William Dean v. Wexford Health Sources, Inc.
18 F.4th 214
| 7th Cir. | 2021Background
- William Dean, an Illinois prisoner, first reported gross hematuria in December 2015; after serial on-site and off-site reviews and imaging, renal cell carcinoma was diagnosed by CT on April 12, 2016; surgery occurred July 19, 2016 and metastatic disease to liver was later confirmed.
- Dean sued Wexford Health Sources and two treating physicians (Dr. Nawoor and Dr. Einwohner) under 42 U.S.C. § 1983 (Eighth Amendment deliberate indifference) and state malpractice/negligence; trial jury awarded $1M compensatory and punitive awards (later reduced by the district court).
- Central trial evidence included excerpts from two Lippert court‑appointed expert reports (2014 and 2018) criticizing Wexford’s collegial‑review process for off‑site care; the district court admitted the excerpts for the non‑hearsay purpose of showing Wexford’s notice, with a limiting instruction.
- The 2018 Lippert report postdated the events here; the 2014 report reviewed other IDOC facilities (not Taylorville) and recommended procedural fixes (e.g., expedited handling of urgent cases).
- On appeal the Seventh Circuit held that the 2018 report was irrelevant and inadmissible for notice, and that—even assuming admissibility of the 2014 report—Dean failed to prove Monell deliberate indifference or that collegial review was the moving force; the court therefore reversed the Eighth Amendment verdicts and directed judgment as a matter of law for all defendants on those claims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of Lippert reports (hearsay/notice/403) | Lippert reports admissible for non‑hearsay purpose: to show Wexford had notice of systemic collegial‑review delays. | Reports are hearsay, prejudicial, and (2018) irrelevant because issued after events; 2014 report not tied to Taylorville practices. | 2018 report inadmissible (irrelevant). Court assumed arguendo admissibility of 2014 report but found it insufficient for Monell; trial admission posed serious Rule 403 concerns. |
| Monell liability for Wexford based on collegial review policy | Lippert reports (and other testimony) show Wexford knew collegial review caused delays and consciously disregarded the risk, making the policy the moving force. | No pattern of similar constitutional violations tied to Taylorville; collegial review had urgent/emergency exceptions (2016) and problems shown were facility‑specific; single incident insufficient for Monell. | Reversed: Dean failed to prove municipal deliberate indifference or moving‑force causation; a single applied instance plus the 2014 report was insufficient. |
| Eighth Amendment claim against Dr. Nawoor (ordering ultrasound vs CT) | Nawoor knew standard of care (urology referral and CT) but chose ultrasound (cheaper/less effective), evidencing deliberate indifference. | Decision to use ultrasound reflected individualized medical judgment given history of kidney stones and renal function risks; at most negligence. | Judgment as a matter of law for Nawoor: evidence showed medical judgment, not the high bar of deliberate indifference. |
| Eighth Amendment claim against Dr. Einwohner (telemedicine nephrologist) | Einwohner recommended re‑imaging and urology but failed to follow up; this inaction contributed to delays. | She had no authority to order off‑site care or join collegial review; could only recommend—no causal power to change course. | Judgment as a matter of law for Einwohner: lack of causation and lack of authority to alter treatment meant no Eighth Amendment liability. |
Key Cases Cited
- Monell v. Dep't of Soc. Servs., 436 U.S. 658 (1978) (municipal liability under § 1983 requires an official policy or custom causing the constitutional violation)
- Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment obligates prisons to provide adequate medical care; deliberate indifference standard)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference requires subjective knowledge of and disregard for a substantial risk)
- City of Oklahoma City v. Tuttle, 471 U.S. 808 (1985) (single‑incident proof generally insufficient for municipal liability absent proof linking it to a policy or obvious risk)
- Bd. of Cnty. Comm’rs v. Brown, 520 U.S. 397 (1997) (pattern evidence supports municipal notice and deliberate indifference; causation/moving‑force analysis)
- Connick v. Thompson, 563 U.S. 51 (2011) (rare cases may impose municipal liability without prior pattern when risk is patently obvious)
- City of Canton v. Harris, 489 U.S. 378 (1989) (failure to train can be a municipal policy claim but requires proof of deliberate indifference to training needs)
- Daniel v. Cook Cnty., 833 F.3d 728 (7th Cir. 2016) (reports admitted for notice are useful but plaintiffs also need substantive evidence linking report findings to local practice to prove municipal liability)
- LaPorta v. City of Chicago, 988 F.3d 978 (7th Cir. 2021) (reciting Monell elements: deprivation of federal right, municipal policy or custom, deliberate indifference, and moving‑force causation)
- Glisson v. Ind. Dep’t of Corr., 849 F.3d 372 (7th Cir. 2017) (inaction can constitute municipal policy where it reflects a conscious decision not to act)
- Wilson v. Wexford Health Sources, Inc., 932 F.3d 513 (7th Cir. 2019) (Lippert reports are hearsay if offered for truth; notice use is non‑hearsay)
- Norfleet v. Webster, 439 F.3d 392 (7th Cir. 2006) (difference of medical opinion does not establish deliberate indifference)