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Hojnowski v. Primecare Medical

April 30, 2009


The opinion of the court was delivered by: Rufe, J.



In this civil rights action, Plaintiff Rodney Hojnowski ("Hojnowski") claims he was denied adequate medical treatment as a pretrial detainee in the Berks County Prison in Berks County, Pennsylvania. In prior stages of the case, numerous defendants were dismissed, leaving only two: Nurse Grace Karrer ("Karrer"), who interacted with Hojnowski at certain relevant times, and PrimeCare Medical, Inc. ("PrimeCare"), the corporation that provided medical and health services in the Berks County Prison during Hojnowski's incarceration (collectively, "Defendants"). After the Defendants moved for summary judgment on all claims and the parties submitted numerous related filings, the Court ordered further briefing on the legal standard applicable to claims of unconstitutional medical treatment made by pretrial detainees, as opposed to convicted prisoners. The parties have submitted supplemental briefs on the issue, distilling their arguments and focusing on the appropriate legal standard. Defendants' Motions for Summary Judgment are now ready for disposition.


Hojnowski's claims pertain to the medical treatment he received during an approximately forty-eight hour period of time in March 2005, and to the policies and procedures that governed the medical care he received. A detailed review of the factual and procedural background of this case is set forth in this Court's Memorandum Opinion of June 27, 2008, and is hereby incorporated into this Memorandum.*fn1 The Court only briefly recapitulates the facts here, taking the evidence in the light most favorable to Plaintiff.

Hojnowski was incarcerated as a pretrial detainee in the Berks County Prison ("Prison") in March, 2005. At that time, Defendant PrimeCare provided medical and health services within the Prison. Defendant Karrer worked in the Prison for PrimeCare, as a nurse.

A. PrimeCare Policies and Procedures

It is undisputed that, under PrimeCare policies and procedures in place at the Prison at the relevant time, a detainee such as Plaintiff could engage the "sick call" process to seek medical attention by submitting a sick call slip describing his condition to Prison medical staff via a drop box. A Prison nurse would then triage the request slip and arrange for the appropriate medical response. If an inmate presented his personal medical concern directly to a nurse who happened to be in the cell block, the nurse would determine on-the-spot whether the concern constituted an emergency requiring immediate treatment, was not emergent but still sufficiently serious as to justify placing the inmate directly into a medical "provider line" to be seen shortly, or instead was a matter appropriately channeled through the sick call triage process.

PrimeCare had an infection control policy in place at the Prison in March of 2005 ("Infection Control Policy" or "ICP").*fn2 The Infection Control Policy does not include a listing or description specifying the infectious diseases or types of infection to which it applies.*fn3 Nor does the ICP prescribe generally applicable procedures for the diagnosis or treatment of infections or infectious diseases in the Prison population, although it does specify basic diagnostic and treatment protocols for cases of Tuberculosis, Hepatitis and HIV,*fn4 and require staff to report certain communicable diseases or circumstances of infectious spread to public health officials.*fn5

Instead, the ICP directs medical staff to establish and maintain an appropriate program for infection control in the Prison that includes "[w]ritten policies, procedure and practice that define surveillance procedures to detect inmate/patients with infectious and communicable disease."*fn6

In March of 2005, in accordance with the latter directive, PrimeCare medical staff maintained certain policies and practices regarding the identification of infections in the Prison. These diagnostic policies and practices made no special provision for the identification of either individual boils or red lumps on the skin or Methicillin resistant Staphylococcus aureus infections ("MRSA"),*fn7 which can manifest as red swollen areas on the skin.*fn8 At that time, Prison medical staff received no particularized training on diagnosing various types of skin infection, including staph infection and MRSA, and instances of such infections were not tracked or automatically reported to public health officials.*fn9 Prior to June, 2005, if an inmate presented with symptoms of skin infection, including MRSA, to a Prison medical staff member, "it was up to the provider's clinical judgment . . . of what their treatment choices and their treatment approach or treatment plan would have been."*fn10

In June of 2005, PrimeCare instituted a differential diagnosis policy for the identification, tracking and treatment of MRSA infections in the Prison population, including the screening of all skin infections with symptoms consistent with MRSA.*fn11 PrimeCare's corporate designee under Federal Rule of Civil Procedure 30(b)(6), Todd Haskins, stated that in the Prison, "prior to PrimeCare developing the MRSA Policy, there was [sic] certainly normal types of . . . folliculitis, skin infections, et cetera . . . but MRSA was not a community issue at that time."*fn12

According to Haskins, PrimeCare instituted the MRSA Policy in the Prison after recognizing that MRSA was an "increasing problem."*fn13 In "early 2005," Defendant Karrer and another nurse working in the Prison noticed more skin infections, including staph ...

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