## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N o. 09

- 3280 K EV I N B. A RNET T, Plai nt i f f

-Appe l l ant, v. T HO M AS A. W EBS TER, M .D ., et al., D efend a nts-A pp ellees.

Appeal from the United States District Court fo r the S outhernDi stricto f Indian a, T erreH aute D ivisi on. No . 2:0 8-cv-09 9-WTL-WGH

—WilliamT. Lawrence , Judge .
A RG UE D M AR CH 30, 2011

— D ECI DE D S EP TE MBE R 12, 2011

Befo re F LA UM, W OO D , a nd T INDER, C ircu it Judges. T INDER, C ircu it Judge. K evi n A rnet t, a f or m erpri sone r at th e B u re au of P ris on s F ed er a l C or re c tio n al C om p lex in T erre H aute, Ind i ana, br ought thi s B iven s ac tio n, s ee Bive ns v. Six Unknown Nam e d Age nts of Fed
. Bure au of Narcoti cs , 4 03 U. S
. 38 8 ( 19 71 ) , f o r c r ue la nd un us ua lpuni sh

m ent un d er the Eighth A m endm ent a gainst a num bero f pr i so n offi ci al s f o r v i o l at i o ns he a l l eg ed o cc ur r ed dur i ng hi s te n month s ta y the r e. W he n Ar ne tt arr i ve d a t th e2 N o. 09

- 3280 Terr e Haute f aci l i ty i n N ov em ber20 06, he was s een b y Thom as W ebst er, M
. D., pri son cl i ni cal dir ecto r. A rnet t in for m ed D r. W eb s t er th at h e h ad rh eu m at oid art h rit is ( RA ) , a seve re and debi l i tat i ng for m o far thri ti s which i s pr o g r essive an d c au se s painfuli nfl amm at i o n o fthe j oi nts and s urr ounding ti ssues , and a ske d for E n bre l ( et an er ce pt) , a medi ca ti on A r ne ttha d b ee n t ak i ng b efo re arr ivin g a t t h e p ris on th at h a d b ee n su c c es sfu l in co nt r o l l i nghi s co ndi ti o n. Bec au se Enb r elwas n’ t o n the pr i so n’ s appr o ve d f o r m ul a r y, p r i s on m edi c a lp e r s o nn e lh a d t o s e e kp r i o r a ppr o va lt o pr escribe the medi ca ti o n b y s ubmi tt i nga no nf or m ula rydrug author i zati on r equest to th e C entr al Offi ce o fthe Bur ea u o fPr i so ns i n W as hi ng to n, D. C. ( BOP) Dr. W ebst ersubm i tte d a r eq uest f orA rnet t t o re cei ve Gab ape nt i n, us ed to t r ea t ne r ve pa in, b utno t Enbr el, a nd al so subm i tte d app ro valf ora consul tat i on w i th an ou ts id e rh eu m at olo gis t. W
. E ric W ilso n, M .D ., st aff p h ys ic ian atTer re H aute, bec am e Arnett’ s pri m ar y c ar e physici an o n Decem ber28 , 20 06. A n o utsi de rhe um ato l ogi st exam i ned A rnet t in Feb ruar y 2 007, and i t ca n be i nfe rr ed th at h e d ire c te d D r. W ilso n t o p lac e A rn et t b ac k on E nb re l. D esp ite the rheu m atologist’s instru ction an d A rne t t ’s re peated pl eas f orthe m edi cati on and co m pla i nts o f continued pai n and sw el l i ng, he di dn ’ t r ece ive Enbre l until O c to b er5, 20 07, el eve n days b ef or e he w as tr ansfer re d fr om the f aci l i ty t o a hal fw ay house. A rnet t was to l d b y the de fen dan ts dur i ngthe mor e th ant enmonths he wait ed f orthe drug thatt h e no n-for m ula ryr equest had been s ubm i tte d, they w er e wai ting f ora re sponse fr o m the BOP, a nd wer e o th er wi se “ wor k i ngo n i t. ” I n theN o. 09

- 3280 3

m ea nt i m e, Arn et t was pr es cr ibed pai n medi cine , b ut nothi ng to tr eatthe i nfl am m ati on a nd deter i or ati on o f hi s j oi nts. B e c a u s e A r n e t ts o u g htl e a v e t o p r o c e e d i n f o r ma pau per i s, the di st r i ctc o ur t sc r ee ne d hi s co m pl aintpur su ant t o 28 U
. S. C. § 1915 ( e) ( 2) ( B), and in so doi ng, di sm i sse d al lthe defen d an ts, exce pt Dr. W ebst er, o n the basi s that A rn et t fa iled to st at e a cla im u p on w h ich relie f co u ld be g ra nted. (S hor tl y a fterscr eeni ng, A rnet t’ s ca se w as tr ansferr ed fro m J ud ge Ric hard L. Young t o J ud ge W il li am T. Law r e n ce.) D r. W ebst er then fil ed a sum m ary j ud gm ent m oti on and the di str i ct c ourtgr anted that m o tion. The di st r i ctc o ur t en te r ed j udg m en t, di r ec ting that pla i nti ffta ke nothi ng byhi s c om pla i nt. A rnet t appeal s both rul i ngs and we affi rm i n part an d r eve rs e i n part
. W e a ffi rm dism issal o fthe non- m edi caldefen d an ts on th e p lea d i n gs , bu t fin d th at A rn et t p ro p er ly s t a t e d a c l a i m a g a i n s tth e me d i c a ld e fe n d a n t s . We , h o weve r, a ffi r m t he di s t r i c tc o ur t ’ s g r a nto fs ummar y j ud gm ent in f avo r ofDr. W ebst erbec ause A rnet t f ai l ed to m eethi s bur den to subm i t e vi dence upon w hi ch a re asonab l e j ury coul d find thatD r. W eb ste r acte d w i th del iber ate i nd i ffer ence.

I. Facts A rnet t brou gh t t h is suit against the foll ow ing Te rre Ha ut e p r i s o n e mpl o y e e s f o r v i o l a t i o n o fh i s Ei g hth Am e nd

m ent r i ghts: W ar den Richar d Veach, H eal th S er vi ces A d m in ist ra to r J u l ia B eig h ley , C as e M an ag er D av id Pa rker, StaffPh ysician W
. Eric W il son, M
. D
. , Ph ysic ia n’s4 N o. 09

- 3280

T he d efen d an ts arg u e tha t there is no thin g in the reco rd to 1 s u p p o r tth e se fa c t s, b u tth e y c a n b e fo u n d in D r . B e r g q u i st ’s S e p t e mb e r 5 , 2 0 0 7, l e t t e r th a twa s a t t a c h e d t o A r n e t t ’ s c o mplaint

. W e al so not e tha t se veral authorit ati ve source s su p p o rt th is d es cr ip tio n o f th e d ise a se . SeeThe M erc k M anual of D iag n os i s and Ther apy 2 8 3

- 8 9 ( 1 8 th e d. 2 0 0 6 ) ( s t a t i n g th a tRA i s a c hr on i c a ut oi m m un e di s e a s e r e s ul t i ngi n pr ogre s s i ve des t ru c t i on ofthe j oi nt s )
. W hi l e Arne tt w i l l ne ed t o pr es en t adm is sible e v idence t o subst anti ate such f act s f or purp oses of s um m ar y j udgm en t, he does not ne ed t o do s o at the pleading st age. A ssi sta nt Yves A
. Paul

- Bla n c , and Clini calDir ecto r Thom as A
. W ebst er, M
. D. ( A rnet t al so sued the Fed er al Bur ea u o fPr iso ns , b utr ec o g ni zingtha t di smi ss alo fthe BO P w as proper, he ha s no t a pp eal ed that rul i ng. ) Because we a r e r evie wi nga di smi ss ala t bo ththe pl ea di nga nd su m m ar y j udg m en t st ag e, we be g i n b y s et tingf o r ththe al legati o ns a nd f ac ts i n Ar ne tt ’ s co m pl ainta nd do cum en ts at ta c h ed th er et o. SeeRegerD ev ., L L C v. Nat’lCity Bank, 59 2 F
. 3d 759, 76 4 ( 7th Ci r. 20 10) ( On a m oti on t o d i s mi s s “ [ w] e c o n s i d e r d o c u me n t s a t t a c h e d t o th e c o mpla i nt as parto fthe com pla i nt i tse l f

. ”) I n 2 00 1, Arnett was di agno se d wi thRA byhi s tr ea ting p h y s i c i a n, S t e v e n R
. B e r g q u i s t, M. D
. R A i n v o l v e s a u t o i mm u ne r eact i ons and i s a pro gr ess i ve dise ase thatcause s pai n and i nfl am m ati on in the j oi nts. A ftero therm edi ca- 1 ti o ns pr o ve d uns ucc es sfuli n c o nt r o l l ing hi s co ndi ti o n, D r. Berg quis t pla ced A rnet t on the drug Enbre l in J an ua r y 2 00 4. Enbr elre duce s j o i ntswel l i ng, hel ps pr ev en tN o. 09

- 3280 5

E nb re l is u se d t o r ed u ce t h e p ro g re ssi o n o f R A
. SeeThe M er ck 2 M anual of

Di agnos i s and Ther apy 2 8 9 ; seeal so P h y si ci an s’D esk R ef er en c e 63 1 ( 65 th e d. 20 11 ) ( “Enbr eli s i ndi c at ed for re duci ng s i gns an d s ym pt om s , . . . i nhibi t i ng the p ro gr es s i on of struc tu ral d am ag e, and im p ro v ing p hy sical fun ction in pat ie nts w ith m od erat el y or s everel y acti ve [ R A ]
. ”)
. The d efe n d a n ts’ cha rac teriza tion of En b rel as “p ain m ed icatio n” is a m is nom er. Thi s f ac ti s n’ tf ound i n Ar ne t t ’ s c om pl ai ntor at t ac he d doc u- 3 m en t s , butwe s t at e i the re t o pr ovi de r el evantbac kgr ound inf orm atio n . Itcan be f ound i n the sum m ary j ud gm ent rec ord in a le tt er from D r. Bergquistdated A pril 2 0 , 2 009. This inf orm atio n is sup p or ted b y E nb rel’s w eb site a nd au tho ritativ e text. S ee ht tp: //w w w .e n brel .com /w hat-is- EN BR EL
. j spx ( las t vi si ted Sept
. 7, 2 0 1 1 ) ( “ Pe op l e wi th i nfl a m m a t or y di s e a s e s s uc h as rh eu m ato id arth ritis
. . . ha v e too m u ch T N F i n th e i r b od ies. E nb re l re d u ce s le v el s o f t h e a c tiv e fo rm o f T N F .”); seeal so M os by’s N urs i ng D rug Ref erence 49 1- 92 ( 25 th e d. 20 12 ) ( s t at ing thatEnbr el“[ b] i nds [ TN F] , whi c h i s i nvol ved i n i m m une a n d in fla m m a to ry re a ct io n s.” ); P h y si ci an s’D esk R ef ere n ce 639 ( “En brel can red uce the effectofTN F in the bod y and block th e d a m a g e t h a t to o m u ch T N F ca n ca u se . . . . ” ). damag e to the j o i nt s, a nd was e ffec ti ve i n de cr ea sing 2 A rn et t’s infla m m at ion an d ac c om p an yin g p ain . E nb re l is a p r o t e i n tha t inh ib i t s i nfl a mm a t i o n i n the b o dyb y s up press i ng a substa nce pro du ced by the i m m une sys tem known as tum ornecros i s f acto r ( TN F)
. S ubsequentl y, 3 Arne ttwas c o nv i ct ed of a fede r alc r i m i na lo ffen se a nd sentenc ed to i m pr i so nm en t. He s el f

- su r r en der ed atthe Te r r e H au te p r i so n o n Nov embe r 1 , 2 00 6, a nd whe n h e ar r i v e d, h e b r o ughth i s Enb r e lme di c a t i o n, b utpri son offic ials co n fisc at ed it u p on arr iva l.6 N o. 09

- 3280 Dur i ngthe ne xtt enmonths , A rne ttl o dge d numer o us or al a n d w rit te n co m p lain ts to th e d efe n d an ts for E nb re l, but to no avai l

. Dr. W ebst erexam i ned A rnet t tw i ce i n N ove m ber20 06. Duri ng bo th exam s, A rnet t t old Dr
. W eb st ertha t he ne ede d Enb rel to co nt r o lhi s RA an d th a t b ec au se h e d id n ’t h av e t h e m ed ica tio n, his j oin ts w er e s w ol l en, es peci al l y hi s knees, and he was i n i ntense pai n; thi s r esul ted i n A rnet t hav i ng to walkwith a can e. D r. W eb s t e r agreed that A rnet t’s j oints w ere sw ol l en. In re sponse to hi s r equests forEnbrel, Dr. W ebst er sa i d, “ W e’ l lwor kon it. ” Dr
. W eb st era tt es te d tha t he ha s n o r e c o l l e c t i o n o fme e t i n gwi th Ar n e t to r d i s c u s s i ng hi s r equest f orEnbrel

. A rnet t a l so i nfo rm ed W ar den Ve ac h in De ce m be r 2 00 6 th athi s Enbr el had be enc o nfi scat ed by pri son em plo yees an d that he needed i t t o contr olhi s RA
. Veach t old A rnet t t o tal k t o H eal th Se rv i ces A dm i ni str ator Bei ghl ey. A rnet t co m pla i ned to Bei ghl ey and she t ol d him to put hi s r equest i n w ri ti ng, whi c h he di d. Dr
. W i l so n b ec ame Ar ne tt ’ s p ri m ar y phy si ci ana t th e p rison beginn ing D ecem ber 28, 2006; he saw A rnet t every ot h er m on th u n til h is t ra n sfe r f r o m th e fa c ility in October20 07. Each ti m e he m et w i th Dr. W i l son, A rnett i nf o r m ed hi m he ne ede d Enb r ela nd withou t i t, he suffer ed fro m j oi nt swel l i ng, part i cul ar l y in h i s knees. Dr. W i l son exam i ned A rnet t’ s knees an d o therj oi nts an d agreed they w ere sw oll en . In re s p o n se to A rnet t’s re que st , D r. W i l son sta ted thathe ha d fi l l ed out new for m s t o ge t E nb re l th at h ad to be se n t t o th e B O P in W a s hing t o n, D. C.N o. 09

- 3280 7 A rnet t’s m ed ical fi le w as pres en ted to the p rison’s uti l i zati on r evi ew co m m i tte e o n N ove m ber16 , 20 06 , for consi derat i on o fDr. W ebst er ’ s r eco m m en dati on that A rnet t r ecei ve a co nsul tat i on w ith a r heum ato l ogi st f or hi s RA; the c o m m i tt ee c o nc ur r ed th atr ev i ew o fArnett’s condi ti on by an o utsi de consul tant w as w ar ra nted. A rnet t was s ee n b yDr
. Henr y Da vi s, a r he um at o l o g i st, o n F eb r uar y 7, 20 07. Dr. Davi s wrot e a l ett erto D r. W ilso n that A rnet t a tta ched to hi s co m pla i n t. T he l ett erexpl ai ned th atArn et t’ s R A h ad ca us ed hi m “ ac ut e swe l l i nga nd pai n i n hi s hand s, w ri sts , knees, and n eck” and thatwh en he s t a r t e d o n Enb r e l, h e di d “ f a i r l y we l l, ” b uth a s b een w i thout i t fo r the l astf our m onths. Dr. Davi s no ted th at A rne ttha d “ be ent ak i ngPe r co ce t an d Nor co wi th

ou t an y ben efit .” D u rin g his ex am in at ion, D r. D av is note d sw el l i ng and te n d erness i n differ ent a re as of A rnet t’ s bo dy and gave hi m an inj ecti on ofDepo- M edro l ( m ed icati on use d to tr eatj oi nt pai n and sw el l i ng tha t occur s w i th ar thri ti s) i n hi s ri ght shoul der. H e sta ted to Dr. W i l son, “Iwould l i ke f or[ A rnet t] to r esum e Enbre l 15 m g o nce a w eek

. ” ( M ore w ill be s ai d about Dr. Davi s’ c om m en t la te r.) A rn et t s till d id n ot r e c e i v e E nb re l, so in A pri l20 07, he a ga in i nfo rm ed Veach that he needed the dr ug to co ntro lhis R A . V each a gain to l d A rnet t t o ta lk to B eig h ley . A rn et t’s m ed ica l ch ar t d at ed A p ril 4 note d that Arnettwas havi ng pai n i n h is ri ght knee and that he r ecei ved “Enbreli nj ecti ons , b u t that was st op p ed w h en h e a rriv ed h er e.” B e t we e n F e b r u a r y and J u l y 2 0 0 7, Ar n e t td i r e c t e d t wo m or e o ra lrequests to B ei ghl ey f orE nbrel

. Bei ghl ey sta ted tha ta r e qu e s tf o r the m edi c a t i o n ha d b e e n s ub mi t t e d,8 N o. 09

- 3280 b uti th a d n o ta r r i v e d. OnJ un e 2 8 , 20 0 7, Ar ne t tfi l e d a w ri tte n re quest with Bei ghl ey f orEnbrel, and sta ted that he was i n i n te n se p ai n fro m hi s j oi nts s w el l i ng ( he descr ibed hi s pai n, “I ’ m walk i ng o n b on e on bo ne and have a lot o f p ain in m y kn ee ”), h ad n otbe en p ro vid ed a su b st itu te for E n b r el, an d h ad n otbe en se en by th e o rt h op ed ic speci al i st as prom i sed. H e r equest ed thathe b e s een b y ei th era r he um at o l o g i sto r a n o r thope di c spe ci al i sts o he co ul d g eta n inj ectio n in h i s k ne e to r el i ev e th e pain. Bei ghl ey re sponded , “You ar e on the l i st to be see n by the o rtho. ” On J uly26, Arnett w as evaluated byan o rthopedic surg eon f orc om pla i nts o fr i ght knee pai n re l ate d to his RA cond iti on an d the su rgeo n inj ecte d A rnet t’s kn ee w ith D ep o-M ed ro l. A rnet t be gan s eeing Physi ci an’ s Assi sta nt Paul

- Blanc on a da i l y b a s i s b e g i nn i ng i n M a y 2 0 0 7
. Ea c h t i me he sa w Paul- Blanc, A rnet t r ei ter ate d his pl ea f or Enbre land sta ted that because he ha d not be en ta ki ng the d ru g, hi s j oi nts wer e swo l l ena nd he was in int en se pa i n. Pa ul

- Bl an c agr eed thatA rnett’ s j oi nts were swol l en. In re sponse to A rnet t’ s r equests , P aul

- Blanc sta ted thata re quest for th e d rug h ad been m ad e bu t t h a t h e h ad not yet h eard anythi ng fro m W ashi ngto n, D. C. St ar ti ng i n M ay 2007, A rnet t a l so w ent t o Case M an ag er Par kertwo to thr ee tim es a w ee k a n d req u es te d th at h e b e p lac ed on E nb re l. Park er to l d him to “t al k t o Blanc. ” Arnett al so fi l ed an adm i ni str ati ve cl ai m f ordam age s with Park er, wh i ch Park erdeni ed. A rnet t a pp eal ed to Veach, w ho a l so d e n i e d th e c l a i m. On Septem ber5, 20 07, upon A rnett’s re quest, Dr. Berg

qui st( Arne tt ’ s f o r m erphy si ci an ) wro te a l et te r t o theN o. 09

- 3280 9 pri son ( “To W hom i t M ay Concern”) th at A rnet t a tta ched to hi s co m pla i nt. Dr. Berg quis t s tat ed that A rnet t ha d b ee n un d er hi s ca r e f o r RA s i nc e J une 2 00 1, tha t he had b ee n on num er ous m edi cati ons and ei therdi d not tol er ate the m edi cati ons ordi d not s how i m prove m ent, an d tha t w he n tak i ngEnb r el, hi s j o i ntpa i n a nd s wel l i ng decrea sed. Dr. Berg quis t pointed out that R A i s a pro g r es si ve di se as e an d i fthe pa i n a nd s wel li ng ofthe j oints is not con troll ed , furth er j oint d am age can occu r. H e con cl ud ed that he tho ught i t “ appropri ate f or M r. A rnet t t o be r eev al uated bya rheum ato l ogi st to hel p m ake the deci si on a s t o the b esttr eat m ent for M r. A rn et t’s rh eu m at oid art h rit is.” A p p ar en tly in re sponse to Dr. Berg quis t’ s l ett er, the pri son fi nal l y g ave A rnet t a n i nj ecti on o fEnbrel

. H e was r el eas ed fro m pri son el eve n days l ate r on Octo ber16
. Ar n e t t a l l e g e d th a t th e “ i n t e n t i o n a l r e fu s a l b y t he Feder alBur ea u o fPr i so n’ s per so nne lt o g i ve [ hi m ] the m ed ication E nb rel

. . . con stitut e[d] a d eliberat e ind ifferen ce t o [ hi s] o bv i o us medi ca lc o ndi ti o n b y tho se de fen dan ts , the r eb y r es ul tingin s ubs tan tial pa in a nd su ffering .
. . and i rreversible ph ysical dam age an d de form ity ofhis joints.” H e asserted that he w as sim p ly left unt r ea te d dur i ngthi s te n- m o nth plus del aywhi l e he “u nne ce ss ar i l y s uffer ed from co nt i nua la nd o ng o i ng pai n and advanci ng physi caldeter i or ati on” i n vi ol ati on ofthe Eighth A m endm ent. W e no w turn to the sum m ar y j ud gm ent r eco rd, supplem en ting th e f acts set forth above only w he re nec essary and constr uingtho se f acts i n l i ght m ostf avo rab le t o10 N o. 09

- 3280 A rnet t. W hen A rnet t a rr i ved at T er re H aute, he ha d se ve r almedi ca lpr o bl ems in a ddi ti o n t o RA, i ncl udi ng c h r o n i c He p a ti t i s C , wh i c h r e s u l t e d i n o v e r t we n t y - t wo encounter s with the m edi calde partm ent o r m edi cal con su ltations w ith sp eciali sts du ring his stay at T e rre H aute. Dr. W ebs te r did a fullphysi calexam o n A rnet t a few da y s afte r he s el f

- su r r en der ed atthe pr i so n a nd again on N o v e m ber 16. Dr. W ebst er review ed A rnet t’s m edi calr eco rds, and A rnet t info rm ed hi m thathe was previ ousl y prescribed Enbreland that thi s drug w as effe c tiv e in co n tr ollin g h is R A an d a l l ev iat in g t h e p ain an d s wel l i ngi n h i s j o i nt s. ( Dr
. W eb st erdi spu te s an y aw ar en es s t h at A rn et t w as t a k in g E nb re l be for e h is ar ri valatthe pri son, but A rnet t has pre sente d evi dence su p p or tin g t h is fa c t, an d w e m u st ac c ep t itas tru e.) Dr. W ebst erwas al so aw ar e that Arnett had been tak i ng the drug Gaba p en tin to tr eatneuro pathy ( nerv e dam age ) and re sul ti ng n er ve pain. Gabapenti n, l i ke E n bre l, was not on the pri son’ s a pp ro ved f or m ula ry . W hen a drug i s no t o n the appr ov ed list, a physi ci an want i ngt o prescrib e th e m edi ca ti o n musts ubmi t a no nf or m ula rydrug author i zati on r eq u est to the BO P f or approval

. Dr. W ebs te r com ple ted such a r equest f or Gab ape nt i n a nd a utho r i ze d Arn et t’ s te m po r ar y c o ntinue d us e o fthe dr ugf o r f o ur te enda y s, pe ndi ngthe d ec isio n o ft h e n on -for m u lar y re q u es t. D r. W eb st er d id not subm i t a r equest f orEnbrel

. H e i ssued A rnet t a pass f ora l ower bunk, r enewed hi s pai n m edi cati on Pe rc oc et, o r d e r e d x - r a y s , a n d s u b mi t t e d a n a p p r o v a l f o r a co nsul tat i on with a rhe um ato l ogi st to the pr i son re vi ew com m i tte e.N o. 09

- 3280 11 A rnet t w as th en assigned to Dr. W il son . A rnet t’s m e d i c a lc h a r to n D e c e mb e r 2 8 , 2 0 0 6 , i n d i c a t e s : “ R A; r efer r alt o r he um at o l o g y pe ndi ng, tr y i ngt o g etEnb r elb ut n ee d th is c on su lt firs t a s c en tr al off ice req u i r e s i t (it is obvi ous he has RA )
. ” A s disc ussed abov e, the req u es t fo r an o utsid e consul tat i on was approv ed and A rnet t s aw Dr
. Da vi s i n F eb r ua r y 2 00 7. Dr
. W ebst er a ve r r ed th athe was no t Arn ett’ s pr i m ar y c ar e phy si ci ana nd “ ha d no pers onali nvol vem ent with Pl ai nti ff’ s m edi calcar e o ther than r e v i e wi ngh i s c ha r ta nd me di c a t i o ns wh e n he fi rs t ar ri ved atFCC Terre H au te. ” He re i ter ate d, “Iwas not Pl ainti ff’ s pri m ar y c ar e physi ci an and h ad n o i nvol vem en t w ith th e re q u es t fo r E nb re l.”A fe w w ee ks aft er h is February20 07 exam byDr. Davi s, how eve r, A rnet t s aw Dr. W ebst eri n the m edi caluni t a nd poi nted out that D r. D av is s ta te d h e s h ou ld be p lac e d b ac k on E nb re l. Arne tt as k ed Dr
. W eb st er what he ha d do ne ab o utg et ting ap p roval f or Enbrel and Dr. W ebst er resp ond e d , “W e’re w or kin g on it.” A rnet t’ s pre scr i pti on f orPer c ocet co nti nued to be re n ew ed . Th e n on -fo r m u lar y re q u es t fo r G ab ap en tin w as d en ied , so h e w as ins te ad p re sc rib ed a n ew p ain m edi cati on, Topam ax , i n Decem ber20 06. These drugs w er e pr escr ibed f or t hei r use in al l evi ating pai n, not r e d u c i n gi n fl a mma t i o n o r s l o wi n gth e p r o g r e s s i o n o fR A. I n A p r i l 2 0 0 7, A r n e t tw a s s e e n d u r i n gs i c kc a l lf o r c o mpl a i nt s o fr i g htkne e p a i n; x - r a y s w e r e o r de r e d a nd a c o ns ent f o r o r tho pe di c c o ns ul t a t i o n wa s c o mpl e t e d. On J u ly 9 , A rn et t w as ev alu at ed d u rin g a ch ro n ic c ar e c lin ic vis it. T h e re c or d ind ica te s t h at h e c on tin u ed to co m p lain ofj oi nt pai n and press ure i n h is knees and that he “[ w ] as12 N o. 09

- 3280 to re cei ve Enbre lbut hasn ’t. N eve r hear d back fro m th e no n- f o r m ul ar y r eque st
. ” The r ec o r d fur th eri ndi ca te s “R eque st E nbr ela g ain” a nd “ Re que stf o l l o w up w i th r heum ato l ogy . ” I t then r eads, “S tar t: Enbrel 15 m g s q per w eek( non f or m ula rysubm i tte d). ” In J uly, Dr. W ebst er al so si gned a re cor d ofm edi calcar e s tat i n g that the uti l i za ti o n r ev i ew c o m m i tt ee a ppr o ve d a f o l l o w-u p appoint m ent w i th Dr. Davi s t o consul t forRA “ASA P. ” A c on su lta tio n sh ee t th at sa m e d ay st at e s “ Sc h ed u le follo w u p co n su lt for [R A ] .
. . A d vis ed to st ar t E nb r e l.” Dr. W i l son subm i tte d a r equest f ora follo w up consul tati on with Dr. Davi s. A rnet t’ s m edi calchar ts i nd i cate th a th e wa s fi n a l l y g i v e n E nb r e lo n Oc t o b e r 5 , 2 0 0 7
. He w as tra n sfe rre d to a h alf-w ay h ou se on O c to b er 16
.
I I . Di s c us s i o n T he dist ri ct cour t dism i sse d W ar den Veach fro m th is acti on o n the basi s that he onl y had an adm i nist ra ti ve r o l e a n d d i s mi s s e d a l lth e o th e r d e fe n d a n t s , e x c e pt Dr. W ebst er, o n the basi s that the re w as n o al l ega ti on i n the com p lai nt sugg est i ve that these defendants ac ted w i th the r eq uis i te m entalst ate o fdel iber ate i nd i ffer ence to s uppo r t a cl ai m unde r the Ei g hth Am en dm en t. The d istri ct cou rt (after the case w as tran sferred to a differ ent j ud ge) then gr anted sum m ar y j ud gm ent in f avo r of D r. W eb st er rea so n in g t h at A rn et t fa iled to su b m i t ev idence showinga genui ne i ssue ofm ate ri alf act that Dr
. W eb st erwas de l ibe r at ely i nd if fer en t to hi s se r i o us m edi calneeds. W e a gr ee that A rnet t f ai l ed to st ate a cl ai m a g ains t th e no n- m edi ca lde fen dan ts, V ea cha ndN o. 09

- 3280 13

M a ny o fthe c a s e s c i t e d i n thi s o pi ni ona r os e un de r 4 2 U. S
. C. 4 § 19 8 3
. Bi ve ns au tho rizes th e fil ing of con stit u t i o na l tort su its a ga i ns tfe de r a l o ffi c e r s in m uch the s a m e wa y tha t4 2 U. S
. C. § 19 8 3 au th o ri z es su ch su its ag a in st st a te o ffice rs . A sh cr oftv. Iqbal, 129 S. C t. 1937, 1948 ( 2009) ( st ati ng that a Bi ve ns ac t i on is the fed era l an alo g to suits b ro u g ht aga inst state o ffi c i als u n d er § 1 9 8 3 ); see a lso K ing v. F ed . B u rea u of P rison s, 415 F. 3d 6 3 4 , 63 6 (7t h C ir . 20 0 5 ) (sam e). Pa rker, bu t d isagree tha t A rnet t’s all egation s w ere in s uffi ci ent t o sta te a cl ai m ag ai nst the m edi caldefendants, D r. W il son, Be ighley, and Pau l- B lanc. W e agree, how ever, that the r eco rd o n sum m ar y j ud gm ent i s insuffi ci ent t o al l ow a re aso nabl e j ury to i nfe r that Dr. W ebst eracted w ith d elib er at e in d iffer en c e. “Th e E i ghth Am endm ent s afeguar ds the pri sone r ag ain sta lac k of m ed ica l ca re th at ‘m ay res u lt in p ain an d s uffer i ngwhi chno o ne s ug g es ts w ou ld se r ve a ny penol ogi calpurpose. ’ ” R odriguez v. Plym outh A m bula n ce Se r v. , 57 7 F
. 3d 816, 82 8 ( 7th Ci r. 20 09) ( quoti ng Est e l l ev. G am ble, 4 29 U
. S. 97, 10 3 ( 1976 ) )
. Pri son offi ci al s v i ol ate 4 the Const i tuti on i ftheyar e del iber ate l y ind i ffer ent t o pri sone rs ’ se ri ous m edi calneed s. E st el le, 42 9 U.S
. at10 4. A ccord ingly, a c la im based on d efi cientm ed ical care m u st d em on st ra te tw o e lem en ts : 1) an ob j ec tiv ely ser i ous m edi calco nd i ti on; and 2 ) an offi ci al ’ s del iber ate in d iffer en c e t o th at co n d itio n . See Jo hn son v . S n yd er, 44 4 F.3 d 57 9, 58 4 (7 th C ir. 20 06 ); see a lso R o e v. E lyea , 63 1 F. 3d 843, 85 7 (7 th C i r. 20 11)
. “Del iber ate i nd i ffer ence to ser i ous m edi calneeds ofa pri sone r const i tutes the unneces sa r y a nd wan to n infl i ct i o n o fpa i n f o rbi ddenb y the14 N o. 09

- 3280 Consti tuti on. ” R o drig uez , 5 77F
. 3d at8 28 ( quo ting E st el le, 429 U
. S. at 103). The defe nd ants don’tdi sag re e that Arnett suffer ed fro m a ser i ous m edi calco nd i ti on. See N o rfleet v. Webster, 43 9 F .3d 39 2, 39 5 (7 th C ir. 20 06 ) (fin d in g t h at rh eu m at oid ar th rit is is a s er iou s m ed ica l ne ed ). A n d be c au se it is u n d isp u te d th at th e d efe n d an ts w e re aw ar e o f th is ser i ous m edi calneed, o ur focus i s o n w hetherthey ac t e d wi th de l ib e r a t e i nd i ffe r e nc e i n the i r r e s po ns e. D elib er at e in d iffer en c e is a su bj ec tiv e s ta n d ar d

. Johns on , 444 F. 3d at 585. To dem onst ra te del iberate i nd i ffer ence, a pl aint i ffmusts ho w tha t th e defen dan t “a ct ed wi tha suffi ci entl y c ulpabl e s tat e o fm i nd , ” s om ethi ng ak i n to re c kle ss n es s. Id. A p ris on offic ial a c ts w ith a su fficie n tly cul pabl e s tat e o fm i nd wh en he knows ofa substa nti al ri sk ofhar m to an inm ate and ei theract s or fails to act ind isr e g a r d of th at risk

. Roe, 63 1 F
. 3d at 857. Del iber ate i nd i ffer ence “i s m or e than negl i gence and a p p ro aches i ntenti onalwrongdoi ng. ” Coll ignon v . M i l wauke eCnty. , 16 3 F .3d 98 2, 98 8 (7 th C ir. 19 98 ). In oth er w or d s, “[d ]elibe r at e i ndi ffer ence i s no t m edi ca lmal pr ac ti ce ; the E igh th A m en d m en t d oe s no t cod ify c om m on law t o rt s.” D uc k w o rth v . Ah m ed, 53 2 F
. 3d 675, 67 9 ( 7th Ci r. 20 08)
. “A j ury ca n infer de liberat e ind ifferenc e on th e b a s is of a p h ysi ci an’ s t re atm ent deci si on [ w hen] the deci si on [ i s] so f arafi el d ofacc epted pro fess i onalst andards as to r ai se the i nfer en ce tha t i t was no t ac tu all y bas ed o n a m edi cal jud gm ent. ” Id. (qu ot at ion m ar ks om itt ed ). A pla i nti ffca n s how thatthe profess i onaldi sr ega rded the need onl y i f the profess i onal ’ s subj ectiv e response w as so i nadequ ate thati t dem onst ra ted an absenceN o. 09

- 3280 15 of p ro fes sio n al jud gm en t, th at is, th at “n o m in im ally com petent profess i onalwould have so re sponded und ertho se ci rcum sta nces. ” Roe, 631 F. 3d at 857 ( quotati on m arks om itted ). A pri sone r, however, “ need not prove thatthe pri son offi ci al s int en d ed, hoped f or, o r desi re d the har m that tr anspi re d.” Wal k er v . B enj am in , 29 3 F
. 3d 1030 , 10 37 ( 7th C ir. 20 02 ); se e also D uckw orth , 53 2 F
. 3d at 679 ( “[ A ] l though del iber ate m eans m or e than neg l i gen[ ce] , i t i s s om ethi ng l ess than pu rpos eful. ”)
. N ord oe s a pri sone r need to s h o w th at h e w as liter ally ign or ed

. G reeno v. D a ley, 414 F. 3d 645, 653 ( 7th Cir
. 2005 )
. That the pr iso ner re cei ved so m e t re atm ent doe s no t for ecl ose hi s del iber ate i nd i ffer ence cl ai m i fthe tr eat m ent r ecei ve d was “so bl atant l y inapp ro pri ate as to ev i dence i ntenti onalm i str ea tm en t li ke ly to se riou sly ag gr av at e hi s c on d itio n .” Id. (qu otation m arks om itted ).

A . Sec ti on 1915(e)(2) S creen ing of Com p laint Ou r re vi ew o fa dism i ssa lunder § 19 15( e) ( 2) ( B) for fai l u r e to st at e a cla im is d e n ov o. D eWa lt v. C a rter, 22 4 F
. 3 d 6 0 7, 6 1 1 ( 7 th C i r . 2 0 0 0 )
. We a pp l y th e s a me st an d ar d u se d for e va lu at in g d i s m iss als u n d er R u le 12 ( b) ( 6) o fthe F ede r alRul es of C ivi lPr o ce dur e, “ ta k i ng al lwel l

- pl ea ded al l eg at i o ns o fthe c o m pl aint as t r ue an d v i e wi n g th e m i n th e l i g h t mo s t f a v o r ab l e t o the pla i nti ff

. ” S an t i ag o v. Walls , 5 99 F.3d 74 9, 756 (7th Cir. 2010 )
. To s ati sfy the not i ce- ple ading st andard ofRule 8 ofthe F ede r alRul es o fCi vi lPr o ce dur e, a c o m pl aint m u st p ro vid e a “s h or t a n d p lain st at em e n t o f th e c laim16 N o. 09

- 3280 showing that the pl eaderis enti tl ed to r el i ef, ” which i s suffi ci ent to provi de the defe nd ant with “f ai r noti ce” of th e c laim an d its ba sis
. Er i c ks o n v . Pa r dus , 5 51 U
. S. 89 , 93 ( 2007 ) ( per curi am ) ( ci ti ng B el l Atl. Co rp. v. Tw om bly, 55 0 U. S
. 5 4 4 , 5 5 5 ( 2 0 0 7 ) a n d qu o t i n gF e d

. R
. Ci v . P
. 8 ( a ) ( 2 ) )
. We m u st how eve r const rue pro se com pla i nts l iber ally and ho l d them to a l ess str i ngent sta nd ar d than form al p lea d in gs d ra fte d by law ye rs . Eri cks on , 55 1 U.S
. at94 (c ita tio n om itt ed ); O br ie cht v. R aem is ch , 51 7 F. 3d 489, 49 1 n.2 (7th C ir. 2008). Re c ent c ase s instr uct us to exam i ne wh etherthe al l ega ti ons i n the com pla i nt sta te a “pl ausibl e” c laim f or r e l ief. Iq b al , 1 2 9 S
. Ct
. a t 1 9 4 9
. To s ur v i v e a mot i o n to dism i ss , the com pla i nt “m ust co ntai n suffi ci ent f actual m att er, acc epted as tr ue, to s ta te a cl ai m to r el i efthat i s pl ausibl e o n i ts f ace. . . . A cl ai m has f aci al pl au sibi l i ty when th e pl aint i ff pl ea ds f ac tu al c o nt en t that al l ow s th e courtto draw the r eas onabl e infe re nce th at th e d efe n d an t is liab le fo r t h e m isc on d u c t a lleg ed .” Id. The c o m pl aint“ m us t ac tuall y s ug g es t th atthe pl ainti ffh as a ri ght t o re l i ef, bypro vi ding al l ega ti ons that ra i se a rig h t to re l i efabo ve the s pecula ti ve l eve l

. ” Wi ndy City M e t al Fabr i ca t ors & Su pply, Inc . v. CI T Tec h. Fi n. Se r vs ., 5 3 6 F
. 3 d 6 6 3 , 6 6 8 ( 7 th Ci r . 2 0 0 8 ) ( qu o t i ng Tam ayo v. B lagoje v ich , 526 F.3d 10 74 , 108 4 (7 th C ir. 20 08 )). Th is doesn’ t i m pose a probability re quir em ent o n pla i nti ff s: “a w ell-p le a d ed co m p lain t m ay p ro c ee d ev en if it st rik es a sa vv y jud ge th at ac tu al p ro of of t h os e fa c ts is i m pr o babl e, a nd tha t a r ec o ve r y i s very r emot e an d unl i kel y. ” Tw om bly, 550 U .S. at55 6. The co m pla i nt m ust i ns te ad ca ll for “e no ug h f ac t to r ai se a r ea so nabl e ex -N o. 09

- 3280 17

The goa l i n tr ea t i ng R A “i s to re duce infl am m at i on as a m ea ns 5 ofp reventi ng eros ion and prog res si ve d ef orm ity. ” See The M er ck (co n tin u ed ...) pec ta ti o n tha t di sc o ve r y wi l lr ev ea le vi den ce ” su ppo r ting th e p lain tiff’s alleg at ion s. Id. Based on a r evi ew o fA rn et t’s com pla i nt and att ached docum en ts w e hav e no tr oubl e fi nd i ng tha t he sta ted a cl ai m a gai ns t m edi ca lde fen dan ts , Dr
. W i l so n, Bei g hl ey, a nd Pa ul

- Bl an c, forv i o l at i o ns unde r the Eighth A m endm ent. The defend an ts knew that A rnet t ha d RA an d was i n c o nt i nuo us pa i n a s a r es ul t o fthe in fl am m ati on in hi s j oi nts; ye t, theydi dn ’ t pr ovi de him m edi cati on t o treat hi s underl yi ng co nd i ti on, notEnbrel as h e r e qu e s t e d a nd Dr
. Da v i s i ns t r uc t e d, n o r a nyo ther substi tute m edi cati on. ( I n hi s a pp el l at e b ri ef, A rnet t des cr ibe s Dr
. Da vi s’ co m m en t as a “ r ec o m m en dat i o n, ” but const rui ng the f acts i n l i ght m ostf avo rabl e t o A rnett, w e p re fer to refe r to it as an “in st ru c tio n .” A fte r all, Dr
. Da vi s i s a RA spe ci al i stwho Arn et t spe ci fi ca l l y went t o s e e fo r a c on su lta tio n . W h en D r. D av is s aid “I w ou ld l ike ” f orA rnet t t o re sum e a speci fi c dosa ge ofEnbrel once a week, that can re aso nabl y b e infe rr ed to be an i nstr ucti on. ) A rnet t w as not provi ded effectiv e tre atm ent o fhi s RA unti lOctobe r 2007, o ve r ten m onths after he ar ri ved atTer re H aute an d fi rs t s ought tr eat m ent. The sum m ar y j ud gm ent r eco rd i nd i cat es that A rnet t w as giv en p ain m ed ica tio n, b u t he w as r e a s on ab ly se ek in g m ed ica tio n to tre at, no t s im p ly m as k, h is c on d iti o n. Ev en tho ug h h e i nf o r m ed pr i so n o ffi ci al s th atthe 518 N o. 09

- 3280

(
. . . c on t i nu e d) 5 M anual of D iagnosis and Ther apy 2 8 3

- 8 9
. Dr u g th e r a p y f o r RA us ual l y c om bi ne s no n- s t er oi dal an t i

- i nfl am m at or y dr ugs ( N SAI Ds) , w hi c h hel p r educ e s ym pt om s , an d dis ea s e m odi fyi ng a n t i r he u m atic d ru g s ( D M A R D s), w hich slow d isease p ro g ress i on. S ee id. NSAIDs ar e us ed t o c ont ro l the s ym pt om s an d si gns ofthe l ocal infla m m atory proces s, and D M A R D S are u sed to m od ify the in flam m ato ry com p on en t of R A an d its d es tr u ct iv e c a p a ci ty
. Se e H a r r i s o n’s P r i nc ipl e s of Int e r na l M e di ci ne 20 89

- 90 ( 17th e d. 20 08 )
. Enbr eli s a m or e re c en ttype ofdrug thati s ali g n ed w ith D M A R D S, but is cl ass ifie d as a “biol ogical res pon se m od ifie r”; i t i s a TN F-ne utral izi ng agent thathas be e n s ho wn t o ha ve a “ m aj ori m pa c to n the s i gn s a nd s ymptom s ofRA a nd al so t o sl ow progress ive dam age to ar ti cular st ructure s. ” S ee Harrison’s P ri n ciple s of In te rnal M edi ci n e 2090 (st atin g tha t TN F -neu traliz ing ag en ts hav e b een “ sh o w n to s l ow the r a t e o fpr og r e s s i ono fj oi ntda m a ge . . . an d t o i m pr ov e d is abi l i t y. ”)
. W e ex pre s s no opi ni on on the appr opr i at e t reatm ent f or Arnett, but w e c it e these authori tat ive s ources to illu stra t e c om m on ly a ccep ted treatm en t op tion s f or ind ivi dua l s wi th RA. pain medi ca ti o n was no t wor k i ng, the y pe r si st ed i n a cour se oftr eat m ent, acc or ding to A rnet t’ s a l l ega tio ns, known to be i neffecti ve . A rnett a l l ege d that the defendants i ntention al l y r efused to pro vi de hi m with E nb re l an d th eir refu sa l to t re at h im ca u se d h im su b st an tia l p ain an d s u f fer in g, in c lu d in g irr ev er sib le physi caldam age and def orm i ty ofhi s j oi nts. These f acts a r e s u ffi c i e n tt o s t a t e a c l a i m. I t i s no t cl earwh y the co m pla i nt wa s al l owed to go f or w ar d against D r. W ebst erbut not the o therm edi calN o. 09

- 3280 19 defe nd ants. W e a re part i cul ar l y c uri ous about the di stri ct cou rt’s reasoning f or dism issi ng Dr. W il son, A r ne tt’s pri m ar y c ar e physi ci an atthe pri son. Dr. W i l son w as awar e o fArn et t’ s co ndi ti o n, his n eed f o r t r ea tment, a nd hi s pl eas f orEnbrel

. In f act, Dr. Davi s wrot e a let ter addr es se d t o Dr
. W i l so n in F eb r ua r y 2 00 7 i nst r uct i ng th atArn et t be pl ac ed ba cko n Enb r el

. The l et te r e xpla i ned the s eve ri ty ofA rnet t’ s co nd i ti on, the ass oci ate d p a i n, a n d th e n e e d f o r t r e a t me n tt o p r e v e n tp e r m an en t j oin t d am ag e. A fte r re c eiv in g t h is let te r, D r. W ilso n st ill did n o thingt o t r e a tAr ne t t ’ s R A wi th e ffe c t i v e me di c ati on. A s t o Bei ghl ey and Paul- Blanc, A rne tt ask ed them r epe at edly f o r E nb rel, b utthe y s i m pl y t o l d hi m tha t th e requ est h ad been su b m itted to the B O P an d they w ere w ai ti ng f ora re sponse. A rnet t has a ser i ous m edi calco n d itio n and his pl eas f ortr eat m ent a nd m edi cati on were ign or ed f oro verte n m onths w hi l e he suffer ed i ntense pai n. I t a pp ear s that a r eque stf or E nb rel was made to the BOP, b utthe n l an gui shed. I t i s uncl earwh o caused the del ay o r w h o w as re sponsibl e forf ollo w i ng- up with the r equest, but w hat w e do know i s that Arnett didn’tr ecei ve an Enbreli nj ecti o n un t i lOc t o b e r 2 0 0 7
. De l ib e r a t e i nd i ffe r e nc e c an i ncl ud e the i ntenti onaldel ay in access to m edi calcar e. R o drig uez , 57 7 F
. 3d at 828. A del ay i n tr eat i ng non- l i fethre ate ni ng but p ainful condi ti ons m ay const i tute deliberat e ind ifferenc e ifthe d e lay ex acerb ated the inj ury or u n n ec es sa rily p ro lon g e d an inm at e’s p ain
. M cGowan v. H ulick, 61 2 F.3d 6 36 , 6 40 ( 7th Ci r. 20 10)
. “[ T]he l ength ofd ela y that i s t ol er abl e depends on the se ri ousness ofthe condi ti on a nd the eas e o fpro vidi ng tr eat m ent. ” Id.20 N o. 09

- 3280 Com parei d. at64 0- 41 ( de lay s in re fer ring i nm ate to d e n t i s t, t o o r a l s u r g e o n, a n d E NT s p e c i a l i s t o v er t he cour se ofse ver alm onths w hi l e inm ate conti nued to suffersi gni fi cant pain and his co nd i ti on dete ri or ate d w as su ffici en t to state a claim of d eliberat e ind ifferenc e ), a nd E dw a rds v . S ny der, 47 8 F
. 3d 827, 83 1 ( 7th Ci r. 20 07) ( guar ds c ou ld be l i abl e fordel aying tr eat m ent for pai nfulbr oke n nose byatl eas t a day- and-a- hal f ) , with G utierrez v . P eters , 11 1 F
. 3d 1364, 13 74 ( 7th Ci r. 19 91) ( di smi ss al f o r f ai l ur e to st at e a cl ai m pr o per be ca us e six

daywai t to s ee a do ct o r w as no t unr ea so nabl y l o ng f o r i nfe c t e d c y s tde e med n o t tha ts e v e r e )
. Ar ne t t ’ s s t e a dy com pla i nts o fes cal ating pai n i nd i cate thatthe del ay of te n m on th s u n re as on ab ly p ro lon ge d h is s u ffer i n g. See Ber ry v . Pe t e r m an , 604 F.3d 435 , 441 (7th C ir. 2010). A l l eg at ions ofr efusalto pro vi de an i nm ate with pr escr ibed m edi cati on o r to f ol l ow the advi ce o fa speci al i st c a n als o s ta te an E igh th A m en d m en t c laim

. S e eWyn n v. So uth w a rd, 251 F
. 3d 588, 59 4 ( 7th Ci r. 20 01) ( f ai l ure to re spond to i nm ate ’ s r equest f or p re scr ibed hear t m edi catio n ); see also R a lsto n v . M cG o vern , 16 7 F
. 3d 1160 , 11 62 (7t h C ir. 19 99 ) (re fu sa l to ad m in ist er p re sc ri b e d p ain m ed ica tio n ); Jone s v. Sim ek, 193 F.3d 485 , 490-91 (7th C ir. 1999 ) ( f ai l ure to f ol l ow advice o f s peci al i sts )
. A rnet t had been prescr ibed Enbrelf orhi s RA befor e hi s a rr i valat Terr e Haute, r epeate dlya sked fo r the m edi cati on a fter h is a rriv al, an d ob ta in ed a l e t te r fro m D r. D av is i nfo rm i ng Dr. W i l son to p lac e him bac k o n the m edi catio n . E ve n if th e p ris on co u ld n ’t g et E nb re l be c au se it was n’ t o n the f o r m ul ar y, medi ca lpe r so nne lc anno t st an d i dl y b y f o r mor e tha n tenmonths whi l e Arne tt ’ s RAN o. 09

- 3280 21

The d efendan ts point out thatArnett did n’ t su bm itex pert 6 op inio n t es t i m ony on the dam agi ng e ffec t s ofRA and t re atm ent options, but A rnet t did att ach D r. D avis’ February 2007 l e t t e r a n d D r . B e r g q u i s t ’ s S e p t e mb e r 2 0 0 7l e t t e r t o h i s c o mplaint, and w hil e we a g ree thatex pert opini on tes ti m ony m ay be neces sar y to s urvive sum m ary ju d gm ent, i t i s not nec es sar y at the pleading s tage. prog re ssi vel y wors ened and caused per m anent dam age to hi s j o i nt s ; the y mus te xp l o r e a l t e r na t i v e t r e a t m ents 6 that ar e a vai l ab le. Se e, e . g. , No rfleet, 43 9 F
. 3d at 395 (i nm ate tr eat ed by Dr. W ebst err ecei ved N apro syn (a N SA I D ) for his RA ). A l though the defendants pro vi ded hi m pai n m edi ci ne, a m edi calpro fess i onal ’ s a cti on s m ay re fl ect del iber ate i ndi ffer en ce i fhe “ choos es a n e as i era nd l es s effi ca ci o us tr eatm ent without e xerci si ng pro fess i onalj ud gm ent. ” See M cGowan , 612 F.3d at64 1 (q u ot at ion m ar ks om itt ed ); see al s o Gil v. R eed , 3 81 F.3d 64 9, 663 (7th Cir. 2004) (w he re outsi de docto r presc ribed pri sone r Vico din, b u t itwas not on th e prison f orm ulary, the p rison d o c tor cou ldn ’t s i mpl y s ub s t i t ut e wi th a n i ne ffec t i v e a l t e r na t i v e me di cati on; he ne eded to consi der o therm or e e ffecti ve subst itu te s); Kel ley v . M cGinnis , 899 F.2d 612 , 616 (7th C ir. 19 90 ) ( com p lai nts uffi ci en t to s ta te c l ai m wher e pl aintiff a lleg ed th at clin ic p er so n n el d elib er at ely g a ve h im certain kind of treatm en t kn ow ing th at it w as ineffective). A pri so n ph ysi ci anc anno t si m pl y c o nt i nue wi tha c ou rs e o f tre at m en t t h at h e k n ow s is ine ffec tiv e in tr ea tin g t h e in m at e’s co n d itio n . Se eGr e e no , 41 4 F
. 3d at 655.22 N o. 09

- 3280 A r ne t t ha s a n i nfl a mm a t o r y c o nd i t i o n, y e t he was neverpro vi ded anti

- i nfl am m ato rym edi cati on, notev en a s pi r i n, a we l l

- k no wn a nd r e a di l y a v ai l ab l e NS AI D. A rnet t wasn’tseekingan unconve nti onaltr eat m ent; he s o ug htmedi ca ti o n tha t woul d r edu ce hi s pain a nd sw el l i ng and sl ow the prog re ssi on of hi s RA
. A l though a n i nm ate i s no t e nti tle d to dem and speci fi c ca re and i s no t en ti tl ed to the b es t care p oss ibl e, he i s en ti tl ed to r ea so nab l e me a s u r e s t o me e t a s u b s t a n t i a l r i s k o f s e r i o us h a r m. Forb e s v. Edgar, 112 F.3d 262 , 267 (7th C ir. 1997). Ar ne tt alle ge s t h at th e m ed ica l d e fen d an ts , d es p ite th eir kn ow led ge of h is s er iou s m ed ica l co n d itio n, i gn or ed h is re quest foreffecti ve tr eat m ent foro verte n m onths. A rnet t’ s a l l ega ti ons that the m edi cal def en d an ts k n o wi n g l y i g n o r e d h i s c o mpl a i n t s o fp a i n b y c o n t i n ui ng w i th a cour se o f tr eat m ent that was i neffecti ve and l ess effi cac ious w ithou t exe rcisin g p rofessional j ud gm en t are su fficie n t t o s ta te a c laim

. See B erry, 60 4 F .3d a t 441- 42 (“W h er e [in m at e] m ad e a m od es t req u es t for tr ea tm en t . . ., Dr. Butl er ’ s obdurate re fu sal to al ter[ i nm ate ’ s] co urse o ft r e a t men tde s pi t e h i s r e pea t e d r e po r t s tha tthe me di ca ti o n was no t wor k i nga nd hi s con d i ti o n was g et ting w or s e , i s suffi cientto defeat her m otion for su m m ary j ud gm ent. ”) ( i nter nalci tat i ons and qu ota ti on m ar ks om itte d). A t thi s s tag e, we cannot saythatA rnet t’ s a ll ega ti ons describe on l y s i m ple negl i gence , as o pp ose d to d elib er at e in d iffer en c e t o a w o rs en in g m ed ica l co n d itio n . S e e, e . g. , S i m ek, 1 9 3 F
. 3 d a t4 9 0 ( pl a i nt i ffs t a t e d a cl ai m wh er e pr i son doctordel aye d arr angi ng appoi ntm ents f ori nm ate to se e s peci al i sts and then failed to f o l l o w the s pec i al i st s’ a dvi ce, d uri ngwhi cht i m e i nm ate’s con d iti on con tinu ed to w orsen ).N o. 09

- 3280 23 M aybe A rnet t wil lbe unabl e to su pp or t hi s f actual a l l e g a t i o ns wi th a dmi s s ib l e e v i de nc e . Mayb e Be i ghl ey and Paul- Blanc proper l y r el i ed o n the advi ce o f D r. W ilso n . M ay b e D r. W ilso n ca n sh ow t h at h e le git im ate l y e x p lor ed al ternati ve opti ons and rej ecte d them for valid reason s or th a t his treatm en t d ecisions w ere o th er wi se b as ed o n h i s m edi ca lj ud gm en t. The se , a nd othe r ques tio n s, w i l lneed t o be e xplor ed thr ough di scove ry . W hetherA rnet t ca n supp or t hi s a l l ega ti ons that th e m edi ca lde fen dan ts wer e del ibe r at ely i ndi ffer en t re m ain s to be s een. The di str i ct c ourtwas to o hastyin dism i ssing h is c l ai m s a gainst the m edi caldefendants, especi al l y g i ven i ts du ty to const rue p ro se co m pla i nts libe ra lly. See M cG o w a n, 612 F.3d a t 6 40 ( i nm ate st ate d a cl ai m wher e he se t f o r th a “pl au sibl e ac co unt o fthe f acts sho w i ng how m uch dela y he experi enced, how o fte n h e an d o th er s asked [th e defen dan t] t o a ct, a nd w hat the co nsequences w er e o fi nac tio n. ”)
. W e do not m ake a n y dete rm i nati on about the ul ti m ate m er i ts of th e alleg at ion s con ta in ed in th e com p lain t, n or sh ou ld our d ec ision to day be r ead as sugg est i ng an ult i m ate o ut c o me. We o nly c o nc l ud e tha tAr ne t th a s s t a t e d a cl ai m “pl ausibl e o n i ts f ace” that t h e m edi caldefendants acte d w i th del iber ate i nd i ffer ence to hi s s er i ous m edi cal condi ti on in vi ol ati on o fthe Eighth A m endm ent. W e co m e t o a di ffer ent c oncl u sio n with r espectto the no n-m ed ica ldefendants, W ar den Veach and Case M anage r Park er . A rnet t co nceded at o ra lar gum ent that Veach was proper l y dism i sse d, so w e l i m i t our disc ussi on to Park er . A rnet t did n’tgo so f aras to sa y that Par ker w as p ro perl y di sm i sse d, but he did co ncede thatPar ker24 N o. 09

- 3280

w as in a sim il ar situation to V e ach

. W e agree. A rnet t’s al l ega ti ons aga i nst Par kerar e m i ni m al

. H e a l l ege s that sta rt i ng i n M ay 2007, h e w en t t o Park ertwo to thr ee ti m es a week and request ed that he be pl aced ba ck on E nb re l. In re sp on se , P ar ke r m er ely sa id , “G o t alk to B lan c .” Park ercannotb e h eld l i abl e o n the basi s o fr espondeat superi or ; to be l i abl e, h e m u st be per sonal l y l i abl e for A rn et t’s inju ry . Se eIq b al, 12 9 S . C t. at 19 48 ; se e also Vance v. Ru msfel d , N os . 10-1 68 7 & 10 -24 42 , 201 1 W L 34 37 51 1, *6 (7th C ir. A ug . 8, 2011). N on- m edi caldefendants, such a s Par ker, can re ly on th e e x p er tis e o f m ed ica l p er so n n el. W e h a v e p re vio u sly sta ted t h at i fa pri sone r i s under the c ar e o fm edi cal expert s, a non- m edi calpri son offi ci alwil lge nera l l y b e j u st ified in b elie vin g t h at th e p ris on er is inca p a b le h an d s. Gre e no , 4 14 F
. 3d at6 56
. W e fi nd the f o l l o wi ng pa s s a g e fr o m Spruil l v. Gills , 3 72 F
. 3d 21 8, 2 36 ( 3d Ci r. 2004 ) , part i cul ar l y instr ucti ve here : [ I ] fa pri sone r i s under the c ar e ofm edi calexper ts

. . . a n o n -m ed ica l p ris on offic ial w ill gen er ally b e jus tifie d in b elie vin g th at th e p ris on er is in ca pab l e ha nds

. T hi s f o l l o ws na tu r al l y fr o m the divi si on o fl aborwithi n a pr i son. Inm ate heal th and safetyi s pro m ote d by di vi ding re sponsib il i ty f orvarious as pects ofi nm ate l i fe a m ong guar ds, adm i ni str ato rs , physi ci ans, and so o n. H oldi ng a non -m ed ica l p rison offici al l iable in a ca se w he re a p ris on er w a s u n d er a p h ys icia n ’s c ar e w ou ld strain th is divisi on of l abor. Se eal s o Gre e no , 414 F.3d a t 6 56 (ad op tin g re as on in g in Spruil l ). H ow ev er , “n on m ed i c al off icia ls c an ‘be ch ar ge ab leN o. 09

- 3280 25

w i th .

. . del iber ate i nd i ffer ence’ w here they have ‘ a r eas on to bel i eve ( oractual kno w l edge) thatpri son doc to rs or thei r ass i sta nts a re m istr eat i ng ( ornottr eat i ng) a pri soner . ’ ” Ha yes v . Sny der, 54 6 F
. 3d 516, 52 5 (7 th Ci r. 20 08) ( quoti ng Spruil l , 372 F. 3d at 236)
. N on- m edi caldefendants c an n otsim p ly i g n o r e a n inm at e’s p ligh t. Se eGr e e no , 41 4 F
. 3d at65 6 ( st at i ngtha t “ [ p] erha ps i t woul d be a di ffer en t m att eri f[ th e non-m edi caldefendant] had i gnor ed Greeno’ s com pla i nts enti re l y, but w e ca n see no del iber ate i nd iffer ence gi ven that he i nvest i gat ed the com pla i nts an d refe rre d th em t o th e m ed ica l p ro vid er s w h o c ou ld b e e x p ec te d to ad d r e s s G re en o’s co n c er n s.” ); see also B erry, 604 F.3d at 440 ( “A s a non m ed ical ad m inis t r a tor, [d efe n d an t] w as en ti t l e d to d efe r to th e jud gm en t o f j ail he al th pro fes si o na l s so l o nga s he di d no t i g no r e [ th e i nm ate ]
. ”)
. H owever, m er e negl i gence i n f ai l i ng to d et ect and preventsu b or dinat es’ m i sco nd uct i s no t s uffi ci ent. Se eVanc ev. Pe ters , 9 7 F.3d 987, 993 (7th Cir. 1996). The pla i nti ff m u st dem onst ra te that “the com m unica

ti o n, i n i t s c o n t e n ta n d ma n n e r o ft r a n s mi s s i o n, g a v e t he pri son offi ci alsuffi ci ent no tice t o alert hi m o r her to ‘ an excess i ve ri sk to i nm ate heal th o r safety
. ’ ” Id. ( quo ting F a r me rs v . Bre n n an , 511 U
. S. 82 5, 83 7 ( 1979 ) )
. Once an offi ci ali s al er ted of such a ri sk, the “r efusalo r decl i nati on to exer ci se the a uthor i ty ofhi s o r her offi ce m ay re fl ect del iber ate di sr ega rd. ” Id. The a l l eg at i o ns i n Ar ne tt ’ s co m pl ainta r e i ns uffi ci en t to s tate a claim that Parker ac ted w ith d eliberat e ind if

fer en ce i n refer r i ngArn et t to medi ca lpe r so nne lwho w er e t re ating Arnett on a r egul arbas i s. T h is is not a cas e w here A rne tt w as bei ng co m ple tel y i gnor ed by m edi cal26 N o. 09

- 3280 staff. A lthou gh Parker w a s a w are, bas ed on A rnet t’s c om pla i nts, thathe wasn’ t r ecei vi ng the speci fi c m edi cati on he sought, A rnet t d oes n’tal l ege thatPar kerco nd oned orapprov ed the m ed i calst aff’ s a l l ege d refusalto provi de hi m m edi calcar e, i m peded thei r abi l ity to provid e effecti ve tr eat m ent, o r w as i n a pos i ti on t o tak e corr ect i ve a ct i o n. Pa r k erwas abl e to r el eg at e to the pri son’ s m edi calst affthe p ro vis i on o fgo od m edi calcar e. SeeB u rk s v . Ra em is ch , 55 5 F
. 3d 592, 59 5 ( 7th Ci r. 20 09) ( “[ I nm at e’ s] c o nt en ti o n tha t an y pub l i c em p lo y ee who knows ( orsho uld know ) a b ou t a wrong m ust do som eth i ngt o fix i t i s j us t ane ff o r t to e va de, b y i ndi r ec ti o n, M onell ’s rul e that publ i c em plo yee s a re res p on sibl e for thei r own m i sdeeds but not f oranyo ne el se’ s. ”)
. “A l ayper son’ s f ai l ure to tel lthe m edi calst affh ow to do i ts j ob cannot be c al l ed d elib er ate i nd i ffer ence; i t i s j ust a f or m o ff ai l i ng to supply a g ra tui tous re scue s er vi ce. ” Id. A rnet t’ s a l l ega ti ons aga i nst P ar kerar e s i m plyto o m eag er to st ate a cl ai m o fdel iber ate i nd i ffer ence aga i nst a n on -m ed ica l d efe n d an t w h o re fer re d A r n e tt to h is tr eat i ng physi ci an’ s a ssi sta nt. M ay b e A rn et t c ou ld h av e c or re c te d t h e d efic ien c ies in his com p lai nt a gainst Parker. A lthou gh the d istri ct cou rt’s dism i ssa lo fPar kerdoes n’ti nd i cate i fi t was with o r w i thout prej ud i ce, gener al l y, an i nvol untarydi sm i ssa l op erates a s a n a d j ud ication on th e m erits i f not otherw ise ind ica te d

. See Fed

. R
. C iv. P. 41(b). Bu t given A rnet t’s pr o s e s t a t us a nd the f a c t tha t he may ha v e b e e n abl e t o cur e th e defi ci en ci es i n h i s cl ai m a g ains t Pa r k er, the dism i ssa lsho u l d have be en witho ut prej ud i ce with lea ve to am en d

. See G landey v. Pendlet on C orr. Fa ci li ty, 30 2N o. 09

- 3280 27 F
. 3d 77 3, 7 75 ( 7th Ci r . 2 00 2) ( cl ai m s di smi ss ed pur su an t to § 1 915(e ) ge nera l l y s houl d be a l l owed to pro ceed if p lain tiff p ay s filin g fe e); see also V a nc e, 2011 W L 34375 11, at *14 n .7 (“A rev er sa l for in ad eq u at e p l e a d i n g w ou ld requ ire an op p ortu nity to cu re th e d efect un less it w ere c l ea r th at th e d efe c t c ou ld n otbe cu re d .”); EEOC v. Con c e n t r a Hea l t h S e r vs. , Inc. , 496 F.3d 773 , 778 (7th C ir. 2007) ( f ai l ure to provi de noti ce und er Fed. R. C iv. P . 8 “s h ou ld n otn or m ally w ar ra n t d ism iss al w ith pre judice ”); D o n a ld v. Co ok C nty. Sher if f’s D ep’t, 9 5 F
. 3 d 5 4 8 , 5 5 5 ( 7th Ci r . 1 9 9 6 ) ( “ [ D] i s t r i c tc o ur t s h a v e a s pe c i a lr e s po ns ib i l i ty to c o ns t r ue p r o s e c o mpl a i nt s l ib e r a l l y a nd t o al l ow am ple o pp or tuni ty f oram en d ing the co m pla i nt wh en i t a pp ear s that byso doi ng the pro se l i tig an t would be able to state a m eritori ou s claim

. ”). Arne tt, ho wev er, ne ve r s o ug htt o a m en d hi s co m pl aint or re - fi l e up on payi ng the fi l i ng fee and th e d istr i ct cour t w as not re quir ed to i nfo rm hi m that he s houl d. “Dis tr i ct j u d ges have no obl i gat i on t o act as counselo r paral ega lto pro se l i ti gants
. ” M yles v . U n ited S ta tes , 41 6 F
. 3 d 5 5 1 , 5 5 2 ( 7 th Ci r . 2 0 0 5 ) ( qu o t a t i o n mar k s o mi t t e d) ( no t i n gth a tp l a i n t i ffc o u l d h a v e a me n d e d th e c o mpla i nt pursuant to Rule 15( a) o fthe Feder alRule s o f C ivi l Proc e d ure after the d istri ct j ud ge d ism issed i t pu rs ua nt to 28 U. S
. C. § 1 9 1 5 A, b uth e di dn ’ ts e e kt o a men d, an d the j udg e ha d no o bl i g at i o n t o i nf o r m pl aint i ff th athe s ho ul d)

. “ F o m en tingl i ti g at i o n i s n ot p ar t o fthe j ud i ci alfuncti on, ” id, and “dis tr i ct j ud ges ar e no t re quir ed to so l i ci t m or e l i ti gat i on s pontaneously, ” Burks , 555 F. 3d at 596. Because A rnet t has n ’ t s ugges ted any w ay h e m igh t h a v e a m en d ed h is c om p lain t t o s ta te a c laim28 N o. 09

- 3280

A s cl ini cal direc tor, D r. W ebst er pres um ably had s up ervis ory 7 a u th o ri ty o v er D r. W ils o n . S ee Norfl eet, 43 9 F. 3d at 39 4 ( s t at i ng (co n tin u ed ...) aga i nst Par ker, we affi rm the dist ri ct c ourt ’ s di sm i ssa l of h im
. See Lea vell v . Ill. D e p ’ t o f Na tura l R es. , 60 0 F
. 3d 798, 808 ( 7th Ci r. 20 10) ( fin d in g that dism i ssa lwith pr ej ud i ce was war r an te d wher e pl aint i ffdi dn’ t ex pl ain h o w s he c ou ld am en d h er co m p lain t t o s ta te a c laim ).

B. Sum m ary J ud gmen tas t o Dr. W ebste r W e r evi ew a dist ri ct c ourt ’ s g ra nt o f sum m ar y j ud gm en t d e nov o, cons tru ing allf acts and reas o n a b le inferen ce s i n the light m o stf av o r ab l e to the no n- m o ving p ar ty
. S p i v eyv . A d a p t i v eMktg . L LC, 6 22 F
. 3d 816, 82 2 ( 7th Ci r . 2 01 0)
. S um m ar y j udg m en t i s appr o pr iat e o nl y i f“ th e m o va nts ho ws tha t th er e i s n o genui ne di spu te a s to a ny m ate ri alf act and the m ova nt i s e nti tl ed to j u d gm ent a s a m atter of l aw . ” Fed

. R. Civ. P. 56(a). A s w e in d ica te d ab ov e, a d efe n d an t c an n otbe liab le un d er Bive ns on th e b asis of resp ond eat su p erior or sup ervi sor y l i abi l i ty, r ather, ther e m ust be i nd i vi du alpart i cip at ion an d inv olv em en t b y t h e d efe n d an t. See Iq b a l, 129 S. C t. at 19 48 -49 ; se e also Vance, 20 11 W L 3437 51 1, at* 6.

“ A b se n t v ica riou s liab ility , eac h G ov er n m en t o fficia l, h is orherti tl e no tw i thsta nd i ng, i s o nl y l i abl e forhi s o r her ow n m i sco nd uct. ” Iq b al , 1 29 S
. Ct
. a t 19 49
. As s uch, D r. W eb st er ca n n otbe h eld liab le m er ely d u e t o h is supervi sor y c apaci ty as cl i ni caldi re cto r. The te st f or 7N o. 09

- 3280 29

(
. . . c on t i nu e d) 7 thatDr. W ebs t er, as c l i ni c al di re ct or, was “i n c har ge ofthe m ed ical car e an d treatm en t of all inm ates.”). W e say p resu m ab ly be c a us e thi s i s n otc l e a r fr om t he r e c or d. es ta b lish in g p er so n al re sp on sib ility w as se t fo rt h in G entry v. D uc k w o rth, 65 F.3d 55 5, 561 (7th Cir. 1995): Of c ours e, [ the defen d an t pri son offi ci al ] cannotbe p erson all y l iable und er a th eory of r e s pond e ats upe r i or . H ow ev er , an offic ial sa tis fies th e p er so n al re sp on sib ili ty re quir em en t of s ecti on 1 983 i fthe conduct c au sin g t h e c on st itu tio n al d ep r i v a tio n oc c u rs ath is dir ecti on o r w i th hi s know l edge an d consent. That i s, h e m ust know abo ut the conduct and f aci l i tat e i t, appr ove i t, co nd one i t, o r turn a bl i nd ey e. In shor t, som e causal connect i on or affi rm ati ve l i n k b etw een t h e ac tio n co m p lain ed ab ou t a n d th e o fficia l su ed is necess ar y for§ 1983 r eco ver y. Id
. ( i n t e r n a l c i t a t i o n s , q u o t a t i o n ma r k s , b r a c k e t s , a nd el l i pses om i tt ed ); s eeals o C hav ez v. Ill
. StatePo li ce, 25 1 F.3 d 61 2, 65 1 (7 th C ir. 20 01 ). Th e S u p re m e C ou rtrec en tly sta ted that“purpose r atherthan know led ge i s r equi re d t o i mpo se B ivens l i abi l i ty. ” Iq b al , 129 S. C t. at 19 49 . A lth o ug h Iq bal w as a d iscr i m i nati on ca se i nvol vi ng di scri m i na tory purpose , the Court’ s r eas oni ng i n that case ha s raised q ue stio n s abou t w he th er a stri cter stan d ard ofper sonall i abi l i ty f orsuperv i sor s a pp l i es in del iberate ind ifferenc e suits. W e recen tly ind icat e d t ha t “m ere
‘ knowle dge and acqui esce nce’ is not suffi ci ent t o i m pose” such l i abi l i ty, but that“Iq b al di d not di sturb the
. . . p rin c i-30 N o. 09

- 3280 pl e s h o l di ngtha ta s up e r v i s o r ma y b e l i ab l e a s a n i nd i v i du al for w ro n gs h e p er so n ally d ire c te d or a u th or i z e d h is s ub o r di na t e s t o i nfl i ct, ” Van ce, 20 11 W L 34375 11, at* 6 & n .5; se e also St arr v. B aca , N o. 09

- 5523 3, 2 01 1 W L 29888 27, at * 4 ( 9th Ci r . J ul y 2 5, 2 01 1) ( “We s ee no th i ngi n Iq b al ind icating th at th e Sup rem e C ou rt i nt en d ed to overturn l o n g s t a n d i n gc a s e l a w o n d e l ib e r a t e i n di ffe r e n c e c l a i ms agains t sup ervisors i n cond iti ons of con fi ne m en t cases
. ”). T he l an d scap e of su ch cla im s after Iq b al r em ai ns m urky, butwe ne ed no t cl ea r the wate rs he r e be ca us e th e recor d doesn’ t s how thatDr. W ebst erwas pers onally i nvol ved i n the al l ege d consti tuti onalvi ol ati ons und er th e st an dar d s etf o r thi n G entry
. D r. W eb st er ex am in ed A rn et t o n tw o oc c as ion s in N ov em b er 20 06 at w h ich tim e, A rn et t in for m ed h im of h is R A a nd need f or Enbrel. Enbrel w asn ’t on the prison ’s for m u lary, so befor e Arnett coul d rec ei ve i t, Dr. W ebst er wo u l d h a v e h a d t o r e q u e s ta u th o r i z a t i o n fr o m th e BOP. Dr. W ebsterput i n a no n-for m ula ryr equest f or G ab ap en tin

— a p a i n med i c a t i o n tha tAr ne t th a d b een tak i ng be f or e hi s a rr i valatTer re H aute

— and conti nued A rnet t o n Gabapenti n tem pora ri l y pendi ng a deci si on on th e non -f o r m u lary r eq ue st. D r. W ebst er did n’t si m i l ar l y put in a r equest f orEnbrelo r continue A rnet t on Enbrelte m pora ri l y. ( W ebst erco ntends that ’ s beca use he wasn’t aw ar e that Arnett had p re viously b een pr escr ibed Enbrel

. ) H owever, Dr. W ebst er d id take further st e ps t o t r e a tAr ne t t : h e i s s ue d h i m a b o t t o m bu nkpass (p re su m ab ly b ec a u se of h is join t p ain ), pr es c rib ed p ain m edi cati on, o rder ed x-r ays , and subm i tte d app ro va lf or c onsulta ti on with a rheum ato l ogi st. A rnet t’ s m edi calN o. 09

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D r. W eb ster’ s na m e d o es ap p ear on A rn ett’ s m ed ical ch arts 8 d ated M arc h 19 and A p ril 14, w hich ind icated tha t A rn ett’ s pa in m edicatio n s w ere renewed

. Also on J uly 9, the ent ry that i ndi c at es Arn et twas t o r ec ei ve Enbre l , butha dn’ tbe c aus e the p rison nev e r hea rd b ack fro m the n on -for m u lary requ est, i n di c a t e s th a tl a b s h a d b e e n r e q u e s t e d b y Dr
. We b s t e r . On J uly 11, D r. W ebst er furthe r sig ned a record ofm edical care s tat ing t hat the uti li zati on review com m it tee app roved a f ol l ow- up a ppo i nt m e ntwi th Dr
. Da vi s t o c on s ul t f or RA. Arne t tdoe s n’ ti ndi c at e thathe s aw Dr. W ebs t eronan y of thes e occ asio n s or dis cuss ed his conditi on w ith D r. W ebst er a n d th e r e i s n o e v i d e n c e ( o th e r th a n D r . We b s t e r ’ s n a me appe ar i ng on the s e doc um en t s ) thathe was pe rs ona l l y i nv olv ed in A rn ett’ s care o n su ch d ates. re cor ds i nd i cate thathe needed a co nsul tat i on with an outsi de rhe uma t o l o g i s tb e f or e r ecei vi ng Enbrel

. A rnet t was see n by Dr. D av i s in Feb ruar y 2 007, duri ng wh i ch ti m e, Dr. W i l son w as hi s pri m ar y c are p h ys i ci an. A rnet t’ s l ast i nter acti on w i th Dr. W ebst er w as a few w eek s after hi s a pp oi ntm ent with Dr. Davi s w h en h e a ske d D r. W ebste r f orEnbrelp u rs u an t t o Dr. Davi s’ i nstr ucti ons. D r. W eb st er res p on d ed , “W e ’ r e w or kin g on it.” A t t h is ti m e, Dr. W ebst er ’ s invol vem ent w i th A rnet t’ s ca re was a pass i ng co nver sat i on in the m edi caluni t. 8 This re cor d doesn’ t a l l ow fo r a re asonabl e j ury to i nfe r that Dr. W ebst er acte d with del iber at e indi ffer ence. I t s eem s Dr. W ebst erm ay have thought a r eq u es t fo r E nb rel h a d been sub m itted and prison m ed ical staff w ere w aiting for a resp ons e from the B O P after A rnet t’s appoint m ent with the rheum ato l ogi st
. Dr. W ebst erf ai l ed32 N o. 09

- 3280 to inv es tig at e fu rt h er w h en A rn et t i n for m ed h im h e s till had not r ecei ved t h e m edi cati on in Feb ruar y 2 007. G ive n A rn et t ’ s co n d itio n an d rep ea te d p lea s fo r E nb re l, Dr. W ebst ersho uld have i nvest i gated further

. A l though h i s f a i l u r e t o d o s o ma y a mo u n tt o n e g l i g e n c e , th e s u mm ar y j ud gm ent r eco rd does notl ead to the con c l usi on th at it r ose to the level of d eliberat e ind ifferenc e. “D eliberat e i ndi f f er en ce i s no t m edi c a l mal pr ac ti ce ; t he Eighth A m endm ent doesn’ t codify com m on l aw to rt s. ” See D uckw orth , 53 2 F
. 3d at 67 9. A rnet t’ s co m m unica ti on t o D r. W eb st er w as s i m p l y n otsu fficie n t, w ith ou t a d d iti onal evi dence, to show that he f ai l ed to ac t d espi te knowle dge o fa substa nti alr i sk of ser i ous har m to A rn et t. See Va nce, 97F. 3d at 993- 94. Dr
. W eb st erpr o vi ded tr ea tmentt o Arn et t when he fi rs t a rr i ved at the Terr e Haute f aci l i ty. I t m ay not have b ee n th e m os t a p p ro p ria te tre at m en t, bu t a p ris on er is onl y e nti tl ed to r eas onabl e m ea su res t o m eeta subst an tia l risk of se riou s h ar m . Fo rbes , 11 2 F. 3d at 267. Dur i ngDr
. W eb st er ’ s br iefc ar e o fArn et t, hi s tr ea tment wa s n’ ts o f a r a fi e l d o fa c cept e d p r o fe s s i o na ls t a nd a r ds as to ra i se the infe re nce that i t was notactual l y b ase d on m ed ica l ju d g m en t. SeeD uckw orth , 532 F.3d at67 9; cf. G il, 381 F.3d at 663 & n.3 ( fi n d in g d eliberat e ind if

fer ence w here the pri son doctorpre scr ibed a drug that w or sened i nm ate ’ s co nd i ti on be cause the a pp ro pri ate drug was not part ofthe BO P’s f or m ula ry ); G ree no , 41 4 F.3d at 654 ( fi nd ing d elib e rate ind ifferenc e w he re m edi c al defendants would notal terGree no’ s co urse of t r e a tm en t o ve r a t w o ye ar p er iod ev en th ou gh h is co ndit i o n was g et tingwor se a nd he was v o m i tingo n aN o. 09

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re gul arbas i s a nd the defe nd an ts never thel ess per si ste d in a cou r s e o f treatm en t know n to be ineffective). Dr
. W eb st ert o o kmeas ur es t o a ddr es s Arne tt ’ s pain, and al though pr escr ibi ng pai n m edi cati on m ay not have been effective in treating A rne t t ’s RA , the su m m ary j ud gm ent re cor d doe sn’ t re veal that no m i ni m al l y c om petent profess i onal w oul d have pro vi ded thi s r egi m e o f tr ea tm en t in th e s h or t t er m , at le as t u n ti l A r n e tt co u ld b e s e e n b y a rh eu m at olo gis t. Se e, e . g. , Gayt on v. M cCoy, 593 F.3d 610, 622-23 (7th Cir. 2010) (nu rse w asn ’t deliberat ely i ndi ffer en t to i nm at e’ s m edi ca lne eds w he re s he to ok rea so n ab le m ea su re s t o e n su re th at inm at e w ou ld getm ed i cati on)
. W i thout som e e vi dence, such a s ex per t o pi ni o n t es ti m o ny, c r ea tinga r ea so nabl e i nfe r e n c e th a tD r . We b s t e r ’ s t r e a t me n td u r i n gth i s t i me fra m e was so i na d eq u ate thati t dem onst ra ted an abse n c e of pr ofess i onalj ud gm ent, A rnet t ca nnot s ucceed aga i nst hi m o n sum m ar y j ud gm ent. Dr. W i l son took ove r as Arn et t’ s pr i m ar y c ar e phy si ci ano n De ce m be r 2 8, a nd he was Arn et t’ s tr ea tingphy si ci anwhen Dr
. Da vi s i nstru cted that A rnet t be p la c e d back on Enbrel. A rnet t’s co m p lai nt s are m ore ap p rop riately d irected tow ard Dr
. W i l so n. A rnet t also hasn ’t presen ted f acts sh ow ing tha t D r. W ebst er w as aw ar e that the continued tr eat m en t A rnet t r ec ei ve d f o r hi s RA w as i ne ffec ti ve . Arn et t o ffer s no evi dence thatDr. W ebst erdi re ctl y o ver saw orapprov ed D r. W ils o n ’s in d ivid u aliz ed tre at m en t d ec isio n s o r in an y way i m peded Dr. W i l son’ s abi l i ty to effecti vel y t re at A rnet t. N ori s there ev i den c e th at Dr. W ebst erexam i ned A rnet t or re vi ew ed hi s chart after N ove m ber 200 6 o r w as34 N o. 09

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o th er wi se i nv o l ve d wi thDr. W i l so n’ s m edi ca lde ci si o ns as to A rn et t’s tre a t m en t re gim e. Com pareM i nix v . C ana re cci, 5 97F. 3d 82 4, 8 34 ( 7th Ci r . 2 01 0) ( affi r m i ng gr ant o fsum m ar y j ud gm ent in f avo r ofdi re cto r of m ed ical services at j ailbecau se m issi ng from the r e c o rd w as “evi dence sugg est i ng tha t [ he] w as aw ar e that [ nurses w er e] per f or m i ng i ncom petent ass ess m ents ofsui ci dal in m at es bu t n ev er th ele ss ac q u ies c ed in t h at p ra c tic e” ), w ith O rtiz v. Webster, N o. 10-2012, 2011 W L 36914 37 (7th C ir. A ug. 24, 20 11) ( re versing sum m ar y j ud gm ent in f avo r of D r. W eb st er w h er e h e w as p e rs on ally inv olv ed in i nm at e’ s ca r e an d the e vi den ce s ho wed tha t he s ubs ta nti al l y a nd unrea sona b ly del aye d necess ar y t re atm ent) a nd Ha yes , 54 6 F
. 3d at 524- 26 ( re ver sing s u m m ar y j ud gm ent in f avo r ofthe d efendant wh er e he continued to m oni torthe i nm ate ’ s t re atm ent a fterthe i ni ti ali n-per son ex am inations ). The r e mu s tb e a c a u s a lc o n n e c t i o n o r a ffi r ma t i v e l i nk between the actio n com pla i ned about and the o ffi ci al sued and that connect i on i s m i ssing w ith respectto D r. W eb st er . Th is isn ’t a ca se w h er e D r. W eb st er sim p ly wal k ed awayfr o m the s i tu at i o n a nd l eft Arne ttwi th o ut m edi cal car e. A re vi ew of A rnet t’ s pri son m ed ical re c or d s i n d ica te s t h at h e w as be in g s ee n reg u lar ly bymed ical st aff, hi s pain medi ca ti o ns wer e be i ng re new ed, x- ra ys w er e per f or m ed, and he was exam ined bya n o ut si de r he um at o l o g i st an d a n o r th o pedi c su r g eo n. Dr
. W eb st erl eft Arne tti n the c ar e o fo th ermedi ca lpe r so nne l, i nc l udi nga s ta ffphy si ci an . W he th er th e ca r e he r ec ei ve d was s o f ara fi el d of acc ept ed pr o fes si o na ls ta nd ar d s a s t o ra ise th e in fer en c e t h at it w as n otac tu allyN o. 09

- 3280 35 ba se d o n medi ca lj udg m en t rem ains t o b e se en . Butthe def en dan ts who se medi ca lj udg m en t i s pr o per l y b eing que st i o ne d i s D r . W i l so n’ s, a nd po ss ibl y Be i g hl ey ’ s an d Pa ul-Blan c’s d ep en d ing on th eir in v o lvem en t in A rnet t’s tr ea tment

— i nd i vi du al s w ho co nti nued to se e Arnett on a r egul arbas i s a fterDr. Davi s in str ucted thathe b e p lac ed ba c k on E nb re l. A rnet t had the burden t o com e for th with ev id en c e to show that Dr. W ebst er w as perso nal l y l i abl e forhi s a l l ege d i na dequa te medi ca lt r ea tmenta fte r De ce m be r 2 00 6, a nd h e h as fa iled t o d o s o. Se e Johns on v. Cam b r i dgeIndu s ., Inc ., 32 5 F
. 3d 89 2, 9 01 ( 7th Ci r . 2 00 3) ( “[ S ] um m ar y j udg m en t i s the ‘ pu t up or shut up’ m om ent in a l aw sui t, wh en a p a r ty m u st sh ow w h at ev id en c e ith as th atw ou ld convi nce a tr i ero ff act to accept i ts v er sio n ofev ents. ”) ( quotati on m ar ks om itte d). W e r eal i ze that thi s m ay be th e re su lt of A rn e tt ’s p ro se st at u s a n d lac k of le ga l skills i n c o nduc tingdi sc o ve r y, b ut A rne tt ’ s pr o s e st atus d oe sn ’t a llev iat e h is b u rd en on su m m ar y jud gm en t. See M a rion v. Radtke, 6 4 1 F
. 3 d 8 74 , 8 7 6

- 7 7( 7 th Ci r . 20 11) ( “[ W ] he n a pl aint i fff ail s t o pr o duce e vi den ce , the de fen dant i s e nti tl ed to j ud gm ent; a de fendant m oving f or sum m ar y j ud gm ent ne ed not produce ev i dence ofi ts ow n.”).

III. Co nc l us i o n Forthe f or ego i ng r ea sons, we A F F I RM dism i ssa lo f Ric h ard Veach and David Par kerf orf ai l ure to sta te a c laim , A F F I RM th e g ra n t o f su m m ar y jud gm en t in favor ofDr. Thom as W ebst er, but R EVER S E di s mi s s a l o f36 N o. 09

- 3280 Dr
. Er i c W i l so n, Yv es Pa ul

- Bl an c, a nd J ul i a Bei g hl ey, a nd R EMA ND f orfurtherpro ceedi ngs.

9- 12- 11