Full opinion text
ROVNER, Circuit Judge. Nicholas D. Rice died in the Elkhart County Jail in December 2004, nearly fifteen months after he was booked at the jail pending trial on a charge of attempted bank robbery. Rice was known to suffer from schizophrenia, and shortly before his death a judge had found him incompetent to stand trial. Although he was seen by mental health professionals while he was being detained, Rice frequently refused to take his prescribed medications, cooperate with medical personnel at the jail, eat his meals, or bathe himself. He was briefly hospitalized at psychiatric and other medical facilities on several occasions during the period of his confinement, and at the time of his death he was awaiting placement at a state psychiatric facility pursuant to the judge’s finding of incompetence. Rice died as a result of psychogenic polydipsia (excessive water drinking), which is a disorder known to manifest in a minority of persons with schizophrenia. Following Rice’s death, his parents, representing his estate (the “Estate”), filed suit in federal court pursuant to 42 U.S.C. § 1983, alleging among other things that jail officials and medical personnel had deprived Rice of due process by exhibiting deliberate indifference to his declining mental and physical condition. The district court entered summary judgment against the Estate on its section 1983 claims, finding in part that correctional and medical personnel had not consciously disregarded Rice’s medical needs and that the ultimate cause of his death was not reasonably foreseeable to them. Estate of Rice ex rel. Rice v. Correctional Med. Servs., No. 06 C 697, Opinion & Order, 2009 WL 1748059 (N.D.Ind. June 17, 2009) (Miller, J.). The Estate then filed a second federal suit, invoking the court’s diversity jurisdiction, in which it reasserted the state wrongful death claims that the judge in the first suit had dismissed without prejudice after disposing of the federal claims. The judge in the second suit dismissed that case on the basis of collateral estoppel, reasoning that his colleague’s finding as to the foreseeability of the cause of Rice’s death precluded recovery on any of the state claims. Estate of Rice ex rel. Rice v. Correctional Med. Servs., No. 09 C 319, Order (N.D.Ind. May 17, 2010) (Lozano, J.) (unpublished). The Estate appeals both judgments. On review of the record, we conclude that a material dispute of fact precludes summary judgment on one of the Estate’s section 1983 claims: that his conditions of confinement were inhumane. We also conclude that the district court erred in dismissing his state claims. We therefore affirm in part and reverse in part. I. On March 5, 2003, Rice, then twenty years old, walked into the KeyBank in Nappanee, Indiana, and announced to a teller that he had a bomb that he would detonate if he was not given money. Then, without explanation and without having taken any money, Rice walked out of the bank. He made his way back to his hometown of Stevensville, Michigan, in a car he had stolen that morning from a neighbor. As he drove back into Stevens-ville, the owner of the car spotted Rice and summoned the police. Rice was jailed in Berrien County, Michigan, on a charge of auto theft. It soon became apparent to the Michigan authorities that Rice had mental difficulties. Rice had begun to exhibit mental problems while he was in high school, and he was eventually diagnosed as suffering from undifferentiated schizophrenia. Schizophrenia is a chronic mental illness which interferes with a person’s ability to accurately perceive what is going on around him, to distinguish fact from fantasy, and to regulate his emotions. Although Rice was prescribed medications for his illness, he did not take them consistently and stopped taking them altogether once he was no longer covered by his parents’ health insurance. Not long after he was jailed in Michigan, various physical and mental problems — including weight loss, unresponsiveness, and lack of hygiene — resulted in Rice’s hospitalization, a finding that he was not competent to stand trial, and eventually his commitment to the Kalamazoo Psychiatric Hospital for a period of nearly two months. The therapy and medication that Rice received during his commitment resulted in a marked improvement in his condition. His mother would later testify that Rice was in the best condition he had been in for quite some time. By the time Rice was discharged from the psychiatric hospital in late August 2003, Indiana authorities had identified him as the suspect in the Key-Bank robbery, and a bench warrant was issued for his arrest. After the Michigan charges against him were resolved, Rice was transferred to the Elkhart County Jail in Indiana, where he was booked on a charge of attempted robbery on September 8, 2003. His bail was set at $20,000. The Elkhart County Jail had an ongoing contract with Correctional Medical Services (“CMS”) to provide comprehensive health care services to inmates of the jail. To serve the general medical needs of the jail’s inmate population, CMS provided the jail with a staff which, in 2004, included the equivalent of approximately six fulltime licensed practical nurses, one full-time registered nurse, one half-time social worker, and a physician who served as the jail’s medical director. CMS in turn contracted with Oaklawn Psychiatric Center in Gosh-en, Indiana, to provide psychiatric services to jail inmates as needed. Pursuant to that contract, mental health treatment decisions were reserved to Oaklawn and one of its physicians, Dr. Bryce B. Rohrer. Rohrer is board-certified in family medicine rather than psychiatry, but he has practiced family psychiatry for many years (his specialty is drug and alcohol addiction), and by the time of Rice’s detention he had been providing psychiatric services to the jail for the previous ten years. Rohrer generally spent one-half day per week at the jail. The CMS medical personnel who performed a screening upon Rice’s arrival at the jail had access to his medical records and were aware of his psychiatric history and the psychotropic medications he had been prescribed for his schizophrenia. Dr. Rohrer met with Rice two days after he was booked into the jail and wrote him a prescription for Seroquel, an anti-psychotic medication that he had been taking prior to his transfer from Michigan. When Rohrer examined Rice several weeks later, Rice had been placed in the jail’s “tank” because he was not communicating. Rohrer’s notes indicate that Rice was not taking his prescribed medication but was practicing self-care. Rohrer was not sure if he was eating. Rohrer concluded that Rice’s behavior was likely explained by psychosis, a traumatic event, or malingering (i.e., feigning illness for secondary gain) and noted his intent to hospitalize Rice at Oak-lawn if further observation revealed that Rice was not eating or was outwardly psychotic. In late October, Rohrer petitioned an Indiana state court to involuntarily commit Rice to a mental facility for a period of seventy-two hours, explaining that Rice was “refusing psychotropic medication and refusing to eat, refusing to communicate most of [the] time, diagnosed as schizophrenic.” R. 198-70 at 3. The court granted the petition, and Rice was admitted to Oaklawn. He was given an intramuscular injection of Haldol, a psychotropic medication, upon his arrival at Oaklawn, but his treating physician there, Dr. Salvador Ceniceros, who is board-certified in both psychiatry and neurology, concluded in short order that there was no probable cause to believe that Rice met the criteria for involuntary commitment or forced medication. Ceniceros would later testify that Rice showed no signs of psychosis, answered his questions plainly and coherently, interacted with others appropriately, was eating and drinking, and accepted medication voluntarily. At Ceniceros’ instruction, Rice was discharged back to the jail less than twenty-four hours after he was admitted. In the following months, Rice continued to exhibit the sort of behavior at the jail which had led Rohrer to seek his involuntary commitment to Oaklawn in October. Rohrer’s notes from November 2003 and January 2004 indicated that although at times Rice was communicative and appeared to be doing better, at other times he was refusing to take his medication and uncommunicative and that his psychotic disorder appeared to be worsening. On November 16, 2003, Rice struck his cellmate in the eye, causing the cellmate to seek medical attention. When Rice subsequently refused an instruction by the correctional staff to step out of the cell, Officer Jennifer Shelton directed her colleague, Jason Koontz, to spray Rice’s face with pepper foam, and Rice was then placed in a restraint chair. Nurses Cindy Lambright and Joy Bell were present when Rice was pepper-sprayed, and they helped rinse his face and eyes. Rice later refused multiple invitations to leave the restraint chair and remained there for a period of over eighteen hours. Ultimately he was dragged from the chair and into a cell by jail staff. In mid-November, Rohrer ordered the nursing staff to administer an intramuscular injection of Haldol to Rice every four weeks provided that he did not object. One such shot was given to Rice, in early December. Rice subsequently asked Rohrer to put him back on Seroquel instead, and Rohrer acceded. But in January 2004, Rohrer noted that Rice was again uncommunicative and sometimes refused to take his medication. Rohrer increased Rice’s prescribed dosage of Seroquel and directed that he be returned to Haldol injections if he refused to take the Seroquel. Rohrer did not see Rice from February 10 — when Rice was again refusing his medication, and Rohrer had to visit Rice in his cell because Rice otherwise refused to see Rohrer — until May 11, 2004. During that time, the nursing staff saw him regularly and observed more of the same behavior that Rohrer himself had documented previously. Nurse Lambright noted in February that Rice refused to take his medications or to wear clothing. His continuing refusal to take medications became a frequent refrain in the subsequent notations of the jail’s medical staff. By April, jail officials, in apparent recognition of the particular challenges that Rice presented, were requesting that his condition and behavior be thoroughly documented. That month, Captain Brad Rogers, the jail’s commander, asked that he be updated on Rice’s status at the jail. In response to that request, Nurse Rebecca Hess, a regional manager for CMS who supervised nurses at both the Elkhart County Jail and other facilities, wrote a one-page memorandum to Rogers and Lieutenant Fred Call, the jail’s warden, concisely summarizing Rice’s history at the jail. Hess noted that efforts had been made to monitor Rice’s weight beginning in December 2003 due to his periodic refusal to eat. She added that there had been no significant changes in Rice’s weight since that time, although he frequently refused to be weighed. Rice also continued to refuse his medications and often refused to see Rohrer. In addition, he refused to leave his cell for visits with family or with his attorney. On April 15, Call emailed a memorandum to the jail’s supervisory staff directing that all out-of-the ordinary occurrences involving Rice be videotaped and or reported, both to document Rice’s behavior on these occasions and to assist his attorney in taking appropriate action. “I’m attempting to work with the public defender office to show this person m[a]y need ... help____ So I would appreciate your reports. The sooner we can get this individual help the better off for all of us.” R. 198-80 at 20. As a result of that directive, the record includes video recordings of several instances in the ensuing months in which jail staff forcibly removed Rice from his cell and showered him. By the end of April, Rice’s condition appears to have deteriorated further. In an April 30 note, Lambright reported that officers had to physically remove Rice from his cell during a “shake down” when he refused to leave the cell on his own. Lambright noted that Rice was unable to stand, that his entire body was jaundiced, that he had a large, three-inch area of dark skin over his coccyx, and that when officers picked him up, dead skin cells sloughed off his body in large numbers. He refused to speak. Rice repeatedly refused to see his parents when they came to the jail. Dr. Paul J. Yoder, a psychologist at Oaklawn, evaluated Rice on April 28, 2004, at the request of Rice’s attorney. Based on Rice’s catatonic and unresponsive behavior, Rice’s counsel was concerned that he was not able to assist in his defense, notwithstanding the prior findings by two psychiatrists (including Ceniceros) that Rice was competent to stand trial. Rice was largely unresponsive when Yoder interviewed him. It was clear to Yoder that Rice suffered from schizophrenia, and that Rice’s functioning improved when he took his medications and worsened when he did not. In his report of May 4, 2004, Yoder considered whether the catatonia Rice displayed might be due to malingering rather than to his mental illness. There were reports from the jail suggesting that Rice altered his behavior depending on whether or not he was being observed. Rice might be feigning catatonia in the hope that he could avoid trial or be found not guilty by reason of insanity, Yoder posited. “However, given Nicholas’ documented history of poor functioning and poor insight when not being treated, this seems very unlikely as a motivating factor for his current behavior.” R. 198-127 at 7-8. Yoder considered other potential motives for Rice to pretend he was more ill than he was, but ultimately was skeptical of the notion that Rice was intentionally and genuinely malingering. He pointed out that the overt symptoms of schizophrenia can wax and wane even when one is not being treated. “Regardless [of] [Rice’s] actual motive and whether or not he is aware of it, it does not appear that he is engaged in this type of malingering behavior when his illness is being effectively treated. As a result, it is my opinion that the malingering is itself the product of his mental illness.” R. 198-127 at 8. Yoder therefore concluded that Rice was not competent to assist his attorney with his defense. “The record is clear that Nicholas is severely mentally ill.” R. 198-127 at 8. Yoder recommended that the court consider ordering Rice’s compliance with psychiatric treatment (i.e., that he be forcibly medicated), and noted that given how well Rice responded to involuntary treatment in Michigan, it was likely that Rice’s symptoms would remit within four to six weeks. “At that point it should be possible to more clearly distinguish between symptoms of schizophrenia and ongoing malingering.” R. 198-127 at 8. On May 11, Rohrer concluded that Rice should again be committed to a psychiatric facility for observation and evaluation for the possibility of involuntary medication. Rohrer’s notes indicate that Rice was refusing to see him, refusing his medications, did not communicate, did not practice self-care, ate only junk food in lieu of regular meals, and appeared to be developing bedsores. In his petition to the court for an order of involuntary commitment and forced medication, Rohrer noted that Rice was “psychotic” and “unable to perform self-care.” R. 192-9 at 47. The court granted the petition. Rice was transferred to Oaklawn that same day. On arrival at the facility, he was catatonic and had to be lifted out of the transport van. However, once again his behavior appears to have changed dramatically following his arrival at the hospital. Ceniceros noted that Rice was cooperating, showering, eating, drinking and agreeing to take his prescribed medication. Ceniceros surmised that Rice was malingering in order to get out of jail, and he again concluded that there was “no probable cause to believe that [Rice] meets the criteria for involuntary commitment.” R. 192-9 at 50. He diagnosed Rice with undifferentiated schizophrenia and/or malingering, and for the second time discharged Rice back to the jail less than twenty-four hours after he was committed. His discharge notes concluded with the following observations: “This morning [Rice] is alert, cooperative, and oriented x 3. He denies any current suicidal or homicidal ideation. Thoughts are linear and goal directed.... He also denies hallucination in all five senses. There is no looseness of association or flight of ideas noted. Intelligence appears to be average based on fund of knowledge and vocabulary; judgment and insight appear [to be] intact. ...” R. 198-145 at 16. Shortly after his return to the jail, Rice was placed in the administrative segregation unit, known as Ward One, where he could be observed more closely. Previously Rice had been housed in the medical ward as well as other areas of the jail, but according to Rogers, medical personnel at the jail had asked that Rice not be returned to the medical ward given his poor hygiene and conduct. In Ward One, he was assigned to cell number 5A, which we are told was the cell most easily viewed from the first-floor control room across from Ward One. Because the cells in Ward One were single-occupancy units, Rice had no cellmate. He was allowed out of the cell one hour per day. Rice remained in the administrative segregation unit until his death seven months later. In June 2004, an Indiana circuit court judge found that Rice was competent to stand trial on the bank robbery charge. At the invitation of and with the agreement of the parties, the judge made that finding without a hearing and based solely on his review of the written reports of the three professionals (including Ceniceros and Yoder) who had evaluated Rice. After examining all reports the Court finds the Defendant to be competent to assist his counsel and further notes that the Defendant was able to converse with the presiding judge in open court and express himself and answer questions appropriately. The Court further notes that Paul J. Yoder’s written report indicates there is some reasonable belief that this Defendant may be faking his catatonic state since he was reported to sleep on a top bunk and the officers did not put him there. Additionally, he has been seen out of his cell on a number [of] occasions and as soon as he spots an officer he freezes and becomes unresponsive. The Court notes that he was responsive in open court and appeared to be well-oriented on the date of hearing herein (June 10, 2004). R. 198-51 at 2-3. The court set Rice’s case for trial on December 6, 2004. Despite the competency finding, Rice continued to exhibit abnormal behavior at the jail: —Captain Rogers would later testify that by June, “I think we were all concerned about his mental capacity....” R. 198-20 at 18, Rogers Dep. 109. —On June 25, 2004, another inmate assaulted Rice in his cell by poking him in the groin with a broomstick through the bars of his cell door. Rather than move in order to avoid the broomstick, Rice simply stood in place, catatonic, while he was assaulted. The attack left visible welts on his back, buttocks, and side. —On August 2, 2004, Rice cut his neck with a disposable razor from which he had bent or broken off the plastic guard in order to expose a portion of the blade. Lambright, on being summoned to Rice’s cell, found him holding a towel over the wound. The one-inch laceration, although located over his carotid artery, was superficial. Rice later told Nurse Sharrone Jones, who became the jail’s charge nurse in 2004, “I just hurt myself,” R. 198-37 at 26, and when asked why by Nurse Lambright, he remarked “I just felt like it,” R. 198-14 at 11. He was taken to Goshen General Hospital for treatment and the wound was sutured. Rice denied any effort to commit suicide, and the physician who treated him in the hospital’s emergency room, Dr. David E. Van Ryn, agreed that he was not genuinely suicidal. Upon being returned to the jail, Rice was placed in a restraint chair for a period of eighteen hours, evidently to ensure that he would not harm himself again. When Rohrer met with Rice the following day, Rice told him, “I won’t talk to you. I’m not psycho.” R. 198-37 at 27. Rohrer indicated in his notes that he thought Rice might be malingering. After investigating the incident, Nurse Hess concluded that Rice had not attempted to kill himself. Given that conclusion, neither CMS nor the jail followed their suicide prevention policies by placing Rice under heightened observation. —Shortly after this incident, Rice experienced a dizzy spell and hit his head on his cell door, resulting in a one-inch laceration between his eyes. CMS personnel treated the wound, but other than lab work, no additional action was taken. —Rice’s abysmal lack of hygiene continued. On August 18, 2004, Lieutenant Call emailed several jail staff members indicating that “[ijt’s time for Mr. Rice to get another shower and have his room cleaned.” R. 198-122 at 2. When correctional officer Stephanie Snyder emailed later that day to report that “[i]t was a very dirty job but we accomplished it,” R. 198-122 at 2, Captain Rogers replied to thank the officers involved. “A person has to feel some empathy toward someone like Nick Rice, who has to be in such a pathetic state of mind to allow himself to get into such a dirty physical state and to behave as he does.” R. 198-122 at 2. During this time period, Rice was not eating regular meals. In July 2004, Rogers emailed a memorandum to the jail’s supervisory officers instructing them to be more proactive in ensuring that food was made available to inmates like Rice (whom he cited by name) who exhibited a reluctance to eat. He admonished staff not to construe an inmate’s silence at meal distribution times as a refusal to eat. He also directed that food be left inside rather than outside of an inmate’s cell, noting that “[i]f the meal is left inside, Rice will typically eat it.” R. 98-118 at 2. By the Fall of 2004, however, Rice’s weight had dropped significantly. A video of him being showered on September 30 reveals him to have been quite thin, if not gaunt. As of the beginning of October, Rice, who was six feet, two inches tall, weighed just 132 pounds, some fifty pounds less than he did at the time of his admission in 2003. A nurse noted the presence of a sore or sores on his hips. On October 5, Rohrer noted that Rice had lost a significant amount of weight, was still refusing to eat or to take medication, appeared to be exhibiting the early onset of bedsores, and required medical attention. For the third and final time, Rohrer sought Rice’s involuntary commitment to an inpatient psychiatric facility for additional care. In support of the petition, Rohrer wrote that “[Rice] is seriously medically [and] psychiatr[ieally] ill and needs intensive medical care as well as [the] availability of psychiatric care.” R. 192-9 at 56. “Oaklawn Hospital] would not be able to provide the intensive medical care,” he added. R. 192-9 at 56. Rohrer explained that in addition to having serious psychiatric difficulties, Rice was “dying from malnourishment.” R. 192-9 at 54. The court granted another seventy-two hour commitment. The order identified four hospitals at which Rice could be placed, in the discretion of the Sheriff: Oaklawn, Goshen General Hospital, Bowen Center, and Elkhart General Hospital for Behavioral Medicine (“Elkhart General”). R. 192-9 at 57. Rohrer had requested that Rice be committed to a hospital where psychiatric care was available, and it was Rohrer’s intent that he be taken to Elkhart General, which had an inpatient psychiatric unit. However, that hospital refused Rice’s admission in the mistaken belief that it did not have a contract with the jail. Instead, Rice was taken to Goshen General Hospital, which unlike Elkhart General had no psychiatric unit. He was admitted and observed by Dr. Allison P. Mathew, who found him to be suffering from symptoms of dehydration and mild malnutrition. After rehydrating Rice and encouraging him to eat, Dr. Mathew concluded that he had been medically stabilized. She assumed that upon discharge, he would be “sent back to Oaklawn for further psychiatric evaluation and management.” R. 198^5 at 27. But when she consulted by telephone the following morning with Dr. Ceniceros at Oaklawn, he opined in light of what Dr. Mathew told him that Rice did not pose an imminent danger to himself or others. According to Mathew, Ceniceros added that he would not accept Rice for admission to Oaklawn in view of his previous conclusion that Rice was malingering, although Ceniceros denies that he said this. Dr. Mathew discharged Rice back to the jail on October 6 with instructions that he be encouraged to eat, given high protein shakes if he would take them, continue on his current medications, and follow up with the Oaklawn psychiatrist (presumably Rohrer) within a week. Upon Rice’s return to the jail, CMS staff made various efforts to improve Rice’s nutrition and more generally to convince him to eat more food. Nurse Jones instructed the jail’s food service to provide Rice with high-protein Resource® Health Shakes twice daily, along with two milks at all meals and extra juice for breakfast. When the jail’s medical director, Dr. Alan Bierlein, assessed Rice on October 25, he issued a second order that Rice be provided with extra food. It appears that there was some delay in obtaining high-protein shakes and that Rice initially was provided with Carnation® Instant Breakfast drinks in lieu of the prescribed protein shakes, but otherwise he was provided with extra food by the jail’s food service as instructed. In addition, there is evidence that CMS nurses saw Rice several times daily following his return from the hospital. As they had since his weight loss was first noted, the nurses brought him extra snacks, encouraged him to eat, and urged him to take his medications. These efforts met with mixed results. Rice continued to refuse many of his meals. On the other hand, he frequently did eat his breakfast, and the record indicates that Rice did not lose additional weight following his return to the jail. And in marked contrast to his typically reclusive and unresponsive behavior, Rice just three days before his death walked out of his cell and showered himself when invited to do so. Other problems persisted, however. Rice regularly refused to take his medication. He was often uncommunicative. He typically did not bathe himself or otherwise attend to his own hygiene. Joshua Shaw, an inmate who was housed in the cell next to Rice, indicated that Rice was “always naked, he had unbelievable odor due to his total lack of hygiene, feces on his body, urine through out his cell, also rotting, uneaten food strewn through out his cell.” According to Shaw, Rice rarely spoke, other than to mumble “go away, go away, go away, go away.” R. 277-105 at 3. When Rohrer saw Rice on November 9, 2004, he wrote: “Refuses to communicate and closes his eyes. Is observed at times getting up [and] eating [and] can run through [the] unit (did this recently), but refuses all help [and] has to practically be carried to get shower by staff. Uncompt. caked feces, refusing all meds.” R. 198-37 at 34. Rohrer ordered the nurses to discontinue Rice’s antipsychotic medications (which he was not taking) and to ask him weekly whether he would resume taking them. Rohrer planned to see him again in a month. On December 6, 2004, the judge presiding over Rice’s criminal case reversed his earlier competency assessment and found Rice incompetent to stand trial. The judge committed Rice to the custody of the Indiana Division of Mental Health and ordered Sheriff Michael E. Books to deliver Rice to a facility designated by the Division. The Division in turn designated the Logansport State Hospital, a psychiatric facility, which accepted Rice for admission. However, because there was no bed available at that time, Rice remained at the jail until space opened up. Unfortunately, Rice died before that happened. Late in the evening of December 17, 2004, inmate Shaw heard Rice gulping water and vomiting in his cell. In the ensuing hours, Shaw and other inmates in the administrative segregation unit “mule-kicked” their cell doors in an effort to get someone’s attention, but according to Shaw’s account, no one ever responded. Jail policy required the guards to conduct hourly checks of all inmates in the administrative segregation unit, but crediting Shaw’s account, one may infer that neither a guard nor anyone else on duty in the overnight hours ever checked on Rice. At approximately 4:30 a.m. on December 18. Rice was found dead in his cell. A frothy pink discharge was noted near his mouth. Autopsies would later reveal that Rice died of acute cardiac arrhythmia triggered by a lethal decline in the sodium level in his blood, which was in turn caused by his excessive consumption of water in the hours prior to his death. Psychogenic polydipsia, a disorder characterized by excessive thirst and compulsive water drinking, is a poorly understood phenomenon that occurs in between six and twenty percent of patients with psychiatric disorders, and most commonly is seen in patients with schizophrenia. Brian Dundas, M.D., Melissa Harris, B.S., and Meera Narasimhan, M.D., Psychogenic Polydipsia Review: Etiology, Differential, and Treatment, 9 Current Psychiatry Reports 236, 236 (2007). It is undisputed in this case that the disorder can occur both in individuals who are taking medication for their schizophrenia and those who are not, and that unless an individual has previously experienced a bout of psychogenic polydipsia, there are no known warning signs that enable medical professionals to predict whether or when he or she will ever suffer from this disorder. How great the risk is that a schizophrenic individual suffering from psychogenic polydipsia will in turn experience hyponatremia, sometimes described colloquially as “water toxicity,” is a matter of dispute on the record in this case. Dr. John Pless, a forensic pathologist who offered evidence on behalf of the defense, wrote in his report that inappropriate hormone secretion, which causes a compulsive water drinker to retain water and excrete electrolytes, thus causing one’s blood sodium level to drop, is “commonly seen” in people with schizophrenia. R. 169-5 at 2. Although he tried to withdraw that statement in a subsequent affidavit (in which he asserted that the phenomenon is “exceedingly rare,” R. 281-10 at 3 ¶ 20, and that the odds of death due to excessive water intake were one in a million, R. 281-10 at 3 ¶ 21), the district court excluded the retraction from evidence. Our research indicates that of all those individuals who do experience psychogenic polydipsia, only ten to twenty percent experience hyponatremia as a result of their compulsive water drinking. Psychogenic Polydipsia Review, 9 Current Psychiatry Reports at 236. The autopsies also support the conclusion that Rice was to some degree underweight and malnourished (the parties’ experts differ as to the degree) at the time of his death. Defense expert Dr. Daniel Scherb indicated that Rice’s recorded weight at death was seventy-five to eighty percent of what would be ideal. Although at least one expert for the Estate opined that malnutrition played a role in Rice’s death, others found no evidence that this was true, and based on the arguments that the parties made on summary judgment, the district court found there to be no dispute that Rice died as a result of compulsive water drinking rather than malnutrition. 2009 WL 1748059, at *5 & n. 5. The Estate does not quarrel with this finding on appeal. The Estate brought this suit under 42 U.S.C. § 1983 against jail officials (in both their official and individual capacities), jail guards, CMS and Oaklawn, CMS nurses who worked at the Elkhart County jail, and Drs. Rohrer and Ceniceros, among others. The Estate contended that jail officials and staff had subjected Rice to inhumane conditions of confinement, used excessive force against him, failed to protect him from harm inflicted by other inmates, employed policies and customs that reflected institutional indifference to the constitutional right of a mentally ill inmate to adequate medical (including psychiatric) care and protection from self-inflicted harm, and individually displayed deliberate indifference to his well-being. The Estate alleged that CMS and Oaklawn also followed policies and customs that reflected deliberate indifference to the plight of mentally ill inmates who lack the ability to care for themselves. The nurses employed by CMS to care for inmates at the jail were alleged to have manifested deliberate indifference to Rice’s declining health and self-destructive tendencies. The Estate charged Drs. Rohrer and Ceniceros with deliberate indifference to Rice’s need for more intensive and proactive psychiatric treatment than he could obtain at the jail. In addition to the federal claims, the Estate asserted wrongful death claims under Indiana law against all defendants. Following two years of extensive discovery, the defendants moved for summary judgment. Judge Miller granted their motions as to each of the section 1983 claims. We shall discuss the particular allegations underlying these claims, and the grounds on which the court entered summary judgment, as we address each claim in turn below. As we have noted, the court also relinquished jurisdiction over the wrongful death claims premised on state law. When the Estate subsequently refiled the wrongful death claims — now limited to the CMS defendants alone — in federal court, Judge Lozano dismissed them on the basis of Judge Miller’s determination that the particular cause of Rice’s death was not reasonably foreseeable to the defendants. II. A. Conditions of Confinement The Estate contends that owing to the deliberate indifference of jail officials and staff, from Sheriff Books on down to the guards, Rice’s conditions of confinement were inhumane. In particular, the Estate alleges that his cell was often filthy and unsanitary, that uneaten food was left to rot there, that his skin was sometimes caked with his own feces, that he had an extremely foul body odor owing to the long periods of time during which he went unbathed, and that he either developed or was on the verge of developing bedsores on multiple occasions (although apparently these were healing at the time of his death). Although there may be unresolved questions as to how often and for how long these conditions occurred, there is no genuine dispute that they did in fact occur. They are documented not only in the declaration from inmate Joshua Shaw, who was housed in the administrative segregation unit in the cell next to Rice’s, but also in various notations and memoranda written by Dr. Rohrer, the nursing staff, and jail officials, and to some extent in the video recordings of the instances in 2004 in which Rice was removed from his cell and showered by jail staff. Nor is there any mystery as to why these conditions occurred: Rice typically refused to shower or perform any sort of self-care whatsoever, left much of the food delivered to his cell untouched, and lay naked and unmoving on his bunk for most of the time. The record (including the videos) reveals that the jail did intervene on occasion to clean both Rice and his cell (there is some evidence that Rice was eventually showered on a weekly basis, although neither the jail’s shower log nor the videos confirm this), but the gist of the Estate’s claim is that there were significant periods of time during which the jail’s staff members simply turned their back on the condition of Rice’s person and cell, knowing that he was living in his own filth. Incarcerated persons are entitled to confinement under humane conditions which provide for their “basic human needs.” Rhodes v. Chapman, 452 U.S. 337, 347, 101 S.Ct. 2392, 2399, 69 L.Ed.2d 59 (1981); see also Farmer v. Brennan, 511 U.S. 825, 832, 114 S.Ct. 1970, 1976, 128 L.Ed.2d 811 (1994); Helling v. McKinney, 509 U.S. 25, 33, 113 S.Ct. 2475, 2480-81, 125 L.Ed.2d 22 (1993); Gillis v. Litscher, 468 F.3d 488, 493 (7th Cir.2006) (prison has duty to provide, inter alia, adequate sanitation and hygienic materials); Board v. Farnham, 394 F.3d 469, 482-83 (7th Cir.2005) (personal hygiene items). Because Rice was a pretrial detainee, it is the due process clause of the Fourteenth Amendment rather than the Eighth Amendment’s proscription against cruel and unusual punishment which is the source of this right. See Bell v. Wolfish, 441 U.S. 520, 535-37, 99 S.Ct. 1861, 1872-73, 60 L.Ed.2d 447 (1979). However, courts still look to Eighth Amendment case law in addressing the claims of pretrial detainees, given that the protections of the Fourteenth Amendment’s due process clause are at least as broad as those that the Eighth Amendment affords to convicted prisoners, City of Revere v. Mass. Gen. Hosp., 463 U.S. 239, 244, 103 S.Ct. 2979, 2983, 77 L.Ed.2d 605 (1983); Brown v. Budz, 398 F.3d 904, 910 (7th Cir.2005); Collignon v. Milwaukee County, 163 F.3d 982, 988 (7th Cir.1998), and the Supreme Court has not yet determined just how much additional protection the Fourteenth Amendment gives to pretrial detainees. Woloszyn v. County of Lawrence, 396 F.3d 314, 319 n. 5 (3d Cir.2005); Estate of Cole by Pardue v. Fromm, 94 F.3d 254, 259 n. 1 (7th Cir.1996); see also Weiss v. Cooley, 230 F.3d 1027, 1032 (7th Cir.2000) (“there is little practical difference between the two standards”). A claim that the conditions of an inmate’s confinement were constitutionally inadequate proceeds through a two-step inquiry. We consider first whether the adverse conditions complained of were “sufficiently serious,” such that the acts or omissions of prison officials giving rise to these conditions deprived the prisoner of a “minimal civilized measure of life’s necessities.” Farmer, 511 U.S. at 834, 114 S.Ct. at 1977; Chapman, 452 U.S. at 347, 101 S.Ct. at 2399. If the answer to that question is yes, we consider whether prison officials were deliberately indifferent to the adverse conditions. Farmer, 511 U.S. at 834, 114 S.Ct. at 1977; Wilson v. Seiter, 501 U.S. 294, 302-04, 111 S.Ct. 2321, 2326-27, 115 L.Ed.2d 271 (1991). An official is deliberately indifferent when he is subjectively aware of the condition or danger complained of, but consciously disregards it. Farmer, 511 U.S. at 837, 114 S.Ct. at 1979; Minix v. Canarecci, 597 F.3d 824, 831 (7th Cir.2010); Sanville v. McCaughtry, 266 F.3d 724, 734 (7th Cir.2001); see also Connick v. Thompson, — U.S. —, 131 S.Ct. 1350, 1360, 179 L.Ed.2d 417 (2011). The district court disposed of this claim largely on the ground that Rice himself created the unsanitary conditions. The jail did not prevent Rice from showering or keeping his cell clean and, on occasion, showered him and cleaned out his cell for him. In the court’s view, this is what distinguished the instant case from Vinning-El v. Long, 482 F.3d 923, 924 (7th Cir.2007) (per curiam), in which we held that assigning an inmate to a cell in which, inter alia, feces and blood covered the wall, presented a triable issue of fact as to whether he was deliberately deprived of his Eighth Amendment right to incarceration in humane conditions. Here, by contrast, “[t]he conditions Mr. Rice endured were self-inflicted and don’t give rise to a claim of deliberate indifference.” 2009 WL 1748059, at *11 (citing Isby v. Clark, 100 F.3d 502, 505-06 (7th Cir.1996) (noting that if the inmate is the cause of the conditions of which he complains, his Eighth Amendment claim is tenuous)). The court did acknowledge that “Mr. Rice’s behavior was driven by his mental illness,” but chose to account for that factor in considering his need for mental health treatment rather than whether jail officials were deliberately indifferent to the conditions of his confinement. Id. The court also added, somewhat more cryptically, that “[u]nder the circumstances of this case, Mr. Rice’s unsanitary condition wasn’t sufficiently serious to constitute a constitutional violation. Prison conditions may be harsh and uncomfortable without violating the Eighth Amendment’s prohibition against cruel and unusual punishment.” Id. We conclude, contrary to the district court, that whether jail officials were deliberately indifferent to Rice’s conditions of confinement presents a material dispute of fact that the factfinder must resolve at trial. That Rice himself created the unsanitary conditions of which his Estate complains certainly is a fact relevant to this claim, as our decision in Isby makes clear. 100 F.3d at 505-06. But given Rice’s mental condition, it by no means forecloses the claim, as the district court appears to have assumed. As we noted in Freeman v. Berge, 441 F.3d 543, 546 (7th Cir.2006), and Hall v. Ryan, 957 F.2d 402, 406 (7th Cir.1992), prison officials have an obligation to intervene when they know a prisoner suffers from self-destructive tendencies. There is evidence that Rice may have been malingering, and it is possible that a factfinder might conclude that Rice’s failure of self-care was knowing, voluntary, and deliberate rather than the product of his mental illness. But there is also a wealth of evidence in the record that would support a contrary finding that Rice truly became incapable of caring for himself as a result of his schizophrenia and that jail officials were well aware of this. In light of that evidence, a factfinder reasonably could conclude that Rice was not responsible for the conditions of his cell and his person, and that prison officials, who were aware of these conditions and of Rice’s illness, were responsible for them in the sense that they did not make more conscientious efforts to bathe Rice and to clean his cell. No doubt Rice’s behavior placed the jail in a difficult position; and a factfinder might conclude that even if jail officials could have done more, they were not deliberately indifferent to the cleanliness of Rice’s person and cell. For example, the record does confirm that jail staff did shower Rice and clean out his cell on multiple occasions. However, in view of evidence suggesting that uneaten food was allowed to accumulate in Rice’s cell, that he went for long periods without being showered, and that the stench of his cell and his person were overwhelming, this claim cannot be resolved on summary judgment. For the same reasons, we cannot sustain the district court’s alternative conclusion that the conditions of Rice’s confinement were not sufficiently serious to support his Fourteenth Amendment claim. Perhaps a factfinder could reach that conclusion. As the district court noted, prison conditions may be uncomfortable, even harsh, without being inhumane. See Farmer, 511 U.S. at 832, 114 S.Ct. at 1976. But on this record, granting the Estate the benefit of all inferences to which it is entitled on summary judgment, a factfinder reasonably could conclude that the conditions of Rice’s confinement exceeded mere discomfort and were constitutionally unacceptable. See, e.g., Gillis, 468 F.3d at 493-94 (evidence that prisoner was stripped naked and placed in cell without, inter alia, adequate sanitation sufficient to survive summary judgment); Vinning-El v. Long, supra, 482 F.3d at 924 (holding defendants were not entitled to qualified immunity on Eighth Amendment claim that inmate was subjected to unsanitary and otherwise inhumane confinement for period of three to six days) (coll, cases). B. Administrative Segregation The Estate has a separate conditions-of-confinement claim relating to Rice’s prolonged assignment to Ward One, the administrative segregation unit of the jail. The record indicates that Rice was housed in that unit for approximately seven months, from mid-May, 2004, until his death the following December. Ostensibly, he was assigned to that unit so that he could be more readily monitored and because his behavior made his assignment elsewhere in the jail problematic. (None of the briefs in this case, unfortunately, discuss with any particularity the nature of this jail’s administrative segregation unit and what types of inmates were housed there.) One of the Estate’s experts, Dr. Joe Goldenson, opined that Rice should have been in placed in the jail’s medical ward, where he had been placed on previous occasions, instead of administrative segregation, because “[i]t is a well established fact that individuals with psychiatric problems decompensate when they are in extreme isolation.” R. 157-2 at 18 ¶ 7. We may make short work of this claim because, as the district court noted, the Estate has provided “little support” for it. 2009 WL 1748059, at *12. Dr. Golden-son’s analysis certainly suggests that a prolonged placement in segregation might have adverse effects on someone in Rice’s condition; and our own decision in Walker v. Shansky, 28 F.3d 666, 673 (7th Cir. 1994), recognizes that prolonged confinement in administrative segregation may constitute a violation of the Eighth Amendment (and therefore the Fourteenth), depending on the duration and nature of the segregation and whether there were feasible alternatives to that confinement. (We note, however, that the claim in Walker also included allegations that the inmate had been denied water for periods of up to one week, had been given inadequate time to exercise, and had been subject to physical abuse.) But the Estate has not discussed in any detail what alternative placements were available to the jail nor, more importantly, has it documented the differences those placements would have made in terms of Rice’s social isolation. We take it as a given that the Estate does not believe he should have been placed in the general population of the jail, as its other claims are premised on the notion that Rice should have been monitored more rather than less closely than he was — and it is undisputed that he was placed in administrative segregation for that very purpose. Rice had been placed in the medical ward on prior occasions, and presumably had he been assigned to that ward rather than to administrative segregation he would have received as much if not more medical attention than he did in segregation. But the record suggests that Rice was not returned to the medical ward at the request of the jail’s medical staff. It also indicates that Rice had daily contact with medical personnel in administrative segregation. More to the point, the Estate does not explain why placement in the medical ward or any other unit of the jail would have reduced the likelihood of decompensation due to isolation. All we know is that Rice had one hour each day to mingle with other prisoners while he was housed in administrative segregation (which the record indicates he often declined); we do not know what additional opportunities for social interaction he would have had in other feasible placements within the jail. It is not too much to expect the Estate’s lawyers, when complaining about the debilitating effects of the jail’s housing decisions, to identify feasible alternatives and to tender evidence supporting the contention that Rice likely would have fared better in one of those alternative placements. This they have not done. C. Excessive Force As we noted in our factual summary, on November 16, 2003, Rice struck his cellmate in the eye. When correctional officers ordered him out of the cell, he did not comply and remained standing in his cell. Officer Koontz, at the direction of Officer Shelton, sprayed pepper foam into Rice’s face in an effort to secure Rice’s compliance with their orders. Rice was then placed in a restraint chair. Nursing staff helped rinse the pepper foam from Rice’s eyes. After some period of time, jail staff attempted to release Rice from the restraint chair, but Rice was unwilling to leave the chair and ultimately remained there for a total of eighteen hours. The Estate contends that the use of the pepper foam, along with his prolonged confinement in the restraint chair, amounted to excessive force. The use of force qualifies as excessive for the purpose of Eighth Amendment and due process jurisprudence when it entails the ‘“unnecessary and wanton infliction of pain.’ ” Whitley v. Albers, 475 U.S. 312, 319, 106 S.Ct. 1078, 1084, 89 L.Ed.2d 251 (1986) (quoting Ingraham v. Wright, 430 U.S. 651, 670, 97 S.Ct. 1401, 1412, 51 L.Ed.2d 711 (1977)). That the degree of force used appears in retrospect to have been unreasonable is not sufficient to establish a constitutional violation. Id. at 319, 106 S.Ct. at 1084. Where, as here, force is employed in the course of resolving a disturbance, the pertinent inquiry is ‘“whether force was applied in a good faith effort to maintain or restore discipline or maliciously and sadistically for the very purpose of causing harm.’ ” Id. at 320-21, 106 S.Ct. at 1085 (quoting Johnson v. Glick, 481 F.2d 1028, 1033 (2d Cir.1973) (Friendly, J.)). Factors relevant to that inquiry include whether jail officials perceived a threat to their safety and the safety of other inmates, whether there was a genuine need for the application of force, whether the force used was commensurate with the need for force, the extent of any injury inflicted, and whatever efforts the officers made to temper the severity of the force they used. Id. at 321, 106 S.Ct. at 1085. See also Forrest v. Prim, 620 F.3d 739, 744-45 (7th Cir.2010); Lewis v. Downey, 581 F.3d 467, 475-77 (7th Cir.2009). The district court characterized the force employed by jail officials on this occasion not as excessive, but as “justified and restrained,” applied in good faith, and resulting in no significant injury to Rice, 2009 WL 1748059, at *13, and the Estate’s cursory treatment of this claim on appeal has not convinced us that the court erred in its analysis. Although the Estate contends that Rice posed no threat to anyone, it does not dispute either that Rice had been fighting with his cellmate or that he failed to comply with the directive that he step out of his cell. A fight among two inmates certainly poses a danger to the inmates involved as well as the jail officials who must intervene to stop it. Rice’s mental illness may explain why he stood unmoving when ordered out of the cell, as the Estate suggests, but the Estate cites no evidence showing that the officer who sprayed Rice’s face with pepper foam appreciated that he was unable, as opposed to unwilling, to comply with the order and employed the pepper spray maliciously rather than in a good faith effort to restore order. The same is true as to the decision to place Rice in a restraint chair. The Estate contends in passing that jail officials violated multiple internal rules in deploying pepper spray, treating Rice for the effects of that spray, and then leaving him in the restraint chair for hours on end, but fails to discuss the relevant rules and how specifically they were violated. That Rice was left in the chair for eighteen hours does give one pause. Yet, it is undisputed that Rice himself refused to leave the chair when invited to do so. This too may have been due to Rice’s mental illness, and to the extent jail officials and/or CMS nurses recognized this possibility, they may have had some obligation not to leave him in the chair. But removing Rice from the chair against his will itself required the use of force (recall that Rice ultimately had to be dragged from the chair), so the nurses along with the guards were in a damned-if-you-do, damned-if-you-don’t situation. The Estate does not identify what alternative steps jail officials should have taken, let alone discuss why their actions would enable a jury to find that they acted maliciously and sadistically as opposed to negligently or reasonably. The district court appropriately entered summary judgment against the Estate on this claim. D. Failure to Protect The Estate next argues that the district court erred in granting summary judgment as to its claim that the jail failed to protect Rice from assaults by other inmates. The claim is based on two incidents: (1) the just-discussed November 16, 2003, incident in which Rice fought with his cellmate, and (2) the incident on June 25, 2004, in which inmate Montie George poked a broomstick through the bars of Rice’s cell and repeatedly struck Rice in the groin area, resulting in visible welts on his body. The district court in its ruling discussed only the second of these two incidents, concluding that summary judgment was warranted because there was no evidence that either the jail or for that matter Rice expected the attack, which the court described as a “random” one. 2009 WL 1748059, at *14. Jail officials have a duty to protect inmates from violent assaults by other inmates. Farmer v. Brennan, supra, 511 U.S. at 833, 114 S.Ct. at 1976-77. They incur liability for the breach of that duty when they were “aware of a substantial risk of serious injury to [an inmate] but nevertheless failed to take appropriate steps to protect him from a known danger.” Guzman v. Sheahan, 495 F.3d 852, 857 (7th Cir.2007) (quoting Butera v. Cottey, 285 F.3d 601, 605 (7th Cir.2002)); see also Santiago v. Walls, 599 F.3d 749, 758-59 (7th Cir.2010). The evidence in this case would not support a finding that jail officials were aware of but did not appropriately respond to a substantial risk that Rice might be assaulted. We know little about the first incident in 2003 other than that Rice struck his cellmate. The defendants represent that Rice actually instigated that fight; but even if he did not, the Estate points to no evidence suggesting that the jail was on notice of the possibility that Rice was at substantial risk of an assault from another inmate and that jail officials knew of this risk. Nor has the Estate identified any connection between this incident and the second one — they occurred in different units of the jail and involved different inmates — which might suggest that the later incident was foreseeable in light of the former. The Estate submitted an affidavit from inmate George, who assaulted Rice with the broomstick, explaining that he attacked Rice because he had become fed up with the smell emanating from Rice’s cell. But the district court excluded from evidence George’s affidavit, along with another affidavit and a declaration from two other inmates who were housed in the administrative segregation unit with Rice, because the Estate had not disclosed these three inmates as prospective witnesses as required by Federal Rule of Civil Procedure 26(a) and (e), and the court surely did not abuse its discretion in so ruling. Although the Estate had obtained the names of these individuals from the defendants during discovery, the Estate did not disclose them as witnesses until responding to the defendants’ motions for summary judgment, and by that time, discovery had closed and the defendants could not depose them. The omission was neither substantially justified nor harmless, such that it might be overlooked pursuant to Rule 37(c)(1). As the district court rightly observed, “The defendants aren’t required to guess which of the many individuals identified during discovery the Estate intends to use to support its claims — that is the sort of indirection the disclosure rules are designed to avoid.” 2009 WL 1748059, at *8. Without George’s affidavit, the second attack on Rice indeed appears to have been random, just as the district court characterized it. But even with the explanation provided by George’s affidavit, there would be no basis on which to conclude that the jail was aware of a substantial risk of injury to Rice. Jail personnel certainly were aware that Rice had a hygiene problem, but so far as the record reveals, they had no notice that he was at risk of assault because of that problem, particularly within the more secure confines of the administrative segregation unit. E. Is Ceniceros a State Actor? The Estate’s claim against Dr. Ceniceros is primarily focused on his refusal to admit Rice to Oaklawn in October 2004. Recall that Dr. Rohrer, concerned that Rice was in peril of dying, had obtained a court order authorizing Rice’s involuntary commitment to one of four inpatient facilities, and Rohrer had attempted to have Rice admitted to Elkhart General Hospital. But after Elkhart General refused to admit Rice in the mistaken belief that it had no contract with the jail, Rice was instead taken to Goshen, where he was seen by Dr. Mathew. Although Rice was determined to be medically stable, Dr. Mathew consulted by telephone with Dr. Ceniceros as to whether Rice might need inpatient psychiatric care, which Goshen was not equipped to provide. But Ceniceros allegedly told Mathew that he did not believe Rice met the criteria for involuntary admission and, based on his prior observations of Rice, that he was likely malingering. The Estate contends that Ceniceros’ refusal to admit Rice sight unseen, despite familiarity with Rice’s schizophrenia, his troubled history at the jail, as well as his colleague Rohrer’s conclusion that Rice was in urgent need of inpatient care, amounted to deliberate indifference to Rice’s condition. Ceniceros’ employer, Oaklawn, had contractually undertaken to provide inpatient psychiatric services to jail inmates who needed it, and so, in the Estate’s view, Ceniceros was a state actor vis-a-vis the psychiatric care that he provided to (or withheld from) inmates. In the Estate’s view, then, if Ceniceros was deliberately indifferent to Rice’s psychiatric condition as alleged, he could be liable as a state actor for his indifference just as CMS’s nurses could be and, for that matter in the same way that Ceniceros’ colleague, Dr. Rohrer — himself an Oaklawn physician — could be. The district court disposed of the claim against Ceniceros on the ground that he was not a state actor, contrary to the Estate’s contention. The court focused on Rice’s prior commitments to Oaklawn in October 2003 and May 2004, rather than Ceniceros’ refusal to admit Rice in October 2004. The record, as the court understood it, indicated that Ceniceros had accepted Rice for treatment at Oaklawn on the two prior occasions not by virtue of Oaklawn’s contract with CMS, but rather pursuant to the court orders which committed Rice involuntarily to Oaklawn for observation and treatment. 2009 WL 1748059, at *16. Presumably, although the court did not address the events of October 2004, the court likewise would have emphasized that Rice’s commitment to Oaklawn was being sought on that occasion not pursuant to Oaklawn’s contract with the jail but pursuant to the court’s order authorizing Rice’s involuntary commitment to one of four facilities, including Oaklawn. The court acknowledged that the Supreme Court’s decision in West v. Atkins, 487 U.S. 42, 51, 108 S.Ct. 2250, 2256, 101 L.Ed.2d 40 (1988), recognizes that private physicians may be deemed state actors when they provide medical care to prisoners at the prison. But the court concluded that West’s rationale does not extend to a private psychiatrist who accepts an inmate into his care pursuant to an emergency commitment order. 2009 WL 1748059, at *16. Providing psychiatric care to an individual who has been involuntarily committed for such care is not a function traditionally reserved to the state, the court reasoned. Id. Because, in the court’s view, Dr. Ceniceros did not serve a public function in caring for Rice, his role was not that of a state actor. We have our doubts as to whether the district court was correct in categorizing Ceniceros as a private rather than a state actor. Rice was treated by Ceniceros in fulfillment of the jail’s obligatio