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Perez v. Talbot

United States District Court, Seventh Circuit

January 23, 2014

FRANCISCO PEREZ, ID#B-78905, Plaintiff,
PAUL TALBOT, M.D., Defendant.


COLIN S. BRUCE, District Judge.

Pro Se Plaintiff Francisco Perez, an inmate at Danville Correctional Center in Danville, Vermilion County, Illinois, filed a Complaint (#1) on March 27, 2012, alleging, pursuant to 42 U.S.C. ยง 1983, that Defendant Paul Talbot, M.D., was deliberately indifferent to Plaintiff's serious medical needs. Defendant filed a Motion for Summary Judgment (#42) on August 9, 2013. Plaintiff filed his Response (#45) on September 4, 2013, and Defendant filed his Reply (#48) on October 7, 2013. On November 14, 2013, Plaintiff filed a Sur-Reply (#49) to Defendant's Reply (#48). Defendant filed a Motion to Strike (#50) the Sur-Reply on December 2, 2013. Plaintiff filed a Response to the Motion to Strike (#51). For the following reasons, Defendant's Motion to Strike (#50) is DENIED, but Defendant's Motion for Summary Judgment (#42) is GRANTED.


Plaintiff is an inmate of the Illinois Department of Corrections at the Danville Correctional Center (DCC). Defendant is a physician licensed to practice medicine in the State of Illinois and was employed by Wexford Health Sources, Inc. (Wexford) as the medical director at the DCC at all times relevant to Plaintiff's Complaint. On July 14, 2011, Plaintiff was playing basketball and injured his left knee. Plaintiff went to the health care unit and was seen by Registered Nurse Steve White. Nurse White's note on the Offender Injury Report indicated that there was no swelling in Plaintiff's left knee, no indication of discoloration, and the knee had full range of motion. Nurse White advised Plaintiff to ice the joint and provided Plaintiff Motrin. Nurse White told Plaintiff to return if there was an increase in pain or swelling. On July 15, 2011, Defendant reviewed Nurse White's note and concluded that Plaintiff should return as needed.

Plaintiff saw Nurse Miles on July 20, 2011, and Miles' progress note indicates that Plaintiff's left knee was swollen. No bony abnormalities or deformities were noted and Plaintiff had full range of motion. Plaintiff was able to bear his own weight. He was given Advil, warm compresses, and scheduled for an x-ray on his left knee. X-rays were taken on July 22, 2011. According to the radiology report, the two views of the left knee revealed normal bony alignment. There was no acute regional bony fracture or discoloration. Minor early degenerative changes were seen. On July 23, 2011, Plaintiff was seen by a nurse practitioner regarding acid reflux disease. No mention was made in the nurse's notes of Plaintiff discussing his knee. On July 29, 2011, a nurse advised Plaintiff that x-ray results were negative and allowed him to return to work. Plaintiff was instructed to return as needed for medical attention. Plaintiff saw nurses twice in August 2011 for issues other than his knee. On September 1, 2011, he saw Nurse Daily for nasal congestion, but Daily's report noted that Plaintiff's knee x-rays showed minor degenerative changes and that Plaintiff refused an Ace bandage and analgesic balm.

Plaintiff first saw Defendant for complaints regarding his left knee on September 2, 2011. Defendant reviewed the x-rays of Plaintiff's knee which showed, at best, early minor osteoarthritis. After a physical exam, Defendant noted, among other things, that Plaintiff's left quadriceps, hamstring, and calf showed no signs of atrophy, a mild limp, very minimal knee effusion, no tenderness in the peripatellar, no patellar tracking problems, and mild mid-popliteal tenderness. Plaintiff had a full range of motion. Plaintiff responded to the Valgus stress test on his left knee with complaints of medial pain. The test was performed only at full extension. After conducting a series of other tests, Defendant concluded that Plaintiff's knee pain was suggestive, at most, of an MCL ligament strain. Defendant identified no sign of a full or partial tear of the MCL. Defendant prescribed Naproxen, a left knee sleeve, and ordered that Plaintiff be scheduled for follow-up at the doctor's sick call in thirty days. Defendant noted that the Valgus stress test was to be repeated at both full extension and twenty-five degree flexion. Plaintiff was also provided education and counseling and advised to avoid stress to the knee such as physical contact sports.

Defendant saw Plaintiff for a follow up visit on October 3, 2011, for Plaintiff's complaints relating to his left knee. During this examination, Plaintiff was stable, in no apparent distress, able to ambulate satisfactorily (though with an antalgic gait), and had good activities of daily living. Defendant noted that Plaintiff stated the Naproxen had helped. Defendant noted no obvious deformities and concluded that Plaintiff had full range of motion in his knees. Plaintiff tested positive on the Valgus stress test at full extension and at thirty degrees flexion of the left knee. After concluding a series of other tests and assessments, Defendant concluded that Plaintiff had a left MCL injury. He renewed Plaintiff's prescription for Naproxen and provided Plaintiff with MCL exercises. He also ordered that Plaintiff be scheduled for a follow up visit in thirty days. Plaintiff testified at his deposition that he was still in pain during the October visit and requested Defendant order him to receive a magnetic resonance imaging (MRI) scan for his left knee.

On November 3, 2011, Defendant saw Plaintiff for his follow up visit. Defendant noted that Plaintiff walked with a normal gait, had full flexion extension and active movement of the left knee, which had no swelling. He also noted that Plaintiff had no new complaints regarding his left knee. Defendant concluded that Plaintiff's left knee strain had improved. Plaintiff was provided education and counseling and continued to have the left knee sleeve. Otherwise, as his condition had improved, no new orders were entered by Defendant regarding Plaintiff's prior complaints of left knee pain. Plaintiff stated, during his deposition, that on this last visit his knee was still somewhat swollen and he continued to request an MRI.

Defendant discussed the MCL in his declaration, which was attached as part of Exhibit 2 to Defendant's Motion for Summary Judgment (#42). The MCL is located on the inner side of the knee and provides stability to the knee joint. The initial treatment for most MCL injuries focuses on reducing the pain and inflammation in the knee while immobilizing the knee to keep it stabilized. The decision to recommend a specific test, such as an MRI, is determined by whether or not the patient's symptoms and presentation suggest a medical need for such test to determine whether a specific course of treatment might be beneficial for the patient. An MRI is not a treatment modaility. Typically, an MRI is utilized only if surgical intervention is being considered. It is one of a number of tests that can be ordered to obtain more information about a person's condition, and may provide guidance or assistance when determining one treatment plan versus another.

In Plaintiff's case, in Defendant's personal opinion, based on his education, training, and experience, an MRI was not required to confirm or reject the severity of Plaintiff's injury, or whether his knee sprain had improved. Defendant claims an MRI would be an unnecessary test, based upon his clinical assessment of Plaintiff's condition, and Defendant would not have recommended surgical intervention or any course of treatment different from what he did provide. Based upon Defendant's clinical assessment of Plaintiff and in his professional opinion, again based on his education, training, and experience, Plaintiff was not, and is not, a surgical candidate for his non-specific knee sprain.

Defendant stated, in his declaration, that all of the care and treatment he provided to Plaintiff was based on Defendant's medical judgment, education, experience, and training. Defendant declared that, while under Defendant's care at DCC, Plaintiff received all care that was medically necessary.

From November 3, 2011 (his last visit with Defendant) through December 12, 2012 (the date of his deposition), Plaintiff had not made any further requests to see Defendant regarding his left knee. Plaintiff is familiar with the sick call request procedure at the DCC, and medical staff would have seen Plaintiff for further complaints regarding his left knee after November 3, 2011, had Plaintiff made a sick call request. According to Plaintiff's medical records, on May 31, 2013, Plaintiff was seen by Nurse White for reported swelling on his knee. According to the note, Nurse White concluded that the swelling was minor and that there was no need for a referral to the doctor. Thus, Defendant did not see or treat Plaintiff at that time. Plaintiff was provided education and pain medication.

Procedural History

Plaintiff filed his Complaint (#1) on March 27, 2012. Count I of Plaintiff's Complaint was captioned: "Defendant Paul Talbot Has Denied the Plaintiff Medical Treatment for a Injured Knee Wheres His Action Are With Deliberate Indifference." Plaintiff alleges he injured his knee on July 7, 2011, and it was not until August 5, 2011 that he was able to see Defendant. Plaintiff alleges that at that time "Defendant was not trying to hear anything Plaintiff was saying and this is a problem throughout [DCC]." Plaintiff also alleges there is a problem with the x-ray machine at DCC and that Defendant knows about the problem, but still allows Plaintiff to walk around with pain and suffering. Plaintiff alleges that Defendant told him to leave his office despite Plaintiff trying to make Defendant aware of the extent of his injury. Plaintiff claims he has requested an MRI, which would reveal injuries to his knee, but that Defendant continues to deny his request. Plaintiff claims he has filed grievances with the DCC on this issue. Plaintiff concludes that: "[t]he improper screening and examination and denial of any treatment and diagnose which were ...

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