The U.S. Court of Appeals for the Seventh Circuit on July 23, 2026 affirmed summary judgment for an Indiana prison psychiatrist and deputy warden sued for deliberate indifference by an inmate who blinded himself and mutilated his genitals during a psychotic episode while on constant suicide watch. The panel held that no reasonable jury could find either official liable under the Eighth Amendment, resolving the case on the limits of deliberate-indifference and causation doctrine rather than on the adequacy of the care Brad Passwater received.
Passwater, who has paranoid schizophrenia and has been incarcerated at Plainfield Correctional Facility for several years, sued Dr. Daniel Rippetoe and Deputy Warden Tricia Pretorius under 42 U.S.C. Section 1983 after an April 16, 2020 incident. Placed on around-the-clock suicide watch, Passwater suffered a psychotic episode, and Dr. Rippetoe, a psychiatrist who worked remotely from Florida via telehealth, directed a nurse to give him an emergency dose of psychotropic medication. No one followed up to check for adverse effects. The medication worsened his psychosis, and Passwater began harming himself, eventually gouging out his eyes and ripping out his testicles. He remains blind and without testicles.
The central question, Judge Lee wrote for the court, was narrower than the tragedy itself: whether the record contained evidence from which a rational jury could find that these two defendants violated Passwater's Eighth Amendment rights. To prevail, an inmate must show an objectively serious medical condition to which officials were subjectively indifferent, meaning they knew of and disregarded a substantial risk to the inmate's health, and that the indifference actually caused the injury.
On the claim against Dr. Rippetoe, the panel concluded the record showed negligence but not a constitutional violation. Passwater pointed to the doctor's deposition testimony acknowledging that a post-medication assessment is "standard," "common," and might even be required by prison policy. But those, the court said, "are words of negligence not deliberate indifference," a standard that requires proof that "no minimally competent professional would have so responded under those circumstances." The panel was pointed in noting the shortcomings: prison policy required nurses to monitor an inmate for two hours after emergency psychotropic medication and report to the prescribing doctor, and when Dr. Rippetoe received no such report, he should have reached out to check on Passwater.
Passwater also argued that Dr. Rippetoe had access to an electronic medical record, filed by mental health professional Mark Lincks, showing Passwater was still suicidal and agitated after the medication. The court found no evidence the doctor read that record or deliberately avoided it, and no evidence that failing to read it would obviously have created a serious risk of harm to any minimally competent physician. Summary judgment for Dr. Rippetoe was therefore appropriate.
The claim against Deputy Warden Pretorius traveled a different route. Plainfield used trained inmates called "suicide companions" to watch prisoners on constant observation, and a two-hour shift limit had been adopted because companions had to remain standing to see through a high window in the cell door. The court agreed a jury could find the two-hour policy existed, that it was significant to monitoring severely suicidal inmates, that there was systemic noncompliance, and that Pretorius, copied on an internal email thread flagging confusion about the policy, failed to correct it.
Even so, the claim failed for lack of causation. Applying tort principles of proximate cause, the panel focused on the conduct of Antoine Fox, the companion assigned to Passwater, who sat in a chair outside the cell despite being told twice by correctional officers to stand up, and never saw the self-harm. Video showed Passwater began punching himself around 1:28 p.m. and drawing blood well before 2 p.m. Had Fox been standing as instructed, the court reasoned, he would have observed the conduct and alerted staff within two hours of starting his noon shift, before any relief companion would have arrived under the two-hour policy. Fox's refusal to stand was "an unforeseeable intervening act" that severed any liability on the part of Pretorius.
The ruling leaves Passwater, who underwent several operations and remains permanently disabled, without a federal damages remedy against either defendant. For prison administrators in the Seventh Circuit, the decision reinforces that policy-level supervisors can escape Section 1983 liability where an intervening actor's failure, rather than the supervisor's inaction, is the direct cause of an inmate's injury, and that violations of best practices or internal medical protocols, without more, do not establish deliberate indifference. The panel of Judges Ripple, Kirsch, and Lee was unanimous, affirming the judgment of U.S. District Judge Matthew P. Brookman.