IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
July 31, 2007
JAMES A. BAEZ, PLAINTIFF
STINE, ET AL., DEFENDANTS
The opinion of the court was delivered by: Judge Rambo
Presently before the court is Defendants' motion to dismiss or, in the alternative, for summary judgment (Doc. 26), the Bivens*fn1 action brought by Plaintiff James A. Baez ("Baez"). Defendants are prison officials and medical staff from the Federal Prison Camp in Duluth, Minnesota ("FPC-Duluth") and the Federal Prison Camp at Schuylkill ("FPC-Schuylkill") in Minersville, Pennsylvania.*fn2 Baez contends that Defendants were deliberately indifferent to his serious medical needs, in violation of the Eighth Amendment. For the reasons that follow, the motion for summary judgment will be granted in favor of Defendants.
I. Statement of Facts
To pierce the allegations of Baez, Defendants have submitted a statement of material facts (Doc. 33), supported by documentation and a declaration of one member of the medical staff of FPC-Schuylkill, as well as declarations of Bureau of Prisons ("BOP") employees who reviewed Baez's administrative remedy process. These submissions reveal the following facts.
At FPC-Duluth, Baez indicated on his intake history form dated September 3, 2003, that he had a history of headaches. (Doc. 33-2 at 19.) However, Baez's medical condition was unremarkable until July 2004, at which time he reported to health services at FPC-Duluth with complaints of neck pain, and was prescribed Ibuprofin. (Id.)
On August 4, 2004, Baez told medical staff during an evaluation that he had suffered neck pain after he fell backward while playing softball. (Id.) Staff diagnosed him with a neck strain and again prescribed Ibuprofin. (Id.) On August 9, 2004, Baez was examined and treated by staff for a superficial abrasion to his left temple. (Id.) He informed staff that he had bumped his head on the latch of his locker while he was bending over. (Id.)
On August 17, 2004, Baez reported to health services with complaints of a headache. (Id.) He described the pain as resonating from the back of his skull, behind his eyes, and in his left ear. (Id.) He also had suffered a single episode of loss of equilibrium while playing the trumpet two days before the examination. (Id.) There were no obviously visible indications of illness. (Id.) Baez was subsequently diagnosed with "dull left ear drum, 1 swelling in the nasal passages, tenderness over the left frontal sinus, a bilateral tenderness over the occipital prominence in the neck." (Id.) He was also diagnosed with myositis (muscle inflammation) and rhinitis. (Id.) Medical staff prescribed him an antihistamine and an anti-inflammatory, and advised him to use moist heat for muscle irritation. (Id.)
On the evening of August 18, 2004, Baez was transported to a community hospital in an ambulance after he was found unconscious in the shower area of his dormitory. (Id.) Within approximately one hour a CT scan was performed, and Baez's condition was given a working diagnosis of sub-arachnoid*fn3 hemorrhage, and he was scheduled for surgery. (Id. at 21.) He was stabilized before surgery to alleviate intra-cranial pressure. (Id.) During surgery, doctors determined that Baez had suffered a left artery aneurysm rupture with sub-arachnoid hematoma. (Id.) After this surgery was performed, another surgery was performed to clip the aneurysm on August 20, 2004. (Id. at 36.) On September 2, 2004, Baez was fitted with a ventricular drainage shunt, and he was awake, responding to commands, and had opened his eyes. (Id.) He was transferred to a rehabilitation facility on September 8, 2004. (Id.) While in rehabilitation, the shunt that was draining excess fluid from Baez's brain ventricle became infected with Methicillin Resistant Staphylococcus Aureus ("MRSA" or "staph infection"). (Id. at 21.) As a result, Baez was returned to the hospital on September 26, 2004, where surgery was performed to replace the shunt on October 11, 2004. (Id.,Doc. 33-5 at 52.)
After the shunt was replaced, Baez was transferred back to the rehabilitation center on October 16, 2004, to continue therapy. (Doc. 33-2 at 21.) On October 22, 2004, Baez was transferred to the Federal Medical Center for inmate patients in Rochester, Minnesota, for further therapy. (Id. at 22.) During an evaluation conducted there on November 3, 2004, Baez indicated that he was doing well, was not on any medications, was maintaining good exercise, and was gaining weight. (Id., Doc. 33-5 at 52.)
Baez was transferred back to FPC-Duluth on January 4, 2005. While there, Baez complained of occasional dizziness, light and noise sensitivity, and some memory dysfunction. (Id.,Doc. 33-6 at 64.) He was examined approximately a dozen times by health services at FPC-Duluth between January and June 2005. (Doc. 33-2 at 22.)
On June 16, 2005, Baez complained of an extreme headache, and was immediately transported to the community hospital emergency room. (Id.) Doctors performed a CT scan, and found the aneurysm clip in place. (Id., Doc. 33-6 at 64.) He was then returned to FPC-Duluth.
Baez was transferred from FPC-Duluth to FPC-Schuylkill on September 6, 2005. Based on his history of a serious medical condition, Baez qualified for quarterly evaluations at the chronic care clinic. (Doc. 33-2 at 23.) Routine laboratory work was ordered.
On September 22, 2005, Baez was seen by Dr. Russell Hendershot for a routine physical examination. Baez was noted to be alert, oriented, and ambulating with a cane. (Id.) He was prescribed Zantac for general gastric distress. (Id.)
On September 29, 2005, Baez was seen again by Dr. Hendershot. He denied any headache, fevers, chills, nausea, or vomiting. (Id.) He complained of some muscle aches, but indicated that these pains were relieved by Motrin. (Id.) The examination revealed "no new neurological deficits." (Id. at 24.) He was prescribed Motrin, as needed for any pain.
Baez was seen again by Dr. Hendershot for complaints of a headache in the left frontal area on October 14, 2005. (Id.) He described the pain as a seven out of ten, with ten being the worst. (Id.) However, an examination again revealed "no new neurological deficits." (Id.) Dr. Hendershot prescribed Tylenol 500mg, and scheduled a consultation with neurosurgery for a routine follow-up of the aneurysm. (Id.)
On October 25, 2005, Baez was seen by Physician's Assistant ("P.A.") Francisco Ortiz for complaints of a headache in the area of the shunt. He described the pain as a six out of ten. (Id.) However, his vital signs were stable and he had no fever. His prescriptions for Motrin and Zantac were renewed.
Baez was examined again by Dr. Hendershot on November 17, 2005, for complaints of severe headache, neck pain, and numbness in his hand. (Id.) Other complaints ranged from sensitivity to light and noise, and muscle pain. Baez suggested to Dr. Hendershot that he was not being treated properly. (Id.) He was subsequently diagnosed with a "chronic heavy cranial headache following surgery, secondary status post ventriculostomy." (Id. at 25.) He was prescribed the antibiotic Cipro, and offered Lamictal, as needed for the pain from the headaches. (Id.)
Baez was seen on two occasions in November 2005 at the Hershey Medical Center for CT scans of his brain. Those scans did not reveal the source of Baez's headaches. A follow-up neurological appointment was planned, but no definite date set.
On December 2, 2005, Baez was examined again by Dr. Hendershot for complaints of headaches. He also complained of side effects from the prescribed medications. Dr. Hendershot informed Baez of the results of both CT scans and the planned neurosurgical follow-up appointment. (Doc. 33-2 at 26.) Baez was also made aware of the chronic problems with his medical conditions and surgical issues including pain management for his chronic headaches. (Id.) However, he again suggested the FPC-Schuylkill health services were not treating him properly. (Id.) During the examination he asserted, "'you don't know what you are doing,' became belligerent and was asked to leave." (Id.) He refused to sign the medical treatment refusal form before leaving the examination. (Id.; Doc. 35 at 1.)
Four days later, during a routine optometry examination Baez's ocular heath was found to be normal. Subsequently, at the end of December 2005, Baez was seen again by Dr. Hendershot for complaints of a throbbing headache. (Doc. 33-2 at 26-7.) Baez described the pain as a four or five out of ten. (Id.) He also complained of pain behind both shoulder blades, a burning sensation on the left side of his face, light sensitivity, and an increase in headaches with greater exposure to light and noise. (Id.) His neurological examination, however, remained unchanged.
On January 3, 2006, Baez had a neurosurgical evaluation with Dr. Akash Agarwal and others at the Hershey Medical Center's Neurosurgical Clinic. The doctors there reviewed a CT scan and performed a CT angiogram on Baez that day. (Doc. 33-6 at 28.) As a result of Baez's persistent physical symptoms and because his aneurysm had been treated over a year earlier, Dr. Agarwal recommended a cerebral angiogram, to be scheduled in the coming weeks.*fn4 (Id.)
On January 5, 2006, Baez was seen by P.A. Kenton Hubble for complaints of a headache and was prescribed Tylenol. (Doc. 33-2 at 27.) One week later, Baez reported to the medical department for sick call complaining of headaches and was seen by P.A. Hubble. (Id.; Doc. 35 at 35.) Baez was prescribed Motrin, but refused other medication for his chronic headaches. (Doc. 33-2 at 27.) He complained of headaches again when he saw P.A. Hubble on February 6, 2006, and was prescribed Tylenol 500mg. (Id.) His neurological examination revealed "no focal neurology deficits." (Id.)
Dr. Hendershot performed another examination of Baez on February 10, 2006. Baez refused medication for his chronic headaches because, "he does not want to take anything because he believes the neurosurgeon did not state he should take any medications chronically." (Id. at 28.) During the examination, he appeared to be in no apparent distress and was able to walk using a cane intermittently. (Id.) Again, his neurological examination revealed "no new focal deficits." (Id.)
Baez reported to the medical department for sick call on March 27, 2006, for complaints of pain behind his left eye, with ear, shoulder and neck pain, and was seen by P.A. Ortiz. He described the pain as a six out of ten, and a nine the prior day. (Id.) Four days later, Baez was seen by Dr. Toa Chaw for a neurology chronic care visit. (Id. at 29.) His neurological examination again revealed "no new focal deficits." (Id.) Dr. Tow diagnosed Baez with "chronic headaches possibly secondary to vascular headache spasms status post cerebral aneurysm clipping." (Id.) Dr. Tow prescribed Ibuprofen 600mg, and ordered diagnostic laboratory tests. (Id.)
On April 18, 2006, Baez reported to the medical department for sick call for complaints of a headache for four days, and was seen by P.A. Ortiz. (Id.) P.A. Ortiz noted that Baez had a chest cold and smelled of cigarette smoke. (Id.) Again, his neurological examination revealed "no new focal deficits." (Id.) Baez refused medication for the chronic pain, stating that he wanted to discuss his medication with doctors at Hershey Medical Center following his planned cerebral angiogram. (Id.) That cerebral angiogram was performed at Hershey Medical Center on April 24, 2006. (Id.)
Three days later, Baez reported to P.A. Ortiz for complaints of numbness and tingling on his left side. (Id.) That same day, Baez received an incident report for disobeying an order of FPC-Schuylkill staff and was placed in the Special Housing Unit ("SHU"). (Id. at 30.)
Dr. Chaw evaluated Baez in the SHU on April 28, 2006, for Baez's chronic pain. (Id.) Again, "no new neurological deficits were noted." (Id.) Dr. Chaw gave Baez an injection of Tordal 30mg for the pain and prescribed Motrin as needed for continued headaches. (Id.) He also scheduled diagnostic x-rays and laboratory tests, as well as follow-up care. (Id.)
Doctors at the Hershey Medical Center reviewed the test results of the April 24, 2006, cerebral angiogram in early May 2006. While the official reading of the results revealed no aneurysm or other vascular abnormality, Dr. Robert Harbaugh expressed concern that Baez may have a "small left internal carotid-posterior communicating artery aneurysm on the right." (Doc. 33-6 at 21.) He planned to see Baez in order to discuss the angiographic findings.
On June 23, 2006, Baez was seen again by Dr. Hendershot for routine neurological chronic care. (Doc. 33-2 at 31.) At this time, he was informed of differing neuroradiology and neurosurgical interpretations of his cerebral angiogram. (Id.) Dr. Hendershot educated him on the risks and benefits of possible surgery. (Id.)
On July 10, 2006, Baez was admitted to the Hershey Medical Center for surgical repair of the right internal carotid artery aneurysm. (Id. at 31-32.) He was released on July 13, 2006, and returned to FCP-Schuylkill. Dr. Hendershot evaluated him that same day, and prescribed Percocet for severe pain for five days, and Motrin 600mg for moderate to severe pain for seven days. (Id. at 32.)
Baez was evaluated by FCP-Schuylkill medical staff several times in July 2006 for post-surgical examinations. On July 31, 2006, Baez was transported to the community hospital emergency room for a possible infection to the suture site. (Id. at 33.) The following month he was informed that he had contracted another staph infection, and treatment was assigned. (Id.) In addition, medical staff educated him on staph infections, as well as hygiene issues. (Id.)
The instant action was commenced on June 21, 2006, alleging "violation of the United States Constitution, 8th Amendment, showing total disregard for the safety of the life of a human being, before, during and after major surgery." (Doc. 1 at 1.) Defendants now move for summary judgment on all claims. Specifically, Defendants contend that summary judgment for defendants is appropriate because the material facts establish that they were not deliberately indifferent to Baez with regard to the medical care provided to him for his serious medical condition.
On January 24, 2007, Baez filed a brief in opposition to Defendants' motion for summary judgment. Although he did not file a counter-statement of material facts,*fn5 he attaches as exhibits to his brief documentary evidence related to exhaustion of administrative remedies*fn6 and an administrative tort claim.*fn7 In addition, the final twenty-one (21) pages of attached documentation contains a chronological set of handwritten notes by Baez relating to his medical care from September 2005 through January 2007. The court will consider this documentation, as well as Defendants' statement of material facts, in resolving the instant motion.
II. Standards of Review
A. Motion to Dismiss
Defendants have filed a motion which, in part, seeks dismissal of the complaint on the grounds that Baez's complaint fails to state a claim upon which relief can be granted, as provided by Rule 12(b)(6) of the Federal Rules of Civil Procedure. The motion, however, goes beyond a simple motion to dismiss under Rule 12(b)(6) because it is accompanied by evidentiary documents outside the pleadings contravening Baez's claims. Rule 12(b) provides, in pertinent part, as follows:
If, on a motion asserting the defense numbered (6) to dismiss for failure of the pleading to state a claim upon which relief can be granted, matters outside the pleading are presented to and not excluded by the court, the motion shall be treated as one for summary judgment and disposed of as provided in Rule 56, and all parties shall be given reasonable opportunity to present all material made pertinent to such a motion by Rule 56.
Fed. R. Civ. P. 12(b). The court will not exclude the evidentiary materials accompanying Defendants' motion to dismiss because Baez also has been given a reasonable opportunity to present material relevant to the motion. Thus, Defendants' motion to dismiss, or in the alternative, for summary judgment, will be treated solely as seeking summary judgment.
B. Summary Judgment
Summary judgment is proper when "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(c); accord Saldana v. Kmart Corp., 260 F.3d 228, 231-32 (3d Cir. 2001). A factual dispute is "material" if it might affect the outcome of the suit under the applicable law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A factual dispute is "genuine" only if there is a sufficient evidentiary basis that would allow a reasonable fact-finder to return a verdict for the non-moving party. Id. at 249. The court must resolve all doubts as to the existence of a genuine issue of material fact in favor of the non-moving party. Saldana, 260 F.3d at 232; see also Reeder v. Sybron Transition Corp., 142 F.R.D. 607, 609 (M.D. Pa. 1992).
Once the moving party has shown that there is an absence of evidence to support the claims of the non-moving party, the non-moving party may not simply sit back and rest on the allegations in its complaint. See Celotex Corp. v. Catrett, 477 U.S. 317, 324 (1986). Instead, it must "go beyond the pleadings and by [its] own affidavits, or by the depositions, answers to interrogatories, and admissions on file, and designate specific facts showing that there is a genuine issue for trial." Id. (internal quotations omitted); see also Saldana, 260 F.3d at 232 (citations omitted). Summary judgment should be granted where a party "fails to make a showing sufficient to establish the existence of an element essential to that party's case and on which that party will bear the burden at trial." Celotex, 477 U.S. at 322-23. "'Such affirmative evidence -- regardless of whether it is direct or circumstantial -- must amount to more than a scintilla, but may amount to less (in the evaluation of the court) than a preponderance.'" Saldana, 260 F.3d at 232 (quoting Williams v. Borough of West Chester, 891 F.2d 458, 460-61 (3d Cir. 1989)).
In their brief in support of the motion for summary judgment, Defendants raise the issue of qualified immunity. The doctrine of qualified immunity provides that government officials performing "discretionary functions," are shielded from suit if their conduct did not violate a "clearly established statutory or constitutional right of which a reasonable person would have known." Wilson v. Layne, 526 U.S. 603, 609 (1999); Saucier v. Katz, 533 U.S. 194, 200-01 (2001). This doctrine provides not only a defense to liability, but "immunity from suit." Hunter v. Bryant, 502 U.S. 224, 227 (1991); Mitchell v. Forsyth, 472 U.S. 511, 526 (1985).
To determine whether government officials have lost their immunity, the court must first decide if the plaintiff has demonstrated "a deprivation of an actual constitutional right." Conn v. Gabbert, 526 U.S. 286, 290 (1999); see also Saucier, 533 U.S. at 201 ("A court required to rule upon the qualified immunity issue must consider . . . this threshold question: Taken in the light most favorable to the party asserting the injury, do the facts alleged show the officer's conduct violated a constitutional right?"); Doe v. Groody, 361 F.3d 232, 237 (3d Cir. 2004); accord Wright v. City of Philadelphia, 409 F.3d 595, 600-01 (3d Cir. 2005) (noting that six Courts of Appeals have ruled that first step in a qualified immunity analysis is whether a constitutional violation has occurred). Second, if the court believes a constitutional violation has occurred, it must consider whether the right was "clearly established." Saucier, 533 U.S. at 201.
When immunity is raised at the summary judgment stage, the court's analysis of the merits of the claims for purposes of summary judgment essentially merges with its analysis of the existence of a deprivation of federal rights for purposes of immunity. See Gruenke v. Seip, 225 F.3d 290, 299-300 (3d Cir. 2000); Russoli v. Salisbury Twp., 126 F. Supp 2d 821, 839-42 (E.D. Pa. 2000); see also Grant v. City of Pittsburgh, 98 F.3d 116, 122 (3d Cir. 1996) ("[C]rucial to the resolution of [the] assertion of qualified immunity is a careful examination of the record . . . to establish . . . a detailed factual description of the actions of each individual defendant (viewed in a light most favorable to the plaintiff).").
Proceeding under the above framework, the court will examine Baez's Eighth Amendment claim to determine whether Defendants are entitled to qualified immunity, and whether summary judgment is warranted.
To demonstrate a prima facie case of Eighth Amendment cruel and unusual punishment based on the denial of medical care, a plaintiff must establish that the defendants acted with "deliberate indifference to [his] serious medical needs." Estelle v. Gamble, 429 U.S. 97, 104 (1976); Durmer v. O'Carroll, 991 F.2d 64, 67 (3d Cir. 1993). There are two components to this standard: Initially, a plaintiff must make an "objective" showing that the deprivation was "sufficiently serious," or that the result of the defendant's denial was sufficiently serious. Additionally, the plaintiff must make a "subjective" showing that defendant acted with "a sufficiently culpable state of mind." Wilson v. Seiter, 501 U.S. 294, 298 (1991); see also Montgomery v. Pinchak, 294 F.3d 492, 499 (3d Cir. 2002).*fn8
This test "affords considerable latitude to prison medical authorities in the diagnosis and treatment of the medical problems of inmate patients. Courts will 'disavow any attempt to second guess the propriety or adequacy of a particular course of treatment . . . which remains a question of sound professional judgment." Little v. Lycoming County, 912 F. Supp. 809, 815 (M.D. Pa.), aff'd, 103 F.3d 691 (1996) (citing Inmates of Allegheny County Jail v. Pierce, 612 F.2d 754, 762 (3d Cir. 1979), quoting Bowring v. Godwin, 551 F.2d 44, 48 (4th Cir. 1977)).
When an inmate is provided with medical care and the dispute is over the adequacy of that care, an Eighth Amendment claim does not exist. Nottingham v. Peoria, 709 F. Supp. 542, 547 (M.D. Pa. 1988). Mere disagreement as to the proper medical treatment does not support an Eighth Amendment claim. Lanzaro, 834 F.2d at 346. Only flagrantly egregious acts or omissions can violate the standard. Medical negligence alone cannot result in an Eighth Amendment violation, nor can any disagreements over the professional judgment of a health care provider. White, 897 F.2d at 108-10.
In the instant case, throughout the relevant time period, Baez was seen on numerous occasions by various medical personnel. He was repeatedly evaluated and was prescribed medication to ease his discomfort. Diagnostic tests were ordered, and performed, to facilitate treatment. Multiple surgeries were performed. Unfortunately, despite all the medical intervention, Baez continues to suffer from discomfort. This is clearly a case where Baez has been given medical attention and is dissatisfied with the results. An inmate's disagreement with medical treatment is insufficient to establish deliberate indifference. Durmer, 991 F.2d at 69; Spruill, 372 F.3d at 235. Courts will not second guess whether a particular course of treatment is adequate or proper. Parham v. Johnson, 126 F.3d 454, 458 n.7 (3d Cir. 1997). Moreover, there is nothing in the record demonstrating that any delay in conducting Baez's cerebral angiogram or, for that matter, any other procedure, was deliberate or intentional on the part of any defendant. Under these circumstances and based upon the well-documented course of treatment set forth in the record, the court finds that Defendants were not deliberately indifferent to Baez's serious medical needs. Thus, Baez fails to establish a constitutional violation and qualified immunity shields Defendants from suit. Defendants' motion for summary judgment on this issue will be granted.*fn9
An appropriate order is attached.
ORDER AND NOW, this 31st day of July, 2007, upon consideration of Defendants' motion to dismiss or, in the alternative, for summary judgment (Doc. 26), and for the reasons set forth in the accompanying memorandum, it is hereby ORDERED that:
1. Defendants' motion for summary judgment (Doc. 26) is GRANTED.
2. The Clerk of Court is directed to ENTER judgment in favor of the defendants and against the plaintiff.
3. The Clerk of Court is further directed to CLOSE this case.
Sylvia H. Rambo United States District Judge