Steele v. Obaisi et al
Filing
53
MEMORANDUM Opinion and Order: The Court denies both: (1) Mills and Pfister's motion to dismiss 28 ; and (2) Wexford's motion to dismiss 31 . Signed by the Honorable Thomas M. Durkin on 5/25/2018:Mailed notice(srn, )
UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
RONALD STEELE,
Plaintiff,
v.
WEXFORD HEALTH SOURCES, INC., et al.,
Defendants.
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No. 17 C 6630
Judge Thomas M. Durkin
MEMORANDUM OPINION & ORDER
Plaintiff Ronald Steele has sued defendants Ghaliah Obaisi (as independent
executor of the estate of Dr. Saleh Obaisi (“Obaisi”)), Randy Pfister, and Don Mills
in their individual capacities, along with Wexford Health Sources, Inc. (“Wexford”),
in a single count complaint for deliberate indifference to Steele’s medical needs.
Currently before the Court are two motions to dismiss: (1) defendants Mills and
Pfister’s motion (R. 28); and (2) defendant Wexford’s motion (R. 31). For the reasons
explained below, the Court denies both motions.
STANDARD
The complaint must provide “a short plain statement of the claim showing
that the pleader is entitled to relief.” Fed. Civ. P. 8(a)(2). Through this statement,
defendants must be provided with “fair notice” of the claim and the basis for it. Bell
Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). This means the complaint must
“contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is
plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly,
550 U.S. at 570). “‘A claim has facial plausibility when the plaintiff pleads factual
content that allows the court to draw the reasonable inference that the defendant is
liable for the misconduct alleged.’” Mann, 707 F.3d at 877 (quoting Iqbal, 556 U.S.
at 678). In applying this standard, the Court accepts all well-pleaded facts as true
and draws all reasonable inferences in favor of the non-moving party. Mann, 707
F.3d at 877.
BACKGROUND
Since at least early 2014, Steele has experienced a spinal condition resulting
in severe and chronic pain in his neck, numbness in his shoulders, arms, and hands,
and a limited range of cervical motion. R. 21 ¶ 15. As a result, Steele has been
unable to sleep through the night or engage in fitness activities. Id. ¶ 16.
At some point in 2014, while housed at Stateville Correctional Center in the
custody of the Illinois Department of Corrections (“IDOC”), Steele began seeking
treatment for his spinal condition from the Stateville medical unit. Id. ¶ 17.
Initially, policies set by Wexford and IDOC resulted in Steele being treated by
registered nurses instead of a licensed physician. Id. ¶¶ 18-19. The registered
nurses prescribed Steele only over-the-counter pain medication, which did not
improve his condition, and they did not refer Steele to a licensed physician. Id.
¶¶ 20-21. Steele tried to seek follow-up treatment from a licensed physician, but
was denied treatment numerous times due to inadequate staffing. Id. ¶ 22.
In April 2015, Steele received authorization to see a licensed physician, and
now-deceased defendant Obaisi—then-medical director at Stateville and an
2
employee of Wexford—began to treat Steele. Id. ¶¶ 23, 44-45. From April 2015
through 2016, Obaisi prescribed Steele over-the-counter pain medication, including
aspirin and naproxen, which did not alleviate Steele’s pain. Id. ¶¶ 24-25.
In late April or early May 2016, Obaisi and Wexford authorized an x-ray,
which Steele received on May 2, 2016. Id. ¶¶ 26-27. Based on the x-ray results,
Stateville medical staff recommended that Steele obtain an MRI from an outside
specialist. Id. ¶ 28. But Obaisi and Wexford did not authorize Steele to see an
outside specialist until early 2017. Id. ¶ 29.
In February 2017, Steele began to see outside specialists at the University of
Illinois-Chicago Medical Center (“UIC”). Id. ¶ 30. An MRI of Steele’s cervical spine
conducted at UIC on March 27, 2017 revealed that Steele suffered from
“degenerative and severe spinal canal stenosis at the C3-C6 vertebrae, with
mylemalacia
at
C3-C4
and
C4-C5
with
multilevel
moderate-to-severe
neuroforaminal narrowing.” Id. ¶¶ 31-32. The MRI also revealed cord signal
changes. Id. ¶ 32.
As a result of the MRI, Steele’s physicians at UIC recommended that he
undergo an Anterior Cervical Discectomy and Fusion surgical procedure at the C3C6 vertebrae. Id. ¶ 34. Steele’s physicians at UIC transmitted an order to Obaisi
and Wexford instructing that Steele should not take aspirin or naproxen for at least
one week prior to his scheduled surgery on May 30, 2017 because of risks of severe
bleeding. Id. ¶¶ 35-36. But Obaisi and Wexford did not communicate this to Steele.
Id. ¶ 37. Because Steele continued to take aspirin and naproxen up to the scheduled
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surgery date, his surgery was cancelled. Id. ¶ 38. Obaisi, Mills, and Wexford did not
provide the necessary approvals to reschedule Steele’s surgery until several months
later. Id. ¶ 39.
On April 3, 2017, Steele approached Pfister, the warden at Stateville, and
complained about his medical condition and Obaisi’s failure to appropriately treat
it. Id. ¶ 63. Steele reiterated those complaints to Pfister on June 3, 2017. Id. ¶ 64.
Pfister responded that he would discuss the issues with Obaisi and help Steele get
appropriate treatment, but Steele believes those discussions never took place. Id.
¶¶ 65-66. Steele followed up with a letter to Pfister on July 1, 2017, to which Pfister
never responded. Id. ¶ 67.
On April 17, 2017, Steele informed Mills, the healthcare administrator at
Stateville, of Obaisi’s failure to provide him with appropriate medical treatment,
and reiterated his complaints on June 1, 2017, July 11, 2017, and September 20,
2017. Id. ¶¶ 58, 60. In Steele’s July 11, 2017 letter to Mills, Steele documented his
efforts to obtain medical treatment and Obaisi’s failure to provide it. Id. ¶ 60. Mills
allegedly dismissed or ignored all of Steele’s complaints and instructed Steele to
discuss his complaints with Obaisi. Id. ¶ 59. Steele informed Mills that Obaisi had
instructed him to discuss the complaints with Mills. Id. Mills then said he would
talk to Obaisi, but Steele believes those discussions never occurred. Id.
Steele filed written grievances with Stateville on June 28, 2016, January 5,
2017, March 2, 2017, and April 14, 2017 about his pain, inappropriate treatment,
and delayed treatment. Id. ¶ 42. All of these grievances were denied. Id.
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Steele filed this lawsuit on September 14, 2017. R. 1. At the time the original
complaint was filed, Steele still had not undergone surgery. See R. 21 ¶ 40. This
Court conducted a Section 1915 merit review and appointed counsel for Steele on
October 10, 2017. R. 5.
Steele finally underwent surgery on November 3, 2017. R. 21 ¶ 40. During
this time, Steele was not timely prescribed a lower bunk permit, double mattress, or
cervical pillow as requested to alleviate his pain. Id. ¶ 41.
Steele’s counsel filed an amended complaint on Steele’s behalf on January 25,
2018. R. 21. That single-count amended complaint alleges deliberate indifference to
Steele’s serious medical needs by all defendants in violation of the Eighth
Amendment, and seeks injunctive relief (ordering defendants to provide a cervical
pillow and a bottom bunk permit) as well as compensatory and punitive damages
pursuant to 42 U.S.C. § 1983. Id. ¶¶ 93-104.
With respect to Wexford in particular, the amended complaint alleges that
Steele’s denial of “access to adequate medical care was caused, at least in part, by
Wexford’s policy or practice of delaying or refusing necessary medical care as a
means of reducing costs.” Id. ¶ 100. Steele alleges that Wexford “has an economic
incentive to provide minimal medical care to inmates” because of its flat payment
contract with Illinois. Id. ¶¶ 68-69. Steele points specifically to Wexford’s alleged
policy or practice of requiring first the Stateville medical director and then a
Pittsburgh-based physician to approve or reject a recommendation before an inmate
can be referred for offsite medical services, which can result in significant delays.
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Id. ¶¶ 82-84. Steele further points to Wexford’s practice of preferring UIC to other,
more local offsite providers, which also can result in significant delays. Id. ¶¶ 85-86.
Steele alleges that as a direct result of Wexford’s policies or practices, Steele
endured many months of unnecessary and unreasonable pain and suffering. Id.
¶¶ 90-92.
In further support of his policy and practice allegations against Wexford,
Steele cites two reports. Both reports are attached to Steele’s amended complaint
and therefore properly considered on a motion to dismiss. E.g., Amin Ijbara Equity
Corp. v. Vill. of Oak Lawn, 860 F.3d 489, 493 (7th Cir. 2017) (“When ruling on a
motion to dismiss, the court may consider documents . . .
attached to the
complaint.”). First, Steele cites Dr. Ronald Shansky’s expert report in Lippert v.
Ghosh, No. 10-cv-4603, Dkt. 339 (May 19, 2015), which criticizes Wexford and
concludes that there is a “major problem with access to care” at Stateville. Id. ¶¶
72-76 & Ex. A. The report finds in particular that inadequate staffing results in
substantial delays in treatment. Id. ¶¶ 76-77.
Second, Steele cites a 2013 report regarding the John Howard Association of
Illinois’ monitoring visits to Stateville (“JHA Report”). Id. ¶ 78 & Ex. B. The JHA
report concludes that medical staff at Stateville “are discouraged by Wexford
administrators from ordering certain medications and supplies due to cost.” Id.
¶ 79. The JHA report also finds that the approval rate for offsite medical services
“varies dramatically based on which Pittsburgh-based physician [designated to
approve referrals] happens to be receiving the phone call.” Id. ¶ 83. And even when
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offsite medical services are authorized by the Pittsburgh-based physicians,
Wexford’s staff routinely takes up to eight weeks to transmit authorization to
Wexford’s preferred offsite provider. Id. ¶ 84. Finally, Steele cites five examples of
recent lawsuits against Wexford alleging that Wexford’s cost-saving policies and
practices prevented the plaintiffs from receiving timely medical treatment. Id. ¶ 87
(collecting cases).
Mills and Pfister together, and Wexford separately, have moved to dismiss
Steele’s amended complaint. R. 28; R. 31. Ghaliah Obaisi, who the Court
substituted for Dr. Saleh Obaisi upon suggestion of Dr. Saleh Obaisi’s death (R. 51),
has answered the amended complaint (R. 52).
ANALYSIS
I.
Mills and Pfister’s Motion
Mills and Pfister first argue that Steele has not stated a claim for deliberate
indifference. They further dispute Steele’s entitlement to certain remedies he seeks.
A.
Adequacy of Pleading Deliberate Indifference
“Prison officials violate the Eighth Amendment’s proscription against cruel
and unusual punishment when they display deliberate indifference to serious
medical needs of prisoners.” Hayes v. Snyder, 546 F.3d 516, 522 (7th Cir. 2008). To
state a claim for deliberate indifference based on failure to provide adequate
medical treatment, a plaintiff must allege facts sufficient to show that he suffered
from “(1) an objectively serious medical condition to which (2) a state official was
deliberately, that is subjectively, indifferent.” Whiting v. Wexford Health Sources,
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Inc., 839 F.3d 658, 662 (7th Cir. 2016). Prison officials may show deliberate
indifference to a serious medical condition through inaction, Gayton v. McCoy, 593
F.3d 610, 623-25 (7th Cir. 2010), or by delaying necessary treatment and thus
aggravating an injury or needlessly prolonging an inmate’s pain, Gomez v. Randle,
680 F.3d 859, 865-66 (7th Cir. 2012).
Mills and Pfister maintain that Steele has not pleaded sufficient facts to
establish either prong of his deliberate indifference claim. But with respect to the
first prong, this Court already has determined in its initial screening of Steele’s
original complaint that Steele “sufficiently identified at least one serious medical
condition that require[d] surgical intervention that [was] inexplicably delayed for
months,” satisfying the first prong of deliberate indifference. R. 5 at 3-4. Steele’s
amended complaint reinforces this Court’s initial conclusion by providing further
detail about his spinal condition and diagnosis.
Mills and Pfister argue that Steele must plausibly allege that his condition
worsened because of the delay and therefore constituted an objectively serious
medical condition satisfying the first prong, citing Knight v. Wiseman, 590 F.3d 458
(7th Cir. 2009), Jackson v. Pollion, 733 F.3d 786 (7th Cir. 2013), and Conley v.
Birch, 796 F.3d 742 (7th Cir. 2015). But these are all summary judgment cases.
They stand for the proposition that at the summary judgment stage, a plaintiff
must “introduce[ ] verifying medical evidence that shows his condition worsened
because of the delay”—i.e., that “the delay . . . caused some degree of harm.” Knight,
590 F.3d at 466 (granting summary judgment where “at most two and a half hours
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passed between the injury . . . and the treatment”); see also Jackson, 733 F.3d at
788-90 (no injury where three-week interruption in receiving blood pressure
medication resulted in only slightly elevated blood pressure); Conley, 796 F.3d at
749 (to survive summary judgment, “the plaintiff must offer verifying medical
evidence that the delay (rather than the inmate’s underlying condition) caused some
degree of harm”). As the Seventh Circuit made clear in Conley, whether a delay in
treatment caused harm is a fact issue not properly resolved on a motion to dismiss.
See 796 F.3d at 749 (reversing grant of summary judgment on deliberate
indifference claim predicated on delay in treatment and explaining that “causation
is normally a matter for the jury”); see also Grieveson v. Anderson, 538 F.3d 763,
779 (7th Cir. 2008) (even at the summary judgment stage, the “verifying medical
evidence” required “to establish the detrimental effect of delay” and therefore “the
seriousness of [plaintiff’s] medical condition” need not be expert testimony; finding a
genuine issue of material fact based on medical records “indicating that [plaintiff]
had a nasal fracture . . . and that he may need to see a specialist”).
At the motion to dismiss stage, the Seventh Circuit has found allegations like
Steele’s of prolonged and unnecessary pain due to a delay in treatment sufficient to
plead a detrimental effect. See, e.g., Gomez, 680 F.3d at 865-66 (plausible deliberate
indifference claim based on four day delay in treating wound that resulted in
“prolonged, unnecessary pain”). Moreover, and in any event, Steele does allege that
his condition was “degenerative,” R. 21 ¶ 32, which plausibly supports an inference
that his condition worsened as a result of defendants’ actions.
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Mills and Pfister further argue that Steele has failed to plausibly allege that
Mills and Pfister knew of and disregarded an excessive risk to Steele’s health for
purposes of the second, subjective prong of his deliberate indifference claim. As this
Court explained in its initial screening order, a prison official who is made aware of
specific conditions posing a serious risk to inmate safety through grievances or
other inmate communications may be subject to personal liability for deliberate
indifference if he or she fails to act reasonably to address that risk. E.g., Gray v.
Hardy, 826 F.3d 1000, 1008 (7th Cir. 2016) (“[plaintiff’s] grievances,” to which
warden signed response, “demonstrate[d] the prison and warden’s knowledge of the
conditions about which [plaintiff] [wa]s complaining”); Perez v. Fenoglio, 792 F.3d
768, 776 (7th Cir. 2015) (“[A] prison official’s knowledge of prison conditions learned
from an inmate’s communications can, under some circumstances, constitute
sufficient knowledge of the conditions to require the officer to exercise his or her
authority to take the needed action to investigate, and, if necessary, to rectify the
offending condition. . . . In other words, prisoner requests for relief that fall on ‘deaf
ears’ may evidence deliberate indifference.”).
This Court already found in its initial screening that Steele “has sufficiently
alleged that he notified Don Mills and Randy Pfister of his unresolved serious
symptoms, both in writing and in person, but they did not act reasonably to ensure
that he received appropriate treatment.” R. 5 at 4. Mills and Pfister nevertheless
argue that Steele’s even more detailed allegations in his amended complaint are
insufficient. Mills and Pfister emphasize that they were at most aware of a five-
10
month delay (between June 2017, when Mills and Pfister learned that Steele’s
initial surgery had to be rescheduled, and the November 2017 surgery). Mills and
Pfister argue that within that window, Steele has made only “unsupported,
conclusory statements” that Mills and Pfister “did not assist with his medical care,”
which at most “amounts to mere negligence.” R. 28 at 4-5.
This argument mischaracterizes the amended complaint. In fact, the
amended complaint alleges the specific dates and contents of Steele’s multiple
complaints to Mills and Pfister about his medical condition and inadequate
treatment, along with their alleged inadequate responses. With respect to Mills, the
amended complaint alleges that Steele sought Mills’s assistance directly on several
occasions between April 2017 and September 2017, including writing him a letter
on July 11, 2017 requesting assistance to reschedule Steele’s surgery as soon as
possible, and that Mills ignored those requests. R. 21 ¶¶ 58-60. The amended
complaint further alleges that for months, Mills (along with Obaisi and Wexford)
failed to provide the necessary approvals to reschedule Steele’s surgery, and that as
a result, Steele endured more than five months of unnecessary pain and suffering.
Id. ¶ 39. Similarly with respect to Pfister, the amended complaint alleges that
Steele complained in person to Pfister about his pain on multiple occasions between
April and June 2017, that Pfister told Steele he would address his concerns and did
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not, and that Pfister ignored a letter Steele wrote on July 1, 2017 asking for help
ordering the medical staff to reschedule his surgery. Id. ¶¶ 63-67.1
These are far more than the unsupported, conclusory statements that Mills
and Pfister make them out to be. The amended complaint’s allegations support a
claim for deliberate indifference by Mills and Pfister in their individual capacities.
See, e.g., Perez, 792 F.3d at 776 (plaintiff stated deliberate indifference claim
against non-medical prison official where “complaint allege[d] that the named
defendants each obtained actual knowledge of [plaintiff’s] objectively serious
medical condition and inadequate medical care through [plaintiff’s] coherent and
highly detailed grievances and other correspondences,” and “that each of these
officials failed to exercise his or her authority to intervene”); Delaney v. DeTella, 256
F.3d 679, 686 (7th Cir. 2001) (“[Plaintiff] alleges that he repeatedly complained to
each of the named defendants, filed a grievance, and requested medical attention
frequently. . . . [Plaintiff] claims the defendants did nothing. This inaction satisfies
the subjective element of an Eighth Amendment claim.”).2
These allegations are corroborated by Steele’s four grievances and his July
2017 letters to Mills and Pfister, which are attached to Steele’s original complaint
(R. 1 at 17-28) and therefore properly considered on this motion to dismiss. See, e.g.,
Sorrentino v. Wexford Health Sources, Inc., 2017 WL 4682735, at *2 n.1 (N.D. Ill.
Oct. 18, 2017).
2
Pfister also argues that he, “in his official capacity as warden, was entitled to
delegate to the prison’s medical staff the provision of good medical care, especially
in light of the fact that there is no dispute that [Steele] was under the continuing
care of medical professionals.” R. 28 at 5. But Steele has not sued Pfister in his
official capacity. See R. 21 ¶ 6 (“Defendant Pfister is sued in his individual
capacity.”). And in any event, as this Court recently explained in the course of
finding that a plaintiff stated a deliberate indifference claim against warden Pfister,
“if the plaintiff can ‘demonstrate that [a] communication, in its content and manner
1
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B.
Remedies Sought
Mills and Pfister also make several arguments to try to cabin the relief Steele
may obtain from them. These requests for relief are not separate claims, but parts
of claims. And the Court does not have power to dismiss parts of claims on a Rule
12(b)(6) motion to dismiss. BBL, Inc. v. City of Angola, 809 F.3d 317, 325 (7th Cir.
2015) (“A motion to dismiss under Rule 12(b)(6) doesn’t permit piecemeal dismissals
of parts of claims; the question at this stage is simply whether the complaint
includes factual allegations that state a plausible claim for relief.”). The Court
nevertheless addresses Mills and Pfister’s arguments in order to clarify the
available remedies going forward.
Mills and Pfister first say that because Steele does not allege that the delay
in treatment exacerbated any physical injury, Steele cannot obtain compensatory
damages for his pain and suffering. They note that “absent a showing of physical
injury, [42 U.S.C. §] 1997e(e)” of the Prison Litigation Reform Act (“PLRA”) “bar[s] a
prisoner’s recovery of compensatory damages for mental and emotional injury.”
Calhoun v. DeTella, 319 F.3d 936, 940 (7th Cir. 2003).
of transmission, gave the prison official sufficient notice to alert him or her to an
excessive risk to inmate health or safety,’ then the plaintiff has plausibly alleged a
deliberate indifference claim.” Sorrentino, 2017 WL 4682735, at *2 (quoting Arnett
v. Webster, 658 F.3d 742, 755 (7th Cir. 2011)).
Here, Steele’s letter to Pfister attached to his original complaint (R. 1 at 19)
makes detailed requests regarding rescheduling his surgery and refers to previous
communications with Pfister. R. 1 at 19. As in Sorrentino, this letter, coupled with
the amended complaint allegations, is sufficient to state a deliberate indifference
claim against warden Pfister. See 2017 WL 4682735, at *2-3 (grievance records
supported plaintiff’s deliberate indifference claim against warden Pfister).
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This principle is well-established, but Steele rightly points out that it does
not apply to the facts as alleged. The amended complaint plausibly describes a
physical injury resulting from defendants’ deliberate indifference, including
prolongation of a degenerative spinal condition that ultimately required surgery. R.
21 ¶¶ 15-16, 21, 25, 38-39, 42, 58-60, 63-67. This is not a case alleging “solely . . .
mental or emotional injury.” Compare Perkins v. Pfister, 711 F. App’x 335, 337 (7th
Cir. 2017) (“Perkins could not be entitled to compensatory damages. He has not
alleged any physical injury, and he cannot recover solely for mental or emotional
injury under the [PLRA].”). At least at this stage, therefore, the Court does not find
that the allegations preclude Steele from seeking compensatory damages.
Next, Mills and Pfister correctly explain that Steele may not recover
injunctive relief from them. Injunctive relief may be obtained against public officials
in their official capacities only. Hill v. Shelander, 924 F.2d 1370, 1374 (7th Cir.
1991) (“[I]njunctive relief against a state official may be recovered only in an official
capacity suit.”). Steele has sued Mills and Pfister in their individual capacities.
In response, Steele concedes this principle, and further acknowledges that his
requested injunctive relief of a bottom bunk permit and a cervical pillow is partially
moot because defendants have provided Steele with a bottom bunk permit. R. 42 at
13. But because defendants have not yet provided Steele with a cervical pillow,
Steele requests that the Court grant him leave to name Mills and Pfister in their
official capacities. The Court grants Steele’s request to amend with respect to Mills.
The Court does not grant Steele’s request with respect to Pfister, however, because
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he is no longer warden of Stateville and in a position to enforce equitable relief. See
R. 48 at 3.
II.
Wexford
Steele’s claim against Wexford “is evaluated under the standard of Monell.”
See, e.g., Taylor v. Wexford Health Servs., Inc., 2012 WL 245165, at *4 (N.D. Ill. Jan.
26, 2012). “To hold [Wexford] liable under § 1983 and Monell, [Steele] must
demonstrate that [Wexford’s] official policy, widespread custom, or action by an
official with policy-making authority was the moving force behind his constitutional
injury.” Daniel v. Cook Cty., 833 F.3d 728, 734 (7th Cir. 2016). “To prove an official
policy, custom, or practice within the meaning of Monell, [Steele] must show more
than the deficiencies specific to his own experience”; he must show “systemic and
gross deficiencies in staffing, facilities, equipment, or procedures in a detention
center’s medical care system.” Id. at 734-35.
This Court previously dismissed Wexford from this case without prejudice
because Steele’s original complaint failed to allege that Wexford’s alleged policy of
“limits on referrals to outside providers to cut costs . . . had anything to do with the
care [Steele] challenges.” R. 5 at 4-5. The Court noted that Steele in his initial
complaint “seem[ed] to allege that the longest delay in his care was internal—as he
awaited an appointment with Dr. Obaisi.” Id. at 5. In his amended complaint,
however, Steele makes 24 paragraphs worth of detailed factual allegations
concerning Wexford’s alleged cost-cutting policy or practice and its impact on
15
Steele’s challenges specifically and other inmates’ experiences at Stateville. R. 21
¶¶ 68-92.
In support of its motion to dismiss, Wexford cites several recent cases in this
district dismissing Monell claims against Wexford, including Taylor v. Wexford
Health Sources, Inc., 2016 WL 3227310, at *4 (N.D. Ill. June 13, 2016), Peacock v.
Rigsby, 2016 WL 1383232, at *3 (N.D. Ill. Apr. 7, 2016), and Young v. Obaisi, 2015
WL 8013437, at *3 (N.D. Ill. Dec. 7, 2015). In each of those cases, however, the
plaintiffs’ allegations were vague and broad; they did not tie the plaintiff’s injury to
any specific Wexford policy or practice. See Taylor, 2016 WL 3227310, at *4
(dismissing Monell claim against Wexford where “allegations of Wexford’s policies
and practices [we]re vague and broad,” without “additional facts to allow the Court
to infer that these policies impacted the care Taylor received”); Peacock, 2016 WL
1383232, at *3 (dismissing Monell claim against Wexford where the plaintiff’s
“factual allegations d[id] not plausibly allege how a cost-cutting policy could
possibly have caused his infection,” and in particular “fail[ed] to allege that the cost
of bandages and antibiotics is a significant percentage of Wexford’s budget such
that a cost-cutting policy would have entailed restricting provision of bandages and
antibiotics”); Young, 2015 WL 8013437, at *3 (dismissing Monell claim against
Wexford where plaintiff did not allege any “policy or practice of Wexford’s that led to
or exacerbated [plaintiff’s] injuries”).
By contrast, as this Court explained in Peacock, numerous courts in this
district have denied motions to dismiss Monell claims against Wexford where “the
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plaintiff alleged deprivation of more expensive treatment (such as denying or
delaying referrals to specialists outside the prison)” based on Wexford’s alleged costcutting policy, “or included additional facts that made the plaintiffs’ claims
plausible.” See Peacock, 2016 WL 1383232, at *3 (citing Harper v. Wexford Health
Sources, 2016 WL 1056661, at *1-3 (N.D. Ill. Mar. 17, 2016) [(Harper I)] (plaintiff
stated Monell claim based on Wexford’s policy of “cost-cutting,” including through
allegations that “when [the plaintiff] received a recommended course of treatment
from physicians in the gastrointestinal unit at the [UIC] Hospital, Wexford, Obaisi
and Stolworthy failed to review the recommendations”); Shaw v. Obaisi, 2015 WL
638521, at *4 (N.D. Ill. Feb. 12, 2015) (plaintiff stated Monell claim against Wexford
based on Wexford’s alleged policies of “refusing or delaying medical treatment
and/or collegial review prescribed by offsite medical professionals such as doctors at
UIC”); Watkins v. Ghosh, 2011 WL 5981006, at *8 (N.D. Ill. Nov. 28, 2011) (plaintiff
stated Monell claim against Wexford based on cost-cutting and understaffing
policies based on allegations that “Wexford lacks a procedure for the treatment of
degenerative disk disease,” that “Wexford further lacks medical personnel
competent to treat these conditions,” and that “[r]ather than referring patients who
suffer from these maladies to outside specialists, Wexford simply denies them
treatment in an effort to cut costs”); Brown v. Ghosh, 2010 WL 3893939, at *9 (N.D.
Ill. Sept. 28, 2010) (plaintiff stated Monell claim based on allegations that “Wexford
Health pressures medical care providers to deny medical care” due to “budget
constraints”); McDonald v. Wexford Health Sources, 2010 WL 3034529, at *3 (N.D.
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Ill. July 30, 2010) (plaintiff stated Monell claim based on allegations that Wexford’s
cost-cutting policy resulted in, among other things, “a decreased number of medical
technicians in the cell houses at Stateville, which resulted in having to wait weeks
and sometimes months to receive medical care”)).
This case is much closer to cases like Harper I, Shaw, Watkins, Brown, and
McDonald than Peacock, Taylor, or Young. Steele alleges a specific Wexford costcutting policy or practice, which he claims resulted in inadequate staffing within the
Stateville medical unit and a cumbersome process for outside specialist referral. See
Baker v. Wexford Health Sources, Inc., 2014 WL 1346613, at *5 (N.D. Ill. Apr. 4,
2014) (plaintiff satisfied Monell requirements based on allegations that “Wexford
has a policy of denying or delaying requests for referrals to outside specialists”).
And Steele’s allegations directly connect the dots between this policy or practice and
Steele’s injury: he alleges significant delays in his referral to an outside specialist as
a direct result of Wexford’s cost-cutting policy related to internal staffing and
outside referrals. See, e.g., Harper v. Wexford Health Sources Inc., 2017 WL
2672299, at *3 (N.D. Ill. June 21, 2017) (Harper II) (distinguishing Peacock and
Taylor and finding that plaintiff stated claim by “alleg[ing] a specific [Wexford]
policy: cost-cutting,” and relating that policy to “his particular, detailed facts”).
Moreover, unlike in Peacock, the link between the alleged cost-cutting policy or
practice and Steele’s injury is plausible because the treatments Steele needed were
“expensive”—i.e., referral to an outside specialist and spine surgery. Compare
Peacock, 2016 WL 1383232, at *3 (treatment needed was bandages and antibiotics).
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Steele further supports his policy or practice allegations by referencing the
Lippert and JHA reports, as well as five examples of recent suits against Wexford
alleging that Wexford’s cost-cutting policy or practice prevented inmates from
receiving timely medical treatment. These allegations satisfy Steele’s obligation to
plausibly plead “systemic and gross deficiencies in staffing, facilities, equipment, or
procedures in a detention center’s medical care system.” Daniel, 833 F.3d at 734;
see, e.g., Harper I, 2016 WL 1056661, at *3 (complaint’s “reference to the experience
of other inmates suggests that the injury he suffered was not an isolated incident he
endured,” supporting a policy or practice claim against Wexford); Haywood v.
Wexford Health Sources, 2017 WL 3168996, at *4 (N.D. Ill. July 26, 2017) (plaintiff
stated policy or practice claim against Wexford where “plaintiff ha[d] not merely
alleged isolated instances of mistreatment,” but instead “included specific factual
allegations regarding multiple Wexford employees’ repeated and consistent
indifference to his and other inmates’ medical needs”).
Wexford points out that the Lippert and JHA reports evaluated conditions at
Stateville prior to Steele’s alleged injuries in this case, and that the Lippert report
identifies deficiencies as being the ultimate responsibility of IDOC, not Wexford.
But this is not the appropriate stage of this case for the Court to review the nuances
of these reports or make factual findings regarding them. For now, it is enough that
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they lend further plausibility to the cost-cutting policy and practice allegations in
Steele’s viable Monell claim against Wexford.3
CONCLUSION
For the foregoing reasons, the Court denies both: (1) Mills and Pfister’s
motion to dismiss (R. 28); and (2) Wexford’s motion to dismiss (R. 31).
ENTERED:
Honorable Thomas M. Durkin
United States District Judge
Dated: May 25, 2018
Wexford also argues that Steele’s amended complaint fails to state a
respondeat superior liability claim against Wexford. As Steele clarifies in his
response, however, he had no intent to state such a claim. Indeed, the amended
complaint never mentions a respondeat superior theory. See R. 21. The Court
therefore declines to address this argument.
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