In the

United States Court of Appeals

For the Seventh Circuit

No. 13-1766

PATRICK HAHN AND ERIK REDWOOD,

Administrator of the Estate of Janet

Louise Hahn, Deceased,

Plaintiffs-Appellants,

v.

DANIEL WALSH, et al.,

Defendants-Appellees.

Appeal from the United States District Court for the 

Central District of Illinois.

No. 2:09-cv-02145-MPM-DGB — Michael P. McCuskey, District Judge.

ARGUED APRIL 15, 2014 — DECIDED AUGUST 12, 2014

Before RIPPLE and WILLIAMS, Circuit Judges, and ST. EVE,

District Judge.*

The Honorable Amy J. St. Eve, of the United States District Court for the *

Northern District of Illinois, sitting by designation.
2 No. 13-1766

RIPPLE, Circuit Judge. Janet Hahn was a pretrial detainee at

the Champaign County Correctional Center (“CCCC”)

immediately before she died as a result of diabetic

ketoacidosis. Patrick Hahn, Mrs. Hahn’s husband, and 1

Erik Redwood, the administrator of her estate, brought this

action, alleging that various government officials and private

contractors failed to provide adequate medical treatment, in

violation of Mrs. Hahn’s rights under the Fourteenth Amendment, the Americans with Disabilities Act, the Rehabilitation

Act and Illinois state law. The district court dismissed some of

the plaintiffs’ claims under Federal Rule of Civil Procedure

12(b)(6) and granted summary judgment in favor of the

defendants on the remaining claims.

The plaintiffs now appeal, raising three issues. First, the

plaintiffs submit that the district court erred in dismissing their

state law wrongful death claim. The district court faulted the

plaintiffs for failing to comply with an Illinois statute that

requires plaintiffs who allege medical malpractice to submit

Diabetic ketoacidosis is a serious complication of diabetes. Individuals 1

with Type-1 diabetes, like Mrs. Hahn, have little or no insulin in their

bodies. Diabetes, Mayo Clinic, http://www.mayoclinic.org/diseasesconditions/diabetes/basics/definition/con-20033091 (last visited July 31,

2014). Insulin transports glucose to cells for use as energy; the absence of

insulin leads to a buildup of glucose in the bloodstream. Id. Many diabetics

modulate this buildup by administering injections of insulin. Id. Diabetic

ketoacidosis occurs when an individual’s body does not break down this

glucose; rather, the body begins to break down fat for fuel. Diabetic

Ketoacidosis, Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/

diabetic-ketoacidosis/basics/definition/con-20026470 (last visited July 31,

2014). This situation causes “a buildup of toxic acids in the bloodstream,”

which can, as in this instance, be fatal. Id.
No. 13-1766 3

with their complaints (1) an affidavit confirming that a medical

professional has verified the claim’s merit and (2) a written

report from that medical professional. Second, the plaintiffs

contend that the district court abused its discretion by dismissing their wrongful death claim with prejudice instead of

granting them leave to amend in order to cure the deficiency.

Finally, they submit that the district court erred in granting

summary judgment to two of the defendants.

We affirm in part and reverse in part the judgment of the

district court. The district court correctly dismissed the plaintiffs’ wrongful death claim but erred by dismissing it with

prejudice. The plaintiffs produced insufficient evidence to

permit their claims against Sheriff Walsh and Health Professionals Ltd. (“HPL”), the jail’s medical services contractor, to

survive summary judgment. Accordingly, we reverse the

district court’s judgment insofar as it dismissed the wrongful

death claim with prejudice. We affirm the remainder of its

decisions.

I

BACKGROUND

A.

We recount the facts in the light most favorable to the

plaintiffs. See Hardaway v. Meyerhoff, 734 F.3d 740, 743 (7th Cir.

2013).

On the evening of June 15, 2007, Mrs. Hahn was arrested

for aggravated domestic batteryandtransported to the satellite

location of the CCCC. The Champaign County Sheriff’s Office,
4 No. 13-1766

headed by Sheriff Daniel Walsh, operates the CCCC. Upon her

arrival, Officer Chad Schweighart processed Mrs. Hahn into

the CCCC as a detainee. She was angry and uncooperative 2

during booking. Mrs. Hahn told Officer Schweighart that she

was diabetic and suicidal, but she refused to provide any

additional information, such as the type of insulin she hadbeen

prescribed. She also refused to sign a release so that the CCCC

couldobtainher medical records. Officer Schweighartreported

this information to his supervisor.

Mrs. Hahn was placed on suicide watch pursuant to a

CCCC policy for handling detainees who are identified as

mentally ill, who demonstrate unusual behavior or who

indicate that they are experiencing suicidal ideations. Accordingly, Mrs. Hahn was given a gown and blanket made from a

material that prevents detainees from fashioning them into

instruments of self-harm. Further, correctional officers were

required to observe Mrs. Hahn every fifteen minutes for signs

of physical or mental distress and to report any such signs to

their supervisors.

Beyond the fifteen-minute checks,theCCCChadadditional

policies in place relevant to Mrs. Hahn’s physical and mental

conditions. First, the CCCC contracted with a private company,

HPL, to provide medical and mental health services to detainees in its custody. All medical issues were referred to HPL’s 3

 This was not Mrs. Hahn’s first detention at the CCCC. In May 2007, she 2

also had been arrested and detained there.

It appears that the CCCC houses both pretrial detainees and sentenced 3

(continued...)
No. 13-1766 5

medical staff and mental health issues were referred to its

counselors. CCCC officers deferred to the judgment of HPL

professionals on issues of medical and mental health. Second,

the CCCC had a policy of not forcing medical care on a

resisting detainee. For example, if a diabetic detainee refused

to have her blood sugar checked or to take insulin, CCCC

officers were not supposed to force care on the detainee; the

officers should have reported the refusal to a supervisor or to

both a supervisor and medical staff. The CCCC also would not

force patients to eat if they refused to do so. If a detainee

refused a meal, the correctional officer on duty should have

notified a supervisor; if the detainee refused more than one

meal, it was “normal practice” for the correctional officer to

notify both a supervisor and medical staff. Medical or mental 4

health staff then decided what to do about a detainee who

refused to eat. Finally, if a detainee was suffering from an

“obvious/life-threatening acute/emergency situation,” CCCC

officers were to call for emergency medical assistance.5

In order to provide the necessary medical and mental

health care, HPL staffed the CCCC with a physician (who

visited once per week), registered nurses and mental health

personnel. Correctional officers could contact an on-call nurse

at any time. HPL provided training on an annual basis to

 (...continued) 3

inmates. For simplicity’s sake, we use the word “detainee” generically, to

refer to all individuals housed in the CCCC.

 R.165 at 9.

4

 Id. (internal quotation marks omitted). 5
6 No. 13-1766

correctional officers about the care and monitoring of diabetic

patients. This training included instruction on how to recognize hypoglycemia and hyperglycemia (low and high blood

sugar, respectively).

In addition to the CCCC’s policies and practices, HPL had

its own policies for identifying and handling detainees suffering from serious medical conditions, including mental illness

and diabetes. For diabetic detainees whose treatment protocol

was unknown, HPL’s policy called for blood sugar to be

checked twice each day using an Accu-Chek glucose meter, for

insulin to be delivered based on a particular dosage scale and 6

for an evening snack to be provided to the detainee. Insulin

could be administered by a nurse, without consulting a

physician. If a diabetic detainee refused treatment, medical

staff would attempt to have the detainee sign a refusal-of-care

form. HPL did not have a specific policy for checking the blood

sugar of diabetic inmates who refused to use the Accu-Chek

machine.

When Mrs. Hahn was first processed into the jail,

Officer Joanne Lewis and a supervisor, Sergeant Michael

Johnson, were among the officers on duty. Officer Lewis gave

Mrs. Hahn a meal on the evening of June 15, 2007. When she

returned to retrieve the tray, Officer Lewis noted that some of

At the time of Mrs. Hahn’s death, HPL had in place a “sliding scale”

6

policy that called for the administration of a particular amount of insulin

based on the individual’s blood sugar reading. See R.133-7 at 36, 46–47, 166.

For example, if an individual’s blood sugar reading was higher than 201 but

lower than 250, he received five units of regular insulin. If it was higher

than 251 but lower than 300, he received eight units of regular insulin.
No. 13-1766 7

the food was gone, but she did not know whether Mrs. Hahn

had eaten it. At some point that evening, Mrs. Hahn took off

her gown and stuffed her gown and blanket into the toilet in

her cell. The cell then flooded. Accordingly, the water to

Mrs. Hahn’s cell was shut off. After the water was shut off,

correctional officers brought Mrs. Hahn water upon request.

Officer Lewis assisted Mrs. Hahn in putting on a new gown.

Sergeant Johnson also interacted with Mrs. Hahn that

evening. He spoke with Mrs. Hahn about her diabetes and

discussed checking her blood sugar. Mrs. Hahn initially

resisted but eventually agreed to have her blood sugar

checked. After contacting the on-call HPL nurse,

Kendra Adams, Sergeant Johnson checked Mrs. Hahn’s blood

sugar and, at 9:40 p.m., her blood sugar reading was 160.

Adams advised Sergeant Johnson that this reading was within

an acceptable range, and no insulin was provided to

Mrs. Hahn. The reading was recorded on a form called the 7

“Blood Sugar and Insulin Tracking Sheet.”

After his interaction with Mrs. Hahn, Sergeant Johnson

wrote an e-mail to HPL staff. He stated that Mrs. Hahn was a

“psych patient,” that she had a cut and stitches on her left arm

(and that the bandage had been removed for safety purposes

because she had made statements about hurting herself), that

she was unpredictable and had flooded her cell, and that her

blood sugar was 160 and she was not given insulin.

The district court noted, however, that a normal blood sugar reading was

7

80–120. The plaintiffs’ expert testified that a reading of 160 is “above what

you’d like in an insulin dependent diabetic, but it is not life-threatening.”

R.165 at 11 n.4.
8 No. 13-1766

Sergeant Johnson also left a message for officers assigned to

subsequent shifts. That message included most of the information given to HPL, as well as a note that Mrs. Hahn had been

very uncooperative and that the water in her cell had been

turned off. CCCC staff started a “segregation log” for

Mrs. Hahn, which noted various information, including her

refusal of meals.

On that same evening, according to the testimony of

Donald MacFarlane, a detainee at the CCCC, Mrs. Hahn stood

at her cell window for more than an hour, yelling that she

needed help and asking that her doctor be called. MacFarlane

testified that this episode began after about 9:00 p.m.

Officer Karee Voges was on duty from 11:45 p.m. on June

15, 2007, to 8:15 a.m. on June 16, 2007. She testified that because

she had interacted with Mrs. Hahn during her prior detention,

she knew that Mrs. Hahn was a Type-1 diabetic and that she

had a history of being angry and uncooperative. Officer Voges

said that throughout that night, she brought Mrs. Hahn cups

of water when requested. She offered breakfast to Mrs. Hahn

around 6:30 a.m., but she documented on the log that

Mrs. Hahn refused the meal.

On the morning of June 16, Mrs. Hahn was seen by both

Alyson Morris, a mental health clinician with HPL, and by 8

Morris had a master’s degree in counseling and received additional 8

training from HPL, which covered suicide prevention and, in particular,

suicide prevention in a correctional environment.
No. 13-1766 9

Susan Swain, a nurse with HPL. Morris’s interaction with 9

Mrs. Hahn was brief; at its conclusion, she wrote an e-mail to

Sergeant Johnson, on which she copied her supervisor. Morris

wrote that Mrs. Hahn was still uncooperative and angry.

Swain arrived at the CCCC around 9:30 a.m. on June 16.

She reviewed Officer Schweighart’s paperwork regarding

Mrs. Hahn. Swain recalled from a prior experience with

Mrs. Hahn and from looking at Mrs. Hahn’s records that

Mrs. Hahn was an insulin-dependent diabetic and that she

previously had refused insulin and blood sugar checks. She

also was aware of the possibility that Mrs. Hahn suffered from

a mental disability. Swain was called to Mrs. Hahn’s cell at

While Mrs. Hahn was detained at the CCCC in May 2007, she had been 9

treated by Swain. At that time, Swain sent an e-mail to an account called

“Corrections” regarding her difficulties with Mrs. Hahn. The e-mail read:

Hi there! This young lady is quite a challenge to work

with. She refuses to disclose any of her medical history or

conditions except for the fact that she is insulin dependant

[sic] diabetic. She also refuses to sign any release of

information and told me that she will not tell me who her

doctor is or where she seeks treatment at. She will be

leaving tomorrow (05-07-07) and she states that she will

not eat while she is here. She has pretty much tied my

hands as far as helping her goes. Please bring her to the

infirmary to test her blood sugar tonight and tomorrow

morning BUT I am not at all sure that she will cooperate

with the test. She can give herself insulin per sliding scale

however I am pretty sure that she will not do that either!

Thanks for your assistance in this matter!!!!

Id. at 3–4.
10 No. 13-1766

around 10:00 a.m. because a correctional officer had tested

Mrs. Hahn’s blood sugar and found it to be 396. The reading 10

was documented on the tracking sheet. When Swain arrived at

Mrs. Hahn’s cell, she attempted to take vital signs and get a

medical history, but Mrs.Hahnresistedproviding information.

Mrs. Hahn also refused to sign a release that would allow

Swain to obtain her medical information from her usual

physician. Swain testified that, at this point in time, Mrs. Hahn

was “oriented to time and place” and did not complain of

feeling poorly. Mrs. Hahn refused to go to the infirmary with 11

Swain. Instead, Swain brought twenty units of insulin to

Mrs. Hahn and administered it in her cell. This was recorded 12

on the tracking sheet. Swain placed Mrs. Hahn on the diabetes

treatment protocol described above. Later that morning,

Mrs. Hahn was taken to bond court.

On the afternoon of June 16, Morris conducted a more

in-depth assessment of Mrs. Hahn. She completed an “Initial

Mental Health Screening and Assessment Form,” which noted

The plaintiffs cite testimonial evidence that a reading of 396 was

10

“extremely high” and that a doctor should have been contacted at this

point. Appellants’ Br. 8 n.13 (internal quotation marks omitted).

 R.165 at 14; see also R.133-7 at 45–46. 11

Swain testified that according to HPL’s scale, an individual with a blood

12

sugar reading of 396 is to be given fifteen units of insulin. However, she

also testified that a doctor had advised her that when the reading is close

to a limit on the scale, she should administer the dosage of insulin

corresponding with the next increment on the scale. Therefore, she

administered twenty units of insulin to Mrs. Hahn.
No. 13-1766 11

Mrs. Hahn’s antidepressant medication and primary mental 13

health clinician. She e-mailed CCCC staff, stating that

Mrs. Hahn was “mentally retarded and a poor historian,” and

that she should remain on suicide watch for at least seventytwo hours. She stated that mental health staff would reevalu- 14

ate Mrs. Hahn’s condition in twenty-four to forty-eight hours.

Morris also told Swain that Mrs. Hahn was uncooperative and

that she was trying to convince Mrs. Hahn about the importance of working with the medical staff to treat her diabetes.

Around 4:00 p.m. on June 16, Mrs. Hahn was escorted to

the infirmary by Officer Jenna Thode for a blood sugar check.

Officer Thode initially wrote down 320 on the tracking sheet as

Mrs. Hahn’s blood sugar level. She then crossed it out and

wrote 107. Officer Thode’s explanation is that 320 is her badge

number, and she had written it accidentally. Mrs. Hahn

refused dinner on the evening of June 16. MacFarlane testified

that Mrs. Hahn looked sick and pale that evening.

Officer Voges worked overnight again from June 16 to June

17. She brought Mrs. Hahn water on several occasions. In the

morning on June 17, Mrs. Hahn refused breakfast.

Officer Voges tried to test Mrs. Hahn’s blood sugar. The AccuChek machine read “E” on two attempts. An “E” reading could

Morris noted that Mrs. Hahn had been prescribed Seroquel. Seroquel is

13

prescribed “as an antipsychotic in the treatment of schizophrenia and other

psychotic disorders,” Dorland’s Illustrated Medical Dictionary 1566, 1698

(32d ed. 2012), but Morris believed that Mrs. Hahn took Seroquel primarily

as a sleep aid.

 R.165 at 14 (internal quotation marks omitted). 14
12 No. 13-1766

indicate that there was not enough blood used or that the stick

containing blood was not inserted properlyinto theAccu-Chek

machine. According to the plaintiffs, it also could mean that

there was “some problem with the machine.” These error 15

readings were not recorded on the tracking sheet. Around 9:00

a.m., Mrs. Hahn asked a different officer to have her blood

sugar checked. When Swain arrived at the CCCC, that officer

told her that Mrs. Hahn had not eaten breakfast and that

attempts to check her blood sugar were unsuccessful. Swain

checked on Mrs. Hahn and, at this point, Mrs. Hahn refused to

allow staff to try to use the Accu-Chek machine again. Swain

told Mrs. Hahn that the failure to check her blood sugar could

compromise her health, but there is no evidence as to whether

anyone asked Mrs. Hahn to sign a refusal-of-treatment form.

At approximately 11:00 a.m. that same morning, a correctional officer told Swain that Mrs. Hahn had reported vomiting

in her cell. Swain immediately went to check on Mrs. Hahn,

but she did not observe any signs of vomiting. Swain said that

she spoke with Mrs. Hahn at this point and observed her for

any signs or symptoms of illness. Throughout the day on June

17, Officer Terrance Alexander had repeated contacts with

Mrs. Hahn. He did not observe any signs of medical or mental

distress. He asked Mrs. Hahn multiple times if she would have

her blood sugar tested, and she refused. Mrs. Hahn refused

lunch that afternoon. At 3:00 p.m., Swain returned to

Mrs. Hahn’s cell. Swain testified that she did not observe any

signs of diabetic ketoacidosis and that Mrs. Hahn spoke to her

 Appellants’ Br. 10.

15
No. 13-1766 13

coherently. She also testified that she offered to test

Mrs. Hahn’s blood sugar, but she refused.

Later that evening, Officer Thode tried to test Mrs. Hahn’s

blood sugar but Mrs. Hahn again refused. Mrs. Hahn also

refused dinner that evening. Mrs. Hahn told Officer Thode that

she had been throwing up for the last few days. Officer Thode

told the officers whose shift followed hers about her interactions with Mrs. Hahn, but Mrs. Hahn’s refusals to have her

blood sugar checked were not documented on the tracking

sheet or segregation log.

Sixty-one cell checks, conducted by multiple correctional

officers, were performed from 3:00 p.m. on June 17 to 6:30 a.m.

on June 18. One officer testified that when he checked on

Mrs. Hahn throughout his overnight shift, she was making

sounds and moving around a lot and that he heard her hitting

the door. Another officer, Matthew McCallister, testified that

sometime between 2:00 a.m. and 4:00 a.m., he opened the door

to Mrs. Hahn’s cell to check on her because she was so close to

the door that he could not see her from the outside, but that

she was responsive and moved away from the door when he

opened it. Two detainees testified that, during the night, they

heard a female detainee stating that she did not feel well, that

she wanted to see the nurse and that she needed insulin.

Early in the morning on June 18, CCCC staff began to treat

Mrs. Hahn’s condition as acute. MacFarlane testified that,

around 6:00 a.m., a correctional officer looked into Mrs. Hahn’s
14 No. 13-1766

cell and said, “This one’s not looking so good.” Approxi- 16

mately twenty-five minutes later, Officer Arnold Mathews

observed Mrs. Hahn and found her to be in medical distress.

He called for medical assistance, and emergency medical

services were contacted. Mrs. Hahn was taken to the hospital,

where tests showed that Mrs. Hahn had a blood sugar reading

of 966, a blood urea nitrogen reading of 62, a creatinine reading

of 3–4 and swelling in the brain as a result of diabetic

ketoacidosis. The plaintiffs’ expert testified that this data

indicated that Mrs. Hahn had been suffering from diabetic

ketoacidosis for hours. Mrs. Hahn died in the hospital laterthat

day.

B.

In June 2009, Mr. Hahn and Mr. Redwood filed an eightcount complaint in the United States District Court for the

Central District of Illinois. The Amended Complaint, filed

shortly after the original complaint, named as defendants the

County of Champaign, Sheriff Walsh, Officer McCallister and

other unnamedChampaign County correctionalofficers.It also

named HPL and unnamed “jail nurse(s).” Lastly, it namedthe

17

City of Urbana and the Urbana police officers who had

arrested Mrs. Hahn on June 15. Only some of the counts in the

 R.165 at 18 (internal quotation marks omitted). 16

 R.3 at 1. 17
No. 13-1766 15

Amended Complaint are relevant here. Count II of the 18

Count I and some of the other counts in the Amended Complaint relate 18

to defendants or claims that are not part of this appeal. Count I of the

Amended Complaint alleged that the individual defendants exhibited

deliberate indifference to Mrs. Hahn’s serious medical needs, in violation

of her Fourteenth Amendment rights, when they refused to take her to a

hospital or provide necessary medical or psychiatric care. Count I was

terminated as to all of the CCCC defendants except for Sheriff Walsh

because those defendants were never served. The police officers were

granted summary judgment on Count I. Sheriff Walsh also was granted

summary judgment on Count I because the plaintiffs could not produce any

evidence establishing his personal knowledge of or involvement in

Mrs. Hahn’s treatment. The plaintiffs do not appeal this portion of the

district court’s summary judgment ruling.

Count III alleged that the City of Urbana exhibited deliberate indifference by failing to implement adequate policies and procedures for handling

arrestees with serious medical and mental health conditions. The district

court granted summary judgment to the City on this count, and the

plaintiffs do not appeal this part of the district court’s decision.

Count VI alleged that Champaign County and HPL violated the

Americans with Disabilities Act and the Rehabilitation Act by failing to

accommodate Mrs. Hahn’s mental health and medical conditions and by

denying her adequate treatment. The district court granted summary

judgment to the defendants on this count. The plaintiffs do not appeal this

determination.

Count VII alleged a claim against all of the defendants by Mr. Hahn for

loss of consortium. The district court dismissed this count, holding that loss

of consortium was not a separate cause of action. It ordered that the

plaintiffs be given leave to amend their complaint to include with their

constitutional claims a demand for damages for loss of consortium. The

plaintiffs therefore filed a Second Amended Complaint that incorporated

(continued...)
16 No. 13-1766

Amended Complaint alleged that Sheriff Walsh had exhibited

deliberate indifference to Mrs. Hahn’s medical needs by failing

to implement policies and procedures necessary to prevent

deaths as a result of inadequate medical and mental health

treatment. Count IV alleged that HPL had exhibited deliberate

indifference by failing to implement adequate policies and

procedures for providing detainees with medical and mental

health care. Count V allegedthat Sheriff Walsh’s failure to train

and supervise jail employees constituted deliberate indifference because it had created an atmosphere where “unconstitutional behavior [wa]s ratified, tolerated, acquiesced or condoned.” Finally, Count VIII alleged that HPL and its nurses 19

had violated Illinois’s Wrongful Death Act, 740 ILCS 180/1 to

/2.2. The plaintiffs requested compensatory and punitive

damages, attorney’s fees and litigation expenses.

The defendants moved to dismiss the complaint on various

grounds. Relevant to this appeal, the County of Champaign,

Sheriff Walsh and HPL moved to dismiss Count VIII, the state

law wrongful death action. Specifically, the defendants

contended that the plaintiffs had failed to comply with an

Illinois state law, 735 ILCS 5/2-622, that required them to

include with their complaint “an affidavit of merit and a

 (...continued) 18

the loss of consortium claims into each of the other, remaining counts. The

plaintiffs make no arguments on appeal about the loss of consortium claim.

 R.3 at 7. 19
No. 13-1766 17

written report from a health professional.” The magistrate

20

judge recommendeddismissing this count for failure to include

the required affidavit and report. Notably, he further wrote

21

that he took “no position as to whether the dismissal should be

with or without prejudice, leaving that [decision] to the

discretion of the District Court.” The district court dismissed 22

Count VIII for failure to include the affidavit and report and

ordered that the dismissal be with prejudice because the

 R.17 at 5. 20

 In reaching this conclusion, the magistrate judge rejected the plaintiffs’ 21

contention that they had satisfied the requirements of section 2-622 by

including in their complaint a paragraph stating:

 50. Plaintiff has been unable to secure the affidavit of

a medical professional in support of the Complaint

because Defendant Daniel Walsh failed and refused to

respond to a duly served Freedom of Information Act

Request for all records, including jail medical records,

concerning Janet Louise Hahn and plaintiff does not have

independent access to these medical records which are

necessary for the review of a medical professional and the

affidavit required.

R.3 at 11. The magistrate judge wrote that even where records cannot be

obtained and, therefore, a report cannot be prepared by a medical professional, section 2-622 requires the plaintiffs’ attorney to submit an affidavit

containing certain information about the attempt to obtain the necessary

records. R.34 at 16. An allegation in the complaint, the magistrate judge

recommended, could not be substituted for the required affidavit. Id.

 R.34 at 17. 

22
18 No. 13-1766

“[p]laintiffs clearly failed to comply with the requirements of

§ 2-622 and the statute of limitations has passed.”23

The plaintiffs then filed a Second Amended Complaint that

addressed the rulings made by the district court on the motions

to dismiss. Counts II, IV and V remained substantially unchanged in the Second Amended Complaint. The plaintiffs did

not include a wrongful death claim in the Second Amended

Complaint. They did, however, file a motion under Federal

Rule of Civil Procedure 59(e) to amend the judgment dismissing Count VIII. They made two arguments: (1) that no affidavit

or report needed to be provided because Federal Rule of Civil

Procedure 8, not Illinois state pleading rules, governed the

sufficiency of their complaint; and (2) that, in the alternative,

they should have been permitted to amend their complaint

under the relation-back doctrine, despite the expiration of the

relevant limitations period. The district court denied the Rule

59(e) motion; it held that section 2-622 applies in federal court

and that dismissal with prejudice was proper because plaintiffs’ counsel knew of the affidavit requirement and failed to

attempt to comply with it before the statute of limitations had

expired.

The case proceeded through discovery, and, in February

2012, the defendants moved for summary judgment. The

district court granted summary judgment in favor of the

defendants. With respect to the claims against Sheriff Walsh in

his official capacity (Counts II and V), the district court held

that the plaintiffshad “not identified evidence sufficient for the

 R.40 at 1–2. 23
No. 13-1766 19

factfinder to conclude that Walsh maintained a policy or

custom evincing deliberate indifference to the needs of

mentally ill or diabetic inmates that resulted in harm to

Janet.” With respect to the claims against HPL, the district

24

court held that, “based upon the evidence in this case, the

medical protocol Janet was prescribed was not the moving

force behind any constitutional violation.”25

II

DISCUSSION

The plaintiffs timely appealed and now challenge three of

the district court’s rulings. First, they submit that the district

court erred in dismissing the state law wrongful death claim

(Count VIII). Specifically, they contend that Illinois’s statutory

requirement that a claim alleging medical malpractice—as the

wrongful death claim against HPL does—be accompanied by

an affidavit and written report confirming the claim’s merit, see

735 ILCS 5/2-622, conflicts with Rule 8 or Rule 11 of the Federal

Rules of Civil Procedure and, therefore, should not be enforced

in federal court under the Erie doctrine. Second, they argue

that the district court’s dismissal with prejudice of the wrongful death claim constituted an abuse of discretion. Finally, they

submit that the district court improperly granted summary

judgment to Sheriff Walsh and HPL on the § 1983 claims.

 R.165 at 42–43.

24

 Id. at 54.

25
20 No. 13-1766

The jurisdiction of this court and of the district court is

secure. We review de novo the district court’s decision to 26

grant the defendants’ motion to dismiss the plaintiffs’ wrongful death claim. See Windy City Metal Fabricators & Supply, Inc.

v. CIT Tech. Fin. Servs., Inc., 536 F.3d 663, 667 (7th Cir. 2008).

We review for abuse of discretion the district court’s decision

to dismiss that claim with prejudice. See Sherrod v. Lingle, 223

F.3d 605, 614 (7th Cir. 2000). Finally, we review de novo the

district court’s grant of summary judgment in favor of the

defendants. Mullin v. Temco Mach., Inc., 732 F.3d 772, 776 (7th

Cir. 2013). In doing so, we construe all facts and draw all

reasonable inferences in the light most favorable to the

plaintiffs. Id.

A.

We first turn to the dismissal of the defendants’ wrongful

death claim. Count VIII of the plaintiffs’ Amended Complaint

alleged that HPL had failed to provide adequate medical

treatment to Mrs. Hahn, in violation of the state’s Wrongful

Death Act, 740 ILCS 180/1 to /2.2. Under Illinois law, a plaintiff

seeking damages for “medical, hospital, or other healing art

malpractice” must attach to his complaint either (1) an affidavit

confirming that he has reviewed the facts of the case with a

health care professional and that the professional believes that

there is a “reasonable and meritorious cause for the filing of

such action,” as well as a copy of the professional’s written

We have jurisdiction under 28 U.S.C. § 1291. The district court had 26

jurisdiction under 28 U.S.C. §§ 1331, 1343 and 1367.
No. 13-1766 21

report on the case, or (2) an affidavit stating an acceptable

reason why such an opinion and report could not be obtained.

735 ILCS 5/2-622(a). The statute goes on to state that “[t]he 27

 Section 2-622 reads, in pertinent part: 27

(a) In any action, whether in tort, contract or otherwise, in

which the plaintiff seeks damages for injuries or death by

reason of medical, hospital, or other healing art malpractice, the plaintiff’s attorney ... shall file an affidavit,

attached to the original and all copies of the complaint,

declaring one of the following:

1. That the affiant has consulted and reviewed the facts of the case with a health

professional ... ; that the reviewing health

professional has determined in a written

report, after a review of the medical record and other relevant material involved

in the particular action that there is a

reasonable and meritorious cause for the

filing of such action; and that the affiant

has concluded on the basis of the reviewing health professional’s review and

consultation that there is a reasonable and

meritorious cause for filing of such action.

... A copy of the written report, clearly

identifying the plaintiff and the reasons

for the reviewing health professional’s

determination that a reasonable and meritorious cause for the filing of the action

exists, must be attached to the

affidavit ... .

(continued...)
22 No. 13-1766

failure to file a certificate required by this Section shall be

grounds for dismissal.” Id. § 5/2-622(g).

The parties do not dispute that if this claim had been

brought in state court, this provision would have required the

plaintiffs to file an affidavit and report conforming to the

statutory requirements. They disagree solely as to whether the

affidavit and report must be attached when the state law claim

is brought in federal court. The district court held that they

must comply with the provisions of state law. 

 (...continued) 27

2. That the affiant was unable to obtain a

consultation required by paragraph 1

because a statute of limitations would

impair the action and the consultation

required could not be obtained before the

expiration of the statute of limitations. ...

3. That a request has been made by the

plaintiff or his attorney for examination

and copying of records pursuant to Part

20 of Article VIII of this Code and the

party required to comply under those

Sections has failed to produce such records within 60 days of the receipt of the

request.

735 ILCS 5/2-622(a). Thus, the statute requires the filing of either an

affidavit and a report or, if those preferred items cannot be obtained, an

affidavit explaining the deficiency. Throughout this opinion, we frequently

refer to this provision as a requirement to submit an “affidavit and report,”

with the understanding that, occasionally, only an affidavit is necessary.
No. 13-1766 23

The plaintiffs now seek a reversal of that ruling. They

submit that section 2-622 is a state procedural rule that conflicts

with either Rule 8 or Rule 11 of the Federal Rules of Civil

Procedure. Therefore, in their view, section 2-622 does not 28

apply in federal court under the terms of the Erie doctrine. The

defendants reply that section 2-622 is state substantive law that

must be applied in federal court.

The district court was correct. The basic doctrine governing

this area stems from Erie Railroad Co. v. Tompkins, 304 U.S. 64

(1938). There, the Supreme Court addressed the question of

whether state law orfederal law controls when the two conflict

in diversity cases. Stated in the broadest of strokes, the Erie 29

doctrine provides that “federal courts sitting in diversity apply

state substantive law and federal procedural law.” Gasperini v.

Ctr. for Humanities, Inc., 518 U.S. 415, 427 (1996). But analysis of

particular applications of this broad doctrine is more nuanced

thansimply labeling a state law “substantive” or “procedural.”

See Lux v. McDonnell Douglas Corp. (In re Air Crash Disaster), 803

The plaintiffs did not argue to the district court that section 2-622

28

conflicts with Federal Rule of Civil Procedure 11. Thus, the issue was

waived. See, e.g., Puffer v. Allstate Ins. Co., 675 F.3d 709, 718 (7th Cir. 2012)

(“It is a well-established rule that arguments not raised to the district court

arewaivedon appeal.”). Nevertheless, we address the possible conflict with

Rule 11 because the defendants did not argue that the issue was waived,

thereby waiving the waiver argument. See, e.g., Riemer v. Illinois Dep’t of

Transp., 148 F.3d 800, 804 n.4 (7th Cir. 1998).

 This body of law applies not only to diversity cases, but also where, as 29

here, federal courts hear state law claims pursuant to their exercise of

supplemental jurisdiction. See Houben v. Telular Corp., 309 F.3d 1028, 1032

(7th Cir. 2002).
24 No. 13-1766

F.2d 304, 313 (7th Cir. 1986) (observing that the Erie doctrine is

not a “monolithic legal principle” that is applied the same way

in all situations (internal quotation marks omitted)).

In this case, the analytical path set out in the Supreme

Court’s later decision in Hanna v. Plumer, 380 U.S. 460 (1965),

provides us with more precise guidance. There, the Court

addressed specifically how we ought to proceed when a state

law is alleged to conflict with a Federal Rule of Civil Procedure. See Windy City, 536 F.3d at 670–71. Under Hanna, “if a

duly promulgatedfederal rule of procedure conflicts with state

law, the Rules Enabling Act, 28 U.S.C. § 2072, commands a

federal court to apply [the federal] rule of procedure unless to

do so would abridge a substantive right under state law.” In re

Air Crash Disaster, 803 F.2d at 313–14 (footnote omitted). In

applying Hanna, we first consider whether there is a conflict

between 735 ILCS 5/2-622 and either Rule 8 or Rule 11, or

whether the state and federal laws may be reconciled. Windy

City, 536 F.3d at 671 (citing Burlington N. R.R. Co. v . Woods, 480

U.S. 1 (1987) and Walker v. Armco Steel Corp., 446 U.S. 740

(1980)). If there is no conflict, then our inquiry ends because

there is no need to displace any rule.

In this case, we conclude that there is no conflict between

section 2-622 and either Rule 8 or Rule 11 and, therefore, we

only need to conduct the first step of the Hanna analysis. See

Shady Grove, 559 U.S. at 398 (“We do not wade into Erie’s

murky waters unless the federal rule is inapplicable or invalid.”). The Supreme Court has held in a number of instances

that a Federal Rule controlled in the face of a conflicting state
No. 13-1766 25

law, but the case before us is more similar to Walker, 446 U.S. 30

For example, in Hanna v. Plumer, 380 U.S. 460, 461 (1965), the plaintiff

30

served a defendant by leaving a summons and complaint at the defendant’s

home with his wife, in compliance with Federal Rule of Civil Procedure

4(d)(1). The defendant contended that service was improper under a

Massachusetts law requiring in-hand service. Id. at 461–62. The Court held

that Rule 4(d)(1) “with unmistakable clarity [said] that in-hand service is

not required in federal courts.” Id. at 470. Therefore, Rule 4(d)(1)

“unavoidabl[y]” conflicted with the Massachusetts rule. Id. In the face of

this conflict, the Court concluded that because Rule 4(d)(1) was valid under

the Rules Enabling Act and the Constitution, it controlled in that case. Id.

at 463–64, 474.

In Burlington Northern Railroad Co. v. Woods, 480 U.S. 1, 2 (1987), the

plaintiffs brought tort claims in Alabama state court against a defendant

who removed those claims to federal court on diversity grounds. The

plaintiffs won a monetary judgment at trial. Id. The defendant posted bond

to stay the judgment pending appeal, and the court of appeals affirmed the

judgment. Id. Under Federal Rule of Appellate Procedure 38, federal

appellate courts have discretion to award damages or costs to appellees in

frivolous appeals. Alabama law, however, mandates that if a monetary

judgment for which the appellant posted bond pending appeal is affirmed

without modification, the Alabama courts must award a penalty to the

appellee in the amount of ten percent of the damages award. Burlington N.,

480 U.S. at 3–4. The Supreme Court held that Rule 38 and Alabama law

directly conflicted because the Alabama law interfered with Rule 38’s

“discretionary mode of operation” and because “the purposes underlying

the Rule are sufficiently coextensive with the asserted purposes of the

Alabama statute to indicate that the Rule occupies the statute’s field of

operation so as to preclude its application in federal diversity actions.” Id.

at 7. Thus, because there was a conflict and because Rule 38 was valid under

the Constitution and the RulesEnabling Act, Rule 38displaced the Alabama

statute in federal diversity cases. Id. at 8.

(continued...)
26 No. 13-1766

740, where the Court held that there was no conflict between

the relevant federal and state rules. In Walker, the plaintiff was

injuredwhilehammering an allegedly defective nail on August

22, 1975. Id. at 741. He filed a diversity suit against the nail’s

manufacturer on August 19, 1977. Id. at 742. However, the

plaintiff did not serve the defendant with process until

December 1, 1977. Id. Under Federal Rule of Civil Procedure 3,

“[a] civil action is commenced by filing a complaint with the

court.” Fed. R. Civ. P. 3; see also Walker, 446 U.S. at 743. Under

Oklahoma state law, however, an action generally is commenced upon service. Walker, 446 U.S. at 742–43. The applicable statute of limitations was two years, so the plaintiff’s suit

was timely under Rule 3 but barred under Oklahoma law. Id.

at 742–43, 748. The Court held that, in diversity cases, Rule 3

 (...continued) 30

In Shady Grove Orthopedic Associates, P.A. v. Allstate Insurance Co., 559

U.S. 393, 397 (2010), the plaintiff filed a diversity suit on its own behalf and

on behalf of a class of plaintiffs who it alleged were owed interest on late

benefits payments received from the defendant. Federal Rule of Civil

Procedure 23 sets out the procedures for pursuing a class action in federal

court; notably, there is no limitation based on the type of relief sought. See

Fed. R. Civ. P. 23. New York law, by contrast, prohibits class action suits

seeking to recover a “penalty,” such as the statutory interest sought by the

plaintiffs. Shady Grove, 559 U.S. at 397. The Court held that both Rule 23 and

the New York law at issue governed when plaintiffs may maintain a class

action and, therefore, there was a direct conflict between them. Id. at 398–99.

A plurality of the Court held that Rule 23 was valid under the Rules

Enabling Act, id. at 407–08 (opinion of Scalia, J.), and five Justices agreed

that Rule 23, not the New York law at issue, should be applied in federal

court. Id. at 416; id. at 416 (Stevens, J., concurring in part and concurring in

the judgment).
No. 13-1766 27

does not displace state tolling rules; rather, it simply “governs

the date from which various timing requirements of the

Federal Rules begin to run.” Id. at 750–51 (internal quotation

marks omitted). Thus, the Court concluded that Rule 3 and the

Oklahoma law “can exist side by side, ... each controlling its

own intended sphere of coverage without conflict.” Id. at 752.

As with the rules in Walker, Rules 8 and 11 and section 2-622

comfortably “can exist side by side” in diversity cases. Nothing

in the operative provisions of Rule 8, Rule 11 or section 2-622

prevents us from simultaneously applying them. Rule 8

governs the content and form of a complaint. It requires, in

pertinent part, that a complaint include a jurisdictional

statement, a statement of the claim and a demand for relief.31

 Rule 8(a) provides: 31

A pleading that states a claim for relief must contain:

(1) a short and plain statement of the

grounds for the court’s jurisdiction, unless the court already has jurisdiction and

the claim needs no new jurisdictional

support; 

(2) a short and plain statement of the

claim showing that the pleader is entitled

to relief; and 

(3) a demand for the relief sought, which

may include relief in the alternative or

different types of relief.

(continued...)
28 No. 13-1766

Section 2-622 says nothing about the contents of the actual

complaint; it is only concerned with a pre-suit consultation and

related attachments to the complaint. Illinois courts have held

specifically that the affidavit and report required by section

2-622 are not to be considered parts of a plaintiff’s complaint.

Garrison v. Choh, 719 N.E.2d 237, 240, 243–44 (Ill. App. Ct.

1999). Rule 8 and section 2-622 govern different aspects of

commencing an action and may be enforced simultaneously

without conflict.

Rule 11 may be enforced consistently with section 2-622 as

well. The relevant portion of Rule 11 provides:

By presenting to the court a pleading, written

motion, or other paper ... an attorney ... certifies

that to the best of the person’s knowledge, information, and belief, ... :

(1) it is not being presented for any improper

purpose, such as to harass, cause unnecessary

delay, or needlessly increase the cost of litigation;

(2) the claims, defenses, and other legal contentions are warranted by existing law or by a

nonfrivolous argument for extending, modifying, or reversing existing law or for establishing

new law; [and]

 (...continued) 31

Fed. R. Civ. P. 8(a).
No. 13-1766 29

(3) the factual contentions have evidentiary

support or, if specifically so identified, will

likely have evidentiary support after a reasonable opportunity for further investigation or

discovery ... .

Fed. R. Civ. P. 11(b)(1)–(3). Section 2-622’s requirement that an

attorney attach an affidavit and report to the complaint does

not interfere with the ability of the attorney to certify the

accuracy and legitimacy of that complaint. Accordingly,

section 2-622 and Rule 11 may be applied simultaneously.

Further, given the respective purposes of Rule 8, Rule 11

and section 2-622, it cannot be said that one of the Federal

Rules occupies the field that section 2-622 aims to regulate and,

therefore, must trump the state law. See Burlington N., 480 U.S.

at 7. The purpose of section 2-622 is “to reduce the number of

frivolous medical malpractice lawsuits that are filed and to

eliminate such actions at an early stage.” Apa v. Rotman, 680

N.E.2d 801, 804 (Ill. App. Ct. 1997). It is designed to ensure 32

that a complaint has “factual validity” and “reasonable merit.”

Garrison, 719 N.E.2d at 243 (internal quotation marks omitted).

By contrast, the purpose of Rule 8 is to provide a defendant

with fair notice of the claims against him. Vicom, Inc. v.

Harbridge Merch. Servs., Inc., 20 F.3d 771, 775 (7th Cir. 1994); see

also Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). Even

after Twombly and Ashcroft v. Iqbal, 556 U.S. 662 (2009), which

clarified that a complaint must state a claim for relief that is

 See also Avakian v. Chulengarian, 766 N.E.2d 283, 294 (Ill. App. Ct. 2002); 32

Tucker v. St. James Hosp., 665 N.E.2d 392, 396 (Ill. App. Ct. 1996).
30 No. 13-1766

“plausible” on its face, we have emphasized that plausibility is

required “in order to assure that a pleading suffices to give

effective notice to the opposing party,” not in order to evaluate

the veracity of the pleaded facts or the ultimate merits of the

plaintiff’s claim. Alexander v. United States, 721 F.3d 418, 422

(7th Cir. 2013); cf. Skinner v. Switzer, 131 S. Ct. 1289, 1296 (2011)

(noting that a complaint need not show whether a plaintiff will

ultimately prevail). Thus the purposes of Rule 8 (fair notice)

and section 2-622 (eliminating frivolous claims) are different

enough that the rules comfortably may coexist in diversity

cases.

With respect to Rule 11, the Supreme Court has stated that

its “central purpose ... is to deter baseless filings in district

court and thus, consistent with the Rules Enabling Act’s grant

of authority, streamline the administration and procedure of

the federal courts.” Cooter & Gell v. Hartmarx Corp., 496 U.S.

384, 393 (1990). “Rule 11 imposes a duty on attorneys to certify

that they have conducted a reasonable inquiry and have

determined that any papers filed with the court are well

grounded in fact, legally tenable, and ‘not interposed for any

improper purpose.’” Id. (quoting Fed. R. Civ. P. 11 (1989)).

Because Rule 11 is about attorney conduct—not about (or only

incidentally about) the merits of a plaintiff’s case—it has a

sufficiently separatepurpose from section 2-622 that no conflict

exists between them.

Our prior cases support the conclusion that Rules 8 and 11

and section 2-622 may be enforced simultaneously in diversity
No. 13-1766 31

cases. In Hines v. Elkhart General Hospital, 603 F.2d 646, 647 33

(7th Cir. 1979), we held that an Indiana law requiring a medical

malpractice plaintiff to obtain the opinion of a medical review

panel prior to initiating a court action did not conflict with any

federal rules and should be enforced in federal courts sitting in

diversity. Indeed, we have noted that, in diversity actions,

application of state law is usually indicated where the state

rule may seem procedural but “is limited to a particular

substantive area.” S.A. Healy Co. v. Milwaukee Metro. Sewerage

Dist., 60 F.3d 305, 310 (7th Cir. 1995) (collecting cases). Such a

limitation, we have said, indicates a “state’s intention to

influence substantive outcomes.” Id. Here, Illinois has limited

section 2-622 to cases involving medical or other healing art

malpractice. We therefore may infer that Illinois’s “goals are

substantive” and would be thwarted if parties having access to

a federal court under diversity jurisdiction could thereby

exempt themselves from the compulsory requirement. See id.

Together, Hines and Healy require the result we reach today:

that section 2-622 must be applied by federal courts sitting in

diversity.

 This conclusion also is consistent with the few of our sister circuits that

33

have addressed this precise issue. See, e.g., Liggon-Redding v. Estate of

Sugarman, 659 F.3d 258, 261–65 (3d Cir. 2011) (finding no conflict between

Rule 8 or Rule 11 and a Pennsylvania statute requiring a “certificate of

merit” to be filed in professional malpractice claims); Chamberlain v.

Giampapa, 210 F.3d 154, 158–61 (3d Cir. 2000) (finding no conflict between

Rule 8 or Rule 9 and a similar New Jersey law); cf. Littlepaige v. United States,

528 F. App’x 289, 292–93 (4th Cir. 2013) (holding that a North Carolina rule

requiring an expert certification in a medical malpractice case applied in a

Federal Tort Claims Act case sounding in medical malpractice brought in

federal court).
32 No. 13-1766

In sum, section 2-622 may be applied in diversity cases

without running afoul of either Rule 8 or Rule 11. Therefore,

the district court properly dismissed the plaintiffs’ wrongful

death claim against HPL because the plaintiffs had failed to

attach the required affidavit and report.

B.

Having determined that the district court properly granted

the defendants’ motion to dismiss the plaintiffs’ state law

wrongful death claim, we now examine the district court’s

decision to dismiss that claim with prejudice. In dismissing the

claim initially, the district court wrote, “Plaintiffs clearly failed

to comply with the requirements of § 2-622 and the statute of

limitations has passed. Therefore, this court concludes that

dismissal of Count VIII with prejudice is proper in this case.”34

In denying the plaintiffs’ Rule 59(e) motion, the district court

emphasized that plaintiffs’ counsel was aware from a prior

case before the same district court that the court enforced

section 2-622. The district court also distinguished between 35

cases where plaintiffs had filed defective affidavits or reports

(wheredismissalwithout prejudice was appropriate) andcases

where they had failed to file an affidavit and report altogether

(where dismissal with prejudice was appropriate).

 R.40 at 2 (citation omitted). 34

 R.49 at 6 (citing Winfrey v. Walsh, No. 07-CV-2093, 2007 WL 4556701, at 35

*1 (C.D. Ill. Dec. 21, 2007)).
No. 13-1766 33

We are mindful of the discretion accorded to district courts

in deciding whether to grant a motion to dismiss with or

without prejudice. We are especially cautious about interfering

with that discretion here because the district court believed

that counsel knew that the district court required compliance

with section 2-622 and deliberately had failed to respect the

court’s prior holdings. Nevertheless, we think that several

considerations require that the district court reconsider this

issue.

First, our cases and Illinois cases suggest that when a claim

is dismissed for failure to include a section 2-622 affidavit and

report, the dismissal should be without prejudice. The Appellate Court of Illinois has held expressly that when a plaintiff

raises a claim that implicates section 2-622 but fails to include

an affidavit and report, the plaintiff should have the opportunity to amend her complaint before it is dismissed with

prejudice:

Section 2-622 is a pleading requirement designed

to reduce frivolous lawsuits, not a substantive

defense which may be employed to bar plaintiffs

who fail to meet its terms. Accordingly, the statute

should be liberally construed and not mechanically

applied to deprive a plaintiff of her substantive

rights. The plaintiff in a medical malpractice action

should be allowed every reasonable opportunity to

establish her case.

The decision as to whether an action should be

dismissed by reason of the plaintiff’s failure to

comply with the requirements of section 2-622 is a
34 No. 13-1766

matter committed to the discretion of the trial court.

When, as in this case, a plaintiff fails to attach the

requisite affidavit and health care professional’s

report to a complaint based on medical malpractice,

a sound exercise of discretion mandates that she be at

least afforded an opportunity to amend her complaint to

comply with section 2-622 before her action is dismissed

with prejudice.

Cammon v. W. Suburban Hosp. Med. Ctr., 704 N.E.2d 731, 738–39

(Ill. App. Ct. 1998) (emphasis added) (citations omitted)

(internal quotation marks omitted). We quoted Cammon and

echoed its sentiment in Sherrod v. Lingle, 223 F.3d 605, 614 (7th

Cir. 2000), where we held that a district court’s failure to

permit a plaintiff to amend his complaint in order to comply

with section 2-622 was an abuse of discretion.36

Second, although the district court believed that plaintiffs’

counsel should have known to submit an affidavit and report

in accordance with section 2-622, it made no specific finding

that the failure to do so was in bad faith or an attempt to delay

The district court distinguished Sherrod v. Lingle, 223 F.3d 605 (7th Cir.

36

2000), from this case because, in Sherrod, the plaintiff had filed a defective

affidavit and report and, in this case, the plaintiffs had failed to file an

affidavit and report at all. We cannot accept this reading of Sherrod. We

reasoned there that, under Illinois law, if a trial court is supposed to give a

plaintiff leave to amend when she fails to file any affidavit and report, then

certainly a trial court should grant a plaintiff leave to amend when she files

a flawed affidavit and report. See id. at 614; cf. Cookson v. Price, 914 N.E.2d

229, 232 (Ill. App. Ct. 2009) (noting that there is no difference between

amending an existing report and submitting a new report in lieu of an old

one).
No. 13-1766 35

litigation. See Cookson v. Price, 914 N.E.2d 229, 232 (Ill. App. Ct.

2009) (holding that it was error for the trial court to refuse to

permit plaintiff to amend his complaint to include a new

affidavit and report complying with section 2-622 where there

was no indication that the plaintiff’s failure to file the report

earlier in the litigation was in bad faith). Further, it did not

explain whether or in what manner the defendants might be

prejudiced by permitting theplaintiffs to replead. See Christmas

v. Dr. Donald W. Hugar, Ltd., 949 N.E.2d 675, 684 (Ill. App. Ct.

2011) (listing prejudice to the other party as one of the factors

that a trial court should consider in determining whether to

grant leave to amend a complaint that did not comply with

section 2-622). On this record, we decline to affirm the district

court’s decision to dismiss the claim with prejudice. Cf. Apa,

680 N.E.2d at 805 (overturning for abuse of discretion a trial

court’s decision to dismiss a claim with prejudice for failure to

comply with section 2-622 because “the trial court failed to take

into consideration the particular facts and unique circumstances of this case,” where there was no indication that the

plaintiff was bringing a frivolous claim and no suggestion of

bad faith or abuse of process).

Finally, the district court’s conclusion that the plaintiffs

could not timely file an amended complaint—attaching a

proper affidavit and report—because the statute of limitations

had lapsed on their wrongful death claim fails to take into

account the possibility that the amendment would relate back

to the plaintiffs’ initial, timely complaint. Cf. Fed. R. Civ. P.

15(c) (explaining the doctrine of relation back). We take no

position on whether relation back would permit amendment
36 No. 13-1766

under the specific circumstances of this case; we only note 37

On remand, the district court may be guided by both federal and state

37

relation back rules. Federal Rule of Civil Procedure 15(c)(1) provides in

relevant part:

An amendment to a pleading relates back to the date of the

original pleading when:

(A) the law that provides the applicable

statute of limitations allows relation back;

[or]

(B) the amendment asserts a claim or

defense that arose out of the conduct,

transaction, or occurrence set out—or

attempted to be set out—in the original

pleading ... .

Thus, either Illinois law (which supplies the statute of limitations for the

plaintiffs’ wrongful death claim here) or Federal Rule of Civil Procedure

15(c)(1)(B) could determine whether an amended pleading relates back to

the plaintiffs’ initial pleading. See Fed. R. Civ. P. 15 advisory committee’s

note to the 1991 amendment (“Whatever may be the controlling body of

limitations law, if that law affords a more forgiving principle of relation

back than the one provided in this rule, it should be available to save the

claim.”); Arendt v. Vetta Sports, Inc., 99 F.3d 231, 236 (7th Cir. 1996).

There is no meaningful distinction, however, between Illinois law on

relation back and Federal Rule of Civil Procedure 15(c)(1)(B). See Henderson

v. Bolanda, 253 F.3d 928, 932–33 (7th Cir. 2001) (“Illinois law on relation back

is not more forgiving [than federal law].”). Illinois permits relation back

when the same two requirements are met: “(1) the original complaint was

timely filed, and (2) the amended complaint grew out of the same transaction or occurrence set forth in the original pleading.” Id.; see also Porter v.

(continued...)
No. 13-1766 37

that the district court’s failure to address the plaintiffs’ properly raised argument, combined with our preference for 38

permitting amendment in this type of case and the lack of

factual findings described above, constituted an abuse of

discretion.39

 (...continued) 37

Decatur Mem’l Hosp., 882 N.E.2d 583, 591–92 (Ill. 2008) (recognizing

similarities between Illinois and federal law on relation back).

 See R.46 at 3. 38

There are several reasons for requiring the plaintiffs to amend their 39

complaint, rather than allowing them simply to file the required affidavit

and report upon remand. First, the operative pleading in the district court

at the time the final judgment was entered was the Second Amended

Complaint, which did not include a wrongful death claim. If this claim is

to be reinstated, it needs to be repleaded.

Second, the Illinois courts that have been confronted with a defective

affidavit and report have required amendment, not just the filing of a new

affidavit and report once the deficiency has been uncovered. See, e.g., Apa

v. Rotman, 680 N.E.2d 801, 804 (Ill. App. Ct. 1997). The Illinois courts

liberally permit amendments in order to prevent technical filing rules from

cutting off a plaintiff’s ability to pursue a meritorious claim. See Cammon v.

W. Suburban Hosp. Med. Ctr., 704 N.E.2d 731, 738–39 (Ill. App. Ct. 1998).

That policy is furthered by requiring amendment here. The plaintiffs never

satisfied all of the requirements for bringing a wrongful death claim;

because the statute of limitations on that claim has expired, they are unable

to bring the claim unless amendment is permitted. If their claim has merit,

then not permitting amendment would cut off a claim because of a technical

filing rule.

Finally, this approach appears to be consistent with the statute, which

(continued...)
38 No. 13-1766

C.

We now turn to the district court’s summary judgment

decision. As previously discussed, the district court granted

summary judgment to the defendants on all claims that

remained after their respective motions to dismiss were

denied. The plaintiffs confine their appeal, however, to the

district court’s grant of summary judgment (1) to

Sheriff Walsh, on the plaintiffs’ § 1983 claims against him in his

official capacity; and (2) to HPL, on the plaintiffs’ § 1983 claim

against the organization.

Our standard of review is clear. We shall affirm the district

court’s grant of summary judgment if, exercising de novo

review and construing all facts and inferences in favor of the

plaintiffs, there is no genuine issue of material fact and the

defendants are entitled to judgment as a matter of law. Guzman

 (...continued) 39

identifies specific situations—not including the one presentedhere—where

a plaintiff may file an affidavit and report late and without amending his

complaint. For example, 735 ILCS 5/2-622(a)(2) provides that where an

affidavit and report cannot be obtained in a timely fashion and the

limitations period is about to expire, the plaintiff may submit with the

complaint only an affidavit explaining the situation, and the required

affidavit and report confirming the claim’s merit may be filed within ninety

days. Subsection 5/2-622(a)(3) similarly states that if a plaintiff cannot

obtain the required affidavit and report because a party has failed to

produce necessary records as required by statute, the plaintiff may submit

with the complaint only an affidavit explaining the situation, and the

required affidavit and report confirming the claim’s merit may be filed

within ninety days. If the legislature wanted litigants in the plaintiffs’

situation to proceed without filing an amended complaint, it could have

included a specific subsection authorizing such a course of action.
No. 13-1766 39

v. Sheahan, 495 F.3d 852, 856 (7th Cir. 2007); see also Fed. R. Civ.

P. 56; Celotex Corp. v. Catrett, 477 U.S. 317, 322–23 (1986);

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249–50 (1986).

1.

The plaintiffs submit that Sheriff Walsh was deliberately

indifferent primarily for failing to ensure that medical staff had

a “written policy or procedure for diabetic detainees whose

blood sugar was not being measured and who refused to

eat.” Because the plaintiffs have sued Sheriff Walsh in his

40

official capacity, they must show (1) that a genuine issue of

material fact exists as to whether he “maintains a policy or

custom that infringes upon the rights protected” by the

Fourteenth Amendment’s Due Process Clause; and (2) that “a

genuine issue of material fact exists as to whether [the death]

was proximately caused by either an official policy of the

municipality or from a governmental custom or usage.”

Pittman ex rel. Hamilton v. Cnty. of Madison, Illinois, 746 F.3d 766,

780 (7th Cir. 2014) (internal quotation marks omitted); see also

Estate of Novack ex rel. Turbin v. Cnty. of Wood, 226 F.3d 525, 530

(7th Cir. 2000) (holding that the “policy or practice must be the

‘direct cause’ or ‘moving force’ behind the constitutional

violation”). A plaintiff can show that a municipality has caused

a constitutional injury either “by demonstrating that [the

municipality’s] policy itself is unconstitutional,” or “by

showing a series of bad acts and inviting the court to infer from

them that the policymaking level of government was bound to

 Appellants’ Br. 27. 

40
40 No. 13-1766

have noticed what was going on and by failing to do anything

must have encouraged or at least condoned ... the misconduct

of subordinate officers.” Estate of Novack, 226 F.3d at 531

(internal quotation marks omitted).

If a plaintiff’s allegation is that an express municipal policy

violates the constitution when enforced, then a single incident

may be sufficient to sustain liability for the municipality under

§ 1983. See Calhoun v. Ramsey, 408 F.3d 375, 379–80 (7th Cir.

2005). However, where, as here, the plaintiffs are concerned

with a lack of policies, we look for “more evidence than a single

incident to establish liability.” Id. at 380. Without evidence that

a series of incidents brought the risk at issue to the attention of

the policymaker, we cannot infer that the lack of a policy is the

result of deliberate indifference because “[t]he absence of a

policy might ... mean only that the government sees no need

to address the point at all, or that it believes that case-by-case

decisions are best, or that it wants to accumulate some experience before selecting a regular course of action.” Id.

In this case, the plaintiffs have not shown that there was a

“series of unconstitutional acts from which it may be inferred

that the [sheriff] knew [CCCC] officers were violating the

constitutional rights of [CCCC] inmates and did nothing.”

Estate of Novack, 226 F.3d at 531. Before the district court, the

plaintiffs alleged that the following put Sheriff Walsh on notice

of the unconstitutional practices in the jail:

(1) [S]even inmates previously died in the jail,

including Quentin Larry, who Plaintiffs contend

died because of deficiencies in the intake process at

the jail; (2) Swain’s email regarding the problems
No. 13-1766 41

with Janet during her May 2007 incarceration was

sent to “Corrections” so Walsh should have received

it; (3) Walsh was personally notified by letter, fax

anda telephone conversation with Plaintiffs’ counsel

in May 2006 about complaints a diabetic inmate,

Joey Morrissey, had about how treatment for his

diabetes was handled at the jail, to which Walsh

responded following an investigation ... .[41]

The problem with these contentions is that none of them

support the conclusion that the sheriff was on notice that the

custom of which the plaintiffs complain on appeal—the

sheriff’s lack of policies for treating a diabetic detainee who

refuses to participate in her own care—could cause death as a

result of diabetic ketoacidosis. Althoughseven individuals had

died in the CCCC, none had died because of complications

from diabetes. In Pittman, 746 F.3d at 780, we held that thirtysix failed suicide attempts and three suicides were not

enough—standing alone—to show that a sheriff’s suicideprevention policies were inadequate because the fact that other

inmates attempted suicide did not necessarily show a deficiency in those policies. Similarly, in this case, the seven deaths

referenced by the plaintiffs—notably, deaths from different

causes than Mrs. Hahn’s—do not show that Sheriff Walsh was

“aware of any ... risk posed by [his] policies or that

[Sheriff Walsh] failed to take appropriate steps to protect

[Mrs. Hahn].” Id.

 R.165 at 39–40. The additional reasons raised to the district court by the 41

plaintiffs are unrelated to the specific policy they allege on appeal is

lacking.
42 No. 13-1766

Swain’s e-mail dealt with a single incident, not a “series,”

and it did not describe any adverse effects on Mrs. Hahn’s

health caused by the policies in place. At best, it showed that

one member of HPL’s nursing staff experienced a temporary

difficulty with one detainee. See Calhoun, 408 F.3d at 380

(noting that the same problem needs to have come up multiple

times to put a municipality on notice that a policy may need to

be implemented to address the situation). The complaint by

counsel on behalf of the earlier detainee, Morrissey, is similarly

flawed. It does not show that detainees suffered a serious risk

of harm, only that one detainee was dissatisfied with his

treatment.Moreover, Morrissey’s situationwouldnothaveput

Sheriff Walsh on notice that he might need a policy for handling diabetic inmates who refuse to participate in their own

care, because those circumstances were not presented in

Morrissey’s situation.

We contrast this case with King v. Kramer, 680 F.3d 1013,

1021 (7th Cir. 2012), where we held that summary judgment

was inappropriate for a municipality where there was evidence

that officials were on notice that the municipality’s medical

policies were causing serious problems at the jail. There, the

plaintiff challenged the jail’s policy of taking detainees off of

their prescribed medications and transitioning them to preferred medications absent proper supervision by a physician.

Id. at 1020–21. We held that there was a triable issue of fact as

to whether the municipality was aware of the problem because

several newspaper articles had addressed it and the sheriff had

publicly acknowledged his awareness of the problem. Id. at

1021. Unlike in King, the plaintiffs here do not point to any

evidence that Sheriff Walsh knew that there was a problem
No. 13-1766 43

with diabetic detainees refusing to participate in their own care

and, as a consequence, suffering serious medical ramifications.

The record before us suggests that any deliberate indifference that may have occurred in this case was at the hands of the

individual correctional officers or HPL employees who

interacted with Mrs. Hahn. Such evidence is legally insuffi42

cient to impose liability under § 1983 on the CCCC’s

policymakers. See Holmes v. Sheahan, 930 F.2d 1196, 1201–02

(7th Cir. 1991) (“[W]ithout more evidence pointing to deficiencies in these procedures, [the plaintiff’s] story suggests a

problem with personnel and the implementation of policy, ...

but not a problem with County policy itself.”). We must

conclude that the district court properly granted summary

judgment on the official capacity claim against Sheriff Walsh.

2.

The plaintiffs next submit that the district court erred in

granting summary judgment to HPL. They first contend that,

contrary to established precedent set forth in Iskander v. Village

of Forest Park, 690 F.2d 126 (7th Cir. 1982), and subsequent

cases, HPL should be liable for the actions of its employees

under a respondeat superior theory of liability. Second, they

submit that even if HPL is not liable under a respondeat

Cf. Egebergh v. Nicholson, 272 F.3d 925, 927–28 (7th Cir. 2001) (holding

42

that there was a genuine issue for trial regarding whether individual

officers who withheld insulin from a diabetic detainee were deliberately

indifferent); Estate of Gee ex rel. Beeman v. Johnson, 365 F. App’x 679, 683–84

(7th Cir. 2010) (same).
44 No. 13-1766

superiortheory of liability, the company is liable under a direct

theory of liability because its policies and procedures for

treating diabetic detainees were deliberately indifferent to the

needs of those individuals. We shall address each of these

contentions.

a.

The plaintiffs submit that they should be able to pursue a

claim under § 1983 against HPL for its employees’ misconduct.

In their view, we have erred in extending the limitation on

municipal liability established in Monell v. Department of Social

Services, 436 U.S. 658 (1978), to private actors. Monell permits

suits against municipal entities under § 1983, but only when a

governmental policy or custom caused the constitutional

deprivation; municipal entities cannot be liable for their

employees’ actions under a respondeat superior theory. Id. at

691. Our cases have extended this limitation to private entities.

See, e.g., Iskander, 690 F.2d at 128 (“Moreover, just as a municipal corporation is not vicariously liable upon a theory of

respondeat superior for the constitutional torts of its employees,

a private corporation is not vicariously liable under § 1983 for

its employees’ deprivations of others’ civil rights.” (citation

omitted)); see also Minix v. Canarecci, 597 F.3d 824, 834 (7th Cir.

2010) (noting that “a corporation that contract[s] with [a] jail to

provide medical services ... is treated the same as a municipality for liability purposes under § 1983”). The plaintiffs ask us to

“revisit these holdings” because they are based on “historical
No. 13-1766 45

misreadings” and we are “free to revisit and reject [our]

extension of Monell to private corporations.”43

As a preliminary matter, the plaintiffs have waived the

issue of HPL’s respondeat superiorliability because they failed

to raise it before the district court. Puffer v. Allstate Ins. Co., 675

F.3d 709, 718 (7th Cir. 2012). In their appellate brief, the

plaintiffs state, “The district court granted summary judgment

to defendant Health Professionals Ltd. (‘HPL’) by applying the

rule that respondeat superior does not apply to Section 1983

claims brought against private corporations.” The district

44

court made no mention of any such contention. Furthermore,

the plaintiffs have identified no part of the district court record

in which a respondeat superior claim was raised or otherwise

discussed. 

We raised the matter of waiver at oral argument, and

plaintiffs’ counsel subsequently submitted a letter pursuant to

Federal Rule of Appellate Procedure 28(j) contending that the

respondeat superior argument was not waived because a court

of appeals may review “‘the merits of each and every theory

the district judge relied upon in deciding the case.’” Essen- 45

tially, the plaintiffs now argue that the district court impliedly

 Appellants’ Br. 32–35 (internal quotation marks omitted). 43

 Id. at 15.

44

App. R. 50 (Letter from Kenneth N. Flaxman to Gino J. Agnello, Clerk, 45

United States Court of Appeals for the Seventh Circuit (Apr. 15, 2014)

(quoting United States v. City of Chicago, 869 F.2d 1033, 1036 (7th Cir. 1989))

(citing Pittman v. Warden, Pontiac Corr. Ctr., 960 F.2d 688, 690–91 (7th Cir.

1992))).
46 No. 13-1766

rejected a theory of respondeat superior liability by granting

summary judgment to HPL. This assertion cannot prevail. The

plaintiffs’ complaint raised only direct claims against HPL. In 46

their opposition to HPL’s motion for summary judgment, the

plaintiffs again discussed only direct claims against HPL. We 47

simply have no basis upon which to infer that the district court

had even considered, much less had relied upon, the rule that

private corporations cannot be held liable in § 1983 actions

under a respondeat superior theory of liability. 

Even if we were to reach the respondeat superior issue, we

would not take the position urged by the plaintiffs. The

plaintiffs point to no “intervening on-point Supreme Court

decision” that would permit us to overrule our prior cases.

De Leon Castellanos v. Holder, 652 F.3d 762, 765 (7th Cir. 2011).

Our considered decision in Iskander is compatible with the

holding of every circuit to have addressed the issue. See Shields

v. Illinois Dep’t of Corr., 746 F.3d 782, 790 & n.2 (7th Cir. 2014)

(collecting cases).

See R.42 at 8 (“[T]his defendant, acting with deliberate indifference

46

and/or negligence, among other things, failed to develop and implement

adequate policies and procedures with the foreseeable result that pretrial

detainees like Janet would not be identified and would not receive

appropriate treatment and monitoring.”).

See R.144 at 88 (discussing how a supervisory defendant may be liable

47

under § 1983 for failing to establish customs or policies to ensure that

unconstitutional practices do not occur or for establishing customs or

policies that lead to unconstitutional practices); id. at 89 (arguing that HPL

unlawfully took no action in response to knowledge that its policy for

treating diabetes was inadequate).
No. 13-1766 47

Because the issue was waived or, alternatively, because it

fails on the merits, we conclude that the plaintiffs’ argument

for holding HPL liable on a respondeat superior theory is

unavailing.

b.

We next assess the plaintiffs’ direct claims against HPL.

“Private corporations acting under color of state law may, like

municipalities, be held liable for injuries resulting from their

policies and practices.” Rice ex rel. Rice v. Corr. Med. Servs., 675

F.3d 650, 675 (7th Cir. 2012). As with municipal defendants

(like Sheriff Walsh, in his official capacity), the plaintiff “must

show that his injury was the result of the ... corporation’s

official policy or custom.” Id. The plaintiff must identify a

policy:

An official policy or custom may be established by

means of an express policy, a widespread practice

which, although unwritten, is so entrenched and

well-known as to carry the force of policy, or

through the actions of an individual who possesses

the authority to make final policy decisions on

behalf of the municipality or corporation.

Id. The plaintiff also must establish a causal link between the

corporation’s policy (or lack of policy) and the plaintiff’s

injury. Id.

The plaintiffs here submit that three of HPL’s policies

caused constitutional violations: (1) the policy of not requiring

HPL employees to obtain detainees’ medical records; (2) the
48 No. 13-1766

policy of administering insulin according to a generic sliding

scale; and (3) the policy of ignoring erroneous readings from

the blood sugar monitoring machines.

The first two of these arguments fail because the plaintiffs

cannot demonstrate the requisite causation. The plaintiffs

present no evidence that obtaining Mrs. Hahn’s medical

records would have saved her life. HPL and CCCC personnel

already knew that Mrs. Hahn was an insulin-dependent

diabetic who was irresponsible with her medications. Indeed,

the plaintiffs do not argue that having Mrs. Hahn’s records

would have prevented her death. Nor do the plaintiffs argue

that HPL’s insulin-dosage policy caused her death. They argue

that the policy was problematic in the abstract but concede that

it did not cause Mrs. Hahn’s death here. If it had, the cause of

death would have been hypoglycemia (low blood sugar), not

diabetic ketoacidosis.48

The plaintiffs’ third contention deserves independent

examination. Unlike their other contentions, there is a link here

between the failure to provide an alternative method of

checking a detainee’s blood sugar and Mrs. Hahn’s death: On

the day before her death, she consented on one occasion to

having her blood sugar checked, only to have that option taken

 Specifically, the plaintiffs’ expert found fault in Swain’s administration

48

of twenty units of insulin based on HPL’s sliding scale, which he believed

“could have killed her in a different manner—with hypoglycemia, or low

blood sugar.” Appellants’ Br. 36–37. This is because some Type-1 diabetics

are particularly sensitive to insulin; therefore, twenty units might have been

much more than needed and could have caused Mrs. Hahn’s blood sugar

to plummet. See id. at 37.
No. 13-1766 49

away from her when the machine would not work. It is

possible that if CCCC or HPL staff had been able to obtain a

reading from Mrs. Hahn at the time she consented to be

checked, that reading might have indicated that she was in

need of immediate treatment. In the plaintiffs’ view, it was

constitutionally actionable for HPL to have failed to provide a

method for monitoring the blood sugar levels of diabetic

detainees when an Accu-Chek machine fails to produce a

reading. 

HPL had a policy in place for rechecking an individual’s

blood sugar when the Accu-Chek machine returned an error

message; the existence of that policy indicates that HPL was

aware that, on occasion, the Accu-Chek machine would not

render an accurate reading. The record shows, however, that

such a malfunction could have been due to a variety of causes,

such as the use of an insufficient amount of blood, improper

insertion of the stick containing blood into the Accu-Chek

machine or a broken machine. Some of these causes are due to

operator error or other circumstances not necessarily linked to

a defect in the machine itself and therefore do not result in

§ 1983 liability. Cf. Rice, 675 F.3d at 676 (noting that where

“most of the errors and omissions” cited by the plaintiffs were

about how staff handled the detainee’s medical condition,

there could be no liability for the policymaker). Absent

evidence that the machine was inoperable a significant number

of times and that its predicable failure to operate was due to a

malfunction of the machine itself, a jury could not find that the

company’s failure to maintain an alternate testing device to

check diabetics’ blood sugar levels on a regular basis was

deliberately indifferent. See Shields, 746 F.3d at 796 (observing
50 No. 13-1766

that isolated incidents do not “support an inference of a custom

or policy,” as is required to find a corporation liable for

deliberate indifference under § 1983).

Conclusion

For the foregoing reasons, we affirm the judgment of the

district court with respect to the applicability of 735 ILCS

5/2-622 in federal district courts. We reverse the district court’s

decision to dismiss the plaintiffs’ wrongful death claim with

prejudice. We affirm the district court’s grant of summary

judgment to Sheriff Walsh and to HPL. The case is remanded

to the district court for further proceedings consistent with this

opinion. Each party will bear its own costs in this appeal.

AFFIRMED in part, REVERSED and REMANDED in part

NO COSTS IN THIS COURT