Frederick Cashner, Jr. v. John Widup
17-1079
| 7th Cir. | Nov 28, 2017Background
- Cashner, pretrial detainee at Porter County Jail (Apr 2011–Jan 2013), suffered frequent, severe headaches and high blood pressure; jail medical services were provided by Advanced Correctional Healthcare (ACH).
- Dr. Nadir Al‑Shami (ACH physician) personally examined Cashner multiple times, issued numerous telephone orders, and frequently changed medications; nurse Kimberly White administered care and scheduled outside appointments; Warden John Widup handled nonmedical custody issues.
- A neurologist (Dr. Vyas) recommended blood work and an MRI after examining Cashner; blood tests were normal. Al‑Shami cancelled the MRI and follow‑up, explaining it was not medically necessary given test results and his opinion that headaches were tension/HTN‑related.
- Cashner missed an early neurologist appointment because the jail was understaffed and another inmate had a medical emergency; a later appointment occurred and prescriptions were given; further testing never occurred because Cashner was transferred after conviction.
- Cashner sued under 42 U.S.C. § 1983 alleging deliberate indifference by Al‑Shami, White, and Widup and a Monell claim against ACH asserting a cost‑saving policy caused treatment delays; district court dismissed ACH at screening and granted summary judgment for the remaining defendants.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Deliberate indifference by treating physician (Al‑Shami) | Al‑Shami cancelled MRI/follow‑up and made dismissive remarks; treatment choices were motivated by spite or cost‑saving, not medical judgment | Al‑Shami exercised medical judgment: examined patient, ordered/adjusted medications, cancelled MRI after reviewing normal tests and concluding it was unnecessary | No deliberate indifference; treatment record shows continuous, medically motivated care and disagreements among physicians do not establish constitutional violation |
| Nurse liability (White) | White conspired/delayed care to save money and failed to ensure specialist care occurred | White followed physician orders and scheduled appointments; no reason to doubt treating physician’s judgment | No deliberate indifference; nurses may defer to physician absent obvious risk, and none shown here |
| Nonmedical supervisor liability (Widup) | Widup participated in or knew of cost‑motivated delays (commented MRIs are expensive) and failed to ensure care | Widup relied on medical staff, intervened to assist (e.g., pill crushing), had no role in cancelling MRI | No deliberate indifference; nonmedical officials may rely on medical expertise unless they have reason to believe care is being withheld |
| Monell/municipal‑style liability for ACH | ACH had a policy to refuse/delay treatment to save money (cost‑containment provisions in the contract) | Conclusory allegation insufficient; contract’s cost provisions don’t plausibly show an unconstitutional policy and jail—not ACH—would bear some costs | Dismissal proper; plaintiff failed to plausibly plead an official policy/custom causing constitutional violation |
Key Cases Cited
- Farmer v. Brennan, 511 U.S. 825 (deliberate indifference requires intent or criminal recklessness)
- Monell v. Dep’t of Soc. Services of City of New York, 436 U.S. 658 (entity liability under § 1983 requires an unconstitutional policy or custom)
- Petties v. Carter, 836 F.3d 722 (standard for pretrial detainee deliberate‑indifference claims)
- Cesal v. Moats, 851 F.3d 714 (medical decisions far afield from accepted standards can show deliberate indifference)
- Duckworth v. Ahmad, 532 F.3d 675 (verbal statements by treating physician do not alone show deliberate indifference when care continues)
- Swanson v. Citibank, N.A., 614 F.3d 400 (conclusory allegations insufficient to state plausible claim)
- Arnett v. Webster, 658 F.3d 742 (nonmedical officials may rely on medical staff absent reason to believe care is being withheld)