Feazell v. Wexford: Seventh Circuit Tightens the Evidentiary Screws — Expert Testimony Required and Monell Causation Re-emphasised

1. Introduction

On 11 June 2025, the United States Court of Appeals for the Seventh Circuit handed down its decision in Joe Feazell v. Wexford Health Sources, Inc. & Pamela E. Hart. The Court affirmed summary judgment and a defence verdict against inmate-plaintiff Joe Feazell, who alleged deliberate indifference to his serious medical needs under the Eighth Amendment. The opinion, authored by Judge St. Eve, touches three recurring battlegrounds in prisoner civil-rights litigation:

• The stringent Monell causation requirement for suing a private medical contractor;
• The deliberate-indifference standard governing claims against individual medical staff; and
• The evidentiary bar on lay testimony concerning medical diagnosis and causation when no expert is offered.

Collectively, the ruling clarifies that (a) prisoners must marshal admissible evidence—often expert testimony—to survive summary judgment or persuade a jury, and (b) courts will strictly police waiver and Rule 701 in such cases.

2. Summary of the Judgment

The Seventh Circuit affirmed:

• Summary judgment for Wexford on the ground that Feazell failed to link any corporate policy (specifically, the “Collegial Review” referral process) to a constitutional violation, as required by Monell v. Department of Social Services.
• Partial summary judgment for Dr. Tilden on Feazell’s “hemorrhoid claim,” holding there was no evidence that Dr. Tilden knew of the condition prior to a colonoscopy; new “sitz-bath” allegations were waived.
• Trial evidentiary rulings excluding Feazell’s lay opinions on medical causation and diagnosis under Federal Rule of Evidence 701; the jury subsequently returned a defence verdict on the remaining “low-hemoglobin” claim.

Accordingly, Feazell takes nothing on appeal; the district court’s judgment is affirmed in full.

3. Analysis

3.1 Precedents Cited and Their Influence

• Monell v. Dep’t of Soc. Servs., 436 U.S. 658 (1978) – Established that municipalities (and by extension private entities acting under colour of state law) are not vicariously liable; plaintiffs must prove a policy or custom was the “moving force.” The Court relies heavily on this “rigorous causation” standard.
• Farmer v. Brennan, 511 U.S. 825 (1994) – Core deliberate-indifference precedent; officials must have actual knowledge of a substantial risk. Cited to reject liability where Dr. Tilden lacked subjective awareness pre-colonoscopy.
• Dean v. Wexford, 18 F.4th 214 (7th Cir. 2021); Howell v. Wexford, 987 F.3d 647 (7th Cir. 2021); Whiting v. Wexford, 839 F.3d 658 (7th Cir. 2016) – Recent Seventh-Circuit cases refining Monell liability and deliberate-indifference analysis; echoed for both liability elements and standard of review.
• Petties v. Carter, 836 F.3d 722 (7th Cir. 2016) (en banc) – Clarifies permissible circumstantial proof of knowledge; Court notes Feazell produced no direct or circumstantial evidence meeting Petties.
• Federal Rule of Evidence 701 and circuit cases (Conn, 7th Cir 2002) – Provide the evidentiary framework to exclude inmate’s self-diagnosis testimony.

3.2 The Court’s Legal Reasoning

1. Monell Claim Against Wexford
   The Court reiterates that to defeat summary judgment, a plaintiff must (i) identify a policy/custom, and (ii) show a direct causal link to a constitutional deprivation. • Feazell cited Wexford’s “Collegial Review” but produced no evidence that it actually caused denial or delay of care. • Alleged pre-2018 delays were waived because not argued below. • Post-hospital delays (two weeks for follow-up, two months to colonoscopy, two months to post-op visit) were unsupported by expert evidence establishing breach of standard of care or deliberate indifference. Lay intuition is insufficient.
2. Individual Liability – Dr. Tilden
   • Knowledge: Under Farmer, subjective awareness is required. Medical records alone do not prove the physician read them. No other circumstantial evidence (repeated complaints, ignored warnings, etc.) existed.
   • Waiver: New “sitz bath” theory raised after discovery cut-off was deemed forfeited.
   • Therefore, no triable issue on the hemorrhoid claim.
3. Evidentiary Rulings
   • Rule 701(c) bars lay testimony grounded in specialised knowledge.
   • Feazell lacked a qualified medical expert, so he could testify only to symptoms he personally perceived, not diagnoses or causation.
   • Counsel’s attempt to elicit barred opinions was correctly stifled; no door was “opened” merely by cross-examination.

3.3 Potential Impact

• Higher Evidentiary Bar for Inmate Litigants: In practical terms, the decision signals that courts will no longer indulge prisoner-plaintiffs who substitute personal lay opinion for expert proof when the claim hinges on medical causation or breach of standard of care.
• Reinforcement of “Rigorous Causation” Standard: The opinion fortifies Monell’s already demanding causation element, likely leading to increased summary-judgment success for private health contractors absent concrete policy-driven evidence.
• Clarified Waiver Doctrine: Failure to articulate a theory (e.g., sitz-bath deprivation) in the pleadings or summary-judgment briefing remains fatal, restoring a measure of predictability for defendants.
• Guidance for Correctional Healthcare Providers: While the ruling is defence-friendly, it underscores that delays can still be actionable if a plaintiff procures proper expert testimony. Providers may wish to document referral timelines meticulously to rebut future claims.

4. Complex Concepts Simplified

• Deliberate Indifference – A constitutional tort requiring proof that (1) the prisoner had an objectively serious medical need, and (2) the defendant knew of but disregarded the risk of harm.
• Monell Liability – A municipality (or private corporation acting like one) is liable only when an official “policy or custom” directly causes the constitutional violation; no automatic liability for employees’ misconduct.
• Collegial Review – Wexford’s internal utilisation-management meeting where specialists and administrators vet outside referrals to control costs and ensure necessity.
• Rule 701 Lay Opinion – A witness without specialised training may offer opinions only if based on personal perception and not reliant on technical knowledge (e.g., one can say “the light was red,” but not “the car was speeding at 55 mph based on skid-mark length”).
• Waiver vs. Forfeiture – “Waiver” is the intentional relinquishment of a known right (failing to raise an issue in district court); “forfeiture” is the inadvertent loss of a right through neglect. Both prevent new arguments on appeal.

5. Conclusion

Feazell v. Wexford is notable less for expanding prisoner rights than for fortifying existing procedural and evidentiary defenses. The Seventh Circuit makes three key takeaways explicit:

1. Plaintiffs cannot rely on common-sense medical inferences where expert testimony is required; Rule 701 sets a hard line.
2. The Monell “moving force” requirement is alive and well; speculation about corporate policies will not survive summary judgment.
3. Issue preservation matters—new factual theories cannot be smuggled in post-discovery or on appeal.

In the broader legal landscape, the opinion provides a cautionary roadmap for Section 1983 litigants: marshal expert evidence early, articulate precise policy-based theories, and beware the shoals of waiver. For correctional health contractors, it offers some comfort but also a reminder that documented, timely care remains the best defence.