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Duckworth v. Ahmad

July 14, 2008


Appeal from the United States District Court for the Southern District of Illinois. No. 02-CV-381-David R. Herndon, Chief Judge.

The opinion of the court was delivered by: Flaum, Circuit Judge.


Before FLAUM, KANNE, and EVANS, Circuit Judges.

Gregg L. Duckworth is an inmate in the Centralia Correctional Facility in southern Illinois and, sadly, in early 2001 a doctor diagnosed him with bladder cancer. This diagnosis came after sixteen months of treatment for gross hematuria-a condition that involves the emission of blood in the urine-by two different doctors, Maher K. Ahmad and Francis Kayira. After his diagnosis, Duckworth filed this suit under 42 U.S.C. § 1983, alleging that both doctors were deliberately indifferent to his serious medical needs and thus violated his Eighth Amendment rights. The parties consented to proceed before a magistrate and, after discovery, the judge recommended granting Dr. Ahmad's motion for summary judgment and denying Dr. Kayira's. The district court adopted the magistrate's recommendation as to Dr. Ahmad but vacated the magistrate's recommendation as to Dr. Kayira, instead entering summary judgment in his favor as well. Duckworth appealed and, for the reasons set out below, we affirm.

I. Background

This case turns on the treatment afforded Duckworth from August 1999 through December 2000. During this period, Duckworth had two stints in two prisons, the Champaign County Jail and the Centralia Correctional Facility, where, as is relevant here, he saw first Dr. Ahmad and then Dr. Kayira respectively. Duckworth first visited Dr. Ahmad in August 1999 and complained of blood in his urine, a condition called gross hematuria. Dr. Ahmad diagnosed Duckworth with "painless hematuria" and conducted a urinalysis, which did not reveal an infection. The doctor then referred Duckworth to a urologist at the Christie Clinic, a nearby group medical practice. But rather than being taken to the urologist, Duckworth went (for reasons unknown) to a general practitioner, Dr. James Blatzer. Dr. Blatzer's tests-including a "mid-stream catch" of his urine-did not indicate the presence of blood. And so Duckworth was discharged with the instructions to return if he saw any blood in his urine in the future.

Over the next few months, Duckworth would go to see Dr. Ahmad four more times, and for three of these visits, Dr. Ahmad labored under the erroneous belief that Duckworth was still receiving treatment at the Christie Clinic. During his next two visits, in October and November 1999, Duckworth did not complain of blood in his urine although a urinalysis conducted during one of these trips revealed trace amounts of blood. And during one of these appointments Duckworth told Dr. Ahmad that he was being treated by a urologist, which was in line with Dr. Ahmad's assumptions.

His final visit came in February 2000. Duckworth complained of blood in his urine and told Dr. Ahmad that he was not, in fact, seeing a urologist. As a result, Dr. Ahmad ordered a number of tests including an intravenous pyelogram or IVP, which is an x-ray of the kidneys and urinary tract. Duckworth testified that prior to this test Dr. Ahmad had told him that "if this comes back clear, I don't want to hear no more out of you." These x-rays did come back clear, and Dr. Ahmad never did treat Duckworth again. Duckworth claims that he tried to receive treatment from Dr. Ahmad a few more times in February 2000 but nurses refused per Dr. Ahmad's orders. Dr. Ahmad claims that he never heard of any request for treatment, but he agrees that he did not treat Duckworth after February 2000.

In July 2000, Illinois prison officials transferred Duckworth to the Centralia Correctional Facility, a medium-security prison seventy miles east of St. Louis. There, Duckworth sought treatment from Dr. Kayira. His first visit was in June 2000 when, once again, Duckworth complained of blood in his urine. During this initial visit, Duckworth told Dr. Kayira about his ten months of hematuria, the ineffectiveness of his four months of treatment, and his fears that he had cancer based on his family's history with the disease. In response, Dr. Kayira ordered a urinalysis, prescribed a painkiller, and requested Duckworth's medical records from the Champaign County Jail. In addition, Dr. Kayira sought to quiet Duckworth's cancer fears. A month later, Duck-worth again sought treatment for hematuria. The tests did not indicate that there was blood in the urine, but it did return a high white blood cell count and bacteria. Believing that this was a recurrent urinary tract infection, Dr. Kayira ordered a "clean catch midstream" and a "culture and sensitivity" test. The results from this test indicated some type of infection, and so Dr. Kayira prescribed antibiotics in an effort to clear it up.

In September 2000, Duckworth complained to a nurse about stomach pains and continued hematuria. When he learned of this, Dr. Kayira ordered a urinalysis and a KUB test-so named as an acronym for kidneys, urinary, and bowels. The urinalysis did not indicate the presence of any blood, but Duckworth did have a slightly high red-blood-cell count, a much higher white-blood-cell count, and a moderate level of bacteria. The KUB test revealed calcific densities or calcium deposits that can indicate the presence of stones in the urinary tract. Based on all this, Dr. Kayira suspected that Duckworth had kidney stones and prescribed a course of antibiotics to treat them. Soon afterwards, Dr. Kayira also requested the results of the IVP that Dr. Ahmad had conducted months earlier. Over the coming months, Duckworth's condition was little improved. After Duckworth complained of stomach pain in October 2000, Dr. Kayira requested a second IVP, which indicated the presence of a bladder stone. In November 2000, Duckworth saw Dr. Kayira again, and a urinalysis revealed an abnormal amount of blood in the urine, high red and white blood cells, and moderate level of bacteria.

Finally, in December 2000, Duckworth complained to Dr. Kayira of pain in his back and abdomen. Dr. Kayira recommended painkillers and referred Duckworth to a urologist, Dr. Manoj H. Desai. Dr. Desai conducted a series of diagnostic tests in December and early January, including a cystoscopy. This last test revealed a cancerous tumor in Duckworth's bladder. Although it is unclear what treatment followed, Duckworth eventually filed this lawsuit against Drs. Ahmad and Kayira. After discovery and cross-motions for summary judgment, a magistrate judge recommended granting Dr. Ahmad's motion and denying Dr. Kayira's. The district court then adopted the recommendation as to Dr. Ahmad and rejected it as to Dr. Kayira, reasoning that his course of treatment did not rise to the level of objective indifference. This appeal followed.

II. Discussion

As he did below, Duckworth argues on appeal that both Drs. Ahmad and Kayira were deliberately indifferent to his gross hematuria. We review de novo the district court's decision to grant the defendants summary judgment on these claims. And, because Duckworth lost below, we reasonably construe the facts in his favor. Greeno v. Daley, 414 F.3d 645, 648-49 (7th Cir. 2005).

The states have an affirmative duty to provide medical care to their inmates. Estelle v. Gamble, 429 U.S. 97, 103 (1976). And the upshot of this duty is that the "deliberate indifference to [the] serious medical needs of prisoners constitutes the 'unnecessary and wanton infliction of pain' " and violates the Eighth Amendment's prohibition against cruel and unusual punishments. Id. at 104. To state a cause of action, a plaintiff must show (1) an objectively serious medical condition to which (2) a state official was deliberately, that is subjectively, indifferent. Sherrod v. Lingle, 223 F.3d 605, 610 (7th Cir. 2000). Deliberate indifference is not medical malpractice; the Eighth Amendment does not codify common law torts. Id. And although deliberate means more than negligent, it is something less than purposeful. Farmer v. Brennan, 511 U.S. 825, 836 (1994). The point between these two poles lies where "the official knows of and disregards an excessive risk to inmate health or safety" or where "the official [is] both aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he . . . draw[s] the inference." Id. at 837. A ...

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