Introduction

This nonprecedential order from the Seventh Circuit addresses a familiar but exacting standard in Eighth Amendment medical-care litigation: the difference between suboptimal or negligent care and “deliberate indifference.” The plaintiff, a Wisconsin prisoner, alleged that prison dental and medical staff were deliberately indifferent to his post-procedure neuropathic symptoms—numbness and pain—stemming from a routine dental anesthetic injection. He sued four defendants under 42 U.S.C. § 1983: two prison dentists (Drs. Christopher Rauch and Michael Brown), the Health Services Unit physician (Dr. Barry Daughtry), and the Health Services Unit manager (Tammy Strumness). The district court granted summary judgment to all defendants; the Seventh Circuit affirmed.

Although nonprecedential, the order synthesizes and applies core Seventh Circuit doctrines in Eighth Amendment prison healthcare cases, including: (1) mere negligence or medical malpractice does not equal deliberate indifference; (2) disagreements among medical professionals about a course of treatment do not suffice; (3) delay-based claims require medical evidence that the delay exacerbated injury or unnecessarily prolonged pain; (4) personal involvement is required for supervisory or administrative defendants; and (5) speculation and unsupported accusations cannot create genuine factual disputes at summary judgment.

Summary of the Opinion

The court affirmed summary judgment for all defendants on de novo review. The panel held that:

• Dr. Rauch (the treating dentist): Allegations that he used local anesthetic without special certification, chose a common practice that rarely causes nerve injury, and used two cartridges amounted at most to negligence, not deliberate indifference. The record reflected reasonable medical judgment by a licensed dentist.
• Dr. Brown (the prison dentist who followed up): Continuing a steroid regimen after an outside oral surgeon opined there was “no utility,” where Brown presented options and the patient chose another round before discontinuation due to ineffectiveness, reflected at most a difference in medical opinion—not criminal recklessness or deliberate indifference.
• Dr. Daughtry (the HSU physician): The record did not support claims that he delayed the Mayo Clinic referral; the plaintiff’s contrary assertion was unsupported and thus insufficient to create a fact issue. Even assuming delay, there was no medical evidence the delay worsened the condition or unnecessarily prolonged pain, especially because Mayo recommended no surgery and conservative management.
• Manager Strumness (HSU manager): No evidence showed personal involvement in medical care or scheduling; the one health services request she saw was answered promptly.

The court also upheld the district court’s denial of a motion to compel and a motion for default judgment related to two versions of an outside provider’s report and a handwritten notation by Dr. Daughtry. The plaintiff provided no evidence of falsification or discovery bad faith, and he could not introduce new evidence for the first time on appeal.

Result: Judgment affirmed.

Background and Timeline

• September 2021: Dr. Rauch fills cavities after administering local anesthetic (two cartridges).
• October 2021: Plaintiff reports persistent left-sided tongue and floor-of-mouth numbness; Dr. Brown diagnoses partial lingual nerve paresthesia; options offered include waiting versus oral-surgery consult; steroid prescribed; oral-surgery referral made.
• October 26, 2021: Oral surgeon (Gunderson) finds decreased sharp/dull discrimination; recommends watchful waiting and possible future neurosurgical referral; notes “no utility” for steroids at that time.
• October 28, 2021: Dr. Brown documents options; plaintiff elects a second steroid round; prescription later discontinued when ineffective.
• November 30, 2021: Second consult at Gunderson; surgeon recommends neurosurgical referral (Mayo Clinic); an Off-Site Service Request and Report is completed that day.
• January 7, 2022: Report stamped received at the prison; Dr. Daughtry adds a note: “Referral to Mayo Oral Surgery. B.D. 1-7-2022.”
• February 2022: Plaintiff asks about surgery or alternatives; HSU manager replies next day that Mayo appointment is being scheduled.
• March 2022 (approx.): Mayo oral/maxillofacial surgery consult diagnoses “chemotoxic” lingual nerve injury from anesthetic; advises vitamins, nutrition; expects healing within 6–12 months; no surgery recommended.
• Six months later: Follow-up at Mayo; no improvement yet; continued conservative plan.
• Litigation: Plaintiff sues under § 1983 alleging deliberate indifference against Rauch, Brown, Daughtry, and Strumness. Discovery dispute arises over two versions of the Gunderson report and a handwritten note. Summary judgment granted to defendants. Appeal follows.

Analysis

Precedents Cited and Their Influence

• Farmer v. Brennan, 511 U.S. 825 (1994): Sets the deliberate indifference standard: an objectively serious medical need and subjective awareness plus disregard of an excessive risk. The court used Farmer’s two-prong framework and emphasized the heightened mental state (akin to criminal recklessness) that exceeds negligence.
• Estelle v. Gamble, 429 U.S. 97 (1976): Reaffirms that inadvertent failure to provide adequate medical care or negligence/malpractice does not constitute an Eighth Amendment violation. The court relied on Estelle to reject claims grounded in alleged certification issues or dosing choices by a licensed dentist.
• Duckworth v. Ahmad, 532 F.3d 675 (7th Cir. 2008): “Deliberate indifference is not medical malpractice; the Eighth Amendment does not codify common law torts.” This quote anchors the court’s refusal to constitutionalize alleged treatment errors.
• Stewart v. Wexford Health Sources, Inc., 14 F.4th 757 (7th Cir. 2021): Treatment must reflect an absence of professional judgment to indicate deliberate indifference. This standard protected the defendants where options were presented, choices documented, and conservative management was medically supported.
• Pyles v. Fahim, 771 F.3d 403 (7th Cir. 2014): Divergent medical judgments (e.g., whether to pursue more aggressive intervention) usually do not indicate deliberate indifference. The court cited Pyles to dismiss claims rooted in disagreement with steroid therapy and dosing.
• Burton v. Downey, 805 F.3d 776 (7th Cir. 2015) and Estate of Cole v. Fromm, 94 F.3d 254 (7th Cir. 1996): Differences of medical opinion are not enough; deliberate indifference requires more than showing another doctor would have acted differently. These cases directly undercut the challenge to Dr. Brown’s decision to extend steroids briefly.
• Walker v. Wexford Health Sources, Inc., 940 F.3d 954 (7th Cir. 2019); McGowan v. Hulick, 612 F.3d 636 (7th Cir. 2010); Gayton v. McCoy, 593 F.3d 610 (7th Cir. 2010): For delay claims, a plaintiff must present medical evidence that the delay exacerbated the injury or unnecessarily prolonged pain. Here, the court found no such evidence, especially given Mayo’s conservative plan.
• Mitchell v. Kallas, 895 F.3d 492 (7th Cir. 2018): Personal involvement is required; administrators not personally responsible for medical decisions generally are not liable. This foreclosed claims against HSU Manager Strumness.
• Thomas v. Blackard, 2 F.4th 716 (7th Cir. 2021): Standard for de novo review of summary judgment; facts viewed in plaintiff’s favor but require admissible evidence, not speculation.
• Weaver v. Speedway, LLC, 28 F.4th 816 (7th Cir. 2022): Unsupported allegations cannot create genuine issues of material fact. This defeated the accusation that the referral note was falsified or that receipt was earlier than the record showed.
• Hirmiz v. New Harrison Hotel Corp., 865 F.3d 475 (7th Cir. 2017): Appellants cannot rely on evidence not presented to the district court. The court declined to consider new psychological-harm records offered for the first time on appeal.
• Gonzalez v. City of Milwaukee, 791 F.3d 709 (7th Cir. 2015) and Brown v. Columbia Sussex Corp., 664 F.3d 182 (7th Cir. 2011): Discovery rulings reviewed for abuse of discretion; sanctions require prejudice and, often, bad faith. The denials of the plaintiff’s motion to compel and motion for default were affirmed.

Legal Reasoning and Application

The panel walked through the deliberate indifference framework and applied it defendant-by-defendant, emphasizing evidentiary burdens at summary judgment.

1) Dr. Rauch (initial anesthetic and cavity fillings)

• Claim: Use of local anesthetic despite high risk of nerve damage; administration of two cartridges; alleged lack of necessary certification.
• Record and inference: Administering anesthetic before filling cavities is standard practice with rare nerve injury risk; Dr. Rauch is a licensed dentist who exercised medical judgment on dosage.
• Holding: At most negligence; no deliberate indifference. Under Estelle, Pyles, and Duckworth, the Constitution does not police alleged malpractice or credential technicalities absent reckless disregard to known excessive risk.

2) Dr. Brown (post-procedure management and steroids)

• Claim: Continued steroid therapy despite outside surgeon’s “no utility” comment and plaintiff’s report of steroid-related discomfort.
• Record and inference: Brown discussed options; the patient opted for another steroid course; prescription was promptly discontinued when ineffective. Differences between Brown and the Gunderson oral surgeon reflect a medical disagreement.
• Holding: Mere treatment disagreement is not deliberate indifference (Burton; Estate of Cole). No showing of criminal recklessness or abandonment of professional judgment (Stewart).

3) Dr. Daughtry (alleged delay in Mayo referral)

• Claim: Daughtry delayed scheduling, evidenced by two versions of the Gunderson report and a January 7, 2022 handwritten note; alleged falsification to conceal earlier receipt.
• Record and inference: The Gunderson report was received January 7; Daughtry’s note documents a same-day referral; plaintiff offered only unsupported speculation to contest timing. Even if there was a delay, no medical evidence showed harm from it.
• Holding: No triable fact on delay or falsification (Weaver); no verifying medical evidence of exacerbation or unnecessary prolongation of pain (Walker; McGowan; Gayton). Mayo recommended no surgery and conservative care; thus, earlier referral would not have changed the course materially on this record.

4) HSU Manager Strumness (administrative role)

• Claim: Failure to ensure timely scheduling; delayed response to requests.
• Record and inference: No evidence of involvement in medical decisions or routine review of health requests; she promptly answered the one request she saw, confirming scheduling underway.
• Holding: Lack of personal involvement defeats § 1983 liability (Mitchell v. Kallas).

5) Discovery motions (motion to compel; default judgment)

• Dispute: Two versions of the Gunderson report; allegation that Daughtry added the handwritten note in bad faith to cover a five-week delay.
• Rulings: No abuse of discretion in denying motions; plaintiff showed neither prejudice (Gonzalez) nor bad faith sufficient for default (Brown v. Columbia Sussex). The district court allowed the plaintiff to challenge authenticity at summary judgment, but he presented no supporting evidence.
• Appellate posture: New psychological-harm evidence cannot be introduced on appeal (Hirmiz).

Impact and Practical Implications

While nonprecedential, the order carries persuasive weight and reiterates several litigation-critical principles for Eighth Amendment medical claims in the Seventh Circuit:

• High evidentiary bar for deliberate indifference: Plaintiffs must show more than negligence, malpractice, or even suboptimal decision-making; they must produce evidence of disregard tantamount to criminal recklessness.
• Medical disagreements do not equal constitutional violations: When providers discuss options and document a reasoned choice—even if later shown ineffective—the claim typically fails absent evidence of blatantly inappropriate care or abandonment of professional judgment.
• Delay claims require verifying medical evidence: To convert alleged scheduling lag into an Eighth Amendment claim, plaintiffs must marshal medical evidence that the delay made the condition worse or needlessly prolonged pain. Where an eventual specialist prescribes no new or different treatment, causation will be difficult to prove.
• Personal involvement is essential: Administrative staff who are not involved in day-to-day medical decisions generally are not liable. Plaintiffs should identify concrete actions or omissions linking administrators to the alleged deprivation.
• Documentation can be dispositive: Contemporaneous notes showing options offered, patient choice, and prompt discontinuation of ineffective therapy support summary judgment. Conversely, plaintiffs should use admissible evidence—such as expert opinions or treatment records—to meet their burden.
• Discovery sanctions are exceptional: Courts require prejudice and, often, bad faith. Absent proof, allegations of document manipulation will not support default or compel further responses.

In practice, this order underscores that successful Eighth Amendment medical claims typically hinge on robust medical proof of harm, clear evidence of reckless disregard, and a concrete causal link between alleged delay or mismanagement and measurable deterioration or unnecessary pain.

Complex Concepts Simplified

• Deliberate indifference: A constitutional standard requiring proof that officials knew about and disregarded an excessive risk to a prisoner’s health. It is more demanding than negligence or malpractice—think conscious disregard, not mere error.
• Professional judgment: If a provider’s decision reflects medical judgment—even if debatable or ultimately wrong—it usually is not deliberately indifferent.
• Verifying medical evidence (harm-from-delay): In delay cases, plaintiffs generally must provide medical evidence—often expert testimony or treatment notes—showing the delay worsened the condition or needlessly increased pain.
• Personal involvement (Section 1983): Liability is personal; supervisors or administrators are not liable simply because they oversee the system. They must themselves have taken—or failed to take—actions that violated the Constitution.
• Summary judgment: A stage where the court decides whether a case should go to trial. The non-moving party must point to specific admissible evidence showing genuine factual disputes; mere allegations or speculation do not suffice.
• Chemotoxic nerve injury: A nerve injury caused by exposure to a chemical agent (here, local anesthetic). Such injuries are often self-limiting and may improve over months without surgery.
• Nonprecedential disposition: The decision can be cited for its persuasive value (per Fed. R. App. P. 32.1) but is not binding precedent within the circuit.

Key Takeaways

• Differences in medical opinion, including between prison clinicians and outside specialists, generally do not prove deliberate indifference.
• Patient choice matters: when clinicians document options and the patient elects a course, it cuts against claims of reckless disregard.
• Delay claims require medical causation evidence; the absence of a different recommended treatment at the eventual specialist visit strongly undercuts causation.
• Unsupported accusations of falsification or earlier receipt of records are insufficient to defeat summary judgment.
• Administrative staff are not liable absent proof of personal involvement in medical decision-making or scheduling failures.

Conclusion

The Seventh Circuit’s affirmance in Webster v. Daughtry reinforces core Eighth Amendment principles: the constitutional threshold for inadequate medical care is high; negligence and treatment disagreements are not enough; delay-based claims turn on medical proof of harm; and personal involvement remains essential for § 1983 liability. On this record—showing standard dental practice, documented treatment options and patient choice, timely discontinuation of ineffective therapy, and an eventual specialist recommendation for conservative management—the evidence did not support a finding of deliberate indifference by any defendant. The order offers a clear, practical roadmap for litigants on the type and quality of evidence necessary to survive summary judgment in prison medical and dental care cases.