Adams v. Harrington
Filing
130
ORDER GRANTING 101 Motion for Summary Judgment and DENYING 120 Motion to Strike. Defendant Samuel Nwaobasi is DISMISSED with prejudice as a Defendant in this matter. This matter shall proceed on Count 1 alleging deliberate indifference as to Defendant Harrington and Count 2 alleging excessive force as to Defendant Stirnaman. Signed by Judge Nancy J. Rosenstengel on 1/24/17. (klh2)
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
BYRON E. ADAMS,
Plaintiff,
vs.
RICHARD HARRINGTON, SAMUEL
NWAOBASI, and BRADLEY J.
STIRNAMAN,
Defendants.
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Case No. 3:14-CV-366-NJR-DGW
MEMORANDUM AND ORDER
ROSENSTENGEL, District Judge:
Now pending before the Court is a Motion for Summary Judgment filed by
Defendant Samuel Nwaobasi on May 16, 2016 (Doc. 101) and a Motion to Strike Reply
filed by Plaintiff Byron E. Adams on October 21, 2016 (Doc. 120). For the reasons set forth
below, the Motion for Summary Judgment is granted, and the Motion to Strike is denied.
INTRODUCTION
This matter is proceeding on a second amended complaint filed by Plaintiff,
Byron Adams, on October 6, 2014 (Doc. 34). Adams is an inmate in the Illinois
Department of Corrections who was formerly incarcerated at Menard Correctional
Center in 2013 and 2014. He alleges that the floor of his cell at Menard was so hot that it
caused second degree burns on his feet. Adams is particularly susceptible to such burns
because he has diabetes and suffers from diabetic neuropathy in his feet. As a result of
the burns, Adams’s big toe was eventually amputated.
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Adams is proceeding on Count 1 for deliberate indifference to serious medical
needs against both Richard Harrington, the former warden at Menard, and Samuel
Nwaobasi, a physician at Menard. Adams alleges that Warden Harrington was both
aware of his medical condition and the condition of his cell but did nothing to alleviate
his health concerns or living conditions, and Dr. Nwaobasi was deliberately indifferent
to his medical condition. Adams also is proceeding on Count 2, a claim for excessive
force against Bradley Stirnaman, a correctional officer at Menard. Adams alleges that
C/O Stirnaman harassed, battered, and assaulted him while he was housed in the
healthcare unit.
Dr. Nwaobasi filed his motion for summary judgment as to Count 1 on May 16,
2016 (Doc. 101). 1 The motion was then stayed while Adams conducted expert discovery
(Doc. 106). Dr. Nwaobasi filed a supplementary memorandum on August 29, 2016
(Doc. 109). Adams filed a response in opposition to the motion for summary judgment
(Doc. 116), and Dr. Nwaobasi filed a reply (Doc. 117). Adams then filed a motion to
strike Dr. Nwaobasi’s reply brief (Doc. 120), to which Dr. Nwaobasi filed a response
(Doc. 121).
MOTION TO STRIKE AND EVIDENTIARY ARGUMENTS
Adams first objects pursuant to Federal Rule of Civil Procedure 56(c)(2) on the
basis that the evidentiary material attached to Defendant Nwaobasi’s motion is
inadmissible (Doc. 120). In particular, Adams argues that his medical records are
Defendant Harrington also seeks summary judgment on Count 1 (Doc. 110), but his motion will be
addressed in a separate order. Defendant Stirnaman did not file a summary judgment motion.
1
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inadmissible hearsay, because they have not been authenticated, and that Defendant’s
expert report issued by Dr. John S. Daniels is inadmissible because it also has not been
authenticated via an affidavit. Both the medical records and expert report can be readily
authenticated, however, and would be admissible at trial. Medical records are
exceptions to the hearsay rule, see Federal Rule of Evidence 803, and Adams has
presented no Daubert motion that would render Dr. Daniels’s expert opinions
inadmissible. Accordingly, the Motion to Strike (Doc. 120) is denied.
In deciding Dr. Nwaobasi’s motion for summary judgment, the Court will
consider Adams’s medical records, Dr. Daniels’s expert report, and Dr. Marla S.
Barkoff’s expert report (Plaintiff’s expert) and give due weight to each piece of evidence.
The Court also will consider Defendant Nwaobasi’s reply brief; while the document
itself is fifteen pages, the argument section is only five pages, and exceptional
circumstances exist for the filing of the reply.
MOTION FOR SUMMARY JUDGMENT
A. Factual Background
It is undisputed that Adams has suffered from diabetes mellitus since at least 2012
and from diabetic neuropathy. Diabetes is a “chronic metabolic disorder . . . caused by an
absolute or relative deficiency of insulin and is characterized, in more severe cases, by
chronic hyperglycemia, glycosuria, water and electrolyte loss, ketoacidosis, and coma.”
STEDMAN’S MEDICAL DICTIONARY 529 (28th ed. 2006). In layman’s terms, diabetes means
that one’s blood sugar is too high, causing various conditions including heart disease,
and relative to this case, lack of sensation in the extremities, i.e., diabetic neuropathy. Id.
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1313. This can in turn lead to various adverse consequences, including the amputation of
digits. It is common knowledge that diabetes is a disease that requires management.
Most persons who suffer from diabetes check their blood sugar levels regularly. They
also undergo A1C testing, which provides an average blood sugar level for multiple
months, 2 and take medication in the form of pills and/or insulin shots designed to
lower or counter the effects of elevated blood sugar. Diabetes also requires an
appropriate diet and exercise in order to avoid or minimize adverse consequences. (See
Doc. 116-2, p. 12; Doc. 109-3, p. 6). There is no cure for the disease; however, if
appropriate steps are taken, it can be managed successfully.
Adams was incarcerated at Menard from January 9, 2013, to June 11, 2014
(Doc. 111, p. 2). 3 During this time period, the medical records reveal that there were
numerous medical service providers who were involved in his care, including Dr.
Robert Shearing, Dr. Samuel Nwaobasi, Dr. John Trost, Dr. Fe Fuentes, and Nurse
Practitioner R. Pollion.
When Adams first arrived at Menard, Dr. Robert Shearing initially ordered
Glipiride and Metformin for his diabetes, but apparently did not believe that insulin was
required (Doc. 102-4, p. 1). Dr. Shearing also ordered weekly accuchecks of Adams’s
The A1C test is a blood test that provides information about a person’s average levels of blood sugar
over the past three months. National Institute of Diabetes and Digestive and Kidney Diseases, The A1C
Test & Diabetes,
https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c-test (last
visited Jan. 24, 2017). The A1C test is the primary test used for diabetes management and diabetes
research. Id. An A1C level below 5.7 is normal. Id. An A1C level of 6.5 or above is indicative of diabetes. Id.
Generally, it is recommended that individuals with diabetes maintain an A1C level of 7 or below. Id.
However, an A1C level between 7 and 8, or even higher in some circumstances, may be appropriate for
some individuals. Id.
3 He may have been transferred to Stateville Correctional Center for a short period of time from March 3,
2013, to April 17, 2013.
2
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blood sugars and ordered Adams to be added to the hypertension and diabetes clinics
(Id. 4, 10). 4 On January 11th, two days after arriving at Menard, Adams reported to a
medical technician that he was not getting his insulin (Id. at p. 2). The medical technician
asked for a physician to review his chart and order the insulin (Id.). The following day,
Dr. Nwaobasi conducted the chart review and ordered Adams to be seen in “combo
clinic for further assessment and [follow up]” (Doc. 102-4, p. 2; Doc. 116-2, p. 6). The
combo clinic occurred every two to three months and was for hypertension and diabetes
check-ups and care (Doc. 102-1).
On April 26, 2013, Adams was seen by Dr. Fe Fuentes for blisters on the balls of
his feet, possibly from “ill-fitting boots” (Doc. 102-4, p 3). Treatment was ordered for two
weeks (Id.). At that time, Adams’s A1C was noted to be 8.1 (Id. at p. 4). Dr. Fuentes
referred Adams to Dr. Nwaobasi for a follow-up appointment (Doc. 116-5, p. 21). Dr.
Nwaobasi spent most of his medical career as a general surgeon and trauma surgeon
(Doc. 102-1). While working at Menard, he did “a lot of small outpatient surgical
procedures” that could be done under local anesthesia (Id.). On May 17th, Dr. Nwaobasi
noted in the medical record that Adams had “bilateral feet ulcers secondary to diabetes
mellitus” that “need to be evaluated for further care” (Doc. 102-4, p. 5). The next day, Dr.
Accu-Chek is a particular brand of at-home blood sugar monitors. It appears to the Court that the brand
name Accu-Chek has been genericized as “accuchecks,” which is commonly used to refer to a blood sugar
measurement taken by pricking the finger to obtain a blood sample and then using a glucose meter to
measure the sample’s glucose level (much like the brand name Band-Aid is now used to refer to any
adhesive bandage). For individuals with diabetes, the recommended target blood sugar level is 80 to 130
right before a meal, and below 180 two hours after the start of the meal. National Institute of Diabetes and
Digestive and Kidney Diseases, Know Your Blood Sugar Numbers: Use Them to Manage Your Diabetes,
https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/know-blood-s
ugar-numbers (last visited Jan. 24, 2017).
4
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Nwaobasi saw Adams and debrided the wounds on his feet and changed the dressings
(Id. at p. 6). 5 He ordered dressing changes every other day and a follow-up “by MD in
one month for re-evaluation” (Id.). A few days later, Adams’s A1C was tested and
measured 8.4 (Doc. 109-10, p. 5). Adams was seen by Dr. Fuentes on July 1, 2013, and
while the record is mostly illegible, it indicates that his “foot ulcers healed” (Id. at p. 7).
By August 2013, Adams’s A1C was decreased to 7.0 (Doc. 109-10, p. 10). Adams refused
A1C testing in November 2013 (Doc. 102-4, p. 11).
In January 2014, Adams began having problems with his feet again. He was
admitted to the Health Care Unit on January 28th by Dr. Trost with second degree burns
and blisters on both of his feet (Doc. 102-4, p. 13). Adams notified prison staff that the
injuries were caused by the hot floors in his cell (Doc. 102-3, p. 4). Adams stayed in the
Health Care Unit for the next thirty-six days. On his second day there, Dr. Nwaobasi was
asked to see Adams (Doc. 102-4, p. 14). The doctor noted a history of diabetic
neuropathy, and debrided and dressed his wounds (Id. at p. 14). The next day, Dr.
Nwaobasi again debrided and dressed Adams’s wounds (Id. at p. 15). Over the next five
days, Adams’s wounds were evaluated twice by Dr. Trost and once by Dr. Fuentes (Id. at
pp. 16–18). Dr. Fuentes referred Adams to Dr. Nwaobasi to once again have his wounds
debrided on February 4th (Id. at p. 18). The wounds were then evaluated by Dr. Fuentes
on February 6th and by Dr. Trost on February 7th (Id. at pp. 20, 21). On February 8th,
Debridement consisted of opening the blister, removing the skin, washing the wound, applying an
antibiotic ointment, and wrapping the wound (Doc. 116-5, p. 28).
5
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Adams saw Dr. Nwaobasi, who noted that the wounds were “healing satisfactorily” (Id.
at p. 22).
Over the next ten days, Adams’s wounds were evaluated on three occasions by
Dr. Trost and on three occasions by Dr. Fuentes (Id. at pp. 23–28). On February 18th,
Adams saw Dr. Nwaobasi to have his wounds debrided for a fourth time (Id. at p. 29).
Dr. Nwaobasi noted that the wounds on both feet were “drying up,” and there was “no
evidence of [a] secondary infection” (Id.). Adams saw Dr. Nwaobasi again the next day
for a dressing change, and the doctor noted that the wounds on Adams’s left foot
“continue to show visible progress” and the “decubitus ulcers are healing well” (Id. at
pp. 29, 30).
Over the next five days, Adams’s wounds were evaluated twice by Dr. Trost and
once by Dr. Fuentes (Doc. 102-4, pp. 31–32; Doc. 102-5, p. 1). Then on February 26th,
Adams saw Dr. Nwaobasi, who noted that Adams’s burn wounds were “healing” (Doc.
102-5, p. 2). On Wednesday, March 5th, Dr. Nwaobasi noted that Adams was “stable and
able to ambulate on his feet,” and Adams was discharged from the Health Care Unit
with various permits, including slow walk, low bunk/gallery, medical lay-in, and food
in cell (Id. at pp. 3–4).
Within a few days, however, Adams again presented to the Health Care Unit with
“new blisters” on the heel of his right foot and the ball of his left foot (Doc. 102-5, p. 5).
Dr. Nwaobasi initiated the same treatment regimen—debridement and antiseptic
washes (Id.). Dr. Nwaobasi did not mention in the medical record that these new
wounds were the result of burns, however, this was noted by a nurse and later by Dr.
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Trost (see id. at pp. 5, 6, 9). On March 13th, Adams was admitted to the Health Care Unit
for a security hold (Id. at p. 6). Over the next week, he saw Dr. Trost on two occasions
before seeing Dr. Nwaobasi again on March 22nd (Id. at pp. 7, 9, 10). Dr. Nwaobasi
debrided the “diabetic ulcers” on both of Adams’s feet and changed his dressings (Id. at
p. 10).
On March 25, 2014, Dr. Fuentes noted Adams’s accucheck reading was high and
ordered an A1C test (Doc. 102-5, p. 11). However, Adams refused to have his blood
drawn (Doc. 102-12, p. 2). On April 2nd, Adams was presented with a memo in response
to his “concern regarding the burns to [his] feet and the healing process” (Doc. 102-7).
The memo instructed Adams that to assist with his healing he needed to limit
ambulation and control his blood sugar, including “minimizing the amount of
commissary foods that are high in carbohydrates and sugars [and] [comply] with finger
sticks and insulin administration” (Id.). That same day, Dr. Nwaobasi debrided the
ulcers on Adams’s left foot under local anesthesia (Doc. 102-5, p. 15). The following day,
Dr. Nwaobasi debrided the ulcers on Adams’s right foot (Id. at p. 17). Dr. Nwaobasi
noted that the right foot showed areas of necrosis and ischemic soft tissue (Id.). He
ordered the dressing on Adams’s feet to be changed every day; he did not prescribe any
new medications for Adams and instead stated “continue orders for control of
[hypertension] and [diabetes mellitus]” (Id. at pp. 15–17).
On April 4th, Dr. Trost saw Adams and noted that he was refusing to take
Metformin or insulin and refusing his accuchecks (Doc. 102-5, p. 18). Dr. Trost noted that
Adams’s diabetes was “poorly controlled,” and his A1C was 10.9 (Id.). After being
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warned of the risks of non-compliance, including loss of limbs, Adams agreed to take the
Metformin and to do the accuchecks (Id.). Dr. Trost ordered accuchecks three times per
day and also ordered an antibiotic for possible infection (Id.). 6 Later that day, however,
Adams had a hyperglycemic incident with blood sugar of 391—which is very high—and
agreed to take his insulin (Id. 20–21). The next day, Adams’s blood sugar dropped to 143
(Id. at p. 21).
A day after that, Dr. Nwaobasi saw Adams at 8:50 a.m. and performed minimal
debridement of the wounds (Doc. 102-5, p. 22). The doctor noted that Adams was
non-compliant and had been refusing to take insulin for control of his diabetes (Id.).
Several hours later, Dr. Nwaobasi was notified that Adams’s blood sugar was high and
he ordered ten units of insulin to be followed by a blood sugar check six hours later (Id.
at p. 23). Later that night, his blood sugar level was 450, but Adams refused to take his
insulin despite being warned of the dangers of “hyperglycemia and post wound
healing” (Id. at p. 25). Dr. Trost was informed but did not enter any new orders; instead,
he opted to see Adams the following morning (Id.). At 2:40 a.m., Adams’s blood sugar
level was 422, and Dr. Trost was informed (Id. at pp. 25, 26). Dr. Trost then saw Adams at
7:50 a.m.; the notes from the visit mention only Adams’s burn wounds and say nothing
about his diabetes (Id. at p. 27). For the next few days, Adams continued to refuse his
insulin, despite being repeatedly counseled that his wounds would not heal if his blood
sugar was high (Id. at pp. 28–32).
6
Beginning April 6, 2014, Adams’s blood sugar was tested three times a day. Prior to April 2014, Adams’s
blood sugar was tested in the mornings every week (Doc. 109-10, p. 4). In May 2014, it was tested twice a
day until Adams’s transfer on June 11, 2014 (Id.).
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On April 9th, Dr. Nwaobasi debrided Adams’s wounds and noted he had “poor
or non compliance with management of his [diabetes]” (Doc.102-5, p. 32). It appears that
Adams began taking his insulin again that same day (see Doc. 102-6, p. 2). On April 10th,
Dr. Fuentes saw Adams and noted his right big toe was “gangrenous,” and parts of his
second and third toes were “turning black” (Doc. 102-6, p. 1). The same wound care was
continued, and Adams was referred to have his toe amputated (Id.). The next day, Dr.
Trost noted that although Adams’s right big toe was gangrenous, his burn wounds were
healing well (Id. at p. 2). On April 12th, Dr. Nwaobasi saw Adams and changed the
dressings on his wounds (Doc. 102-6, p 3). By April 13th, Adams was again refusing to
take his Metformin and the antibiotics that had recently been prescribed because he
claimed they made him vomit (Doc. 102-6, pp. 4–13; Doc. 102-12). His refusal continued
for the next nine days (see Doc. 102-6, Doc. 102-12).
On April 16th, Adams was evaluated by Dr. Robert Brewer at Southern Illinois
Hospital, who recommended amputation of the toe (Doc. 102-9). 7 Dr. Nwaobasi
changed the dressing on Adams’s wounds on April 18th, and Dr. Fuentes did so on
April 19th, 21st, and 22nd (Doc. 102-6, pp. 9, 11, 14, 15). Dr. Nwaobasi saw Adams on
April 23, 2014, and noted that they were waiting on referral for possible amputation (Id.
at p. 16). He had no further meaningful contact with Adams after that date. 8
The report indicates that Adams “has a gangrenous toe on the l foot.” The Court assumes (or rather
hopes) this was a typo as there appears to be no dispute that the correct toe was in fact amputated.
8 Adams was brought to an emergency room on April 25, 2014 for “anterior chest discomfort,” excessive
heart rate, and a possible infection (Doc. 102-10). It appears that he did not have a negative heart event,
and his heart rate was reduced with medication (Id.).
7
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On April 29, 2014, Dr. Fuentes indicated that Adams had no complaints at 8:10
a.m., but by 9:45 a.m., Adams was found on the floor and unresponsive (Doc. 102-6, pp.
22-24). The nurse’s notes indicate that Adams’s blood sugar levels were 58 at 9:45 a.m.
and rose to 158 by 10:15 a.m. after measures were taken (Id.). Adams reported that he
had not eaten his lunch tray, and the nurse educated him on eating after taking insulin
(Id). Dr. Trost was informed (Doc. 109-21, p. 1). 9 Adams refused insulin the next
morning at 2:20 a.m. because his blood sugars were low at 66, and he refused again on
May 2, 2014 (Id. at p. 25; Doc. 102-6, p. 27).
Adams’s toe was amputated on May 5, 2014. The following day while Adams was
still at the hospital, his blood sugar level was 28; he was given food and dextrose, which
raised his blood sugar to 148 (Doc. 109-20). He was discharged the same day with
instructions to follow up in two weeks (Doc. 102-11). Adams had another episode of low
blood sugar (61 and 55) on May 7th and was again educated on the necessity of eating
after taking insulin (Doc. 102-6, p. 29). As noted above, Adams was transferred from
Menard on June 11, 2014.
B. Legal Standards
The standard applied to summary judgment motions under Federal Rule of Civil
Procedure 56 is well-settled and has been succinctly stated as follows:
Summary judgment is appropriate where the admissible evidence shows
that there is no genuine dispute as to any material fact and that the moving
party is entitled to judgment as a matter of law. A “material fact“ is one
identified by the substantive law as affecting the outcome of the suit. A
Dr. Barkoff indicated that Adams had two episodes of hypoglycemia in April 2014 (Doc. 116-2).
However, the medical records only show that this one episode occurred in April.
9
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“genuine issue” exists with respect to any such material fact . . . when “the
evidence is such that a reasonable jury could return a verdict for the
nonmoving party.” On the other hand, where the factual record taken as a
whole could not lead a rational trier of fact to find for the non-moving
party, there is nothing for a jury to do. In determining whether a genuine
issue of material fact exists, we view the record in the light most favorable
to the nonmoving party.
Bunn v. Khoury Enterprises, Inc., 753 F.3d 676, 681 (7th Cir. 2014) (citations omitted).
In order to prevail on a claim for deliberate indifference to a serious medical need,
there are “two high hurdles, which every inmate-plaintiff must clear.” Dunigan ex rel.
Nyman v. Winnebago Cnty., 165 F.3d 587, 590 (7th Cir. 1999). First, the plaintiff must
demonstrate that his medical condition was “objectively, sufficiently serious.” Greeno v.
Daley, 414 F.3d 645, 652-653 (7th Cir. 2005) (citations and quotation marks omitted).
Second, the plaintiff must demonstrate that the “prison officials acted with a sufficiently
culpable state of mind,” namely deliberate indifference. Greeno, 414 F.3d at 653.
There is no question that Adams’s diabetes and the injuries to his feet constituted
serious medical conditions. Thus the only question for the Court is whether Dr.
Nwaobasi acted with deliberate indifference with respect to Adams’s conditions.
In order to show that prison officials acted with deliberate indifference, a plaintiff
must put forth evidence that the prison officials knew that the prisoner’s medical
condition posed a serious health risk, but they consciously disregarded that risk.
Holloway v. Delaware Cnty. Sheriff, 700 F.3d 1063, 1073 (7th Cir. 2012). “This subjective
standard requires more than negligence and it approaches intentional wrongdoing.” Id.;
accord Berry v. Peterman, 604 F.3d 435, 440 (7th Cir. 2010) (“Deliberate indifference is
intentional or reckless conduct, not mere negligence.”); McGowan v. Hulick, 612 F.3d 636,
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640 (7th Cir. 2010) (“[N]egligence, even gross negligence does not violate the
Constitution.”)
For a medical professional to be held liable under the deliberate indifference
standard, he or she must respond in a way that is “so plainly inappropriate” or make a
decision that is “such a substantial departure from accepted professional judgment,
practice, or standards,” that it gives rise to the inference that they intentionally or
recklessly disregarded the prisoner’s needs. Holloway, 700 F.3d at 1073; Hayes v. Snyder,
546 F.3d 516, 524 (7th Cir. 2008) (quoting Sherrod v. Lingle, 223 F.3d 605, 611 (7th Cir.
2000)). In other words, a prison medical professional is “entitled to deference in
treatment decisions unless no minimally competent professional would have so
responded under those circumstances.” Roe v. Elyea, 631 F.3d 843, 857 (7th Cir. 2011)
(quoting Sain, 512 F.3d at 894–95). See also Holloway, 700 F.3d at 1073 (“There is not one
‘proper’ way to practice medicine in prison, but rather a range of acceptable courses
based on prevailing standards in the field.” (quoting Jackson v. Kotter, 541 F.3d 688, 697
(7th Cir. 2008))).
C. Analysis
From the parties’ briefs, there appears to be no dispute that Dr. Nwaobasi
appropriately treated Adams’s external foot conditions—the blister and ulcers that
formed in 2013 and 2014 that required debridement, antibiotics, and dressings—while he
was housed at Menard (see Doc. 102, Doc. 109, Doc. 116). The medical records show that
his blisters and ulcers were routinely and frequently treated and checked, and there is no
evidence that the treatment protocol followed by Dr. Nwaobasi was improper. There is
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also no evidence that Dr. Nwaobasi was involved with or deliberately indifferent as to
Adams’s toe amputation, at least with respect to the procedure itself.
Adams argues, however, that Dr. Nwaobasi’s treatment fell short because he did
nothing to treat the underlying cause of Adams’s foot problems: his diabetes (Doc. 116).
During the relevant time period, the medical records reveal that there were numerous
medical service providers who were involved in Adams’s care, including Dr. Robert
Shearing, Dr. Samuel Nwaobasi, Dr. John Trost, and Dr. Fe Fuentes. It is clear from the
records, however, that Adams’s diabetes was primarily being managed by Dr. Trost and
the diabetes clinic, and on occasion, by Dr. Fuentes. For instance, the standing orders for
Adams’s diabetes medications and blood sugar testing were issued by the diabetes
clinic, or Dr. Trost and Dr. Fuentes when necessary; Dr. Trost was the physician
routinely notified by nurses of hypo and hyperglycemic events; and each time Adams
refused his diabetes treatment, Dr. Trost or Dr. Fuentes were listed as the attending
physician responsible for explaining to Adams the risks, possible complications, and
probable consequences (see Doc. 102-4, pp. 9, 11; Doc. 102-6, pp. 18–19, 20, 21, 25, 26, 28,
30; Doc. 102-12, p. 2, 5, 7–35).
On the other hand, Dr. Nwaobasi argues that, as a surgeon, he was only tasked
with caring for Adams’s external foot condition, and he was not responsible for
management of Adams’s diabetes (Doc. 102, Doc. 109). It is clear from the medical
records that Dr. Nwaobasi’s involvement with Adams’s diabetes was extremely limited.
Specifically, when Adams first arrived at Menard in January 2013, Dr. Nwaobasi
reviewed Adams’s chart after Adams complained he was not getting his insulin and
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then referred Adams to the diabetes clinic. This is consistent with his testimony that he
would not handle patients with poorly controlled diabetes and would instead refer the
patient to his colleague because it is a medical issue “beyond [his] capability”
(Doc. 116-5, pp. 13, 46). Then in April 2014, Dr. Nwaobasi ordered reactionary insulin on
one occasion after being informed by a nurse that Adams’s blood sugar was high. There
is also no evidence that Adams specifically sought care for his diabetes (or
hypo/hyperglycemic events) from Dr. Nwaobasi or that he complained to Dr. Nwaobasi
about the care he was receiving from Dr. Trost or Dr. Fuentes.
The medical records instead make very clear that Dr. Nwaobasi’s primary role in
Adams’s care was with respect to the wounds on his feet. Each visit that Dr. Nwaobasi
had with Adams was spent debriding his wounds and/or changing the dressings. In
fact, Dr. Nwaobasi was the only physician at Menard who debrided the wounds. Adams
does not dispute that, because of his surgical background, Dr. Nwaobasi was specifically
asked by his colleagues to perform the debridement (see Doc. 116). While Dr. Nwaobasi
was aware that Adams had diabetes, and noted as much in his medical record entries, he
also was aware that it was being primarily managed and treated by Dr. Trost.
Adams nonetheless argues that Dr. Nwaobasi should have done more in light of
Adams’s poorly controlled diabetes, especially when he was aware of hypo and hyper
glycemic events (Doc. 116, p. 18). To support this contention, Adams relies almost
exclusively on his expert, Dr. Marla Barkoff (Doc. 116). Dr. Barkoff’s ultimate conclusion
is that:
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[Plaintiff’s] team of nurses and doctors failed to properly treat [his]
diabetes through diet, failed to properly manage [his] glycemic control,
and failed to properly prevent, recognize, and treat complications from
diabetes including problems with [his] kidney function, peripheral
neuropathy, and peripheral vascular disease.
(Doc. 116-2, p. 4). Such a conclusion may be sufficient in a medical malpractice case
against the entire medical staff at Menard, but it is insufficient in this matter because Dr.
Nwaobasi cannot be held liable for the actions of other medical providers. There is no
respondeat superior liability in Section 1983 litigation; liability is premised on the personal
actions of each defendant. See Sanville v. McCaughtry, 266 F.3d 724, 740 (7th Cir. 2001).
Almost all of the actions discussed by Adams were taken by providers other than
Dr. Nwaobasi (compare Doc. 116, pp. 17–18 and Doc. 116-2 with Docs. 102-4, 102-5, and
102-6). With respect to Dr. Nwaobasi’s personal actions, Adams claims the doctor was
deliberately indifferent by failing to mention in his April 30th note the hypoglycemic
event that occurred the day before (Doc. 116-2, p. 16; Doc. 109-1, p. 14; Doc. 102-6, p. 25).
As Defendant’s expert Dr. Daniels noted, however, there was no need for Dr. Nwaobasi
to make note of the prior day’s events when the purpose of his visit was to check on the
status of Adams’s foot wounds, and the hypoglycemic event had already been
addressed by Dr. Trost and the nursing staff (Doc. 109-3, p. 4). To the extent the
hypoglycemic event necessitated a change in medication (see Doc. 109-2, p. 2; but see Doc.
109-3, p. 4), there is no reason to think Dr. Nwaobasi would be the one to make that call
or had the expertise to do so. See Holloway v. Delaware Cnty. Sheriff, 700 F.3d 1063, 1074
(7th Cir. 2012) (“prison physician, as the inmate’s acting primary care doctor, is free to
make his own, independent medical determination as to the necessity of certain
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treatments or medications, so long as the determination is based on the physician’s
professional judgment and does not go against accepted professional standards.”)
Adams also claims that Dr. Nwaobasi was deliberately indifferent because he was
unaware of whether Adams’s blood sugar was being monitored, he did not monitor his
blood sugar logs, and he took no effort to “coordinate” his “glycemic control” with other
healthcare providers (Doc. 116, p. 18; Doc. 116-2, p. 20). Dr. Barkoff opined that Dr.
Nwaobasi’s “[f]ailure to acknowledge and optimize [Plaintiff’s] glycemic control while
managing a skin injury and infection is against standard medical practice for a caring
[sic] for a diabetic patient with a skin injury and likely contributed to [Plaintiff’s] poor
wound healing, gangrene, and eventual amputation” (Doc. 116-2, p. 20).
But once again, the record here reveals that Dr. Nwaobasi was not Adams’s
primary physician; rather, he was acting as a surgical specialist and was tasked with the
specific treatment of Adams’s external foot problems. There is no evidence that Adams
appeared to be in acute distress or complained about his diabetes not being managed
during any of his visits with Dr. Nwaobasi. There is also no reason to think that isolated
instances of hypo or hyperglycemic incidents would have alerted a reasonable doctor in
Dr. Nwaobasi’s position to question the treating physician’s treatment plan, especially
when the doctor is aware that the patient is uncooperative with the treatment plan.
Doctors are entitled to deference in their treatment plans; in this case, Dr. Nwaobasi is
entitled to deference on his decision to defer to the treatment plan formulated and put
into effect by the medical providers who oversaw the management of Adams’s diabetes:
the diabetes clinic, Dr. Trost, and Dr. Fuentes. See Roe v. Elyea, 631 F.3d 843, 857 (7th Cir.
Page 17 of 18
2011). No jury would find that Dr. Nwaobasi’s reliance on Dr. Trost’s judgment was “so
far afield of accepted professional standards as to raise the inference that it was not
actually based on a medical judgment.” Norfleet v. Webster, 439 F.3d 392, 396 (7th Cir.
2006). There is simply no evidence that Dr. Nwaobasi drew the inference that a serious
risk of harm existed that was not being adequately treated.
CONCLUSION
For the reasons set forth above, the Motion for Summary Judgment filed by
Defendant Samuel Nwaobasi on May 16, 2016 (Doc. 101) is GRANTED, and the Motion
to Strike Reply filed by Plaintiff Byron E. Adams on October 21, 2016 (Doc. 120) is
DENIED.
This matter shall proceed on Count 1 alleging deliberate indifference as to
Defendant Harrington and Count 2 alleging excessive force as to Defendant Stirnaman.
IT IS SO ORDERED.
DATED: January 24, 2017
NANCY J. ROSENSTENGEL
United States District Judge
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