Zachary Johnson v. Bessie Dominguez
5 F.4th 818
| 7th Cir. | 2021Background
- Plaintiff Zachary Johnson, incarcerated at Dixon Correctional Center, reported a prior hernia (first noticed in 2009) and sought surgical repair beginning in 2011.
- From 2011–2016 Dixon medical staff evaluated Johnson repeatedly (over 90 visits); exams often showed no hernia, and when present it was small, reducible, and not strangulated or incarcerated.
- Treatment consisted primarily of non‑surgical measures: abdominal binders, over‑the‑counter analgesics, activity restrictions, and monitoring; providers repeatedly advised follow‑up for worsening or visible bulge.
- District court appointed an expert (Dr. Toyama), who testified elective surgery is standard for a medically fit patient but Johnson’s uncontrolled diabetes meant he was not necessarily medically fit; Toyama expressed no criticism of the defendants’ care.
- The district court granted summary judgment for defendants, finding no evidence of deliberate indifference; the Seventh Circuit affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the hernia (or resulting pain) was an objectively serious medical condition | Johnson: hernia and chronic pain were serious and required surgery | Defendants (below): dispute; on appeal defendants did not renew this challenge | Court assumed, without deciding, there was a triable issue on seriousness but resolved appeal on subjective prong |
| Whether defendants were deliberately indifferent by refusing surgical referral | Johnson: defendants refused surgery, provided ineffective conservative care, causing prolonged pain | Defendants: non‑surgical management was reasonable given inconsistent exams, small reducible hernia, lack of strangulation, and uncontrolled diabetes | Held: No deliberate indifference; treatment fell within professional judgment; summary judgment affirmed |
| Whether the medical care was blatantly inappropriate or showed lack of professional judgment (expert evidence) | Johnson: Dr. Toyama’s standard-of-care statement supports that surgery was appropriate | Defendants: Toyama said surgery is elective for medically fit patients, Johnson was not medically fit, and Toyama had no criticisms | Held: Expert did not show a departure from acceptable professional judgment; evidence insufficient for deliberate indifference |
| Whether delay or an institutional policy denying non‑emergent hernia surgery supports liability | Johnson: defendants delayed/denied needed surgery and caused unnecessary pain | Defendants: decision not to refer was a medical judgment, not an unreasonable delay; policy argument was not raised below | Held: Delay claim unsupported on the record; policy argument waived for failure to develop below |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment requires adequate medical care for prisoners)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference requires subjective knowledge and disregard of substantial risk)
- Anderson v. Liberty Lobby, 477 U.S. 242 (1986) (summary judgment standard)
- Whiting v. Wexford Health Sources, Inc., 839 F.3d 658 (7th Cir. 2016) (elements of deliberate indifference claim)
- Wilson v. Wexford Health Sources, Inc., 932 F.3d 513 (7th Cir. 2019) (deference to medical judgment; violation only if no minimally competent professional would respond similarly)
- Duckworth v. Ahmad, 532 F.3d 675 (7th Cir. 2008) (medical malpractice/negligence is distinct from deliberate indifference)
- Johnson v. Doughty, 433 F.3d 1001 (7th Cir. 2006) (disagreement with doctor’s treatment generally insufficient for deliberate indifference)
- Collignon v. Milwaukee Cty., 163 F.3d 982 (7th Cir. 1998) (extreme departures from standards can show absence of professional judgment)
- Berry v. Peterman, 604 F.3d 435 (7th Cir. 2010) (significant delay in effective treatment may support deliberate indifference)
- Puffer v. Allstate Ins. Co., 675 F.3d 709 (7th Cir. 2012) (issues not raised or developed below are waived)