In the

United States Court of Appeals

For the Seventh Circuit ____________________ 

No. 22-1585 

VICTOR R. BROWN, 

Plaintiff-Appellant, 

v.

DANIEL LAVOIE, 

Defendant-Appellee. 

____________________ 

Appeal from the United States District Court for the

Eastern District of Wisconsin. 

No. 2:20-cv-00319 — Lynn Adelman, Judge. 

____________________ 

ARGUED SEPTEMBER 19, 2023 — DECIDED JANUARY 23, 2024 

____________________ 

Before EASTERBROOK, WOOD, and KIRSCH, Circuit Judges. 

WOOD, Circuit Judge. Victor Brown, an inmate in the Wisconsin Department of Corrections, has a history of self-harm. 

One morning while he was particularly upset, Brown forced

a two-inch metal screw into his own flesh by his left elbow. 

The screw was embedded so deeply that it could not be seen 

without manipulating the skin, and so a prison nurse called

the prison doctor, Daniel LaVoie, to extract it. 
2 No. 22-1585 

Dr. LaVoie twice tried, and twice failed, to extract the 

screw using a pair of metal-ring forceps. He did so without 

using any anesthetic to deaden the site. When he first informed Brown that this would be his approach, Brown protested by attempting to head-butt him. During the second attempt, Dr. LaVoie again refused to apply an anesthetic, even 

though Brown’s pain was obvious. The doctor poked at

Brown’s arm and tried to pull on the screw for several 

minutes as Brown shouted in pain. He paused only to make 

dismissive comments, such as telling Brown that he needed to 

change his attitude. Eventually Brown was taken to a local 

hospital, where staff administered an anesthetic and removed 

the screw painlessly and quickly. 

In this lawsuit, Brown claims that Dr. LaVoie was deliberately indifferent to his serious medical condition in violation 

of the Eighth Amendment. The district court granted summary judgment to Dr. LaVoie. Although it was willing to assume that Brown had a serious medical condition, it concluded that Dr. LaVoie was not deliberately indifferent to that 

condition and thus did not violate Brown’s Eighth Amendment rights. For good measure, the court added that in any 

event Dr. LaVoie was entitled to qualified immunity. We see 

things differently. When we view the record in the light most 

favorable to Brown, as we must, there is a genuine dispute of 

material fact about Dr. LaVoie’s state of mind. We therefore 

reverse and remand for further proceedings.

I 

A closer look at the record helps to explain why summary 

judgment on both those grounds was premature. Brown alleges that around noon on August 21, 2019, two prison supervisors were called to his cell after he had an altercation with 
No. 22-1585 3

an official. The cell window was covered with a towel when 

they arrived. Brown informed them that he had removed the 

mirror from the cell wall; he banged it against the door as 

proof. The supervisors asked Brown to remove the towel from 

his window, but he did not immediately do so. Instead, 

Brown swallowed six pieces of metal and inserted a two-inch

metal screw from the mirror into his flesh at the crook of his 

left elbow. He then removed the towel and told the supervisors what he had done.

More prison officials arrived after Brown agreed to come 

out of his cell. They handcuffed Brown, placed a spit-guard 

over his mouth, strapped him into a restraint chair, and took 

him to a nurse’s station in the prison. The nurse inspected 

Brown’s inner left elbow and determined that Brown needed 

to see a doctor. In a video recording of the incident, the nurse 

can be heard saying, “I gotta call a doctor. ... I can feel it in 

there ... but I can’t even see it.”

Still strapped into the restraint chair, Brown was brought

to a hearing room, where he sat for over half an hour. Several 

officials approached him during that time. Brown indicated to 

the first that he would not allow the prison doctor to remove 

the screw. A second official told Brown that he would be kept 

in restraints until the screw was removed. This official suggested that Brown should permit the doctor to remove it so

that he could go to bed. Brown eventually agreed to see the

doctor, at which point he was carted back to the nurse’s station. 

Dr. LaVoie was waiting at the station when Brown arrived. 

He studied Brown’s inner elbow from a short distance and

then drew a pair of metal-ring forceps from a sterile bag. As

Dr. LaVoie bent down to extract the screw with the tool, 
4 No. 22-1585 

Brown asked whether anesthetics would be used to numb the 

site. Dr. LaVoie said “No.” Frightened, Brown immediately

reacted by attempting to head-butt the doctor. Dr. LaVoie 

quickly backed away, but before leaving the station, he said 

to Brown: “Well, maybe you deserve to be strapped down in 

the bed.”

Video from the incident shows that the officials next took 

Brown to a cell and strapped him into a restraint bed. They 

secured Brown’s torso with belts across his chest and legs, and 

restricted his limbs by fastening his upper arms, wrists, and 

ankles to the bed. Brown believed that he would remain 

strapped down until the screw was removed, and so he eventually agreed to see the doctor again. When Dr. LaVoie entered the cell to make a second attempt at removal, Brown

specifically said, through the spit-guard, “I want you to use 

anesthesia.” Dr. LaVoie replied, “No. You stuck a screw in 

your arm, not me, and this is a consequence of your actions.”

This time, Dr. LaVoie worked at Brown’s arm for nearly 

five minutes. Prison officials stood around Brown to help the 

doctor; some of them prevented Brown from raising his neck

so that he could see his arm. Brown had several dissociative 

experiences, and within 90 seconds, his arm started bleeding—so much so that an official requested a trash can “for the 

bloody stuff.” The video recording of the incident shows that 

as Brown shouted in pain, Dr. LaVoie responded with dismissive comments, and a tone of annoyance, perhaps even 

sarcasm. The following is a partial transcription of what was

said:

Brown: Alright, I need a break. I need a break. 

Break. Ow, you fucker! I need a break! 
No. 22-1585 5

Dr. LaVoie: This is—this is not something I did. 

Do you understand that—Mr. Brown? 

Brown: You got a real slick attitude, huh?

Dr. LaVoie: Yeah, well, your attitude is the one 

that needs to change. 

... 

Brown: Can’t you just—pull it out?

Dr. LaVoie: Well, you didn’t put it in right. 

Brown: Ow!

Dr. LaVoie: You put it in so it’s hard to get out. 

So next time, don’t do that.

... 

Brown: I don’t like that. I don’t want [indiscernible]

Dr. LaVoie: You don’t want what?

Brown: I can’t go—I can’t keep going on like 

that.

Prison Official: He’s close.

Brown: No, he’s not! It’s not even on the surface!

Dr. LaVoie: I thought he was agreeing to have 

this done.

Prison Official: He did agree.

... 

Brown: Stop! STOP! STOP!! You bitch! I’m refusing!
6 No. 22-1585 

Even after Brown begged Dr. LaVoie to stop, the doctor 

persisted in poking in Brown’s arm for another few seconds. 

Brown then shouted, “Why do you keeping digging in my 

arm?” Dr. LaVoie finally gave up, stood, and said to Brown: 

“No. You know what? It can stay there. That’s fine.” He wiped 

the ring forceps and left the cell.

Brown fell asleep in the restraint bed, where he remained 

(still strapped in) for nearly four hours until he was taken to 

a local hospital, accompanied by three officials. The hospital 

staff “deemed it obvious” that local anesthesia was required 

for the procedure, and after administering an anesthetic they 

painlessly removed the screw in under three minutes.

II

Invoking 42 U.S.C. § 1983, Brown filed this lawsuit against 

Dr. LaVoie, who, he asserted, had acted with deliberate indifference toward Brown’s serious medical condition in violation of the Eighth Amendment. Brown also contended that 

several other prison officials had violated the Eighth Amendment by failing to intervene to stop Dr. LaVoie. The latter 

claims have all been resolved, and so we say no more about 

them.

Along with his complaint, Brown filed a motion to recruit 

counsel pursuant to 28 U.S.C. § 1915(e)(1). The district court 

denied this request, both initially and on reconsideration. After the district court issued a screening order, Brown renewed 

his request for counsel. This time he attached to the motion

the letters he sent to 24 attorneys seeking assistance with his 

case. In the motion itself, Brown explained that he suffers 

from several mental illnesses and a documented learning disability, all of which affect his ability to engage in this 
No. 22-1585 7

litigation; that although he is 28 years old, he has completed 

school through only the eighth grade and has not earned a 

GED; and that he relies on the assistance of other prisoners to

conduct his case. The district court denied this request as well.

Dr. LaVoie then moved for summary judgment. He argued that Brown could not succeed on the merits of his Eighth 

Amendment claim and that even if Brown cleared that hurdle, 

Dr. LaVoie was entitled to qualified immunity. The doctor 

submitted a short declaration to support his motion. His account was similar to the one from Brown that we have described above, but there are some differences. Dr. LaVoie 

stated that when he first tried to remove the screw, Brown 

asked whether he would use an anesthetic, and Dr. LaVoie 

said no. Brown’s version to this point is the same. Brown then 

attempted to head-butt him—something Brown concedes that 

he did. Dr. LaVoie said that in response to the head-butt, he 

paused the treatment; Brown agrees that the doctor backed 

off then. Brown adds, however, that as Dr. LaVoie left, he 

commented that “maybe [Brown] deserve[d] to be strapped 

down in the bed.”

Both parties agree that Dr. LaVoie tried again to remove 

the screw. Brown adds that he specifically asked Dr. LaVoie 

to use anesthesia before the second attempt, but that Dr. LaVoie refused. The only explanation he gave, according to 

Brown, was that Brown had “stuck a screw in [his] arm” and 

that “this [was] a consequence of [his] actions.” Both sides 

agree that Dr. LaVoie stopped after about five minutes,

shortly after Brown shouted that he revoked his consent. Dr. 

LaVoie did not explain his chosen course of treatment, why 

he continued it as Brown shouted in pain, or what he meant 

by saying essentially that Brown deserved the pain. 
8 No. 22-1585 

The district court granted summary judgment in favor of 

Dr. LaVoie. In so doing, it found that no rational trier of fact 

could conclude that Dr. LaVoie’s decision not to use anesthesia and his wielding of the forceps inside Brown’s flesh 

amounted to deliberate indifference. The court thought that 

this conclusion followed from Snipes v. DeTella, 95 F.3d 586 

(7th Cir. 1996), a case in which we held that a prison doctor 

did not violate the Eighth Amendment by removing a broken

toenail without applying topical anesthesia. The court 

acknowledged that the removal of a screw “may have been 

more invasive than the removal of a toenail,” but it reasoned 

that the attempted screw removal “was not a ‘major surgery’ 

that ‘obviously’ required some form of anesthetic.” As an alternative basis for summary judgment, the district court concluded that Dr. LaVoie was entitled to qualified immunity. 

This was so, the court said, because in light of Snipes, Brown 

had no clearly established right to an anesthetic.

At this stage of the appeal, Brown challenges the district 

court’s judgment in favor of Dr. LaVoie. In an earlier order, 

we affirmed the district court’s rulings on other aspects of the 

case, but we recruited counsel to assist with Brown’s claim 

against Dr. LaVoie.1 See Brown v. LaVoie, No. 22-1585, 2023 

WL 154798 (7th Cir. Jan. 11, 2023). The remaining issues before us are whether Dr. LaVoie was entitled to summary judgment and whether the district court abused its discretion by 

not recruiting counsel to assist Brown with this claim. Because 

we reverse on the first ground, we have no need to reach the 

second.

1 We thank Madeline Clark and the firm of Jones Day for their assistance to Brown and to the court.
No. 22-1585 9

III

As we already have noted, we review the district court’s 

order awarding summary judgment de novo, construing the 

record in the light most favorable to Brown and drawing all 

reasonable inferences in his favor. See Burton v. Downey, 805 

F.3d 776, 783 (7th Cir. 2015). 

The Eighth Amendment to the United States Constitution 

lies at the center of this case. Among other things, it protects 

prisoners from being subjected to “unnecessary and wanton 

infliction of pain.” Gregg v. Georgia, 428 U.S. 153, 173 (1976). 

That proscription includes “deliberate indifference to serious 

medical needs of prisoners.” Estelle v. Gamble, 429 U.S. 97, 104 

(1976). “To determine if the Eighth Amendment has been violated in the prison medical context, we perform a two-step 

analysis, first examining whether a plaintiff suffered from an 

objectively serious medical condition, and then determining 

whether the individual defendant was deliberately indifferent 

to that condition.” Petties v. Carter, 836 F.3d 722, 727–28 (7th 

Cir. 2016) (en banc). The parties do not dispute that Brown suffered from an objectively serious medical condition, and so 

we need only determine whether a reasonable trier of fact

could conclude that Dr. LaVoie was deliberately indifferent to 

Brown’s condition.

A. Deliberate Indifference

The deliberate-indifference standard of the Eighth 

Amendment mirrors the recklessness standard of the criminal 

law. See Rivera v. Gupta, 836 F.3d 839, 842 (7th Cir. 2016). In 

order to state a deliberate-indifference claim against a prison 

doctor, it is thus not enough to show “mere” negligence in 

treating a serious medical condition. See Estelle, 429 U.S. at 
10 No. 22-1585 

105–06. At the same time, a plaintiff does not bear the burden 

of showing that a doctor intentionally denied necessary treatment. See Jones v. Simek, 193 F.3d 485, 490 (7th Cir. 1999). 

The key question is whether the record contains the requisite evidence of a culpable mental state on the doctor’s part. 

“[T]he prison official must act or fail to act despite his 

knowledge of a substantial risk of serious harm.” Gil v. Reed, 

382 F.3d 649, 664 (7th Cir. 2004) (citing Farmer v. Brennan, 511 

U.S. 825, 837 (1994)). We apply this standard both when a 

plaintiff claims that a doctor provided no medical treatment, 

and when the claim is that the doctor provided inadequate 

treatment. Indeed, we have stressed that “[a] doctor who provides some treatment may still be held liable if he possessed 

a sufficiently culpable mental state.” Zaya v. Sood, 836 F.3d 

800, 805 (7th Cir. 2016) (citing Petties, 836 F.3d at 729–30) (emphasis omitted). 

We also have emphasized the importance of deferring to 

the professional judgment of medical personnel. See, e.g., Sain 

v. Wood, 512 F.3d 886, 894–95 (7th Cir. 2008). This is because 

“[a] doctor who claims to have exercised professional judgment is effectively asserting that he lacked a sufficiently culpable mental state.” Zaya, 836 F.3d at 805. Even then, however, 

a doctor is entitled to summary judgment only “if no reasonable jury could discredit that claim.” Id. 

We have identified several prototypical situations in 

which a jury might discredit a prison doctor’s proffered justification for his chosen course of treatment. See generally Petties, 836 F.3d at 729–31. It is not necessary to restate each of 

them here; it is enough to note just one. Where a plaintiff puts 

forward evidence that a doctor failed to exercise medical 

judgment, it is for the jury to decide whether the doctor had a 
No. 22-1585 11

sufficiently culpable mental state. See Rasho v. Elyea, 856 F.3d 

469, 476 (7th Cir. 2017) (citing Petties, 836 F.3d at 730). A plaintiff may show a lack of professional judgment by introducing 

evidence of some other motive for the doctor’s chosen course 

of action, such as hostility or ill-will towards the plaintiff. See 

Rivera, 836 F.3d at 842; Rasho, 856 F.3d at 476. 

Brown has put forward sufficient evidence to raise a material question about Dr. LaVoie’s state of mind. Both Dr. LaVoie’s own statements and his troublesome course of treatment could support a finding of deliberate indifference. The 

record shows that Dr. LaVoie viewed the procedure as a “consequence” of Brown’s behavior, and that he persisted in his 

efforts to remove the screw without applying anesthesia as 

Brown shouted in pain and pleaded for an end to it. As Dr. 

LaVoie continued to root around with the ring forceps in an 

effort to grab the screw embedded in Brown’s arm, he told 

Brown that he needed a change of attitude, reminded him that 

it was his own fault the screw was in his arm, and blamed him

for inserting it in a way that made removal more challenging. 

These comments could be interpreted as signs of annoyance, 

if not hostility. Some of them come across as sarcastic (or so a 

jury could find). And in addition to Dr. LaVoie’s behavior 

throughout the procedure, the record shows that Dr. LaVoie 

persisted in his unsuccessful efforts to remove the screw 

(which took longer than the hospital’s successful procedure) 

and thereby callously prolonged Brown’s pain.

Taking the record evidence in the light most favorable to 

Brown, a jury could find that medical judgment did not motivate Dr. LaVoie’s chosen course of treatment. First, the fact 

that Brown had tried to head-butt Dr. LaVoie supports the inference that the doctor wanted to inflict pain upon Brown in 
12 No. 22-1585 

retaliation for Brown’s action; similarly, a jury could see the 

doctor’s response as based on “personal hostility,” Rivera, 836 

F.3d at 842, or “personal prejudices or animosity,” Rasho, 856 

F.3d at 476. In addition, a reasonable jury could infer from the 

content and tone of his comments that Dr. LaVoie chose not 

to use anesthesia because he intended to punish Brown for 

inserting the screw into his elbow in the first place. Looking 

at Dr. LaVoie’s statement to Brown that he needed to change 

his attitude, a jury might infer that the doctor persisted without anesthesia to deter Brown from engaging in similar acts 

of self-harm in the future. If any non-medical reasons of this 

kind motivated the doctor’s judgment, then that would be a 

basis for a finding of deliberate indifference. (It should go 

without saying, but we add in the interest of completeness, 

that a rational jury might equally reject these inferences and 

find in Dr. LaVoie’s favor.)

Our conclusion is reinforced by the fact that Dr. LaVoie 

has offered no evidence that he did exercise medical judgment 

in attempting to remove the screw from Brown’s arm. His 

declaration in support of summary judgment was limited to a 

brief statement of what happened. Nothing in it suggests that 

he exercised professional judgment either in his assessment of 

the need for anesthesia or in his decision to use the forceps for 

a screw buried so far in the flesh that the nurse could not even 

see it. While the failure to present such evidence is not necessarily dispositive at the summary judgment stage, its absence 

here is striking because it is “common sense” that pulling a 

screw from Brown’s flesh without anesthesia could carry a 

substantial risk of harm. Gil, 385 F.3d at 662; see also Petties, 

836 F.3d at 729. But even if Dr. LaVoie were to introduce evidence that he exercised medical judgment, his state of mind

would remain a question for the jury. Evidence to that effect
No. 22-1585 13

would merely contribute to the existing dispute about Dr. LaVoie’s motivation, and so his credibility and the weight to assign his testimony would be matters for the jury to decide. See 

Rasho, 856 F.3d at 476–77 (citing Anderson v. Liberty Lobby, Inc., 

477 U.S. 242, 255 (1986)).

As we noted earlier, the district court felt itself bound by 

our decision in Snipes, where we held that a prison doctor who 

decided not to anesthetize an inmate’s toe before removing a 

partially torn-off toenail did not act with deliberate indifference. See 95 F.3d at 591. The district court took Snipes to mean 

that a prison doctor need not apply an anesthetic when performing a minor surgery. And because removing a screw 

from the arm is not major surgery, the court reasoned, Dr. LaVoie did not act with deliberate indifference when he chose 

not to anesthetize Brown’s arm. Dr. LaVoie, both in the district court and on appeal, relies on the same understanding of

Snipes.2

But Snipes does not establish a rigid rule about the use of 

anesthesia, much less a rule about the line between major and 

minor surgery. As an initial matter, it is a far cry between the 

removal of a torn toenail and the extraction of a two-inch 

screw embedded beneath the surface of the arm. And once we 

look beyond the nature of the injury to the reasoning that supported Snipes, that case becomes increasingly inapposite. In 

Snipes, there was no question about the doctor’s motivation; 

the doctor was understood to have exercised his medical 

judgment, and the only issue before us was whether his decision not to administer an anesthetic conformed to

2 Dr. LaVoie withdrew his arguments on the merits of Brown’s Eighth 

Amendment claim, and so we do not elaborate upon them here.
14 No. 22-1585 

contemporary medical expertise and practices. As we have 

noted before, Snipes was based on the determination that “reasonable medical minds may differ over the appropriate treatment for” removing a busted toenail. King v. Kramer, 680 F.3d 

1013, 1019 (7th Cir. 2012). The doctor had to weigh the risks 

of using anesthesia (including the possibility “that an injection of anesthetic would have hurt more than quickly removing the nail”) in light of the benefits of doing so. Snipes, 95 F.3d 

at 591–92. Given the prevailing medical practices of that time, 

we determined that the balance could tip either way. Here, by 

contrast, the issue is whether Dr. LaVoie exercised any medical judgment, and there was no evidence at all indicating that 

he weighed the risks and benefits of using anesthesia for the 

extraction procedure. Our decision here is thus entirely consistent with Snipes. 

B. Qualified Immunity

Dr. LaVoie argues that even if he was deliberately indifferent to Brown’s condition, he is nonetheless entitled to summary judgment on qualified-immunity grounds. The district 

court agreed. But qualified immunity is not a basis for summary judgment here.

“The doctrine of qualified immunity protects government 

officials ‘from liability for civil damages insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have 

known.’” Pearson v. Callahan, 555 U.S. 223, 231 (2009) (quoting 

Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982)). We already have 

noted that Brown’s Eighth Amendment claim turns on Dr. LaVoie’s state of mind. If, in attempting to remove the screw as 

he did, Dr. LaVoie was motivated by a desire to punish Brown 

or otherwise inflict or prolong pain, then his conduct violated 
No. 22-1585 15

clearly established law under the Eighth Amendment. See, 

e.g., Gil, 381 F.3d at 661–62. Whether that (or something else)

was Dr. LaVoie’s motive, is a question that only a jury may 

resolve.

IV 

As we noted at the outset, Brown also challenges the district court’s denial of his second motion for recruited counsel. 

Given our decision on the deliberate-indifference element, we 

need not decide whether that denial amounted to an abuse of 

discretion. But on remand we encourage the district court to 

consider whether it might now be appropriate to recruit counsel to assist Brown. Cases involving state-of-mind requirements may be difficult for pro se litigants, see, e.g., Pruitt v. 

Mote, 503 F.3d 647, 655–56 (7th Cir. 2007) (en banc), and the 

considerations that inform whether to recruit counsel often 

change as a case progresses toward discovery or a trial, see, 

e.g., Perez v. Fenoglio, 792 F.3d 768, 785 (7th Cir. 2015). We are 

confident that the district court will revisit that decision on 

remand with Brown’s circumstances in mind.

The judgment of the district court is REVERSED and 

Brown’s case against Dr. LaVoie is REMANDED for further 

proceedings consistent with this opinion.
16 No. 22-1585 

KIRSCH, Circuit Judge, concurring in the judgment. I agree 

with the result. In reaching that result, the majority focuses on 

Dr. LaVoie’s comments to Brown, which a jury could view as 

dismissive, annoyed, or sarcastic. But we need not look to 

these comments at all. Instead, I would find a genuine dispute 

of material fact because the hospital staff “deemed it obvious” 

that Brown required anesthesia for the screw removal, and 

Dr. LaVoie has offered no explanation whatsoever for his refusal to administer anesthesia. Considering only this evidence, a jury could find that Dr. LaVoie was deliberately indifferent to Brown’s serious medical needs because his treatment decision was “so far afield of accepted professional 

standards as to raise the inference that it was not actually 

based on a medical judgment.” Arnett v. Webster, 658 F.3d 742, 

751 (7th Cir. 2011) (quotation omitted). For this reason, I agree 

that the district court’s grant of summary judgment should be 

reversed.