Tyrone Robinson v. Joan Hannula

In October 2017 while incarcerated at Stanley Correctional Institution in Stanley, Wisconsin, Robinson developed a rash all over his body, a sore throat, a left earache, taste problems, and dry, peeling lips and skin. For five days, prison nursing staff treated him with antihistamines, pain medication, Vaseline, and topical lotion. But his rash worsened, leading to an emergency room visit where he was diagnosed with "allergy hives" and prescribed a five-day regimen of steroids. Robinson alleged that the emergency room physician recommended future providers investigate the cause of the allergic reaction.

Two weeks after the emergency room visit, Dr. Hannula first examined Robinson. Robinson reported that, although the steroid had helped, the rash had since returned. Dr. Hannula observed extremely dry skin; flat-discolored areas with small, raised bumps; and no signs of infection. She diagnosed Robinson with eczema and a possible allergic reaction and said that she wanted to rule out scabies as the cause of Robinson's symptoms. Accordingly, her initial treatment plan included another five-day steroid prescription, twice-daily topical cream, a one-year antihistamine prescription, and a new body cleanser.

Dr. Hannula examined Robinson twice more, on November 6 and 13, largely maintaining Robinson's treatment plan with minor adjustments. These included introducing a nerve pain medication, which Dr. Hannula increased during the second visit.

After his third visit with Dr. Hannula, Robinson saw nursing staff twice to address continued pain and itching and occasional bleeding from scabs. During those visits, he requested a skin culture.

On November 29, two weeks after Dr. Hannula had last seen Robinson, she examined him again. She found his rash largely resolved but noted dry skin and several new red lesions. To investigate further, she ordered a skin biopsy, took a culture of one lesion, and slightly altered Robinson's medications.

On December 7, Dr. Hannula reviewed the biopsy results, which showed that Robinson's symptoms might be medication related. The next day, Dr. Hannula discontinued Robinson's psychiatric medication, carbamazepine, which he had started two months before his symptoms appeared. Dr. Hannula later testified that it is uncommon for psychiatric medications to cause an allergic reaction months after initiation. By mid-January 2018, Robinson's symptoms had significantly improved, and he stopped seeing Dr. Hannula.

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Robinson sued Dr. Hannula under 42 U.S.C. § 1983, alleging that Dr. Hannula's deliberate indifference to his symptoms caused a harmful delay in treatment. Both parties sought summary judgment, and the district court entered judgment for Dr. Hannula. The court assumed that Robinson's condition was objectively serious but concluded that Dr. Hannula did not consciously disregard Robinson's medical needs. The court found that Dr. Hannula examined Robinson multiple times within a month, adjusting a complex treatment plan during each visit. Further, the court concluded that Dr. Hannula had not impermissibly delayed ordering a skin biopsy and culture. Although Robinson pointed to the emergency room physician's recommendation in October that providers should investigate the cause of Robinson's allergy hives, the court concluded that it did not change the result. The recommendation did not appear in the medical note, and Dr. Hannula exercised her independent medical judgment in treating Robinson.

Robinson appeals. We review the district court's decision de novo, reviewing the record and drawing all reasonable inferences from it in Robinson's favor. Lockett v. Bonson, 937 F.3d 1016, 1022 (7th Cir. 2019).

To establish a violation of his rights under the Eighth Amendment, Robinson must show that Dr. Hannula was deliberately indifferent to an objectively serious medical condition. Farmer v. Brennan, 511 U.S. 825, 837 (1994); Lockett, 937 F.3d at 1023. There is no dispute that Robinson suffered from a serious medical condition, so we consider only whether Dr. Hannula knew of and disregarded a substantial risk of serious harm. Because Robinson alleges that Dr. Hannula provided constitutionally deficient treatment, we frame his claim "as a challenge to 'a deliberate decision by a doctor to treat a medical need in a particular manner.'" Lockett, 937 F.3d at 1023 (quoting Snipes v. DeTella, 95 F.3d 586, 591 (7th Cir. 1996)).

Robinson argues that Dr. Hannula unreasonably delayed ordering a skin biopsy and culture and terminating his carbamazepine prescription. From the time Dr. Hannula began treating Robinson, 30 days elapsed before she ordered the lab tests, and 39 days elapsed before she stopped the medication. Because it should have been obvious when Dr. Hannula began treating him that his symptoms were caused by his medication, Robinson says, the delayed testing and termination of the carbamazepine prescription prolonged his suffering unnecessarily.

In support of his argument, Robinson points to two documents he submitted at summary judgment that, he says, the district court overlooked. The first is a fact sheet from WebMD that discusses the use, side effects, and precautions of carbamazepine.

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The sheet explains that blood tests should be done before starting carbamazepine and while taking it. It also explains that while a serious allergic reaction is rare, a person should seek medical help right away for signs of an allergic reaction, including rash, itching, or swelling. The second document, from the Mayo Clinic website, details the symptoms of Stevens-Johnson syndrome, a rare disorder of the skin. The document explains that certain psychiatric medications can trigger the condition. Robinson also points out that in Dr. Hannula's sworn declaration, she admits that she was aware that Robinson was taking carbamazepine, knew of the warnings associated with it, and understood that it could cause Stevens-Johnson Syndrome.

Even considering this evidence, we agree with the district court that no reasonable jury could find that Dr. Hannula was deliberately indifferent to Robinson's symptoms. To be sure, Robinson has presented some evidence that carbamazepine can cause a serious allergic reaction and possibly conditions like Stevens-Johnson syndrome that affect the skin. But his evidence also confirms Dr. Hannula's sworn statement that these reactions are rare. And Robinson presents no evidence that conflicts with Dr. Hannula's statement that these reactions are even less likely to emerge months after starting a medication. Given Robinson's delayed allergic response and the rarity of severe reactions, a jury could not find that Dr. Hannula's actions were a gross deviation from acceptable medical judgment. See Lockett, 937 F.3d at 1023 (citing Pyles, 771 F.3d at

409) (disagreement with medical expertise insufficient on its own to establish violation of Eighth Amendment). Indeed, when Dr. Hannula first treated Robinson, she identified a possible allergic reaction, prescribed more steroids and antihistamines, and prescribed a new cleanser to help rule out scabies as the underlying cause. Dr. Hannula monitored Robinson regularly for several weeks, and when changes to the prescribed treatment regimen did not fully resolve Robinson's symptoms, she ordered lab tests. When those tests revealed a possible drug reaction, Dr. Hannula acted quickly to terminate Robinson's carbamazepine prescription.

Robinson counters that Dr. Hannula should have immediately ordered a lab test based on the report from his emergency room visit. But that report stated only that Robinson had "allergy hives." It did not specify a potential cause. Even if the emergency room physician had told Robinson that a skin biopsy was necessary to determine the cause, Robinson presents no evidence that Dr. Hannula was aware of that statement. Further, Dr. Hannula was entitled to rely on her own medical judgment about the progression of Robinson's symptoms to determine the appropriate course of treatment. See Lockett, 937 F.3d at 1023. She spent only 30 days treating Robinson's

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complex symptoms before ordering further testing. No reasonable jury could conclude that this delay was unreasonable under the circumstances.

AFFIRMED

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