Ryan K. Mathison v. Scott Moats

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 14‐3549
R YAN K. MATHISON,
Plaintiff‐Appellant,
v.
S COTT MOATS , et al.,
Defendants‐Appellees.
____________________
Appeal from the United States District Court for the
Central District of Illinois.
No. 12 C 1319 — Joe Billy McDade, Judge.
____________________
S UBMITTED J ANUARY 19, 2016— D ECIDED FEBRUARY 8, 2016
____________________
Before P OSNER , EASTERBROOK , and SYKES , Circuit Judges.
P OSNER , Circuit Judge. Ryan Mathison, an inmate at the
Federal Correctional Institution in Pekin, Illinois, brought
this Bivens suit against members of the prison staff and now
appeals from the district court’s grant of summary judgment
in favor of the defendants.
At 3 a.m. one morning Mathison, who suffers from
chronic high blood pressure, was awakened by excruciating

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2 No. 14‐3549
pain in his chest and left arm and other symptoms of a heart
attack. He summoned a guard (defendant Wickman), to
whom he explained his symptoms. The guard immediately
summoned the supervising lieutenant (defendant Omelson),
who in turn called the nurse on call (defendant Wall), who
told the lieutenant that Mathison’s condition was not an
emergency. Having decided there was no emergency, Wall
instructed Mathison (via Omelson) to go to the infirmary in
the morning. Mathison went at 6:45 a.m.—almost four hours
after he had suffered what was indeed a heart attack. The
lieutenant had deferred to Wall’s decision that there was no
emergency.
Upon Mathison’s arrival at the prison infirmary, howev‐
er, the medical staff realized he had a serious problem, and
after giving him tests and some drugs had him transported
by ambulance to the nearest hospital emergency room,
which was in Pekin but didn’t have the necessary equipment
or expertise to treat a serious heart attack and so had him
taken immediately to a Peoria hospital to receive advanced
cardiac care. There he received a stent placement and was
diagnosed with a heart attack. He remained in the hospital
for two days and then was returned to the prison.
His suit is against the guard he first summoned, the su‐
pervising lieutenant, the nurse on call, and the doctor who
treated him in the prison infirmary. He charges them with
deliberate indifference to a serious medical condition, the
indifference consisting both of confining him to his cell for
almost four hours after he awoke with severe pain and
spoke to the guard on duty, and of not treating him in the
infirmary until 8 a.m.—five hours after the onset of his heart
attack. (He also sued the United States, under the Federal

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No. 14‐3549 3
Tort Claims Act, but he has not appealed from the district
judge’s dismissal of his FTCA claim.)
Defendant Moats, the prison doctor, declared in discov‐
ery that the delay in treating Mathison’s heart attack had not
caused damage to his heart. But he based this opinion main‐
ly on what he’d been told by a doctor at the Peoria hospital,
rather than on medical records.
Blood contains an enzyme called troponin; an elevated
level of troponin signifies damage to the heart muscle. There
are several tests for determining the level of troponin in a
person’s blood. See, e.g., Vinay S. Mahajan & Petr Jarolim,
“How to Interpret Elevated Cardiac Troponin Levels,” 124
Circulation 2350 (2011). The range in a healthy person, ac‐
cording to the test that was used to measure the level of tro‐
ponin in blood drawn from the plaintiff in the emergency
room at the Pekin hospital the morning he arrived, is zero to
.07 ng/ml (nanograms per milliliter). The plaintiff’s blood
was found to contain .32 ng/ml of troponin that morning,
which 9 hours later peaked at 33.8 ng/ml and about 9 hours
after that dropped to 18.9 ng/ml.
In granting summary judgment in favor of the defend‐
ants, the judge remarked that as a prisoner Mathison was
entitled only to “minimal care,” as distinct from the medical
care “he would receive if he were a free person, let alone an
affluent free person.” That may be true in general, but not in
life and death situations. A prison inmate has a right to re‐
ceive prompt medical treatment of a heart attack. Williams v.
Leifer, 491 F.3d 710, 716 (7th Cir. 2007). Yet against the evi‐
dence that the normal range of troponin in a healthy heart
does not exceed .07 ng/ml, the judge relied on Dr. Moats’s

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4 No. 14‐3549
unsupported opinion that a level of .32 ng/ml is within the
normal range.
Moats had made no effort through tests or an examina‐
tion to determine whether Mathison’s heart attack, exacer‐
bated by the delay in treating it, had caused significant heart
damage. That was excusable, however, because Moats is not
a cardiologist—that is why an ambulance should have been
summoned by Lieutenant Omelson given her suspicion that
Mathison indeed was having a heart attack, and she doubt‐
less would have summoned one had Wall advised her to do
so when Mathison first complained of excruciating pain in
his chest and left arm. But the fact that Moats is not a cardi‐
ologist is also a reason why the judge should not have cred‐
ited his testimony that Mathison’s troponin level was within
the normal range. Cf. Rowe v. Gibson, 798 F.3d 622, 627 (7th
Cir. 2015). And a further reason was that the .32 ng/ml tro‐
ponin level was discovered in a test conducted six hours af‐
ter the heart attack, though the level peaks on average 24
hours after the first symptoms of a heart attack. E.g., Brian P.
Shapiro, et al., “Cardiac Biomarkers,” Mayo Clinic Cardiology
773, 774 (2007).
The defendants’ lawyer thus was not justified in holding
out Moats as an expert on cardiology and during discovery
submitting an “expert report” by him stating that Mathison
had suffered no damage to his heart. Moats was not quali‐
fied to offer such an opinion as evidence—and a medical re‐
port from a nurse practitioner who examined Mathison de‐
termined his troponin level to have been 18 ng/ml after the
heart attack, contradicting Moats’s statement that there
could not have been damage to Mathison’s heart because he
hadn’t had an elevated level of troponin.

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No. 14‐3549 5
As for the five hours during which (the defendants do
not deny) Mathison experienced excruciating pain while
awaiting treatment—pain that could have been alleviated by
giving him oxygen, aspirin, and nitroglycerin (for his pain
was quickly alleviated when Dr. Moats gave him those palli‐
atives)—the judge ruled as a matter of law that the failure of
treatment could not be evidence of deliberate indifference to
a serious medical condition. The ruling had no basis in law
or medicine. Delay in treating a heart attack “is a strong pre‐
dictor for short‐term survival rate and a surrogate for the
amount of damaged myocardial [heart] tissue.” Jerry Avorn,
et al., “Therapeutic Delay and Reduced Functional Status Six
Months After Thrombolysis for Acute Myocardial Infrac‐
tion,” 94 Am. J. Cardiology 415, 419 (2004). We held in Wil‐
liams v. Leifer, supra, that a six‐hour delay in administering
nitroglycerin to treat an inmateʹs severe chest pain could
create liability for deliberate indifference to an acute medical
need.
Although the prison’s treatment of Mathison’s heart at‐
tack was incompetent, the guard whom Mathison sum‐
moned to his cell when the attack began (defendant Wick‐
man) can’t be thought to have exhibited deliberate indiffer‐
ence to Mathison’s condition. For he immediately notified
his superior, the supervisory lieutenant, as protocol re‐
quired; he had no medical training that would have enabled
him to do more for Mathison. Dr. Moats, though he should
not have been allowed to testify as an expert witness, cannot
be thought to have exhibited deliberate indifference to
Mathison’s plight either. He was not made aware of
Mathison’s condition until 8 a.m., and proceeded to give him
emergency treatment and promptly summoned an ambu‐
lance to take him to the nearest hospital emergency room.

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6 No. 14‐3549
That leaves the supervisory lieutenant (Omelson) and the
nurse (Wall). Wickman, the guard, had summoned Omelson
to Mathison’s cell when Mathison first alerted the guard to
the excruciating pain in his chest and arm, and she talked to
Mathison (without entering the cell) and told him it sounded
as if he were having a heart attack. She then spent 20
minutes trying unsuccessfully to reach Nurse Wall. A heart
attack is a life‐endangering event, and Omelson had the au‐
thority to call 911 and summon an ambulance. She’d inferred
from talking to Mathison that he was having a heart attack
(“I do believe you’re having a heart attack”), and that infer‐
ence was a sufficient basis for making such a call given the
difficulty she was having locating Wall. But if in doubt as to
what to do, she should one imagines have called a doctor or
a hospital emergency room for advice. Her failure to make
such a call left Mathison in agony for almost five more
hours. Cf. Farmer v. Brennan, 511 U.S. 825, 842 (1994); Cava‐
lieri v. Shepard, 321 F.3d 616, 622 (7th Cir. 2003).
Wall claims to have concluded from Omelson’s report
(when Omelson finally reached him in the course of the
night) of Mathison’s symptoms that Mathison was not hav‐
ing a heart attack, even though Omelson told him that
Mathison was experiencing acute pain in his chest and his
left arm, which are classic symptoms of a heart attack. Wall
could have told Omelson to call 911, or called Moats himself,
but instead he relied on impressions that he gleaned from
Omelson, who was not medically trained and who had
learned of Mathison’s symptoms only from talking to
Mathison from outside his cell. Wall’s behavior was thor‐
oughly unprofessional—especially since, unlike Omelson, he
was aware of Mathison’s medical history, which included
the fact that he was in the prison’s chronic care program for

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No. 14‐3549 7
treatment of his chronic high blood pressure, a condition
that creates an increased risk of a heart attack. See William B.
Kannel, ʺCoronary Risk Factors: An Overview,ʺ Cardiovascu‐
lar Medicine 1809, 1815–17 (1995).
There is more. Wall testified that after Omelson told him
that Mathison was experiencing acute chest and arm pain, he
asked Omelson some unspecified questions. Whether a
nurse could accurately diagnose a heart attack on the basis
of a second‐hand account by a person with no medical train‐
ing may be doubted, but in any event Wall has not explained
what questions he asked; nor did he instruct Omelson to
gather more information to help him ascertain whether
Mathison needed immediate treatment. And just as with re‐
gard to Omelson, a professionally responsible reaction by
Wall to Mathison’s plight would have imposed no cost or
risk on Wall. Cf. Gayton v. McCoy, 593 F.3d 610, 623 (7th Cir.
2010); Sain v. Wood, 512 F.3d 886, 894–95 (7th Cir. 2008).
And when Mathison arrived at the infirmary Nurse Wall
remarked that he must be the inmate having the heart attack.
This implies that Wall had concluded from talking with
Lieutenant Omelson during the night that Mathison was hav‐
ing a heart attack. Yet Wall had nevertheless chosen to do
nothing—further evidence of deliberate indifference.
The district judge said that Omelson’s and Wall’s inac‐
tion had not “denied Plaintiff the minimal civilized measure
of life’s necessities.” We think that civilization requires more
in a life and death situation, and are left to wonder what the
judge thinks the minimum level of care is to which a prison‐
er who is suffering a heart attack is entitled.

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8 No. 14‐3549
We affirm the dismissal of the claims against Wickman
and Moats, but reverse the dismissal of the claims against
the other two defendants and remand the case for further
proceedings consistent with this opinion.
A FFIRMED IN P ART , R EVERSED IN P ART , AND R EMANDED

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