MIDDLETON v. WEXFORD OF INDIANA et al
ORDER GRANTING DEFENDANTS' MOTION FOR SUMMARY JUDGMENT AND DIRECTING ENTRY OF FINAL JUDGMENT - The defendants' motion for summary judgment, dkt. 34 , is granted. Judgment consistent with this Entry shall now issue. Copy to plaintiff via US Mail. Signed by Judge James Patrick Hanlon on 9/7/2021. (KAA)
Case 2:20-cv-00110-JPH-MJD Document 55 Filed 09/07/21 Page 1 of 10 PageID #: 332
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
TERRE HAUTE DIVISION
JASON M. MIDDLETON,
WEXFORD OF INDIANA,
ORDER GRANTING DEFENDANTS' MOTION FOR SUMMARY JUDGMENT
AND DIRECTING ENTRY OF FINAL JUDGMENT
Plaintiff Jason M. Middleton, an Indiana inmate, brought this action under
42 U.S.C. § 1983 alleging that Dr. Franco and Wexford of Indiana, LLC (Wexford)
violated his Eighth Amendment rights by delaying necessary dental treatment
and enacting policies that caused the delay, respectively. Dkt. 1, 7. Defendants
filed a motion for summary judgment which is now fully briefed. Dkt. , 46,
48, 51, 52. Because there is no genuine issue of material fact as to the claims
asserted, Defendants' motion for summary judgment is GRANTED.
Summary Judgment Standard
Summary judgment shall be granted "if the movant shows that there is no
genuine dispute as to any material fact and the movant is entitled to judgment
as a matter of law." Fed. R. Civ. P. 56(a). A "material fact" is one that "might affect
the outcome of the suit." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
(1986). The moving party must inform the court "of the basis for its motion" and
specify evidence demonstrating "the absence of a genuine issue of material fact."
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Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). Once the moving party meets
this burden, the nonmoving party must "go beyond the pleadings" and
identify "specific facts showing that there is a genuine issue for trial." Id. at 324.
The Court views the facts in the light most favorable to the non-moving party
and all reasonable inferences are drawn in the non-movant's favor. Barbera v.
Pearson Educ., Inc., 906 F.3d 621, 628 (7th Cir. 2018).
A dispute about a material fact is genuine only "if the evidence is such that
a reasonable jury could return a verdict for the nonmoving party." Anderson, 477
U.S. at 248. If no reasonable jury could find for the non-moving party, then there
is no "genuine" dispute. Scott v. Harris, 550 U.S. 372, 380 (2007).
Facts and Background
A. The Parties
At all times relevant to the complaint, Mr. Middleton was an Indiana
Department of Correction (IDOC) inmate housed at the Putnamville Correctional
Miguel Franco, D.D.S. is a dentist employed by Wexford at Putnamville.
Dkt. 36-2 ⁋⁋ 1-2 (Affidavit of Miguel Franco, DDS).
Wexford of Indiana, LLC is the entity with whom the IDOC contracted to
provide medical services to inmates. Dkt. 36-3 at ⁋ 7 (Affidavit of Dr. Michael
Mr. Middleton's Dental Issues
Prior to Dr. Franco's arrival at Putnamville on October 28, 2019,
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Putnamville had been without a full-time dentist for several months. Dkt. 36-2,
⁋ 8. Dr. Tyler was serving as a part-time dentist seeing patients at the facility for
acute dental needs. Id. When Dr. Franco started at Putnamville, there were still
numerous inmates in need of evaluations and treatment. Id.
In September and October 2019, Mr. Middleton submitted Health Care
Request forms complaining about two broken teeth that were causing him pain.
Dkt. 36-1 at 2 (Dental Records); dkt. 36-5 at 22:18-23:5 (Middleton's
Deposition). 1 In response, x-rays were taken on October 10, 2019. Dkt. 36-1 at
2. The x-rays showed that tooth #2 had decay into the nerve and that another
tooth might be restorable. Id. The Dental Records show that 20 Naproxen pills
were dispensed to Mr. Middleton for pain on October 31, 2019. Id. at 1.
Dr. Franco saw Mr. Middleton for the first time on November 15, 2019.
Dkt. 36-2 at ⁋ 9. During this visit, Mr. Middleton complained of pain in the area
of tooth #2 (which is his upper right side) and teeth #28 and #29 on his lower
right side. Id. Dr. Franco believed that while teeth #28 and #29 were decayed,
they could be restored. Id. Tooth #2, however, was beyond restoration and
required extraction. Id. After obtaining Mr. Middleton's consent, Dr. Franco
extracted tooth #2 on that same day. Id. Dr. Franco informed Mr. Middleton that
he would be scheduled to return for the fillings of tooth #28 and #29 within six
weeks. Id.; dkt. 36-5:34:18-25.
Mr. Middleton provides no legal authority in support of his request to "strike" his
deposition nor does he designate evidence supporting the statement that "it may not
be accurate, or complete". Dkt. 46 at 5. Accordingly, his request to strike is denied.
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Mr. Middleton returned on November 19, 2019, to have fillings put into
teeth #28 and #29. Dkt. 36-2 at ⁋ 11. After this appointment, Mr. Middleton's
teeth stopped hurting. Dkt. 36-5 at 44:5-8.
A few weeks later, December 31, 2019, Dr. Tyler performed a cavity
restoration on tooth #24. Dkt. 36-3 at ⁋ 12.
Mr. Middleton testified that he lost 75 pounds between September 21 and
November 14, 2019. Dkt. 36-5 at 14:8-10; 16:8-22. Medical records, however,
show that Mr. Middleton was approximately the same weight on September 17,
2019 (160 pounds), and on December 12, 2019 (167 pounds). Dkt. 36-2 at ⁋ 20.
Mr. Middleton explained that there was no discrepancy between his testimony
and the medical records. Rather, he gained 77 pounds between November 14
and December 12. Dkt. 36-5 at 16:20-22.
Dr. Franco never observed that Mr. Middleton was unnaturally thin, nor
did he appear malnourished or dehydrated. Dkt. 36-2 at ⁋ 18. Dr. Franco is not
aware of any medical possibility that a patient could lose 75 pounds in a matter
of weeks, and in a few weeks thereafter regain all that weight. Id. at ⁋ 21.
Dr. Michael Mitcheff was employed by Wexford as the Regional Medical
Director at all relevant times. Dkt. 36-3 at ⁋ 2. 2 It is his professional opinion that
it is "nearly impossible" to have weight fluctuations of 70-80 pounds over a few
months. Id. ⁋ 12. Even extreme levels of weight losses and gains would be more
Mr. Middleton's objection to Dr. Mitcheff's testimony on the basis that he believes
Dr. Mitcheff is a liar and has been disrespectful and unprofessional in the past, is
overruled because his alleged "previous history" with Dr. Mitcheff, dkt. 46 at 3, is not
basis to disqualify him as a witness. See Fed.R.Evid. 701 and 702.
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in the range of 20-25 pounds. Id. Based on Dr. Mitcheff's review of medical
records dating from September 2019 through January 2020, Mr. Middleton
complained of dental pain and losing weight. Id. ⁋ 13. None of the records reflect
the drastic weight loss alleged by Mr. Middleton. Id.
IDOC Healthcare Services Directives Policy 2.33A on "acceptable wait
times" states that after a referral, a patient with routine dental needs must be
evaluated within six weeks. Dkt. 36-2 at ⁋ 25; dkt. 36-4. Policy 2.33A was not
created by Wexford but already existed when Wexford began its contract with
the IDOC. Dkt. 36-3 at ⁋ 7. Nothing in Policy 2.33A prohibits medical staff from
scheduling a patient for more urgent care as deemed necessary. Id. at ⁋ 8. And
patients who have emergencies or acute dental needs are to be seen as soon as
possible. Id. at ⁋ 6. Wexford staff are required to comply with the policy to the
extent possible. Id. at ⁋ 7.
Mr. Middleton argues that the Defendants were deliberately indifferent to
his serious dental needs. At all relevant times, Mr. Middleton was a convicted
offender so the Eighth Amendment applies to his deliberate indifference claims.
Estate of Clark v. Walker, 865 F.3d 544, 546, n.1 (7th Cir. 2017).
The Eighth Amendment "standard encompasses both an objective and
subjective element: (1) the harm that befell the prisoner must be objectively,
sufficiently serious and a substantial risk to his or her health or safety, and
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(2) the individual defendants were deliberately indifferent to the substantial risk
to the prisoner's health and safety." Eagan v. Dempsey, 987 F.3d 667, 693 (7th
Cir. 2021) (internal quotation omitted); Farmer v. Brennan, 511 U.S. 825, 837
(1994); Walker v. Wexford Health Sources, Inc., 940 F.3d 954, 964 (7th Cir. 2019).
"A 'serious' medical need is one that has been diagnosed by a physician as
mandating treatment or one that is so obvious that even a lay person would
easily recognize the necessity for a doctor's attention." Eagan, 987 F.3d at 695
(internal quotation omitted). The subjective standard "requires more than
negligence and approaches intentional wrongdoing." Goodloe v. Sood, 947 F.3d
1026, 1030 (7th Cir. 2020) (internal quotation omitted). Even a showing of
medical malpractice is not sufficient. Id. "Rather, the evidence must show that
the prison official . . . knew or was aware of—but then disregarded—a substantial
risk of harm to an inmate's health." Id.
The Defendants argue that they are entitled to summary judgment
because Mr. Middleton has not designated evidence showing that they were
deliberately indifferent to Mr. Middleton's dental needs.
Claim Against Dr. Franco
Mr. Middleton claims Dr. Franco was deliberately indifferent when he told
him that he would have to wait six weeks after having tooth #2 extracted for
treatment of the two other teeth that were bothering him.
To determine if a prison official acted with deliberate indifference, we "'look
into [the official's] subjective state of mind.'" Eagan, 987 F.3d at 695 (quoting
Petties v. Carter, 836 F.3d 722, 728 (7th Cir. 2016)). "Even objective
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recklessness—failing to act in the face of an unjustifiably high risk that is so
obvious that it should be known—is insufficient to make out a claim." Petties,
836 F.3d at 728. "Instead, the Supreme Court has instructed us that a plaintiff
must provide evidence that an official actually knew of and disregarded a
substantial risk of harm." Id.
Mr. Middleton has presented no evidence from which a reasonable jury
could infer that Dr. Franco knew of and ignored a substantial risk of serious
harm. Rather, the undisputed record shows that Dr. Franco extracted tooth # 2
on November 15, 2019, and that four days later he filled cavities in two other
teeth that were causing Mr. Middleton pain.
To the extent Mr. Middleton alleges that he lost and later regained 75
pounds in a matter of months because of dental pain, the designated evidence
does not support this claim. Mr. Middleton's Health Care Request forms on which
he allegedly documented weighing himself every day from September through
December 2019, are not in the record. Moreover, his handwritten notes that
allegedly show his weight fluctuating 20 pounds from one day to the next in
December 2020, dkt. 46-1 at 5, are not authenticated and therefore not
And two physicians have opined that such an extreme
fluctuation in weight would not be possible.
Even if Mr. Middleton had lost significant amounts of weight, there is no
designated evidence showing that Dr. Franco was aware of such weight loss. No
reasonable jury could find that Dr. Franco "actually knew of and disregarded a
substantial risk of harm," Petties, 836 F.3d at 728, relating to weight loss.
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For these reasons, Dr. Franco is entitled to summary judgment.
Claim Against Wexford
Although a private entity, Wexford acts under color of state law and
therefore may be liable for violating Mr. Middleton's Eighth Amendment rights
under Monell v. Dep't of Soc. Servs., 436 U.S. 658 (1978). See Walker, 940 F.3d
at 966. "Prevailing on such a claim requires evidence that a Wexford policy,
practice, or custom caused" the deliberate indifference. Id. To prevail on a Monell
claim, "a plaintiff must ultimately prove three elements: (1) an action pursuant
to a municipal [or corporate] policy, (2) culpability, meaning that policymakers
were deliberately indifferent to a known risk that the policy would lead to
constitutional violations, and (3) causation, meaning the municipal [or corporate]
action was the 'moving force' behind the constitutional injury." Hall v. City of
Chicago, 953 F.3d 945, 950 (7th Cir. 2020).
Here, Mr. Middleton has not established that Wexford's policy permitted a
six-week wait time for routine dental care. Rather, the wait time was pursuant
to an IDOC policy that Wexford medical staff were expected to follow. Even if it
had been Wexford's policy, however, Mr. Middleton has not shown that such a
policy violated his constitutional rights because it was not applied to Mr.
Middleton in November 2019. Instead, Dr. Franco treated Mr. Middleton's three
problematic teeth over a period of four days.
Mr. Middleton argues that Wexford and Dr. Franco "misused" the six-week
policy by marking patients' needs as "routine" when they were actually "acute,"
thereby providing cover for not scheduling them sooner. Dkt. 46 at 11-13. But
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Mr. Middleton has not presented evidence that this occurred. A party opposing
summary judgment must "respond to the moving party’s properly-supported
motion by identifying specific, admissible evidence showing that there is a
genuine dispute of material fact for trial." Grant v. Trs. of Ind. Univ., 870 F.3d
562, 568 (7th Cir. 2017). Inferences supported only by speculation or conjecture
will not suffice. Skiba v. Ill. Cent. R. R. Co., 884 F.3d 708, 721-22 (7th Cir. 2018).
No reasonable jury could find that Wexford had a policy that caused a
denial of necessary treatment to Mr. Middleton. See Thomas v. Martija, 991 F.3d
763, 774 (7th Cir. 2021) (affirming grant of summary judgment in favor of
Wexford where no individual defendant was liable and where plaintiff presented
no evidence of a policy not to provide adequate care).
For the reasons discussed above, the defendants' motion for summary
judgment, dkt. , is granted. Judgment consistent with this Entry shall now
JASON M. MIDDLETON, 158480
727 Moon Road
Plainfield, IN 46168
Case 2:20-cv-00110-JPH-MJD Document 55 Filed 09/07/21 Page 10 of 10 PageID #: 341
Douglass R. Bitner
KATZ KORIN CUNNINGHAM, P.C.
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