75 F.4th 673
7th Cir.2023Background
- June 18, 2017: Inmate Mario Arce was kneed in the right thigh during soccer and sent from Pinckneyville to a local ER, then transferred to Saint Louis University Hospital for possible compartment syndrome.
- Orthopedic notes are sparse; hospital discharge listed a right thigh contusion and recommended a follow-up in two days (Affinia) or one week with primary care; Arce says ortho told him to re-test in two days but no such note appears in the record.
- At Pinckneyville, Nurse Practitioner Bob Blum requested the two-day outside follow-up, but Wexford’s collegial-review process denied the offsite referral as unnecessary, concluding there was no compartment syndrome.
- July 7, 2017 ultrasound diagnosed a blood clot (DVT); Arce was treated with anticoagulants, monitored, given physical therapy, and prescribed various pain medications over the next year as symptoms persisted.
- Arce sued Wexford, Nurse Practitioner Blum, and Dr. Alberto Butalid under the Eighth Amendment for deliberate indifference (failure to diagnose/treat compartment syndrome, delay in follow-up, inadequate pain management, and Wexford policies motivating cost-based denials). The district court granted summary judgment for defendants; the Seventh Circuit affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Failure to diagnose/treat compartment syndrome | Arce: defendants ignored orthopedist’s alleged suggestion to re-test and thus failed to diagnose/treat compartment syndrome causing lasting injury | Defendants: no objective evidence of compartment syndrome; hospital and treating doctors concluded contusion and no necrosis | No evidence Arce had compartment syndrome; summary judgment for defendants |
| Unreasonable delay in follow-up care | Arce: denial of a two-day follow-up and ten-day wait caused harm | Defendants: collegial review constrained offsite referrals; timing within professional judgment; no proof delay caused additional harm | Ten-day delay not shown to be unreasonable or to have caused harm; summary judgment for defendants |
| Inadequate pain treatment | Arce: defendants refused stronger/more effective analgesics, prolonging suffering | Defendants: they repeatedly adjusted meds (OTC and prescription including narcotics and neuropathic agents); exercised medical judgment | Records show active treatment and med adjustments; no evidence of deliberate indifference |
| Monell claim against Wexford (policies) | Arce: collegial review/utilization policies caused denial of needed care for cost reasons | Wexford: even if policy creates risk, Arce cannot show he was harmed by it here | No proof that Wexford’s policies caused harm to Arce; Monell claim fails |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment prohibits deliberate indifference to serious medical needs)
- Monell v. Department of Social Services, 436 U.S. 658 (municipal/enterprise liability for unconstitutional policies)
- Pyles v. Fahim, 771 F.3d 403 (deliberate indifference requires more than negligence)
- Petties v. Carter, 836 F.3d 722 (providing some care does not automatically defeat an Eighth Amendment claim)
- Johnson v. Rimmer, 936 F.3d 695 (substantial departure from accepted professional judgment can show deliberate indifference)
- Perez v. Fenoglio, 792 F.3d 768 (unjustified delay that exacerbates injury can violate the Eighth Amendment)
- Williams v. Liefer, 491 F.3d 710 (plaintiff must show delay caused harm)
- Arnett v. Webster, 658 F.3d 742 (Eighth Amendment requires reasonable measures to alleviate known inmate pain)
- Gabb v. Wexford Health Sources, Inc., 945 F.3d 1027 (affirming summary judgment for Wexford where plaintiff could not show harm from prison medical care)
- Zaya v. Sood, 836 F.3d 800 (delay in medical care can amount to Eighth Amendment violation but requires proof of unreasonableness or harm)