De’adrian C. Boykins v. Sheri Wilson

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted January 7, 2025*
Decided January 8, 2025
Before
AMY J. ST. EVE, Circuit Judge
JOHN Z. LEE, Circuit Judge
JOSHUA P. KOLAR, Circuit Judge
No. 23-3027
DE’ADRIAN C. BOYKINS,
Plaintiff-Appellant,
v.
SHERI WILSON, et al.,
Defendants-Appellees.
Appeal from the United States District
Court for the Southern District of
Indiana, Indianapolis Division.
No. 1:21-cv-00316-JPH-TAB
James P. Hanlon,
Judge.
O R D E R
De’Adrian Boykins, an Indiana prisoner with poorly controlled diabetes, appeals
the summary judgment rejecting his claim that medical providers at his facility acted
with deliberate indifference when they changed his insulin regimen. Because no
* 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NONPRECEDENTIAL DISPOSITION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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reasonable jury could find that the medical providers’ treatment violated the Eighth
Amendment, we affirm.
I
We construe the record in favor of Boykins, the party opposing summary
judgment. See Arce v. Wexford Health Sources Inc., 75 F.4th 673, 678 (7th Cir. 2023). While
incarcerated at Pendleton Correctional Facility, Boykins—a Type 1 diabetic—relied on
insulin injections to manage his diabetes. In March 2020, a physician assistant at the
prison, Sheri Wilson, noted that Boykins’s A1C (a measurement of average blood-sugar
level over multiple months) exceeded the normal range. She renewed his prescriptions
for Humulin R (“R-insulin”), a fast-acting insulin, and Novolin N (“N-insulin”), a slow-
acting insulin. Boykins previously had received both medications twice daily. Wilson
upped Boykins’s R-insulin prescription to three times a day during mealtimes. His
medical records reflect that he was instructed to adhere to a low-carbohydrate diet.
By June, when Wilson again saw Boykins, his A1C had improved slightly, so she
lowered Boykins’s prescription for R-insulin to two doses a day. In her notes, Wilson
did not elaborate upon her decision. She and Dr. Duan Pierce, Wexford Health Sources’
associate regional director, later explained that the main consideration for a two-a-day
rather than three-a-day dose of this insulin was the “nature of security practices.”
Wilson later stated in an affidavit that she believed this adjustment would improve
Boykins’s A1C.
Soon thereafter, Boykins submitted a healthcare request form, complaining about
the change in his prescription. He believed that his diabetes would be better controlled
with three rather than two daily doses of R-insulin. Boykins’s A1C continued to
improve, though it remained higher than it should.
In December, Boykins complained to Wilson that he was experiencing low blood
sugar (hypoglycemia) in the mornings. Wilson recorded in her notes that Boykins had
refused some of his N-insulin morning doses based on these self-reports of low blood
sugar. In response to his concerns, she decreased his N-insulin evening dosage. Despite
the adjustment to his prescription, Boykins experienced several hypoglycemic episodes
during which he was unresponsive for a short period of time.
In early 2021, a nurse, concerned about three recent episodes in which Boykins’s
blood sugar had dropped, emailed Wilson; Dr. Pierce; and the prison’s medical director,
Dr. Martial Knieser. She proposed increasing Boykins’s insulin injections to three times

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a day—a schedule she deemed “much safer,” noting that “several other diabetics”
already received insulin at lunchtime. Wilson replied that Boykins had missed many
doses of insulin the previous month, and she questioned whether Boykins was eating as
instructed when he received his insulin. Dr. Pierce asked that Boykins’s regimen be
reviewed.
On January 20, Boykins was seen by Dr. Knieser for what appeared to be another
hypoglycemic episode. Boykins’s blood sugar and vitals, however, tested as normal.
Dr. Knieser, noting that Boykins smelled of alcohol, suspected intoxication. Dr. Knieser
reported his observations to Dr. Pierce, who rejected Boykins’s request for an additional
daily dose of R-insulin and concluded that Boykins needed more education about diet
and medication control.
Later that month, Wilson decreased Boykins’s insulin dosages based on his
continued issues with low blood sugar. She ordered the prison’s medical staff to hold
Boykins’s R-insulin dose if his blood sugar continued to drop.
On February 6, Boykins sued Wilson, Dr. Knieser, and Dr. Pierce for deliberate
indifference toward his diabetic condition, in violation of his rights under the Eighth
Amendment. See 42 U.S.C. § 1983. Boykins asserted that the medical providers acted
recklessly by reducing his prescription for R-insulin from three to two doses a day and
then refusing to increase the number of doses in light of his hypoglycemic episodes.
In the weeks that followed, the medical providers continued with his twice-a-day
insulin regimen. On February 10, Wilson, responding to emails from prison staff about
Boykins’s blood-sugar issues, explained that she had adjusted—and was monitoring—
his insulin dosages, but his blood-sugar levels were being affected by his eating habits
and substance abuse. Meanwhile, Dr. Knieser, who had treated Boykins for low blood
sugar on consecutive days, later stated that he saw no reason to change Boykins’s
insulin regimen. Dr. Knieser reported Boykins’s statement that he did not miss his
insulin injections but ate irregularly.
On February 26, Wilson, upon receiving a complaint from Boykins about not
receiving enough insulin, increased his R-insulin prescription to three daily doses.
In the spring of 2021, Boykins experienced multiple hypoglycemic episodes that
necessitated immediate treatment. To monitor Boykins’s blood sugar more closely,
Dr. Knieser tried to move him to a cell closer to the prison’s clinic and even considered

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moving him to the prison’s medical ward or infirmary. On April 30, Dr. Pierce learned
that Boykins at times had refused his insulin and reportedly been intoxicated.
The district court entered summary judgment for the defendants, ruling that
Boykins presented no evidence from which a jury could find that any of the medical
providers was deliberately indifferent to his diabetic condition. Regarding Dr. Knieser
and Wilson, the court explained, the record showed that both responded to changes in
Boykins’s diabetes, and that they appropriately exercised medical judgment in treating
it. As for Dr. Pierce, the court noted that his role in Boykins’s treatment was only
indirect, and that no jury could infer that he did not exercise medical judgment when
opining about Boykins’s insulin regimen.
II
Under the Eighth Amendment, medical providers may be held liable for
deliberate indifference if they know about and yet consciously disregard a serious
medical condition. Farmer v. Brennan, 511 U.S. 825, 837 (1994). The standard for
deliberate indifference essentially is one of criminal recklessness. Davis v. Kayira,
938 F.3d 910, 915 (7th Cir. 2019). Medical providers’ decisions are entitled to deference
“unless no minimally competent professional would have so responded under those
circumstances.” Id. (internal citation omitted). Because the district court decided the
case on summary judgment, our review is de novo. Arce, 75 F.4th at 678.
On appeal, Boykins primarily argues that there is a fact dispute over whether
Wilson’s decision to change his insulin prescription in June 2020 was supported by
medical judgment. He maintains that no evidence in the record shows that her decision
was medically justified.
This argument misconstrues the record. Wilson explained in her affidavit that
staffing and security concerns in the prison posed logistical and medical challenges to
administering insulin three times a day. She stated that delays in the distribution of
fast-acting insulin (for instance, on account of shift changes or lockdowns) could harm
diabetic prisoners if it were not administered right before or after a meal as intended.
Administrative convenience can be a permissible factor in a prison’s treatment decision,
as long as that decision does not exclude reasonable medical judgment about inmate
health. Roe v. Elyea, 631 F.3d 843, 863 (7th Cir. 2011). Boykins offered no evidence
suggesting that Wilson’s decisions excluded reasonable medical judgment over his
health. To the contrary, she attested in her affidavit that the change in Boykins’s
prescription “needed to occur to continue improving [his] A1C.”

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Boykins next argues that a reasonable jury could infer that the prescription
change in June 2020 was not based on medical judgment because other prisoners
continued to receive insulin three times a day. But even if other prisoners were
receiving a third dose, the record corroborates Wilson’s belief that Boykins stood to
benefit most by receiving insulin twice a day. Boykins may disagree with Wilson’s
decision to change his prescription, but mere disagreement is insufficient to show that
she did so with deliberate indifference. See Thomas v. Martija, 991 F.3d 763, 772 (7th Cir.
2021). He has not pointed to any evidence in the record to suggest that the treatment
plan deviated so substantially from accepted professional judgment that no reasonable
medical provider would reach the same judgment. Id.
Boykins argues, relatedly, that a reasonable jury could infer that the defendants’
refusal to increase his prescription to three daily doses was based not on medical
judgment but rather the false premise that he had been non-compliant with his insulin
regimen. But to establish deliberate indifference, Boykins needed to show that the
defendants were aware of and intentionally disregarded an excessive risk to his health.
See Farmer, 511 U.S. at 837. He has not pointed to evidence to call into question their
belief—based on their interactions with him, their review of his medical records, and
their correspondence with medical staff—that the treatment choices amounted to care
that was adequate .
Finally, Boykins argues that the district court overlooked a factual dispute about
the extent of Dr. Pierce’s involvement in his care. As evidence of Dr. Pierce’s direct
involvement in the decision to lower his R-insulin prescription to two daily doses,
Boykins points to Dr. Pierce’s email exchanges with Dr. Knieser and Wilson, opining
that there was no need to change Boykins’s insulin regimen. But as we have explained,
no reasonable jury could find that this opinion—without more—reflected anything but
the sound exercise of Dr. Pierce’s medical judgment.
AFFIRMED

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