Bahrs v. Baker

641 F. App'x 601
CourtCourt of Appeals for the Seventh Circuit
DecidedApril 14, 2016
DocketNo. 15-2210
StatusPublished
Cited by1 cases

This text of 641 F. App'x 601 (Bahrs v. Baker) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bahrs v. Baker, 641 F. App'x 601 (7th Cir. 2016).

Opinion

ORDER

Shawn Bahrs, an Illinois inmate suffering from Stage 4 colon cancer, brought this suit under 42 U.S.C. § 1983 against Thomas Baker, a prison doctor, and Wexford Health Sources, Inc., the healthcare provider at Western Illinois Correctional Center. Bahrs claimed that the defendants had acted with deliberate indifference in not diagnosing and treating his cancer sooner. A jury returned a verdict for the defendants, and the district court denied Bahrs’s postjudgment motion arguing that inadequate performance by his pro bono counsel warranted a new trial. Bahrs now appeals, challenging the denial of his post-judgment motion along with other eviden-tiary and procedural rulings. We reject his appellate claims and affirm the judgment in favor of the defendants.

At trial the parties differed about the conclusions to be drawn from the evidence, but for the most part the underlying facts were not disputed. Bahrs was assigned to the Western Illinois Correctional Center in the fall of 2011, and not long after he complained to a nurse about frequent diarrhea and abdominal pain. He was told that he would be scheduled to see a doctor, but his follow-up inquiries and even a grievance did not prompt action by infirmary staff. So it was not until four months after he reached the prison that Bahrs first saw Dr. Baker, a general practitioner.

During that first visit in January 2012, Bahrs reported that he had been diagnosed previously with irritable bowel syndrome. For a year, he said, he had been experiencing abdominal pain, multiple episodes of diarrhea each day, and occasional blood in his stools. Bahrs also told the doctor that he was experiencing bloating, gas, and pain from cramps. And he had lost seven pounds since entering the prison. Bahrs told Dr. Baker that his family had a history of prostate cancer but not colon cancer. Dr. Baker’s physical examination did not reveal any abnormality except for an anal fissure, which he described at trial as a “crack in the skin.” Dr. Baker concluded that the fissure was the likely source of the blood in Bahrs’s stools. He ordered blood tests, screening for prostate cancer, and an abdominal X-ray. Dr. Baker testified at trial that Bahrs, who was 48 years old at the time of his first appointment, was not due to start regular colonoscopy screenings until age 50. Even so, after that first appointment he noted in Bahrs’s chart that a colonosco-py might become necessary. He prescribed loperamide (marketed as Imodium) for the diarrhea and Tylenol for the abdominal pain.

[603]*603When Bahrs returned two weeks later, Dr. Baker explained that the test results were mostly normal. The X-ray, he said, showed a significant amount of stool in the colon, but he did not think that was unusual. The blood test, however, had indicated anemia, so Dr. Baker ordered a repeat test. Bahrs reported that the loperamide had eased his diarrhea but the cramping continued. Bahrs also said that he no longer saw blood in his stools, which was confirmed by another laboratory test. Dr. Baker examined Bahrs’s rectum and saw that the fissure had healed, supporting his theory that the fissure was the source of the blood. Dr, Baker renewed the prescription for loperamide, scheduled a follow-up appointment, and ordered the nursing staff to monitor Bahrs’s weight over the next month. He again noted in Bahrs’s chart that a colonoscopy might be needed.

Bahrs had expected to see Dr. Baker for the follow-up in March 2012, but he met instead with a nurse practitioner. Bahrs reported that his diarrhea had been less frequent since the last visit. His weight remained stable. His energy level still was low, though he was able to play soccer. Afterward, two more appointments with Dr. Baker were scheduled — for two and three weeks later — but both were can-celled without explanation.

Meanwhile, the grievance that Bahrs had filed before his first visit with Dr. Baker finally was addressed by the doctor. Dr. Baker responded in writing that he had seen Bahrs twice after the grievance was filed, in January and February 2012, and that several tests had been performed initially. He noted the possible diagnosis of irritable bowel syndrome and the positive effect of the loperamide. He added that more tests had been ordered after results showed that Bahrs was anemic.

Bahrs saw Dr. Baker for the third time on April 2, 2012.- Bahrs still reported diarrhea and cramping, but the fissure had not reappeared, and there was no evidence of blood in Bahrs’s stools. After Bahrs asked whether a parasite or bacteria could be causing his diarrhea, Dr. Baker ordered additional tests and prescribed antibiotics. Dr. Baker also prescribed dicyclomine to relieve the cramping and scheduled another appointment for the following month. At trial Dr. Baker testified that, so far while treating Bahrs, he had not observed anything causing him to suspect cancer. He explained that Bahrs’s diarrhea had appeared to improve with medication, his vital signs and weight were stable, and he had not reported a family history of colon cancer.

Bahrs returned to Dr. Baker for the fourth time on May 2. He still reported experiencing diarrhea three times a day and frequent cramping, so Dr. Baker decided that it was timé to involve a gas-troenterologist to assess the need for a colonoscopy. Dr. Baker requested that Wexford’s utilization management team approve the referral but on the paperwork characterized the need for the outside specialist as not “urgent.” A Wexford committee approved that request but suggested admitting Bahrs to the infirmary for a few days to monitor his diarrhea. For two days Bahrs stayed at the infirmary while nurses tracked the nature and frequency of his bowel movements. He told Dr. Baker that he felt as if something was lodged in his bowel. On May 9, one week after submitting the referral request, Dr. Baker received approval from Wexford for the outside consultation. He scheduled the appointment for June 29, which, he said at trial, was the date offered by the gastroen-terologist’s office.

After examining Bahrs on June 29, the gastroenterologist opined that a colonosco-[604]*604py was needed. Dr. Baker concurred and four days later asked Wexford for approval, which was given a week later. The gastroenterologist, Dr. Baker testified, did not specify when to schedule the colonos-copy or suggest that Bahrs’s situation was an emergency, and when he called to schedule the appointment, the gastroenter-ologist’s office offered a date in August 2012. Dr. Baker saw Bahrs three times during July and assured him that a colo-noscopy had been scheduled. At the last minute, however, the appointment was pushed back a week because, Bahrs says, the medical staff had not properly prepared him for the procedure.

On August 31, 2012, the gastroenterologist performed the colonoscopy and discovered a softball-sized tumor in Bahrs’s colon. The gastroenterologist recommended a biopsy and surgery to remove the tumor because it was causing blockage. Two weeks later, on September 14, the biopsy results revealed that the mass was cancerous. Dr. Baker then submitted an urgent request to Wexford for an oncology referral, which was approved the same day. The oncologist examined Bahrs on September 20, performing a CT scan and recommending surgery to remove the mass. Dr. Baker approved that recommendation the following day.

A surgeon examined Bahrs one week later, on September 26, and recommended immediate surgery to reheve the blockage in Bahrs’s colon. That procedure was performed the same day after Dr. Baker obtained emergency approval.

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641 F. App'x 601, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bahrs-v-baker-ca7-2016.