Kevin Clanton v. United States ( 2021 )


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  •                                In the
    United States Court of Appeals
    For the Seventh Circuit
    ____________________
    No. 20-2059
    KEVIN CLANTON,
    Plaintiff-Appellee,
    v.
    UNITED STATES OF AMERICA,
    Defendant-Appellant.
    ____________________
    Appeal from the United States District Court for the
    Southern District of Illinois.
    No. 3:15-cv-00124-NJR-RJD — Nancy J. Rosenstengel, Chief Judge.
    ____________________
    ARGUED JANUARY 14, 2021 — DECIDED DECEMBER 17, 2021
    ____________________
    Before RIPPLE, KANNE, and ROVNER, Circuit Judges.
    ROVNER, Circuit Judge. This case is on appeal for the second
    time, from an action brought in the district court by Kevin
    Clanton under the Federal Tort Claims Act. Clanton alleged
    that nurse practitioner Denise Jordan, an employee of the U.S.
    Public Health Service, failed to educate him about his severe
    hypertension or to monitor its advancement, and as a result
    of that negligent care his hypertension developed into Stage
    V kidney disease. As a result, Clanton required dialysis and,
    2                                                   No. 20-2059
    at the age of 35, a kidney transplant, and is expected to endure
    further cycles of dialysis and another transplant in the future.
    Following a five-day bench trial, the district court found the
    United States liable, rejected the government’s comparative-
    negligence argument as to Clanton, and awarded Clanton
    nearly $30 million in damages.
    The United States appealed to this court, arguing that the
    district court erred in its comparative-negligence analysis and
    in its assessment of damages. We upheld the damages calcu-
    lation, but remanded for the court to assess Clanton’s com-
    parative negligence under Illinois’s reasonable-person stand-
    ard. Clanton v. United States, 
    943 F.3d 319
     (7th Cir. 2020)
    (“Clanton I”). On remand, the court again concluded that com-
    parative negligence was inapplicable in this case, and the gov-
    ernment has again appealed.
    I.
    For context, we briefly recount the facts underlying the
    Federal Torts Act claim, which are set forth in greater detail
    in the district court’s initial order. After a pre-employment
    physical exam in June 2008, Clanton was informed that his
    blood pressure was too high, and that he needed medication
    to lower it before he could be cleared for work. Clanton
    sought medical care for it at the Quick Care Clinic, where he
    was treated by nurse practitioner Denise Jordan. Jordan noted
    a diagnosis of obesity and hypertension, ordered routine lab
    work, and directed Clanton to follow up with her at Windsor
    Health Center the next week.
    On June 12, 2008, Clanton had his first office visit with Jor-
    dan at the Windsor office. At that appointment, Jordan gave
    him Clonidine in the office to lower his blood pressure, which
    No. 20-2059                                                     3
    immediately lowered it from 210/170 to 200/130. She also gave
    him some sample blood pressure medications to take home
    and told him to come back in a week. From her notes, she ap-
    pears to have talked to him about healthy eating habits but
    did not document any other patient education efforts. She
    signed the form clearing him to return to work.
    Clanton did not return for nearly two years, during which
    time he generally felt fine, with no symptoms of high blood
    pressure such as blurred vision, headaches or shortness of
    breath. He returned to Jordan in July 2010, when a routine
    physical from his employer indicated that his blood pressure
    was too high and that he needed to seek medical care. He saw
    Jordan on July 21, 2010, and although the medical records
    documented that he had not had blood pressure medication
    during that time, the record does not reflect that Jordan dis-
    cussed the two-year absence or the risks. Jordan again gave
    Clonidine to Clanton in the office to lower his blood pressure,
    which brought it down to some extent. She gave Clanton a
    prescription for blood pressure medication and told him to
    return in a week but did not order any lab work.
    Clanton returned three weeks later, on August 11, 2010,
    and he had 10 appointments with her over the ensuing 2
    years, at which she checked his blood pressure, administered
    medication for his high blood pressure readings, and pre-
    scribed medications for him to take at home. She noted on
    some occasions that he was noncompliant, such as an ap-
    pointment in which she documented that he refused to take a
    medication she had previously prescribed. He had stopped
    taking one of the medications that he believed did not work
    as well as the others, because, as he explained at trial, he still
    felt bad when taking it. Jordan never discussed with Clanton
    4                                                     No. 20-2059
    whether the medication could be causing the adverse symp-
    toms that he was associating it with, nor did she explain to
    him that his hypertension could cause such symptoms. She
    never educated or instructed Clanton about the nature of his
    hypertension disease, the risks of uncontrolled high blood
    pressure (including kidney damage), the fact that he was at
    increased risk for complications because he is African-Amer-
    ican, why it was important for him to stay on his medication
    and return for appointments even when he felt fine, or the po-
    tential consequences of sporadic treatment. Throughout that
    time, Jordan failed to consult with a supervising physician re-
    garding Clanton’s care—even on the occasion in which she
    sent him to the emergency room when he experienced blurred
    vision and the medication in the office did not sufficiently
    lower his blood pressure.
    At Clanton’s appointment with Jordan in July 2011, she or-
    dered lab tests for the first time since his initial visit to her in
    2008. Those lab tests revealed signs of kidney disease, but she
    never saw the results. She admitted that had she seen the re-
    sults, she would have referred Clanton to a nephrologist. Dur-
    ing Clanton’s final visit in October 2012, Jordan again ordered
    lab work, which revealed extensive kidney damage. At this
    point, Clanton was suffering from Stage IV chronic kidney
    disease. Neither Jordan nor any one at the clinic communi-
    cated those results to Clanton, nor was he referred to a spe-
    cialist. Two months later, Clanton was taken to the hospital
    suffering from shortness of breath. His blood pressure was
    high, and he was finally advised at that time of his severe kid-
    ney disease. He was subsequently diagnosed with Stage V
    kidney disease in February 2013.
    No. 20-2059                                                     5
    Clanton began undergoing hemodialysis in March 2013
    and received a kidney transplant in November 2015. Since
    that time, he has been compliant with his medication regime
    and his doctor’s advice. He would later testify that while he
    was under Jordan’s care, he did not understand the nature of
    his underlying disease or the risks he faced if he did not take
    appropriate steps to control his high blood pressure.
    As the useful life of a transplanted kidney is ten years,
    Clanton faces the prospect of returning to dialysis and having
    one or more additional kidney transplants in the future. The
    stipulated cost of his past medical care is approximately $2.8
    million, and the cost of his future kidney-related medical care
    is, according to Clanton, estimated to be $14.5 million.
    Clanton sued the government for malpractice under the
    Federal Tort Claims Act, which was the exclusive remedy for
    his injuries under 
    42 U.S.C. § 233
    (a). After a five-day bench
    trial, the district court found that Jordan was negligent in fail-
    ing to properly educate Clanton about the nature and poten-
    tial complications of his disease and the risks of not adhering
    to a treatment plan, and that as a consequence, Clanton
    treated his hypertension as a chronic or sporadic condition
    and only sought treatment when he felt bad or was informed
    of high blood pressure readings. The court also found that Jor-
    dan was negligent in not taking action in response to the 2011
    and 2012 lab results showing that Clanton was suffering from
    kidney disease and in failing to consult with a supervising
    physician regarding Clanton’s care. The district court consid-
    ered whether Clanton was contributorily negligent for miss-
    ing follow-up appointments, not taking his medications as
    prescribed, and failing to check on his lab results, as the gov-
    ernment argued, but concluded he was not contributorily
    6                                                  No. 20-2059
    negligent. Clanton was awarded $15.9 million in economic
    damages and $13.75 million in non-economic damages, for to-
    tal damages of approximately $29.7 million.
    We remanded the case because the court, in making its de-
    cision regarding comparative negligence, had determined
    only whether Clanton’s conduct was subjectively reasonable
    given Clanton’s own knowledge, but had not compared Clan-
    ton’s understanding of his condition to that of a reasonable
    person in his situation in assessing comparative negligence as
    is required under Illinois law. Clanton I, 943 F.3d at 323. We
    noted that Clanton was in the position of a person whose care-
    giver had failed to provide information as to the severity of
    his condition, but who also had a few external clues that he
    was seriously unwell, such as two employment-related phys-
    icals which showed dangerously high blood pressure. Id. We
    held that “[t]he district court must determine how a reasona-
    ble person in the same position would have acted and com-
    pare Clanton’s behavior to that objective standard of care.” Id.
    We rejected the government’s challenges to the damage
    award.
    II.
    Therefore, the only issue for the district court on remand
    was the application of the objective component of Illinois’
    comparative negligence standard. As we recognized in Clan-
    ton I, to assess comparative negligence under Illinois law,
    “[c]ourts must apply the familiar reasonable-person standard,
    an objective test that asks ‘whether plaintiff ... used that de-
    gree of care which an ordinarily careful person would have
    used ... under like circumstances.’” Clanton I, 943 F.3d at 323,
    quoting McCarthy v. Kunicki, 
    823 N.E.2d 1088
    , 1101 (Ill. App.
    No. 20-2059                                                    7
    Ct. 2005); Long v. City of New Bos., 
    440 N.E.2d 625
    , 628 (Ill.
    1982).
    The district court held that under that reasonable-person
    standard, Clanton was not comparatively negligent. Moreo-
    ver, the court held that even if it had found negligence on the
    part of Clanton, any such negligence was not a contributing
    cause of his injury because there was no evidence that any of
    his conduct prior to July 2011 was the cause in fact of his kid-
    ney failure or the legal cause of his injuries.
    The government’s argument on appeal is that, despite giv-
    ing lip service to the reasonable person standard, the district
    court’s determination was actually once again based on Clan-
    ton’s subjective knowledge. It argued that the court improp-
    erly focused on Clanton’s own knowledge of his medical con-
    dition, and that the court had no basis under Illinois law for
    imposing upon the reasonable-person standard a require-
    ment that the provider inform the plaintiff in detail about all
    aspects of his illness and treatment before finding compara-
    tive negligence. In addition, the government asserts that the
    court’s alternative holding—that any negligence by Clanton
    was not a contributing cause of his injury—was inconsistent
    with the record.
    In considering the government’s appeal of the court’s de-
    cision, it is critical to recognize precisely the procedural con-
    text and the limits of the government’s challenge. First, the
    government seeks to overturn a court’s decision that followed
    a five-day bench trial. The court therefore had the oppor-
    tunity to assess the credibility of the witnesses, and to make
    fact findings, and its determination proceeds from that factual
    foundation. We review any challenge to a district court’s fact
    findings under a clearly erroneous standard, and conclusions
    8                                                  No. 20-2059
    of law de novo. Keller v. United States, 
    58 F.3d 1194
    , 1197 (7th
    Cir. 1995).
    Tasked with applying the reasonable person standard, the
    district court considered evidence that would establish what
    Clanton should have known because a reasonable person
    would be expected to have such knowledge in similar circum-
    stances. The court discussed evidence that was introduced at
    trial as to what is generally known about hypertension. That
    included testimony from three expert witnesses, establishing:
    that patients often feel well when they have high blood pres-
    sure, which provides “misinformation” to them as to whether
    they are ill; that it is common for people to think that if they
    do not feel sick there is no need for treatment; that high blood
    pressure is a silent killer, and that patient education is abso-
    lutely essential to controlling it especially in a young person
    who is facing something that does not produce any symptoms
    which would let him know what is happening; and that pa-
    tients “routinely do not understand that medication must be
    taken daily, even when the patient feels better, and that they
    have to be educated on the chronic nature of the disease and
    the risks associated with not following a physician’s advice.”
    Dist. Ct. Op. at 6. In addition, the court noted that “experts
    also testified at trial that it is common for hypertension pa-
    tients to not understand the need to take medications daily
    and to return to the doctor regularly.” 
    Id.
     Finally, the court
    noted that there was no evidence at all in the record indicating
    that it was common knowledge in the community that there
    is a causal link between uncontrolled hypertension and kid-
    ney damage or failure, and that—to the contrary—the gov-
    ernment even presented an expert witness contesting the link
    between uncontrolled hypertension and kidney damage. 
    Id.
    at 6–7.
    No. 20-2059                                                     9
    Based on that testimony, the court made the following fac-
    tual findings:
    Thus, the Court finds that a reasonable person
    would not know or understand the importance
    of taking medication regularly, monitoring
    one’s blood pressure, and returning for regular
    office visits even when he or she feels well. And
    there is certainly nothing in the record that
    shows a reasonable person, unless specifically
    educated or otherwise informed, would know
    that uncontrolled hypertension may be causing
    harm even when he or she feels well and could
    lead to serious, irreversible kidney damage if
    left untreated.
    Dist. Ct. Op. at 7.
    Notably, the government presents no challenge to those
    fact findings. It never argues that the expert testimony was
    insufficient to support the court’s findings, or that the find-
    ings were otherwise clearly erroneous. Instead, the govern-
    ment argues only that the district court failed to apply the rea-
    sonable-person standard at all, but rather relied once again on
    Clanton’s subjective knowledge in determining that there was
    no comparative negligence. Because no challenge is raised as
    to those factual findings, we do not review them at all. See,
    e.g., United States v. Vines, 
    9 F.4th 500
    , 512 (7th Cir. 2021) (we
    will not manufacture challenges to determinations by the dis-
    trict court that are not raised by the plaintiff on appeal); Hack-
    ett v. City of S. Bend, 
    956 F.3d 504
    , 510 (7th Cir. 2020) (“An ap-
    pellant who does not address the rulings and reasoning of the
    district court forfeits any arguments he might have that those
    10                                                    No. 20-2059
    rulings were wrong.”). The court’s analysis of what a reason-
    able person would do, therefore, was made in the context of
    those fact findings as to what a reasonable person would un-
    derstand as to the illness, its dangers, and its potential for pro-
    gression.
    In addition to considering what a reasonable person
    would understand as to hypertension generally, the court also
    considered how the additional external clues that he was se-
    riously ill which we identified in our opinion remanding the
    case, such as two employment-related physicals which
    showed dangerously high blood pressure, would impact how
    a reasonable person in the same situation would have acted.
    The court conducted that analysis against the backdrop of its
    uncontested findings set forth above.
    First, the court considered what a reasonable person
    would understand when informed, after each of two employ-
    ment-related physicals separated by two years, that his blood
    pressure was too high and that he needed medication to lower
    it. The court held that a reasonable person would then take
    the action that the employer required—which is to go to a
    healthcare provider to get medication to lower his blood pres-
    sure so that he could return to work. Id. at 8. And, as the court
    pointed out, that is precisely what Clanton did. He went to
    Jordan after the initial employer notification, and followed up
    with another appointment within a week, at which time Jor-
    dan gave him medication to lower his blood pressure and
    signed the form that allowed him to return to work. Given the
    court’s findings that a reasonable person would not be aware
    that asymptomatic high blood pressure can cause damage,
    nor of the importance of taking medication regularly, moni-
    toring one’s blood pressure, and returning for regular office
    No. 20-2059                                                   11
    visits even when he or she feels well, the finding that a rea-
    sonable employee would act as Clanton did is supported by
    that evidence. The court concluded that “from these two
    failed work-related physicals, a reasonable person would
    only have learned that you cannot pass a work physical with
    a high blood pressure reading until you see a healthcare pro-
    vider and take a single or short-term dose of medications
    given to you by that healthcare provider.” Id. The court fur-
    ther found that “[t]here is nothing from these facts that would
    tell a reasonable person that hypertension is a chronic health
    condition with serious consequences if it is not consistently
    monitored and treated on a daily basis for his lifetime.” Id.
    The court therefore rejected the argument that Clanton
    “should have known” that he was seriously unwell based on
    those work physicals. And it reached the same conclusion
    with respect to the 2008 trip to the emergency room. Id. The
    court noted that Clanton sought treatment because of a severe
    headache, that he was informed that he had high blood pres-
    sure and given medicine, and he then felt better. Id. From that
    incident, the court found that a reasonable person would only
    have learned that a one-time dose of medicine would resolve
    the symptoms of high blood pressure, and that nothing in that
    incident would inform him that he had a serious, chronic con-
    dition that could cause kidney damage. Id. at 8–9.
    Illinois courts have repeatedly recognized that the deter-
    mination of due care in a comparative negligence claim is a
    factual determination, left to the trier of fact. See Gilman v.
    Kessler, 
    548 N.E.2d 1371
    , 1378 (Ill. App. Ct. 1989) (holding that
    “[g]enerally, the issue of whether plaintiff exercised due care
    for her own safety is a question of fact for the jury”), quoting
    Blacconeri v. Aguayo, 
    478 N.E.2d 546
    , 550 (Ill. App. Ct. 1985);
    Gruidl v. Schell, 
    519 N.E.2d 963
    , 967 (Ill. App. Ct. 1988) (“The
    12                                                   No. 20-2059
    question of contributory negligence is ordinarily a question of
    fact for the jury. If there is any evidence of contributory neg-
    ligence on the part of the plaintiff, a question of fact is pre-
    sented that must be left to the jury for determination.”) The
    court made those fact findings based on the evidence in the
    record, and the government does not challenge them. Instead,
    the government argues that the district court never applied
    the reasonable-person standard, but once again found the ab-
    sence of comparative negligence based solely on Clanton’s
    subjective understanding. In addition, the government asserts
    that the court erroneously held that comparative negligence
    can never be found unless the provider first educates the in-
    dividual as to the disease, its risks, and the treatments needed
    for it.
    The government characterizes that analysis as a subjective
    analysis, not an objective one, but that is not a fair characteri-
    zation. The court considered not only what Clanton knew or
    would conclude as a result of his medical interactions, but
    what a reasonable person would conclude. It considered
    whether those incidents would have alerted a reasonable per-
    son to the chronic nature of the illness and the need for con-
    sistent action to address it, even if Clanton himself did not
    draw those conclusions. But based upon the court’s initial fact
    determinations, a reasonable person would not have any
    knowledge of the long-term risks posed by hypertension.
    Therefore, the base of knowledge for the hypothetical “rea-
    sonable person” is limited to that information which is appar-
    ent from the medical treatment or is otherwise conveyed to
    them, as by the medical practitioners or other means.
    In its earlier opinion, the district court had held that Clan-
    ton did not understand the seriousness of his blood pressure
    No. 20-2059                                                   13
    levels, the chronic nature of his condition, or the conse-
    quences of not controlling it, and therefore he treated his hy-
    pertension as one would treat an acute or episodic condition,
    like a headache or a sinus infection. The court has now found
    that a reasonable person would not understand that high
    blood pressure was a serious, chronic condition, and in that
    context a reasonable person would seek medical treatment
    when symptoms flared—as one would do for a condition that
    is acute or episodic rather than chronic and progressive. It is
    the difference between the treatment “as needed” that a rea-
    sonable person would be expected to pursue for occasional
    headaches, as opposed to the close monitoring one would ex-
    pect if that headache evidenced a growing brain tumor. As we
    discussed, those findings are based on expert testimony, and
    are not challenged here. With those findings that a reasonable
    person would also lack the knowledge as to the nature of that
    condition, its risks, and the need for continual treatment for
    it, the court’s conclusion that Clanton’s actions were con-
    sistent with that which a reasonable person would have taken
    is based on an application of the reasonable person standard,
    and not on his subjective knowledge. The government’s only
    challenge in this case is that the court did not apply the objec-
    tive standard, but the court’s analysis refutes that. We empha-
    size that the holding here is an extremely narrow one, dictated
    by the government’s tailored legal challenge and the uncon-
    tested factual findings below.
    As additional evidence that the court did not adhere to the
    reasonable-person standard, the government argues that the
    court’s analysis conflicts with Illinois cases applying that
    standard. Specifically, the government asserts that Jordan’s
    failure to provide Clanton information as to his disease has
    no application to Clanton’s contributory negligence, and that
    14                                                   No. 20-2059
    Illinois cases hold that a patient’s failure to follow medical ad-
    vice constitutes contributory negligence. The obviousness of
    the risk, and whether a reasonable person would perceive a
    danger, however, has always been relevant to the determina-
    tion as to whether the person’s actions constituted due care.
    See, e.g., Gilman, 
    548 N.E.2d 1378
    , quoting Blacconeri, 
    478 N.E.2d 546
     at 550 (“Where a danger is obvious to a person of
    ordinary intelligence, the law will charge one with knowledge
    of it. … It is incompatible with the exercise of due care for
    one's own safety and protection to voluntarily expose oneself
    to danger of which one is aware; ordinary prudent persons do
    not knowingly place themselves in a position of peril or dan-
    ger”); Long v. City of New Bos., 
    440 N.E.2d 625
    , 628–29 (Ill.
    1982) (noting that the “[f]ailure to observe and avoid danger
    which is obvious to a person of ordinary intelligence has been
    held to be contributory negligence in numerous cases,” and
    examining whether a danger “should have been apparent” to
    the plaintiff). Consider an example: if a pedestrian were cross-
    ing a street, a reasonable pedestrian would be expected to ap-
    preciate the danger posed by traffic, and to take action, such
    as looking both ways before proceeding, to ensure that the
    risk was avoided. If that pedestrian while crossing the street
    were then struck by a plane, however, a court would not find
    contributory negligence in the failure of the pedestrian to also
    look up before proceeding. Although the damage might have
    been avoided had the pedestrian looked up before proceed-
    ing, a reasonable person crossing a street would not perceive
    himself to be in danger from a plane, even if planes were reg-
    ularly flying overhead, and thus would not be expected to
    look up in the exercise of reasonable care. On the other hand,
    if the pedestrian were crossing a runway, the risk of such a
    No. 20-2059                                                   15
    calamity would be one that a reasonable person should rec-
    ognize, and in that case the failure to also scan the skies could
    constitute a lack of due care. The nature of the risk, and
    whether a reasonable person would be aware of it, are rele-
    vant considerations in the objective analysis as to whether the
    actions were negligent.
    Here, the district court found that a reasonable person
    would not perceive high blood pressure as a chronic illness,
    with the risk of progressive damage to the kidneys, as op-
    posed to an acute illness to be treated as symptoms required.
    The damage that occurred from the “silent killer” was not one
    that, absent education, a reasonable person would foresee. So,
    like a pedestrian proceeding across a street, the patient would
    be expected to address the illness as symptoms indicated a
    flare-up to avoid adverse consequences from those symp-
    toms, but the progressive damage to the kidneys while
    asymptomatic for a person in that situation would not be a
    risk that he would perceive, and therefore not one that he
    would be expected to act to forestall.
    The district court’s factual findings establish that the risk
    of long-term damage even in the absence of symptoms is not
    one that a reasonable person would perceive as to this partic-
    ular disease. For many diseases, the nature of the disease and
    its ramifications will be a matter of general knowledge, such
    that a reasonable person would be expected to perceive the
    risk to his health and to take action appropriate to address
    that risk even absent education from a medical practitioner.
    But in this case, the court found that the expert testimony es-
    tablished that there is a widespread lack of knowledge as to
    hypertension, its chronic nature, and the health danger that it
    16                                                  No. 20-2059
    poses unrelated to any symptoms, and in such an environ-
    ment in which the danger is not perceived by the general pub-
    lic, a reasonable person would not be expected to take action
    to avoid it.
    And the government recognizes as much in its own argu-
    ment. In arguing that the court “provided no legal basis for its
    belief that it is totally reasonable for people to ignore medical
    advice, stop taking medications, and skip medical appoint-
    ments for an extended period, so long as they have not been
    explicitly informed in detail about all of the possible conse-
    quences of failing to follow that advice,” the government then
    proceeds:
    It is not as if high blood pressure is some rare or
    arcane medical issue that no laymen have ever
    heard of. Reasonable people know about it, and
    reasonable people who are diagnosed with it
    take reasonable precautions—like, for example,
    following medical advice, keeping appoint-
    ments with medical providers, and taking their
    prescribed medications.
    Appellant’s Brief at 23. Even the government, then, recog-
    nizes that the knowledge of the layperson as to the disease
    impacts the reasonable person analysis; and although the
    government states that “[i]t is not as if high blood pressure is
    some rare or arcane medical issue,” the district court made
    fact findings that hypertension is an arcane issue that is not
    understood by the average person absent education. And the
    government does not contest those findings or the testimony
    underlying them, and provides no cites or support for its off-
    hand, contrary characterization of the disease. The govern-
    No. 20-2059                                                 17
    ment could have argued that the fact findings were clearly er-
    roneous, and that patients possess a sufficient awareness of
    hypertension to understand the need for regular medication
    and follow-up. But the government chose not to bring such an
    argument, and any legal challenge therefore assumes the facts
    found by the district court.
    In repeatedly stating that reasonable people follow medi-
    cal advice and keep appointments, the government fails to
    acknowledge the court’s findings that reasonable people
    would not understand the need to treat the illness when
    asymptomatic. It is the difference between what is reasonable
    behavior for an acute, episodic condition and a chronic one.
    Clanton took the medication when he had reason to believe it
    was needed, whether because it was necessary to be given the
    clean bill of health for a return to work or because he experi-
    enced headaches and other symptoms that would alert him to
    the need for treatment. And once he received the work clear-
    ance or the adverse symptom was alleviated, he sought no
    further treatment, as is typical and expected for an acute con-
    dition that is treated on an as-necessary basis. And in fact,
    even when he did follow up with additional appointments for
    his disease, on numerous occasions he was instructed merely
    to return to the clinic “as needed,” which would simply rein-
    force the perception that his need for medical care was tied to
    his experience of symptoms. The noncompliance decried by
    the government is an inadequate and unreasonable response
    to a chronic condition of which a reasonable person is or
    should be aware, but the court explicitly found that a reason-
    able person would not be aware of the chronic and dangerous
    nature of hypertension absent education, which did not occur
    here. The court, then, did not hold, as the government asserts,
    18                                                 No. 20-2059
    that comparative negligence will never be found if the medi-
    cal practitioner fails to inform the patient about his disease,
    and its consideration of the information provided by Jordan
    does not mean the court was applying a subjective standard
    rather than a reasonable-person analysis.
    The holding in this case is circumscribed by the uncon-
    tested factual findings by the court as to the disease, the gen-
    eral public’s common understanding of it, and the knowledge
    that a reasonable person would possess in the absence of ed-
    ucation by a medical practitioner. The holding is therefore
    limited to the context of those narrow factual findings. As
    such, it does not apply beyond the contours of this case. A
    district court in another case, faced with different expert tes-
    timony, could well find that a reasonable person had a more
    extensive knowledge of hypertension than the court found in
    this case, and therefore that a reasonable person would have
    an awareness of the risk and would be expected to act in a
    way to avoid it. But here, the court was presented with evi-
    dence that people generally have no knowledge of hyperten-
    sion and its risk, and we do not review that determination be-
    cause the government does not claim that it is clearly errone-
    ous. As is often the case where the reasonable-person stand-
    ard is applied, the holding here is specific to the facts pre-
    sented and the findings that the trier of fact reached. See Gil-
    man, 
    548 N.E.2d at 1378
    ; Gruidl, 
    519 N.E.2d at 967
    .
    Finally, the government argues that the court did not
    properly apply the reasonable-person standard because its
    holding is inconsistent with Illinois cases that have held that
    noncompliance with medical advice constitutes contributory
    negligence without requiring a showing that the provider first
    explained the consequences of failure to follow that advice.
    No. 20-2059                                                             19
    See Krklus v. Stanley, 
    833 N.E.2d 952
    , 961 (Ill. App. Ct. 2005);
    Pantaleo v. Our Lady of Resurrection Med. Ctr., 
    696 N.E.2d 717
    ,
    728 (Ill. App. Ct. 1998); Gruidl, 
    519 N.E.2d at 967
    . But those
    Illinois cases cited by the government do not undermine the
    district court’s holding. Those cases do not hold that noncom-
    pliance with medical instructions is always contributory neg-
    ligence; nor do they hold that noncompliance is never contrib-
    utory negligence. Rather, the Illinois cases relied upon by the
    government recognize that comparative negligence is an issue
    to be decided by the trier of fact. The issue before the court in
    each of those cases was whether the court properly presented
    the issue of comparative negligence to the jury.1 Those courts
    merely held that the facts were sufficient to allow a jury to
    determine whether the plaintiff’s actions were negligent, and
    therefore that the jury’s finding of comparative negligence
    was not against the manifest weight of the evidence. See, e.g.,
    Gruidl, 
    519 N.E.2d at 967
     (holding that “[i]f there is any evi-
    dence of contributory negligence on the part of the plaintiff, a
    question of fact is presented that must be left to the jury for
    determination.”); Pantaleo, 
    696 N.E.2d at 726
     (“we will not up-
    set the verdict ‘merely because the jury could have drawn dif-
    ferent inferences and conclusions from conflicting testimony’
    1  The government points as well to Ford-Sholebo v. United States, 
    980 F. Supp. 2d 917
    , 997–98 (N.D. Ill. 2013), which did not involve a review of
    a jury verdict. In that case, the judge found comparative negligence after
    a trial, based on Solebo’s regular refusal to take the seizure medicine ad-
    ministered on a daily basis by the prison official. This case presents no
    conflict for the same reasons as the other cases. The district court in the
    present case did not hold that noncompliance can never constitute com-
    parative negligence, and the factual findings as to what a reasonable per-
    son would know are absent in Ford-Sholebo and are dispositive—and un-
    challenged—here.
    20                                                    No. 20-2059
    presented at trial”); Krklus, 
    833 N.E.2d 952
    , 961, 964 (holding
    that “the question of whether comparative negligence is ap-
    propriate in a particular medical malpractice case must be de-
    cided on a case-by-case basis” and the court did not err in in-
    structing the jury that it could consider comparative negli-
    gence, but noting that “our conclusion is firmly rooted in the
    specific facts of the case at bar”). The cases certainly do not
    hold that those facts require a finding of comparative negli-
    gence. The decision to submit the issue to the trier of fact is
    merely a determination that the facts in those cases would
    support a decision either way, which is why the issue was nei-
    ther decided as a matter of law prior to trial, nor overturned
    post-trial. The court in this case similarly allowed the issue to
    go to trial, although in this case the trier of fact was the judge,
    not a jury. And after hearing the evidence, the court deter-
    mined that the facts did not demonstrate negligence on the
    part of the plaintiff, just as the jury in the cases cited by the
    government held that the facts demonstrated negligence. The
    court in the present case did not hold that, in all cases, a med-
    ical provider must provide information as to a person’s dis-
    ease and its risks and treatments in order for noncompliance
    to constitute comparative negligence. As was true for the Illi-
    nois cases cited by the government, the district court’s deci-
    sion in this case was tied to the facts in this case, and in par-
    ticular to the factual findings as to what a reasonable person
    would understand as to this particular disease absent any ed-
    ucation from a medical provider. The district court’s analysis
    is therefore consistent with the application of the reasonable
    person standard in those cases, and there is no conflict with
    those decisions.
    No. 20-2059                                                    21
    III.
    In summary, the district court did not base its decision on
    Clanton’s subjective understanding. The court made findings
    as to what an objectively reasonable person would under-
    stand as to hypertension and found that a reasonable person
    would not understand the potential for damage in the absence
    of any symptoms, and therefore would not understand the
    need to take medication or see a medical provider when
    asymptomatic. The government does not contest those find-
    ings by the court, and therefore, we accept them as true and
    express no opinion at all as to those findings. Based on those
    findings, the court held that Clanton’s actions were not incon-
    sistent with the due care that would be expected of a reason-
    able person. Whether the fact findings are supportable, and
    whether that conclusion as to due care is supportable, are not
    issues before us now. The only issue raised by the govern-
    ment is whether the court continued to apply the subjective
    test on remand, or whether the court analyzed comparative
    negligence under the proper reasonable-person standard
    which we instructed the court to apply on remand. The dis-
    trict court’s order reveals that it properly identified the stand-
    ard and applied it, and the government has not demonstrated
    reversible error. Because we affirm on this ground, we need
    not consider the court’s alternative argument that any com-
    parative negligence could not be considered a “substantial
    cause” of Clanton’s injury.
    The decision of the district court is AFFIRMED.