United States Court of Appeals 

For the Seventh Circuit 

Chicago, Illinois 60604 

Submitted June 17, 2022*

Decided June 21, 2022 

Before 

MICHAEL Y. SCUDDER, Circuit Judge 

AMY J. ST. EVE, Circuit Judge 

CANDACE JACKSON-AKIWUMI, Circuit Judge

No. 21-3175 

ROBERT TURBEN, 

Plaintiff-Appellant, 

v. 

NANCY MARTHAKIS, 

 Defendant-Appellee.

 Appeal from the United States District 

Court for the Northern District of Indiana, 

South Bend Division. 

No. 3:19-CV-141-JD 

Jon E. DeGuilio, 

Chief Judge. 

O R D E R 

 Robert Turben, an Indiana inmate, appeals the entry of summary judgment on 

his deliberate-indifference claims against a prison physician, Dr. Nancy Marthakis, for 

her treatment of his foot pain and diabetes. The district court concluded that no 

reasonable jury could find that Dr. Marthakis was deliberately indifferent to Turben’s 

medical needs. We affirm. 

*

 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NONPRECEDENTIAL DISPOSITION 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. 21-3175 Page 2 

We present the facts in the light most favorable to Turben, the nonmoving party. 

See Hackett v. City of South Bend, 956 F.3d 504, 506 (7th Cir. 2020). Turben first saw 

Dr. Marthakis in January 2018 while he was incarcerated at the Indiana State Prison. 

(He is now housed at the Plainfield Correctional Facility.) At that time, he complained 

of ongoing pain in his right foot. Dr. Marthakis ordered an x-ray, which revealed 

osteopenia (the loss of bone mass) but no acute fracture or dislocation, and she 

prescribed an increased dose of nerve-pain medication. At the same appointment, she 

also recommended that Turben use a wheelchair, but he declined and chose to continue 

to use crutches. 

Dr. Marthakis continued to monitor and treat Turben’s foot pain. In February, 

after a nurse observed that Turben was pocketing rather than taking his nerve-pain 

medication, Dr. Marthakis prescribed a different medication that had less potential for 

misuse. But Turben balked at taking it because of side effects that he regarded as severe. 

The following month Dr. Marthakis assessed Turben’s foot and recommended that he 

use a wheelchair or walker, but he refused because he did not want his mobility 

restricted. Several months later, Dr. Marthakis evaluated Turben’s foot several more 

times, even ordering an additional x-ray that showed mild degenerative change but no 

acute fracture or dislocation. She also offered him pain medication (which he sometimes 

refused because of his concern about side effects); ordered custom orthopedic shoes for 

him; and referred him for physical therapy, which he briefly attended. In early 2019, 

Dr. Marthakis declined Turben’s request to see a podiatrist. She explained that she did 

not deem a referral justified based on Turben’s x-rays and his continued refusal to 

follow medical guidance for treating his symptoms. She instead offered him a walker 

and pain medication, both of which he declined. 

During this same period, Dr. Marthakis treated Turben for diabetes, which he 

managed with a 70/30 insulin regimen (a mixture of 70% intermediate-acting and 30% 

fast-acting insulin). In May 2018, Dr. Marthakis—over Turben’s objections—changed 

his brand of insulin from Humulin 70/30 to Novolin 70/30; Turben said he preferred 

Humulin because of a past experience with Novolin that made him sick. Dr. Marthakis 

stated in an affidavit that she thought that Turben’s glucose-level irregularities 

stemmed from noncompliance with his insulin regime and diet. His medical records 

reflect that in June 2018, he once had refused both his insulin shot and his diabetic meal 

option (which he regarded as too bland). 
No. 21-3175 Page 3 

In early July, Turben was twice hospitalized for diabetes-related issues. He was 

first hospitalized on July 9, when he showed up at the nurse’s station for a glucose-level 

check appearing winded, his color off, and having a distant look in his eyes. His 

medical records reflected that he had missed at least three insulin shots in the preceding 

week. (Turben asserts that he missed some of these visits because he was vomiting and 

dehydrated.) At the hospital, Turben was diagnosed with ketoacidosis (dangerously 

high blood acids because of a lack of insulin) and treated with IV fluids and a drip of 

Humalog 75/25 insulin (which had a slightly different ratio of intermediate-to-fastacting insulin than his current regimen). Upon his return from the hospital, 

Dr. Marthakis placed an order to resume his Humulin 70/30 insulin. 

Three days later, on July 12, Turben was hospitalized for another diabetic 

episode. That afternoon, after receiving a call reporting that Turben was not feeling 

well, a nurse assessed him in his cell and saw that he was vomiting and unable to eat or 

drink. Upon being informed of Turben’s condition, Dr. Marthakis instructed the nurse 

to place him on IV fluids and perform a urine test; if ketones (blood acids that could 

indicate dangerously low insulin levels) were present in his urine, Turben was to be 

sent to the emergency room immediately. The urine sample indeed tested positive for 

ketones, and the nurse promptly ordered an ambulance. The nurse then updated 

Dr. Marthakis on Turben’s condition, and she instructed the nurse to run more tests and 

place Turben on an insulin drip before taking him to the emergency room. The nurse 

did as told and cancelled the ambulance. About an hour later, Turben went into 

respiratory distress. Another nurse made an emergency call to summon more medical 

staff and custody staff. Turben was rushed to the nurse’s station. A few minutes later, 

Dr. Marthakis was notified of Turben’s condition and she directed the nurses to rush 

him to the emergency room. At the hospital, Turben was stabilized, and he returned to 

the prison later that day. 

Turben then sued Dr. Marthakis under 42 U.S.C. § 1983 for deliberate 

indifference. As relevant to this appeal, he argued that she inadequately treated his foot 

pain by misdiagnosing his condition and refusing to refer him to a podiatrist. He also 

argued that she inappropriately treated his diabetes (1) by changing his insulin from 

Humalog 75/25 back to Humulin 70/30 after his July 9 hospital visit—a modification 

that, he asserts, made him sick enough to require a second hospitalization—and (2) by 

instructing his nurse to cancel the ambulance when he fell ill on July 12. 

The district court entered summary judgment for Dr. Marthakis, concluding that 

no reasonable jury could find that she was deliberately indifferent to Turben’s foot pain 
No. 21-3175 Page 4 

or diabetes. With regard to his foot pain, the court explained that it was undisputed that 

Dr. Marthakis consistently provided him with pain medication, physical therapy, and 

non-weightbearing devices to help him walk (some of which Turben refused), and that 

she reasonably believed he did not require a podiatrist referral because x-rays of his foot 

revealed no fracture or dislocation. Further, the court explained, Turben’s disagreement 

with Dr. Marthakis about his need for a referral did not amount to an Eighth 

Amendment violation. As for Turben’s diabetes, the court concluded that no reasonable 

jury could find that it was “plainly inappropriate” for Dr. Marthakis to change his 

insulin regimen to a different brand of the same drug, and that the Eighth Amendment 

did not entitle him to a specific type of insulin. Additionally, the court ruled, no 

reasonable jury could find that Dr. Marthakis was deliberately indifferent on July 12 

when she delayed Turben’s transfer to an emergency room so that nurses could run 

tests and try to stabilize his condition at the prison. 

 On appeal, Turben argues that the district court wrongly entered summary 

judgment for Dr. Marthakis on each of his deliberate-indifference claims. First, with 

regard to his foot condition, he argues that the court overlooked evidence that she failed 

to develop an adequate long-term treatment plan to alleviate his pain. He faults her for 

not identifying the source of his chronic pain and offering him only medication with 

uncomfortable side effects. 

To establish deliberate indifference, Turben must furnish evidence sufficient to 

persuade a reasonable jury that Dr. Marthakis recklessly disregarded a serious risk to 

his health. See Estelle v. Gamble, 429 U.S. 97, 104–05 (1976); Lewis v. McLean, 864 F.3d 556, 

562–63 (7th Cir. 2017). To succeed on his claims, he must show that Dr. Marthakis’s 

treatment of his conditions was “blatantly inappropriate.” See Pyles v. Fahim, 771 F.3d 

403, 409 (7th Cir. 2014). In evaluating whether Dr. Marthakis was deliberately 

indifferent to Turben’s health, we examine the totality of her medical care. See Petties v. 

Carter, 836 F.3d 722, 728 (7th Cir. 2016). 

With regard to Turben’s foot pain, the district court correctly concluded that he 

did not furnish sufficient evidence for a jury to infer that Dr. Marthakis’s care violated 

the Eighth Amendment. The record shows that Dr. Marthakis made repeated efforts to 

treat Turben’s reported pain in his right foot: she ordered x-rays and custom-shoe wear 

for his injured foot, prescribed pain medication for him, and offered him 

accommodations that included a wheelchair and a walker. Although Dr. Marthakis 

declined Turben’s request to see a podiatrist, the record reflects that she exercised her 

medical judgment based on an assessment of his condition—an assessment which we 
No. 21-3175 Page 5 

afford deference unless no minimally competent professional would have responded as 

such under the circumstances. See Pyles, 771 F.3d at 409. And any disagreement between 

Turben and Dr. Marthakis about the appropriate course of treatment is insufficient to 

establish deliberate indifference. Id. at 412. 

As for his claim that Dr. Marthakis acted with reckless disregard in treating his 

diabetes, Turben argues that the court overlooked evidence that she exacerbated his 

glucose-level irregularities by harmfully modifying his insulin regimen. He points first 

to her decision to switch him from Humulin 70/30 to Novolin 70/30 (when the latter 

brand had previously made him ill); and second, from Humalog 75/25 to Humulin 

70/30 (after he was treated with the former during his first hospitalization). He asserts 

that her change of his insulin after his emergency-room visit was the cause of his second 

hospitalization. 

But the district court correctly determined that Turben did not produce evidence 

sufficient to persuade a reasonable jury that Dr. Marthakis’s changes to his insulin 

prescription constituted deliberate indifference. Turben may disagree with Dr. 

Marthakis’s chosen course of treatment, but this disagreement does not create a fact 

issue over whether Dr. Marthakis acted with an intentional disregard toward his health. 

See Dean v. Wexford Health Sources, Inc., 18 F.4th 214, 243 (7th Cir. 2021). Nor does 

Turben point to any evidence in the record to suggest that her decision to switch his 

insulin brand from Humulin 70/30 to Novolin 70/30 was the source of his glucose-level 

irregularities that led to his hospitalization. 

Finally, Turben maintains that Dr. Marthakis delayed necessary emergency 

treatment for his diabetic episode on July 12, when she directed his nurse to cancel the 

ambulance request without personally evaluating his condition. But as the district court 

concluded, there is no evidence that Dr. Marthakis needed to examine him personally to 

arrive at a proper diagnosis. It is undisputed that Turben was being evaluated and 

tested by nurses who were reporting to Dr. Marthakis. On this record, a jury could not 

infer that it was “blatantly inappropriate” for her to choose to run tests and try to 

stabilize his condition before sending him to the emergency room. See Pyles, 771 F.3d at 

409 (citations omitted). 

AFFIRMED