NOELLE C. COLLINS, Magistrate Judge.
Before the court is the Motion for Summary Judgment filed by Defendants Don Pokorny and Chad Davenport. (Doc. 36). The matter is fully briefed and ready for disposition. The parties have consented to the jurisdiction of the undersigned United Sates Magistrate Judge. (Doc. 42). See 28 U.S.C. § 636(c).
The court may grant a motion for summary judgment "if 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." Fed. R. Civ. P. 56(a).
The moving party always bears the burden of informing the court of the basis of its motion.
Where the non-moving party "fails to properly address another party's assertion of fact as required by Rule 56(c), the court may . . . consider the fact undisputed for purposes of the motion. . . [or] grant summary judgment if the motion and supporting materials — including the facts considered undisputed — show that the movant is entitled to it . . . ." Fed. R. Civ. P. 56(e).
In ruling on a motion for summary judgment, the court must view the facts in the light most favorable to the nonmoving party, and all justifiable inferences are to be drawn in its favor.
Complaint, that Defendants Don Pokorny and Chad Davenport, failed to provide him with proper medical care, in violation of 42 U.S.C. § 1983, while he was incarcerated under Defendants' supervision. Plaintiff sues Defendants in their individual capacities, and specifically claims they failed to transport him to a competent medical provider, including a pediatric hand specialist; failed to comply with instructions and warnings from Plaintiff's treating physician; and failed and refused to carry out Plaintiff's physician's treatment plans and orders, including that Plaintiff have surgery for a mal-union of the right hand. Plaintiff further contends that Mary E. Rashid, M.D., diagnosed him with a mal-union in his hand; she stated that Plaintiff should have this malunion surgically repaired; and, by the time Defendants sought medical treatment for Plaintiff, other than initially splinting his injury, the fracture had already healed with a mal-union deformity. (Doc. 10).
Defendants contend, in their pending Motion for Summary Judgment, that they are entitled to summary judgment in their favor on Plaintiff's claim of a failure to provide medical treatment and, alternatively, that they are entitled to qualified immunity. (Doc. 36).
On February 15, 2011, the Circuit Court of St. Charles County, Family Court Division, entered an Order and Judgment committing Plaintiff to the legal and physical custody of the Division of Youth Services (DYS) for an indefinite term. The DYS is a State agency, charged with the care and treatment of delinquent youth committed to its custody by one of Missouri's juvenile courts. (Doc. 37-3).
Before Plaintiff's commitment to the DYS, on February 14, 2011, he was examined by Dr. Thomas Applewhite for an injury to his right hand. Dr. Applewhite diagnosed Plaintiff with a healing fracture of the distal second metacarpal. Dr. Applewhite noted that there was no significant displacement or misalignment. On February 18, 2011, Plaintiff received a nursing assessment. The assessment noted that Plaintiff had suffered an injury to his right hand in December 2010; he had received no treatment at that time; Plaintiff was able to move all five fingers in his right hand; and there was only mild swelling in Plaintiff's right hand. On February 22, 2011, Plaintiff was seen for a physical examination by Dr. Maria Dunston. Dr. Dunston noted that Plaintiff had a healing fracture in his right hand.
On Saturday, March 19, 2011, Plaintiff complained of right hand pain and was referred to a doctor for examination. On March 28, 2011, Plaintiff injured his right hand when he hit it on a desk during school. He was seen by Registered Nurse Hulse. Nurse Hulse noted that Plaintiff had moderate swelling and prescribed a treatment of ice and bandaging. Further, Nurse Hulse ordered that Plaintiff be seen by urgent care if the injury was not better by the following morning, and noted that Plaintiff had a prior fracture to the same hand.
On March 29, 2011, Plaintiff was examined by Dr. Wendolyn DiSalvo in the emergency room at Christian Hospital. Dr. DiSalvo ordered an x-ray of Plaintiff's right hand; diagnosed Plaintiff with a fracture of the neck of the metacarpal and a sprained finger, and prescribed Motrin and Percocet for pain relief. Dr. DiSalvo noted that any recommendations for surgery would need to come from an orthopedic doctor. Plaintiff's hand x-ray was reviewed by Dr. Paul Busse. Dr. Busse diagnosed Plaintiff with a healing fracture of the distal second metacarpal and noted that there was no acute injury. Specifically, the x-ray report of this date states that Plaintiff had a "healed or healing fracture of the distal end of the second metacarpal with considerable periosteal new bone formation"; "acute fracture or dislocation [were] not seen elsewhere." The impression was "old healed or healing fracture distal second metacarpal" and "negative for acute osseous injury." (Doc. 39-7, DYS 594).
On April 1, 2011, Plaintiff received a follow-up assessment of his hand by Nurse Hulse. Nurse Hulse noted that there was mild swelling of the right hand and recommended an orthopedic appointment and that Plaintiff's hand be kept immobile, using a splint and wrap. Nurse Hulse also prescribed pain medication. On April 5, 2011, Plaintiff was seen by Dr. Dunston for treatment of his right hand. Dr. Dunston noted that the previously performed x-ray showed a healing fracture and no acute fracture or dislocation. Dr. Dunston also noted slight swelling over the M-P joint, and prescribed the continued use of a brace and a follow-up appointment in three weeks.
On April 11, 2011, Plaintiff was taken to Cardinal Glennon Children's Medical Center for an appointment with Dr. Rashid, an orthopedic specialist, for his right hand injury. Dr. Rashid diagnosed Plaintiff with a closed fracture of the neck of the metacarpal and instructed Plaintiff to return for a follow-up visit in September 2011, at which time an x-ray would be obtained. This doctor prescribed acetaminophen for Plaintiff to use as needed. (Doc. 39-7, DYS 598). On physical examination of Plaintiff's right hand, Dr. Rashid reported that Plaintiff had "mild swelling, tenderness of the index metacarpal with no instability; ligaments intact." (Doc. 45-4 at 5). Dr. Rashid also reported as follows:
(Doc. 45-4 at 6).
Plaintiff contends that additionally, on this date, Dr. Rashid recommended a referral to a juvenile orthopedic hand specialist. (Doc. 46 (Plaintiff's Answers to Defendants' Statements of Uncontroverted Material Facts, hereafter "Pl. Ans.") ¶ 21). Medical records of this date, however, do not reflect such a recommendation. (DYS 598). As authority for his assertion that Dr. Rashid recommended a referral, Plaintiff cites his and his father's affidavits. These affidavits do not reference an orthopedic referral on April 11, 2011, but rather state that Dr. Rashid indicated, at an unspecified date, that Plaintiff needed surgery to repair his hand. (Doc. 45-3 (Pl. Aff.) ¶ 4; Doc. 45-1 (Ricky Robinson Aff.) ¶ 3).
Plaintiff's father met with Dr. Rashid on May 16, 2011, "regarding possible operative therapy for his son." Dr. Rashid discussed the "risks and benefits of the procedure with Plaintiff's father, including "infection, tendonitis from hardware irritation and nonunioin." Dr. Rashid's records reflect that Plaintiff's father was "concerned about the retained plate and screws and want[ed] to think about surgery." Plaintiff and his father were to see Dr. Rashid on a "p.r.n. basis." (Doc. 45-4 at 8).
On July 7 and 22, and August 9, 13, and 14, 2011, Plaintiff complained of right hand pain or knuckle and index finger pain. Defendants contend, and Plaintiff denies, that Plaintiff refused medical treatment for his symptoms on these dates.
Nurse Hulse's notes of August 23, 2011, reflect that Plaintiff's father called and stated that he wanted his son to have his "hand fixed now & not wait till he got released"; Nurse Hulse told Plaintiff's father that they were "following orthopedic order[s] & orth stated in writing that it could wait until [Plaintiff's] release." Nurse Hulse's notes further reflect that she then notified Dr. Dunston of the father's call; Dr. Dunston instructed her to find out when Plaintiff was to be released; and Dr. Dunston said she would talk to orthopedics. Nurse Hulse's notes also reflect that Plaintiff's father called again on August 24, 2011, and, after becoming upset with what he was told, said he would be calling his attorney, and hung up. (DYS 441).
Plaintiff's medical records reflect that, on October 6, 2011, Plaintiff was transported to Cardinal Glennon Children's Medical Center, where he was examined by orthopedic surgeons Jessica C. McMichael, M.D., and Philip Sinatra, M.D. (Doc. 45-4 at 10-11). Dr. McMichael reported, pursuant to physical hand examination, that Plaintiff had "no swelling. Right IF mildly shortened, with no rotational deformity. Can flex nearly to distal palmar crease. Intact sensation to light touch.. . . C/O `weird feeling' but no gross tenderness to palpation of fracture sight. Brisk capillary refill. 5/5 grip strength." (Doc. 45-4 at 10). Additionally, Dr. McMichael reported:
(
Dr. McMichael also stated that Plaintiff had been seen by Dr. Rashid, who discussed "osteotomy, ORIF," and that Plaintiff and his father "verbalize their understanding of the risks/benefits of surgery, but had to defer surgery until release by state custody due to safety concerns. He is here today to reestablish care. Currently doing well and only complains of vague hand pain when writing. Otherwise, fully functional." (
October 6, 2011 medical records reflect Plaintiff was instructed to follow-up if his symptoms worsened or failed to improve. Medical records of this date further reflect that no activity restrictions were imposed on Plaintiff, or medications prescribed, and Plaintiff was to have a return appointment with Dr. Panattoni, "when available."
On Saturday, November 12, 2011, Plaintiff complained of right hand pain after he hit his bunk. Plaintiff was monitored and reevaluated the following morning. (Doc. 37-1, ¶ 29, Doc. 46, ¶ 29).
On November 14 and 28, and December 6 and 7, 2011, Plaintiff complained of right hand pain. Defendants contend, and Plaintiff denies, that Plaintiff refused treatment for his symptoms on these dates.
On Tuesday January 24, 2012, Plaintiff complained of right hand pain. Defendants contend, and Plaintiff disputes, that Plaintiff refused treatment on this date.
On January 27, 2012, Plaintiff was released from DYS's custody to his father, Ricky Robinson.
During the time relevant to Plaintiff's First Amended Complaint, Defendant Don Pokorny was the Regional Administrator for the DYS's St. Louis Region. He was responsible for all agency operations in the St. Louis region, including residential care, non-residential services, and business and administrative functions. Defendant Pokorny provided direct supervision of the Service Coordination units as well as supervision of three Assistant Regional Administrators in the region. He had no involvement in the day to day operations of Missouri Hills, Spanish Lake Campus.
In response to Defendants' assertion that Defendant Pokorny had no involvement with Plaintiff's medical care (Doc. 37-1, DSUMF ¶ 6), Plaintiff alleges that Defendant Pokorny "had the authority to direct and duty to direct Plaintiff's requested medical care by a juvenile orthopedic hand specialist" (Doc. 46, Pl. Ans. ¶ 6). To support this allegation, Plaintiff has provided a computer printout which merely reflects that Defendant Pokorny is the "Designated Principal Assistant, Administrative Services, Non-Residential Care and Southeast Region," and which lists staff working under him. (Doc. 45-2). This printout does not even suggest that Defendant Pokorny "had the authority to direct and duty to direct Plaintiff's requested medical care by a juvenile orthopedic hand specialist"; thus, the court deems Defendants' factual allegation regarding Defendant Pokorny's involvement in Plaintiff's medical care undisputed. Fed. R. Civ. P. 56(e)(2).
Defendant Chad Davenport is employed as the Facility Manager for Cottage 7, Spanish Lake, where Plaintiff was housed after his commitment to DYS. Defendant Davenport, who is not a medical doctor, does not have any involvement in conducting medical exams or diagnosing medical complaints. Defendants allege, and Plaintiff denies, that while he was living in Cottage 7, Defendant Davenport "did not see him with any injury that caused [him] to believe that he had a need for immediate medical care beyond the care he was receiving from medical staff." (Doc. 37-1, DSUMF ¶ 8).
In support of his denial of this suggested undisputed fact, Plaintiff asserts that, while he was living in Cottage 7, a meeting was held between his father, Ricky Robinson, and Defendant Davenport, wherein a recommendation by Dr. Rashid for a referral to a juvenile orthopedic hand specialist was discussed and requested and demanded by Plaintiff's father. Also, in response to Defendants' contention that Defendant Davenport did not see Plaintiff with an injury that caused him to believe Plaintiff had a need for immediate medical care beyond what he was receiving, Plaintiff has provided an August 29, 2011 letter sent by his counsel to Defendant Pokorny—not to Defendant Davenport—stating that Plaintiff injured his right hand and required the services of an orthopedic specialist "to determine how best to provide surgical correction of a malunion in the hand." The letter further states that it was "a renewed demand for immediate treatment with an orthopedic surgeon." (Doc. 45-1).
The failure to provide medical care to a prisoner violates the Eighth Amendment when it involves a deliberate indifference to serious medical needs.
"Serious medical need" has been defined as a medical need which "has been diagnosed by a physician as requiring treatment, or one that is so obvious that even a layperson would easily recognize the necessity for a doctor's attention."
Mere negligence does not establish a constitutional violation.
Additionally, an inmate does not have a right to a particular course of treatment nor does an inmate establish deliberate indifference by showing that another doctor might have ordered a different course of treatment than that actually taken.
Where the treatment received by an inmate may not have been as extensive as that which would have been given by a private health-care provider, an inmate does not necessarily establish deliberate indifference.
"Liability under § 1983 requires a causal link to, and direct responsibility for, the deprivation of rights."
For purposes of the pending Motion, the court will assume Plaintiff's broken hand was a serious medical condition.
Second, although Dr. Rashid opined that Plaintiff would benefit from surgery, Dr. McMichael specifically recommended that Plaintiff not have surgery. Plaintiff has no constitutional right to a particular course of treatment, especially when there are differing opinions as to recommended treatment.
Third, Plaintiff's medical records do not reflect that any doctor, including Dr. Rashid, recommended
When Plaintiff returned to Cardinal Glennon Children's Hospital, in October 2011 for follow-up of his hand injury, Dr. McMichael noted that surgery might not resolve Plaintiff's problem with his hand and that Plaintiff had cosmetic concerns regarding his hand. Significantly, Dr. McMichael recommended Plaintiff
Fourth, the delay in Plaintiff's receiving surgery for his hand until after his ultimate release from DYS's custody fails to establish an Eighth Amendment violation because Plaintiff has not demonstrated that the delay adversely affected his prognosis,
Fifth, although Plaintiff and his father may have preferred—and actually demanded—that Plaintiff receive surgery prior to his release, the failure of Defendants or anyone else affiliated with DYS to acquiesce to their wishes or demands does not violate the Eighth Amendment, given Plaintiff's failure to demonstrate a resulting negative affect on his prognosis.
Sixth, even assuming that Defendant Pokorny and Defendant Davenport knew of Plaintiff's serious medical need, the undisputed facts fail to establish that they deliberately disregarded it.
Seventh, Plaintiff has not established deliberate indifference to his serious medical condition merely because his treatment may not have been as extensive as that which would have been given by a private health-care provider. Thus, even though the record does not reflect that he saw Dr. Panattoni pursuant to Dr. McMichael's recommendation, Plaintiff has failed to establish a constitutional violation.
Eighth, despite Plaintiff's assertions that he should have received immediate surgery or surgery prior to his release, he fractured his hand in December 2010, and had not had it treated prior to entering DYS custody in February 2011.
Ninth, and most significantly, Plaintiff has
The court finds, therefore, that Plaintiff has failed to establish deliberate indifference to his serious medical needs, in violation of the Constitution, and that summary judgment should be granted in favor of Defendants.
"In a § 1983 action, state actors may be entitled to qualified immunity."
In
Given that Plaintiff has failed to establish that Defendants deliberately denied him medical care for his serious medical condition, in violation of the Constitution, the court further finds that Defendants are entitled to qualified immunity.
Accordingly,