by Mark Wilson
On September 19, 2022, the U.S. Court of Appeals for the Seventh Circuit reversed a lower court’s grant of summary judgment to Illinois prison officials accused of violating a state prisoner’s civil rights with a 29-month surgery delay.
Richard White injured his left knee while playing basketball at Shawnee Correctional Center in June 2015. He was taken by wheelchair to the infirmary to be seen by medical personnel contracted by the state Department of Corrections from private provider Wexford Health Sources, Inc. But Nurse Practitioner (NP) Blake Woods refused to examine White because he did not have an appointment. So White was given crutches and sent away.
Four days later Woods saw White for knee pain and scheduled a follow-up appointment on July 10, 2015. Woods’ treatment notes do not indicate whether he performed a complete physical exam of White’s knee. But before the follow-up, he saw White again on July 3, 2015, after the prisoner’s knee “popped” and he could not extend or bend his leg. Woods prescribed a steroid, an anti-inflammatory and a leg wrap. He also ordered an x-ray for the first time.
The x-ray revealed osteoarthritis and fluid in the knee joint, but no fractures or dislocations. Woods later admitted that “the only objective way to diagnose” a tear in the meniscus or anterior cruciate ligament (ACL) would be with an MRI. But he did not order one, claiming that it “wasn’t time to do one yet.” White later offered uncontroverted expert testimony, however, that such injuries must be treated within two to six weeks.
During the appointment on July 10, 2015, Woods noted that White’s knee was “still swollen,” but he did nothing to rule out an ACL or meniscus tear. One month later, Woods again noted that White complained of left knee pain and that the knee had moderate swelling and mild warmth. Woods finally referred White to Dr. Alfonso David on August 10, 2015, because he knew Woods likely needed “something more,” such as a “specialty referral or an MRI.”
Dr. David saw White for the first time on August 13, 2015, seven weeks after the prisoner first sought treatment. David noted that White’s knee was tender and could not be fully extended. But instead of an MRI, he ordered a second x-ray and diagnosed White with a left knee ligament strain. The x-ray again revealed excessive fluid around the knee.
Ten weeks after White’s injury and four weeks after their first appointment, Dr. David finally requested that Wexford’s collegial review board approve an MRI referral on September 8, 2015. Wexford’s collegial review policy requires corporate office pre-approval for offsite care; its collegial review board is a group of doctors who review and approve such requests.
Based on that review, Wexford denied White an MRI and recommended that he undergo physical therapy instead. White continued to complain of pain as he participated in physical therapy for the next two months, until November 30, 2015.
White still complained of severe knee pain on January 28, 2016. The next day Woods again saw him for “unresolved ACL issues.” Dr. David then diagnosed White with an ACL sprain on March 14, 2016.
Between July 2016 and November 2017, White continued to complain of knee pain, of snapping in the joint and an inability to straighten his leg. Dr. David did not submit a second request for an MRI until November 16, 2017. This time, Wexford’s collegial review board approved the request.
White finally received the MRI nearly two and a half years after the injury – one year and 11 months after Woods first noted an “unresolved ACL issue.” The MRI revealed meniscus and ACL tears which were then surgically repaired. Yet following surgery, White has continued to have knee problems.
White brought suit pro se in federal court for the Southern District of Illinois against Wexford, Woods and David. Proceeding under 42 U.S.C. § 1983, he alleged that they were deliberately indifferent to his serious medical needs, in violation of his Eighth Amendment guarantee of freedom from cruel and unusual punishment.
The case was assigned to a magistrate, and White picked up counsel from Chicago attorneys Joel and Kenneth Flaxman. They convinced the district court to reopen discovery, but they were not successful in getting permission to amend his complaint.
The district court then dismissed the claims against Wexford and granted summary judgment to both Woods and David. But in doing so, it ignored White’s unrebutted expert testimony that an ACL injury must be addressed within six weeks.
The Seventh Circuit reversed that decision, finding that “a jury could ... reasonably conclude that Nurse Woods and Dr. David’s continued conservative treatment was ineffective and delayed White from receiving adequate medical care to address his knee injury within the window that would save White a lifetime of recurring knee problems.”
The Court also said a jury could find Woods’ “decisions not to perform a complete examination ... and not to refer White to Dr. David, for an MRI or anything else, for nearly seven weeks were deliberately indifferent.” As to Dr. David, the court found that “a jury could conclude that he unreasonably delayed necessary treatment for White’s knee injury” for more than two years and that the decision “was not the product of medical judgment.” See: White v. Woods, 48 F .4th 853 (7th Cir. 2022).
The case then returned to the district court, where the parties proceeded to reach an undocketed settlement on April 6, 2023. PLN has requested a copy and will report the terms if and when it is received. See: White v. Wexford Health Sources, Inc., USDC (S.D. Ill.), Case No. 3:18-cv-00165.
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