Jackson v. Santos

UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF ILLINOIS

SPARKY JACKSON, )

)

Plaintiff, )

v. )

) Case No. 3:17-cv-1135-GCS

VENERIO SANTOS, )

JESSICA KNEBEL, )

SUSAN WALKER, and )

ANN LAHR, )

)

Defendants. )

MEMORANDUM & ORDER

SISON, Magistrate Judge:

INTRODUCTION AND BACKGROUND

Pending before the Court are motions for summary judgment filed by Defendants

Knebel and Santos (Doc. 49, 50, 64) and Defendants Lahr and Walker (Doc. 57, 58).1

Jackson only filed an opposition to the summary judgment motion filed by Knebel and

Santos. (Doc. 56). Based on the reasons delineated below, the Court GRANTS the

motions for summary judgment.

On October 23, 2017, Jackson filed a complaint pursuant to 42 U.S.C. § 1983

alleging that his constitutional rights were violated while he was housed at Centralia

1 Pursuant to Federal Rule of Civil Procedure 56, Timms v. Frank, 953 F.2d 281 (7th Cir. 1992) and

Lewis v. Faulkner, 689 F.2d 100 (7th Cir. 1982), Defendants filed the required notices informing Jackson of

the consequences of failing to respond to the motions for summary judgment. (Doc. 51, 59).

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Correctional Center (“Centralia”). (Doc. 1). Specifically, Jackson alleges that Defendants

were deliberately indifferent to his serious medical needs in violation of the Eighth

Amendment. On November 27, 2017, the Court conducted its preliminary review of

Jackson’s complaint pursuant to 28 U.S.C. § 1915A. The Court allowed Jackson to proceed

on one count of deliberate indifference to serious medical needs in violation of the Eighth

Amendment against Santos, Knebel, Lahr, and Walker regarding his symptoms of rectal

pain, abdominal pain, constipation, bad breath, and dry mouth in violation of the Eighth

Amendment. (Doc. 7).

FACTS2

The following facts are taken from the record and presented in the light most

favorable to Jackson, the non-moving party, and all reasonable inferences are drawn in

his favor. See Ricci v. DeStefano, 557 U.S. 557, 586 (2009).

The events surrounding this lawsuit occurred at Centralia. Jackson is an inmate

within the Illinois Department of Corrections (“IDOC”) and currently housed at Dixon

Correctional Center (“Dixon”). Defendant Santos is a physician at Centralia. Defendant

Knebel is a nurse at Centralia. Defendant Walker is a grievance officer, not a physician.

Defendant Lahr is a member of the Administrative Review Board (“ARB”), not a

physician.

Jackson was transferred to Centralia sometime in April 2016. On August 9, 2016,

2 These facts are not in dispute unless noted.

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Jackson first reported to the healthcare unit for hemorrhoids. Jackson complained of

rectal burning and protrusion from the rectum. There were no complaints of bleeding or

itching. The nurse observed slight protrusion but there were no signs of trauma. The

nurse referred Jackson to the physician.

Jackson was first seen by Santos on August 12, 2016. At this visit, Santos performed

a rectal exam on Jackson. He diagnosed Jackson with internal hemorrhoids, ordered

Jackson to keep the area clean, and prescribed anti-hemorrhoid cream.

On August 21, 2016, Jackson sent a request to healthcare stating that he saw Santos

on August 12, 2016 and that his condition had gotten worse. Jackson returned to the

healthcare unit on August 23, 2016. He complained of blood in his stool the night before

and complained of burning. The nurse noted the inspection of the anal area was within

normal limits, and there were no signs of bleeding or trauma around the anal area. The

nurse referred Jackson to a physician. Jackson contends that he told the nurse that the

hemorrhoids were causing severe pain, swelling and burning with a little speck of blood

on the tissue.

On August 25, 2016, Santos examined Jackson for the second time for complaints

of rectal pain and burning. The medical records reveal and Santos’s affidavit state that

Jackson denied any constipation and refused the rectal examination. Santos continued

Jackson on the anti-inflammatory cream. Jackson counters that he was not physically

examined by Santos at this visit, that he told Santos the cream was not working and that

it made his situation worse and that Santos refused to treat his condition. Jackson further

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counters that he told Santos that he was reluctant to use the bathroom and that Santos

did not mention a rectal examination.

On September 9, 2016, Jackson returned to the healthcare unit complaining of

blood in his stool. The nurse examined Jackson and found no signs of hemorrhoids,

redness, or swelling present. Jackson was admitted to the infirmary for a 23 hour period

to monitor his condition. Jackson contends that he went to the bathroom reluctantly. He

had pain, burning, and swelling and saw a lot of blood in the stool and on the tissue after

wiping. Jackson contends that the nurse told him she was going to need three stool

samples, and in response, Jackson told her that he really did not want to use the toilet

due to all the pain, burning and swelling. Jackson gave the nurse three stool samples and

contends that the nurse noted blood, hemorrhoid and a mucus like substance.

Jackson was discharged from the infirmary on September 10, 2016. Jackson was

educated on the need to increase his fluids and fiber intake. Jackson was placed on the

schedule to see a physician.

On September 12, 2016, Santos examined Jackson for complaints of blood in his

stool. At that time, Jackson complained of burning defecation. Santos performed a rectal

examination and ordered a hemoccult test, which was negative. Santos diagnosed

Jackson with internal hemorrhoids and continued him on hemorrhoid cream. Jackson

contends that the problem with Santos is that he never changed his method of treatment.

According to the medical records, Jackson did not return to the healthcare unit

regarding any complaints of rectal pain or burning until December 2016. Jackson

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contends that he wrote Lisa Krebs on October 31, 2016, indicating there was no reason for

him to see Santos because every time he went to see Santos, Santos did nothing and he

did not prescribe different treatment.

On December 5, 2016, Jackson put in a request slip to healthcare for complaints of

swelling, pain, and burning to his rectum while using the toilet. Jackson contends that he

asked not to see Santos and he signed a refusal slip for Santos. On December 10, 2016,

Jackson sent another request slip to healthcare, described his symptoms and asked to be

examined by any doctor other than Santos.

On December 12, 2016, Jackson returned to the healthcare unit. Jackson

complained of blood in his stool and pain in his rectal area. The nurse noted that the

hemorrhoids were visualized, but that there was no sign of blood or trauma. The nurse

referred Jackson to the doctor. Jackson contends he told the nurse that he did not want to

see Santos because he keeps prescribing the same cream that he thought was causing the

pain.

On December 14, 2016, Dr. Garcia examined Jackson. He diagnosed Jackson with

an anal tear and prescribed antibiotics TAO and Keflex. Dr. Garcia also counseled Jackson

on the need to ensure his rectal area remained clean. Jackson contends that Dr. Garcia

told him to stop using the hemorrhoid cream.

On January 17, 2017, Santos saw Jackson for complaints of abdominal pain,

burning in the rectal area and a foul order coming from his mouth. According to the

medical records, Santos completed a rectal examination. Santos did not find any signs of

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tearing and diagnosed Jackson with rectal pain and irregular bowel movements. Further,

Santos ordered an x-ray of Jackson’s abdomen, prescribed fiberlax stool softener, and

educated Jackson on anal hygiene. Santos did not find any significant issues with

Jackson’s breath. Jackson contends that at this visit Santos gave him a colon cancer

physical. Jackson disagrees with Santos’s opinion about his breath.

On January 18, 2017, Dr. Garcia examined Jackson for complaints of foul order

from his mouth and burning to his rectum. Dr. Garcia diagnosed Jackson with possible

GERD and hemorrhoids.3 Dr. Garcia prescribed Jackson Pepcid, continued him on

fiberlax and educated him on proper anal hygiene.

On March 11, 2017, Jackson saw a dentist/oral hygienist about the foul order

coming from his mouth. The dentist/oral hygienist indicated that everything looked fine

and asked Jackson if he saw a doctor, and he told her yes.

Jackson did not return to the healthcare unit until July 20, 2017. At this time,

Jackson complained of abdominal pain.

On July 21, 2017, Santos examined Jackson regarding the abdominal pain, noted

the abdomen was soft and his bowel sounds were normal. A urinalysis was performed,

and the results came back negative. Santos diagnosed Jackson with urethritis and told

Jackson to increase his fluid intake.

On August 5, 2017, Jackson maintains that he sent a request slip to Knebel about

3 Jackson agrees that Dr. Garcia diagnosed him with GERD; he is not sure about the hemorrhoids.

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all of his health issues and asked for a face-to-face meeting with her to discuss.

On August 9, 2017, Jackson saw a nurse at the healthcare unit and complained

about pain in his stomach, foul odor coming from his mouth and hemorrhoids. Jackson

also told her that he did not want to see Santos.

On August 11, 2017, Santos saw Jackson for complaints of upper adnominal pain.

Santos ordered a second KUB x-ray of Jackson’s abdomen and a follow-up to discuss the

results. Jackson contends that he asked Santos why he had not seen a specialist after all

his complaints and that Santos said it was not necessary.

The results of the KUB produced a finding of mild increased gas in the stool and

in the colon. There was also no obstruction of free air, no mass and organomegaly, nor

were there any abdominal calcifications noted.

On August 19, 2017, Jackson was seen by Dr. Butalid, who discussed the KUB

results. Dr. Butalid examined Jackson and ordered Pepcid 20 mg twice a day and a follow-

up in three weeks. Dr. Butalid noted that if Jackson’s symptoms did not improve, an

ultrasound might be needed.

On September 14, 2017, Santos saw Jackson for his abdominal pain. Jackson

indicated that he was not experiencing any relief from his abdominal pain. Santos

examined Jackson, assessed that gallbladder disease needed to be ruled out and

submitted a referral to collegial review for approval of the ultrasound. Santos also

ordered Jackson not to eat any spicy foods.

During collegial review on September 18, 2017, the Director of Utilization

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Management, Dr. Ritz, ordered an alternate treatment plan to obtain a CBC and metabolic

profile, to consider adding a stool softener, and to implement diet modifications based

on a review of Jackson’s commissary records. Dr. Ritz noted that if Jackson’s symptoms

persisted after 6 to 8 weeks to resubmit for the ultrasound. The alternative treatment plan

was implemented on September 25, 2017.

Eight weeks after the expiration of the alternative treatment plan, Jackson was still

experiencing symptoms of abdominal pain. Thus, on December 18, 2017, Santos appealed

the collegial decision from September 18, 2017 and requested that Jackson be sent for an

ultrasound. Dr. Ritz approved the ultrasound.

On December 21, 2017, Santos saw Jackson for a follow-up on his blood results.

Santos informed Jackson that the results were negative for H. Pylori. Jackson did not have

any complaints at this time. The ultrasound was performed on Jackson’s right upper

quadrant. The results of the ultrasound were negative for gallbladder disease.

On January 4, 2018, Santos saw Jackson regarding his ultrasound and CBC

results. Jackson indicated he had no complaints at that time. Santos informed Jackson that

his test results were negative for gallbladder disease and that his CBC was normal.

Jackson made no further complaints to Santos regarding abdominal pain in 2018.

However, on February 7, 2018, Jackson spoke with Dr. Garcia about his CBC and

abdominal pain.

Jackson has never spoken to Knebel in person regarding any of the concerns

contained in his complaint. He only communicated to Knebel through a letter. Jackson

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admitted that if Knebel never received the letter, he would not have any allegations

against her. Jackson also testified that he does not understand why she would not have

received the letter.

With respect to the other Defendants, Grievance #17-8-59 is the only contact

Jackson had with Defendant Walker concerning his medical treatment. Grievance #17-8-

59 is the only grievance Defendant Lahr received from Jackson concerning his medical

needs.

LEGAL STANDARDS

Federal Rule of Civil Procedure 56 governs motions for summary judgment.

Summary judgment is appropriate if the movant shows that there is no genuine dispute

as to any material fact and that the movant is entitled to judgment as a matter of law. See

Archdiocese of Milwaukee v. Doe, 743 F.3d 1101, 1105 (7th Cir. 2014)(citing FED. R. CIV. PROC.

56(a)). Accord Anderson v. Donahoe, 699 F.3d 989, 994 (7th Cir. 2012). A genuine issue of

material fact remains “if the evidence is such that a reasonable jury could return a verdict

for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). Accord

Bunn v. Khoury Enterpr., Inc., 753 F.3d 676, 681-682 (7th Cir. 2014).

In assessing a summary judgment motion, the district court views the facts in the

light most favorable to, and draws all reasonable inferences in favor of, the nonmoving

party. See Anderson, 699 F.3d at 994; Delapaz v. Richardson, 634 F.3d 895, 899 (7th Cir. 2011).

As the Seventh Circuit has explained, and as required by Rule 56(a), “we set forth the

facts by examining the evidence in the light reasonably most favorable to the non-moving

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party, giving [him] the benefit of reasonable, favorable inferences and resolving conflicts

in the evidence in [his] favor.” Spaine v. Community Contacts, Inc., 756 F.3d 542, 544 (7th

Cir. 2014). The Court’s role at summary judgment is not to evaluate the weight of

evidence, to judge witness credibility, or to determine the truth of the matter. Instead, the

Court is to determine whether a genuine issue of fact exists. See Nat’l Athletic Sportwear

Inc. v. Westfield Ins. Co., 528 F.3d 508, 512 (7th Cir. 2008).

The Supreme Court has recognized that deliberate indifference to the serious

medical needs of prisoners may constitute cruel and unusual punishment under the

Eighth Amendment. See Estelle v. Gamble, 429 U.S. 97, 104 (1976). To prevail on a claim for

deliberate indifference to a serious medical need, there are “two high hurdles, which

every inmate-plaintiff must clear.” Dunigan ex rel. Nyman v. Winnebago Cnty., 165 F.3d

587, 590 (7th Cir. 1999). First, the plaintiff must demonstrate he suffered from an

objectively serious medical condition. Id. at 591-592. Second, the plaintiff must establish

the individual prison officials were deliberately indifferent to that condition. Id.

The first consideration is whether the prisoner has an “objectively serious medical

condition.” Arnett v. Webster, 658 F.3d 742, 750 (7th Cir. 2011). “A medical condition is

objectively serious if a physician has diagnosed it as requiring treatment, or the need for

treatment would be obvious to a layperson.” Pyles v. Fahim, 771 F.3d 403, 409 (7th Cir.

2014)(citations omitted). It is not necessary for such a medical condition to “be life-

threatening to be serious; rather, it could be a condition that would result in further

significant injury or unnecessary and wanton infliction of pain if not treated.” Gayton v.

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McCoy, 593 F.3d 610, 620 (7th Cir. 2010). Accord Farmer v. Brennan, 511 U.S. 825, 828

(1994)(violating the Eighth Amendment requires “deliberate indifference to a substantial

risk of serious harm”)(internal quotation marks omitted) (emphasis added)).

To show prison officials acted with deliberate indifference, a plaintiff must put

forth evidence that prison officials not only knew that the prisoner’s medical condition

posed a serious health risk, but they consciously disregarded that risk. See Holloway v.

Delaware Cnty. Sheriff, 700 F.3d 1063, 1073 (7th Cir. 2012). “This subjective standard

requires more than negligence and it approaches intentional wrongdoing.” Id. Accord

Berry v. Peterman, 604 F.3d 435, 440 (7th Cir. 2010)(stating that “[d]eliberate indifference

is intentional or reckless conduct, not mere negligence.”); McGowan v. Hulick, 612 F.3d

636, 640 (7th Cir. 2010)(stating that “negligence, even gross negligence does not violate

the Constitution.”).

Assessing the subjective prong is more difficult in cases alleging inadequate health

care as opposed to lack of care. Without more, a “mistake in professional judgment

cannot be deliberate indifference.” Whiting v. Wexford Health Sources, Inc., 839 F.3d 658,

662 (7th Cir. 2016). The Seventh Circuit explained:

By definition a treatment decision that is based on professional judgment

cannot evince deliberate indifference because professional judgment implies a

choice of what the defendant believed to be the best course of treatment. A

doctor who claims to have exercised professional judgment is effectively

asserting that he lacked a sufficiently culpable mental state, and if no

reasonable jury could discredit that claim, the doctor is entitled to summary

judgment.

Id. (citing Zaya v. Sood, 836 F.3d 800, 805-806 (7th Cir. 2016)).

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This is in contrast to a case “where evidence exists that the defendant [ ] knew

better than to make the medical decision[] that [he] did.” Whiting, 839 F.3d at 662 (quoting

Petties v. Carter, 836 F.3d 722, 731 (7th Cir. 2016)(alterations in the original). A medical

professional’s choice of an easier, less efficacious treatment can rise to the level of

violating the Eighth Amendment, however, where the treatment is known to be

ineffective but is chosen anyway. See Berry, 604 F.3d at 441. The Eighth Amendment does

not require that prisoners receive “‘unqualified access to health care.’ Rather, they are

entitled only to “‘adequate medical care.’” Johnson v. Doughty, 433 F.3d 1001, 1013 (7th

Cir. 2006)(citations omitted).

Defendants moved for summary judgment arguing that they were not deliberately

indifferent to Jackson’s serious medical needs. Jackson opposes the motions. As the

motions are ripe, the Court turns to address the merits of the motions.

ANALYSIS

I. Medical Provider Defendants

A. Serious Medical Need

First, Knebel and Santos argues that Jackson’s complaints of dry mouth and bad

breath do not constitute a serious medical condition. Specifically, Defendants argue that

there is not a single medical record that demonstrates any medical physician deemed

Jackson’s complaints for dry mouth or bad breath as requiring medical treatment. The

record does not establish that Jackson’s subjective complaints about bad breath and dry

mouth ever became a serious medical issue. There is also no medical evidence that his

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complaints of bad breath and dry mouth constituted an objectively serious condition that

mandated treatment. See, e.g., Guitierrez v. Peters, 111 F.3d 1364, 1372 (7th Cir. 1997)(noting

that not every ache, pain, or discomfort can support an Eighth Amendment claim.).

Jackson first complained about his bad breath while housed at Big Muddy Correctional

Center before he was transferred to Centralia. He saw a dentist who found that his oral

hygiene was very good and was informed that he should consult with a physician if he

thought there was a problem. Although the Court acknowledges that bad breath and dry

mouth is unpleasant, there is nothing to indicate that Jackson had a serious medical

condition and that Defendants failed to properly treat that condition. Thus, Defendants

Knebel and Santos are entitled to summary judgment regarding Jackson’s bad breath and

dry mouth claims. Out of an abundance of caution, however, the Court will also address

these conditions under the deliberate indifference standard.

B. Deliberate Indifference

Construing the evidence in the light most favorable to Jackson, the Court finds that

he has not established that either Santos or Knebel was deliberately indifferent to his

medical needs regarding his hemorrhoids, abdominal pain, bad breath, dry mouth and

constipation. The record reveals that from August 2016 to January 2018 Santos provided

appropriate medical treatment to Jackson. Santos regularly saw Jackson, and Jackson

admitted that Dr. Santos prescribed him hemorrhoid cream, fiberlax, ordered a

hemoccult test, and educated him on anal hygiene. Additionally, Santos referred

Jackson’s abdominal pain complaints to collegial review for an ultrasound to rule out

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gallbladder disease. Santos also appealed the collegial review’s decision to provide

alternate treatment after that treatment did not work so that Jackson could get an

ultrasound. Obviously, the treatment was not the treatment Jackson wanted or

demanded. However, mere disagreement or dissatisfaction as to the treatment received

does not amount to deliberate indifference. See Edwards v. Snyder, 478 F.3d 827, 831 (7th

Cir. 2007); Forbes v. Edgar, 112 F.3d 262, 267 (7th Cir. 1997); Ciarpaglini v. Saini, 352 F.3d

328, 331 (7th Cir. 2003); Snipes v. DeTella, 95 F.3d 586, 592 (7th Cir. 1996). There is no

evidence that Santos’s treatment of Jackson’s hemorrhoids was such a substantial

departure from accepted professional judgment, or so plainly inappropriate, as to permit

the inference that he intentionally or recklessly disregarded Jackson’s serious medical

needs. Rather, Santos exercised his professional judgment and recommended a more

conservative course of treatment for the symptoms associated with Jackson’s

hemorrhoids, constipation, abdominal pain, bad breath and dry mouth.

Likewise, there is no evidence that Knebel was deliberately indifferent to Jackson’s

serious medical needs. For example, Jackson has not established that Knebel was aware

of his complaints. Jackson admitted that he did not have a face-to-face conversation with

Knebel. He also admitted that his only interaction with Knebel was a letter he wrote to

her, and Jackson is unaware if Knebel ever received that letter. Thus, there is no evidence

that Knebel was deliberately indifferent to his serious medical needs. Thus, Santos and

Knebel are entitled to summary judgment.

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II. Defendants Ann Lahr and Susan Walker

Prison officials, who are non-medical professionals, are entitled to rely upon the

judgment of medical professionals to avoid liability under the Eighth Amendment. See

Lee v. Young, 533 F.3d 505, 511 (7th Cir. 2008). For example, the Seventh Circuit found that

“as a layperson, the warden could rely on the medical staff’s expertise as long as he did

not ignore [an inmate] or his mistreatment.” Diggs v. Ghosh, 850 F.3d 905, 911 (7th Cir.

2017).

Lahr and Walker contend they cannot be liable because they reasonably relied on

the judgment of medical professionals. They also argue there is no evidence that Jackson’s

grievances were ignored or mishandled, and they were not personally involved in

Jackson’s medical treatment. Based on the record, the undersigned finds that Jackson has

not established that either Lahr or Walker was deliberately indifferent to Jackson’s

serious medical needs. Both Defendants were part of the grievance process and not

medical providers or professionals. Jackson was seen regularly in the healthcare unit.

The record reflects that Walker, a grievance officer, responded to only one

grievance regarding Jackson’s medical treatment, grievance #17-8-59. In response,

Walker responded as follows: “[i]t is this writer’s findings that the offender’s medical

records, the medical records are being addressed by the facility’s health care staff:

therefore, I recommend grievance denied. Only qualified Medical staff determine

medical care.” (Doc. 58-2, p. 1). Similarly, Lahr, a member of the ARB, denied grievance

#17-8-59 finding it was appropriately addressed by the facility Administration, and

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finding, “[p]er HCU, offender is receiving treatment for this issue.” (Doc. 58-2, p. 1).

The Eighth Amendment does not require that prisoners receive “unqualified

access to health care[.]” Rather, they are entitled only to “adequate medical care.” Johnson,

433 F.3d at 1013. The record reflects that Walker investigated the medical issues Jackson

complained of in grievance #17-8-59, and Walker provided Jackson with a response.

Likewise, the record reflects that Lahr, in the last step of the grievance process, denied

Jackson’s grievance. Walker and Lahr were entitled to rely on the advice and treatment

rendered by the medical professionals. Prison grievance procedures are not mandated by

the Constitution, and alleged mishandling of grievances by persons who otherwise did

not cause or participate in the underlying conduct states no claim. See Owens v. Hinsley,

635 F.3d 950, 953 (7th Cir. 2011). Similarly, prison officials who simply processed or

reviewed inmate grievances lack personal involvement in the conduct forming the basis

of the grievance, which precludes liability under Section 1983. See Owens v. Evans, 878

F.3d 559, 563 (7th Cir. 2017). Accordingly, no reasonable jury could find that there is

evidence that either Walker or Lahr was deliberately indifferent to Jackson’s serious

medical needs. Nor could any reasonable jury find that either Walker or Lahr ignored

Jackson’s medical concerns by simply reviewing and denying one grievance.

CONCLUSION

Accordingly, the Court GRANTS the motion for summary judgment filed by

Santos and Knebel (Doc. 49) and the motion for summary judgment filed by Lahr and

Walker (Doc. 57). The Court finds in favor of Venerio Santos, Jessica Knebel, Susan

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Walker, and Ann Lahr against Sparky Jackson. Further, the Court DIRECTS the Clerk of

the Court to enter judgment reflecting the same and close the case. Jackson shall take

nothing from this case.

IT IS SO ORDERED.

Digi i

Dated: June 30, 2020. Gitally signed

Atty ol | OM by Judge Sison

“=~ Date: 2020.06.30

16:11:55 -05'00'

GILBERT C. SISON

United States Magistrate Judge

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