Kugler v. Rao et al

Filing 115

SUMMARY JUDGMENT OPINION entered by Judge Sue E. Myerscough on 3/24/2017. Defendants' Motions for Summary Judgment 88 , 91 , 100 and 102 are GRANTED. All pending motions are denied as moot, and this case is terminated, with the parties t o bear their own costs. Judgment to be entered in favor of the Defendants and against Plaintiff. If the Plaintiff wishes to appeal this judgment, he must file a Notice of Appeal with this Court within 30 days of the entry of judgment. Fed. R. App. P. 4(a)(4). If the Plaintiff does choose to appeal, he will be liable for the $505.00 appellate filing fee regardless of the outcome of the appeal. (MAS, ilcd)

E-FILED

Monday, 27 March, 2017 01:59:27 PM
Clerk, U.S. District Court, ILCD

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF ILLINOIS
SPRINGFIELD DIVISION
DEVIN M. KUGLER,

v.
RAO, et al.

)
)
)
Plaintiff,
)
)
)
)
)
Defendants. )

14-3133

SUMMARY JUDGMENT OPINION
SUE E. MYERSCOUGH, U.S. District Judge:
Plaintiff, proceeding pro se and presently civilly committed at
Rushville Treatment and Detention Facility, brought the present
lawsuit alleging claims under 42 U.S.C. § 1983 and the Fourteenth
Amendment and the Religious Land Use and Institutionalized
Persons Act, 42 U.S.C. § 2000cc-1, related to the forced
administration of psychotropic medication. The matter comes
before this Court for ruling on the Defendants’ Motions for
Summary Judgment. (Docs. 88, 91, 100, 102). The motions are
granted.

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LEGAL STANDARD
Summary judgment should be granted “if the movant shows
that there is no genuine dispute as to any material fact and the
movant is entitled to judgment as a matter of law.” Fed. R. Civ. P.
56(a). All facts must be construed in the light most favorable to the
non-moving party, and all reasonable inferences must be drawn in
his favor. Ogden v. Atterholt, 606 F.3d 355, 358 (7th Cir. 2010).
The party moving for summary judgment must show the lack of a
genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S.
317, 323 (1986). In order to be a “genuine” issue, there must be
more than “some metaphysical doubt as to the material facts.”
Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574,
586 (1986). “Only disputes over facts that might affect the outcome
of the suit under the governing law will properly preclude the entry
of summary judgment.” Anderson v. Liberty Lobby, Inc., 477 U.S.
242, 248 (1986).
FACTS
Plaintiff is civilly committed at Rushville Treatment and
Detention Facility (“Rushville” or “TDF”) pursuant to the Illinois
Sexually Violent Persons Commitment Act, 725 Ill. Comp. Stat. §
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207/1 et seq. Defendants were employed at the facility in the
following capacities: Defendant Vallebhaneni (also known as “Dr.
Rao”), Defendant Bednarz, and Defendant Tinwalla were
psychiatrists; Defendant Walker was the Director of Nursing;
Defendant Rhoades was a nurse; and Defendants Louck and Lodge
were psychologists.
On February 12, 2014, Plaintiff was removed from his therapy
group for reasons that included his use of derogatory language
towards other group members and an admitted infatuation with his
primary therapist. Shortly thereafter, Plaintiff was placed in a
mental health observation cell after he threatened to kill staff
members and attempted to leave the facility. (Doc. 102-3 at 2-14).
In Plaintiff’s words, “I was crying. I was screaming….I kicked on
doors, made a couple of threats…threatened self-harm….” Pl.’s
Dep. 99:13-15.
Defendant Bednarz prescribed Ativan, an anxiety medication,
and Haldol, an antipsychotic medication, at that time. (Doc. 113-1
at 9). Plaintiff initially took the Ativan, but later refused it. (Doc.
113 at 10). On February 13, 2014, he threatened to kill another
resident. (Doc. 88-6 at 13). On February 15, 2014, staff observed
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Plaintiff to have scratches on his wrist, presumably from a suicide
attempt. (Doc. 113 at 10).
Between mid-February and March 25, 2014, Defendant
Vallabhaneni and Defendant Tinwalla met with Plaintiff separately
on several occasions. Defendant Tinwalla met with Plaintiff on
February 16, 2014, and they discussed Plaintiff’s attempts to walk
out of the facility. Plaintiff stated his recollection of the events
leading to his placement on mental health status was “fuzzy.” Id. at
15.
Defendant Vallabhaneni met with Plaintiff on three occasions
(February 22 and 28; March 7, 2014). Each time, Defendant
Vallabhaneni noted Plaintiff’s refusal to take his medications. Id. at
15-17; (Doc. 113-1 at 20-21). Defendant Vallabhaneni diagnosed
Plaintiff with manic bipolar disorder with psychotic breaks. (Doc.
113-1 at 20-21). He also noted Plaintiff’s history of loss of selfcontrol, self-injurious behavior, agitation, and threats towards
others. Defendant Vallabhaneni concluded that Plaintiff had the
potential to cause self-inflicted harm or harm to others, and he
recommended enforced medication. Defendant Vallabhaneni
referred Plaintiff to Defendant Tinwalla for a second opinion. After
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meeting with Plaintiff on March 9, 2014, Defendant Tinwalla
concluded that Plaintiff “would benefit from psychotropic
medication (voluntary or enforced) at this time.” Id. at 23.
On March 14, 2014, Plaintiff threatened to kill staff members
and harm himself. Plaintiff had struck a window with his hand
until the shatterproof glass cracked. Plaintiff also had scratched
his left wrist, drawing blood in an apparent suicide attempt.
Plaintiff was notified on March 24, 2014, that a hearing before
the Treatment Review Committee had been scheduled for the next
day. (Doc. 91-4 at 2). The notice informed Plaintiff of the reasons
for the hearing and also indicated that Defendant Rhoades, a nurse,
had been appointed as Plaintiff’s Staff Assistant. Plaintiff testified
at his deposition that he was allowed to submit a list of witnesses to
testify on his behalf.
On March 25, 2014, Plaintiff appeared before the Treatment
Review Committee (“Committee”). The Committee consisted of three
Rushville officials: Defendant Bednarz, Defendant Louck, and
another non-defendant official. According to the documentation
provided, the Committee noted Plaintiff’s then-recent suicide
attempt, threats against staff, and the window Plaintiff cracked in
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the healthcare unit. Plaintiff also stated, according to the exhibit,
that he would not take “psychiatric medications.” Plaintiff’s
witnesses were not called to testify, but Plaintiff testified in his
deposition that they would not have offered any new information.
Pl.’s Dep. 45:3-13; (Doc. 113-1 at 25).
The Committee “concur[ed] with [the] Involuntary
Administration of Psychotropic Medication.” (Doc. 91-4 at 1). As
the basis for this decision, the Committee found that Plaintiff
suffered from a mental illness or mental disorder, that medication
was in his best interests, and that a substantial risk that Plaintiff
would harm himself or others existed because of his mental
condition. Plaintiff was then placed on a forced regimen of
psychotropic medication (Zyprexa) until November 2014. Plaintiff
was subsequently placed on blood pressure medication to treat the
side effects of the psychotropic medication. Plaintiff continued to
see Defendant Vallabhaneni at regular intervals during the period of
enforced medication. Pl.’s Dep. 50:10-13.
Plaintiff told the Committee on March 25, 2014, that he would
not take the psychotropic medications voluntarily for religious
reasons. Plaintiff practices Satanism and has done so since
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approximately 2003. Plaintiff testified that, as part of his religious
practice, he has followed the Ninth Enochian Key since 2011. This
tenet “warns of the use of substances, devices[,] or pharmaceuticals
which might lead to the delusion and subsequent enslavement of
the master.” (Doc. 109-1 at 3). Plaintiff interprets this tenet as
prohibiting the ingestion of psychotropic drugs.
ANALYSIS
Fourteenth Amendment Claims
Plaintiff possesses “a significant liberty interest in avoiding the
unwanted administration of [psychotropic] drugs under the Due
Process Clause of the Fourteenth Amendment.” Washington v.
Harper, 494 U.S. 210, 221-22 (1990); Youngberg v. Romeo, 457
U.S. 307, 316 (1982). Plaintiff’s liberty interest must be viewed in
the context of his confinement, and a regulation or rule infringing
upon it must be rationally related to legitimate state interests to be
constitutionally valid. Harper, 494 U.S. at 222 (citing Turner v.
Safley, 482 U.S. 78 (1987)). The Illinois Administrative Code
provides:
d)

An adult resident [committed pursuant to the
Illinois Sexually Violent Persons Commitment Act],
or, if the resident is under guardianship, the
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resident's guardian, may refuse generally accepted
treatment services, except the Resident Behavior
Management System.
1)

Administration of Psychotropic Medication
A)

Psychotropic medication shall not be
administered to any resident against his
or her will or without the consent of the
parent or guardian of a minor who is
under the age of 18, unless:
i)

A psychiatrist, or in the absence of a
psychiatrist a physician, has
determined that: the resident suffers
from a mental illness or mental
disorder; and the medication is in
the medical interest of the resident;
and the resident is either gravely
disabled or poses a likelihood of
serious harm to self or others; and

ii)

The administration of such
medication has been approved by
the Treatment Review Committee
after a hearing (see subsection (d)(2)
of this Section). However, no such
approval or hearing shall be
required when the medication is
administered in an emergency
situation. An emergency situation
exists whenever the required
determinations listed in subsection
(d)(1)(A)(i) of this Section have been
made and a psychiatrist, or in the
absence of a psychiatrist a
physician, has determined that the
resident poses an imminent threat
of serious physical harm to self or
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others. In all emergency situations,
the procedures set forth in
subsection (d)(5) of this Section
shall be followed.
59 Ill. Admin. Code § 299.330(d)(1)(A).
The Court must examine four factors when determining the
reasonableness of a challenged rule: “(1) whether the restriction is
rationally related to a legitimate and neutral government objective;
(2) whether there are alternative means of exercising the right that
remain open to the inmate; (3) what impact an accommodation of
the asserted right will have on [staff] and other [residents]; and, (4)
whether there are obvious alternatives to the [restriction] that show
that it is an exaggerated response to [penological] concerns.” Ortiz
v. Downey, 561 F.3d 664, 669 (7th Cir. 2009) (citing Lindell v.
Frank, 377 F.3d 655, 657 (7th Cir. 2004)).
Harper recognized that state officials have a compelling
interest in the security and safety of the institutions they manage,
and that officials are also obligated to provide residents “with
medical treatment consistent not only with [the resident’s] medical
interests, but also within the needs of the institution.” Harper, 494
U.S. at 225. Plaintiff acknowledged this duty in his deposition
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testimony and admitted that TDF officials were attempting to
prevent him from harming himself. Pl.’s Dep. 111:15-24. Plaintiff
could not identify any viable non-medication approaches to address
his situation, id. 121:4-16, and failing to address the situation
could have dire effects on Plaintiff, staff, and residents alike.
Nothing in the record suggests that the policy was an exaggerated
response. Given that the Illinois policy in question applies only
when a resident is gravely disabled or poses a threat of significant
harm to himself or others, and after a trained medical professional
has determined that the resident suffers from a mental condition
that is treatable through medication, the Court finds that the policy
is rationally related to legitimate penological interests.
Plaintiff is entitled to the minimal procedural protections
under the Due Process Clause. The Illinois policy provides for
notice, the appointment of a staff assistant, the right to be present
at the hearing, the ability to identify witnesses to testify on the
resident’s behalf, and a determination by a committee consisting of
individuals not involved in a resident’s treatment. 59 Ill. Admin.
Code § 299.330(d)(2)(A)-(L). Here, Defendant Vallabhaneni
determined that Plaintiff suffered from a mental condition and that
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the administration of psychotropic drugs to treat that condition
would be beneficial. He sought a second opinion from Defendant
Tinwalla who concurred in the assessment.
Plaintiff received notice of a hearing, the appointment of a staff
assistant, the opportunity to identify witnesses on his behalf, and
he was allowed to be present at the hearing. Though the Committee
did not call Plaintiff’s witnesses to testify, Plaintiff admitted that his
witnesses would not have offered any testimony in addition to his
own. Cf. Piggie v. Cotton, 344 F.3d 674, 678 (7th Cir. 2003)
(“[T]here is no right to call witnesses [at a disciplinary hearing]
whose testimony would be irrelevant, repetitive, or unnecessary.”).
Therefore, the Court finds that no reasonable juror could
conclude that the Defendants violated Plaintiff’s Fourteenth
Amendment rights.
Religion Claims
Plaintiff also asserts that the ingestion of psychotropic drugs,
voluntary or not, violates his religious beliefs. The Religious Land
Use and Institutionalized Persons Act (“RLUIPA”) prohibits
governmental imposition of a “substantial burden on the religious
exercise” of a confined individual, even if the burden results from a
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rule of general applicability, unless the burden “(1) is in furtherance
of a compelling governmental interest; and (2) is the least restrictive
means of furthering that compelling governmental interest.” 42
U.S.C. § 2000cc–1(a). In establishing a claim under RLUIPA, the
plaintiff bears the initial burden of showing (1) that he seeks to
engage in an exercise of religion; and, (2) that the challenged
practice substantially burdens that exercise of religion. Id. §
2000cc–2(b); Holt v. Hobbs, --- U.S. ---, 135 S. Ct. 853, 862 (2015).
“Religious exercise,” as defined in the statute, means “any
exercise of religion, whether or not compelled by, or central to, a
system of religious belief.” See 42 U.S.C. § 2000cc-5(7)(A).
Requests for religious accommodation “must be sincerely based on
a religious belief and not some other motivation.” Holt, 135 S. Ct.
at 162. Defendants do not argue that refraining from the ingestion
of psychotropic medications is not a religious exercise within the
context of this case, or that Plaintiff’s beliefs are not sincerely held.
RLUIPA does not define “substantial burden,” but recent
Supreme Court decisions frame the relevant inquiry as whether the
inmate was required to “engage in conduct that seriously violates
his religious beliefs.” Holt, 135 S. Ct. at 862 (quoting Burwell v.
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Hobby Lobby Stores, Inc., 573 U.S. ---, ---, 134 S. Ct. 2751, 2775
(2014)); see Schlemm v. Wall, 784 F.3d 362, 364 (7th Cir. 2015)
(applying the Holt and Hobby Lobby standards). In so ruling, the
Supreme Court “articulate[d] a standard much easier to satisfy”
than the longstanding jurisprudence interpreting RLUIPA in light of
First Amendment rights.1 Schlemm, 784 F.3d at 364.
Viewing the evidence in the light most favorable to Plaintiff,
and accepting his interpretation of the Ninth Enochian Key, the
Court finds that Plaintiff has made a prima facie case that the
administration of psychotropic drugs places a substantial burden
on his religious practices.
The burden now shifts to the Defendants to show that the
forced administration of psychotropic medications was the least
restrictive means in furthering a compelling government interest.
This standard “requires the government to ‘sho[w] that it lacks
other means of achieving its desired goal without imposing a
substantial burden on the exercise of religion by the objecting
Prior to the Supreme Court’s decisions in Holt and Hobby Lobby, courts
interpreted “substantial burden” for RLUIPA purposes as “one that necessarily
bears direct, primary, and fundamental responsibility for rendering religious
exercise…effectively impracticable.” Schlemm, 784 F.3d at 364; see also
Nelson v. Miller, 570 F.3d 868, 876 (7th Cir. 2009) (RLUIPA has been
“interpreted with reference to Supreme Court free exercise jurisprudence.”).
1

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part[y].’” Holt, 135 S. Ct. at 863 (quoting Hobby Lobby, 134 S. Ct.
at 2780). “If a less restrictive means is available for the government
to achieve its goals, the government must use it.” Id. (internal
quotations omitted).
As discussed in the previous section, TDF officials have a
compelling interest in maintaining the safety and security of staff
and residents within the facility. In this situation, Plaintiff acted in
a manner that caused TDF officials to conclude that he posed a risk
of substantial harm to himself and others. Plaintiff’s behavior
included an attempt to escape the facility, suicide attempts,
threatening staff and other residents with physical harm, and
striking a shatterproof window until it cracked.
The short-term solution to these exhibited behaviors, as
disclosed by the record, involved placing Plaintiff in a mental health
observation cell with nothing more than a suicide smock and
suicide blanket. Such confinement eliminates a substantial portion
of the risk of harm to others, and to a lesser extent, the risk of
Plaintiff harming himself. The parties, and this Court, however, do
not suggest that this type of confinement is a viable long-term
solution—the negative effects of prolonged, isolated confinement
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have been well-documented within this judicial circuit. See Kervin
v. Barnes, 787 F.3d 833, 837 (7th Cir. 2015) (noting that serious
psychological consequences from confinement in segregation have
been well documented). Plaintiff testified further that he refused to
take medication voluntarily and attempts at one-on-one counseling
were ineffective. Pl.’s Dep. 121:4-16.
In light of these events, TDF officials were out of options. More
conservative treatment options compatible with Plaintiff’s religious
practices had failed to eliminate the substantial threat Plaintiff
posed to himself and others at the TDF. Within the context of
institutional security, a solution short of long-term confinement in a
mental health observation cell was not available. Therefore, the
Court finds that Defendants have shown that the enforced
administration of psychotropic medications was the least restrictive
means of furthering a compelling government interest and that no
reasonable juror could conclude that Defendants violated Plaintiff’s
rights under RLUIPA.
Medical Claims
In its Merit Review Opinion, the Court found that Plaintiff
stated a plausible claim for deliberate indifference to a serious
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medical need. (Doc. 6). Plaintiff testified at his deposition that he
did not intend to pursue a deliberate indifference to a serious
medical need claim and that he desired to withdraw this claim
against the Defendants. Pl.’s Dep. 128:7-13. Plaintiff has not filed
any motion to that effect.
Insofar as Plaintiff still seeks to pursue these claims, he
maintains a right under the Fourteenth Amendment to adequate
medical care. Estelle v. Gamble, 429 U.S. 97, 104-05 (1976);
Burton v. Downey, 805 F.3d 776, 784 (7th Cir. 2015). Claims of
negligence, medical malpractice, or disagreement with a prescribed
course of treatment are not sufficient. McDonald v. Hardy, 821
F.3d 882, 888 (7th Cir. 2016) (citing Pyles v. Fahim, 771 F.3d 403,
408 (7th Cir. 2014), and Duckworth v. Ahmad, 532 F.3d 675, 679
(7th Cir. 2008)). Rather, liability attaches when “the official knows
of and disregards an excessive risk to inmate health or safety; the
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).

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Medical professionals are deliberately indifferent only if “the
decision by the professional is such a substantial departure from
accepted professional judgment, practice, or standards, as to
demonstrate that the person responsible actually did not base the
decision on such a judgment.” Sain v. Wood, 512 F.3d 886, 894-95
(7th Cir. 2008). Nonmedical officials may be held liable for
intentionally denying or delaying access to medical care or
interfering with treatment once prescribed. Estelle, 429 U.S. at
104.
Nothing in the record suggests that the medical professionals
treating Plaintiff substantially deviated from accepted professional
judgment. In addition, the record does not support a finding that
Plaintiff’s access to medical treatment was obstructed in any way.
Therefore, the Court finds that no reasonable juror could conclude
that Defendants were deliberately indifferent to Plaintiff’s serious
medical need.
IT IS THEREFORE ORDERED:
1) Defendants’ Motions for Summary Judgment
[88][91[100][102] are GRANTED. The clerk of the court is
directed to enter judgment in favor of Defendants and
against Plaintiff. All pending motions are denied as moot,
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and this case is terminated, with the parties to bear their
own costs.
2) If Plaintiff wishes to appeal this judgment, he must file a
notice of appeal with this Court within 30 days of the
entry of judgment. Fed. R. App. P. 4(a)(4). A motion for
leave to appeal in forma pauperis MUST identify the issues
the Plaintiff will present on appeal to assist the court in
determining whether the appeal is taken in good faith. See
Fed. R. App. P. 24(a)(1)(c); see also Celske v Edwards, 164
F.3d 396, 398 (7th Cir. 1999)(an appellant should be given
an opportunity to submit a statement of his grounds for
appealing so that the district judge “can make a
reasonable assessment of the issue of good faith.”); Walker
v. O’Brien, 216 F.3d 626, 632 (7th Cir. 2000)(providing that
a good faith appeal is an appeal that “a reasonable person
could suppose…has some merit” from a legal perspective).
If Plaintiff does choose to appeal, he will be liable for the
$505.00 appellate filing fee regardless of the outcome of
the appeal.
ENTERED:

March 24, 2017.

FOR THE COURT:
s/Sue E. Myerscough
SUE E. MYERSCOUGH
UNITED STATES DISTRICT JUDGE

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