Court Opinion

ID: 9962506
Source: CourtListenerOpinion
Date Created: 2024-04-23 20:00:28.954298+00
Date Added: 2024-06-11T08:18:58.387074
License: Public Domain

In the

    United States Court of Appeals
                For the Seventh Circuit
                    ____________________
No. 23-1220
RICHARD RODGERS,
                                               Plaintiff-Appellant,
                                v.

WILLIAM RANKIN, et al.,
                                            Defendants-Appellees.
                    ____________________

        Appeal from the United States District Court for the
                      Central District of Illinois.
       No. 4:20-cv-04121-SLD-JEH — Sara Darrow, Chief Judge.
                    ____________________

   ARGUED NOVEMBER 28, 2023 — DECIDED APRIL 23, 2024
               ____________________

   Before EASTERBROOK, HAMILTON, and BRENNAN, Circuit
Judges.
    HAMILTON, Circuit Judge. Plaintiﬀ-appellant Richard
Rodgers entered the East Moline Correctional Center with a
history of scoliosis and back pain that had been treated surgi-
cally by implanting steel rods in his back. His back pain per-
sisted during his time in prison. At some point during his im-
prisonment, the rods in his back broke. The broken hardware
went undetected for more than a year after two radiologists
2                                                  No. 23-1220

misread his x-rays. Eventually, the jail’s primary care physi-
cian, defendant-appellee Dr. William Rankin, discovered the
broken hardware when he double-checked Rodgers’ x-ray
images. Dr. Rankin arranged for Rodgers to receive corrective
surgery. After that surgery, Rodgers needed another after de-
veloping an infection.
    After this ordeal, Rodgers sued the radiologists and Dr.
Rankin, as well as other defendants not at issue in this appeal.
The district court screened Rodgers’ complaint under
28 U.S.C. § 1915A and dismissed his Eighth Amendment
claims against the radiologists because Rodgers did not state
a viable constitutional claim against them. The court allowed
Rodgers to proceed against Dr. Rankin but eventually granted
summary judgment for him. The court found that Rodgers
had not come forward with evidence that would allow a rea-
sonable jury to find that Dr. Rankin had violated the Eighth
Amendment by acting with deliberate indiﬀerence toward
Rodgers’ serious medical condition. Rodgers has appealed.
    We aﬃrm the judgment of the district court. Regarding the
radiologists, the Eighth Amendment requires allegations of
more than mere negligence to state a viable claim. Rodgers
alleged no more than negligence by the radiologists. As for
Dr. Rankin, we agree with the district court that the evidence
would not support a reasonable finding that Dr. Rankin acted
with deliberate indiﬀerence to Rodgers’ serious medical con-
dition. In fact, Dr. Rankin deserves the credit for having found
the radiologists’ errors in reading the x-rays and putting
Rodgers on the path to the corrective surgery he needed.
No. 23-1220                                                  3

I. Factual and Procedural Background
   Richard Rodgers endured scoliosis for years before enter-
ing the East Moline Correctional Center. Sometime before his
imprisonment, he had metal rods known as Harrington rods
implanted in his back to straighten his spine. Twice before his
imprisonment, those rods had broken, requiring further sur-
gery.
    Rodgers’ back problems persisted at the prison. In Decem-
ber 2016, Rodgers met with Dr. William Rankin, the physician
for the prison, to discuss his back pain and other ailments.
Rodgers told Dr. Rankin that he had Harrington rods in his
back and that they had broken previously. Dr. Rankin had
never before treated a patient with Harrington rods. After
noting that Rodgers had some tenderness along his spine, Dr.
Rankin gave him ibuprofen and Robaxin, a muscle relaxer.
Dr. Rankin also ordered a low-bunk permit and an extra blan-
ket to reduce stress on Rodgers’ back.
    Rodgers’ medical records show that he next complained
of back pain in May 2018. Rodgers and Dr. Rankin met again
for an appointment that month. Rodgers complained that he
had been feeling “sharp, throbbing, and constant pain” at the
base of his neck for a couple of months. Dr. Rankin ordered x-
rays and a follow-up appointment.
     The x-rays came back a few days later. Dr. Naveed Yousuf,
the radiologist who examined Rodgers’ x-rays, reported that
Rodgers’ hardware “appears to be intact and in satisfactory
alignment.” Despite that promising report, Dr. Rankin de-
cided to increase Rodgers’ Robaxin dosage because he was
still experiencing back pain.
4                                                  No. 23-1220

   Rodgers’ medical records do not reflect that he com-
plained of back pain again until December 2018, when he re-
ported to a nurse that he had “nervy” back pain that “comes
and goes.” Dr. Rankin added a prescription for gabapentin to
Rodgers’ treatment regimen of Ultram, Robaxin, and Tylenol.
    In September 2019, Rodgers complained of “shooting”
pain, saying it felt like there was “something digging” into his
back. Dr. Rankin ordered a second round of x-rays. Again, the
x-ray report—this time signed by Dr. Jonathan Foss—said
that the “hardware appears intact.”
    This time, however, Dr. Rankin reviewed the x-rays him-
self. He thought the Harrington rods appeared to be broken.
Dr. Rankin asked Dr. Foss to look at the x-rays again. Dr. Foss
did so and revised his report. He agreed that the Harrington
rods appeared fractured. Dr. Rankin later acknowledged that,
upon further review, Rodgers’ first x-ray from May 2018 also
showed a broken Harrington rod, though Dr. Rankin at that
time had accepted Dr. Yousuf’s report that they were intact.
    Having determined that the Harrington rods were broken,
Dr. Rankin sought out specialists to treat the issue. He first
referred Rodgers to an orthopedic specialist, but that special-
ist was unable to provide the treatment Rodgers needed. Dr.
Rankin next referred Rodgers to a neurosurgeon. Dr. Rankin
also ordered a CT scan and in the meantime increased Rodg-
ers’ Robaxin dosage. Eventually, in March 2020, Rodgers met
with the neurosurgeon.
   The neurosurgeon recommended surgery to replace the
Harrington rods. Rodgers received care in the prison infir-
mary until the surgery finally occurred in June 2020, in the
midst of the COVID-19 pandemic. After the surgery, Rodgers
No. 23-1220                                                   5

developed an infection while staying in the prison infirmary
to recover. He underwent another procedure to treat the in-
fection. Dr. Rankin monitored Rodgers’ condition throughout
this time by ordering monthly labs and other tests. In Decem-
ber 2021, Rodgers had yet another surgery to replace his Har-
rington rods, this time with a material less prone to infection.
    Believing that his medical care had fallen beneath consti-
tutional standards, Rodgers filed this suit against Dr. Rankin,
Dr. Yousuf, Dr. Foss, and the prison’s corporate healthcare
provider, Wexford Health Sources, Inc. Pursuant to 28 U.S.C.
§ 1915A, the district court screened Rodgers’ complaint. The
court construed the complaint as alleging Eighth Amendment
claims against all defendants. With this understanding, the
court determined that Rodgers stated an Eighth Amendment
claim against Dr. Rankin and Wexford Health Sources for de-
liberate indiﬀerence to a serious medical need. But the district
court also concluded that Rodgers did not state an Eighth
Amendment claim against Dr. Yousuf or Dr. Foss because,
even taking Rodgers’ allegations as true, he did not allege that
those doctors’ actions exhibited anything worse than negli-
gent treatment.
    After discovery, Dr. Rankin and Wexford Health Sources
moved for summary judgment. The district court granted
their motion, concluding that Rodgers failed to establish a
genuine dispute of material fact as to whether Dr. Rankin
acted with deliberate indiﬀerence in dealing with him. With-
out an underlying constitutional violation, the district court
also ruled that Rodgers’ claim against Wexford failed.
6                                                     No. 23-1220

II. Analysis
    Injuries and illnesses are common behind prison walls,
and because prisoners are unable to obtain their own medical
treatment, the government bears responsibility for providing
necessary medical care. If government oﬃcials fail to provide
medical treatment or act with deliberate indiﬀerence toward
a serious medical need, they may be held liable for violating
the Eighth Amendment. Failure to treat injuries and illnesses
appropriately can inflict pain and suﬀering that serve no le-
gitimate penological purpose. Estelle v. Gamble, 429 U.S. 97,
103 (1976).
     Prison oﬃcials do not violate the Constitution every time
they fail to heal a prisoner’s injury or cure an illness. Id. at 106
(“Medical malpractice does not become a constitutional vio-
lation merely because the victim is a prisoner.”); McGee v. Ad-
ams, 721 F.3d 474, 481 (7th Cir. 2013) (“Deliberate indiﬀerence
is not medical malpractice .…”), quoting Duckworth v. Ahmad,
532 F.3d 675, 679 (7th Cir. 2008). Only when government oﬃ-
cials act with “deliberate indiﬀerence to serious medical
needs of prisoners” do they cause “unnecessary and wanton
infliction of pain” that violates the Eighth Amendment. Es-
telle, 429 U.S. at 104. Determining whether medical treatment
in a prison setting violates the Eighth Amendment involves a
two-step inquiry: first, did the plaintiﬀ have an objectively se-
rious medical condition, and second, did the defendant-oﬃ-
cial act with deliberate indiﬀerence to that condition? Petties
v. Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en banc). The par-
ties agree that Rodgers’ scoliosis was a suﬃciently serious
medical condition, so we focus on deliberate indiﬀerence.
    The deliberate indiﬀerence standard ensures that liability
is imposed only on prison oﬃcials who act with a suﬃciently
No. 23-1220                                                    7

culpable state of mind. To satisfy the standard, prisoner-
plaintiﬀs must show that a prison oﬃcial “actually knew of
and disregarded a substantial risk of harm.” Id. Mere negli-
gence, or even objective recklessness, is not enough. A medi-
cal professional’s erroneous treatment decision violates the
Eighth Amendment only where it represents “such a substan-
tial departure from accepted professional judgment, practice,
or standards as to demonstrate that the person responsible
did not base the decision on such a judgment.” Id. at 729, quot-
ing Estate of Cole v. Fromm, 94 F.3d 254, 261–62 (7th Cir. 1996).
We apply these standards first to the radiologists and then to
Dr. Rankin.
   A. The Radiologists
   In a screening order, the district court construed the alle-
gations against the radiologists, Dr. Yousuf and Dr. Foss, as
Eighth Amendment claims and dismissed them. We agree
with the district court’s order. To state a claim for deliberate
indiﬀerence under the Eighth Amendment, Rodgers needed
to allege that the radiologists “actually knew of and disre-
garded a substantial risk of harm.” Petties, 836 F.3d at 728 (em-
phasis omitted). His complaint failed to do so. He alleged only
that “[t]he statements in the report are not true to the images
taken.” He did not allege that the radiologists intentionally
misrepresented their findings, knowingly committed some
other form of wrongdoing, or did not care whether their read-
ings were correct or not. Without such allegations, the com-
plaint fails to state an Eighth Amendment claim.
    Also, at no point in the district court proceedings did
Rodgers indicate that he intended to bring state-law claims
for medical malpractice. In oral argument on appeal, as well,
Rodgers disclaimed intending to bring such a claim. So while
8                                                  No. 23-1220

we assume the factual allegations in Rodgers’ complaint
could support claims for medical malpractice or negligence,
that theory has been waived.
    B. Dr. Rankin
    Rodgers contends next that Dr. Rankin’s chosen course of
treatment demonstrated deliberate indiﬀerence to his back
pain. According to Rodgers, Dr. Rankin—who had no prior
experience with Harrington rods—ignored Rodgers’ concern
that his rods had broken and refused to consult a specialist
about the matter. Instead, to treat Rodgers’ back pain, Dr.
Rankin prescribed pain medication and monitored the situa-
tion. This course of treatment allegedly delayed correction of
the broken Harrington rods by more than a year.
    To prove an Eighth Amendment claim for deliberate indif-
ference to a serious medical condition, a prisoner does not
need to show that a physician or nurse literally ignored his
condition. Where the prisoner received some care, however,
it is not easy to prove deliberate indiﬀerence. One path, as
noted, is to show that a medical professional’s treatment de-
cision was “such a substantial departure from accepted pro-
fessional judgment, practice, or standards as to demonstrate
that the person responsible did not base the decision on such
a judgment.” Estate of Cole, 94 F.3d at 261–62. Another path is
to show that a medical professional refused to consult a
needed specialist and/or persisted in a course of treatment
that the professional knew was not eﬀective when reasonable
alternatives were available. E.g., Pyles v. Fahim, 771 F.3d 403,
411–12 (7th Cir. 2014); Berry v. Peterman, 604 F.3d 435, 441–42
(7th Cir. 2010); Greeno v. Daley, 414 F.3d 645, 655 (7th Cir.
2005).
No. 23-1220                                                   9

    Rodgers essentially points out that his broken Harrington
rods could have been identified sooner if a diﬀerent course of
treatment had been pursued. We assume he could have been
saved from significant pain if that had happened. But to sur-
vive summary judgment on his deliberate indiﬀerence claim,
Rodgers needed to submit evidence creating a dispute as to
whether Dr. Rankin’s course of treatment followed one of
these inappropriate paths. Rodgers did not do so. The district
court properly granted summary judgment.
       1. Failure to Consult a Specialist
    Failure to consult a specialist can demonstrate deliberate
indiﬀerence to a serious medical condition if the doctor’s de-
cision was “blatantly inappropriate.” Pyles, 771 F.3d at 411,
quoting Roe v. Elyea, 631 F.3d 843, 858 (7th Cir. 2011). The un-
disputed evidence shows this was not such a case. To the ex-
tent that Rodgers disputes portions of the evidentiary record,
he has not provided evidence that creates a genuine dispute
of material fact. We take the events chronologically.
          a. December 2016
    When Rodgers first met Dr. Rankin in December 2016, he
reported only generalized back pain. Dr. Rankin examined
Rodgers and noted some “tenderness along the spine.” He
did not diagnose broken Harrington rods, and there simply is
no evidence that he should have done so at that time, let alone
that any competent physician would have done so. Dr. Ran-
kin prescribed ibuprofen and a muscle relaxer, and he or-
dered some special accommodations for Rodgers to ease the
stress on his back. According to the evidence in the record,
Rodgers did not complain to the medical staﬀ about back pain
again for more than a year. This factual record does not create
10                                                    No. 23-1220

a dispute of material fact as to whether Dr. Rankin’s treatment
in December 2016 exhibited deliberate indiﬀerence. If any-
thing, from Dr. Rankin’s perspective, it would have appeared
that the treatment was eﬀective given the lack of follow-up by
Rodgers.
    Rodgers disputes this evidentiary record. He asserts that
he complained of worsening pain throughout 2017. But the
only evidence he oﬀers to support this assertion is a prison
grievance he wrote two years later, in 2019. The statements in
that grievance were not made under oath and they do not con-
temporaneously corroborate his version of events. Nobody,
including Rodgers himself, testified to the veracity of the
statements in his grievance. Admissible evidence was needed
to create a genuine dispute of material fact on the point. Fed.
R. Civ. P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252
(1986). That is lacking here.
           b. May 2018
    Dr. Rankin next saw Rodgers about his back in May 2018.
Rodgers complained of “sharp, throbbing and constant pain”
at the base of his neck for a few months. Dr. Rankin testified
that he examined Rodgers and noted that he walked “well”
but had some muscles bulging out more on the right side of
his back than on his left. Dr. Rankin ordered x-rays for Rodg-
ers.
    The x-ray report came back a few days later. Dr. Naveed
Yousuf, the radiologist, reported that Rodgers’ hardware “ap-
pears to be intact and in satisfactory alignment.” (That finding
later turned out to be wrong.) This x-ray report presented Dr.
Rankin with a medical puzzle: Rodgers reported an increase
in pain, yet there was no identifiable reason for it. Because
No. 23-1220                                                              11

Rodgers’ pain was not “severe,” Dr. Rankin decided to in-
crease his muscle relaxer dosage and continue to monitor his
progress.1
    A doctor who is stumped by a patient’s serious condition
cannot just throw up his hands when it is obvious that expert
attention is needed. Pyles, 771 F.3d at 412. Consider, for exam-
ple, Berry v. Peterman, 604 F.3d 435 (7th Cir. 2010). We reversed
summary judgment in favor of a jail physician because the
physician refused to refer a prisoner to a dentist despite re-
peated complaints of prolonged and serious tooth pain and
the proven ineﬀectiveness of pain medication. Id. at 441–42.
    Rodgers’ situation was quite diﬀerent. The information
available to Dr. Rankin at the time indicated that the pain
medication and other accommodations were working. Rodg-
ers did not report back pain again until December 2018.2
    We assume that other doctors might have decided to con-
duct additional testing or consult sooner with a specialist to
determine the root cause of Rodgers’ back pain. But Rodgers
has not presented any evidence that Dr. Rankin’s course of
treatment departed so substantially from professional stand-
ards of care as to support an inference that he was not exer-
cising his professional judgment. Rodgers submitted an

    1 Rodgers contends that he told Dr. Rankin he believed the pain was

caused by his Harrington rods and that he asked to see a specialist. Again,
these assertions are supported only by Rodgers’ unsworn 2019 prison
grievance and fail to establish a genuine dispute of a material fact. We ex-
press no opinion on whether admissible evidence of such a request by
Rodgers would have been material to the outcome here.
    2 In December 2018, Rodgers complained of “nervy” back pain that

“comes and goes.” Dr. Rankin added a prescription for gabapentin to his
existing regimen of Ultram, Robaxin, and Tylenol.
12                                                    No. 23-1220

expert witness report by Dr. Ryan Herrington, but that report
failed to dispute the adequacy of Dr. Rankin’s treatment.
Large sections of the report do nothing more than reiterate
portions of Dr. Rankin’s deposition. To the extent that the re-
port disagreed with Dr. Rankin’s course of treatment, it
showed only that one person—Dr. Herrington himself—
would have made diﬀerent choices. The report does not raise
a genuine dispute as to whether medical professionals more
generally would view Dr. Rankin’s course of treatment as in-
eﬀective or inappropriate. See Petties, 836 F.3d at 729 (“[E]vi-
dence that some medical professionals would have chosen a
diﬀerent course of treatment is insuﬃcient to make out a con-
stitutional claim.”).
           c. September 2019
    Nine more months passed before Rodgers complained of
back pain again. In September 2019, he reported feeling
“shooting” pain in his back. He said it felt like something was
digging into his back. In response to the marked increase in
pain, Dr. Rankin ordered a second round of x-rays. Again, the
x-ray report—signed this time by Dr. Jonathan Foss—said er-
roneously that Rodgers’ Harrington rods “appear[ed] intact.”
    Generally, in both medicine and law, physicians are enti-
tled to rely upon expert opinions of specialists. Accordingly,
our case law teaches that a physician can be deemed deliber-
ately indiﬀerent if he or she refuses, at least without good rea-
son, to take instructions from a specialist. See Petties, 836 F.3d
at 729, citing Arnett v. Webster, 658 F.3d 742, 753 (7th Cir. 2011).
But here, after reading the second x-ray report, Dr. Rankin de-
cided to review the x-rays himself. Exercising his own judg-
ment to double-check the x-rays turned out to be the right
course. He discovered that Rodgers’ Harrington rods were
No. 23-1220                                                  13

fractured. Dr. Rankin told Dr. Foss what he had found, and
Dr. Foss double-checked and confirmed that the Harrington
rods were indeed broken. He revised his x-ray report to note
the broken hardware. Dr. Rankin immediately began to seek
out specialists to treat the problem.
    From this record, no reasonable jury could find that it was
obvious that Dr. Rankin should have sought specialized ad-
vice earlier. Far from it. Dr. Rankin tried to discern the cause
of Rodgers’ back pain. When those attempts failed, he pre-
scribed pain medication that could at least manage Rodgers’
pain. When Rodgers’ pain increased, Dr. Rankin made re-
newed eﬀorts to figure out why. He twice ordered x-rays that
should have revealed Rodgers’ broken Harrington rods much
earlier, and he personally discovered the broken rods after
two erroneous reports from radiologists.
    Rodgers contends that Dr. Rankin did not “monitor” him
after May 2018. The factual record belies this assertion. In ad-
dition to the instances noted above in which Dr. Rankin ex-
amined Rodgers after he reported pain, Dr. Rankin saw Rodg-
ers at least two additional times in September 2018 and April
2019 for unrelated health matters. The evidence does not
show that Rodgers reported back pain at either appointment.
    Further, even if Rodgers’ assertion that Dr. Rankin failed
to monitor him were true as a factual matter, Rodgers fails to
explain why it would matter in relation to his deliberate indif-
ference claim. He does not provide evidence that the prevail-
ing standards of care dictated that Dr. Rankin monitor Rodg-
ers more than he did. Again, Rodgers fails to establish a dis-
puted material fact.
14                                                  No. 23-1220

       2. Delay
    It is well established that delayed treatment of painful con-
ditions can demonstrate deliberate indiﬀerence. See Petties,
836 F.3d at 730 (collecting cases). Arguing along those lines,
Rodgers contends that Dr. Rankin’s course of treatment
caused an inexcusable delay in resolving his back pain. We
have no trouble assuming that Rodgers suﬀered severe pain
due to his broken Harrington rods. Hindsight tells us that the
rods had broken as early as May 2018, yet Rodgers did not
undergo surgery until June 2020. It is easy to imagine that al-
ternative courses of treatment could have eased his pain
sooner.
   But liability under Section 1983 for an individual defend-
ant is determined based on individual responsibility. Rodgers
has not presented evidence showing that Dr. Rankin himself
caused the delay through deliberate indiﬀerence to Rodgers’
condition. Other factors—especially Dr. Yousuf’s error in
reading the May 2018 x-rays and later eﬀects of COVID on
healthcare in prisons—delayed the surgery Rodgers ulti-
mately needed. Because Rodgers does not present evidence
demonstrating that Dr. Rankin’s course of treatment
amounted to deliberate indiﬀerence, we aﬃrm summary
judgment on this ground.
       3. Retaliation
    Finally, Rodgers argues that Dr. Rankin threatened to re-
duce his pain medication in retaliation for submitting medical
complaints. To support this assertion, however, Rodgers
again relies on only the statements in his unsworn 2019 prison
grievance. The grievance fails to create a dispute of material
fact for the reasons discussed above. All the other admissible
No. 23-1220                                             15

evidence in the record controverts this claim. Every time
Rodgers complained of an increase in pain, Dr. Rankin tried
altering his pain medication to alleviate the symptoms.
Simply put, Rodgers has not presented evidence creating a
genuine dispute as to whether Dr. Rankin threatened to re-
duce his pain medication.
   The judgment of the district court is AFFIRMED.