Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Carle’s medical residency program, which has an employment component, was governed by annual contracts. Residents were required to complete rotations before advancing and to pass the Step 3 U.S. Medical Licensing Examination before entering the third year. A third Step 3 failure results in termination. Carle residents cannot graduate unless they complete licensing requirements. Illinois medical students with five failures in the Step tests are not eligible for licensure without significant remediation. Rodrigo failed his first attempts at Step 1 and Step 2. He was required to repeat four rotations. His supervisors thought a neuropsychological examination might identify issues affecting his performance. Rodrigo never underwent recommended testing. Carle extended Rodrigo’s first and second years to allow him to repeat rotations and the Step 3 test, which he failed a second time. Rodrigo then informed Carle that he had a sleep disorder. Although Rodrigo did not request an accommodation, the director suggested that he take time off. Rodrigo did so, but failed a third time. Rodrigo asked to be promoted so that he could attempt to pass Step 3 in California. After termination of his residency, Rodrigo sued under the Americans With Disabilities Act. 42 U.S.C. 1210. The Seventh Circuit affirmed summary judgment in favor of Carle, finding that Rodrigo was not a “qualified individual.” Passing Step 3 is an “essential function.” Rodrigo presented no evidence of a causal connection between his protected activity (seeking an accommodation) and his termination. View "Rodrigo v. Carle Foundation Hospital" on Justia Law

Madden, suffering from morbid obesity, respiratory acidosis, congestive heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, obesity hypoventilation syndrome, hypertension, and hyperlipidemia, was admitted to the V.A. Hospital several times before his last admission on December 28, 2007. The Hospital placed Madden in respiratory isolation. On the same day, Madden’s wife described him as “not being himself,” and unsuccessfully requested the presence of a staff member in the room with Madden at all times. The Hospital allowed Madden to sit in a wheelchair because of his difficulty with lying in bed. Madden consistently reported that he was feeling fine, with a few comments about shortness of breath. On January 1, 2008, Madden was found unresponsive in his wheelchair. It took the Hospital 25 minutes to resuscitate him; Madden had suffered a cardiopulmonary arrest. On January 25, Madden was transferred to a long‐term care facility. He never regained consciousness and died on January 8, 2010. Madden’s estate filed a wrongful death suit under the Federal Tort Claims Act. The Seventh Circuit affirmed in favor of the government, agreeing that the government’s expert’s opinions were supported by medical records, relevant literature, data, studies, and medical explanations; while the government successfully impeached the family’s expert, a family friend, for lack of consultation of relevant medical literature and even Madden’s medical records. View "Madden v. United States Department of Veterans Affairs" on Justia Law

Proctor, an Illinois prisoner who was confined for seven years at Hill Correctional Center, suffers from chronic abdominal pain and spasms in his colon. He sued medical providers working at Hill for Wexford Health Sources, the contractor providing healthcare to Illinois prisoners, and corrections officials, claiming that they violated the Eighth Amendment by not ordering a colonoscopy and endoscopy to diagnose his persistent abdominal pain. The district court granted summary judgment for the defendants. The Seventh Circuit affirmed. A jury could not reasonably find that the defendants were deliberately indifferent to Proctor’s medical condition. Proctor’s abdominal pain and colon spasms were investigated thoroughly, and that investigation substantiated only a diagnosis of IBS. Over the course of treating him, the medical professionals routinely performed physical exams and ordered X‐rays, an ultrasound, bloodwork, stool cultures, and other tests, but the results were consistently normal. The decision whether further diagnostic testing— like a colonoscopy—was necessary is “a classic example of a matter for medical judgment. View "Proctor v. Sood" on Justia Law

Moshiri, other physicians, and hospital administrators were charged (42 U.S.C. 1320a-7b(b)) based on a kickback scheme. The former director of the podiatry residency program (Noorlag) testified that teaching contracts were a vehicle to pay physicians for referrals. Moshiri received $2,000 per month and was named as the Director of External Podiatric Office Rotations. Another doctor was named to that position at the same time. According to Noorlag, neither doctor was considered to hold that position, and neither performed the related duties. The Chair of the Counsel on Podiatric Medical Education, which oversees and certifies residency programs nationally and publishes standards, offered an expert opinion that teaching stipends are uncommon for attending physicians at residency programs and that he had never heard of such a physician being paid $2,000 per month. According to multiple witnesses, Moshiri did not conduct workshops and did not manage external rotations. Moshiri worked with residents about three times per month, while 11 other program physicians averaged 10 cases per month with residents. During the period at issue, the Hospital billed Medicare and Medicaid $482,000 for patients Moshiri treated. The Hospital’s Chief Operating Officer had recorded conversations in which Moshiri discussed his referrals. The agent who arrested Moshiri testified that Moshiri said that “the contract turned into basically paying for patients.” The Seventh Circuit upheld Moshiri’s conviction, rejecting challenges to the sufficiency of the evidence and to the expert testimony. View "United States v. Moshiri" on Justia Law

Substantial evidence supported finding that hospital’s contracts with physicians violated Anti-Kickback statute.Novak and Nagelvoort participated in a scheme under which Sacred Heart Hospital paid illegal kickbacks to physicians in exchange for patient referrals. Novak was the Hospital’s owner, President, and Chief Executive Officer. Nagelvoort was an outside consultant, and, at various times. served as the Hospital’s Vice President of Administration and Chief Operating Officer. Federal agents secured the cooperation of physicians and other Hospital employees, some of whom recorded conversations. Agents executed warrants and searched the Hospital and its administrative and storage facilities. The prosecution focused on direct personal services contracts, teaching contracts, lease agreements for the use of office space, and agreements to provide physicians with the services of other medical professionals. The Seventh Circuit affirmed their convictions under 42 U.S.C. 1320a-7b(b)(2)(A) and 18 U.S.C. 371, rejecting arguments that there was insufficient evidence to prove that they acted with the requisite knowledge and willfulness under the statute; that the government failed to prove that certain agreements fell outside the statute’s safe harbor provisions; and that Nagelvoort withdrew from the conspiracy when he resigned his position, so that any subsequent coconspirator statements were not admissible against him. View "United States v. Naglevoort" on Justia Law

Inmate’s allegation that prison dentist intentionally sutured inmate’s gum without removing pieces of broken drill bit was sufficient to withstand screening. While Dr. Craig was extracting a wisdom tooth from Echols, an Illinois inmate, a drill bit broke. Craig sutured Echols’ gum with gauze and at least one half‐inch long piece of the broken bit still inside, where it caused pain for about two weeks before it was finally removed. Echols alleges that Craig sutured the site after intentionally packing it with non‐soluble gauze and without first locating the missing shards from the broken drill bit. The district court screened Echols’ 42 U.S.C. 1983 complaint under 28 U.S.C. 1915A, and dismissed it, stating that Echols’ allegations were factually frivolous. The Seventh Circuit vacated, holding that Echols’ allegations are quite plausible and state a claim for violation of the Eighth Amendment. Echols sufficiently alleged that Craig’s actions were so inappropriate that the lawsuit cannot be dismissed at screening. View "Echols v. Craig" on Justia Law

The Seventh Circuit reversed summary judgment for the defendants in a suit by Johnson, an inmate of the Rushville Treatment and Detention Facility for persons believed prone to sexual violence, claiming that staff had caused Johnson to take the antipsychotic drug Risperdal, for more than a month, without Johnson’s knowledge or consent. The staff did not follow Illinois’s procedures for ordering forced medication; Johnson had not been found to be dangerous to himself or others. The doctor prescribed Risperdal after Johnson complained about feelings of aggression and hopelessness, even though Johnson refused to consent. The doctor stated that he wrote the prescription so that Johnson could take the medication if he wanted it. The nurse, not knowing what the pill was, included the Risperdal with Johnson’s medications for blood pressure, cholesterol, and stomach problems, so Johnson took the drug without noticing it. The Seventh Circuit noted that the Supreme Court has recognized a “significant liberty interest,” under the due process clause in “avoiding the unwanted administration of antipsychotic drugs,” which can have “serious, even fatal, side effects.” While Johnson was not forced to take the pill, the doctor “must have known that pills were delivered to the inmates, unlabeled, in little cups.” View "Johnson v. Tinwalla" on Justia Law

Collins, a regular heavy drinker, had suffered alcohol withdrawal, and kept a bottle of Librium to treat withdrawal and anxiety. Collins had Librium with him when he was arrested for DUI. The jail physician, Dr. Al‐Shami, who approved Collins’s use of the Librium while in custody. Collins was taken to a cell; officers checked on him every 15 minutes. The next day Collins began to complain of shaking from alcohol withdrawal. He was given Librium and vitamins. By lunchtime, Collins was better and eating normally. In the afternoon, he began to complain again. A nurse called Dr. Al‐Shami, who ordered that Collins be given the normal treatment for alcohol withdrawal. After being treated for additional incidents, Collins was taken to the hospital. The examining physician concluded that Collins was not suffering from delirium tremens. Collins was returned to the jail. Collins continued to display strange behavior, interspersed with periods of normalcy. Officers continued to check on Collins every 15 minutes. Eventually, Collins was again taken to the hospital. Collins was hypothermic, had low blood pressure, and was suffering from dehydration, sepsis, and acute respiratory failure. He was in a medically‐induced coma for several days. The Seventh Circuit affirmed summary judgment for the defendants in Collins's suit under 42 U.S.C. 1983, concluding that the level of care was reasonable. View "Collins v. Al-Shami" on Justia Law

While lifting a heavy door at his prison job in 2008, Cesal heard a “snap” in his back and felt pain in his leg and hip. He sought treatment from the prison’s medical staff but was dissatisfied with their response. He alleged that he received a three-year runaround, during which his pain was ignored, that the Clinical Director canceled Cesal’s insulin prescription in retaliation for Cesal’s filing a complaint about the inadequate care. Without the prescription, Cesal, an insulin-dependent diabetic, was unable to control his blood sugar and suffered additional pain and harm. He filed a second complaint with the prison about the insulin deprivation. Cesal, acting pro se, sued the Clinical Director and another Pekin physician. At the screening phase, 28 U.S.C. 1915A, the district court identified an Eighth Amendment deliberate indifference claim and a First Amendment retaliation claim related to the withholding of insulin. The court granted the defendants summary judgment, reasoning that the statute of limitations had run and that, in any event, there was no question of material fact that would justify allowing his case to proceed. The Seventh Circuit affirmed, acknowledging that "Cesal’s allegations are troublesome," but noting important differences between ordinary, or even aggravated, medical malpractice, and an Eighth Amendment violation View "Cesal v. Molina" on Justia Law

Inmate Diggs injured his knee in a fight in 2006 and complained to medical staff about knee pain and instability 14 times. In 2009, Dr. Ghosh, the prison’s medical director, recommended that Diggs be assigned to a lower bunk and ordered an MRI, which revealed that his right ACL had a complete tear. Ghosh got approval from Wexford, the private company that contracts with Illinois to provide prison medical care, for Diggs to receive orthopedic follow‐up. Notwithstanding recommendations by the outside providers, Diggs received no physical therapy and no follow‐up. After several delays and changes in staff, Diggs unsuccessfully filed an emergency grievance, requesting surgery and complaining that his placement effectively confined him to his cell. In 2015, a Wexford physician reportedly stated that no local doctor would perform the surgery. Diggs sued, alleging that the doctors and warden were deliberately indifferent to his torn ACL and intentionally had caused him emotional distress. He sought an injunction to compel the warden to authorize surgery. The district court granted summary judgment for all defendants, finding that the doctors had treatment choices and that Diggs did not establish that the warden knew about the supposed mistreatment nor that the defendants’ conduct was extreme and outrageous. The Seventh Circuit vacated in part, finding that a reasonable jury could rule in favor of Diggs on the deliberate indifference claims. View "Diggs v. Ghosh" on Justia Law