O R D E R
Victor Thomas, a Wisconsin prisoner who experienced substantial bleeding from his nose after an emergency room visit, sued two medical professionals and others for violating the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd, his constitutional rights under 42 U.S.C. § 1983, and state law. The district court granted * We have agreed to decide the case without oral argument because the briefs and record adequately present the facts and legal arguments, and oral argument would not significantly aid the court. FED. R. APP. P. 34(a)(2)(C).
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with FED. R. APP. P. 32.1
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summary judgment for the defendants on each federal claim and relinquished supplemental jurisdiction over his state-law claims. See 28 U.S.C. § 1367. We affirm.
I
We recount the facts in the light most favorable to Thomas, drawing all reasonable inferences and disputes of fact in his favor. See Jackson v. Esser, 105 F.4th 948, 961 (7th Cir. 2024). In April 2023, Thomas, then an inmate at Fox Lake Correctional Institution, underwent surgery at a University of Wisconsin hospital to remove a nasal tumor. Two weeks later, he began to bleed from his nose. Prison guards described the bleeding as "profuse[]" and "extreme," to the point that blood created a "puddle" on the floor. Concerned by the amount of blood loss, the guards rushed Thomas to a nearby emergency room operated by Waupun Memorial Hospital. Waupun had a contract with the state requiring it to provide prisoners with medical services,
"including inpatient, outpatient and emergency services."
Upon his arrival, Thomas was attended to by Dr. Syed Mohiuddin, a doctor in Waupun's emergency room, along with a nurse. The nurse, who observed that the bleeding had stopped, assigned him an acuity level of three (on a one-to-five scale), meaning that his condition was "urgent" but not in need of triage. Thomas then underwent a CT scan, which revealed "hyperdense fluid/hemorrhage" in his sinuses. Dr. Mohiuddin interpreted this to mean that the nose at one point had been bleeding— known as epistaxis—but the bleeding no longer was active or at risk of "any adverse health consequence." He also noted that Thomas's blood pressure was high but not so high that it presented an acute health risk.
After examining Thomas in person and confirming that the bleeding had stopped, Dr. Mohiuddin concluded that Thomas's condition was not an emergency. To prevent further bleeding, Dr. Mohiuddin had Thomas blow his nose to clear existing clots and applied tranexamic acid, a common clotting agent that reduces the likelihood and severity of rebleeding. After the medication was applied, Thomas was discharged. As the guards drove Thomas back to the prison, his nose began bleeding again, so he was returned to the hospital and readmitted. His intake was handled by Nurse Valeria Paredes, who assigned him a level three acuity rating. Dr. Mohiuddin again examined Thomas and noticed "some" active bleeding. Realizing that the tranexamic acid was insufficient, he proceeded to the next level of treatment: nasal packing (that is, inflating packs to apply pressure within the nasal canal to stop the flow of blood, which allows the body's natural clotting agents to work more effectively).
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The level to which Dr. Mohiuddin inflated the pack is disputed. Because the pressure of a nasal pack can be painful, Dr. Mohiuddin said that he inflated the pack only partially, enough to stop the flow of blood but no more than necessary. Thomas, however, attested in a sworn declaration that Dr. Mohiuddin did not inflate the pack at all.
It is undisputed that Dr. Mohiuddin did not see any active bleeding after inserting the pack or think that Thomas's high blood pressure warranted emergency treatment. Dr. Mohiuddin then ordered Thomas's discharge, instructing him to return if the bleeding resumed.
Whether Thomas bled again before leaving Waupun is also disputed. He maintains that while waiting for Nurse Paredes to bring him his discharge paperwork, his bleeding resumed "profusely." As he recounts, the guards told her as much when she returned, but she offered only gauze or a towel before escorting him and the guards out of Waupun. Nurse Paredes, however, denies seeing Thomas bleed or being told that he was bleeding. The contemporaneous medical records make no mention of a bleed.
II
Thomas sued Dr. Mohiuddin, Nurse Paredes, Waupun, and the Wisconsin Injured Patients and Families Compensation Fund (which is responsible for paying certain medical malpractice damages). He asserted that the treatment he received violated the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd, and his right under the Eighth Amendment to constitutionally adequate healthcare as a prisoner, 42 U.S.C. § 1983. He also brought malpractice claims under state law, invoking supplemental jurisdiction. See 28 U.S.C. § 1367.
Shortly before discovery started, Thomas asked the district court to recruit counsel on his behalf. The court denied his motion, noting that Thomas's complaint was factually detailed, his writing sophisticated, and he had discovery tools at his disposal—despite being unable to conduct depositions while incarcerated. The district court later granted the defendants' motion for summary judgment. For Thomas's claim under the Emergency Medical Treatment and Active Labor Act, the court ruled that Thomas failed to produce admissible evidence from which a jury could find that he suffered an emergency medical condition during his first visit to the emergency room. And for his second visit, the court continued, jurors would be compelled to find that Thomas's bleed was stabilized once discharged from Waupun.
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For Thomas's § 1983 claim, the court explained that Dr. Mohiuddin and Nurse Paredes were not "state actors" because their relationship to the Wisconsin Department of Corrections and to Thomas were too attenuated to support the conclusion that they were acting under color of state law. Without a federal claim remaining, the court relinquished jurisdiction over Thomas's state-law claims
III
Thomas appeals, arguing that the district court improperly granted summary judgment on his claims and should have recruited him counsel.
A. Claim under the Emergency Medical Treatment and Active Labor Act
The Emergency Medical Treatment and Active Labor Act, passed as a response to the national problem of hospitals "dumping" indigent patients without health insurance, seeks to "guarantee patient entry into the medical system via mandatory appropriate medical screenings and stabilization prior to transfer." Partin v. Baptist Healthcare Sys., Inc., 135 F.4th 549, 558 (7th Cir. 2025) (citations omitted). The Act mandates hospitals to assess whether an emergency room patient suffers from an
"emergency medical condition," meaning that the patient's health is "in serious jeopardy" or the patient faces "serious [bodily] impairment or … dysfunction."
See 42 U.S.C. § 1395dd(a), (e)(1)(A). If such a condition is present, the hospital must (as relevant here) "stabilize" the patient, meaning "that no material deterioration of the condition is likely to result from or occur" once the patient is "transfer[ed]" or
"discharge[d]." Id. § 1395dd(b), (e)(3)(B), (e)(4). If an individual has an emergency medical condition that is not stabilized before discharge, he may sue the hospital for money damages. Id. § 1395dd(c)(1), (d)(2)(A).
Thomas maintains, first, that he suffered from an emergency medical condition when he initially arrived at Waupun. Drawing upon general explanations in his discharge papers that nasal bleeds can sometimes be dangerous and worsened by high blood pressure, he argues that the district court should have inferred from those explanations a material dispute of fact about the emergency nature of his condition. We see no error. That the discharge papers suggest some nasal bleeds with high blood pressure are emergency conditions does not mean Thomas's bleed was an emergency condition. And the record reflects that Dr. Mohiuddin exercised his medical judgment to conclude that Thomas's bleed, which had stopped before Thomas's arrival at Waupun, was not an emergency medical condition. The same is true of Thomas's
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high blood pressure. Although prison medical staff gave him medication after his return from Waupun to lower his blood pressure, that sheds no light on whether the blood pressure was so high that it risked "serious [bodily] impairment or … dysfunction." See 42 U.S.C. § 1395dd(a), (e)(1)(A).
Thomas further contends that the renewed bleeding after Dr. Mohiuddin applied the nasal packing was an emergency that Nurse Paredes refused to treat, leaving him with an emergency condition that was not stabilized before his discharge from Waupun. We again see no error by the district court. Given the contrary medical records that Thomas was not bleeding, Thomas did not marshal enough evidence to allow a reasonable jury to find that his bleeding did resume, or that any renewed bleeding reached the point of placing him at a serious risk of harm. See F ED. R. CIV. P. 56(a); 42 U.S.C. § 1395dd(a), (e)(1)(A).
B. Claim under 42 U.S.C. § 1983
When the state outsources to a private healthcare provider its constitutional obligation to provide prisoners with healthcare, a plaintiff suing under § 1983 must show that the provider acted under color of state law. See 42 U.S.C. § 1983. This requires
"such a 'close nexus between the State and the challenged action' that the challenged action 'may be fairly treated as that of the State itself.'" Rodriguez v. Plymouth Ambulance Serv., 577 F.3d 816, 823 (7th Cir. 2009) (quoting Jackson v. Metro. Edison Co., 419 U.S. 345, 351 (1974)); see also West v. Atkins, 487 U.S. 42, 55 (1988). More specifically, the private provider acts under color of state law only if it has "function[ally]" and "voluntarily"
taken on the state's healthcare obligations. Rodriguez, 577 F.3d at 825, 827. Thomas argues that the district court discounted the significance of (1) Waupun's contract with the state and (2) the state's collaborative role in creating Waupun's guidelines for employees interacting with prisoners. But although a contract is strong evidence of state action, a contract alone is not enough to render a healthcare provider a state actor. Id. at 827. And the contract here is less persuasive because Dr. Mohiuddin and Nurse Paredes were independently obligated by state and federal law to treat anybody who visited the emergency room. See id. at 827-28. Moreover, we give
"significant weight to the degree to which the work of the private medical provider is controlled or influenced by the state," id. at 827, and nothing in the record suggests that Dr. Mohiuddin's and Nurse Paredes's work was so influenced here. Rather, the
"incidental" and "transitory" nature of emergency care suggests the opposite. See id. Dr. Mohiuddin attested he would provide the same care to any patient. And the collaborative policies Thomas identifies are safety measures (such as not leaving
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medicine or dangerous objects unattended around inmate patients), not treatment directives. They explicitly say that inmates must receive the same medical care as any other patient.
C. Appointment of Counsel
Thomas finally asks us to reverse the district court's denial of his pre-discovery motion for counsel. Relying on language from Perez v. Fenoglio, 792 F.3d 768, 784 (7th Cir. 2015), that "[w]here an inmate alleges an objectively serious medical condition, it may be better to appoint counsel … than to dismiss a potentially meritorious claim and leave the prisoner in harm's way," Thomas argues that the severity of his bleeding supported his request for counsel. He also argues that the court should have considered how the absence of a medical expert—unobtainable without counsel—would affect his chances at summary judgment.
We review the denial of a motion for counsel under the deferential abuse of discretion standard, Watts v. Kidman, 42 F.4th 755, 761 (7th Cir. 2022), and we see no abuse here. The language from Perez that Thomas relies upon is dicta and relevant only when the injury itself affects the plaintiff's capability to litigate his case. Dorsey v. Varga,
55 F.4th 1094, 1106 (7th Cir. 2022) (citing Perez, 792 F.3d at 784); Watts, 42 F.4th at 767. The proper consideration was whether Thomas seemed competent to litigate this case, Pruitt v. Mote, 503 F.3d 647, 654 (7th Cir. 2007) (en banc), and the district court reasonably concluded that he was. His filings in the district court were cogent; the case appeared, at least on the pleadings, relatively straightforward; and Thomas could seek discovery from the relevant witnesses through interrogatories and requests for production. To the extent that Thomas's need for counsel changed as discovery progressed, it was incumbent upon him to move for counsel anew. See Watts, 42 F.4th at 767. Indeed, the court's order denying counsel explicitly invited him to do so.
AFFIRMED
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