FREDERICK J. KAPALA, District Judge.
Defendants' motion for summary judgment [309] is granted. Defendants' motion to bar plaintiff's expert [312] is denied as moot. This case is closed.
Antwann Green has sued two prison doctors, Dr. Imhotep Carter and Dr. Bessie Dominguez, alleging that they were deliberately indifferent to his serious medical needs while he was incarcerated at the Dixon Correctional Center ("Dixon").
The thyroid gland is a butterfly shaped organ on the neck that has several functions, one of which includes controlling the body's metabolism. The thyroid produces several hormones, notably for this case thyroid stimulating hormone (TSH), triiodothyroxine (T3), and thyroxine (T4). Hypothyroidism is a condition where the thyroid gland is not producing those hormones properly, which can affect the body's metabolism. Common symptoms of hypothyroidism are goiter, fatigue, hyperpigmentation of the skin, brittle or thinning hair, brittle skin, unexplained weight gain, constipation, memory problems, muscle aches, and, at advanced stages, slowing of the reflexes of the muscles and nerves. Hypothyroidism varies in degree from borderline or subclinical cases to severe cases. Many individuals with mild hypothyroidism are asymptomatic and the condition may become better or worse with time.
During the relevant time period of this lawsuit, Green was incarcerated at Dixon as a consequence of a murder conviction. Green has never been diagnosed with a soy allergy and, prior to incarceration, was not diagnosed with hypothyroidism. After his incarceration, and since 1998, Green has received a vegan diet in accordance with the tenets of his religion. Green was transferred to Dixon in 2005, and began at that time to seek medical care from various medical caregivers (none of whom are at issue in this suit nor is their care) for a panoply of problems: shoulder pain, bone and muscle aches, numbness, fatigue, rapid heartbeat, brittle hair, constipation, dizzy spells, abdominal pain, loss of hair, shortness of breath, deformed fingernails, flatulence, and sleep disturbance. At the end of 2006, Green was given the first of several TFTs, which returned results showing him in the normal reference range for T3, T4, and TSH.
In August 2009, Green was given another TFT. In that test, he again scored slightly out of range for TSH, but within the normal range for his T3 and T4 levels. The results were the same when he was tested again in December 2009. Although Green discusses in his depositions various medications given to him by providers during this pre-defendant-care period of time—including some treatment for Green's complaints of constipation—there are few specifics in Green's testimony and no medical records in the record provided to the court to illuminate what that treatment looked like. In January 2010, Green filed a medical grievance (there is no evidence that he had been seen by Carter prior to this grievance or that Carter was ever made aware of the grievance) in which he complained about untreated abdominal and lower back pain and indicated his belief that he had hypothyroidism. In that grievance, Green requested a soy-free vegan diet, mentioned a lawsuit filed in the Central District of Illinois against IDOC by prisoners claiming that soy-heavy diets ultimately caused or exacerbated their hypothyroidism (
At the outset of his deposition, Carter testified that he did not recall Green or the care he provided at all, and was relying on the medical records and treatment notes for his testimony. Nevertheless, Carter was employed at Dixon as the medical director from January 4, 2010 to July 24, 2011 by Wexford Health Sources, Inc., the vendor which provides medical services at Dixon. Green first saw Carter on February 25, 2010 based on complaints of a metal taste in his mouth, constipation, and abdominal pain. Carter noted, after a physical examination, that Green's abdomen was soft, demonstrated positive bowel sounds, was non-tender, and did not demonstrate rebounding or masses. Based on Green's complaints of constipation and abdominal pain, Carter ordered plaintiff to undergo a stool guaiac test and scheduled a collegial review (where Wexford physicians and staff discuss the patient's medical condition and care necessary to address the condition and which is also necessary to schedule off-site procedures) to obtain a right upper-quadrant abdominal ultrasound for Green. On March 5, 2010, Carter discussed Green's condition at the collegial review and noted that the stool guaiac test had returned negative. The collegial review denied Carter's request for an ultrasound and, instead, decided to monitor Green's condition on site and recommend him for collegial review in the future if needed.
Sometime in early 2010, Green received literature concerning hypothyroidism and informed Carter that he believed he had hypothyroidism. Green's testimony is unclear as to when that occurred and the first time hypothyroidism is mentioned in his medical records is in June 2010,
Regardless, on April 1, 2010, Carter again saw Green for complaints of abdominal pains and trouble with bowel movements. A physical examination again showed Green's abdomen to be normal and Carter informed Green that he was likely constipated. Carter ordered Green to undergo a number of laboratory tests to investigate Green's condition, including a KUB (kidney, uterus, and bladder) x-ray of his abdomen, a comprehensive metabolic panel, and a urinalysis test. Carter also prescribed Green fiber tablets in an effort to relieve his constipation. On April 6, 2010, Green underwent the KUB abdominal x-ray, which showed only that Green had mild constipation.
On May 10, 2010, despite the fiber tablets, Carter saw Green for complaints of abdominal pains and constipation. Carter performed a physical exam, which was normal, and discontinued the apparently ineffective fiber tablets. Instead, he prescribed Lactulose and Colace laxatives in an attempt to alleviate Green's constipation. On May 30, 2010, Green filed a grievance concerning his medical care, although again there is no evidence in the record that Carter was made aware of that grievance. In it, Green claims that he had been complaining for three years of intestinal problems, pain in his stomach and groin region, "brain fog," fatigue, irregular or rapid heart beats, painful fingernails, spots on his skin, a bulge in the lower right section of his stomach, and constipation lasting as long as five days. Green also complained that Carter had prescribed him the same medication as previous prison doctors, notwithstanding the fact that he informed Carter that those medications did not alleviate his symptoms. Finally, Green diagnosed his problem as hypothyroidism. Thus, he demanded treatment for hypothyroidism, to be treated for an intestinal blockage, and to receive a soy-free vegan diet, which he claimed was a cause of his hypothyroidism.
On June 4, 2010, Carter saw and examined Green to further evaluate his abdominal pains. At that time, Green stated that he wanted to join the
That same day, Green filed another grievance concerning Carter's care (again, though, no evidence in the record suggests Carter saw that grievance). In the grievance, he stated that Carter called him an "ambulance chaser," told him that there is no proof that soy causes thyroid problems, and otherwise acted unprofessionally towards Green. Because of that, Green requested that Carter be disciplined, that Green be cared for by a different doctor, and that Green receive a CEA test and a TFT (apparently notwithstanding the fact that Carter had already ordered those tests).
Green underwent the TFTs on June 8, 2010 and June 22, 2010, both of which returned normal and within laboratory reference ranges for all three hormones. The CEA test was also negative. On June 15, 2010, the grievance officer denied Green's May 30, 2010 and June 4, 2010 grievances because the first thyroid test did not suggest hypothyroidism and recommended that Green drink more water to ease his constipation.
Carter saw Green next on July 14, 2010, this time complaining of pain in his side. On that date, Carter followed up on his prior request to obtain an abdominal ultrasound for Green. Carter wanted to obtain an ultrasound of Green's gallbladder to further investigate Green's reported abdominal pain, bloating, and weight loss. Carter appealed the denial of his previous request via a collegial review to obtain an abdominal ultrasound for Green. Based on his appeal, Wexford approved the gallbladder ultrasound for Green, which he underwent on September 1, 2010. The abdominal ultrasound was normal.
On September 22, 2010, Carter saw Green due to complaints of constipation and bloating. Carter explained the ultrasound results to Green, performed a physical examination of Green's abdomen (which was normal), came to the conclusion that Green suffered from chronic constipation, and adjusted Green's medication. In particular, Carter discontinued Green's fiber tablets (it is not clear on the record when Green began a regimen of fiber tablets again after Carter's previous discontinuation of that treatment) and Colace prescription, while increasing Green's Lactulose prescription. On October 6, 2010, Carter again saw Green for complaints of constipation and also a complaint of a lump in the lower left side of Green's rib cage. Carter examined Green's abdomen and found it normal, noted Green's continued weight gain and healthy appearance, and again concluded that Green suffered from chronic constipation. Moreover, according to the medical records, Green informed Carter that his bowels were moving better with the Lactulose syrup, and Carter did not change Green's treatment.
That same day, Green grieved Carter's care. In that grievance, Green claims that he told Carter that the medication was not working, that he was still experiencing constipation, and that he was now experiencing a lump under his rib cage. Green also wrote that he requested a colonoscopy, but that Carter told him there was no need for a biopsy, except "maybe a mental biopsy." Additionally, Carter told Green that he was just going to have to live with the pain. According to Green, Carter continued to prescribe the same medication notwithstanding its previous ineffectiveness.
According to the medical records, on November 30, 2010, Green saw Carter for complaints of abdominal pains, constipation, and that the Lactulose was no longer working. Carter noted that a physical exam of Green's abdomen was normal, but also noted Green's previous family history of colon cancer. Carter concluded that Green continued to suffer from chronic constipation notwithstanding the maximum permissible dose of Lactulose. As such, Carter requested a collegial review of Green's case in order to obtain outside consultation at University of Illinois Chicago's (UIC) gastrointestinal clinic.
On December 3, 2010, Carter completed a medical special services referral and report in order to obtain an outside consultation for Green at the UIC gastrointestinal clinic. On December 7, 2010, Carter discussed Green's case in a collegial review with another Wexford physician. At that time, that physician and Carter approved Green for an outside gastrointestinal consultation at UIC. On December 8, 2010, Wexford issued final approval of Carter's request for Green to undergo an outside gastrointestinal evaluation at UIC. On March 9, 2011, Green was examined by Dr. Muhammad Nauman Jhandier at UIC. Green reported to Dr. Jhandier that he had not moved his bowels in five-to-six days. Dr. Jhandier planned to perform a colonoscopy on Green. Dr. Jhandier also ordered fiber and Miralax for Green.
On March 11, 2011, Carter saw Green during a medical writ follow-up for his visit to UIC. At that time, Carter reviewed Dr. Jhandier's report and recommendations and noted that Dr. Jhandier recommended a stool regimen for Green and a colonoscopy. However, Green was already on a stool regimen as recommended by Dr. Jhandier. Carter examined Green's abdomen at that time, which was normal (i.e. soft, non-tender, and demonstrated positive bowel sounds). Based on Dr. Jhandier's recommendation and Green's medical history, Carter planned a collegial review for Green to obtain a colonoscopy. After Carter presented his request, Green was approved for a colonoscopy on March 15, 2011. On that same day, Carter saw Green and informed him of the results of his most recent laboratory tests (all of which were normal) and that he had been approved for the colonoscopy.
On March 25, 2011, Green underwent the colonoscopy at UIC. The doctor performing the procedure determined that Green's rectum, sigmoid colon, ascending colon, cecum and ileocecal valve were normal. Four polyps, each three to five millimeters, were found in Green's descending and traverse colon, which were removed during the colonoscopy. Green was thereafter discharged from UIC and ordered to return for a follow-up visit (the record is unclear whether this follow-up visit at UIC occurred).
On March 30, 2011, Carter saw Green during a medical writ follow-up after his colonoscopy at UIC. At that time, Carter reviewed the results of Green's colonoscopy results and recommendations, and noted that there was no identified reason for Green's bowel abnormalities. Carter examined Green at that time and noted that he appeared healthy. Carter also examined Green's abdomen, and noted that it was soft, non-tender, and demonstrated positive bowel sounds. Carter's assessment for Green was chronic constipation and that he recently had colon polyps removed. As such, Carter continued Green's current management plan, including his laxatives. Carter ordered Green to be re-evaluated in thirty days in order to evaluate the effectiveness of Green's bowel regimen. Green did not follow-up in thirty days with Carter, indeed Green never returned, or sought to return, to Carter after the March 30, 2011 visit. Carter ceased working at Dixon in July 2011. It is undisputed that, during the same period Carter was treating Green for constipation, he also treated him for hypertension, treatment about which Green does not complain.
It is unclear from the record when Dominguez first provided care to Green, but his complaint focuses on the time after he ceased receiving care from Carter. On February 9, 2011, Dominguez saw Green for complaints of fatigue and joint pain. At that appointment, Dominguez reviewed at least the most recent of Green's TFT results (which came back normal for all three hormones). She ordered additional tests to determine the source and severity of Green's joint pain, including an erthrocyte sedimentation rate (ESR) test, which is used to determine the amount of inflammation in a patient's body, and a antinuclear antibodies (ANA) test, which is used to investigate whether a patient has an autoimmune disorder. Dominguez also prescribed anti-inflammatory medication, including Naprosyn, and instructed Green, who is according to the record a body builder with "six pack abs,"
On July 14, 2011, Dominguez saw Green for his complaints of chronic constipation, muscle aches, and his request for Metamucil. Dominguez's assessment of Green's condition at that time included chronic constipation, body/muscles aches and pain (mild arthritis), and thoracic and lumbar muscle pain. Dominguez ordered Metamucil, a fiber supplement, for Green to try and alleviate his constipation. Dominguez also ordered Green to try walking exercises to alleviate his constipation. Finally, Dominguez ordered Naprosyn for Green to treat his muscle aches and pains.
On May 8, 2012, Dominguez saw Green for a complaint of gastrointestinal discomfort in the right-upper quadrant of his abdomen, as well as a complaint that he was always tired. Green also stated at that time that his bowel movements were generally alright. Dominguez examined Green at that time and determined that he had right-upper quadrant abdominal pain, but no hepatomegaly nor back or costal vertebral tenderness. Green also stated that he had been eating his meals with no problems, that he did not have nausea or vomiting, did not report weight loss, and he had good bowel sounds on exam. Dominguez then reviewed at least some of Green's medical records, including his x-rays, UIC consultation records, and his colonoscopy test results, and noted that there was no definitive reason found for Green's gastrointestinal complaints. Nevertheless, Dominguez ordered various laboratory tests, including a complete blood count and a comprehensive metabolic panel and instructed Green to return for further evaluation after those tests.
On May 21, 2012, Dominguez saw Green for that follow-up examination to review and discuss his laboratory results. At that time, Dominguez examined Green, who stated that he had abdominal pain in the right-upper quadrant of his abdomen and that his prior thyroid tests could demonstrate a cause of his fatigue. Dominguez performed a physical exam, which showed Green's abdomen was soft, without right upper quadrant tenderness, and demonstrated good bowel sounds. Dominguez also reviewed Green's most recent laboratory results—a complete metabolic panel, a complete blood count, and a urinalysis—which were all normal. Given Green's statement concerning his thyroid, Dominguez noted in her chart that Green may have a thyroid problem and ordered him to undergo another TFT and to return in two weeks for a follow up on his TFT results. The result of that TFT, given on May 23, 2012, showed that Green's TSH was, like his 2009 exams and unlike his 2010 exams, slightly elevated, but that his T3 and T4 levels were within normal range. At some point, although the record is not clear on when, Green allegedly told Dominguez about his concerns about his thyroid and soy's effect thereon, and Dominguez responded "Don't even try it, we've been through this already."
On June 4, 2012, Dominguez saw Green for his follow-up examination. Dominguez reviewed Green's TFT results and noted that Green's TSH levels were elevated, though his T3 and T4 levels were still within normal ranges. However, Dominguez was concerned that Green was abnormally sensitive to fluctuations in his TSH levels because of his chronic problems and other symptoms consistent with hypothyroidism. As such, Dominguez diagnosed Green with mild hypothyroidism and prescribed Synthroid for him, which is used to regulate the body's TSH levels. Dominguez ordered Green not take the Synthroid within thirty minutes of eating. Dominguez further ordered Green to undergo a repeat TFT in one month to determine whether the Synthroid was working. The parties agree that Green was never at risk of harm by receiving Synthroid, since it was a low dose and his TSH levels were being monitored. The next TFT occurred on July 3, 2012, which showed a decrease in TSH from the previous test, and all three hormones were reported as being in normal range.
On July 12, 2012, Dominguez saw Green for a follow up on the July 3, 2012 TFT. Dominguez advised Green that the results were normal and that his TSH levels were within range. Green testified that, following treatment with Synthroid, his condition improved. At that time, Green requested Metamucil for his constipation, which Dominguez ordered as a daily treatment along with Green's Synthroid. On November 16, 2012, Dominguez saw Green for a routine physical, where she noted his hypothyroidism and continued his Metamucil and Synthroid medications. On November 27, 2012, Green received a follow-up TFT, which returned all three hormone levels as normal. In December 2012, Dominguez saw Green at the general medical clinic and noted his controlled hypothyroidism and reviewed his most recent TFT results. Dominguez ordered Green to continue taking his Synthroid. Green testified that, after receiving his prescription for Synthroid and voluntarily avoiding the soy-based products in his food by spending a significant amount of money at the prison commissary to supplement his diet, he has seen an improvement in his condition, however his symptoms have periodically continued.
In April 2012, Green filed the instant suit claiming deliberate indifference to a serious medical need. Specifically, he alleges that Carter and Dominguez were deliberately indifferent for failing to diagnose and treat his hypothyroidism and for failing to prescribe him a soy-free diet. Carter and Dominguez, based on the above-stated record, have moved for summary judgment, arguing (1) there is insufficient evidence for a reasonable jury to conclude they were deliberately indifferent to a serious medical need and (2) even if there were, they are entitled to qualified immunity. Defendants have also moved to bar Green's expert witness in a separate motion. Because the court ultimately concludes that defendants are entitled to summary judgment even assuming the admissibility of the expert's testimony, the court need not address the motion to bar and it is denied as moot.
Summary judgment is appropriate "if the movant 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). In evaluating such a motion, the court's role is not to weigh the evidence and determine the truth of the matter, but to determine whether there is a genuine issue for trial.
"[D]eliberate indifference to [the] serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain" such that a prisoner may bring a cause of action against a prison official.
Carter first argues that no reasonable jury could conclude that he subjectively inflicted cruel and unusual punishment through deliberate indifference to Green's serious medical needs. Green argues, in response, that the following acts could be relied upon by a reasonable jury to find that Carter was subjectively indifferent: (1) the delay in diagnosing and treating Green's hypothyroidism despite his symptoms remaining unchanged throughout his treatment, (2) Carter prescribed the same medications as had been previously prescribed and proven ineffective, (3) Carter called Green an "ambulance chaser" and diagnosed him with a psychosomatic disorder, and (4) Carter refused to prescribe a soy-free diet despite the fact that Green's expert has testified that it is "well established that the chemical properties of soy can interfere with thyroid function in people, and that consuming soy can negatively affect the efficacy of medication used to treat hypothyroidism" and Green showed Carter some literature to the same effect during his treatment.
As to the first, the record does not bear out the existence of any delay in treatment, but, rather, a delay in correctly diagnosing Green. But there is not even sufficient evidence on the record to support a finding of negligence in Carter's failing to diagnose Green with hypothyroidism, much less deliberate indifference. In the thirteen months Carter cared for Green, he saw Green eleven times for various complaints of abdominal pain or constipation. At all eleven of those appointments, Carter performed a physical examination of Green's abdomen. Additionally, he sought two ultrasounds (ultimately only getting approval for one), a KUB x-ray, a comprehensive metabolic panel, a urinalysis test, two TFTs (and reviewed several others), a CEA test, a consult from a specialist at UIC, and a colonoscopy. Green suspected that he had a thyroid problem, but an inmate is not permitted to dictate the course of his treatment or diagnosis and Carter is not required to replace his medical judgment with that of his patient's.
For similar reasons, Green's argument that a jury could conclude Carter was deliberately indifferent for failing to start Green on Synthroid earlier fails. Synthroid is designed to treat hypothyroidism, and Carter had very good reasons (even if potentially incorrect ones) to conclude that Green did not have hypothyroidism. Moreover, in the materials offered by Green from Synthroid's manufacturer, it specifically indicates that Synthroid is contraindicated for patients with abnormal TSH, but normal T3 and T4 levels, which is the only way Green has
Green next argues that a jury could conclude Carter was deliberately indifferent by prescribing the same care other doctors in the past had (specifically, fiber tablets and laxatives), which had been ineffective at treating his conditions previously. Indeed, a physician who continues the same treatment plan repeatedly despite having been told that the plan was ineffective runs the risk of being liable for deliberate indifference.
Next, Green argues that a jury could rely on the fact that Carter called Green an "ambulance chaser" and diagnosed him with a psychosomatic disorder (which Green equates to accusing him of faking) to find that he was deliberately indifferent. However, the fact that a prison physician suspects or even accuses an inmate of lying or exaggerating about his symptoms is not evidence of deliberate indifference where, as here, the medical provider continues to treat the inmate.
That leaves only Green's argument that Carter was deliberately indifferent for refusing to prescribe a soy-free diet. As support for his argument, he relies on the report from his expert chemist, who testified in pertinent part that it is "well established that the chemical properties of soy can interfere with thyroid function in people, and that consuming soy can negatively affect the efficacy of medication used to treat hypothyroidism." The expert's testimony, however, only establishes an effect on the thyroid gland from soy, it does not establish the magnitude of the effect or whether whatever that magnitude is has permeated the medical community sufficiently that failure to prescribe a soy-free diet is something no minimally competent doctor would decline to do. Indeed, the record belies any contention that this scientific research has made the leap to medical treatment protocols. None of the various medical documents offered by Green in support of his case state that a soy-free diet is a required treatment protocol with those with slightly out-of-the-normal-range-TSH values.
Moreover, Carter is entitled to qualified immunity on this issue.
Based on the foregoing, there is insufficient evidence on the record for a reasonable jury to conclude that Carter was deliberately indifferent to Green's hypothyroidism, and none of Green's arguments to the contrary, individually or as a group, change that analysis. Even if there were, Carter is entitled to qualified immunity. Accordingly, the motion for summary judgment is granted as to Carter.
Green's arguments concerning Dominguez's care are similar to those made against Carter, specifically he argues that a reasonable jury could conclude she was deliberately indifferent due to (1) the delay in diagnosing and treating Green for hypothyroidism, particularly in light of his history of symptoms and her admitted failure to review all of Green's medical records; (2) her prescribing the same medications as previous doctors had attempted despite being told that they did not work; (3) her refusal to prescribe a soy-free diet, even after placing Green on Synthroid which is known to be affected by a soy-heavy diet; and (4) her telling Green, at some point in her treatment when he raised soy and thyroid concerns, "Don't even try it, we've been through this already."
As to the first, Dominguez initially saw Green, at least for the relevant purposes of this lawsuit, on February 9, 2011 for complaints of joint pain (Green does not argue that the treatment provided for those complaints was deliberately indifferent or even inadequate). Dominguez reviewed some of his medical records, but admitted in her deposition that she did not know that Green had two binders of medical records and thus may have missed whatever was in the other binder. Based on her testimony, a reasonable jury could conclude that she did not review the 2009 TFTs, which showed slightly elevated TSH levels, as she testified that had she seen those TFTs she would have ordered a TFT for Green at that time. But that admission, which is the basis for the majority of Green's argument as to this first point, does not move the ball towards deliberate indifference. Green did not present in February with complaints tied to his hypothyroidism, but with complaints of arthritis pain. So the fact that Dominguez did not sua sponte realize that Green may have some undiagnosed thyroid problems, about which he was not complaining, can hardly be considered deliberate indifference when she treated him fully for the issues about which he appeared before her. He did not see Dominguez for constipation until July 2011, at which time he requested Metamucil. She gave him that fiber supplement, ordered him to attempt walking exercise to relieve his constipation, and provided him with pain medication. After that, Green did not return with constipation or abdominal complaints until nearly a year later, in May 2012. Certainly she had no reason to assume that treatment was ineffective where Green did not return to see her for those issues for nearly a year. In May 2012, when he did return, she ordered two sets of tests, including eventually the two TFTs which led her to conclude, in June 2012, that he had mild hypothyroidism and prescribe Synthroid. At most, her failure to review his full medical records and diagnose, or at least test Green for, hypothyroidism in July 2011 was negligence, there is nothing in the record which would permit a jury to conclude deliberate indifference in the treatment history before the court.
Next, Green faults Dominguez for prescribing fiber supplements, despite the fact that the treatment had been ineffective before. However, the undisputed record discloses that when Dominguez prescribed that treatment for Green,
Green's third argument centers around Dominguez's refusal to prescribe a soy-free diet.
That leaves only Green's argument that Dominguez's statement "Don't even try it, we've been through this already" when Green raised his concerns about his thyroid and soy diet is evidence of deliberate indifference. It is unclear from the record when Dominguez is supposed to have made this statement (she denies ever saying it, but the court is bound at this point to accept that she did), but it ultimately does not matter for the same reasons that the callous and dismissive statements purportedly made by Carter are not evidence of deliberate indifference where, as here, Dominguez continued to treat and seek diagnostic testing for Green throughout the complained-of period.
Finally, Dominguez is entitled to qualified immunity for essentially the same reasons as set out
Based on the foregoing, there is insufficient evidence on the record for a reasonable jury to conclude that Dominguez was deliberately indifferent to Green's hypothyroidism, and none of Green's arguments to the contrary, individually or as a group, change that analysis. Even if there were, Dominguez is entitled to qualified immunity. Accordingly, the motion for summary judgment is granted as to Dominguez.
Defendants' motion for summary judgment is granted. This case is closed.