Saterfield v. Baldwin et al
Filing
165
ORDER granting in part and denying in part 149 Motion for Summary Judgment. Signed by Magistrate Judge Gilbert C. Sison on 3/30/2021. (mjf)
UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
LLYOD SATERFIELD, K53497
Plaintiff,
vs.
ROBERT SMITH, and
MOHAMMED SIDDIQUI,
Defendants.
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Case No. 3:18-cv-00560-GCS
MEMORANDUM & ORDER
SISON, Magistrate Judge:
In March 2018, Plaintiff Llyod Saterfield filed suit against Defendants Dr. Robert
Smith and Dr. Ritz, the latter of whom has since been dismissed. (Doc. 1). Plaintiff brings
this claim pursuant to 42 U.S.C. § 1983, alleging that Defendants were deliberately
indifferent to his chronic lower back pain and related medical issues during Plaintiff’s
incarceration at Menard Correctional Center. (Doc. 1, ¶ 45). On January 22, 2019, Plaintiff
filed an Amended Complaint adding Defendant Dr. Mohammed Siddiqui. (Doc. 72).
Pending before the Court is Defendants’ motion for summary judgment. (Doc. 149). For
the reasons delineated below, the motion for summary judgment is GRANTED in part
and DENIED in part.
FACTUAL ALLEGATIONS
In 2013, Plaintiff began complaining of lower back pain while he was incarcerated
at Menard Correctional Center. (Doc. 153, p. 3). On August 4, 2014, Plaintiff underwent a
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Magnetic Resonance Imaging scan (“MRI”), which revealed a moderate bilateral spinal
stenosis at level L4-L5. Id. At that time, treating physicians prescribed Plaintiff Ibuprofen.
(Doc. 153, p. 4). However, in 2017, Plaintiff was hospitalized with acute kidney failure,
which was attributed to his intake of Ibuprofen. Id. On September 5, 2017, Defendant
Siddiqui prescribed Plaintiff Tramadol for his continued back pain. Id. On September 8,
2017, Defendant Siddiqui submitted a referral request for an MRI of Plaintiff’s spine. Id.
Dismissed-party, Dr. Ritz, requested that Plaintiff’s x-rays be updated and that the 2014
MRI report be presented before the referral request of the MRI was approved. Id.
Defendant Siddiqui then ordered a subsequent x-ray of Plaintiff’s spine, which was
performed on October 26, 2017. (Doc. 153, p. 5).
In early November 2017, Defendant Siddiqui submitted another referral request
for an MRI on Plaintiff’s spine. (Doc. 153, p. 5). Defendant Smith reviewed Plaintiff’s
condition and determined that he needed more information, including an updated x-ray
report and the 2014 MRI. Id. On November 27, 2017, Plaintiff discussed the x-rays with
Defendant Siddiqui, who noted Plaintiff’s chronic lower back pain. Id. Defendant
Siddiqui renewed Plaintiff’s prescription for Tramadol and referred Plaintiff to physical
therapy. Id.
On December 8, 2017, Plaintiff again met with Defendant Siddiqui regarding his
condition. (Doc. 153, p. 5). Defendant Siddiqui entered a request for the 2014 MRI report
due to Defendant Smith’s previous request for collegial review. Id. He also noted that
Plaintiff’s pain was being controlled by Tramadol and put in a renewed referral for a
physical therapy evaluation. Id.
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On January 18, 2018, Plaintiff underwent his physical therapy evaluation. (Doc.
154, p. 5).1 Plaintiff reported that Tramadol controlled his pain, but experienced higher
levels of pain without the medication. Id. After the evaluation, Plaintiff was scheduled
for several weeks of physical therapy appointments. Id. On February 16, 2018, Defendant
Siddiqui again saw Plaintiff regarding his condition. Id. Defendant Siddiqui noted that
there had been no response to physical therapy. Id. He therefore initiated a referral
request for an MRI. Id.
On February 22, 2018, after review of the x-rays and previous MRI report,
Defendant Smith did not approve of the referral “at this time.” (Doc. 153, p. 6). Defendant
Smith instead recommended Plaintiff be prescribed Elavil, a nerve pain medication; he
further recommended that Plaintiff continue with conservative on-site management. Id.;
(Doc. 154, p. 15-16). Despite Defendant Smith’s recommendation, Defendant Siddiqui did
not prescribe or administer Elavil to Plaintiff in 2018. (Doc. 154, p. 10).
Throughout April, May and June of 2018, Plaintiff experienced continued back
pain and indicated that Tramadol was no longer controlling his pain. (Doc. 153, p. 6-7).
On June 18, 2018, Defendant Siddiqui submitted a referral for an MRI, indicating that
other medications had not been successful and that Plaintiff continued to complain of
There is some discrepancy as to the date on which Plaintiff began physical therapy. Plaintiff asserts
he began physical therapy on January 18, 2017. (Doc. 154, p. 5). Using this date, Plaintiff’s physical therapy
prescription would last until March 1, 2017, given that Plaintiff was scheduled for six weeks of physical
therapy. Id. However, Defendants assert that Plaintiff began physical therapy on January 28, 2017. (Doc.
150, p. 6). Using this date, Plaintiff would not complete physical therapy until March 11, 2017. Because the
Court examines the facts in the light most favorable to Plaintiff, as the non-moving party, the Court assumes
that Plaintiff began physical therapy on January 18. See Regensburger v. China Adoption Consultants, Ltd., 138
F.3d 1201, 1205 (7th Cir. 1998)(citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986)).
1
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pain. (Doc. 153, p. 7). On June 22, 2018, the proper personnel approved Defendant
Siddiqui’s request for a new MRI. Id.
On July 31, 2018, Defendant Siddiqui determined that Plaintiff’s spinal stenosis
was slightly worse than in 2014 and that Plaintiff should undergo an orthopedic
consultation. (Doc. 153, p. 7). On August 2, 2018, Defendant Siddiqui and Dr. Ritz
discussed that recommendation. Id. Dr. Ritz then approved the request for an orthopedic
surgeon evaluation. (Doc. 153, p. 7-8).
On October 3, 2018, after Plaintiff received an orthopedic evaluation by an offsite
specialist, Defendant Siddiqui submitted a referral request for Plaintiff to undergo an L45 laminectomy, which was approved. (Doc. 153, p. 8). Plaintiff underwent laminectomy
on November 19, 2018. Id. On January 14, 2019, Plaintiff indicated that he was very
pleased with the surgical results and that he had no radicular symptoms. (Doc. 153, p. 9).
Plaintiff informed the provider that his symptoms were relieved by either brace or splint,
and by rest at both follow-up appointments. Id.
LEGAL STANDARDS
Summary judgment is proper where the pleadings and affidavits, if any, “show
that there is no genuine issue as to any material fact and that the moving party is entitled
to judgment as a matter of law.” FED. R. CIV. PROC. 56(c); Oates v. Discovery Zone, 116 F.3d
1161, 1165 (7th Cir. 1997)(citing Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986)). The
movant bears the burden of establishing the absence of a genuine issue as to any material
fact and entitlement to judgment as a matter of law. See Santaella v. Metro. Life Ins. Co., 123
F.3d 456, 461 (7th Cir. 1997)(citing Celotex, 477 U.S. at 323). This Court must consider the
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entire record, drawing reasonable inferences and resolving factual disputes in favor of
the non-movant. See Regensburger, 138 F.3d at 1205 (citing Anderson, 477 U.S. at 255). See
also Smith v. Hope School, 560 F.3d 694, 699 (7th Cir. 2009)(stating that “we are not required
to draw every conceivable inference from the record . . . we draw only reasonable
inferences”) (internal citations omitted). Summary judgment is also appropriate if a
plaintiff cannot make a showing of an essential element of his claim. See Celotex, 477 U.S.
at 322. While the Court may not “weigh evidence or engage in fact-finding[,]” it must
determine if a genuine issue remains for trial. Lewis v. City of Chicago, 496 F.3d 645, 651
(7th Cir. 2007).
In response to a motion for summary judgment, the non-movant may not simply
rest on the allegations in his pleadings; rather, he must show through specific evidence
that an issue of fact remains on matters for which he bears the burden of proof at trial.
See Walker v. Shansky, 28 F.3d 666, 670–671 (7th Cir. 1994), aff'd, 51 F.3d 276 (citing Celotex,
477 U.S. at 324). No issue remains for trial “unless there is sufficient evidence favoring
the non-moving party for a jury to return a verdict for that party . . . if the evidence is
merely colorable, or is not sufficiently probative, summary judgment may be granted.”
Anderson, 477 U.S. at 249–250 (citations omitted). Accord Starzenski v. City of Elkhart, 87
F.3d 872, 880 (7th Cir. 1996); Tolle v. Carroll Touch, Inc., 23 F.3d 174, 178 (7th Cir. 1994). In
other words, “inferences relying on mere speculation or conjecture will not suffice.” Trade
Fin. Partners, LLC v. AAR Corp., 573 F.3d 401, 407 (7th Cir. 2009) (internal citation omitted).
See also Anderson, 477 U.S. at 252 (finding that “[t]he mere existence of a scintilla of
evidence in support of the [non-movant's] position will be insufficient; there must be
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evidence on which the jury could reasonably find for the [non-movant]”). Instead, the
non-moving party must present “definite, competent evidence to rebut the [summary
judgment] motion.” EEOC v. Sears, Roebuck & Co., 233 F.3d 432, 437 (7th Cir. 2000)
(internal citation omitted).
ANALYSIS
A prisoner seeking to establish that the medical care he received in prison was so
insufficient as to violate the Eighth Amendment must prove that: (1) he had an objectively
serious medical need, and (2) the defendant prison official was deliberately indifferent to
that need. See Arnett v. Webster, 658 F.3d 742, 750 (7th Cir. 2011). A medical condition is
objectively serious if a physician has determined that treatment is mandated, or if it is “so
obvious that even a lay person would easily recognize the necessity for a doctor's
attention.” Johnson v. Snyder, 444 F.3d 579, 584-585 (7th Cir. 2006)(citing Gutierrez v. Peters,
111 F.3d 1364, 1373 (7th Cir. 1997)), overruled on other grounds in Hill v. Tangherlini, 724
F.3d 965, 968 n.1 (7th Cir. 2013). In order to find that a defendant was deliberately
indifferent, there must be a condition that required treatment, knowledge on the part of
the health care provider of an excessive risk to health or safety, and a decision to
disregard that risk. See Sellers v. Henman, 41 F.3d 1100, 1102 (7th Cir. 1994)(citing Farmer
v. Brennan, 511 U.S. 825 (1994)). Deliberate indifference exists only where an 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, 511 U.S. at 837-838.
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When a plaintiff asserts a claim of deliberate indifference on the basis of a
defendant physician’s care, that plaintiff must show the decision is “such a substantial
departure from accepted professional judgment, practice, or standards as to demonstrate
the person responsible did not base the decision on such judgment.” Roe v. Elyea, 631 F.3d
843, 857 (7th Cir. 2011). This standard exceeds mere negligence; instead, a plaintiff must
show intent or reckless disregard. See Farmer, 511 U.S. at 837-838.
The Court finds that a reasonable jury could find that Defendant Siddiqui was
deliberately indifferent to Plaintiff’s serious medical needs. Accordingly, summary
judgment is denied as to Defendant Siddiqui. However, the Court finds that a reasonable
jury could not find that Defendant Smith was deliberately indifferent to Plaintiff’s serious
medical needs. As such, summary judgment is granted as to Defendant Smith.
I.
Whether Defendant Siddiqui Exhibited Deliberate Indifference to Plaintiff’s
Serious Medical Needs
When determining whether a defendant physician was deliberately indifferent to
an inmate’s serious medical needs, the Court applies a totality of the circumstances
approach. See Petties v. Carter, 836 F.3d 722, 728-729 (7th Cir. 2016) (internal citations
omitted). Plaintiff makes three arguments supporting his contention that Defendant
Siddiqui was deliberately indifferent to Plaintiff’s serious medical needs: (i) Defendant
Siddiqui continued an ineffective course of treatment by prescribing Plaintiff Tramadol,
(ii) Defendant Siddiqui prolonged Plaintiff’s pain by failing to refer Plaintiff for an MRI
in a timely manner, and (iii) Defendant Siddiqui failed to follow Defendant Smith’s
recommendation to prescribe Plaintiff Elavil. Under the totality of the circumstances, the
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Court finds that a reasonable jury could determine that Defendant Siddiqui
demonstrated deliberate indifference to Plaintiff’s serious medical needs.
Persisting in a course of ineffective treatment constitutes cruel and unusual
punishment in violation of the Eighth Amendment when a defendant doctor chooses the
“easier and less efficacious treatment” without exercising professional judgment. Arnett
658 F.3d at 754 (internal citations omitted). See also White v. Napoleon, 897 F.2d 103, 109
(3rd Cir. 1990)(finding a violation of the Eighth Amendment where a defendant doctor
insisted on continuing the same course of treatment when that doctor knew the treatment
was painful and ineffective). The standard is not whether a plaintiff took steps to request
a specific, different course of treatment. Instead, the proper analysis considers whether
the defendant doctor knew he was providing deficient treatment. See Petties, 836 F.3d at
726.
Delay in treatment may evidence deliberate indifference to a plaintiff’s serious
medical needs when it is both: (1) inexplicable or unnecessary, and (2) intolerable when
weighed against the seriousness of the condition and the ease with which the condition
could be treated. See, e.g., Petties, 836 F.3d at 730 (stating that inexplicable delay which
serves no penological interest is evidence supporting an inference of deliberate
indifference); Grieveson v. Anderson, 538 F.3d 763, 779 (7th Cir. 2008)(finding deliberate
indifference when guards delayed treatment of a broken nose for a day and a half); Miller
v. Campanella, 794 F.3d 878, 880 (7th Cir. 2015)(holding that failing to provide over-thecounter medicine to treat gastro-esophageal reflux disease for two months established a
genuine issue of material fact as to deliberate indifference because the medicine is easy
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to obtain). Cf. Gutierrez v. Peters, 111 F.3d 1364, 1374 (7th Cir. 1997)(determining that a sixmonth delay in treating a relatively mild cyst infection was not indicative of deliberate
indifference). Courts recognize that prisons have limited resources making delays in
treatment more likely. See Petties, 836 F.3d at 730. Therefore, in order to sustain a claim
for deliberate indifference based on a delay in treatment, a plaintiff must provide
independent evidence that the delay either exacerbated the underlying injury or illness
or prolonged the plaintiff’s pain unnecessarily. Id. at 730-731. See also Gayton v. McCoy,
593 F.3d 610, 624 (7th Cir. 2010)(noting that if a plaintiff can proffer no evidence that a
delay in medical treatment exacerbated an injury, summary judgment should be granted
on the issue of causation).
Courts apply the same analysis to a physician’s decision to delay referral to a
specialist. Because referral is an exercise of medical discretion, the failure to refer
indicates deliberate indifference to a prisoner’s serious medical needs only if it is blatantly
inappropriate. See, e.g., Pyles v. Fahim, 771 F.3d 403, 411 (7th Cir. 2014)(discussing a
defendant’s failure to refer a plaintiff for an MRI). Nevertheless, plaintiffs are not
required to provide “objective evidence” of their condition before referral becomes
appropriate. See Greeno v. Daley, 414 F.3d 645, 655 (7th Cir. 2005). Nor are plaintiffs
required to show they were literally ignored in their requests for a referral. See Perez v.
Fenoglio, 792 F.3d 768, 778 (7th Cir. 2015)(citing Arnett, 658 F.3d at 751).
In assessing whether delayed referral supports a claim for deliberate indifference,
courts consider the severity of plaintiff’s condition, the length of the delay, and whether
the delay exacerbated the underlying injury or unnecessarily prolonged a plaintiff’s
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suffering. See McGowan v. Hulick, 612 F.3d 636, 640 (7th Cir. 2010). See also Perez, 792 F.3d
at 778 (stating that a defendant doctor waiting four days to refer plaintiff to a specialist,
by which time it was too late for the specialist to suture the wound, could support a claim
for deliberate indifference); Grieveson, 538 F.3d at 779 (holding that when plaintiff had a
nasal fracture and could experience further bleeding, then later needed surgery to repair
his nose, the failure to refer the plaintiff to a specialist could support finding deliberate
indifference); Jones v. Simek, 193 F.3d 485, 490-491 (7th Cir. 1999)(finding a reasonable jury
could rule in favor of plaintiff under the totality of circumstances where defendant
acknowledged plaintiff needed to see a specialist, yet did not provide a specialist for six
months; did not provide pain medication; and refused to follow a specialist’s advice once
plaintiff was finally referred).
However, a defendant physician is not liable when authorities deny the
physician’s request for a referral, the decision to pursue referral is an exercise of
professional judgment, and the denial is beyond the physician’s control. See, e.g., Perez,
792 F.3d at 779 (acknowledging that showing “someone else was in control” could
support granting summary judgment after discovery); Walker v. Benjamin, 293 F.3d 1030,
1038 (7th Cir. 2002)(upholding a decision granting summary judgment when the plaintiff
failed to show that delay between the initial visit, diagnosis and specialist’s treatment
were within the defendant physician’s control); Baker v. Wexford Health Services, Inc., 118
F. Supp. 3d 985, 996-997 (N.D. Ill. 2015)(granting summary judgment when the defendant
physician submitted a referral for collegial review, which the collegial review board then
denied; thus, the record showed that “someone else was responsible for the alleged
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delays”). But cf. Goodloe v. Sood, 947 F.3d 1026, 1032 (7th Cir. 2020)(stating plaintiff’s case
should survive summary judgment when a defendant doctor undertook no renewed
effort to arrange for plaintiff to see a specialist when referral was medically necessary and
had been delayed for two weeks).
Similarly, a physician’s decision to deviate from the recommendation of a
specialist may indicate deliberate indifference when that decision suggests that the
physician did not apply medical judgment. The prison physician is a prisoner’s primary
care physician, as such, that physician is “free to make his own determination” on the
basis of professional judgment. Holloway v. Delaware County Sheriff, 700 F.3d 1063, 1074
(7th Cir. 2012). If a plaintiff can show that no minimally competent professional would
have so determined under those circumstances, summary judgment is not appropriate.
See Collignon v. Milwaukee Cnty., 163 F.3d 982, 989 (7th Cir. 1998). In contrast, a plaintiff
who merely shows evidence that some professionals would have chosen a different course
of treatment has not provided sufficient evidence to overcome summary judgment. See
Petties, 836 F.3d at 729 (citing Steele v. Choi, 82 F.3d 175, 179 (7th Cir. 1996)) (emphasis in
original).
When a prisoner has informed a prison physician that a course of treatment is not
working, and when a specialist instructs the physician to pursue a different course of
treatment, a physician’s failure to do so may also indicate deliberate indifference. See
Arnett, 653 F.3d at 752. See also Jones, 193 F.3d at 490-491 (reversing summary judgment
for a prison doctor who failed to follow a specialist’s advice). However, a mere difference
of opinion between professionals does not give rise to deliberate indifference. See Estate
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of Cole by Pardue v. Fromm, 94 F.3d 254, 261 (7th Cir. 1996), cert. denied, 519 U.S. 1109 (1997).
The operative distinction is whether the two physicians disagree about a subjective issue
of medical judgment or whether the treating physician deliberately mistreated the
plaintiff. Id. (citing Estelle v. Gamble, 429 U.S. 97, 107 (1976)).
Plaintiff first argues that Defendant Siddiqui continued a course of treatment
known to be ineffective by prescribing Tramadol. Although Plaintiff’s pain was getting
worse from an eight out of ten in April 2018 to a nine out of ten less than one month later,
Defendant Siddiqui continued to treat Plaintiff by prescribing Tramadol. (Doc. 154, p. 11).
Plaintiff additionally reported that Tramadol was not working to treat his pain and that
his pain was spreading from his middle and upper back and neck to his legs and arms.
Id. Defendant Siddiqui himself noted that Tramadol did not seem to be effective and that
Plaintiff’s spinal stenosis was worsening. (Doc. 150, p. 14-15). Nevertheless, Defendant
Siddiqui continued to prescribe Tramadol for Plaintiff’s pain at the exact same
prescription level as had been prescribed since 2017. (Doc. 154, p. 11-12).
Next, Plaintiff asserts that Defendant Siddiqui prolonged Plaintiff’s pain by failing
to refer Plaintiff for an MRI and to an orthopedic surgeon in a timely manner. Defendant
Siddiqui first submitted a referral request for an MRI on September 8, 2017; this referral
was denied pending updated x-rays and a 2014 MRI report. (Doc. 150, p. 4). In early
November 2017, Defendant Siddiqui submitted another request for an MRI referral after
ordering an x-ray of Plaintiff’s spine in October 2017. Id. at p. 5. After review, Defendant
Smith again requested Defendant Siddiqui provide additional information, including an
x-ray and the Plaintiff’s 2014 MRI results. Id. Defendant Siddiqui discussed the x-ray
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results with Plaintiff on November 27, 2017; he then submitted the 2014 MRI results to
Defendant Smith for review on December 8, 2017. Id.
Defendant Siddiqui referred Plaintiff to physical therapy on January 18, 2018.
(Doc. 154, p. 5). When Plaintiff did not show improvement after the initial rounds of
treatment, Defendant Siddiqui again initiated a referral request for an MRI on February
16, 2018. (Doc. 150, p. 6). Defendant Smith denied this request on February 22, 2018. Id. at
p. 6. As Plaintiff’s back pain worsened, Defendant Siddiqui again requested an MRI
referral on June 18, 2018. Id. at p. 7. The collegial review board approved this request. Id.
The MRI indicated slightly worse results on July 6, 2018, and on July 31, 2018, Defendant
Siddiqui requested Plaintiff be referred to a specialist. Id. This request was approved on
August 2, 2018, and Plaintiff saw a specialist on October 3, 2018. Id. at p. 7-8. Plaintiff,
however, asserts that by delaying his referral until June 2018, Defendant Siddiqui
prolonged Plaintiff’s pain, especially in light of Defendant Siddiqui’s continuation of an
ineffective course of treatment with Tramadol. (Doc. 154, p. 12, 14).
Finally, Plaintiff argues that Defendant Smith recommended Plaintiff be
prescribed Elavil, a nerve pain medication. (Doc. 154, p. 10). Defendant Siddiqui signed
off on this recommendation. Id. at p. 10. However, Defendant Siddiqui – who was
responsible for prescribing Plaintiff’s prescriptions – did not prescribe Elavil for Plaintiff
anytime in 2018. Id. at p. 10-11. Instead, Defendant Siddiqui continued Plaintiff’s
Tramadol prescription as Plaintiff’s pain worsened over the course of March, April and
May of 2018. Id. at p. 11.
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Defendant Siddiqui responds that he consistently referred Plaintiff for an MRI
throughout 2017 and 2018. (Doc. 150, p. 13-14). However, in 2017 and February 2018, after
review of the available data, the MRI referrals were denied. Id. at p. 14. Defendant
Siddiqui further points out that he submitted an MRI request in June 2018 when Plaintiff’s
pain began worsening. Id. This referral was approved, and Plaintiff received treatment
which alleviated his pain shortly thereafter. Id. In addition to initiating multiple MRI
requests, Defendant Siddiqui also treated Plaintiff with Tramadol, physical therapy, and
diagnostic x-rays. (Doc. 158, p. 15). Overall, Defendant Siddiqui asserts he provided
treatment using his medical judgment in order to alleviate, rather than prolong, Plaintiff’s
pain. Id. at p. 16.
It is true that when Defendant Siddiqui first prescribed Tramadol, Plaintiff
reported decreased pain. (Doc. 150, p. 4). Plaintiff also demonstrated an increased range
of motion. Id. As Plaintiff’s treatment progressed, Plaintiff consistently reported that
Tramadol assisted in controlling his pain. Id. at p. 5. Defendant Siddiqui also noted that
Plaintiff reported much higher levels of pain without Tramadol than with Tramadol. Id.
at p. 6. However, Plaintiff also stated that his pain was increasing after his physical
therapy appointments had concluded. Id. at p. 14. Between Defendant Siddiqui’s referral
on February 16, 2018 and the referral on June 18, 2018, Plaintiff complained that Tramadol
was no longer controlling his pain five times. Id. at p. 6-7.
Plaintiff’s six-week physical therapy prescription expired a few weeks after
Defendant Siddiqui made the referral request on February 16, 2018. (Doc. 154, p. 5). Prior
to the completion of physical therapy, Defendant Siddiqui noted that it did not appear to
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be helping Plaintiff. Id. A month after Plaintiff had completed his physical therapy
appointments Plaintiff experienced continued back pain (from April to May), and he
indicated that Tramadol was no longer controlling the pain. (Doc. 153, p. 6-7). In fact,
Plaintiff reported his pain as being an eight or nine out of 10 with the pain spreading
throughout his entire upper body. (Doc. 154, p. 11). When Defendant Siddiqui saw
Plaintiff on May 21st, he knew that physical therapy was not effective, that Tramadol was
no longer controlling the pain, and that Plaintiff’s pain had increased in severity. Despite
this knowledge, Defendant Siddiqui did not prescribe Elavil, as had been recommended,
but instead renewed Plaintiff’s Tramadol prescription at the exact same level as before.2
Furthermore, other than renewing the aforementioned prescription, Defendant Siddiqui
did not take any other steps to alleviate Plaintiff’s considerable pain as he had done in
prior appointments with Plaintiff. This decision appears to be inexplicable given that
Defendant Siddiqui himself noted that Plaintiff’s pain medication no longer appeared to
be as effective as it had been in the winter of 2017 and early 2018. Id. at p. 14.
The Court notes that Defendant Smith is not a specialist, but a peer of Defendant Siddiqui’s.
Accordingly, Defendant Siddiqui is not deliberately indifferent merely because he did not follow
Defendant Smith’s recommendation to administer Elavil, rather than Tramadol. See Estate of Cole by Pardue,
94 F.3d at 261. However, Defendant Smith’s recommendation does provide an example of a similar,
alternative treatment to which Plaintiff may have been responsive. Plaintiff previously noted that Tramadol
had controlled his pain suggesting that a different nerve medication may have had an impact on his pain.
Additionally, there is no evidence that providing Elavil would have been more difficult than providing
Tramadol. Nor does Defendant Siddiqui explain why he continued with the Tramadol prescription rather
than Elavil. It is true that standing alone the failure to administer Elavil at most probably amounts to
negligence. However, when coupled with Defendant Siddiqui’s knowledge of Plaintiff’s pain and the fact
that other treatments and Tramadol were not working, Defendant Siddiqui’s failure to administer Elavil
further contributed to an inexplicable delay in Plaintiff’s effective treatment and the prolonging of
Plaintiff’s pain.
2
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Defendant Siddiqui’s decision on May 21st also stands in stark contrast with how
Defendant Siddiqui had previously treated Plaintiff. In late 2017 and early 2018,
Defendant Siddiqui consistently requested an MRI referral for Plaintiff. While it is true
that Defendant Siddiqui did not have the ultimate authority to order a referral, such a
referral could not be accomplished without Defendant Siddiqui first requesting one.3 The
fact that Defendant Siddiqui previously requested an MRI referral on three separate
occasions prior to the June 2018 referral request is an implicit acknowledgement that he
believed such a referral was medically necessary. Thus, Defendant Siddiqui’s decision to
wait almost a month later until June 18 to request another referral seems all the more
questionable and inexplicable in light of what Defendant Siddiqui knew and how he had
treated Plaintiff in the past. This delay arguably prolonged Plaintiff’s pain unnecessarily.
Furthermore, the ease with which this could have been alleviated was readily apparent,
i.e., referring Plaintiff for an MRI, which was ultimately done, albeit a month later during
which Plaintiff endured considerable pain. As such, the Court finds that a reasonable jury
could find that Defendant Siddiqui demonstrated deliberate indifference to Plaintiff’s
serious medical needs, and summary judgment is denied as to Defendant Siddiqui.
3
The facts and inferences drawn from those facts as construed in favor of Plaintiff show that this is
in fact the case. First and foremost, the successful referral which was approved in June only came about
after Defendant Siddiqui had requested it. Moreover, when Defendant Smith denied the MRI referral on
February 22, 2018, Defendant Smith noted that he was denying it “at this time” (Doc. 153, p. 6), which
implied that Defendant Siddiqui should try again. This would presumably be after Plaintiff’s physical
therapy had been completed and after sufficient time had passed to determine how Plaintiff was
responding to Elavil.
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II.
Whether Defendant Smith Exhibited Deliberate Indifference to Plaintiff’s
Serious Medical Needs
An MRI is a “classic example of a matter for medical judgment.” Pyles, 771 F.3d at
411 (citing Estelle, 429 U.S. at 107). A defendant’s decision to forego an MRI referral
supports finding deliberate indifference only when that decision goes against the norms
of professional conduct. See, e.g., Broadfield v. Williams, No. 18-2300, 768 Fed. Appx. 544,
549 (7th Cir. April 22, 2019)(finding that the decision to order an x-ray and an MRI in lieu
of referring to a specialist fell within a doctor’s medical discretion and so was not
demonstrative of deliberate indifference); Ray v. Wexford Health Sources, Inc., 706 F.3d 864,
866 (7th Cir. 2013)(finding that the decision not to refer a plaintiff for an MRI to doublecheck an arthritis diagnosis was not indicative of deliberate indifference because the
defendants were properly treating the plaintiff for arthritis). See also Pyles, 771 F.3d at 411
(stating that the decision to forego an MRI was not suggestive of deliberate indifference
because it was “implicitly endorsed” by other medical professionals).
Defendant Smith first denied Defendant Siddiqui’s request that Plaintiff be
referred for an MRI in November 2017 because Defendant Smith did not have access to a
recent x-ray or Plaintiff’s 2014 MRI, both of which contained helpful information in
diagnosing Plaintiff’s pain. (Doc. 150, p. 5). In light of the fact that Defendant Smith did
not have complete information, the denial of this MRI referral does not demonstrate
deliberate indifference. It is clearly within a doctor’s discretion and does not go against
the norms of professional conduct to deny an MRI referral under these circumstances.
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Defendant Siddiqui requested another MRI referral on February 16, 2018, which
was denied by Defendant Smith on February 22, 2018. (Doc. 153, p. 6). Defendant Smith
did have the requested information that he did not have when he denied the first MRI
request in November 2017. However, at this time, Plaintiff was still undergoing his sixweek course of physical therapy. (Doc. 150, p. 6). Even though Defendant Siddiqui
indicated that physical therapy was not working, it is not unreasonable, nor does it go
against professional norms, to wait until all of Plaintiff’s sessions had been completed
before making a final assessment regarding the efficacy of physical therapy. This alone
would appear to provide sufficient grounds for Defendant Smith to reject the second MRI
request.
But with this second denial, Defendant Smith also recommended that Defendant
Siddiqui prescribe Plaintiff Elavil, another pain medication. (Doc. 150, p. 6). Plaintiff
contends that the decision to forego an MRI in favor of “conservative onsite treatment,”
including Elavil and physical therapy, is indicative of deliberate indifference. (Doc. 154,
p. 15). While it is true that Plaintiff was experiencing some pain at the time this referral
was denied, it appeared that Tramadol was controlling the pain in February 2018.
Plaintiff did not complain of significantly increased pain until later. And, even though
Defendant Siddiqui presumably informed Defendant Smith that physical therapy did not
appear to be working, Plaintiff still had a few more sessions to complete. It does not
stretch the bounds of professional discretion to wait and see whether Plaintiff’s pain
could be controlled and managed better with Elavil rather than Tramadol prior to
approving an MRI referral. Moreover, to the extent that this decision had the effect of
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continuing Plaintiff’s pain, it still does not amount to deliberate indifference as Defendant
Smith was still treating the pain, rather than ignoring it.4 Accordingly, Defendant Smith’s
denial of the second MRI request does not indicate deliberate indifference, and thus,
summary judgment as to Defendant Smith is granted.
CONCLUSION
For the above-stated reasons, Defendants’ motion for summary judgment is
GRANTED in part and DENIED in part. Summary judgment is granted in favor of
Defendant Smith and denied as to Defendant Siddiqui. Accordingly, the Court DIRECTS
the Clerk of the Court to dismiss Defendant Smith from the case.
IT IS SO ORDERED.
Digitally signed
by Judge Sison 2
Date: 2021.03.30
13:45:25 -05'00'
______________________________
GILBERT C. SISON
United States Magistrate Judge
Dated: March 30, 2021.
4
While it is true that Plaintiff never actually received Elavil, this supports finding Defendant
Siddiqui was deliberately indifferent. It does not support finding that Defendant Smith was deliberately
indifferent because there is no evidence that Defendant Smith had actual knowledge that Plaintiff was not
receiving the proper prescription. See Gevas v. McLaughlin, 798 F.3d 475, 480 (7th Cir. 2015)(citing Farmer,
511 U.S. at 837)(stating that a defendant must have actual knowledge of a serious risk of harm in order to
be deliberately indifferent).
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