Adam Pegues v. John Coe

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted April 10, 2019*
Decided April 11, 2019
Before
AMY C. BARRETT, Circuit Judge
MICHAEL B. BRENNAN, Circuit Judge
MICHAEL Y. SCUDDER, Circuit Judge
No. 18-2066
ADAM PEGUES,
Plaintiff-Appellant,
v.
JOHN COE, et al.,
Defendants-Appellees.
Appeal from the United States District
Court for the Southern District of Illinois.
No. 16-CV-239-SMY-RJD
Staci M. Yandle,
Judge.
O R D E R
Adam Pegues, a former Illinois inmate, reported experiencing unalleviated pain
in his stomach, back, and legs for more than three years while he was incarcerated. The
prison’s medical staff administered tests and x-rays and referred him to a physical
therapist, but they could not determine any cause of his pain. Pegues sued medical staff,
the medical contractor, and prison staff for deliberate indifference and for failure to
accommodate his disability-related needs. The district court entered summary
judgment for the defendants. Because Pegues did not submit evidence from which a
* 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NONPRECEDENTIAL DISPOSITION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 Fed. R. App. P. 32.1

-- 1 of 5 --

No. 18-2066 Page 2
reasonable jury could find that any defendant deliberately disregarded his health, we
affirm the judgment.
We recount the following facts, and make all reasonable inferences from them, in
Pegues’s favor. See Kemp v. Liebel, 877 F.3d 346, 350 (7th Cir. 2017).
When he arrived at Lawrence Correctional Center in Sumner, Illinois, in March
2014, Pegues complained to medical staff and the warden about gastrointestinal pain
and blood in his stool. Over the next three years, Pegues reported that his pain
intensified, but multiple rounds of lab work, examinations, and x-rays did not yield any
explanation.
In March 2014, shortly after his arrival at Lawrence, Pegues was examined by
Dr. John Coe, an employee of Wexford Health Services, Inc., which contracts with the
Illinois Department of Corrections to provide medical services. Dr. Coe noted that
Pegues’s abdomen was tender, so he prescribed laxatives and later added medication
for bowel spasms, an antidepressant, and Tylenol. Pegues continued to complain of
abdominal pain and difficulty, and Dr. Coe admitted him to the infirmary for a few
days of observation.
Throughout the fall, Pegues experienced other types of pain. In August, he said
that urinating was painful, and in September he noted generalized back pain and
difficulty walking. Two months later, pain persisted in his back, abdomen, and
genitalia, and he requested use of a wheelchair. Both a neurological exam and urinalysis
turned up nothing unusual. Dr. Coe acknowledged that Pegues had lower-back
tenderness but declined to prescribe a wheelchair.
In early 2015, Pegues complained of chest pain (in addition to continuing pain in
his back and abdomen), and Dr. Coe ordered a spinal x-ray. The image showed mild
narrowing of the disc space in his lower spine. Dr. Coe determined that this was part of
the normal aging process, but Pegues countered that diagnosis with evidence that the
narrowing could also be spinal stenosis.
In October, just days after Dr. Coe recorded a normal physical exam, Pegues fell
down a flight of stairs when his legs “gave out.” Dr. Coe then prescribed a low gallery
and low bunk. Two weeks later, Pegues complained of back pain and leg numbness that
prevented him from walking. Dr. Coe performed a physical exam and found tenderness
in Pegues’s lower back and hyper-reflexivity in his legs. He admitted Pegues to the

-- 2 of 5 --

No. 18-2066 Page 3
infirmary, prescribed use of a wheelchair, and ordered an x-ray that again reflected
disc-space narrowing.
After Pegues received a wheelchair, he requested a wheelchair attendant. He also
requested permission for additional showers because he was struggling to maintain his
hygiene in his cell. The prison denied these requests.
Meanwhile, Dr. Coe still could not ascertain the cause of Pegues’s pain, so after a
discussion with a colleague, he decided to refer Pegues to a physical therapist for
evaluation. The therapist believed that Pegues was exaggerating his symptoms (she
noted, for instance, that Pegues held open a door for her, despite complaining that he
could not move his arms) and recommended against physical therapy. For the next two
months, Pegues reported that he could not walk. Dr. Coe sent him back for another
evaluation, and the therapist again recommended against physical therapy.
Pegues brought deliberate-indifference claims against the warden, Dr. Coe,
Tammy Kimmel (a nurse), and Wexford as well as a claim for injunctive relief against
the director of the Illinois Department of Corrections under the Americans with
Disabilities Act, 42 U.S.C. § 12132, and the Rehabilitation Act, 29 U.S.C. § 794. During
discovery, the district court twice denied Pegues’s motions for preliminary injunctions
seeking accommodations and referrals to outside medical specialists for evaluation.
The district court ultimately granted motions for summary judgment filed
separately by the medical defendants and the Department of Corrections. The court
determined that, although Pegues had a serious medical condition, he had not
demonstrated that the defendants consciously disregarded his needs: the warden was
entitled to reasonably rely on the medical defendants to provide care; the actions of
Kimmel and Dr. Coe did not permit an inference that they intentionally or recklessly
disregarded his needs; and Wexford was not aware of any risk posed by its policy
regarding referral to outside specialists. As for Pegues’s claim under the ADA and the
Rehabilitation Act, the court ruled that he had not provided evidence sufficient to infer
that his access to programs or services was restricted based on the Department’s denial
of his requested accommodations.
Two weeks after the court’s judgment, Pegues was released from prison, and two
weeks after that he filed his notice of appeal.

-- 3 of 5 --

No. 18-2066 Page 4
On appeal, Pegues argues generally that the defendants were deliberately
indifferent to his medical needs. But Pegues has not met his burden of producing
evidence from which a factfinder could conclude that any defendant consciously
disregarded a risk to his health. Dr. Coe, for instance, examined Pegues on a
near-monthly basis and ordered numerous tests, x-rays, and medications to address
and diagnose his symptoms; when he still could not ascertain the cause of Pegues’s
pain, he consulted with a colleague before referring Pegues to a physical therapist. To
the extent that Pegues faults Dr. Coe for delaying months to prescribe a wheelchair, the
medical record—the unremarkable results from x-rays, urinalysis, and Dr. Coe’s own
physical and neurological examinations—does not reflect that the doctor’s delay was
“so blatantly inappropriate” to be intentional mistreatment. Greeno v. Daley, 414 F.3d
645, 654 (7th Cir. 2005). Pegues has not pointed to evidence that calls into question the
adequacy of the doctor’s care or treatment. See Pyles v. Fahim, 771 F.3d 403, 412 (7th Cir.
2014) (doctor not deliberately indifferent where tests and examinations were normal
and x-rays showed only “mild” spinal degeneration).
Nor does the evidence permit any inference that Kimmel treated him with
deliberate indifference. The basis of Pegues’s claim against her is unclear, but the record
does not contain evidence sufficient to allow a reasonable jury to find that she acted
with “reckless disregard” to his medical condition. Perez v. Fenoglio, 792 F.3d 768, 777
(7th Cir. 2015).
As for Pegues’s claim against Wexford, the company cannot be held liable under
§ 1983 unless it had a policy or custom that caused a constitutional violation, Shields
v. Ill. Dep't of Corr., 746 F.3d 782, 789 (7th Cir. 2014), and Pegues has not identified any
constitutional violation in his treatment, Petty v. City of Chicago, 754 F.3d 416, 424
(7th Cir. 2014).
As for Warden Duncan, the district court correctly granted summary judgment
in his favor. Pegues testified that he spoke with Duncan only once, on March 22, 2014,
and he provides no evidence that Duncan knew that his pain persisted. Non-medical
officials generally will be justified in believing that an inmate under medical
professionals’ care is in capable hands, Arnett v. Webster, 658 F.3d 742, 755 (7th Cir.
2011), so without evidence that Duncan knew that he was receiving inadequate medical
care, Pegues cannot succeed on a claim against him.

-- 4 of 5 --

No. 18-2066 Page 5
Finally, Pegues’s claims for injunctive relief under the ADA and the
Rehabilitation Act are now moot, given his release from custody in April 2018. Grayson
v. Schuler, 666 F.3d 450, 451 (7th Cir. 2012).
AFFIRMED

-- 5 of 5 --