Peter Cotts v. Seth Osafa, 692 F.3d 564

Cotts injured by inguinal hernia in prison; persistent pain and requests for surgery over five months were denied.
Healthcare providers repeatedly reduced the hernia instead of performing repair; Cotts argues reducibility barred surgical candidacy regardless of pain.
After parole, Cotts sought treatment; initial hospital and clinic attempts to address the hernia failed due to cost or access, delaying surgery.
Upon return to prison, medical staff documented the condition as severe but again refused surgery because the hernia was reducible.
Wexford Health Sources, Inc. policy-guided care allegedly limited surgical intervention for reducible hernias; dispute whether policy or actual practice governed care.
Trial used pattern Seventh Circuit instructions for deliberate indifference; district court issued its own misleading instructions, including references to cruel and unusual punishment and damages as liability elements.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the elements instruction misstated the law by adding cruel and unusual punishment as an element	Cotts argues the instruction improperly added an independent element.	Wexford argues instruction explained punishment concept within the Eighth Amendment.	Yes, error requiring new trial because it could mislead jurors.
Whether the instruction conflated damages with liability by using damage language as an element	Cotts contends 'damage' language wrongly made damages an eligibility prerequisite for liability.	Defendants contend the difference was minimal and harmless.	Yes, instruction was confusing and prejudicial; remand for new trial.
Whether the court properly instructed on Wexford policy liability and how policy or practice establishes deliberate indifference	Cotts contends a broader policy or practice showing could establish liability beyond written policy.	Defendants argue policy need not be written for liability.	Remand appropriate to resolve policy/practice evidence on remand.

Estelle v. Gamble, 429 U.S. 97 (U.S. 1976) (deliberate indifference to serious medical need violates Eighth Amendment)
Farmer v. Brennan, 511 U.S. 825 (U.S. 1994) (necessity of showing deliberate indifference for Eighth Amendment claim)
Gayton v. McCoy, 593 F.3d 610 (7th Cir. 2010) (elements of deliberate-indifference claim; no separate cruel-and-unusual-punishment element)
Alcala v. Emhart Indus., Inc., 495 F.3d 360 (7th Cir. 2007) (judge may depart from pattern instructions to clarify law)
Woodward v. Correctional Med. Servs., 368 F.3d 917 (7th Cir. 2004) (actual practice may establish deliberate indifference even without written policy)
Minix v. Canarecci, 597 F.3d 824 (7th Cir. 2010) (policy-based liability framework for private providers)
Calhoun v. DeTella, 319 F.3d 936 (7th Cir. 2003) (nominal damages permitted for Eighth Amendment violations)
Tyus v. Urban Search Mgmt., 102 F.3d 256 (7th Cir. 1996) (requires actual injury when not an element of the claim)
Gonzalez v. Feinerman, 663 F.3d 311 (7th Cir. 2011) (substantial departure from professional judgment can support liability)
Francis v. Franklin, 471 U.S. 307 (U.S. 1985) (explains how other instructions do not dissipate error in challenged instruction)
United States v. Perez, 43 F.3d 1131 (7th Cir. 1994) (confusion in liability instructions can prejudice)