United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Submitted September 15, 2021*

Decided October 20, 2021 

Before

DAVID F. HAMILTON, Circuit Judge

MICHAEL Y. SCUDDER, Circuit Judge

THOMAS L. KIRSCH II, Circuit Judge

No. 20-2567 

DANNY R. RICHARDS,

Plaintiff-Appellant, 

v. 

WEXFORD OF INDIANA LLC, et al., 

Defendants-Appellees.

Appeal from the United States District 

Court for the Southern District of 

Indiana, Terre Haute Division. 

No. 2:18-cv-00165-JPH-DLP

James P. Hanlon, 

Judge. 

O R D E R

Danny Richards, an Indiana inmate, sued three prison doctors and their 

employers under 42 U.S.C. § 1983 for deliberate indifference to his serious health needs.

The district court entered summary judgment for the defendants. But a fact question 

* 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NONPRECEDENTIAL DISPOSITION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
No. 20-2567 Page 2 

remains over whether one doctor conducted a rectal exam in a way that violated 

Richards’s rights, so we vacate the judgment on that issue. Otherwise, we affirm. 

I 

A 

While incarcerated at the Wabash Valley Correctional Facility, Richards sought 

medical care for both diabetes and ulcerative colitis. Corizon Health was the contracted 

healthcare provider for the Indiana Department of Correction until March 2017, when 

Wexford of Indiana took over. We recount the facts about the treatment in the light 

most favorable to Richards. See Thomas v. Martija, 991 F.3d 763, 767 (7th Cir. 2021). 

Dr. Jackie West-Denning began treating Richards for diabetes in December 2017. 

Based on his “alarmingly high” blood glucose levels, she ordered insulin injections and 

daily blood glucose tests. When she saw him a month later, however, his blood sugar 

was still high. Richards was experiencing painful side effects from the insulin injections, 

and so he accepted the injections only when his blood sugar was over 150. Dr. WestDenning explained that the side effects would fade once his body acclimated to the 

insulin in four to eight weeks and that he should “deal with it” because he “is a big 

boy.” At his next visit, Richards again reported pain from the injections. But based on 

his unstable blood glucose levels, Dr. West-Denning increased his dose. Finally, in May 

2018, Dr. West-Denning discontinued the insulin shots because of Richards’s noncompliance, but she continued to counsel Richards on his diabetes, which stabilized. 

For his ulcerative colitis, Richards had previously undergone abdominal 

surgeries—from which Dr. West-Denning did not have complete records—but he

continued to report symptoms including excessive bowel movements. In February 2018, 

Dr. West-Denning discontinued a prescription for gabapentin (an anticonvulsant used 

for nerve pain) that a previous provider had issued for his rectal pain. Instead, she 

ordered an anti-inflammatory medication (sulfasalazine) and suppositories. When 

Richards protested, Dr. West-Denning explained that the Department of Correction had 

restricted the drug because of abuse and trafficking. She thought that the new drug

would treat his underlying condition and help with the pain, which she did not believe 

was nerve pain. (She also had concerns about giving gabapentin—a drug that she said 

was potentially habit-forming—to someone like Richards with a history of self-harm.) 

At the same appointment, which took place in Richards’s restricted housing unit, 

Dr. West-Denning performed a rectal exam in a cramped room that, Richards says, 

lacked privacy and was filthy. According to Richards, correctional officers also were 

present in the room for security purposes. And, by Richards’s account, two other 
No. 20-2567 Page 3 

officers and three inmates, from outside the exam room, were able to see through a 

window into the room as Dr. West-Denning performed the rectal exam. The exam table, 

Richards adduced, was sticky, and there were bloody cotton balls and bandages on the 

floor. Richards protested; he requested privacy and asked the doctor to clean the exam 

table. Instead, Dr. West-Denning retorted that Richards “lost his right to privacy and 

cleanliness when he came to prison.” She gave him the option to refuse the exam or “get 

undress[ed].” He acquiesced but found it “humiliat[ing].” When he told her as much, 

Dr. West-Denning “just smiled” and ended the visit. 

Richards continued to report rectal pain and frequent bowel movements. He 

repeatedly asked for a prescription that would treat what he believed was rectal nerve 

pain and reported that the suppositories burned. Dr. West-Denning urged him to wait 

eight weeks for the sulfasalazine to take effect and reordered a zinc oxide cream for his

irritated skin. When he again complained of abnormal bowel movements, Dr. WestDenning ordered steroids, which Richards initially refused to take, and added another 

anti-inflammatory drug. In late March, Dr. West-Denning prescribed a different 

anticonvulsant (oxcarbazepine) for the nerve pain. At that time, she also ordered 

antibiotics, a stool stabilizer, and steroids along with various tests. 

In 2018, Richards filed three grievances about allegedly inadequate medical 

treatment: In February, he complained that Dr. West-Denning wrongly discontinued his 

prescription for nerve pain; in March, he asserted that a healthcare administrator, who 

is not a defendant, refused to tell him the side-effects of his steroids; and in June (after 

he filed this lawsuit), he faulted Dr. West-Denning for ignoring the pain that his insulin

injections caused. None of the grievances was sustained. 

Turning to federal court, Richards sued Dr. West-Denning, two other doctors

(Mary Chavez and Samuel Byrd), Corizon, and Wexford for deliberate indifference to 

his serious health needs. As relevant to this appeal, he alleged that Dr. West-Denning 

disregarded his pain caused by his ulcerative colitis and insulin injections; that 

Dr. Chavez and Dr. Byrd failed to diagnose, treat, or recommend a specialist for his 

diabetes and acid reflux; and that Wexford and Corizon had an unconstitutional policy

of providing cheaper medication when more effective medication was available. 

B 

The district court allowed the claims to proceed, 28 U.S.C. § 1915A, and Richards 

also moved for the recruitment of counsel. The court denied his first request because he

had not shown reasonable efforts to obtain counsel independently. In denying the 

subsequent motions, the court explained that Richards demonstrated competence to

litigate: The claims involved his personal experience, and his stated difficulties with 
No. 20-2567 Page 4 

comprehension had not limited his ability to litigate any more than the average 

prisoner; he had competently responded to filings and managed the discovery process. 

In three groups, the defendants moved for summary judgment, and the district 

court granted each motion. First, the court determined that Richards had not exhausted 

the prison’s administrative remedies against Dr. Chavez, her employer, Corizon, and 

Dr. Byrd (who worked for both Corizon and later Wexford). See 42 U.S.C. § 1997e(a). 

None of his grievances was filed while Corizon was the prison’s healthcare provider, 

and none mentioned those defendants nor the allegations against them. Second, the 

court concluded, as relevant to this appeal, that no reasonable jury could find that 

Dr. West-Denning displayed deliberate indifference to Richards’s pain from his 

ulcerative colitis or insulin injections. Nor did he support his contention that her 

employer, Wexford, had a policy of withholding effective but expensive treatment such 

as gabapentin. 

Richards appeals.

II

A 

Richards first argues that he raised a genuine dispute about whether Dr. WestDenning performed a rectal exam in a manner designed to humiliate him. To be sure, he 

is not challenging Dr. West-Denning’s determination that the rectal exam was medically

necessary. Rather, Richards contends that by gratuitously exposing him to others, 

performing the exam in a filthy room, and making demeaning comments, Dr. WestDenning engaged in demeaning and degrading conduct that violated the Eighth 

Amendment. 

It is true that Richards’s amended complaint did not contain factual allegations 

about the February 2018 rectal exam. But Richards did focus on this event as part of his 

opposition to the defendants’ motion for summary judgment, and the defendants 

replied on the merits. All of this led to the district court, in turn, addressing the 

substance of the allegations on the merits. In these circumstances, we see the merits of 

this issue as within the scope of the deliberate indifference claim litigated at summary 

judgment. Thus, on this record, the claim is properly on appeal. See, e.g., Torry v. 

Northrop Grumman Corp., 399 F.3d 876, 878–79 (7th Cir. 2005) (determining that the 

parties litigated the claims at issue on appeal by implied consent in the course of the 

proceedings in the district court). 

On the merits, we agree with Richards that he raised a genuine issue of a 

material fact about whether Dr. West-Denning sought to humiliate him by performing 
No. 20-2567 Page 5 

the rectal exam after he raised privacy and sanitary concerns. The Eighth Amendment 

bars the “calculated harassment unrelated to prison needs.” Hudson v. Palmer, 468 U.S. 

517, 530 (1984). Perhaps the best analogy is to strip searches. They are permitted when 

justified by penological interest, but must not be executed in a manner that gratuitously 

causes humiliation. See Mays v. Springborn, 575 F.3d 643, 649 (7th Cir. 2009) (concluding 

that a genuine dispute existed over whether public strip searches held in a cold room 

with guards who did not change their gloves and made demeaning comments “were 

conducted in a harassing manner intended to humiliate”). 

Furthermore, Richards submitted evidence that Dr. West-Denning taunted him 

when he asked for privacy and for her to clean the sticky exam table, telling him that he 

“lost his right to privacy and cleanliness when he came to prison.” Assuming the 

comment was made (as we must, at this stage of the proceedings), it is some evidence of 

deliberate indifference to the humiliating conditions. Coupled with the sensitive nature 

of the exam, the conduct could rise to the kind of torment and humiliation without a 

penological (or medical) purpose that can violate the Eighth Amendment. Mays, 

575 F.3d at 649; see Washington v. Hively, 695 F.3d 641, 643 (7th Cir. 2012) (concluding 

that touching “intended to humiliate the victim or gratify the assailant’s sexual desires” 

during search created triable claim).

B 

Richards also maintains that the district court wrongly entered summary 

judgment on his claim that Dr. West-Denning disregarded the pain caused by his 

ulcerative colitis and insulin injections. For this claim to survive summary judgment, 

Richards needed evidence that Dr. West-Denning knew of, but recklessly disregarded, 

an excessive risk of serious harm. See Farmer v. Brennan, 511 U.S. 825, 837 (1994). 

Concerning the pain from the insulin injections, Richards offered no evidence 

that Dr. West-Denning acted recklessly or worse by continuing to prescribe the shots 

despite the negative side effects he reported. First, arguably unprofessional comments

(such as being told to be a “big boy,” here), without more, generally do not violate a 

prisoner’s constitutional rights. See Beal v. Foster, 803 F.3d 356, 358 (7th Cir. 2015).

Neither her statement nor her order to increase the insulin dosage signal a failure to 

exercise her medical judgment; she prescribed insulin and adjusted the dose to treat his 

“abnormally high” blood sugar and counseled him that the side effects should subside 

in a few weeks. Doctors are entitled to deference in their decision-making, and Richards 

presented no evidence that Dr. West-Denning’s actions reflected a substantial departure 

from accepted professional standards. See Johnson v. Dominguez, 5 F.4th 818, 825 (7th Cir. 

2021) (citing cases). In fact, Richards’s diabetes stabilized while under her care. 
No. 20-2567 Page 6 

C 

Richards next argues that by failing to prescribe a medication that specifically

addressed nerve pain for nearly two months, Dr. West-Denning impermissibly 

persisted in an ineffective course of treatment. But Richards, again, points to no 

evidence from which a reasonable jury could conclude that the doctor failed to use her

professional judgment. Id. First, the undisputed facts show that Dr. West-Denning 

believed that she was following the Department of Correction’s policy of reducing 

prescriptions for a frequently trafficked drug and that she thought that gabapentin was 

a bad idea for Richards specifically. Second, the doctor took action to address Richards’s 

pain differently. See Lockett v. Bonson, 937 F.3d 1016, 1025 (7th Cir. 2019). She ordered 

medication that she thought would address the underlying condition, ulcerative colitis, 

and reduce his pain. At most, the record shows that Dr. West-Denning disagreed with a 

previous provider about the best course of treatment. But a reasonable difference of 

opinion between medical professionals is not evidence of deliberate indifference. 

See id. at 1023. And, although Richards preferred gabapentin, the Constitution entitles 

Richards to adequate medical care, not to demand specific medication. See id. at 1024. 

D 

Turning to the other defendants, we agree with the district court’s conclusion 

that Richards did not exhaust his administrative remedies with respect to the claims 

against Dr. Byrd, Dr. Chavez, and Corizon. Richards had to follow the Indiana 

Department of Correction’s Offender Grievance Process, see Woodford v. Ngo, 548 U.S. 

81, 90–91 (2006), which required that he file one grievance per “event or issue” and that 

each grievance explain “how the situation or incident affects” him and “suggest 

appropriate relief or remedy.” IND. DEP’T CORR., POL’Y & ADMIN. PROCS. No. 00-02-301 

§ XI(A)(5), (7), (11). He also had to file a formal written grievance within 20 days of the 

complained-of incident. Id. No. 00-02-301 § XI. The three grievances in the record

describe events that occurred almost a year after Dr. Chavez and Corizon stopped 

providing medical care at the prison. They do not describe incidents or treatment 

decisions involving Corizon, Dr. Chavez, or Dr. Byrd. Therefore, these grievances did 

not provide the prison notice of, or the opportunity to correct, any mistake by these 

defendants. See Woodford, 548 U.S. at 89. 

To the extent that Richards now responds that the administrative process was 

not available to him in time to file a timely grievance, or that the prison prevented him 

from doing so, he waived those arguments by not raising them in response to the 

summary-judgment motions. See Fenster v. Tepfer & Spitz, Ltd., 301 F.3d 851, 859 (7th Cir. 

2002). 
No. 20-2567 Page 7 

E 

As for Wexford, the state’s current prison healthcare contractor, Richards 

asserted in his complaint, and argued in the district court, that he was injured by an 

unconstitutional policy or practice of prioritizing cost-savings over effective treatment, 

namely gabapentin. See generally Monell v. Dep't of Soc. Servs., 436 U.S. 658 (1978). But he 

provided no evidence, beyond speculation, that any such policy or practice existed, or 

caused him to receive constitutionally deficient medical care for his pain. See Beatty 

v. Olin Corp., 693 F.3d 750, 754 (7th Cir. 2012). On appeal, Richards contends that

treatment records were falsified and makes other arguments unrelated to the supposed 

prioritization of cost-effectiveness, so he gives us no reason to question the district 

court’s ruling. 

F 

Finally, Richards challenges the denial of his multiple motions for the 

recruitment of counsel. But the district court did not abuse its discretion when it denied 

these requests. The court followed the parameters of Pruitt v. Mote, first by requiring 

Richards to independently seek representation, then by reasonably weighing Richards’s 

abilities against the difficulty of the case. 503 F.3d 647, 654–55 (7th Cir. 2007) (en banc). 

Further, on appeal, Richards does not point to any prejudice besides difficulty 

navigating the discovery process. See id. at 660. And he does not explain how he might 

have disputed the evidence of adequate treatment for his medical conditions. 

We have considered Richards’s other arguments, and none has merit. Therefore, 

we VACATE the judgment as it concerns the way the rectal exam was conducted and 

REMAND for further proceedings. We otherwise AFFIRM.