Opinion ID: 183790
Heading Depth: 4
Heading Rank: 2

Heading: Injury, Causation and Damages

Text: Dr. Elyea also submits that Mr. Roe failed to provide sufficient evidence from which a reasonable jury could conclude that the IDOC two-year policy, and its application to him during his 2004 incarceration, caused him any injury. First, Dr. Elyea claims that Mr. Roe failed to account for other factors that could have been the cause of any injury, including a failure to receive treatment while not in custody and abuse of alcohol. Second, he claims that the incarceration period in question for Mr. Roe lasted only nine months, and that, for a period during those nine months, Mr. Roe was being treated (apparently mistakenly) for latent tuberculosis; such treatment was incompatible, he notes, with treatment for hepatitis C, and thus the treatment period could not be completed during the incarceration. Third, Dr. Elyea claims that the success of treatment is highly variable, and thus, it would be rank speculation to find the policy harmed Mr. Roe. Appellee/Cross-Appellant's Br. 36. As the Supreme Court repeatedly has noted, § 1983 creates a species of tort liability. Heck v. Humphrey, 512 U.S. 477, 483, 114 S.Ct. 2364, 129 L.Ed.2d 383 (1994) (internal quotation marks omitted). A successful § 1983 plaintiff therefore must establish not only that a state actor violated his constitutional rights, but also that the violation caused the plaintiff injury or damages. Harris v. Kuba, 486 F.3d 1010, 1014 (7th Cir.2007). We begin with the concept of injury. At trial in 2008, the district court noted that Mr. Roe appeared in significantly diminished health. Further, it is apparently undisputed that Mr. Roe's liver disease had progressed so significantly shortly thereafter that it caused his death. Dr. Elyea contends that other causes might well have accounted for Mr. Roe's condition, and, therefore, no injury has been demonstrated. Dr. Elyea notes that Mr. Roe did not obtain treatment for himself when he was not incarcerated and, further, that there is some evidence in the record that Mr. Roe had engaged in other behaviors that put his liver health at risk after leaving IDOC custody in 2004. [18] These observations, although correct, miss the mark. The administrator of Mr. Roe's Estate need not prove that this severe progression of disease in 2008 to the point of death is directly traceable to Dr. Elyea's conduct. All that is required to support the verdict is some actual compensable injury, causally connected to the application to Mr. Roe of IDOC policy set by Dr. Elyea. [19] The record is sufficient to support the jury's conclusion on this issue. At trial, Mr. Roe testified that his symptoms included stomach distention, nose bleeds, rashes and bowel irregularity that had worsened significantly in the months leading to trial. R.110 at 44. His prison records, which provide contemporaneous accounts of his physical complaints, verify that some of these symptoms stretched back to the period in question and beyond. See, e.g., Doc. 1-286, Offender Outpatient Progress Notes (Apr. 7, 2004) (noting complaints of left abdominal pain ascribe[d]... to hepatitis C and the corresponding physician plan to order ALT and AST testing in response); Doc. 1-288, Offender Outpatient Progress Notes (May 6, 2004) (noting pain in left side of abdomen which radiates to left leg, directly under which the physician has written Hepatitis C. Not a candidate for biopsy of liver, and noting ALT and AST levels of 180); Doc. 1-248, Medical Progress Notes (July 15, 2002) (noting bowel issues). Furthermore, in his deposition testimony, Mr. Roe stated that, not long after his release from prison in 2004, he was sent for a consultation with a liver specialist. [20] According to Mr. Roe, that specialist confirmed by simple palpation of his abdomen that Mr. Roe had early stages of cirrhosis and fibrosis setting in, and that treatment should proceed even without a biopsy being performed. [21] Trial Ex. 6, Roe Dep. 23. At that time, Mr. Roe could not afford the treatment because he was awaiting approvals on his applications for public assistance. We previously have held that testimony from which a jury could infer that a prison employee's overnight delay in providing treatment for an inmate's infection caused many more hours of needless suffering was sufficient to withstand summary judgment. See Gil v. Reed, 381 F.3d 649, 662 (7th Cir.2004) (emphasis added). We have little difficulty in concluding that the symptoms Mr. Roe endured during the period of his relevant incarceration and shortly thereafter were, in and of themselves, and regardless of the more severe symptoms that would befall him in the years following, at least minimally sufficient to support the jury's verdict and compensatory damages award. See Naeem v. McKesson Drug Co., 444 F.3d 593, 605 (7th Cir.2006) (noting the standard of review). The plaintiffs, and Mr. Roe specifically, proceeded precariously in this regard by failing to introduce their own medical expert, who might have testified directly to the medical issues involved in the causation analysis. [22] Instead, the plaintiffs relied on the adverse testimony of Dr. Elyea himself and on the Guidelines. Although this way of proceeding was a risky trial strategy when the condition at issuehepatitis Cwas outside the common experience of lay jurors, [23] we must conclude that, in this case, the evidence recounted above was minimally sufficient to allow a reasonable juror to conclude that an injury attributable to the policy had been established by Mr. Roe. Dr. Elyea did produce contrary evidence on the issue of whether any of the plaintiffs, including Mr. Roe, suffered any injury as a result of IDOC treatment policy. Dr. Elyea himself testified, consistent with the Guidelines, that the normal course of HCV infection would take twenty or more years to result in significant liver disease, if it does so at all, and remains asymptomatic unless the disease is at its end stages. R.110 at 94, 95. At trial, counsel for Dr. Elyea contended that the lack of any short-term impact of the disease justified, in all cases covered by the policy, denial of further testing and consideration for treatment. Id. at 190-91. The force of these general statements about the normal progression of the disease, however, did not require the jury to find that, in the case of Mr. Roe, he was not injured by the failure of IDOC to provide treatment. In fact, these general statements are particularly unpersuasive when the prison's own medical records indicate that Mr. Roe believed he had been infected since the 1970s; it is unsurprising, therefore, that he had advanced liver disease in 2003. The short-term for Mr. Roe, it seems, was actually the long-term consequence of a decades-old infection. [24] The State contends that, despite the evidence we already have discussed, facts specific to Mr. Roe's case demonstrate that any injury he suffered was not the result of the blanket length-of-incarceration-based IDOC policy rather than sound medical judgment. The State notes that the Guidelines recommend twenty-four weeks of antiviral treatment for Mr. Roe, but that, because of his original misdiagnosis for tuberculosis, he could not have completed treatment during his incarceration. Mr. Roe, however, had thirty weeks remaining in his incarceration when a repeat tuberculosis test revealed the misdiagnosis. Moreover, although the State is correct to note that current treatment for tuberculosis is a contraindication for interferon treatment for hepatitis C, there is nothing in the record to suggest that tuberculosis treatment prevents the pre-treatment work-up, including the biopsy. See Trial Ex. 3 at 49. If tuberculosis, or indeed any other contraindication to the work-up was present in Mr. Roe's case, the State should have provided evidence of it at trial. Moreover, because of his prior incarceration periods in IDOC facilities in the not-distant past, Mr. Roe already had had numerous tests related to hepatitis C and other health screens. In light of the existing medical record, it is not clear what remained to be done in the typical six-month pre-biopsy work-up in his case, nor did the State analyze the medical records on this point at trial. See Trial Ex. 6, Roe Dep. 23 (noting that a specialist had recommended treatment in 2004 without biopsy because liver disease was evident on physical examination). Finally, the State submits that Mr. Roe cannot establish causation because the success of treatment for hepatitis C is highly variable. Although the record supports the conclusion that the long-term efficacy of interferon treatment is not known, the record also supports the view that the treatment denied Mr. Roe is the standard in the medical community and the standard in the prison medical community. See R.110 at 130-31 (testimony from Dr. Elyea noting that [t]he experts feel that reducing viral load through interferon therapy is the appropriate treatment, although, because the treatment is relatively new, long-term efficacy is not known); see also Trial Ex. 3 at 44 (Antiviral therapy is recommended for patients with chronic hepatitis C and a liver biopsy with portal or bridging fibrosis and at least moderate inflammation and necrosis.); id. at 43 (Inmates with suspected compensated cirrhosis based on clinical and laboratory parameters should be either referred directly for liver biopsy or treated empirically (without biopsy confirmation) in consultation with a specialist. (emphasis added)). In our view, this evidence of the general standard of care is a sufficient basis from which a jury reasonably could infer that some of Mr. Roe's injury and discomfort during the relevant period is attributable to the failure of IDOC to treat him consistent with that standard. More importantly, we see no reason to conclude that the uncertainty of the long-term efficacy of treatment prevents a jury from concluding that the denial of that treatment, in a specified period, resulted in an injury to Mr. Roe. Accordingly, we conclude that the record contains sufficient evidence of causation to support the jury's verdict in favor of Mr. Roe. [25]