will undertake its own factual 

 

2013 WL 1192397, at *2 (W.D. Wis. March 22, 2013) (providing for longterm assessments of plaintiff’s prison trust account to pay for courtappointed expert if plaintiff did not prevail). 

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research, opening up opportunities to save any losing case 

by offering new evidence on appeal.3

From the larger perspective of our judicial system, the 

independent factual research the majority endorses and even 

requires here is not something that federal courts can carry 

out reliably on a large scale. History is probably the academic field closest to the practice of law and judging. Yet historians regularly scoff at the phenomenon called “law-office history.” See Velasquez v. Frapwell, 160 F.3d 389, 393 (7th Cir. 

1998) (Posner, J.) (“[J]udges do not have either the leisure or 

the training to conduct responsible historical research or competently umpire historical controversies. The term ‘law-office 

history’ is properly derisory and the derision embraces the 

efforts of judges and law professors, as well as of legal advocates, to play historian. * * * Judges don’t try to decide contested issues of science without the aid of expert testimony, 

and we fool ourselves if we think we can unaided resolve 

issues of historical truth.”), vacated in part, 165 F.3d 593 (7th 

Cir. 1999). 

Law-office or judicial-chambers medicine is surely an 

even less reliable venture. The internet is an extraordinary 

resource, but it cannot turn judges into competent substitutes for experts or scholars such as historians, engineers, 

 3 If parties on appeal try to supplement the record as the majority 

does here, they are rebuked and may even be sanctioned. E.g., Hart v. 

Sheahan, 396 F.3d 887, 894–95 (7th Cir. 2005) (stating general rule but 

finding no violation because appeal was from dismissal on pleadings); 

Holmberg v. Baxter Healthcare Corp., 901 F.2d 1387, 1392 n.4 (7th Cir. 1990) 

(striking portions of appellee’s brief). Under the majority’s approach, we 

could not take such steps in response to parties’ invitations to our court 

to repeat what the majority does here. 

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chemists, psychologists, or physicians. The majority’s instruction to the contrary will cause problems in our judicial 

system more serious than those it is trying to solve in this 

case. 

IV. How Reliable is Our Research? 

Thus far I have avoided debating the details of the majority’s research, but they deserve closer attention. The specific 

details highlight the more general criticisms I have directed 

at such factual research by judges. 

First, on the websites the majority relies upon, we find 

important disclaimers that emphasize the need for filtering 

their information through qualified medical advice, which 

no member of this court is qualified to provide. The Physician’s Desk Reference site says it is to be used “only as a reference aid. It is not intended to be a substitute for the exercise of professional judgment. You should confirm the information on the PDR.net site through independent sources 

and seek other professional guidance in all treatment and 

diagnosis decisions.” www.pdr.net (last visited August 19, 

2015, as were all websites cited here). The Mayo Clinic and 

Zantac websites have similar disclaimers advising readers to 

talk to a physician or other health care provider before acting on the information on the websites. See 

www.mayoclinic.org/about-this-site/terms-conditions-usepolicy; www.zantacotc.com/zantac-maximumstrength.html#faqs. 

Second, after we get past the disclaimers, the content of 

the majority’s websites simply does not give clear support to 

the majority’s views (a) that Dr. Wolfe was wrong in saying 

that the 150 mg pills Rowe was receiving twice a day could 

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be equally effective even if not given shortly before meals, let 

alone (b) that Dr. Wolfe was so thoroughly and obviously

wrong that a jury could infer that prison staff were deliberately indifferent to Rowe’s health needs. The majority’s websites instead show that some degree of medical judgment is 

needed to decide when best to administer which size pills 

for patients with different needs, especially patients like 

Rowe with chronic conditions. 

The Mayo Clinic site says that patients taking prescription strength Zantac twice a day should take one in the 

morning and one at bedtime. The majority discounts that 

advice because Rowe was taking an over-the-counter dosage 

of 150 mg pills rather than the prescription dosage of 300 mg 

pills. Ante at 8. Yet that explanation overlooks the advice 

from both the manufacturer and the Mayo Clinic that a patient should not take the over-the-counter pills for more than 

two weeks unless directed by a doctor. For patients like Rowe, 

taking Zantac long-term to treat GERD, the Mayo Clinic offers more specific guidance. It advises that adult patients 

with GERD take the 150 mg pill two times a day without 

specifying that the pills should be taken shortly before 

meals. www.mayoclinic.org/drugs-supplements/histamineh2-antagonist-oral-route-injection-route-intravenousroute/proper-use/drg-20068584. That advice from the Mayo 

Clinic seems identical to Dr. Wolfe’s view. 

Similarly, the PDR advises that for treatment of GERD, 

“Symptomatic relief commonly occurs within 24 hours after 

starting therapy with ZANTAC 150 mg twice daily,” again 

without indicating any need to take the pills before meals. 

www.pdr.net/full-prescribing-information/zantac-150-and300-tablets?druglabelid=241#section-standard-1. 

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The “full prescribing information” on the Physician’s 

Desk Reference website says that for treatment of GERD 

with the 150 mg and 300 mg pills, “Symptomatic relief 

commonly occurs within 24 hours after starting therapy with 

ZANTAC 150 mg twice daily,” again without saying anything about taking pills before meals. www.pdr.net/fullprescribing-information/zantac-150-and-300-

tablets?druglabelid=241. And again, that was Rowe’s diagnosis and those were his pills in 2011. 

The majority draws on the PDR website and “common 

sense” regarding how long the pills remain effective. Ante at 

17. The PDR website, however, simply does not provide sufficient data on absorption and clearance rates for the medicine to allow us to exercise our own (non-expert) judgment 

about whether the timing of Rowe’s pills was appropriate. It 

certainly does not allow us to conclude that the timing could 

have amounted to deliberate indifference to his serious 

health needs or to find that Dr. Wolfe’s uncontradicted affidavit did not support the district court’s entry of summary 

judgment on this claim. 

Of course, the point of this discussion of the websites is 

not to debate the majority on the medical fine points. The 

websites the majority relies upon tell us themselves that their 

information needs to be interpreted by a qualified physician. 

None of this information is in the record. None was before 

the district court, nor is it properly before us. 

The majority’s interpretation of its internet research is not 

a reliable substitute for proper evidence subjected to adversarial scrutiny. And while Dr. Wolfe’s affidavit is far less detailed than the information the majority has explored on the 

internet, I also see no basis for the majority’s harsh criticism 

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of him, especially when Dr. Wolfe has not been given any 

opportunity to respond or explain.4

* * * 

In the end, whether Dr. Wolfe’s testimony about the timing for Rowe’s doses was right or wrong in some pure and 

objective sense, or in a case tried with ample resources and 

talent on both sides, is not the question for us. For purposes 

of summary judgment, Dr. Wolfe’s testimony was undisputed. We have no business reversing summary judgment 

based on our own, untested factual research. By doing so, 

the majority has gone well beyond the appropriate role of an 

appellate court. I respectfully dissent from the reversal of 

summary judgment on Rowe’s claims based on the timing of 

his medication. 

 4 The majority criticizes Dr. Wolfe’s affidavit for not providing an 

explanation for his opinion about the timing of the Zantac doses. The 

majority overlooks Federal Rule of Evidence 705, which permits conclusory expert testimony unless and until the conclusions are challenged, 

which Dr. Wolfe’s affidavit was not in the district court. He has not yet 

been called upon to explain his opinion in this case. The fact that he is a 

defendant does not disqualify him from offering an affidavit; we often 

affirm summary judgment based on a moving party’s testimony. The 

majority points out that Dr. Wolfe is “a frequent defendant in prisoner 

civil rights suits,” ante at 6, as if that reflected poorly on his professionalism. Virtually any physician serving large numbers of prisoners will be 

“a frequent defendant in prisoner civil rights suits.” 

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