Brenda Quinn , as administrator for the Estate of Travis Fredrickson v. Wexford Health Sources , Inc .

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 20-1483
BRENDA Q UINN , as administrator for the Estate of Travis
Fredrickson,
Plaintiff-Appellant,
v.
WEXFORD HEALTH S OURCES , I NC ., et al.,
Defendants-Appellees.
____________________
Appeal from the United States District Court for the
Southern District of Illinois.
No. 3:17-cv-00669-NJR — Nancy J. Rosenstengel, Chief Judge.
____________________
A RGUED J ANUARY 20, 2021 — DECIDED A UGUST 9, 2021
____________________
Before EASTERBROOK, WOOD, and BRENNAN , Circuit Judges.
WOOD, Circuit Judge. Travis Fredrickson was a troubled
person. Events not pertinent to this appeal landed him in Illi-
nois’s prison system, where he spent time at several institu-
tions. Throughout that time, he received services to manage
his serious mental-health problems, which included anxiety,
depression, and the effects of long-term drug dependence.
While in custody at the Pinckneyville Correctional Center

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2 No. 20-1483
(operated by the Illinois Department of Corrections, or
IDOC), he died by suicide.
Frederickson’s mother and representative, Brenda Quinn,
filed this lawsuit under 42 U.S.C. § 1983 for violations of her
son’s Eighth Amendment rights two years to the date after his
death. She alleges that several IDOC employees, of whom two
now remain, showed deliberate indifference to her son’s risk
of harm, and she accuses Wexford Health Sources, Inc., which
contracts with Illinois to provide health services in its prisons,
of failing to implement and follow procedures to ensure that
incarcerated persons receive continuous mental-health ser-
vices during transfers between IDOC facilities. The district
court granted the defendants’ motions for summary judg-
ment. We agree with its assessment of the record, and so we
affirm.
I
In the month that preceded Fredrickson’s death, IDOC
transferred him twice: first, from Shawnee Correctional Cen-
ter to Jacksonville Correctional Center; and then from Jack-
sonville to Pinckneyville Correctional Center. Quinn’s claims
stem from what happened (or did not) at every step of the
way, and the facts paint a sad picture.
Shawnee Correctional Center
Fredrickson did not express any mental-health concerns
when he arrived at Shawnee in December 2012. Mental-health
staff first learned of his mental-health risks when he at-
tempted death by suicide in February 2013. Shawnee placed
him on “crisis watch,” meaning that he was put in a special
cell and monitored at five, ten, 15, or 30-minute intervals, de-
pending on his mental state. While he was at Shawnee,

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No. 20-1483 3
Wexford psychiatrist Dr. Sayed Raza diagnosed him with ma-
jor depressive disorder. Today, such a finding would auto-
matically categorize Fredrickson as “seriously mentally ill,”
but at the time, prison health staff reserved the “serious” label
for incarcerated persons experiencing moments of crisis, de-
creased functioning, and increased need. Dr. Raza started
Fredrickson on a combination of anti-depressants and psy-
chotropic medications. Another Wexford employee, licensed
clinical social worker Amanda Smith, became Fredrickson’s
primary therapist. Over the course of Fredrickson’s counsel-
ing sessions, Smith and her supervisor, IDOC social worker
Katherine Hammersley, viewed Fredrickson as an active,
even model, participant in therapy sessions. Nonetheless,
these efforts were not enough to prevent Fredrickson’s return
to crisis watch at Shawnee in October 2014, after he expressed
suicidal ideation, hopelessness, anxiety, panic, and (as a side-
effect of drug abuse) an inability to cope. Dr. Raza, in consul-
tation with Hammersley, decided that Fredrickson would be
better served at a facility that could offer drug-treatment pro-
gramming and additional therapeutic attention for mood sta-
bilization.
At the same time the transfer was being discussed,
Fredrickson continued to struggle. Staff placed him on crisis
watch in February 2015, and again from May 27, 2015, to June
1, 2015 (from this point, all relevant events occur in 2015).
There was good news, too. IDOC accepted Fredrickson’s
transfer request and agreed to send him to Jacksonville Cor-
rectional Center on June 3. Jacksonville was closer to Fredrick-
son’s family, and it provided drug-treatment programs.
Fredrickson himself, as well as Shawnee’s staff, were hopeful
that he would be allowed eventually to participate in those
programs. Satisfied that Fredrickson was mentally stable and

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4 No. 20-1483
concerned with fulfilling his wish for drug treatment, Shaw-
nee’s mental health staff cleared him for the transfer to Jack-
sonville. Normally, staff would have scheduled a follow-up
appointment seven days after Fredrickson’s removal from cri-
sis watch, on June 8, but the timing of the transfer precluded
that. Alternatively, Fredrickson should have had a follow-up
appointment at Jacksonville, but that never happened either.
Jacksonville Correctional Center
Jacksonville received Fredrickson on June 3. With him
came his IDOC master file, medical records, and mental-
health records, including an “offender health status transfer
summary” that contained notes about his current medications
and his recent mental-health crisis. Concerned about
Fredrickson’s extensive mental-health needs and accompany-
ing records, Hammersley directly called the Jacksonville men-
tal-health team. She spoke briefly with two staff members, but
they were busy with direct service. She followed the call with
an email to two members of Jacksonville’s mental-health
team, including psychologist Dr. Francis Asama. In the email,
Hammersley noted Fredrickson’s history of addiction, anxi-
ety, depression, and diagnoses of major depressive disorder
and meth abuse disorder. She also discussed his status as
someone who was seriously mentally ill, noting his recent
stint under crisis watch; listed Fredrickson’s medications; and
invited the Jacksonville mental-health team to call her or
Smith for any further information. No one responded to Ham-
mersley’s email or otherwise reached out to Shawnee.
Dr. Asama conducted a mental health screening and an
evaluation of suicide potential that day. The doctor noted that
Fredrickson reported that he was experiencing feelings of
hopelessness or helplessness, depression, and anxiety. The

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No. 20-1483 5
notes do not mention any time spent on crisis watch, or
Fredrickson’s past attempts at death by suicide or suicidal
ideation. A different page of the same form, however, reflects
Fredrickson’s 2001 hospitalization for psychiatric treatment
for “att[empted] suicide.” Jacksonville staff provided no
screening summary; instead, they simply referred Fredrick-
son for services as a “routine mental health referral” and a
“psychiatric referral.” The evaluation of suicide potential in-
dicated that there were no contemporaneous reports that
Fredrickson was, or might be, at risk of death by suicide, but
it also failed to indicate previous attempts at death by suicide.
In conflict with Jacksonville’s own mental-health screening, it
also reported no indications of anxiety or depression.
There was an additional element that affected Fredrick-
son’s time at Jacksonville. Upon his arrival, he earned a disci-
plinary charge for carrying a “cuff key,” a homemade device
to remove handcuffs, in his boot. For this infraction, staff
placed him in disciplinary segregation. On June 8, Fredrick-
son wrote to his mother, Brenda Quinn, explaining his predic-
ament.
Well fuck, bad luck strikes again. … A homemade sew-
ing needle was hidden in the boots my cell[illegible]
gave me when my shoes got stolen. … They are fuck-
ing shipping me somewhere; probably way worse that
Shawnee. … I got 30 days … segregation. … [illegible]
here because of my mental problems and need for drug
treatment. I can’t express in words how important this
is other than life or death. Does God hate me? Why do
I always seem to get the worst possible outcome? Is my
time up? Are my chances in life all over. I’m beyond
hopelessness now, I’m trying not to be but WTF. Call

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6 No. 20-1483
the Warden, email also EVERDAY!! Please. I did not
do this, it was an accident and I fully cooperated and
told them the truth. I was told I would be able to stay
here if I told the truth and I did. I would have never
jeopardized it or took a risk. … I did not know ….
A correctional counselor saw Fredrickson in segregation
that day. She noted Fredrickson “said he was okay.” Despite
being assessed by a correctional counselor for visual signs of
distress (something normally done for mental-health patients
in segregation), Fredrickson never received counseling at
Jacksonville. Also, as we noted earlier, he did not receive the
post-crisis-watch follow-up appointment he should have had
on June 8.
Licensed clinical social worker Debbie Webb observed
Fredrickson on June 9. She reported that he was “reading on
his bunk [and] stated he was ‘ok’.” But on June 10, Fredrick-
son was found guilty of a reduced disciplinary charge for the
contraband in his boot, which turned out to be a broken,
sharpened pair of toenail clippers. He sent another letter to
his mother that day.
Well I have wrote the warden and spoke to him in per-
son. It does not look good. I really need your support
in changing his mind. … If all fails, I know it’s a lot to
ask, but call the headquarters is springfield and see if
they will send me to Big Muddy River prison in Ina.
They are a disciplinary prison and the have drug treat-
ment. I feel like I’m living in a living Hell. Most likely
I’ll be shipped back to Shawnee, but Picknyville will be
the runner up, which is way worse than Shawnee. I’m
so upset. I cant even get mad or cry. In Picknyville, you
only get 2 showers a week, only out 1 hour a day. I

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No. 20-1483 7
should have just stayed a Shawnee! For once in my life
Im not fucking up and karma from my past is killing
me. Imma try to do my best. Suck it up, and hopefully
come home someday. I think the anti-phsychotic med-
icine is helping. … What a turnaround. I didn’t even
make it one foot in the door, and Im going to Real Real
Prison. I’m not mentally equipped nor physically
equipped for a place like that. I really really need
EVERY-ONE’S HELP, as many people you can think
of to help me get them to change their mind or ship me
somewhere w/ drug treatment.
In the margins of his letter, Fredrickson inserted the words
“Transfer Coordinator,” indicating exactly who he thought
his mother should speak with at IDOC headquarters. He also
included a note to “call Amanda Smith Mental Health of
Shawnee and see if she can help!”
Webb saw Fredrickson again on June 12 and completed a
mental-health evaluation. The eleven-page document was
thorough; it recorded Fredrickson’s history with addiction,
drug treatment, depression, suicidal ideation, and past at-
tempts at suicide, as well as his most recent period of crisis
watch, his 2001 psychiatric hospitalization, his past and cur-
rent medications, and information about his family. Fredrick-
son also reported feelings of depression and hopelessness. In
the summary section of the evaluation, Webb included narra-
tive observations.
The offender is a recent transfer from Shawnee CC. He
is currently in segregation for having a homemade nee-
dle in boot. “They say it is a handcuff key.” He is on
the list to be transferred. He repeats being depressed
most of his life. He states he feels helpless and

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8 No. 20-1483
hopeless. He states he will have times of increased de-
pression. During these times he will be depressed most
of the day, have low energy and will sleep most of the
time. He has difficulty thinking & concentrating. He
has been diagnosed with Major Depressive Disorder
and [illegible]. He has been in drug treatment several
times. His incarcerations are related to drug use. He
states he [illegible] never tried to hurt himself, but was
[illegible] … suicidal ideations. He reports he was hav-
ing withdrawal and did not have [illegible] detox. …
He does not have [illegible] good coping skills for
stress & gets overwhelmed easily.
Webb concluded that Fredrickson was suited for a general
outpatient housing unit rather than crisis watch. On June 13,
a Jacksonville nurse completed another offender health status
transfer summary. She noted Fredrickson’s medications, anx-
iety, history of substance abuse, and attempts at death by su-
icide albeit without providing any date for the latter occur-
rence, despite a prompt for that information. When asked
about Fredrickson’s “current treatments,” the nurse re-
sponded “None.” Two days later, on June 15, a correctional
officer reported seeing Fredrickson during segregation
rounds. Once again, “[Fredrickson] said he was ok.” Webb
observed Fredrickson on June 16. She recorded his dislike for
being “locked up so much” and his desire “to have more
movement,” but she ultimately found no action required.
That same day, Quinn fulfilled Fredrickson’s request, pen-
ning letters to Jacksonville’s then-warden Marvin Reed and
Amanda Smith at Shawnee.
In her letter to “Mr. Reed”, Quinn pleaded for her son. She
explained that Fredrickson’s shoes had been stolen at

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No. 20-1483 9
Shawnee. He was unable to purchase more while “confined
to the health care ward” before his transfer (presumably a ref-
erence to his period of crisis watch just before his transfer
from Shawnee to Jacksonville), and so he borrowed shoes that
his cellmate gave him. She added that Fredrickson “has been
working for this transfer for over a year[,]” doing “everything
his counselor and the doctors at Shawnee Correctional asked
him to do” because he was in “dire need of counseling and a
drug program.” She asked the Warden to contact Amanda
Smith and closed with a final appeal:
Please believe his story. I am asking that you please
give him a chance to stay at Jacksonville where he will
get the medical and mental help he needs to have to
eventually become a productive member of society,
find a job, and raise a family once released.
On June 17, Quinn sent a fax to Amanda Smith; it con-
tained Fredrickson’s two letters, Quinn’s letter to Smith, and
Quinn’s letter to Mr. Reed. Quinn’s letter to Smith begged her
to read Fredrickson’s letters and contact Jacksonville. Upon
receipt of the fax, Smith and Hammersley discussed Fredrick-
son’s situation. They found it “very strange” that Fredrickson
would do anything that might jeopardize his chances of stay-
ing at Jacksonville given how hard he had worked to get there
and how hard they had worked to get him there. Hammersley
felt “worried” and “concerned” for his wellbeing and viewed
the letters as obvious signs of distress and anxiety. But when
asked about her initial impressions of Fredrickson’s letters af-
ter the initiation of this lawsuit, she recalled that she did not
think Fredrickson was at risk of hurting himself.
Smith and Hammersley took the fax to Shawnee’s Assis-
tant Warden, Camille Etienne, to determine if there was

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10 No. 20-1483
anything they could do on behalf of Fredrickson. Because
Fredrickson was no longer at Shawnee, Etienne responded
that there was nothing for them to do and suggested that
Quinn contact Jacksonville directly. Neither Smith nor Ham-
mersley responded to Quinn’s fax. In any event, Jacksonville
decided not to keep Frederickson; it transferred him to Pinck-
neyville Correctional Center the day that Shawnee received
Quinn’s fax, unbeknownst to Shawnee’s staff or Quinn.
Pinckneyville Correctional Center
Fredrickson was transferred directly from segregation
housing at Jacksonville to segregation housing at Pinckney-
ville. Nancy Knope, a Wexford licensed practical nurse, con-
ducted an intake interview upon his arrival. She recorded that
Frederickson’s medications should be continued as ordered.
The following day a different mental-health professional
completed a new evaluation of suicide potential. She found
that there were no present reports of a risk of suicide and doc-
umented Fredrickson’s past attempts at death by suicide. For
follow-up, she recommended adding Fredrickson to the men-
tal-health caseload and noted that he is “on meds.” During
mental-health segregation rounds on June 21, another mental-
health professional observed Fredrickson “sitting on bunk
reading a book” and wrote that Fredrickson “report[ed] no
issues or concerns.” A correctional counselor checked on him
again on June 23 and reported no issues. His medical records
reflect, and Quinn acknowledges, that Fredrickson received
his medications without any interruption across the three
IDOC facilities.
On June 26, mental-health staff placed Fredrickson’s cell-
mate, John Cain, on crisis watch in a “naked cell,” leaving
Fredrickson in his cell alone. Cain later revealed that he and

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No. 20-1483 11
Fredrickson had devised a plan for each of them to get a single
cell. The plan required Fredrickson to write a request slip on
Cain’s behalf. Cain did not know that Fredrickson fabricated
the slip, writing that Cain was hearing voices. With well over
fifty percent of Pinckneyville’s population on the mental-
health caseload and a completed death by suicide in the same
housing unit one week earlier, staff removed Cain swiftly.
Correctional Officer Alexander Rodman was on duty that
evening between 3:00 p.m. and 11:00 p.m. Rodman completed
rounds of the segregation unit every thirty minutes and con-
ducted a “final wing check” at 10:30 p.m. At the end of Rod-
man’s shift, Correctional Officer Frederico Fernandez re-
placed him for the 11:00 p.m. to 7:00 a.m. shift. At approxi-
mately 12:04 a.m. on June 27, Fernandez found Fredrickson
unresponsive as a result of an apparent suicide by hanging.
As part of its investigation into the circumstances sur-
rounding Fredrickson’s death, IDOC interviewed a number
of men housed on Fredrickson’s housing wing. Michael Wil-
liams had a cell near Fredrickson’s and told investigators that
he heard Fredrickson kicking the cell door and asking for help
around midnight on June 27. Williams recalled hearing other
men in the unit taunt Fredrickson to go ahead and take his
own life. Williams also recalled seeing Fredrickson tie bed-
sheets together. Jody Lagresse heard Fredrickson kicking on
the cell door calling out for “C.O.” and confirmed that he also
heard the taunts. Willie White, for his part, overheard some-
one having a conversation with staff about having suicidal
ideation at the 10:00 p.m. wing check. Rodman, who had par-
ticipated in annual mental-health training sessions as part of
his employment, reported that he never heard Fredrickson

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12 No. 20-1483
make any remarks indicating that he was in any sort of dis-
tress or needed help.
In her complaint, Quinn alleged that Wexford’s policies
resulted in its failures to provide continuity of care during
transfers between IDOC facilities. Quinn also accused Wex-
ford and the state of Illinois of having an unwritten agreement
knowingly to provide substandard medical care to IDOC’s
population. Quinn further argued that individual IDOC and
Wexford employees, including Dr. Raza, Nancy Knope, Kris-
tin Hammersley, Correctional Officers Rodman and Fernan-
dez, and two other Wexford employees who came into con-
tact with Fredrickson, showed deliberate indifference to
Fredrickson’s medical needs. This, Quinn asserted, led to his
mental anguish and loss of life.
The district court granted defendants’ motions for sum-
mary judgment on all claims. On appeal, Quinn has narrowed
her arguments significantly. She appeals only the district
court’s judgment rejecting her claims of deliberate indiffer-
ence against individual defendants Hammersley and Rod-
man and against Wexford for failing to provide continuity of
care during the transfers between IDOC facilities, all in viola-
tion of the Eighth Amendment.
II
We consider a district court’s grant of summary judgment
de novo, construing all facts and inferences in the light most
favorable to Quinn as the nonmoving party. Figgs v. Dawson,
829 F.3d 895, 902 (7th Cir. 2016). Summary judgment is proper
“if the movant shows that there is no genuine dispute as to
any material fact and the movant is entitled to judgment as a

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No. 20-1483 13
matter of law.” Jajeh v. County of Cook, 678 F.3d 560, 566 (7th
Cir. 2012); F ED. R. C IV. P. 56(a).
A. Individual Defendants Hammersley and Rodman
We begin with Quinn’s claims against the remaining two
individual defendants—social worker Kristin Hammersley
and Correctional Officer Alexander Rodman. To survive sum-
mary judgment, Quinn had to present evidence from which a
reasonable jury could find that one or both of them exhibited
deliberate indifference to Fredrickson’s mental health risks.
As the Supreme Court put it in Farmer v. Brennan, 511 U.S. 825
(1994):
[A] prison official cannot be found liable under
the Eighth Amendment for denying an inmate hu-
mane conditions of confinement unless the official
knows of and disregards an excessive risk to inmate
health or safety; the official must both be aware of facts
from which the inference could be drawn that a sub-
stantial risk of serious harm exists, and he must also
draw the inference.
Id. at 837. In other words, there is both an objective and a sub-
jective component to the claim, each of which must be satis-
fied. See Collins v. Seeman, 462 F.3d 757, 760 (7th Cir. 2006).
The objective element is not disputed here: the imminent risk
of death by suicide is not something that might be objectively
reasonable, in contrast to the use of force to quell a riot, see
Whitley v. Albers, 475 U.S. 312 (1986). The risk of suicide is a
grave one, “not one that today’s society chooses to tolerate.”
Helling v. McKinney, 509 U.S. 25, 36 (1993); see also Minix v.
Canarecci, 597 F.3d 824, 831 (7th Cir. 2010).

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14 No. 20-1483
We therefore focus on the subjective element. For that part
of her case, Quinn must present evidence that would permit
a trier of fact to find that the individual defendant in question
“(1) subjectively knew the prisoner was at substantial risk of
[death by] suicide and (2) intentionally disregarded the risk.”
Collins, 462 F.3d at 761. It is not enough to show that prison
officials “should have been aware” of the risk. Id. (emphasis in
the original). A defendant is not liable where she was “not
alerted to the likelihood” of the risk of death by suicide. Id.
Viewing this record sympathetically to Quinn, it is possi-
ble to view certain decisions made by IDOC and Wexford em-
ployees as poor, even negligent. The focus of Shawnee’s med-
ical staff on Fredrickson’s desire to have drug treatment may
have led them prematurely to release him from crisis watch
and transfer him to Jacksonville, and thereby to disregard his
fragile mental state and the level of support that had helped
him cope in past moments of crisis. Similarly, by failing to re-
spond to Hammersley’s email and phone call, Jacksonville
staff may have allowed Fredrickson’s unreliable statements
about his own mental-health history to have an outsized in-
fluence upon his entry into Jacksonville. Documentation and
record keeping also may have been sloppy. That in turn may
explain why Fredrickson did not have a follow-up appoint-
ment at Jacksonville on June 8, seven days after he left crisis
watch at Shawnee.
But the bar for the defendants is low. In order to defeat a
summary-judgment motion in an Eighth Amendment case,
Quinn must show that the defendants exhibited “more than
mere or gross negligence, but less than purposeful infliction
of harm.” Lisle v. Welborn, 933 F.3d 705, 717 (7th Cir. 2019)
(quotation omitted). Quinn has failed to meet that standard.

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No. 20-1483 15
We first look at her claim against Hammersley. Quinn ar-
gues that Hammersley exhibited deliberate indifference to-
ward Fredrickson’s serious mental illness when she failed to
contact appropriate medical staff or respond to Quinn after
reading Fredrickson’s June 8 and June 10 letters. Quinn rea-
sons that the letters, along with Hammersley’s professional
training and her personal experience treating Fredrickson, es-
tablish the subjective-knowledge element of the claim.
We can assume that Hammersley realized that Fredrick-
son was not doing well when she read the two letters to his
mother. Indeed, she said so. Hammersley also testified that
Shawnee’s staff had helped Fredrickson develop tools to ex-
press his emotions. Hammersley viewed Fredrickson’s June 8
discussions of karma and whether God hates him less as indi-
cators of a risk of self-harm and more as his way to articulate
anger, sadness, and a desire for advocacy. Fredrickson’s June
10 letter talked about the efficacy of his medications, his goal
to do his best despite his feelings of hopelessness, and his ex-
pectation to come home one day. Hammersley observed that
Fredrickson was looking to the future, a “good sign.” Subjec-
tively, therefore, she did not think that Fredrickson was at risk
of death by suicide.
Quinn analogizes Hammersley’s actions to those of the de-
fendant in Mathison v. Moats, 812 F.3d 594 (7th Cir. 2016), but
that situation was a far cry from Frederickson’s. In Mathison,
the defendant had a heart attack while incarcerated and
alerted a guard immediately. The guard summoned his lieu-
tenant, who called a nurse. The nurse told the lieutenant that
Mathison’s condition was not an emergency and instructed
Mathison to go to the infirmary the following day. Id. at 596.
We found that the nurse and lieutenant both displayed

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16 No. 20-1483
deliberate indifference and reversed the district court’s grant
of summary judgment. Id. at 598–99.
Hammersley, in contrast, had no responsibility for
Fredrickson’s mental-health care after his departure from
Shawnee nor did she have any up-to-date information about
his status at Jacksonville. The fact that she voluntarily dis-
cussed possible next steps with her assistant warden does not
change things. Furthermore, unlike the obvious crisis in
Mathison, there was no objective sign in Fredrickson’s letters
or elsewhere indicating the need for immediate intervention.
Quinn fares no better with her claim against Rodman. She
asserts that summary judgment was wrong because the par-
ties dispute whether Fredrickson sought mental-health ser-
vices from Rodman. Rodman was trained to know what to do
when someone is experiencing a mental-health crisis. Alt-
hough he was not regularly told whether an incarcerated per-
son was receiving mental-health services, he testified that any
time someone reported a mental-health crisis, he would doc-
ument that fact by filling out a mental-health referral and an
incident report.
The problem is that Rodman had not interacted with
Fredrickson before the night of his death. He reported that
their first interaction occurred during his 10:00 p.m. check of
the segregation unit. At that time, Rodman said, Fredrickson
was alive. The dispute is over whether Frederickson later
asked Rodman to help him. Rodman testified that Frederick-
son never did so, through his final wing check at 10:30 p.m.
Quinn sees a dispute of material fact with respect to the
alleged request. She points out that inmates Michael Wil-
liams, Jody Lagresse, and Willie White reported that

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No. 20-1483 17
Fredrickson desperately called out for mental-health services
just before his death. Viewing the evidence in the light most
favorable to Fredrickson, the testimony shows that Fredrick-
son was banging on his cell door to the point of annoying
other men in his housing unit. Rodman was on duty at the
time. But that is as far as the record can take us. We have no
evidence that Rodman heard or could have heard Fredrick-
son’s pleas, the banging, or the responses from other men. Too
many questions remain to establish a factual dispute. What
time did Fredrickson request help? Was Rodman in the hous-
ing unit to hear the request? How large is the housing unit?
What other housing units did Rodman monitor that night?
Could Rodman hear the segregation wing when he was sur-
veying a different housing unit?
At oral argument, we asked whether any evidence existed
in the record to answer these questions. Plaintiff’s counsel
said no and tried to shift the consequences of that gap to the
defendants. But this was not an issue on which the defendants
bore the burden of proof, and thus they did not have an obli-
gation to submit such evidence. We are a little surprised that
this question even arose, as the respective burdens of the par-
ties have been well established since the Supreme Court’s de-
cision in Celotex Corp. v. Catrett, 477 U.S. 317 (1986). “A party
seeking summary judgment always bears the initial responsi-
bility of informing the district court of the basis for its motion,
and identifying those portions of [the record] … which it be-
lieves demonstrate the absence of a genuine issue of material
fact.” Id. at 323. Pertinent here, the Court found “no express
or implied requirement in Rule 56 that the moving party sup-
port its motion with affidavits or other similar materials ne-
gating the opponent’s claim.” Id. (emphasis in the original).
That settles this point.

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18 No. 20-1483
B. Wexford
Quinn also seeks to hold Wexford responsible for Freder-
ickson’s death. See Monell v. New York City Dep't of Soc. Servs.,
436 U.S. 658 (1978) (municipality liability); Glisson v. Indiana
Dep’t of Corrections, 849 F.3d 372, 378–79 (7th Cir. 2017) (pri-
vate corporate liability for those providing essential public
services). In order to move ahead on this part of the case,
Quinn must prove that Wexford’s official policy, or an estab-
lished custom, or a decision by a final decision maker, caused
the alleged constitutional violation. Often the lack of liability
on the part of the subordinate actors means that there is noth-
ing unlawful for which the entity might be liable, but that is
not always the case. “[I]f institutional policies are themselves
deliberately indifferent to the quality of care provided, insti-
tutional liability is possible.” Glisson, 849 F.3d at 379. Plaintiffs
can make this showing in a number of ways, including by
demonstrating that “pervasive systemic deficiencies … were
the moving force behind” an injury. Dixon v. County of Cook,
819 F.3d 343, 349 (7th Cir. 2016). Quinn has not pointed to any
such institutional policy.
In support of her argument, Quinn relies on deposition
testimony from several Wexford employees: Dr. Roderick
Matticks (Wexford’s Lead Regional Medical Director for Illi-
nois) and Amanda Smith (Wexford employee and Fredrick-
son’s primary therapist at Shawnee); Hammersley (Smith’s
supervisor at Shawnee and an IDOC employee); and plain-
tiff’s expert Dr. Kathryn Burns. According to Dr. Matticks,
while Wexford expects transferring and receiving IDOC facil-
ities to communicate with each other for purposes of continu-
ity of care, he could not recall a specific written policy to that
effect. Quinn argues that a jury could find that there was no

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No. 20-1483 19
such policy, and that its absence accounts for the missing, mis-
leading, and inconsistent information in Fredrickson’s mental
health records. Those gaps in turn resulted in the failure of
the Jacksonville staff to conduct the follow-up appointment
Frederickson should have had seven days after leaving crisis
watch at Shawnee. Quinn also ties the lack of any written pol-
icy to Hammersley and Smith’s inability to chart or communi-
cate their concerns for Fredrickson’s well-being after he was
unexpectedly placed in segregation upon his arrival to Jack-
sonville and after receiving Quinn’s June 17 fax.
No doubt, the Wexford employees could have done more
to ensure better continuity of care for Frederickson, as he
transferred across three facilities. But Quinn has not pointed
to evidence sufficient to allow a trier of fact to find “systemic
and gross deficiencies” in Wexford’s procedures or lack
thereof. Dixon, 819 F.3d at 348. This is a difficult task when
allegations stem from the experiences of one person. See
Grievson v. Anderson, 538 F.3d 763, 774 (7th Cir. 2008). Quinn’s
argument ignores the fact that IDOC had protocols for intra-
system transfers (a fact of which Fredrickson was aware, as
reflected in his June 10 letter). She also fails to point to more
than individual statements made by subordinate employees
from both Wexford and IDOC based on their review of
Fredrickson’s mental-health records. Wexford is responsible
for the mental-health needs of IDOC’s incarcerated popula-
tion, but IDOC is responsible for transfers. Dr. Matticks testi-
fied that Wexford “defaults to IDOC policies and procedures
when it comes to … intrasystem transfers.”
IDOC policy mandates that transferring and receiving fa-
cilities write down offender health-status transfer summaries,
evaluations of suicide potential, mental-health screenings,

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20 No. 20-1483
mental-health evaluations, and nurse-intake interviews. They
also require transferring facilities to send sealed medical rec-
ords to the receiving facility. Shawnee, Jacksonville, and
Pinckneyville were responsible for different parts of that
form, and they did their job. Fredrickson received an evalua-
tion of suicide potential and a mental-health screening on
June 3, upon his arrival to Jacksonville, and on June 18 Pinck-
neyville staff conducted another evaluation of suicide poten-
tial.
Hammersley noted that IDOC requires the completion of
a mental-health evaluation within 14 days of when a trans-
feree is referred for mental-health services. Licensed social
worker Debbie Webb completed the 11-page form on June 12,
nine days after Fredrickson’s arrival to Jacksonville. Nurse
Nancy Knope completed the nurse-intake interview when
Fredrickson arrived at Pinckneyville on June 17, and she re-
ferred him to mental-health services. IDOC also requires men-
tal-health staff to conduct segregation rounds at least every
seven days as a wellness check. Jacksonville staff did so, view-
ing Fredrickson during segregation rounds on June 9 and
June 16. At Pinckneyville, staff saw him in segregation on
June 21 and were due in the wing again on June 27. Even
though those checks were not themselves mental-health treat-
ment, they provided the necessary first step of identifying
need. Though Dr. Matticks is unable to point to Wexford’s
written policies concerning IDOC intra-system transfers, the
record establishes that IDOC has written policies that were
followed, albeit imperfectly.
III
The fact that Quinn was not able to put together a case
that, if believed by a trier of fact, would have shown an Eighth

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No. 20-1483 21
Amendment violation against one or more of the defendants
in no way minimizes her personal loss. But if there is a legal
theory here, it must lie in another area of law. Mental health
is notoriously difficult to assess and treat, and unfortunately
the relevant staff did not appreciate how dire Frederickson’s
crisis was. Quinn has not pointed to sufficient evidence on
which a reasonable jury could tie either individual defendants
Hammersley or Rodman, or institutional defendant Wexford,
to Fredrickson’s death. In light of these conclusions, we have
no need to reach the question whether the individual defend-
ants had qualified immunity.
We A FFIRM the judgment of the district court.

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