BRIAN K. EPPS, Magistrate Judge.
Plaintiff, an inmate at Hays State Prison in Trion, Georgia, is proceeding pro se and in forma pauperis ("IFP") in this civil rights case. Before the Court is Defendant's motion for summary judgment. (Doc. no. 48.) For the reasons set forth below, the Court
Because Plaintiff is proceeding IFP, the Court screened Plaintiff's amended complaint in compliance with the IFP statute, 28 U.S.C. §§ 1915(e) and 1915A. The Court allowed Plaintiff to proceed with a claim for deliberate indifference to a serious medical need, based on Plaintiff's allegations that he has not received proper medical treatment for an injury to his left hand sustained in a prison fight. (
The case proceeded through the standard discovery period, during which Dr. Cheney took Plaintiff's deposition. (Doc. no. 48-3, Pl.'s Dep.) Dr. Cheney argues at summary judgment that, even assuming Plaintiff's injury was an objectively serious medical need, Plaintiff cannot satisfy the subjective component of a deliberate indifference claim. (
Because Dr. Cheney submitted with his summary judgment motion a Statement of Undisputed Material Facts pursuant to Loc. R. 56.1, the Court deems admitted all facts in that Statement which find support in the record and Plaintiff has not properly opposed.
On June 26, 2012, Plaintiff was incarcerated at Ware State Prison ("WSP") in Waycross, Georgia. (Pl.'s Dep. 7.) Plaintiff was a member of the gang known as the "Gangster Disciples," and got into a fight with several Hispanic inmates, resulting in Plaintiff being repeatedly stabbed and cut by other inmates. (
Following Dr. Sutker's surgery, Plaintiff, who is right-handed, had a cast extending from his left hand to above his left elbow, and after spending several days in the hospital, Plaintiff returned to WSP. (Pl.'s Dep. 12; Med. Rec. 5, 15-16, 68.) On July 19, 2012, Plaintiff transferred from WSP to TSP, and other than a brief trip back to state court for criminal proceedings, Plaintiff stayed at TSP and was under Dr. Cheney's care until December 19, 2012, when he transferred to Smith State Prison ("SSP"). (Doc. no. 11, p. 5; Pl.'s Dep. 17, 30-31; Cheney Aff. ¶¶ 4, 10, 21.)
At all times relevant to this litigation, Dr. Cheney was a licensed doctor serving as the medical director at TSP. (Cheney Aff. ¶¶ 3, 4.) His duties included supervising medical staff, making medical evaluations and assessments of inmates' medical conditions in order to oversee and provide healthcare to inmates, determining what treatments inmates should and may receive, including whether the treatment should be provided in prison or referred to an outside facility, managing chronic illness, prescribing medication, and providing necessary emergency care. (
As a doctor and the medical director, it is within Dr. Cheney's discretion, based on his professional medical judgment, to determine whether an inmate needs treatment by a specialist or other outside medical provider. (
Upon Plaintiff's arrival at TSP on July 19, 2012, he was provided with pain medication. (Med. Rec. 18.) On July 30, 2012, Plaintiff was transported from TSP to Savannah for a follow-up appointment with Dr. Sutker, an appointment which had been arranged prior to Plaintiff's arrival at TSP. (
On August 7, 2012, Dr. Cheney and John A. Martin, a physical therapist, saw Plaintiff in his dormitory to evaluate his hand and formulate a physical therapy plan. (Med. Rec. 24; Pl.'s Dep. 15.) Because of severe nerve and tendon damage resulting from the June 26th fight at WSP, in Dr. Cheney's medical opinion, the prognosis for regaining substantial use of Plaintiff's left hand was poor. (Cheney Aff. ¶ 35.) Mr. Martin conducted initial stretches and massaging of Plaintiff's hand, but in consultation with Dr. Cheney, determined Plaintiff would participate in physical therapy through a self-directed "home exercise program," delineated in the medical records from that date as HEP, rather than having weekly meetings with a physical therapist. (Med. Rec. 24; Cheny Aff. ¶¶ 36-37; Pl.'s Dep. 15.) Plaintiff agrees he was given exercises to perform on his own but also maintains he was told during that meeting that he would receive in-person physical therapy every Tuesday and Thursday. (Doc. no. 51-1, Revere Aff. ¶ 38; Pl.'s Dep. 15.) Plaintiff has never contested he was instructed on how to conduct self-therapy, but he maintains the self-therapy was not good enough for him. (Pl.'s Dep. 31.)
After that August 7th evaluation, Dr. Cheney and other TSP medical personnel "observed" Plaintiff when they conducted weekly rounds. (Cheney Aff. ¶ 42.) The records documenting the weekly rounds list a date, time, and name of medical personnel conducting the observation, but the records do not state, what, specifically the person observed with respect to any particular medical issue. (Med. Rec. 26-31; Cheney Aff. ¶ 63.) Although not documented in the medical records, Dr. Cheney recalls, and Plaintiff agrees, Dr. Cheney evaluated Plaintiff's hand on approximately September 21, 2012, and explained Plaintiff needed to continue performing his self-directed physical therapy. (Cheney Aff. ¶ 47; Pl.'s Dep. 16-17.) One week later, on September 26, 2012, the medical records show Dr. Cheney checked on Plaintiff's progress and again instructed Plaintiff on how to perform the self-directed physical therapy exercises. (Cheney Aff. ¶¶ 48-49; Med. Rec. 32.)
Plaintiff temporarily transferred to Fulton County for criminal proceedings on October 4, 2012, and returned to TSP on October 11, 2012. (Pl.'s Dep. 17.) Upon his return, he was housed in the medical department until, at Plaintiff's request and without involvement from Dr. Cheney, he was moved on October 16, 2012, because it was too cold for him in the medical department. (Pl.'s Dep. 17-22; doc. no. 11, pp. 10-11.) Plaintiff believes he was placed in the medical department because the receiving nurse at TSP allowed Plaintiff to see a physical therapist, and they notified Dr. Cheney that direct physical therapy rather than self-directed therapy was necessary. (Pl.'s Dep. 18-19.)
Dr. Cheney does not recall ever being notified that Plaintiff had a consultation with a physical therapist upon his return to TSP or that Plaintiff had been scheduled for any additional physical therapy. (Cheney Aff. ¶¶ 50-52.) There is no dispute, however, that TSP went on lockdown on October 11th because a correctional officer had been killed by an inmate, and Plaintiff did not receive any direct physical therapy during the five days he was housed in the medical department. (Pl.'s Dep. 20-22.) At no time during Plaintiff's stay in medical did Dr. Cheney's medical opinion change insofar as his belief that "the previously prescribed self-directed physical therapy was a medically adequate form of physical therapy and proper treatment for Plaintiff's physical condition." (Cheney Aff. ¶ 55.)
After Plaintiff moved from the medical department back to the F-2 dormitory, the weekly observations of Plaintiff continued, again with no specific indication of what was observed, and appointments were scheduled for Plaintiff to meet with Dr. Cheney on November 1 and 5, 2012. (
On November 27, 2012, Dr. Cheney evaluated Plaintiff's hand, and after assessing the flexion in the remaining fingers on Plaintiff's left hand, determined his condition had worsened. (Med. Rec. 35.) Dr. Cheney concluded the deterioration occurred because Plaintiff was non-compliant with the self-directed physical therapy. (Cheney Aff. ¶ 60.) Dr. Cheney believed the self-directed program, if properly performed by Plaintiff, was adequate treatment. (
On December 18, 2012, Dr. Cheney again evaluated Plaintiff's hand, noting not much change from the December 13th evaluation but also that Plaintiff had reported a more limited range of motion than normal. (Cheney Aff. ¶ 67; Med. Rec. 37-39.) At that point, Dr. Cheney made a consultation request for Augusta State Medical Prison, but on December 19, 2012, Plaintiff was transferred to SSP. (Cheney Aff. ¶¶ 68-69; Med. Rec. 38-39; Pl.'s Dep. 28.) The transfer was administrative, controlled by Central Office personnel for the Department of Corrections, not by Dr. Cheney. (Cheney Aff. ¶ 70.) Upon his transfer to SSP, Plaintiff ceased to be under Dr. Cheney's care. (
On March 18, 2013, Plaintiff fell at SSP coming out of the shower, aggravating the injury to his left hand, but he refused treatment of his hand, against medical advice. (Med. Rec. 40-41.) On May 14, 2013, medical personnel at SSP evaluated Plaintiff for physical therapy for his left hand, and he received physical therapy treatments by outside physical therapists from May 20, 2013, through August 28, 2013. (Med. Rec. 42-70.) Plaintiff was discharged from physical therapy because he had achieved his maximum potential. (
Summary judgment is appropriate only if "there is no genuine dispute as to any material fact and the movant is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(a). "The mere existence of some factual dispute will not defeat summary judgment unless that factual dispute is material to an issue affecting the outcome of the case."
If the burden of proof at trial rests with the movant, to prevail at the summary judgment stage, the movant must show that, "on all the essential elements of its case . . ., no reasonable jury could find for the nonmoving party."
If the moving party carries the initial burden, then the burden shifts to the non-moving party "to demonstrate that there is indeed a material issue of fact that precludes summary judgment."
To prevail on a claim for deliberate indifference to a serious medical need, Plaintiff must prove that: (1) he had a serious medical need — the objective component, (2) a defendant acted with deliberate indifference to that need — the subjective component, and (3) his injury was caused by a defendant's wrongful conduct.
To satisfy the objective component regarding a serious medical need, a prisoner must demonstrate that his medical need "has been diagnosed by a physician as mandating treatment or . . . is so obvious that even a lay person would easily recognize the necessity for a doctor's attention."
Thus, mere allegations of negligence or malpractice do not amount to deliberate indifference.
Neither does a mere difference in opinion between prison medical officials and the inmate as to the latter's diagnosis or course of treatment support a claim of cruel and unusual punishment.
Conceding for his motion that Plaintiff's injuries to his left hand constitute an objectively serious medical need, (doc. no. 48-1, p. 15), Dr. Cheney argues no reasonable person could find that the medical care rises to the level of deliberate indifference. Because the "Eighth Amendment did not compel [Dr. Cheney] to check his own medical training and judgment at the door, simply because he was informed that some other doctor at some other time had prescribed" a different type of physical therapy for Plaintiff, summary judgment for Dr. Cheney is appropriate.
The undisputed facts show Dr. Cheney was not responsible for the treatment provided immediately after Plaintiff's fight at WSP. Rather, when Plaintiff arrived at TSP, Dr. Sutker had completed the surgery, and Plaintiff was wearing a cast. (Pl.'s Dep. 12; Med. Rec. 15-16.) Immediately upon his arrival on July 19, 2012, Plaintiff was examined and given pain medication. (Med. Rec. 18.) Dr. Sutker removed the cast and staples on July 30th, and wrote a Therapy Script containing no specific list of exercises or therapy activities. (
At the August 7th examination, Dr. Cheney formed the medical opinion, based on an exercise of his professional judgment, that Plaintiff's prognosis for regaining substantial use of his left hand was very poor because of the severe nerve and tendon damage from the injuries sustained during the fight at WSP. (Cheney Aff. ¶ 35.) The physical therapist conducted initial stretches and massaging of Plaintiff's hand, but in consultation with Dr. Cheney, determined Plaintiff would participate in physical therapy through a self-directed "home exercise program," rather than having weekly meetings with a physical therapist. (Med. Rec. 24; Cheney Aff. ¶¶ 36-37; Pl.'s Dep. 15.) Plaintiff agrees he was given exercises to perform on his own but also maintains he was told during the August 7th meeting that he would receive in-person physical therapy every Tuesday and Thursday. (Doc. no. 51-1, Revere Aff. ¶ 38; Pl.'s Dep. 15.)
There is a dispute as to how often Plaintiff's hand was checked by TSP medical personnel between August 7th and September 21, 2012, but that dispute is not material. Even if the Court presumes Plaintiff's hand was not checked during the documented weekly rounds, (Med. Rec. 26-28), both sides agree Dr. Cheney saw Plaintiff and evaluated his hand on approximately September 21, 2012 (Pl.'s Dep. 16; Cheney Aff. ¶ 47.) At that time, Dr. Cheney explained Plaintiff needed to continue performing his self-directed physical therapy. (Cheney Aff. ¶ 47; Pl.'s Dep. 16-17.) One week later, on September 26, 2012, Dr. Cheney checked on Plaintiff's progress and again instructed Plaintiff on how to perform the self-directed physical therapy exercises. (Cheney Aff. ¶¶ 48-49; Med. Rec. 32.)
Plaintiff left TSP on October 4, 2012, to attend court in Fulton County, and upon his return on October 11, 2012, Plaintiff was assigned to stay in the medical department. (Pl.'s Dep. 17-22; doc. no. 11, pp. 10-11.) There is a dispute between the parties as to why Plaintiff was told he would be staying in the medical department, but again, the dispute is not material. Although Plaintiff maintains he was told by someone other than Dr. Cheney he would be staying in medical because he needed face-to-face physical therapy, Dr. Cheney knew nothing about this. (Cheney Aff. ¶¶ 50-52; Pl.'s Dep. 18-19.) To the contrary, Dr. Cheney continued to believe the self-directed therapy, if performed by Plaintiff, was the appropriate course of treatment. (Cheney Aff. ¶ 55.) In any event, because of the prison lockdown and Plaintiff's request to move, he never received any in-person physical therapy during the five days he stayed in the medical department. (Pl.'s Dep. 19-20.)
Plaintiff argues he was promised physical therapy even though he left the medical department, and he disputes the reason he was told why he did not receive that therapy. (Pl.'s Dep. 21, 26.) But the reason someone other than Dr. Cheney may have told Plaintiff he was not receiving face-to-face physical therapy is not material because Dr. Cheney never changed his professional opinion that self-directed therapy was appropriate. (Cheney Aff. ¶¶ 53, 55.) Although the record shows Dr. Cheney had appointments scheduled with Plaintiff on November 1st and 5th, there is no dispute those appointments were cancelled because of security concerns and Plaintiff's absence from his cell at the appointment time. (
When Dr. Cheney examined Plaintiff's hand on November 27, 2012, and assessed the flexion in his fingers, he determined Plaintiff's condition had worsened. (Med. Rec. 35.) Dr. Cheney concluded the deterioration occurred because Plaintiff was non-compliant with the self-directed physical therapy. (Cheney Aff. ¶ 60.) Dr. Cheney also provided "extensive instruction on remediation" during the November 27th evaluation. (
On December 18, 2012, Dr. Cheney again evaluated Plaintiff's hand, noting not much change from the December 13th evaluation but also that Plaintiff had reported a more limited range of motion than normal. (Cheney Aff. ¶ 67; Med. Rec. 37-39.) At that point, Dr. Cheney made a consultation request for Augusta State Medical Prison, but on December 19, 2012, Plaintiff was transferred to SSP. (Cheney Aff. ¶¶ 68-69; Med. Rec. 38-39; Pl.'s Dep. 28.) The transfer was administrative, controlled by Central Office personnel for the Department of Corrections, not by Dr. Cheney. (Cheney Aff. ¶ 70.) Upon his transfer to SSP, Plaintiff ceased to be under Dr. Cheney's care. (
Plaintiff did not begin to receive face-to-face physical therapy until approximately five months after his arrival at SSP, and approximately two months after he sustained additional injury to his hand after falling in the shower. (Med. Rec. 40-41, 68.) Upon completion of that therapy, the medical records show, and Plaintiff agrees, his hand had reached its maximum potential. (Med. Rec. 44; Pl.'s Dep. 28-29.)
Even if the Court draws every inference in Plaintiff's favor that he only saw Dr. Cheney on August 7, September 21, and November 27, 2012 (Pl.'s Dep. 15, 16, 27; doc. no. 51, p. 58), there is no evidence showing deliberate indifference by Dr. Cheney. Exercising his professional judgment, Dr. Cheney formulated a treatment plan for Plaintiff and explained the proper procedure for performing the self-directed therapy. (Cheney Aff. ¶ 37.) The first instruction on this therapy came within a week of Plaintiff having his cast removed, and on Dr. Cheney's subsequent evaluations of Plaintiff's hand, he continued to believe until December 18, 2012 that, if performed, the self-directed therapy was an appropriate course of treatment for Plaintiff. (Cheney Aff. ¶¶ 37, 55, 60, 61, 65, 68.) Plaintiff concedes he received this instruction, he simply disagreed it was sufficient. (Pl.'s Dep. 31.)
However, as explained above and repeatedly applied in the Eleventh Circuit:
Plaintiff's cases cited in his opposition briefing are inapposite because they address situations in which a plaintiff was not provided any medical care when it was immediately apparent such care was needed. (Doc. no. 51, pp. 30-33.) Here, in contrast, medical care was provided, just not the type Plaintiff wanted. Importantly, the defendants in Plaintiff's cases were not doctors basing their decisions on professional, medical judgment. For example, in
In
Plaintiff's unsubstantiated contentions about comments from physical therapists and other medical personnel at TSP and SSP suggesting in-person physical therapy should have been conducted earlier does him no good. Not only would such comments merely suggest a difference in professional opinion, which as described above is not a basis for Eighth Amendment liability, but there is no evidence in the record to substantiate such claims.
Plaintiff's care in this case has not been so grossly incompetent, inadequate, or excessive as to shock the conscience or be intolerable to fundamental fairness.
As Dr. Cheney aptly summarizes,
(Doc. no. 53, p. 13.)
Thus, under the undisputed facts and Plaintiff's version of the disputed facts, no reasonable juror could find the treatment provided by Dr. Cheney at TSP violates the Eighth Amendment, and summary judgment should be granted to Dr. Cheney.
For the reasons set forth above, the Court
SO REPORTED and RECOMMENDED.