Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-15-01647/USCOURTS-ca7-15-01647-0/pdf.json

Parties Involved:
Alfonso David
Appellee
Wexford Health Sources, Inc.
Appellee
Calvin Whiting
Appellant

Document Text:

In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 15-1647 

CALVIN WHITING, 

Plaintiff-Appellant, 

v.

WEXFORD HEALTH SOURCES, INC., 

and ALFONSO DAVID, 

Defendants-Appellees. 

____________________ 

Appeal from the United States District Court for the 

Northern District of Illinois, Eastern Division. 

No. 12 C 2917 — Elaine E. Bucklo, Judge. 

____________________ 

ARGUED OCTOBER 26, 2015 — DECIDED OCTOBER 12, 2016 

____________________ 

Before WOOD, Chief Judge, BAUER and SYKES, Circuit 

Judges. 

SYKES, Circuit Judge. While serving a probation-revocation 

sentence in an Illinois prison, Calvin Whiting fell ill with 

what turned out to be a rare form of non-Hodgkin’s lymphoma. A prison doctor initially diagnosed an infection and 

prescribed antibiotics and nonprescription pain relievers. It 

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was not until two months later that the doctor ordered a 

biopsy and the cancer was discovered. 

Whiting filed this lawsuit under 42 U.S.C. § 1983 against 

the prison doctor and the prison’s private medical provider 

alleging that they were deliberately indifferent to his serious 

medical needs during the two months that his cancer went 

undiagnosed. The district court granted summary judgment 

to both defendants. We affirm. 

I. Background 

Calvin Whiting violated the terms of his probation on an 

Illinois burglary conviction and was sent to the Shawnee 

Correctional Center in Vienna, Illinois, in July 2010. Wexford 

Health Sources, Inc., provides medical services for inmates 

in Illinois prisons. Dr. Alfonso David is the medical director 

at Shawnee. On October 15, 2010, Whiting went to the 

prison’s medical center seeking treatment for pain in his left 

jaw, left ear, and groin; he also discovered nodules developing in these areas. A nurse examined him and thought he 

had an ear infection; she gave him amoxicillin (an antibiotic) 

and Motrin. 

About a week later Whiting returned to the medical center complaining that his pain had worsened and the amoxicillin had given him a rash. He was given Bactrim, a different antibiotic, instead. Chest and abdominal x-rays also were 

ordered. Dr. David is listed as the prescribing physician for 

these orders, but it’s not entirely clear whether he or the 

nurse saw Whiting that day. 

Over the next few days, Whiting told two different nurses that his pain and the bumps were getting worse. The 

nurses gave him Tylenol and scheduled an examination with 

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Dr. David. On October 26 Whiting was sick enough to be 

admitted to the infirmary. Dr. David saw him the next day. 

Dr. David’s observations from the October 27 examination indicate that Whiting’s pain was continuing (and possibly worsening), his lymph nodes were swollen, and he had 

developed a mass in his jaw. Dr. David ordered blood work 

and submitted a biopsy request to Wexford’s “Collegial 

Review Committee.” This “committee”—just Dr. David 

himself and one other physician—denied the biopsy request 

on November 1. The two doctors decided to try two different 

antibiotics (doxycycline and Augmentin), one after the other, 

and proceed with a biopsy if this course of treatment did not 

work. Dr. David implemented this treatment plan that same 

day. Whiting continued to receive nonprescription pain 

medication. 

The first few days on the new antibiotic regimen showed 

promise: Two nurses reported some improvement in Whiting’s condition. But by November 7 Whiting was reporting 

new bumps and increased pain. On November 29 a nurse 

observed many more bumps and scheduled another appointment with Dr. David. On December 2 Dr. David examined Whiting and resubmitted the biopsy request. It was 

approved four days later, and the biopsy was performed on 

December 21, almost two full months after Dr. David first 

submitted the biopsy request to the “committee.” The results 

revealed that Whiting had a rare type of non-Hodgkin’s 

lymphoma. 

Dr. David referred Whiting to an outside oncologist, 

Dr. Mahnaz Lary, who diagnosed Stage IV SLK positive 

anaplastic large cell lymphoma, a rare and aggressive form 

of the disease. Chemotherapy began in early January 2011. 

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In June 2011 Whiting’s lymphoma appeared to be in complete remission, but by August the disease had returned. 

Whiting began another round of chemotherapy. In October 

2011 he was approved for a stem-cell transplant at Barnes 

Jewish Hospital in St. Louis. A scan in December 2011 

showed the lymphoma again in remission. 

Whiting’s prison sentence ended in January 2012. After 

his release he received additional chemotherapy and a stemcell transplant at the University of Chicago Medical Center. 

A biopsy in June 2012 brought bad news: the lymphoma was 

back. Since then Whiting has been receiving palliative 

chemotherapy and remains a candidate for another stem-cell 

transplant. 

Whiting filed this suit against Dr. David and Wexford 

alleging that they were deliberately indifferent to his serious 

medical needs in violation of the Eighth Amendment.1 His 

claim focuses on the period from late October 2010, when 

Dr. David first examined him, and early January 2011, when 

chemotherapy began. Whiting argues that the decision to 

postpone the biopsy and continue to treat him for an infection forced him to endure severe pain during this two-month 

period. 

Both defendants moved for summary judgment. 

Dr. David argued that the evidence was insufficient to 

support an inference that he acted with the necessary culpable state of mind. Wexford argued that Whiting failed to 

produce evidence showing that his injury was caused by a 

policy or custom, a necessary element for liability under 

 

1 The suit named other defendants as well, but Whiting did not pursue 

his claims against them.

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Monell v. Department of Social Services, 436 U.S. 658 (1978). 

The district judge accepted these arguments and entered 

judgment for the defendants. 

II. Discussion 

We review the court’s order granting summary judgment 

de novo, viewing the evidence and drawing all reasonable 

inferences in Whiting’s favor. Burton v. Downey, 805 F.3d 776, 

783 (7th Cir. 2015). Summary judgment is appropriate if 

“there is no genuine dispute as to any material fact and the 

movant is entitled to judgment as a matter of law.” FED. R.

CIV. P. 56(a). A factual dispute is “genuine” “if the evidence 

is such that a reasonable jury could return a verdict for the 

nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 

242, 248 (1986). 

A. Dr. David 

“[D]eliberate indifference to serious medical needs of 

prisoners constitutes the ‘unnecessary and wanton infliction 

of pain’ proscribed by the Eighth Amendment.” Estelle v. 

Gamble, 429 U.S. 97, 104 (1976) (quoting Gregg v. Georgia, 

428 U.S. 153, 173 (1976)) (citation omitted). To prevail on a 

deliberate-indifference claim, the plaintiff must prove that he 

suffered from “(1) an objectively serious medical condition 

to which (2) a state official was deliberately, that is subjectively, indifferent.” Duckworth v. Ahmad, 532 F.3d 675, 679 

(7th Cir. 2008). Lymphoma is an objectively serious medical 

condition, and Whiting submitted expert testimony that he 

would have suffered significantly less pain during November and December of 2010 if a biopsy had been ordered and 

chemotherapy begun. As in many deliberate-indifference 

cases, the dispute rests on the second element of the claim. 

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A prison official is deliberately indifferent only if he 

“knows of and disregards an excessive risk to inmate health 

or safety.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). The 

state-of-mind element is measured subjectively: The defendant must know of facts from which he could infer that a 

substantial risk of serious harm exists, and he must actually 

draw the inference. Id.; see also Petties v. Carter, No. 14-2674, 

2016 WL 4631679, at *3 (7th Cir. Aug. 25, 2016) (en banc) 

(“[T]he Supreme Court has instructed us that a plaintiff must 

provide evidence that an official actually knew of and disregarded a substantial risk of harm.”). The requirement of 

subjective awareness tethers the deliberate-indifference 

cause of action to the Eighth Amendment’s prohibition of 

cruel and unusual punishment; “an inadvertent failure to 

provide adequate medical care cannot be said to constitute 

‘an unnecessary and wanton infliction of pain.’” Estelle, 

429 U.S. at 105 (emphasis added). 

When a prison medical professional is accused of providing inadequate treatment (in contrast to no treatment), evaluating the subjective state-of-mind element can be difficult. 

It’s clear that evidence of medical negligence is not enough 

to prove deliberate indifference. Id. at 106 (“Medical malpractice does not become a constitutional violation merely 

because the victim is a prisoner.”); Petties, 2016 WL 4631679, 

at *3 (“[P]laintiffs must show more than mere evidence of 

malpractice to prove deliberate indifference.”); see also McGee 

v. Adams, 721 F.3d 474, 481 (7th Cir. 2013); Duckworth, 

532 F.3d at 679 (“Deliberate indifference is not medical 

malpractice; the Eighth Amendment does not codify common law torts.”); Greeno v. Daley, 414 F.3d 645, 653 (7th Cir. 

2005) (“[N]either medical malpractice nor a mere disagreement with a doctor’s medical judgment amounts to deliberCase: 15-1647 Document: 39 Filed: 10/12/2016 Pages: 17
No. 15-1647 7

ate indifference.”). So without more, a mistake in professional judgment cannot be deliberate indifference. 

By definition a treatment decision that’s based 

on professional judgment cannot evince deliberate indifference because professional judgment implies a choice of what the defendant 

believed to be the best course of treatment. A 

doctor who claims to have exercised professional judgment is effectively asserting that he 

lacked a sufficiently culpable mental state, and 

if no reasonable jury could discredit that claim, 

the doctor is entitled to summary judgment. 

Zaya v. Sood, No. 15-1470, 2016 WL 4621045, at *3 (7th Cir. 

Sept. 6, 2016). 

On the other hand, “where evidence exists that the defendant[] knew better than to make the medical decision[] 

that [he] did,” then summary judgment is improper and the 

claim should be submitted to a jury. Petties, 2016 WL 

4631679, at *5. State-of-mind evidence sufficient to create a 

jury question might include the obviousness of the risk from 

a particular course of medical treatment, id. at *4; the defendant’s persistence in “a course of treatment known to be 

ineffective,” id.; or proof that the defendant’s treatment 

decision departed so radically from “accepted professional 

judgment, practice, or standards” that a jury may reasonably 

infer that the decision was not based on professional judgment, id. (quotation marks omitted). 

No evidence in this case supports an inference that 

Dr. David “knew better” than to pursue the course of treatment that he did. He explained in his deposition that altCase: 15-1647 Document: 39 Filed: 10/12/2016 Pages: 17
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hough he considered the possibility of lymphoma, he 

thought Whiting had an infection and treated him for that 

condition, putting off an invasive biopsy until it was clear 

that aggressive antibiotic treatment wasn’t working. Whiting 

argues that Dr. David’s decision on November 1 to try two 

more antibiotics when the first two were ineffective is sufficient for a jury to infer that the doctor was deliberately 

indifferent. But no expert testified that Dr. David’s chosen 

course of treatment was a substantial departure from accepted medical judgment, and the decision was not so obviously 

wrong that a layperson could draw the required inference 

about the doctor’s state of mind without expert testimony. 

Our decision in Duckworth is instructive on this point. 

There we confronted a claim that two prison physicians 

should have ordered a cystoscopy to rule out bladder cancer 

as soon as they noticed blood in the plaintiff’s urine. The 

first physician didn’t suspect cancer; the second physician 

was aware of the cancer risk but thought that the plaintiff 

had another condition and pursued a course of treatment 

consistent with that diagnosis. 532 F.3d at 680–81. The 

plaintiff provided expert testimony from an experienced 

urologist that cancer should always be ruled out when a 

patient has blood in his urine. Id. at 681. We held that the 

expert’s testimony showed only “how a reasonable doctor 

would treat Duckworth’s symptoms, but it [did] not shed 

any light into [the defendant’s] state of mind.” Id. In other 

words, it “just ... reiterate[d] the standard for medical 

malpractice, which falls short of deliberate indifference.” Id.

The evidence here falls even further short of what’s required. Whiting doesn’t have any expert testimony indicating that Dr. David’s infection diagnosis and concomitant 

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treatment plan departed from accepted medical practice, 

much less substantially so. 

Whiting compares his case to Hayes v. Snyder, 546 F.3d 

516 (7th Cir. 2008), but the similarities are superficial. The 

prison physician in Hayes gave the plaintiff an antibiotic and 

Tylenol III for obvious and excruciatingly painful testicular 

cysts; he also refused to authorize a referral to a specialist. 

Unlike this case, the plaintiff in Hayes produced considerable 

evidence showing that the physician’s choice of treatment 

was not based on a mere mistake in professional judgment. 

For example, the physician—the medical director at the 

prison—acknowledged in his deposition that other prison 

doctors who saw the plaintiff ordered prescription-strength 

pain medication and a referral to a specialist. Id. at 524. The 

defendant’s approval was required before these steps could 

be taken, but he “refused to give that approval,” asserting an 

after-the-fact justification that he didn’t have the proper 

paperwork. Id. He also claimed, implausibly, that he 

“wouldn’t know which specialist to send [the plaintiff] to” 

without more clinical information. Id. at 526. We concluded 

on these facts that the evidence was sufficient for a fact 

finder to conclude that the doctor was subjectively indifferent to the plaintiff’s medical needs. Id. 

Here, in contrast, the record contains no evidence from 

which a jury could infer that Dr. David was subjectively 

indifferent to Whiting’s condition—in short, that Dr. David 

knew that the additional antibiotics would be ineffectual but 

persisted in this course of treatment anyway. Without expert 

testimony a lay jury could not infer that because amoxicillin 

and Bactrim did not work, it was obvious to Dr. David that 

the doxycycline and Augmentin also would fail. To survive 

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summary judgment Whiting needed to present evidence 

sufficient to show that Dr. David’s decision was “so far 

afield of accepted professional standards as to raise the 

inference that it was not actually based on a medical judgment.” Norfleet v. Webster, 439 F.3d 392, 396 (7th Cir. 2006). 

He did not do so. The district court properly granted summary judgment for Dr. David. 

B. Wexford 

Whiting’s claim against Wexford meets the same fate. 

Wexford is a private corporation, but we’ve held that the 

Monell theory of municipal liability applies in § 1983 claims 

brought against private companies that act under color of 

state law. Shields v. Ill. Dept. of Corr., 746 F.3d 782 (7th Cir. 

2014) (noting every circuit court that has addressed the issue 

has extended the Monell standard to private corporations 

acting under color of state law). To prevail on his Monell 

claim, Whiting needs to show that Wexford’s policy, practice, or custom, caused a constitutional violation. Thomas v. 

Cook Cty. Sheriff’s Dep’t, 604 F.3d 294, 303 (7th Cir. 2009). This 

requirement can be satisfied by evidence that “an official 

with final policy-making authority” acted for the corporation. Id. That’s the theory Whiting invokes on appeal: He 

argues that Dr. David was a final policymaker for Wexford. 

But Whiting’s filings in the district court weren’t entirely 

clear on this point, so the argument is probably waived. 

Everroad v. Scott Truck Sys., Inc., 604 F.3d 471, 480 (7th Cir. 

2010). Waiver aside, the claim fails on the merits for two 

independent reasons. 

First, Dr. David did not have final policymaking authority in the relevant sense. He may have had the final say on 

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Whiting’s treatment plan and thus was the final decisionmaker with respect to his care, but that’s not nearly enough 

to show he was the final policymaker. See Valentino v. Village of 

South Chicago Heights, 575 F.3d 664, 675 (7th Cir. 2009) (noting difference between having decision-making authority for 

some decisions and having the responsibility “for establishing final government policy on a particular issue”). 

Second, Whiting’s theory of Monell liability is contingent 

on a finding that Dr. David, the ostensible final policymaker, 

was individually liable for deliberate indifference. Our 

decision in Thomas makes clear that Monell liability does not 

always require a finding of individual liability. 604 F.3d at 

305. But if the plaintiff’s theory of Monell liability rests 

entirely on individual liability, as Whiting’s does here, 

negating individual liability will automatically preclude a 

finding of Monell liability. Id.

AFFIRMED. 

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WOOD, Chief Judge, concurring in part and dissenting in 

part. Calvin Whiting is suffering from a deadly disease: a rare 

form of non-Hodgkin’s lymphoma. The Mayo Clinic’s website 

describes this as “a cancer that originates in your lymphatic 

system,” and then spreads throughout the body. See NonHodgkin’s lymphoma, Definition, MAYO CLINIC, 

http://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/basics/definition/con-20027792 (last visited 

Oct. 12, 2016). Whiting fell ill while he was serving a sentence 

in Illinois’s Shawnee Correctional Center for a probation violation, and so of necessity he turned for help to the prison doctors. Dr. Alfonso David, the medical director at Shawnee and 

an employee of Wexford Health Sources, Inc., the company 

that holds the contract for medical services at that institution, 

was Whiting’s treating physician. 

It took Dr. David almost two months from Whiting’s first 

visit to the infirmary in mid-October 2010 to get approval for 

a biopsy of nodules in Whiting’s swollen lymph nodes, even 

though he had power to order one if he deemed it an “emergency.” Despite the fact that Whiting presented not only with 

pain in his left jaw and his ear, but also with nodules and pain 

in his groin, a nurse at Shawnee thought he had an ear or 

throat infection and gave him amoxicillin (plus Motrin for his 

pain). The amoxicillin caused a rash, and so a few days later 

Dr. David switched him to Bactrim and ordered chest and abdominal x-rays. Those results showed enlarged cervical 

(neck) nodes and a mass in Whiting’s left jawbone. Whiting 

was also complaining of severe pain. It was then that Dr. David suggested a biopsy of the nodules to a second colleague, 

who vetoed that course. (Defendants describe this as submission to a “review committee,” but that is a bit grandiose for a 

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simple process through which one doctor consults with a second and allows the second to override his recommendation.) 

During November and December, Dr. David continued 

with the fruitless course of antibiotics, although he changed 

the particular drugs to doxycycline and Augmentin. In early 

December, he again suggested a biopsy to the other colleague. 

This time the two agreed to order the biopsy. It was performed 

on December 21 and revealed that Whiting had Stage IV SLK 

positive anaplastic large cell lymphoma. (A group called the 

Lymphoma Research Foundation describes this as a rare type 

of aggressive T-cell lymphoma, which can progress rapidly 

without treatment. See LYMPHOMA RESEARCH FOUNDATION, 

http://www.lymphoma.org/site/pp.asp?c=bkLTKaOQLmK8E

&b=6293639 (last visited Oct. 12, 2016).) Whiting began chemotherapy at that point and has continued his battle with cancer, cycling between remission and relapse. 

Focusing only on the two months between his first visit to 

Dr. David and the start of his chemotherapy, Whiting sued 

both Dr. David and Wexford, contending that the care he received violated his Eighth Amendment right to be free from 

cruel and unusual punishment. See Estelle v. Gamble, 429 U.S. 

97 (1976). During that period, he contends, he was in severe 

pain and his cancer was going untreated. Dr. David knew that 

Whiting was suffering and that a biopsy was necessary, yet he 

proceeded on a “business as usual” basis. Dr. Nancy Bartlett, 

who treated Whiting later at Barnes Jewish Hospital in St. 

Louis, described this delay in treatment as “cruel and unusual.” Whiting’s treating oncologist after his release from 

Shawnee, Dr. Justin Kline, said much the same thing. Dr. Kline 

opined that if chemotherapy had been started right away, it 

would have had two desirable effects: alleviation of Whiting’s 

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pain and destroying the cancer. He also declared that Whiting 

“would not have experienced the pain he did between October 27, 2010, and January 2011” if the biopsy had been performed when Dr. David first mentioned that possibility. 

The district court granted summary judgment for both defendants, and my colleagues have voted to affirm. I agree with 

them that Whiting’s case against Wexford was properly rejected, but, without taking any position on the ultimate outcome, I would reverse and remand for further proceedings 

against Dr. David. 

It is well established that a prisoner asserting an Eighth 

Amendment claim based on the medical care he received 

must show two things: first, that he has a serious medical 

need, and second that the defendant was deliberately indifferent—not merely negligent or oblivious—to his needs. Gamble, 429 U.S. at 104; see also Farmer v. Brennan, 511 U.S. 825, 835 

(1994). I focus here only on the subjective element of the test, 

because all members of this panel agree with the district court 

that there was enough evidence to reach a jury on the objective element. This is the same type of case as the one we considered in Petties v. Carter, No. 14-2674, 2016 WL 4631679 (7th 

Cir. Aug. 25, 2016) (en banc), in which the inmate received 

some medical care, but the facts permit more than an inference 

of medical malpractice—they permit an inference of deliberate indifference. 

The critical point that Petties established is that the furnishing of some care does not automatically defeat an Eighth 

Amendment claim (raised through the Fourteenth Amendment for a state prisoner). Instead, as Petties held, it is essential 

to “look at the totality of an inmate’s medical care when considering whether that care evidences deliberate indifference 

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to serious medical needs.” Id. at *3. We went on to say that 

“[i]f a risk from a particular course of medical treatment (or 

lack thereof) is obvious enough, a factfinder can infer that a 

prison official knew about it and disregarded it.” Id. Acknowledging that the line between (minimally) competent 

medical judgment and deliberate indifference can be difficult 

to draw, we gave several examples of situations in which a 

finding of an Eighth Amendment violation is possible. At 

least two of them fit Whiting’s allegations: “[persistence] in a 

course of treatment known to be ineffective,” id. at *4, and the 

choice of “an easier and less efficacious treatment without exercising professional judgment,” id. at *5 (internal quotation 

marks omitted). We summarized the central point as follows: 

[R]epeatedly, we have rejected the notion that 

the provision of some care means the doctor 

provided medical treatment which meets the 

basic requirements of the Eighth Amendment. 

Rather, the context surrounding a doctor’s treatment decision can sometimes override his 

claimed ignorance of the risks stemming from 

that decision. When a doctor says he did not realize his treatment decisions (or lack thereof) 

could cause serious harm to a plaintiff, a jury is 

entitled to weigh that explanation against certain clues that the doctor did know. 

Id.

In my view, the rule most recently reaffirmed in Petties 

(dating back to Gamble) governs Whiting’s case. It would be 

possible on this record for a jury to conclude that Dr. David 

was exercising his medical judgment over the critical period, 

even if that judgment was mistaken or even negligent. He saw 

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Whiting on several occasions; he tried various antibiotics, 

which he says he regarded as conservative responses to Whiting’s symptoms, and the antibiotic treatments at times seemed 

to be having some positive effect. He did not perceive Whiting’s situation to be an emergency, and so he did not exercise 

his limited authority to order a biopsy on his own. Instead, he 

invoked the “Collegial Review Committee” process described 

above. 

But that is not the only inference that is possible from these 

facts. Whiting has brought forth evidence that would permit 

a trier of fact to infer deliberate indifference. No one, Dr. David included, paid any attention to the fact that nodules were 

not limited to Whiting’s neck and face, but instead were also 

in his groin. A jury could conclude that Dr. David paid no 

heed to the fact that the antibiotics and Motrin he was prescribing for Whiting’s pain were, by Whiting’s account, utterly 

ineffective. Had he checked the medical records, he would 

have seen that Whiting repeatedly informed Shawnee’s medical unit that he was in extreme pain. In McGowan v. Hulick,

612 F.3d 636 (7th Cir. 2010)—decided before Whiting’s first 

complaint about nodules in his left jaw and groin, and accompanying pain—we reaffirmed that “[a] delay in treatment 

may constitute deliberate indifference if the delay exacerbated the injury or unnecessarily prolonged an inmate’s 

pain.” Id. at 640 (citing Gamble, 429 U.S. at 104–05); Gayton v. 

McCoy, 593 F.3d 610, 619 (7th Cir. 2010); and Edwards v. Snyder, 

478 F.3d 827, 832 (7th Cir. 2007). See also Petties, 2016 WL 

4631679 at *5; Arnett v. Webster, 658 F.3d 742, 753 (7th Cir. 

2011). A delay when the physician recognizes that the condition may be life-threatening (as Dr. David did, given his initial 

request for a biopsy) is even more troublesome. Perhaps if Dr. 

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David had tried one or two courses of antibiotics before moving to more serious measures, this case would be different. 

But a jury could find that it was apparent by the time the third 

and fourth antibiotics were tried that this course of treatment 

was ineffective for both the underlying condition and the 

pain. 

Finally, the existence of the so-called collegial review 

mechanism does not compel summary judgment in favor of 

Dr. David. It is, in effect, a device to obtain a second opinion. 

As the record presently stands, it is unclear whether the second doctor’s “no” automatically trumps the treating physician’s judgment that a procedure is necessary (a situation that 

would undermine a finding of deliberate indifference on the 

first doctor’s part), or if the second doctor just has an opportunity to persuade the first doctor to reconsider his opinion. 

The former does not strike me as “collegial,” and the latter is 

not something that deserves to be called a “review.” Nothing 

reveals whether, or why, Dr. David changed his mind about 

the need for a biopsy at the end of October. Taking the facts 

and reasonable inferences from them in the light most favorable to Whiting, I must assume that Dr. David saw no reason 

to invoke his authority to override the second doctor and obtain a biopsy on an urgent basis. A jury would be entitled to 

infer deliberate indifference to Whiting’s serious medical 

need on the basis of those facts. 

Looking at the record as a whole in the light most favorable to Whiting, I conclude that summary judgment in Dr. David’s favor should not have been granted. I therefore dissent 

to that extent and would order further proceedings on this 

part of the case. 

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