United States District Court

Northern District of Indiana

Hammond Division

ESTATE OF CEDELL WRIGHT, ) 

 )

Plaintiff, )

 )

 v. ) Civil Action No. 2:13-CV-333 JVB

)

LAKE COUNTY, IN et al., )

 )

Defendants. )

OPINION AND ORDER

Plaintiff, the estate of Cedell Wright, has sued Defendant Dr. William Forgey under 42

U.S.C. § 1983, alleging that his deliberate indifference to Wright’s serious medical needs while

he was a pretrial detainee at the Lake County jail resulted in Wright’s death. This matter is

before the Court on Dr. Forgey’s motion for summary judgment (DE 125) and motion to strike

certain evidence Plaintiff has offered in opposition to the summary judgment motion (DE 150). 

A. Facts

The following facts are taken as true for the purposes of Dr. Forgey’s motion. They are

taken largely from Dr. Forgey’s Statement of Undisputed Material Facts (because Plaintiff, in its

response to the motion, does not challenge any of those facts or identify, in its Statement of

Genuine Disputes any facts it contends are genuinely disputed) and augmented by facts set out in

the “Facts” section of Plaintiff’s brief. 

Dr. Forgey is a physician affiliated with Correctional Health Indiana Inc., an Indiana

corporation that has contracted to provide health services to inmates at the Lake County Jail. He
is not an employee of the Lake County Jail or the Sheriff of Lake County, but serves as the Jail’s

medical director. He held that position when Cedell Wright, was a pretrial detainee at the Jail

from November 9, 2012, to March 4, 2013, the day he died. Although Dr. Forgey stated in his

affidavit that he was not responsible for supervising or administering mental health services at

the jail, he had a collaborative practice agreement with Faith Ornelas, a Clinical Nurse

Specialist, that called for Dr. Forgey to work with Ornelas to provide health care services to

patients of the Lake County Jail, including providing psychiatric medication prescriptions and

counseling.

Wright’s jail medical records indicate that he was 5'10" tall and weighted 134 lbs when

he arrived at the Jail. According to a mental health/suicide intake screening, Wright reported

that he had nothing to look forward to and felt that there was no help for him and his situation. 

A mental health evaluation was attempted on November 20, 2012, but Wright signed a mental

health refusal of care form. Additional attempts at mental health screenings were not successful. 

On November 20, 2012, Wright also refused a comprehensive health screening.

On November 30, 2012, Wright reported that he had been constipated for two weeks and

that constipation was a recurring problem for him. He also reported a loose tooth and severe pain

from the four teeth adjacent to the loose tooth. He was described as thin and emaciated. He

refused the mineral oil that was prescribed for his constipation. He was given a dental

appointment and scheduled for a clinic visit that he refused. Mr. Wright was ordered to see Dr.

Forgey or a nurse practitioner in five days.

On December 3, 2012, Wright refused to come to the clinic. On December 4, he refused

a lab draw. On December 7, he refused dental treatment. Dr. Forgey saw him on December 9,

2
when he noted that Wright was prescribed multiple vitamins due to his emaciated condition, but

refused them.

On December 10, 2012, Wright refused dental care and complained of constipation and

abdominal pain. He was given mineral oil. That evening he made an urgent care call, reporting

that he had not had a bowel movement in four weeks, had abdominal pain, and had spit up blood. 

A nurse practitioner’s assessment was constipation with impaction and abdominal pain. Wright

was insisting on a stool softener, but she told him it could not be given until the impaction

cleared. Wright did not want the impaction manually cleared and agreed to try a suppository

first. He was to see the nurse practitioner two days later, but on December 13, 2012, he refused

a clinic visit.

On December 18, 2012, Wright again complained of abdominal pain and constipation. 

His abdomen was slightly distended but it was not painful upon touch. He was given a dose of

mineral oil and was scheduled to have a clinic visit on December 20. On that date, Wright was

evaluated by Dr. Jose Agusti regarding abdominal pain, constipation, and diarrhea. 

On January 12, 2013, Wright lost a tooth and complained of a sharp ache in his left ear. 

Dr. Forgey was called and he ordered an antibiotic and pain medication for ten days, as well as a

dental visit. However, Wright did not take these medications as directed.

On January 14, 2013, Wright was seen by a mental health worker (at least the Court

believes the initials after her name—QMPH—stand for “qualified mental health provider”) after

it was reported that he was not integrating with the general population, was not eating, was

losing weight and had not showered in five days. The mental health worker described him as

emaciated, flat, and irritable. He avoided eye contact and his speech was slow, soft, and slurred.

3
Wright told her that he would refuse “psych” medications because he had never taken any

medications in his life. He appeared lethargic, withdrawn, and depressed. He was moved to the

medical wing on the fourth floor for medication, observation, and stabilization.

The Jail medical records document that the mental health staff evaluated him on January

15, 17, 18, 21, and 22. It was noted that he was refusing to eat because he did not like jail food.

A nurse practitioner discussed the importance of calorie intake to ensure immune system

strength and stated that the plan was to consult with the medical director and consider Megace

(an appetite stimulant). Wright said he would try to eat more. He was also told that mental

health services were available if he wanted to talk to a mental health worker. On January 22 he

reported experiencing auditory hallucinations that he did not find particularly distressing and had

a depressive demeanor. His weight was recorded as 126.8 pounds. The importance of eating

was again discussed. The plan was to start him on Risperdal and Cogentin.

On January 22, Mr. Wright met with his criminal attorney, Derrick Julkes. Julkes was

shocked to see how emaciated Mr. Wright had become while in custody. Julkes feared that if

Wright’s condition deteriorated further, he would die. Julkes spoke with the deputy warden and

sent a letter to several Jail officials. 

On January 28, 2013, Dr. Agusti saw Wright. He weighed 128 pounds, reported no

complaints, and told Dr. Agusti that he had always been slim and was doing fine. Dr. Agusti

noted rales in his lungs and that Wright wasn’t eating well and refused to have labs drawn and

refused medication. Dr. Agusti diagnosed cachexia.1

1

Neither party took the trouble to define this term in their briefs or affidavits. Scouring the record, as the

Court is not required to do, it discovered an incomprehensible definition in the expert report of David Thomas, one

of Plaintiff’s experts: “Cachexia is weight loss is [sic] due to the break-down of protein (catabolism) which is due to

the increased metabolic rate as a result of cytokines released by immune cells and proteolytic enzymes which break

4
Later that day, Nurse Ornelas did a psychiatric evaluation of Wright. According to the

evaluation, he was actively hallucinating and had a history of auditory and visual hallucinations. 

Wright told Ornelas that he would continue to decline medications. She diagnosed him as

having schizoaffective disorder. Risperdal and Cogentin were discontinued because Wright

refused to take them. 

Wright refused a mental health evaluation on February 4, 2013. On February 5, a nurse

practitioner evaluated him because he was refusing to eat and claimed he could not hear. He

now weighed 125 pounds. It was determined that his body-mass index was less than eighteen

and he had hearing loss in both ears because of thick ear wax plugs. He was prescribed ear

drops. He was also evaluated by the mental health staff. The mental health worker met with

someone on the medical staff. Once again, the plan was to consult with Dr. Forgey and consider

Megace for Wright.

The jail medical records from February 6 through 9 document Wright’s refusal to take

various prescribed medications including ear drops, a flu immunization, and Tamiflu. The latter

medications were prescribed because Mr. Wright had been exposed to an inmate who had died of

Influenza B.

On February 11, 2013, an urgent care assessment was performed because Wright had

been complaining of diarrhea for 24 hours and told the medical staff person that he was too weak

to clean himself or get up to go to the bathroom. Dr. Forgey instructed the Jail officers to have

Wright washed and prescribed Imodium. He was scheduled to be seen in clinic the following

down protein.” (DE 144-17 at 21.) Resorting to the dictionary, the best definition the Court could find is that

cachexia is a general physical wasting and malnutrition usually associated with chronic disease. 

Https://www.merriam-webster.com/dictionary/cachexia.

5
day but refused to go. He was placed on respiratory isolation for refusing treatment for

Influenza B. He was again scheduled for a clinic visit for February 18 for exposure to Influenza

B but again refused to go.

On February 19, 2014, the mental health staff evaluated Wright again. His only

complaint was soiled pants. The mental health worker discussed the problem with Jail officers

who said they would get him new pants. The mental health worker’s plan was to continue

current treatment and follow up as needed.

On February 28, 2013, Dr. Agusti evaluated Wright. His charting indicates that Wright’s

lungs were clear, that his skin was warm and dry and had good color, that his abdomen was soft,

not tender, and that he had positive bowel sounds in all four quadrants. He described Wright as

being in mild pain or distress.

On March 3, 2013, Dianna Reed, a medical assistant, came to see Wright because Jail

officers reported that he was curled up in a fetal position with covers over his head. She

documented some vital signs and reported that he was alert and oriented.

At 7:23 on the morning of March 3, Wright was found unresponsive in his cell. Among

others, Dr. Agusti was on the scene. CPR was started and advanced cardiac life support protocol

was followed. He was shocked and an endotracheal tube was inserted. Wright was transported

to Methodist Hospital, where he was pronounced dead at 8:22 am.

Dr. John Cavanaugh performed an autopsy on Wright on March 5. He found the cause of

death to be lobar type pneumonia that he said had been present for days, with fecal impaction a

contributing factor. However, Dr. Forgey disagrees with Dr. Cavanaugh’s conclusions. He

believes Wright had heart trouble and went into cardiac arrest, that after he was intubated the

6
tube became dislodged, and that he died from lack of oxygen after cardiac arrest. He believes

that the dislodged tubing could have caused post-death congestion and trauma to the lungs that

Dr. Cavanaugh saw as pneumonia.

B. Plaintiff’s Experts’ Opinions

According to Dr. David L. Thomas’s affidavit submitted by Plaintiff in opposition to

summary judgment, Wright’s Jail medical records show a continual worsening of his physical

condition and mental health. Such a decline can be reversed by undertaking aggressive mental

and physical health measures, which Dr. Forgey did not order. Dr. Thomas further opines that 

Wright was clearly a danger to himself: he was acutely psychotic and caused harm to himself by

refusing medications and food. Little attention was paid to Mr. Wright’s diagnosis of cachexia

when the treating physicians should have ordered a work-up to determine its underlying cause. 

In Dr. Thomas’s view, Dr. Forgey should have intervened with forced medication. 

Dr. Cheryl Wills opines in her affidavit that Wright’s mental disorder was sufficiently

severe to meet criteria for involuntary hospitalization and that those responsible for providing 

mental health services at the Jail were grossly unresponsive to his needs. 

C. Discussion

(1) The Motion to Strike

Dr. Forgey seeks to strike paragraphs 14, 19, 21, and 22 of the Thomas affidavit. 

However, his brief in support of the motion is confusing. He purports to quote from paragraph

14 but the allegedly objectionable language (“A review of the medial [sic] records shows that

7
Forgey turned a blind eye to Mr. Wrights serious medical needs by ignoring his deteriorating

mental health state”) appears nowhere in that paragraph, or anywhere else in his affidavit that the

Court can find, although somewhat similar language can be found in paragraph 19. Accordingly,

paragraph 14 will not be stricken.

As to paragraph 19, Dr. Forgey objects to Dr. Thomas’s opinion that the care provided to

Wright fell well below the applicable standard of care. The objected-to language in paragraph

21 is Dr. Thomas’s opinion that the Jail health care providers “tripped the threshold of deliberate

indifference by documenting Mr. Wright’s regular and complete downward spiral.” (DE 144-17

at 5.) Dr. Forgey seeks to strike the following language from paragraph 22: “While in the

custody of the Lake County Jail, the jail health care providers failed to take appropriate actions

to provide treatment for Mr. Wright and as a proximate result are responsible for his death.” 

(Id.) He insists that these opinions amount to impermissible legal conclusions.

Dr. Forgey also objects to certain language in paragraph 9 of Dr Cheryl Wills’s affidavit. 

He claims that her opinion that “those responsible for providing appropriate mental health

services to inmates were grossly unresponsive to Mr. Wright’s need for mental health services”

and “[t]he breach in the Jail Management’s fiduciary obligation to provide competent psychiatric

services to Mr. Wright resulted in his severe physical and emotional pain, suffering, disability

and death.” (DE144-15 at 3.) 

 The ultimate legal question that must be answered in this case is whether Dr. Forgey’s

conduct amounted to deliberate indifference to Wright’s serious medical needs. Federal Rule of

Evidence 704(a) provides that an opinion is not objectionable just because it embraces an

ultimate issue. However, experts are not permitted to testify as to their legal conclusions. Good

8
Shepherd Found. v. Momence, 323 F.3d 557, 564 (7th Cir.2003). Accordingly, the Court will

strike Dr. Thomas’s legal conclusion in paragraph 21 that the Jail health care providers’ conduct

toward Wright amounted to deliberate indifference. The other opinions Forgey has objected to

are not legal conclusions, and will not be stricken.

(2) The Motion for Summary Judgment

Dr. Forgey maintains that he is entitled to qualified immunity, but even if that defense

does not apply to him as the employee of a private medical provider, there is no genuine issue as

to whether Dr. Forgey acted with deliberate indifference to Wright’s medical needs.

On the qualified immunity issue, the Seventh Circuit’s very recent opinion in Estate of

Clark v. Walker, Nos. 16-3560 & 16-3644, 2017 WL 3165632, at *4 (7th Cir. July 26, 2017) 

made it clear that a private doctor working for a public institution is not entitled to the protection

of qualified immunity. Dr. Forgey is a private doctor working for a corporation that has a

contract with the Lake County Jail. As such, the defense of qualified immunity is not available

to him. 

 Summary judgment is appropriate only if, construing the record in the light most

favorable to the nonmoving party, no jury could reasonably find in favor of that party. 

McDonald v. Hardy, 821 F.3d 882, 888 (7th Cir. 2016). Thus, with qualified immunity out of

the case, the only issue is whether there is evidence from which a reasonable jury could conclude

that Dr. Forgey was deliberately indifferent to Wright’s serious medical needs. While this is an

unusual case, there is evidence from which a jury could reach that conclusion.

A defendant is deliberately indifferent to a prisoner’s medical needs if he knows of and

9
disregards an excessive risk to his health. Greeno v. Daley, 414 F.3d 645, 653 (7th Cir. 2005). 

The medical records in this case show a patient who repeatedly refused medication and treatment

against his own interest, who would not eat, whose appearance was described as emaciated, and

who suffered from serious mental illness. While numerous different healthcare providers saw

Wright and evaluated him during his incarceration, very little treatment occurred because of his

refusals. Meanwhile his mental and physical health steadily declined. A jury could find that Dr.

Forgey knew from Wright’s medical records documenting his weight loss and refusal of

medications that he was a danger to himself and that more aggressive measures such as forced

medication, a psychiatric referral, and forced nutrition should have been considered. Instead, the

medical staff did little more than chart his downward spiral. 

Dr. Forgey’s handling of Wright’s treatment is in marked contrast to the conduct of Dr.

Rohrer, a defendant in Rice v. Correctional Medical Services, 675 F.3d 650 (7th Cir. 2012),

which the Seventh Circuit viewed as a close case. Id. at 685. In that case, the court held that Dr.

Rohrer could not be found to have been deliberately indifferent to inmate Rice’s needs when

three times during his incarceration Dr. Rohrer petitioned an Indiana state court to involuntarily

commit Rice after he refused psychotropic medication, refused to eat, refused to communicate,

and had a diagnosis of schizophrenia. Id. at 684–85. 

Dr. Forgey maintains that he was not responsible for supervising or administering mental

health services at the Jail, but the existence of the collaborative practice agreement he had with

Nurse Ornelas creates a question of fact as to what his responsibility for Wright’s mental health

was.

10
D. Conclusion

For the foregoing reasons, Dr. Forgey’s motion to strike (DE 150) is GRANTED IN

PART and DENIED IN PART. His motion for summary judgment (DE 125) is DENIED. 

 

SO ORDERED on September 6, 2017.

 s/ Joseph S. Van Bokkelen 

Joseph S. Van Bokkelen

United States District Judge

11