Opinion ID: 2999434
Heading Depth: 2
Heading Rank: 2

Heading: There is a disputed issue of material fact as to

Text: whether Cook County had a widespread prac- tice of failing to provide timely methadone treatment. The plaintiff provided sufficient evidence to create a disputed issue of material fact as to whether Cook County had a widespread practice or custom of inordinate delay in providing methadone treatment to inmates, which caused proximate harm to Davis. For instance, in his deposition, pharmacist Singh’s testimony, read in the light most favorable to the plaintiff, establishes that there are essentially no policies or procedures in place at Cook County to ensure that the verification of an inmate’s outpatient methadone treatment program is conducted in a timely fashion. Similarly, Singh’s testimony established that there is an absence of policies or procedures to ensure that once such verification is obtained, security personnel are informed in a timely fashion and inmates are brought to the pharmacy within a reasonable time period. Indeed, Singh testified that there is essentially no established checks-and-balances system to make sure that patients who suffer from methadone withdrawal—which the parties do not dispute is a significant medical issue—do not fall through the cracks for several days (or more). As a result, 12 No. 05-1695 according to Singh, it can routinely take one or two days for the pharmacy to confirm an inmate’s participation in a methadone program, and perhaps much longer to bring the inmate to the pharmacy as there is no “hard and fast rule” as to when security officers bring inmates to the pharmacy. (Singh Dep. at 39-43, 80.) Moreover, these customary delays may be exacerbated when an inmate’s admission occurs during the weekend, where there is very limited staffing in the pharmacy. In addition to Singh’s testimony, Cook County personnel working directly with the inmates confirmed a widespread practice of at least three days’ delay simply to verify the inmate’s outpatient methadone treatment regimen (and all indications in the record are that the process of confirming an inmate’s methadone program is no more than a confirmatory telephone call). For instance, Officer Collier confirmed that, based on his extensive fourteen years of experience working at the jails, it can take up to three days to verify methadone treatment: Just by working in there for as long as I have, I know that’s what it takes. It takes about that much time if you are on a methadone program before you got incarcerated. It takes about three days . . . . When they come in, they are instantly withdrawn when they come in. They are sick when they come in. Some of them take it better than others. It depends on that individual. Most of them are sick for at least three to five days unless they were on a methadone program when fill [sic] the cards, they approve it. They get on methadone. It’s not so bad on them. (Collier Dep. at 24-26.) In addition, social worker Bowers also testified that it routinely took three days to verify that a person was on methadone. (Bowers Dep. at 51). Indeed, Bowers claimed that the paramedics that she purportedly No. 05-1695 13 contacted also confirmed that it took at least three days to verify methadone treatment and Bowers memorialized this understanding in her October 1, 2002, log entry.5 (Bowers Dep. at 48-49, Ex. 1). Mrs. Davis testified that Cook County personnel told her that “Cook County don’t work that fast,” suggesting that the delays that Mr. Davis was experiencing were customary. (D. Davis Dep. at 119). Finally, physician assistant Barbara Davis confirmed that she often provided medications other than methadone for periods of several days in an attempt to limit withdrawal symptoms until the jail received confirmation from the inmate’s outpatient program. (B. Davis Dep. at 9). This indirectly confirms that Cook County’s custom and practice routinely involved delays of at least three days in obtaining confirmation, and, coupled with Singh’s testimony above, suggests that it may be significantly longer before an inmate actually receives methadone. Cook County’s contrary arguments are unpersuasive. The thrust of Cook County’s argument, at least with respect to the evidence cited above, is that the testimony of Bowers is entirely inadmissible hearsay and Officer Collier’s testimony is too conclusory and void of requisite specific facts to defeat summary judgment. With regard to Bowers, Cook County focuses exclusively on Bowers’s purported conversation with an unidentified paramedic, which indeed is inadmissible hearsay if offered solely to prove that Cook County routinely had three-day delays. But Cook County ignores that Bowers also testified as to the delays based on 5 Defendants contend that Bowers’s testimony and log entry are inadmissible hearsay and therefore cannot be considered at the summary judgment stage. This evidence, however, is admissible for the purpose of establishing Bowers’s notice and awareness of at least alleged routine delays in verifying methadone treatment, although it is certainly inadmissible for establishing the truth of what the paramedic personnel purportedly told Bowers. 14 No. 05-1695 her personal experience as a social worker. Bowers had twelve years of experience as a social worker, and she attended to various requests from inmates on a daily basis. (Bowers Dep. at 49). During her deposition, Bowers was asked whether it was her prior understanding as a social worker for the jail that it takes three days for the jail to verify that an inmate is on a methadone program outside of the jail, and she responded in the affirmative. (Bowers Dep. at 51). This, of course, is plaintiff’s stronger evidence, and it would indeed be odd if a social worker with experience at Cook County jail lacked any personal knowledge of the general delays in receiving treatment. In any event, to the extent that Bowers’s personal experiences are not representative or otherwise lack a firm foundation, that is a fruitful avenue for cross-examination, but is not a good basis for granting summary judgment. Cook County also argues that Officer Collier’s testimony is insufficient because it is nothing more than “generalized evidence,” lacking specific facts (such as “the percentage or numbers of inmates who had to wait for three days, two days, or for only a day” and whether those inmates also had serious medical needs). Instead, Cook County contends, Officer Collier’s testimony shows—at most—nothing more than “isolated instances where an unknown number of inmates, for unknown reasons, experienced a delay in receiving methadone.” Cook County supports this argument by relying on our decision in Jones v. City of Chicago, 787 F.2d 200 (7th Cir. 1986). But Jones is readily distinguishable. At issue in Jones was whether a municipality customarily ignored complaints of sexual misconduct by gynecologists performing pelvic examinations. Id. at 205. The plaintiffs contended that sexual misconduct by city-employed physicians was not rare and attempted to support this contention by relying on a broad comment by the Department’s Director of Women’s Health, who essentially stated that such complaints may not be rare in general No. 05-1695 15 medical practice, whether in public or private clinics.6 Id. at 206. Because this single statement was merely a general conclusion (and one not targeted at the specific circumstances of the plaintiffs’ claims), we held that this “statement amount[ed] to little more than a bald and conclusory statement.” Id. In contrast, here the testimony from Bowers and Officer Collier about routine delays in providing methadone directly targeted the jail facility at issue in this case and was much more than a single “bald and conclusory statement” about correctional facilities in general. Cf. Jones, 787 F.2d at 206. Cook County also contends that plaintiff’s claims here fail because she has not presented enough evidence showing a series of past bad acts by Cook County. But to survive summary judgment, a plaintiff need not present a full panoply of statistical evidence showing the entire gamut of a defendant’s past bad acts to establish a widespread practice or custom. Instead, it is enough that a plaintiff present competent evidence tending to show a general pattern of repeated behavior (i.e., something greater than a mere isolated event). See, e.g., Cosby v. Ward, 843 F.2d 967, 983 (7th Cir. 1988) (explaining that “[t]here is no clear consensus among the courts as to what level of frequency of the challenged conduct evidences a custom, except that it must be more than one instance”). Cook County misinterprets our decision in Jackson v. Marion County, 66 F.3d 151, 152 (7th Cir. 1995), where we explained that “[t]he usual way in which an unconstitutional policy is inferred, in the absence of direct evidence, is 6 The Director’s initial statement appeared to more directly target the plaintiffs’ claims of what occurred with the municipality’s public clinics, but, he subsequently clarified that he was only “talking in general in the medical practice,” and this court appears to have credited that clarification. Jones, 787 F.2d at 206. 16 No. 05-1695 by showing a series of bad acts and inviting the court to infer from them that the policymaking level of government was bound to have noticed what was going on and by failing to do anything must have encouraged or at least condoned, thus in either event adopting, the misconduct of subordinate officers.” Id. And as we indicated, “[w]hen this method of proof is used, proof of a single act of misconduct will not suffice; for it is the series that lays the premise of the system of inference.” Id. But here, the plaintiff does not point to just one instance of delay without more and ask the court to infer an unconstitutional custom or practice on that basis alone. Rather, the plaintiff points to the delay in the instant case, delays inherent in the methadone verification procedures as related by pharmacist Singh, and the widespread delays attested to by Collier and Bowers based on their experiences as a correctional officer and social worker, respectively, among other circumstantial evidence supporting the existence of a general custom or practice. Cook County also argues that the plaintiff cannot establish a widespread custom or practice because she failed to identify any other incarcerated individuals who had suffered from lack of methadone treatment. This argument, however, fails to appreciate the difference between showing repeated past bad acts versus repeated past injuries. See Woodward v. Correctional Med. Servs. of Ill., Inc., 368 F.3d 917, 929 (7th Cir. 2004). To establish a widespread custom or policy, the plaintiff here was not required to show that Cook County’s alleged repeated pattern of delay (i.e., its alleged past “bad acts”) actually caused pain and suffering to other inmates in need of medical intervention (i.e., repeated past injuries). See id. Instead, it was enough to provide competent evidence tending to show that Cook County routinely failed to provide methadone to inmates for several days. See id. (holding that “the plaintiff’s failure to introduce evidence of any suicide at the Lake County jail besides [the plaintiff]” did not “doom[] plaintiff’s efforts to No. 05-1695 17 prove a custom or practice.” “[Defendant] does not get a ‘one free suicide’ pass”); see also Estate of Moreland v. Dieter, 395 F.3d 747, 760-61 (7th Cir. 2005) (citing Woodward for the proposition that “the plaintiff need not show that the policy practice, or custom resulted in past deprivations of rights”). Now, whether Cook County in fact routinely had several days’ delay, of course, is a disputed material fact at the heart of this case. Thus, Cook County’s persistent argument that any delays were isolated and due to factors outside of its control may well carry the day with the fact-finder—but these are not arguments amenable to summary judgment. See, e.g., Hall v. Ryan, 957 F.2d 402, 406 (7th Cir. 1992) (affirming the denial of defendants’ motion for summary judgment and explaining that “[a]t trial the defendants may be able to adduce various defenses, but they may not now avoid suit under the qualified immunity doctrine on the record as it now exists”).