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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 January 7, 2025*

Decided January 8, 2025 

Before

AMY J. ST. EVE, Circuit Judge

JOHN Z. LEE, Circuit Judge 

JOSHUA P. KOLAR, Circuit Judge

No. 23-3027 

DE’ADRIAN C. BOYKINS,

Plaintiff-Appellant, 

v. 

SHERI WILSON, et al., 

Defendants-Appellees.

Appeal from the United States District 

Court for the Southern District of 

Indiana, Indianapolis Division. 

No. 1:21-cv-00316-JPH-TAB

James P. Hanlon, 

Judge.

O R D E R

De’Adrian Boykins, an Indiana prisoner with poorly controlled diabetes, appeals 

the summary judgment rejecting his claim that medical providers at his facility acted 

with deliberate indifference when they changed his insulin regimen. Because no 

* 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NONPRECEDENTIAL DISPOSITION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. 23-3027 Page 2 

reasonable jury could find that the medical providers’ treatment violated the Eighth 

Amendment, we affirm.

I 

We construe the record in favor of Boykins, the party opposing summary 

judgment. See Arce v. Wexford Health Sources Inc., 75 F.4th 673, 678 (7th Cir. 2023). While 

incarcerated at Pendleton Correctional Facility, Boykins—a Type 1 diabetic—relied on 

insulin injections to manage his diabetes. In March 2020, a physician assistant at the 

prison, Sheri Wilson, noted that Boykins’s A1C (a measurement of average blood-sugar 

level over multiple months) exceeded the normal range. She renewed his prescriptions 

for Humulin R (“R-insulin”), a fast-acting insulin, and Novolin N (“N-insulin”), a slowacting insulin. Boykins previously had received both medications twice daily. Wilson 

upped Boykins’s R-insulin prescription to three times a day during mealtimes. His 

medical records reflect that he was instructed to adhere to a low-carbohydrate diet. 

By June, when Wilson again saw Boykins, his A1C had improved slightly, so she

lowered Boykins’s prescription for R-insulin to two doses a day. In her notes, Wilson

did not elaborate upon her decision. She and Dr. Duan Pierce, Wexford Health Sources’ 

associate regional director, later explained that the main consideration for a two-a-day 

rather than three-a-day dose of this insulin was the “nature of security practices.” 

Wilson later stated in an affidavit that she believed this adjustment would improve 

Boykins’s A1C. 

Soon thereafter, Boykins submitted a healthcare request form, complaining about 

the change in his prescription. He believed that his diabetes would be better controlled 

with three rather than two daily doses of R-insulin. Boykins’s A1C continued to 

improve, though it remained higher than it should. 

In December, Boykins complained to Wilson that he was experiencing low blood 

sugar (hypoglycemia) in the mornings. Wilson recorded in her notes that Boykins had 

refused some of his N-insulin morning doses based on these self-reports of low blood 

sugar. In response to his concerns, she decreased his N-insulin evening dosage. Despite 

the adjustment to his prescription, Boykins experienced several hypoglycemic episodes

during which he was unresponsive for a short period of time. 

In early 2021, a nurse, concerned about three recent episodes in which Boykins’s 

blood sugar had dropped, emailed Wilson; Dr. Pierce; and the prison’s medical director, 

Dr. Martial Knieser. She proposed increasing Boykins’s insulin injections to three times 

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a day—a schedule she deemed “much safer,” noting that “several other diabetics” 

already received insulin at lunchtime. Wilson replied that Boykins had missed many 

doses of insulin the previous month, and she questioned whether Boykins was eating as 

instructed when he received his insulin. Dr. Pierce asked that Boykins’s regimen be 

reviewed. 

On January 20, Boykins was seen by Dr. Knieser for what appeared to be another 

hypoglycemic episode. Boykins’s blood sugar and vitals, however, tested as normal. 

Dr. Knieser, noting that Boykins smelled of alcohol, suspected intoxication. Dr. Knieser 

reported his observations to Dr. Pierce, who rejected Boykins’s request for an additional 

daily dose of R-insulin and concluded that Boykins needed more education about diet 

and medication control. 

Later that month, Wilson decreased Boykins’s insulin dosages based on his 

continued issues with low blood sugar. She ordered the prison’s medical staff to hold 

Boykins’s R-insulin dose if his blood sugar continued to drop.

On February 6, Boykins sued Wilson, Dr. Knieser, and Dr. Pierce for deliberate 

indifference toward his diabetic condition, in violation of his rights under the Eighth 

Amendment. See 42 U.S.C. § 1983. Boykins asserted that the medical providers acted 

recklessly by reducing his prescription for R-insulin from three to two doses a day and 

then refusing to increase the number of doses in light of his hypoglycemic episodes.

In the weeks that followed, the medical providers continued with his twice-a-day 

insulin regimen. On February 10, Wilson, responding to emails from prison staff about 

Boykins’s blood-sugar issues, explained that she had adjusted—and was monitoring— 

his insulin dosages, but his blood-sugar levels were being affected by his eating habits 

and substance abuse. Meanwhile, Dr. Knieser, who had treated Boykins for low blood 

sugar on consecutive days, later stated that he saw no reason to change Boykins’s 

insulin regimen. Dr. Knieser reported Boykins’s statement that he did not miss his 

insulin injections but ate irregularly. 

On February 26, Wilson, upon receiving a complaint from Boykins about not 

receiving enough insulin, increased his R-insulin prescription to three daily doses. 

In the spring of 2021, Boykins experienced multiple hypoglycemic episodes that 

necessitated immediate treatment. To monitor Boykins’s blood sugar more closely, 

Dr. Knieser tried to move him to a cell closer to the prison’s clinic and even considered

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moving him to the prison’s medical ward or infirmary. On April 30, Dr. Pierce learned 

that Boykins at times had refused his insulin and reportedly been intoxicated. 

The district court entered summary judgment for the defendants, ruling that 

Boykins presented no evidence from which a jury could find that any of the medical 

providers was deliberately indifferent to his diabetic condition. Regarding Dr. Knieser 

and Wilson, the court explained, the record showed that both responded to changes in 

Boykins’s diabetes, and that they appropriately exercised medical judgment in treating 

it. As for Dr. Pierce, the court noted that his role in Boykins’s treatment was only 

indirect, and that no jury could infer that he did not exercise medical judgment when 

opining about Boykins’s insulin regimen. 

II

Under the Eighth Amendment, medical providers may be held liable for 

deliberate indifference if they know about and yet consciously disregard a serious 

medical condition. Farmer v. Brennan, 511 U.S. 825, 837 (1994). The standard for 

deliberate indifference essentially is one of criminal recklessness. Davis v. Kayira, 

938 F.3d 910, 915 (7th Cir. 2019). Medical providers’ decisions are entitled to deference 

“unless no minimally competent professional would have so responded under those 

circumstances.” Id. (internal citation omitted). Because the district court decided the 

case on summary judgment, our review is de novo. Arce, 75 F.4th at 678.

On appeal, Boykins primarily argues that there is a fact dispute over whether 

Wilson’s decision to change his insulin prescription in June 2020 was supported by 

medical judgment. He maintains that no evidence in the record shows that her decision 

was medically justified. 

This argument misconstrues the record. Wilson explained in her affidavit that 

staffing and security concerns in the prison posed logistical and medical challenges to

administering insulin three times a day. She stated that delays in the distribution of 

fast-acting insulin (for instance, on account of shift changes or lockdowns) could harm 

diabetic prisoners if it were not administered right before or after a meal as intended. 

Administrative convenience can be a permissible factor in a prison’s treatment decision, 

as long as that decision does not exclude reasonable medical judgment about inmate

health. Roe v. Elyea, 631 F.3d 843, 863 (7th Cir. 2011). Boykins offered no evidence 

suggesting that Wilson’s decisions excluded reasonable medical judgment over his 

health. To the contrary, she attested in her affidavit that the change in Boykins’s 

prescription “needed to occur to continue improving [his] A1C.” 

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Boykins next argues that a reasonable jury could infer that the prescription 

change in June 2020 was not based on medical judgment because other prisoners 

continued to receive insulin three times a day. But even if other prisoners were

receiving a third dose, the record corroborates Wilson’s belief that Boykins stood to 

benefit most by receiving insulin twice a day. Boykins may disagree with Wilson’s

decision to change his prescription, but mere disagreement is insufficient to show that 

she did so with deliberate indifference. See Thomas v. Martija, 991 F.3d 763, 772 (7th Cir. 

2021). He has not pointed to any evidence in the record to suggest that the treatment 

plan deviated so substantially from accepted professional judgment that no reasonable 

medical provider would reach the same judgment. Id. 

Boykins argues, relatedly, that a reasonable jury could infer that the defendants’ 

refusal to increase his prescription to three daily doses was based not on medical 

judgment but rather the false premise that he had been non-compliant with his insulin 

regimen. But to establish deliberate indifference, Boykins needed to show that the 

defendants were aware of and intentionally disregarded an excessive risk to his health. 

See Farmer, 511 U.S. at 837. He has not pointed to evidence to call into question their

belief—based on their interactions with him, their review of his medical records, and 

their correspondence with medical staff—that the treatment choices amounted to care 

that was adequate. 

Finally, Boykins argues that the district court overlooked a factual dispute about 

the extent of Dr. Pierce’s involvement in his care. As evidence of Dr. Pierce’s direct 

involvement in the decision to lower his R-insulin prescription to two daily doses, 

Boykins points to Dr. Pierce’s email exchanges with Dr. Knieser and Wilson, opining

that there was no need to change Boykins’s insulin regimen. But as we have explained, 

no reasonable jury could find that this opinion—without more—reflected anything but 

the sound exercise of Dr. Pierce’s medical judgment.

AFFIRMED

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