Opinion ID: 4548568
Heading Depth: 2
Heading Rank: 3

Heading: The Nurse Defendants

Text: Moving on to the individual nurses’ actions, we agree with the district court that Nurse Rea reasonably responded to Pulera’s ﬁrst medical request, which did not give her notice of any serious problems, let alone a risk of suicide. Pulera simply asked that she deliver his medications “for [his] pain, anxiety, and depression.” He did not even mention symptoms. Indeed, contrary to Pulera’s argument, he did not say he was depressed, only that the pills were for depression. Any rational factﬁnder would see this message the way Rea did: as a simple request for medicine. She reasonably responded to that request by telling Pulera he would receive his medications, if Dr. Butler approved them. She then gave Dr. Butler all the information necessary to decide not to approve them. The request that Pulera sent to Nurse Gilanyi did include symptoms—physical symptoms. Pulera complained that his heart was pounding and hurt, that he could not breathe, and that he needed his medications or he could die. That Pulera was concerned about dying, or even that he might have been having an anxiety attack, did not put Gilanyi on notice that he might be contemplating suicide. The request signaled that he feared dying not from self-harm, but from a heart attack or lack of oxygen. A correctional oﬃcer was qualiﬁed to conﬁrm that Pulera was, in fact, breathing and not apparently in cardiac arrest, so it was reasonable for Gilanyi to ask one to do so and rely on his assessment. Like in Florek, 649 F.3d at 600, summary judgment was proper because Pulera’s “outward appearance did not put oﬃcers on notice” of his condition despite his complaints of serious symptoms. (And unlike Florek, who did suﬀer a heart attack, there is no evidence those No. 19-2291 21 serious symptoms ever manifested.) With the oﬃcer’s conﬁrmation that Pulera was ﬁne and just wanted his medications, Gilanyi appropriately responded that the doctor had not prescribed them. The Fourth Amendment requires that arrestees receive reasonable care, not speciﬁc care, no matter how many times they ask. Id. at 600–01 (citing Jackson v. Kotter, 541 F.3d 688, 697 (7th Cir. 2008)); see also Williams v. Ortiz, 937 F.3d 936, 944 (7th Cir. 2019) (same under Fourteenth Amendment). Pulera resists the comparison to Florek and instead bases his argument on Belbachir v. Cty. of McHenry, 726 F.3d 975 (7th Cir. 2013). We recognized in Belbachir that “[a] severely depressed person who has hallucinations, acute anxiety, and feelings of hopelessness and helplessness and who cries continually, talks incessantly of death, and is diagnosed as suicidal, is in obvious danger.” Id. at 982. Pulera’s request, though, did not put Gilanyi on notice of any of these facts or anything similar. At most, one might be able to infer she had notice that Pulera was suﬀering “acute anxiety,” but we afﬁrmed summary judgment for the nurse who knew only of Belbachir’s anxiety and panic attacks and not her other issues. Just like that nurse, Gilanyi was not even negligently responsible for a suicide risk that Pulera never told her about. Id. Regarding Nurse Reed, Pulera argues that her calling a correctional oﬃcer to check on him was an unreasonable response to his third medical request. Just like the second, though, Pulera’s most pressing assertion was that he could not breathe. A call to a correctional oﬃcer to physically check 22 No. 19-2291 on him was one reasonable way for Reed to conﬁrm that Pulera was not in immediate danger. 2 Pulera’s third request admittedly went further than his second and mentioned other symptoms—he was vomiting, dizzy, and just generally sick—but Nurse Reed, too, went further than relying on the correctional oﬃcers’ report. She informed Pulera that someone would check his blood pressure and called Dr. Butler, who expanded it to a full vitals check. This was a reasonable response to Pulera’s remaining complaints, which while certainly worthy of investigation, were not an apparent emergency. Cf. Gayton v. McCoy, 593 F.3d 610, 621 (7th Cir. 2010) (noting that “[v]omiting, in and of itself, is not an uncommon result of being mildly ill, and, absent other circumstances … does not amount to an objectively serious medical condition” under the Eighth Amendment). At the vitals check, Pulera would be face-to-face with a nurse who could see his symptoms and hear anything he had to say. When Nurse Summers-Sgroi performed the check, she saw nothing wrong and Pulera admits he never said a thing about other symptoms or suicidal thoughts. Pulera bases his claim against her on his brother William’s phone call. Summers-Sgroi contends that this call did not give her notice of a risk of suicide because all she heard was yelling about clonazepam before she transferred the call. William, though, 2 Although the timeline surrounding this call to the correctional oﬃcer is jumbled, Pulera does not develop an argument that Reed did not in fact call the oﬃcer. Even if he disputed whether she had, though, Pulera would still have a problem with causation. A delayed response to Pulera’s reported symptoms might be concerning, but there is no evidence that Pulera’s injuries resulted from those symptoms. No. 19-2291 23 disputed this story; he says he told whoever he spoke with that Pulera was suicidal and never admitted yelling. That this call came from an outside source does not “refute the receipt of notice.” Ortiz, 656 F.3d at 533. Still, even under Pulera’s version of the facts, it was not objectively unreasonable for Summers-Sgroi to discount the call. Though no one knows whether she received the call before or after the vitals check (or even Pulera’s attempt), at best she had either just seen Pulera or was just about to see him. When confronted with a healthy patient who mentioned no problems and an outside caller saying the patient was distraught, a reasonable nurse could believe her own observations over the phone call. Indeed, that is precisely what we suggested the defendant who answered the phones in Ortiz should have done, given a jail’s understandable hesitance to accept medical requests from outside sources. Id. at 529. Summers-Sgroi saw Pulera and observed no reason whatsoever to believe Pulera was suicidal—Pulera admits he did not tell her he was suicidal and does not contest her determination that his vitals were “excellent.” Under these circumstances, it was not unreasonable for her to take no special precautions against his attempted suicide. Because Pulera’s individual claims against the nurses fail, so too must his Monell claims against VNCC and the county. Although individual liability is not always a prerequisite for municipal liability, see Glisson v. Ind. Dep't of Corr., 849 F.3d 372, 378 (7th Cir. 2017) (en banc), Pulera argues only that the facility inadequately trained its nurses and had a de facto policy permitting them to delegate all their duties to correctional oﬃcers. Even assuming Pulera could prove the training inadequate or the lax policy unconstitutional, he cannot show 24 No. 19-2291 causation. See id. at 379 (“The central question is always whether an oﬃcial policy, however expressed … caused the constitutional deprivation.”). The nurses acted appropriately under the circumstances, both generally and to the extent they relied on correctional oﬃcers, so their alleged lack of training and overreliance on oﬃcers could not have caused Pulera’s injuries. See City of Los Angeles v. Heller, 475 U.S. 796, 799 (1986) (per curiam) (“If a person has suﬀered no constitutional injury … the fact that the departmental regulations might have authorized the use of constitutionally excessive force is quite beside the point.”).