Cesal v. Moats
851 F.3d 714
| 7th Cir. | 2017Background
- In March 2008 Cesal, an insulin-dependent diabetic and Pekin prison welder, injured his back lifting a heavy door and reported acute hip/leg pain and numbness. He received initial nurse/PA care, ibuprofen, an x-ray and later an MRI; he was excused from work and given interim accommodations.
- Cesal filed grievances beginning April–June 2008 about alleged inadequate care for his back; the BOP denied appeals after an MRI and outside neurology consult were performed and conservative treatment continued.
- On June 27, 2008, Cesal alleges Clinical Director Dr. Moats — angry about the grievance — cancelled Cesal’s sliding-scale insulin prescription; Cesal remained without insulin (but on metformin) for an extended period and suffered hyperglycemia symptoms.
- Cesal exhausted administrative remedies as to both the back-care grievance (final denial November 25, 2008) and the diabetes grievance (final denial May 26, 2009). Moats partially restored insulin at a reduced dose on October 29, 2010 and returned full prior dosage by February 22, 2011.
- Cesal filed a Bivens suit in December 2012 against Drs. Moats and Molina asserting (1) Eighth Amendment deliberate indifference to his back injury and (2) First Amendment retaliation (and Eighth Amendment claim) for withholding insulin. The district court granted summary judgment for defendants on statute-of-limitations and merits grounds as to both claims.
- The Seventh Circuit majority affirms: rejects tolling/continuing-violation arguments for the insulin claim (limitations ran from partial restoration in Oct. 2010) and concludes no genuine dispute that Moats’s care for the back and the reduced insulin dosage fell short of Eighth Amendment deliberate indifference or proved retaliation. Judge Posner dissents, urging reversal and development of the record with counsel and a medical expert.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Cesal stated an Eighth Amendment claim for insulin withholding at screening | Cesal alleged Moats canceled insulin in retaliation and knew withholding would cause pain and harm | Moats contended the claim was mischaracterized and treatment choices were medical judgment | Court: Screening should have recognized an Eighth Amendment claim re: insulin (plausible deliberate indifference alleged) |
| Whether Cesal’s back-care claim is time-barred | Cesal argued the injury was ongoing while at Pekin and limitations should run from last act (transfer off Moats’s care) | Defendants argued suit was untimely if measured from final grievance denial (Nov. 25, 2008) | Court: Limitations for back claim tolled during exhaustion and accrual may run from last act; summary judgment on SOL for back claim was inappropriate (statute issue resolved in plaintiff’s favor) |
| Whether evidence permits a reasonable jury to find Moats deliberately indifferent re: back care | Cesal contended delays and failures (including lack of diagnosis of middle-back fracture) amounted to deliberate indifference, not mere negligence | Moats argued Cesal received prompt and ongoing conservative treatment, imaging, and specialist consult; differences are medical judgment | Court: No reasonable jury could find deliberate indifference on back; care was conservative but adequate and lacking evidence Moats knew of/ignored middle-back injury |
| Whether insulin-withholding claims (retaliation and deliberate indifference) survive summary judgment or are time-barred | Cesal urged that harm continued until full restoration of prior insulin dose (Feb. 22, 2011) and that reduced dose was ineffective and retaliatory | Moats argued partial restoration on Oct. 29, 2010 restarted accrual and dosage choice was medical judgment—not retaliation or deliberate indifference | Court: Accrual ran from Oct. 29, 2010 (partial restoration); suit filed Dec. 20, 2012 was untimely; no evidence Moats knew reduced dose was inadequate or acted with retaliatory motive — summary judgment affirmed |
Key Cases Cited
- Bivens v. Six Unknown Named Agents, 403 U.S. 388 (establishing a damages remedy against federal officers for constitutional violations)
- Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment deliberate indifference standard for serious medical needs)
- Farmer v. Brennan, 511 U.S. 825 (subjective knowledge/deliberate indifference standard)
- Turley v. Rednour, 729 F.3d 645 (7th Cir. 2013) (accrual for continuing constitutional violations runs from last incident)
- Perez v. Fenoglio, 792 F.3d 768 (7th Cir. 2015) (pro se complaints construed liberally; deliberate-indifference pleading standard)