Graening v. Wexford Health Sources, Inc., 1:20-cv-00400

Plaintiff, an incarcerated person, sued Wexford Health Sources under 42 U.S.C. § 1983 alleging deliberate indifference for delayed referral to an ENT for ear pain, ringing, vertigo, and hearing loss.
After dismissals of individual defendants, only Wexford remained; at the pleading stage the court allowed a Monell claim to proceed based largely on a statement by Nurse New that Wexford "was not approving any specialist appointments unless the inmate was dead or dying" and the alleged multi-month delay.
Discovery closed with plaintiff taking little to no formal discovery (no deposition of Nurse New or expert), relying on his complaint, his affidavit, a fellow inmate’s affidavit, and his deposition.
Wexford produced evidence: (1) Nurse New’s comment does not reflect a corporate policymaker decision; (2) WVDCR COVID-19 restrictions limited non-emergency outside appointments; and (3) an expert (Dr. Capito) opined there was no breach of the medical standard of care.
The court found plaintiff failed to present evidence creating a triable issue on (a) a Monell policy or custom causally connected to an Eighth Amendment violation, and (b) an underlying Eighth Amendment violation (plaintiff offered no expert rebuttal). Summary judgment for Wexford was granted.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Existence of a Wexford policy or custom (Monell)	Nurse New’s statement and delays show a de facto corporate practice of withholding referrals	New’s remark is isolated/hyperbolic and plaintiff produced no evidence tying refusals to Wexford policymakers	No triable issue; New’s comment and limited other evidence insufficient to show a policy or custom
Causation from policy to constitutional harm	Delays and grievance process showing refusal caused denial of care	Delays are isolated and not tied to Wexford policymaking; WVDCR COVID-19 restrictions explain outside-visit delays	No triable issue; plaintiff failed to connect alleged practice to a policymaker or to show it caused an Eighth Amendment violation
Underlying Eighth Amendment violation (deliberate indifference)	Failure/refusal to refer to ENT constituted deliberate indifference to serious medical need	Medical judgment was reasonable; expert evidence shows no breach of standard of care	No triable issue; unrebutted expert shows no standard-of-care violation, so no Eighth Amendment violation
Effect of COVID-19 / WVDCR policy on delay defense	Plaintiff disputes being told pandemic caused delay; says referral was denied	Wexford produced WVDCR policy limiting non-emergency outside appointments during pandemic	Court credited the COVID-19 policy as a non-Wexford reason for delay; plaintiff’s speculation insufficient to overcome it

Monell v. Dep’t of Soc. Servs., 436 U.S. 658 (1978) (municipal liability requires an unconstitutional policy or custom)
Estelle v. Gamble, 429 U.S. 97 (1976) (medical malpractice vs. Eighth Amendment deliberate indifference)
Celotex Corp. v. Catrett, 477 U.S. 317 (1986) (summary judgment burden and failure of proof)
Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986) (standard for assessing evidence at summary judgment)
Owens v. Baltimore City State’s Att’ys Off., 767 F.3d 379 (4th Cir. 2014) (pleading Monell claims)
Jordan by Jordan v. Jackson, 15 F.3d 333 (4th Cir. 1994) (Monell standards and summary judgment role)
Bd. of County Comm’rs v. Brown, 520 U.S. 397 (1997) (causation requirement for Monell liability)
Spell v. McDaniel, 824 F.2d 1380 (4th Cir. 1987) (Monell principles applied to private corporations)
Lytle v. Doyle, 326 F.3d 463 (4th Cir. 2003) (sources of municipal policy or custom)
Hixson v. Moran, 1 F.4th 297 (4th Cir. 2021) (alternative treatment does not automatically show deliberate indifference)
Miltier v. Beorn, 896 F.2d 848 (4th Cir. 1990) (deliberate indifference requires treatment so grossly incompetent as to permit inference of intent)