Pyles v. Fahim, 14–1752.
| Decision Date | 13 November 2014 |
| Docket Number | No. 14–1752.,14–1752. |
| Citation | 771 F.3d 403 |
| Parties | Christopher PYLES, Plaintiff–Appellant, v. Magid FAHIM, Doctor, Medical Director, Menard CC, et al., Defendants–Appellees. |
| Court | U.S. Court of Appeals — Seventh Circuit |
Christopher Pyles, Menard Correctional Center, Menard, IL, for Plaintiff–Appellant.
Timothy Patrick Dugan, Attorney, Sandberg Phoenix & Von Gontard P.C., St. Louis, MO, for Defendants–Appellees.
Before WOOD, Chief Judge, and EASTERBROOK and RIPPLE, Circuit Judges.
Christopher Pyles, an Illinois prisoner, injured his back when he slipped on wet stairs at Menard Correctional Center. Mr. Pyles sometimes used those stairs when showering, and a month before his fall he had alerted the warden, Donald Gaetz, that this stairway can be treacherous because of the water tracked from the nearby showers. Mr. Pyles contends, in this action under 42 U.S.C. § 1983, that Warden Gaetz was deliberately indifferent to the hazard, and that Wexford Health Sources (“Wexford”), which provides contract medical care to Menard inmates, and a Wexford physician, Magid Fahim, were deliberately indifferent to his back injury. Mr. Pyles alleged that, after initially being treated for his fall, he suffered ongoing, significant pain, yet Dr. Fahim refused to investigate its cause.
At screening, see 28 U.S.C. § 1915A, the district court dismissed Mr. Pyles's claim against the warden. A magistrate judge (presiding by consent) later granted summary judgment for Wexford and Dr. Fahim on the medical claim. On appeal, Mr. Pyles challenges the adverse rulings on both of his Eighth Amendment claims.
Although we do not fully agree with the district court's analysis, we conclude that the court correctly reasoned that the slipping hazard about which Mr. Pyles complained was not sufficiently dangerous to support an Eighth Amendment claim. We also agree with the district court that, from the evidence submitted at summary judgment, a finder of fact could not reasonably conclude that Mr. Pyles's medical claim rests on more than a disagreement with Dr. Fahim about the appropriate course of treatment. We therefore affirm the judgment of the district court.
In late June 2009, Mr. Pyles addressed and sent to Warden Gaetz an emergency grievance in which he complained that the stairs that he and others in the cell block use to access the “six gallery” showers become dangerously slick from water tracked by the inmates' shower shoes.1 This footwear was required, but the inmates had no means of drying the soles before accessing the stairs, and the stairs themselves lacked measures to reduce the slipping hazard caused by accumulated water. In his grievance, Mr. Pyles recounted his own difficulties with safely traversing the stairs and requested that additional precautions be taken to address the issue.2 As far as the record shows, no one replied to Mr. Pyles's grievance.
Then, on July 25, 2009, roughly five weeks after he submitted his emergency grievance, Mr. Pyles fell on the wet stairs while returning from the “six gallery” showers.3 He struck his head on a step and then injured his lower back as he tumbled down the stairs. He lost consciousness and was temporarily paralyzed from the waist down. He first was taken to a local hospital. CT scans did not reveal spinal damage, but a radiologist recommended an MRI “[i]f there remains a clinical concern for injury.”4 An MRI, the radiologist explained, “is more sensitive in evaluating the soft tissues.”5 Before the day ended, Mr. Pyles was airlifted from the local hospital to a hospital in St. Louis, Missouri. During his stay at that facility, doctors obtained MRI views of Mr. Pyles's head, neck, and spine. His treating physicians also ordered additional CT scans. The attending radiologists reported that none of these diagnostic procedures showed abnormal results.6 The doctors in St. Louis diagnosed Mr. Pyles with a spinal contusion. Mr. Pyles was seen by both a physical therapist and an occupational therapist in St. Louis. After observing Mr. Pyles's unsteady gait and lingering mobility problems, each prescribed some therapy to improve Mr. Pyles's functional mobility.
Mr. Pyles returned to Menard after five days in St. Louis. He remained in the prison infirmary for another four days, where he was seen daily by staff. Afterward, he was released to the general population, but continued to complain about extreme pain in his lower back. Doctors examined him six times in the next two months. Each time, the treating physician concluded that only a painkiller, usually nonprescription ibuprofen, was warranted.7 Two back X-rays revealed “[p]ost [t]raumatic [a]rthritic changes” in Mr. Pyles's spine, but no fracture or other abnormality.8
In late September 2009, two months after Mr. Pyles's injury, Dr. Fahim joined Wexford as the medical director at Menard. When Dr. Fahim first examined Mr. Pyles in January 2010, he wrote in the medical file that he had not detected any abnormality. He substituted, nevertheless, a muscle relaxer and a prescription painkiller for the nonprescription ibuprofen that Mr. Pyles previously had been receiving. Dr. Fahim also instructed Mr. Pyles on the “proper exercise [and] stretching of [b]ack mus[c]les” that could alleviate his back pain.9 Mr. Pyles informed the Doctor that his back pain had been worsening and requested another MRI, but Dr. Fahim said he did not see the need.
Dr. Fahim examined Mr. Pyles twice more, in May and October 2010. Both times he wrote in the medical notes that Mr. Pyles reported low back pain but that the examination revealed no problems. During the May visit, however, Dr. Fahim increased the dosages of Mr. Pyles's medications, and then in October he prescribed a corticosteroid, an anticonvulsant, and a drug commonly used in treating osteoarthritis.
During the period that Dr. Fahim was treating him, Mr. Pyles also was being seen by other medical personnel at Menard. None reported a need for additional medical care. A new X-ray was taken in May of that year, but it showed only “minimal” or “mild” degenerative changes to Mr. Pyles's spine.10
Dr. Fahim did not examine Mr. Pyles again after October 2010, and in August 2011 he left Wexford's employ. During this period Mr. Pyles continued seeing other physicians and medical staff nearly once per month. On one occasion Dr. Fahim did review Mr. Pyles's medical file after another physician forwarded a request from Mr. Pyles for an MRI. Dr. Fahim again refused to order the test, explaining that no physician at Menard had recommended an MRI after examining Mr. Pyles.
Near the time of Dr. Fahim's resignation, however, Mr. Pyles's family physician provided a letter stating that, if she were treating Mr. Pyles, she would have ordered an MRI and “referred him to a specialist if needed.”11 It is unclear from this correspondence, however, whether Mr. Pyles's personal physician knew that he had been hospitalized after his fall. Nevertheless, notes written in Mr. Pyles's file by doctors who succeeded Dr. Fahim as medical director endorse Dr. Fahim's view that another MRI was unnecessary.
Mr. Pyles maintained, in grievances to prison officials and in his declaration to the district court, that Dr. Fahim had refused to record the true nature and substance of his complaints. Mr. Pyles maintained that he has suffered constant, excruciating pain in his lower back, radiating into his legs; this pain, he said, was more intense when he was sitting or reclining and caused numbness when he stood. He did not experience pain in his neck or thoracic region, but the pain in his lower back had grown increasingly worse since his return from the St. Louis hospital. He did not contest, however, that Dr. Fahim had changed the medication that he prescribed to treat the back pain or that Dr. Fahim and other medical staff regularly had instructed him about stretching exercises that could help alleviate his back pain. Mr. Pyles also acknowledged that physical activity partly relieved his pain.
Mr. Pyles further testified at his deposition that Dr. Fahim had once said that a new treatment (a cortisone shot) might be attempted and that a visit to a specialist might be warranted. These plans were scrapped, however, after Mr. Pyles visited with another doctor. Mr. Pyles contended that an appointment with the specialist never was scheduled for the same reason that he never received an additional MRI: Wexford has a policy of limiting the medical care it provides in order to cut costs, and the company effectuates this policy by rewarding employees who successfully control costs.
Mr. Pyles bases this belief on conversations that he had with unnamed medical staff at the jail, who told him that a visit to a specialist or an MRI would not happen “because it costs too much money.”12 Because of this alleged policy, Mr. Pyles seeks to hold Wexford responsible for what he characterizes as deliberate indifference to his back pain.
Dr. Fahim, for his part, maintains that he never received incentives to cut costs by providing less expensive treatment, and an affidavit submitted by a Wexford manager further attests that the company does not offer rewards or bonuses to physicians who minimize costs by withholding necessary medical care.
Mr. Pyles brought this action in May 2011, nearly two years after his injury and before Dr. Fahim's departure. In addition to claiming that Warden Gaetz had been deliberately indifferent to the risk of injury from the slippery stairs, Mr. Pyles alleged that Dr. Fahim and Wexford deliberately had ignored his back pain. Mr. Pyles alleges that, instead of addressing the underlying cause of his pain, Dr. Fahim merely continued to prescribe ineffective drugs, while ignoring Mr. Pyles's complaints of continuous and worsening back pain. The need for “a change in treatment,” Mr. Pyles alleged, “would have been obvious” to a layman, and the failure to change course renders the treatment ...
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