No Per Se Deliberate Indifference from DAA Rationing: Individual‑Capacity Liability Requires Personal Knowledge and Causation

Introduction

In Skyler Tackett v. Kristen Dauss, No. 23-2246 (7th Cir. Mar. 31, 2025), the U.S. Court of Appeals for the Seventh Circuit affirmed summary judgment for the Chief Medical Officer of the Indiana Department of Correction (IDOC), Dr. Kristen Dauss, on an Eighth Amendment deliberate indifference claim brought in her individual capacity. The case arises from the tragic death of inmate Raymond Tackett from complications of chronic Hepatitis C (HCV), despite the availability of direct‑acting antivirals (DAAs) that can cure HCV within weeks.

The lawsuit followed years of controversy over IDOC’s practice of rationing DAAs to the sickest prisoners—a practice challenged in the class action Stafford v. Carter, which resulted in a judicial finding that medical rationing lacked a medical basis and a later settlement implementing a phased rollout of DAA treatment. After settling with frontline medical providers and IDOC’s medical contractor, Wexford, Ms. Tackett pursued only an individual‑capacity damages claim against Dr. Dauss. The core issues on appeal concerned whether a high-level policymaker can be held personally liable without evidence of personal knowledge of the inmate’s situation and whether a non‑universal access policy for DAAs is per se unconstitutional for individual damages liability.

The Seventh Circuit’s decision clarifies the boundaries of individual‑capacity liability for prison medical policymakers, emphasizing individualized knowledge and causation and rejecting a categorical rule that non‑universal access policies automatically constitute deliberate indifference in damages suits.

Summary of the Opinion

The court, per Judge Jackson-Akiwumi, affirmed summary judgment for Dr. Dauss. Although Mr. Tackett suffered from an objectively serious medical condition (chronic HCV), the court held that Ms. Tackett failed to present evidence from which a reasonable jury could find that Dr. Dauss, in her personal capacity, was deliberately indifferent to his medical needs.

The court identified two decisive gaps in proof:

Personal knowledge and involvement: The record did not show that Dr. Dauss knew Mr. Tackett was not receiving DAAs or that she was personally involved in his care or in the denial of treatment after he qualified for priority access in July 2019.
Causation: Because Mr. Tackett became eligible under IDOC’s priority policy (and a nurse requested DAAs for him), there was no evidence that the policy itself prevented his treatment. The court found no record basis to conclude that a different policy (universal, immediate treatment) would have changed the outcome for Mr. Tackett.

The panel also rejected the argument that any policy short of immediate universal access to DAAs is unconstitutional as a matter of law. It underscored the practical constraints reflected in Stafford: plaintiffs there initially sought immediate universal treatment or a court-ordered timeline but later agreed to a settlement allowing a phased rollout. That sequence undermined the plausibility of a categorical rule deeming non‑universal access tantamount to deliberate indifference in individual damages cases.

Analysis

Precedents Cited and Their Role

Estelle v. Gamble, 429 U.S. 97 (1976): The foundational Eighth Amendment doctrine—deliberate indifference to serious medical needs violates the Constitution. The court applied this basic framework, treating chronic HCV as an objectively serious medical condition.
Petties v. Carter, 836 F.3d 722 (7th Cir. 2016): Sets the two‑prong deliberate indifference test—objective seriousness and subjective deliberate indifference. The first prong was undisputed; the case turned on the second.
Johnson v. Doughty, 433 F.3d 1001 (7th Cir. 2006): Clarifies that malpractice, negligence, or even gross negligence does not equal deliberate indifference. The opinion leverages this to explain that even if policy choices were poor or negligent, that does not suffice for constitutional liability absent proof of deliberate indifference.
Rasho v. Jeffreys, 22 F.4th 703 (7th Cir. 2022): Deliberate indifference hinges on actual knowledge and conscious disregard of substantial risk; it is a factual question but requires record evidence. The court insisted on proof that Dr. Dauss actually knew of Mr. Tackett’s plight and consciously disregarded it—evidence that was lacking.
Hafer v. Melo, 502 U.S. 21 (1991): Distinguishes individual‑capacity lawsuits from official‑capacity claims; liability in an individual‑capacity claim must be based on the defendant’s personal actions. This principle foreclosed reliance on the actions of Dauss’s predecessor and required plaintiff to tie Mr. Tackett’s harm to Dauss’s own conduct.
Schacht v. Wisconsin Department of Corrections, 175 F.3d 497 (7th Cir. 1999): At summary judgment, a party must identify evidence that could convince a trier of fact. The court used this to stress that conjecture about policy or generalized criticisms cannot substitute for evidence of causation and knowledge.
In re Jepson, 816 F.3d 942 (7th Cir. 2016), citing Warth v. Seldin, 422 U.S. 490 (1975): A plaintiff generally may not rest a claim on the rights or injuries of third parties. The court invoked this to say that even if non‑prioritized inmates might have strong claims against the policy, Ms. Tackett cannot litigate those claims on Mr. Tackett’s behalf.
Trahanas v. Northwestern University, 64 F.4th 842 (7th Cir. 2023): Articulates the familiar summary judgment standard and vantage point (facts viewed in the non‑movant’s favor). The court applied it yet found the evidentiary record insufficient.
Stafford v. Carter, No. 1:17-cv-00289-JMS-MJD, 2018 WL 4361639 (S.D. Ind. Sept. 13, 2018): A pivotal backdrop. The court recognized Stafford’s merits ruling (no medical reason to ration DAAs) but highlighted the later settlement’s phased timeline. Stafford’s procedural history underscored the practical constraints and undermined any per se rule of unconstitutionality for non‑immediate universal treatment in the context of an individual-capacity damages claim.

Legal Reasoning

The Seventh Circuit’s reasoning proceeds in three steps: the governing standard for deliberate indifference, individualized attribution of fault in an individual‑capacity claim, and causation.

Deliberate indifference requires subjective awareness and conscious disregard. The court reaffirmed that the Eighth Amendment’s subjective prong demands proof that the defendant actually knew of and consciously disregarded a substantial risk to the inmate’s health. This is more than negligence or substandard care. It requires evidence that the official perceived the risk to the particular plaintiff and disregarded it.
Individual‑capacity liability turns on personal involvement. Relying on Hafer, the court emphasized that Ms. Tackett had to tie Mr. Tackett’s injury to Dr. Dauss’s own acts or omissions after she became Chief Medical Officer in March 2019. The record did not show that Dr. Dauss personally handled or was made aware of Mr. Tackett’s case, or that she intervened to deny treatment after he became eligible in July 2019.
Causation was lacking because the policy did not bar Mr. Tackett’s access once he qualified. The court carefully separated the policy’s existence from its causal role in this individual case. By July 2019, Mr. Tackett had indicators of cirrhosis and was eligible under the policy, and a nurse formally requested DAAs for him. The record contained no evidence that the policy—old or new—prevented his treatment. Nor was there evidence that, had IDOC adopted a universal‑access policy, Mr. Tackett would have received DAAs in time to avoid his death. The causal gap was fatal to the claim.

The court additionally rejected the plaintiff’s broad constitutional argument: that any policy short of immediate DAA access for all HCV‑positive inmates is unconstitutional. Two points drove the rejection:

Specific causation problem: Even if a universal‑access policy is normatively preferable, Ms. Tackett failed to show that such a policy would have altered the outcome for Mr. Tackett, who already qualified for priority by July 2019.
Practical feasibility as a marker of reasonableness: The Stafford plaintiffs’ own litigation posture—initially seeking immediate treatment or a court timeline, then agreeing to a phased settlement—showed that immediate universal treatment was not practically achievable at the time. That context undercuts a per se rule that non‑universal access equals deliberate indifference for an individual‑capacity damages claim.

In short, the opinion hews to established doctrine but clarifies an important application: maintaining a rationing policy, by itself, does not establish individual‑capacity deliberate indifference—especially where the inmate at issue was within the policy’s priority category and the breakdown appears to have occurred elsewhere in the system.

Impact

The decision will likely influence prisoner medical litigation and the strategic framing of claims against high‑level correctional medical officials:

Individual‑capacity claims face a higher evidentiary bar: Plaintiffs must present specific evidence that the policymaker personally knew of, and consciously disregarded, the individual inmate’s medical needs, and that the policymaker’s conduct or policy caused the deprivation in that case.
No per se constitutional rule against phased medical rollouts (in damages suits): While system‑wide rationing may be vulnerable to injunctive challenges (as in Stafford), this decision resists transforming non‑universal access policies into automatic constitutional violations for damages claims against individuals.
Class‑wide relief vs. individual damages: The opinion underscores the doctrinal gap between class actions seeking institutional reform and individual‑capacity damages claims. Success in the former does not translate, without more, into liability in the latter.
Role of feasibility and settlement history: The court’s reliance on the Stafford settlement timeline signals that practical constraints and negotiated remedial frameworks can bear on the reasonableness analysis in Eighth Amendment cases—at least when evaluating per se arguments in damages suits.
Proof of causation becomes central for medically complex cases: Where an inmate later qualifies under a policy and a request is made, plaintiffs will need evidence explaining why treatment still did not occur and how the policymaker’s conduct caused that failure (e.g., directives, funding freezes, approval bottlenecks attributable to the policymaker).

Complex Concepts Simplified

Deliberate Indifference vs. Negligence: Deliberate indifference requires proof that an official actually knew of a substantial risk to an inmate’s health and consciously disregarded it. Negligence—even gross negligence—is not enough. Think of deliberate indifference as “knowingly ignoring a serious risk,” not merely “making a mistake” or “failing to meet the standard of care.”
Individual‑Capacity vs. Official‑Capacity: Suing an official in an individual capacity targets the person’s own actions; the plaintiff must show the official personally caused the harm. Official‑capacity claims are essentially against the office/state entity and typically seek forward‑looking relief (e.g., changes in policy); they do not require the same proof of personal involvement.
Causation in § 1983 Medical Claims: It is not enough to show a bad policy exists. The plaintiff must connect that policy—or the defendant’s personal actions—to the specific injury suffered by the plaintiff, demonstrating that the harm would likely have been avoided “but for” the defendant’s conduct.
Summary Judgment Burden: At this stage, a plaintiff must point to concrete, admissible evidence that would allow a reasonable jury to find in their favor. Criticisms of policy or generalized assertions cannot substitute for proof that the defendant knew and caused the harm in the plaintiff’s case.
DAAs and HCV Policies: DAAs are highly effective HCV treatments. Some prison systems initially rationed them to the sickest due to cost and implementation challenges. Courts may find such rationing vulnerable in class-wide injunctive suits; however, an individual damages claim still requires showing that the specific deprivation flowed from the defendant’s knowledge and actions.

Key Factual Timeline (Context)

2008: Mr. Tackett diagnosed with HCV.
2013–2017: DAAs approved; by 2017 national guidance recommends DAAs for virtually all chronic HCV patients.
2017–2018: IDOC policies prioritize DAAs for advanced disease; few inmates are treated, sparking Stafford.
Sept. 2018: Stafford merits ruling against IDOC on liability; remedies phase begins.
Mar.–Oct. 2019: With Dr. Dauss newly in role, parties move toward settlement; phased rollout of DAAs is negotiated.
July 2019: Mr. Tackett shows indicators of cirrhosis; he becomes eligible for priority DAAs; a nurse requests treatment.
Nov. 2019: Mr. Tackett dies of HCV-related complications before receiving DAAs.
Jan. 2020: Stafford settlement approved, codifying phased DAA rollout.

What Would Likely Have Changed the Result?

The court’s reasoning strongly suggests that evidence of the following might have created a triable issue:

Documentation that Dr. Dauss personally knew Mr. Tackett’s DAA request had stalled and nevertheless took no steps to address it.
Evidence that Dr. Dauss implemented or maintained an approval or funding mechanism that predictably denied DAA treatment to eligible inmates and that this mechanism blocked Mr. Tackett’s July 2019 request.
Proof that, under a universal‑access policy realistically available to IDOC at the time, Mr. Tackett would likely have received DAAs in time to avert his fatal complication.

Conclusion

The Seventh Circuit’s decision in Tackett v. Dauss does not excuse systemic failures in prison healthcare, nor does it endorse rationing life‑saving medications. It does, however, demarcate the evidentiary and doctrinal limits of individual‑capacity Eighth Amendment liability for high‑level prison medical officials. The court holds that:

There is no per se deliberate indifference rule that makes non‑universal access to DAAs unconstitutional for individual‑capacity damages claims.
To hold a policymaker personally liable, a plaintiff must show the official’s actual knowledge of the plaintiff’s serious medical need, conscious disregard of that risk, and a causal link between the official’s actions or policy and the specific harm.

Set against the Stafford litigation’s mixed record—judicial condemnation of rationing on the merits, followed by a negotiated phased remedy—Tackett reinforces the separation between class‑wide injunctive relief and individual damages liability. For future litigants, the opinion offers clear guidance: in suits against high‑level officials, success will turn on individualized proof of knowledge and causation, not on generalized critiques of system‑wide policy alone.