## 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. 07

- 2783 F LOYD K. H AYES, Plai nt i f f

-Appe l l ant, v. D O NAL D N. S NYDER, J ES S E M O NTG O M ERY, M AR K A. P IE RS ON, W ANDA L. B ASS, an d W I L L I A M M. H AMBY, D efend a nts-A pp ellees.
Appeal from the United States District Court fo r the C entral D istricto f Illino is. No . 04- cv-1062

—Mi ch ael M . M ihm, Judg e.
A RG UE D M AY 30, 2008

— D ECI DE D O CT OB ER 9, 2008

Befo re B AUER, R IPPLE, a nd W OO D , C ircu it Judges. W OO D , C i r c u it Judge. S i nce 20 01, Fl oyd K. H aye s has s u ffe r e d fr o m a me d i c a l c o n d i t i o n t ha t c a u s e s s p a s ms i n the cre m ast er i c m uscl e a sso ci ate d w i th the le ft si de of hi s sc ro tum
. Duri ng the se spasm s, wh i ch oc cur a t l eas t onc e, an d often m ultiple tim es, e a ch da y, H ayes’s c re m as te ric m u sc le c ra m p s a n d ret ra c ts , com p re ss in g h is tes ti cl e an d causi ng excr uci ating pai n. W hen thes e2 N o. 07

- 2783 spasm s be gan, ar ound Septem ber20 01, H aye s was an i nm ate atI l l i noi s’ s H i l l Corr ecti onalCenter( “H i l l ”)

. Fr om tha tt i me thr o ugh Aug us t2 0 0 2 , wh e n Ha y e s wa s r elea se d from H ill an d p lac ed on p ar ole , he rep e a te d ly so ug ht m edi ca l t r ea tmentf o r thi s pain. In 2 00 4, he b r o ug ht th is l aw su it und er 42 U .S.C. § 1983 , all eging th at D r. W il li am M
. Ham by, medi ca l di r ec to r a t H i l l dur i ngthe re l evantti m e per i od, and var i ous no n-m edi calpri son o ffi ci al s wer e del ibe r at ely ind if fer en t to hi s se r i o us m edi ca l ne eds i n v i o l at i o n o fthe Ei g hth Am en dm en t. The dist ri ct courtgrante d sum m ar y j ud gm ent in f avo r ofbo th Dr. H am by and t he non- m edi caldefendants. H aye s chal l en ges bo th r ulings o n appeal

. W e a ffi rm the j ud gme n ti n f av o r o fth e n o n - me d i c a l p r i s o n o ffi c i a l s , b u twe r ev er se the j udg m en t f o r Dr

. H amby a nd r emand th e c as e fo r tr ial.

I H ayes, now i n hi s e ar l y 6 0s, i s a Vi etnam W arve ter an and fo rm erKentucky S tate T ro oper . In 199 7, he b ega n ser vi ng a 10- yea r sent en c e i n the I l l i noi s Depart m ent o f Corr ecti ons, the bul k of wh i ch he s pent atH i l l

. H aye s fi r s tc o m pl ai ne d o ft e s t i c u l a r c y s t s i n th e f a l l o f2 0 0 0
. An ult ra sound or dered byH i l l physi ci an Dr. M oham m ed C hou d ry rev ealed th at th e cysts w ere ben ign; blood w ork and ur i nal ysi s re sul ts w er e nor m al

. Dr. Ch oudry d id not re ferH aye s t o a urol ogi st, but he did di scuss H aye s’ s ca se w i th a urol ogi st i n Decem ber20 00. Choud ryco ncl ud ed that nei therthe re m ova l o fthe cyst s no r a refe rra l f or a u r o l o g y c o ns ul to r b i o ps y wa s i nd i c a t e d.N o. 07

- 2783 3 A s tim e w en t on, the cyst s beca m e la r g e r and m ore pai nful

. W or ri ed and experi enci ng i ntense discom f or t, H aye s a ske d in M ar ch 200 1 t o be s een b y a uro l ogi st f or a bi opsy ofthe cyst s. H i s r eq u es t a nd r el ate d gri evance w er e d en ied , an d H ay es to ok n o fu r th er ac tio n u n til S ept embe r 2 00 1, whenhis p ain be g ant o b o th erhi m o n a daily b asi s. H e s ought tr eat m ent and w as gi ven a pro phyl a c t i c a nt ib i o t i c a nd T y l e no l I I If o r the p a i n. As i ns t r uc t e d, H aye s vi si ted the m edi caluni t o n Octobe r 4, 20 01. H e s aw D r. H am by th at d ay, an d also 10 d ay s later. ( T hos e w ere his only tw o “ in -person ” visi ts w ith D r. H am by.) D r. H am by w rote on H ayes’s ch art tha t he obs e r v e d “ten d erne ss” and “d iscom fort, ” bu t he d id not us e t h e w ord “pai n. ” Ha ye s asse rt s that he com pla i ned ofpai n at thos e vi si ts; Dr. H am by counter s, base d sol el y o n hi s no tes , that he m us t no t ha ve tho ug htHay es was i n much pain. ( D r. H am by asse rted that he h ad no ind ep en d en t m em ory of H ay es .) W hen H aye s r etur ned to the m edi cal unito n Octobe r 29, 20 01 , h e s aw Dr. Ri chard S hute f orthe fi rs t o fse ver al ti m es . Dr

. S hut e’ s no te s f r o m tho se v i si ts indi ca te tha t he w anted to r eferH aye s t o a ur ol ogi st an d prescr ibe pr es cr i pti o n- st r en g thpa i n medi ca ti o ns , b uttha t Dr. H am by refuse d to app rove th ose treatm en ts. H ay e s’s r ec o l l ec ti o n o fhi s vi si ts wi thDr

. S hute sug g es ts the sam e: “[ Dr. S hute] sa i d he coul dn ’ t m ake Docto r H am by g i v e me th o s e o u t s i d e t e s t s th a th e h a d a s k e d f o r . . . . He tol d m e h e coul dn ’ t g i ve m e no thi ng di ffer ent b ecause H am by w oul dn ’ t a p p rove. Ever ythi ng S hute di d, oka y, D oc to r H am b y h ad to ap p ro ve or d isa p p ro ve .”4 N o. 07

- 2783 Dr

. Ha mby s t a t e d in hi s d epo s i t i o n tha th e n e v e r a ppr o ve d the ur o l o g y r efer r alo r pa i nk i l l erpr es cri p ti o ns b ec au se h e d id n otrec eiv e t h e p ro p er form s. N ot h in g in the r eco rd es tabl i shes w hethersuch for m s were i n f act filled ou t o r, ind ee d , w h et h er th ey w er e re q u i r e d atall. W ha t w e d o know i s tha t D r. Shu te m ad e note s in H ayes’s chartabo ut H aye s’ s increasi ng pai n, wrote atl eas t o nce that H aye s sh oul d have a uro l ogyr efer ra l, and al so presc ribed ibup ro fen and w ro te perm i ssi on s l i ps that al l o wed Hay es t o ha ve i ce pa ck s to e as e hi s pain. The se m i ni m alr em edi es did notpro vi de re l i eff or H ay es . H av in g b ee n to ld by D r. Sh u te th at n o m or e c ou ld be done “beca use Ham by w oul dn ’ ta pp ro ve, ” Hayes bega n to w ri te l ett er s a nd to file gr i evance s with non- m edi cal pr i so n o ffi ci al s, compl aini ngtha t he was no t r ec ei ving a d e q u a t e t re at m en t fro m th e m ed ica l un it

— specifi cally, Dr. H am by. H e wrot e a l ettero n A pri l 16 , 20 02, address ed to Assi st an t Ad m i ni st r at i ve Di r ec to r J es se M o nt g o m ery . The let te r ex p re ss ly a sk ed to se e a “s p ec ialis t” in th e a p p ro p riat e fi el d o fmedi cine “ to de te r m i ne whatthese g r o wths ar e.” H e r e fer re d to a p rior let te r th at h e h ad se n t t o H ill Dir ecto r Donal d Snyder, and the n att em pted to describe h i s c o n d i t i o n, a s k i n gMo n t g o me r y t o “ e x c u s e my gr aphic detai l s”: My t e s t i c l e s s we l l ab n o r ma l l y . My l e ftte st i c l e d r a ws up w ar d l i ke a l eg cra m p w hi ch cau se s m y peni s t o bend up w ar d i nto a fi shhookpositi on. In or der t o u r i n a t e , I m u s t r e a c h d o w n a n d u n d e r t o p u l l my tes ti cl e down to unbend m y peni s. A s y ou ca n i m agine, thi s i s a n extr em el y pai nfulthi ng that I m u st do eac h t i me Ig o t o th e b a th r o o m.N o. 07

- 2783 5 H e r ei ter ate d that thi s w as an “ongo i ng undiagnose d condi ti on”; not ed that at l eas t o ne exam i ni ng ph ysi ci an had sai d that H aye s shoul d be seen by a ur ol ogyspeci al i st, but Dr. H am by had deni ed the re quest; and wrote t hat “[ i ] n the mea nt i me, I r e mai n i n c o ns t a nt pa i n w i th n ew gro w th s b ein g d isc ov er ed w ee kly .” A fterM ontg om er y rec ei ved thi s l ett er, an a dm i ni str ati ve ass i sta nt atH i l l wrote the f ol l owin g em ail, se nt M ay 9, 20 02 , to p er so n n el in th e m ed ica l un it: Ia m r e s e a r c hinga r e s po ns e to i nma t e H a y e s f o r ADD M o nt g o m ery . I n I nm at e H ay es ’ c o r r es po nde nc e he c om p lain s o f in su fficie n t c ar e b y h ea lth c ar e st aff, i.e., tes ti cl es continue to swel l, di ffi cul ty uri nati ng due to b en t p en is, n u m b n es s in ri g h t p alm an d fing er s . . . . Bo tt o m l i ne , he want s o ute ar l y . Ca n y o u g i ve me a ny updat e o n hi s m edi ca l co ndi ti o n? W he n conduct i ng pri orr evi ew i n Decem ber20 01, hi s co nd i ti on was th enr epo r te d a s r emai ni ngs tabl e an d he al thcare needs be i ng ad dress ed. J ust a br i efhi sto ry/c om m ents w i l l suffi ce. Dr. H am by re sponded to t h is e m ai l so m eti m e in M ay 2002 w ith a th ree-pa ge, single-spa ced sum m ary of H ayes’s chartand m edi calhi sto ry, st ar ti ng i n Se pt em b er20 00. Dr. H am by’s l ett erco ncl ud ed by sta ti ng tha t Hayes had “a ri ght e pidi dym alcy st” and a “s m all l eft e pidi dym al cyst
. T he s e h a v e r e mai ne d s t ab l e e xc e ptf o r s e l f

- r e po r ted sw ellin g a n d o c c as ion al t en d er n es s. . . . T ele p h on e c on su ltat i on a nd l ength off ol l ow-up i nd i cate t h e e pidi dym al cyst s a re s im p ly cyst s. B iopsy an d /or surgical excision are n otind ica te d atth is t im e.”6 N o. 07

- 2783 A ssi sta nt W ar den W anda Bass was pl aced i n ch ar ge ofr espondi ng to H aye s’ s co m pla i nt, and she sent a l ett er to H aye s o n M ay 2 4, 2002 , st ating tha t s he had cont acte d th e m ed ica l un it d ire c to r (D r. H a m b y), w h o in tu rn ind ica te d tha t H ay es was b eing“ se en and moni to r ed o n a re gu lar ba sis .” H aye s wrot e a re sponse to Bass on J une 10, 2002 , r ei ter ati ngtha t th e pr o bl em was tha t he was b ei ng“ se ena nd m oni tor ed, ” but not bei ng treated

. In additi on t o re pea t i n g h i s c o mpl a i n t s ab o u t h i s “ s e v e r e p a i n ” a n d t he m edi cal unit ’ s re fusal to or der a r efer ra l o r tes ts, he a dd ed that “[ a] l though Iwas gi ven pain m ed icati on in the past, they now r efuse t o do so

. ” He att ached hi s m edi calfi l es to th e l e t t e r, n o t i n gth a tth e y “ c l e a r l y s h o w th e p a i na nd extr em e chang es” i n hi s co nd i ti on that he had t o endu re . Bass r esponded to thi s l ett ero n J une 17, 20 02: A s ind i cate d i n m y r esponse to yo u dated 05/24 /0 2, your m edi cal concerns have been re vi ew ed b y app ro pr i at e m edi ca l staff

. Howev er, upo n r ec ei pt o fy o ur m ost re cent cor re spondence, I had a disc ussio n with the Heal th Ca re U ni t Ad m i ni str ato r. Your m edi cal c h ar t h as ag ain be en rev iew ed

. A ccord ing to you r m ed ical record s, you hav e a history ofscr ota l cy sts wh i ch oc casi onal l y s w el l and cau se y o u pa i n. The se c y st s d o respo nd t o i ce pa ck s an d Ibuprofen. The U ro l og i st you saw on Decem ber16 , 2000 and the curr ent m edi cal Dir ecto r i nd i cate that yo u d o n otreq u ire fu rt h er int e rv en tio n . H ow ev er , i f you fee l y ou nee d fur thereducati on r ega rdi ng cy sts , p lea se sign u p for n u rs e s ickca ll.N o. 07

- 2783 7 W ar denM ar kPi er so n c o nc urred wi thBa ss ’ s co nc l us i o ns i n a l ett erdated J uly1, 20 02. The concl usi on o fthe non- m ed i calpri son offi ci al s, bas ed on th e inform ation th ey ha d received from H il l’ s m edi ca l s ta ff, was tha t no th i ng fur th erne ede d t o b e do ne ab o utHaye s’ s m edi ca l c o m pl aint s. F o r the s ak e o fa cc ur ac y, ho wev er, we no te tha t Bas s was i n erro rwhens he re fer re d i n h erl ett ero fJ une 17 to H aye s’ s s eeing a urol ogi st on Decem ber 16, 2000
. H aye s never “saw” a ur ol ogi st w h ile h e w as atH ill; D r. C h ou d ry , a n on -sp ec ialis t, sim p ly note d i n H ayes’s chartthat hehad discu ssed H ayes’s case with a uro l ogi st. Fur ther m or e, al though Bass was cor rec t that Hayes’ s pai n often r esponded to i ce pack s a nd ibu p rofen, even those m inim al treatm en ts w ere tak en away fro m hi m atso m e point. A l though Hayes did notfi nd Bass’ s r esponse satisf actor y, he di d as sh e sugge ste d and fi l ed f our “nurse si ck cal l ” r equests betw een M ay and Jul y of20 02. These eff or ts w er e unavai l i ng. In add i ti on to w ri ti ng l ett er s, H aye s a l so f i l e d a f o r ma l g r i e v a n c e o n J u n e 2 0 , 2 0 0 2 , s t a t i n g th athe ha d r epe at ed ly co m pl aine d abo uthi s “e xt r eme pa i n, cancer, and sw ol l en te sti cal s [ si c ], and l ack of m ed ical care to all co n c er n ed p ar tie s.” H e fu rt h er n ot ed th at “I’m in extr em e Pain” and re quested “ P ai n M edi cati on, Pro per cancerte st, po[ ss] ibl e r em ova l o f gr owths on t est i cal s [ si c ] [ , ] I ce forS w ol l en Test i cal s [ si c ], Pr opero utsi de m edi cal C ar e.” The gr i evance o ffi cerdeni ed thi s g ri evan c e o n J uly12 , 2002 , st ating that “D r. H am by ( M D) r esponds [ that] i nm ate H ayes’ [ si c ] fi rs t co m pla i ned ofte sti cl e pr obl em s o n8 N o. 07

- 2783 9/ 18 /0 0. W as tre at ed an d te st ed ac c o r d in gly .” T h is in d icate s tha t de s pi t e Dr

. Ha mby ’ s a s s e r t i o n tha t he wa s no t i nvol ved w i th H aye s’ s ca se at any t i m e a fterOctobe r 2001 a nd tha t he “ wo ul d ne v e r ha v e s e e n” Ha y e s ’ s J une 20, 2002 , gr i evance , a tr i ero ff act coul d concl ud e other w i se. T he gri evan ce rep ort m akes sev eral r eferenc e s to Dr. H am b y, and i t s tat es that Dr. H am by w as the s ourc e f ro m wh i ch t he gr i evance o ffi cerr ecei ved the i nfo rm ati on upon w hi ch he ba sed the denia l

. T he r esponse D r. H am by su p p li ed to assist w ith B ass’s rep ly to H ayes’s Apri l 1 6, 2 00 2, l etter a l so was a ppar en tly us ed as the basi s fordenyi ng the f or m algr i evance thatH aye s fi l ed on J une 20. W ar den Pie rs on co ncurr ed i n th e deni alo fthat gr i evance o n J uly18 , 20 02. H ay es w as relea se d fr o m Hi l l o n Aug us t 15 , 2 00 2. The sam e day, he went dir ectly f ro m the pri son to the Vet er ans’ A dm i ni str ati on ( “V A ”) H ospi tali n Danvil l e, I l l i noi s, se ek i ngt r ea tmentf o r hi s pain. W he n h e ar r i ve d, the h os p ita l st aff t h ou gh t t h at h is c h ief iss u es inv olv ed h is m ental, notphysi cal, heal th. The r eas on i s s i m ple : thr ee days be f or e Hayes’ s r el eas e fro m H i l l, the hospi tal re c eiv ed a ca ll fro m H ill in for m in g i t th at H ay es li ke ly w ou ld be go i n g t h er e u p on h is re lea se an d th at h is “ p rim ar y pr obl em s a re p sychi atr i c. ” Hayes does sufferfro m po s t
- t r a uma t i c s t r e s s di s o r de r o n a c c o un to fboth c hi l dho o d tra um a an d hi s se r vi ce i n Vi etna m , b uthi s r ea so ns f orvi si ti ng the hos pit alth at d ay had nothi ng to do with post- tr aum ati c st re ss diso rder

. The pro gr ess not es f ro m the date he was adm i tte d re portthatH aye s was “a dm i tte d on 8/1 5/ 02 w ith th e c h ief c om p lain t o f te st icu lar p ain .” N otwithstandi ng tha t co m pla i nt, the hospi tal se nt H aye sN o. 07

- 2783 9
st ra igh t t o th e p sy c h iat ry w ar d an d ga ve h im on ly 15 min ut es wi tha ur o l o g i st, Dr

. Nar ay anR. Am in. The Danvil l e ho spi taldi d, how eve r, pro vid e H aye s with presc ri pti ons f oribuprofen and D ar voce t ( a nar cot i c) f or hi s pai n bef or e di schar gi ng hi m o n A ugust 2 5, 20 02. H aye s then l eft Danvi l l e and went o n to hi s fi nal destinat i o n, Ke n t u c k y, wh e r e h i s f ami l y i s . T h e r e , Ha y e s s a w a nu r s e p r a c t i t i o ne r a tthe Le xing t o n VA Ho s pi t a l on S e pt e mbe r 1 2 , 2 0 0 2
. S he eva l ua t e d h i m a nd o r de r e d a tes ti cul arul tr aso und and uro log y consul t. On Septe m ber 3 0 , 2 0 0 2 , h e s a w p r i ma r y c a r e p h y s i c i a n D r . A l i c i a B i g h a m, who pr es cr ibe d Lo r tab ( an o th erna r co ti c) f o r hi s pain; he then s aw u ro l ogi st Dr. W i l l i am Ter ence Connor o n Oc t o b e r 1 0 , 2 0 0 2
. Dr

. Co nn o r di a g no s e d Ha y e s wi th “cr em a[ s] ti c m uscl e spasm w i th chro ni c pai n and peroni es [ si c ] di se as e. ” Pe y r o ni e’ s di se as e is a co nne ct i ve t i ss ue d i s or d er inv olv in g t h e g ro w th of fibr ou s s c ar tis su e in the s oft ti ss ue o fthe pe ni s. The ha r den ed sc art i ss ue p reven ts th e norm al ti s s u e from m oving w he re i t othe rw ise w ou ld in a he a lt h y organ, and this cau ses an abn orm al( and often pain fu l) curv atur e o fthe penis
. U ro l ogi sts can di agno se thi s co nd i ti on, thou gh i t s om eti m es tak es an ev en hi gherdegr ee ofspeci al ty because “the di sea se and i t s c ur r e ntt r e a t men t s a r e n o twe l l u nd e r s t oo d by m ost ur o l o g i s t s i n g e ne r a l pract i ce. ” S ee http: // en .w ikip ed i a. or g/ w i ki /Pe yr oni e’ s_di sea se . A f ter g et tingthi s di agno si s, Hay es was r ef erred t o a pa i nm anage m ent s peci al i st, Dr. J ose ph A tal l ah, for t re atm ent. H e r e mai ns un de r Dr

. At a l l a h’ s c a r e a nd c o nt i nues to re c eiv e t re at m en ts an d m ed i c at ion to m an ag e h is c h ro n ic pain.10 N o. 07

- 2783 H aye s fi l ed thi s l aw sui t unde r 42 U

. S. C. § 1 983 on M ar ch 3, 20 04, al l eging tha t Dr. H am by knew th at H aye s w as endu ring excruci ating p ai n and nonethel ess r efused to p ro vid e re ad ily av aila b le p re sc rip tio n -st re n gt h p ain m edi ca ti o n o r t o r eferHay es t o a ur o l o g y s pec ial is t who c o ul d d i a g no s e a nd p r o pe r l y t r e a th i m. He further ass er ted thatDr. H am by and his subo rdi nates pro vi ded o nl y no n- p r es cr i pti o n medi ca ti o n a nd i ce pa ck s, a nd th atDr

. Ham byt er m i na te d e ve n thi s m i ni m alt r eat m en t f o r H a y e s ’ s p a i n a ft e r fi n d i n go u tth a tH a y e s h a d c o mp lain ed to n on -m ed i c a l p ris on offic ials ab ou t h is p ain an d filed form al g rie va n c es ab ou t h is m e d i c a l ca re . In add i ti on, H aye s co ntended that the n on-m edi calpri son offi ci al s a l so vi ol ate d his co n stituti onalr i ghts w hen they f ai l ed pr o per l y to r es po nd t o hi s se r i o us medi ca l c o ndi ti o n. On M ar ch1 9, 2 00 7, the di st r i ctc o ur t g r an te d the de fen dan ts ’ mot i o ns f o r sum m ar y j udg m en t, r ul i ngb o tho n the m er i ts and on the basi s o fqual i fi ed im m unity. I t deni ed H aye s’ s m ot ion t o al terthe j ud gm ent, and thi s a pp eal f o l l o wed. W e no te th at al th o ug h H ay es’ s compl aint i nitiall y nam ed f our non- m edi caldefendants, he ha s vol untari l y withd ra w n two ofthem ( Dir ecto r Snyder an d A ssistan t A d m in istrative Director M ont gom ery), l eaving o nl y W ar den Pie rs on a nd A ssi sta nt W ar den B as s fo r th is a p p ea l.

II W e r evi ew the dist ri ct c ourt ’ s g ra nt o fsum m ar y j ud gm ent deno vo , exam i ni ng the r eco rd i n the li ght m ost fav or ab le to th e no n -m ov in g p a rt y. Koge rv. Bryan , 52 3N o. 07

- 2783 11 F
. 3d 78 9, 7 96 ( 7th C ir
. 2 00 8)

. “ Pr i so n o ffi ci al s vi o l at e th e Ei g hth Am en dm en t’ s p r o sc r i pti o n a g ains t cr ue l a nd un us ua l p un is hm en t w he n th ey d isplay ‘deliberate ind if

fer ence to ser i ous m edi calneeds ofpri soners. ’ ” Gre e no v. D a ley , 4 14 F. 3d 645, 65 2 ( 7th Ci r. 20 05) ( quoti ng Es t e l l ev. G am ble, 4 29 U. S

. 9 7, 1 04 ( 19 76 ) )

. In Gre e no , we spe l l ed o ut th e t w o-p ar t t es t t h at ap p lies to th es e c laim s: A cl ai m ofdel iber ate i nd i ffer ence to a s er i ous m edi cal need c ontains bo th an obj ecti ve and a subj ecti ve c om p on en t. T o s at isfy th e o bj ec tiv e c o m p on en t, a p ris on er m u st d em on st ra te th at h is m ed ica l co n d iti on i s “ obj ecti vel y, suffi ci entl y s er i ous. ” Far m erv. Bre nna n , 5 11 U. S

. 825, 8 34 ( 19 94 ) ( i nt erna l quo ta ti o ns om itt ed ); se e also Walkerv. Benjam in , 29 3 F
. 3d 1030 , 10 37 ( 7th Ci r. 20 02)

. A seri ous m edi calcond i ti on is one that ha s be endi agno se d b y a p hy si ci ana s m an dat i ng tr eat m ent o r one that i s so obv i ous that e ven a l ay per so n wo ul d pe r ce i ve the ne ed f o r a do ct o r ’ s at te ntio n . See Foelkerv. O utagam ie Co unty, 39 4 F

. 3d 510, 512- 13 ( 7th Ci r. 20 05)

. To sati sfy the subj ecti ve com pon en t, a p ris on er m u st d em on st ra t e t h at p ris on offic i al s a cted with a “ ‘ suffi ci entl y c ulpabl e s tat e o f m i nd

. ’ ” Fa rm er, 51 1 U.S

. at83 4 ( quo ti ng Wi l s on v. Seiter, 50 1 U.S

. 29 4, 29 7 ( 1991 ) )

. The o ffi ci als m ust know ofand dis re gar d an exces si ve ris k to i nm ate h ea lth; i nd eed the y m ust “ both be aw ar e o ff acts f ro m wh i ch the i nfe re nce co uld be drawn that a subs t a nt i a l r i s ko fs e r i o us h a r m e xi s t s ” a nd “ mus ta l so draw the i nfe re nce. ” Fa rm er, 511 U

. S. at 837. T hi s i s no t to sa y that a pri sone r m ust e stabl i sh thato ffi ci als i n t e n d ed or d es ire d th e h ar m th at tra n sp ire d

. Wa lk er,12 N o. 07

- 2783 29 3 F
. 3d at1 03 7. Ins te ad, i t i s e no ug h to sho w tha t th e defen dants kne w ofa s ubs ta nt i alr i sko fha r m t o the in m at e an d d isr eg ar d ed th e r i s k. Id. A dd i ti onal l y, “a f actfi nd erm ay concl u d e that a pri son offi ci alknew ofa subst an tia l r i sk f ro m the ver y f act that the r i sk w as obvi ous. ” Fa rm er, 51 1 U.S

. at84 2. Id. at 653 (p arall el ci tations om itted ).

A W e co nsi der fi rs t whether, as an obj ecti ve m att er, H aye s has pre sente d enough ev i dence to support a fi nd i ng tha t he suffer ed f r o m a s er i o us medi ca l c o ndi ti o n. In Gut i e r rez v. P eters , 11 1 F

. 3d 1364, 13 73 ( 7th C ir. 1 997) , we explained th ata pr i so ne r ’ s m edi cal ne ed i s “s er i o us ” wher e “the failu re to t r e at a p ris on er ’s c on d itio n co u ld res u lt in furthersi gni fi cant inj ury orthe unnecessary a nd wanton i nfl i cti on o fpai n, ” a nd we noted, with a pp ro val, thato ther cour ts had fo und the f ol l owing ci rcum sta nces to be i nd i c a t i o ns tha ta p r i s o ne r h a s a se r i o us me di c a l n e e d: “The exi ste nce o fan inj ury that a r eas onabl e doctor o r pat i en t woul d fi nd i m po r ta nta nd wor th y o fc o m m en t ortr eat m ent; the prese nce of a m edi calco nd i ti on that si gni fi cantl y a ffects an in d ividual ’ s dai l y a cti vi ti es; o r the e xi ste nce o fchr oni c and subst anti alp ain
. ” Id. ( ci tations an d qu otation m arks om itted ). The non- m edic al defendants di d not br i efthe i ssue of se r i o us medi ca l ne ed; the y r ely f o r tha t po i nto n the re aso ni ng o fthe dist ri ct c ourtand w hatev erDr. H am by ha d t o s ayi n h i s br i ef

. The y f o cus i ns tead o n the i r a r g u-N o. 07

- 2783 13

m en t tha t the y l acke d the su bj ective com p one nt of d eliberate i nd i ffer ence, and so we postpone our conside ra ti on ofH aye s’ s cl ai m ag ai nst them unti l we re ach tha t i ssue. Dr. H am by urge s us to fi nd thatH aye s di d not h ave a serious m ed ical ne ed

. H e also ch a racterizes H ayes’s posi ti on a s a r equest for a rul e under w hi ch “a pri son phy sicia n vi ol ate s the Ei ghth Am endm ent when he or she f ai l s t o diagnose atthe ver y fi rs t sta ge a r ar e, pro gr essiv ely w or se n in g c on d itio n th at m as q u er ad es in it s e ar ly sta ges as an insi gni fi cant m edi calco nd i ti on. ” The Ei ghth A m endm ent, he c oncl ud es, r equi re s no such thi ng. ButDr

. Ham byi s as k i ngus t o di sr egard i m po r ta nt p arts of the record

. A s w e hav e d etailed a bove , Dr. H am by’ s invol vem ent in H aye s’ s ca se w as m uch gr eat er than he i s i m ply i ng her e. A l th ou gh Dr. H am by gave H ayes’s co m pla i nts o fpai n l i ttl e wei ght, we have r eco gnized that “self-repo r t in g i s often th e only i nd icator a do ct o r ha s o fa pa ti en t’ s co ndi ti o n, ” an d s o the r e “i s no re quir em ent that a p ri sone r provi de ‘ obj ecti ve’ ev i dence of hi s p ai n and suffer i ng. ” Gre e no , 41 4 F.3d at 65 5. H ay es d id tr y t o ob ta ina re fer ra l to a sp ec i a l i s t, w h o p re su m ab ly coul d have pro vi ded ( one w ay ort h e o ther ) the ki nd o f “obj ec tive ” e vi dence thatDr. H am by thi nks was l acking. H ayes w as ne ver p erm itte d t o see a sp eciali st, how ever, because Dr. H am by re fused to author i ze a r efer ra l

. S ee i d. ( “[ T] he de fen dan ts f ai l to ackno wl edg e tha t Gr ee no s pen t tw o yea rs t ryi ng to obt ai n ‘ ob j ecti ve’ ev i dence, but w as preve nted fro m doing so by Dr. Dal ey and the o ther m edi calpro vi ders. ”) ; se e a l so C o o per v . Ca sey, 97 F. 3d 914, 916-17 (7th Cir. 1996).14 N o. 07

- 2783 The dis tr i ct c ourtco ncl ud ed that because a l ayper son w oul d not be abl e to “ diagnose ” Hayes’ s m al ady o r “d et er m in e w h at t re at m en t w as n ee d ed ,” H ay es ’s c on d iti on was noto bj ecti vel y s er i ou s. T h is i s no t the co rr ect sta nd ar d. The Eight h A m endm ent’ s pro tect i ons ar e no t tr i gge re d onl y b y c ond itio n s that a l ayper son w oul d be ab l e t o di agno se and tr ea t, es pec i al l y whenthe de fen dan t i s no t a l ayper son but i s instea d a p h ys ician. A tr i ero f f act coul d concl ud e in H aye s’ s ca se that eve n a l ay p er son w oul d rea l i ze that a m an with c yst s a nd g row ths o n hi s t est i cl es, wh o coul d not e ven ur in at e w i thout extr aor di na r y mea s ur e s a nd who r e pe a t e dl y c o mpl a i ne d o f ex cru ciating an d i ncr ea singpa in, woul d requ ire “a d octor’s a tt en tio n .” E ve n m or e s o, a re as on ab le p h ys icia n sh ou ld have re alize d that the pati ent was t ry i ng to br i ng a ser i ous condi ti on to hi s or her att enti on. Se e G utierrez , 1 1 1 F
. 3 d a t1 3 7 3 ( r e c o g ni z i ngtha ta “ s e r i o us me di c a l n e e d” exi sts wh er e the co nd i ti on features “chr oni c a n d substa nti alpai n”)

. H aye s has m et hi s bur den ofsho w i ng, f or pur po se s o fs um m ar y j udg m en t, thathe was s uffer i ng f r o m a s er i o us medi ca l c o ndi ti o n.

B T he sub j ective com p onento fHay es ’ s Ei ghth Am en dm en t claim s requ ires him to prese nt f a c t s from w hich a j ury c o u ld find that the relevan t offici als knew of H ayes’s se riou s m ed ica l co n d itio n bu t in te n tio n ally or re c kle ss ly d isr eg ar d ed it. Gre e no , 41 4 F

. 3d at 65 3 (ci ti ng Fa rm er, 51 1 U .S. at 8 37 ); Walkerv. Benjam in , 293 F. 3d 1030 , 10 39- 40 ( 7th C ir. 2002) ( col l ecting ca ses )

. H aye s doe s no t nee d toN o. 07

- 2783 15 p ro ve th at h is c om p lain ts of se ve re p ain w er e “ lite ra lly i gnor ed, ” s ee S he r r odv . L i n gl e, 2 2 3 F
. 3d 605, 611 (7th Cir. 2000 ) ; r ather, he m u st sho w o nl y that the defendants’ re spon se s to i t were so pla i nl y inapp ro pri ate as to perm i t the i nfe re nce that the defendants i ntenti onal l y o r re c kle ss l y d isr eg ar d ed h is n ee d s. Gre e no , 41 4 F

. 3d at 653 ( ci ti ng Fa rm er, 51 1 U.S

. at83 7)

. W e be gi n ouranal ysi s o f th i s co m po ne nt wi th Dr

. H amby, an d th en co ns i der the non- m edi caldefendants.

1 D r. H am b y arg u es th at h e c an n otbe d ee m ed d elib er at ely in d iffer en t b ec au se th e d iag n os is t h at H ay es ev en tu ally ob ta in ed w as for a “ra re , pr og re ss ive ly w or se n in g c on d iti on wh i ch obj ecti vel y a pp ear s in i ts earl y s tag es as an i ns i g ni fi ca ntmedi ca l c o ndi ti o n. ” H e ar g ue s th atHay es’ s condi ti on wh en he ar ri ved atthe L exi ngto n VA H ospi tal in l ate Sep tem ber 2002 w as n o t t h e sam e as w ha t D r. Ha mb y s a w wh e n h e e x a mi n e d Ha y e s i n O c t o b e r 2 0 0 1

. He iden tifies th e criti cal qu estion p resen ted here as: “w as D r. H am by’ s m edi caltre atm ent o fthi s pri sone r w as [ si c ] so bl atant l y inapp ro pri ate as to ev i dence i ntenti onalm i str ea tm ent?” This i s a l m ostco rr ect, but i t i s m i ssing a cruci alpoi nt. Thi s ca se co m es to us on sum m ar y j ud gm ent. Thus, the com ple te questi on is w hether, wh en vie w in g t h e re c or d in t h e ligh t m os t fa vo ra b le t o H ay es , a re aso nabl e t ri ero ff act c o u l d concl ud e that Dr. H am by w as su bj ec tiv ely aw ar e o f H ay es ’s s er i ou s m ed ica l co n d iti on a nd ei therkno w i ngl y o r re ckl ess l y di sr ega rded i t.16 N o. 07

- 2783 Sub j ective aw aren ess an d d eliberat e ind ifferenc e norm al l y c an be prove d onl y with ci rcum sta nti alev i dence. H er e, th e re c o r d i n c lu d es a n u m b er of fac ts th at w ou ld supp or t those fi nd i ngs with re spect to Dr. H am by. Fi rs t, as we a l r ea dy ha ve po inted out, Dr

. Ham by ’ s i nv o l ve m en t i n Hay es ’ s tr ea tmentatHi l l was no t l i m i te d t o hi s two i nperso n exam i nati ons ofH aye s in Octobe r 2001

. H e was mo n i t o r i n gHa y e s ’ s t r e a t me n ta tl e a s te n o u g h t o b e i n a posi ti on t o provi de the non- m edi calpri son offi cials with a th orough s um m ar y o fH aye s’ s char t in M ay 2002
. I n ad d iti on, Dr. H am by’s ap p roval w as req uired before v a r i o us t r e a t men t s , s uc h a s p r e s c r i pt i o n- s t r e ng th med

i c i ne o r a r e fe r r a l t o a s pe c i a l i s t, c o ul d b e a dmi ni s t e r ed to H aye s, and he r efused to gi ve t h at ap prova l

. Dr. H am by ac k no wl edged i n h i s depo si ti o n tha t o th erphy si ci an s a tHi l l h a d r e q u e s t e d th e s e t r e a t me n t s f o r Ha y e s . He ass er ted thatthe reas on he denie d thei r re quests w as that he did not re cei ve the proper paperw or k. That m ay or ma y n o tb e t r ue

— i t depends on whether a t ri ero ff act woul d b el i ev e Dr

. Ham b y ’ s e x p l an at i o n. W ha t i s i m po r ta nt at thi s point i s that thi s t est i m ony re veal s that D r. H am by co nt i nue d t o b e awar e o fHay es ’ s co ndi ti o n a nd i nvol ved i n hi s t re atm ent l ong afterOctobe r 2001

. Dr. H am by’ s deposi ti on t est i m ony al so sugge sts that ev eni fhe ha d r ec ei ve d f o r m alpa per wor k req uest i ngthe addi ti o na l t r ea tment s, he pr o babl y woul d ha ve do ne n ot h in g d iffer en tly . D r. H am b y st at ed fla tly in h is d ep os iti on that no pai n experi enced by any p risone r ev e r w arra nts pr escr i pti on- str ength pai nki l l er s. H e a cknowle dged that the “ pol i cy for al l physi ci ans in [ the Depart m ent o f C or re c tio n s]” is to d isp en se p re sc rip tio n -st re n gt h p ainN o. 07

- 2783 17

m ed ica tio n s (op iat es ) on ly w h en th e p h ys icia n “a b so lu te ly fel t they were nece ssa ry . ” He w ent o n, however, to st ate hi s be l i efthatp ri sone rs neve r needed such drugs, and so he pe r so na l l y ne ve r pre sc r ibe d the m . W he n a sk ed whathe w oul d do i fhe saw a p ati ent “ w hose l eve l o fpai n orwh ose c on d itio n w ar ra n te d an op iat e le ve l of p ain m ed ica tio n,” Dr

. H amby r epl i ed th athe woul d “ [ p] utthe m i n the i nfi r m ar y a nd o bs er ve them a nd yo u v ery r api dl y f o und th at T yle n ol w as all th ey n ee d ed

. T h at w as m y e x p er ien c e.” T h i s s u g g e s t s th a te v e n i fth e a l l e g e dl y r e q u i r e d f o r ms had been s ubm i tte d to Dr. H am by, he woul d not hav e si g ne d o ffo n a r eque stt o pr o vi de H ay es wi thpr es cr i pti o nstr ength p ai n m edi ci ne. ( Dr. H am by neverdi stingui shed b et w ee n op iat es an d oth er ty p es of p re sc rip tio n p ain me d i c a t i o n s , a n d s o a t r i e r o ff a c tw o u l d n o tb e c o mpel l ed to c on c lu de that hi s co ncer ns exte nd ed to o pia tes alo n e.) Dr

. Ham by ’ s at to r ne y o bj ec te d t o a ny l i ne o fque st i o ni ng re l ating to hi s cl i ent’ s pre scr ibi ng m etho ds, arg uingthat “[ t] here ’ s no ev i dence i n thi s ca se that [ H aye s] ev er needed an y ot h erm edi cati on duri ng the ti m e fra m e that Dr

. Ham byw as tr ea tinghi m . . . . ” Tha t o bj ec ti o n s tr i k es us a s b i zar re , g i v e n the e v i de nc e Ha y e s h a s p r e s e nt e d. F ur th er m o r e, Hay es s ho wed tha t he st opped r ec ei ving eve n the m i ni m al tr eat m ent o fo ver - the- counteribuprofen and i c e p ac ks i n M ay 2002 , r i ght a fterDr. H am by l ear ned from the n on-m ed ical p rison offici als that th ey w ere i nvesti gat i ng a com pla i nt fro m H aye s about i nadequ ate m edi cal car e. H aye s ar gues that Dr. H am by re vok ed these tr eat m ents i n re tali ati on f orhi s co m pla i nts. I fbel i eve d18 N o. 07

- 2783 by a trier of f act, that cou ld fac t o r i nt o a find ing tha t D r. H amby was de l ibe r at ely i ndi ffer en t to Hay es ’ s co ndi ti o n. Dr. H am by’ s t est i m ony i s a l so re veal i ng w i th r espectto hi s d eni al s o fH aye s’ s per si ste nt r equests to se e a speci al i st i n uro l ogy . Duri ng hi s deposi ti on, D r. H am by w as shown a note i n H ayes’s c hartfro m ano ther physi ci an atH i l l, Dr. S hu te, wh o had rec om m ended th at H ay es be giv en a u ro log y re fer ra l: Q [H ay es ’s c ou n se l]:

. . . A n d it s a ys refe rra l for u ro logy . N ow can yo u see wh er e i t s ays that ? A [D r. H am b y]: It sa ys refe rra l for u ro log y w or k-u p . Q: Okay. A : W h at ev er th at m ea n s. Q: So yo u don’tkno w wh at that m eans? A : Ihav e no id ea. H e d idn ’t fil l ou t any f orm . H e d idn ’t spel l o ut anythi ng. H er e, D r. H am b y p ro fes se d to “h av e n o id e a ” w h a t it m eans f ora physi ci an to wri te “r efer ra l foruro l ogyworkup” o n H ay es ’ s ch ar t. A t r i er o f f ac t co ul d r ej ect the asse r t io n that the d irector ofa m ed ical un it i s not aw are of t h e m eani ng o fthatphrase , as wellas the noti on that the m edi caldi re cto r knows nothi ng unti l a subor dinat e p hy sician fi ll s out a fo r m e x p lai nin g the conc ep t of a re fer ra l to a speci al i st. Even i fso m e type o ff or m was re quir ed bef or e a H i l l physi ci an could pro vi de H aye s w ith an ou ts id e re fer ra l to a u ro log ist, a fac t-fin d er co u ld i nf er f r o m D r . Ha mb y ’ s r e s p o n s e s o n th i s p o i n tth a the was ho st i l e an d di smi ss i ve t o Hay es ’ s nee ds. The f ol l owing exchange i s t el l i ng:N o. 07

- 2783 19 A [ Dr

. Ha mby ] : Th e l i mi t a t i o n f o r a r e fe r r al was m edi ca l ne ce ss i tya nd tha t’ s th e way i t ha s be ena nd i t i s ev ery wher e y o u go. The pr ac ti ce o fmedi cine w i thin the p r i s o n s y s t e m a nd o ut s i de the p r i son sys tem i s e sse nti al l y the sa m e. Q [Hayes’ s co unsel ] : W he n y ou spea k o fm edi cal n e c e s s i t y, i fs o me b o dy ’ s h a v i n gp a i n, e v e n e x t r e me pai n but the pai n i s no t

— i s no t r el ate d to a f atal illn es s o r a d et er iora tin g s or t o f illn es s, co u ld th at p ain nonethel ess be consi dered a m edi calnece ssi ty? A : The pa in co uld be and Iem phasi ze coul d be l i ste d as a m edi calnece ssi ty i fIco uld docum ent a cause f o r the pa i n. Q : S o i f som ebod y w ere com p lai nin g abou t a severe pain o r s ubs ta nt i alpa i n a nd y o u c o ul dn’ t do cument a cause, then w oul d that perso n then no t

— n otbe ab le to see a speci al i st? A : Iw ou ld n ’t k n ow w h ich sp ec ia l i s t t o s en d h im to if Ican’ t co m e up w i th a docum ented ca use for pai n such a s r e a c h i n gu p , g r ab b i n ga t e s t i c l e a n d p u l l i n gi td o wn an d ha ving th e g uy g o i nt o s pas m . . . . Ors o m ethi ng li ke th at. Idon ’t

— Ido n’t ne ed to c o m e up wi tha docum ented di agno si s. Ineed t o com e up with s om eth i ngtha t Ido n’ t k no w w ha t iti s [ th at ] i s ca us i ng pai n that Ican docum ent. These a re tr oubl i ng st ate m ents. Dr. H am by’ s a sse rt i on th at a pa ti en t’ s r epo r t o fe xt r eme pa i n wi th o uta do cum en te d ca u se d oe s n otc on st itu te a “m ed ica l ne c es sit y,” and his i nsi ste nce that a r efer ra l to a speci al i st i s no t20 N o. 07

- 2783 appr o pr i at e when “Ido n’ t k no w whati t i s [ th at ] i s ca us i ng the pai n, ” m ake no sense . The f act that a gener alprac ti ti oner i s unabl e t o i denti fy o r docum ent the cause o fa pati ent’ s pai n does not str i ke us as a reas on t o re je ct a re quest t o see a speci al i st; i nd eed, as H aye s’ s co un sel o bs er ved , it su g g es ts j us t th e o ppo si te
. Dr

. Ham bye ss en ti al l y s ai d that he wil l notr efera pati ent t o a s peci al i st unl es s he a l r ea dy k no ws what th e pr o bl em i s ( an d thus does not need the speci al i st’ s inpu t)

. But th e v er y r eas on w hy a speci al i st w oul d b e c all ed i n i s that a ge nera l i st i s u n a b l e t o id en tify th e c au se of a p ar tic u lar ailm en t. If w h at Dr. H am by w as say i ng was thatno re fer ra l was needed because H ayes was not“r eal l y” i n substa nti al pai n, ther e is a differ ent pr obl em . That t ake s us backto th e ev i den ce i ndi ca ting th at Dr

. H amby k ne w o f, b ut disr ega rded, H aye s’ s r epeate d repor ts ofse ve re, pro gr essi ve l y wor se ni ngpa i n. A nd w hi l e Dr

. Ham bys ai d, i m pl au sibl y, thathe woul d not “k n ow wh i ch speci al i st to send [ H ay es ] to i fIcan’ t co m e up w i th a docum ented cause f orpai n, ” no o ne her e di sputes t h at the proper sp ec ialis t fo r an ev alu at i o n o f H ay es ’s t es tic u lar p ain w as a ur ol ogi st. The r eco rd show s that Dr. H am by knew th atDr

. S hut e r eque st ed a ur o l o g y r efer r ali n 2 00 1, a nd th ata s ea r l y a s S ept embe r 2 00 0, Dr

. Cho udr y ha d do ne a ur ol ogywork- up and co nsul ted with a ur ol ogi st ab o u tH ay es ’ s c a s e . Ha y e s ’ s me d i c a l r e c o r d s s h o w a u n i v e r s a l a wa r e n e s s o fth e f a c tth a tth e s e p r o b l e ms w er e the dom ai n ofa urol ogi st. Though w e co uld s ay m or e, thi s is enough t o show that a reason able trier of f act co uld conc lud e tha t D r. H am by’s tr eat m ent o fH aye s co nsti tuted d el iber ate i nd i ffer ence toN o. 07

- 2783 21

a s er i ous m edi calneed. Su m m ary j ud gm ent was there

f or e a n i napp ro pri ate r eso l uti on o fH aye s’ s ca se aga i nst Dr. H am by.

2 The posi ti on o fthe non- m edi caldefendants i s di ffer ent. H er e ag ai n, our pr i o r de ci si o n in Gre e no i s instr ucti ve. Greeno, l i ke H ayes, had com pla i ned to non- m edi cal pri s o n o ffi c i a l s , b o th i n l e t t e r s a nd b y fi l i ngf o r malg r i evan ce s, tha t h e was r ec ei vingi na dequa te c ar e f r o m the p rison’s m ed ical un it. T he d istri ct cou rt gra nt ed sum m ary j u d g me n to r d i s mi s s a l f o r a l l o fth e d e fe n d a n t s . We concl ud ed that sum m ar y j ud gm ent was appro pri ate for som e of th em , bu t not all

. W he n discu ss in g G reen o’s cl ai m s aga i nst the gr i evance offi cer w ho handl ed “atl eas t se ve n ” o f G re en o’s inm at e c om p lain ts (C h ar les M iller, a no n- med i c a l o ffi c i a l ) , we s t a t e d: G reen o cont en d s tha t M il ler w as d eliberat ely ind ifferen t t o h is m ed ica l n e e d s b ec au se h e fa iled to inv es tig at e th e co m pl aint s o r r emedy the medi ca l de fen dan ts ’ f ail ure t o pr o vi de appr o pr i at e tr ea tment
. Our re vi ew of the r eco rd, however, r eve al s that M i l l er r ev i ewe d Gr ee no ’ s co m pl aint s an d v er ifie d wi ththe m edi calo ffi ci al s that Gre eno w as re cei vi ng tr eat m ent. W e do n ot think M i l l er ’ s f ai l ure to tak e further acti on o nce he h ad r efer re d the m att erto the m edi cal provi ders can be vi ew ed as del iber ate i nd i ffer ence. 414 F. 3d at 655- 56. W e w ent o n to adopt the r eas oni ng o f th e Thi r d Ci r cui t i n Spruil l v. Gillis , 372 F. 3d 218, 236 ( 3d Cir

. 20 04) , wh i ch hel d that22 N o. 07

- 2783 [i]f a p ris on er is u n d er th e c ar e o f m ed ica l ex p er ts
. . . a non-m edi calp ri son offi ci alwil l ge nera l l y b e j usti fi ed in b elie vin g th at th e pr iso n er is in ca p ab le h an d s. T h is f o l l o ws n a t u r a l l y f r o m th e d i v i s i o n o f l ab o r wi th i n a pri son. Inm ate heal th and safety i s pro m ote d by divi ding re sponsibi l i ty f orvar i ous a spects ofi nm ate l i fe a m ong guar ds, adm i ni str ato rs , physi ci ans, and so o n. Hol di nga no n- m edi ca l pr i so n of fi cial l i ab l e i n a case w he re a prisone r w as u nd e r a ph ysician’s care w ou ld strain th is divisi on of l abor. 37 2 F
. 3 d a t 2 3 6

. We a d d e d th a t we “ d e c l i n e [ d ] t o e xt en d r e s po ns ib i l i t y f o r Gr e e no ’ s m e di c a l ca r e to Mi l l e r . P e r ha ps i t would be a differ ent m att eri fM i l l erhad i gnor ed Gr ee no ’ s co m pl aint s en ti r ely, b utwe ca n see no del ibe r at e i ndi ffer en ce g i ve n tha t he i nv es ti gat ed th e com p lai nt s and referr ed them to the m ed ical p ro v id e rs w ho co uld be exp ecte d to add re ss Greeno’ s co ncer ns. ” 4 14 F. 3d at 656 ( ci ti ng He r nan dez v. Ke ane, 34 1 F

. 3d 137, 14 8 ( 2d C ir. 20 03 )). A cco rd, Joh nso n v . D o ug hty, 433 F. 3d 1001 , 10 12 (7th C ir. 2006). Li k e M il l eri n Gre e no , th e n on -m ed ica l d efe n d an ts in thi s ca se i nvest i gat ed H aye s’ s com pla i nts a nd r efer re d them to the re sponsibl e m edi calpro vi ders. H aye s r eco gni zes the hurdle that Gre e no p re se n ts , bu t h e a rg u es th at h is case i s di ffer ent, bec ause, as Spruil l r ec o g ni ze d, no nm edi calo ffi ci al s ca n “be charg eabl e with the Eighth A m en d m en t scient er requ irem en t of d eliberat e ind ifference” w here they have “a r eas on t o bel i eve ( oractual kn ow ledge ) th at p rison d o c tors or their assistant s are m i str eat i ng ( or not tr eat i ng) a p ris oner . ” Spruil l , 37 2 F
. 3dN o. 07

- 2783 23
at 236; se e a l so Gre e no , 414 F.3d at65 5-5 6; Johns on , 43 3 F.3 d at10 12 . H er e, H ay es arg u es , B as s a n d P ier s o n d id have actualkno w l edge, o r at l eas t r eas on t o bel i eve , that th e p r i s o n d o c t o r s w e r e “ mi s t r e a t i n g( o r n o tt r e a t in g ) ” h i m. H e no te s th athe t o l d Ba ss abo uth is p ain an d abo ut the doct or s’ r efusalto r espond to hi s pl eas f ortr eat m ent. T h e n on -m ed ica l d efe n d an ts co u n te r th at th ey inv es tigat ed H aye s’ s co m pla i nts, so ught r epor ts f ro m m edi cal offic ials , an d relie d on th e jud gm e n t o f th e p ris on p h ys ici an s. The y no te tha t al th ou g h Gre e no a nd Johns on r e v e r s e d s u mma r y j u d g me n t s f o r c e r t a i n m edic al offic ials i n e ac h c as e, tho se c as es a ffi r m ed th e jud gm en ts f o r no nm edi cald efe n dants be cause the l att erhad i nvest i gat ed “a nd v er i fi ed w i ththe medi ca l o ffi ci al s th at[ th e i nm ate s were] r ecei vin g tre atm ent, and w er e e nti tl ed to re ly on th e jud gm en ts of m ed ica l st aff.” The qu e s t i o n i s wh e the r the n o n- med i c a l de fe nd a nt s h ad an y d u ty to d o m or e t h an th ey d id , i n ligh t o f th eir knowle dge o fthe si tuati on. W e thi nk not

. The pol i cy su p p orting th e pres um p tion th at non -m ed ical offici als are en tit led to d efe r to th e p ro fes sio n al jud gm en t o f th e fa c ili ty’ s m edi calo ffi ci al s o n q uesti ons ofpri sone rs ’ m edi cal car e i s a so u n d one. H er e, the non- m edi calo ffi ci al s r esp ond ed read il y and pr o m p tly to each of H ayes’s letters and gri evance s. They c ontac ted M edi calDir ector H am by and t he adm i ni str ato r, r equesting r epor ts and sum m ar i es abou t the care tha t H ayes h ad received i n ord er to ensu re them sel ves that hi s co m pla i nts di d not r equi re further ac ti o n . Atwo r s t, th e y ma y h a v e b e e n n e g l i g e n ti n f a i l i ng to i nvest i gat e further afterr ecei vi ng the sum m ar i es24 N o. 07

- 2783 f ro m the m edi calst aff, but negl i gen ce i s no t del iber ate ind ifferenc e. B ecau se th e non -m ed ical d efend an ts w ere enti tl ed to rely o n the profess i onalj ud gm ent o fm edi cal pr i so n o ffi ci al s, a nd b ec au se no th i ngi n Dr

. H am by’s re port s m ade i t obvi ous that Hayes m i ght no t be re c eiv in g a d eq u at e c ar e, th e d is t r i c t c ou rtco rre c tly gr anted sum m ar y j u d gm ent in f avo r ofthe non- m edi cal defe nd ants.

C Befo re co ncl ud i ng, we m ust s ay a w or d about quali fi ed i m m u n i ty, bec ause Dr. H am by ar gued i n the al ternati ve th athe wa s en ti tl ed to j udg m en t o n tha t g r o und. The d istri ct cou rt conc lud ed that allof th e d efend an ts w ere enti tl ed to qual i fi ed i m m unity. It base d that c oncl usi on sol el y o n i ts deter m i natio n that none o fthe defe nd ants had vi ol ated H aye s’ s Ei ghth Am endm ent r i ghts. Because H aye s had “ f ai l ed to est abl i sh the vi ol ati on of a fe d eral ri ght, ” the court f ound, he co uld notdefeatthe defe nd ants’ cl ai m s forqual i fi ed i m m u n i ty. On app eal, Dr. H am by h as not prese nted an al ternati ve ar gum ent t o supp or t a fi ndi ngo fqua l i fi ed i m m uni ty. W e ha ve r ej ec te d the d ist rict cour t’ s concl usi on that H aye s f ai l ed to sta te a cl ai m unde r th e Eighth A m endm ent, o r that he f ai l ed to co m e f orw ard wi the no ug h e vi den ce t o s uppo r t su cha cl ai m . I t has bee n est abl i shed f ordecades that pri son physi ci ans v i ol ate inm ate s’ co nsti tuti onalr i ghts w hen they del iber ate l y di sr ega rd an i n m ate ’ s s er i ous m edi cal con d iti on, and only a tri al can resolve th e fa cts th at are i n dis pu te.N o. 07

- 2783 25 III Th e j ud g men ti n f a v o r o fM a r kA

. Pi e r s o n a nd Wan da L. Bass i s A F F I RMED . The j u d g me n ti n f a v o r o fWi l l i a m M. H am by i s R EV ER S ED a nd R EMA NDE D f orfurtherpro ceedi ngs c onsi ste nt with thi s o pini on. The co sts o n appeal sh al l b e di vi ded equa l l y b etwee n a ppel l an t H ay es a nd ap p elle e H am b y.

10- 9- 08