State law provides the rule of decision on some S1983 substantive legal questions related to the defense raised, so the assertion of the state statutory evidentiary privilege defense, although defeated by the federal rule on the privilege in question, doesn't mean that all substantive defenses have been presently waived.
Lack of notes from a deceased physician and a delay in the referral to a specialist deft present an issue for trial, as they might show either not receiving a prisoner's claim or a deliberate indifference to the claim.
An institution-level medical director within a larger corporation is not a unilateral setter of standards for purposes of Monell liability.