United States District Court, W.D. Wisconsin
KERRY L. STEVENSON, Plaintiff,
KARL M. HOFFMAN, Defendant.
OPINION AND ORDER
WILLIAM M. CONLEY, DISTRICT JUDGE
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.
March of 2015, Dr. Hoffman was employed by the Wisconsin
Department of Corrections (“DOC”), and he was
working as a physician at NLCI.
Stevenson's Head Condition and Dr. Hoffman's Referral
to a Neurologist
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.
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
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
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,
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.
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?