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Parris Lewis Wall, Jr v. Rachael Rackovan


March 30, 2011


The opinion of the court was delivered by: Judge Caldwell


I. Introduction

Parris Lewis Wall, a pro se prisoner, filed this civil rights complaint against a sole defendant, Rachael Rackovan, a Physician's Assistant-Certified (PA) at the Allenwood Federal Correctional Institution (FCI-Allenwood), in Allenwood, Pennsylvania. Wall asserts an Eighth Amendment challenge to the medical care, or rather lack there of, he received from PA Rackovan for thrush (oral condition caused by the fungus Candida albicans).*fn1

Doc. 1, Compl.

Rackovan has filed a motion for summary judgment. We will evaluate the motion under the well established standard. See Lawrence v. City of Philadelphia, 527 F.3d 299, 310 (3d Cir. 2008). The court will grant the motion.

II. Background

We take this background from the properly supported factual assertions in the parties' briefs and the evidentiary submissions.

Parris Lewis Wall, Jr., was incarcerated at FCI-Allenwood from October 28, 2008, through July 16, 2009. Doc. 24, Def.'s Statement of Material Facts (DSF) at ¶ 1. He was housed in the institution's SHU from February 25, 2009, until his transfer on July 16, 2009, to USP-Lewisburg. Id. at ¶ 2. Wall regularly uses a steroid inhaler to treat his asthma. Doc. 1, Compl. at p. 2; see also Doc. 23-2, Exs. in Supp. Def.'s Mot. for Summ. J. at p. 23.*fn2

Wall, who resided in the SHU, awoke and groomed himself by 5:30 a.m. each day. Doc. 27, Wall's Resp. to Rackovan's Decl. at p. 2. Upon waking each day, he scrubbed his tongue with salt water. Id. He also scrubbed his tongue several times throughout the day because of white coating which would accumulate during the day. Id. at p. 3. He received breakfast, in his cell, any time between 6:00 a.m. and 6:45 a.m. each day. Id. at p. 2. According to Wall, PA Rackovan made her rounds in the SHU between 6:30 a.m. and 7:30 a.m. Id.

In late April 2009, Wall believed he developed thrush due to his use of his AdvairTM asthma medication, an orally inhaled steroid. Doc. 1 at p. 2. PA Rackovan was Wall's assigned PA at the time. Id. On April 20, 2009, he complained to Rackovan that he had a yeast infection in his mouth. DSF at ¶ 3. After examining his mouth, she found no evidence of lesions, growths, coatings or white areas. DSF at ¶ 4. Wall had already scrubbed his mouth prior to this encounter with Rackovan "so that was probably the reason she didn't notice" the infection Wall was complaining about. Doc. 1 at p. 2. Rackovan counseled Wall about rinsing his mouth with water after using his steroid inhaler. DSF at ¶ 6. Wall did not require treatment at that time. Id. at ¶ 5.

On April 22, 2009, Wall was seen by RN Sholder after complaining of chest pain. Id. at ¶ 7. During that visit, Wall did not complain about suffering from an infection or issues related to his mouth. Id. at ¶ 8. The following day, PA Rackovan spoke with Wall during sick rounds in the SHU. Id. at ¶ 9. He stated he was feeling much better and that the chest pain had gone away. He did not voice any other complaints. Id. at ¶ 10.

On May 29, 2009, and June 2, 2009, RN Shoemaker received Wall's sick call slips wherein he complained that he was suffering from an oral yeast infection and that he was not properly examined by PA Rackovan when he complained of this problem earlier. Id. at ¶ 11; Doc. 1 at pp. 9-10. It was noted that Wall was to see the doctor at the end of June. Doc. 24 at ¶ 12.

On June 19, 2009, while Rackovan was making rounds in the SHU, Wall requested a refill of his inhaler. She submitted the prescription for renewal. Id. at ¶ 13. The same day, Wall was examined by Dr. Miller during the pulmonary chronic care clinic. Id. at ¶ 14; Doc. 23-2 at p. 23. Dr. Miller noted that Wall's asthma "has been fairly controlled on advair but he gets some irritation in his mouth and has been treated in the past for thrush." Doc. 23-2 at p. 23. His mouth was examined for erythema, white plaques, dryness, fetid odor and other issues. Id. No positive results were noted. Doc. 24 at ¶ 16. Wall did not report being in any pain at the time of the exam and was instructed on rinsing his mouth out after using his inhaler. Id. at ¶¶ 15-16.

On June 24, 2009, PA Rackovan treated Wall for a small scratch or friction burn to his right thumb. Id. at ¶ 17. He did not complain about any infection or other issues with his mouth at that time. Id. at ¶ 18.

Wall was treated by an emergency medical technician on June 26, 2009, for a small abrasion on his right hand near the base of his right thumb after being handcuffed.

Id. at ¶ 19; Doc. 23-2 at p. 28. He did not make any other verbal complaints at the time and reported no pain. Id.

On June 29, 2009, while Rackovan was making rounds in the SHU, Wall was provided with written information on yeast infections as requested. Doc. 1 at p. 11; DSF at ¶ 21. He did not complain about an infection or other issues with his mouth at the time. Id. at ¶ 22.

Rackovan is familiar with the condition known as Candida albicans, which is also known as thrush. Id. at ¶ 23. At no time did Rackovan ever witness or observe any evidence of thrush in Wall's mouth. Id. at ¶ 24. Had she ever observed this condition in Wall's mouth, she would have provided him with the appropriate treatment. Id. at ¶ 25.

III. Discussion

Wall believes he suffered from thrush from late April 2009 until July 20, 2009, when he was transferred to USP-Lewisburg. At Lewisburg, was diagnosed with Candidiasis of the mouth and prescribed oral medication. He believes Rackovan ignored his requests for treatment for thrush due to her failure to properly examine him or to notice the signs and symptoms of the condition.

The Eighth Amendment prohibits cruel and unusual punishment. U.S. Const. amend. XIII; see Wilson v. Seiter, 501 U.S. 294, 296-97, 111 S.Ct. 2321, 2323, 115 L.Ed.2d 271 (1991). A defendant violates an inmate's right to medical care under the Eighth Amendment when he or she is deliberately indifferent to the inmate's serious medical need. Estelle v. Gamble, 429 U.S. 97, 105-06, 97 S.Ct. 285, 292, 50 L.Ed.2d 251 (1976).

A prison official violates the Eighth Amendment only when two requirements are met: (1) the deprivation alleged is, objectively, sufficiently serious, and (2) the official is, subjectively, deliberately indifferent to the inmate's health or safety. See Farmer v. Brennan, 511 U.S. 825, 834, 114 S.Ct. 1970, 1977, 128 L.Ed.2d 811 (1994). The inmate must satisfy this two-part conjunctive test. Without the requisite mental state, a prison official's conduct alone will not constitute deliberate indifference. Id., 511 U.S. at 837-38, 114 S.Ct. at 1979. To be deliberately indifferent, a prison official must know of, and disregard, an excessive risk to inmate health or safety. Id., 511 U.S. at 837-38, 114 S.Ct. at 1979. Deliberate indifference can be shown by a prison official "intentionally denying or delaying access to medical care or intentionally interfering with [medical] treatment once prescribed." Estelle, 429 U.S. at 104-05, 97 S.Ct. at 291. Allegations of malpractice or negligent treatment are insufficient to entitle a plaintiff to relief. Id.

Furthermore, deliberately delaying necessary medical diagnosis for a long period of time in order to avoid providing care may constitute deliberate indifference that is actionable. See Durmer v. O'Carroll, 991 F.2d 64 (3d Cir. 1993). A medical need is serious where it "has been diagnosed by a physician as requiring treatment or is . . . so obvious that a lay person would easily recognize the necessity for a doctor's attention." Monmouth County Corr. Institutional Inmates v. Lanzaro, 834 F.2d 326, 347 (3d Cir. 1987) (citations omitted). Persistent severe pain qualifies as a serious medical need. "If 'unnecessary and wanton infliction of pain' results as a consequence of denial or delay in the provision of adequate medical care, the medical need is of the serious nature contemplated by the Eighth Amendment." Id. at 347 (3d Cir. 1987)(quoting Estelle, 429 U.S. at 103, 97 S.Ct. at 290).

Mere allegations that a physician or a medical department staff member "has been negligent in diagnosing or treating a medical condition does not state a valid claim of medical mistreatment under the Eighth Amendment . . . ." Estelle, 429 U.S. at 106, 97 S.Ct. at 292. Similarly, a "medical decision not to order an X-ray, or like measures, does not represent cruel and unusual punishment. At most it is medical malpractice." Id., 429 U.S. at 107, 97 S.Ct. at 293. "[A]s long as a physician exercises professional judgment his behavior will not violate a prisoner's constitutional rights." Brown v. Borough of Chambersburg, 903 F.2d 274, 278 (3d Cir. 1990). Medical negligence alone cannot result in an Eighth Amendment violation, nor can any disagreements over the professional judgment of a health care provider. White v. Napoleon, 897 F.2d 103, 108-110 (3d Cir. 1990). In sum, negligence, unsuccessful medical treatment, or an inmate's disagreement with his medical treatment is insufficient to establish deliberate indifference. See Durmer, 991 F.2d at 69.

In this case, Wall contends he did not receive adequate medical care from PA Rackovan for his complaints of thrush. The undisputed record before the court reveals that during the time that Wall believed he was suffering from thrush, he was not only examined by PA Rackovan, but also Dr. Miller, for his complaints. Both PA Rackovan and Dr. Miller found no evidence that Wall was suffering from thrush. Moreover, Wall himself states that his symptoms were not obvious because of his rigorous oral hygiene routine. Still, PA Rackovan did not ignore Wall's complaints of thrush -- she examined him but found no evidence of the infection. Almost a month and a half after his initial complaint to PA Rackovan, Dr. Miller examined Wall without seeing any evidence of infection. In both instances, the medical professionals exercised their medical judgment when evaluating and making treatment decisions for Wall. The fact that Rackovan did not agree with Wall's self-diagnosis, or the fact that he was diagnosed with thrush at USP-Lewisburg, does not establish that she violated his Eighth Amendment right against cruel and unusual punishment. At most it is medical malpractice, if that.

Under these circumstances, based upon the undisputed facts presented, and the portions of Wall's medical records presented to the court for review, there is no basis to conclude the PA Rackovan was deliberately indifferent to Wall's medical needs. Thus, Wall has failed to establish an Eighth Amendment constitutional violation. Defendant Rackovan's motion for summary judgment will be granted.

We will issue an appropriate order.

/s/William W. Caldwell

William W. Caldwell United States District Judge



CIVIL NO. 1:CV-10-0716

(Judge Caldwell)

ORDER AND NOW, this 30th day of March, 2011, for the reasons set forth in the accompanying memorandum, it is ordered that:

1. PA Rackovan's Motion for Summary Judgment (doc. 22) granted.

2. The Clerk of Court is directed to enter judgment in favor of defendant Rackovan, and against Plaintiff.

3. The Clerk of Court shall close this file.

William W. Caldwell United States District Judge

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