UNITED STATES COURT OF APPEALS 

FOR THE TENTH CIRCUIT 

_________________________________ 

CHESTER LEE RENEAU, 

 Plaintiff - Appellant, 

v. 

MARY CARDINAS, in her individual 

capacity; JUDY BRIZENDINE, in her 

individual capacity; DOCTOR LOUIS 

CABILING, in his individual capacity; 

RICK RAEMISCH, Executive Director, in 

his individual and official capacities, 

 Defendants - Appellees. 

No. 20-1220 

(D.C. No. 1:17-CV-02595-PAB-SKC) 

(D. Colo.) 

_________________________________ 

ORDER AND JUDGMENT*

_________________________________ 

Before PHILLIPS, McHUGH, and CARSON, Circuit Judges. 

_________________________________ 

 Chester Lee Reneau, proceeding pro se, appeals from the district court’s grant 

of summary judgment to prison nurse Mary Cardinas and prison doctor 

Louis Cabiling in his 42 U.S.C. § 1983 civil rights suit.1

 Exercising jurisdiction 

* After examining the briefs and appellate record, this panel has determined 

unanimously that oral argument would not materially assist in the determination of 

this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is therefore 

ordered submitted without oral argument. This order and judgment is not binding 

precedent, except under the doctrines of law of the case, res judicata, and collateral 

estoppel. It may be cited, however, for its persuasive value consistent with 

Fed. R. App. P. 32.1 and 10th Cir. R. 32.1. 

1

 Mr. Reneau does not challenge the judgment with regard to other defendants. 

FILED 

United States Court of Appeals 

Tenth Circuit 

March 31, 2021

Christopher M. Wolpert 

Clerk of Court
2 

under 28 U.S.C. § 1291, we affirm the grant of summary judgment to Dr. Cabiling, 

but we reverse and remand for further proceedings on Mr. Reneau’s claim against 

Nurse Cardinas. 

BACKGROUND2

 Mr. Reneau is an inmate in the Colorado Department of Corrections. On 

Wednesday, March 8, 2017, he slipped while climbing down the ladder from his bunk 

bed at Crowley County Correctional Facility. He fell against the metal seat and table 

affixed to the wall, injuring his left shoulder, his left leg, and his right wrist. His 

wrist was merely bruised, but as it turned out, Mr. Reneau had torn his rotator cuff 

and fractured the fibula bone in his leg. 

 At first, Mr. Reneau did not think he was too injured, and he went to breakfast. 

But then he started feeling pain and noticed bruising. Mr. Reneau declared a medical 

emergency and reported to the medical clinic, where Nurse Cardinas was on duty. 

When the nurse called him into the examination room, he told her about his fall. He 

“showed [her] a large bruise with swelling on his left leg, a large bruise with swelling 

on his left shoulder, and a bruise on his right wrist.” R. at 42. He “explained to [her] 

that his left leg and his left shoulder were in severe pain and that he could not lift his 

2

 We recite the facts in the light most favorable to Mr. Reneau. See Self v. 

Crum, 439 F.3d 1227, 1230 (10th Cir. 2006). The defendants relied only on 

Mr. Reneau’s deposition testimony. As the magistrate judge noted in his report and 

recommendation, however, the amended complaint was signed under penalty of 

perjury, and thus it also serves as evidence, see Howard v. Waide, 534 F.3d 1227, 

1230 n.2 (10th Cir. 2008). 
3 

left arm or move his left foot.” Id. And he said that it felt like something in his 

shoulder was injured and something in his leg was broken. 

 Nurse Cardinas asked Mr. Reneau what he would like her to examine. He 

said, “I would like to have my wrist examined, my leg examined, and my shoulder 

examined.” Id. at 156. She responded, “Well, it’s not going to work that way,” id., 

which Mr. Reneau understood to mean that she would examine only one injury 

during the visit, and she was making him choose which one. Becoming upset, 

Mr. Reneau told her that if she did not examine all his injuries, he would file a 

§ 1983 suit against her. Instead of examining any of Mr. Reneau’s injuries, 

Nurse Cardinas called a security guard and sent Mr. Reneau back to his unit for being 

uncooperative. 

 Mr. Reneau waited a few days to make sure Nurse Cardinas was not on duty, 

then returned to the medical unit on two consecutive days, on or about March 12 and 

13. During one visit, the nurse(s) then on duty (not party to this litigation) examined 

his leg, and during the other, his shoulder. X-rays were requested but not taken until 

Wednesday, March 15, because the prison takes X-rays only once a week. When 

read on Friday, March 17, the X-rays showed nothing with regard to Mr. Reneau’s 

shoulder but confirmed his leg fracture. That same day, his leg was put in a 

temporary cast for the weekend. 

 On Monday, March 20, Mr. Reneau saw Dr. Cabiling for the first time. 

Dr. Cabiling replaced the temporary cast with a permanent cast, but he rejected 

Mr. Reneau’s request for an MRI of his shoulder, instead sending him for a second 
4 

set of X-rays. In April or May of 2017, Dr. Cabiling also gave Mr. Reneau a 

cortisone shot for his shoulder, which helped him move his arm “a little bit better for 

. . . three to four months.” Id. at 169. Mr. Reneau was transferred to a different 

prison, out of Dr. Cabiling’s care, in February 2018. In September 2019, an MRI of 

his shoulder revealed one definite and one probable tear. A doctor recommended 

surgery in February 2020. 

 Mr. Reneau filed suit under § 1983, alleging Nurse Cardinas and Dr. Cabiling 

violated the Eighth Amendment by exhibiting deliberate indifference to his serious 

medical needs. After discovery, the defendants moved for summary judgment, 

arguing that Mr. Reneau failed (1) to present evidence that Nurse Cardinas knew of 

the seriousness of his medical needs, and (2) to show that his claim against 

Dr. Cabiling was anything more than a disagreement about the type and course of 

medical treatment provided. 

 The magistrate judge recommended granting the defendants’ motion as to 

Dr. Cabiling, stating that Mr. Reneau’s arguments established nothing more than a 

disagreement with Dr. Cabiling’s course of treatment. But he recommended denying 

the defendants’ motion as to Nurse Cardinas because a reasonable factfinder could 

conclude that, having seen Mr. Reneau’s injuries and heard his reports of pain, she 

chose to ignore a substantial risk of serious harm by refusing to examine him. Both 

sides objected to portions of the report and recommendation. 

 The district court adopted the recommendation as to Dr. Cabiling. It rejected 

the recommendation to allow the case against Nurse Cardinas to proceed, however, 
5 

holding that Mr. Reneau had failed to present evidence to show that Nurse Cardinas 

actually drew an inference of serious harm. 

 Mr. Reneau now appeals. 

DISCUSSION 

I. Legal Standards 

 We review the district court’s grant of summary judgment de novo. 

See Sealock v. Colorado, 218 F.3d 1205, 1209 (10th Cir. 2000). Summary judgment 

is appropriate when “the movant shows that 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). We construe Mr. Reneau’s pro se filings liberally, but we do not act as his 

lawyers. See Hall v. Bellmon, 935 F.2d 1106, 1110 (10th Cir. 1991). 

 In Estelle v. Gamble, the Supreme Court held that prison officials’ “deliberate 

indifference to serious medical needs of prisoners constitutes the unnecessary and 

wanton infliction of pain proscribed by the Eighth Amendment.” 429 U.S. 97, 104 

(1976) (citation and internal quotation marks omitted). An Eighth Amendment 

medical-needs inquiry has two prongs, one objective and one subjective. See Farmer 

v. Brennan, 511 U.S. 825, 834 (1994). Under the objective prong, the deprivation 

must be “sufficiently serious.” Id. (internal quotation marks omitted). And under the 

subjective prong, the official must have a “sufficiently culpable state of mind.” Id. 

(internal quotation marks omitted). 

 For purposes of summary judgment, the defendants did not contest whether 

Mr. Reneau’s injuries were sufficiently serious to satisfy the objective prong. Thus, 
6 

we need examine only the subjective prong. In prison-conditions cases, the required 

“state of mind is one of deliberate indifference to inmate health or safety.” Id.

(internal quotation marks omitted). In this context, a prison official cannot be liable 

“unless the official knows of and disregards an excessive risk to inmate health or 

safety; the official must both be aware of facts from which the inference could be 

drawn that a substantial risk of serious harm exists, and he must also draw the 

inference.” Id. at 837. 

II. Claim Against Nurse Cardinas 

 Mr. Reneau’s claim against Nurse Cardinas arises out of her failure to examine 

his injuries on March 8, 2017, thus delaying the necessary treatment (such as X-rays 

and casting of his leg) and causing him to suffer unnecessary pain. Mr. Reneau 

argues that the district court construed the facts in the light most favorable to 

Nurse Cardinas, rather than to Mr. Reneau, and that it erred in requiring him to 

present evidence that Nurse Cardinas drew an inference of substantial harm. He 

asserts that if she lacked knowledge of his medical needs, it was because she refused 

to examine him. 

Nurse Cardinas had a dual role: she was not only a medical provider, but also 

the gatekeeper for more advanced medical providers, such as the prison doctor(s). 

“A prison medical professional who serves solely as a gatekeeper for other medical 

personnel capable of treating the condition may be held liable under the deliberate 

indifference standard if she delays or refuses to fulfill that gatekeeper role.” Mata v. 

Saiz, 427 F.3d 745, 751 (10th Cir. 2005) (ellipsis and internal quotation marks 
7 

omitted)). “An inmate need not show that a prison official acted or failed to act 

believing that harm actually would befall an inmate; it is enough that the official 

acted or failed to act despite his knowledge of a substantial risk of serious harm.” Id.

at 752 (internal quotation marks omitted). “Whether a prison official had the 

requisite knowledge of a substantial risk is a question of fact subject to demonstration 

in the usual ways, including inference from circumstantial evidence, and a factfinder 

may conclude that a prison official knew of a substantial risk from the very fact that 

the risk was obvious.” Id. (internal quotation marks omitted). “This is so because if 

a risk is obvious so that a reasonable man would realize it, we might well infer that 

the defendant did in fact realize it.” Id. (brackets and internal quotation marks 

omitted). 

Viewed in the light most favorable to Mr. Reneau for purposes of summary 

judgment, the undisputed facts are that Mr. Reneau told Nurse Cardinas that he had 

fallen, showed her bruising and swelling on his leg and shoulder, told her he was in 

severe pain and could not lift his left arm or move his left foot, and told her that it 

felt like something in his shoulder was injured and something in his leg was broken. 

Nurse Cardinas then communicated to him that she would not examine all of his 

injuries during the visit and asked him to choose which injury she would examine.3

 

3

 Before the district court, the defendants asserted that Nurse Cardinas asked 

which injury she should examine “first.” R. at 142, 146, 332, 335. But the 

defendants’ motion for summary judgment relied solely on Mr. Reneau’s testimony, 

and Mr. Reneau never testified that Nurse Cardinas asked which injury she should 

examine “first.” Rather, he consistently asserted that she declined to examine all his 

injuries during the visit, and she directed him to choose which injury she would 
8 

When he became upset at being denied assessment of all his injuries and told her that 

he would file a § 1983 action against her if she did not examine all his injuries, she 

called security and had him removed from the medical clinic without examining any 

of his injuries. These facts, if believed by a factfinder, sufficiently establish the 

subjective prong of the Eighth Amendment. 

A prisoner has a constitutional right to medical care for his serious medical 

needs. See Estelle, 429 U.S. at 103-04. It follows that if a prisoner suffers multiple 

serious injuries, he has a right to medical treatment for each such injury. The facts 

recited by Mr. Reneau, if believed, establish that at the outset of the March 8 visit, 

Nurse Cardinas refused or declined to examine all of Mr. Reneau’s asserted injuries. 

Further, Nurse Cardinas sent him back to his cell without examining him and without 

providing so much as an aspirin, despite his complaints of severe pain and the 

evident bruising that he showed her. A reasonable factfinder could conclude that she 

failed to perform her duties to provide medical attention, to ascertain whether any of 

Mr. Reneau’s injuries required more advanced medical care, and to refer him for such 

care. See Burke v. Regalado, 935 F.3d 960, 994-95 (10th Cir. 2019) (holding that 

evidence established an Eighth Amendment violation where nurse declined to 

examine inmate suffering paralysis who later died); Mata, 427 F.3d at 755-56, 758 

(reversing summary judgment in favor of nurse who declined to provide any 

examine. Before this court, the defendants have elected not to continue their 

district-court argument, but instead recognize that “the evidence is undisputed 

Ms. Cardinas informed Plaintiff she could only examine one injury.” Aplee. Br. at 

17. 
9 

treatment to inmate suffering severe chest pain); Sealock, 218 F.3d at 1210-11 

(reversing summary judgment in favor of officer who failed to call for medical 

assistance when inmate suffered severe chest pains); id. at 1211-12 (reversing 

summary judgment in favor of a physician’s assistant, where the evidence left open 

the possibility that he was informed of inmate’s chest pain but failed to summon an 

ambulance); see also Al-Turki v. Robinson, 762 F.3d 1188, 1194 (10th Cir. 2014) 

(noting, in considering qualified immunity, that it is clearly established in this circuit 

that “a deliberate indifference claim will arise when a medical professional 

completely denies care although presented with recognizable symptoms which 

potentially create a medical emergency, . . . and the prison official, knowing that 

medical protocol requires referral or minimal diagnostic testing to confirm the 

symptoms, sends the inmate back to his cell” (internal quotation marks omitted)). 

Nurse Cardinas asserts that “although the evidence in the summary judgment 

record may demonstrate [she] was aware of facts to draw the inference that Plaintiff 

was injured, . . . there is no evidence in the summary judgment record to suggest 

[she] actually drew the inference a substantial risk of harm existed as to Plaintiff and 

then disregarded that risk.” Aplee. Br. at 15-16. She notes that before she could 

conduct an examination, Mr. Reneau became upset and was escorted out. A 

reasonable factfinder, however, could conclude that before their disagreement, 

Mr. Reneau presented Nurse Cardinas with sufficient facts to establish that there was 

an obvious substantial risk to him of serious injury. When apprised of the underlying 

circumstances (a fall off a ladder), and the results (bruising, swelling, severe pain, an 
10 

inability to move appendages, and a feeling that something in the area was broken or 

torn), the possibility of a serious injury would be obvious even to a layperson. From 

the circumstantial evidence, a reasonable factfinder therefore could conclude that 

Nurse Cardinas actually drew the inference of a substantial risk of serious harm. 

See Farmer, 511 U.S. at 842; Mata, 427 F.3d at 752.4

 

Moreover, Nurse Cardinas cannot rely on her own failure to conduct an 

examination to conclusively establish that she did not in fact draw the inference that 

Mr. Reneau had suffered serious injuries. See Mata, 427 F.3d at 752 (“An official 

would not escape liability if the evidence showed that he merely refused to verify 

underlying facts that he strongly suspected to be true, or declined to confirm 

inferences of risk that he strongly suspected to exist.” (internal quotation marks 

omitted)). And viewing the evidence in Mr. Reneau’s favor, he became upset 

because he perceived that Nurse Cardinas was refusing to examine all of his injuries. 

It is a reasonable inference that, had she assured him she would in fact examine all 

his injuries, the examination would have proceeded without further incident. 

In Mata, we stated that “[a] prisoner may satisfy the subjective component by 

showing that defendants’ delay in providing medical treatment caused either 

4

 Of course, “the obviousness of a risk is not conclusive and [Nurse Cardinas] 

may show that the obvious escaped [her].” Farmer, 511 U.S. at 843 n.8; see also id.

at 844 (“[I]t remains open to the officials to prove that they were unaware even of an 

obvious risk to inmate health or safety. That a trier of fact may infer knowledge from 

the obvious, in other words, does not mean that it must do so.”). “[K]ey facts remain 

in dispute and nothing we say should be taken as suggesting liability must attach after 

they are sorted out at trial.” Blackmon v. Sutton, 734 F.3d 1237, 1246 (10th Cir. 

2013). 
11 

unnecessary pain or a worsening of [his] condition.” Id. at 755. At a minimum, 

Mr. Reneau left the clinic on March 8 with a fractured fibula bone, and without any 

pain-relieving medication. It is a reasonable inference that he suffered pain from his 

broken bone until he received treatment several days later. Further, the prison did 

not take X-rays until March 15. As the magistrate judge noted, the record indicates 

that the prison takes X-rays once a week. It is a reasonable inference that had 

Nurse Cardinas examined Mr. Reneau on the morning of Wednesday, March 8, he 

would not have had to wait until Wednesday, March 15, for X-rays and until Friday, 

March 17, for a temporary cast.5

 It thus is a reasonable inference that 

Nurse Cardinas’s failure to examine Mr. Reneau on March 8 caused an unnecessary 

delay in treating his fractured fibula. 

For these reasons, we reverse the grant of summary judgment to 

Nurse Cardinas and remand for further proceedings. 

III. Claim Against Dr. Cabiling 

 The district court held that Mr. Reneau’s disagreement with Dr. Cabiling’s 

course of treatment failed to establish that the doctor was deliberately indifferent to 

Mr. Reneau’s medical needs. Mr. Reneau argues that his claim is not merely a 

disagreement with Dr. Cabiling’s medical judgment because (1) Dr. Cabiling “chose 

to pursue an easier less efficacious course of medical treatment,” which “states a 

5

 The defendants assert that “[a] temporary cast was put on Plaintiff’s leg the 

same week as his fall.” Aplee. Br. at 4. That is incorrect. The undisputed facts are 

that Mr. Reneau was injured on Wednesday, March 8, and the temporary cast was 

applied nine days later on Friday, March 17. 
12 

valid Eighth Amendment claim,” Aplt. Opening Br. at 12; (2) Dr. Cabiling’s response 

was not a reasonable treatment for a torn rotator cuff; and (3) Dr. Cabiling denied 

him access to an orthopedic specialist capable of evaluating the need for surgery. 

 It is well-established that “a prisoner who merely disagrees with a diagnosis or 

a prescribed course of treatment does not state a constitutional violation, absent 

evidence the prison official knew about and disregarded a substantial risk of harm to 

the prisoner’s health or safety.” Self v. Crum, 439 F.3d 1227, 1231 (10th Cir. 2006) 

(brackets, citation, and internal quotation marks omitted). “Where the necessity for 

treatment would not be obvious to a lay person, the medical judgment of the 

physician, even if grossly negligent, is not subject to second-guessing in the guise of 

an Eighth Amendment claim.” Mata, 427 F.3d at 751; see also Estelle, 429 U.S. at 

106 (“Medical malpractice does not become a constitutional violation merely because 

the victim is a prisoner.”). As particularly relevant here, “the question whether an 

X-ray or additional diagnostic techniques or forms of treatment is indicated is a 

classic example of a matter for medical judgment. A medical decision not to order an 

X-ray, or like measures, does not represent cruel and unusual punishment.” Estelle, 

429 U.S. at 107; see also Ledoux v. Davies, 961 F.2d 1536, 1537 (10th Cir. 1992) 

(noting that types of medication prescribed and referrals to specialists are generally 

matters of medical judgment). 

 It is correct that “[i]f a prison doctor . . . responds to an obvious risk with 

treatment that is patently unreasonable, a jury may infer conscious disregard.” Self, 

439 F.3d at 1232. But this type of “claim is . . . actionable only in cases where the 
13 

need for additional treatment or referral to a medical specialist is obvious,” such as 

when a medical professional (1) “recognizes an inability to treat the patient due to the 

seriousness of the condition and his corresponding lack of expertise but nevertheless 

declines or unnecessarily delays referral”; (2) “fails to treat a medical condition so 

obvious that even a layman would recognize the condition”; or (3) “completely 

denies care although presented with recognizable symptoms which potentially create 

a medical emergency.” Id. The record does not establish that any of these situations 

occurred here. 

 The record contains no evidence that Dr. Cabiling was unable to treat 

Mr. Reneau’s shoulder or that the injury to his shoulder was so obvious that even a 

layman would recognize a rotator cuff tear. Moreover, Dr. Cabiling provided some 

treatment, which gave Mr. Reneau some relief from pain for a matter of months. 

And the record contains no evidence to support Mr. Reneau’s assertions that 

Dr. Cabiling’s course of action was dictated solely by cost considerations or that his 

treatment was patently unreasonable in the circumstances. See id. at 1235 

(“Summary judgment requires more than mere speculation. It requires some 

evidence, either direct or circumstantial, that [the practitioner] knew about and 

consciously disregarded the risk.”). 

 For these reasons, we affirm the grant of summary judgment to Dr. Cabiling. 

CONCLUSION 

 Mr. Reneau’s motion to proceed without prepayment of costs and fees is 

granted. The district court’s grant of summary judgment to Nurse Cardinas is 
14 

reversed and remanded for further proceedings. The remainder of the judgment is 

affirmed. 

Entered for the Court 

Gregory A. Phillips 

Circuit Judge