Rodriguez v. Ahmed

Filing 66

MEMORANDUM AND ORDER, the Court GRANTS Dr. Ahmed's motion for summary judgment (Doc. 60) and DIRECTS the Clerk of Court to enter judgment accordingly. Signed by Judge J. Phil Gilbert on 5/18/2023. (jdh)

UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
JOE L. RODRIGUEZ,
Plaintiff,
v.

Case No. 20-cv-1236-JPG

F. AHMED,
Defendant.
MEMORANDUM AND ORDER
This matter comes before the Court on the motion for summary judgment filed by
defendant Dr. Faisal Ahmed (Doc. 60). Plaintiff Joe L. Rodriguez has responded to the motion
(Doc. 62), and Dr. Ahmed has replied to that response (Doc. 65).
Rodriguez filed this civil rights action pro se pursuant to Bivens v. Six Unknown Named
Agents of the Federal Bureau of Narcotics, 403 U.S. 388, 397 (1971), complaining of the
medical care he received in 2020 and 2021 while he was an inmate at the Federal Correctional
Institute at Greenville, Illinois (“FCI-Greenville”). Rodriguez claims that Dr. Ahmed, the
Clinical Director at FCI-Greeneville, denied him adequate medical treatment for his scalp
condition (seborrheic dermatitis), back injury, hernia, type 2 diabetes (“T2D”), and elevated liver
enzymes in violation of his Eighth Amendment rights. He seeks monetary and injunctive relief.
The Court will grant summary judgment for Dr. Ahmed because the evidence shows that,
even though he made a highly unprofessional comment to Rodriguez, he provided adequate
medical care within the range of accepted professional judgment, adjusted or changed
medications if they were insufficiently effective, referred Rodriguez to an outside specialist
when he was stumped, and followed up on a red flag that could have signified a larger problem.

I.

Summary Judgment Standard
Summary judgment is appropriate only if the moving party can show “there is no genuine

issue as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R.
Civ. P. 56(a); Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). The moving party has the
burden of establishing that no material facts are genuinely disputed. Lawrence v. Kenosha Cty.,
391 F.3d 837, 841 (7th Cir. 2004). Any doubt about the existence of a genuine issue must be
resolved in favor of the nonmoving party. Id.
When presented with a motion for summary judgment, the Court does not decide the
truth of the matters presented, and it cannot “choose between competing inferences or balance
the relative weight of conflicting evidence.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
(1986); accord Hansen v. Fincantieri Marine Grp., 763 F.3d 832, 836 (7th Cir. 2014).
Once a properly supported motion for summary judgment is filed, the adverse party
“must set forth specific facts showing that there is a genuine issue for trial.” Anderson, 477 U.S.
at 250 (internal quotations omitted). The Court must then “view all the evidence in the record in
the light most favorable to the non-moving party and resolve all factual disputes in favor of the
non-moving party.” Hansen, 763 F.3d at 836 (internal quotations omitted). If the “evidence is
such that a reasonable jury could return a verdict for the nonmoving party[,]” then a genuine
dispute of material fact exists. Zaya v. Sood, 836 F.3d 800, 804 (7th Cir. 2016) (internal
quotations omitted).
II.

Relevant Facts
Viewing the evidence and drawing all reasonable inferences in favor of Rodriguez, the

evidence in the file establishes the following relevant facts for the purposes of this motion.
Rodriguez was convicted of a federal crime in May 2019 and was sentenced to serve 144

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months in prison. The Bureau of Prisons (“BOP”) assigned him to start serving his sentence at
FCI-Greenville. He arrived there on October 21, 2019, and remained there until he was
transferred to another institution on July 15, 2021. This lawsuit concerns the medical treatment
Rodriguez received at FCI-Greenville during that time, when Dr. Ahmed was the Clinical
Director of the healthcare unit for the prison.
A.

Rodriguez’s Health

On the day he arrived at FCI-Greenville, Rodriguez met with physician’s assistant (“PA”)
Schneider for an intake appointment. With respect to his medical conditions, Rodriguez told PA
Schneider the following:
•

Diabetes: Before his incarceration he had controlled his T2D with two different oral
medications (Metformin and Invokana/canagliflozin), and he had started insulin
injections (Lantus) while he was on pretrial detention in county jails. On his intake
form, he indicated he did not need to take insulin injections and only wanted pills to
control his T2D as he had done before his arrest;

•

Back injury: He took muscle relaxers (Flexeril) for back pain and spasms from a 2008
truck accident, and he already had a two-week prescription when he arrived at the prison;
and

•

Scalp condition: He had been suffering from scalp problems (seborrheic dermatitis)
since before his arrest. In the past, a dermatologist had given him a steroid injection to
treat it.

PA Schneider developed a treatment plan that substituted Tylenol for Flexeril and that included
blood pressure medication for hypertension, Metformin and insulin for T2D, and an anti-fungal
shampoo for the scalp condition. Dr. Ahmed approved Rodriguez’s participation in the Chronic
Care Clinic and PA Schneider’s treatment plan.
Two days later, on October 23, 2019, Rodriguez saw PA Mills, who found that Rodriguez
did not have a hernia as he had been earlier advised by a jail medical provider, was obese, and
had a full range of motion in his spine. PA Mills also prescribed an anti-fungal solution for

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Rodriguez’s scalp, and ordered lab tests and an appointment with an eye doctor. Dr. Ahmed
reviewed and approved PA Mills’s decisions. One of the tests ordered revealed elevated liver
enzymes.
The lab tests also revealed that Rodriguez’s blood glucose level and his A1c level (a
measure of glucose control over the prior two- to three-month period) were high. To help
manage his diabetes, at Dr. Ahmed’s direction, twice a day medical staff tested Rodrigues’s
blood glucose level and administered insulin injections. On one occasion, Rodriguez received an
additional insulin injection at Dr. Ahmed’s direction to treat a high blood glucose incident. In
December 2019, Rodriguez was issued a blood glucose testing monitor that he could keep with
him and use any time. A nurse also reviewed his diet with him and advised him that additional
lifestyle counseling (e.g., regarding diet and physical activity) was available to him.
FCI-Greenville medical staff continued to monitor and treat Rodriguez’s various health
problems, including various treatments for his scalp condition.
B.

Dr. Ahmed’s Direct Care

Chronic Care Clinic on February 18, 2020
Rodriguez had his first visit to the Chronic Care Clinic with Dr. Ahmed on February 18,
2020. Rodriguez had gained weight since he arrived at FCI-Greenville and was still obese. He
asked Dr. Ahmed to prescribe Invokana, which he had taken before his arrest, but Dr. Ahmed
refused. Generally, in his selection of medications to treat diabetes, Dr. Ahmed considered an
inmate’s A1c level and his dietary and medication compliance. In Dr. Ahmed’s opinion and in
his experience, no medication would work if a patient does not control his diet. He found, based
on Rodriguez’s commissary purchases (many high-fat, high-salt, low-nutrient items) and weight
gain, that Rodriguez was not compliant with dietary recommendations for people with T2D. In

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his judgment, insulin was a better choice for non-compliant patients because it could be more
easily adjusted based on daily carbohydrate intake. In fact, Rodriguez did not consume all of the
food he purchased at the commissary but gave it to or traded it with other inmates, which he
pointed out to Dr. Ahmed at the time.
Additionally, Invokana was not on the BOP’s drug formulary, so Dr. Ahmed was not
allowed to prescribe it until an inmate had been unsuccessful on other formulary medication
while complying with dietary recommendations, which Rodriguez had not been. Indeed, Dr.
Ahmed had prescribed Invokana and other non-formulary drugs to other inmates who exercised
reasonable control to limit their carbohydrate intake. In any case, Dr. Ahmed would not have
selected Invokana for Rodriguez anyway because of its potential side-effects. In the end, Dr.
Ahmed added an additional T2D medication to Rodriguez’s treatment plan (glipizide) and
continued the orders for insulin and Metformin.
As for Rodriguez’s seborrheic dermatitis, Dr. Ahmed prescribed special shampoo and a
new steroidal lotion when Rodriguez complained that the treatments he was using (anti-fungals)
were not working. Dr. Ahmed declined to give a steroid injection because it was not the primary
treatment for the condition and because it posed a risk of infection, especially to someone with
uncontrolled T2D like Rodriguez.
Dr. Ahmed also refused to prescribe Flexeril for Rodriguez’s back pain and continued the
order for Tylenol. Again, Flexeril was a non-formulary drug, and in his opinion Rodriguez did
not need it. Also, inmates were known to sell it within the prison, and inmates could become
addicted to it and abuse it. The BOP only permitted the use of such muscle relaxers—or sedative
hypnotics, as Dr. Ahmed refers to them—on a short term basis after an inmate has had extensive
orthopedic surgery or for other specific chronic conditions that Rodriguez did not have.

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At the Chronic Care Clinic visit, Rodriguez also told Dr. Ahmed he had been diagnosed
with a hernia in the past which bothered him at night, and he asked for surgery. Dr. Ahmed
examined the area of Rodriguez’s complaint and determined it was not a hernia but a diastasis
rectus.1 Dr. Ahmed told Rodriguez it did not require surgery and could be alleviated by simple
exercise, but he did not explicitly tell Rodriguez it was not a hernia. He told Rodriguez he would
not operate because he was not going to spend any more of the taxpayers’ money on him. Dr.
Ahmed thought it appropriate for observation and monitoring, for which Rodriguez could visit
the prison’s healthcare unit.
In the same visit, Dr. Ahmed informed Rodriguez that some of his blood test results
indicated elevated liver enzymes, which were consistent with fatty liver.2 Dr. Ahmed ordered an
ultrasound to investigate further and confirmed Rodriguez had fatty liver that had not yet
progressed to cirrhosis. He advised Rodriguez to modify his lifestyle to lose weight, the only
treatment known for avoiding the progression to cirrhosis.
Dr. Ahmed also told Rodriguez that he would not give him the treatments Rodriguez
wanted but only what the doctor himself wanted. He advised Rodriguez that one way to get rid
of his problems was to hang himself in his cell.
Following Rodriguez’s first visit to Dr. Ahmed at the Chronic Care Clinic, FCIGreenville medical staff continued to treat Rodriguez’s conditions. Several times, PA Mills

“‘Diastasis recti’ means your belly sticks out because the space between your left and right
belly muscles has widened. You might call it a ‘pooch.’” WebMD, Abdominal Separation
(Diastasis Recti), https://www.webmd.com/baby/guide/abdominal-separation-diastasis-recti
(visited May 5, 2023). A medical provider at another BOP facility later confirmed this
diagnosis.
1

“Fatty liver disease (steatosis) is a common condition caused by having too much fat build up in
your liver.” Cleveland Clinic, Fatty Liver Disease, https://my.clevelandclinic.org/health/
diseases/15831-fatty-liver-disease (visited May 5, 2023).
2

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increased his insulin dosage because his blood glucose was elevated. An ultrasound of
Rodriguez liver was also performed on April 17, 2020.
Doctor’s Appointment on June 10, 2020
Rodriguez saw Dr. Ahmed next on June 10, 2020. At that visit, Dr. Ahmed reviewed the
April 17, 2020, liver ultrasound with him. The ultrasound showed non-inflamed gallstones and
no mass lesions on his liver. Rodriguez had gained weight since his Chronic Care Clinic visit, so
Dr. Ahmed counseled him again on the connection between poor diet and many of Rodriguez’s
health problems.
Again, after this visit, FCI-Greenville medical staff continued to treat Rodriguez’s
previously identified conditions, including adjusting his insulin dosage as well as diagnosing and
treating other emerging problems.
Chronic Care Clinic on March 22, 2021
Rodriguez saw Dr. Ahmed next on March 22, 2021, and they discussed diabetes and
blood sugar control. Dr. Ahmed increased Rodriguez’s oral diabetes medication (glipizide) and
again counseled him on his increased weight, on his commissary choices, and to stop eating
high-sugar junk food. With respect to Rodriguez’s scalp, Dr. Ahmed changed the prescription
shampoo to a coal tar shampoo and ordered a different topical steroidal cream which he thought
would reduce the itch and avoid potentially damaging scratching. Dr. Ahmed ordered a hand xray and a back x-ray when Rodriguez complained of pain. The hand x-ray showed minimal
osteoarthritic changes but was otherwise unremarkable. The back x-ray was unremarkable as
well.
Doctor’s Appointment on May 4, 2021
When Rodriguez saw Dr. Ahmed next on May 4, 2021, he asked Dr. Ahmed to change

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his scalp medication, which Dr. Ahmed did.
Doctor’s Appointment on May 25, 2021
On May 25, 2021, Rodriguez saw Dr. Ahmed for his scalp and blood sugar levels. Dr.
Ahmed increased his insulin dosage and told him he would refer him to a dermatologist for his
scalp problem. An appointment was not available until October 2021 in part due to difficulty
getting appointments during the COVID-19 pandemic. Dr. Ahmed discontinued the scalp
medication Rodriquez was using at his request. Before Rodriguez was able to see the
dermatologist, he was transferred to another BOP facility in July 2021 where Dr. Ahmed was not
his doctor.
During his entire stay at FCI-Greenville, Rodriguez was able to accomplish activities of
daily living, including working at a UNICOR job. He never had a diabetes-related seizure and
was never hospitalized.
III.

Discussion
A.

Legal Standard

Rodriguez’s claim is governed by the Eighth Amendment deliberate indifference
standard. The Eighth Amendment prohibits the infliction of cruel and unusual punishment. The
test for an Eighth Amendment violation due to conditions of confinement, including medical
care, has two components, an objective and a subjective one. Farmer v. Brennan, 511 U.S. 825,
834 (1994); see Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016).
First, the condition of confinement about which the inmate complains must be objectively
serious. Farmer , 511 U.S. at 834 (quoting Rhodes v. Chapman, 452 U.S. 337,347 (1981)). An
objectively serious medical need is “one that has been diagnosed by a physician as mandating
treatment or one that is so obvious that even a lay person would easily recognize the necessity

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for a doctor’s attention.” Johnson v. Snyder, 444 F.3d 579, 584-85 (7th Cir. 2006) (quotations
omitted). A serious medical condition need not be life-threatening to be serious. Diaz v.
Godinez, 693 F. App’x 440, 443 (7th Cir. 2017) (citing Gomez v. Randle, 680 F.3d 859, 865 (7th
Cir. 2012)).
Second, the official must have a sufficiently culpable state of mind, that is, he must at a
minimum be deliberately indifferent. Farmer, 511 U.S. at 834. Deliberate indifference requires
more than mere negligence. Petties, 836 F.3d at 728 (citing Estelle v. Gamble, 429 U.S. 97, 106
(1976)). An official is deliberately indifferent if he “knows of and disregards an excessive risk
to inmate health or safety.” Farmer, 511 U.S. at 837; accord Johnson, 444 F.3d at 585 (“The
standard requires that an officer have ‘subjective awareness’ of the serious medical need and
then act with indifference to that need.”). A plaintiff need not show that his serious medical
needs were literally ignored; it may be enough to show that the defendant’s response was “so
plainly inappropriate as to permit the inference that the defendants intentionally or recklessly
disregarded his needs.” Haywood v. Hathaway, 842 F.3d 1026, 1031 (7th Cir. 2016) (internal
quotations omitted). Indeed, deliberate indifference may be found where a treatment decision
was blatantly inappropriate or such a significant departure form accepted professional judgment
that it calls into doubt whether the decision was even an exercise of medical judgment. Petties,
836 F.3d at 729-30; Norfleet v. Webster, 439 F.3d 392, 396 (7th Cir. 2006). “[E]vidence that
some medical professionals would have chosen a different course of treatment is insufficient to
make out a constitutional claim.” Petties, 836 F.3d at 729 (emphasis in original).
B.

Analysis

The Court addresses each of Rodriguez’s medical needs for which he claims Dr. Ahmed
provided constitutionally deficient treatment, then it considers his medical needs as a whole.

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1.

T2D

No party disputes that Rodriguez’s T2D was a serious medical need, so the Court’s focus
is on whether Dr. Ahmed was deliberately indifferent to that need. Considering all the evidence,
the Court concludes he was not.
Since Rodriguez’s arrival at FCI-Greenville, the medical staff prescribed him insulin and
Metformin, medications he had previously been prescribed for this T2D. Rodriguez requested
Invokana from Dr. Ahmed on February 18, 2020, which he had also been given in the past. Dr.
Ahmed declined to prescribe it because, in his medical judgment and experience, Invokana was
not appropriate for inmates with T2D who did not follow recommendations to reasonably control
their carbohydrate intake—what he called non-compliant patients. It appeared to him that
Rodriguez was a non-compliant patient because his A1c was high, he had gained approximately
fifteen pounds since his intake, and his commissary purchase record indicated he bought a good
deal of high-fat and high-salt food. Additionally, although not the deciding factor, rules required
that Rodriguez try and fail with a formulary medication before a non-formulary medication like
Invokana could be prescribed.
Even if Invokana had been on the drug formulary available to Dr. Ahmed to prescribe, in
his medical judgment, insulin was the most effective treatment. It could be more easily adjusted
based on an inmate’s daily carbohydrate intake, and did not come with the potential negative side
effects of Invokana. Consequently, Dr. Ahmed prescribed insulin, Metformin, and glipizide.
Dr. Ahmed’s difference of opinion from Rodriguez’s prior doctors that Invokana was an
appropriate treatment amounts, at the most, to a difference of medical opinion, which cannot
support a deliberate indifference medical claim unless the chosen path was blatantly
inappropriate. Here, it was not. What is effective outside prison—or even in a jail—is not

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necessarily appropriate for a prison inmate, and a prison doctor would be remiss not to
understand and account for the effect of a changed environment on the appropriate course of
treatment. Dr. Ahmed appropriately used his professional medical judgment here to select a
course of treatment he thought would be effective for Rodriguez in prison. Dr. Ahmed followed
up periodically, adjusted Rodriguez’s medication dosages when needed, and encouraged him to
eat well, exercise, and lose weight, critical components of managing T2D. No reasonable jury
could find he was deliberately indifferent to Rodriguez’s need for treatment of his T2D.
2.

Scalp Condition (seborrheic dermatitis)

Dr. Ahmed contends Rodriguez’s scalp condition is not an objectively serious medical
condition required to be addressed under the Eighth Amendment because it is not lifethreatening. However, as noted above, an ailment does not have to be life-threatening to be
serious as long as it is serious enough that a physician mandates treatment. Rodriguez’s rash
likely meets this standard because his pre-arrest doctors as well as Dr. Ahmed himself thought it
needed to be treated.
Nevertheless, no evidence shows Dr. Ahmed was deliberately indifferent. He approved
plans to treat Rodriguez’s scalp condition with topical anti-fungal and steroid medications and/or
medicated shampoos, and when one treatment did not seem to do much good, he tried another.
When none of them cured the problem, he referred Rodriguez to an outside dermatologist.
Again, he declined Rodriguez’s request for his prior treatment—a steroid injection—because, in
his medical judgment, it was not the primary treatment for Rodriguez’s condition and because he
thought the dangers from an injection outweighed any benefit it might bring. Indeed, in
retrospect, it appears the condition was stubborn, and even Rodriguez’s pre-arrest doctors were
not able to cure it even with a steroid injection.

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No reasonable jury could find that Dr. Ahmed consciously disregarded a risk posed by
Rodriguez’s scalp condition. On the contrary, Dr. Ahmed exercised his medical judgment to try
new, appropriate treatments when earlier ones did not work but not to try treatments he thought
too risky in light of Rodriguez’s health problems. No evidence suggests this was a blatantly
inappropriate way of addressing Rodriguez’s scalp condition. Dr. Ahmed’s failure to land on a
“cure” does not render him deliberately indifferent.
3.

Alleged Hernia

As with Rodriguez’s scalp condition, Dr. Ahmed asserts that what Rodriguez believed
was a hernia was not an objectively serious medical need. Indeed, Dr. Ahmed and PA Mills
examined Rodriguez and determined that his condition was not a hernia but was diastasis rectus
which, in his medical judgment, did not require surgery or a visit to an outside specialist. No
evidence suggests this assessment shoots wide of the range of acceptable medical judgments. In
the absence of a physician’s judgment that the condition mandated treatment, it does not amount
to an objectively serious medical need.
To the extent Dr. Ahmed and PA Mills may have misdiagnosed Rodriguez’s condition
and he really did have a hernia, that mistake would constitute negligence, at the most. And
negligence cannot support liability for deliberate indifference under the Eighth Amendment.
4.

Back Pain

Dr. Ahmed again argues that Rodriguez’s back pain is not an objectively serious medical
need. Even if it were, no evidence suggests Dr. Ahmed was deliberately indifferent to this need.
He approved using Tylenol as a substitute for Flexeril, the medication Rodriguez had been taking
for pain that began in a truck accident about ten years earlier. In his medical judgment, Dr.
Ahmed believed Tylenol was adequate to relieve Rodriguez’s pain. Furthermore, he believed

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Flexeril was only for short-term use, posed a risk of addiction and abuse, and threatened the
security of the institution because inmates were known to sell the pills unlawfully. No
reasonable jury could find that Dr. Ahmed disregarded Rodriguez’s need for pain medication by
prescribing a safer drug he believed would be effective rather that providing the more dangerous
drug of Rodriguez’s choice. His response was not blatantly inappropriate considering
Rodriguez’s needs and the circumstances.
5.

Liver

Dr. Ahmed’s response to elevated liver enzymes in Rodriguez’s blood test was not
deliberate indifference. When he noted the elevated level, he ordered an ultrasound, and that
ultrasound identified a condition called fatty liver that had not yet progressed to cirrhosis. Dr.
Ahmed advised Rodriguez of the only known way to prevent that progression—modifying his
lifestyle to lose weight. The ultrasound revealed no mass lesions on the liver that might be
cancer. Rodriguez suggests Dr. Ahmed was deliberately indifferent because he did not send him
to a liver specialist. No reasonable jury could come to that conclusion based on the evidence in
the file. Dr. Ahmed considered an ultrasound showing no cancer and advised Rodriguez of how
to treat fatty liver, the condition he actually had. This is a far cry from disregarding Rodriguez’s
medical needs.
6.

Dr. Ahmed’s Comments

One final word is warranted here about Dr. Ahmed’s February 18, 2020, speculation that
Rodriguez could commit suicide to solve his problems. Rodriguez is correct that Dr. Ahmed’s
suggestion was reprehensible and thoroughly unprofessional. Nevertheless, the uncontroverted
evidence reflects that despite such an abhorrent statement by Dr. Ahmed, in fact he continued to
exercise his professional medical judgment to treat Rodriguez with the diligence required by the

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Eighth Amendment.
February 18, 2020, was not Dr. Ahmed’s finest hour. The notes from Rodriguez’s visit
on that day reflect a very contentious meeting where Rodriguez demanded certain treatments,
and Dr. Ahmed repeatedly explained that he would not prescribe those treatments simply
because Rodriguez had used them in the past. For example, with respect to Invokana, Dr.
Ahmed’s notes read:

Def.’s Resp. Ex. 1 (Doc. 61 at 58). With respect to surgery for the hernia Rodriguez believed he
had:

Id. With respect to medication for Rodriguez’s back pain:

Id. (Doc. 61 at 59).
Even if these notes do not reflect exactly what happened in the visit, it is abundantly clear

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that Dr. Ahmed was frustrated at Rodriguez, and that came out in his inappropriate comments.
However, in light of the care he gave Rodriguez at that visit and throughout his incarceration at
FCI-Greenville, no reasonable jury could find those comments were manifested in actual
deliberate indifference to any of Rodriguez’s serious medical needs. Indeed, as Dr. Ahmed
announced he would in his notes from February 18, 2020, he gave Rodriguez “the treatment for
what he need[ed]. . . . .” In fact, when viewing Dr. Ahmed’s treatment of Rodriguez as a whole,
no reasonable jury could find he was deliberately indifferent to any individual medical need or to
his collective need for health care.
IV.

Conclusion
For the foregoing reasons, the Court:
•

GRANTS Dr. Ahmed’s motion for summary judgment (Doc. 60); and

•

DIRECTS the Clerk of Court to enter judgment accordingly.

IT IS SO ORDERED.
DATED: May 18, 2023

s/ J. Phil Gilbert
J. PHIL GILBERT
DISTRICT JUDGE

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