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

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United States Court of Appeals 

For the Seventh Circuit 

Chicago, Illinois 60604 

Submitted March 19, 2020*

Decided March 20, 2020 

Before 

DANIEL A. MANION, Circuit Judge 

DIANE S. SYKES, Circuit Judge 

AMY J. ST. EVE, Circuit Judge

No. 19-1352 

DANIEL A. TROYA, 

Plaintiff-Appellant, 

v. 

WILLIAMS E. WILSON, et al.,

 Defendants-Appellees.

 Appeal from the United States District 

Court for the Southern District of Indiana, 

Terre Haute Division. 

No. 2:17-cv-00162-JRS-DLP 

James R. Sweeney, II, 

Judge. 

O R D E R 

Daniel Troya, a federal inmate in Indiana, had surgery to remove hemorrhoids. 

Contending that the prison’s medical staff deliberately ignored his medical needs in the 

wake of surgery, Troya filed this Bivens action. See Bivens v. Six Unknown Named Agents 

of Fed. Bureau of Narcotics, 403 U.S. 388 (1971). Because no reasonable juror could find 

that the defendants recklessly ignored Troya’s post-surgical needs, we affirm the 

judgment. 

*

 We have agreed to decide the case without oral argument because the briefs and 

record adequately present the facts and legal arguments, and oral argument would not 

significantly aid the court. FED. R. APP. P. 34(a)(2)(C). 

NONPRECEDENTIAL DISPOSITION 

To be cited only in accordance with Fed. R. App. P. 32.1 

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No. 19-1352 Page 2 

Troya had a successful hemorrhoidectomy. Afterward, his surgeon prescribed a 

painkiller and a stool softener, though he advised Troya that he could use an over-thecounter stool softener. He told Troya that “[s]ome pain and swelling,” constipation, and 

“a small amount of rectal bleeding” are “normal” after surgery. He instructed Troya to 

consume “full liquids today,” to “increase to soft diet tomorrow [and] regular diet in 

one week,” and to “drink plenty of fluids to keep the bowels soft.” The surgeon also 

urged Troya to contact the hospital in two days if he had not had a bowel movement. 

When Troya returned to prison, a nurse evaluated him. As the surgeon wanted, 

she ordered from the prison’s pharmacy the painkiller and stool softener. And like the 

surgeon, she told Troya to drink plenty of fluids and eat soft foods. Troya received the 

painkiller (for which constipation is a likely side-effect) but not the stool softener, which 

took a few days to arrive. He received his regular diet from the prison. 

Troya next met with a physician assistant. Three days after the surgery, he told 

her that the pain and bleeding were resolving, but he had not received the stool softener 

or had a bowel movement. The assistant told Troya that “someone” dropped the ball on 

delivering the prescribed stool softener that the nurse had ordered. She reminded him 

that he could buy an over-the-counter softener, which the surgeon deemed acceptable, 

at the commissary. He did so later that day. She also placed a second order with the 

pharmacy for the prescribed softener and ordered a laxative. Like the surgeon, who had 

advised Troya to wait two days after beginning his post-surgical treatment before 

contacting the hospital for next steps, the assistant told Troya to take the drugs and call 

her in two days. When the assistant learned, after those two days, that Troya still had 

no bowel movement, she ordered two doses of magnesium citrate, a strong laxative. 

The second dose would be administered only if necessary three hours after the first. 

Troya received his laxative that evening from nurses. The first dose did not move 

his bowels, though he reported pain, cramping, and disorientation. He received the 

second dose on schedule. That night Troya became ill. Prison staff found him in the fetal 

position surrounded by vomit and blood; he also had some blood near his rectum and 

an elevated pulse and blood pressure. Medical staff rushed Troya to a hospital. There he 

received another powerful laxative, intravenous fluids, and a liquid diet to treat him for 

“moderate constipation.” He remained there for three days. 

Troya decided to sue. He alleged that the two prison nurses, the physician 

assistant, prison administrators, and a “John Doe” nurse violated the Eighth 

Amendment by ignoring his surgeon’s advice. See Carlson v. Green, 446 U.S. 14 (1980) 

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No. 19-1352 Page 3 

(recognizing Eighth Amendment claims in Bivens action). The district court screened the 

complaint, see 28 U.S.C. § 1915A, and dismissed the John Doe defendant, reasoning that 

under Wudtke v. Davel, 128 F.3d 1057, 1060 (7th Cir. 1997), a plaintiff cannot proceed 

against an unknown defendant. During discovery, Troya moved four times for 

recruited counsel. The court denied the motions, ruling that Troya was competent to 

proceed pro se, given the nature of his claims, his GED and general health, and his 

“very well-written and reasoned” filings (prepared with a fellow inmate’s help). The 

court said that it would reconsider recruiting counsel “at trial or at other points in the 

case” if Troya’s self-representation became difficult. It later entered summary judgment 

for all defendants, ruling that no reasonable jury could find that Troya’s constipation 

was a serious medical condition and, in any case, no defendant was indifferent to it. 

On appeal, Troya contends that he had a serious need for post-surgical care that 

the defendants ignored. Even a layperson, he argues, would know to follow the 

surgeon’s orders to get him a stool softener and soft-food diet immediately; the failure 

to do so led to the emergency-room visit and three days at the hospital. 

To survive summary judgment on his deliberate indifference claims, Troya 

needed to supply evidence that would permit a jury to find that he had an objectively 

serious medical condition that the defendants deliberately ignored. Farmer v. Brennan, 

511 U.S. 825, 834 (1994); Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016). We review 

de novo the district court’s conclusion that he failed to do so. See Petties, 836 F.3d at 727. 

We may assume, as Troya argues, that the district court too narrowly construed 

his medical condition as simply constipation, rather than post-surgery recovery. An 

inmate’s medical condition is serious when a physician prescribes treatment to avert 

“unnecessary and wanton infliction of pain.” Estelle v. Gamble, 429 U.S. 97, 104 (1976); 

Lewis v. McLean, 864 F.3d 556, 563 (7th Cir. 2017). We will assume as a factual matter 

that this covers Troya’s situation. To recover, his surgeon advised Troya to take a 

painkiller, use a stool softener, eat soft foods, drink liquids, and then call for help later, 

if needed, to reduce the pain, rectal bleeding, and constipation that normally follow any 

hemorrhoidectomy. 

But we agree with the district court that no reasonable juror could conclude that 

the defendants deliberately ignored the surgeon’s advice for recovery. We begin with 

the nurse who saw Troya upon his return from surgery. On Troya’s first day back in 

prison, this nurse followed the surgeon’s advice and ordered the prescriptions for the 

painkiller and stool softener. True, the pharmacy did not deliver the stool softener until 

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a few days later, but no evidence shows that the nurse caused that delay. See Miller v. 

Harbaugh, 698 F.3d 956, 962 (7th Cir. 2012) (prison officials not liable under Eighth 

Amendment if “remedial step was not within their power”). The nurse also followed 

the surgeon’s advice about Troya’s diet; she advised Troya to drink liquids and eat soft 

foods. Troya does not contend that his regular diet lacks soft foods, so the nurse did not 

ignore the doctor’s order to make soft foods available. 

Next, Troya contends that a jury could find that the two nurses deliberately 

ignored his needs by giving him magnesium citrate after he had been constipated for 

five days. We disagree. The nurses permissibly followed orders from the physician 

assistant to treat prolonged constipation. The assistant told them to administer the drug 

in two doses, with the second dose only if, as happened, the first did not induce a bowel 

movement. And they did so. Furthermore, no one told the nurses to stop the treatment 

if, as Troya reported, he had pain and cramping from the initial dose. Nurses who 

follow medical orders that, as here, are not obviously wrong have complied with the 

Eighth Amendment. See Holloway v. Del. Cty. Sheriff, 700 F.3d 1063, 1075 (7th Cir. 2012). 

We now turn to the physician assistant who, Troya argues, recklessly ignored his 

surgeon’s advice; we conclude that no jury could reach that finding. When the assistant 

met with Troya two days after his surgery and learned that he had not received a stool 

softener or had a bowel movement, she reasonably implemented the surgeon’s protocol. 

She reordered the prescription, reminded Troya that he could use the softeners from the 

commissary, and thus enabled him to get the treatment that the surgeon wanted him to 

have for two days before taking next steps. When she learned after those two days that 

Troya’s status was unchanged, she again took reasonable steps: she prescribed a strong 

laxative—treatment later validated by the hospital, whose care Troya does not 

denigrate. Thus, the physician assistant did not recklessly ignore Troya’s needs. 

See Norfleet v. Webster, 439 F.3d 392, 396 (7th Cir. 2006) (To infer deliberate indifference, 

a treatment decision “must be so far afield of accepted professional standards as to raise 

the inference that it was not actually based on a medical judgment.”). 

Next, we address Troya’s claim against the prison administrators. Troya offered 

no evidence that they even knew about his condition or were personally involved in his 

care, so they cannot be liable. See Estate of Miller v. Marberry, 847 F.3d 425, 428 (7th Cir. 

2017). And as managers of caregivers, they are likewise not personally responsible for 

Troya’s care. See Ashcroft v. Iqbal, 556 U.S. 662, 677 (2009). 

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Two final issues remain, the first of which is Troya’s contention that the district 

court erred in denying his requests for counsel. He argues that the court mistakenly 

found that he was competent to represent himself even though a fellow inmate had 

prepared his filings and he needed an attorney to obtain a medical expert. We review 

the decision to deny counsel for abuse of discretion, Pruitt v. Mote, 503 F.3d 647, 658 

(7th Cir. 2007) (en banc), and no abuse occurred here. The district court applied the 

correct legal standard when it concluded that Troya could represent himself given his 

GED, health, and competent filings. The court knew that Troya had the help of a fellow 

inmate, and it assured him that it would reconsider recruiting counsel if circumstances 

changed. We recognize that counsel can help a prisoner secure an expert, but Troya’s 

case was not prejudiced by the lack of an expert. His claim turns on his contention that 

the defendants ignored his surgeon’s advice. As we have explained, the defendants did 

not recklessly disregard that advice: the nurses ordered the required drugs immediately 

(even though Troya could have obtained a stool softener himself); and as the surgeon 

wanted, the physician assistant waited for two days after Troya began taking those 

drugs before responding to his constipation. We thus have no reason to believe that 

recruited counsel would have changed the outcome of the case. See id. at 659. 

 

Finally, Troya challenges the dismissal of the John Doe defendant. He argues that 

the court should have permitted him to proceed against the unnamed nurse. But the 

court dismissed the claim without prejudice, and when Troya later learned the nurse’s 

name, he could have moved to amend his complaint to add the defendant. Thus, the 

court’s decision was permissible. See Donald v. Cook Cty. Sheriff’s Dep’t, 95 F.3d 548, 556 

(7th Cir. 1996) (court may “dismiss[] the complaint without prejudice” if defendant’s 

identity is initially unknown). 

The judgment of the district court is therefore AFFIRMED. 

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