United States District Court, N.D. Illinois, Western Division
CHRISTOPHER A. HARRIS, SR., Plaintiff,
WEXFORD HEALTH SOURCES, INC., HECTOR GARCIA, JILL WAHL, and JAMES NIELSEN, Defendants.
MEMORANDUM OPINION AND ORDER
Z. LEE, UNITED STATES DISTRICT JUDGE
Christopher Harris, Sr., formerly an inmate at Dixon
Correctional Center (“Dixon”), brings this
lawsuit against three prison doctors and the prison’s
healthcare provider, Wexford Health Sources, Inc.
(“Wexford”), alleging that Defendants were
deliberately indifferent to pain he suffered from
gynecomastia, a condition involving swelling of the breast
tissue in men. Defendants have moved for summary judgment.
For the reasons provided below, Defendants’ motions
  are granted.
was an inmate at Dixon between 2010 and 2018. Defs. Wahl,
Garcia, & Wexford’s LR 56.1(a) Stmt. Facts
(“Wexford Grp. Defs.’ SOF”), ECF No. 131.
Wexford employs physicians who provide medical care to
prisons, including Dixon. See Id . ¶¶
Jill Wahl is a physician licensed to practice in Illinois,
board certified in family medicine. Id. ¶ 2.
She worked for Wexford as a traveling medical doctor,
including at Dixon, from 2007 through March 2015.
Hector Garcia is a physician and Wexford’s National
Medical Director. Id. ¶ 3. In that role, he
provides inpatient care, travels to different sites, and
occasionally participates in “collegial
reviews”-a process Wexford uses to approve requests for
consultations and off-site treatment. Id.
¶¶ 3, 70–71.
James Nielsen is a physician licensed to practice in
Illinois, board certified in psychiatry. Id. ¶
4. He is an independent contractor who has worked with
Wexford since 2004 or 2005, providing telemedicine services
to prisons in Illinois. Id. These services consist
of providing care through video conferencing equipment or
similar means. Def. Nielsen’s LR 56.1(a) Stmt. Facts
(“Def. Nielsen’s SOF”) ¶ 6, ECF No.
Harris’s Treatment History
began seeing Dr. Nielsen in 2010 for mental-health treatment.
Wexford Grp. Defs.’ SOF ¶ 5. Among other
medications, Dr. Nielsen prescribed Risperdal, an
antipsychotic psychotropic medication that can cause
“increased prolactin levels and gynecomastia.”
Id. ¶¶ 5– 6. Gynecomastia is a
“condition where a male develops an enlargement of
breast tissue.” Id. ¶ 7. It can cause
discomfort due to engorgement of the affected tissues.
Id. ¶ 8.
developed gynecomastia after taking Risperdal. Id.
¶¶ 9–11. On June 10, 2010, he and Dr. Nielsen
discussed the Risperdal prescription, including its role in
his “complaints of breast tissue growth.”
Id. ¶ 9. Harris mentioned that he was
“very uncomfortable” with his chest, and
explained that it had been growing. Id. ¶ 10;
Wexford Grp. Defs.’ Ex. A, Harris Dep. at 31:14-15, ECF
Dixon, Dr. Nielsen’s practice, qualifications, and
privileges were restricted to treating mental illnesses and
psychiatric problems. Def. Nielsen’s SOF ¶¶
11–12. His privileges and competence did not extend to
the prescription of pain medication or the treatment of
gynecomastia. Id. ¶¶ 13–14. As such,
Dr. Nielsen had no role in assessing what medication Harris
could or could not receive for his physiological conditions,
including gynecomastia. Id. ¶¶
15–18. According to Dr. Nielsen, gynecomastia is an
issue typically treated at the health care unit by the
primary health care physicians, who are able to prescribe
pain medication. Id. ¶¶ 20–22.
this reason, at their June 10 meeting, Dr. Nielsen directed
Harris to “speak to primary care” regarding his
concerns about his gynecomastia. Wexford Grp. Defs.’
SOF ¶ 11; Wexford Grp. Defs.’ Ex. D, Nielsen Dep.,
Ex. 1 at ¶ 0062–63, 6/10/10 Mental Health
Diagnostic & Treatment Note, ECF No. 131-10. This meant
that Harris should use the “sick call” process at
Dixon. Wexford Grp. Defs.’ SOF ¶ 12.
initiate the sick call process, an inmate submits a
“request slip” to see a nurse. Id. Once
an inmate does so, he is placed on a nurse’s schedule
for an initial consultation to see if the nurse can address
his issues. Id. After three visits for the same
issue, the inmate is referred to a physician, nurse
practitioner, or physician’s assistant. Id.
Harris is familiar with this process and has utilized it in
the past. Id.
saw Dr. Nielsen again on August 9, 2010. Id. ¶
14. Harris’s prolactin level was elevated, which is
indicative of hyperprolactinemia. Id. Dr. Nielsen
discontinued Harris’s Risperdal because Harris had
stopped taking it and did not want to take it anymore.
Id. He directed Harris to seek out assistance
through sick call and also referred Harris to the health care
unit. Id. ¶ 16.
after Harris stopped taking the Risperdal, however, he
noticed that the swelling in his chest did not subside, and
his right nipple began to protrude. Id. ¶ 15.
He saw Dr. Nielsen again on July 11, 2011, at which point Dr.
Nielsen again directed Harris to seek out treatment through
sick call. Def. Nielsen’s SOF ¶ 28. Harris did not
see Dr. Nielsen from the fall of 2011 until early 2013.
Wexford Grp. Defs.’ SOF ¶¶ 21, 23.
this time, Harris did have several other medical
appointments. For example, he saw Dr. Carter, a physician at
the prison, and they discussed his prolactin level (although
Harris may not have allowed Dr. Carter to conduct a physical
exam). Pl.’s LR 56.1(b) Resp. Wexford Grp. Defs.’
SOF ¶ 18, ECF No. 138.
also saw Dr. Wahl on August 9, 2011. Wexford Grp.
Defs.’ SOF ¶ 20. Dr. Wahl addressed Harris’s
complaints of back pain, but there was no discussion of
gynecomastia, breast tenderness, or breast enlargement.
Id. Dr. Wahl saw Harris again for low back pain on
April 19, 2012. Id. ¶ 22. Again, Dr. Wahl
recorded no discussion of gynecomastia pain or discomfort at
that appointment. Wexford Grp. Defs.’ Ex. B, Wahl Dep.
at 38:16-22, ECF No. 131-2.
complained about his gynecomastia to Dr. Nielsen again on
July 22, 2013. Wexford Grp. Defs.’ SOF ¶ 24. Dr.
Nielsen ordered a check of Harris’s prolactin levels,
directed Harris to go to sick call, and referred him to the
health care unit for treatment. Id. The next day,
Harris saw a registered nurse at the health care unit, but no
discussion of gynecomastia was documented. See
Pl.’s LR 56.1(b) Resp. Wexford Grp. Defs.’ SOF
¶ 25. The day after that-July 24-Harris was given a sick
call appointment. Wexford Grp. Defs.’ SOF ¶ 26.
Defendants contend that Harris refused this appointment, but
Harris disputes this. Id.; Pl.’s LR 56.1(b)
Resp. Wexford Grp. Defs.’ SOF ¶ 26. Harris
presented again for sick call on August 6, 2013, but no
mention of gynecomastia was documented. Pl.’s LR
56.1(b) Resp. Wexford Grp. Defs.’ SOF ¶ 27. He had
two more appointments without any documented mention of
gynecomastia-one on August 13, 2013, with Dr. Young Kim; and
another on August 23, 2013, with Dr. Bessie Dominguez.
Id. ¶¶ 28–29.
September 30, 2013, Harris saw Dr. Nielsen, who again
referred him to the health care unit for treatment of his
gynecomastia. Wexford Grp. Defs.’ SOF ¶ 30. On
November 8, Harris complained to Dr. Nielsen that he was
dissatisfied with his primary care. Id. ¶ 31.
Dr. Nielsen then referred Harris to the health care unit for
the third time that year. Id.; see Nielsen
Dep., Ex. 1 at ¶ 00032, 11/8/13 Mental Health Diagnostic
& Treatment Note, ECF No. 131-11 (“Primary care
referral (third) for rule out gynecomastia . . . .”).
November 14, Harris saw Dr. Dominguez for his complaints of
gynecomastia. Wexford Grp. Defs.’ LR 56.1(b) Resp.
Pl.’s Stmt. Add’l Facts (“Pl.’s
SOAF”) ¶ 16, ECF No. 141. Dr. Dominguez referred
Harris to Dr. Wahl, suggesting that he receive a mammogram.
Wexford Grp. Defs.’ SOF ¶ 34.
Wahl saw Harris on December 4, 2013-this time specifically
for his gynecomastia. Id. Her notes from the visit
indicate that Harris had some firmness in his breasts, with
his left breast firm below the nipple, and his right breast
full without a discrete mass. Id. ¶ 35. She
also noted that there was no nipple discharge. Id.
Dr. Wahl assessed Harris as having “bilateral
gynecomastia with left breast firmness.” Id.
¶ 36. She told Harris that the growth was not cancerous
or otherwise a problem. Id. ¶¶ 36, 38. Dr.
Wahl testified that, in general, gynecomastia is not a
serious condition and it can be monitored with physical
exams. Id. ¶ 67. She did not believe surgery
was necessary because gynecomastia is generally a cosmetic
issue, and the potential risks of surgery outweigh the
benefits. Id. ¶¶ 38, 69. Nevertheless, she
referred Harris for an ultrasound, which is typically the
first step to address breast irregularities. Id.
weeks later, on December 24, 2013, Dr. Wahl conducted a
“collegial review” with Dr. Garcia concerning
Harris’s case. Id. ¶ 40. A
“collegial review” consists of a phone call
between a physician at the prison and a physician on the
“collegial review team” at Wexford, whereby the
on-site physician discusses and seeks approval for off-site
medical care and treatment. Id. ¶¶
70–71. After discussing Harris’s condition, Dr.
Garcia approved him for an on-site bilateral breast
ultrasound. Id. ¶ 40. Dr. Garcia testified that
an ultrasound is used for gynecomastia patients to rule out
tumors; if there is no tumor, the only treatment is cosmetic
surgery. Id. ¶ 68.
ultrasound took place on February 4, 2014. Id.
¶ 42. It showed “prominent glandular tissue in the
retroareolar regions of both breasts, consistent with
gynecomastia.” Id. Dr. Wahl and Dr. Garcia
conducted another collegial review following the ultrasound,
on February 19. Id. ¶ 43. They discussed
whether Harris should undergo a mammogram. Id. Dr.
Wahl, however, reported that she had not noticed a mass in
Harris’s breast. Id. ¶ 44.
conclusion of their discussion, Dr. Wahl and Dr. Garcia
determined that Harris’s gynecomastia was benign in
nature. Id.; see Wexford Grp. Defs.’
Ex. C, Garcia Dep. at 57:16-23, 70:3-5, ECF No. 131-9. They
decided not to move forward with a mammogram and to follow up
on Harris’s case in six months, if necessary. Wexford
Grp. Defs.’ SOF ¶ 44. Dr. Wahl later testified
that Harris did not need immediate attention because his
gynecomastia presented as a fairly typical cosmetic
condition. Id. ¶ 45.
March 18, 2014, Harris saw Dr. Nielsen, who again directed
him to follow up with his primary care physician.
Id. ¶ 46. The same day, Harris saw Dr. Wahl for
a follow-up to discuss the results of his ultrasound.
Id. ¶ 47. Dr. Wahl made a note of
Harris’s prolactin levels and conducted a physical
exam. Id. ¶¶ 47–48. She concluded
that Harris had bilateral breast fullness, but no
“discrete nodules and no axillary nodules.”
Id. ¶ 48. There was no significant change in
his condition. Id. Because Harris’s prolactin
levels were ...