Deference to Medical Judgment in Prison Healthcare: Denial of Plastic‑Surgery Referral and Gabapentin for Pseudo‑Gynecomastia Is Not Deliberate Indifference

Case: Joe’vone M. Jordan v. Laura Sukowaty and Robert Weinman, No. 24-2118 (7th Cir. Dec. 3, 2024) (nonprecedential disposition)

Panel: Easterbrook, St. Eve, and Maldonado, Circuit Judges

Disposition: Affirmed (summary judgment for defendants)

Introduction

This nonprecedential Seventh Circuit order addresses a recurring question in Eighth Amendment prison medical-care litigation: when does an institutional medical judgment—particularly a decision to deny a specialist surgical referral and to discontinue a particular pain medication—cross the line into constitutionally actionable deliberate indifference?

Plaintiff-appellant Joe’vone Jordan, a Wisconsin inmate, alleged that two Department of Corrections officials—Associate Medical Director Dr. Laura Sukowaty and Health Services Manager (registered nurse) Robert Weinman—were deliberately indifferent to his serious medical needs. Jordan suffers from painful breast tissue, which an endocrinologist diagnosed as pseudo‑gynecomastia (excess fatty tissue rather than enlarged glandular tissue). Although an endocrinologist and a prison physician recommended a plastic-surgery consultation and discussed tamoxifen, Dr. Sukowaty cancelled the surgical referral as cosmetic and declined to renew gabapentin (initially prescribed for a shoulder issue), while approving alternative measures such as weight loss, compression vests, and over-the-counter pain relievers. Weinman responded to Jordan’s communication by endorsing the care plan and recommending weight loss.

The district court granted summary judgment to the defendants, concluding that no reasonable jury could find deliberate indifference on this record. The Seventh Circuit affirmed, emphasizing deference to documented medical judgment, the insufficiency of doctor-to-doctor disagreements to prove deliberate indifference, and the constitutional limits of a prisoner’s entitlement to specific medications or to be pain-free.

Summary of the Opinion

Procedural posture: Cross-motions for summary judgment. The district court denied Jordan’s motion and granted defendants’ motion. Review is de novo.
Threshold procedural issues:
- Local Rule compliance. The district court had discretion to relax or enforce local summary-judgment rules governing responses to proposed facts; no abuse of discretion occurred given the cross-motions and evidentiary submissions.
- Magistrate judge consent. Only Jordan consented. Seventh Circuit reaffirmed that all parties must consent under 28 U.S.C. § 636(c)(1), and Wisconsin DOJ’s blanket consent applies only through screening—and did not apply here. The district judge retained authority to rule dispositively.
Eighth Amendment analysis:
- Serious medical need. The court declined to resolve whether pseudo‑gynecomastia is objectively serious; it assumed arguendo seriousness and proceeded to the second prong.
- Deliberate indifference. No reasonable jury could find that defendants were deliberately indifferent. The record showed:
  - Dr. Sukowaty exercised medical judgment in cancelling the plastic-surgery consultation as cosmetic and recommending weight loss, compression garments, and OTC analgesics; tamoxifen remained available; multiple compression vests were ordered; and indigent access to medication was explained.
  - Discontinuation of gabapentin (prescribed for prior shoulder pain) was medically reasoned because gabapentin treats neuropathic pain, not pseudo‑gynecomastia-related pain.
  - Weinman, in an administrative nursing role, reasonably deferred to the treating physician’s medical judgment.
Holding: The undisputed record reflected a course of treatment grounded in medical judgment, not a substantial departure from professional standards. Summary judgment for defendants was affirmed.

Analysis

Precedents Cited and Their Influence

FARMER v. BRENNAN, 511 U.S. 825 (1994): Sets the deliberate-indifference framework: an objectively serious medical need and a subjective component akin to criminal recklessness—knowledge of and disregard for an excessive risk. The Seventh Circuit applied Farmer’s two-part test, focusing here on the subjective prong.
Petties v. Carter, 836 F.3d 722 (7th Cir. 2016) (en banc): Establishes that disagreement among medical professionals does not establish deliberate indifference, and persisting with an ineffective course of treatment may show deliberate indifference when the ineffectiveness is known. The court used Petties to explain why the endocrinologist’s and prison physician’s referral recommendation did not transform Dr. Sukowaty’s contrary view into a constitutional violation, and why “weight loss” was not shown to be a known-ineffective option given Jordan’s weight remained in the obese range.
JACKSON v. KOTTER, 541 F.3d 688 (7th Cir. 2008): Deference to medical judgment: when a physician explains a decision on medical grounds, liability attaches only if the decision is a substantial departure from accepted standards. The panel found Dr. Sukowaty’s documented judgments fit comfortably within Jackson.
Zaya v. Sood, 836 F.3d 800 (7th Cir. 2016): Reinforces that medical decisions grounded in professional judgment, even if debatable, are not deliberate indifference. Applied to the gabapentin discontinuation.
Arce v. Wexford Health Sources Inc., 75 F.4th 673 (7th Cir. 2023): The Eighth Amendment does not guarantee a prisoner’s preferred medication or a pain-free existence. The court relied on Arce to reject a right to gabapentin or complete pain elimination.
BERRY v. PETERMAN, 604 F.3d 435 (7th Cir. 2010): Nurses may reasonably defer to physician judgment. Used to uphold Weinman’s deference to Dr. Sukowaty’s treatment plan.
Whiting v. Wexford Health Sources, Inc., 839 F.3d 658 (7th Cir. 2016): A documented course of treatment generally undermines deliberate indifference. The approval of compression garments and consideration of medication options supported the defense.
Brown v. Osmundson, 38 F.4th 545 (7th Cir. 2022): The Constitution does not promise the most effective treatment or the inmate’s preference. The court cited this to underscore that alternatives (weight loss, compression, OTC analgesics) can be constitutionally adequate.
Holcomb v. Freedman Anselmo Lindberg, LLC, 900 F.3d 990 (7th Cir. 2018): Summary-judgment standard—facts viewed in the light most favorable to the nonmovant. The panel framed the factual narrative in Jordan’s favor but still found no triable issue.
Edgewood Manor Apartment Homes, LLC v. RSUI Indem. Co., 733 F.3d 761 (7th Cir. 2013): District courts have broad discretion to enforce or relax local rules. This supported rejecting Jordan’s complaint about unresponded proposed facts.
28 U.S.C. § 636(c)(1); Coleman v. Labor & Industry Review Comm’n, 860 F.3d 461 (7th Cir. 2017); Brown v. Peters, 940 F.3d 932 (7th Cir. 2019); Carlson ex rel. a class v. Northrop Grumman Severance Plan, 67 F.4th 871 (7th Cir. 2023): Collectively clarify that magistrate judge jurisdiction requires unanimous consent; Wisconsin DOJ’s blanket consent is limited to initial screening; and district judges retain dispositive authority absent full consent.

Legal Reasoning: How the Court Reached Its Decision

The court organized its reasoning around the two elements of an Eighth Amendment medical-care claim, but resolved the case on the subjective prong.

Objective seriousness (assumed arguendo): Without deciding whether painful pseudo‑gynecomastia qualifies as a serious medical condition, the court assumed it did and proceeded to examine the defendants’ mental state and conduct.
Subjective deliberate indifference:
- Plastic-surgery referral: The endocrinologist and a prison physician suggested a plastic-surgery consultation, but neither opined surgery was medically necessary for Jordan’s condition. A difference of opinion among physicians, the court emphasized, does not show deliberate indifference. Here, Dr. Sukowaty provided a reasoned medical explanation: imaging and labs suggested pseudo‑gynecomastia (fatty tissue), making surgery cosmetic; alternative treatments—weight loss, compression vests, OTC analgesics—were appropriate.
- Gabapentin discontinuation: Gabapentin is for neuropathic pain, not pain typically associated with pseudo‑gynecomastia, and Jordan’s shoulder surgery had been successful. Stopping gabapentin was, on this record, a medically supported decision, not reckless disregard of risk.
- Alternative measures and persistence: Jordan’s claim that weight loss did not help did not create a triable issue because he remained in the obese range during the relevant period; thus, it was not shown that further weight reduction was known to be futile. The approval and fitting of compression vests, the availability of tamoxifen (which Jordan declined due to side-effect concerns), and instruction on obtaining indigent medications all reflected an active treatment plan.
- Nurse Weinman’s role: Weinman, acting administratively, could rely on the physician’s clinical judgments. There was no evidence that he ignored obvious risks or that his conduct impeded care.
Constitutional floor, not ceiling: Reiterating that the Eighth Amendment guarantees adequate, not optimal, medical care, the court underscored that inmates are not entitled to specific drugs (e.g., gabapentin) or to be pain-free.

Impact and Practical Significance

Although designated nonprecedential, this order is instructive for several recurring issues in prison medical litigation:

Deference to documented medical judgment: When a physician explains a treatment path with reference to diagnostic evidence, courts are reluctant to infer deliberate indifference absent proof of a substantial departure from accepted standards. Administrative cancellation of a specialist referral can be constitutionally permissible if grounded in medical reasoning (e.g., surgery deemed cosmetic).
Specialist referrals vs. constitutional necessity: A referral recommendation or inter-physician disagreement does not equal constitutional necessity. Plaintiffs must marshal evidence that denial of a referral reflects nonmedical motives or a stark deviation from professional norms.
Medication choice and “right to be pain-free”: The decision reinforces Seventh Circuit authority that inmates have no right to a particular drug (here, gabapentin) or complete pain eradication. Evidence that a drug is used for a different pain modality, coupled with alternative measures, undercuts deliberate indifference.
“Ineffective treatment” theory requires notice and futility: To show unconstitutional persistence with an ineffective approach, a plaintiff needs evidence that the provider knew the approach would not work. Here, the plaintiff’s continuing obesity left the efficacy of further weight loss an open question, and compression vests were provided.
Nurse/administrator liability: Absent red flags that a physician’s plan is plainly inappropriate, a nurse in an administrative role may rely on the physician’s judgment without incurring deliberate-indifference liability.
Procedural guardrails: The order underscores district courts’ discretion with local rule enforcement in summary-judgment practice and clarifies that magistrate judge jurisdiction requires unanimous party consent; blanket DOJ consent in Wisconsin is limited to initial screening.

Complex Concepts Simplified

Gynecomastia vs. pseudo‑gynecomastia:
- Gynecomastia is the growth of glandular breast tissue in males, sometimes painful and hormonally driven.
- Pseudo‑gynecomastia is excess fatty tissue in the chest without glandular enlargement. It may cause pain, but endocrine tests and imaging typically show little glandular tissue.
Tamoxifen: A selective estrogen receptor modulator sometimes used off-label to relieve gynecomastia-related pain; can have notable side effects. In this case, it was discussed as an option, not required, and Jordan declined it due to side-effect concerns.
Compression vest/binder: A noninvasive device that compresses chest tissue to reduce discomfort—commonly used as a conservative management strategy.
Gabapentin: A medication for neuropathic (nerve-related) pain. The physician attested it was not indicated for pain associated with pseudo‑gynecomastia and that Jordan’s prior indication (shoulder pain) had resolved.
Deliberate indifference (legal standard): Requires more than negligence or a difference of opinion. The provider must know of and disregard an excessive risk to inmate health. A medical decision must be a substantial departure from professional judgment to be actionable.
“Cosmetic” vs. “medically necessary” surgery: The Constitution does not require elective or cosmetic procedures. If surgery is to relieve significant pain or functional impairment and is medically necessary, the analysis might differ. Here, based on diagnostics indicating pseudo‑gynecomastia, the physician deemed surgery cosmetic.
Objective seriousness vs. subjective indifference: Even if a condition is serious, a prison official is not liable unless they respond with reckless disregard, as opposed to reasoned medical care—even if not the inmate’s preferred approach.

Procedural Nuances Worth Noting

Cross-motions do not merge the standards: Even with cross-motions, courts consider each motion on its own, viewing facts in favor of the nonmovant. The Seventh Circuit applied this lens but still found the record insufficient to reach a jury.
Local Rule 56 discretion: A court can relax strict enforcement of local summary-judgment procedures when both sides submit robust factual materials.
Magistrate jurisdiction requires unanimous consent: Partial consent or blanket agency-level consent limited to screening cannot force dispositive proceedings before a magistrate judge.

Key Takeaways

A prison doctor’s reasoned decision to deny a plastic-surgery referral as cosmetic, supported by tests suggesting pseudo‑gynecomastia, does not amount to deliberate indifference—especially where conservative treatments are provided and discussed.
Discontinuing a medication that is not clinically indicated for the condition at issue, coupled with alternative treatments, is a medical judgment the Eighth Amendment typically respects.
Inmates do not have a constitutional right to particular medications or to be pain-free; the constitutional requirement is adequate care, not optimal care.
Nurses and administrators may defer to physicians’ judgments absent obvious evidence of danger or neglect.
To survive summary judgment on an “ineffective treatment” theory, a plaintiff must show the provider knew the treatment was futile and persisted anyway; general dissatisfaction with results is insufficient.

Conclusion

The Seventh Circuit’s nonprecedential affirmance in Jordan v. Sukowaty & Weinman reinforces a consistent theme in Eighth Amendment jurisprudence: courts will not second-guess reasonable, documented medical judgments, even amid professional disagreement, absent evidence of a substantial departure from accepted practice or reckless disregard of a known serious risk. Here, diagnostic results pointing to pseudo‑gynecomastia, conservative treatment measures, the availability (and rejection) of tamoxifen, the issuance of compression vests, and a medically explained discontinuation of gabapentin together negated any inference of deliberate indifference. The decision underscores both the limits of constitutional medical claims in prison and the importance of evidentiary showings that a chosen course of treatment was known to be ineffective or nonmedical in motivation.

Finally, while the order is nonprecedential, it offers practical guidance: in prison medical-care disputes, plaintiffs seeking to reach a jury must produce evidence that the defendant’s actions were not merely debatable or conservative, but a substantial deviation from professional standards or the product of conscious disregard—especially when conservative measures have been adopted and explained.