United States District Court, S.D. Illinois
CARLOS A. MONTANEZ, Plaintiff,
DR. JOHN TROST, WEXFORD HEALTH SOURCES, INC. and DR. STEPHEN RITZ, Defendants.
MEMORANDUM AND ORDER
ROSENSTENGEL, CHIEF JUDGE:
matter is before the Court on an Amended Report and
Recommendation of United States Magistrate Judge Mark A.
Beatty (Doc. 202), which recommends that the Motion for
Summary Judgment filed by Defendants Dr. Stephen Ritz, and
Wexford Health Sources, Inc. (Doc. 174) be granted in part
and denied in part. The Amended Report and Recommendation was
entered on May 22, 2019 (Doc. 202). On May 31, 2019, Montanez
filed an objection (Doc. 206). On June 4, 2019, Dr. Ritz
filed an objection (Doc. 215). That same day, Wexford filed a
response to Montanez's objection (Doc. 216). For the
reasons set forth below, the Court adopts the Report and
an inmate of the Illinois Department of Corrections,
complains of conduct that took place while he was
incarcerated at Menard Correctional Center. Montanez alleges
that he was assaulted by an inmate at Menard and then taken
to a local hospital until he was transferred to Barnes-Jewish
Hospital in St. Louis, Missouri (“Barnes”) for
treatment. While at Barnes, medical personnel diagnosed
Montanez with multiple fractures on the right side of his
face (Doc. 145-5, p. 9). On October 8, 2015, Montanez was
discharged from Barnes with a recommendation to consult
Ophthalmology for “possible blunt trauma to the
globe.” (Doc. 140-1, p. 2). He was also discharged with
instructions to have a CT scan to diagnose further injuries
and make follow-up appointments to be seen by the
Ophthalmology Clinic at Barnes within two to three weeks and
the Plastic Surgery Clinic at Barnes within one week (Doc.
145-5, p. 15).
his discharge on October 8th, Montanez was transferred to
Menard's Health Care Unit (“HCU”), where Dr.
Trost assumed responsibility for his care (Doc. 145-3, p. 8).
On October 14, 2015, Dr. Hager, a medical professional at
Menard, evaluated Montanez and agreed with the recommendation
from Barnes that Montanez needed follow-up care (Id.
at p. 15; Doc. 180-1). Montanez also reported experiencing
blurry vision, pain, nausea, difficulty with eye movement,
and double and quadruple vision (“diplopia”)
(Docs. 140-2, 140-3, 140-5). Dr. Trost then recommended that
Montanez be seen by an ophthalmologist and Dr. Ritz, a
physician working for Wexford Health Sources, Inc.
(“Wexford”), approved the recommendation (Docs.
140-2, 140-3, 140-4).
November 5, 2015, Menard personnel scheduled an appointment
for Montanez to be seen by Dr. Mark Nekola, an
ophthalmologist with Quantum Vision, on November 24, 2015
(Doc. 140-2). Dr. Nekola evaluated Montanez and provided the
following assessment: “Mr. Montanez gives conflicting
symptoms but I do think he has an orbital floor fracture on
the left side. There is no restriction to movement on exam.
That said I would have an ENT take a look at x rays/scans to
decide if it needs repair.” (Id. at p. 13).
November 25, 2015, in accordance with Dr. Nekola's
recommendation, Dr. Trost wrote a request for Montanez to be
seen by an ENT, and the request was approved by Dr. Ritz
(Doc. 140-2). The ENT declined to see Montanez, however, and
recommended that he be seen by a plastic surgeon instead
(Doc. 140-3, p. 5; Doc. 140-5).
December 7, 2015, Menard medical personnel scheduled an
appointment with Plastic Surgery Consultants for Montanez to
be evaluated on December 17, 2015 (Doc. 140-2). Dr. Richard
Hehmann, a plastic surgeon employed at Plastic Surgery
Consultants, evaluated Montanez and recommended that he be
seen by an oculoplastic surgeon to determine whether his
double vision would benefit from surgery (Doc. 140-7).
Trost then requested a referral for an outside specialist,
which Dr. Ritz approved on January 6, 2016 (Doc. 140-2).
Menard's scheduling office had difficulty scheduling the
appointment because outside providers refused to treat
Montanez (Doc. 140-2, p. 16). Dr. Trost again requested a
referral for an outside specialist, which Dr. Ritz approved
on January 15; the Menard scheduling office then made an
appointment for Montanez to be seen by an ophthalmologist
February 1, an ophthalmologist evaluated Montanez, noted that
he was experiencing diplopia in all directions except with
his straight forward gaze, and suggested that he “would
not pursue surgical correction.” (Id. at p.
29). On March 17, in accordance with that recommendation, Dr.
Couch, an oculoplastic surgeon, evaluated Montanez and
concluded that he has “no limitation in eye movement in
the medial and lateral gaze . . . I do not see signs or
symptoms to suggest that the diplopia has been caused by
fracture.” (Id. at p. 31). Dr. Couch then
recommended a “repeat of a CT scan of his orbits and
return to discuss this further in the near future.”
(Doc. 145-7, p. 3).
April 2016, Montanez fell when climbing down from the top
bunk, and he alleges this was due to his double vision (Doc.
145-7). After the fall, Menard medical personnel evaluated
Montanez for his shoulder pain and provided him with pain
medication (Doc. 140-2). On May 26, Dr. Trost evaluated
Montanez and recommended physical therapy (Id.). Dr.
Ritz approved physical therapy and, in July 2016, medical
personnel from the Southern Illinois Health Care
Rehabilitation Institute of Chicago treated Montanez
(Id.). In August, Montanez started to refuse
physical therapy sessions because he believed that it was not
helping his shoulder (Id.). On October 13, Montanez
met with an optometrist to obtain new glasses to help address
his vision issues, but the optometrist noted in his report
that Montanez “refuses new gls litigation @ menard . .
. .” (Doc. 140-8).
Report and Recommendation
Beatty recommends denying the motion for summary judgment as
to Dr. Ritz because a reasonable jury could find that Dr.
Ritz consciously disregarded the risks associated with
delaying Montanez's follow-up with a plastic surgeon.
Specifically, Judge Beatty found that there were issues of
fact as to whether: (1) Dr. Ritz knew of Barnes's
recommendation that Montanez see a plastic surgeon for
follow-up within one week of his discharge; and (2) Dr. Ritz
should have modified Dr. Trost's initial recommendation
to include an off-site medical referral for Montanez to visit
a plastic surgeon.
Beatty recommends granting the motion for summary judgment as
to Wexford because Montanez fails to present evidence to
support any type of causal link or connection between the
alleged policy and claimed constitutional violation. As to
Montanez's claim that Wexford maintained a practice of
condoning employee misconduct despite knowing it delayed
treatments, Judge Beatty found that this policy has no
bearing on whether Dr. Trost's failure to follow
Barnes's specific recommendation ultimately amounts to
deliberate indifference. As to Montanez's claim that
Wexford maintained a practice of hiring underqualified
medical directors despite knowing it caused ...