Yates, Michael v. Hoffman, Karl et al

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
MICHAEL YATES,
Plaintiff, 	OPINION AND ORDER
v.
22-cv-472-wmc
DR. KARL HOFFMAN,
ROSLYN HUNEKE, and
DR. DANIEL LAVOIE,
Defendants.
Representing himself, plaintiff Michael Yates filed a civil rights complaint under 42
U.S.C. § 1983, claiming that the defendants denied him adequate and timely medical care
for chronic lower back pain during his incarceration by the Wisconsin Department of
Corrections (“DOC”). The court granted Yates leave to proceed with Eighth Amendment
claims against these defendants. Specifically, the court granted Yates leave to proceed with
claims that Dr. Karl Hoffman and Health Services Manager (“HSM”) Roslyn Huneke took
no meaningful steps over eight months to soothe his chronic pain or ensure a prompt
diagnosis or treatment. (Dkt. #5, at 3-4.) The court also granted Yates leave to proceed
with his claim that Dr. Daniel LaVoie unreasonably delayed approval of an authorization
request for a steroid injection for 40 days. 	(Dkt. #22.) 	Pending before the court is the
defendants’ motion for summary judgment on the grounds that: (1) Yates has not met his
burden of proof to show his medical care was constitutionally inadequate; and (2)
alternatively, defendants are entitled to qualified immunity. (Dkt. #61.) For the reasons
explained below, defendants’ motion will be granted.
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UNDISPUTED FACTS 1
Plaintiff Michael Yates is currently incarcerated at Jackson Correctional Institution.
At all times relevant to the complaint, however, he was incarcerated at the New Lisbon
Correctional 	Institution 	(“NLCI”), 	where 	defendants 	Hoffman 	and 	Huneke 	were
employed. 	As the HSM and a registered nurse, Huneke provided administrative support
and direction for the NLCI Health Services Unit (“HSU”). 	However, because her position
was mainly administrative, she typically did not provide medical care to inmates, which
was instead the responsibility of other HSU nursing staff and advanced care providers
(“ACPs”), such as Dr. Hoffman. 	As for defendant LaVoie, he was then the Associate
Medical Director for the DOC Bureau of Health Services, and supervised physicians who
worked in DOC facilities, but did not provide medical care directly to inmates during the
period relevant to plaintiff’s complaint.
In January 2019, Dr. Hoffman responded to Yates’ general complaints of back pain
by prescribing acetaminophen, 650 mg up to four times a day, as a “Keep on Person” or
“KOP” 	medication, 	meaning 	that 	Yates 	could 	keep 	this 	medication 	in 	his 	cell.
1 Unless otherwise noted, the following facts are undisputed as drawn from the parties’
proposed findings of fact and supporting evidence, which is viewed in the light most favorable
to plaintiff as non-movant. 	Because many of plaintiff’s responses to defendant’s proposed
findings of fact are argumentative, conclusory, or unsupported by competent evidence, plaintiff
has failed to comply with the court’s procedures on summary judgment, which were provided
to all parties during the preliminary pretrial conference. 	(Preliminary Pretrial Packet (dkt.
#15) Proc. to be Followed on Mot. For Summ. Judg., §§ I-II). 	As a result, the court treats
those facts as undisputed. (Id. § II(C)); Hedrich v. Bd. of Regents of Univ. of Wis. Sys., 274 F.3d
1174, 1178 (7th Cir. 2011) (courts are to consider only evidence set forth in proposed finding
of fact with proper citation); Rivera v. Guevara, 319 F. Supp. 3d 1004, 1018 (N.D. Ill. 2018)
(disregarding at summary judgment factual “submissions that [merely] make legal arguments
and assert legal conclusions”).
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Acetaminophen is an analgesic designed to treat or manage pain by reducing inflammation
or changing the way the brain processes pain. 	One month later, in February 2019, Dr.
Hoffman further prescribed Yates ibuprofen, 800 mg to be taken twice a day as needed for
pain, also as a KOP medication. Ibuprofen is a nonsteroidal anti-inflammatory (“NSAID”)
medication designed to reduce pain, fever, and other types of inflammation.
According to Dr. Hoffman, the overall goal of pain management is to maintain a
patient’s functionality through medication and non-medication-based interventions in the
least restrictive way possible, so that they may maintain their lifestyle. Hoffman explains
that when treating complaints of pain it is important to evaluate whether “lower-level
medications” like analgesics and NSAIDs are effective in treating that pain before
prescribing more advanced (i.e., stronger) medications. 	Thus, it is a common medical
practice to begin a patient with complaints of pain on a more easily accessible medication
(such as acetaminophen or ibuprofen) before prescribing more advanced pain management
medications. This is done mainly to address a patient’s complaints of pain on the lowest
dose and least intensive pain mediation possible, but is also important in a prison setting,
where certain medications have a higher potential for abuse or diversion among the inmate
population.
Dr. Hoffman also explains that prescribing pain medication is patient-dependent,
meaning that medications are prescribed based on that individual’s condition, allergies,
and symptoms. 	Thus, acetaminophen and ibuprofen are considered the best front-line
defense for addressing complaints of pain for patients because these medications are easily
accessible and do not generally cause significant side effects. Dr. Hoffman concluded that
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these two medications in tandem were appropriate options for Yates when he initially
complained of pain in January and February 2019.
On April 2, 2019, Yates had a separate appointment with Dr. Hoffman to discuss
his thyroid status and hypertension. 	During that appointment, Yates informed Dr.
Hoffman that he was experiencing pain when moving his right hip. 	Yates indicated that
he had been experiencing pain in his hip for a few months. 	Dr. Hoffman ordered a
consultation with a physical therapist to assess Yates’ complaints of hip pain. That same
day, Yates was scheduled for a physical therapy assessment.
On May 7, 2019, Yates was next evaluated by a physical therapist, who indicated
that Yates’ condition was appropriate for physical therapy and provided him with a
treatment plan. 	In particular, Yates was given a home exercise program that featured
stretching, but also had six weekly sessions with the physical therapist.
Initially, Yates reported some improvement with physical therapy. During his final
sessions with the physical therapist, however, Yates indicated he was continuing to
experience pain in his hip and back with little to no improvement from the first visit,
despite performing his home exercise program five to seven days per week. 	Still, the
physical therapist noted at each of the sessions that Yates “appear[ed] in no apparent
distress.” The physical therapist also noted that Yates’ reported complaints of lower back
pain were “vague” and “somewhat questionable,” as he was continuing his physical therapy
exercise regimen. 	After their final session on June 25, 2019, the physical therapist
concluded that Yates was not progressing as planned and had not met the goals of physical
therapy. 	Accordingly, the physical therapist’s plan was for Yates to follow up with a
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primary care 	physician 	regarding 	his symptoms, 	which were 	“consistent with 	L4/5
herniation.”
DOC inmates who have medical needs are instructed to submit a written Health
Service Request (“HSR”) with specific information regarding the nature of their concern.
HSU nursing staff triage these HSRs each day and respond accordingly. 	If the inmate’s
concern requires an appointment with a medical provider, nursing staff will schedule the
appointment. Inmates generally see a nurse first, who may then refer the inmate to see an
ACP, such as the institution physician. Although nurses do not have authority to prescribe
medication or make diagnoses, they rely on established nursing assessment protocols to
help guide the care they provide and interventions they recommend. 	Further, if nursing
staff evaluate an inmate patient and determine that further medical care is necessary, they
may also discuss the inmate’s condition with another ACP, who can order additional
treatment or make recommendations, or order them to be seen by an ACP based on the
inmate’s symptoms, the nurse’s evaluation, and other potential constraints -- such as the
ACP’s availability. After evaluation by an ACP, it may even be determined by the provider
that the inmate requires an appointment at an offsite facility for further evaluation or
treatment, because it cannot be completed onsite. However, only ACPs can place an order
for an inmate to be seen at an offsite facility.
On June 27, 2019, Yates submitted an HSR directed to Dr. Hoffman, informing
him that he had finished his physical therapy for his hip and low back pain, but with no
noticeable results or improvement. 	Although nurses typically respond to HSRs, Dr.
Hoffman replied on June 28, 2019, that he would see Yates on a “scheduled basis” and
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entered an order of referral “to primary care” for his complaints of low back pain. 	Yates
submitted three inquiries to the HSU during July 2019, asking when he would be seen.
Nursing staff responded to each correspondence, informing Yates that he was scheduled to
be seen by a primary care provider.
On August 6, 2019, Yates submitted another HSR renewing complaints of back
pain. He was seen by a nurse the same day. Yates advised the nurse that he had injured
his back previously in 1982, stated that physical therapy did not help with his lower back,
and indicated that his pain was increasing and was running down his leg. 	Nursing staff
consulted Dr. Hoffman, who ordered an MRI of Yates’ lumbar spine.
On August 26, 2019, Dr. Hoffman saw Yates for his scheduled appointment with a
primary care provider to address his low back pain and reevaluate his treatment plan.
Based on Yates’ complaints, Dr. Hoffman noted the possibility of sciatica or L4-L5 disc
herniation, which occurs when the discs between the fourth and fifth lumbar vertebrae in
the spine are damaged or a nerve is compressed. Disc herniation can cause sciatica, which
refers to nerve pain that travels along the path of the sciatic nerve, from an individual’s
lower back into the buttocks and down each leg.
During this appointment, Dr. Hoffman conducted a physical examination to rule
out a pinched nerve and tested the range of motion in Yates’ hips. Dr. Hoffman observed
that (1) Yates’ level of functionality did not appear impacted by his complaints of pain,
and (2) his physical examinations did not yield any significant results. Because Yates had
what Dr. Hoffman determined to be an adequate trial of both acetaminophen and
ibuprofen, he offered to add a low dose of duloxetine to treat Yates’ pain in tandem with
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those existing medications. 	Duloxetine is a selective serotonin and norepinephrine
reuptake inhibitor (“SNRI”), which works to block the reabsorption of serotonin and
norepinephrine into nerve cells. 	SNRIs have been proven effective in treating chronic,
long-lasting pain. 	Similar to NSAIDs, duloxetine is also a lower-level pain reliever. 	By
prescribing duloxetine, Dr. Hoffman wanted to evaluate whether a different classification
of medication that worked differently from the other previously prescribed medications
would manage his pain effectively. 	Dr. Hoffman explains that this was done to address
Yates’ complaints of pain while avoiding a more advanced pain medication when his
functionality did not require it.
On August 29, 2019, Yates had his first dose of duloxetine. On September 2, 2019,
Yates reported in correspondence that the duloxetine was helping. 	HSM Huneke
responded by encouraging Yates to continue with his plan of care, informing him that the
advice and direction he had received from nurses and physical therapy were appropriate
for his condition, and that back pain can be difficult and persistent. 	In a separate letter,
Huneke also confirmed that Dr. Hoffman had ordered an MRI and would see Yates after
the results came back.
Unfortunately, on September 11, 2019, Yates reported in an HSR that the
duloxetine’s effectiveness had lessened. Dr. Hoffman responded by encouraging Yates to
continue to take the medication as prescribed for an additional two weeks to better evaluate
its effectiveness. 	However, on September 12, 2019, Yates submitted another HSR,
reporting adverse side effects. The next day, Yates was seen by nursing staff, who discussed
his issues with Dr. Hoffman. 	With dwindling reported effectiveness and adverse side
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effects, Dr. Hoffman then discontinued the duloxetine.
A few days later, on September 15, 2019, Yates wrote a letter to Huneke,
complaining more generally of a delay in treatment for his back, hip, and leg pain. 	On
September 18, 2019, Yates again submitted an HSR, complaining that his pain had
increased since the duloxetine had been discontinued. In response, Dr. Hoffman explained
his 	reasoning 	for 	discontinuing 	the 	duloxetine 	and 	offered 	him 	a 	prescription 	for
amitriptyline, a tricyclic antidepressant that can be used in low doses to treat neuropathic
pain in a manner like duloxetine. 	Dr. Hoffman placed the order for amitriptyline on
September 18, 2019, to commence on September 23.
On September 19, 2019, HSM Huneke also responded to Yates’ September 15
letter, 	explained 	that 	Dr. 	Hoffman’s 	schedule 	was 	booked 	for 	several 	weeks, 	and
encouraged him to follow his treatment plan. In particular, Huneke noted that Yates had
just been seen by Dr. Hoffman on August 26 and by nursing staff on September 12. She
also noted that he was taking acetaminophen and ibuprofen, in addition to his physical
therapy exercises, and utilizing a TENS unit for his pain. In Huneke’s opinion, therefore,
Yates’ condition was stable and non-emergent. 	Huneke further noted that an MRI had
been scheduled along with a follow-up appointment with Dr. Hoffman. 	Finally, Huneke
reminded Yates that letters were not the proper method of communicating with the HSU
and to submit an HSR in the future if he had any new or worsening symptoms to report.
On September 19, 2019, Yates wrote another letter to Dr. Hoffman, informing him
that he had been told there was a topical cream designed to block nerve pain, and asking
if it was available to try before his taking amitriptyline. In response, Dr. Hoffman informed
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Yates that he had ordered a topical medication (lidocaine) for him, but would still
recommend he start the low dose of amitriptyline, as well.
Yates received both the lidocaine cream and his first dose of amitriptyline on
September 23, 2019. Several days later, however, Yates reported to Dr. Hoffman that the
amitriptyline was also producing adverse side effects, despite the low dosage. In response,
Dr. Hoffman discontinued the amitriptyline, although also noting that Yates had failed to
complete an adequate trial of that medication to evaluate its possible effectiveness. 	Dr.
Hoffman noted further that, given the low dosage prescribed, amitriptyline was unlikely to
be causing any severe adverse side effects. 	Dr. Hoffman also wrote back to Yates on
September 27 and offered to try yet another anti-inflammatory medication, like naproxen
or meloxicam.
On October 1, 2019, Yates finally received an MRI of his lumbar spine at Mile Bluff
Medical Center in Mauston. 	On October 3, Dr. Hoffman reviewed the offsite provider’s
notes, indicating that Yates had a right lateral recess disc protrusion at L4-L5, and disc
disease at L5-S1, with possible compression of the L5 nerve root.
On October 10, Yates then had a follow-up appointment with Dr. Hoffman. During
that appointment, Yates commented that ibuprofen made no noticeable difference in his
pain, and stated that he would like to try a different anti-inflammatory, such as naproxen,
which he had taken in the past without side effects. 	However, because Yates walked
without any obvious signs of discomfort, and got up and down from the exam table without
incident, Dr. Hoffman believed that Yates was not in significant pain. 	Indeed, Dr.
Hoffman noted that Yates’ general ease of movement suggested that his complaints of pain
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were out of proportion to the findings of the MRI, as well as his own physical examination.
Nevertheless, Dr. Hoffman ordered a neurosurgery consultation to further evaluate
Yates’ condition. In the meantime, to the extent that Yates continued to complain of pain,
Dr. Hoffman continued to believe that trials of more conservative options, such as
acetaminophen combined with anti-inflammatories, were appropriate. 	Accordingly, Dr.
Hoffman discontinued Yates’ prescription for ibuprofen but prescribed naproxen at 500
mg twice per day, alongside his prescription for acetaminophen. 	Naproxen is another
NSAID medication designed to treat pain and inflammation caused by various conditions,
including muscle and back pain. 	Dr. Hoffman prescribed Yates the highest dosage of
naproxen allowed under DOC’s standards, which he felt was appropriate as a next level of
medication above ibuprofen given that Yates’ functionality did not appear significantly
impacted by his reports of pain. Plus, Dr. Hoffman did not want to overprescribe him with
a higher-level medication that was not necessary.
Consistent with Dr. Hoffman’s directions, HSU staff also sent Yates’ medical file to
the Gundersen Health System Neurosurgery Department in La Crosse for an evaluation
and recommendation for a course of treatment for his back pain and MRI diagnosis. On
October 11, 2019, the HSU received a fax from a neurosurgeon at Gundersen Health
System, 	who 	reviewed 	Yates’ 	records 	and 	also 	recommended 	that 	he 	exhaust 	all
conservative care options, including steroid injections, before considering surgery. 	Dr.
Hoffman reviewed this correspondence on October 16, 2019, and submitted a prior
authorization request to the DOC Class III Committee or Medical Director for a pain clinic
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referral that same day.2 	Dr. Hoffman made that request so Yates could be seen at UW
Hospitals and Clinics for a second opinion on the necessity of the steroid injection
procedure, which could not be performed onsite at NLCI. 	While Dr. LaVoie approved
that request that same day, he had no further involvement with Yates’ care.
On October 21, 2019, Yates submitted an HSR indicating that unless he was
standing or walking a lot, the naproxen prescription had reduced his pain level. After Yates
requested a higher dosage, however, nursing staff informed him that he was already at the
highest dose allowed under DOC protocols and the dosage could not be increased. 	On
October 29, Yates also had a consultation for a steroid injection at the UW Health pain
clinic. The provider who screened Yates documented the treatment he had already received
and approved him for “3 consecutive injections as needed.” That same day, Dr. Hoffman
ordered a steroid injection to treat L5 radiculopathy. 	Although Yates had assumed that
the prior authorization for the pain clinic consultation meant he would receive the injection
on that same day, Dr. Hoffman clarified that the prior authorization was for a consultation
with the pain clinic to determine whether steroid injections were necessary.
On November 12, 2019, Yates then submitted an HSR asking when his steroid
injection would be scheduled. 	Nursing staff informed him that while ordered, staff were
still working to get the procedure scheduled with an offsite provider. 	Neither HSM
2 According to Dr. LaVoie, the Class III Committee makes determinations about offsite medical
treatment for “non-urgent” medical services, in contrast with Class I and II requests that are
“urgent,” where a delay in treatment could cause life-threatening injury to the patient and do
not require prior approval by a designated authority to be completed. 	Although prior
authorization was not required for the pain clinic consultation, Dr. LaVoie noted that there
were circumstances in which ACPs would submit prior authorization requests “out of an
abundance of caution or due diligence.”
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Huneke nor Dr. Hoffman were involved in scheduling appointments with offsite providers,
which were handled by the Medical Program Assistant Advanced (“MPAA”). An order for
the steroid injection was faxed to the offsite facility on November 12, and it was noted
that the facility would call back to set up the appointment. An order for a steroid injection
was also re-submitted by fax on November 27, 2019, and the procedure was scheduled for
December 27, 2019, at a Gundersen Health System facility.
On December 4, 2019, Yates wrote to Dr. Hoffman, reporting that naproxen
reduced his pain to a point, but he was still experiencing pain after 9 hours because the
naproxen wore off. In response to that letter, Yates was seen by nursing staff on December
5. 	Staff again observed that Yates ambulated at a normal pace with no noticeable
difficulties. During that appointment, Yates indicated that he was willing to try meloxicam
for his complaints of pain, another NSAID that is more potent and longer lasting than
naproxen. Accordingly, Dr. Hoffman prescribed Yates meloxicam at 7.5 mg twice per day
as a replacement for naproxen. 	On December 18, however, Yates wrote to Dr. Hoffman
and advised that the switch from naproxen to meloxicam had made no difference in his
pain levels. 	While Dr. Hoffman then offered to prescribe him ibuprofen four times per
day, Yates responded on December 26 that he did not want a prescription for ibuprofen,
noting again that the naproxen and meloxicam reduced but did not eliminate his pain.
On December 27, 2019, Yates had an offsite appointment at Gundersen Health
System Neuroscience with physician’s assistant (“PA”) Natalie Pomranke. 	While Dr.
Hoffman’s intention was that Yates would receive a steroid injection during the same
appointment, this did not occur. 	Instead, Pomranke treated the appointment as a
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“consult,” recommended that Yates receive a lumbar epidural steroid injection, and placed
orders for that procedure to be done. If the lumbar epidural steroid injection was pursued,
Pomranke added that Yates should have a follow-up appointment to determine its
effectiveness and any next steps. If Yates’ symptoms continued to be significant, Pomranke
further recommended that a trial of neuropathic pain medication, such as gabapentin or
Lyrica (pregabalin), would be reasonable.
On December 30, 2019, Dr. Hoffman reviewed Pomranke’s recommendations,
learning that Yates had not, in fact, received a steroid injection during the December 27
appointment. Dr. Hoffman explains that when an offsite appointment is scheduled for a
procedure to be conducted, the decision to conduct the procedure is at the discretion of
the offsite provider. However, DOC medical staff do not have the authority to direct the
medical care provided at an offsite facility. 	Thus, although Dr. Hoffman had ordered a
steroid injection for Yates and intended it to occur on December 27, Dr. Hoffman had no
control over the offsite provider’s actions or decisions.
Consistent with Pomranke’s recommendation, Dr. Hoffman ordered a lumber
epidural steroid injection on January 8, 2020, but did not order a prescription for
neuropathic pain medication, such as gabapentin or pregabalin, because neither are listed
in the DOC formulary, which is a list of prescription and non-prescription medications
that are ordinarily available to authorized prescribers. 	When a drug is not listed on the
formulary, an ACP must submit a request for non-formulary drug approval. 	Gabapentin
is used to treat seizure disorders but is also used to treat nerve pain, which is considered
an “off-label” use. 	Thus, gabapentin is a non-formulary medication when prescribed to
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treat any condition other than a seizure disorder.
Dr. Hoffman explains further that gabapentin is problematic in the prison setting
because it has the potential for abuse and diversion. Inmates will often snort gabapentin
to get a high similar to valium, which can lead to health, safety, and security risks. While
this is sometimes done by the inmate with the prescription, it is also common for inmates
to sell or be extorted for their gabapentin prescriptions. 	Because of these issues, DOC
required medical providers to use a special form for approval of prescriptions of gabapentin
and pregabalin. 	The criteria for approval included the failure of first-line treatments for
pain, such as ibuprofen, NSAIDS, amitriptyline, and duloxetine.
Dr. Hoffman states that he did not prescribe gabapentin or pregabalin for Yates in
particular because of its potential for misuse in the correctional setting, as well as a number
of other reasons. 	First, the offsite treatment provider (PA Pomranke) recommended that
steroid injections be administered before considering neuropathic pain medication, such as
gabapentin 	or 	pregabalin. 	Second, 	although 	Yates 	had 	been 	prescribed 	NSAIDs,
amitriptyline, and duloxetine, as required for the criteria for requesting gabapentin, he had
not completed adequate trials of these medications to determine their effectiveness. Third,
Dr. Hoffman and other medical providers observed that Yates had a high level of
functionality, despite his complaints of pain, and did not show obvious distress during
appointments. 	Fourth, and finally, Yates had an ongoing course of treatment through
various medications and, although he indicated that the medications were ineffective to
treat his pain, his functionality did not support his claims.
On January 14, 2020, Yates wrote a letter to Dr. Hoffman, expressing that he was
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in pain and asking if he could be prescribed gabapentin or pregabalin, as recommended by
PA Pomranke. Dr. Hoffman interpreted the request as a warning sign that Yates may be
drug seeking for gabapentin or pregabalin. Regardless, Dr. Hoffman responded that neither
gabapentin nor pregabalin could be considered because Yates had not completed adequate
trials of duloxetine or amitriptyline, as required by DOC guidelines. 	Defendant Huneke
also responded by informing Yates that an adequate trial of these medications was typically
two to three months, and DOC Bureau of Health Services had guidelines that physicians
must follow for treating chronic conditions.
On February 3, 2020, Yates finally received an L4-L5 interlaminar epidural steroid
injection at Gundersen Health System. On February 13, Dr. Hoffman reviewed the offsite
report and noted that Yates tolerated the procedure well. 	On February 17, Yates had a
follow-up appointment with PA Pomranke. During that appointment, Yates reported that
his pain intensity was markedly improved since the injection, although he still had some
discomfort with activity. Pomranke noted that Yates appeared to rise easily from a seated
position and his gait was normal. 	Pomranke recommended that Yates receive a repeat
lumbar epidural steroid injection, additional physical therapy, and if his symptoms
continued to be significant, a trial of neuropathic pain medication. 	Yates did not submit
any other HSRs regarding complaints of back pain after his steroid injection in February
2020.
OPINION
To prevail on a claim for relief under 42 U.S.C. § 1983, a plaintiff must establish
that: someone deprived him of a right secured by the Constitution or laws of the United
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States, and whoever deprived him of this right was acting under the color of state law. D.S.
v. E. Porter Cnty. Sch. Corp., 799 F.3d 793, 798 (7th Cir. 2015) (citing Buchanan-Moore v.
Cnty. of Milwaukee, 570 F.3d 824, 827 (7th Cir. 2009)). 	Here, plaintiff alleges that Dr.
Hoffman, HSM Huneke, and Dr. LaVoie violated his rights under the Eighth Amendment
by failing or refusing to provide him with adequate pain medication or other treatment for
his back pain. 	The defendants have moved for summary judgment, arguing that plaintiff
has no evidence from which a reasonable jury could find such a violation. The defendants
argue further that they are entitled to qualified immunity.
Summary judgment is appropriate if the moving party shows that “there is no
genuine dispute as to any material fact[,] and the movant is entitled to judgment as a
matter of law.” 	Fed. R. Civ. P. 56(a). 	If the moving party meets this burden, then the
non-moving party must provide evidence “on which the jury could reasonably find for the
nonmoving party” to survive summary judgment. 	Trade Fin. Partners, LLC v. AAR Corp.,
573 F.3d 401, 406-07 (7th Cir. 2009) (alteration adopted and quotation marks omitted).
At summary judgment, disputed facts are viewed in a light most favorable to the plaintiff
as the non-moving party. 	Parker v. Four Seasons Hotels, Ltd., 845 F.3d 807, 812 (7th Cir.
2017).
Although pro se litigants are entitled to liberal construction of their pleadings, they,
too, have the burden to come forward in response to a motion for summary judgment with
evidence that demonstrates a genuine issue of material fact. 	Arnett v. Webster, 658 F.3d
742, 760 (7th Cir. 2011) (“[A plaintiff’s] pro se status doesn’t alleviate his burden on
summary judgment.”) (citation omitted). Further, while the court views the record “in the
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light most favorable to the nonmovant and constru[es] all reasonable inferences from the
evidence in his favor,” Moore v. Western Ill. Corr. Ctr., 89 F.4th 582, 590 (7th Cir. 2023),
a nonmovant is only entitled to favorable inferences that are supported by admissible
evidence, not those based upon mere speculation or conjecture, Grant v. Trustees of Ind.
Univ., 870 F.3d 562, 568 (7th Cir. 2017), or upon “[c]onclusory statements, not grounded
in specific facts,” Bordelon v. Bd. of Educ. of the City of Chicago, 811 F.3d 984, 989 (7th Cir.
2016). Here, there is simply no evidence that defendants’ ongoing treatment ever departed
from standard protocols to address plaintiff’s chronic back pain through gradually
increasing the extent of medical interventions, particularly in a prison setting, however
frustrating that may have understandably been for plaintiff.
I. 	Claims Under the Eighth Amendment
The Eighth Amendment gives prisoners the right to receive adequate medical care.
Estelle v. Gamble, 429 U.S. 97 (1976). 	Specifically, “deliberate indifference to serious
medical needs of prisoners constitutes the unnecessary and wanton infliction of pain
proscribed by the Eighth Amendment.” Id. at 104 (quotation marks and citation omitted).
To prevail on a claim of constitutionally inadequate medical care an inmate must
demonstrate two elements: (1) an objectively serious medical condition; and (2) a state
official who was deliberately (that is, subjectively) indifferent to the risks presented by that
condition. 	Giles v. Godinez, 914 F.3d 1040, 1049 (7th Cir. 2019); 	Arnett, 658 F.3d, at
750.
Defendants do not dispute that plaintiff’s chronic back pain was an objectively
serious medical condition, but argue that there is no evidence that they acted with
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deliberate indifference. 	“Deliberate indifference” means that the official was aware that
the prisoner faced a substantial risk of serious harm but disregarded that risk by consciously
failing to take reasonable measures to address it, which is a decidedly high standard. Forbes
v. Edgar, 112 F.3d 262, 266 (7th Cir. 1997). 	Specifically, acts of deliberate indifference
require more than negligence, or even gross negligence, but require something less than
purposeful acts. 	Farmer v. Brennan, 511 U.S. 825, 835-36 (1994). 	The threshold for
deliberate indifference is not met unless: (1) “the official knows of and disregards an
excessive risk to inmate health or safety”; or (2) “the official [is] both aware of facts from
which the inference could be drawn that a substantial risk of serious harm exists,” and he
or she draws that inference yet deliberately fails to take reasonable steps to avoid it. Id. at
837. The evidence here does not begin to reach this threshold
A. Claims Against Dr. Hoffman
Plaintiff was granted leave to proceed with claims that Dr. Hoffman took no
meaningful steps to alleviate his chronic back pain for a period of eight months, until he
finally received a steroid injection in February 2020. 	The undisputed medical records
show, however, that Dr. Hoffman provided treatment throughout the relevant time period.
To the extent that plaintiff claims that Dr. Hoffman provided constitutionally deficient
treatment, that claim is “a challenge to ‘a deliberate decision by a doctor to treat a medical
need in a particular manner.’” 	Lockett v. Bonson, 937 F.3d 1016, 1023 (7th Cir. 2019)
(quoting Snipes v. DeTella, 95 F.3d 586, 591 (7th Cir. 1996)). In such cases, courts must
defer to a medical professional’s treatment decision “unless ‘no minimally competent
professional would have so responded under those circumstances.’” 	Pyles v. Fahim, 771
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F.3d 403, 409 (7th Cir. 2014) (quoting Sain v. Wood, 512 F.3d 886, 894–95 (7th Cir.
2008)).
Although plaintiff alleges that defendant Dr. Hoffman took no steps to treat his
back pain until he received a lumbar epidural steroidal injection in February 2020, it is
undisputed that Hoffman prescribed plaintiff several different pain medications, including
acetaminophen and ibuprofen, as well as referring plaintiff for a six-week course of physical
therapy. 	Moreover, when physical therapy and basic pain medications failed to address
plaintiff’s needs and his symptoms indicated possible L4-L5 herniation, Dr. Hoffman also
ordered an MRI to diagnose his condition and offered stronger prescriptions for duloxetine
and amitriptyline to manage his pain, in addition to granting plaintiff’s request for the
topical cream lidocaine. When plaintiff indicated that he was unable to tolerate low doses
of duloxetine or amitriptyline after only a short trial, Dr. Hoffman further offered
prescriptions for naproxen and then meloxicam to treat his nerve pain. 	And when that
proved insufficient, Dr. Hoffman ordered a neurosurgery consultation after reviewing the
results of plaintiff’s MRI, in order to assess the severity of his condition, to be followed by
an authorization request for an assessment at the UW Health pain clinic. 	Once Dr.
Hoffman received confirmation that a steroid injection was approved to treat plaintiff’s
chronic back pain, Dr. Hoffman also promptly ordered the steroid injection to take place
at an offsite provider. While the offsite provider did not perform the steroid injection at
the scheduled appointment on December 27, 2019, the procedure was ordered as
recommended by the offsite provider, and took place on February 3, 2020. Finally, while
Dr. Hoffman had intended the steroid injection to take place on December 27, 2019, the
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delay was through no fault of Hoffman, who had no control over scheduling delays or the
offsite provider’s treatment decisions.
In short, Dr. Hoffman’s decision to provide lower level pain relief, physical therapy,
and other conservative treatment measures to plaintiff before ordering an MRI and a pain-
clinic consultation for a steroid injection reflects professional judgment, not deliberate
indifference. Zaya v. Sood, 836 F.3d 800, 805 (7th Cir. 2016) (“By definition a treatment
decision that’s based on professional judgment cannot evince deliberate indifference
because professional judgment implies a choice of what the defendant believed to be the
best course of treatment.”). 	Similarly, Dr. Hoffman’s decision to order the steroid
injection, which was delayed at the offsite provider’s discretion, fails to show that he was
deliberately indifferent to plaintiff’s needs. 	Id. 	Plaintiff has presented no evidence that
Dr. Hoffman knowingly persisted in a course of ineffective treatment. See Greeno v. Daley,
414 F.3d 645, 655 (7th Cir. 2005). 	Nor does plaintiff otherwise present any evidence
from which a reasonable jury could conclude or infer that Dr. Hoffman’s treatment
decisions were “so blatantly inappropriate as to evidence intentional mistreatment,” Snipes,
95 F.3d at 592, or were “such a substantial departure from accepted professional judgment,
practice, or standards,” as to support a constitutional claim. Brown v. Osmundson, 38 F.4th
545, 551 (7th Cir. 2022) (citations omitted). 	As a result, Dr. Hoffman’s treatment
decisions based on medical judgment are entitled to deference and do not constitute
deliberate indifference as a matter of law. Johnson v. Dominguez, 5 F.4th 818, 825 (7th Cir.
2021); see also Snipes, 95 F.3d at 591 (“Medical decisions that may be characterized as
‘classic example[s] of matter[s] for medical judgment,’ Estelle, 429 U.S. at 107, such as
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whether one course of treatment is preferable to another, are beyond the [Eighth]
Amendment’s purview.”).
While plaintiff appears to claim that Dr. Hoffman should have prescribed naproxen
or a neuropathic pain medication, such as gabapentin or pregabalin, sooner, “[d]isagreement
between a prisoner and his doctor, or even between two medical professionals, about the
proper course of treatment generally is insufficient, by itself, to establish an Eighth
Amendment violation.” 	Pyles, 771 F.3d at 409. 	Further, prison inmates are not entitled
to demand specific care. 	Arnett, 658 F.3d at 754. 	The Seventh Circuit has routinely
rejected claims by prisoners that are “based on a preference for one medication over
another unless there is evidence of a substantial departure from acceptable professional
judgment.” 	Lockett, 937 F.3d at 1024 (emphasis in original). 	Plaintiff presents no such
evidence here.
Finally, to the extent that plaintiff also complains of delays in receiving a steroid
injection, he does not show that Hoffman’s decision to first request a consultation with
the UW Health pain clinic was “such a substantial departure from accepted professional
judgment, practice, or standards, as to demonstrate that the person responsible actually
did not base the decision on such a judgment.” Jackson v. Kotter, 541 F.3d 688, 697 (7th
Cir. 2008). 	Nor does plaintiff show that Hoffman had any involvement in scheduling
appointments or control over the treatment decisions made by other medical providers at
offsite facilities once the scheduled appointments occurred. 	See Miller v. Harbaugh, 698
F.3d 956, 962 (7th Cir. 2012) (defendants cannot be held liable under § 1983 “if the
remedial step was not within their power”). 	Moreover, delays in receiving care for non-
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urgent conditions are typical and do not suggest that plaintiff’s needs were disregarded
with deliberate indifference. See Williams v. Tannan, No. 20-cv-1659, 2022 WL 1620347,
at *5 (E.D. Wis. May 23, 2022) (“Having to wait before seeing a doctor for a non-
emergency situation is not deliberate indifference; it is a fact of life, inside and outside of
prison.”). 	Because no reasonable jury could conclude that Dr. Hoffman was deliberately
indifferent to plaintiff’s complaints of pain, he is entitled to summary judgment on
plaintiff’s Eighth Amendment claims against him.
B. Claims Against HSM Huneke
Defendant Huneke argues that plaintiff cannot establish that she acted with
deliberate indifference to a serious medical need either. 	The court agrees. 	As the HSM
serving in an administrative or supervisory role, Huneke was not responsible for treating
inmates and had no authority to prescribe medications or other treatments that could only
be authorized by ACPs. 	(Huneke Decl. (dkt. #65) ¶¶ 8-12.) 	To be held liable under §
1983, a plaintiff must prove the defendant’s personal participation or direct responsibility
for the alleged constitutional deprivation. Mitchell v. Kallas, 895 F.3d 492, 498 (7th Cir.
2018) (citing Wilson v. Warren Cnty., 830 F.3d 464, 469 (7th Cir. 2016)). If the defendant
lacked authority to provide the care requested, she cannot be held liable for violating the
plaintiff’s rights. See Miller, 698 F.3d at 962; Scott v. Brown, No. 24-cv-103-jdp, 2025 WL
2322394, at *6 (W.D. Wis. Aug. 12, 2025).
Plaintiff does not dispute that he was under the care of Dr. Hoffman and other
ACPs, who were responsible for his plan of care. Plaintiff presents no evidence from which
a reasonable jury could conclude that defendant Huneke was personally involved in
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providing medical treatment, nor that she had any authority over the treatment he was
prescribed. Colbert v. City of Chicago, 851 F.3d 649, 657 (7th Cir. 2017); see also Machicote
v. Roethlisberger, 969 F.3d 822, 828 (7th Cir. 2020) (holding that a health services manager
was not liable where she had no authority to intervene in treatment prescribed by a doctor).
Likewise, plaintiff points to no evidence showing that defendant Huneke was not entitled
to defer to Dr. Hoffman’s medical judgment. 	Pulera v. Sarzant, 966 F.3d 540, 553 (7th
Cir. 2020); see also Holloway v. Delaware Cnty. Sheriff, 700 F.3d 1063, 1075 (7th Cir. 2012)
(“[N]urses may generally defer to instructions given by physicians” unless “it is apparent
that the physician’s order will likely harm the patient.”). In addition, although defendant
Huneke held an administrative and supervisory role in the HSU, plaintiff cannot hold her
vicariously liable for the actions of his treatment providers or insist that she perform the
jobs of others. 	Burks v. Raemisch, 555 F.3d 592, 595 (7th Cir. 2009) (“[N]o prisoner is
entitled to insist that one employee do another’s job”). Because no reasonable jury could
find that defendant Huneke acted with deliberate indifference to plaintiff’s medical needs,
plaintiff does not establish an Eighth Amendment violation, and she is entitled to summary
judgment on plaintiff’s claim against her, as well.
C. Claims Against Dr. LaVoie
Finally, plaintiff claims that defendant Dr. LaVoie violated his rights by taking 40
days to approve his steroid injection. However, the undisputed record shows that LaVoie
had no involvement in plaintiff’s care beyond approving Dr. Hoffman’s prior approval
request for a pain clinic consultation the same day that it was submitted. Thus, Dr. LaVoie
reasonably asserts that he had no personal involvement in plaintiff’s direct medical care
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and plaintiff has established no basis for liability against him in his supervisory capacity.
Plaintiff has not offered any argument in response to the defendants’ motion for summary
judgment on the claims against Dr. LaVoie and has apparently abandoned those claims.
See Mach v. Will Cnty. Sheriff, 580 F.3d 495, 501 (7th Cir. 2009) (recognizing that a
plaintiff may abandon a claim by failing to respond to argument against it at the summary
judgment stage); Nichols v. Michigan City Plant Planning Dep’t, 755 F.3d 594, 600 (7th Cir.
2014) (“The non-moving party waives any arguments that were not raised in its response
to the moving party’s motion for summary judgment.”). Because there is no evidence from
which a reasonable jury could find a constitutional violation, Dr. LaVoie is entitled to
summary judgment on the claims made against him.
II. Qualified Immunity
Additionally, the defendants assert entitlement to qualified immunity. (Dkt. #62,
at 18-21.) 	Qualified immunity protects government officials from liability for damages
unless they violate statutory or constitutional rights that were clearly established at the
time of the violation. Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). Once the defense is
raised, a plaintiff bears the burden of defeating it. 	Garcia v. Posewitz, 79 F.4th 874, 879
(7th Cir. 2023). Plaintiff has not come forward with evidence showing that the defendants
violated his constitutional rights by denying him adequate medical care with deliberate
indifference. 	Accordingly, the court concludes that the defendants are also entitled to
qualified immunity, although the outcome is the same.
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ORDER
IT IS ORDERED that:
1) The motion for summary judgment filed by defendants Dr. Karl Hoffman,
Roslyn Huneke, and Dr. Daniel LaVoie (dkt. #61) is GRANTED.
2) The clerk of court is directed enter judgment in favor of the defendant and to
close this case.
Entered this 22nd day of January, 2026.
BY THE COURT:
/s/
__________________________________
WILLIAM M. CONLEY
District Judge
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