Walker v. Wexford Health Sources, Inc.
| Decision Date | 15 October 2019 |
| Docket Number | No. 17-2821,17-2821 |
| Citation | 940 F.3d 954 |
| Parties | George WALKER, Plaintiff-Appellant, v. WEXFORD HEALTH SOURCES, INC., et al., Defendants-Appellees. |
| Court | U.S. Court of Appeals — Seventh Circuit |
David T. Raimer, Attorney, Jones Day, Washington, DC, for Plaintiff-Appellant.
Julie Ann Teuscher, James Frederick Maruna, Attorneys, Cassiday Schade LLP, Chicago, IL, for Defendants-Appellees.
Before Flaum, Sykes, and St. Eve, Circuit Judges.
George Walker is an inmate at Stateville Correctional Center. He has an incurable motor neuron disease called primary lateral sclerosis ("PLS") that causes weakness in his voluntary muscles. Walker alleges that his healthcare providers at Stateville—Wexford Health Sources and Dr. Saleh Obaisi—were deliberately indifferent to his medical needs after he underwent spinal surgery in March 2011.1 Specifically, Walker alleges defendants failed to: (1) ensure he received proper follow-up care after his surgery, and (2) allowed undue delays in his treatment by outside experts. Defendants’ failures, he asserts, delayed his diagnosis and caused him to suffer from the undiagnosed PLS in the interim. Defendants successfully moved for summary judgment on all of Walker’s claims. We affirm.
During the relevant period, the State of Illinois subcontracted with Wexford Health Sources to provide healthcare services to inmates at all the facilities managed by the Illinois Department of Corrections ("IDOC"). Saleh Obaisi, M.D., was a Wexford employee who served as Stateville’s Medical Director from August 2012 until his death in December 2017.
Stateville’s onsite healthcare facilities included an urgent care center, various medical clinics, and an infirmary. The physicians, nurse practitioners, and physician’s assistants at Stateville were Wexford employees; the nurses and other medical personnel were a mix of Wexford and IDOC employees. All the medical providers at Stateville, whether employed by Wexford or not, followed IDOC’s administrative policies and procedures. Nonetheless, Wexford’s corporate representative testified that when deciding how to provide the best care for patients, clinicians relied on their training and experience first, and the governing policies second.
When the medical professionals and facilities at Stateville could not address an inmate’s conditions, Wexford referred such inmates to outside providers like the University of Illinois at Chicago Medical Center ("UIC"). Typically, referrals had to go through a collegial peer review process, which Wexford called "Utilization Management" ("UM"). In the event of a medical emergency, however, Stateville’s Medical Director could make referrals to another hospital, St. Joseph’s Medical Center, without securing UM’s preapproval.
In practice, UM consisted of a weekly conference call in which medical professionals reviewed an inmate’s case and the suggested treatment. Participants in the call included: Wexford’s UM Director for Illinois, Wexford’s Corporate UM nurse, Wexford physicians, Wexford staff, and IDOC’s healthcare unit administrator. If the onsite Medical Director was ever dissatisfied with the alternative treatment plan UM authorized for a patient, the director could appeal that decision.
If UM approved a patient for an offsite consultation at UIC, the UM department would enter the information into Wexford’s computer program ("WexCare"), which triggered an electronic notice to the prison and UIC. Then, the staff at IDOC and UIC would coordinate to schedule the inmate’s appointment. With respect to surgery referrals, UM often issued a "global approval," which authorized both the surgery and any necessary follow-up care. Whenever UIC received a global approval, it would call Stateville directly to arrange the follow-up care for the inmate.
UM’s authorizations were valid for ninety days. From 2011 to 2014, however, Wexford did not have a system in place to alert its staff when an authorization expired before the inmate had received treatment.2
On March 1, 2010, a Wexford physician’s assistant examined Walker, noting that he had right leg twitching and reports of weakness. Over the course of the next year, Walker underwent several examinations with specialists and other medical professionals. These appointments culminated in a recommendation by a UIC neurosurgeon, Dr. Sergey Neckrysh, that Walker have spinal surgery to decompress and fuse the lumbar spine. UM gave a global approval for the surgery and follow-up care.
Walker had spinal surgery at UIC on March 23, 2011. He remained at UIC for three days following his surgery. When he returned to Stateville, the infirmary admitted him; his discharge note from UIC called for a follow-up appointment with Dr. Neckrysh in three months, including a CT scan of the lumbar spine. Walker testified that three UIC nurses told him they would see him in six to eight weeks for a follow-up CT scan. The follow-up appointment never occurred. It was the first of many delays that prompted Walker to bring this lawsuit. As Walker testified, "it’s been all down hill ever since the surgery." Walker also testified, however, that none of his treating doctors have ever told him that his condition would have improved if he had been sent back to UIC within three months of his March 2011 surgery.
The medical records tell a more complicated story. During Walker’s first three days at the infirmary, five treatment notes recorded that his surgical incision was healing well. When the infirmary staff removed Walker’s staples on April 7, 2011, they cleaned the incision site and did not record any signs or symptoms of redness or infection. Later that day, the infirmary discharged Walker, reporting his minimal discomfort and giving him permits for low bunk, low gallery, and special medical restraints.
Approximately four weeks after the surgery, Walker received a physical therapy examination at Stateville. The therapist stated that Walker explained that his pain had resolved, and that the surgical scar was well-healed with minor adhesion (excessive growth of scar tissue). Between May 26, 2011, and August 31, 2012, the record shows that Walker saw Stateville medical providers on eight different occasions and that he informed them of the improvement to his back following the surgery. Walker also completed two eight-week courses of physical therapy with an onsite provider at Stateville. He then did sixteen months of physical therapy in his cell. During Walker’s deposition, defendants’ lawyer asked: "Did your condition improve at all through the physical therapy?" Walker responded: The timing and nature of this irritation, however, is unclear from Walker’s testimony.
Dr. Obaisi first examined Walker on September 26, 2012, almost exactly eighteen months after Walker’s surgery. He documented that Walker complained of an unsteady gait, weakness in his legs, upper thigh pain, and bilateral foot drop. Dr. Obaisi’s appointment note also stated that he suspected that Walker might have upper motor neuron syndrome. As a result, Dr. Obaisi ordered x-rays and provided Walker with muscle relaxers and anti-inflammatory medication. Once Dr. Obaisi received the results from one of the blood tests and learned that Walker’s levels were elevated, Dr. Obaisi sought UM’s approval for a neurology consultation at UIC. Wexford approved the referral on December 2, 2012, but UIC did not schedule a neurology appointment until April 24, 2013.
At his deposition, Dr. Obaisi testified that his focus during this initial visit was Walker’s condition; he did not "really pay attention" to whether Walker had seen UIC neurosurgery for his post-surgery visit. Nonetheless, when Walker’s attorney specifically asked Dr. Obaisi why he did not send Walker back to UIC neurosurgery for the follow-up, Dr. Obaisi explained he wanted to see the results from some tests before presenting Walker’s case to UM—this way, Dr. Obaisi could support his concern regarding upper motor neuron syndrome. He also testified that he did not have control over UIC’s scheduling, that specialists generally prioritize scheduling by the urgency of cases, and that Dr. Neckrysh does not call people "very easily."
Walker continued to receive treatment from Dr. Obaisi and several other medical professionals. A summary of this later treatment appears below in chronological order.
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