Joyner v. Wexford Health Sources, Inc.

UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF ILLINOIS

ROBERT JOYNER, )

)

Plaintiff, )

)

vs. ) Case No. 3:20-cv-00054-GCS

)

VENERIO SANTOS, )

)

Defendant. )

)

MEMORANDUM & ORDER

SISON, Magistrate Judge:

Pending before the Court is Defendant’s Motion for Summary Judgment. (Doc.

71). Defendant Santos (“Santos”) filed his Motion for Summary Judgment and

Memorandum of Support on May 19, 2022. (Doc. 71, 72). In the motion, Defendant argues

that “the underlying facts of th[e] case demonstrate [that he] was not deliberately

indifferent to [Plaintiff’s] injuries or that any action or inaction on his part caused injury

to . . . Plaintiff.” (Doc. 72, p. 1). Plaintiff timely filed a Memorandum of Law in Opposition

to Defendant’s Motion for Summary Judgment on June 17, 2022. (Doc. 73). Defendant

Santos filed a Reply Memorandum of Law in Support of his Motion for Summary

Judgment on July 1, 2022. (Doc. 74). For the reasons delineated below, the Court

GRANTS in part and DENIES in part Defendant’s Motion for Summary Judgment.

PROCEDURAL HISTORY

Plaintiff Robert Joyner, an inmate of the Illinois Department of Corrections

(“IDOC”) currently incarcerated at Centralia Correctional Center (“Centralia”) brought

suit against Defendants Wexford Health Sources, Inc. (“Wexford”), Lana Nalewaja

(“Nalewaja”), Alfonso David (“David”), Venerio Santos (“Santos”), John Baldwin

(“Baldwin”), Kym Johnson (“K. Johnson”), Sarah Johnson (“S. Johnson”), Patty Sneed

(“Sneed”), Debbie Knauer (“Knauer”), Ann Lahr (“Lahr”), and Susan Walker (“Walker”)

pursuant to 42 U.S.C. § 1983. (Doc. 1). In his Complaint, Plaintiff alleges that he received

inadequate medical care for his hemorrhoids and rectal bleeding, as well as for pain in

his throat, chest, and abdomen beginning in January 2018. (Doc. 1, p. 9-15). On March 16,

2020, the Court completed its preliminary review of Plaintiff’s Complaint pursuant to 28

U.S.C. § 1915A. (Doc. 10). The Court construed Plaintiff’s allegations into the following

count:

Count 1: Dr. David, Venerio Santos, Lana Nalewaja, John Baldwin, Kym

Johnston, Sarah Johnson, Patty Sneed, Debbie Knauer, Ann Lahr, Susan

Walker, and Wexford Health Sources, Inc. were deliberately indifferent

under the Eighth Amendment to Plaintiff’s complaints of pain and bleeding

rectum.

(Doc. 10, p. 3). However, all Defendants, apart from David and Santos were dismissed

without prejudice from the action due to Plaintiff’s failure to state a claim. (Doc. 10, p. 4).

Neither of the remaining Defendants filed a Motion for Summary Judgment on the Issue

of Exhaustion of Administrative Remedies and the case proceeded to consideration on

the merits. (Doc. 32). However, on July 31, 2020, Defendant David filed a Motion to

Dismiss for Failure to State a Claim along with a Memorandum of Support. (Doc. 33, 37).

The Court granted David’s Motion to Dismiss and dismissed Plaintiff’s claims against

David with prejudice. (Doc. 42). As such, Defendant Santos is the only Defendant

remaining.

BACKGROUND

A. Plaintiff’s Gun Shot Incident & Mental Health

Plaintiff has been incarcerated in an IDOC correctional center since 2006.1 (Doc. 73,

Exh. 2, p. 5:13-14). Prior to his incarceration, Plaintiff was the victim of a shooting incident

that occurred in 1998. Id. at p. 3:6-9. Plaintiff was shot 6 times in the hip and spine while

he was attempting to assist a woman being carjacked. Id. at p. 3:21-24; (Doc. 73, p. 10).

Following the shooting, Plaintiff underwent surgery to treat his injuries at Christ

Hospital. Id. at p. 4:9. Plaintiff had an intramedullary rod placed in his left femur and

exploratory surgery on his abdomen to address an injury to one of his kidneys. Id. at p.

3:21-24; (Doc. 73, p. 10). A Jackson-Pratt2 drain was implanted on the opposite side of

Plaintiff’s liver to address any lingering internal bleeding after the exploratory surgery.

(Doc. 73, p. 10; Doc. 73, Exh. 2, p. 6:20-21).

As a result of this incident, Plaintiff claims that he suffers from post-traumatic

stress disorder (“PTSD”). (Doc. 73, Exh. 2, p. 2:3-16). Plaintiff was also diagnosed as

having schizoaffective disorder by Qualified Mental Health Provider (“QMHP”) Staci

Murray on February 23, 2018. (Doc. 72, Exh. 1, p. 4). This diagnosis was confirmed by

psychiatrist, Dr. Michael Bednarz on April 3, 2018. Id. at p. 6. The psychiatric progress

1 Prior to arriving at Centralia Correctional Center, Plaintiff was incarcerated in Shawnee

Correctional Center until mid-February 2018. (Doc. 72, p. 1). The record does not indicate whether Plaintiff

has been housed at any other additional facilities.

2 A Jackson-Pratt drain is used to address any “contin[uos] oozing and shedding of cells and bodily

fluid” following surgery. The drain “removes fluid” and “speeds healing.” When the bulb of the drain is

compressed, the drain suctions fluid out of the body automatically. See Cleveland Clinic, Health Library,

“How to Care for the Jackson-Pratt Drain”, https://my.clevelandclinic.org/health/articles/21104-how-to-

care-for-your-jackson-pratt-drain (last visited Feb. 15, 2023).

note from the April 3rd appointment states that Plaintiff “continues to have fixed

delusion[s] that a device has been inserted into his abdomen the last time he had surgery

in 1998.” Id. Plaintiff believes that this device or another device implanted during the 1998

surgery is causing his gastrointestinal issues, headaches, and esophageal problems. (Doc.

72, Exh. 3, p. 2:15-25). Plaintiff was proscribed and is still taking medications to address

his mental health symptoms. (Doc. 72, Exh. 1, p. 6; Doc. 72, Exh. 3, p. 20:20). During his

deposition, Defendant Santos indicated that a patient’s history of “delusions” does not

change how he views “what they’re telling him about their symptoms.” (Doc. 73, Exh. 1,

p. 12:20-23).

B. Plaintiff’s Physical Care at Centralia Correctional Center

The medical records documenting Plaintiff’s care date back to February 2018.3

(Doc. 72, Exh. 1). Plaintiff visited the Centralia Health Care Unit (“HCU”) on February 4,

2018. (Doc. 72, Exh. 1, p. 1). At this visit, Plaintiff was seen by an unknown doctor

(signature illegible). Id.; (Doc. 72, p. 2). Plaintiff complained that he had been experiencing

chest pain “for many years” allegedly caused by an electronic “transmitter in his body.”

(Doc. 72, Exh. 1, p. 1). Plaintiff also reported that he had previously received no

3 A radiology report dated June 17, 2014, was also attached as one of Plaintiff’s exhibits. The report

indicates that Plaintiff had been complaining of chest pain and that he “fe[lt] like [he was] choking.” X-rays

of the abdomen and chest were reportedly taken on June 16, 2014. The three images of the abdomen

revealed that Plaintiff’s gas pattern was normal; that there were no renal calculi; and that there was a

metallic density “which may be a bullet fragment” projecting along the superolateral aspect of Plaintiff’s

right hip. Two separate images were taken of Plaintiff’s chest. The x-rays revealed that Plaintiff’s heart was

of normal size; that there was “strand density” in the right pulmonary base “which may be due to

atelectasis or fibrosis”; and an asymmetric elevation or eventration of the right hemidiaphragm. (Doc. 73,

Exh. 3, p. 1).

medication for the pain. Id. In response, the unknown doctor referred Plaintiff to the

mental health department and proscribed him Pepcid for heartburn relief. Id.

Plaintiff returned to the HCU on February 15, 2018. (Doc. 72, Exh. 1, p. 2). Plaintiff

was seen by Nurse Shaw (“Shaw”) and complained of sharp chest pains. Id. Plaintiff

reported to Shaw that he had been experiencing episodes of sharp chest pain for the past

year and that the pain would occur during activity or rest. Id. Plaintiff also indicated that

the pain would wake him from sleep. Id. Plaintiff rated the pain of these episodes as a 10

on the pain scale and noted that he had been experiencing nausea, dizziness, vomiting,

and shortness of breath in conjunction with the episodes. Id. Upon examination, Shaw

found Plaintiff’s lungs to be clear and his vital signs normal. Id. at p. 3. Shaw referred

Plaintiff to a doctor for further evaluation. Id.

Plaintiff was first seen by Defendant Dr. Santos (“Santos”) on April 10, 2018, for

abdominal pain. (Doc. 72, Exh. 1, p. 8). Plaintiff complained of irregular bowel

movements, and he reported that he sustained injuries to his abdomen in 1998 from a

gunshot wound. Id. Santos examined Plaintiff and found that he was not in distress, had

no heart murmurs or rails in the lungs, and had bowel sounds plus two with a healed

scar on his abdomen. Id. Santos assessed Plaintiff as status-post gunshot wound to the

abdomen with a history of bowel obstruction. Id. He ordered a Kidney, Ureter, and

Bladder (“KUB”) x-ray of Plaintiff’s abdomen and planned a follow up visit to discuss

the results. Id. at p. 9.

OneRadiology took the KUB x-ray as ordered on April 11, 2018. Id. at p. 9. The x-

ray found that the “visualized bowel gas” was unremarkable and that no “abnormal

calcifications were seen in the abdomen or pelvis.” Id. Pelvic phleboliths were also found

to be present. Id. No radiopaque foreign bodies were seen nor was any bowel dilation

identified. Id. Although the x-ray indicated that there was a limited field of view, the x-

ray did not locate any acute findings. Id.

Dr. Santos had a follow up visit with Plaintiff on May 1, 2018. (Doc. 72, Exh. 1, p.

10). At the visit, Plaintiff voiced no concerns. Id. Santos examined Plaintiff, noted his

history of a gunshot wound to the abdomen, and observed that his abdomen was soft

and non-tender with normal bowel sounds. Id. Dr. Santos reportedly reviewed the KUB

x-ray results and counseled Plaintiff. Id. During the counseling, Santos indicated to

Plaintiff that the x-ray results were normal and there was no evidence of obstruction. Id.

Plaintiff disputes that he was ever shown or given any information about these x-rays.

(Doc. 73, Exh. 2, p. 8:20-25).

On May 4, 2018, Dr. Santos saw Plaintiff to assess his complaints of an unresolved

sore throat with ear pain. (Doc. 72, Exh. 1, p. 11). Santos examined Plaintiff and observed

that his throat was congested and red and that his ear canal was obstructed with wax. Id.

However, Plaintiff’s heart and lung sounds were determined to be normal. Id. Dr. Santos

diagnosed Plaintiff with an acute respiratory tract infection and bilateral impacted

cerumen4. Id. Santos ordered Amoxicillin, a Debrox protocol5, and instructed Plaintiff to

increase his fluid intake. Id.

X-rays of Plaintiff’s chest were subsequently ordered by Dr. Santos. (Doc. 72, Exh.

1, p. 12). On May 5, 2018, OneRadiology took the x-rays as ordered. Id. The x-rays

revealed a “slight asymmetric elevation of the right hemidiaphragm.” Id. No active

infiltrate was seen, but “minimal subsegmental atelectasis” was identified as being

possibly present at the lung bases. Id. The x-rays further showed that Plaintiff’s heart was

not enlarged and that there was no sign of pleural effusion or pneumothorax. Id.

Plaintiff saw Dr. Santos again on May 25, 2018, for a sore throat and ear pain. (Doc.

72, Exh. 1, p. 13). Santos examined Plaintiff and noted that his ear drum was intact with

no drainage seen in the throat. Id. Dr. Santos assessed Plaintiff as having an upper

respiratory tract infection and continued his previously proscribed antibiotic treatment

plan. Id.

Dr. Santos had another visit with Plaintiff on May 31, 2018. (Doc. 72, Exh. 1, p. 14).

Dr. Santos observed that Plaintiff was alert and in no apparent distress. Id. Dr. Santos

reviewed Plaintiff’s May 8th x-ray results with Plaintiff, indicating “x-ray film shown” in

his medical note. Id. Santos’s assessment of the May 8th x-ray was that the images showed

4 Cerumen impaction is the medical term for earwax blockage. See Cleveland Clinic, Health Library,

“Earwax Blockage”, https://my.clevelandclinic.org/health/diseases/14428-ear-wax-buildup--blockage

(last visited Feb. 15, 2023).

5 Debrox is one of the hydrogen peroxide or peroxide based ear drops commonly used to dissolve

ear wax in the ear canal. See Cleveland Clinic, Health Library, “Earwax Blockage”,

https://my.clevelandclinic.org/health/diseases/14428-ear-wax-buildup--blockage (last visited Feb. 15,

2023).

“segmental atelectasis in the lungs.” Id. Santos instructed Plaintiff to do deep breathing

exercises to manage his symptoms. Id.

Plaintiff’s next visit with Dr. Santos occurred on November 5, 2018. (Doc. 72, Exh.

1, p. 16). Plaintiff complained of irritation of the urethra for five days, which followed an

incident where he submerged his penis in toilet bowel water. Id. Santos examined

Plaintiff and found no urethral discharge or skin lesions. Id. A prior urinalysis done by a

nurse before the appointment was negative. Id. Dr. Santos diagnosed Plaintiff with non-

specific urethritis, ordered Bactrim, and advised Plaintiff to increase his fluid intake. Id.

On December 16, 2018, Plaintiff presented to the HCU with abdominal and chest

pain. (Doc. 72, Exh. 1, p. 17-18, 19-20). As to the abdominal pain, Plaintiff reported that

he had been suffering from abdominal cramps and bloody stools for years. Id. at p. 17.

Upon examination, Plaintiff’s abdomen was soft and non-tender. Id at p. 18. As to the

chest pain, Plaintiff reported that stabbing pain ran from his “heart to his throat” and

“comes and goes” without explanation. Id. at p. 19. In both medical notes, the HCU

recommended that a call be placed to Dr. Siddiqui. Id. at p. 18, 20.

Dr. Santos next saw Plaintiff on December 19, 2018, to address the complaints of

chest and abdominal pain. (Doc. 72, Exh. 1, p. 21). Plaintiff voiced no concerns during this

encounter, and Santos observed that Plaintiff was in no apparent distress. Id. Dr. Santos

found that Plaintiff had no heart murmurs and had clear and resonant lungs with no rails.

Id. Santos assessed Plaintiff as having non-specific chest pain and that he be released from

the HCU. Id. Santos also advised that Plaintiff continue with all previously proscribed

medications and follow up in five days. Id.

On March 31, 2019, Plaintiff reported pain in his rectum, abdomen, and knee to a

nurse at Centralia. (Doc. 73, Exh. 3, p. 4). Plaintiff reported to the nurse that he had

experienced this pain before and that nothing had ever been done about it. Id. Plaintiff

also reported that he was having roughly two bowel movements per day and that blood

was present in his stool during each bowel movement. Id. The nurse placed Plaintiff in

the M.D. line for a physician to follow-up on Plaintiff’s concerns. Id.

On April 2, 2019, Plaintiff saw Defendant Dr. Santos pursuant to the nurse’s

recommendation. (Doc. 72, Exh. 1, p. 22). Plaintiff reportedly informed Santos that he had

suffered from rectal bleeding from hemorrhoids for years. Id. Upon examination, Santos

observed that Plaintiff was alert and in no clear sign of distress; he also had a normal

heart and lung examination, positive bowel sounds, and no palpable masses in his

abdomen. Id. Santos assessed Plaintiff as having internal hemorrhoids and degenerative

joint disease in his left knee. Id. Santos’s plan of care included replacing Plaintiff’s knee

sleeve, a hemoccult blood stool test, a KUB x-ray, and Fiberlax laxatives. Id. Santos also

planned to have a follow up appointment with Plaintiff to discuss the results of the

ordered diagnostic testing. Id.

Dr. Santos followed up with Plaintiff about his hemorrhoids on April 8, 2019. (Doc.

72, Exh. 1, p. 23). During the visit Santos noted that Plaintiff complained of constipation

and occasional bleeding from hemorrhoids. Id. Dr. Santos observed that Plaintiff was not

in any apparent distress and that his abdomen was soft and tender; he also had positive

bowel sounds. Id. Santos reported that he reviewed the results of Plaintiff’s KUB x-ray

and noted that the x-ray was within normal limits. Id. Defendant Santos assessed Plaintiff

as being constipated with internal hemorrhoids; he also ordered Colace6 and counseled

him to increase fluids and continue treatment. Id.

Plaintiff saw Santos once again on May 14, 2019, for a routine physical

examination. (Doc. 72, Exh. 1, p. 49). During the examination, Santos conducted a digital

rectal exam on Plaintiff using gloves and a lubricating gel. Id. Defendant Santos identified

non-thrombosed internal hemorrhoids during the exam. Id.

On May 20, 2019, following the rectal exam, Plaintiff saw Nurse Mohmeyers

during a nurse sick call to address his complaints of hemorrhoids and rectal bleeding.

(Doc. 72, Exh. 1, p. 24). Nurse Mohmeyers examined Plaintiff and found no bleeding

around the anal area or signs of trauma but noted Plaintiff’s complaints of hemorrhoids.

Id. Nurse Mohmeyers also noted that “bright red blood” was present in Plaintiff’s stool

and that the “S/R” hemorrhoid cream protocol was ineffective. Id. Upon evaluating

Plaintiff, Nurse Mohmeyers referred Plaintiff for a follow up appointment with a

physician. Id.

Dr. Santos saw Plaintiff for this follow up appointment on May 22, 2019. (Doc. 72,

Exh. 1, p. 25). During this visit, Plaintiff complained of occasional rectal bleeding and

nasal congestion. Id. However, Plaintiff denied that he was suffering from constipation.

Id. Dr. Santos assessed Plaintiff as having non-thrombosed internal hemorrhoids, ordered

Preparation H cream per protocol, directed Plaintiff to increase his fluids, and proscribed

10mg of Claritin for nasal congestion. Id. Defendant Santos testified that at this point, he

6 Colace is a common brand of docusate used as a stool softener. See Cleveland Clinic, Health

Library, Drugs, Devices and Supplements, “Stool Softener”,

https://my.clevelandclinic.org/health/drugs/23274-stool-softener (last visited Mar. 2, 2023).

was not concerned about Plaintiff suffering from anemia because it was controlled with

an iron supplement. (Doc. 72, Exh. 2, p. 19:12-18).

Plaintiff next saw Dr. Santos on July 1, 2019, to address complaints of abdominal

pain and diarrhea. (Doc. 72, Exh. 1, p. 26). Plaintiff had reported that he had been

experiencing both bloody and green mucus filled stool to a nurse, who referred Plaintiff

to a physician for follow up. (Doc. 73, Exh. 3, p. 7). Plaintiff also reported to the nurse that

he had lost five pounds over the course of one week due to the consistent diarrhea. Id.

During the visit, Plaintiff reported on and off loose bowel movements for one week that

occurred four or five times per day. Id. Upon examination, Santos found Plaintiff’s

abdomen to be soft, but tender with pressure to the mid-abdomen. Id. Plaintiff’s bowel

sounds were also found to be somewhat hyperactive. Id. Dr. Santos advised Plaintiff to

increase his fluid intake and ordered Imodium to treat the diarrhea. Id. Santos noted in

his deposition that diarrhea can impact hemorrhoids by making them more inflamed.

(Doc. 72, Exh. 2, p. 21:18-21).

On August 31, 2019, Plaintiff’s stool was tested for blood using a hemoccult test

after Plaintiff complained to a nurse of bloody stools, abdominal pain and rectal pain.7

(Doc. 72, Exh. 1, p. 27; Doc. 73, Exh. 3, p. 9). Plaintiff’s hemoccult test was positive for

blood, and Dr. Santos followed up with Plaintiff regarding these lab results on September

7 Plaintiff was assessed twice by a nurse before being seen by Dr. Santos on August 31, 2019. Plaintiff

saw a nurse on August 22, 2019, due to pain caused by his hemorrhoids. (Doc. 73, Exh. 3, p. 9). The nurse

noted that upon visual inspection, Plaintiff had small protruding hemorrhoids. Id. Plaintiff was also seen

by a nurse on August 28, 2019, due to abdominal pain (Doc. 73, Exh. 3, p. 10). During this visit, Plaintiff

complained of light green and blood stool. Id. Plaintiff also expressed concerns about colon cancer during

this visit. Id.

3, 2019. Id. During the visit, Plaintiff denied that he had suffered from rectal bleeding, but

reported a history of abdominal surgery in 1998. Id. Dr. Santos then examined Plaintiff

and found that he was in no distress and that his heart, lungs, and abdomen were normal.

Id. Santos assessed Plaintiff as having non-thrombosed internal hemorrhoids that were

reducible. Id. Dr. Santos advised Plaintiff on proper anal hygiene and ordered that

Plaintiff continue to use the Preparation H cream previously proscribed. Id. Santos also

noted that he would review Plaintiff’s older medical records and ordered Complete

Blood Count (“CBC”) and Basic Metabolic Panel (“BMP”) blood tests. Id.

Dr. Santos saw Plaintiff once again on October 7, 2019, to evaluate his abdominal

pain. (Doc. 72, Exh. 1, p. 28). Plaintiff had complained of the abdominal pain to a nurse

on October 4, 2019, stating that he was experiencing vomiting, bloody stools, and an

urgency to urinate. (Doc. 73, Exh.3, p. 11). During this visit with Santos, Plaintiff

complained of on and off dark stools. Id. Dr. Santos examined Plaintiff and found that he

had a healthy abdomen, which was soft and non-tender, with positive bowel sounds. Id.

Dr. Santos also conducted a rectal exam where he found a small external hemorrhoid. Id.

Santos assessed Plaintiff as having internal hemorrhoids and planned additional

hemoccult stool tests; he also proscribed Plaintiff ibuprofen for pain management and

advised him on his diet. Id.

On October 11, 2019, Dr. Santos saw Plaintiff to follow up on his hemoccult blood

tests. Plaintiff had reported dark colored stools during bowel movements. (Doc. 72, Exh.

1, p. 29). Dr. Santos conducted a rectal examination and found that Plaintiff had non-

tender and non-thrombosed external hemorrhoids. Id. Santos noted that Plaintiff’s CBC

blood test was within normal limits and that the hemoccult stool test was positive. Id. Dr.

Santos discontinued the Feosol, advised the Plaintiff on anal hygiene, directed Plaintiff

to increase his fluid intake, and ordered repeat hemoccult blood stool tests and CBC labs

after one month. Id.

Dr. Santos saw Plaintiff to address his high blood pressure on October 30, 2019.

(Doc. 72, Exh. 1, p. 30). Plaintiff also complained about blood in his stool during this visit.

Id. Dr. Santos found that Plaintiff’s abdomen was soft and non-tender with no palpable

masses and positive bowel sounds. Id. He assessed Plaintiff as having controlled

hypertension and ordered Tylenol. Id. Dr. Santos also ordered additional hemoccult

blood tests and CBC labs to further assess Plaintiff’s complaints of bloody stools. Id.

Santos noted that he would follow up with Plaintiff once he received the results. Id.

Dr. Santos followed up with Plaintiff’s lab results on November 14, 2019. (Doc. 72,

Exh. 1, p. 31). Plaintiff complained of on and off rectal bleeding ranging in color from

bright red to dark red since he had suffered from a gun shot wound in 1998. Id. Dr. Santos

examined Plaintiff and found that he was not actively bleeding as indicated by the

hemoglobin values in the repeat CBC labs. Id. However, two of Plaintiff’s hemoccult

samples came back positive and contained frank blood. (Doc. 73, Exh. 3, p. 16). Within

the M.D. note, Defendant Santos noted Plaintiff’s historic hemoglobin levels. Id. Santos

reported that Plaintiff’s hemoglobin levels were: 13.6 in April 2019, 14.1 in August 2019,

13.7 in September 2019 and 12.0 in November 2019. Id. Defendant Santos testified that a

normal range for a male’s hemoglobin is between 13.2 and 18. (Doc. 72, Exh. 2, p. 22: 9-

14). Dr. Santos assessed Plaintiff as having rectal bleeding and ordered a repeat blood

test, Feosol Iron tablets, B12 vitamins, Folic Acid pills, and Tylenol. Id. Santos noted that

he intended to follow up with Plaintiff in two weeks’ time. Id.

Plaintiff’s follow-up visit with Dr. Santos occurred on November 27, 2019. (Doc.

72, Exh. 1, p. 32). During the visit, plaintiff still complained of blood in his stool. Id. Dr.

Santos’s physical exam found that Plaintiff’s heart and lungs sounded normal, that his

abdomen was soft and non-tender with positive bowel sounds, and that there were no

palpable masses. Id. Dr. Santos also conducted a rectal exam on Plaintiff. Id. The rectal

exam revealed that Plaintiff’s sphincter had good tone and that his internal hemorrhoids

were not bleeding. Id. Defendant Santos discontinued Plaintiff’s iron tablets and planned

to refer Plaintiff to collegial review for a possible colonoscopy. Id.

Following Plaintiff’s follow-up visit on November 27, 2019, Dr. Santos referred

Plaintiff for a consultation with a gastroenterologist. (Doc. 72, Exh. 1, p. 38). Dr. Santos

indicated that he was making the referral because Plaintiff had complained of a

gastrointestinal bleed for one month; he also had positive hemoccult stools and

hemorrhoids. Id. The referral was approved on December 18, 2019. Id.; (Doc. 72, Exh. 4,

p. 1).

Dr. Santos then saw Plaintiff again following his medical furlough on December

20, 2019. (Doc. 72, Exh. 1, p. 34). In his M.D. note, Defendant Santos noted that Plaintiff

had no complaints and that the outside gastroenterologist who saw Plaintiff

recommended that he undergo an esophagogastroduodenoscopy (“EDG”), as well as a

colonoscopy. Id. Dr. Santos’s treatment plan was to follow the recommendations of the

gastroenterologist. Id. Plaintiff’s EDG and colonoscopy were approved on December 27,

2019. (Doc. 72, Exh. 1, p. 39).

On January 30, 2020, Plaintiff underwent a colonoscopy performed by Dr. Merrilee

Brandt at St. Mary’s Hospital in Centralia, Illinois. (Doc. 72, Exh. 1, p. 43-44). The

colonoscopy showed Grade 3 internal and external hemorrhoids along with some

inflammation. Id. No fissures, polyps or other lesions in the abdomen were identified. Id.

at p. 43. Biopsies were taken from the duodenum, the antrum, the GE junction, and the

esophagus. Id. The biopsied tissue was then sent to pathology for analysis. Id. No

evidence of cancer was identified in the pathology report, but the tissue samples

exhibited characteristics consistent with mild gastropathy. (Doc. 72, Exh. 1, p. 41-42).

Plaintiff saw Dr. Santos following his colonoscopy on February 14, 2020, to address

complaints of his hemorrhoids worsening. (Doc. 72, Exh. 1, p. 35). Dr. Santos noted

Plaintiff status as post EGD and colonoscopy and assessed him as having gastritis and

internal/external hemorrhoids. Id. Defendant Santos counseled Plaintiff to increase

fluids; he also ordered Fiberlax, Prilosec, and daily Preparation H suppositories. Id.

Defendant Santos testified that Dr. Brandt’s findings from the colonoscopy did not

explicitly include a recommendation for surgery on Plaintiff’s Grade 3 hemorrhoids.

(Doc. 72, Exh. 2, p. 32:20 – 34:10). However, Santos also testified that hemorrhoids could

be considered to require surgery when they are “bothering the patient.” Id. at p. 33:17.

Santos further testified that he was aware that Plaintiff was experiencing severe pain and

discomfort from his hemorrhoids at this time. Id. at p. 34:1-3.

Dr. Santos subsequently retired from his position at Centralia in May 2020 and

thereafter worked intermittently visiting correctional facilities until January 2021. (Doc.

72, p. 2:11-18). Santos then undertook a pro re nata position for one month at Graham

Correctional Facility when the acting medical director retired in January 2021. Id. at p.

2:19-24. Plaintiff’s care was then undertaken by Dr. Jodi Pelegrin. (Doc. 72, Exh. 1, p. 36).

Plaintiff saw Dr. Pelegrin on October 23, 2020, for a check-up, where he

complained of tarry stools. Id. She noted that Plaintiff reported that his hemorrhoid cream

was not helping and that he takes his Fiberlax and iron supplements daily as proscribed.

Further, she noted that Plaintiff’s bloodwork revealed hemoglobin levels of 12.1 on March

14, 2020, and 8.4 on August 28, 2020. Id. She also noted Plaintiff’s long history of

hemorrhoids and anemia. Id. Dr. Pelegrin ordered 3 hemmocult stool samples, a CBC,

and an iron panel. Id. She also instructed Plaintiff to continue the iron and hemorrhoid

suppositories and noted that she intended to send Plaintiff to gastroenterology for a

consult. Id.

Plaintiff subsequently underwent a hemorrhoidectomy at St. Mary’s Hospital in

Centralia, Illinois, on April 19, 2021. (Doc. 72, Exh. 5, p. 1-2). The surgeon noted that the

largest hemorrhoid was in the right anterior region, but that Plaintiff had significant

dilated hemorrhoids in all three positions. Id. Further, the surgeon noted that the

hemorrhoids extended proximally for at least 3 cm in distance. Id. Two of the

hemorrhoids were excised and banded. Id.

Plaintiff underwent a second hemorrhoidectomy on October 14, 2021. (Doc. 72,

Exh. 5.). The surgeon noted that Plaintiff had previously underwent a hemorrhoidectomy

for prolapsing hemorrhoids, but that he continued to have episodic prolapse and

bleeding. Id. The surgeon further noted that Plaintiff was not anemic as he was prior to

the first surgery. Id.

In his deposition, Plaintiff stated that from the time he arrived at Centralia in 2018

until his hemorrhoidectomy surgeries performed in 2021, that he experienced significant

pain from his hemorrhoids and rectal bleeding. (Doc. 72, Exh. 2, p. 19:17-20:10). Plaintiff

described the pain as “excruciating.” Id. at p. 20:8. Plaintiff noted that his hemorrhoids

caused him to experience pain while going about his basic daily activities, which included

sitting down, using the bathroom, and sleeping. Id. at 19:20-20:1. Plaintiff further noted

that enduring this pain negatively impacted his mental wellbeing. Id. at p. 20:19.

C. Care Plans for Hemorrhoids at Central Correctional Center

One common component of treatment for hemorrhoids is a sitz bath. (Doc. 72, p.

8). A sitz bath is a process in which a patient suffering from hemorrhoids can sit in a

warm basin of water to relieve pain. Id. Dr. Santos testified in his deposition that sitz

baths are a treatment available to inmates in their housing units. (Doc. 72, Exh. 2, p. 12:7-

11). He further testified that sitz baths are prescribed if the hemorrhoids are “really

painful.” Id. Santos also stated that there would be no reason why he would deny a

patient a sitz bath. Id. at p.12:15-16. Dr. Santos indicated that prescribing a sitz bath is a

typical “part of the counseling” for inmates that are experiencing hemorrhoids. Id. at

p.20:7. He also noted that the typical counseling contains a recommendation for inmates

to use a warm towel or heating pad for further relief. Id. at p. 20:11-13. Santos testified

that he has no reason to believe that he deviated from the standard counseling procedure

in this case. Id. at p. 20:20. However, Plaintiff testified in his deposition that Dr. Santos

denied him access to a sitz bath as a treatment option. (Doc. 72, Exh. 3, p. 13:2-4). When

Plaintiff asked Dr. Santos about the sitz bath treatment, Santos allegedly told Plaintiff that

“we don’t do that here.” Id. This caused Plaintiff to believe that sitz baths were

unavailable to inmates at Centralia Correctional Center.

Dr. Santos also elaborated on the medication protocol for the treatment of

hemorrhoids in his deposition. Santos testified that there are two separate cream-based

protocols for treating hemorrhoids at Centralia Correctional Center. (Doc. 72, Exh. 2, p.

18:13-15). Santos noted that medical practitioners use Anusol cream initially and then

move to using Preparation H cream when that proves to be ineffective. Id. at p. 18:17-21.

Defendant Santos indicated that the difference between Anusol and Preparation H is that

the latter contains hydrocortisone while the former does not. Id. at p. 18:20-24. Dr. Santos

stated that he proscribed Plaintiff with Preparation H cream on May 22, 2019, in response

to the Anusol cream being ineffective. Id. p. 19:1-3. Plaintiff testified that at some point,

he indicated the hemorrhoid creams were ineffective and that Santos did nothing in

response. (Doc. 73, Exh. 3, p. 18:1-14). When Plaintiff inquired about other treatment

options, Santos reportedly told Plaintiff that further interventions were “too expensive.”

Id. Santos also noted that when both topical hemorrhoid creams are ineffective, that the

next step in the care plan protocol is to proscribe the inmate daily hemorrhoidal

suppositories. Id. at p. 30:6-9. Santos proscribed Plaintiff Preparation H suppositories

during their visit on February 14, 2020. (Doc. 72, Exh. 1, p. 35).

LEGAL STANDARDS

Summary judgment is proper when the pleadings and affidavits “show that there

is no genuine issue as to any material fact and that the moving party is entitled to

judgment as a matter of law.” FED. R. CIV. PROC. 56(c); Oates v. Discovery Zone, 116 F.3d

1161, 1165 (7th Cir. 1997)(citing Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986)). The

movant bears the burden of establishing the absence of a genuine issue as to any material

fact and entitlement to judgment as a matter of law. See Santaella v. Metropolitan Life Ins.

Co., 123 F.3d 456, 461 (7th Cir. 1997)(citing Celotex, 477 U.S. at 323). This Court must

consider the entire record, drawing reasonable inferences and resolving factual disputes

in favor of the non-movant. See Regensburger v. China Adoption Consultants, Ltd., 138 F.3d

1201, 1205 (7th Cir. 1998)(citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986)).

See also Smith v. Hope School, 560 F.3d 694, 699 (7th Cir. 2009)(stating that “we are not

required to draw every conceivable inference from the record . . . we draw only

reasonable inferences”) (internal citations omitted). Summary judgment is also

appropriate if a plaintiff cannot make a showing of an essential element of his claim. See

Celotex, 477 U.S. at 322. While the Court may not “weigh evidence or engage in fact-

finding[,]” it must determine if a genuine issue remains for trial. Lewis v. City of Chicago,

496 F.3d 645, 651 (7th Cir. 2007).

In response to a motion for summary judgment, the non-movant may not simply

rest on the allegations in his pleadings; rather, he must show through specific evidence

that an issue of fact remains on matters for which he bears the burden of proof at trial.

See Walker v. Shansky, 28 F.3d 666, 670–671 (7th Cir. 1994), aff'd, 51 F.3d 276 (citing Celotex,

477 U.S. at 324). No issue remains for trial “unless there is sufficient evidence favoring

the non-moving party for a jury to return a verdict for that party . . . if the evidence is

merely colorable, or is not sufficiently probative, summary judgment may be granted.”

Anderson, 477 U.S. at 249–250 (citations omitted). Accord Starzenski v. City of Elkhart, 87

F.3d 872, 880 (7th Cir. 1996); Tolle v. Carroll Touch, Inc., 23 F.3d 174, 178 (7th Cir. 1994). In

other words, “inferences relying on mere speculation or conjecture will not suffice.” Trade

Fin. Partners, LLC v. AAR Corp., 573 F.3d 401, 407 (7th Cir. 2009) (internal citation omitted).

See also Anderson, 477 U.S. at 252 (finding that “[t]he mere existence of a scintilla of

evidence in support of the [non-movant's] position will be insufficient; there must be

evidence on which the jury could reasonably find for the [non-movant]”). Instead, the

non-moving party must present “definite, competent evidence to rebut the [summary

judgment] motion.” EEOC v. Sears, Roebuck & Co., 233 F.3d 432, 437 (7th Cir. 2000)

(internal citation omitted).

DISCUSSION

A prisoner, like Plaintiff, seeking to establish that the medical care he received in

prison was so insufficient as to violate his Eighth Amendment rights must prove that: (1)

he had an objectively serious medical need; and (2) the defendant prison official was

deliberately indifferent to that need. See Arnett v. Webster, 658 F.3d 742, 750 (7th Cir. 2011).

See also Greeno v. Daley, 414 F.3d 645, 652-653 (7th Cir. 2005); Langston v. Peters, 100 F.3d

1235, 1240 (7th Cir. 1996); Thomas v. Walton, 461 F. Supp.2d 786, 793 (S.D. Ill. 2006). In this

case, Defendant does not dispute that Plaintiff’s pain in his chest, throat, abdomen, and

rectum constitute objectively serious medical conditions. (Doc. 72, p. 16-19). Rather,

Defendant’s contention is that no reasonable trier of fact could find that the Defendant’s

handling of Plaintiff’s conditions constituted deliberate indifference. Id. Therefore, the

Court will proceed to analyze Plaintiff’s assertion that Defendant Dr. Santos’s treatment

of Plaintiff amounted to deliberate indifference.

For Plaintiff to properly assert that Defendant was deliberately indifferent to his

serious medical needs, he must show that Defendant had subjective knowledge of - and

then disregarded – an excessive risk to his health. See Greeno, 414 F.3d at 653. While

Plaintiff does not need to show that Defendant “literally ignored” his complaint, he is

required to demonstrate that Defendant was aware of his medical condition and that

Defendant either knowingly or recklessly disregarded it. Hayes v. Snyder, 546 F.3d 516,

524 (7th Cir. 2008). “Something more than negligence or even malpractice is required” to

prove deliberate indifference. Pyles v. Fahim, 771 F.3d 403, 409 (7th Cir. 2014). See also

Hammond v. Rector, 123 F. Supp.3d 1076, 1086 (S.D. Ill. 2015)(noting that “isolated

occurrences of deficient medical treatments are generally insufficient to establish . . .

deliberate indifference”). Rather, deliberate indifference involves “intentional or reckless

conduct, not mere negligence.” Berry v. Peterman, 604 F.3d 435, 440 (7th Cir. 2010) (citing

Gayton v. McCoy, 593 F.3d 610, 620 (7th Cir. 2010)).

Plaintiff first asserts that Defendant Dr. Santos was deliberately indifferent to

Plaintiff’s complaints of pain in his chest, throat, and abdomen because Santos allegedly

failed to treat these conditions properly. (Doc. 73, p 15-16). Plaintiff acknowledges that

Santos’s treatment alleviated Plaintiff’s throat and chest pain but noted that his

abdominal pain persisted. Id. at 15. Still, Plaintiff asserts that Defendant Santos’s alleged

failure “to review the results of any imaging with [Plaintiff]” and Defendant’s failure “to

show [Plaintiff] the results of any imaging” constitute deliberate indifference because

Defendant Santos thereby “refused to investigate [Plaintiff’s] source of pain.” Id. The

Court disagrees. “The fact that Plaintiff did not get a satisfactory explanation of his test

results does not establish deliberate indifference.” See Miller v. Rauner, No. 17-cv-859-NJR,

2017 WL 4284568, at *5 (S.D. Ill. Sept. 27, 2017).

Even if this were not the case, Plaintiff’s medical records clearly demonstrate that

Defendant Santos adequately treated Plaintiff’s chest, throat, and abdominal pain.8

Defendant repeatedly ordered KUB x-rays of Plaintiff’s abdomen for the purpose of

diagnosing the reported pain in that area. (Doc. 72, Exh. 1, p. 9, 22). Each of Plaintiff’s

KUB x-ray results was within normal limits. Id. Further, Defendant Santos proscribed

Plaintiff Imodium, Pepcid, and Fiberlax when Plaintiff experienced episodes of

abdominal pain; he also counseled Plaintiff on his diet to alleviate the symptoms. (Doc.

72, Exh. 1, p. 1, 22, 35; Doc. 73, Exh. 3, p. 7). Additionally, when Plaintiff’s colonoscopy

and EDG were performed, it only confirmed Dr. Santos’s initial diagnosis, i.e., that

Plaintiff’s abdominal pain was related to “mild gastropathy” commonly seen with the

8 The Court acknowledges that Plaintiff has a history of mental health concerns. However, regardless

of Plaintiff’s belief about the origin of the cause of his physical symptoms, adequate investigation and

treatment of those symptoms are required.

usage of NSAIDS or alcohol or associated with bile reflux. (Doc. 72, Exh. 1, p. 40). Dr.

Santos’s treatment of Plaintiff was consistent with this finding.

Defendant also sufficiently addressed Plaintiff’s intermittent throat and chest

pains. Plaintiff’s chest pain was determined to be “non-specific”, and Plaintiff was

diagnosed with gastroesophageal reflux disease (“GERD”). (Doc. 72, Exh. 1, p. 21).

Plaintiff was proscribed Pepcid, and Dr. Santos suggested diet modifications to address

Plaintiff’s GERD diagnosis. X-rays of Plaintiff’s lungs were also ordered. (Doc. 72, Exh. 1,

p. 12). Lastly, when Plaintiff experienced throat pain, Plaintiff was proscribed

Amoxicillin. (Doc. 72, Exh. 1, p. 11). While Plaintiff may not have received the care that

he desired to receive, only care that is so “blatantly inappropriate as to evidence

intentional mistreatment likely to seriously aggravate the prisoner’s condition” qualifies

as deliberate indifference. See Machicote v. Roethlisberger, 969 F.3d 822, 828 (7th Cir.

2020)(quoting Pyles, 771 F.3d at 409). Defendant Santos’s treatment of Plaintiff’s

abdominal pain, throat pain, and chest pain do not rise to this level. Therefore, as to

Plaintiff’s throat, stomach, and chest pains, Defendant’s Motion is GRANTED.

Next, Plaintiff asserts that Defendant Santos’s care of Plaintiff’s hemorrhoids and

rectal pain amounted to deliberate indifference because Santos knew that his treatments

were ineffective and because he did not refer Plaintiff to a specialist sooner. (Doc. 73, p.16-

20). In response, Defendant asserts that Plaintiff has failed to put any verifying evidence

in the record that establishes Plaintiff suffered from a detrimental effect from any alleged

delay in medical treatment. (Doc. 72, p. 18) (citing Langston v. Peters, 100 F.3d 1235, 1240

(7th Cir. 1996)). Defendant also notes that the decision of whether or not to use diagnostic

testing (such as a colonoscopy) is a decision left for a prison physician’s independent

medical judgment and does not amount to deliberate indifference so long as the inmate

does not face a serious risk to his health. Id. (citing Jones v. Natesha, 233 F. Supp.2d 1022,

1029-30 (N.D. Ill. 2002)). Here, the Court believes that by construing the facts and all

reasonable inferences in Plaintiff’s favor, a jury could conclude that Dr. Santos’s

treatment of Plaintiff’s rectum pain and hemorrhoids amounted to deliberate

indifference.

Plaintiff initially reported that he was suffering from rectal pain and hemorrhoids

on March 31, 2019. (Doc. 73, Exh. 3, p. 4). Dr. Santos first saw Plaintiff for these symptoms

on April 2, 2019. (Doc. 72, Exh. 1, p. 22). From April 2019 through February 2020,

Defendant Santos cared for Plaintiff’s rectal pain and hemorrhoids. During this time

period, Santos did alter his treatment plan. Initially, Santos utilized Anusol cream to treat

Plaintiff’s hemorrhoids and then switched to Preparation H cream on May 22, 2019, once

that proved to be ineffective. (Doc. 72, Exh. 1, p. 25). Defendant again altered his

treatment plan to include Preparation H suppositories on February 14, 2020. Id. at p. 35.

Defendant Santos also supplied Plaintiff with iron tablets when his hemoglobin levels

dropped. The nine months between Santos proscribing the Preparation H Cream to the

next iteration of treatment, during which Plaintiff’s condition objectively worsened could

be found to indicate deliberate indifference.

Deliberate indifference can be established when a Plaintiff experiences an

“inexplicable delay” in responding to an inmate’s serious medical condition. See Petties v.

Carter, 836 F.3d 722, 731 (7th Cir. 2016). This is especially so if that delay exacerbates an

inmate’s medical condition or unnecessarily prolongs suffering. See Williams v. Liefer, 491

F.3d 710, 715-716 (7th Cir. 2007). Between May 2019 and February 2020, Plaintiff endured

significant pain and Defendant Santos continued to proscribe a hemorrhoid cream

protocol even though Plaintiff’s condition continued to worsen – as demonstrated by

Plaintiff’s declining hemoglobin levels and weight loss. (Doc. 73, Exh. 3, p. 7, 16).

Additionally, Plaintiff testified that at some point, when he indicated that the hemorrhoid

creams were ineffective, that Santos did nothing in response to alter his treatment

protocol. (Doc. 73, Exh. 3, p. 18:1-14). When Plaintiff inquired about other treatment

options at this time, Santos reportedly told Plaintiff that further interventions were “too

expensive.” Id. The delay in altering the treatment plan for nine months could therefore

amount to deliberate indifference.

Alternatively, deliberate indifference may be found after Dr. Santos received the

results of Plaintiff’s EDG and colonoscopy. On January 30, 2020, Plaintiff underwent a

colonoscopy and EDG. (Doc. 72, Exh. 1, p. 43-44). Dr. Merilee Brandt indicated that

Plaintiff suffered from Grade 3 internal and external hemorrhoids. Id. During his

deposition, Dr. Santos admitted that he was aware that these hemorrhoids were causing

Plaintiff significant discomfort at this time. Dr Santos also admitted that Grade 3

hemorrhoids require surgery at some point and then clarified that “actually, any

[hemorrhoids] – if it’s bothering the patient [can require surgery].” This indicates to the

Court that Defendant was not providing Plaintiff with care that in his professional

judgment met the appropriate standard of care. “When a doctor is aware of the need to

undertake a specific task and fails to do so, the case for deliberate indifference is

particularly strong.” Goodloe v. Sood, 947 F.3d 1026, 1031 (7th Cir. 2020). See also Petties, 836

F.3d at 731 (stating that “. . . where evidence exists that the defendant knew better than

to make the medical decision that they did, a jury should decide whether or not

defendants were actually ignorant to the risk of harm they caused.”). Defendant Santos’s

stated opinion and his care of Plaintiff are contradictory; therefore, a jury should decide

whether his decision-making amounts to deliberate difference in this case. Thus, as to

Defendant Santos’s treatment of Plaintiff’s rectal pain and hemorrhoids, the Motion for

Summary Judgment is DENIED.

CONCLUSION

Accordingly, the Court GRANTS in Part and DENIES in Part the Motion for

Summary Judgment filed by Defendant Venerio Santos. (Doc. 71). The Court GRANTS

the Motion regarding Plaintiff’s claims of chest, throat, and abdominal pain. However,

the Court DENIES the Motion as to Plaintiff’s claims concerning rectal pain and

hemorrhoids. The Court DIRECTS the Clerk of Court to enter judgment reflecting the

same at the conclusion of the case.

IT IS SO ORDERED.

DATED: March 27, 2023. Digitally signed by

- . Judge Sison

ANlet 33. pate: 2023.03.27

10:58:02 -05'00'

GILBERT C. SISON

United States Magistrate Judge

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