Murphy v. Wexford Health Care Source Inc. et al
Filing
126
ORDER GRANTING 107 Motion for Summary Judgment. Judgment is granted in favor of Defendants Mohammed Siddiqui and Wexford Health Sources, Inc., and this case is DISMISSED with prejudice. The Clerk of Court is DIRECTED to enter judgment and close this case on the Court's docket. Signed by Magistrate Judge Mark A. Beatty on 8/18/2022. (klh2)
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 1 of 21 Page ID #675
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
JAMELL A. MURPHY,
)
)
Plaintiff,
)
)
vs.
)
)
WEXFORD HEALTH CARE SOURCES, )
INC. and MOHAMMED SIDDIQUI,
)
)
Defendants.
)
Case No. 3:19-CV-1051-MAB
MEMORANDUM AND ORDER
BEATTY, Magistrate Judge:
Plaintiff Jamell Murphy, a prisoner in the Illinois Department of Corrections, filed
this lawsuit pursuant to 42 U.S.C. § 1983, alleging that his constitutional rights were
violated at Menard Correctional Center (Doc. 1; Doc. 86). 1 More specifically, Plaintiff
alleges that Dr. Mohammed Siddiqui and Wexford Health Sources, Inc. provided
constitutionally inadequate medical care for a mass on his left lung and another mass on
his spleen (Doc. 86). This matter is currently before the Court on the motion for summary
judgment filed by Dr. Siddiqui and Wexford (Doc. 107; see also Doc. 108). For the reasons
explained below, the motion is granted.
FACTS
Defendant Wexford Health Sources, Inc. (“Wexford”) is a private corporation that
1
The Amended Complaint at Doc. 86 is the operative complaint in this matter.
Page 1 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 2 of 21 Page ID #676
contracts with the IDOC to provide medical services to inmates in IDOC facilities (see
Doc. 116, pp. 1–2). Mohammed Siddiqui is a physician employed by Wexford (Doc. 1083, pp. 3–4). He was a Travelling Medical Director from 2015 until 2017 and then the
Medical Director at Menard from 2017 to 2021 (Id.).
Plaintiff testified that his symptoms, including coughing up blood, trouble
breathing on occasion, chest pain, and testicular pain, began in 2009 or 2010 (Doc. 108-1,
pp. 5, 6, 13, 14; see Doc. 86). On July 24, 2009, Plaintiff had a testicular ultrasound and the
radiologist reported normal testes and a “cystic structure” on the right side that was
probably “an epididymal cyst or spermatocele2 (Doc. 108-2, p. 1).
In November 2010, Plaintiff complained in part about “increased mucus
production,” which Dr. Magid Fahim (who is a non-Defendant) thought was due to a
“common cold” (Doc. 108-2, p. 2). Dr. Fahim ordered a chest x-ray, and the radiologist
reported a “prominence of the left paramediastinal region” 3 that could be a mass or
lymphadenopathy4 (Id. at p. 3). The radiologist stated, “CT could be a further benefit.”
A spermatocele (also called a spermatic or epididymal cyst) is a fluid-filled sac (cyst) that grows in the
epididymis—the small, coiled tube located in the scrotum on the upper testicle that collects and transports
sperm. They are noncancerous and typically painless, but they could cause pain and discomfort if they
grow
too
large.
MAYO
CLINIC,
Spermatocele,
https://www.mayoclinic.org/diseasesconditions/spermatocele/symptoms-causes/syc-20377829 (last visited August 3, 2022).
2
The mediastinum is the area in the middle of the chest that lies between the lungs, and the sternum and
spinal column. The area contains vital organs, including the heart, esophagus, and trachea. Mediastinal
tumors develop in one of three areas of the mediastinum: the anterior (front, closer to the sternum), the
middle, or the posterior (back, closer to the spine). MEDLINEPLUS, Mediastinal Tumor,
https://medlineplus.gov/ency/article/001086.htm (last visited August 3, 2022).
3
According to Wexford’s corporate representative, Dr. Glen Babich, adenopathy is any disease or
inflammation that involves glandular tissue or lymph nodes (Doc. 108-5). The term is usually used to refer
to lymphadenopathy, or swollen lymph nodes (Id.). Adenopathy and lymphadenopathy are not cancerous
or malignant (Id.).
4
Page 2 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 3 of 21 Page ID #677
(Id.). Plaintiff testified that he was not told about the mass in his chest (see Doc. 108-1, pp.
5, 6).
Approximately one month after the chest x-ray, in December 2010, Plaintiff saw
Dr. Samuel Nwaobasi and complained that he was coughing up blood and chest pain
“for five years” (Doc. 108-2, p. 4).5 Dr. Nwaobasi referred Plaintiff to Dr. Fahim (who was
the Medical Director at Menard at the time) “for possible CT scan of chest based on recent
[chest] x-ray report” (Id.). It does not appear that a CT scan was approved, and instead a
follow-up chest x-ray was performed in February 2011 (Id. at p. 6). The “prominence” in
Plaintiff’s chest was seen once again but “there [was] no significant change since the
previous study” (Id.). The radiologist thought it “likely represent[ed] anatomic variation”
but recommended another follow-up x-ray in six months “to assure that there is no
underlying lesion” (Id.). That same month, Plaintiff also had another testicular
ultrasound, and the probable epididymal cyst was still present (Id. at p. 5).
Another chest x-ray was taken on September 16, 2011, showing the “prominence”
in Plaintiff’s chest was still present and appeared “slightly more prominent, which could
be related to the decreased inspiratory effort with decreased lung volumes”—in other
words Plaintiff took a shallower breath and his lungs were not as full for this x-ray as
they were for the last (Doc. 108-2, p. 7).6 The radiologist recommended a follow-up chest
Dr. Nwaobasi was originally named as a Defendant in this case (Doc. 1). However, he was already
deceased by the time Plaintiff filed his complaint (Doc. 1; Doc. 7). When Plaintiff failed to identify a proper
party to substitute in place of Dr. Nwaobasi, the doctor was dismissed without prejudice as a Defendant in
this case (Doc. 59).
5
Before a chest x-ray is taken, the technician asks the patient to take a deep breath and hold it because that
helps the heart and lungs to show up more clearly on the image. MAYO CLINIC, Chest X-rays,
6
Page 3 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 4 of 21 Page ID #678
CT “to be prudent” and “to exclude a developing process” (Id.).
The chest CT was approved and performed approximately three weeks later on
October 5, 2011 (Doc. 108-2, p. 8). The radiologist noted a “soft tissue density mass . . .
measuring approximately 2.5 x 3.0 x 3.5 cm . . . in the left anterior mediastinum” as well
as a small pulmonary nodule in the right lung (Id.). The differential diagnosis for the
mediastinal mass “includes but is not limited to lymphoma versus less likely metastatic
disease,” and further evaluation with a PET scan was recommended (Id.).7 The PET scan
was performed at Memorial Hospital of Carbondale on November 15th (Id. at pp. 10–13;
Doc. 108-4, pp. 12–13). The nodule in the right upper lobe measured less than a centimeter
(“subcentimeter”), had an SUV max of 0.5,8 and was “likely benign” (Doc. 108-4, pp. 12–
13). The left mediastinal mass measured 3 x 3 centimeters and had an SUV max of 1.6,
meaning it was not suspicious for cancer, and “most likely represents adenopathy,” or
swollen lymph nodes (Id.; Doc. 108-5). “Hyperactive focus distal esophagus with SUV
https://www.mayoclinic.org/tests-procedures/chest-x-rays/about/pac20393494#:~:text=The%20X%2Dray%20technician%20may,more%20clearly%20on%20the%20image (last
visited August 3, 2022).
A positron emission tomography scan (“PET scan”) is a type of imaging test that shows how organs and
tissues are working in real time and is used to detect a variety of conditions, including cancer, heart disease,
and brain disorders. During a PET scan, a special dye containing radioactive tracers is given to the patient
and the dye collects in areas of the body with high levels of metabolic or chemical activity. Diseased cells,
such as cancer cells, are generally more active and have a higher metabolic rate than normal cells and absorb
large amounts of the dye. The patient’s body is then scanned and the areas where the dye has collected
show up as bright spots on the scan. MAYO CLINIC, Positron Emission Tomography Scan,
https://www.mayoclinic.org/tests-procedures/pet-scan/about/pac-20385078 (last visited August 3,
2022); CLEVELAND CLINIC, PET Scan, https://my.clevelandclinic.org/health/diagnostics/10123-pet-scan
(last visited August 3, 2022). See also Doc. 108-5.
7
SUV stands for standardized uptake value and is a measure of the tracer absorption in a particular area.
Wexford’s corporate representative, Dr. Glen Babich, attested in a declaration that, generally speaking, an
SUV uptake of under 4.0 is considered not suspicious for cancer/neoplasm (Doc. 108-5).
8
Page 4 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 5 of 21 Page ID #679
max of 4.4,” was also noted, which “could be inflammatory or neoplastic,”9 and “[d]irect
visualization” was recommended (Doc. 108-4, pp. 12–13). According to Wexford’s
corporate representative, Dr. Glen Babich, tissues lining the digestive tract are generally
more active and absorb more dye during a PET scan because they are subjected to the
rigors of intake and digestion and the body regularly replaces the tissues thus increasing
dye consumption (Doc. 108-5). Additionally, inflammation caused by gastritis would
further increase dye consumption (Id.).
Dr. Nwaobasi’s notes on November 21, 2011 indicate that the PET scan was
“negative” and an EKG was “normal” except for sinus bradycardia (Doc. 108-2, p. 14).10
Dr. Nwaobasi also wrote that there was “no evidence of pulmonary or cardiac [cause] for
[Plaintiff’s] chest pain” (Id.). He noted that approval for an upper endoscopy had been
requested and received, (Id.),11 in order to “directly visualize” Plaintiff’s esophagus, as
recommended. The EGD was performed on January 6, 2012 (Doc. 108-2, pp. 16–17). The
A neoplasm is an abnormal mass of tissue, also commonly referred to as a tumor. Neoplasms may be
benign/non-cancerous
or
malignant/cancerous.
YALE
MEDICINE,
Neoplasm
(Tumor),
https://www.yalemedicine.org/conditions/neoplasm (last visited August 3, 2022).
9
An electrocardiogram (“EKG”) is a test that records the electrical signals in the heart and is used to detect
heart
problems
and
monitor
the
heart's
health.
MAYO
CLINIC,
Electrocardiogram,
https://www.mayoclinic.org/tests-procedures/ekg/about/pac-20384983 (last visited August 3, 2022).
Bradycardia is a slow heart rate. It can cause dizziness, fatigue, weakness, or shortness of breath. MAYO
CLINIC,
Bradycardia,
https://www.mayoclinic.org/diseases-conditions/bradycardia/symptomscauses/syc-20355474 (last visited August 3, 2022). It is unclear when the EKG was conducted (see Doc. 1082).
10
An esophagogastroduodenoscopy (“EGD”), which is also referred to as an upper endoscopy, is a
procedure used to look at the inner lining of the upper digestive tract, including the esophagus, stomach
and duodenum, which is the first part of the small intestine. CLEVELAND CLINIC, Upper Endoscopy,
https://my.clevelandclinic.org/health/treatments/4957-upper-endoscopy-procedure (last visited August
3, 2022).
11
Page 5 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 6 of 21 Page ID #680
radiologist noted the presence of erosive gastritis and distal esophagitis, (id.), both of
which involve damage/inflammation of sections of the digestive tract but are not
cancerous or malignant (Doc. 108-5). Tissue samples taken during the endoscopy were
positive for H. pylori (Doc. 108-2, pp. 18–19). It is undisputed that H. pylori “is a common
digestive bacterium that can cause conditions similar to those experienced by Plaintiff”
(Doc. 116, p. 5).12 It is also undisputed that no source of bleeding was identified during
the upper endoscopy (see Doc. 116, p. 7; see also Doc. 108-2, p. 18). Plaintiff testified that
Dr. Nwaobasi told him he had an ulcer and never told him about the mediastinal mass
in his chest (Doc. 108-1, p. 5; see also id. at pp. 8, 9). Plaintiff was given medication to treat
the H. pylori, which he testified helped alleviate some of his complaints, but he continued
to cough up blood (Doc. 108-1, pp. 10–11).
Plaintiff had another chest x-ray taken in January 2012 following his complaints
that he was coughing up blood (Doc. 108-2, p. 20) and a follow-up chest x-ray in July 2012
(Id. at p. 21). Both noted that the mediastinal mass remained largely unchanged (Id.).
According to Dr. Siddiqui, a noncancerous mass can be left untreated if it is not causing
any problems or symptoms (Doc. 108-3, p. 28). Another chest x-ray was taken on January
10, 2013, following Plaintiff’s complaints that he was coughing up blood and had
abdominal pain (Id. at p. 22). The radiologist did not mention the mediastinal mass or
Helicobacter pylori (H. pylori) is a bacteria that can infect your stomach and cause peptic ulcers. Signs
or symptoms of an H. pylori infection include an ache or burning pain in the abdomen, nausea, loss of
appetite, frequent burping, bloating, and unintentional weight loss. MAYO CLINIC, Helicobacter pylori
infection,
https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171
(last visited July 29, 2022).
12
Page 6 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 7 of 21 Page ID #681
note any other abnormalities (Id.). Two months later, in March 2013, Plaintiff complained
that he was out of medicine for his esophagitis and was coughing up blood (Doc. 108-2,
p. 24). His medications were renewed for one month (Id.). Plaintiff made the same
complaints in June 2013 (Id. at p. 25). Another chest x-ray and labs were ordered and
Plaintiff’s prescriptions were renewed for three months (Id.). The chest x-ray was taken
on June 12th, and the radiologist did not mention the mediastinal mass or note any other
abnormalities (Doc. 108-2, p. 23).
The medical records provided to the Court drop off after June 9, 2013, and resume
in late March/early April 2017, when Plaintiff complained of a stomachache and reported
coughing up blood and a history of ulcers (Doc. 108-2, pp. 26, 27). Labs were ordered and
Plaintiff was given a prescription for Prilosec and told to follow-up in one month (Id. at
p. 27). A similar scenario played out in September 2017 (Id. at p. 28).
It is undisputed that Dr. Mohammed Siddiqui became involved in Plaintiff’s
medical care in the fall of 2018 (see Doc. 116, p. 6; see also Doc. 108-3, p. 5). Specifically,
Plaintiff underwent another chest x-ray on October 23, 2018, apparently at the direction
of Dr. Siddiqui (see Doc. 116, p. 6), following his complaint of shortness of breath and
chest pressure (Doc. 108-2, p. 29). The report noted an “extra density” in Plaintiff’s chest
that measured up to five centimeters (Id.). A CT scan was recommended to further
investigate whether it was a mass or enlarged lymph node (Id.).
The first record of Dr. Siddiqui actually seeing Plaintiff is from December 4, 2018,
approximately one and a half months after the chest x-ray (Doc. 108-2, p. 30). At that visit,
Plaintiff complained about chest pain, his heart skipping beats, and occasional shortness
Page 7 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 8 of 21 Page ID #682
of breath (Id.). Dr. Siddiqui noted that a previous EKG showed no evidence of PVCs but
did show “significant bradycardia” (Id.). 13 He further noted Plaintiff had a left
mediastinal mass, was currently on psychiatric medications, and had no history of
hypertension or angina (Id.). Dr. Siddiqui noted he had already received approval from
Wexford for a chest CT scan and a referral to a cardiologist (Id; Doc. 108-3, pp. 5–6, 7).
The CT scan was performed on December 21, 2018 (Doc. 108-2, p. 32). The
mediastinal mass, measuring 4.5 x 2.9 x 1.7 centimeters, was seen, and other adjacent
smaller masses, likely adenopathy, were noted (Id.). The radiologist stated the etiology of
the mediastinal mass was uncertain, but malignant neoplasm was possible and a biopsy
should be considered (Id.). He also noted the previously-identified nodule in Plaintiff’s
right upper lobe, which he characterized as a “calcified granuloma” (Id.). Finally, a twocentimeter nodule on Plaintiff’s spleen was observed for the first time, which the
radiologist stated was “possible metastasis” (Id.). Following the CT scan, Dr. Siddiqui
sought and received approval for a biopsy but it does not appear the biopsy was ever
done (see id. at pp. 32, 33, 40; Doc. 108-3, p. 8).
Plaintiff saw cardiologist Dr. Shahabuddin Mohammad on January 18, 2019 (Doc.
108-2, pp. 34–38). Dr. Mohammad concluded that Plaintiff had sinus bradycardia (which
is a slow heart rate), “most likely due to the athletic nature of the patient” (Id.). He further
Premature ventricular contractions (PVCs) are extra heartbeats that disrupt the regular heart rhythm,
sometimes causing a sensation of a fluttering or a skipped beat in the chest. Occasional PVCs usually are
not a concern and likely do not need treatment if they are not frequent or bothersome and the patient does
not have an underlying heart condition. MAYO CLINIC, Premature Ventricular Contractions,
https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/symptomscauses/syc-20376757#:~:text=Overview,skipped%20beat%20in%20the%20chest (last visited August 3,
2022).
13
Page 8 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 9 of 21 Page ID #683
noted that Plaintiff’s chest pain was “most likely musculoskeletal,” and the chest pain
and shortness of breath were not likely due to a cardiac issue (Id.). He stated that Plaintiff
did not require “any further workup” but did recommend further evaluation by a Holter
monitor for 48 hours and perhaps a beta-blocker, depending on the results (Id.).14 Finally,
he wrote that the mediastinal mass and hemoptysis (coughing up blood) would be
managed by Plaintiff’s primary care physician (Id.).
Dr. Siddiqui followed the cardiologist’s recommendation to evaluate Plaintiff with
a Holter monitor, and based on the results, Plaintiff was started on a beta-blocker (Doc.
108-2, p. 41). Dr. Siddiqui also sought and received approval from Wexford for a
consultation with a cardiothoracic surgeon (see Doc. 108-2, pp. 39, 40; see also Doc. 108-3,
pp. 8–9). Before that consultation could take place, however, Plaintiff underwent a
(seemingly unplanned) chest x-ray and a CT angiogram at Memorial Hospital in
Carbondale on March 12, 2019 (Id. at pp. 42–44). 15 The report indicates that the left
mediastinal mass measured approximately 41 x 24 x 43.5 millimeters, which was “slightly
decreased in size in comparison to the previous exams in 2011” (Id.) (emphasis added).
There was no definite evidence of pulmonary embolus or significant pulmonary nodules
or opacities (Id.). Plaintiff’s heart appeared normal, as did his upper abdomen, body wall
A Holter monitor is a small, wearable device that records the heart's rhythm and is used to detect or
determine
the
risk
of
irregular
heartbeats.
MAYO
CLINIC,
Holter
Monitor,
https://www.mayoclinic.org/tests-procedures/holter-monitor/about/pac20385039#:~:text=A%20Holter%20monitor%20is%20a,details%20about%20the%20heart's%20condition
(last visited August 3, 2022).
14
Neither party mentioned how these tests came to pass (see Docs. 108, 115, 116, 117). It appears, however,
the tests were done in the emergency room after Dr. Siddiqui sent Plaintiff to the hospital because he was
coughing up blood (see Doc. 108-2, pp. 42–44, 46; see also Doc. 108-1, p. 12).
15
Page 9 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 10 of 21 Page ID #684
soft tissues, and bones (Id.). The report also states that Plaintiff still needs a biopsy
because they were unsuccessful in their attempt (Id.).
On March 18, 2019, Plaintiff saw Dr. Russell McElveen, a cardiothoracic surgeon
at Carbondale Memorial Hospital, regarding the mediastinal mass (Doc. 108-2, pp. 46–
48; see also id. at pp. 49–50). Dr. McElveen noted “I discussed risk of removing the mass. I
did tell him that I do not think it is cancer, but we will have to get tissue to make a final
diagnosis. My goal is to remove the mass but would not [put] any vital structures at risk
given that the mass has not grown much over an 8-year time span.” (Id. at p. 48).
Three days later, Dr. Siddiqui saw Plaintiff again, where Plaintiff complained
about testicular pain for more than five years (Doc. 108-2, p. 45). Dr. Siddiqui performed
a testicular examination and found Plaintiff’s testicles to be normal, non-tender, and
without masses or cysts (Id.). He provided reassurance to Plaintiff (Id.).
Dr. McElveen, the cardiothoracic surgeon, reported that Plaintiff wanted to have
the mediastinal mass removed “for concerns of cancer” and the surgery took place on
April 30, 2019 (Doc. 108-2, pp. 49–50). The mass was noted to be mobile and not affixed
to any structures. Dr. McElveen spent about two and a half hours removing portions of
the mass and noted “the mass was adherent to the phrenic nerve and careful dissection
was used to dissect the mass off of the phrenic nerve” (Id.). He was not able to remove
the entire mass due to its location (Doc. 108-1, p. 13; see also Doc. 108-2, p. 64). According
to Dr. Siddiqui and Dr. Babich, there is no way of knowing if sooner surgical removal of
the mediastinal mass could or would have affected the mass’s proximity to the phrenic
nerve (Doc. 108-3, p. 12; Doc. 108-5). Pathology results revealed that the mass was
Page 10 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 11 of 21 Page ID #685
“negative for any metastatic or cancerous lesion” (Doc. 108-2, pp. 51–53). The final
diagnosis was benign angiomyoma (Id.).
In May 2019 and August 2019, Dr. Siddiqui noted that Plaintiff still needed a CT
scan to follow-up on the splenic nodule (Doc. 108-2, pp. 54, 57). It took place on October
1, 2019 (Doc. 108-2, p. 59). The splenic lesion was “stable from the prior exam” in
December 2018 (Id.). The “etiology remain[ed] indeterminate” but it could be a “cystic
lesion” or “hemangioma or hamartoma” and “malignant etiologies . . . [were] considered
relatively less likely due to the stability over nearly 10 months” (Id.).
Dr. Siddiqui saw Plaintiff again on October 8, 2019, where Plaintiff complained of
pain in his left testicle but refused a testicular exam (Doc. 108-2, p. 60). Plaintiff also
complained of chest pain and blood in his urine (Id.). Dr. Siddiqui ordered a urinalysis,
discussed the possibility of epididymitis and potential treatment, and discussed the
results of the recent CT scan (Id.). He noted that Plaintiff wanted “more
opinions/surgery” (Id.). A testicular ultrasound conducted on November 26, 2019,
showed a “small left epididymal cyst” (Id. at p. 61). There was no mention of the
previously identified right cyst (see id.).
Dr. Siddiqui saw Plaintiff again on June 22, 2020, where Plaintiff complained that
he was coughing up blood (Doc. 108-2, pp. 62, 67). Dr. Siddiqui requested and received
approval from Wexford for a CT scan (Id.). A chest CT and abdominal CT were performed
on October 5, 2020 (Id. at pp. 63–64). A two-centimeter mass on the spleen was noted,
“which may represent hemangioma,” and an ultrasound was recommended to correlate
that finding (Id.). A hemangioma is a noncancerous/nonmalignant growth of blood
Page 11 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 12 of 21 Page ID #686
vessels and other tissues (Doc. 108-5). The radiologist further also noted that the
mediastinal mass was still present but had decreased in size (because some of it was
surgically removed) and now measured about two-and-a-half centimeters (Doc. 108-2,
pp. 63–64). The recommended ultrasound of Plaintiff’s spleen was performed on
December 18, 2020 (Id. at p. 69). The radiologist noted a “2.8 centimeter hyperechoic
splenic lesion . . . this is statistically most likely to represent hemangioma” (Id.).
There are no additional medical records and Dr. Siddiqui left his employment with
Wexford in July 2021 (Doc. 108-3, p. 4; see Doc. 108-2, Doc. 108, Doc. 115, Doc. 116, Doc.
117).
Wexford’s corporate representative, Dr. Glen Babich, was asked to testify as to
whether, between 2010 and 2011,16 Wexford had any policies or procedures, written or
unwritten, regarding when imaging studies are needed for a patient; ordering imaging
studies in general or in response to coughing up blood, chest pain, fainting or passing
out; generating medical records or reports following an imaging study; informing
patients of the results of an imaging study (Doc. 108-6; see also Doc. 108-7). He was also
asked whether Wexford had any policies or procedures detailing medical treatment or
procedures for when a mass/lesion is revealed on a patient’s lung or for an ulcer (Doc.
108-6; see also Doc. 108-7). Dr. Babic testified that Wexford did not have any such policies
or procedures between 2010 and 2011; rather, these were all matters left to the discretion
16
The parties agreed to limit the time period to 2010 and 2011 (Doc. 108, p. 9; Doc. 116, p. 10).
Page 12 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 13 of 21 Page ID #687
of the individual healthcare provider based on his or her knowledge, skill, education and
training (Doc. 108-6).
LEGAL STANDARD
Summary judgment is proper “if the movant shows that there is no genuine issue
as to any material fact and the movant is entitled to judgment as a matter of law.” FED. R.
CIV. P. 56(a). The moving party always bears the initial responsibility of showing that it
is entitled to summary judgment. Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986);
Modrowski v. Pigatto, 712 F.3d 1166, 1168 (7th Cir. 2013). The manner in which this
showing can be made depends upon which party will bear the burden of proof on the
challenged claim(s) at trial. Celotex, 477 U.S. at 331 (Brennan, J., dissenting). In cases such
as this one, where the burden of proof at trial rests on the plaintiff, the defendant can
make its initial showing on summary judgment in one of two ways. Id.; see Hummel v. St.
Joseph Cty. Bd. of Comm'rs, 817 F.3d 1010, 1016 (7th Cir. 2016); Modrowski, 712 F.3d at 1168.
First, the defendant can show that there is an absence of evidence—meaning a complete
failure of proof—supporting an essential element of the plaintiff’s claim. Celotex, 477 U.S.
at 331; Hummel, 817 F.3d at 1016. Second, the defendant can present affirmative evidence
that negates an essential element of the plaintiff’s claim. Celotex, 477 U.S. at 331; Hummel,
817 F.3d at 1016.
If the movant fails to carry its initial responsibility, the motion should be denied.
Kreg Therapeutics, Inc. v. VitalGo, Inc., 919 F.3d 405, 415 (7th Cir. 2019). On the other hand,
if the movant does carry its initial responsibility, the burden shifts to the non-moving
party to “inform the trial judge of the reasons, legal or factual, why summary judgment
Page 13 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 14 of 21 Page ID #688
should not be entered.” Wrolstad v. Cuna Mut. Ins. Soc'y, 911 F.3d 450, 455 (7th Cir. 2018)
(citation omitted). The non-moving party cannot rely on allegations in the pleadings but
rather must come forward with evidentiary materials that set forth “specific facts
showing that there is a genuine issue for trial” on all essential elements of his case. Celotex,
477 U.S. at 324; Siegel v. Shell Oil Co., 612 F.3d 932, 937 (7th Cir. 2010); Lewis v. CITGO
Petroleum Corp., 561 F.3d 698, 702 (7th Cir. 2009); see also FED. R. CIV. P. 56(c)(1). “Where
the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no ‘genuine issue for trial.’” Armato v. Grounds, 766 F.3d 713, 719
(7th Cir. 2014) (quoting Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574,
587 (1986)). In deciding a motion for summary judgment, the court “must view all the
evidence in the record in the light most favorable to the non-moving party and resolve
all factual disputes in favor of the non-moving party.” Hansen v. Fincantieri Marine Grp.,
LLC, 763 F.3d 832, 836 (7th Cir. 2014).
DISCUSSION
The Eighth Amendment’s proscription against cruel and unusual punishment
creates an obligation for prison officials to provide inmates with adequate medical care.
Minix v. Canarecci, 597 F.3d 824, 830 (7th Cir. 2010) (citing Farmer v. Brennan, 511 U.S. 825,
832, (1994)). Evaluating whether the Eighth Amendment has been violated involves a
two-prong analysis. The court first looks at whether the plaintiff suffered from an
objectively serious medical condition and, second, whether the “prison officials acted
with a sufficiently culpable state of mind,” namely deliberate indifference. E.g., Holloway
v. Delaware Cty. Sheriff, 700 F.3d 1063, 1073 (7th Cir. 2012). In applying this test, the court
Page 14 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 15 of 21 Page ID #689
“look[s] at the totality of an inmate’s medical care when considering whether that care
evidences deliberate indifference to serious medical needs.” Petties v. Carter, 836 F.3d 722,
728–29 (7th Cir. 2016).
Defendants argue that Plaintiff cannot prove either prong of the deliberate
indifference analysis (Doc. 108). The Court finds, however, that it need not address the
first prong—whether Plaintiff was suffering from a serious medical condition—because
even if it is assumed that he did, he has not put forth sufficient evidence from which a
jury could conclude that Dr. Siddiqui or Wexford exhibited deliberate indifference.
A prison official exhibits deliberate indifference when they know of a serious risk
to the prisoner’s health but they consciously disregard that risk. Holloway v. Delaware Cty.
Sheriff, 700 F.3d 1063, 1073 (7th Cir. 2012) (citation omitted). “The standard is a subjective
one: The defendant must know facts from which he could infer that a substantial risk of
serious harm exists and he must actually draw the inference.” Rasho v. Elyea, 856 F.3d 469,
476 (7th Cir. 2017) (quoting Zaya v. Sood, 836 F.3d 800, 804 (7th Cir. 2016)). The deliberate
indifference standard “requires more than negligence and it approaches intentional
wrongdoing.” Holloway, 700 F.3d at 1073. It is “essentially a criminal recklessness
standard, that is, ignoring a known risk.” McGee v. Adams, 721 F.3d 474, 481 (7th Cir. 2013)
(citation omitted).
A. Dr. Mohammed Siddiqui
Plaintiff’s claim against Dr. Siddiqui is that the doctor failed to provide timely and
adequate medical treatment for the mass on his lung and the mass on his spleen, which
caused him to cough up blood and suffer unnecessary pain in his stomach, chest, and
Page 15 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 16 of 21 Page ID #690
testicles (Doc. 86; see also Doc. 108-1, p. 12).
In the context of medical professionals, the deliberate indifference standard has
been described as the “professional judgment standard.” Sain v. Wood, 512 F.3d 886, 895
(7th Cir. 2008). Treatment decisions are “presumptively valid” and entitled to deference
so long as they are based on professional judgment—meaning they are fact-based with
respect to the particular inmate, the severity and stage of his condition, the likelihood and
imminence of further harm, and the efficacy of available treatments—and do not go
against accepted professional standards. Johnson v. Rimmer, 936 F.3d 695, 707 (7th Cir.
2019) (citation omitted); Rasho v. Elyea, 856 F.3d 469, 476 (7th Cir. 2017); Roe v. Elyea, 631
F.3d 843, 859 (7th Cir. 2011). A medical professional may be held to have displayed
deliberate indifference if the treatment decision was “blatantly inappropriate” even to a
layperson, Pyles v. Fahim, 771 F.3d 403, 409 (7th Cir. 2014); see also Petties, 836 F.3d at 729
(a jury can infer deliberate indifference when “a risk from a particular course of medical
treatment (or lack thereof) is obvious.”), or there is evidence that the treatment decision
was “such a substantial departure from accepted professional judgment, practice, or
standards, as to demonstrate that the person responsible actually did not base the
decision on such a judgment.” Petties, 836 F.3d at 729; see also Pyles, 771 F.3d at 409 (“A
medical professional is entitled to deference in treatment decisions unless ‘no minimally
competent professional would have so responded under those circumstances’”).
Defendants argue there is no evidence from which a jury could conclude that Dr.
Siddiqui acted with deliberate indifference to Plaintiff’s medical conditions (Doc. 116, pp.
13–15) and Plaintiff made no argument to the contrary (see Doc. 116). After reviewing the
Page 16 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 17 of 21 Page ID #691
evidence, the Court agrees with Defendants.
It is undisputed that Dr. Siddiqui did not become involved in Plaintiff’s care until
late October 2018 (Doc. 116, p. 6). Dr. Siddiqui started with a chest x-ray, which led to a
chest CT scan, a consultation with a cardiologist, another chest x-ray and a CT angiogram,
a consultation with a cardiothoracic surgeon, and culminated in surgery to remove the
mediastinal mass on April 30, 2019—approximately six months after Dr. Siddiqui became
involved in Plaintiff’s care. Pathology confirmed the mass was not cancerous, which is
what various doctors had long-suspected. With respect to the mass on Plaintiff’s spleen,
it has been monitored since it was discovered on December 21, 2018 in the midst of Dr.
Siddiqui’s efforts to evaluate the mediastinal mass. Plaintiff has had two additional CT
scans and a splenic ultrasound. The mass has been reported as stable and is most likely a
benign growth.
Despite the care he received, Plaintiff apparently thinks that Dr. Siddiqui did not
do enough for him or act quickly enough (see Doc. 108-1, p. 12). However, the evidence
shows that Dr. Siddiqui took continuous steps to investigate the cause of Plaintiff’s
symptoms and to evaluate the mediastinal mass in his chest and the mass on his spleen
and provide treatment when necessary and appropriate. Dr. Siddiqui did everything that
was recommended by the radiologists and specialists. There is no diagnostic exam or
treatment that was refused. And there is no expert testimony that Plaintiff necessitated
more urgent care or that the timeline of care provided by Dr. Siddiqui was unreasonably
long given Plaintiff’s condition, and neither is self-evident from the medical records.
For these reasons, no reasonable jury could find that Dr. Siddiqui acted with
Page 17 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 18 of 21 Page ID #692
deliberate indifference, and he is entitled to summary judgment.
B. Wexford Health Sources, Inc.
A private corporation acting under the color of state law, like Wexford, can be held
liable under § 1983 for constitutional violations based on the Monell theory of municipal
liability. Glisson v. Indiana Dep't of Corr., 849 F.3d 372, 378–79 (7th Cir. 2017) (en banc). The
corporation cannot be held liable simply because it employed the alleged wrongdoer, Est.
of Perry v. Wenzel, 872 F.3d 439, 460 (7th Cir. 2017); rather, “a plaintiff must show that his
constitutional injury was caused by the corporation’s own actions. Pyles v. Fahim, 771 F.3d
403, 409–10 (7th Cir. 2014) (quoting Minix v. Canarecci, 597 F.3d 824, 832 (7th Cir. 2010)).
This requires a plaintiff to demonstrate that “the ‘moving force’ behind his constitutional
injury” was an express policy adopted and promulgated by the corporation, an informal
but widespread and well-settled practice or custom, or a decision by an official of the
corporation with final policymaking authority. Dixon v. Cnty. of Cook, 819 F.3d 343, 348
(7th Cir. 2016) (citing City of Canton v. Harris, 489 U.S. 378, 379 (1989)); Glisson, 849 F.3d at
379. An unconstitutional corporate policy can also “take the form of . . . a gap in expressed
policies.” Dixon, 819 F.3d at 348 (quoting Thomas v. Cook Cnty. Sheriff's Dep't, 604 F.3d 293,
303 (7th Cir. 2009)).
Here, Plaintiff claim is rooted in Wexford’s lack of policies and procedures in
2010 and 2011 about imaging studies, generally speaking, as well as treating tumors and
ulcers (Doc. 115, p. 6; see also Doc. 86).17 These matters were instead left to the discretion
17
The parties agreed to limit the time period to 2010 and 2011 (Doc. 108, p. 9; Doc. 116, p. 10).
Page 18 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 19 of 21 Page ID #693
of individual healthcare providers based on their knowledge, skill, education and
training (Doc. 115, p. 6). Plaintiff argues that “the absence of any policies or procedures
led to systematic deficiencies,” which is the reason he “did not receive treatment needed
for his objectively serious medical needs” (Id.).
Wexford’s deliberate choice not to enact general policies to guide the medical
staff's decision-making is not in and of itself a constitutional violation. See Glisson, 849
F.3d at 380, 382 (“[W]e are not holding that the Constitution or any other source of federal
law required Corizon to adopt the Directives or any other particular document.”). Rather,
Plaintiff has to show that Wexford had actual knowledge that these general policies were
necessary to ensure prisoners received adequate medical care and that constitutional
violations would occur in the absence of the polices, yet Wexford nevertheless did
nothing to enact such policies. See Glisson, 849 F.3d at 382. See also King v. Kramer, 680 F.3d
1013, 1021 (7th Cir. 2012) (where municipality has “actual or constructive knowledge that
its agents will probably violate constitutional rights, it may not adopt a policy of
inaction”); Thomas v. Cook Cnty. Sheriff's Dep't, 604 F.3d 293, 303 (7th Cir. 2010) (“[I]n
situations where rules or regulations are required to remedy a potentially dangerous
practice, the County's failure to make a policy is also actionable.”). In other words,
Plaintiff has to show that Wexford “fail[ed] to have procedures in place for addressing a
known risk of serious harm.” Lapre v. City of Chicago, 911 F.3d 424, 430 (7th Cir. 2018).
Plaintiff has not put forth evidence necessary to make the requisite showings. First,
Plaintiff has not even demonstrated that he suffered a constitutional injury. The Court
already determined that Dr. Siddiqui was not deliberately indifferent, and Plaintiff made
Page 19 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 20 of 21 Page ID #694
no argument that Dr. Fahim, Dr. Nwaobasi, or any other clinicians who saw him acted
with deliberate indifference (nor is it readily apparent) (see Doc. 115). Consequently, there
is no constitutional injury that could possibly be attributed to Wexford’s lack of policies
or protocols. Wexford is therefore entitled to summary judgment.
But even if there was an underlying constitutional violation by one of the
individual clinicians, Plaintiff has not put forth evidence sufficient for a reasonable jury
to conclude that Wexford knew its physicians would violate prisoners’ constitutional
rights in the absence of the policies at issue. For example, Plaintiff made no argument and
presented no evidence of a prior pattern of similar constitutional violations where
medical staff mishandled prisoners who were coughing up blood or fainting, who
reported chest pain, or who had tumors (see Doc. 115). See J.K.J. v. Polk Cnty., 960 F.3d 367,
380 (7th Cir. 2020), cert. denied 141 S. Ct. 1125 (2021). Absent evidence of a pattern of
problems caused by a lack of protocols, Plaintiff could still present a viable Monell claim
if he showed his situation was the type that prison medical providers were almost certain
to encounter and involved “a risk of constitutional violations . . . so high and [a] need for
training so obvious” that the failure to act could “reflect deliberate indifference and allow
an inference of institutional culpability.” J.K.J., 960 F.3d at 380–82 (holding that jury could
find the risk of male prison guards sexually assaulting female inmates was so blatantly
obvious that the county’s failure to provide a meaningful policy or training on preventing
and detecting such assaults could be characterized as deliberate indifference). 18 But
See also City of Canton, Ohio v. Harris, 489 U.S. 378, 390 n.10 (1989) (providing the example that police
officers will be required to arrest fleeing felons, and they are given firearms in part to accomplish that task,
18
Page 20 of 21
Case 3:19-cv-01051-MAB Document 126 Filed 08/18/22 Page 21 of 21 Page ID #695
Plaintiff made no argument and provided no evidence that his situation fell into this
“narrow range of circumstances.” J.K.J., 960 F.3d at 380.
Consequently, no reasonable jury could conclude that Wexford's lack of policies
or procedures caused Plaintiff any constitutional harm, and Wexford is entitled to
summary judgment.
CONCLUSION
The motion for summary judgment filed by Defendants Mohammed Siddiqui and
Wexford Health Sources, Inc. (Doc. 107) is GRANTED. Judgment is granted in their favor
and this case is DISMISSED with prejudice. The Clerk of Court is DIRECTED to enter
judgment and close this case on the Court’s docket.
IT IS SO ORDERED.
DATED: August 18, 2022
s/ Mark A. Beatty
MARK A. BEATTY
United States Magistrate Judge
which makes “the need to train officers in the constitutional limitations on the use of deadly force . . . ‘so
obvious,’ that failure to do so could properly be characterized as ‘deliberate indifference’ to constitutional
rights.”); Glisson, 849 F.3d at 382 (holding a jury could find that prison knew for certain its medical
providers would be confronted with patients with chronic illnesses and the need to establish protocols for
the coordinated care of chronic illnesses was so obvious that the provider’s failure to do so could be seen
as deliberate indifference).
Page 21 of 21
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?