Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-15-03462/USCOURTS-ca7-15-03462-0/pdf.json

Parties Involved:
Ravi Gupta
Appellee
Cesar Lopez
Appellee
Jessie Rivera
Appellant

Document Text:

In the 

United States Court of Appeals 

For the Seventh Circuit ____________________

No. 15‐3462

JESSIE RIVERA,

Plaintiff‐Appellant,

v.

RAVI GUPTA and CESAR LOPEZ,

Defendants‐Appellees.

____________________

Appeal from the United States District Court for the

Western District of Wisconsin.

No. 13 C 56 — William M. Conley, Chief Judge.

____________________

SUBMITTED AUGUST 18, 2016 — DECIDED SEPTEMBER 8, 2016

____________________

Before POSNER, EASTERBROOK, and SYKES, Circuit Judges.

POSNER, Circuit Judge. Jessie Rivera, a federal inmate, suf‐

fers from numbness and pain as a result of second‐degree

burns on his left leg, foot, and ankle. His suit accuses a phy‐

sician named Ravi Gupta, and a prison health services ad‐

ministrator named Cesar Lopez, of deliberate indifference to

his need for substantial medical treatment, thereby violating

his Eighth Amendment rights. See Farmer v. Brennan, 511

U.S. 825, 834 (1994); Estelle v. Gamble, 429 U.S. 97, 104–05

Case: 15-3462 Document: 26 Filed: 09/08/2016 Pages: 7
2 No. 15‐3462

(1976). The district court entered summary judgment for the

defendants, precipitating this appeal. (Rivera had also

brought a claim under the Federal Torts Claims Act, but the

district court rightly dismissed it on the authority of United

States v. Demko, 385 U.S. 149 (1966), which holds that the In‐

mate Accident Compensation Act, 18 U.S.C. § 4126(c)(4),

precludes FTCA claims for prisoners injured while working.)

The prison kitchen in which Rivera was working in May

2011 when the accident occurred had a history of large kettle

pots’ boiling over and spilling water on the floor. One of

these pots, containing dirty water, butter, and shortening,

had been boiling over for more an hour when Rivera slipped

on the wet floor underneath the pot, scalding his leg. A

nurse diagnosed him with second‐degree burns on his left

lower leg and ankle, removed the dead skin around the

wound, dressed the burn, and prescribed a narcotic pain

medication, a wheelchair (because the burn was making it

difficult for him to walk), and a lower bunk, and told him

not to engage in strenuous physical activity.

For several weeks Rivera returned to the healthcare unit

daily so that medical staff could monitor the burn for infec‐

tion and clean and dress the wound. In these visits he con‐

tinued to complain that pain and numbness in his left leg,

ankle, and foot were making walking difficult for him. A

physician assistant told him that his symptoms probably

were a normal part of the healing process and suggested that

he return to the health care unit in six months if he was still

experiencing numbness and difficulty walking. When he re‐

turned six months later and complained that he was indeed

still experiencing pain and numbness he was told that the

symptoms probably were permanent but that he could see

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No. 15‐3462 3

Dr. Gupta, the director of the prisonʹs clinic, if he wanted a

physician’s opinion.

Rivera met with Gupta, told him that the numbness and

pain in his leg, ankle, and foot had not abated, and said he

wanted treatment from a burn specialist and that his family

would pay for the treatment. According to Rivera, Gupta re‐

fused to examine him, look up his records, or authorize any

treatment, instead admonishing him that he wouldn’t have

scalded himself had he not been in prison, that “only God”

could help him now, and that if he complained about numb‐

ness and pain in his leg again, Gupta would write a discipli‐

nary report. Gupta disputes Rivera’s account but at the

summary‐judgment stage of the case we are obliged to ac‐

cept Rivera’s version. See Tradesman Int’l, Inc. v. Black,

724 F.3d 1004, 1009 (7th Cir. 2013). Conflicting factual asser‐

tions, both plausible, can be resolved only by a trial.

Rivera supports his deliberate‐indifference claim with

excerpts from medical websites which suggest that severe

burns can cause nerve damage, that damaged nerves can

progressively worsen if untreated, and that nerve‐pain med‐

ications and physical therapy can reduce the nerve damages

from chronic, persistent pain and numbness. The validity of

this medical information is not contested.

As for Lopez—the prison’s health‐services administrator

who is the other defendant—Rivera claims to have com‐

plained to him early on about the inadequate medical treat‐

ment that he was receiving, and Lopez never followed up.

But Lopez is not a medical professional, and the medical

staff was aware of Rivera’s condition and had as we know

told him to wait six months to allow the burn further time to

heal, before he sought additional treatment. The grant of

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summary judgment for Lopez thus was proper. See, e.g.,

McGee v. Adams, 721 F.3d 474, 483 (7th Cir. 2013).

Not so with regard to Dr. Gupta. The district judge

granted summary judgment in his favor without considering

the website excerpts, and noted that despite the “odd ex‐

change” between Rivera and Gupta, Rivera had produced

no expert evidence that Gupta had been deliberately indif‐

ferent to Rivera’s numbness and pain. The judge also denied

Rivera’s request for counsel. While acknowledging that

“counsel could have assisted Rivera in responding to de‐

fendants’ motion for summary judgment in several respects,

perhaps most critically in possibly securing expert testimo‐

ny,” the judge said that no amount of expert testimony

would “alter [his] determination that defendants’ decision to

refuse [Rivera’s] request for a referral” to a burn specialist

was not “blatantly inappropriate.” This was an odd thing to

say, given that Rivera’s condition was at root a burn prob‐

lem. Nor did the judge explain the basis for his unalterable

“determination.”

Gupta argues that the numbness and pain in Rivera’s leg

and foot were not serious. But Rivera submitted evidence

from which a jury could reasonably find that they were. He

claims that for nine months he suffered from pain and

numbness that made walking difficult, and he had presented

as we noted earlier uncontested evidence from reputable

medical websites indicating that severe burns such as he’d

experienced can damage nerves and cause progressively

worsening pain or numbness (or both) and that medication

and physical therapy can relieve those conditions.  

Yet Gupta refused to examine Rivera or provide any

medical treatment for his pain and numbness, thereby delib‐

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No. 15‐3462 5

erately ignoring a serious medical condition, as in the com‐

parable cases of Gonzalez v. Feinerman, 663 F.3d 311, 314–15

(7th Cir. 2011); Hayes v. Snyder, 546 F.3d 516, 524–25 (7th Cir.

2008); and Brock v. Wright, 315 F.3d 158, 166–68(2d Cir. 2003).

Apropos to this case is our statement in Miller v. Campanella,

794 F.3d 878, 880 (7th Cir. 2015), quoting Williams v. OʹLeary,

55 F.3d 320, 324 (7th Cir. 1995), that “a prison officer is delib‐

erately indifferent if he ‘knows of and disregards an exces‐

sive risk to inmate health.’”

Gupta responds that there was no medical treatment

that could have relieved Rivera’s numbness or pain, because

his condition was a “normal” part of the healing process and

his “neurovascular exam” was normal. But Gupta is not a

neurologist or a specialist in the treatment of burn injuries

and did not explain the medical basis for his contention that

pain and numbness nine months after a burn were normal.

Nor is the relevance of “normality” apparent. It is “normal”

to experience pain after a fall or other accident, but also

“normal” to treat it. Peritonitis is a “normal” consequence of

a bacterial or fungal infection in the abdomen, but requires

prompt medical attention as left untreated it can lead to se‐

vere, potentially life‐threatening infection. A refusal to treat

peritonitis on the ground of “normality” would certainly

amount to deliberate indifference rather than just to medical

malpractice, and likewise a refusal to treat a painful and pro‐

tracted burn injury on the same ground.

The statements that Rivera claims Gupta made during

their one meeting could well incline a reasonable jury to

doubt Gupta’s good faith in refusing to treat Rivera or allow

him to seek treatment from a burn specialist, because Rivera

could receive help only from “God.” And very improperly

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he threatened Rivera with discipline if he continued to com‐

plain of numbness and pain. A reasonable jury might well

infer that personal hostility, divorced from medical judg‐

ment, had motivated Gupta’s refusal to provide Rivera with

any further treatment, even by a burn specialist whom Rive‐

ra’s family would have compensated.

We are mindful of the Supreme Courtʹs ruling in Helling

v. McKinney, 509 U.S. 25, 35 (1993), that a prisoner who

claims that the defendants have failed to handle his health

issues properly must establish “both the subjective and the

objective elements necessary to prove an Eighth Amendment

violation.” The objective component is the seriousness of the

inmate’s medical condition, and as Rivera’s burn injury was

objectively serious, that element of the test is satisfied. The

subjective component is the “deliberate indifference” com‐

ponent and one way to satisfy it is by showing that the pris‐

on doctor provided no treatment even though the circum‐

stances indicated that treatment clearly was warranted, thus

permitting an inference that in failing to provide any treat‐

ment the doctor had acted with a culpable state of mind (de‐

liberate indifference, equivalent to recklessness in criminal

law). So there is evidence of both Helling components of Ri‐

vera’s claim and therefore his case against Gupta should go

to a jury.

The defendants suggest that Rivera must have been ex‐

aggerating his symptoms because he never complained to

the medical staff about the pain and numbness in his leg af‐

ter his appointment with Gupta in 2012. That would not be

surprising were it true, given the brush‐off that Gupta had

given him and the threat to discipline him if he continued

complaining about numbness and pain and difficulty walk‐

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No. 15‐3462 7

ing. Rivera may indeed have given up on the medical staff of

the prison (FCI‐Oxford), but two years after his brush‐up

with Gupta, and after being transferred to another prison

(MCC‐Chicago)—where he no longer had to worry about

Gupta—Rivera told a clinician at his new prison that he still

had pain and numbness at the burn site.

A final point: although Rivera does not argue on appeal

that the district judge abused its discretion in denying his

motion for counsel, the judge’s unquestionably correct re‐

mark that “counsel could have assisted Rivera in responding

to defendants’ motion for summary judgment in several re‐

spects, perhaps most critically in possibly securing expert

testimony,” persuades us that on remand the judge should

recruit counsel for Rivera. Cf. Pruitt v. Mote, 503 F.3d 647,

655–56 (7th Cir. 2007) (en banc).

The judgment in favor of Dr. Gupta is reversed, the

judgment in favor of Mr. Lopez affirmed, and the case re‐

manded to the district court for further proceedings, con‐

sistent with this opinion, concerning the plaintiff’s claim

against Gupta.

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