The opinion of the court was delivered by: Chief Magistrate Judge Amy Reynolds Hay
John Phillips ("Phillips" or "the Plaintiff") filed this civil rights action pursuant to 42 U.S.C. § 1983. In Count I of the three count Amended Complaint (Doc. 84), he alleges that his rights under the Eighth and Fourteenth Amendments to the U.S. Constitution were violated when he was denied timely medical care during the term of his incarceration at the Allegheny County Jail. Phillips bases a second section 1983 claim*fn1 against Bruce Dixon, M.D., Warden Ramon Rustin, and the municipal Defendants, for failing to train corrections officers in the recognition of serious injuries, and acquiescing in a custom that unduly delayed care to inmates needing immediate medical attention. In a third count, Phillips alleges a state law claim for medical malpractice.*fn2 The Court addresses here the Defendants' pending Motions for Summary Judgment. The first of these (Doc. 63) was filed on behalf of the Allegheny County Jail ("the Jail"), the Jail's Warden, Ramon Rustin ("Rustin"), the Allegheny County Health Department ("the Health Department"), Allegheny County ("the County"), and Corrections Officer, Christine Leech ("Leech").*fn3 The second (Doc. 68 ) was filed by Bruce Dixon, M.D. ("Dixon"), the CEO of Allegheny Correctional Health Services, Inc. ("ACHS"), and ACHS, a non-profit corporation created to provide health care to inmates at the Jail. Both Motions will be granted.
In the Amended Complaint, Phillips alleges that while he was incarcerated at the Jail on or about May 21, 2005, he was struck in the eye by a handball during a game with a fellow inmate (Doc. 84 at ¶12).*fn4 He "immediately sought out [Leech], and requested medical attention.
(Id. at ¶13). According to Phillips, Leech instructed him to fill out a standard form requesting medical treatment. (Doc. 97 at pp.9-12). She allegedly assured Phillips that she would expedite his request by leaving the form in the medical unit after her shift. (Id. at p.9). Normal process required that medical slips be left in a box on the pod where they would be collected by a clerk, sorted by a nurse according to urgency, and used to schedule inmates' appointments. (Doc. 84 at ¶¶16, 17). Phillips expected that he would be seen the next day. (Doc. 97 at p.12). There is no record that a medical form was completed or delivered to the medical unit on the date of the injury. Leech testified that she does not remember interacting with Phillips, and had never been presented with a complaint about an eye injury from any inmate. (Doc. 97 at pp.117-119).
The next day, Phillips approached the medication nurse on his pod, complained of eye pain, and requested Motrin. (Id. at p.13). She told him that she did not have any, and asked Phillips whether he had completed a medical form. (Id.). When he said that he had, she stated that he would be called soon. (Id.). When he did not hear from the medical unit, Phillips submitted a second medical form dated May 25th, writing, "was hit in eye with handball a week ago and irritation and pain still persist. Redness." (Id. at p.32). That form is marked to show that it was received by the medical unit on May 26, 2005. (Id.) Phillips was seen on May 27th by a nurse who is not a Defendant. In her treatment note, the nurse wrote that Phillips complained of drainage from and film in his eye, and saw "occasional streaking." (Id.). She also wrote that she did not observe drainage, redness or any other problem. She noted that Phillips was comfortable with follow up in the event that he experienced future problems, and described his condition as "stable." (Id.).
Phillips admits that he waited three weeks after the May27th evaluation to seek further treatment, and that he attempted to contact the medical unit only after he had lost his vision. (Doc. 69-6 at pp.62-63). He contends that he then completed multiple medical slips, notifying medical personnel at the Jail that he was blind. (Id.). According to Phillips, he did not receive a response to these requests, until he completed a form received by the medical unit on July 21, 2005. (Id. at p.63).*fn5 On the slip, Phillips reported "borderline blindness in left eye from a handball accident a couple months ago." (Doc. 90 at p.48). The treatment note associated with the July 21st medical slip is dated August 11, 2005, and reflects that Phillips had "lost vision in his left eye." (Id.) Where earlier he had been able to make out shapes and shadows, he "now can't see." (Id.). Phillips states that he was told that he had a cataract. (Doc. 70-6 at p.93). The person who generated this treatment note is not identified. This "provider" concluded that Dr. Patterson, the ACHS Medical Director, should consider referring Phillips for an ophthamology exam. (Doc. 90 at p.48). Dr. Patterson approved a referral the same day, citing "visual acuity left eye" and "remote trauma." (Doc. 90 at p.50). He checked a box on the referral form terming the request "routine." (Id.). Phillips contends that after he was seen by Dr. Patterson, he heard nothing, and complained to his group counselor, Mr. Issacs, about the difficulty securing medical care. (Doc. 70-6 at pp.92-93). According to Phillips, Issacs consulted Dr. Mebane, a "psych doctor" who came to visit Phillips on his pod. (Id.). Phillips credits Dr. Mebane with arranging for him to be seen by doctors at UPMC. (Id.)
On September 1, 2005, Phillips was evaluated by an ophthalmologist, Hazem Samy, M.D., who concluded that Phillips had suffered a central retinal vein occlusion ("CVRO"), and that the loss of vision in his left eye was irreversible. In his Findings and Recommendations, Dr. Samy wrote:
Central retinal vein occlusion left eye, will need to protect right eye as it is the only good one. Will need new glasses for eyes both to see better & to protect his right eye ASAP.
Follow up with us here for possible laser treatment for neovascularization of his iris should it occur. [Return] in 2 weeks. (Doc. 90 at p.50). The follow up visit was scheduled. (Id.). Phillips saw an ophthalmologist again on September 15, 2005, (id. at p.64), but as of September 29, 2005, had not received his glasses. On that date, Phillips completed a form titled "Inmate's Request to Staff Member," which was addressed to Dana Phillips, Chief Operating Officer of ACHS. (Id. at p.51). The Plaintiff explained that he was not taken to an appointment at UPMC on September 22, 2005. (Id.). Although it is not clear when Phillips received his glasses or was next seen at UPMC, the medical record shows that he was evaluated in November, (id. at p.62), and underwent laser treatment and an eye injection in December 2005. (Id. at pp.58-61). Phillips was seen again in January 2006. (Id. at p.56).
In support of his claims, the Plaintiff has submitted an expert's report prepared by Richard Sobel, M.D., M.P.H., who, based on his "years of experience in the medical care of inmates and as medical director and contractor of prison health services," writes that Leech's decision "to ignore the potential for serious eye injury would have been a reckless act of indifference to the inmate's right to treatment, i.e. for a serious medical condition requiring emergency evaluation." (Doc. 45 at p.2). According to Dr. Sobel, corrections officers at Allegheny County Jail are not capable of recognizing or are not adequately trained to recognize the basic need for urgent medical evaluation when an inmate has suffered eye trauma. ( Id.). Dr. Sobel concluded that the unidentified nurse who examined Phillips on May 27, 2005 "demonstrated deliberate indifference to the inmate in that she excluded the potential for a vision threatening injury without an exam or referral to a medical provider for urgent evaluation." (Id. at p.3). This nurse's action was, in Sobel's opinion, at least partially attributable to inadequate training, oversight, review and quality assurance policies. (Id.). "Allegheny County Jail personnel acted with deliberate indifference to the serious medical needs of John Phillips." (Id. at p.5).
Joel D. Brown, M.D., a Pittsburgh opthamologist, provided a second expert's report, concluding that the handball injury "was the initiating factor that let [sic] to the loss of vision in [Phillips's left] eye." (Doc. 46 at p.1). "The injury probably caused injury or trauma to the anterior segment of the eye. This led to increased pressure in the eye or glaucoma, which subsequently led to the vein occlusion." (Id.). In Dr. Brown's opinion, "this could have been treated aggressively through medical and/or surgical means... [and] may have resulted in better control of Phillips's eye pressure, therefore deceasing the likelihood of his having a CVRO." (Id.).
Despite the fact that neither of the nurses is a Defendant in this matter, Phillips submits a third expert's report, prepared by Dana Bissontz, R.N., the President of Candan Legal Nurse Consulting. (Doc. 47). In her opinion, the nurse "who triaged Mr. Phillips failed to render appropriate and proper nursing care" when she failed to recognize "'red flags' for an eye injury indicating immediate need for care," thus delaying appropriate treatment. (Id.).
The Defendants' medical expert, Andrew Eller, M.D., a retina specialist and associate professor in the Department of Ophthalmology at the University of Pittsburgh, "disputes the severity of the ocular trauma that was purportedly sustained." (Doc.115 at p.3). He wrote, "To a reasonable degree of medical certainly I can state that immediate medical attention was not required.... [T]aking [Phillips] to an ophthalmologist for acute eye care was not necessary, and would not have altered the ultimate outcome for this eye." (Id.). "The cause of CVRO remains an enigma, but it has never been associated with blunt trauma... [B]lunt ocular trauma cannot induce a coagulopathy." (Id.) "No early intervention with medical or surgical treatment is available for a CVRO. When a CVRO is diagnosed, the recommended treatment is 'observation.' If iris neovascularization is identified... laser... treatment is advised. It should be noted that early laser treatment does not affect the ultimate outcome, or the course of the CVRO." (Id. at p.4).
A party seeking summary judgment must demonstrate the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The non-moving party must respond by presenting evidence that a genuine issue of material fact compels a trial. (Id. at 324). In doing so, the non-moving party must point to specific facts rather than to "some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986). This means that the non-moving party cannot defeat summary judgment by relying on unsupported assertions, bare allegations, or speculation. See Ridgewood Bd. of Educ. v. N.E. ex rel. M.E., 172 F.3d 238, 252 (3d Cir.1999). The mere existence of some evidence favoring the non-moving party will not defeat the motion. There must be enough evidence with respect to a particular issue to enable a reasonable jury to find in favor of the non-moving party. Anderson v. Liberty Lobby, 477 U.S. 242, 248 (1986). In evaluating the evidence, the Court must consider all facts and their reasonable inferences in the light most favorable to the non-moving party. See Pennsylvania Coal Ass'n v. Babbitt, 63 F. 3d 231, 236 (3d Cir.1995). The Court may not assess credibility or the weight of the evidence; it may determine only the existence of a triable issue of fact. Big Apple BMW of N. Am. Inc., 974 F.2d 1358, 1362 (3d Cir.1992). A motion for summary judgment will be granted where the materials in the record, if reduced to admissible evidence, would be insufficient to satisfy the non-moving party's burden of proof at trial. Celotex, 477 U.S. at 322.
A. The Constitutional ...