Demetrius Cooper v. Charles Dombeck

undisputed evidence showed the decision to end Cooper's prescription was based on Dombeck's medical judgment and that mere disagreement between medical professionals did not show deliberate indifference. We affirm the judgment. In March 2020, Cooper began complaining about chronic fatigue and extreme pain throughout his body. Prison medical professionals gave him several drugs meant to manage chronic pain, including ibuprofen and Tylenol, as well as four prescription drugs, each of which was discontinued because Cooper said they were unhelpful or caused negative side effects. In October 2020 and May 2021, Cooper attended physical therapy sessions and was given exercise programs for pain relief. None of those treatments proved effective, so medical staff sent him to a rheumatology specialist, who recommended that the prison treat Cooper for fibromyalgia and prescribe gabapentin. Separately, in December 2020, Cooper received surgery for a hernia and began complaining of ilioinguinal nerve pain (pain from his lower abdomen to thigh), possibly caused by nerve entrapment in scar tissue after the surgery. At his post-surgical follow- up, the doctor recommended treating Cooper's nerve pain also with gabapentin, and Cooper's physician ordered it. When Cooper complained that gabapentin was not managing his pain, another specialist recommended he switch to pregabalin and prescribed a topical gel for his scar tissue. Throughout this time, several providers noted that Cooper's behavior was incongruent with the degree of pain he reported, and at least one expressed doubt that increasing his pain medication was medically necessary. But Cooper's treatment continued with gabapentin and then pregabalin, and after a dosage increase, he says, pregabalin effectively managed his pain. In late August 2022, however, Cooper was transferred to Waupun Correctional Institution in Waupun, Wisconsin. After a transfer, all prescriptions need to be re-issued in the name of a prescriber at the new location. Because of confusing notes left on the prescription, Waupun's staff immediately withheld pregabalin pending confirmation that it had been approved. Two days later, Dombeck reviewed Cooper's medical records and ordered a lab test to determine if pregabalin was in Cooper's system at a therapeutic dose. Dombeck then emailed the prison's associate medical director, explaining that unless she objected, he would discontinue Cooper's pregabalin prescription. He gave two reasons. First, Cooper had not adequately trialed any prescription before pregabalin. (Dombeck discounted the prior prescriptions because Cooper switched off of three so quickly and had not tried a dosage increase for the fourth.) And, second, the fibromyalgia and inguinal nerve pain diagnoses were based on subjective reports of pain rather than objective signs, and his medical charts

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suggested he had remained functional even while telling providers that gabapentin was ineffective. The medical director agreed, so Dombeck discontinued the prescription. On the same day as Dombeck's initial evaluation, Cooper submitted a health services request declaring that he was on a hunger strike because his pregabalin prescription and special diet were discontinued upon his transfer to Waupun. Cooper maintains that he was never on a hunger strike and had only threatened one while eating food from the canteen. But for 13 days, he continued to inform prison officials he was on a hunger strike and he refused several meals and any hunger-strike assessments, so the medical staff treated him as if he was on a hunger strike despite their own apparent doubts. Because a hunger strike could make them dangerous, Dombeck discontinued Cooper's prescriptions for Tylenol and ibuprofen, expecting that someone would reinstate these prescriptions once the strike ended. Dombeck saw Cooper during this period, and their descriptions of the appointment diverge. Cooper attests that Dombeck said he did not treat fibromyalgia and nerve pain, refused to provide any medication to manage Cooper's pain, and would not explain his reasoning. Dombeck insists he explained his reasoning to Cooper and told him he could try other drugs once he had a primary-care appointment. The day after this encounter, Dombeck emailed the associate medical director and two other prison medical staff explaining again that he would leave Cooper's pregabalin prescription discontinued unless any of them objected. None did. According to Cooper, ending his pregabalin prescription brought back his fibromyalgia and nerve pain and triggered withdrawal symptoms such as headaches, muscle aches, dizziness, and depression. Cooper submitted seven health services requests complaining of extreme pain. Staff repeatedly responded that he had a scheduled appointment and informed Cooper explicitly one time that he could discuss trialing other medication at such an appointment. Dombeck personally responded to one request, writing that he had already explained why he discontinued Cooper's prescriptions and reiterating that Cooper had an upcoming appointment with nurse Diana Simmons. Cooper attests that on the same day, he encountered Dombeck by chance and told him about his symptoms, but that Dombeck responded, "I already told you that I don't treat nerve damage or fibromyalgia … . Maybe you can convince [] Simmons; but if it was left up to me, you wouldn't receive anything."

Cooper saw Simmons in October 2022, six weeks after entering Waupun, and she started a trial of a different drug to treat his chronic pain, but she too declined to prescribe gabapentin or pregabalin until other drugs had been tried.

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Cooper filed this suit under 42 U.S.C. § 1983, alleging that Dombeck had violated the Eighth Amendment by refusing to treat his fibromyalgia, nerve pain, and withdrawal in deliberate indifference to a serious medical condition. He also brought a medical-negligence claim under state law.

The district court eventually granted Dombeck's motion for summary judgment, concluding that no reasonable jury could find that Dombeck had consciously disregarded Cooper's medical needs. The court reasoned that Dombeck had exercised medical judgment before discontinuing the pregabalin prescription by ordering a lab test, reviewing the prior drug trials, and consulting with other providers. The court also considered reasonable Dombeck's decision to withhold Tylenol and ibuprofen given the risks from Cooper's reported hunger strike. The court declined to exercise supplemental jurisdiction over Cooper's negligence claim.

On appeal, we begin by disposing of Cooper's argument that the district court should have stricken Dombeck's reply in support of summary judgment. The district court reasonably determined that Dombeck had substantially complied with the local rules, and so did not abuse its discretion in considering Dombeck's proposed facts. See Richardson v. Kharbouch, 156 F.4th 849, 855 (7th Cir. 2025). On the merits, Cooper maintains that a reasonable jury could find that Dombeck failed to replace the pregabalin with any alternative treatment for his symptoms. We review the district court's decision to grant summary judgment de novo, construing all facts and reasonable inferences in the light most favorable to Cooper, the non-moving party. Riley v. Waterman, 126 F.4th 1287, 1295 (7th Cir. 2025). To establish deliberate indifference, Cooper was required to show that Dombeck knew of and disregarded an objectively serious medical condition. See McDaniel v. Syed, 115 F.4th 805, 832 (7th Cir. 2024). Because Dombeck conceded that Cooper's fibromyalgia and nerve pain were objectively serious medical conditions, the only issue in contention was whether Dombeck knew of and disregarded that condition. To show a genuine dispute on that question, Cooper needed to provide evidence allowing a reasonable jury to find that

"no minimally competent professional" would have responded as Dombeck did. Jackson

v. Esser, 105 F.4th 948, 961-62 (7th Cir. 2024) (citation omitted). Cooper did not present sufficient evidence from which a jury could find that Dombeck's decision to withhold painkillers fell so far short of professional standards. Cooper emphasizes that three prior specialists had recommended treating Cooper's pain with gabapentinoids (the class of drugs including gabapentin and pregabalin). But prison medical staff are not required to follow the recommendation of specialists if they

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are aware of the recommendations and choose a different course of action based on their own medical judgments. See Wilson v. Adams, 901 F.3d 816, 822 (7th Cir. 2018). Here, Dombeck explained that he discontinued Cooper's pregabalin prescription because, in his medical judgment, Cooper's prior drug trials were inadequate, and his medical record did not identify objective indicia of pain. Although "there is no requirement that a prisoner provide 'objective' evidence of his pain and suffering,"

Greeno v. Daley, 414 F.3d 645, 655 (7th Cir. 2005), Dombeck explained that he would have expected to see physical manifestations of pain if pregabalin was justified. Despite Cooper's prior doctors having eventually prescribed pregabalin, they had similarly noted that Cooper's reports of extreme pain did not match his functional ability or behavior. Even if those doctors decided prescribing pregabalin was still justified, we cannot say that Dombeck's demand for physical manifestations of pain and a longer history of drug trials was "a substantial departure from accepted professional judgment, practice or standards." Wilson, 901 F.3d at 822 (quoting Sain v. Wood, 512 F.3d 886, 895 (7th Cir. 2008)). Mere disagreement between medical professionals about how to treat a condition does not, by itself, prove deliberate indifference. See Riley, 126 F.4th at 1296.

We credit, as we must, Cooper's declaration recounting that Dombeck said that he would not give Cooper anything to treat his pain if it were up to him, but those statements do not themselves provide evidence of deliberate indifference. Even if Dombeck's phrasing may have been dismissive, "the Eighth Amendment does not entitle incarcerated patients to their preferred pain medication" or require doctors keep them "completely pain-free." Arce v. Wexford Health Sources, Inc., 75 F.4th 673, 681 (7th Cir. 2023). And here Dombeck had already made an informed medical judgment and knew he was imposing only a temporary lapse in treatment for Cooper. As medical staff repeatedly informed Cooper, he had an upcoming appointment with Simmons where he could start a trial of a new prescription. Though inexplicable delays in treatment which serve no penological interest can be evidence of deliberate indifference, see Grieveson v. Anderson, 538 F.3d 763, 779 (7th Cir. 2008), Cooper has not submitted evidence that no minimally competent professional would have allowed a prisoner complaining of pain, but evincing no physical symptoms, to wait six weeks for a primary-care appointment to obtain prescription painkillers. See Arce, 75 F.4th at 681. Dombeck also did not leave Cooper bereft of pain treatment in the interim: when Dombeck cancelled the pregabalin, Cooper's medical records reflected active orders for Tylenol, ibuprofen, and the topical gel, and that he had received physical therapy

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exercises to perform for pain relief. Cooper's hunger strike then compelled Dombeck to discontinue Tylenol and ibuprofen because they posed a risk to Cooper's health. And though these were apparently not restarted once the strike ended, and Cooper says he did not have access to the gel despite the fulfilled order in his medical record, no evidence suggests Dombeck was made aware of these facts, and "[d]eliberate indifference depends on the defendant's 'subjective state of mind.'" McDaniel, 115 F.4th at 832 (quoting Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en banc)).

AFFIRMED

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