In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 16‐2899
ESTATE OF DENNIS SIMPSON, et al.,
Plaintiffs‐Appellants,
v.
MARK E. GORBETT, JAMES TINDELL, JARED WILLIAMS, JOHNNY
YORK, TRAVIS HARBAUGH, and CORY LEHMAN,
Defendants‐Appellees.
____________________
Appeal from the United States District Court for the
Southern District of Indiana, Indianapolis Division.
No. 1:14‐cv‐01035‐SEB‐MJD — Sarah Evans Barker, Judge.
____________________
ARGUED JANUARY 6, 2017 — DECIDED JULY 14, 2017
____________________
Before WOOD, Chief Judge, and BAUER and ROVNER, Circuit
Judges.
WOOD, Chief Judge. This case concerns the death of Dennis
Simpson, an inmate who fell off an upper bunk while incar‐
cerated in the Bartholomew County Jail for a drunken driving
conviction. Simpson was intoxicated when he reported to the
jail to serve his weekend stay, prompting officers initially to
place him in a holding cell. After they thought he was sober,
2 No. 16‐2899
they assigned him to an upper bunk in a two‐person cell, even
though he was obviously obese. While sleeping, Simpson
went into convulsions and fell off the bunk on to the hard con‐
crete floor. He died from his injuries.
His estate sued six county employees—five officers and
the sheriff—arguing that the conditions under which the jail
kept Simpson and the care he received were inadequate under
the Eighth Amendment. The district court found there was in‐
sufficient evidence to show the defendants were aware of, but
disregarded, a risk to Simpson’s health and safety, and so
granted them summary judgment. We affirm.
I
Simpson reported to the Bartholomew County Jail around
10:30 a.m. on Friday, November 29, 2013. He was there to
serve his second of three weekends of confinement as punish‐
ment for a May 2013 drunk driving violation. Anyone could
see that Simpson was obese. Although the officers did not
know Simpson’s precise weight (368 pounds) because they
did not weigh him at check‐in, one of the defendants correctly
guessed that Simpson weighed between 350 and 400 pounds.
Simpson also was intoxicated that morning. The deputy
processing him upon his arrival, Officer Johnny York, smelled
alcohol on Simpson’s breath. York tested Simpson’s blood
alcohol content (BAC), and found it was 0.23%, just short of
three times Indiana’s legal limit for driving. York notified his
supervisor, Sergeant James Tindell, who in turn asked
Simpson whether he was experiencing withdrawal
symptoms. Simpson said he was not. Bartholomew County
Jail policy called for intoxicated inmates with BACs under
0.25% to be placed in holding cells until they were sober. In
No. 16‐2899 3
accordance with that rule, Simpson was placed in a holding
cell containing only benches—no beds. At some point
Simpson complained to York about his placement, to no avail.
York responded that Simpson was too intoxicated to be placed
in a cell with bunk beds at that time. York served Simpson
lunch around 11:20 a.m.; this was apparently the last time
those two had contact. Officer Travis Harbaugh, another
defendant, replaced York that evening. At some point when
Harbaugh checked on Simpson, Simpson reported that he
had blood in his stool. Harbaugh informed a supervising
officer, Jared Williams, about Simpson’s condition.
Around 11:30 p.m., Harbaugh moved Simpson to a cell
that had two bunk beds. Harbaugh and York said that it was
common practice to use a burn‐off chart to estimate how
many hours it takes a person’s blood alcohol level to reach
zero. (While blood‐alcohol content is certainly relevant in
these situations, if the person is an alcoholic, so are with‐
drawal symptoms such as delirium tremens; the latter symp‐
toms do not normally manifest themselves until withdrawal
happens—that is, when BAC nears zero. We address this
briefly below.) At the time of transfer, the defendants appar‐
ently believed Simpson was sober, although they did not re‐
test him. The lower bunk in Simpson’s new cell was occupied,
and so Simpson was given the upper bunk. Simpson’s bed
was affixed to a wall of the jail cell a little more than four feet
off the ground. It was only 30 inches wide. (To put this in con‐
text, we note that a standard twin bed is about 25% wider, at
38 inches.)
Simpson slept on his assigned upper bunk for some time.
But around 3:15 a.m., he suddenly began experiencing sei‐
zure‐like convulsions. He rolled out of the bunk and fell to the
4 No. 16‐2899
concrete floor, hitting his head. Officers Harbaugh and Cory
Lehman witnessed Simpson’s fall and ran into the cell to
check on him. Finding him unresponsive, they performed
CPR on him until paramedics arrived and rushed him to a
nearby emergency room, where he was pronounced dead at
4 a.m. For the purposes of the summary judgment motion, the
defendants concede that Simpson died of injuries sustained
from his fall, and that his fall was precipitated by an alcohol
withdrawal seizure.
Simpson’s estate asserts that at the time of Simpson’s fall,
jail policy “required inmates weighing more than 350 pounds
to be placed in lower bunks.” It supports this contention with
an indirect citation to an undated order apparently from the
Bartholomew County Sheriff’s Department concerning the
jail’s medical care policies for inmates. But the only indication
of any such policy comes from Advanced Correctional
Healthcare, which did not enter into a contract to provide
medical services for the jail until November 2013. Thus, we
see no evidentiary support for the Estate’s contention that jail
policy called for obese inmates to be given lower bunks and
accordingly disregard that possibility.
After Advanced Correctional came on the scene, which
was several months after Simpon’s death, it promulgated
medical guidelines for the jail. Included in the Advanced Cor‐
rectional guidelines was a list of “criteria for Bottom Bunks.”
The list called for certain people to be given lower bunks, in‐
cluding inmates who are elderly, have diagnosed seizures or
diabetes, or, as relevant here, were obese, defined as weighing
over 350 pounds. Another rule called on the facility to
“[a]ddress ‘serious’ medical, dental, and mental health is‐
sues.”
No. 16‐2899 5
In the wake of Simpson’s unfortunate death, Simpson’s
son, Devon Simpson, and sister, Gloria Skinner, brought this
section 1983 action against six county officials in their
individual and official capacities, on Simpson’s behalf as
representatives of his estate. The lawsuit named as
defendants Sheriff Mark E. Gorbett—the head of the jail—and
deputies York, Williams, Harbaugh, Lehman, and Tindell.
The complaint alleged that the defendants were deliberately
indifferent to Simpson’s serious medical needs and that they
subjected him to inhumane conditions of confinement, in
violation of the Eighth Amendment. The district court
construed the Estate’s deliberate indifference claim as
embracing three theories of liability: one concerning the
conditions of Simpson’s confinement, another concerning the
failure to provide adequate medical care, and the third
against Gorbett in his official capacity for failure to train
adequately his deputies.
The defendants filed a motion for summary judgment on
September 21, 2015. The district court granted the motion on
June 22, 2016, for all defendants and all claims. Lehman and
Williams prevailed because, as the Estate acknowledged,
neither officer had been involved with Simpson’s care before
his fall. York, Tindell, and Harbaugh were entitled to
summary judgment on the official capacity claims because
those claims duplicated the official capacity claim against
Sheriff Gorbett, who was in charge of the jail. The Estate’s
claim against Gorbett in his individual capacity foundered
because Gorbett was not personally involved in Simpson’s
care.
That left the individual capacity claims against York,
Tindell, and Harbaugh, and the official capacity claim against
6 No. 16‐2899
Gorbett for failure to train employees about how to care for
drunken or obese inmates. The court found no evidence that
would allow a factfinder to conclude that the deputies were
deliberately indifferent in the care they rendered and the
conditions of Simpson’s confinement. Finally, it dismissed the
official‐capacity claim against Sheriff Gorbett on the ground
that no evidence in the record could support a finding that a
top‐bunk assignment posed a substantial risk to obese
inmates, and so the sheriff could not be liable for failing to
train his officers about such a risk.
II
The Estate appeals from the district court’s adverse rulings
on its claims of deliberate indifference for failure to provide
adequate medical care claims and constitutionally defective
conditions of confinement claims. (It does not appeal the re‐
jection of its failure‐to‐train claim.) It is not clear which de‐
fendants, and in what capacity, its appeal covers. Nonetheless,
with the failure‐to‐train claim out of the case, the duplicative
nature of the official‐capacity claims indisputable, and the
acknowledged fact that Lehman, Williams, and Gorbett were
not personally involved in Simpson’s care, we conclude that
this appeal can be limited to the individual‐capacity claims
against York, Tindell, and Harbaugh (the “deputy defend‐
ants”).
Because this is an appeal from the grant of summary judg‐
ment, our consideration of the case is de novo. Petties v. Carter,
836 F.3d 722, 727 (7th Cir. 2016). We evaluate the record in the
light most favorable to the non‐movant, the Estate, and draw
all inferences in its favor. Id. Summary judgment is warranted
if the movant “shows that there is no genuine dispute as to
any material fact and that the movant is entitled to judgment
No. 16‐2899 7
as a matter of law.” Fed. R. Civ. P. 56(a); see also Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 250–51 (1986). A genuine issue
of material fact exists when “the evidence is such that a rea‐
sonable jury could return a verdict for the nonmoving party.”
Anderson, 477 U.S. at 248.
A
We turn first to the conditions of Simpson’s confinement.
The Estate contends that the deputies’ assignment of
Simpson—a drunk and obese man—to the two‐and‐a‐half
foot wide upper bunk was unsafe and inhumane. A jail’s
conditions violate the Eighth Amendment when “(1) there is
a deprivation that is, from an objective standpoint, sufficiently
serious that it results in the denial of the minimal civilized
measure of life’s necessities, and (2) where [jail] officials are
deliberately indifferent to this state of affairs.” Gray v. Hardy,
826 F.3d 1000, 1005 (7th Cir. 2016) (internal quotation marks
omitted) (citing Farmer v. Brennan, 511 U.S. 825, 834 (1994)).
We begin with the first requirement. Unacceptable condi‐
tions include those that pose a “substantial risk to inmate
health or safety.” See Farmer, 511 U.S. at 837; Peate v. McCann,
294 F.3d 879, 882 (7th Cir. 2002). Jail conditions “may be un‐
comfortable, even harsh, without being inhumane.” Rice ex
rel. Rice v. Corr. Med. Servs., 675 F.3d 650, 664–65 (7th Cir. 2012)
(citing Farmer, 511 U.S. at 832). This means that to defeat sum‐
mary judgment the plaintiff must show that a factfinder rea‐
sonably could conclude that the conditions of Simpson’s con‐
finement “exceeded mere discomfort and were constitution‐
ally unacceptable.” Rice, 675 F.3d at 664–65.
8 No. 16‐2899
Before we can analyze the Estate’s claim, we must give a
more precise account of the relevant conditions of confine‐
ment. The Estate contends that Simpson was drunk when the
defendants transferred him to the upper bunk. But the record
does not permit that inference. While Simpson indisputably
was intoxicated when he reported to Bartholomew Jail, the
deputy defendants kept Simpson in the holding cell for nearly
13 hours to give his body what they believed was sufficient
time to process the alcohol in his system. The Estate provides
no evidence that Simpson was still intoxicated when he finally
was given a bed. Although it challenged the accuracy of the
“burn off” chart because the document did not account for
Simpson’s obesity, it has not revived that attack here. That is
just as well: whether the chart is a good general guide is not
enough, by itself, to show what Simpson’s blood‐alcohol level
was when he was moved. A plaintiff must meet a motion for
summary judgment with evidentiary materials that show
there is a genuine issue for trial. Siegel v. Shell Oil Co., 612 F.3d
932, 937 (7th Cir. 2010). The Estate has failed to do so with
respect to Simpson’s intoxication at the time of the bunk as‐
signment.
The record does support a finding that the officers as‐
signed Simpson, a visibly obese man who had been highly in‐
toxicated 13 hours earlier, to the narrow upper bunk. We as‐
sume that there are some circumstances where a small, ele‐
vated bed might pose a “substantial risk of serious harm” to
an inmate’s health or safety. Farmer, 511 U.S. at 834. But the
Estate has not provided evidence that (if accepted) would
show the requisite level of risk and harm here. We do not un‐
derstand the Estate to be arguing that 30‐inch bunks, or top
bunks, are unconstitutional for all inmates; the Estate is chal‐
No. 16‐2899 9
lenging the assignment of a morbidly obese man to this nar‐
row, upper bed. But its argument that the bunk was unreason‐
ably dangerous to Simpson rests almost entirely on hind‐
sight—that is, what happened after Simpson had been sleep‐
ing in apparent safety for several hours, when he suddenly
had convulsions, tumbled off, and suffered his fatal injury.
But because our inquiry is objective, we cannot base our con‐
clusion exclusively on what came to pass. Based on this rec‐
ord, we cannot conclude that Simpson’s bunk assignment ob‐
jectively was so dangerous that it denied Simpson “the mini‐
mal civilized measure of life’s necessities.” Id. (internal cita‐
tion omitted).
The bottom‐bunk policy does not save the Estate’s claim,
even if we were to assume that it was in place at the time of
Simpson’s fall. Section 1983 protects against “constitutional
violations, not violations of … departmental regulation
and … practices[.]” Scott v. Edinburg, 346 F.3d 752, 760 (7th
Cir. 2003). The Estate argues that a jury could use the policy
as circumstantial evidence of the defendants’ knowledge of
the risk. It is mistaken. It is one thing to say that circumstantial
evidence may support an inference that the defendants had
actual knowledge of a condition, see Farmer, 511 U.S. at 842;
Hall v. Bennett, 379 F.3d 462, 464 (7th Cir. 2004), but it is quite
another thing to say that the policy also supports an inference
that the defendants knew that the condition in question was
unreasonably dangerous or otherwise in violation of the
Eighth Amendment.
In any event, even if we were to assume that a trier of fact
could find in the Estate’s favor on the objective part of the con‐
stitutional inquiry, it would still be out of luck. A jail or prison
10 No. 16‐2899
official may be found liable only if he “knows of and disre‐
gards an excessive risk to inmate health or safety.” Farmer,
511 U.S. at 838. This means that the defendants must have
acted with more than simple or even gross negligence, alt‐
hough they do not need to act purposefully or knowingly in‐
flict harm. Washington v. LaPorte Cnty. Sherriff’s Dep’t, 306 F.3d
515, 518 (7th Cir. 2002). The requisite level of knowledge may
be inferred in instances where the risk posed by the condition
is obvious. Farmer, 511 U.S. at 842; Hall, 379 F.3d at 464.
There is a dearth of evidence suggesting deliberate indif‐
ference. Even if we assume that assigning a man as large as
Simpson, who obviously had an alcohol problem, to a narrow
top bunk was objectively dangerous, there is no indication
that the deputy defendants were aware of the risk posed by
that assignment or that they knew the risk was excessive. The
Estate argues that a factfinder could infer the requisite
knowledge because it was plain at a glance that Simpson’s bed
was too small to accommodate his frame. But there is a differ‐
ence between discomfort and danger, and that glance could
not reveal to the deputies whether the poor fit created a “sub‐
stantial risk.” See Farmer, 511 U.S. at 844. The Eighth Amend‐
ment demands that officials ensure “reasonable safety,” not
that they protect against all risks. Id. at 844–45. The risk of in‐
jury from a fall onto a concrete floor is obvious, but the chance
that someone would fall is not. Perhaps tellingly, the record
reveals no evidence showing that other obese inmates (or oth‐
ers suffering from alcohol withdrawal) fell off their bunks in
Bartholomew Jail, or that anyone else sustained serious inju‐
ries. The rule is that an official who should have, but failed, to
perceive a significant risk cannot be held liable. See id. at 838.
It applies to these defendants.
No. 16‐2899 11
B
That leaves us with the Estate’s Eighth Amendment
deliberate‐indifference claims for failure to provide adequate
medical care for Simpson’s obesity and alcoholism. Because
the Eighth Amendment requires that inmates receive
adequate medical care, officials violate the Constitution when
they are deliberately indifferent to inmates’ serious medical
needs. Estelle v. Gamble, 429 U.S. 97, 103–05 (1976). A claim of
deficient medical care requires proof of an objectively serious
medical condition, and the official’s deliberate indifference to
that condition. Duckworth v. Ahmed, 532 F.3d 675, 679 (7th Cir.
2008). The defendants concede that Simpson’s obesity and
alcoholism were objectively serious medical conditions. We
thus turn immediately to the deliberate‐indifference inquiry.
See Zentmyer v. Kendall Cnty., Ill., 220 F.3d 805, 810 (7th Cir.
2000).
The plaintiff has the burden of demonstrating that there is
evidence from which a factfinder could conclude that the de‐
fendants acted with a sufficiently culpable state of mind.
Farmer, 511 U.S. at 834. In deliberate‐indifference claims based
on inadequate medical care, one way of satisfying that burden
is to show that the risk from a course of treatment—or a lack
of treatment—is obvious enough that a factfinder could infer
that the defendant knew about the risk, yet disregarded it.
Petties, 836 F.3d at 729. We take into account what risk the de‐
fendants knew of, and whether the treatment they rendered
“was so far afield” from what one would expect that a jury
could infer deliberate indifference. Duckworth, 532 F.3d at 680.
We begin with the deputies’ response to Simpson’s obesity.
Although they did not know about his medical diagnosis or
his precise weight, a reasonable jury could conclude that the
12 No. 16‐2899
defendants knew Simpson was obese based on his physical
appearance. But the Estate leaves us in the dark as to what
risk Simpson’s obesity presented or what care the deputy de‐
fendants should have furnished to Simpson during his week‐
end stay. Perhaps the Estate believes that Simpson should
have been given a lower bunk or no bunk altogether; but if
this is so, it has just re‐stated its conditions‐of‐confinement
claim. We cannot discern a free‐standing medical‐treatment
claim related to obesity. In the absence of some indication of
what care was owed, but not rendered, the defendants cannot
be held liable.
The Estate’s claims regarding Simpson’s intoxication and
“chronic alcoholism” come closer to the mark, but in the end
they fare no better. The Estate marshals no evidence to
suggest that Officers York, Tindell, and Lehman knew that
Simpson was an alcoholic. They knew only—at most—that he
was serving a relatively lenient sentence for driving while
intoxicated, and that he was inebriated when he showed up
for his second weekend. Absent any indication that the
defendants knew that Simpson was addicted to alcohol and
thus was likely to suffer from serious withdrawal symptoms,
we may consider only whether a jury could find that the
deputies rendered constitutionally defective care for his
intoxication.
We conclude, as did the district court, that this record
would not support such a finding. The undisputed record
shows that the defendants tailored their care for Simpson to
account for his intoxication. After Officer York smelled
alcohol on Simpson’s breath, he promptly tested his alcohol
level and notified his supervisor, Tindell, of the result. In turn,
Tindell asked Simpson if he was experiencing any withdrawal
No. 16‐2899 13
symptoms. Simpson said no. The deputies then held Simpson
in a bunk‐less holding cell for more than half a day, until they
believed he was sober. They did not observe Simpson
exhibiting any signs of distress during this time.
Unfortunately, the risk posed by Simpson’s intoxication
did not pass as he sobered. Withdrawal symptoms may occur
hours, if not days, after a heavy, long‐term drinker stops or
reduces his alcohol consumption—long after his blood‐
alcohol level zeroes out. See, e.g., Louis A. Trevisan et al.,
Complications of Alcohol Withdrawal, 22 ALCOHOL HEALTH &
RES. WORLD 61, 62 (1998); Marc A. Schuckit, Recognition and
Management of Withdrawal Delirium (Delirium Tremens), 371
NEW ENG. J. MED. 2109, 2109–10 (2014). Seizures most often
occur within 48 hours after a person stops drinking alcohol,
al‐though they may occur several days later. Trevisan, at 62.
Other withdrawal symptoms, such as delirium tremens—
disturbances in cognition and attention, which may include
hallucinations—similarly can manifest days after a
dependent person stops consuming. Id.; Christopher Pelic &
Hugh Myrick, Who’s at Greatest Risk for Delirium Tremens,
2 CURRENT PSYCHIATRY 14, 17 (2003).
But there is no indication that the deputies were aware of
the extent of Simpson’s drinking problem, or of the protracted
risk period that follows when a heavy drinker experiences
withdrawal. In the absence of such evidence, it is impossible
to conclude that the defendants were deliberately indifferent.
Even the Estate fails to argue what care defendants should
have rendered, but did not, for Simpson’s intoxication.
14 No. 16‐2899
III
Had the deputies known about Simpson’s alcoholism and
the risk posed by withdrawal, they might have taken addi‐
tional steps to protect Simpson from accidental harm. But in
the absence of any indication that they knew of a serious risk,
they cannot be held liable under section 1983 for either the
conditions of confinement or the medical treatment they pro‐
vided. We AFFIRM the judgment of the district court.