Richard FOELKER, Plaintiff-Appellant, v. OUTAGAMIE COUNTY et al., Defendants-Appellees, 394 F.3d 510

TERENCE T. EVANS, Circuit Judge. After 2 days in the Outagamie County jail, according to a social worker there, Richard Foelker was “confused and disoriented” and, despite having defecated in his cell and on himself, he was “unaware of the mess that he created.” Although his condition, which resulted from his forced withdrawal from methadone, continued to deteriorate, he was not taken to the hospital for 2 more days.

That delay, along with Foelker’s inability to obtain methadone while he was incarcerated, forms the basis of this appeal from the dismissal of his suit alleging a violation of his constitutional rights. Foelker turned himself in at the jail on April 27, 2000, to begin serving a sentence in connection with a conviction for operating a motor vehicle under the influence of an intoxicant. At the time, Foelker was on a methadone maintenance treatment program designed to wean people off of their narcotic addition.

The program was administered by Valley Health Services, a clinic in the town of Menasha in Outagamie County. He had been on the program for about 5 weeks when he self-reported at the jail, but he had not taken his daily dose of methadone when he arrived. He says he didn’t take his dose because he was ill in the morning and the clinic closed at noon. Soon after Foelker’s arrival at the jail, Paul Mintzlaff, a registered nurse, examined him. Foelker told Mintzlaff that he needed to receive a dose of methadone to avoid going into withdrawal.

The next morning, Marcia Allain, the jail’s nursing coordinator, evaluated Foelker and told him that he would not receive methadone during his incarceration because he had been off the drug for 3 days. Still, Allain called Valley Health Services because it worked with the jail and provided methadone for other inmates. Allain was told that Foelker should receive a reduced dose of methadone.

It is neither clear nor particularly relevant at this point why the methadone never made it to the jail; it is only important that Foelker did not receive any methadone that day or, for that matter, at any time while he was there. At 1:15 p.m. on Foelker’s third day in a holding cell, Brian Sehertz, another registered nurse, checked on Foelker, then reported to Sergeant John Behrent that Foelker could be moved to a cell with the general population if necessary.

An hour later, Sergeant Behrent told Sehertz that Foelker had defecated on himself and on the floor of the holding cell and that the stench was “unbearable.” Although Sehertz says he thought Foelker was “playing the system” and not in need of medical attention, he arranged for Diane Mandler, supervisor of the Outagamie County Crisis Program and the Case Management Program of Outagamie County, to evaluate Foelker.

Mandler, a social worker, examined Foelker at 4:15 p.m. and found that he was confused, disoriented, and hearing voices, and that, although he knew that he had not taken methadone for several days, he was unaware that he had defecated on himself and on the floor of his cell. Mandler recommended that Foelker be observed but did not push for immediate medical attention. Neither Sehertz nor Mandler saw Foelker the next day. Foelker remained in his cell despite again defecating on the floor.

The following morning, Mintzlaff found Foelker to be “disoriented.” Foelker thought he was at “the wedding hotel” waiting to be married and was hallucinating about another person in his cell. Mint-zlaff left a message with Mandler and called the jail’s doctor, who recommended that Mintzlaff give Foelker thiamine, a drug used for alcohol withdrawal, which he did. Mintzlaff returned 2 hours later and found Foelker in the same condition. An hour after that, Mintzlaff sent Foelker to the hospital. Foelker eventually was diagnosed with acute delirium, secondary to drug withdrawal.

Foelker spent 4 days in the hospital before being transferred back to the Outagamie County jail. Foelker sued under 42 U.S.C. § 1983, claiming that those responsible for caring for him violated his Eighth and Fourteenth Amendment rights by denying him methadone and, as his condition worsened, by failing to provide him adequate medical care. After the complaints against several defendants were dismissed, the district court granted a motion for

summary judgment in favor of the remaining defendants. Foelker appeals only his Eighth Amendment claims against Sehertz and Mandler and his derivative statutory indemnification claim against Outagamie County, the outcome of which depends on the outcome of Foelker’s claims against the County employees, see Wis. Stat. § 895.46 (2002). To prevail, Foelker must show deliberate indifference to a serious medical need. See Estelle v.

Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). “A ‘serious’ medical need is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.” Jackson v. Illinois Medi-Car, Inc., 300 F.3d 760, 765 (7th Cir.2002) (quoting Gutierrez v. Peters, 111 F.3d 1364, 1371 (7th Cir.1997)). We review the district court’s grant of

summary judgment de novo. See, e.g., Mateu-Anderegg v. School Dist. of Whitefish Bay, 304 F.3d 618, 623 (7th Cir.2002). Although the district court found otherwise, defendants argue that Foelker failed to present evidence of a serious medical need because he could not show that he was in “pain or extreme distress.” We side with the district court. That Foelker was not in extreme distress does not necessarily mean that he did not have a serious medical need. Here, as it turns out, the opposite is true.

The fact that Foelker was not distressed despite believing he was at the “wedding hotel” and defecating on the floor of his cell and on himself is strong evidence of a severe medical need. Defendants also argue that Foelker must not have had a serious medical need because both Schertz and Mandler examined him and did not send him to the hospital. But that doesn’t mean Foelker didn’t have a serious medical need, only that defendants took no action to treat him, which is exactly what Foelker claims was the problem.

The question, then, is whether, as they now suggest, Schertz and Mandler were merely negligent in their assessment of Foelker’s condition or whether they were deliberately indifferent to his medical needs. See Jackson, 300 F.3d at 765 (“Evidence that the official acted negligently is insufficient to prove deliberate indifference.”). “ ‘[DJeliberate indifference’ is simply a synonym for intentional or reckless conduct, and ... ‘reckless’ describes conduct so dangerous that the deliberate nature of the defendant’s actions can be inferred.” Qian v. Kautz, 168 F.3d 949, 955 (7th Cir.1999).

Schertz and Mandler argue — and the district court agreed — that Foelker failed to present evidence showing that the defendants knew how serious Foelker’s condition was. While it is true that Foelker has not presented evidence of, say, statements by Schertz and Mandler proving that they knew the severity of Foelker’s condition, direct evidence is not always necessary to state a claim. See Farmer v. Brennan, 511 U.S. 825, 842, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994) (allowing proof of deliberate indifference by “inference from circumstantial evidence”).

Undisputed evidence shows that Schertz checked on Foelker the night of April 28 and again around 1:15 p.m. the next day. He did not seek further medical attention for Foelker, even though Foelker had defecated on the floor of his cell and on himself. Although Schertz might have honestly believed, as he claims, that Foelker “was playing the system,” a reasonable jury could consider that Schertz knew that Foelker had not taken his methadone and was exhibiting signs of withdrawal and thus conclude that Schertz knew there was something seriously wrong with Foelker.

It could thus conclude that Schertz recklessly or maliciously allowed the situation to fester. Similarly, after examining Foelker a few hours after Schertz on April 29, Mandler found Foelker to be “confused and disoriented” and “unaware” that he had defecated in his cell. Although Mandler knew that Foelker might have been suffering from methadone withdrawal, she recommended only that he continue to be monitored. Again, she might not have understood the severity of the situation and might have negligently believed that Foelker did not need additional medical attention.

But drawing all inferences in Foelker’s favor, as we must at this stage, a reasonable jury could also conclude that she intentionally allowed Foelker to suffer from the effects of his withdrawal. We, of course, cannot predict how a jury would view this situation. The facts, as we have presented them, put the best light on Foelker’s view of the case. A contrary-view might actually present a truer picture of the situation. At this stage of the litigation, we think the case should not have been short-circuited on

summary judgment. Therefore, we ReveRse the judgment and RemaND the case for further proceedings.