Joe Feazell v. Wexford Health Sources, Inc .

In the
United States Court of Appeals
For the Seventh Circuit
____________________
Nos. 23-3337 & 24-1435
JOE F EAZELL,
Plaintiff-Appellant,
v.
WEXFORD HEALTH SOURCES, I NC . and PAMELA E. HART,
Administrator of the Estate of Andrew H. Tilden,
Defendants-Appellees.
____________________
Appeals from the United States District Court for the
Central District of Illinois.
No. 19-cv-1340 — Karen L. McNaught, Magistrate Judge.
____________________
A RGUED J ANUARY 29, 2025 — DECIDED J UNE 11, 2025
____________________
Before BRENNAN , SCUDDER , and S T. EVE, Circuit Judges.
ST. EVE, Circuit Judge. Joe Feazell, an inmate at Pontiac Cor-
rectional Center, sued his doctor, Andrew Tilden, and the
prison’s healthcare contractor, Wexford Health Sources, Inc.
He alleged that Wexford and Dr. Tilden were deliberately in-
different to his hemorrhoid condition and significant gastro-
intestinal bleeding, in violation of the Eighth Amendment.

-- 1 of 10 --

2 Nos. 23-3337 & 24-1435
The district judge initially denied the defendants’ motion
for summary judgment, and the parties consented to proceed
before a magistrate judge. The defendants then moved for re-
consideration of the summary judgment decision. The magis-
trate judge agreed that reconsideration was proper and
granted summary judgment for Wexford and partial sum-
mary judgment for Dr. Tilden.
Feazell went to trial on his remaining claim against Dr. Til-
den. He did not call an expert witness to testify to his medical
diagnoses or their causes. Instead, Feazell attempted to pro-
vide testimony on these matters himself. The court barred him
from doing so, and the jury returned a verdict for the defense.
Feazell appeals both the magistrate judge’s summary
judgment decision and her evidentiary rulings. Finding no er-
ror in either, we affirm.
I. Background
Feazell first entered state custody in 2014. He began re-
ceiving treatment for his longstanding hemorrhoid condition
and intermittent bleeding soon after. His providers pre-
scribed him hemorrhoid creams, pain relievers, and iron sup-
plements. Then, in the fall of 2018, Feazell was transferred to
Pontiac Correctional Center.
In Feazell’s first months at Pontiac, he saw medical staff
for a variety of ailments—but not his hemorrhoid condition.
Feazell had his first interaction with Dr. Tilden in December
of 2018, during one of these many visits. At that appointment,
Dr. Tilden reviewed Feazell’s lab results and conducted a
baseline exam. One of Feazell’s labs indicated that he had ab-
normally low levels of hemoglobin, a sign of anemia. Yet Dr.

-- 2 of 10 --

Nos. 23-3337 & 24-1435 3
Tilden did not document the abnormal lab value in his clinical
note or take follow-up action.
About one week later, Feazell’s psychiatrist contacted Dr.
Tilden to express concern about his labs. Dr. Tilden waited
another week to act, at which point he called Feazell to the
prison’s urgent care. During this visit, Feazell informed med-
ical staff that he had suffered from rectal bleeding for six
months and had shortness of breath when he exerted himself.
Urgent care staff ordered repeat lab testing, which showed
that Feazell’s hemoglobin levels had fallen further.
That same day, Dr. Tilden contacted a local hospital to re-
quest that it admit Feazell for testing. The hospital advised
him that admission was unnecessary. Feazell began to vomit
shortly thereafter, however, prompting his emergency admis-
sion. Meanwhile, Feazell’s hemoglobin levels declined fur-
ther. By the time he was admitted to the hospital, he needed a
blood transfusion.
Feazell’s inpatient physicians medically stabilized him
and then discharged him back to Pontiac. In his discharge or-
ders, Feazell’s doctors recommended an outpatient colonos-
copy to confirm the source of his bleeding. Dr. Tilden entered
the referral, Wexford’s Utilization Management department
approved it, and within six weeks of his hospital discharge,
Feazell underwent the procedure.
The colonoscopy revealed severe hemorrhoids. So his gas-
troenterologist recommended he consult with a colorectal
surgeon. Two days after that, on February 20, Feazell met with

-- 3 of 10 --

4 Nos. 23-3337 & 24-1435
Dr. Tilden to discuss follow-up care. Dr. Tilden ordered the
surgical consult a month and a half later.*
Once Dr. Tilden entered the referral, the system’s gears
turned quickly. Wexford approved the referral, and in late
May Feazell saw a surgeon, who recommended he undergo a
hemorrhoidectomy. Four days after Feazell’s surgical consult,
Dr. Tilden referred him for surgery. On July 2, 2019, approxi-
mately one month after this final referral, Feazell underwent
surgery to remove his hemorrhoids.
Following his surgery, Feazell commenced this suit
against Dr. Tilden and Wexford. In his pro se complaint, he
invoked 42 U.S.C. § 1983 and alleged that beginning in 2015,
and continuing until his hemorrhoid surgery in July of 2019,
the defendants were deliberately indifferent to his serious
medical needs, in violation of the Eighth Amendment.
Feazell asserted two distinct claims against Dr. Tilden:
that he was deliberately indifferent (1) when he failed to
promptly respond to Feazell’s abnormal lab results (his “low
hemoglobin claim”), and (2) when he failed to adequately
treat Feazell’s hemorrhoids (his “hemorrhoid claim”). Feazell
further alleged that Wexford, too, was liable because its pro-
tocol for treating his hemorrhoids was ineffective and delib-
erately indifferent to their severity.
The district court denied the defendants’ motion for sum-
mary judgment, concluding that a rational juror could find for
Feazell. The district court also instructed the parties to
* The record does not clarify why Dr. Tilden waited to order the con-
sult. Regardless, Feazell does not argue the turnaround time was im-
proper.

-- 4 of 10 --

Nos. 23-3337 & 24-1435 5
consider consenting to trial by a magistrate judge. All parties
consented and the district court transferred the case.
Shortly thereafter, the defendants moved for reconsidera-
tion of the summary judgment decision. Magistrate Judge
McNaught granted the motion and entered summary judg-
ment for Wexford and partial summary judgment for Dr. Til-
den. As to Wexford, Judge McNaught reasoned that because
Feazell had failed to offer any evidence that the injury he al-
leged was attributable to a Wexford policy or practice, his Mo-
nell claim could not survive summary judgment.
Judge McNaught also granted summary judgment for Dr.
Tilden on Feazell’s hemorrhoid claim, reasoning that Feazell
had offered no evidence that Dr. Tilden knew of his hemor-
rhoids prior to his colonoscopy. And Feazell’s recounting of
his treatment after Dr. Tilden became aware of his hemor-
rhoids did not evince deliberate indifference. Feazell’s new
argument—that Dr. Tilden was deliberately indifferent to the
prison’s failure to provide him with post-operative sitz baths,
as prescribed—did not alter the court’s calculus. Feazell had
not included his sitz bath allegations in his complaint, so
Judge McNaught deemed them waived.
Only on his low hemoglobin claim did Judge McNaught
find that Feazell had demonstrated a genuine issue of mate-
rial fact. Feazell took the claim to trial, where he attempted to
testify to the effects of his bleeding and the results of his co-
lonoscopy. The court sustained objections to this testimony,
and the jury ultimately returned a verdict for the defense.
II. Discussion
Feazell now appeals the magistrate judge’s summary
judgment decision. He also challenges the court’s evidentiary

-- 5 of 10 --

6 Nos. 23-3337 & 24-1435
rulings at trial. We review a grant of summary judgment de
novo, drawing all reasonable inferences in the nonmovant’s
favor. Balle v. Kennedy, 73 F.4th 545, 553 (7th Cir. 2023). We
review a trial court’s evidentiary rulings for abuse of discre-
tion. United States v. Pierson, 89 F.4th 976, 985 (7th Cir. 2024).
A. Eighth Amendment Claim Against Wexford
“The Eighth Amendment’s ban on ‘cruel and unusual
punishments’ obligates prison officials to provide medical
care to prisoners in their custody.” Dean v. Wexford Health
Sources, Inc., 18 F.4th 214, 234 (7th Cir. 2021) (citation omitted).
So deliberate indifference to a prisoner’s objectively serious
medical condition violates the Constitution. Whiting v. Wex-
ford Health Sources, Inc., 839 F.3d 658, 661 (7th Cir. 2016); see
also Farmer v. Brennan, 511 U.S. 825, 828, 837 (1994).
Section 1983 supplies a private right of action to prisoners
seeking to enforce their Eighth Amendment rights. Dean, 18
F.4th at 235; 42 U.S.C. § 1983. But because municipalities are
not vicariously liable for constitutional torts committed by
their employees, plaintiffs who wish to invoke § 1983 against
a municipality must prove that a government policy or cus-
tom caused their constitutional deprivation. Monell v. Dep't of
Soc. Servs. of City of New York, 436 U.S. 658, 690–91 (1978); How-
ell v. Wexford Health Sources, Inc., 987 F.3d 647, 653 (7th Cir.
2021).
Monell’s rule against vicarious liability extends to private
corporations, like Wexford, which act under color of state law.
Arce v. Wexford Health Sources Inc., 75 F.4th 673, 682 (7th Cir.
2023). Feazell thus must point to a Wexford policy or custom
that was “the moving force” behind his federal civil rights vi-
olation. Dean, 18 F.4th at 235 (quoting First Midwest Bank

-- 6 of 10 --

Nos. 23-3337 & 24-1435 7
Guardian of Est. of LaPorta v. City of Chicago, 988 F.3d 978, 987
(7th Cir. 2021)). “This ‘rigorous causation standard’ requires
‘a direct causal link between the challenged municipal action
and the violation of [the plaintiff’s] constitutional rights.’” Id.
(alteration in original) (quoting LaPorta, 988 F.3d at 987).
Before our court, Feazell contends that Wexford’s “Colle-
gial Review” policy of scrutinizing external referrals at
weekly meetings both denied him appropriate care in the four
years prior to his winter 2018 hospital admission and delayed
his surgical care afterwards.
Denying or delaying necessary treatment to an incarcer-
ated person suffering from avoidable pain can violate the
Eighth Amendment. Howell, 987 F.3d at 653. Yet Feazell never
argued in the district court that Wexford’s Collegial Review
policy caused him to receive deficient care prior to his winter
2018 hospitalization, so he has waived the contention. See
Duncan Place Owners Ass’n v. Danze, Inc., 927 F.3d 970, 974 (7th
Cir. 2019) (“[A] party waives the ability to make a specific ar-
gument for the first time on appeal when the party failed to
present that specific argument to the district court ….” (inter-
nal quotation marks omitted)).
Feazell’s claim that Collegial Review unconstitutionally
delayed his post-hospitalization treatment fares no better. He
identifies three delays allegedly attributable to Collegial Re-
view. They include: (1) a two-week delay in receiving a rou-
tine follow-up appointment after his hospital discharge, (2) a
two-month delay in receiving a colonoscopy, and (3) a two-
month delay in receiving a post-operative follow-up appoint-
ment.

-- 7 of 10 --

8 Nos. 23-3337 & 24-1435
Whether a delay in medical care constitutes deliberate in-
difference depends on the seriousness of the prisoner’s condi-
tion and the ease of providing treatment. Reck v. Wexford
Health Sources, Inc., 27 F.4th 473, 483 (7th Cir. 2022); see also
McGowan v. Hulick, 612 F.3d 636, 640 (7th Cir. 2010). Yet
Feazell offered no evidence of the standard of care for severe
hemorrhoids, or of the availability of the treatments he alleges
Wexford delayed.
Moreover, Feazell’s cited delays—considered individually
or in tandem—were not “so obviously wrong” that a layper-
son may draw the inference that they amounted to “a substan-
tial departure from accepted medical judgment,” as is re-
quired for a finding of deliberate indifference. See Whiting, 839
F.3d at 663. Feazell thus failed to demonstrate a genuine issue
of fact that Wexford’s Collegial Review policy caused a viola-
tion of his Eighth Amendment rights.
B. Eighth Amendment Claims Against Dr. Tilden
Feazell also appeals the magistrate judge’s entry of sum-
mary judgment for Dr. Tilden on his hemorrhoid claim. He
challenges the court’s holding that Dr. Tilden was unaware of
Feazell’s hemorrhoids prior to his colonoscopy, and its deter-
mination that he waived his sitz bath allegations.
The Supreme Court has instructed that officials may only
be deliberately indifferent to actually known risks. Farmer, 511
U.S. at 837; see also Petties v. Carter, 836 F.3d 722, 728 (7th Cir.
2016) (en banc). To survive summary judgment on his pre-
hospitalization claim, then, Feazell must establish a genuine
issue of material fact that Dr. Tilden had subjective
knowledge of his hemorrhoids before receiving the results of
his colonoscopy.

-- 8 of 10 --

Nos. 23-3337 & 24-1435 9
Proffering direct evidence of subjective knowledge is the
simplest way to carry this burden, but circumstantial evi-
dence can also suffice. Petties, 836 F.3d at 728. “[T]he existence
of documents the doctor regularly consulted which advised
against his course of treatment, evidence that the patient re-
peatedly complained of enduring pain with no modifications
in care, [or] inexplicable delays or departures from common
medical standards,” for example, may indicate actual
knowledge of a substantial risk. Id. at 731.
Here, Feazell failed to come forward with either direct or
circumstantial evidence of Dr. Tilden’s knowledge of his hem-
orrhoids prior to his colonoscopy. He offered only his medical
records, forwarded from prior institutions, which document
his hemorrhoid condition. But without evidence that the
standard of care requires reviewing all of a patient’s volumi-
nous medical records or that Dr. Tilden regularly did so,
Feazell’s medical records do not create a genuine issue of ma-
terial fact as to Dr. Tilden’s knowledge.
Feazell’s sitz bath allegations cannot save his hemorrhoid
claim, either. Feazell did not include them in his complaint
and the district court did not abuse its discretion when it
found he had waived them. See Ollison v. Gossett, 136 F.4th 729,
739–41 (7th Cir. 2025); Schmees v. HC1.COM, Inc., 77 F.4th 483,
488 (7th Cir. 2023).
C. Evidentiary Rulings at Trial
Lastly, Feazell challenges evidentiary rulings that barred
him from testifying to his medical diagnoses and their effects.
Federal Rule of Evidence 701 prohibits lay witnesses from
offering opinions based on “scientific, technical, or other spe-
cialized knowledge” governed by the expert witness rule.

-- 9 of 10 --

10 Nos. 23-3337 & 24-1435
Fed. R. Evid. 701(c); see also United States v. Conn, 297 F.3d 548,
554 (7th Cir. 2002) (explaining that lay testimony may not be
used to “provide specialized explanations or interpretations
that an untrained layman could not make if perceiving the
same acts or events” (quoting United States v. Peoples, 250 F.3d
630, 641 (8th Cir. 2001)).
In advance of trial, the court granted Dr. Tilden’s Estate’s
motion to bar Feazell from testifying to his medical diagnoses
or their effects. The court explained in detail that Feazell could
testify to his perceptions, such as when he started and
stopped bleeding. He was not qualified to testify about med-
ical causation or diagnosis, though. So Feazell could not, for
example, tell the jury why the bleeding started or what symp-
toms it caused. Despite this ruling, Feazell’s counsel asked
him on re-direct whether his mental health conditions “got
worse” because of his anemia, and to explain the results of his
colonoscopy. The magistrate judge sustained objections to
both questions.
Whether Dr. Tilden’s Estate opened the door to testimony
on Feazell’s hemorrhoid condition and the psychological ef-
fects of his anemia, as Feazell contends, is not material. The
district court barred the medical causation and diagnosis tes-
timony because Feazell was not competent to give it—not be-
cause it was irrelevant. In short, the court’s ruling was not er-
roneous, much less an abuse of discretion.
* * *
The judgment of the district court is
AFFIRMED.

-- 10 of 10 --