JEREMY LOCKETT, Plаintiff-Appellant, v. TANYA BONSON and BETH EDGE, Defendants-Appellees.
No. 19-1012
United States Court of Appeals For the Seventh Circuit
ARGUED MAY 17, 2019 — DECIDED AUGUST 28, 2019
Before RIPPLE, MANION, and SYKES, Circuit Judges.
We conclude that the record will not support a jury determination that NP Bonson was deliberately indifferent to Mr. Lockett‘s needs in prescribing medication. Mr. Lockett did not exhaust his administrative remedies on his claim against
I.
BACKGROUND
A.
Mr. Lockett has been housed at WSPF, a facility within the Wisconsin Department of Corrections (“WDOC“), since November 2014. He has a significant medical history, having been diagnosed with sickle cell disease, a chronic condition that causes pain, sometimes acutely. During certain periods called sickle cell crises, the pain becomes so severe that it requires immediate emergency medical treatment. A sickle cell crisis usually resolves within five to seven days, although a severe crisis may result in pain that persists for weeks or months.
Other factors further complicate Mr. Lockett‘s health situation. His records contain a diagnosis of cannabis dependence, antisocial personality disorder, adjustment disorder, and mild depression in 2010.3 He also has a documented history of substance abuse, including marijuana, ecstasy, and cocaine. Health care providers have prescribed various medications to treat his depression.
The events underlying his claims occurred over a several-month period at the end of 2016. On September 2, 2016, Mr. Lockett sent a health services request, complaining that his routine pain medication, tramadol, was not working to control his back pain. In response, NP Bonson switched Mr. Lockett‘s pain medication to Tylenol #3, a mild opioid. Five days later, on September 7, 2016, a medical staff member (whose name does not appear in the record) evaluated Mr. Lockett. According to Mr. Lockett, during this evaluation, he told the caregiver that his Tylenol #3 was not controlling his pain. The relevant entry on his chart does not reflect, however, any discussion of the efficacy of his pain medication—only that Mr. Lockett had reported to the medical department so that laboratory work could be undertaken and his neck pain evaluated and treated. Shortly thereafter, NP Bonson renewed Mr. Lockett‘s prescription for Tylenol #3, first for a period of two weeks and then for another month.
Throughout the month of September, Mr. Lockett remained on Tylenol #3, administered four times daily on what the WSPF terms medication passes.4 From September 23 through September 25, he missed several doses, at lеast once because he declined it. Between September 26 and October 3, Mr. Lockett did not receive his pain medication at all. Although he filed a health services request during that time, he asked only about whether he would have an appointment with a specialist for his sickle cell disease and did not mention the lack of pain medication.
On October 3, 2016, medical staff determined that Mr. Lockett was in sickle cell crisis. In accordance with the emergency nursing protocol, he was transferred to the local emergency room for treatment. When he returned to the WSPF the following day, another WSPF nurse, Anderson, documented in Mr. Lockett‘s inmate medical records a recommendation from the treating emergency room physician that Mr. Lockett be given oxycodone, a stronger, immediate-release opioid, to treat his sickle cell pain. The entry in Mr. Lockett‘s chart originally instructed, “Please fill the Rx in the morning,”5 but that note was
Two days after his return to WSPF, Mr. Lockett filed a health services request. He stated that he was in constant pain and asked why he was not receiving the medication prescribed by the emergency room physician. Nurse Edge responded to his request by noting that he was receiving pain medication, although it was the Tylenol #3 he had received in the prior month, not the oxycodone recommended by the external physician. Mr. Lockett responded on October 6 with an administrative complaint. He claimed that NP Bonson was denying him “the correct medication.”8 His complaint was rejected.
Just two days later, on October 8 and 9, Mr. Lockett refused his doses of Tylenol #3 during medication pass. Although the nurse “educated [him] about [the] importance of pain control and taking pain medication on [a] regular ba-sis,” Mr. Lockett “reported he just didn‘t need the medication at that time.”9
On November 11, Mr. Lockett did not receive his medication during two of his four daily medication passes. Four days later, he filed an administrative complaint against Nurse Edge for failing to deliver the medication. He claimed that he had asked WSPF staff to call for the medication, but because the call was not received until after the second missed pass, Nurse Edge informed him that he would have to wait for the third pass to receive the medication. After investigation, his complaint was dismissed. Mr. Lockett contends that he took a timely appeal of this dismissal by placing the appeal in an outgoing box, but also admits that he never received a receipt or a response. The record contains no copy of Mr. Lockett‘s appeal, and, according to the WDOC complaint examiner, the WDOC has no record of having received it.10
On November 17, Mr. Lockett requested to be seen by a nurse. During that visit, he reported “unbearable” pain and that the pain medication was not doing anything.11 The nurse documented that Mr. Lockett declined his pain medication because it was ineffective. He was sent to the emergency room and treated. When he returned two days latеr, another WSPF nurse, Bethel, documented the treating physician‘s medication order for APAP, another form of aceta-minophen, on a short-term basis, and a long-term change from acetaminophen with codeine to one with hydrocodone. NP Bonson countersigned, accepting the recommendation. She prescribed the new medication as recommended by the physician
Just days later, however, he ran out of his supply of the hydrocodone. When he called for pаin medication for the night, he was given tramadol by a separate on-call doctor, and a subsequent doctor switched him to Tylenol #3. When he filed a health services request with NP Bonson, she indicated that she had put in an order for his hydrocodone. Two weeks later, anticipating that he would run out over a holiday, he again filed a health services request with NP Bonson, who replied the same day that it would be refilled because she did not “want [him] to run out either!”12
B.
On May 17, 2017, Mr. Lockett initiated this action by filing a pro se complaint under
Following discovery, the defendants moved for summary judgment, which the district court granted in full. Although it wаs undisputed that Mr. Lockett‘s sickle cell disease is a serious medical condition as contemplated by the Eighth Amendment, the court concluded that the evidence did not establish deliberate indifference on the part of either NP Bonson or Nurse Edge.
Addressing the claim, the court found that there was no evidence that NP Bonson was aware that Mr. Lockett had not been receiving his medication over the several-day period in September and October 2016. Therefore, she could not have known of a substantial risk of serious harm. With respect to her October 4, 2016 decision to continue treating Mr. Lockett with Tylenol #3, instead of the oxyсodone, which had been recommended by the emergency room physician, the court determined that her decision “was a justified exercise of professional judgment given the information before her.”13 The court found that NP Bonson “based her decision on Lockett‘s medical record and history, her concern about opioid use and substance abuse in prison, the high amount of Oxycodone prescribed, and the fact that prior to the October incident, Lockett‘s long-term pain appeared to have been successfully managed by the Tylenol #3.”14 The court also found that Mr. Lockett‘s assertion that he had notified NP Bonsоn on September 7, 2016, that the Tylenol #3 was not helping his pain was “not supported by the record.”15 Further, even if this allegation were true, her decision did not constitute deliberate indifference because Mr. Lockett had made no other complaint over a month-long period, “indicating that the Tylenol #3 was sufficient to treat his long-term pain.”16 Therefore, the court ruled, NP
Turning to Mr. Lockett‘s claim against Nurse Edge and her delay in providing him with medication in November 2016, the district court found that he had failed to exhaust his administrative remedies within the WDOC. Mr. Lockett asserted that he had filed a timely appeal from the Reviewing Authority‘s decision but never had received a response. Hоwever, he presented no evidence of the Corrections Complaint Examiner‘s receipt of his appeal. Because the WDOC rules provide that the Corrections Complaint Examiner “shall, within 5 working days after receiving an appeal, issue a written receipt of the appeal to the inmate,”
II.
DISCUSSION
We review the district court‘s decision to grant the defendants’ motion for summary judgment de novo. Witham v. Whiting Corp., 975 F.2d 1342, 1345 (7th Cir. 1992). We view the record and draw all reasonable inferences from it in the light most favorable to Mr. Lockett, the nonmoving party. Dunigan ex rel. Nyman v. Winnebago Cty., 165 F.3d 587, 590 (7th Cir. 1999). We will affirm the judgment if there is no genuine dispute of material fact and if the defendants are entitled to judgment as a matter of law. Bailor v. Salvation Army, 51 F.3d 678, 681 (7th Cir. 1995).
Mr. Lockett challenges the district court‘s resolution of only two of his Eighth Amendment claims. First, with respect to NP Bonson, he contends that the district court erred in concluding that, as a matter of law, she did not act with deliberate indifference to his medical needs in rejecting the physician‘s recommendation to increase his pain medication and in choosing instead to continue him on his prior course of Tylеnol #3. With respect to Nurse Edge, Mr. Lockett maintains that the district court erred in concluding that he had failed to exhaust his administrative remedies.18 We address each of these contentions in turn.
A.
We begin with the claim that NP Bonson acted with deliberate indifference in treating Mr. Lockett‘s pain when he returned from the emergency room on October 4, 2016.
The Eighth Amendment‘s prohibition on cruel and unusual punishment “protects prisoners from prison conditions that cause ‘the wanton and unnecessary infliction of pain,‘” including “grossly inadequate medical care.” Pyles v. Fahim, 771 F.3d 403, 408 (7th Cir. 2014) (quoting Rhodes v. Chapman, 452 U.S. 337, 347 (1981)). To prevail on a claim based on deficient medical care, the plaintiff “must demonstrate two elements: 1) an objectively serious mеdical condition; and 2) an official‘s deliberate indifference to that condition.” Arnett v. Webster, 658 F.3d 742, 750 (7th Cir. 2011). The first element, an objectively serious medical condition, is satisfied if “a physician has diagnosed it as requiring treatment, or the need for treatment would be
“Deliberate indifference is a subjective standard.” Arnett, 658 F.3d at 751. To be found liable under the Eighth Amendment, a prison official “must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994); see also Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en banc) (“[T]he Supreme Court has instructed us that a plaintiff must provide evidence that an official actually knew of and disregarded a substantial risk of harm.“). Whether a prison official acted with the requisite state of mind “is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence.” Farmer, 511 U.S. at 842. In making this assessment, “we must examine the totality of an inmate‘s medical care.” Dunigan, 165 F.3d at 591 (quoting Gutierrez, 111 F.3d at 1375). The standard is a rigorous one. To establish the requisite mental state, our cases make clear that “[s]omething more than negligence or even malpractice is required.” Pyles, 771 F.3d at 409; see also Estelle v. Gamble, 429 U.S. 97, 106 (1976) (“Medical malpractice does not become a constitutional violation merely because the victim is a prisoner.“).
Within the universe of deliberate indifference cases is a narrower category when a prisoner alleges not that his condition was ignored entirely, but that he received constitutionally deficient treatment for the condition. We have clarified that these cases are better framed “not [as] deliberate indifference to a serious medical need,” but as a challenge to “a deliberate decision by a doctor to treat a medical need in a particular manner.” Snipes v. DeTella, 95 F.3d 586, 591 (7th Cir. 1996). In such cases, we defer to a medical рrofessional‘s treatment decision “unless ‘no minimally competent professional would have so responded under those circumstances.‘” Pyles, 771 F.3d at 409 (quoting Sain v. Wood, 512 F.3d 886, 894–95 (7th Cir. 2008)). A “[d]isagreement between a prisoner and his doctor, or even between two medical professionals, about the proper course of treatment generally is insufficient, by itself, to establish an Eighth Amendment violation.” Id. Our standard reflects the reality that there is no single “‘proper’ way to practice medicine in a prison, but ra-ther a range of acceptable courses based on prevailing standards in the field.” Jackson v. Kotter, 541 F.3d 688, 697 (7th Cir. 2008). Nevertheless,
“where evidence exists that the defendant[] knew better than to makе the medical decision[] that [he] did,” then summary judgment is improper and the claim should be submitted to a jury. State-of-mind evidence sufficient to create a jury question might include the obviousness of the risk from a particular course of medical treatment; the defendant‘s persistence in “a course of treatment known to be ineffective“; or proof that the defendant‘s treatment decision departed so radically from “accepted professional judgment, practice, or standards” that a jury may reasonably infer that the decision was not based on professional judgment.
Whiting v. Wexford Health Sources, Inc., 839 F.3d 658, 662–63 (7th Cir. 2016) (alterations in original) (citations omitted) (quoting Petties, 836 F.3d at 730–31). A medical
We routinely have rejected claims, however, where a prisoner‘s claim is based on a preference for one medication over another unless there is evidence of a substantial departure from acceptable professional judgment. Pointedly, in Burton v. Downey, 805 F.3d 776, 785–86 (7th Cir. 2015), we considered a claim by a detainee who had requested narcotic medication to address his pain after surgery. Prison staff prescribed a non-narcotic pain medication, even though a primary care physician outside of prison previously had prescribed a narcotic. Prison staff noted that the synthetic opiate that they administered had “less addictive potential” than the primary care physician‘s stronger method of pain relief. Id. at 786. The fact that the physician outside of prison had prescribed another medication merely demonstrated “that another doctor would have followed a different course of treatment,” which was “insufficient to sustain a deliberate indifference claim.” Id. To meet such a standard, we reiterated, required evidence of a “substantial departure from accepted professional judgment.” Id. at 785 (quoting Jackson, 541 F.3d at 697). The decision to prescribe non-narcotic pain medication was within the bounds of professional judgment. Id. at 785–86; see also Snipes, 95 F.3d at 591 (noting that “[t]he administration of pain killers requires medical expertise and judgment” and that their use “entails risks that doctors must consider in light of the benefits“).
The record before us demonstrates that NP Bonson employed professional judgment in her treatment of Mr. Lockett‘s sickle cell disease, both in the long term and in her specific response to his October 2016 sickle cell crisis. As required by WSPF protocol, the prison sent Mr. Lockett to the local emergency room for treatment of a sickle cell crisis. Although the external treating physician recommended that Mr. Lockett take oxycodone, NP Bonson elected to use a different pharmaceutical. She noted that Mr. Lockett “[h]ad [a] one time dose [of] Oxycodone 20mg from Hospital,” but she discontinued that medication and returned him to his prior course of Tylenol #3.19 She noted in the chart that Tylenol #3 had successfully managed his chronic pain.
Mr. Lockett submits that NP Bonson‘s decision to “overrule[]” the non-prison doctor and to deny him the medication that he requested “displayed knowing disregard for his suffering.”20 It is firmly established, however, that mere “[d]isagreement between a prisoner and his doctor, or even between two medical professionals, about the proper course of treatment generally is insufficient, by itself, to establish an Eighth Amendment violation.” Pyles, 771 F.3d at 409; see also Ciarpaglini v. Saini, 352 F.3d 328, 331 (7th Cir. 2003); Snipes, 95 F.3d at 591. With respect to pain control specifically, our cases recognize that these are matters that require the application of “medical expertise and judgment.” Snipes, 95 F.3d at 591. All we have here is NP Bonson‘s “deliberate decision,” based on a professional assessment, to treat Mr. Lockett‘s sickle cell pain using Tylenol #3 instead of oxycodone. Id. That decision cannot support an Eighth Amendment violation. As in Burton, the record, taken as a whole, demonstrates that NP Bonsоn clearly exercised her medical judgment in making her
Moreover, the totality of NP Bonson‘s care demonstrates affirmatively that she was “continually solicitous of” and “responsive to” Mr. Lockett‘s medical needs. Dunigan, 165 F.3d at 592. She promptly responded to Mr. Lockett‘s health services requests and timely filled and renewed his prescriptions during the relevant time frame. The district court correctly concluded that no reasonable jury could have found that NP Bonson acted with deliberate indifference in treating Mr. Lockett‘s sickle cell disease. The district court properly granted summary judgment in hеr favor.
B.
Mr. Lockett also asks that we review his contention that Nurse Edge violated the Eighth Amendment when she told him that he would have to wait until the next pass to receive his medication, even though he had not received it on the two earlier consecutive passes. The district court entered summary judgment for Nurse Edge on this claim, concluding that Mr. Lockett had failed to exhaust his administrative remedies. Mr. Lockett submits he did everything required under the WDOC‘s rules to exhaust those remedies and therefore had the right to present them to the district court.
The Prison Litigation Reform Act provides that “[n]o action shall be brought with respect to prison conditions” under
There is no dispute that Mr. Lockett initially took the required steps under the Wisconsin Administrative Code to file his complaint. The dispute centers on whether Mr. Lockett took an appeal from the denial of that initial complaint. Mr. Lockett claims that he did;22 in response, Nurse Edge provided the affidavit of Ellen Ray, an Institution Complaint Examiner and
In Dole v. Chandler, 438 F.3d 804 (7th Cir. 2006), we considered whether an Illinois prisoner had exhausted his administrative remedies. Dole claimed to have filed a complaint using the appropriate prison guidelines and to have retained a full handwritten copy for himself tо guard against the consequences of the original being lost. He placed his complaint in outgoing mail, and the parties did not dispute that it was picked up by a guard and should have been considered mailed. Dole received no response to his complaint, however, and by the time he inquired, the deadline for filing had passed. Dole asked us to deem his claim exhausted, although prison authorities had no record of having received it, let alone of having reviewed it on the merits. We concluded that, under the circumstances, Dole “had done all that was reasonable to exhaust his administrative remedies.” Id. at 812. In our opinion, we addressed the district court‘s concern that siding with Dole meant that “all prison inmates could henceforth avoid the PLRA‘s exhaustion requirement simply by claiming that they mailed a letter.” Id. We observed, however, that Dole had produced undisputed evidence that his complaint had been taken by a prison guard in due course. Id.; see also id. at 811. Furthermore, we noted that “future false claims can be minimized by setting up a receipt system for prison mail.” Id. at 812.
Wisconsin has such a system.23 The applicable regulations mandate that the prisoner receive a receipt for a complaint: A Corrections Complaint Examiner “shall, within 5 working days after receiving an appeal, issue a written receipt of the appeal to the inmate.”
Reading the regulations in their totality, we must conclude that Mr. Lockett was obliged to regard the absence of receipt as a red flag; he should have undertaken, through the complaint procedure, an inquiry to ascertain why he had not received this important document. Having failed to make that inquiry, he may not now counter evidence that the prison did not receive his administrative appeal with a bald assertion of a timely filing.26
We also note that requiring a prisoner in Mr. Lockett‘s position to employ the complaint system to ascertain the fate of his appeal and the receipt of filing is compatible with the primary purpose of the exhaustion doctrine: it alerts the prison officials to the existence of the problem and affords an opportunity to repair the injury. Turley v. Rednour, 729 F.3d 645, 649 (7th Cir. 2013). Moreover, it is a practice known to our case law. Cf. Brengettcy v. Horton, 423 F.3d 674, 678, 682 (7th Cir. 2005) (allowing a prisoner to file an action in the district court after seeking, through the prison grievance system, an explanation for an earlier grievance to which he had never received a reply); Lewis v. Washington, 300 F.3d 829, 831–32 (7th Cir. 2002) (plaintiff followed up with Internal Affairs Office and with the warden and filed multiple griev-ances renewing his claims in the face of unanswered requests).
To be sure, the burden of proof on the exhaustion issue is on the defendants. Kaba, 458 F.3d at 681. Once the defendants asserted that defense through the affidavit and attached documentation of Ray, the Complaint Examiner, Mr. Lockett had to introduce sufficient evidence to demonstrate that there was a genuine issue of triable fact with respect to that defense. His own affidavit, while relevant and probative on the issues of whether he ever filed an appeal or received a receipt, is insufficient to establish that he ever exhausted the opportunity to resolve the matter within the prison system by making
Absent evidence that he attempted to avail himself of such a reasonable course, he has not fulfilled his obligation to support his affidavit‘s assertion that he filed the appeal. He does not have the receipt, and he has made no assertion that he ever made a reasonable inquiry as to why he never received one. Since the regulations clearly give him the path for making such an inquiry, he has not exhausted the available remedies. The district court committed no error in entering summary judgment to Nurse Edge on this count.
Conclusion
Because the district court committed no error in resolving the deliberate indifference claims Mr. Lockett brought аgainst NP Bonson and Nurse Edge, we affirm its judgment.
AFFIRM