United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER
Z. Lee, United States District Judge.
Cordell Williams (“Plaintiff”) is an inmate
incarcerated at Stateville Correctional Center
(“Stateville”) who suffers from Crohn's
disease. He brings this civil rights action pursuant to 42
U.S.C. § 1983 against Defendants LaTanya Williams
(“Ms. Williams”), Liping Zhang (“Dr.
Zhang”), Parthasarathi Ghosh (“Dr. Ghosh”),
Imhotep Carter (“Dr. Carter”), and Wexford Health
Services (“Wexford”), alleging deliberate
indifference to his serious medical needs in violation of the
Eighth Amendment. He seeks monetary damages as well as
injunctive relief. Defendants have filed a motion for summary
judgment. For the reasons stated herein, Defendants'
motion is granted in part and denied in part.
where otherwise noted, the following facts are not in
material dispute. Plaintiff has been incarcerated in various
correctional facilities in Illinois since 1994. See
Defs.' LR 56.1(a)(3) Stmt. ¶ 11, ECF No. 271. In
1998, he was diagnosed with Crohn's disease. Id.
¶ 12. Crohn's disease is chronic inflammatory
disease of the small intestine and colon. Pl.'s LR
56.1(b)(3)(C) Stmt. ¶ 6, ECF No. 281. The symptoms of
Crohn's disease include diarrhea, constipation, bloody
stool, loss of electrolytes, weight loss, abdominal pain,
ulcers, infections, small bowel obstructions, abscesses, and
the formation of fistulas between the bowel and other areas
of the abdomen. Id. It is undisputed that these
symptoms are “very painful.” Id.
April 2009-August 2009: Lapses in Medications upon
Plaintiff's Transfer to Stateville
was transferred to Stateville from another correctional
facility on April 8, 2009. Defs.' LR 56.1(a)(3) Stmt.
¶ 14. As of that date, Ms. Williams, Dr. Zhang, and Dr.
Ghosh were Wexford employees who worked at Stateville.
Pl.'s LR 56.1(b)(3)(B) Stmt. ¶¶ 5, 7-8, ECF No.
280. Ms. Williams was a physician's assistant, Dr. Zhang
was a staff physician, and Dr. Ghosh was the medical
director. Id. At the time of Plaintiff's
transfer, Ms. Williams, Dr. Zhang, and Dr. Ghosh knew that
Plaintiff had Crohn's disease and was taking several
medications. Pl.'s LR 56.1(b)(3)(C) Stmt. ¶ 12.
April 10, 2009, Plaintiff received a supply of medications
for treatment of his Crohn's disease. Defs.' LR
56.1(a)(3) Stmt. ¶ 15. On May 1, 2009, however, his
medications were discontinued. Id. ¶ 16;
Pl.'s LR 56.1(b)(3)(B) Stmt. ¶¶ 16-17. Five
days later, on May 6, 2009, Ms. Williams learned that
Plaintiff was inquiring about the status of his medications.
Defs.' LR 56.1(a)(3) Stmt. ¶ 16. Ms. Williams
confirmed with Dr. Zhang that Plaintiff's medications
should have been continued through September 1, 2009, rather
than discontinued on May 1, 2009, and Ms. Williams
subsequently submitted a new prescription order for Plaintiff
to the pharmacy. Id. ¶ 17; Pl.'s LR
56.1(b)(3)(B) Stmt. ¶ 17. On May 12, 2009, Plaintiff
began receiving his medications again. Defs.' LR
56.1(a)(3) Stmt. ¶ 18.
six weeks later, on June 23, 2009, Plaintiff developed a
headache and passed out in his cell. Id. ¶ 20;
Pl.'s LR 56.1(b)(3)(B) Stmt. ¶ 20. Later that day,
Ms. Williams evaluated him and ordered a treatment plan that
included a prescription for Prednisone, a steroid that
reduces inflammation and is used to treat acute symptoms of
Crohn's disease. Defs.' LR 56.1(a)(3) Stmt.
¶¶ 21-22. According to Plaintiff, however, he never
received the Prednisone. Pl.'s LR 56.1(b)(3)(B) Stmt.
¶¶ 21, 23. He posits that he failed to receive it
because some of his prescription orders and medical records
were listed under the wrong inmate registration number.
Id. ¶ 23; Defs.' LR 56.1(a)(3) Stmt., Ex.
B, Pl.'s Dep., at 54:6-59:10.
9, 2009, Plaintiff was admitted to the Stateville infirmary
due to weight loss and rectal bleeding. Defs.' LR
56.1(a)(3) Stmt. ¶ 24; Pl.'s LR 56.1(b)(3)(B) Stmt.
¶ 24. Dr. Ghosh evaluated Plaintiff and prescribed
Prednisone, Bentyl, Azulfidine, and folic acid for treatment
of his symptoms. Defs.' LR 56.1(a)(3) Stmt. ¶ 24.
Plaintiff claims that, during this evaluation, Dr. Ghosh
learned that some of Plaintiff's medical records were
listed under the incorrect inmate registration number.
Pl.'s LR 56.1(b)(3)(B) Stmt. ¶ 24.
following week, on July 16, 2009, Plaintiff returned to the
infirmary in significant pain. Id. He claims that he
informed Ms. Williams at this time that he was not receiving
his medications. Id. Ms. Williams wrote Plaintiff
another prescription for Prednisone later that day.
Id. Next, around July 23, 2009, Plaintiff returned
to the infirmary again, this time complaining of pain in his
feet and dehydration. Id. He asserts that he still
had not received some of his medications as of this date,
although he does not claim to have informed anyone of that
fact during this visit to the infirmary. See id.
25, 2009, Plaintiff had a check-up appointment with Dr.
Ghosh. Defs.' LR 56.1(a)(3) Stmt. ¶ 25. In addition,
on July 30, 2009, Dr. Zhang evaluated Plaintiff for
complaints of edema. Id. ¶ 26. Based on her
evaluation, Dr. Zhang recommended that Plaintiff be referred
to a gastroenterologist. Id. Such outside referrals
were handled by Dr. Ghosh as Stateville's medical
director. Id. ¶ 27. Later that day, Dr. Ghosh
secured approval for Plaintiff to be evaluated at an outside
facility, and he filled out a Medical Special Services
Referral and Report Form (“Referral Form”) to
refer Plaintiff to a gastroenterologist at the University of
Illinois at Chicago (UIC). Id. ¶ 28.
August 11, 2009, Dr. Zhang learned that Plaintiff had written
a letter to Dr. Ghosh complaining of abdominal cramps and a
lapse in his medications. Id. ¶ 29; Pl.'s
LR 56.1(b)(3)(B) Stmt. ¶ 29. In response, Dr. Zhang
prescribed Bentyl to alleviate Plaintiff's cramps.
Defs.' LR 56.1(a)(3) Stmt. ¶ 29. The prescription
order, however, was written using the wrong inmate
registration number. Pl.'s LR 56.1(b)(3)(B) Stmt. ¶
30. On September 3, 2009, Ms. Williams learned that Plaintiff
had not been receiving his medications. See id.;
Defs.' LR 56.1(a)(3) Stmt. ¶ 30. Accordingly, Ms.
Williams followed up with Stateville's pharmacy.
Defs.' LR 56.1(a)(3) Stmt. ¶ 30. Pharmacy staff told
her that Plaintiff's medications had arrived that day and
would be distributed. See id.
September 2009-April 2010
result of Dr. Zhang's recommendation and Dr. Ghosh's
referral, Plaintiff was evaluated at UIC Gastroenterology by
Dr. Russell Brown (“Dr. Brown”) on September 15,
2009. Id. ¶ 31. Based on his evaluation, Dr.
Brown recommended that Plaintiff stop taking Azulfidine and
start taking Pentasa. Id. He also requested
Plaintiff's medical records. Id.
this initial evaluation at UIC, Dr. Ghosh secured approval
for Plaintiff to return for a second evaluation on October 12
and 13, 2009. Id. ¶¶ 32-33. At this second
evaluation, Plaintiff received a CT scan of his abdomen and
pelvis. Id. ¶ 32. According to Plaintiff, the
CT scan revealed a large inflammatory mass in the lower right
quadrant of his abdomen, but Dr. Brown could not determine
whether the mass was infected or merely inflamed, because
Stateville had failed to provide the medical records that Dr.
Brown had previously requested. Pl.'s LR 56.1(b)(3)(B)
Stmt. ¶¶ 32-33.
on the results of the CT scan, Dr. Brown ordered Plaintiff to
continue his current medications, as well as to start taking
Cipro and Flagyl. Defs.' LR 56.1(a)(3) Stmt. ¶ 33.
Plaintiff asserts that Dr. Brown also ordered a follow-up
appointment with Plaintiff in four weeks so that he could
review Plaintiff's medical records and determine the
appropriate course of treatment for the mass in his abdomen.
See Pl.'s LR 56.1(b)(3)(B) Stmt. ¶ 33;
see also Pl.'s LR 56.1(b)(3)(C) Stmt., Ex. 9, at
¶ 168 (Dr. Brown's medical notes of 10/13/2009).
Defendants point out, however, that the Referral Form
corresponding to Dr. Brown's evaluation on October 12 and
13, 2009, does not specifically request such a follow-up.
Defs.' LR 56.1(a)(3) Stmt. ¶ 33; id., Ex.
L, at 3 (Referral Form for UIC visit of 10/13/2009).
parties dispute whether Dr. Ghosh and Dr. Zhang knew that Dr.
Brown had requested a four-week follow-up appointment with
Plaintiff after evaluating him on October 12 and 13, 2009.
Plaintiff argues that Dr. Ghosh and Dr. Zhang indeed knew
about the request. In support, he points to a medical record
dated October 27, 2009, in which Dr. Ghosh noted that he
needed to schedule a follow-up appointment for Plaintiff with
UIC Gastroenterology. See Pl.'s LR 56.1(b)(3)(B)
Stmt. ¶ 33. Plaintiff also points to a medical record
dated November 19, 2009, in which Dr. Zhang, after examining
Plaintiff and prescribing medication for him, likewise noted
that Plaintiff should be scheduled for a follow-up
appointment at UIC. Id. ¶ 36; see also
Defs.' LR 56.1(a)(3) Stmt. ¶ 36. Dr. Ghosh, however,
testified that he was unaware that Dr. Brown had requested a
follow-up appointment with Plaintiff. Pl.'s LR
56.1(b)(3)(C) Stmt. ¶ 26; Defs.' LR 56.1(a)(3)
Stmt., Ex. C, Ghosh Dep., at 102:2-17. On December 17, 2009,
Dr. Ghosh referred Plaintiff for a follow-up appointment at
UIC. See Defs.' LR 56.1(a)(3) Stmt. ¶ 37.
Dr. Ghosh testified that he scheduled this appointment based
upon his independent determination that an appointment was
appropriate, rather than based upon the request from Dr.
Brown. See id.; Ghosh Dep. at 102:2-23. The
appointment was originally scheduled for March 23, 2010, but
it was later rescheduled for April 13, 2010. Defs.' LR
56.1(a)(3) Stmt. ¶ 37.
Additional Lapses in Medications
addition to delays surrounding the scheduling of his
four-week follow-up at UIC, Plaintiff claims that he
experienced multiple lapses in the receipt of his medications
throughout late 2009 and early 2010. First, around October
24, 2009, Plaintiff stopped receiving Prednisone. Pl.'s
LR 56.1(b)(3)(C) Stmt. ¶ 16. After he filed a grievance,
his Prednisone prescription was restarted on October 29,
2009. Id. Next, on December 17, 2009, Plaintiff
stopped receiving Pentasa. Id. ¶ 17. Plaintiff
again filed a grievance, and his Pentasa prescription was
reinstated about a month later, on January 15, 2010.
Id. On January 26, 2010, Plaintiff again stopped
receiving Prednisone. See Id. ¶ 13.
February 1, 2010, Plaintiff saw Ms. Williams for an
evaluation. Defs.' LR 56.1(a)(3) Stmt. ¶ 38. During
this evaluation, Plaintiff inquired about the status of his
follow-up appointment at UIC, and he informed Ms. Williams
that his Prednisone had been discontinued the previous week.
Id. In response, Ms. Williams checked the status of
Plaintiff's follow-up appointment and advised Plaintiff
that the appointment had already been scheduled.
Id.; Pl.'s LR 56.1(b)(3)(C) Stmt. ¶ 27.
Additionally, that same day, Ms. Williams prescribed him a
two-month supply of Prednisone. Defs.' LR 56.1(a)(3)
Stmt. ¶ 38. Plaintiff began receiving Prednisone again
three days later, on February 4, 2010. Pl.'s LR
56.1(b)(3)(C) Stmt. ¶ 13.
February 9, 2010, Plaintiff submitted a grievance complaining
that some of his prescriptions had not been dispensed.
Id. ¶ 18. Following the submission of this
grievance, Plaintiff's prescription for Pentasa was
restarted on February 17, 2010, and his prescriptions for
Prednisone, folic acid, and iron were restarted on March 25,
2010. Id. Plaintiff also claims that he filed a
grievance on April 7, 2010, to report that his abdomen was in
pain, that he had not been seen in a timely fashion even
though he had submitted multiple sick-call requests, and that
his medications had yet again been discontinued. Id.
April 2010-October 2014: Plaintiff's Surgery and
April 13, 2010, Plaintiff visited UIC Gastroenterology for
his follow-up appointment with Dr. Brown. Defs.' LR
56.1(a)(3) Stmt. ¶ 39. Dr. Brown recommended adjustments
to Plaintiff's medication regime and ordered Plaintiff to
return for further evaluation. Id. Accordingly,
after Dr. Ghosh again secured approval for an outside
referral, Plaintiff returned to UIC on June 9, 2010.
Id. ¶ 40. At that time, Plaintiff's
Crohn's disease was found to be clinically stable.
14, 2010, however, Plaintiff developed an elevated fever and
abdominal pain. See Pl.'s LR 56.1(b)(3)(B) Stmt.
¶ 41. Five days later, on June 19, 2010, he was admitted
to UIC, where he remained as an inpatient for about a month.
Defs.' 56.1(a)(3) Stmt. ¶ 41. During that month,
Plaintiff underwent surgery comprising a small bowel
resection, an ileectomy, and the installation of a colostomy
bag. Id. ¶ 42. Dr. Brown later testified that
the delay between Plaintiff's CT scan in October 2009 and
his follow-up appointment in April 2010 possibly contributed
to the need for surgery. Pl.'s LR 56.1(b)(3)(C) Stmt.,
Ex. 1, Brown Dep., at 83:14- 85:13; see also
Pl.'s LR 56.1(b)(3)(B) Stmt. ¶¶ 39, 41. On July
22, 2010, Plaintiff was discharged from UIC and returned to
Stateville. Defs.' LR 56.1(a)(3) Stmt. ¶ 44.
October 13, 2010, Plaintiff returned to UIC for a
post-surgery follow-up appointment. Id. ¶ 47.
At that time, UIC physicians ordered that Plaintiff start
Remicade infusion treatments at UIC. See Id. Dr.
Robert Carroll (“Dr. Carroll”), a
gastroenterologist who treated Plaintiff at UIC around this
time, testified that a patient starting Remicade infusions
should receive three infusions within the first six weeks of
treatment. See Pl.'s LR 56.1(b)(3)(C) Stmt.
¶ 28; Defs.' LR 56.1(a)(3) Stmt., Ex. G, Carroll
Dep., at 35:14-36:12. He also testified that, after the
initial three infusions, the patient should continue
receiving infusions at least once every eight weeks.
Pl.'s LR 56.1(b)(3)(C) Stmt. ¶ 28; Carroll Dep. at
Dr. Ghosh secured approval for Plaintiff to receive Remicade
treatments at UIC, Plaintiff received his first Remicade
infusion in November 2010. Defs.' LR 56.1(a)(3) Stmt.
¶ 48. He received his second Remicade infusion on
December 9, 2010. Id. ¶ 49. When UIC physicians
sent the Referral Form corresponding to the December 9
appointment back to Stateville, they noted on the form:
“follow up PRN.” Id., Ex. L, at 7
(Referral Form for UIC visit of 12/9/2010). The parties
dispute whether this notation gave Defendants knowledge of
whether and when Plaintiff was to be scheduled for additional
Remicade infusions at UIC.According to Defendants, “follow
up PRN” was an instruction for Stateville medical staff
to simply “follow up as needed, ” and not
necessarily to schedule Plaintiff for additional Remicade
infusions. See Defs.' LR 56.1(a)(3) Stmt. ¶
49. For his part, Plaintiff contends that “follow up
PRN” was an instruction to continue scheduling
Plaintiff for Remicade infusions on a regular basis, given
that Remicade is supposed to be administered every eight
weeks rather than on an irregular, “as needed”
basis. See Pl.'s LR 56.1(b)(3)(B) Stmt. ¶
49. During the next year, Plaintiff was not scheduled for any
additional Remicade infusions. See Id. ¶ 54;
Defs.' LR 56.1(a)(3) Stmt. ¶¶ 49-54.
March 2011, Dr. Ghosh left his position as Stateville's
medical director. Pl.'s LR 56.1(b)(3)(B) Stmt. ¶ 5.
Dr. Carter took over as Stateville's medical director in
July 2011. Id. ¶ 6. In September 2011, Dr.
Carter learned that Plaintiff was complaining about the lapse
in his Remicade treatments. Defs.' LR 56.1(a)(3) Stmt.
¶ 53. In response, on September 22, 2011, Dr. Carter
secured approval to refer Plaintiff for an appointment at UIC
on December 1, 2011. Id. ¶ 54. He noted on the
Referral Form for this appointment that Plaintiff's
Remicade treatments had been interrupted since December 2010.
Pl.'s LR 56.1(b)(3)(B) Stmt. ¶ 54. Accordingly, on
December 1, 2011, Plaintiff went to UIC and received a
Remicade infusion for the first time in approximately one
year. See Defs.' LR 56.1(a)(3) Stmt. ¶ 55.
When UIC physicians returned Plaintiff's Referral Form
for this appointment to Stateville, they noted: “Dr.
Carroll strongly recommends that [Plaintiff] receive Remicade
infusions per ...