United States District Court, S.D. Illinois
MEMORANDUM AND ORDER
J. Rosenstengel Chief U.S. District Judge.
before the Court is the Report and Recommendation of
Magistrate Judge Gilbert C. Sison (Doc. 147), in which he
recommends the undersigned grant the motions for summary
judgment filed by Defendants Dr. John Coe and Wexford Health
Sources, Inc. (“Wexford Defendants”) (Doc. 93)
and Defendants John Baldwin, Steven Duncan, Lorie Cunningham,
and Nicholas Lamb (“IDOC Defendants”) (Doc. 112).
Plaintiff Brian DeBlasio timely filed an objection to the
Report and Recommendation (Doc. 150). For the reasons set
forth below, the Court adopts Judge Sison's
recommendations and grants Defendants' motions.
Brian DeBlasio filed this lawsuit under 42 U.S.C. § 1983
alleging Defendants violated his constitutional rights as an
inmate in the Illinois Department of Corrections (IDOC)
housed at Lawrence Correctional Center (Doc. 1).
Specifically, DeBlasio claims Defendants were deliberately
indifferent to his serious medical needs concerning his
“chronic back and abdominal pain, chronic constipation,
fractured vertebra and elevated blood pressure, ” in
violation of the Eighth Amendment (Id.).
claims stem from medical treatment he sought beginning in
2015. In September 2015, DeBlasio saw a physician's
assistant, Travis James, who noted that DeBlasio had right
testicle pain, flank pain, and a small amount of blood in his
urine (Id. at p. 9). James also noted tenderness on
the right flank area (Id.). James suspected either
epididymitis, which is inflammation of part of the testicle,
or a kidney stone (Id.). On September 17, 2015,
James saw DeBlasio for a follow-up exam and noted DeBlasio
reported significant right flank pain and sharp pain in the
inguinal area (Id. at p. 11). James ordered an x-ray
of DeBlasio's abdomen and the pain medication Toradol
September 21, 2015, James reviewed the results of the x-ray
with DeBlasio and charted “noticed issue
w/vertebrae.” (Id. at p. 16). DeBlasio
testified that James looked at the x-ray for kidney stones,
but did not see any. When James looked higher on the x-ray,
DeBlasio testified, James told him to sit down and asked if
he had been injured because there was a problem with his
vertebrae (Doc. 113-2 at p. 9). DeBlasio could not recall any
injuries to his back (Id.). James ordered Motrin 800
mg, a back support, a low bunk and low gallery permit, and a
follow-up in two weeks (Id.; Doc. 119-1 at p. 56).
DeBlasio alleges “on information and belief” that
he may have a fracture in his back due to James's
reaction to his x-ray (Doc. 113-2 at pp. 8-9). James is not
an x-ray technician, however, and he did not diagnose
DeBlasio with a fracture in his vertebrae (Doc. 113-2 at pp.
8-9; Doc. 113-3).
October 5, 2015, Dr. John Coe, the Medical Director at
Lawrence, examined DeBlasio for his complaints of testicular
and abdominal pain (Doc. 94-8 at p. 2). His blood pressure at
this visit was 140/90 (Doc. 94-4 at p. 18). Dr. Coe examined
DeBlasio's back and hips, noting that upon movement his
right hip had some limitations and pain (Doc. 94-8 at p. 2).
He also examined DeBlasio's testicles and noted that his
prostate was tender and swollen. Dr. Coe diagnosed DeBlasio
with epididymitis, or inflammation of part of the testicle,
which can cause pain in the lower abdomen/pelvic region, pain
and tenderness in the testicles, and issues with urination
(Id.). Because it can be caused by an infection, Dr.
Coe ordered 15 days of the antibiotic Cipro in addition to
Tylenol and Bisacodyl, a laxative (Id.). He also
ordered an x-ray of DeBlasio's right hip and lumbar
spine, as well as a follow-up appointment after the x-ray
October 14, 2015, Dr. Coe saw DeBlasio to follow up on the
lumbar x-ray (Id.). The x-ray showed only mild
degenerative disease (Id.; Doc. 94-4 at p. 19). Dr.
Coe noted that DeBlasio moved well and was able to get up and
down from the table without difficulty (Id.). Dr.
Coe also performed neurological testing, which revealed no
deficits (Id.). Dr. Coe further noted that DeBlasio
was not wearing his back support (Id.). Because mild
degeneration is not uncommon and does not require medical
intervention, and based on the normal findings from the
examination, Dr. Coe found that additional treatment was not
required for DeBlasio's low back and hip complaints
also examined DeBlasio's testicles and found that the
epididymis was no longer swollen (Id. at p. 3). He
did note, however, a tender, three-millimeter knot on
DeBlasio's testicles, as well as tenderness near an old
appendectomy scar (Id.). Dr. Coe ordered that
DeBlasio remain on the same medication and be scheduled for a
follow-up appointment (Id.).
October 23, 2015, DeBlasio went to nurse sick call with
complaints of abdominal, back, and testicular pain (Doc. 94-4
at pp. 20-22). His blood pressure was 168/98 (Id.).
Dr. Coe was contacted and ordered that DeBlasio receive
Toradol, a pain and anti-inflammatory medication
examined DeBlasio on October 26, 2015, noting that bowel
sounds were present but not very active and that his abdomen
was tender near his gallbladder (Doc. 94-8 at p. 3).
DeBlasio's blood pressure on this date was 133/100 (Doc.
94-4 at p. 22). Dr. Coe suspected possible gallstones and
requested a gallbladder ultrasound through the Collegial
Review process (Doc. 94-8 at p. 3). Collegial Review is a
Wexford process by which a case is presented to other
physicians to determine what an appropriate treatment plan is
for the patient, including whether imagining, specialty
evaluation, or testing should be performed (Id.).
The gallbladder ultrasound was approved and performed on
October 28, 2015 (Id.). The results were normal
next saw DeBlasio on November 12, 2015 (Id. at p.
4). In addition to discussing the normal ultrasound results,
Dr. Coe examined DeBlasio and noted a weakened area near his
old appendectomy scar, as well as a weakened internal right
inguinal ring that was tender and bulged when DeBlasio
coughed (Id.). Dr. Coe attested that he thought
DeBlasio may have early signs of a hernia. He also considered
whether DeBlasio may have internal scar tissue from his
previous appendectomy that could be causing abdominal
discomfort (Id.). Because either condition can cause
discomfort with constipation, Dr. Coe ordered Fiberlax,
Colace (a stool softener), and Milk of Magnesia (a laxative
and antacid) (Id.). He also ordered a urinalysis
test (Id.). DeBlasio's blood pressure was 146/90
at this visit (Doc. 94-4 at p. 28).
urinalysis came back positive for blood, so Dr. Coe ordered
another urinalysis that could be sent away for additional
testing (Id.). Dr. Coe saw DeBlasio on November 20,
2015, and again noted pain and tenderness near the inguinal
area and appendectomy scar (Id. at p. 32). His blood
pressure was 155/101 (Id.). Dr. Coe submitted his
case to Collegial Review to determine an appropriate
treatment plan, and on November 24, 2015, DeBlasio was
approved to see an outside urologist (Id. at p. 36).
he could see the urologist, on November 30, 2015, DeBlasio
reported to the Healthcare Unit with dizziness,
lightheadedness, and a small amount of blood in his spit
(Id. at p. 5; Doc. 113-3 at p. 41). DeBlasio was
sent to Lawrence County Memorial Hospital for evaluation, but
a chest and abdomen x-ray came back unremarkable
(Id.). DeBlasio received an IV infusion of Vasotec,
a medication that can be used to lower blood pressure (Doc.
113-2 at p. 19). Dr. Andrew West at Lawrence Hospital
diagnosed DeBlasio with Irritable Bowel Syndrome (IBS),
history of blood in vomit, and right inguinal pain, but he
ruled out a right inguinal hernia (Doc. 113-3 at p. 40; Doc.
119-1 at p. 39). Dr. West wrote a prescription for Alosetron,
which can be used to treat IBS,  and Librium, an anti-anxiety
medication (Doc 1-1 at p. 7; Doc. 94-8 at p. 10). Dr. Coe
attested that IBS is not a serious medical condition and can
be controlled with an appropriate diet, exercise, stress
management, sleep, and medication (Doc. 94-8 at p. 5).
testified that on December 1, 2015, the day after his ER
visit, he asked Dr. Coe about getting blood pressure
medication, but his blood pressure was normal at that time
(Doc. 113-2 at pp. 21-22). DeBlasio further testified that he
asked Dr. Coe about his blood pressure numerous times after
his ER visit, but he could not provide any specific dates
(Doc. 113-2 at p. 22).
was seen by the urologist, Dr. Gary Reagan, on December 24,
2015 (Id.). Dr. Reagan recommended a cystoscopy,
which is a scope of the bladder through the urethra
(Id.). Dr. Coe submitted the cystoscopy
recommendation to Collegial Review; it was approved on
January 5, 2016, and performed on February 9, 2016
(Id. at p. 6). The cystoscopy did not reveal any
structures, tumors, lesions, or stones that could account for
the blood in DeBlasio's urine (Id.; Doc. 94-5 at
p. 38). Furthermore, although Dr. Reagan found DeBlasio had
an enlarged external ring, there was no distinct hernia
(Id.). Dr. Reagan suggested that DeBlasio only
follow up as needed, as routine follow up was not necessary
(Id.). Dr. Coe saw DeBlasio on February 11, 2016, as
follow up after his procedure, and ordered additional Toradol
and Motrin (Doc. 94-8 at p. 6). DeBlasio's blood pressure
on this date was 150/104 (Doc. 94-4 at p. 55)
February 23, 2016, DeBlasio returned to Dr. Coe for
reexamination at the request of the Warden. DeBlasio
complained of pain in his right groin, right pelvis, and
right scrotum, where he reported increased swelling
(Id. at p. 56). Dr. Coe noted mild tenderness in
DeBlasio's right testicle and near his appendectomy scar
(Id.). He also noted that DeBlasio's right
internal ring was tender with roughing and a bulge
(Id.). Dr. Coe further examined DeBlasio's
prostate and rectum, noting no lesions, no external
hemorrhoids, no masses, and no stool present (Id.).
He diagnosed DeBlasio with adhesion pain from his
appendectomy, pre-hernia pain, mild and recurrent
epididymitis, and a history suggestive of symptom
magnification (Id. at p. 57). Dr. Coe ordered
antibiotics and scheduled a follow up for 10 days
(Id. at p. 56).
February 25, 2016, Dr. Coe noted that DeBlasio's blood
pressure had been high since October 2015 (Id. at p.
58). Dr. Coe ordered that his blood pressure be checked at
the next appointment, after the round of antibiotics was
over, and to start him on a prescription medication if
appropriate (Id.). Dr. Coe attested that one's
blood pressure can fluctuate, and medication is not
immediately required due to high readings (Doc. 94-8 at p.
5). He further attested that blood pressure should be
monitored over time and non-medication approaches can be
taken to lower high blood pressure (Id.).
March 4, 2016, Dr. Coe examined DeBlasio as a follow up to
his February 25 visit. He noted that DeBlasio continued to
have pain but did not have a hernia, his testicles were
normal and symmetric, and his blood pressure was normal at
118/85 (Doc. 94-4 at p. 59).
March 23, 2016, DeBlasio reported to the Healthcare Unit for
nausea and vomiting (Id. at p. 60). His abdominal
examination was normal, he showed no signs of guarding,
tenderness, or distention, and his blood pressure was normal
at 128/82 (Id. at pp. 60-61). On April 1, 2016, Dr.
Coe saw DeBlasio and examined his abdomen and groin, noting
no abnormalities (Id. at p. 62). Dr. Coe ordered
Pepcid, Tums, Colace, and Fiberlax to treat DeBlasio's
abdominal discomfort (Id.).
again saw DeBlasio on April 21, 2016, to address
DeBlasio's concern that he had a left side groin hernia
(Id. at p. 63). Dr. Coe found no left-sided hernia,
not even a bulge (Id.). Dr. Coe went over
DeBlasio's prior x-ray and further educated DeBlasio on
his right-side pre-hernia that only slightly bulged when he
24, 2016, DeBlasio saw Nurse James regarding an H Pylori
(stomach bacteria that can cause abdominal discomfort) test
that was negative (Id. at p. 64; Doc. 94-8 at p. 8).
DeBlasio reported that he had abdominal pain that got worse
when his stomach was full after eating (Id.). James
noted that DeBlasio has had multiple tests done for his