George Walker v. Wexford Health Sources, Inc., 940 F.3d 954

Background

Plaintiff George Walker, a Stateville inmate with progressive neurologic disease (later diagnosed as primary lateral sclerosis), underwent lumbar fusion at UIC on March 23, 2011; UIC issued a global approval for surgery and follow-up.
The scheduled three‑month post‑op neurosurgery follow‑up did not occur; from 2011–2014 Wexford’s UM system had no reliable alert for expired off‑site authorizations.
Walker received intermittent on‑site care at Stateville from Wexford clinicians including Dr. Saleh Obaisi (first saw Walker Sept. 26, 2012); Dr. Obaisi ordered tests and sought UM approval for neurology referral in Dec. 2012; UIC neurology appointment occurred April 24, 2013.
Over 2013–2016 Walker had multiple off‑site evaluations and imaging; UIC identified hardware issues and ultimately performed revision/extension fusion March 30, 2016; UIC clinicians diagnosed Walker with PLS while he was treated after the second surgery.
Walker sued Dr. Obaisi and Wexford under 42 U.S.C. § 1983, alleging deliberate indifference: (1) Obaisi failed to secure timely post‑op follow‑up/referrals; (2) Wexford maintained policies/practices (including failing to track expired authorizations) that caused delays.
The district court granted summary judgment for defendants; the Seventh Circuit affirmed on the merits, holding no genuine issue of deliberate indifference by Obaisi or municipal‑level liability for Wexford.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Dr. Obaisi was deliberately indifferent to Walker’s serious medical needs	Obaisi delayed/refused timely referrals to UIC and ignored delays, causing diagnostic/treatment delay	Obaisi reasonably ordered tests, treated symptoms, lacked control over UIC scheduling, and did not cause the delays	No deliberate indifference; summary judgment for Obaisi
Whether Wexford is liable under Monell for policies/practices that caused the delay	Wexford failed to implement procedures to ensure authorized off‑site care occurred and deferred scheduling to UIC, constituting a policy of inaction	Wexford lacked control over UIC schedule; occasional missed referrals ≠ knowledge of a widespread constitutional risk	No municipal liability; summary judgment for Wexford
Whether Walker proved causation/verifying medical evidence that delays worsened his condition	Delays in follow‑up caused deterioration and foreclosed alternative treatment options	Medical record and expert testimony do not establish that earlier follow‑up would have prevented deterioration; causation speculative	Plaintiff failed to show the required causal link or non‑speculative verifying medical evidence
Whether Walker exhausted administrative remedies under PLRA	Walker argued exhaustion was not dispositive here	District court found failure to exhaust; appellate court held merits disposition obviated need to resolve exhaustion	Seventh Circuit did not decide exhaustion because it affirmed on the merits

Key Cases Cited

Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment prohibits deliberate indifference to prisoners’ serious medical needs)
Farmer v. Brennan, 511 U.S. 825 (1994) (subjective knowledge standard for constitutional risk)
Monell v. Department of Social Services, 436 U.S. 658 (1978) (municipal liability requires a policy or custom causing the violation)
Whiting v. Wexford Health Sources, Inc., 839 F.3d 658 (7th Cir. 2016) (distinguishing negligence from deliberate indifference in prison medical care)
Glisson v. Indiana Dep’t of Correction, 849 F.3d 372 (7th Cir. 2017) (a policy of inaction can ground Monell liability in prison context)
Petties v. Carter, 836 F.3d 722 (7th Cir. 2016) (subjective deliberate indifference standard explained)
Jackson v. Pollion, 733 F.3d 786 (7th Cir. 2013) (delay‑of‑care claims require verifying medical evidence that delay caused harm)
Pepper v. Village of Oak Park, 430 F.3d 805 (7th Cir. 2005) (individual liability under § 1983 requires personal causation or participation)