Opinion ID: 1405731
Heading Depth: 2
Heading Rank: 2

Heading: Deliberate Indifference to a Serious Medical Condition

Text: In order to sustain a § 1983 claim for violation of Taylor's Fourteenth Amendment due process right to adequate medical care, the plaintiff must show that: (1) Taylor had an objectively serious medical condition; (2) the defendants knew of the condition and were deliberately indifferent to treating her; and (3) this indifference caused her some injury. See Hayes v. Snyder, 546 F.3d 516, 522 (7th Cir.2008); Qian v. Kautz, 168 F.3d 949, 955 (7th Cir.1999). An objectively serious medical condition is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would perceive the need for a doctor's attention. Hayes, 546 F.3d at 522. A medical condition need not be life-threatening to be serious; rather, it could be a condition that would result in further significant injury or unnecessary and wanton infliction of pain if not treated. See Reed v. McBride, 178 F.3d 849, 852 (7th Cir.1999). With regard to the deliberate indifference prong, the plaintiff must show that the official acted with the requisite culpable state of mind. Id. This inquiry has two components. The official must have subjective knowledge of the risk to the inmate's health, and the official also must disregard that risk. Collins v. Seeman, 462 F.3d 757, 761 (7th Cir.2006). Evidence that the official acted negligently is insufficient to prove deliberate indifference. See Payne for Hicks v. Churchich, 161 F.3d 1030, 1040 (7th Cir.1998). Rather, `deliberate indifference' is simply a synonym for intentional or reckless conduct, and that `reckless' describes conduct so dangerous that the deliberate nature of the defendant's actions can be inferred. Qian, 168 F.3d at 955. Simply put, an official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference. Higgins v. Corr. Med. Serv. of Ill., Inc., 178 F.3d 508, 510 (7th Cir.1999); see also Hudson v. McHugh, 148 F.3d 859, 864 (7th Cir.1998). Even if a defendant recognizes the substantial risk, he is free from liability if he responded reasonably to the risk, even if the harm ultimately was not averted. Farmer v. Brennan, 511 U.S. 825, 843, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). Whether a medical condition is serious and whether a defendant was deliberately indifferent to it are fact questions, to be resolved by a jury if a plaintiff provides enough evidence to survive summary judgment. See Hayes v. Snyder, 546 F.3d 516, 523 (7th Cir.2008). The district court granted summary judgment to the defendants because it found that they did not show a deliberate indifference to a serious medical need of Taylor's; we review this decision de novo, viewing all facts in the light most favorable to the plaintiff. Williams v. Rodriguez, 509 F.3d 392, 398 (7th Cir.2007).
The district court found that Taylor's CHF, but not her vomiting, was a serious medical condition. There is no dispute that Taylor had a serious heart condition, CHF, which was diagnosed by a doctor. Taylor's prison medical records reflected this and noted that she was required to take six different medications to manage this condition. So, Taylor's CHF was a serious lifelong medical condition, and a jury could find that Taylor's complaints of chest pain during her incarceration at PCJ made the defendants aware that she had an objectively serious medical condition that required medical intervention. Vomiting, in and of itself, is not an uncommon result of being mildly ill, and, absent other circumstances (e.g., vomiting continuously for a long period of time, having blood in one's vomit, or the like), does not amount to an objectively serious medical condition. However, given that PCJ and its medical staff were on notice of Taylor's CHF, they should have been more concerned about her vomiting than that of the average ill inmate. When Taylor arrived at PCJ she complained of chest pain. Subsequently, she complained of nausea and vomited enough to make several prison guards very concerned for her health. There is no need to parse the two conditions and call one serious and the other not. As Dr. Weinstein testified, excessive vomiting could exacerbate Taylor's heart condition. The seriousness of her vomiting is highlighted by the fact that several prison guards thought it prudent to collect her vomit in a bag and call the nurse to see if Taylor could be examined immediately. At minimum, a jury could find that, although not life threatening, Taylor's vomiting could have led to increased pain or injury as a result of her heart condition, allowing the plaintiff to survive the defendant's motion for summary judgment on the issue of whether she exhibited a serious medical condition. See Farmer, 511 U.S. at 843, 114 S.Ct. 1970.
The district court did not find that any of the defendants' actions extended beyond mere negligence into the realm of deliberate indifference because it found that Taylor's complaints were not indicative of crushing chest pain or chest pain that signaled an emergency. Given this conclusion, the district court found that the nursing staff was reasonable in assuming Taylor was drug seeking and responded appropriately to Taylor's complaints by putting her on the list to be seen by a doctor three days after her initial complaints of chest pain. In reaching these conclusions, the analysis weighed the evidence and neglected to view the facts in the light most favorable to the plaintiff as the non-moving party. The record reflects that Taylor's CHF was a life threatening condition known to the defendants through Taylor's medical records. Her specific complaints of chest pain while she was incarcerated at PCJ, either alone or in conjunction with her serious vomiting, could certainly lead a jury to believe that she had a serious medical condition. Whether a reasonable jury could possibly find for the plaintiff depends on the knowledge each individual defendant had regarding Taylor's condition, and how each defendant responded to her requests for medical attention. So, we must examine the defendants' knowledge and actions individually.
Dr. Norman Johnson, Sheriff Michael McCoy, and Superintendent Steven Smith did not have contact with Taylor during the days immediately preceding her death. So, in order to sustain a due process claim against them, the plaintiff needs to show that they had knowledge of Taylor's condition and somehow ratified the deliberate indifference of those persons who were directly responsible for Taylor's care. See Hudson, 148 F.3d at 863. Given that the record reveals no evidence that they knew of Taylor's incarceration, condition, or requests for medical attention, summary judgment in their favor is appropriate.
It is well established that there is no respondeat superior liability under § 1983. See Horwitz v. Bd. of Educ. of Avoca Sch. Dist. No. 37, 260 F.3d 602, 619-20 (7th Cir.2001). A private corporation is not vicariously liable under § 1983 for its employees' deprivations of others' civil rights. Iskander v. Vill. of Forest Park, 690 F.2d 126, 128 (7th Cir.1982). Generally, to maintain a viable § 1983 action against a municipality, a government agent (such as Advanced Correctional Healthcare, Inc.), or individual policymaking defendants in their official capacities (such as Johnson, McCoy, and Smith), a plaintiff must demonstrate that a constitutional deprivation occurred as the result of an express policy or custom promulgated by that entity or an individual with policymaking authority. See Latuszkin v. City of Chicago, 250 F.3d 502, 504 (7th Cir. 2001). So, in order to maintain an action against Advanced Correctional Health Care, Inc. or Peoria County, the plaintiff must show that PCJ's healthcare policy was a moving force behind Taylor's death or needless suffering. Latuszkin, 250 F.3d at 505. Here, the plaintiff cites two policies which he contends contributed to Taylor's death. First, he claims that the jail's policy did not permit the guards to directly contact Dr. Johnson when they felt that a prisoner needed a doctor's attention. Second, he argues that when a prisoner is very sick guards should check on her every half hour. At PCJ, a doctor is present to take appointments on Mondays, Wednesdays, and Fridays. The doctor is on call twenty-four hours a day, seven days a week, for any medical emergency. Prison policy dictates that a doctor is supposed to be contacted if a prisoner complains of a serious medical condition, specifically including chest pain. At all other times there is a nurse or nurse practitioner on site to handle minor emergencies and other ailments. Although mandating a doctor's visit or constant prisoner checks would likely reduce the number of illness-related deaths or injuries, it is neither economically prudent nor feasible to put such policies in place. As the plaintiff conceded at oral argument, the policies that were in place were sufficient to provide Taylor with adequate medical care; instead, the plaintiff alleges that the harm to Taylor resulted from the nurses' failure to follow these policies. So, any type of Monell claim fails. See Monell v. City of New York, 436 U.S. 658, 98 S.Ct. 2018, 56 L.Ed.2d 611 (1978). As such, summary judgment for all non-nurse defendants is appropriate. We now turn to the defendants that actually had contact with Taylor prior to her untimely death.
Nurse Radcliff was the first medical professional to treat Taylor upon her arrival at PCJ. Taylor complained of chest pains. Nurse Radcliff failed to follow PCJ's protocol which requires her to contact a doctor when an inmate complains of chest pains. She also failed to take Taylor's vital signs. Instead, Nurse Radcliff responded to Taylor's complaints by putting her on the list to have her vitals checked each morning, and, according to her own statements, asked Taylor about the severity of her chest pain. More importantly, she had Taylor call her brother to bring her CHF medication to PCJ and put a specific note on Taylor's chart to call the doctor if the medication was not delivered by the next day. [D]eliberate indifference may be inferred based upon a medical professional's erroneous treatment decision only when the medical professional's decision is such a substantial departure from accepted professional judgment, practice, or standards as to demonstrate that the person responsible did not base the decision on such a judgment. Estate of Cole by Pardue v. Fromm, 94 F.3d 254, 261-62 (7th Cir. 1996). If this standard is not met, the deliberate indifference question may not go to the jury. Id. Here, although she did not have Taylor immediately examined by a doctor, given that she took reasonable measures to ensure that Taylor would get her medication, and put a notation in her chart to have her seen by a doctor if they did not arrive, it cannot be said that Nurse Radcliff's judgment departed so substantially from the professional norm that she acted deliberately indifferent to Taylor's health. Nor can it be said that her actions were so dangerous that the deliberate nature of her conduct can be inferred. Qian, 168 F.3d at 955. So, summary judgment in Nurse Radcliff's favor is appropriate.
Nurse Mattus examined Taylor after she complained of nausea. During this examination, Taylor neither vomited nor complained of chest pain. In response, Nurse Mattus put Taylor on the morning sick call list, but refused to give her any medication to quell her nausea. Certainly Nurse Mattus should have checked Taylor's chart and ascertained whether Taylor's CHF medications had been delivered, and in response to finding that they had not been, immediately followed up with Dr. Johnson. But, her failure to do so was not a deliberate indifference to a serious medical condition, but mere negligenceTaylor neither vomited nor complained of chest pain during the visit; had she done so, our analysis might be different. But since she did not, and negligence is not actionable as a due process violation, summary judgment in favor of Nurse Mattus is appropriate. See Steele v. Choi, 82 F.3d 175, 178 (7th Cir. 1996) (courts must distinguish between deliberate indifference to serious medical needs of prisoners, on the one hand, and negligen[ce] in diagnosing or treating medical condition, on the other, and only the former violates the Eighth Amendment (citations omitted)).
Later that morning, Taylor again went to PCJ's infirmary complaining of nausea. Nurse Hibbert examined her and found that her blood pressure was high. Taylor asked for anti-nausea medication but did not vomit. Nurse Hibbert did not give Taylor this medication, but she testified that had she seen Taylor vomit, protocol would have dictated that she administer anti-nausea medication to her. She also testified that she knew of Taylor's CHF, and that the prison policy stated that a nurse should retrieve a prisoner's medical chart before examining her. Had she done so, she would have seen that Taylor was supposed to have been examined by a doctor because her brother failed to bring her CHF medications to the prison, and that Taylor had complained of chest pain during intake. Later that day, Taylor vomited while attending a court proceeding via video. The prison guards were so concerned about Taylor's health that they felt it necessary to collect her vomit in a trash bag. Admirably, they immediately called Nurse Hibbert and told her that Taylor needed to be examined as soon as possible. (Nurse Hibbert disputes the guards' version of events, but for our purposes we accept it as true). Despite clear indications that Taylor was in serious medical needshe had complained of chest pain, exhibited high blood pressure hours earlier, and vomited during a video hearingNurse Hibbert refused to see Taylor, and instead told the guards to have her fill out a sick request form. See Walker v. Benjamin, 293 F.3d 1030, 1037 (7th Cir.2002) (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970) ([A] factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious.). Nurse Hibbert herself admitted that if she had seen Taylor vomit, she would have given her anti-nausea medication. But faced with the guards' concern and a bag full of vomit, she did not. In fact, the record reveals that the reason she did nothing was, because, according to the guards' testimony, it was approaching the end of her shift and she wanted to let the next nurse handle the situation. As a result of her inaction, Officer Browning, one of the guards that told Nurse Hibbert to examine Taylor, thought that Nurse Hibbert violated prison protocol, and filed a complaint against her. And all three of the guards present at the video hearing testified for the plaintiff in this matter. Given that Nurse Hibbert refused to treat or even see Taylor in spite of her serious medical condition, a jury could easily find that her actions surpassed mere negligence and entered the realm of deliberate indifference. In fact, the guards' testimony regarding Taylor's condition, and the various acts that they took to try to help her, shows that even a layperson would believe that Taylor's condition was serious. See Hayes, 546 F.3d at 522. Therefore, we reverse the district court's grant of summary judgment in favor of Nurse Hibbert.
The district court also found that none of the nurses' actions was the proximate cause of Taylor's death. See Berman v. Young, 291 F.3d 976, 982 (7th Cir.2002) (noting that plaintiff must produce evidence that she sustained actual injury and that her injuries had a causal connection with the alleged [Section 1983] due process violation) (citations omitted). The district court concluded Gayton needed to show, through expert testimony, that the nurses' inaction necessarily caused Taylor's death. And without such testimony, the district court found he could not establish proximate cause. Because Dr. Weinstein's testimony concerning the possible connection between Taylor's vomiting and her tachycardia should not have been excluded, the plaintiff now has expert evidence to establish causation. Moreover, even if the plaintiff could not proffer expert testimony in this case, he still would have adequate causation evidence to reach trial against Nurse Hibbert. Proximate cause is a question to be decided by a jury, and only in the rare instance that a plaintiff can proffer no evidence that a delay in medical treatment exacerbated an injury should summary judgment be granted on the issue of causation. See Grieveson, 538 F.3d at 779; Cooper, 211 F.3d at 1015. Expert testimony is not always necessary to establish causation in a case where an inmate alleged that prison employees violated his due process rights by failing to provide him with adequate medical care: Clearly, expert testimony that the plaintiff suffered because of a delay in treatment would satisfy the requirement. On the other hand, evidence of a plaintiff's diagnosis and treatment, standing alone, is insufficient if it does not assist the jury in determining whether a delay exacerbated the plaintiff's condition or otherwise harmed him. Grieveson, 538 F.3d at 779 (citing Liefer, 491 F.3d at 715). But if the plaintiff offers evidence that allows the jury to infer that a delay in treatment harmed an inmate, there is enough causation evidence to reach trial. Grieveson, 538 F.3d at 779. In Grieveson, an inmate alleging prison officials violated his due process rights by failing to provide him with adequate medical care did not introduce expert testimony that the delay in medical care caused him to suffer. Id. Nonetheless, because he introduced the medical records relating to his injury, which could have led a jury to infer that a delay in treatment could have unnecessarily prolonged and exacerbated his injury, we concluded he had enough evidence to survive summary judgment. Id. The same is true here. The plaintiff has offered evidence that Taylor had a serious medical condition, the guards thought her condition serious enough that she needed medical attention, and Nurse Hibbert actively ignored her requests for treatment. This is enough for a jury to find that Taylor incurred many more hours of needless suffering for no reason as a result of Nurse Hibbert's inaction. Id. This is especially true because the constitutional deprivation at issue is a failure to provide Taylor with due process in the form of adequate medical treatment; the plaintiff need not prove that Nurse Hibbert's inaction necessarily led to Taylor's death, but rather that her suffering was exacerbated by Nurse Hibbert's failure to provide her with adequate medical care. See id.; see also Liefer, 491 F.3d at 715-16.