In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 15‐3179
KENNETH COLLINS,
Plaintiff‐Appellant,
v.
NADIR AL‐SHAMI and
ADVANCED CORRECTIONAL HEALTHCARE, INC.,
Defendants‐Appellees.
____________________
Appeal from the United States District Court for the
Southern District of Indiana, Indianapolis Division.
No. 1:13‐CV‐01838‐TWP‐DML — Tanya Walton Pratt, Judge.
____________________
ARGUED OCTOBER 26, 2016 — DECIDED MARCH 20, 2017
____________________
Before FLAUM, EASTERBROOK, and WILLIAMS, Circuit
Judges.
FLAUM, Circuit Judge. Following an arrest for driving while
intoxicated, Kenneth Collins was booked into the Jackson
County Jail in Indiana. Collins later sued a jail physician and
the physician’s employer (a private corporation) under
2 No. 15‐3179
42 U.S.C. § 1983 and Indiana state law, claiming that the doc‐
tor had provided inadequate medical care to Collins during
his detention. The district court awarded summary judgment
to defendants, and we affirm.
I. Background
On August 12, 2012, Kenneth Collins was arrested for op‐
erating a vehicle while intoxicated. Collins was a regular
drinker, and he drank heavily—often consuming around
thirty beers every two days. Because he had in the past suf‐
fered from symptoms of alcohol withdrawal, Collins usually
kept with him a bottle of Librium, a benzodiazepine com‐
monly prescribed to treat withdrawal and anxiety disorders.
See http://www.drugs.com/cdi/librium.html (last visited
March 20, 2017). Collins had the bottle of Librium with him
when he was arrested in August 2012, and a booking officer
at the Jackson County Jail telephoned the assigned jail physi‐
cian, Dr. Nadir Al‐Shami, to ask about the medication. Dr. Al‐
Shami approved Collins’s use of the Librium while in custody,
and directed that he take the medication in accordance with
the dosages listed on the prescription bottle. Collins was
taken to a jail cell around 7:00 PM, and from 9:00 PM to around
11:30 PM, an officer checked on him approximately every fif‐
teen minutes.
Officers continued to check on Collins into the next morn‐
ing, observing that he was responsive and had no complaints.
At approximately 8:30 AM on August 13, however, Collins be‐
gan to complain of shaking from alcohol withdrawal, and he
was given some of the Librium, as well as some thiamine (vit‐
amin B1) and a multivitamin. By lunchtime, Collins was feel‐
ing better and eating normally; but in the afternoon, he began
to complain again of having withdrawal symptoms, including
No. 15‐3179 3
shaking, nausea, and vomiting. A nurse measured his heart
and respiratory rates, temperature, oxygen levels, and blood
pressure, and called Dr. Al‐Shami to report her findings. The
doctor ordered that Collins be given the normal treatment for
alcohol withdrawal: Librium, thiamine, and multivitamins.
Dr. Al‐Shami also ordered that Collins be monitored for signs
of withdrawal, such as shaking, sweating, and changes in
mental state.
Around 7:30 the next evening (on August 14), an officer at
the jail heard Collins talking to himself in his cell, and so went
over to check on him. Collins was responsive and knew where
he was, but seemed indifferent to his surroundings. When a
nurse entered his cell around midday on August 15, Collins
was delusional and showing signs of paranoia. The nurse
called Dr. Al‐Shami, but he was unavailable, so she tele‐
phoned another on‐call physician. That physician advised the
nurse to discontinue the Librium treatment and to instead ad‐
minister a one‐time dose of Haldol, an anti‐psychotic agent.
See http://www.drugs.com/cdi/haldol.html (last visited
March 20, 2017). The nurse gave Collins the Haldol, but his
symptoms did not improve; so when Dr. Al‐Shami returned
the nurse’s earlier phone call, he told her to send Collins to the
emergency room.
Collins was taken to the hospital around 1:00 PM, where
medical staff measured his vital signs—all of which were nor‐
mal—and performed a blood work‐up. The latter showed
slightly low potassium levels, and higher‐than‐normal levels
of lactic acid and bilirubin (high bilirubin is a common symp‐
tom of alcoholism), but the examining physician, Dr. Mark
Guffey, concluded that Collins was not suffering from delir‐
ium tremens (an acute form of alcohol withdrawal), because
4 No. 15‐3179
his heart and respiratory rates were not very high, and be‐
cause he was not sweating, shaking, or otherwise acting “jit‐
tery.” Dr. Guffey thought the Librium pills were unnecessary,
and so did not advise the jail staff to continue treating Collins
with that medication upon his discharge from the hospital.
After Collins returned to the jail, officers saw that he was
having trouble sleeping and was standing on the top bunk of
his bed, so they moved him to a padded cell for his safety.
Then, in the early morning of August 17, 2012, an officer
thought that Collins was having “bad [delirium tremens]
from alcohol,” and called Dr. Al‐Shami. The doctor ordered
that Collins be given some Librium immediately, and again
each day for the next ten days. Later that morning, the doctor
made his weekly visit to the jail and examined Collins in per‐
son. Dr. Al‐Shami took Collins’s pulse and listened to his
heart, which were both normal (though Collins did appear
jaundiced). Dr. Al‐Shami also reviewed Collins’s medical rec‐
ords (from both the jail and the recent hospital visit), and or‐
dered that he be given a potassium supplement and sodium
bicarbonate to treat his low potassium and high lactic‐acid
levels, respectively. Dr. Al‐Shami believed that Collins was
suffering from delirium tremens, but because Collins had just
been released from the hospital, and because his condition
had not changed since then, Dr. Al‐Shami thought Collins’s
symptoms could be monitored and treated adequately by jail
personnel.
Collins continued to display strange behavior, however.
Late at night on August 19, Collins told an officer that Collins
was “in a room of a house and [could not] fix it”; and a few
hours later, in the early morning of August 20, jail staff over‐
heard Collins talking to himself about two kids “going
No. 15‐3179 5
around [and] stealing stuff.” Collins refused to eat breakfast
that morning, or lunch later that day—though by 10:30 PM, he
was responsive and walking around his cell. Collins was still
responsive on August 21, but on the morning of the 22nd, he
spent several hours lying on the floor of his cell, at times dis‐
robing, and would not eat any food. A nurse spoke with him
and thought him capable of some coherent conversation, but
noted that he had an unsteady gait, and so renewed the in‐
struction for continuous monitoring. Jail officers began to ob‐
serve Collins every fifteen minutes per the nurse’s orders, and
by lunchtime, Collins was eating once more. In the evening,
Collins was still responsive but again tried to take his clothes
off.
Officers continued to check on Collins every fifteen
minutes, and Collins was sitting up and eating at 9:15 AM on
August 23. Collins was still sitting up in his cell when officers
checked on him again at 9:30 and 9:45 that morning; but when
a nurse came by around 10:00 AM, she found that Collins’s
mental state had deteriorated. He was unable to converse
with her or maintain eye contact, and he could not sit up or
stand without help. The nurse called Dr. Al‐Shami, who in‐
structed her to send Collins back to the emergency room for
further evaluation and lab work. The nurse complied, and
Collins was taken to the hospital for a second time. Hospital
staff determined that Collins was hypothermic (his body tem‐
perature was 84.2 degrees), that he had low blood pressure,
and that he was suffering from dehydration, sepsis, and acute
respiratory failure. Collins was treated at the hospital and re‐
mained there, in a medically‐induced coma, for several days.
He did not return to the jail.
6 No. 15‐3179
In November 2013, Collins sued Dr. Al‐Shami under Indi‐
ana common law and 42 U.S.C. § 1983, claiming that the doc‐
tor had been negligent and had violated Collins’s Fourteenth
Amendment rights. Collins also named as a defendant Dr. Al‐
Shami’s employer, Advanced Correctional Healthcare, Inc.,
which had contracted with the Jackson County Sheriff’s De‐
partment to provide physician services at the jail. Defendants1
filed a motion for summary judgment, which the district court
granted as to both the state‐law and constitutional claims.
Collins appeals.
II. Discussion
We review de novo a district court’s grant of summary
judgment, construing all facts and drawing all reasonable in‐
ferences in favor of the non‐moving party. See Frye v. Auto‐
Owners Ins. Co., 845 F.3d 782, 785 (7th Cir. 2017) (citation omit‐
ted). Summary judgment is appropriate where there are no
genuine issues of material fact and the movant is entitled to
judgment as a matter of law. Fed. R. Civ. P. 56(a).
A. The Federal Claims
“[D]ifferent constitutional provisions, and thus different
standards, govern depending on the relationship between the
state and the person in the state’s custody.” Currie v. Chhabra,
728 F.3d 626, 630 (7th Cir. 2013) (citing Graham v. Connor,
490 U.S. 386, 394–95, 395 n.10 (1989); Belbachir v. Cty. of
McHenry, 728 F.3d 626, 628–30 (7th Cir. 2013)). The Fourth
Amendment applies to the period of confinement between a
1 Collins initially sued several employees of Jackson County and the City
of Seymour, as well, but settled with those defendants in April 2015. The
term “defendants,” as used in this opinion, therefore refers only to Dr. Al‐
Shami and Advanced Correctional Healthcare.
No. 15‐3179 7
warrantless arrest and the probable‐cause determination, id.
at 629, 631 (citations omitted); the Due Process Clause of the
Fourteenth Amendment governs after the probable‐cause de‐
termination has been made, see Lopez v. City of Chi., 464 F.3d
711, 719 (7th Cir. 2006) (citations omitted); and the Eighth
Amendment applies after a conviction, id. The parties in this
case agree that Collins’s federal claims are subject to the Due
Process Clause, but disagree on what that Clause entails.
In the past, we have applied to due‐process claims of in‐
adequate medical care the deliberate‐indifference standard
derived from the Eighth Amendment. See, e.g., Pittman ex rel.
Hamilton v. Cty. of Madison, Ill., 746 F.3d 766, 775 (7th Cir. 2014);
Smith v. Knox Cty. Jail, 666 F.3d 1037, 1039 (7th Cir. 2012); Minix
v. Canarecci, 597 F.3d 824, 831 (7th Cir. 2010). That standard
includes both an objective and subjective component, see
Minix, 597 F.3d at 831 (citations omitted), and thus is more
difficult to satisfy than its Fourth Amendment counterpart,
which requires only that the defendant have been objectively
unreasonable under the circumstances, see Lopez, 464 F.3d at
718 (citing Abdullahi v. City of Madison, 423 F.3d 763, 768 (7th
Cir. 2005)). Collins argues that under Kingsley v. Hendrickson,
— U.S. —, 135 S. Ct. 2466 (2015), it is the objective‐unreason‐
ableness standard that governs here, see id. at 2473 (applying
a “solely … objective” standard to a pre‐trial detainee’s
claims)—but Kingsley was an excessive‐force case, and we
have not yet addressed whether its reasoning extends to
claims of allegedly inadequate medical care, cf. Phillips v. Sher‐
iff of Cook Cty., 828 F.3d 541, 554 n.31 (7th Cir. 2016). We need
not (and do not) resolve that issue here, however, as even un‐
der the less‐demanding standard, Collins’s federal claims still
cannot succeed.
8 No. 15‐3179
1. The Claim Against Dr. Al‐Shami
Collins argues that the treatment he received from Dr. Al‐
Shami was objectively unreasonable under the circumstances,
because Dr. Al‐Shami did not monitor Collins’s vital signs, or
ensure that his vital signs were monitored, on a regular basis.
In support of this argument, Collins points to the deposition
testimonies of some of his other treating physicians, to a jour‐
nal article on the evaluation and treatment of individuals suf‐
fering from alcohol withdrawal, and to an “Alcohol With‐
drawal Protocol” issued by Dr. Al‐Shami’s employer, Ad‐
vanced Correctional Healthcare. These materials do not
demonstrate what Collins urges.
Dr. Guffey, the emergency‐room doctor who treated Col‐
lins when he was first sent to the hospital on August 15, 2012,
did refer to vital signs when asked at his deposition about di‐
agnosing delirium tremens (an acute form of alcohol with‐
drawal). Patients suffering from delirium tremens, explained
Dr. Guffey, typically will have a very high heart rate and a
“fairly high” respiratory rate, and may have a higher‐than‐
normal body temperature. However, Dr. Guffey also de‐
scribed more qualitative indicators of acute withdrawal, ex‐
plaining that patients with delirium tremens will be “sweaty,
very jittery, [or] shaking.” Dr. Jonathan Light, who treated
Collins after he returned to the same hospital on August 23,
2012, similarly described a collection or “cluster” of relevant
symptoms, including, on the quantitative side, an elevated
heart rate and hypertension (high blood pressure), but also
including symptoms that may be observed or discovered
through visual inspection or conversing with the patient, such
No. 15‐3179 9
as tremulousness, agitation, confusion, severe anxiety, head‐
aches, hallucinations, diarrhea, vomiting, and excessive
sweating.
Dr. Grant Olsen, an inpatient specialist who also treated
Collins during his second hospital visit on August 23, like‐
wise discussed a comprehensive approach to diagnosing de‐
lirium tremens. While Dr. Olsen would often use vital signs to
look for delirium tremens, he stated that, for inpatients, he
would typically evaluate alcohol‐withdrawal symptoms us‐
ing the Clinical Institute Withdrawal Assessment, or “CIWA,”
scale. The CIWA method, as explained in the journal article on
which Collins also relies, see Max Bayard et al., Alcohol With‐
drawal Syndrome, 69(6) AM. FAM. PHYSICIAN 1325, 1443–50
(2004),2 calls for healthcare providers to complete a worksheet
that ascribes a numeric score to an array of symptoms typi‐
cally associated with alcohol withdrawal, such as nausea and
vomiting; tremors; “[p]aroxysmal sweats”; anxiety; agitation;
tactile, auditory, and visual disturbances; headaches; and dis‐
orientation and “clouding of sensorium.” The more severe the
symptom, the higher the score and, collectively, the higher the
risk of developing delirium tremens. (The worksheet also in‐
cludes fields for recording the patient’s heart rate and blood
pressure, but ascribes a score to neither.)
Collins highlights that the Bayard article lists tachycardia
(elevated heart rate), fever, and hypertension as specific indi‐
cia of delirium tremens. The article does mention those symp‐
toms in connection with severe alcohol withdrawal; but the
article also refers to qualitative symptoms of the condition
2 Available at http://www.aafp.org/afp/2004/0315/p1443.html (last visited
March 20, 2017).
10 No. 15‐3179
(e.g., agitation, disorientation, and hallucinations), id. at Table
2. Vital signs are not the article’s sole, or even primary, focus,
and nothing in that document suggests that if a patient’s vital
signs are not measured frequently, healthcare providers will
be unable to assess the severity of the patient’s withdrawal.
Collins next points to the Alcohol Withdrawal Protocol
created by Dr. Al‐Shami’s employer, Advanced Correctional
Healthcare. The protocol suggests to jail personnel the actions
they should take if they suspect a detainee might be suffering
from withdrawal. These actions include: asking the detainee
a series of questions (when the detainee last drank alcohol,
how much they drink daily, and whether they have a history
of liver disease or seizures); examining the detainee—i.e., tak‐
ing their “[v]itals” (blood pressure, temperature, pulse, and
respiratory rate) and looking for other symptoms (e.g., trem‐
ors, confusion) that might require treatment; recording the re‐
sults of that examination; and scheduling a visit with a physi‐
cian or “responsible medical provider.” The protocol also
states that, after treatment with any medication (as directed
by a healthcare provider), the detainee’s vital signs should be
monitored every four hours for the first day of confinement,
and then again during each shift while medications continue.
Collins argues that the protocol establishes a standard of
medical care, and that the standard therefore includes the reg‐
ular monitoring of a detainee’s vital signs. On each page of the
document, however, is written:
These Protocols are designed to assist the staff
in the gathering of information to be communi‐
cated to the medical staff. The Protocols are not
intended to establish a standard of medical care and
No. 15‐3179 11
are not standing orders. All treatments must be or‐
dered and approved b[y] a Nurse Practitioner,
Physician Assistant or Physician.
(emphasis added). Several jail employees also testified at their
depositions that the protocol forms are in general used by
non‐medical jail staff for the limited purpose of collecting in‐
formation when medical professionals are not present or
available to see detainees in person. At most, the protocol re‐
flects the kind of data that some physicians3 thought might be
helpful in assessing a detainee’s alcohol withdrawal. The ma‐
jority of those data concern the detainee’s appearance and be‐
havior, not his vital statistics, and in any event, there is no
suggestion that acute alcohol withdrawal cannot be treated or
diagnosed absent those particular statistics.
Vital signs aside, Collins argues that Dr. Al‐Shami is still
liable under § 1983, because the on‐site jail staff should have
at least monitored Collins’s overall condition, and Dr. Al‐
Shami did not advise those staff members about when to con‐
tact him should Collins’s symptoms worsen. This argument,
too, is unpersuasive. First, it is not apparent from the record
that Dr. Al‐Shami was responsible for giving orders of pre‐
cisely this kind. Moreover (and relatedly), Collins points to no
evidence reasonably suggesting that the orders Dr. Al‐Shami
did give were deficient. Dr. Al‐Shami instructed that Collins
be observed for signs of withdrawal (including sweating,
shaking, and changes in mental state), and Collins was
checked—frequently—by on‐site personnel, who collectively
telephoned Dr. Al‐Shami at least four times about Collins’s
3 The “[s]ource” of the protocol is listed as the “Physician Advisory
Board.”
12 No. 15‐3179
condition and twice sent him to the hospital at Dr. Al‐Shami’s
request.
Collins stresses that Dr. Olsen was unable to assess the
quality of care actually given to Collins during his detention
because, according to Dr. Olsen, he did not have a complete
“clinical picture” of Collins’s condition. That Dr. Olsen could
not opine on the adequacy of Collins’s treatment is not evi‐
dence that the treatment was objectively inadequate—and nor
do the records from Dr. Light, on which Collins also relies, fill
that gap. Dr. Light had remarked in his treatment notes from
August 28, 2012, that Collins’s altered mental state was likely
symptomatic of delirium tremens that had been “inade‐
quately managed … with oral Librium at [the] jail.” At his
deposition, however, Dr. Light clarified that this comment
was not about the relevant standard of care. According to Dr.
Light, he had meant to convey only that, despite the Librium
treatment (as ordered by Dr. Al‐Shami), Collins’s alcohol
withdrawal had continued to progress—a possibility even
where alcohol‐withdrawal symptoms have been managed ap‐
propriately.
Defendants’ medical expert, Dr. Benton Hunter, reviewed
Collins’s medical records and a chronology of his treatment at
the Jackson County Jail, and concluded that Dr. Al‐Shami’s
conduct was reasonable and in accordance with the applica‐
ble standard of care. Collins has not presented any evidence
suggesting that this conclusion was erroneous. The district
court thus correctly dismissed Collins’s § 1983 claim against
Dr. Al‐Shami.
No. 15‐3179 13
2. The Claim Against Advanced Correctional Healthcare
Collins argues that, if Dr. Al‐Shami is liable under § 1983,
Al‐Shami’s employer should likewise be held liable under the
doctrine of respondeat superior. Under existing precedent, nei‐
ther public nor private entities may be held vicariously liable
under § 1983. See Monell v. Dep’t of Soc. Servs. of City of N.Y.,
436 U.S. 658, 691 (1978) (discussing municipal liability); Is‐
kander v. Vill. of Forest Park, 690 F.2d 126, 128 (7th Cir. 1982)
(extending Monell to suits against private corporations) (cita‐
tions omitted). Though we have recently questioned whether
the rule against vicarious liability should indeed apply to pri‐
vate companies, see Shields v. Ill. Dep’t of Corr., 746 F.3d 782,
786, 789–95 (7th Cir. 2014), we again leave that question for
another day. Dr. Al‐Shami is not liable, so—even if the theory
of respondeat superior were available—neither is his employer.
B. The State‐Law Claims
Collins also brought a medical‐malpractice claim against
Dr. Al‐Shami and Advanced Correctional Healthcare under
Indiana law. (There is no dispute that respondeat superior ap‐
plies in Indiana.) To succeed on such a claim, Collins must
show that Dr. Al‐Shami owed Collins a duty of care, that the
doctor’s actions did not conform to that standard of care, and
that Collins was proximately injured by the doctor’s breach.
See McSwane v. Bloomington Hosp. & Healthcare Sys., 916 N.E.2d
906, 910 (Ind. 2009).
Collins seeks to avoid summary judgment on his state‐law
claims using the same evidence he presented in support of his
§ 1983 claims. That evidence, however, for reasons already
discussed, is insufficient to create a genuine issue of material
14 No. 15‐3179
fact. The state‐law claims against Dr. Al‐Shami and Advanced
Correctional Healthcare were correctly dismissed.
III. Conclusion
For the foregoing reasons, we AFFIRM the judgment of the
district court.