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Davis v. Kayira

United States Court of Appeals, Seventh Circuit

September 16, 2019

Dennis Davis, Plaintiff-Appellant,
Francis Kayira, Defendant-Appellee.

          Argued March 25, 2019

          Appeal from the United States District Court for the Central District of Illinois. No. 15-cv-3075-SLD - Sara Darrow, Chief Judge.

          Before WOOD, Chief Judge, and Flaum and Sykes, Circuit Judges.


         Dennis Davis is an Illinois prisoner suffering from kidney disease. After receiving dialysis on a Saturday morning, he told a prison nurse that his mind was fuzzy and his body was weak. Both complaints were similar to side effects he had experienced in the past after dialysis. The nurse called Dr. Francis Kayira, the prison's medical director, who was on call. The doctor asked her whether Davis had asymmetrical grip strength, facial droop, or was drooling-all classic signs of a stroke. When she said "no," Dr. Kayira determined that Davis was experiencing the same dialysis-related side effects as before rather than something more serious. He told the nurse to monitor the problem and call him if the symptoms got worse. Dr. Kayira didn't hear anything else for the rest of the weekend, but on Monday morning he examined Davis and discovered that he had in fact suffered a stroke.

         Davis later sued Dr. Kayira, alleging that he acted with deliberate indifference to his medical needs in violation of the Eighth Amendment. Davis also raised a state-law medical-malpractice claim. The district court entered summary judgment for Dr. Kayira on both claims. The judge ruled that the deliberate-indifference claim failed because there is no evidence that Dr. Kayira was aware of symptoms suggesting that Davis was suffering a stroke. And the state-law claim failed because Davis lacked expert testimony about the appropriate standard of care. A magistrate judge had blocked Davis's sole expert because he wasn't disclosed in time, and Davis never objected to that ruling before the district court.

         We affirm. Davis lacks evidence of deliberate indifference. And because he did not ask the district court to review the magistrate judge's exclusion of his expert, his state-law claim fails as well.

         I. Background

         Davis is currently serving a prison sentence at the Graham Correctional Center in central Illinois. He has a history of diabetes, high blood pressure, and renal disease. Davis's renal disease requires dialysis, a treatment he began in 1996 and continues to receive three times a week.

         Davis received dialysis early on the morning of Saturday, June 21, 2014. He told a nurse almost immediately afterward that he was feeling weak. She observed a number of symptoms, including slurred speech, an inability to follow commands, weak hand grasps, and pupils that were pinpoint and nonreactive. At 5:45 a.m. she called Dr. Kayira, the medical director at Graham Correctional Center. Dr. Kayira was on call for the weekend, but he wasn't otherwise scheduled to return to the prison until Monday morning. The nurse told him about the complaints and mentioned that Davis had previously experienced similar symptoms after dialysis. That isn't surprising given that patients are often fatigued after dialysis because of fluid withdrawal. Dr. Kayira asked the nurse whether Davis had asymmetrical hand-grip strength, whether he was drooling, and whether his face was drooping. She said "no" to all three, which led Dr. Kayira to conclude that Davis wasn't having a stroke but was instead suffering the same dialysis-related side effects as before. Dr. Kayira directed the nurse to put Davis in the infirmary to be monitored more closely, and he told her to have the daytime nurse call back if symptoms worsened.

         Over the weekend Davis's condition deteriorated. But while the medical staff reported its observations in a series of handwritten notes, there is no evidence that anyone notified Dr. Kayira. A medical technician wrote at 6 a.m. on Saturday that Davis was confused and his grip was weaker on one side than the other. The same note mentioned that Dr. Kayira had asked for the daytime nurse to evaluate the patient and call him back, but it did not say whether Dr. Kayira was told about the asymmetry. According to another note-written at an unknown time-Davis said that his left arm and leg weren't working and he thought he was having a stroke. A note written at 8 a.m. on Sunday said that Davis couldn't move one of his legs as much as normal. A note written at 3:30 p.m. the same day observed that Davis was weak in his left hand and leg but that he could raise his arms and sit up in bed. Notes the following morning continued to record weakness on Davis's left side. Again, none of the notes indicated that Dr. Kayira was notified of these changes in Davis's condition.

         When Dr. Kayira examined Davis in person on Monday, he immediately recognized that Davis's strength was asymmetrical and he had likely suffered a stroke. Dr. Kayira transferred Davis to a hospital where the stroke was confirmed.

         The following year Davis sued Dr. Kayira under 42 U.S.C. § 1983 alleging that he acted with deliberate indifference to his medical condition in violation of his Eighth Amendment right to be free from cruel and unusual punishment. He later amended his complaint to add a state-law medical-malpractice claim. Dr. Kayira was the only named defendant. More than a year into the litigation, Davis sought leave to amend his complaint again to add five nurses. The judge denied the motion because it was untimely and would cause undue prejudice and delay.

         After filing suit, Davis obtained a report from a board-certified physician stating that his claim had merit, a prerequisite for the medical-malpractice claim under state law, which requires a plaintiff to obtain a certificate of merit at the pleading stage. See 735 Ill. Comp. Stat. 5/2-622 (2015). The report concluded that "Dr. Kayira knew or should have known that Dennis Davis was suffering from a ...

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