Walker v. Peters

• Decision Date: 30 November 2000
• Docket Number: No. 97-4058,97-4058
• Citation: 233 F.3d 494
• Parties: (7th Cir. 2000) CLARA WALKER, Plaintiff-Appellant, v. HOWARD PETERS, SALVADOR GODINEZ, RICHARD GRAMLEY, et al., Defendants-Appellees
• Court: U.S. Court of Appeals — Seventh Circuit

Page 494

233 F.3d 494 (7th Cir. 2000)

CLARA WALKER, Plaintiff-Appellant, v. HOWARD PETERS, SALVADOR GODINEZ, RICHARD GRAMLEY, et al., Defendants-Appellees.

No. 97-4058

In the United States Court of Appeals For the Seventh Circuit

Argued December 10, 1999

Decided November 30, 2000

Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No. 93 C 5831--James B. Moran, Judge.

Before EASTERBROOK, ROVNER and DIANE P. WOOD, Circuit Judges.

ROVNER, Circuit Judge.

Dwayne Walker was a prisoner who suffered from a variety of serious illnesses. He sued a number of prison officials and doctors for violating his Eighth Amendment right to be free from cruel and unusual punishment, claiming these various individuals were deliberately indifferent to his serious medical needs. The district court granted summary judgment in favor of the defendants, finding that, at most, Walker's complaints amounted to a malpractice action and not a constitutional deprivation. We affirm.

I.

Dwayne Walker suffered from hemophilia, avascular necrosis of his right hip, arthritis, retinoschisis, a partially fused right ankle, a partially fused left elbow, a pinched nerve in his back, and AIDS. He suffered from mental problems as well, including anti-social personality disorder. He was incarcerated by the Illinois Department of Corrections ("IDOC") from June 1984 until his death in August 1999.¹ Because of his hemophilia, Walker required infusions of a substance known as "Factor VIII," a clotting protein that occurs naturally in the blood of persons who do not suffer from hemophilia. Factor VIII, marketed under the trade name "Factorate," is a concentrate derived from donor blood. In the early 1980s, donor blood was not yet tested for the presence of HIV, and consequently, a large percentage of hemophiliacs contracted HIV and, subsequently, AIDS, as a result of taking Factor VIII. The defendants do not dispute Walker's statement that 90% of hemophiliacs taking Factor VIII during this time period eventually contracted AIDS.

Walker exhibited a number of symptoms consistent with HIV infection and AIDS from the beginning of his incarceration. In particular, he exhibited generalized lymphadenopathy and an inverted T-4 helper cell/T-8 suppressor cell ratio, and these symptoms were noted in medical records transferred to the prison within a few months of the date of his incarceration. Because he was in a high risk group for contracting AIDS, and because he exhibited these symptoms, certain prison doctors assumed Walker was HIV positive, or strongly suspected that he had HIV infection and/or AIDS. One of the prison doctors noted in Walker's record that he "received so much Factor VIII [that he is] assumed to be HIV positive." Another health summary in Walker's prison records indicated that Walker was at high risk for AIDS because of his hemophilia, and another indicated that he had repeatedly refused to take a blood test to confirm or rule out HIV infection. Walker does not deny that he refused to take the confirmatory blood test, but explained that the results would have stigmatized him in prison.

Although he exhibited these symptoms and fell into this high risk group, and although some prison officials and physicians assumed he was HIV positive, Walker received no treatment for this condition until 1993. The parties agree that the appropriate treatment for a person infected with HIV and possibly suffering from AIDS was AZT, an anti-viral drug that became generally available in 1987, and Bactrim, a widely available antibiotic that is effective in preventing certain opportunistic infections associated with AIDS. The defendants contend that they did not prescribe these medications for Walker because he would not take the confirmatory test. It would have been malpractice, they maintain, to administer the potent and dangerous drug AZT without confirmation that Walker was in fact HIV positive. They maintain that they were merely following the Centers for Disease Control ("CDC") criteria when they required a positive HIV test before prescribing AZT. Walker contends they did not provide the proper treatment for more sinister reasons. He argues that the CDC guidelines did not require a positive HIV test for an AIDS diagnosis beginning in 1987. He also points to the IDOC AIDS Manual, which he claims allows AZT treatment for inmates with a CD4 count below 300 whether or not HIV infection has been confirmed. Moreover, upon his transfer to another prison in the Illinois system in late 1993, he began receiving AZT and Bactrim even though he continued to refuse to take the confirmatory HIV test. Finally, Walker maintains that if the HIV test was required before treatment, the defendants could have forced him, under Illinois law, to take the test at any time. The defendants are not allowed, Walker argues, to avoid learning the true nature of his condition once they have reason to believe he is seriously ill.

Walker's treatment for hemophilia also proved to be troublesome. Construing the facts in favor of Walker as we must on summary judgment, hemophiliacs are able to sense their need for Factor VIII, and should be infused with the substance when they ask for it. Apparently hemophiliacs can learn to recognize the signs that they are having an internal bleed, and that clotting factor is needed. Factor VIII should be infused as soon as possible after the patient senses the need. The consequences for an untreated bleed can be severe and permanent. Untreated bleeds in joints can lead to extreme pain and limitation of the movement of that joint in the future. A delay of even an hour can have dire consequences. Walker states that on many occasions when he requested Factor VIII, prison officials refused to give it to him. Other times, he was offered Factor VIII which had been improperly prepared, and he refused to take it. The defendants counter that Walker was an unreliable indicator of his need for Factor VIII, that he often asked for it when he did not need it, and that he then refused to take it without good reason after it had been mixed. Because the substance must be discarded three hours after it is prepared, Walker's refusals led to repeated spoilage of the expensive substance. Rather than preparing the substance every time Walker requested it, a prison doctor would examine him and determine whether Walker actually needed the Factor VIII before dispensing it. The defendants claim that Walker was not harmed by this policy and that his own actions made appropriate treatment nearly impossible.

Walker sued a number of prison officials and doctors for deliberate indifference to his serious medical needs, in violation of the Eighth Amendment proscription against cruel and unusual punishment. Count I of his complaint alleged that the defendants failed to take the medically necessary steps to determine whether he was infected with HIV or whether he had AIDS, that they failed to timely inform him of his HIV or AIDS status, and that they failed to treat him for HIV infection and AIDS. Count II alleged that the defendants failed to provide Walker appropriate treatment for his hemophilia by routinely refusing to give him Factor VIII, and by not informing non-medical prison staff of the greater risk of physical injury to Walker inherent in his hemophilia. Walker also complains in Count II that the defendants failed to provide adequate pain management for his hemophilia and that even when they began treating him for AIDS, the treatment was not medically appropriate.

The defendants moved for summary judgment and the district court granted judgment in favor of the defendants on both counts. The court found that the defendants' failure to treat Walker for HIV or AIDS could not constitute deliberate indifference because Walker could have obtained treatment by agreeing to the HIV confirmatory test. The court also held that a refusal to provide AZT without a confirmatory test was a matter of medical judgment, and that action based on medical judgment could never rise to the level of a constitutional violation. The court found that, contrary to Walker's claim, Illinois law did not give the defendants authority to test Walker for HIV against his will unless he had otherwise consented to treatment. Because the record was replete with Walker's refusal to consent to treatment in a variety of contexts and because he had expressly refused to consent to the HIV test, the district court held that Illinois law did not grant authority to the defendants to test Walker for HIV against his will. As for Walker's complaint that the defendants sometimes refused to give him Factor VIII when he requested it, the court found that requiring clinical observation before dispensing Factor VIII could not constitute deliberate indifference because it was, once again, action based on medical judgment. Finally, the court granted summary judgment in favor of the non- medical defendants because Walker could not demonstrate that they were personally responsible for any decisions regarding his medical care. The court therefore granted summary judgment in favor of all of the defendants and against Walker on Counts I and II. Walker appeals.

II.

On appeal, Walker contends that the defendants were deliberately indifferent to his serious medical needs because they failed to take the medically necessary steps to determine whether he was HIV positive or had AIDS, failed to timely inform him of his HIV or AIDS status, and failed to timely provide the medical treatment necessary for a person with HIV disease or AIDS. He also maintains that the defendants were deliberately indifferent to his serious medical needs when they routinely failed to provide appropriate treatment for his hemophilia. Finally, he argues that even when the defendants did begin to treat him for AIDS, they did not provide treatment in a medically appropriate manner.

The defendants contend that...