Feazell v. Wexford Health Sources, Inc.
Seventh Circuit solidifies standards for:
(1) proving a private contractor’s Monell liability,
(2) showing a physician’s subjective knowledge in deliberate-indifference claims, and
(3) limiting lay testimony on medical causation.

Introduction

In Feazell v. Wexford Health Sources, Inc. the United States Court of Appeals for the Seventh Circuit confronted familiar terrain in prisoner-rights litigation: the boundary between negligent (or even sub-optimal) medical treatment and constitutionally actionable “deliberate indifference” under the Eighth Amendment. Joe Feazell, an Illinois inmate, sued both his treating physician (Dr. Andrew Tilden’s estate) and Wexford Health Sources, the private company contracted to provide healthcare at Pontiac Correctional Center. He alleged that delays and failures in treating his severe hemorrhoids and associated gastrointestinal bleeding violated his constitutional rights.

After an initial denial of summary judgment, a magistrate judge—on reconsideration—granted judgment for Wexford and partially for Dr. Tilden, leaving only a single “low-hemoglobin” claim for trial. The jury ultimately found for the defense. On appeal Feazell challenged: (i) the summary-judgment reversals, and (ii) evidentiary rulings that barred him, as a lay witness, from opining on medical diagnosis and causation. The Seventh Circuit affirmed across the board, producing a decision that crystallizes three doctrinal points:

• A prisoner must tie an alleged constitutional violation to a specific corporate policy or custom—and provide evidence of causation—to sustain a Monell claim against a private healthcare contractor.
• To pin “subjective knowledge” on an individual physician, the plaintiff must produce more than voluminous medical records; he needs evidence showing the doctor actually knew, or circumstantially had to know, of the serious risk.
• Federal Rule of Evidence 701(c) squarely prohibits lay testimony on medical causation; a prisoner-plaintiff cannot fill an expert gap with his own opinions even when he personally experienced the symptoms.

Summary of the Judgment

Writing for a unanimous panel (Judges Brennan, Scudder, and St. Eve), Judge St. Eve held:

1. Wexford Health Sources. Summary judgment was proper because Feazell failed to show any evidence that Wexford’s “Collegial Review” process—under which outside referrals are vetted weekly—caused delays rising to deliberate indifference.
   • Pre-hospitalization: Argument waived on appeal.
   • Post-hospitalization: Two-week, two-month, and another two-month intervals were not so obviously improper that a jury could infer unconstitutional conduct without expert evidence.
2. Dr. Tilden (Hemorrhoid Claim). Feazell adduced no direct or circumstantial proof that Dr. Tilden knew about the hemorrhoids before the colonoscopy, nor could he rely on newly raised “sitz-bath” allegations absent from his pleadings. Summary judgment therefore stood.
3. Evidentiary Rulings at Trial. The magistrate judge properly barred Feazell from testifying about medical causation and diagnosis; Rule 701(c) and Seventh-Circuit precedent mandate expert testimony for such topics. Attempts to “open the door” through defense examination did not override the foundational competence requirement.

Analysis

A. Precedents Cited

• Monell v. Department of Social Services, 436 U.S. 658 (1978) – The cornerstone for municipal (and by extension, private-contractor) liability requiring a policy or custom to be the “moving force” behind a constitutional violation.
• Farmer v. Brennan, 511 U.S. 825 (1994) – Sets the deliberate-indifference standard: official must have subjective awareness of a substantial risk.
• Petties v. Carter, 836 F.3d 722 (7th Cir. 2016) (en banc) – Illustrates ways to infer subjective knowledge (e.g., obvious departure from medical judgment, repeated complaints, or unexplained delays).
• Whiting v. Wexford Health Sources, 839 F.3d 658 (7th Cir. 2016) – Defines when delay in treatment can amount to deliberate indifference, emphasizing need for evidence beyond mere disagreement with care.
• Howell v. Wexford, 987 F.3d 647 (7th Cir. 2021); Dean v. Wexford, 18 F.4th 214 (7th Cir. 2021) – Cement application of Monell to private entities and articulate heightened causation requirement.
• United States v. Conn, 297 F.3d 548 (7th Cir. 2002) – Clarifies Rule 701’s bar on lay opinions involving specialized knowledge.

“This ‘rigorous causation standard’ requires a direct causal link between the challenged municipal action and the violation of the plaintiff’s constitutional rights.” —Feazell, slip op. at 7 (quoting LaPorta)

B. Legal Reasoning

1. Monell Causation & Policy Proof. The court treated Wexford exactly like a municipality. Feazell needed: (1) identification of a specific policy (Collegial Review), and (2) evidence that the policy, not isolated negligence, directly caused unconstitutional delay. He produced no expert testimony on standard of care or medical necessity, rendering his delay allegations speculative.
2. Subjective Knowledge of Dr. Tilden. The Seventh Circuit re-emphasized that large volumes of prior medical records do not automatically impute knowledge to a physician. Without evidence that Tilden actually reviewed the records (or had to), no reasonable jury could find deliberate indifference.
3. Evidentiary Enforcement of Rule 701(c). Distinguishing personal-perception testimony (“I bled daily”) from medical-opinion testimony (“my anemia worsened my mental health”), the panel endorsed strict policing of expert boundaries. The ruling prevents plaintiffs from smuggling causation theories to the jury absent qualified experts and Rule 26 disclosures.
4. Waiver Doctrine. New factual theories (the “sitz-bath” deprivation) raised for the first time on summary-judgment reconsideration were deemed waived; the panel invoked recent cases (Ollison v. Gossett, 136 F.4th 729 (7th Cir. 2025); Schmees v. HC1.com, 77 F.4th 483 (7th Cir. 2023)) to underscore the point.

C. Potential Impact

• Higher Evidentiary Bar for Prisoner-Plaintiffs. Prisoners litigating medical-care claims now have an even clearer message: expert testimony is practically indispensable whenever causation, standard of care, or reasonableness of delay is at issue.
• Private Contractor Liability. The decision strengthens the analogy between private prison-health providers and municipalities, reinforcing that plaintiffs must connect the dots between policy and harm, rather than rely on respondeat superior or isolated missteps.
• Strategic Litigation Effects. • Early retention of medical experts will become standard.
  • Pleadings must capture all factual bases (e.g., post-operative care) or risk waiver.
  • Defense counsel can confidently seek Rule 701 exclusions to foreclose lay medical opinions.
• Doctrinal Clarification on “Knowledge.” The panel’s insistence on proof that a doctor actually reviewed critical records may cabin attempts to infer knowledge too casually from merely “available” information.

Complex Concepts Simplified

• Deliberate Indifference: More than negligence; the official knows of, and disregards, an excessive risk to inmate health or safety.
• Monell Liability: A municipality (or private contractor performing a public function) is liable only if a policy, custom, or practice itself causes the constitutional harm—not merely because its employee erred.
• Collegial Review: Wexford’s internal, weekly meeting where doctors decide whether to approve outside referrals—a cost-control mechanism. Plaintiffs must show how such review caused harmful delay.
• Rule 701(c): Limits lay witnesses to opinions based on personal perception that do not require specialized knowledge. Medical causation is the province of experts under Rule 702.
• Waiver on Appeal: Arguments not raised in the district court generally cannot be asserted for the first time on appeal, except for pure legal issues or in extraordinary circumstances.

Conclusion

Feazell stands as a robust reaffirmation of core Eighth-Amendment and civil-rights principles in the prison-healthcare context. The Seventh Circuit sharpened the evidentiary and pleading expectations for inmates alleging deliberate indifference: identify a concrete policy, prove its causal link, establish a doctor’s actual knowledge, and secure qualified experts for medical questions. By doing so, the court curtails the reach of anecdotal delay allegations and lay-opinion testimony, ensuring that only well-supported claims move forward. Future litigants—plaintiffs and defendants alike—ignore these tightened standards at their peril.