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Seventh Circuit Says Lack of Expert Testimony Dooms Illinois Prisoner’s Medical Neglect Claim

by Douglas Ankney

The U.S. Court of Appeals for the Seventh Circuit offered an Illinois state prisoner a hard lesson on July 27, 2023, affirming dismissal of his medical neglect claim against prison contractor Wexford Health Sources, Inc., for lack of evidence that expert testimony could have provided.

While playing soccer at Pinckneyville Correctional Center (PCC) in June 2017, Mario Arce was kneed in the thigh. Eventually sent to a hospital, he was given a “strike test” by an orthopedic specialist to check for compartment syndrome, “a serious medical condition that occurs when there is increased pressure in a compartment of the body that results in insufficient blood supply to tissue,” the Court later recalled. Emergency surgery is required to relieve the pressure, which can otherwise “result in tissue death (necrosis) and permanent muscle damage.”

While the results of the strike test were not in the record, Arce contended that the orthopedic specialist said he “needed to be re-tested in two days to determine if he needed surgery.” But the treating physician’s notes indicated only that the orthopedist concluded Arce had a “right thigh contusion”—a bruise—and was “clear for discharge,” with instructions to follow up within two days with an Affinia Healthcare doctor.

Back at PCC, Arce submitted a request for the follow-up. But Wexford’s “collegial review” process determined that his medical record indicated “no fracture” and “no evidence of compartment syndrome,” so he needed only less costly on-site follow-up care.

Meanwhile Arce continued to experience severe pain. The following week an ultrasound indicated he had a blood clot in his injured thigh. As the Court recalled, Arce’s treatment “consisted mainly of regular physical therapy, medications to treat the blood clot, occasional follow-up visits at the healthcare unit, and monitoring to ensure that no new clot had developed.” For pain, he was prescribed over-the-counter pain relievers, though he twice got the low-level narcotic Ultram. Eventually, the blood clot dissolved, but Arce asserted he had “never regained his full range of motion in his right leg and that his pain continues.”

He filed suit pro se in federal court for the Southern District of Illinois in July 2018, alleging his Eighth Amendment rights were violated when Wexford (1) failed to rule out or treat compartment syndrome and denied him a follow-up with an orthopedic specialist; (2) delayed his follow-up appointment for 10 days from his hospital visit; (3) refused him stronger pain medication; and (4) used its “collegial review” policy to deny needed medical treatment simply to save on costs. The district court appointed him counsel from attorneys Matthew S. Darrough of Thompson Coburn LLP in St. Louis and John B. Julian of Gori Law Firm, P.C. in Edwardsville. It then granted summary judgment for Defendants, concluding that Arce had not offered any evidence to convince a jury of his arguments. Arce appealed.

The Seventh Circuit began by observing that Arce’s injury and blood clot were “serious medical needs,” so deliberate indifference to them was proscribed by the Eighth Amendment in Estelle v. Gamble, 429 U.S. 97 (1976). The question, as framed in Stockton v. Milwaukee County, 44 F.4th 605 (7th Cir. 2022), was “whether Arce has presented enough evidence to permit a trier of fact to conclude that the defendants were deliberately indifferent in treating these conditions and that their allegedly inadequate care caused him harm.”

While “[p]roving deliberate indifference can be difficult where a medical professional has provided at least some treatment,” the Court said, if treatment represented a “substantial departure from accepted professional judgment, practice, or standards”—as laid out in Johnson v. Rimmer, 936 F.3d 695 (7th Cir. 2019)—or if an unjustifiable delay “exacerbated the inmate’s injury or unnecessarily prolonged his pain,” as held in Perez v. Fenoglio, 792 F.3d 768 (7th Cir. 2015), then deliberate indifference can be shown.

Arce’s claim failed, though, because he presented no evidence for a jury to conclude that he ever had compartment syndrome. Nor that a 10-day wait for follow-up care was unreasonable for a bruised thigh. The pain relief provided to him was also not inadequate, since Defendants altered his medications as his pain increased.

Finally, there was no evidence that Wexford’s collegial review process caused Arce to suffer harm—though, as with every other failure of his case, this could possibly have been overcome by expert testimony. Except that Arce presented none. Accordingly, the district court’s judgment was affirmed. See:Arce v. Wexford Health Sources Inc., 75 F.4th 673 (7th Cir. 2023).   

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Related legal case

Arce v. Wexford Health Sources Inc.