Mr. Barnes was a prisoner at Stateville. He suffered from prolapsed hemorrhoids, which caused him pain while defecating. He began complaining about this pain in July 2016 and finally received surgery in April 2019. In between, he was prescribed laxatives and sent out for evaluations by specialists at UIC Hospital several times. After his surgery, he sued the individual doctors to whom he complained about the pain, and Wexford under a Monell theory of liability, alleging that the collegial review process was responsible for the delays. The District Court entered summary judgment[H4.1] for all defendants, Barnes appealed, and the 7th Circuit affirmed.
This case breaks no new ground doctrinally. However, there are several interesting points about the opinion which are worth noting:
First, factually, the court relies (albeit in minor part) on the fact that Barnes’ medical records do not show that he complained about pain during several appointments. This is a common point raised by judges to discount assertions of pain, and it is important for advocates to establish that Wexford (and IDOC) have an unwritten rule of “one problem per visit.” Thus, the fact that a prisoner’s medical records don’t include a reference to continuing pain when he was there for some other medical problem does not mean either that he was not in pain, or even that he did not complain.
Second, the court’s discussion of what evidence is needed to establish that a delay violated the constitution is confusing. The court notes that delay which causes unnecessary pain when a ready remedy was available can constitute a constitutional violation, even if the delay does not aggravate the underlying condition, citing Gomez v. Randle, 680 F.3d 859, 865–66 (7th Cir. 2012) (holding that the plaintiff stated an Eighth Amendment deliberate indifference claim because “even though [the four-day] delay [in treatment for plaintiff’s infected gunshot wound] did not exacerbate [the plaintiff’s] injury, he experienced prolonged, unnecessary pain as a result of a readily treatable condition”) and Edwards v. Snyder, 478 F.3d 827, 831 (7th Cir. 2007) (a plaintiff who dislocated his finger, and suffered immense pain, and was denied treatment for two days properly presented a deliberate-indifference claim). However, the court then goes on to hold that “a prisoner must offer verifying medical evidence that shows that the delay was detrimental. Williams v. Liefer, 491 F.3d 710, 715 (7th Cir. 2007) (finding that “expert testimony that the [prisoner] suffered because of a delay in treatment” could serve as verifying medical evidence).” The court does not explain why a prisoner’s testimony that he was in pain for the time treatment was delayed would not be sufficient. In other words, do you really need an expert to establish that an untreated gunshot wound is painful?
Third, the court holds that because neither of the individual doctors violated the constitution, then Wexford’s policies regarding collegial review could not violate the constitution. This seems inexplicable. Even if the individual doctors timely requested treatment, if that treatment was delayed (or denied) by Wexford through the collegial review process, then it seems clear that Wexford’s policy caused the constitutional violation, even if no doctor is liable. I suspect that this holding is limited to the facts of this specific case, but practitioners should be aware of the broad language the court used.
Finally, the real lesson of this case is that if the outside specialists agree with the treatment recommended by the Wexford doctors (as happened here), then plaintiff faces an almost impossible burden.
