Andrew Obregon v. Jamie Barker

shoes. See 42 U.S.C. § 1983. He also appeals the denial of his motions to recruit counsel and to further amend his complaint. We affirm.

I.

We review the entry of summary judgment de novo, summarizing the facts in the light most favorable to Obregon, the nonmoving party. Moore v. W. Ill. Corr. Ctr.,

89 F.4th 582, 590 (7th Cir. 2023). Obregon first complained of lower back pain in April 2021 while incarcerated at Columbia Correctional Institution. He saw a doctor there in early July after a fall down a staircase exacerbated his back pain. From late July through September, Obregon had three physical therapy sessions for lower back pain and other physical therapy sessions for ankle pain and pelvic floor dysfunction. In December, a doctor at Columbia ordered an MRI, which showed severe degenerative disc disease in Obregon's lower back and minimal disc impingement on his nerve roots. In February 2022, the doctor treated Obregon with a one-week trial of tramadol, an opioid medication. Accounts conflict on whether the tramadol helped his pain. In March 2022, Obregon was transferred to Stanley Correctional Institution. In response to a message about the transfer of his care, a physical therapist noted that Obregon had already received physical therapy for back pain at Columbia, so he recommended scheduling an epidural steroid injection. Throughout March and early April, Obregon sent health services requests complaining of back pain and asking when he was going to see a doctor. Nurses responded to his requests, first telling him that a referral was ordered, then that appointments were pending. The nurses encouraged Obregon to continue taking the acetaminophen and ibuprofen he had been given. In mid-March, Obregon also submitted a request asking when he was going to be able to get high-top shoes as prescribed while he was at Columbia. A nurse responded that his request was sent to the special needs committee per prison policy. In mid-April, Obregon inquired again about the status of the high-top shoes. After receiving this inquiry, a nurse sent a message to a doctor asking whether Obregon's high-top shoe restriction could be removed because staff felt the state-provided shoes with orthopedics were appropriate, and this would comply with Stanley's security policy. The doctor responded that the restriction could be removed. Defendant Jamie Barker, a health services manager, was mentioned in this exchange, though only to note that she was part of the team that reviewed Obregon's file upon his transfer to Stanley. Barker's role was to provide administrative support, but she did not evaluate, diagnose, prescribe medications, or otherwise have any ability to override medical providers' decisions.

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Obregon sent several more requests from April through early July asking about the status of his back injection. Nurses continued to respond that he had an offsite-provider referral pending, that Stanley did not have an on-site doctor at that time, and that Obregon could see a nurse at sick call if he wished. In July 2022, Obregon saw Dr. Cary Effertz, an off-site pain specialist, who recommended a steroid injection. Two weeks later, Obregon was referred to Dr. Radu Filipescu to follow up on the appointment with Dr. Effertz. Dr. Filipescu, a general practitioner, worked at Stanley as a contract physician from late May through mid-September 2022. He reviewed Obregon's medical file and declined to order the steroid injection because Obregon's chief complaint was pain, not numbness or tingling. Dr. Filipescu decided that the best course of action was to continue Obregon on ibuprofen and acetaminophen and to order a second, more involved course of physical therapy, since Obregon had previously received only three physical therapy sessions for his back. In late August, Obregon submitted another request asking to see a doctor for his back pain. Barker responded that he had an appointment scheduled to see a doctor in a few months. In the meantime, as prescribed by Dr. Filipescu, Obregon started a course of six physical therapy sessions. After those sessions, the physical therapist recommended a steroid injection because Obregon was still experiencing pain and intermittent numbness. Obregon received several epidural steroid injections from February 2023 through 2024. He continued to complain of back pain. Obregon filed this lawsuit in October 2023, asserting that several defendants acted with deliberate indifference when they ignored his back pain and that Barker retaliated against him for his complaints about lack of medical care by canceling his high-top shoe restriction. After reviewing his medical record, Obregon moved to amend his complaint in February 2024, and the court granted the motion. The amended complaint removed the other defendants besides Barker and added Dr. Filipescu. Obregon moved for recruitment of counsel three times, early in the litigation. Barker and Dr. Filipescu later moved for summary judgment, and the district court granted their motions. As to the Eighth Amendment claim against Dr. Filipescu, the court concluded that the evidence confirmed he based his treatment decisions on his medical judgment and that no reasonable jury would find otherwise. Nor would a reasonable jury find, the court added, that Dr. Filipescu had persisted in an ineffective course of treatment by prescribing physical therapy instead of a steroid injection:

Obregon had only three physical therapy sessions over the previous ten months, and his treatment plan was in line with accepted professional standards. As to the Eighth

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Amendment claim against Barker, the court explained that no reasonable jury could conclude that she consciously disregarded Obregon's lower back pain because Obregon did receive treatment during the time he alleged that Barker ignored him. And because Barker's role was primarily administrative, she did not have the authority to override Dr. Filipescu's medical decisions. The court also granted summary judgment to Barker on the retaliation claim, reasoning that she was not the one who cancelled Obregon's footwear restriction, and even if Barker had been involved, no reasonable jury would find that the decision was in retaliation for Obregon's complaints.

II.

On appeal, Obregon maintains that Dr. Filipescu's decision not to follow the recommendation of the off-site pain specialist demonstrated lack of medical judgment and that Dr. Filipescu persisted in a treatment plan known to be ineffective. But we afford great deference to medical providers' treatment decisions unless they are so inadequate as to demonstrate an absence of professional judgment, see Stewart v. Wexford Health Sources, Inc., 14 F.4th 757, 763 (7th Cir. 2021), and Obregon did not produce evidence that would allow a reasonable jury to find that Dr. Filipescu failed to use his professional judgment. No evidence in the record suggests that Dr. Filipescu's treatment of Obregon's back pain with physical therapy, ibuprofen, and acetaminophen was so inadequate as to reflect an absence of professional judgment. Indeed, the opinion of a surgeon Obregon saw in 2024 indicated that conservative management through physical therapy was still appropriate. As the district court explained, Dr. Filipescu's disagreement with the specialist does not mean his decided course of treatment was contrary to accepted professional standards. See Pyles v. Fahim, 771 F.3d 403, 409 (7th Cir. 2014); Wilson v. Adams, 901 F.3d 816, 822 (7th Cir. 2018). Further, a reasonable jury could not find on this record that Dr. Filipescu was persisting in treatment known to be ineffective. Dr. Filipescu, knowing that steroid injections often are ineffective for treating lower back pain, thought further physical therapy beyond Obregon's three prior sessions was advisable and could potentially improve Obregon's condition. As for his Eighth Amendment claim against Barker, Obregon continues to argue that Barker had the ability to make sure he received treatment for his pain and refused to do so. But as the district court explained, the evidence demonstrates that Barker was an administrative employee who lacked the authority to change or override a medical provider's decision. Medical employees are entitled to defer to a doctor's medical judgment. See Pulera v. Sarzant, 966 F.3d 540, 553 (7th Cir. 2020). Further, the record contradicts Obregon's argument that Barker prevented him from getting care for ten

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months after his transfer to Stanley: during that period, Obregon received medical attention from nurses, Dr. Effertz, Dr. Filipescu and a physical therapist. Next, Obregon maintains that Barker cancelled his medical restriction permitting him to purchase high-top shoes in retaliation for his complaints, in violation of the First Amendment. But the evidence demonstrates that a nurse and doctor—both non-defendants—cancelled the restriction, not Barker. Obregon asserts the email exchange between the nurse and doctor regarding the cancellation of his restriction was falsified, but he provides no evidence of falsification. Because Barker was not involved in the alleged constitutional deprivation, she cannot be held liable. See Colbert v. City of Chicago, 851 F.3d 649, 657 (7th Cir. 2017).

Further, Obregon argues that the district court abused its discretion by denying him recruitment of counsel because his claims were complex and he was incapable of litigating the case on his own. But we see no abuse of discretion. Courts considering motions to recruit counsel ask whether the plaintiff appears competent to litigate the case given its factual and legal complexity. Pruitt v. Mote, 503 F.3d 647, 654-55 (7th Cir. 2007) (en banc). In his motions to appoint counsel, Obregon cited the difficulty of taking depositions, the need to present medical evidence, the fact that his claim involved a difficult to prove "state of mind" claim, and his elementary-level reading capacity. The court applied the standard in Pruitt and acted within its discretion to conclude that Obregon's specific claims were not so medically or legally complex that he needed an attorney. The court acknowledged his elementary reading level, PTSD, and ADHD, but noted that these had not thus far prevented him from completing the necessary litigation tasks. And the court made clear that Obregon could renew his requests if his circumstances changed.

Obregon also urges that the district court abused its discretion by not permitting him to amend his complaint a second time. In his motion to file a second amended complaint, filed after Barker and Dr. Filipescu moved for summary judgment, Obregon sought to add Eighth Amendment deliberate indifference claims against a nurse and physical therapist who, he alleged, wrongfully denied him high-top shoes for his ankle pain. The district court denied the motion because the new claims were based on facts beyond the scope of the first amended complaint. This was not an abuse of discretion, as Obregon's lawsuit thus far had focused on the treatment of his back pain, with his ankle condition appearing only in the context of a retaliation claim. He may not use a single complaint to bring unrelated claims against different defendants. See, e.g., Owens

v. Evans, 878 F.3d 559, 566 (7th Cir. 2017). To add a claim against two new defendants

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about the adequacy of treatment for his ankle condition would have altered the case's scope and caused delay and prejudice to the existing defendants, who had already moved for summary judgment. See Airborne Beepers & Video, Inc. v. AT & T Mobility LLC,

499 F.3d 663, 667 (7th Cir. 2007); Zimmerman v. Bornick, 25 F.4th 491, 494 (7th Cir. 2022). We have considered Obregon's remaining arguments, and none has merit.

AFFIRMED

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