Brian Doyle v. STEPHEN RITZ and WEXFORD HEALTH SOURCES, INC.

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted November 2, 2023*
Decided November 3, 2023
Before
FRANK H. EASTERBROOK, Circuit Judge
ILANA DIAMOND ROVNER, Circuit Judge
DORIS L. PRYOR, Circuit Judge
No. 23-1351
BRIAN DOYLE,
Plaintiff-Appellant,
v.
STEPHEN RITZ and WEXFORD
HEALTH SOURCES, INC.,
Defendants-Appellees.
Appeal from the United States District
Court for the Southern District of Illinois.
No. 19-cv-1210-NJR
Nancy J. Rosenstengel,
Chief Judge.
O R D E R
Brian Doyle, an Illinois prisoner, has wounds on his scalp that generate fluid and
lead to chronic infections. To treat his condition, doctors provided Doyle with skin
cleansers, antibiotics, and incisions to drain fluid, but not further treatment that his
health might not tolerate. He has sued his prison’s healthcare contractor (Wexford
* 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. F ED. R. A PP . P. 34(a)(2)(C).
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with F ED. R. APP . P. 32.1

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No. 23-1351 Page 2
Health Sources, Inc.) and one of its administrators for violating his Eighth Amendment
rights by not providing more treatment. The district court ruled against Doyle at
summary judgment. Because no reasonable jury could find that the administrator or
Wexford deliberately disregarded Doyle’s medical needs, we affirm.
We construe the evidence in the light most favorable to Doyle. See Stockton v.
Milwaukee County, 44 F.4th 605, 614 (7th Cir. 2022). For two decades Doyle has had fluid
retention and infections in wounds on his scalp because of skin ailments. In 2016,
Dr. Stephen Ritz, a Wexford administrator, met with Doyle’s treating doctor (a process
called collegial review) and approved the doctor’s request that Doyle see a general
surgeon about his wounds. Doyle saw that surgeon. She advised against a form of
surgery (a resection of the back of Doyle’s scalp) because she predicted difficulties
getting a surgical incision to heal. She recommended that Doyle see a plastic surgeon,
which he did. Dr. Ritz, however, denied two follow-up visits with that surgeon,
preferring instead to see how Doyle responded to an approach that another outside
doctor had recommended: using an antiseptic skin cleanser and an antibiotic.
Doyle continued with the treatment of skin cleanser and an antibiotic for at least
nine months. Later, one wound on his scalp became infected. His physician
recommended that a plastic surgeon excise it. On collegial review, though, Dr. Ritz
declined that referral in favor of the previous recommendation from the outside doctor
that Doyle continue to use the antiseptic skin cleanser and an antibiotic. A month later,
during collegial review, Dr. Ritz noted that the cleanser treatment had worked: Doyle’s
scalp had no open areas. He recommended that Doyle continue with that treatment and
be reevaluated if his wound reopened. It did reopen, and a doctor then performed an
incision and drainage.
Dr. Ritz denied other treatment that Doyle wanted. During a follow-up visit a
few days after the incision and drainage, a nurse practitioner saw that Doyle’s blood
pressure and blood-sugar levels were uncontrolled. Doyle, however, refused to take the
medicine, including insulin, to address those conditions. (Instead, Doyle asked the
nurse practitioner for a single cell on the belief that it would help prevent infections.) As
a result, he was not a candidate for further surgery when Doyle’s treating physician
noted that a scalp wound had stopped draining fluid. Dr. Ritz denied that physician’s
referral to an outside specialist because he wanted to control Doyle’s blood-sugar levels
first. Two months later, Dr. Ritz saw that Doyle’s condition had not improved, but
because no abscess was present, he again had Doyle continue with his antibiotics and
sought to have him control his elevated blood-sugar levels before any surgery.

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No. 23-1351 Page 3
A few months later, a Wexford administrator approved a surgical evaluation for
Doyle. The surgeon concluded that a resection of the affected skin would, as the general
surgeon had previously opined, be problematic because the surgical incision might not
close. But the surgeon recommended, and Dr. Ritz approved, an incision and drainage
of a scalp wound because of accumulated fluid. When the surgeon proceeded, the fluid
had already drained naturally. A plastic surgeon whom Doyle saw a few months later
also advised against surgery. This surgeon asked for an MRI, which Dr. Ritz approved.
The MRI revealed no further fluid collection.
Nine months later, Doyle’s wound became infected again, and Dr. Ritz approved
referrals for further treatment. First, Dr. Ritz approved a referral to the plastic surgeon
who had ordered the MRI. This surgeon referred Doyle to a different facility. There, a
doctor referred him to a dermatologist, and Dr. Ritz approved that referral. The
dermatologist prescribed a medicated wash and the same antibiotic Dr. Ritz originally
had Doyle take. Another doctor concurred that a resection was not advisable and urged
Doyle to follow the non-surgical treatment that the dermatologist had suggested.
Almost one year later, a physician’s assistant made a similar recommendation.
Doyle sued Dr. Ritz and Wexford under 42 U.S.C. § 1983 for deliberately
disregarding his medical needs. In Doyle’s view, Dr. Ritz wrongly rejected some of the
recommendations from his doctor to see outside specialists and improperly rejected
Doyle’s request for a single cell. And Wexford, Doyle contended, had a policy forcing
Dr. Ritz to make those decisions. The defendants moved for summary judgment, which
the district court entered. It first ruled that a reasonable jury could not find against Dr.
Ritz: He reasonably monitored Doyle’s health and approved requests for outside
referrals when warranted, and other doctors prescribed treatment similar to Dr. Ritz’s
plan of care. Second, it concluded that Doyle furnished no evidence showing that
placing him in a single cell was medically necessary. Finally, it ruled that no evidence
suggested that Wexford had a policy or practice of denying referrals or single-cell
requests.
On appeal, Doyle mainly argues that Dr. Ritz violated his Eighth Amendment
rights by denying some requests from his doctor that he see outside specialists who,
Doyle contends, might have resolved fluid accumulation and infections in his scalp. But
to stave off summary judgment on his Eighth Amendment claim, Doyle had to supply
evidence that Dr. Ritz deliberately disregarded an excessive risk of harm from those
conditions. See Farmer v. Brennan, 511 U.S. 825, 847 (1994). This requires evidence
suggesting that Dr. Ritz’s decisions were “not actually based on a medical judgment.”
Stewart v. Wexford Health Sources, Inc., 14 F.4th 757, 763 (7th Cir. 2021) (citation omitted).

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For two reasons, we agree with the district court that Doyle failed to meet his
burden. First, the uncontradicted evidence establishes that Dr. Ritz followed reasonable
medical judgment. He approved a request from Doyle’s doctor in 2016 that Doyle see a
general surgeon; he reasonably accepted that surgeon’s advice to avoid a resection
because of the associated risks; he reasonably adopted an alternative treatment of skin
cleansing and antibiotics (which an outside doctor recommended and initially worked);
he reasonably delayed surgery when Doyle’s blood pressure and diabetes were
uncontrolled (partly because Doyle refused to take his medicine); and he reasonably
approved a referral for an MRI as well as referrals to surgeons and a dermatologist
when the fluid accumulation and infections persisted. Even then, doctors continued to
advise against surgery and favored the scalp-washing and antibiotic plan that Dr. Ritz
had adopted, further confirming the reasonableness of his approach. Finally, no
evidence suggests that placing Doyle in a single-occupancy cell would solve Doyle’s
problems. This record thus lacks evidence that Dr. Ritz deliberately disregarded Doyle’s
serious medical needs.
Doyle’s claim against Dr. Ritz fails for a second reason. He did not show that any
delay in seeing specialists “exacerbated the injury or unnecessarily prolonged pain.”
Dean v. Wexford Health Sources, Inc., 18 F.4th 214, 242 (7th Cir. 2021) (citation omitted).
Rather, as just mentioned, the specialists warned about the complications that a
resection would entail and therefore advised against it. Thus, a reasonable jury could
not find that delays in seeing specialists made Doyle worse off.
Finally, Doyle’s claim that Wexford had a policy or practice of ignoring medical
recommendations or requests to be placed in single-occupancy cells likewise falls short.
He did not point to evidence of such a policy in the district court, and he does not do so
here.
AFFIRMED

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