STEPHEN C. WILLIAMS, Magistrate Judge.
Pursuant to
Plaintiff filed his complaint alleging deliberate indifference against the Defendants on July 2, 2018 (Doc. 1). As narrowed by the Court's threshold order (Doc. 7), Plaintiff's complaint alleges that he injured his leg while playing soccer on June 18, 2017, causing severe pain in his thigh, the inability to bend his leg or toes, and the inability to put weight on the injury (Doc. 7, p. 2). Plaintiff initially saw Dr. Butalid for the injury and he was subsequently taken to Pinckneyville Hospital (Id. at p. 2-3). Plaintiff received an x-ray but was ultimately referred to a specialist for his injury (Id. at p. 3). Plaintiff was subsequently examined by a specialist and diagnosed with Compartment Syndrome (Id.). The specialist recommended immediate surgery for Plaintiff's condition, directly that Plaintiff return in two days for surgery (Id.). Plaintiff returned to Pinckneyville on June 19, 2017 and was next examined by Nurse Blum on June 28, 2017 (Id.). Plaintiff's leg at that time was bruised from the upper thigh to ankle and was extremely swollen and painful (Id.). Plaintiff inquired of the surgery and Nurse Blum informed him that the request would not be quick as it had to be approved by "corporate" (Id.). Blum provided Plaintiff with generic Motrin for Plaintiff's pain, which was of no help in alleviating his symptoms (Id.).
Plaintiff submitted a grievance regarding a follow-up appointment with the specialist on June 30, 2017 (Doc. 7, p. 3). Collegial later denied the request for surgery and referred Plaintiff for an ultrasound scheduled for July 7, 2017 (Id.). The ultrasound revealed a blood clot in Plaintiff's thigh and he was prescribed blood thinners (Id.). Plaintiff complained to Dr. Butalid of pain but Butalid failed to provide him with any pain medication (Id.). Plaintiff was released from the infirmary on July 12, 2017 and returned to general population (Id. at p. 4). He was also provided with more blood thinners which did nothing to alleviate the swelling or pain (Id.).
Plaintiff was seen by Nurse Blum again on August 30, 2017 (Doc. 7, p. 4). Plaintiff complained to her that his requests for medication and treatment were being ignored and she told him that he would not get "high grade medication here." (Id.). Blum prescribed him with a few days of Ultram but it did not alleviate the pain (Id.). Plaintiff apparently did receive physical therapy as he met with a physical therapist on September 25, 2017 (Id.). After seeing Plaintiff's swelling and bruising, the therapist recommended another ultrasound (Id.). Plaintiff heard no further response despite submitting grievances on September 28, 2017 and November 15, 2017 (Id.).
Plaintiff saw Nurse Adesanyapa on November 25, 2017 and informed him of the physical therapist's recommendation for an ultrasound or neuropathy medication (Doc. 7, p. 5). The nurse told Plaintiff he would not get that treatment and would have to deal with the pain (Id.). He provided Plaintiff with Tylenol (Id.).
On November 27, 2017 Plaintiff was transferred to the emergency room at Pinckneyville Hospital for swelling in his leg (Doc. 7, p. 5). Plaintiff alleges that his leg at that time was severely swollen, that he had severe pain and could not walk (Id.). The hospital could not determine the source of his symptoms and recommended Plaintiff be seen by a specialist (Id.). Plaintiff was later returned to Pinckneyville (Id.). Plaintiff again saw Nurse Blum on March 11, 2018 and informed her that he was still in pain, which was worsening, and that the blood thinners were not helping (Id.). She told him that he was lucky to be getting anything and ended the visit (Id.). Nurse Blum prescribed more blood thinners on March 17, 2018, albeit in a lower dosage than Plaintiff had previously received, as well as gave him a few days' worth of Ultram (Id.).
Plaintiff received his second ultrasound sometime in March (Doc. 7, p. 5). The ultrasound indicated that Plaintiff still had a blood clot in his leg. Dr. Butalid prescribed neuropathy medication which Plaintiff admits did help with his pain (Id.). However, Butalid later stopped the medication sometime after Plaintiff submitted another grievance on March 29, 2018 (Id. at p. 6). Plaintiff alleges that he continues to suffer from the blood clot and continues to suffer pain.
The undersigned held an evidentiary hearing on July 16, 2018. The undersigned sought testimony on the status of Plaintiff's condition, including the blood clot and his continued leg pain, as well as the current treatment plan for Plaintiff's condition.
The undersigned first heard testimony from Christine Brown, the healthcare administrator at Pinckneyville Correctional Center. She reviewed Plaintiff's medical records from June 1, 2017 to the present. Plaintiff suffered an injury to his leg while playing soccer on June 18, 2017. He was later diagnosed with a blood clot, that was considered to be non-blocking. An ultrasound report from March 28, 2018 confirmed that Plaintiff still had the blood clot in his leg, but the clot was in a superficial vein, not a main artery, and was nonocclusive meaning that the clot was not blocking the artery (Doc. 21-1, p. 199).
As to whether Plaintiff was suffering from compartment syndrome, Brown testified that compartment syndrome occurs when circulation to a portion of the body is compromised. Because the circulation is compromised, a patient could lose the extremity. However, the medical records show that compartment syndrome was ruled out by the doctors at St. Louis University Hospital (hereinafter "SLU") when Plaintiff was transferred there. Compartment syndrome was suspected after Plaintiff's initial injury and he was transferred to SLU so that he could be examined, as compartment syndrome is a very serious condition. The doctors at SLU diagnosed Plaintiff, instead, with a contusion of his right thigh and recommended a follow-up in two days (Doc. 21-1, p. 130). While at SLU, Plaintiff was initially examined and was set to be released when it was discovered that he had been transferred to determine if he was suffering from compartment syndrome (Id. at p. 145). He was then assessed by an orthopedic specialist and a strike test was performed (Id. at p. 146). The doctors ultimately determined that Plaintiff did not suffer from compartment syndrome.
While SLU recommended that Plaintiff follow-up at Affinia Healthcare after his hospital visit, Brown testified that Affinia is an urgent care center and not an orthopedic specialist. As such, the prison took that recommendation to mean that Plaintiff was to follow-up with a doctor for general care, and that the referral was not for a specialist. Plaintiff was sent back to the Pinckneyville Hospital in November 2017 for swelling but he was not referred to a specialist or given any diagnosis at that time (Doc. 21-1, p. 166). Instead, it was recommended that he be kept on the same medications he was currently taking for his pain and the blood clot in his leg (Id. at p. 166-167). Plaintiff was seen on July 1, 2018 and no swelling was noted in his leg (Id. at p. 88).
Plaintiff was prescribed a variety of medications for his condition. He was initially prescribed Cymbalta for arthritis but was later prescribed Pamelor for nerve pain when the Cymbalta did not help his symptoms (Doc. 21-1, p. 193-97). Plaintiff was also prescribed Warfarin for the blood clot. Brown testified that Plaintiff currently receives an increased dosage of Coumadin which was increased on July 1, 2018. He also receives Neurontin three times a day for his pain. He was previously given Neurontin twice a day but the dosage has increased.
Plaintiff also testified at the hearing. He testified that he still cannot bear weight on his right leg. He continues to suffer pain in the leg and if he stands for too long, then the leg swells. He also suffers from numbness and tingling. He is losing muscle in his leg because he cannot bear weight on it.
Plaintiff testified that he believes that he is suffering from compartment syndrome caused by the blood clot. He continues to have swelling when he walks and he has a lump behind his knee. While he was not able to previously bend his knee, he testified that he has received physical therapy and is now able to bend the knee and has most mobility back. Plaintiff still uses a crutch to walk and the more he is mobile the more pain he has.
While Defendants pointed out that the medical records noted numerous no-shows for doctor's appointments, the undersigned does not construe those no-shows as refusals of treatment. One no-show was because he was on the yard and another was because he was at school. Neither of those are refusals of treatment.
At the conclusion of the first evidentiary hearing, the undersigned found that there remained numerous unanswered questions regarding Plaintiff's condition and care. The undersigned noted a concern that Defendants could be persisting in an ineffective course of treatment and no evidence from a treating physician was provided to the Court. As such, the undersigned directed Defendants to submit a response from Dr. Butalid regarding Plaintiff's current treatment.
The Court received Defendants' response, including an affidavit from Dr. Alberto Butalid, on July 26, 2018 (Doc. 30). Dr .Butalid testified that he monitored Plaintiff's care from June 18, 2017 to July 19, 2018, when Dr. Butalid transferred to Vandalia Correctional Center (Doc. 30-1, p. 1). Dr. Butalid testified that when Plaintiff was first transferred to Pinckneyville Hospital after his injury, that hospital was not equipped to determine if Plaintiff suffered from compartment syndrome, which Dr. Butalid described as a condition where pressure from swelling results in insufficient blood supply to the tissues (Doc. 30-1, p. 2). He was transferred to SLU where an orthopedic specialist performed a strike test on Plaintiff's leg to determine if he was suffering from compartment syndrome; the specialist determined that Plaintiff did not have compartment syndrome (Id.). He was released with the diagnosis of a contusion and recommendation to be seen by a medical doctor in two days (Id.).
Plaintiff was transferred back to Pinckneyville Correctional Center and placed in the infirmary (Doc. 30-1, p. 2). While a collegial review was done to determine if Plaintiff needed an orthopedic consult, the review determined that there was no medical reason for an additional consult as Plaintiff did not have compartment syndrome (Id.). Instead, Plaintiff was supervised in the infirmary and sent for an ultrasound of his leg when he continued to suffer from swelling (Id.). The July 7, 2017 ultrasound indicated that Plaintiff had a "nonocclusive thrombosis", a blood clot where blood is still able to pass through the vein (Id.).
To treat the blood clot, Plaintiff was prescribed blood thinners including Coumadin and Lovenex (Doc. 30-1, p. 3). Dr. Butalid testified that there is no standard time for a blood clot to dissolve with the use of anticoagulants, but that surgery is not recommended as it can cause additional blood clots (Id.). In addition to the medication, Plaintiff was prescribed therapy from August to November 2017 in order to help his body naturally dissolve the clot (Id.). Although Plaintiff was sent to the Pinckneyville Hospital due to swelling again in November 2017, the staff at the hospital ultimately recommended continued treatment with Coumadin (Id.). A second ultrasound was taken in March 2018 due to Plaintiff's continued complaints of pain and swelling (Id.). The ultrasound showed that Plaintiff still suffered from a nonocclusive thrombosis (Id.).
Dr. Butalid testified that more recently, Plaintiff was recommended for another ultrasound of Plaintiff's leg (Doc. 30-1, p. 5). Although Dr. Butalid transferred to Vandalia Correctional Center in July, he testified that he would consult with the new medical director at Pinckneyville to obtain another ultrasound of Plaintiff's leg.
Prior to the hearing, Defendants provided the Court with additional medical records, to include the ultrasound recommended by Dr. Butalid. The ultrasound was taken on July 31, 2018. The ultrasound showed that Plaintiff no longer suffered from deep vein thrombosis in his right lower extremity. The ultrasound examination noted that the veins in Plaintiff's right leg were free from thrombus, had normal flow, and were normally compressible.
The undersigned held another evidentiary hearing on September 6, 2018 after reviewing the affidavit from Dr. Butalid and additional medical records. At that hearing, Dr. Justin Young testified that he reviewed Plaintiff's medical records and examined Plaintiff the day prior to the hearing. Dr. Young testified that Plaintiff does not have compartment syndrome as there was no tension in the right leg. He also did not have any chronic signs of compartment syndrome which include foot drop or claw foot. His leg had no tension or wood-like feeling which would be indicative of the condition. Further, his pulse in the leg was intact and there was no discoloration to the leg. Thus, Dr. Young does not believe that Plaintiff is suffering from compartment syndrome nor is there any immediate threat to his limb.
Dr. Young also testified that he reviewed the ultrasound ordered by Dr. Butalid. The ultrasound was negative for deep vein thrombosis. There is no blood clot in the leg. While Plaintiff testified that he still suffers from symptoms, including pain in the leg, Dr. Young testified that he does not believe that the pain is associated with the clot as the clot is dissolved. However, Dr. Young testified that he will continue to prescribe Plaintiff anticoagulants for the next few months in order to prevent additional clots from forming. He also testified that Plaintiff is possibly suffering from neuropathic pain associated with his previous injury or he could have disc deterioration. Dr. Young testified that he will order x-rays of the lumbar spine and will increase Plaintiff's pain medication. Plaintiff testified that he was previously prescribed Neurontin and although the pain medication initially provided him with some relief, it has since stopped working. Dr. Young also stated that he will send Plaintiff for a physical therapy consult.
Injunctions are extraordinary equitable remedies that are to be granted in civil cases only when specific criteria are clearly met by the movant.
In the context of prisoner litigation, there are further restrictions on courts' remedial power. The scope of the court's authority to enter an injunction in the corrections context is circumscribed by the Prison Litigation Reform Act (PLRA).
The Seventh Circuit has described injunctions like the one sought here, where an injunction would require an affirmative act by the defendant, as a mandatory preliminary injunction.
The undersigned
Plaintiff alleges that Defendants are being deliberately indifferent to the blood clot in his right leg. He also alleges that he is suffering from compartment syndrome in that leg since an injury in June 2017. Prison officials violate the Eighth Amendment's proscription against "cruel and unusual punishments" if they display deliberate indifference to an inmate's serious medical needs.
To prevail, a prisoner who brings an Eighth Amendment challenge of constitutionally-deficient medical care must satisfy a two-part test.
Prevailing on the subjective prong requires a prisoner to show that a prison official has subjective knowledge of—and then disregards—an excessive risk to inmate health.
Here, the undersigned finds no evidence that Plaintiff is suffering from compartment syndrome. The medical records indicate that while medical staff at Pinckneyville Hospital were concerned that Plaintiff could be suffering from compartment syndrome, and thus transferred him to SLU for an opinion from a specialist, the specialist at SLU ultimately concluded that Plaintiff did not suffer from compartment syndrome. Dr. Butalid also affirmed in his affidavit that compartment syndrome was ruled out by the specialist at SLU. Further, Dr. Young testified that Plaintiff has none of the symptoms that would indicate compartment syndrome. Plaintiff does not have any symptoms for the condition, which includes foot drop or claw foot and tension or wood-like feeling in the leg. Plaintiff also has an intact pulse and no discoloration which would also be indicative of compartment syndrome. There is simply no evidence in the record that Plaintiff is suffering from compartment syndrome.
While there is evidence that Plaintiff suffered from a blood clot in his right leg, the evidence in the record suggests that Plaintiff was treated for that condition and it ultimately resolved. Plaintiff was provided with anticoagulants for his blood clot. He was sent to follow-up ultrasounds to confirm the continued presence of the blood clot. He was even sent back to Pinckneyville Hospital in November 2017 for continued swelling and the doctors there recommended continued treatment with the anticoagulants. Further, the medical records suggest that the blood clot was not threatening to his limb as the clot was located in a superficial vein and was nonocclusive, meaning that blood was allowed to pass through the vein. Dr. Butalid testified that the proper treatment for this type of clot was anticoagulants which Plaintiff continues to be prescribed, even at the time of the September 6, 2018 hearing. Plaintiff has failed to present any evidence that this continued treatment is inappropriate. Further, the medical records support Dr. Butalid's testimony that the use of anticoagulants was proper to dissolve the clot as it appears from Plaintiff's most recent ultrasound that the clot did, indeed, dissolve. The July 31, 2018 ultrasound found no evidence of a blood clot in Plaintiff's right leg.
Further, the undersigned finds no evidence that Plaintiff continues to be treated with deliberate indifference. While Plaintiff no longer has a blood clot in his right leg, Dr. Young, his current treating physician, testified that he will continue Plaintiff on the anticoagulants in order to prevent future blood clots from developing. While Plaintiff testified that he continues to suffer from pain in his right leg, and continues to use a crutch, Dr. Young testified that Plaintiff could be suffering from neuropathic pain stemming from his original injury. The evidence in the medical records suggest that medical personnel continue to treat Plaintiff for this pain and are not simply persisting in an ineffective course of treatment. See
Accordingly, the undersigned
Pursuant to 28 U.S.C. § 636(b)(1) and Local Rule 73.1(b), the parties may object to any or all of the proposed dispositive findings in this Recommendation. The failure to file a timely objection may result in the waiver of the right to challenge this Recommendation before either the District Court or the Court of Appeals.
