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Sparks v. Susquehanna County

April 3, 2009

DOLORES B. SPARKS, PLAINTIFF,
v.
SUSQUEHANNA COUNTY, WILLIAM BRENNAN, SUSQUEHANNA COUNTY PRISON BOARD, JOHN DOES 1-10, HASSAN KHALIL, JOANN WISER, AND CAROLE SMALACOMBE, DEFENDANTS



The opinion of the court was delivered by: (Judge Munley)

MEMORANDUM

Before the court are defendants' motions for summary judgment (Docs. 64, 66). Having been fully briefed and argued, the matter is ripe for disposition.

Background*fn1

This suit arises out of the death of Beth Ann Croasdale ("Decedent") at the Susquehanna County Correctional Facility ("SCCF") on April 2, 2004. On that day, Croasdale suffered a severe asthma attack; she was transported from the prison to a local hospital and was pronounced dead. The deceased was admitted to the SCCF in January 2004 for operating a vehicle with a suspended or revoked license. (Amended Complaint (hereinafter "Cmplt") (Doc. 33) at ¶ 11). On the day she died, Croasdale remained incarcerated at the SCCF. (Statement of Material Facts of Defendants Susquehanna County; William Brennan; Susquehanna County Prison Board; Joann Wiser and Carole Smalacombe (Doc. 67) (hereinafter "County Defendants' Statement") at ¶ 2). Plaintiff alleges in part that the defendants failed to provide Croasdale with access to Albuterol and the device she needed to deliver the medication she needed to control her severe asthma, and that her death was thus the result of defendants' deliberate indifference to Croasdale's serious medical need. (Id. at ¶ 4).

On February 4, 2004, Croasdale submitted a request to the Warden, Defendant Brennan, asking that she be allowed to have her nebulizer*fn2 in her cell. (Id. at ¶ 5). Plaintiff points out that Croasdale complained that she did not have access to her medication, writing that she should have used her nebulizer four times a day but had only been able to use it once, and then after waiting ten-fifteen minutes. (Plaintiff's Statement of Facts in Response to Defendants' Susquehanna County; William Brennan; Susquehanna County Prison Board; Joann Wiser and Carole Smalacombe's Statement of Facts (Doc. 80) (hereinafter "Plaintiff's Response to County Defendants' Statement") at ¶ 5). This situation, plaintiff contends, violated a direct order in the prison allowing Croasdale to have access to the inhaler four times a day. (Id.).

The Susquehanna County Defendants (Susquehanna County, William Brennan, Susquehanna County Prison Board, Joann Wiser and Carole Smalacombe) contend that prison records indicate that officials approved this request on February 10, 2004. (County Defendants' Statment at ¶ 6). Plaintiff complains that defendants make no reference to the record for this fact. (Plaintiff's Response to County Defendants' Statement at ¶ 6). In addition, she points out that Defendant Brennan attempted to hide a document during the course of the litigation (the inmate request form). (Id.). This previous action, plaintiffs insist, should lead the court to discount the current claim. (Id.).

Defendants also contend that testimony from witnesses indicate that Croasdale had access to the nebulizer and Albuterol from February 10, 2004. (County Defendants' Statement at ¶ 7). Plaintiff points out that the statements from two of the witnesses, Deborah Corgan and Tracey Sherman, are unsworn statements from Croasdale's former cellmates. (Plaintiff's Response to County Defendants' Statement at ¶ 7). These statements, she argues, should be discounted because no one could cross-examine them and because fear of retaliation from the defendants could have influenced their statements. (Id.). Plaintiff also disputes whether the other statements cited by defendants support defendants' argument. (Id.). In any case, an autopsy performed on Croasdale revealed a high level of Albuterol in her bloodstream. (County Defendants' Statement at ¶ 8). Plaintiff's expert, after reviewing the toxicology report, came to a similar conclusion. (Id.).

Defendant Joanne Wiser was the Correctional Officer on duty at the time of Croasdale's death. (Id. at ¶ 9). She testified that she was trained and certified in CPR. (Id.). Croasdale had an asthma attack while Wiser was in charge of the cell block, and Wiser did not perform CPR. (Id. at ¶ 10). The parties dispute the reasons for this failure. (Id. at ¶ 10; Plaintiff's Response to County Defendants' Statement at ¶ 10). Defendants contend that Wiser was trained not to perform CPR on an inmate who was breathing, as Croasdale was. (County Defendants' Statment at ¶ 10). Plaintiff insists that Wiser did not testify that she was trained not to take such action, but instead that she assumed that CPR should not be performed on a breathing patient. (Plaintiff's Response to County Defendants' Statement at ¶ 10). Moreover, plaintiff contends that several witnesses testified that Wiser had reported she would "never" perform CPR on an inmate. (Id.). Defendants claim that no expert testimony indicates that this failure to perform CPR contributed to Croasdale's death. (County Defendants' Statement at ¶ 11). Plaintiff agrees that the expert reports do not state explicitly that a lack of CPR caused the death, but points out that the reports allege that the failure to administer CPR fell below a reasonable standard of care and represent deliberate indifference to a serious medical need. (Plaintiff's Response to County Defendants' Statement at ¶ 11).

Plaintiff asserts that defendants did not perform any adequate medical examination of the decedent when she was admitted to the SCCF. (County Defendants' Statement at ¶ 13). Defendants contend that Dr. Hassan Khalil, the prison doctor, examined decedent when she arrived there on January 19, 2004. (Id. at ¶ 14). Plaintiff points out that defendants cite no evidence to prove that this examination occurred, and argue that in any case the examination was wholly inadequate. (Plaintiff's Response to County Defendants' Statement at ¶ 14).

Defendants contend that the prison had a policy of allowing staff to call Dr. Khalil or his practice whenever a medical issue occurred. (County Defendants' Statement at ¶ 15). Plaintiff points out that defendants do not cite to the record for this claim, and contend that Dr. Khalil testified only that he was available for consultations by telephone about medication at any time. (Plaintiff's Response to County Defendants' Statement at ¶ 15). Defendants also claim that Dr. Khalil saw decedent every time she requested medical attention, but plaintiff contends that the records do not indicate that Khalil actually saw the decedent and that even if he saw her, he gave her only a cursory examination. (County Defendants' Statement at ¶ 16; Plaintiff's Response to County Defendants' Statement at ¶ 16). When Dr. Khalil saw a patient and ordered medication, he was usually assisted by Diane Barron, a Correctional Officer who had no medical training. (County Defendants' Statement at ¶ 17; Plaintiff's Response to County Defendants' Statement at ¶ 17). She ordered the medications. (Id.). Plaintiff contends that Barron actually gave the medication to inmates. (Plaintiff's Response to County Defendants' Statement at ¶ 17).

The prison contends that any failure to provide prescribed medication was contrary to prison policy and Warden Brennan and the Prison Board were unaware of that failure. (County Defendants' Statement at ¶ 18). Plaintiff, however, points out that prison policy required Dr. Khalil, as health-care provider, to provide a regular written report on the health-care delivery system. (Plaintiff's Response to County Defendants' Statement at ¶ 18). The prison warden was to review that information and revise the system as necessary. (Id.). In practice, however, plaintiff contends that the Warden and Prison Board did nothing to ensure adequate policies and Dr. Khalil never provided a written report. (Id.). The written health-care policies of the prison did nothing but copy into the alleged local policies provisions from the Pennsylvania code. (Id.). Plaintiff cites to an expert report provided by Dr. Robert Greifinger to support her claim that the health-care policies followed at the prison were wholly inadequate. (See Id.).

The case also addresses the treatment provided the decedent by Dr. Hasan Khalil. At the time of the incident, a contract existed between Endless Mountain Health Systems and Susquehanna County to provide health care for inmates at the SCCF. (Defendant Hassan Khalil's Statement of Material Facts (Doc. 65) (hereinafter "Khalil's Statement") at ¶ 2). The plaintiff insists that this contract did not provide for services to be rendered at the prison, but only for hospital care. (Plaintiff's Statement of Facts in Response to Defendant Khalil's Statement (Doc. 77) (hereinafter "Plaintiff's Response to Khlalil") at ¶ 2). Dr. Khalil works as an independent contractor for Endless Mountain Health System. (Khalil's Statement at ¶ 3). The parties dispute, however, whether Dr. Khalil operates independently from Endless Mountain in his role as doctor at that prison. (Id.; Plaintiff's Response to Khalil, ¶ 3). According to the plaintiff, Khalil was paid by the prison, and is therefore an employee of the prison. (Plaintiff's Response to Khalil at ¶ 3).

Dr. Khalil testified that in fulfilling his duties at the prison, he arrives twice a week, visits new inmates, performs physicals on them, and visits sick patients. (Khalil's Statement at ¶ 4). According to the plaintiff, Dr. Khalil was also required by the prison to provide written reports on the health care delivery system in the prison, and to review his findings with prison administrator's annually. (Plaintiff's Response to Khalil at ¶ 4). Khalil did not perform these functions. (Id.). He also did nothing to ensure that quality health-care is delivered at the prison, despite what plaintiff claims is a contractual obligation to do so. (Id.). The parties dispute whether there was any expectation that Dr. Khalil be at the prison daily, and whether he had knowledge of certain manuals, procedures and regulations in the prison. (Khalil's statement at ¶¶ 13-18; Plaintiff's response to Khalil at ¶¶ 13-18). Plaintiff contends that whether he was expected at the prison every day is not relevant to the claim at hand, nor is Khalil's knowledge about prison policies unrelated to medical care. (Plaintiff's Response to Khalil at ¶¶ 13-18). The parties also dispute whether Dr. Khalil served as an independent contractor who agreed to visit the principles twice a week, or whether he should be considered the official "prison doctor." (Khalil's statement at ¶¶ 22-23; Plaintiff's Response to Khalil at ¶¶ 22-23). Dr. Khalil contends that his role was to visit and examine prisoners who reported a need, while the plaintiff argues that the official prison manual lists Dr. Khalil as the prison's "health care provider." (Khalil's statement at ¶ 24; Plaintiff's Response to Khalil at ¶ 24).

The parties also dispute whether an on-call physician was available at the prison. (Dr. Khalil's Statement ¶ 5; Plaintiff's Response to Dr. Khalil at ¶ 5). Testimony indicated that under prison policy, a doctor remained on-call at all times, but that prisoners with medical issues were often taken to a hospital rather than treated by a physician.*fn3 (Id.). According to the plaintiff, Dr. Khalil never trained staff on how to recognize an emergency or investigated whether adequate policies exist. (Plaintiff's Response to Dr. Khalil at ¶ 6). She contends that this policy left prison staff unaware of how to treat ill prisoners and led to Croasdale's death. (Id.).

The parties dispute who was in charge of medical training for the prison at the time of Croasdale's death. While Deputy Warden Joshua Weller testified that such training was provided by Diamond Pharmacy, plaintiff points out that Weller did not testify that Diamond Pharmacy provided this training at the time of plaintiff's death. (Khalil's Statement at ¶ 9; Plaintiff's Response to Khalil at ¶ 9). In any case, Diamond Pharmacy's training involved the distribution of pharmaceuticals, and this training, according to the plaintiff, was inadequate. (Plaintiff's Response to Khalil at ¶ 9). Moreover, Dr. Khalil alleges that no one ever complained to him that he was supposed to provide medical training at the prison. (Khalil's Statement at ¶ 10). Plaintiff contends that the testimony on this matter indicates that no one had insisted that Dr. Khalil was to provide training on the distribution of medication. (Plaintiff's Response to Dr. Khalil at ¶ 10).

Defendants insist that no one at the prison ever complained about the care that Dr. Khalil provided, or asserted that he had not fulfilled his duties as prison doctor. (Khalil's Statement at ¶ 11-12). Plaintiff disputes the relevance of any complaints to the question of whether Dr. Khalil violated Croasdale's rights and points to Dr. Robert B. Greifinger's expert report, which concludes that Dr. Khalil fell short of his professional responsibilities by failing to follow nationally-accepted clinical guidelines for treating asthma patients, failing to train staff adequately, and failing properly to organize medical care at the prison. (Plaintiff's Response to Dr. Khalil at ¶¶ 11-13; see also Report of Dr. Robert B. Greifinger, Exh. B to Plaintiff's Reponse to Dr. Khalil (Doc. 78)).

Dr. Khalil performed in intake physical on the decedent on January 19, 2004. (Khalil's statement at ¶ 31). He found a history of asthma and diagnosed acute bronchitis. (Id. at ¶ 32). Khalil prescribed numerous medications, including Levaquin, Fluoxet, and Prednisone. (Id.). Khalil saw decedent again on February 10, 2004. (Id. at ¶ 33). Khalil diagnosed a shortness of breath secondary to asthma and an upper respiratory infection. (Id.). He planned to give her a steroid and antibiotic three times a day for seven days. (Id.). Plaintiff disputes whether Khalil wrote this information in his report of the visit or testified to it later, at his deposition. (Plaintiff's response to Khalil's statement at ¶ 33). He saw decedent again on February 25, 2004. (Khalil's statement at ¶ 36). According to the defendants, he prescribed a medrol dose pack and albuterol. (Id.). Plaintiff asserts that Khalil never testified that he prescribed albuterol, and that his written order contains no such prescription. (Plaintiff's response to Khalil's statement at ¶ 36).

Khalil also examined decedent on March 8, 2004. (Khalil's statement at ¶ 34). Decedent again complained of difficulty breathing and other problems. (Id.). The parties dispute what Khalil's notes indicate about the doctor's orders. (Id.; Plaintiff's response to Khalil at ¶ 34). Defendant asserts that he prescribed prednisone and albuterol and directed the staff to "continue nebulizer." (Khalil's statement at ¶ 34). Plaintiff contends that there was no direction to continue nebulizer, but only the phrase "nebs albuterol." (Plaintiff's response to Khalil at ¶ 34). Khalil next examined decedent on March 19, 2004. (Khalil's statement at ¶ 35). Decedent complained of sinus troubles, and defendant insists that Khalil prescribed Biaxin, Evelox and a decongestant. (Id.). Plaintiff insists that these drugs were not all prescribed. (Plaintiff's response to Khalil's statement at ¶ 35).

Decedent complained on February 4, 2004 that she was not allowed to have her nebulizer in her cell. (Khalil's statement at ¶ 38). The parties dispute whether defendants acceded to this request. (See Id at ¶ 39; Plaintiff's response to Khalil's statement at ¶ 38). Plaintiff insists that the records indicate that plaintiff did not have the nebulizer in her cell, but had to request it from guards when she needed it. (Plaintiff's response to Khalil's statement at ¶ 39). The parties agree, however, that decedent used the nebulizer on the date of her death. (Khalil's statement at ¶ 40). They disagree over whether decedent had the machine with her or had to request it. (Khalil's statement at ¶ 42; Plaintiff's response to Khalil's statement at ¶ 42). Plaintiff insists that the high level of albuterol in decedent's body on the day of her death indicates the extreme distress she was under, not that she had proper access to the asthma medication. (Plaintiff's response to Khalil's statement at ¶ 41). In any case, Croasdale's blood was positive for Albuterol at her autopsy. (Khalil's statement at ¶ 42).

Defendant cites to the statement of an inmate, Deborah Corgan, who reported that the decedent always had a nebulizer in her room, along with medicine. (Khalil's statement at ΒΆ 44). Corgan claimed that the guards had never neglected or mistreated ...


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