Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-14-03173/USCOURTS-ca7-14-03173-0/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. 14-3173 

JOSEPH CONLEY, 

Plaintiff-Appellant, 

v.

KIMBERLY BIRCH, 

Defendant-Appellee. 

____________________ 

Appeal from the United States District Court for the 

Southern District of Illinois. 

No. 3:11-cv-13 — Stephen C. Williams, Magistrate Judge. 

____________________ 

ARGUED MAY 28, 2015 — DECIDED AUGUST 6, 2015 

____________________ 

Before FLAUM, KANNE, and SYKES, Circuit Judges. 

FLAUM, Circuit Judge. Joseph Conley appeals a district 

court’s grant of summary judgment to prison physician Dr. 

Kimberly Birch on Conley’s claim that Dr. Birch displayed 

deliberate indifference to his serious medical needs by declining to promptly order an x-ray of his injured hand. On 

December 24, 2009, Conley’s hand was examined by a prison 

nurse, who described Conley’s symptoms to Dr. Birch over 

the phone. Those symptoms included throbbing pain, severe 

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
2 No. 14-3173 

swelling, discoloration, and loss of function throughout the 

entire hand; the nurse concluded in his treatment notes that 

Conley suffered from a “possible/probable fracture.” Dr. 

Birch ordered a regimen of ibuprofen and ice but did not order an x-ray until almost five days later. The x-ray revealed 

that Conley’s hand was indeed fractured, and years later, he 

continues to suffer from chronic pain and limited mobility. 

Based on the information in the record, and drawing all inferences in the light most favorable to Conley, we conclude 

that a reasonable jury might find that Dr. Birch strongly suspected that Conley’s hand had been fractured, yet refused to 

take reasonable measures to evaluate or treat his injury. We 

therefore reverse the district court’s grant of summary judgment in favor of Dr. Birch and remand the case for trial. 

I. Background 

On December 22, 2009, Joseph Conley, then an inmate at 

the Vienna Correctional Center, was involved in a physical 

altercation with a fellow inmate, who swung a combination 

lock at Conley’s head. Conley blocked the hit with his right 

palm but on impact, he “heard a pop” and felt excruciating 

pain in his hand. Over the course of the next two days, Conley’s hand swelled and his range of motion became severely 

limited. Conley made repeated requests for medical attention, which were largely ignored by various Vienna employees, but which are not relevant to this appeal.1

 

1 These employees—June Daymon, Tracie Stanford, and Carol Fauless—

were joined as defendants in the instant suit, and the district court denied their motions for summary judgment on Conley’s claims of deliberate indifference. Daymon, Stanford, and Fauless did not participate in 

this appeal.

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
No. 14-3173 3

On the evening of December 24, Conley showed his injured hand to yet another Vienna employee, Lieutenant Brian Felton. By this point, Conley’s hand had “swollen up like 

a boxing glove real big.” Felton escorted Conley to the health 

care unit. There, Conley was examined by nurse Tracy Potts. 

During the examination, Potts filled out two medical forms, 

an “Offender Injury Report” and an “Offender Outpatient 

Progress Note.” In the “Objective Findings” section of the 

Injury Report, Potts observed: “right hand swollen, discolored, all fingers and thumb involved with palm bruising also. Mild pain.” In the “Evaluation of Injury” section, Potts 

wrote “possible/probable fracture.” On the Progress Note, 

Potts recorded additional observations: he indicated that 

Conley suffered from “throbbing” and “severe pain or swelling, discoloration, [and] limited motion.” He specified that 

Conley was experiencing “limited movement of all four fingers and thumb,” and that Conley’s pain was a “2–3” on a 1–

10 scale. Finally, Potts circled the word “Fracture,” but 

placed a question mark next to that diagnosis. Potts’s notes 

do not indicate any gross deformity or signs of a vascular or 

neurological deficit. 

After examining Conley, Potts placed a call to defendant 

Kimberly Birch, the sole physician assigned to the Vienna 

facility, who was at her home celebrating the Christmas holiday. Neither Potts nor Dr. Birch has any independent recollection of the contents of this phone call, and Conley did not 

overhear the conversation. The parties agree, however, that 

it was standard protocol for Potts to share his full assessment with Dr. Birch during a telephone referral. After speaking with Dr. Birch, Potts gave Conley an ice pack and ibuprofen. According to Conley, Potts explained that “there was 

nothing he could do [for Conley] because of the holidays,” 

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
4 No. 14-3173 

and that “all he could do” was recommend ice and ibuprofen. (Potts had independent authority to provide patients 

with painkillers and ice but only Dr. Birch had the authority 

to order x-rays, which she could do over the phone.) Dr. 

Birch did not report to work on Christmas Day and, although she does not recall, she concedes that she may not 

have returned to work until December 29, 2009. She examined Conley in person the morning of December 29—some 

four-and-a-half days after Potts’s initial evaluation of Conley’s injury—and upon examination, ordered an x-ray. 

Conley does not challenge any of Dr. Birch’s subsequent 

actions or omissions, but a brief recital of successive events is 

informative nonetheless. X-rays for Vienna inmates are performed offsite at the Shawnee Correctional Center and are 

provided by Wexford Health Sources, Inc. Inmates in need 

of x-rays are transported to Shawnee by van, typically twice 

per week, although Wexford has conceded that the availability of x-ray technicians may have been limited over the holidays. Conley’s x-ray was scheduled for January 6, 2010. 

However, it appears that on the morning of January 6, he 

signed a refusal of treatment form in which he specifically 

declined the scheduled x-ray. Conley claims that Nurse Jeffery Brown presented the form to him without explanation 

and that Conley signed the form without reading it. When 

Dr. Birch saw Conley later that same morning, Conley was 

confused as to why he had not received his x-ray. He was 

informed that he had signed a refusal form and that the van 

transporting inmates to Shawnee had already left. Dr. Birch 

then re-ordered the x-ray and refilled Conley’s pain medication. Conley did not see Dr. Birch again. He was transferred 

to Big Muddy Correctional Center on January 13, 2010 and 

eventual x-rays confirmed that his hand was broken. Conley 

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
No. 14-3173 5

suffered permanent damage from the injury: he continues to 

experience chronic pain and frequent swelling, and further 

suffers from a weakened grip and permanent extension lag 

(the inability to fully straighten his finger). 

On January 7, 2011, Conley brought suit under 42 U.S.C. 

§ 1983, alleging that various defendants violated his Eighth 

Amendment rights by demonstrating deliberate indifference 

to his serious medical needs in the days following his injury. 

Defendants included Dr. Birch, Wexford, and Illinois Department of Corrections employees Brown, Daymon, Stanford, Fauless, Penny George, Michael Randle, and John Cox. 

The district court dismissed Conley’s claims against Randle 

and Cox, and all remaining defendants moved for summary 

judgment. The court entered summary judgment in favor of 

Brown, George, and Wexford, and denied summary judgment with respect to Daymon, Stanford, and Fauless. 

With regard to his claim against Dr. Birch, Conley argued 

that, based on her conversation with Potts on the evening of 

December 24, 2009, Dr. Birch strongly suspected that Conley’s hand was fractured. And, in declining to either seek 

prompt confirmation of Conley’s condition (by ordering an 

x-ray) or provide precautionary treatment (immobilization 

with a splint), she displayed deliberate indifference to his 

medical needs. Conley deposed Dr. Birch, who opined that, 

if a hand is described as discolored with all fingers swollen, 

that injury may be a mere contusion rather than a fracture. 

She further explained that it was her custom to defer to the 

professional judgment of the reporting nurse in determining 

whether an x-ray was necessary. Finally, Dr. Birch acknowledged that, in the case of a broken hand, callus formation 

(the process by which the bone starts to fuse and repair itCase: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
6 No. 14-3173 

self) begins “very quickly”—that is, within a matter of days. 

Conley’s medical expert, Dr. Bruce Schlafly, was also deposed. He explained that, given a “diagnosis from the nurse 

of possible or probable fracture of the hand,” “the appropriate treatment then would have been to apply a splint and 

order X-rays.” He also stated that “it would have been reasonable to obtain the X-rays of the right hand within three to 

five days” of Conley’s December 24 examination.2

After reviewing the record, the district court determined 

in a one-paragraph analysis that no reasonable jury could 

conclude that Dr. Birch had acted with deliberate indifference. The court concluded that while providing only ice and 

ibuprofen to Conley on December 24 was “a conservative 

course of treatment,” it was nonetheless appropriate for 

someone “complaining of pain and swelling.” Conley v. 

Birch, No. 11-cv-13, 2013 WL 6229960, at *8 (S.D. Ill. Dec. 2, 

2013). While the district court admitted that the situation 

was “certainly unfortunate,” it determined that, because 

Conley’s symptoms could just as easily have indicated a contusion, his fracture “was not so obvious to Birch ... that the 

failure to immediately [order an x-ray] rises to the level of 

deliberate indifference.” Id. Conley appeals.3

 

2 Recall that while Dr. Birch ordered an x-ray within five days of December 24, that x-ray was not scheduled to be performed until January 6, 

2010. 

3 We recruited pro bono counsel to represent Conley on appeal and now 

thank John M. Robinson of Jones Day for his very capable assistance to 

his client and the court. 

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
No. 14-3173 7

II. Discussion 

We review the district court’s grant of summary judgment to Dr. Birch de novo. Johnson v. Koppers, Inc., 726 F.3d 

910, 914 (7th Cir. 2013). In doing so, we must examine the 

record in the light most favorable to Conley as the nonmoving party, resolving all evidentiary conflicts and drawing all 

reasonable inferences in his favor. Id. Summary judgment is 

appropriate only if Dr. Birch has demonstrated that “there is 

no genuine dispute as to any material fact” and that she “is 

entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). 

A prison official may be found in violation of an inmate’s 

Eighth Amendment right to be free from cruel and unusual 

punishment if she acts (or fails to act) with “deliberate indifference to [his] serious medical needs.” Estelle v. Gamble, 429 

U.S. 97, 104 (1976). The Supreme Court has interpreted the 

“deliberate indifference” standard to require a “reckless[] 

disregard[]” of a substantial risk to inmate health. Farmer v. 

Brennan, 511 U.S. 825, 836 (1994). “Deliberate indifference” 

demands more than a showing of mere negligence: “an official’s failure to alleviate a significant risk that [s]he should 

have perceived but did not, while no cause for commendation, cannot ... be condemned as the infliction of punishment.” Id. at 838. 

To survive summary judgment on his claim of deliberate 

indifference, Conley must produce evidence suggesting that 

his injury amounted to an “objectively serious medical condition,” and that Dr. Birch was “aware of the condition and 

knowingly disregarded it.” Ortiz v. Webster, 655 F.3d 731, 734 

(7th Cir. 2011). That said, Conley’s fracture need not yet have 

been diagnosed as such to have demanded action on the part 

of Dr. Birch. An official may not escape liability by “reCase: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
8 No. 14-3173 

fus[ing] to verify underlying facts that [s]he strongly suspect[s] to be true.” Farmer, 511 U.S. at 843 n.8. If Conley has 

put forth sufficient evidence to permit a reasonable jury to 

conclude that Dr. Birch’s “inaction substantially and unreasonably delayed necessary treatment,” then he has done 

enough to withstand summary judgment. Ortiz, 655 F.3d at 

735. 

Applying this standard to the facts of the instant case, we 

believe a reasonable jury could find that, based on the information conveyed to her in her December 24 telephone 

conversation with Nurse Potts, Dr. Birch strongly suspected 

that Conley’s hand was fractured. Because neither Potts nor 

Dr. Birch has any independent recollection of their December 24 conversation, Potts’s treatment notes are the most 

probative evidence of the information that Potts transmitted 

to Dr. Birch regarding Conley’s injury. (We assume that Potts 

relayed the full extent of his observations to Dr. Birch during 

their call, as all parties concur that this was standard practice 

for telephone referrals at Vienna.) These treatment notes 

suggest a serious injury: Conley suffered from “severe” 

swelling despite the fact that his injury occurred two days 

prior; he experienced loss of function and mobility extending to all four of his fingers and his thumb, even though the 

blow was to his palm only; his hand was discolored; and, 

most importantly, Potts described the injury as a “possible/probable fracture.” Further, while Dr. Birch insisted in 

her deposition that Conley’s symptoms could have indicated 

a contusion rather than a fracture, we think it highly implausible that Potts would have telephoned Dr. Birch at her 

home, after working hours, on Christmas Eve, if he suspected that Conley’s hand was merely bruised. 

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
No. 14-3173 9

Considering this evidence in the light most favorable to 

Conley, a jury might reasonably find that Dr. Birch concluded that Conley’s hand was probably fractured. Of course, we 

cannot be certain of the conclusion that Dr. Birch actually 

drew. But state of mind is an “inquiry that ordinarily cannot 

be concluded on summary judgment,” Mkt. St. Assocs. Ltd. 

P’ship v. Frey, 941 F.2d 588, 597–98 (7th Cir. 1991), and the 

record suggests that Potts communicated information sufficient to lead Dr. Birch to strongly suspect that Conley had 

suffered a fracture. Whether she in fact made that inference 

is a question for trial. 

Our inquiry does not end there, however. Now that we 

have determined that Dr. Birch may well have been aware of 

Conley’s “objectively serious medical condition,” we must 

also determine whether a reasonable jury might conclude 

that she “knowingly disregarded” that condition. Ortiz, 655 

F.3d at 734. Dr. Birch did not direct Potts to entirely withhold 

treatment from Conley: after all, Conley was provided ice 

and ibuprofen, and was informed that Dr. Birch would examine him when she returned to work. The relevant inquiry, 

then, is whether the provision of only painkillers and ice to 

an inmate suffering from a suspected fracture constitutes deliberate indifference. On this issue too, Conley has introduced enough evidence to create a dispute of material fact. 

We have explained that while the “deliberate indifference” standard “does not permit claims for mere negligence 

or claims alleging that a reasonable medical judgment unfortunately led to a bad result, a prisoner is not required to 

show that he was literally ignored.” Sherrod v. Lingle, 223 

F.3d 605, 611 (7th Cir. 2000) (citations omitted). Therefore, 

Conley may demonstrate that Dr. Birch was deliberately inCase: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
10 No. 14-3173 

different even though she provided some minimal treatment. See id. (“If knowing that a patient faces a serious risk 

of appendicitis, the prison official gives the patient an aspirin and an enema and sends him back to his cell, a jury could 

find deliberate indifference ... .”). In the opinion of Conley’s 

medical expert, the “appropriate” treatment for a probable 

fracture would have been to immobilize Conley’s hand using 

a splint and to promptly order x-rays, to be taken within 

three to five days. Dr. Birch, of course, did not recommend 

immediate immobilization and, although she ordered an xray approximately five days after learning of Conley’s injury, 

his x-ray was not slated to be performed for an additional 

eight days (January 6, 2010). Although there is no suggestion 

that Dr. Birch herself scheduled the x-ray, it is reasonable to 

infer—based on Vienna’s standard practice of releasing inmates for x-rays only twice per week (and less frequently 

over the holidays)—that Dr. Birch knew that it would be 

some time before Conley received his x-ray. 

Additional support for the contention that the treatment 

Conley received was insufficient can be found in Conley’s 

deposition testimony. Conley stated that when Potts returned from speaking with Dr. Birch on December 24, he lamented that “there was nothing he could do [for Conley] because of the holidays,” and that “all he could do” was recommend ice and ibuprofen. This statement suggests that 

Potts believed that the severity of Conley’s condition necessitated more drastic treatment, but that Potts’s hands were tied 

as he had independent authority only to provide painkillers 

and ice. Based on this evidence, we believe that a reasonable 

jury could conclude that, in refusing either to promptly 

evaluate Conley’s condition (by ordering an x-ray or performing an in-person exam) or to provide appropriate preCase: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
No. 14-3173 11

cautionary treatment (by immobilizing his hand), Dr. Birch 

acted with deliberate indifference to Conley’s serious medical needs. 

Our conclusion that Conley’s claim of deliberate indifference survives summary judgment does not necessarily indicate that Conley is likely to win at trial. There is evidence 

pointing in both directions, and while a jury might draw inferences favorable to Conley, the record also permits the opposite inferences. After all, Potts’s treatment notes convey 

some uncertainty as to Conley’s diagnosis, as Potts described 

Conley’s injury as a “possible/probable fracture” and a “? 

Fracture.” Also, though his hand was severely swollen, Conley was experiencing only mild pain (a “2–3” on a 1–10 scale) 

at the time of his visit with Potts. Because Potts customarily 

shared his full assessment during a telephone referral, we 

can assume that these observations were communicated to 

Dr. Birch, along with a report of Conley’s more serious 

symptoms. Further, because Dr. Birch stated in her deposition that she generally deferred to the professional judgment 

of the reporting nurse in determining whether to order an xray, a jury might conclude that Potts did not feel that an xray was necessary. Finally, considering that Dr. Birch would 

have been able to order an x-ray over the phone in a matter 

of minutes, doing so likely would not have interfered with 

her holiday plans; as a result, Conley’s proffered motive for 

Dr. Birch’s decision not to order an x-ray—that is, so that she 

would not be forced to interrupt her Christmas vacation—

appears dubious. 

However, these are factual questions that should be left 

to the judgment of a jury. Here, rather than viewing all facts 

in the light most favorable to Conley, the district court “imCase: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
12 No. 14-3173 

permissibly resolved questions of material fact in favor of 

the defendant[] and relied on those to determine that the 

prison medical staff did not show deliberate indifference.” 

Sherrod, 223 F.3d at 611. While “deliberate indifference” is 

indeed a high bar, Conley has introduced evidence sufficient 

to permit a jury to conclude that Dr. Birch acted with reckless disregard for his medical needs. 

On a final note, Dr. Birch also contends that Conley cannot demonstrate that her delay in ordering an x-ray caused 

his injury. We have held that, “[i]n cases where prison officials delayed rather than denied medical assistance to an 

inmate,” the plaintiff must “offer verifying medical evidence 

that the delay (rather than the inmate’s underlying condition) caused some degree of harm.” Jackson v. Pollion, 733 

F.3d 786, 790 (7th Cir. 2013) (citation and internal quotation 

marks omitted). Here, thirty-five days passed between the 

date on which Conley fractured his hand (December 22, 

2009), and the date on which that fracture was diagnosed 

(January 26, 2010); however, Conley blames Dr. Birch for 

fewer than five days of this lengthy delay. Thus, while Dr. 

Birch appears to concede that the overall delay may have 

contributed to the severity of Conley’s injury, she argues 

that Conley has made no showing of what harm, if any, can 

be specifically attributed to her relatively minor role in delaying his diagnosis. 

As an initial matter, we have determined that “causation 

is normally a matter for the jury.” Collins v. Am. Optometric 

Ass’n, 693 F.2d 636, 640 (7th Cir. 1982). But more importantly, 

Dr. Birch acknowledged in her deposition that, following a 

fracture, callus formation begins to take place “very quickly”; presumably, if bones fuse together improperly, permaCase: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13
No. 14-3173 13

nent injury may result. We therefore find Dr. Birch’s uncontroverted testimony sufficient to permit a jury to conclude 

that, by declining to order an x-ray of Conley’s hand at such 

a crucial point in the healing process, she exacerbated his 

lasting injuries. 

III. Conclusion 

For the foregoing reasons, we REVERSE the district court’s 

grant of summary judgment to Dr. Birch and REMAND the 

case for further proceedings consistent with this opinion. 

Case: 14-3173 Document: 45 Filed: 08/06/2015 Pages: 13