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Ramos-Vazquez v. Primecare Medical

September 30, 2010

JOSE M. RAMOS-VAZQUEZ, PLAINTIFF,
v.
PRIMECARE MEDICAL, INC., BERKS COUNTY, ENOS MARTIN, M.D., VICTORIA GESSNER, M.D., AND GEORGE WAGNER, DEFENDANTS.



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

MEMORANDUM OPINION AND ORDER

Plaintiff Jose Ramos-Vazquez brings the instant action against defendants Berks County, PrimeCare Medical, Inc. ("PrimeCare"), a privately owned health care provider responsible for providing on-site health care services to inmates at Berks County Prison ("BCP"), two doctors, and the Prison Warden, alleging cruel and unusual punishment in violation of the Eighth Amendment of the United States Constitution, made applicable to the States by the Fourteenth Amendment, and/or violations of his Due Process rights secured by the Fourteenth Amendment, pursuant to 42 U.S.C. § 1983. Plaintiff's claims arise out of the medical treatment he received during his incarceration at Berks County Prison. Now before the Court are Defendants' three Motions to Dismiss*fn1 and Plaintiff's responses thereto.*fn2

I. FACTUAL AND PROCEDURAL BACKGROUND

Plaintiff Ramos-Vazquez commenced this action pro se on February 18, 2009, naming Prison Warden George Wagner ("Warden Wagner") and PrimeCare employees Dr. Enos Martin and Dr. Victoria Gessner as defendants in his initial Complaint.*fn3 In March of 2009, all three defendants moved to dismiss the complaint. In response, Plaintiff moved for appointment of counsel; the Court granted that motion and denied the motions to dismiss without prejudice. On February 3, 2010, through his court-appointed counsel, Plaintiff filed an Amended Complaint in which he named PrimeCare and Berks County as additional defendants.*fn4 PrimeCare, Dr. Martin and Dr. Gessner (collectively, the "Medical Defendants") jointly moved to dismiss the Amended Complaint pursuant to Fed. R. Civ. P. 12(b)(6); Warden Wagner and Berks County filed separate but similar motions to dismiss.*fn5 The underlying factual allegations are identical as to all three sets of defendants, and as the claims against each defendant are interconnected and often dependent on the claims against other defendants, this opinion addresses all three motions.

Plaintiff's claims arise out of medical treatment he received while he was incarcerated at Berks County Prison in Pennsylvania from approximately February 1, 2008 to April 8, 2008. Plaintiff alleges that, for many years, he has been diagnosed with and treated for serious mental illnesses, including schizophrenia, bipolar disorder, and schizoaffective disorder.*fn6 As a result of his underlying disorders, he has experienced symptoms including depression, anxiety, paranoia, insomnia, aggression, hypomania, hallucinations, and suicidal ideation.*fn7 During 2006 and 2007, Plaintiff received treatment for these illnesses at a clinic in Reading, Pennsylvania, where he was prescribed several psychotropic medications, including an antipsychotic for his schizophrenia. With this medication, he alleges, his symptoms improved.*fn8 In 2007, Plaintiff moved to Florida, where he sought further treatment for his mental disorders, and was prescribed an antipsychotic, an antidepressant, and various other medications.*fn9

While in Florida, Plaintiff missed a scheduled court appearance related to a Pennsylvania burglary charge, and, in January 2008, was apprehended in Florida by a bail bondsman.*fn10

Plaintiff was briefly incarcerated in Florida, before being transferred to BCP on February 1, 2008. Plaintiff alleges that he was in possession of his prescription medications during his Florida imprisonment and transfer to Pennsylvania, but that he was not permitted to keep these medications after his arrival at BCP.*fn11 Plaintiff was "quarantined" during the first ten days of his incarceration at BCP, during which time he was evaluated by a nurse, but not a doctor.*fn12 Plaintiff was prescribed an antidepressant on February 2, 2008, and had his first appointment with Dr. Martin, a psychiatrist employed by PrimeCare, on February 18th.*fn13 Plaintiff alleges that while Dr. Martin noted that Plaintiff was suffering from a "mood disorder," he did not note any other diagnosis, and refused to prescribe an antipsychotic.*fn14 Instead, Dr. Martin prescribed only an antidepressant medication,*fn15 and on February 26th, yet another antidepressant.*fn16 Feeling that his mental health symptoms had not only failed to improve, but had, in fact, worsened under Dr. Martin's treatment, Plaintiff filled out an "Inmate Communication Form" directed to Warden Wagner on February 29th, in which he requested "different and/or additional medical treatment." He did not receive a response to this request.*fn17 On March 4th, Plaintiff submitted one of several "Sick Call Requests," complaining about his current medication, and was told by BCP personnel that he was scheduled for a follow-up appointment with Dr. Martin; this second and final appointment with Dr. Martin took place on or about March 18th.*fn18 Plaintiff states that at this appointment he told Dr. Martin that he was continuing to experience symptoms of psychosis, including insomnia, hyperactivity, auditory hallucinations, nightmares, a desire to hurt himself or others, "feeling out of place," and the sensation of "'having his head in the air'."*fn19 Plaintiff alleges that, as before, he told Dr. Martin that the prescribed antidepressants were not alleviating these symptoms and requested that Dr. Martin prescribe the antipsychotic that Plaintiff felt had been effective for him in the past. Again, Dr. Martin did not prescribe an antipsychotic, but increased the dose of antidepressants.*fn20

In addition to his appointments with Dr. Martin, Plaintiff was seen by Dr. Gessner for the treatment of chronic back and neck pain during his incarceration at BCP.*fn21 Plaintiff alleges that he also told Dr. Gessner, a PrimeCare supervisor, that he wished to have more frequent appointments with Dr. Martin, that his current antidepressant medication was not working, and that he wished to take an antipsychotic, which had been effective for him in the past.*fn22 Dr. Gessner prescribed a pain reliever for Plaintiff's back and neck pain, but did not assist Plaintiff in obtaining additional appointments with a psychiatrist nor did she prescribe any antipsychotic medication.*fn23

On or about April 8, 2008, Plaintiff was released from BCP with three days worth of the antidepressants he had been prescribed by Dr. Martin.*fn24 Plaintiff alleges that, because his symptoms of mental illness had worsened during his incarceration and were severe at the time of his release, he made multiple attempts to obtain additional and/or more effective medication by contacting his probation officer, a non-profit organization that provides mental health services in the Reading area, the police, and emergency medical services. None were able to provide him with immediate psychiatric care or medication.*fn25

Within ten days of his release from custody, on April 18, 2008, having been unable to secure effective medication or other psychiatric care, Plaintiff alleges that he suffered a severe psychotic break, during which he shot himself in both feet, drove a nail through each hand, punched his mother and pregnant sister-in-law and threatened to kill his mother.*fn26 In order to subdue Plaintiff and take him into custody after this assault, police found it necessary to shoot him in the abdomen.*fn27 Plaintiff was taken to Reading Hospital, where in addition to treating his gunshot wounds, doctors immediately diagnosed him as a paranoid schizophrenic and prescribed an antipsychotic, which he received throughout his hospital stay.*fn28

Plaintiff was released from the Hospital into the custody of BCP on April 23, 2008, and remained there until December of 2009.*fn29 Within three days of his return to BCP, Plaintiff saw a psychiatrist and was prescribed two antipsychotics, several different antidepressants, and/or sedatives.*fn30 During his second incarceration at BCP, Plaintiff states that he received appropriate medical treatment and that his symptoms improved.*fn31

Plaintiff alleges that the actions of Dr. Martin, Dr. Gessner and Warden Wagner during his first BCP incarceration, pursuant to the policies, procedures and/or customs of PrimeCare and Berks County, constituted deliberate indifference to Plaintiff's serious medical needs and were the proximate cause of his unnecessary and avoidable physical injuries and mental and emotional anguish.*fn32 Specifically, Plaintiff alleges that Dr. Martin and Dr. Gessner were repeatedly informed by Plaintiff of his serious mental illness and of his need for the medication which had been effective in treating it, knew that his symptoms were getting worse throughout his incarceration, refused to prescribe an antipsychotic, and may in fact have exacerbated Plaintiff's symptoms by prescribing an inappropriate combination of antidepressants and pain relievers.*fn33

Plaintiff further alleges that, through the Inmate Communication Form he filed, Warden Wagner knew of Plaintiff's serious medical needs and the problems with his treatment, but refused to address them himself, and/or acquiesced in Dr. Martin's and Dr. Gessner's deliberate indifference.*fn34 With respect to the quality and extent of the medical care provided to Plaintiff during his incarceration at BCP, Plaintiff alleges that Defendants Martin, Gessner, Wagner and other BCP personnel acted at all times pursuant to the policies, procedures and/or customs of Defendants Berks County and PrimeCare, such that in establishing those policies and procedures the County and PrimeCare demonstrated deliberate indifference to Plaintiff's serious medical needs.*fn35 Furthermore, Plaintiff alleges that all Defendants acted under color of state law in providing medical services or treatment to inmates at BCP or overseeing the provision of that treatment.*fn36 In sum, Plaintiff alleges that all Defendants' individual actions and ...


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