The opinion of the court was delivered by: Reagan, District Judge
On March 1, 2005, Plaintiff Anthony Gay filed a two-count complaint (Doc. 1) against Dr. Rakesh Chandra, a psychiatrist who treated him at the Tamms Correctional Center in 2004 ("Tamms"). Gay's first claim is that the conditions of confinement to which Dr. Chandra subjected him from March 14, 2004 through July 11, 2004 violated the Eighth Amendment. Gay alleges that the temperatures in his cell were so low as to pose a substantial risk of harm. He also alleges that he was physically restrained without food or clothing for long periods of time without legitimate reason and was restrained for 32 hours on a metal slab bed without a mattress. Gay also alleges that Dr. Chandra was deliberately indifferent to his physical well-being when he knowingly ordered Gay into therapeutic restraints while Gay held a metal object in his mouth. Gay's second claim is that from January 29, 2004 through May 4, 2004 Dr. Chandra was deliberately indifferent to his serious mental health needs by refusing to give medication that would alleviate Gay's compulsion to self-mutilate.
On March 25, 2009, Dr. Chandra filed a motion for summary judgment (Doc. 95), arguing that based on the evidence, a reasonable juror could not find in favor for Gay on either claim. Having fully reviewed the parties' filings, the Court GRANTS IN PART AND DENIES IN PART Dr. Chandra's motion for summary judgment.
Gay is a 35-year-old inmate who is currently incarcerated at Tamms. During his incarceration, Gay has resided in a number of Illinois prisons where he has been treated for a variety of conditions requiring psychiatric treatment. See Doc. 100-11. For example, in December of 2000, a psychiatrist at the Pontiac Correctional Center noted that Gay mutilated himself, had a Mood and Personality Disorder, and asked to be given medication. Id. at p. 2.Five months later, the psychiatrist at Menard Correctional Center noted that Gay slashed his right thigh with a razor and exhibited hostile behavior by cursing and making threatening gestures. Id. at p. 6.Gay subsequently required an emergency transfer to the Dixon Psychiatric Center ("Dixon") due in part to his decision to take off his bandages applied to a self inflicted wound and scribble blood on his cell's wall. Id. Consequently, the psychiatrist at Dixon determined that he needed to continue his psychotropic medication. Id. The treatment by these psychiatrists also included medication to help Gay's condition. Id.
On January 28, 2004, Gay was transferred to Tamms. His transfer summary stated that he had previously inserted foreign objects into his penis, had a personality and "impulse control" disorder, mutilated himself and assaulted staff; however, he was not taking any "psychtropic" medications when he arrived. Doc. 95-2, pp. 1-2. Due to the information contained in his transfer summary, a nurse placed Gay on psychiatric observation the day after he arrived and recommended for Gay to be placed on a mental health treatment plan. Id. at p. 2. As a part of the mental health treatment plan, Gay was to be treated by Tamms' entire mental health staff. Id. at p. 3.
On February 6, 2004, Dr. Chandra conducted his initial psychiatric evaluation of Gay. Doc. 95-2, p. 4. He determined that Gay had "Axis II diagnosis of antisocial personality order" and "narcissistic personality disorder." Id. at pp. 4-5. Although Gay asked Dr. Chandra for medication (particularly, elavil and sinequan), Dr. Chandra determined psychotropic medication was unnecessary because Gay was just angry that he was transferred to Tamms. Id. at p. 4. On February 9, 2004, Gay cut his right thigh and then asked a nurse to come see what he had done. Id. at p. 5. The nursing staff at Tamms treated Gay's wounds; however, due to Gay's self-destructive behavior, Dr. Chandra ordered prison staff to place Gay on suicide watch in a strip cell where he would receive finger foods, a mental health assessment and a safety blanket. Id. Additionally, security was ordered to observe him every 10 minutes. Id.
Throughout February of 2004, Gay continued to cut himself. On February 13, 2004, Gay cut his thighs and legs. Doc. 95-2, p. 9. On February 20, 2004, Gay cut his leg again and reopened a wound that was on his right groin. Id. at p. 6. And on February 23, 2004, Gay cut his penis, right thigh, and, once again, reopened the wound over his right groin. Id. at p. 10. Tamms' medical staff treated Gay's wounds every time he cut on himself. See Doc. 95-2. As a result of Gay cutting on himself, sutures had to be placed in Gay's penis, and the nursing staff had to clean his wounds. Id. at pp. 10-11.
After these incidents, Dr. Chandra determined that Gay cut on various parts of his body not because he was depressed or had psychosis, but because he was a manipulator. Doc. 95-2, pp. 6, 10. He believed that Gay harmed himself in order to receive attention from the prison's medical staff. Id. at pp. 6, 8. Dr. Chandra determined that Gay specifically wanted the attention of Dr. Kelly Rhodes, who was the on-site psychologist at Tamms. Doc. 95-2, p. 6. In spite of his conclusion, Dr. Chandra kept Gay on suicide watch for almost three weeks in February of 2004 so that Gay could be monitored closely. Id. at pp. 6-11. Gay was discharged from suicide watch on February 27, 2004. Id. at p. 11.
On March 5, 2004, Gay asked Dr. Chandra if he could go back on medication. Id. at p. 11. Gay said he felt isolated because he was alone, and he was upset because Dr. Rhodes had not come to see him. Id. at p. 10. He told Dr. Chandra that he intended to cut himself, but he denied being depressed or suicidal. Id. Dr. Chandra diagnosed Gay as having antisocial personality disorder and narcissistic personality disorder, but he did not believe Gay's condition warranted psychotropic medication. Id. at p. 11.
Shortly after Dr. Chandra examined him, Gay began pulling on his scabs and cutting his penis. Doc. 95-2, p. 12. As a result, Dr. Chandra ordered Gay to be placed on suicide watch in a strip cell again. Id. Dr. Chandra still found that Gay did not need any "psychotropic medication" for his condition. Id. at p. 13.
Despite the close monitoring Gay received while he was on suicide watch, on March 14, 2004, Dr. Chandra decided to place Gay in therapeutic restraints throughout the night. Doc. 95-2, p. 13. He made this decision because Gay began to yell, verbally abused the nurses, reopened his old cuts on various parts of his body and stated that he intended to harm himself even more. Id. at p. 13-14. Dr. Chandra believed that restraining Gay would prevent him from harming himself any further. Id. at p. 14. He did not permit Gay to eat while he was on therapeutic restraints because Dr. Chandra believed Gay could harm himself if there was something in his mouth. Id. at p. 13.
While Gay was restrained, he was naked with only a "chuck" (i.e. a pad) to cover his groin area. Doc. 100-4, p. 4. Gay describes the bed to which he was restrained as "a metal bed frame with a solid metal bottom" and describes the experience as like "being tied down to the hood of a car." (Doc. 100-2, p. 2). The cell in which Gay was restrained naked was, allegedly, excessively cold. Gay told a nurse while confined that he had "chills." (Doc. 100-5, p. 3). A different nurse was often cold while working in the prison despite being fully clothed (Doc. 100-4, p. 4). Other inmates also had the experience of being restrained with "icy cold air" blowing on them. (Doc. 100-6, p. 2; Doc. 100-7, p. 2).
Despite his decision to place Gay in restraints, Dr. Chandra still did not believe that Gay needed any psychotropic medication. Doc. 95-2, p. 15. He believed that Gay was being manipulative and engaged in "self-harm for secondary gain rather than as a result of any mental illness." Id. He also opined that Gay receives sexual gratification when female medical staff members treat his wounds. Id. at p. 16-17. He also noted that once Gay was released from restraints, he immediately asked to see Dr. Rhodes. Doc. 95-2, p. 10.
Unfortunately, Gay's destructive behavior continued to escalate in April 2004 after he was released from restraints. On April 1, 2004, at approximately 9:30 p.m., Gay cut himself on his right thigh and forearm because he was angry about not receiving his mail. Id. at p. 16. See also Doc. 95-11, Exh. 70. When one of the nurses came to see him, he said: "I'll cut everytime you're here. Next time I'll cut my dick so you have to clean it." Id. As a result of Gay's behavior, the nurse contacted Dr. Chandra who was not at the prison at the time, and he ordered that Gay be placed in therapeutic restraints again. Doc. 95-2, p. 16. Dr. Chandra's order directed the staff not to give Gay any food, water, or medication during this time. Doc. 95-2, pp. 17-18.
Before the prison staff was able to place any therapeutic restraints on Gay, however, a prison official told Nurse Kay Jordan that Gay had some type of object, either a staple or a paperclip, lodged between his front lower teeth. Doc. 95-2, p. 18; see also Doc. 95-11, Exh. 71; Doc 100-9, p. 5. Jordan tried to see the object but Gay threatened to bite her and would not let her even see the object. Doc. 95-2, pp. 17-18. Consequently, Nurse Jordan contacted Dr. Chandra who ordered the prison staff to proceed with their plan to place Gay in therapeutic restraints. Id.
Approximately two hours later, after threatening to throw his feces on a nurse, Gay swallowed what he announced was a paperclip. Id. He began coughing and spitting up mucus and blood, and he told the prison staff members that the paperclip was stuck in his throat. Doc. 95-11, Exhs. 72, 73, 74.
After releasing Gay from restraints, the prison's security staff tried to open Gay's mouth and perform the Heimlich Maneuver, but both attempts proved unsuccessful. Doc. 95-2, p. 18. As a result, they called an ambulance and Gay was taken to a local hospital at around midnight on April 2, 2004. Doc. 95-11, Exh. 75. When Gay returned from the hospital, he was placed back into therapeutic restraints for what was left of the sixteen hours Dr. Chandra had previously ordered and was released from restraints only for the purpose of relieving himself. Doc. 95-11, Exh. 77.
Dr. Chandra re-evaluated Gay the same morning that Gay returned from the hospital to determine whether therapeutic restraints were still necessary. Doc. 95-2, p. 19. His assessment was that Gay was not depressed, psychotic, or upset, but that Gay was manipulative and showed poor judgment. Id. Gay remained in therapeutic restraints until April 2, 2004, at 10:45 p.m., and then he was placed on suicide watch and remained closely supervised for the next three days. Doc. 95-11, Exh. 80; Doc. 95-2, p. 19.
Throughout the following months, the cycle of placing Gay on and off suicide watch and/or therapeutic restraints continued due to Gay's erratic behavior. See Doc. 95-2. Dr. Chandra claims that Gay was calm when he examined him after he returned from the hospital; however, Gay cut his wrist, thigh, and left hipbone while he was on a writ to another prison. Id. at p. 20. One day, Gay would not say or do anything that would lead one to believe he would harm himself, but within twenty-four hours, Gay cut his penis again, smeared blood in his cell, and shoved blood stained pieces of paper out of his cell's door. Id. at pp. 21-22. On April 17, 2004, Gay told a nurse he was going to cut himself and asked to be tied down. Id. at p. 25. Dr. Chandra ordered that Gay be placed in therapeutic restraints for 16 hours; however, twenty minutes after Gay was released, Dr. Chandra apparently ordered that he be restrained again for another 16 hours. Id. at p. 25.
In May and June Gay reopened wounds to his arm, wrists, and legs, continued to cut his arm, leg, and penis, and placed toilet paper and toothpaste on his penis. Doc. 95-2, pp. 28-29, 30, 33. As a result, Dr. Chandra ordered that Gay be placed on therapeutic restraints approximately ten times between April and July of 2004. According to Dr. Chandra, throughout this time, Gay called nurses vulgar names, tried to gratify himself, and encouraged another inmate to follow his example and cut himself. Id. at p. 26.
C. Summary Judgment Standard
Summary judgment is proper only when "there is no genuine issue as to any material fact and the moving party is entitled to a judgment as a matter of law." FED.R.CIV.P.56(c); Haefling v. United Parcel Service, Inc., 169 F.3d 494, 497 (7th Cir. 1999); Dempsey v. Atchison, Topeka and Santa Fe RailwayCo., 16 F.3d 832, 836 (7th Cir. 1994). "The judgment sought should be rendered if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law." FED.R.CIV.P. 56 (c). The initial burden is upon the moving party to establish that no material facts are in dispute as to an essential element of the non-moving party's case. Delta Consulting Group, Inc. v. R. Randle Const., Inc., 554 F.3d 1133, 1137 (7th Cir. 2009). Once the moving party meets the burden, the non-moving party must come forward with evidence that establishes a genuine issue for trial. Fed. R. Civ. P. 56(e).
A fact is material if it is outcome determinative under applicable law. Hardin v. S.C. Johnson & Son, Inc., 167 F.3d 340, 344 (7th Cir. 1999); Smith v. Severn, 129 F.3d 419, 427 (7th Cir. 1997); Estate of Stevens v. City of GreenBay, 105 F.3d 1169, 1173 (7th Cir. 1997). Even if the facts are not in dispute, summary judgment is inappropriate when the information before the court reveals a good faith dispute as to inferences to be drawn from those facts. Plair v. E.J. Brach & Sons, Inc., 105 F.3d 343, 346 (7th Cir. 1997); Lawshe v. Simpson, 16 F.3d 1475, 1478 (7th Cir. 1994); Dempsey, 16 F.3d at 836.
In deciding such a motion, the trial court must determine whether the evidence presented by the opposing party is such that a reasonable jury might find in favor of that party after a trial.
The inquiry performed is the threshold inquiry of determining whether there is the need for a trial - whether, in other words, there are any genuine factual issues that properly can be resolved only by a finder of fact because ...