Mercer v. APS Healthcare, Inc., 9:13-cv-00840

Background

Pro se plaintiff James R. Mercer, Jr., a DOCCS inmate, sued APS Healthcare (a private contractor), two APS reviewers (Winkler, Strenio), and two DOCCS Regional Medical Directors (Misa, Amatucci) under 42 U.S.C. § 1983 for Eighth Amendment deliberate indifference arising from repeated denials of orthopedic referrals for chronic shoulder pain.
APS had a state contract to perform utilization review of specialty-care referrals for DOCCS, using nurse reviewers and medical directors who applied Milliman guidelines; DOCCS regional medical directors made final decisions on denied referrals.
Between October 2009 and August 2011 multiple orthopedic referrals were denied or deferred in favor of conservative care (physiatry, injections, physical therapy); plaintiff later underwent rotator-cuff surgery in 2013 and was told he may need a shoulder replacement.
Procedurally, plaintiff moved for summary judgment; APS and State defendants cross‑moved. The magistrate judge addressed summary judgment standards, state-action, statute of limitations/continuing violation, personal involvement, and the Eighth Amendment deliberate‑indifference test.
Court found APS’s contractual role with DOCCS created sufficient state action for § 1983, but concluded the record did not show the requisite subjective deliberate indifference by APS reviewers or by the DOCCS regional directors; Winkler was dismissed for lack of proven personal involvement.
Recommendation: deny plaintiff’s summary judgment motion and grant defendants’ cross‑motions for summary judgment; all denials were characterized as permissible non‑negligent medical judgment or, at worst, negligence (insufficient for § 1983).

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
State action: whether APS’s review is "state action" for § 1983	APS’s denials caused deprivation of constitutional rights; APS performed a state function	APS claimed it gave preliminary determinations and DOCCS had final authority	Held: APS’s contractual role with DOCCS transforming its review into state action (state actor)
Timeliness / continuing violation: whether early denials (2009–2010) are time‑barred	Mercer invoked continuing violation to include earlier denials with later ones within limitations period	Defendants argued some claims fall outside 3‑yr statute of limitations	Held: Continuing violation doctrine applies; all related denial claims considered because similar conduct continued into the limitations period
Personal involvement: whether Winkler can be held liable	Mercer identified Winkler by initials on denials	Winkler denied being shown to have personally made the denials; plaintiff provided no reliable method for identification	Held: Plaintiff failed to show Winkler’s personal involvement; Winkler recommended for dismissal
Eighth Amendment deliberate indifference: whether denials amounted to constitutionally inadequate care	Mercer: repeated denials and delays of orthopedic care caused harm and amounted to deliberate indifference	Defendants: decisions reflected medical judgment favoring conservative treatment; at worst negligence, not deliberate indifference	Held: Denials reflected reasonable non‑invasive treatment decisions and did not meet the subjective recklessness standard; summary judgment for defendants recommended

Key Cases Cited

Celotex Corp. v. Catrett, 477 U.S. 317 (summary judgment burden rules)
West v. Atkins, 487 U.S. 42 (private physicians under contract can be state actors)
Farmer v. Brennan, 511 U.S. 825 (deliberate indifference standard)
Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment medical care claim)
Shomo v. City of New York, 579 F.3d 176 (continuing violation doctrine for medical indifference claims)
Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (summary judgment standard on sufficiency of evidence)
Ashcroft v. Iqbal, 556 U.S. 662 (requirement of individual conduct for § 1983 liability)
Chance v. Armstrong, 143 F.3d 698 (serious medical need and culpable mental state analysis)