The opinion of the court was delivered by: Judge Jones
(Magistrate Judge Carlson)
REPORT AND RECOMMENDATION*fn1
I. Statement of Facts and of the Case
This case, which comes before the Court for consideration of a motion for summary judgment, presents a striking example of the challenges faced by inmates and corrections medical personnel in trying to address the medical needs of chronically-ill prisoners.
The plaintiff in this case, Mark Callaham, is one such chronically-ill inmate. Callaham is a state prisoner currently housed at the State Correctional Institution (SCI) Retreat. Callaham suffers from a chronic illness, Hepatitis C. As a result of this illness Callaham's immune system has been permanently compromised, making him susceptible to various other infections and ailments.
B. The History of Callaham's Medical Treatment
In the Fall of 2004, while serving his sentence, Callaham began experiencing a serious of rashes, and skin infections, which were both painful and unsightly. With respect to these skin conditions which afflicted Callaham, uncontested evidence confirms that prison officials engaged in a lengthy, if only intermittently successful, course of treatment for the plaintiff over the next several years.*fn2
This treatment began on August 27, 2004, when Callaham was seen by defendant Yarczower, who prescribed Aristocort creme for a rash that Callaham was experiencing. One month later, on September 24, 2004, Callaham was seen again by Yarczower and reported that the rash on his lower legs, arms, hands that had been ongoing for approximately one month, had not responded to the cream and was spreading.
Medical staff then began treating Callaham's skin condition in earnest throughout the Fall of 2004, following a multi-faceted program of treatment for this skin infection. As part of this treatment, blood work was ordered on Callaham to try to identify the source of the infection. In addition, medical staff conducted a series of further examinations of Callaham throughout the Fall of 2004, caring for this inmate on at least a half dozen occasions. During these examinations, Callaham was given various antibiotics and a biopsy was scheduled. In addition, Callaham was prescribed ointments and medications to be applied to the area of his rash, and further blood work was drawn to help establish a possible diagnosis of this rash.
Medical staff reviewed these laboratory studies throughout the Fall of 2004, and regularly saw Callaham, while noting that despite their efforts Callaham continued to experience complications due to this rash. During the winter months of 2004, medical personnel pursued a search for answers to these medical problems, prescribing a host of medications for Callaham including Aristocort creme, A&D ointment Benadryl, Dixocycline, Flaglyl, Vistaril, Bactrim, Tylenol and Prednisone. In addition, a further biopsy was ordered for Callaham in November 2004.
As 2004 drew to a close medical staff redoubled their efforts to address Callaham's skin rash and infections, treating and counseling him regularly, providing him with hypo-allergic soap, prescribing medications and ointments, and drawing additional blood work for analysis. Prison medical personnel also explained to Callaham the chronic nature of his illness, counseling himthat it was very likely the extent of these lesions was due to his Hepatitis C, which impaired his immune system, and that the scars from these skin conditions might persist for an extended period.
Throughout 2005 this course of treatment continued in an effort to curb Callaham's skin conditions. During this period, medical personnel saw and examined Callaham on a regular, often monthly, basis. Medical staff also provided Callaham with a variety of treatments in the form of medications, ointments, soaps, topical creams and steroids. Moreover, medical staff endeavored to address Callaham's needs through changes in his diet, ordering one cup of yogurt daily for him, in addition to special soaps, medications and ointments.
While at various times during early 2005 doctors noted improvement in Callaham's condition, and Callaham himself indicated that he felt better, the skin rash persisted and Callaham began voicing concerns about his aesthetic appearance. Medical staff tried to address Callaham's medical concerns, by treating this rash throughout the remainder of 2005, and employing an array of treatments, including yogurt, Aveeno soap, various ointments and medications. Medical records also document that doctors and staff met with Callaham regarding his concerns about his aesthetic appearance, discussing his medical history and other alternatives to help improve or reduce these pigmented scars. Moreover, further biopsies and tests were undertaken to resolve this chronic condition.
This course of treatment then continued to be carried on by prison medical personnel in 2006, with further testing and blood work ordered for Callaham, while doctors prescribed a range of medicated soaps, ointments and various drugs for his rash and skin lesions. Doctors also undertook additional treatments including steroid systemic injections, vitamin B-12 treatment, folic acid, varying topical steroids and kenalog injections. Doctors took these steps in an effort to both curb the rash and reduce its effect upon Callaham's appearance. Callaham was also informed that, due to his other medicals problems, this was a life-long condition which might improve over time but would always afflict him.
As part of these on--going efforts, in early 2006, physicians arranged a dermatology consultation for Callaham which was conducted by a specialist in this field, Dr. Schleicher. During this consultation the dermatologist agreed that the treatment provided to Callaham was proper, and further explained to Callaham about the progress of treating the pigmented spots left by this rash, indicating that it might take years for some of Callaham's blemishes and scars to lessen. In order to address these aesthetic appearance concerns, the dermatologist suggested that one potential option might be treatment of the blemishes with a medication, ...