Chris Njos v. John Coe

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted February 22, 2023 *
Decided March 1, 2023
Before
DIANE S. SYKES, Chief Judge
DAVID F. HAMILTON, Circuit Judge
JOHN Z. LEE, Circuit Judge
No. 21-1708
CHRIS NJOS,
Plaintiff-Appellant,
v.
JOHN COE, et al.,
Defendants-Appellees.
Appeal from the United States District
Court for the Southern District of Illinois.
No. 18-cv-598-RJD
Reona J. Daly,
Magistrate Judge.
O R D E R
Chris Njos, an Illinois inmate, sued his prison’s health-services provider and
several doctors and nurses under 42 U.S.C. § 1983 for deliberate indifference to his
serious health needs. The magistrate judge entered summary judgment for the
* 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. A PP. P. 34(a)(C).
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with FED. R. A PP. P. 32.1

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defendants upon determining that Njos lacked evidence that they deliberately delayed
treatment or disregarded his serious health conditions. We affirm.
We recount the facts and draw all reasonable inferences in Njos’s favor. Gabb v.
Wexford Health Sources, Inc., 945 F.3d 1027, 1030 (7th Cir. 2019). While incarcerated at
Menard Correctional Center, Njos sought medical care for ear, neck, and shoulder pain
and high blood pressure. Dr. Mohammed Siddiqui first examined him in mid-2017.
Dr. Siddiqui found Njos’s blood pressure was elevated, changed his blood pressure
medication, and ordered more frequent blood-pressure monitoring. Around this time
Wexford Health Sources, Inc., the prison’s healthcare-services provider, appointed
Dr. Siddiqui, its employee, as Menard’s medical director.
Nicole Marshall, a nurse at Menard who was employed by the Illinois
Department of Corrections, also treated Njos in 2017 for his pain and hypertension. On
one occasion Njos complained of dizziness, a headache, blurred vision, and shortness of
breath. Marshall recorded Njos’s blood pressure at 170/100, then 132/100, and observed
that he did not appear to be in distress. The relevant Department of Corrections policy
provided that an emergency referral is proper if an inmate has a blood-pressure reading
greater than 180/120 or if his blood pressure is lower but is accompanied by symptoms
such as headache, blurred vision, chest pain, and dizziness. Marshall made a physician
referral for Njos—but not an emergency referral. Njos saw a physician about a month
later.
In June 2017 Njos fell down, possibly because of a seizure, and was taken to the
healthcare unit. Dr. Siddiqui ordered seizure medication, a CT scan, and a consultation
with an outside neurologist. The CT scan was completed a month later and showed
normal results; Dr. Siddiqui then contacted Menard schedulers to expedite the
neurology appointment. Still, delays occurred in the coordination between Menard staff
and the outside specialist. Njos first saw a neurologist in August 2017. The neurologist
recommended an MRI of the cervical spine, continued medication with the addition of a
muscle relaxant, physical therapy, and a follow-up visit in three to four months.
By September, however, Dr. Siddiqui had not received the neurologist’s report
and so had not yet implemented the recommendations. That month Njos saw
Dr. Siddiqui again with further complaints of pain and lightheadedness. Njos requested
an MRI of his left shoulder, but Dr. Siddiqui ordered an X-ray, which detected a
fracture in Njos’s left clavicle. Menard staff finally received the neurologist’s report
about a month later. At that point staff prescribed new medication, and Dr. Siddiqui

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No. 21-1708 Page 3
ordered physical therapy and an MRI of Njos’s cervical spine, as the neurologist had
recommended.
Njos had the MRI about a month later, but it took almost another month for
Menard staff to receive the MRI results and adjust Njos’s treatment plan based on the
findings. In further visits with Dr. Siddiqui, Njos continued to report pain. In March
2018 Dr. Siddiqui approved another neurology appointment, but it was not scheduled
until May because of issues related to the transfer of medical records.
Njos sued Marshall, Dr. Siddiqui, and others under 42 U.S.C. § 1983 for
deliberate indifference to his medical needs in violation of his rights under the Eighth
Amendment. Njos alleged that Marshall should have entered an emergency referral in
2017 because of his high blood-pressure reading. He asserted that Dr. Siddiqui, as the
director, was liable for failing to supervise those responsible for scheduling, leading to
delays in his neurology appointments and new courses of treatment. Njos also
complained that the treatment delays caused him worsening pain and that Dr. Siddiqui
was aware that his pain medications were ineffective. He also sued Wexford as a quasi-
state actor under Monell v. Department of Social Services, 436 U.S. 658 (1978), asserting
that Wexford’s policies caused the continued delay of his medical treatment.
After the close of discovery, the Wexford and Illinois Department of Corrections
defendants separately moved for summary judgment. Assisted by court-recruited
counsel, Njos opposed the motions. A magistrate judge, presiding by the parties’
consent under 28 U.S.C. § 636(c) and Rule 73 of the Federal Rules of Civil Procedure,
entered judgment in the defendants’ favor. The magistrate judge concluded that
Marshall may not have followed policy but her actions did not cause Njos harm and
that Dr. Siddiqui’s treatment of Njos was reasonable and based on his professional
judgment. Regarding Wexford, the magistrate judge concluded that Njos lacked
evidence of a practice or policy of delaying treatment and that his scheduling delays
were largely attributable to outside specialists.
Njos, now proceeding pro se, appeals, and we review the decision to grant
summary judgment de novo, Gabb, 945 F.3d at 1032, limiting our discussion to the
arguments developed in Njos’s appellate brief.1 For his claims to survive summary
judgment, Njos needed sufficient evidence from which a reasonable jury could find that
1 As the magistrate judge’s detailed factual summary recounts, Njos interacted
with, and later sued, numerous doctors and nurses at Menard and outside the prison,
including Dr. John Coe. But his appeal focuses on Siddiqui, Marshall, and Wexford.

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the defendants recklessly disregarded a substantial risk of serious harm to his health.
See Farmer v. Brennan, 511 U.S. 825, 837 (1994).
Njos contends that summary judgment in Marshall’s favor was inappropriate
because she violated Department of Corrections policy when she did not make an
emergency referral based on his hypertension symptoms during a 2017 visit. To succeed
under § 1983, however, Njos must establish not only that a state actor violated his
constitutional rights but also that the violation caused him harm. Gabb, 945 F.3d at 1032.
Njos showed neither. First, a failure to follow Department policy, without more, does
not demonstrate a violation of the Constitution. See Estate of Simpson v. Gorbett, 863 F.3d
740, 746 (7th Cir. 2017). Second, as the magistrate judge explained, Njos did not show
that the nonemergency referral had any consequence. At the visit in question, Marshall
took two vastly different blood- pressure readings, with the second being lower than
the first. She noted that Njos was not in any apparent distress and made a standard
physician referral. Njos did not present any evidence that not seeing a physician for this
issue sooner made his condition worse. See Lord v. Beahm, 952 F.3d 902, 905 (7th Cir.
2020).
Next, Njos contends that Dr. Siddiqui’s refusal to change his medication despite
ongoing complaints of pain and failure to quickly follow through on the neurologist’s
recommendations (like the MRI and adding a muscle relaxer) unnecessarily prolonged
his suffering. A prisoner may establish that medical personnel acted with deliberate
indifference by demonstrating that the treatment he received was “blatantly
inappropriate.” Pyles v. Fahim, 771 F.3d 403, 409 (7th Cir. 2014). Here, Dr. Siddiqui
ordered increased monitoring of and altered the medication for Njos’s hypertension on
several occasions. Dr. Siddiqui also waited to receive the neurologist’s report before
ordering further testing and prescribing the muscle relaxer. These were conscious
medical judgments, and Njos does not explain why they were blatantly inappropriate
or otherwise constitutionally deficient. See id.
Njos also asserts that as medical director, Dr. Siddiqui is liable for months-long
delays in scheduling tests and appointments with specialists because he failed to
supervise the relevant staff members. Dr. Siddiqui was not responsible for requesting
medical records or scheduling appointments with outside providers. And under § 1983
he cannot be liable based only on his status as the supervisor of others. Doe v. Purdue
Univ., 928 F.3d 652, 664 (7th Cir. 2019). Officials are accountable for their own acts; they
are not vicariously liable for the conduct of subordinates. See Ashcroft v. Iqbal, 556 U.S.
662, 667 (2009); Vance v. Rumsfeld, 701 F.3d 193, 203–05 (7th Cir. 2012) (en banc).

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Finally, summary judgment was also appropriate for Wexford on the Monell
claim. Njos argues that a “policy of inaction” caused the numerous delays that he
contends were violations of his rights. See Gabb, 945 F.3d at 1035. However, he did not
provide evidence of a policy or custom beyond his own experience with delayed
treatment. (He offered news stories about delays in other Wexford-affiliated prisons but
did not link them to his alleged injuries at Menard.) A handful of treatment delays for
one prisoner is insufficient to establish an unconstitutional policy. See Hildreth v. Butler,
960 F.3d 420, 426–27 (7th Cir. 2020).
AFFIRMED

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