In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 14‐1829
DERRICK ECHOLS, JR.,
Plaintiff‐Appellant,
v.
FREDERICK A. CRAIG,
Defendant‐Appellee.
____________________
Appeal from the United States District Court for the
Northern District of Illinois, Eastern Division.
No. 11 C 6686 — George M. Marovich, Judge.
____________________
ARGUED NOVEMBER 16, 2016 — DECIDED MAY 4, 2017
____________________
Before EASTERBROOK, KANNE, and HAMILTON, Circuit
Judges.
HAMILTON, Circuit Judge. Derrick Echols, an Illinois in‐
mate, claims in this suit under 42 U.S.C. § 1983 that prison
dentist Dr. Frederick Craig (an employee of Wexford Health
Sources) violated the Eighth Amendment by providing dental
care with deliberate indifference to Echols’ serious health
2 No. 14‐1829
needs. While Dr. Craig was extracting a wisdom tooth, a drill
bit broke. Dr. Craig sutured Echols’ gum with gauze and at
least one half‐inch long piece of the broken bit still inside,
where it caused pain for about two weeks before it was finally
removed.
Knowledge is the key issue in this lawsuit. Echols alleges
that Craig sutured the extraction site after intentionally
packing it with non‐soluble gauze and without first locating
the missing shards from the broken drill bit. The district court
screened Echols’ operative complaint, see 28 U.S.C. § 1915A,
and dismissed it with the explanation that Echols’ allegations
are factually frivolous. On appeal, we conclude that Echols’
allegations are quite plausible and state a claim for violation
of the Eighth Amendment. We vacate the judgment and
remand for further proceedings.
I. Factual and Procedural Background
Because we review a dismissal on § 1915A screening, we
treat the allegations in the complaint as true, but without
vouching for their objective truth. Plaintiff Echols is a prisoner
in the Stateville Correctional Center. He filed a pro se
complaint alleging that Dr. Craig and Dr. Jaqueline Mitchell
(another dentist employed by Wexford) were deliberately
indifferent to the pain and potential for further injury caused
by having the gauze and fragment of drill bit sutured into his
gum. Dr. Craig had removed one of Echols’ wisdom teeth and
sewed up the extraction area.
According to Echols’ initial complaint, when he returned
to Dr. Mitchell nine days after the extraction to have the
sutures removed, he complained of a metallic taste in his
mouth, blood and pus oozing from the extraction site, a small
No. 14‐1829 3
knot in the gum next to that site, and a lot of pain. But Dr.
Mitchell, instead of ordering an X‐ray, simply told Echols that
these problems would go away. The next day Echols asked to
see a dentist again because the pain had increased, but his
request was denied. Three days after that, the initial
complaint continued, a wad of gauze and a piece of metal drill
bit (about one‐half inch long) dislodged from Echols’ gum
while he was rinsing his mouth.
Dr. Mitchell then opened the extraction site and removed
more gauze and a small piece of tooth root. Echols attached to
this complaint a mostly illegible chart from the prison
infirmary listing the dental services he received and a
“Shakedown Record” confirming that Echols, fourteen days
after the tooth extraction, gave prison staff a “Dental Drill Bit”
and a “small piece of gauze.” He also attached a grievance
officer’s decision substantiating his grievance about the
incident and acknowledging that an “X ray was produced to
verify objects were in grievant’s mouth,” and the
Administrative Review Board’s decision recounting Echols’
allegation that, after the half‐inch piece had worked loose, Dr.
Mitchell had removed more of the broken bit from his gum
after an X‐ray.
The district court screened this complaint under 28 U.S.C.
§ 1915A and initially allowed it to proceed against both
Dr. Craig and Dr. Mitchell. Later the court granted Dr.
Mitchell’s motion to dismiss for failure to state a claim. After
the court had recruited counsel to assist Echols under
§ 1915(e)(1), he amended the complaint to drop Dr. Mitchell
from the lawsuit. This amended complaint repeated the
allegations in the initial complaint. As before, Echols claimed
that Dr. Craig, by leaving the gauze and broken bit in the
4 No. 14‐1829
extraction site and not following up on his condition, ignored
an obvious risk and caused him more than two weeks of
unnecessary pain.
On Dr. Craig’s motion, the district court dismissed the
amended complaint, again on the ground that it failed to state
a claim of deliberate indifference. The court reasoned that in
the revised version, Echols did not allege explicitly that Dr.
Craig intended to cause him pain or that he knew about the
gauze and broken drill bit in his gum. The court
acknowledged that deliberate indifference can be inferred
from treatment decisions that are far afield of accepted
professional standards. The court found, however, that no
such inference could arise in this case because Echols did not
allege that Dr. Craig made a treatment decision to leave metal
and gauze in the extraction site.
The district court gave Echols another chance to amend his
complaint, which he did. But by then his lawyer had
withdrawn. The second amended complaint (the pro se
version at issue in this appeal) included new details. Echols
alleges that during the tooth extraction, he heard a popping
sound and that Dr. Craig, who was performing the procedure
with Dr. Mitchell’s assistance, responded to his inquiry by
saying, “Gosh, the drill bit broke,” and then, “Everything’s
okay.” Dr. Mitchell asked Dr. Craig if he had the drill bit, and,
according to Echols, Dr. Craig replied, “It broke.” Dr. Craig
then sutured the site after packing it with gauze, which,
Echols maintains, is not done by dentists because gauze does
not dissolve. Later that day, Echols continues, the infirmary
was placed on lockdown when administrators learned that a
drill bit was missing. Echols later complained to prison
administrators and to Dr. Craig and Dr. Mitchell multiple
No. 14‐1829 5
times that he tasted metal, had blood and pus oozing from the
extraction site, and was in extreme pain, but his requests to be
examined were ignored.
The second amended complaint includes additional
information that Echols learned from personal investigation.
An X‐ray that Dr. Craig took after the extraction, says Echols
in the complaint, shows the broken bit inside his sutured
gum. Echols points to the favorable decision on his grievance
and the line in that decision saying that an “X ray was
produced to verify objects were in grievant’s mouth.” In the
second amended complaint, Echols also alludes to the follow‐
up ruling of the Administrative Review Board, which implies
that the X‐ray was taken before Dr. Mitchell reopened the
extraction site and shows more pieces of the bit still in his
gum.
In screening Echols’ second amended complaint under
§ 1915A, the district court called his allegations “factually
frivolous” and dismissed the lawsuit with prejudice. The
court began by acknowledging that the complaint “includes
additional factual allegations which, if true, would suggest”
that Dr. Craig had reason “to believe the drill bit was lost in
Echols’ mouth but sutured his wound nonetheless.” Yet this
scenario, the court asserted, was “fanciful and incredible” for
three reasons. First, the new allegations were not mentioned
in Echols’ grievances or first two complaints even though
these documents were quite detailed and one of the com‐
plaints was drafted by counsel. Second, the medical records
attached to the complaint did not identify Dr. Mitchell as a
participant in the initial procedure to extract the tooth. And,
third, according to the court, Echols admitted that he was
6 No. 14‐1829
“heavily sedated” during the procedure yet alleged he over‐
heard the conversation between the two dentists about the
broken drill bit.
II. Analysis
On appeal, Echols argues that the district court erred by
dismissing his Eighth Amendment claim against Dr. Craig as
factually frivolous. He asserts that his additional allegations
in the second amended complaint are consistent with the
allegations in the earlier versions and are not implausible or
frivolous.
A complaint cannot be dismissed under § 1915A as
factually frivolous unless it rests on allegations that are clearly
baseless, irrational, fanciful, or delusional. See Felton v. City of
Chicago, 827 F.3d 632, 635 (7th Cir. 2016); Edwards v. Snyder,
478 F.3d 827, 829–30 (7th Cir. 2007). In our view, Echols’ new
allegations—those, which in the district court’s view, raise the
inference that Dr. Craig knew the broken drill bit was “lost”
in Echols’ gum when he sutured it closed—are quite plau‐
sible, not “factually frivolous.”
Echols alleges that wadded gauze and at least one shard
from the broken drill bit were in his sutured gum two weeks
after the extraction. Echols attached supporting evidence to
his complaint, though that should not be necessary at the
pleading stage. Dr. Craig was the one using the drill. It takes
no logical stretch to infer that he knew the bit was intact when
he began and broken by the time he finished. According to
Echols, Dr. Craig even announced during the procedure that
the bit had broken. There is ample reason to think that Dr.
Craig sutured the extraction site without having located the
missing portion of the broken bit that was found two weeks
No. 14‐1829 7
later. It also takes no logical stretch to infer that Dr. Craig
likely knew that gauze and shards of the broken drill bit were
still in the wound, or at least that he was deliberately
indifferent to that possibility.
The additional allegations in the second amended
complaint are consistent with what Echols had said all along
in his grievances and first two complaints. Such new
information may even be added on appeal so long as the
additional allegations are consistent with the complaint. E.g.,
Dixon v. County of Cook, 819 F.3d 343, 349 (7th Cir. 2016);
Reynolds v. CB Sports Bar, Inc., 623 F.3d 1143, 1147 (7th Cir.
2010); see also Scott v. Chuhak & Tecson, P.C., 725 F.3d 772, 782–
83 (7th Cir. 2013) (explaining that amended complaint
supersedes earlier version, and that allegations and state‐
ments in superseded complaint cannot be considered on a
motion to dismiss). The fact that Echols added them in the
second amended complaint does not render them frivolous.
On the sedation point, Echols has never asserted that the
extraction was performed under a general anesthetic, and the
medical records submitted to the district court indicate that it
was not. The district court went too far by inferring from the
pleadings that Echols was too “heavily sedated” from a local
anesthetic to hear, comprehend, and remember the
conversation between Dr. Craig and Dr. Mitchell about the
broken drill bit.
Dr. Craig argues that the complaint does not allege the
knowledge, intent, or recklessness required to state a claim of
deliberate indifference. See Berry v. Peterman, 604 F.3d 435, 440
(7th Cir. 2010); Riccardo v. Rausch, 375 F.3d 521, 525–26 (7th
Cir. 2004). He made this argument in his motion to dismiss
Echols’ first amended complaint; he did not have a chance to
8 No. 14‐1829
repeat it concerning the second amended complaint since the
latter was dismissed on the court’s own initiative. Thus,
although the district court did not dismiss the second
amended complaint and the lawsuit on this basis, Dr. Craig
can seek affirmance on this ground, at least if there is a flaw
that could not be corrected by further amendment. See Dibble
v. Quinn, 793 F.3d 803, 807 (7th Cir. 2015); Locke v. Haessig,
788 F.3d 662, 666 (7th Cir. 2015).
We find, however, that the second amended complaint
sufficiently alleges the subjective element of deliberate
indifference. See Rivera v. Gupta, 836 F.3d 839, 842 (7th Cir.
2016); Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016) (en
banc). We liberally construe Echols’ second amended
complaint and accept as true the factual allegations in that pro
se submission, while drawing all reasonable inferences in
Echols’ favor. See Perez v. Fenoglio, 792 F.3d 768, 776 (7th Cir.
2015). We have no difficulty concluding that Echols states a
plausible claim of deliberate indifference. See Dixon, 819 F.3d
at 350; Perez, 792 F.3d at 777. Echols alleges that Dr. Craig
violated the Constitution when he “turned a blind eye to his
serious medical needs.” Dr. Craig knew he broke a drill bit
during the extraction, Echols alleges, but sutured his gum
without accounting for the broken pieces. Echols also alleges
that Dr. Craig, after suturing part of the broken bit into his
gum, obtained an X‐ray that confirmed its presence but did
nothing to address the problem.1 Additionally, Echols
1 We reject Dr. Craig’s assertion that this allegation is contradicted by
documents submitted with Echols’ complaint. The initial decision on
Echols’ grievance states, “An X ray was produced to verify objects were in
grievant’s mouth.” The follow‐up decision from the Administrative
Review Board, in recounting the factual underpinnings of Echols’
grievance, explains that an X‐ray taken when Echols returned to the
No. 14‐1829 9
plausibly alleges that Dr. Craig packed into the extraction site
non‐soluble gauze (it must have been non‐soluble if it was re‐
moved two weeks later) and then sutured the wound with
this foreign material inside. Nothing at this stage conclusively
rebuts Echols’ plausible allegation that suturing the drill bit
and gauze into his mouth was far afield of accepted
professional medical standards or the inference that it was so
far afield that a jury might infer the action was not merely
negligent, which would not violate the Eighth Amendment,
but reflected deliberate indifference, which would.
Echols’ allegations are sufficient to put Dr. Craig on notice
of the claim. See Fed. R. Civ. P. 8(a); Swanson v. Citibank, N.A.,
614 F.3d 400, 403–04 (7th Cir. 2010). Echols sufficiently alleges
that Dr. Craig’s actions were so inappropriate that the lawsuit
cannot be dismissed at screening. See Dixon, 819 F.3d at 350
(complaint alleging that prison physician and nurse offered
only non‐prescription pain medication despite knowledge of
a chest tumor, intense pain, and partial paralysis stated claim
for deliberate indifference); Perez, 792 F.3d at 777 (complaint
alleging that prison physician and nurse forced inmate to wait
for treatment of gaping wound and open dislocation despite
knowledge of injury’s severity stated claim for deliberate
indifference); Rodriguez v. Plymouth Ambulance Serv., 577 F.3d
816, 830 (7th Cir. 2009) (complaint alleging that emergency
infirmary revealed that still more of the drill bit was sutured into his gum.
These documents might be referring to a single X‐ray taken after the half‐
inch shard came out of Echols’ mouth, or the separate decisions might be
referring to different X‐rays. But either way, the two decisions do not
conclusively undermine Echols’ allegation that Dr. Craig took an X‐ray of
his mouth immediately after the extraction. See Atkins v. City of Chicago,
631 F.3d 823, 831–32 (7th Cir. 2011).
10 No. 14‐1829
medical technician failed to remedy incorrectly inserted
intravenous needle after inmate complained of pain stated
claim for deliberate indifference even if initial insertion was
only negligent); Edwards, 478 F.3d at 830–31 (complaint al‐
leging that prison physician forced inmate to wait two days
before treating fractured bone showing through open wound
stated claim for deliberate indifference).
Accordingly, the district court’s judgment is REVERSED
and the case is REMANDED for further proceedings.