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Harris v. Wexford Health Sources, Inc.

United States District Court, N.D. Illinois, Western Division

September 22, 2019




         Plaintiff 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 [129] [132] are granted.

         Factual Background[1]

         I. The Parties

         Harris 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 . ¶¶ 2–4.

         Dr. 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. Id.

         Dr. 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.

         Dr. 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. 134.

         II. Harris’s Treatment History

         Harris 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.

         Harris 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 No. 131-1.

         At 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.

         For 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.

         To 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.

         Harris 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.[2] Id. ¶ 16.

         Even 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.

         During 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.

         Harris 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.

         Harris 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.

         On 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 . . . .”).

         On 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.

         Dr. 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. ¶ 37.

         Several 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.

         The 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.

         At the 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.

         On 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 ...

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