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Seventh Circuit Refuses to Hold Wexford Liable for Prisoner’s Pain from Medical Transports in “Black Box” Restraint

David M. Reutter

For prison officials and healthcare providers who refused to grant an Illinois prisoner an exemption from wearing “black box restraints” during medical transport, a federal district court in the state also refused to find an Eighth Amendment violation, and the U.S. Court of Appeals for the Seventh Circuit affirmed that decision on October 1, 2021.

The prisoner, Lavertis Stewart, “suffers from several medical ailments including carpal tunnel syndrome in both wrists, Hepatitis C, Grade III cirrhosis of the liver, neutropoenia, lateral epicndylitis (tennis elbow), arthritis, shoulder impingement, shoulder capulitis/arthritis and bursitis, and arthritis bone spurs,” the Court recalled. In addition to the care he was receiving at Dixon Correctional Institution (DCC), Stewart also made visits to doctors outside the prison with some frequency.

Under prison policy, prisoners transported outside the facility were required to wear a “black box” restraint, a hard plastic box that encloses the chain and keyhole portions of the handcuffs the prisoner is wearing. A metal slide clamps the box shut, and a metal fixture attached to the prisoner’s waist then slides through the box and clamp. Once that is in place, a chain is wrapped snuggly around the prisoner’s waist and looped through the metal fixture and padlocked. It is a very uncomfortable and restrictive device.

Beginning in 2009, Stewart requested black box exemptions. His civil rights complaint alleged instances of suffering due to a failure to get exemptions through the end of 2016. Over those seven years, most of Stewart’s exemption requests were denied, though he was granted a few. At those times, however, his exemptions expired without renewal.

The complaint focused on exemption denials issued by Dr. Antreas Mesrobian, who was employed before he died by the prison’s privately contracted healthcare provider, Wexford Health Sources, Inc. Mesrobian denied all of Stewart’s exemption requests he was presented, while other Wexford doctors granted them.

Stewart’s pro se complaint was filed in federal court for the Northern District of Illinois on July 19, 2012, accusing Mesrobian—and later his estate—as well as Wexford and DCC Assistant Warden Wayne Steele of deliberate indifference to his serious medical needs by denying him black-box exemptions. The complaint was dismissed by the district court, but that dismissal was reversed by the Seventh Circuit on April 22, 2014. See: Stewart v. Special Adm’r of Est. of Mesrobian, 559 F. App'x 543 (7th Cir. 2014). After discovery ensued, Defendants moved for summary judgment, which the district court granted. Stewart appealed.

Taking up the case again, the Seventh Circuit found that when faced with Stewart’s exemption requests, “Mesrobian responded in various ways including by evaluating Stewart’s complaints of pain, examining his shoulder and wrists, prescribing pain medication, and referring Stewart to physical therapy.”

“We cannot say that no minimally competent doctor could have made the same assessment,” the Court observed, nor did it find “Dr. Mesrobian’s response was ‘so far afield of accepted professional standards as to raise the inference that it was not actually based on a medical judgment,’” quoting Norfleet v. Webster, 439 F.3d 392 (7th Cir. 2006). “Nor,” the Court added, “does Dr. Mesrobian’s conduct rise to the level of criminal recklessness that an Eighth Amendment violation requires.”

The Court further found that Stewart could not sue Wexford for vicarious liability without establishing a “policy,” “custom or practice” that deprived Stewart of a constitutional right, quoting Milestone v. City of Monroe, Wis., 665 F.3d 774 (7th Cir. 2011).

There was also no proof that prison officials had a policy or custom of denying black box exemptions, since Stewart himself was sometimes granted them. And Steele could not be held liable, either, since “a non-medical prison official will generally be justified in believing that the prisoner is in capable hands,” the Court concluded, citing Arnett v. Webster, 658 F.3d 742 (7th Cir. 2011).

Thus the district court’s judgment was affirmed. On appeal, Stewart was represented by attorneys Jeffrey M. Heckendorn, Rachel A. Remke and Frederick J. Sperling of Schiff Hardin LLP in Chicago. See: Stewart v. Wexford Health Sources, Inc., 14 F.4th 757 (7th Cir. 2021).

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Related legal case

Stewart v. Wexford Health Sources, Inc.