CHARLES RONALD NORGLE, District Judge.
Firas Ayoubi ("Plaintiff") sues physician assistant Carlos Altez ("Altez"), Cook County Sheriff Thomas Dart ("Dart"), Chairwoman of the Department of Correctional Health at Cermak Health Services of Cook County ("Cermak") Dr. Connie Mennella ("Mennella"), and Cook County (collectively, "Defendants") pursuant to 42 U.S.C. § 1983 for deliberate indifference to Plaintiff's objectively serious medical need. In particular, the claim against Altez is in his individual capacity for treatment of Plaintiff's condition allegedly in violation of Plaintiff's Fourteenth Amendment rights; the claims against Dart and Mennella are in their official capacities for alleged systemic deficiencies at the Cook County Department of Corrections ("CCDOC") and Cermak; and Cook County remains in this litigation for indemnification purposes only. Before the Court is Defendants' motion for summary judgment. For the following reasons, the motion is granted.
Plaintiff, a thirty-one-year-old male, has been detained at the CCDOC since December 2012. Altez served as a licensed physician assistant at Cermak, Dart is the Cook County Sherriff, and Mennella chaired the Department of Correctional Health at Cermak. In roughly August 2013, Plaintiff developed a one-centimeter lump beneath the areola of his left nipple. He described the pain associated with the lump as an uncomfortable prickling pain and burning feeling. At another time, he characterized the pain as "like getting pricked with a needle from the inside out." Pl.'s Resp. to Defs.' Statement of Facts ("PRDSOF") ¶ 4. In other instances, Plaintiff described the pain as discomfort. Deposition testimony shows that on some occasions Plaintiff stated that his pain was constant and at other times sporadic. It never in any way interfered with his daily activity as an inmate.
On January 15, 2014, Plaintiff received medical treatment for a different health problem, but he did not notify the medical provider about the lump. On February 1, 2014, Plaintiff filled out a Health Service Request ("HSR") seeking treatment for the painful lump. The HSR indicated increasing pain and size. The next day, Plaintiff saw Nurse Elizabeth Santos ("Santos") and asked for pain medication. Santos declined to provide pain medication at this initial appointment. Instead, Santos booked an appointment for Plaintiff to see Altez on February 26, 2014. On February 13, 2014, Plaintiff completed another HSR in which he reiterated his pain and stated that he had not received pain medication. On February 15, 2014, later Santos gave Plaintiff twelve 200mg tablets of ibuprofen.
On February 26, 2014, Plaintiff saw Altez regarding the lump. Plaintiff's vitals were taken prior to seeing Altez. At the appointment, Altez conducted a physical examination of Plaintiff's chest, including the areola. Altez ultimately diagnosed Plaintiff with gynecomastia. Gynecomastia is the excessive growth of the male mammary glands, generally associated with metabolic derangements that lead to estrogen accumulation, testosterone deficiency, and hyperprolactinemia. In some cases, gynecomastia may develop to the stage at which milk is produced, commonly called lactation. Although not as common in males in their twenties, as Plaintiff was at the time of his February 26, 2014 diagnosis, the condition is relatively common among infants, adolescents, and men over fifty.
Altez's treatment notes indicate that Plaintiff complained of sharp and intermittent chest pain. Plaintiff alleges that Altez made light of Plaintiff's condition by laughing while asking whether Plaintiff was lactating and that he was embarrassed as a result of Altez's asking such a question. Plaintiff asked Altez for pain medication but claims that Altez declined to provide the medication at that point. However, Altez did prescribe the antibiotic clindamycin, which is used to treat serious infections. Altez also ordered several blood tests, including a complete blood count with differential to test Plaintiff's blood cell and platelet count, a follicle-stimulating hormone test to evaluate Plaintiff's testicular function and spermatozoids production, and a thyroid stimulate hormone test to determine if Plaintiff had thyroid abnormalities. Additionally, Altez ordered an ultrasound of Plaintiff's left breast and nipple, which took place on March 4, 2014, six days later. The ultrasound was used to confirm the gynecomastia diagnosis and to rule out other (and potentially malignant) breast conditions such as cancer or an abscess. Plaintiff's deposition also reflects that he underwent a second ultrasound to check his other breast. Plaintiff was scheduled for a follow-up appointment on March 19, 2014. He was not treated with pain medication in the interim.
At the March 19, 2014 appointment, Altez discussed the ultrasound results with Plaintiff. The results confirmed the gynecomastia diagnosis. The test did not reveal any other abnormalities. Plaintiff asserts that Altez made additional embarrassing comments and again did not prescribe pain medication. For example, Plaintiff claims that Altez stated that Plaintiff could handle the condition because he is a "big boy,"
Altez informed Plaintiff that if the gynecomastia did not go away on its own, Plaintiff could have a surgeon "cut it off."
Contrary to Altez's medical opinion, Plaintiff alleges that gynecomastia is a serious condition. Plaintiff stated at his deposition that his sources for this conclusion are articles that his former cellmate provided to him. Plaintiff also could not remember the authors of any of these articles. In his deposition, however, Plaintiff acknowledges that the gynecomastia did not limit him at all outside of experiencing pain, embarrassment, and repeatedly visiting outside hospitals.
After declining surgery, on April 9, 2014, Plaintiff submitted another HSR, claiming constant and severe pain and stating that he had not received pain medication. In response, Plaintiff was scheduled for an appointment with Nurse Lisa Locke ("Locke"). Locke did not provide pain medication. On April 30, 2014, however, Santos gave Plaintiff another twelve 200mg tablets of ibuprofen, though Plaintiff asserts that it was for an unrelated ailment. On June 3, 2014, Plaintiff was prescribed pain medication for his gynecomastia. The record reflects that Altez took notes on his computer "on every visit,"
Plaintiff was also able to purchase eight pain pills per week from the CCDOC commissary for the duration of the treatment at issue. The commissary sold two pills for about 45 cents. Plaintiff stated in his deposition he accessed the commissary for these pills "regularly."
In sum, Plaintiff received numerous tests, declined the surgical removal of the growth on his areola, and consistently received and purchased pain and other medication. That notwithstanding. Plaintiff alleges that Altez was deliberately indifferent because Altez failed to treat to Plaintiff's pain and made light of Plaintiff's condition. Plaintiff submitted his Complaint on June 9, 2014.
"Summary judgment is appropriate when `the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.'"
Plaintiff was a pretrial detainee at the time of the treatment at issue in this case. Pretrial detainees are protected by the Fourteenth Amendment, rather than the Eighth Amendment's protection from cruel and unusual punishment, which applies only to people who have been convicted.
Deliberate indifference claims have both an objective and subjective component.
The Court first addresses whether the medical condition alleged is objectively, sufficiently serious. Plaintiff asserts that his condition meets the objective prong because (1) a lay person can recognize that the growth of painful breast tissue necessitates a doctor's attention, and Altez actually diagnosed Plaintiff with gynecomastia and determined that the condition required treatment; and (2) Plaintiff's condition negatively impacted his daily activities due to constant pain.
The Court rejects Plaintiff's argument. First, although Plaintiff is correct that Altez diagnosed the condition and determined that Plaintiff required treatment, Plaintiff's symptoms, as explained in medical literature infra, do not rise to the objective level of seriousness needed to find a constitutional violation. Second, Plaintiff's deposition testimony belies his contention that his gynecomastia impinged on his daily activities.
Plaintiff provides inconsistent statements regarding the type and consistency of his pain. As to the consistency, at different times, Plaintiff complained of consistent chest pain and intermittent chest pain. Plaintiff stated on some occasions that the pain manifested itself in a pricking and burning feeling. In other instances, Plaintiff referred to the pain as discomfort. As an initial matter, the Seventh Circuit, albeit in the context of smoke inhalation, has held that chest pains "are, objectively speaking, relatively minor . . . they are not the sort of objectively serious injury or medical need that amounts to a denial of the minimal civilized measure of life's necessities necessary to state a violation of the Fourteenth Amendment."
According to the Mayo Clinic,
The medical literature indicates that the condition is not considered serious by medical professionals, often requires no treatment, and is not likely to pose serious physical complications. Plaintiff fails to articulate any greater medical risk stemming from his chest pain, which undermines his claim.
Moreover, Plaintiff fails to support his contention that the condition is serious with any reliable evidence. Plaintiff asserted at his deposition that gynecomastia is a serious medical condition. In response to an inquiry regarding his evidence to support that position, Plaintiff explained that he had read articles which stated that gynecomastia was a serious, painful condition. However, Plaintiff never named the title of any such articles and admitted that he could not recall the author of any of the materials that he read. Plaintiff additionally conceded at his deposition that he did not obtain the articles from a medical professional or anyone with a background in science; rather, his former layperson cellmate provided the unidentified literature. Without any evidence from a reliable source to establish the seriousness of his condition, Plaintiff sets forth no more than his own subjective opinion. Thus, the Court rejects Plaintiff's attempt to establish the objective seriousness of his condition.
Plaintiff also argues that his "condition negatively impacted his daily life, making even basic daily activities — such as putting on a shirt or lying down in bed — very painful." Pl.'s Mem. in Opp. at 8;
As set forth above, Plaintiff's arguments fail to establish the objective prong of a deliberate indifference claim. "To survive summary judgment, the nonmoving party must show evidence sufficient to establish every element that is essential to its claim and for which it will bear the burden of proof at trial."
Assuming arguendo that Plaintiff suffered from an objectively serious medical condition, he still cannot satisfy the subjective prong because Altez did not disregard whatever risk existed; rather Altez's course of treatment fell squarely within his medical discretion. Plaintiff argues that Altez failed to prescribe pain medication for Plaintiff's gynecomastia despite knowing that Plaintiff was in serious and constant pain. Plaintiff also asserts that Altez's unprofessional humor and off-hand comments demonstrate that Altez did not take Plaintiff's condition seriously and was therefore deliberately indifferent. Additionally, although Plaintiff does not sue Santos, Locke, or any other medical professional involved in his treatment, he attempts to buttress his deliberate indifference allegations based on his interactions with the other medical professionals. The Court thus addresses his treatment allegations as a whole. The record reveals that the medical attention Plaintiff received belies his claim, and Altez's comments do not give rise to a constitutional infraction.
First, Altez's treatment of Plaintiff was thorough and sought to identify the condition and ensure that Plaintiff did not suffer from serious complications. Negligence is insufficient to prove deliberate indifference,
Altez and other medical professionals consistently examined Plaintiff and provided treatment within their professional discretion. Plaintiff does not dispute that Altez examined him approximately five times.
Plaintiff's challenge that Altez should have prescribed pain medication is a nonstarter. Altez sought to protect Plaintiff against more serious complications, and Plaintiff's mere disagreement with Altez's course of action cannot amount to deliberate indifference.
On March 19, less than a month later, Altez provided additional detail during the second appointment. There, Altez confirmed the diagnosis of mild gynecomastia, explained that the condition often resolves on its own, advised that the condition was benign and not infected, and assured Plaintiff that all tests were normal other than the gynecomastia. Although gynecomastia often resolves itself and does not pose a substantial risk of serious complications, Altez also told Plaintiff that if the condition did not resolve itself, Plaintiff could "cut it off."
Plaintiff's referral to the plastic surgeon demonstrates that he received a treatment option that could mitigate his pain and embarrassment as a result of the gynecomastia. A concern regarding cosmetic scarring does nothing to negate the fact that Plaintiff was provided with a treatment option both within the medical professional's discretion and supported by medical literature. And, the explanation of risks attendant to surgery demonstrates the surgeon's concern for Plaintiff's condition and desire to fully inform Plaintiff regarding the procedure. Plaintiff thus rejected a reasonable course of treatment recommended by Altez and the plastic surgeon and at best states a preference for pain medication. He has therefore not put forth evidence suggesting "the obviousness of the risk from a particular course of medical treatment; [Altez's] persistence in a course of treatment known to be ineffective; or proof that [Altez's] treatment decision departed so radically from professional judgment, practice, or standards that a jury may reasonably infer that the decision was not based on professional judgment."
The totality of Plaintiff's treatment also undermines Plaintiff's contention that Altez had the requisite subjective state of mind. Plaintiff's assertion that Altez was deliberately indifferent because he did not prescribe sufficient pain medication is contradicted by Plaintiff's ongoing receipt of Tylenol, Advil, or ibuprofen from other medical professionals.
Plaintiff received pain medication on several occasions throughout the duration of his medical treatment. On February 15, 2014, Santos provided Plaintiff with twelve 200mg tablets of ibuprofen in response to his HSR submitted just two days earlier. On April 30, 2014, Santos gave Plaintiff another twelve 200mg tablets of ibuprofen, albeit for Plaintiff's complaint regarding a separate medical issue. On June 3, 2014, Plaintiff was prescribed medication as part of his treatment for the gynecomastia. Between visits to the medical professionals, Plaintiff admitted that he was able to purchase pain pills weekly from the CCDOC commissary and stated in his deposition that he did so regularly. Furthermore, Plaintiff admitted in his deposition that "the pain medicine the nurse was giving me, the Tylenols or Advil packs [were] . . . several packs more than I'm allowed to buy on the commissary . . ." PRDSOF, Ex. B, 166:17-20. Plaintiff asserts that he was not prescribed medication for the gynecomastia pain until June 3, 2014 and that Altez should have prescribed pain medication rather than (or in addition to) the course of treatment provided. However, Plaintiff's medication orders reflect that he was regularly given ibuprofen by various medical professionals (in addition to the medicine provided by Santos), including on dates before and after June 3, 2014. On July 31, 2013, Plaintiff received 600mg tablets of ibuprofen; on December 4, 2013, Plaintiff received 400mg tablets of ibuprofen; on January 15, 2014, Plaintiff received 400mg tablets of ibuprofen; on June 18, 2014, Plaintiff received 600mg tablets of ibuprofen; on August 27, 2014, Plaintiff received 400mg tablets of ibuprofen; on April 7, 2015, Plaintiff received 400mg tablets of ibuprofen; and on July 21, 2015, Plaintiff received 400mg tablets of ibuprofen. PRDSOF, Ex. M. CCSAO at 244-46. Given Plaintiff's extensive and continuous receipt of pain medication, the Court finds no support for the proposition that Defendants deliberately withheld treatment in order to inflict pain upon Plaintiff.
That Altez declined to provide additional pain medication while other medical professionals were providing Plaintiff with ibuprofen further demonstrates that Altez was not recklessly disregarding Plaintiff's gynecomastia.
Additionally, in his deposition, Plaintiff complained of pain, embarrassment, and "repeated visits to the outside hospital." PRDSOF, Ex. B, at 142:18-19 (emphasis added). Repeated treatment represents the antithesis of deliberate indifference.
To the extent Plaintiff's assertion of deliberate indifference rests on an alleged delay in the provision of pain medication, the claim still fails. A delay in the provision of medical treatment for painful condition may give rise to a deliberate indifference claim.
In his brief, Plaintiff states that Altez did not prescribe pain medication between the February 26, 2014 and March 19, 2014 appointments and that he did not receive any pain medication between April 30, 2014 and June 3, 2014. Plaintiff also complained in his deposition that "[i]t wasn't the fact that I was not prescribed pain medication at all. It was just the delayed prescribing of the pain medicine and the lack of pain medicine, is what I'm complaining about." PRDSOF, Ex. B, 164:23-165:2. However, medical professionals within a penal institution need not accede to every request for a prescription drugs.
Even if Plaintiff had shown a delay in his treatment, he fails to provide evidence that his condition worsened as a result thereof. Plaintiff offers only his anecdotal statement of worsening pain in support of his contention that Altez's alleged delay warrants a finding of deliberate indifference. Here, while there is no expert testimony, Plaintiff asserts no more than a "bare recitation of the treatment received."
Plaintiff's allegations that Altez made unprofessional, off-hand comments also fail to support his claim because they do not demonstrate that Altez did not take Plaintiff's condition seriously. Plaintiff claims that Altez first-bumping Plaintiff, laughing when Altez asked Plaintiff if his gynecomastia caused him to lactate, and calling Plaintiff's a "big boy" is indicative of deliberate indifference. Viewed by Plaintiff, the question whether he was lactating is offensively embarrassing. However, objectively viewed, it is an appropriate, legitimate inquiry regarding a symptom of gynecomastia, which is widely recognized within the medical profession. To the ill-advised layperson, routine questions regarding bodily functions should be avoided. As to Altez allegedly laughing, the Seventh Circuit recently ruled that laughing at a patient does not establish a medical professional's deliberate indifference. In
Finally, Plaintiff alludes to embarrassment and psychological difficulties associated with his gynecomastia throughout his pleadings. Such difficulties coping do not alter the deliberate indifference calculus because Plaintiff never sought treatment for psychological problems. In his deposition, Plaintiff admitted that he had access to a mental health specialist and that he elected not to pursue medical treatment for psychological problems associated with his gynecomastia. Specifically he stated, "I mean, there's — A mental health specialist is not going to make my gynecomastia go away. . . . I haven't — I decided to not really purs — you know, as for medical treatment when it comes to that." PRDSOF, Ex. B, 173:15-21. Furthermore, Altez (and Santos and Locke) would not have treated Plaintiff for mental health difficulties, thus further undermining any claim against them for deliberate indifference. Accordingly, for the alternative reason that Plaintiff fails to establish the subjective prong of his deliberate indifference claim, summary judgment is granted in favor of Altez.
The Court briefly addresses Plaintiff's
Plaintiff's deliberate indifference claim against Altez fails because neither the objective nor the subjective components necessary to prevail are satisfied. Because there is no underlying constitutional violation, Plaintiff's
IT IS SO ORDERED.