PAUL W. GRIMM, District Judge.
Ndokey Enow's pro se Complaint alleges that Dr. Talmadge Reeves provided him inadequate medical care in violation of his rights under the Eighth Amendment.
Enow claims that on February 17, 2017, Dr. Reeves discontinued his medication for Zoloft, a psychotropic drug, without notice or due process, in violation of his rights under the Eighth Amendment. ECF No. 1 at 7, ¶ 8; ECF No. 48 ("Pl. Opp'n") at 2, ¶ 3. Enow denies that he was hoarding this medication. Pl. Opp'n at 3, ¶ 8.
The facts germane to this issue were summarized in my Memorandum Opinion dated February 16, 2018. ECF No. 38 at 20. On January 25, 2017, Dr. Reeves saw Enow for psychiatric treatment, at which time Dr. Reeves noted that Enow was being seen every 12 weeks to monitor the Zoloft he was prescribed for depression. Id. On February 13, 2017, Nurse Victoria Midgette reported that Enow was found hoarding 20 Zoloft pills. Id. The following day, Dr. Reeves discontinued the Zoloft prescription without seeing Enow due to concerns about hoarding. Id. On March 24 and 25, 2017, Enow submitted sick call slips stating that he was not receiving his anti-depressant medicine and, in the March 24, 2017 sick call slip, he complained of suffering heart palpitations, chest pain, pain attacks, and other symptoms. Id.
On May 10, 2017, Dr. Reeves saw Enow for the "12 week" check-up, although more than 12 weeks had passed since the last visit on January 25, 2017. Enow told Dr. Reeves that he was "prescribed Zoloft 50 mg. and he was breaking it in two [be]cause it cause[s] his stomach to bubble." Id. In response to the concern expressed by Enow, Dr. Reeves prescribed Zoloft 25 mg. Id. Dr. Reeves continued to see Enow after the medication was discontinued in February 2017 and decided to reorder the medication at half strength at his next appointment because Enow had been on the medication for many years. Decl. of Dr. Reeves, ECF No. 25-3 ("Dr. Reeves Decl. I"), at ¶ 5. Dr. Reeves advised Enow that in the future he needed to refuse the medication instead of pretending to take it or to hoard it. Id. Dr. Reeves states that it is standard prison policy to discontinue medication if an inmate is hoarding it. Id. at ¶ 7.
Given these facts, I determined there remained a genuine dispute of material facts making summary judgment inappropriate. ECF No. 38 at 21. Specifically, at issue was (1) whether Enow was hoarding medication, and if he was not, whether Dr. Reeves was aware the report of hoarding was incorrect; (2) if Enow was hoarding his medication or Dr. Reeves was unaware the report was inaccurate, did the abrupt discontinuation of the medication without seeing the patient for more than twelve weeks, despite Enow's complaints about adverse effects from the discontinuance, violate acceptable medical standards; (3) whether the discontinuation of the medication caused the injuries alleged and, if so whether Dr. Reeves was aware or should have been aware of the possible adverse effects; and (4) whether Dr. Reeves knew or should have known about the sick call slips complaining of adverse effects. Id.
In order to establish an Eighth Amendment claim, Enow must show that Dr. Reeves' actions amounted to deliberate indifference to a serious medical need. See Estelle v. Gamble, 429 U.S. 97, 106 (1976). There is no underlying distinction between the right to medical care for physical ills and its psychological and psychiatric counterpart. Bowring v. Godwin, 551 F.2d 44, 47 (4th Cir. 1977); see also DePaola v. Clarke, 884 F.3d 481, 486 (4th Cir. 2018) ("Courts treat an inmate's mental health claims just as seriously as any physical health claims.").
Deliberate indifference to a serious medical need requires proof that, objectively, a prisoner was suffering from a serious medical need and that, subjectively, the prison staff were aware of the need for medical attention but failed to either provide it or ensure it was available. See Farmer v. Brennan, 511 U.S. 825, 834-37 (1994); see also Heyer v. U.S. Bureau of Prisons, 849 F.3d 202, 209-10 (4th Cir. 2017); King v. Rubenstein, 825 F.3d 206, 218 (4th Cir. 2016); Iko v. Shreve, 535 F.3d 225, 241 (4th Cir. 2008). Objectively, the medical condition at issue must be serious. See Hudson v. McMillian, 503 U.S. 1, 9 (1992) ("Because society does not expect that prisoners will have unqualified access to health care, deliberate indifference to medical needs amounts to an Eighth Amendment violation only if those needs are `serious.'"); Jackson v. Lightsey, 775 F.3d 170, 178 (4th Cir. 2014). The subjective component requires "subjective recklessness" in the face of the serious medical condition. See Farmer, 511 U.S. at 839 (1994); see also Anderson v. Kingsley, 877 F.3d 539, 544 (4th Cir. 2017).
"Deliberate indifference is a very high standard—a showing of mere negligence will not meet it. . . . [T]he Constitution is designed to deal with deprivations of rights, not errors in judgment, even though such errors may have unfortunate consequences." Grayson v. Peed, 195 F.3d 692, 695-96 (4th Cir. 1999). "[A]ny negligence or malpractice on the part of . . . doctors in missing [a] diagnosis does not, by itself, support an inference of deliberate indifference." Johnson v. Quinones, 145 F.3d 164, 166 (4th Cir. 1998). Further, "[a] prisoner's disagreement with medical providers about the proper course of treatment does not establish an Eighth Amendment violation absent exceptional circumstances." Lopez v. Green, No. PJM-09-1942, 2012 WL 1999868, at *2-3 (D.Md. June 4, 2012) (citing Wright v. Collins, 766 F.2d 841, 849 (4th Cir. 1985)).
Dr. Reeves states that on February 13, 2017, a psychiatric nurse informed him that Enow was found hoarding his medications.
Dr. Reeves provides several reasons why he did not need to see Enow in person before discontinuing the Zoloft. First, Enow's condition did not warrant an appointment. Enow did not suffer a major mental illness; rather, he was diagnosed with an adjustment disorder with elements of depression. Dr. Reeves Decl. II at 2 ¶ 6.
Second, Dr. Reeves saw Enow on January 25, 2017, twenty days before the medication was discontinued, and Enow was doing well. Enow had not complained about any change in his mental health between the visit on January 25, 2017 and February 14, 2017, when the Zoloft was discontinued. Id. ¶ 7. Dr. Reeves maintains Enow was stable from a mental health perspective at the time he discontinued the Zoloft so that an appointment to assess Enow's mental health status at the time was unnecessary. Id. ¶ 6. Dr. Reeves thought it reasonable to see Enow every three to four months for follow-up. Therefore the next appointment after the Zoloft was stopped occurred on May 10, 2017, "3 ½ months after Enow's last scheduled appointment." Id. ¶ 10.
Lastly, Dr. Reeves typically sees patients at Eastern Correctional Institution for scheduled appointments because he treats many inmates and would have "difficulty providing effective, timely treatment" to each patient if he were "required to schedule an appointment with an inmate when medication was being discontinued — particularly in situations such as here where the inmate was taking a very low level dose of medication." Id. at 3 ¶ 9.
Dr. Reeves states that Enow should have informed him that he was taking only half his medication. Then Dr. Reeves could have reduced the prescribed dosage to avoid a situation where the inmate is distributing or selling the excess or stockpiling it to overdose. Id. at 3-4 ¶ 12.
Dr. Reeves was "never made aware of Mr. Enow's sick call request" prior to this lawsuit. Id. at 4 ¶ 13. Sick call slips are sent to the medical department which is responsible for sending sick call slips pertaining to mental health and psychiatric issues to the psychology department. Enow's sick call slips were never sent to the psychology department. Id. Dr. Reeves does not supervise the medical department. Id.
In his Opposition, Enow asserts without explanation that there are genuine issues of material fact in dispute precluding summary judgment. Pl. Opp'n at 5. Enow notes there has been no discovery, although he does not specify the documents he seeks or how they would assist him in responding to Dr. Reeves' Motion. Id. Enow later observes the email from the psychiatric nurse is not in the record, Pl. Opp'n at 8, but fails to state how obtaining this document is necessary to oppose summary judgment.
Enow also asserts that Dr. Reeves acted "contrary to a physician's instruction" when he intentionally interfered with his prescribed treatment. Pl. Opp'n at 6. The gravamen of Enow's Complaint is that Dr. Reeves' abrupt discontinuation of his Zoloft amounted to deliberate indifference to his serious medical need. Enow, however, does not refute that Dr. Reeves stopped the Zoloft after considering information from a reliable medical source, Enow's stable mental health condition, whether there was a need for a medication taper, and the risks posed by hoarding medication. Under these circumstances, Dr. Reeves' decision to stop the Zoloft was not reckless. Dr. Reeves was not aware of and did not ignore a "substantial risk of harm" to Enow by stopping the Zoloft without first meeting with him. The mere fact that Dr. Reeves intentionally changed an existing medical order does not amount to Eighth Amendment deliberate indifference.
Importantly, Enow does not dispute that Dr. Reeves was unaware of the adverse side effects he purportedly suffered or of the sick call slips. Dr. Reeves was unaware of a need for earlier follow-up with Enow. Thus, even when the facts are viewed in the light most favorable to Enow, there are no genuine issues of material fact in dispute to suggest that Dr. Reeves acted with requisite deliberate indifference to support the claimed constitutional violation. Accordingly, Dr. Reeves is entitled to summary judgment as a matter of law.
For these reasons, I will grant Dr. Reeves' Motion for Summary Judgment (ECF No. 41) and close this case. A separate Order follows.
