United States District Court, S.D. Illinois
REONA J. DALY UNITED STATES MAGISTRATE JUDGE.
Bishara Thomas, an inmate in the custody of the Illinois
Department of Corrections (“IDOC”), brings this
action under 42 U.S.C. §1983 alleging his constitutional
rights were violated while he was incarcerated at Menard
Correctional Center. In particular, Plaintiff alleges he has
been denied adequate medical treatment for his hiatal hernia,
causing him to suffer severe abdominal pain and bloating.
Plaintiff is proceeding on an Eighth Amendment deliberate
indifference claim against Dr. John Trost, Dr. Steve Ritz,
and Wexford Health Sources, Inc. (“Wexford”).
Defendant Jeff Hutchinson, the current warden at Menard, is
named in his official capacity to carry out any injunctive
relief, if necessary.
matter is now before the Court on the Motion for Summary
Judgment filed by Defendants Dr. Trost, Dr. Ritz, and Wexford
(Doc. 129), and the Motion for Summary Judgment filed by
Defendant Hutchinson (Doc. 131). For the reasons set forth
below, the Motion filed by Dr. Trost, Dr. Ritz, and Wexford
is GRANTED IN PART AND DENIED IN PART, and
the Motion filed by Hutchinson is DENIED.
Thomas has been incarcerated at Menard Correctional Center
since 2005 (Deposition of Bishara Thomas, Doc. 130-5, p. 2).
Since 2009, Thomas has suffered chronic, severe pain, which
he describes as tightness or pressure in the upper area of
his stomach, as well as pain and constipation in his lower
abdomen (Id. at 3, 21). By 2013 or 2014, the pain
intensified, rising to about a ten on a ten-point scale
(Id. at 3).
first reported complaints of stomach pain and constipation on
November 4, 2009 during a visit to Nurse Sick Call
(Deposition of Dr. Trost, Doc. 136-2, p. 17; see
Plaintiff Thomas' Medical Records, Doc. 130-1, pp. 1-2).
The nurse did not refer Thomas to a physician, but provided
him with Metamucil and Maalox and ordered that he be on a
twenty-four hour liquid diet (Id.). Throughout the
remainder of 2009 and 2010 Thomas was regularly evaluated for
complaints of abdominal pain (Doc. 136-2 at 18-20;
see Doc. 130-1 at 3-14). Thomas underwent laboratory
testing and x-rays of his chest and abdomen, and received
prescriptions for Bentyl, a medication used to treat bowel
problems, Milk of Magnesia, a laxative and antacid, and
Colace, a stool softener used to treat constipation
(Id.). There is no evidence demonstrating any
treatment or evaluation of Thomas' complaints in 2011.
was seen on May 27, 2012 for complaints of abdominal pain
during Nurse Sick Call (Doc. 136-2 at 20; see Doc.
130-1 at 15). Thomas was seen for similar complaints of pain
throughout 2013, for which he received a prescription for
Zantac, a medication used to block the release of acid into
the stomach, Milk of Magnesia, Fibercon, a laxative used to
treat constipation, and Protonix, a protein pump inhibitor
used to treat Gastroesophageal reflux disease
(“GERD”) (Doc. 136-2 at 20-24; see Doc.
130-1 at 16-38).
Dr. Trost, the Medical Director at Menard, first saw Thomas
on December 30, 2013, wherein Thomas complained of epigastric
pain (Affidavit of John Trost, M.D., Doc. 130-2, ¶¶
2, 5; see Doc. 130-1 at 39). Dr. Trost conducted a
physical examination and found Thomas' abdomen was flat,
soft, and non-tender; however, he referred Thomas for an
ultrasound of his gallbladder for further evaluation (Doc.
130-2 at ¶ 5; see Doc. 130-1 at 39). The
ultrasound referral was approved and it was completed on
February 6, 2014 (see Doc. 130-1 at 40-42). The
ultrasound findings were normal and there was no evidence of
cholelithiasis or cholecystitis (Doc. 130-2 at ¶ 6;
see Doc. 130-1 at 42).
was again evaluated for complaints of abdominal pain or
pressure on March 12 and March 15, 2014 (Doc. 130-2 at
¶¶ 7-8; see Doc. 130-1 at 43-45). On March
15, 2014, a non-party physician conducted a physical
examination that was unremarkable and issued Thomas a
prescription for Reglan, a medication used to treat
complaints of heartburn, nausea and vomiting, and Zantac
(Doc. 130-2 at ¶ 8; see Doc. 130-1 at 45).
After Thomas followed-up again with a nurse on April 17,
2014, he was referred to Dr. Trost for another evaluation
(Doc. 136-2 at 25).
Trost conducted a physical examination of Thomas on April 23,
2014 (Doc. 130-2 at ¶ 9; see Doc. 130-1 at 46).
His assessment was that of peptic ulcer disease or gastritis
(Doc. 136-2 at 25; see Doc. 130-1 at 46). Dr. Trost
ordered a stool check for the Helicobacter pylori (“H.
Pylori”) antigen, and prescribed Thomas Protonix (Doc.
130-2 at ¶ 9; see Doc. 130-1 at 46). Thomas was
to return in two weeks (Id.).
agreed to provide a stool sample for the H. Pylori screen on
May 28, 2014 (Doc. 130-2 at ¶ 11; see Doc.
130-1 at 48). The results of the screening were negative
(Doc. 130-2 at ¶ 11; see Doc. 130-1 at 49).
was not seen again for complaints of abdominal pain and
related symptoms until July 23, 2014, although he was
regularly seen in the interim for other conditions (Doc.
130-2 at ¶¶ 12-21; see Doc. 130-1 at
50-65). After performing an unremarkable physical examination
on July 23, 2014, the nurse issued Thomas a prescription for
Prilosec (Doc. 130-2 at ¶ 21; see Doc. 130-1 at
65). Thomas saw the same nurse again on September 3, 2014,
complaining of epigastric distress and heartburn (Doc. 130-2
at ¶ 5; see Doc. 130-1 at 65). The nurse
ordered an x-ray of Thomas' abdomen, an updated H. Pylori
screening, and prescribed him Milk of Magnesium and Fibercon
(Doc. 130-2 at ¶ 23; see Doc. 130-1 at 65). The
abdominal x-ray revealed a mild degree of stool in the colon
and non-specific distention in the loops of the small bowel,
which could indicate early ileus, or intestinal obstruction
(Doc. 130-2 at ¶ 24; see Doc. 130-1 at 67).
During his follow-up visit on September 5, 2014, the nurse
ordered a comprehensive metabolic panel (“CMP”),
complete blood count (“CBC”), and an updated H.
Pylori screening (Doc. 130-2 at ¶ 25; see Doc.
130-1 at 68). The blood testing produced unremarkable
results, including a negative screening for H. Pylori (Doc.
130-2 at ¶ 25; see Doc. 130-1 at 69-70).
saw Dr. Trost again on September 17, 2014, to address his
complaints of epigastric pain (Doc. 130-2 at ¶ 26;
see Doc. 130-1 at 71). Dr. Trost conducted a
physical examination and diagnosed Thomas with non-specific
abdominal pain (Id.). Dr. Trost issued Thomas a
prescription for Prilosec and Colace and requested that he
return for re-examination in six weeks (Id.). During
his follow-up exam with Dr. Trost on October 29, 2014, Thomas
continued to complain of epigastric pain with some nausea,
and reported the Prilosec was ineffective (Doc. 130-2 at
¶ 29; see Doc. 130-1 at 74). Dr. Trost again
assessed Thomas as suffering from non-specific abdominal pain
and issued Thomas a prescription for Lactulose, a laxative
used to treat constipation (Id.). Dr. Trost referred
Thomas to collegial for referral to receive a CT scan of his
abdomen and for examination by a gastrointestinal specialist
Trost presented Thomas' case in collegial on October 30,
2014 to Dr. Ritz, Wexford's Corporate Utilization
Management Director (Doc. 130-2 at ¶ 30; see
Doc. 130-1 at 75). Dr. Ritz did not authorize the referrals,
indicating that more information was needed before an outside
consultation could be considered (Doc. 130-2 at ¶ 30;
see Doc. 130-1 at 75-76). Dr. Trost's proposed
referrals were again discussed with Dr. Ritz during collegial
on November 6, 2014 (Doc. 130-2 at ¶ 31; see
Doc. 130-1 at 77-78). During collegial, Thomas' recent
bloodwork and weight were discussed (Id.). Dr. Ritz
did not approve the request for a CT scan or evaluation with
a gastrointestinal specialist; rather, he recommended that
Thomas continue to receive conservative treatment onsite
(Id.). An x-ray of Thomas' abdomen was taken on
November 7, 2014, which revealed a moderate degree of stool
in the colon (Doc. 130-2 at ¶ 32; see Doc.