Antonio Maddox v. Karl J. Bertram

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted July 28, 2026*
Decided August 3, 2026
Before
MICHAEL Y. SCUDDER, Circuit Judge
AMY J. ST. EVE, Circuit Judge
NANCY L. MALDONADO, Circuit Judge
No. 25-2448
ANTONIO MADDOX,
Plaintiff-Appellant,
v.
KARL J. BERTRAM, et al.,
Defendants-Appellees.
Appeal from the United States District
Court for the Eastern District of
Wisconsin.
No. 24-cv-1376-pp
Pamela Pepper,
Chief Judge.
O R D E R
Antonio Maddox, a Wisconsin prisoner, alleges that a doctor and a hospital
violated his constitutional rights while providing him medical care. See 42 U.S.C. § 1983.
* We have agreed to decide the case without oral argument because the brief 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NONPRECEDENTIAL DISPOSITION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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The district court dismissed his complaint at screening for failure to state a claim.
See 28 U.S.C. § 1915A(b). We affirm.
We assume the truth of the allegations in Maddox’s complaint. See Marion v.
Columbia Corr. Inst., 559 F.3d 693, 694 (7th Cir. 2009). Maddox was incarcerated at Fox
Lake Correctional Institution, which he alleged has a contract with Waupun Memorial
Hospital to treat its prisoners’ medical conditions. He claimed he was sent to the
hospital for abdominal pain and bloating, which stemmed from a decades-old injury
and subsequent surgeries. When he was admitted, he signed a form titled “Conditions
of Treatment for Hospitals.” In addition to consenting to medical care, it included a
section entitled “Teaching Programs,” which said:
I understand that this hospital or clinic may participate in teaching
programs to train future doctors, nurses, and allied health professionals
and that, from time to time, residents, interns, medical students, nursing
students and various allied health professional students may participate in
my care. I understand that I may limit my participation in those teaching
programs at any time by informing my doctor, nurse, or other healthcare
professional that I do not want residents, interns, or students to participate
in my care.
Maddox was also given another form, “Rules for Inmates Admitted to Waupun
Memorial Hospital,” which he was required to sign.
Maddox alleged that he was diagnosed with small-bowel obstruction and
scheduled for an exploratory surgery to remove blockages in his abdomen. Before the
surgery, and two days after he signed the previous forms, Maddox signed another form
consenting to the surgery. It authorized Dr. Karl Bertram “and whomever they may
designate as their assistants” to perform the surgery. It specified that Maddox
“consent[ed] to the administration of anesthesia to be applied by the above stated
provider, if indicated, or under the direction of the Department of Anesthesiology.”
And it authorized the hospital to take photographs and admit observers during the
procedure for educational purposes.
Although Bertram successfully performed the abdominal surgery on Maddox,
there were complications with the anesthesia. Maddox alleged the anesthesia was
administered by a certified registered nurse anesthetist and a student nurse anesthetist
but, during the surgery, the certified registered nurse left to attend to another patient.
The student nurse took charge of the anesthesia and failed to monitor Maddox

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properly. When Maddox was taken off anesthesia, a large amount of bile came out of
the tubes removed from his throat, and he was unable to breathe. He required
intubation and transfer to the intensive care unit. A correctional officer saw Bertram yell
at the student nurse for his failure to monitor Maddox and to inform Bertram that
Maddox had aspirated.
Maddox was transferred to the University of Wisconsin-Madison hospital for
critical care. He required resuscitation and mechanical ventilation, and he had acute
hypoxic respiratory failure. Although his original surgery was successful, Maddox
alleged that he was told that he did not heal properly because of his post-surgery
complications and was recommended ongoing outpatient physical therapy. Maddox
alleged he experienced brain fogginess, memory deficits, migraines, mobility deficits,
respiratory problems, and nightmares for several months following the surgery.
Maddox sued Bertram and Waupun Memorial Hospital for violations of his
constitutional rights and Wisconsin state law.1 He asserted that the forms he signed did
not adequately inform him that a student nurse would be in charge of his anesthesia
and that he did not consent to the student nurse’s involvement in his surgery. He also
asserted that Bertram violated his rights by allowing the student nurse to take charge of
the anesthesia without proper supervision.
The district court dismissed Maddox’s claims without prejudice. It reasoned that
Maddox did not state an Eighth Amendment claim against Bertram because once
Bertram learned there was a problem with the removal of the tubes for anesthesia,
Maddox received proper care. It also determined that Maddox did not state a claim for
a violation of his right to informed consent under the Fourteenth Amendment because
he was not deprived of the information that a reasonable patient would need to make
an informed decision. When Maddox signed the initial consent form, the court
reasoned, he was explicitly informed that he could request to limit student participation
in his care, and yet he did not do so. Finally, the district court concluded that it did not
have subject matter jurisdiction over Maddox’s state-law claims; because all the parties
1 In his complaint, Maddox also named the Wisconsin Injured Patients and
Family Compensation Fund as a defendant. Because he does not discuss the fund in his
brief, any claims against it are waived. See Miller v. Chi. Transit Auth., 20 F.4th 1148, 1155
(7th Cir. 2021).

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are citizens of Wisconsin, Maddox did not meet the requirements for diversity
jurisdiction.2
On appeal, Maddox contests the district court’s conclusion that he did not state a
claim for a violation of his constitutional rights. We review the court’s decision de novo.
Marion, 559 F.3d at 696.
We agree with the district court that Maddox does not state a claim that Bertram
violated his Eighth Amendment rights. To state a claim under the Eighth Amendment,
Maddox must plausibly allege that (1) he suffered from an objectively serious medical
condition and (2) Bertram was deliberately indifferent to that medical condition.
See Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en banc). The life-threatening
complications from the anesthesia in Maddox’s surgery were objectively serious.
See Knight v. Wiseman, 590 F.3d 458, 463 (7th Cir. 2009). We note that Bertram cannot be
vicariously liable for the actions of the student nurse because supervisor liability is not
available under § 1983. Stockton v. Milwaukee Cnty., 44 F.4th 605, 619 (7th Cir. 2022). So
Maddox must show that Bertram had personal involvement in the constitutional
violation and the requisite state of mind. Bostic v. Murray, 160 F.4th 831, 841 (7th Cir.
2025).
Drawing all reasonable inferences in favor of Maddox, there was “some causal
connection or affirmative link between” Bertram’s inaction—allowing the student nurse
to take charge of the anesthesia in Maddox’s surgery—and the serious harm to Maddox.
Id. (quotations omitted). The consent form that Maddox signed prior to the surgery
specified that the administration of anesthesia would be applied “by the above stated
provider,” (here, Betram), “or under the direction of the Department of
Anesthesiology.” There is no indication from Maddox’s complaint that an
anesthesiologist oversaw the administration of anesthesia in his surgery, so we assume
Bertram maintained control and oversight of the anesthesia. We can reasonably infer
that Bertram’s control over the anesthesia meant that his inaction in directing the
student nurse’s treatment established a causal connection between Bertram and the
harm that Maddox experienced.
But Maddox cannot show that Bertram had the necessary state of mind for an
Eighth Amendment violation—that he acted “either knowingly or with deliberate,
reckless indifference” to Maddox’s health. Stockton, 44 F.4th at 619 (quotation omitted).
This requires that Bertram both knew of facts from which he could infer that Maddox
2 Maddox does not appeal the dismissal of his state-law claims.

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was at a substantial risk of serious harm, and that Bertram actually drew that inference.
Whiting v. Wexford Health Sources, Inc., 839 F.3d 658, 662 (7th Cir. 2016).
Maddox alleges that a correctional officer saw Bertram yelling at the student
nurse about his improper treatment of Maddox and his failure to inform Bertram that
Maddox had been unable to breathe. We cannot reasonably infer from these facts that
Bertram doubted the student nurse’s ability to monitor Maddox on anesthesia—in other
words, that he believed Maddox to be at a substantial risk of serious harm. Bertram
learned about the complications from the student nurse’s monitoring of Maddox’s
anesthesia only after they arose, and Maddox does not point to anything that alleges
that Bertram was “on actual notice of the risk” that the student nurse’s monitoring
would harm Maddox. Bostic, 160 F.4th at 844. Based on these allegations, Bertram did
not “act[] in a way that revealed a deliberate choice to allow a constitutional violation to
happen.” Id. at 844–45.
We also agree with the district court that Maddox does not state a claim that his
Fourteenth Amendment rights were violated. To state a claim that the hospital violated
his right to informed consent, Maddox must plausibly allege that “(1) he was deprived
of information that a reasonable patient would deem necessary to make an informed
decision about his medical treatment, (2) the defendant acted with deliberate
indifference to [Maddox’s] right to refuse treatment, and (3) if [Maddox] had received
the information, he would have refused the treatment.” Knight v. Grossman, 942 F.3d
336, 344 (7th Cir. 2019).
Maddox does not state a claim because he was not deprived of the information
he needed to make an informed decision about his treatment. The initial consent form
that Maddox signed upon his admission to the hospital explains that nursing students
may participate in his treatment and that he can opt out of their participation by
informing a healthcare professional that he does not want students treating him.
See Williamson v. Curran, 714 F.3d 432, 436 (7th Cir. 2013) (written instruments attached
to a complaint become part of the complaint and can be considered in determining
whether the plaintiff states a claim). This provided Maddox with the information
needed—that a student could be involved in his surgery. Informed consent does not
require the hospital to provide “all conceivable information” about a treatment. Knight,
942 F.3d at 342 (quotation omitted). Maddox was informed that students were
occasionally involved in medical treatment and how to limit students’ involvement if he
did not want students to participate. He did not avail himself of that opportunity.

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Maddox responds that the consent form that he signed before the surgery limited
the educational aspects of the surgery to only the taking of photographs and the
admission of observers. But there is no language in the form that limits educational
opportunities to only those activities, nor any indication that the surgical consent form
contradicts or replaces the initial consent form that Maddox signed on arrival at the
hospital. Maddox overemphasizes the surgical consent form; when read together,
however, both forms contemplate and allow for educational opportunities for students
as part of Maddox’s medical care. Cf. Temme v. Bemis Co., 622 F.3d 730, 734 (7th Cir.
2010) (when interpreting contracts, related documents are read together).
Maddox also contends that the circumstances under which he signed the initial
consent form rendered his consent involuntary. Because he signed the form before he
knew what treatment he would require and he was given the initial form at the same
time as the form specifying the rules for prisoners admitted to the hospital—which he
was required to sign—he argues that these circumstances negated his consent. But the
circumstances under which Maddox signed the forms do not alter the information they
provided. He does not contend that he did not understand the consent forms, nor can
he argue that they did not provide him with the information that he could opt out of
medical treatment from nursing students at any time. When he signed the consent
forms, he received this information and he did not act on it to limit student
participation in his treatment. Contrast with Johnson v. Tinwalla, 855 F.3d 747, 749
(7th Cir. 2017) (due process violation where prisoner was prescribed a medication
despite revoking his consent for the medication by scratching out his signature on the
consent form).
Finally, Maddox asserts that the district court erred in dismissing his complaint
without allowing him the opportunity to amend. While we often encourage district
courts to allow pro se litigants an opportunity to amend their complaint before
dismissing a case, the court did not err here because it dismissed Maddox’s complaint
without prejudice. See Perez v. Fenoglio, 792 F.3d 768, 783 (7th Cir. 2015) (“[T]he PLRA’s
screening requirement does not—either explicitly or implicitly—justify deviation from
the usual procedural practice, which in this circuit is for courts to grant leave to amend
or to dismiss without prejudice.” (citation omitted)).
AFFIRMED

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