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Stevenson v. Hoffman

United States District Court, W.D. Wisconsin

August 26, 2019

KARL M. HOFFMAN, Defendant.



         While incarcerated at the New Lisbon Correctional Institution (“NLCI”) in March of 2015, pro se plaintiff Kerry Stevenson claims that the defendant, Dr. Karl Hoffman, was deliberately indifferent to his report of a lump on his head in violation of the Eight Amendment. Tragically, that lump ultimately required a craniectomy to rectify a bone infection, scalp abscess and epidural abscess. Now before the court is defendant's motion for summary judgment. (Dkt. #14.) Because no reasonable jury could find that the defendant acted with deliberate indifference on the evidence of record, the court will grant Dr. Hoffman's motion and enter judgment in his favor.


         In March of 2015, Dr. Hoffman was employed by the Wisconsin Department of Corrections (“DOC”), and he was working as a physician at NLCI.

         I. Stevenson's Head Condition and Dr. Hoffman's Referral to a Neurologist

         In 2012, prior to the relevant time period, Stevenson underwent a right-side craniotomy after a serious motorcycle crash. In 2014, he began experiencing seizures and was diagnosed with trauma induced epilepsy. He was also diagnosed with a subdural hematoma. Stevenson is also diabetic. The combination of these conditions has rendered Stevenson more susceptible to infection.

         On March 9, 2015, when Stevenson was incarcerated at NLCI, he suffered a seizure. In response, he was transported to the Mile Bluff Medical Center Emergency Room. The physical exam at the time was negative for evidence of head injury, and Stevenson's mental status was normal. Although discharged back to NLCI that same day, Stevenson was instructed to return to the emergency room if his condition worsened. Dr. Hoffman examined Stevenson for the first time on March 19, 2015, as a follow-up to his hospitalization, but Stevenson is not pursuing a claim related to that examination. Dr. Hoffman cannot remember whether he knew, at that time, that Stevenson previously underwent head surgery, but he was aware that Stevenson went to the emergency room after suffering a seizure. Dr. Hoffman does not believe that he examined Stevenson's skull during this exam, but during his deposition, Hoffman testified that he had a sense that he “wasn't all there” because of complications with the brain injury he suffered as a result of the motorcycle accident.

         At around the same time as that exam, Stevenson noticed a mass on the right side of his skull and reported it to Nurse Carol Walter. On April 9, 2015, Stevenson was examined by a nurse, who memorialized their discussion, in part, as follows:

States lump on side of [right] head a few weeks since his seizure. States sometimes it gets bigger during the day and harder … States not sure if he had a lump on [right] side of head [before] seizure or not. States noticed lump about 3 weeks ago.

(Ex. 1000 (dkt. #17-1) at 71-72.) The nurse described the lump as 3.5 cm in diameter, fluid-filled and soft, but that Stevenson denied any pain. However, Stevenson avers that the lump was actually painful if pressure was applied to it. The nurse also reported normal vital signs, including normal temperatures.

         After speaking with Dr. Hoffman, the nurse scheduled an appointment for Stevenson to meet with Dr. Hoffman. While Dr. Hoffman does not remember the conversation with the nurse, he avers that his practice would have been to defer to the nurse's assessment when evaluating next steps for Stevenson. Dr. Hoffman testified in his deposition that he, like doctors working outside of prisons, routinely rely on skilled nurses to assess and triage patients. Hoffman also admitted being overwhelmed by the number of patients he had to see during this time period, further admitting that he “did not go through every chart every day and look at every nursing documentation, ” but that when he saw a problem, he would “go back a couple pages” to see what the documentation had been. (Hoffman Dep. (dkt. #19) at 29, 38-39.)

         On April 15, 2019, Stevenson was again seen by Nurse Walter. During that examination, Walter once again assessed the lump on his head, recording that it was 3.0 cm in diameter, soft, but had not changed since he was seen on April 9. In contrast, Stevenson avers that he believed the lump had grown to the size of a golf ball (about 4.3 cm) by that time. (Stevenson Decl. (dkt. #22) ¶ 15.) The nurse reported that his vitals were normal, and he was not in pain, but again Stevenson claims that the lump was painful to the touch. (Id. ¶ 24.) During this visit, they discussed Stevenson's recent dizzy spell and sunburn. According to Stevenson, he also discussed the lump on his head with Walter. Afterwards, the nurse did not consult with Dr. Hoffman or any other doctor, noting that Stevenson was scheduled to be seen by a physician that week.

         Dr. Hoffman examined Stevenson two days later, on April 17, 2016. During that appointment, Stevenson reminded Hoffman that the lump had been there for over a month. Dr. Hoffman assessed Stevenson's head, and noted:

[Right] temple has a soft-fluid feeling bulge, [approximately] 2-3-cm diameter, not red, not tender, seems associated with the craniotomy scar.

(Ex. 1000 (dkt. #17) at 67-68.) Dr. Hoffman did not believe Stevenson was suffering from an infection because the lump was not red, warm to the touch, and Stevenson did not report pain. Instead, Dr. Hoffman was concerned that he was suffering from a buildup of fluid inside and outside of his brain (hydrocephalus), which was causing pressure. (See Ex. 1000 (dkt. #17-1) at 68.) Dr. Hoffman later testified in his deposition about his impressions,

Impressions: No. 1, he had seizures. No. 2, he had a bulge in the right temple possibly related to his old head trauma. And again, I was not looking for infection. I was looking for an increased intracranial pressure and a breach in the skull allowing that fluid to come through and bulge the scalp, ok? ...

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