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Koukos v. Chester County

United States District Court, E.D. Pennsylvania

February 8, 2017

CHRISTOPHER KOUKOS, et al., Plaintiffs,
CHESTER COUNTY, et al., Defendants.


          GERALD J. PAPPERT, J.

         Plaintiffs Christopher Koukos, a former inmate of Chester County Prison, and his wife Carly sued Chester County, PrimeCare Medical Inc., Prison Warden D. Edward McFadden, Prison Deputy Warden of Treatment Ronald M. Phillips, Medical Assistant Jenice Abney, Nurses Amanda Hines and Samantha Budynkiewcz, Medical John Does 1-10[1] and Correctional John Does 1-7.[2] Koukos alleges, inter alia, that Defendants provided inadequate medical care in violation of his rights under 42 U.S.C. § 1983 and the Eighth Amendment to the United States Constitution. Currently before the Court is a motion to dismiss for failure to state a claim filed by Chester County, McFadden, Phillips and Correctional Does. As explained below, the Court grants in part and denies in part the Defendants' motion.


         On August 20, 2014, Christopher Koukos was sentenced by the Chester County Court of Common Pleas to nine to twenty-three months of incarceration. (Pls.' Am. Compl. ¶ 27, ECF No. 10, Ex. 1.) Prior to his sentencing, Koukos was being treated for various medical conditions for which he was prescribed several medications. Specifically, he was taking diazepam, metoprolol, oxycodone, oxycontin, paroxetine, prilosec, paxil and klonopin for ailments which included tachycardia, neck and shoulder pain, migraines, numbness in his extremities and post-traumatic stress disorder. (Id. ¶¶ 18-19.) In anticipation of his incarceration, Koukos consulted with his physicians and obtained from them a summary of his medical history, treatment and prescribed medications, together with the actual medications in their prescription bottles (“medical needs package”) to bring with him for presentation to the appropriate prison medical personnel. (Id. ¶ 20.) He took his last dose of medication at 11:00 a.m. on the day of his sentencing. (Id.) He was sentenced at 1:00 p.m. and arrived at Chester County Prison (“CCP”) at approximately 3:00 p.m. (Id. ¶¶ 17, 21.)

         Upon his arrival, he presented his medical needs package to Correction Doe 1, a young African American male correctional officer. (Id. ¶ 21.) Koukos alleges that Correction Doe 1 wrongfully informed him that his package would be transferred to PrimeCare, the private company that provides health services to CCP inmates, for consideration and distribution. Koukos contends that Correction Doe 1 knew or should have known that his package would be destroyed. (Id. ¶ 21.) At approximately 8:00 p.m. he was seen by a PrimeCare Medical Assistant Jenice Abney, for what he later learned was an initial intake medical examination. (Id. ¶ 22.) During the examination, Koukos requested that he be permitted to take a dose of his next scheduled medication, an opiate, because he had already missed one dose. (Id. ¶ 23.) According to Koukos, Abney informed him that all of the medication he had brought into the prison would be destroyed and that she was unable to provide him any of his prescribed medications, since any medications would need to be prescribed by a PrimeCare doctor. There was, however, no doctor regularly at the prison. (Id.)

         At the conclusion of the examination, Abney noted in prison records that Koukos was at risk for opiate and benzodiazepine withdrawal and that he had a heart condition. (Id. ¶ 24.) She also noted that for medical reasons, Koukos should be assigned to a bottom bunk. (Id.) Amanda Hines, a licensed practical nurse employed by PrimeCare, reviewed Abney's notes prior to the conclusion of the examination and was therefore also aware of Koukos's medical needs. (Id. ¶ 25.) Koukos alleges that neither Abney nor Hines informed him of his “right” to a bottom bunk assignment or took any actions to ensure that Koukos would thereafter be monitored or evaluated while undergoing opiate and benzodiazepine detoxification. (Id. ¶¶ 24, 25, 27.)

         His intake examination concluded around 10:00 p.m. At that time, Koukos alleges that Correctional Does 2 and 3 were “either not personally advised of and/or in any event ignored the [ ] medical designation and instead assigned [Koukos] to occupy the top bunk in a cell, placing him at serious, foreseeable, and known risk of falling and sustaining serious bodily injury or death.” (Id.) By 10:15 p.m., as a result of having been without his prescription medication for approximately eleven hours, Koukos began to experience debilitating physical and psychological withdrawal symptoms, including prolonged spasms, shaking and profuse sweating. (Id. ¶ 28.) He informed Correctional Doe 4 that he had not received his necessary medication and was feeling ill, to which Doe 4 allegedly responded, “Get away from me, you're making me nervous. Medical is closed.” (Id. ¶ 29.) Koukos immediately requested and filled out a medical request slip indicating that he was suffering from opiate and benzodiazepine withdrawal and that the prison had failed to provide him with the appropriate detox medication as well as his prescribed medication for tachycardia. (Id. ¶ 30.) He then tried to sleep but was unable to due to increasingly severe withdrawal symptoms, which in turn began to exacerbate his tachycardia. (Id. ¶ 31.)

         On August 21 Koukos went to breakfast but was unable to eat due to nausea, stomach cramping and his other ongoing symptoms of withdrawal. (Id. ¶ 32.) At that time, he spoke to Correctional Doe 5 and requested to be sent to the medical department to be evaluated and receive treatment for his symptoms of profuse sweating, shaking and disorientation, which he alleges were or should have been apparent to Doe 5. (Id.) According to Koukos, Correction Doe 5 denied his request and sent him back to his cell. (Id. ¶ 33.) Koukos then completed another medical request slip seeking attention for his worsening symptoms of opiate withdrawal and tachycardia. (Id.)

         Koukos was similarly unable to eat lunch so he submitted another medical request slip seeking treatment, this time to Correction Doe 6. (Id. ¶ 34.) That request was also denied and he was taken to his cell. (Id.) As a result, Koukos's symptoms further intensified, exacerbating his heart condition and causing him to shake and sweat uncontrollably. (Id. ¶ 37.) He claims Correctional Does continued to ignore these observed symptoms and he was left in his top bunk and denied medical attention. (Id.)

         In the early morning hours of August 22, allegedly as the result of his withdrawal symptoms, sleeplessness and uncontrollable spasms, Koukos fell from the upper bunk. (Id. ¶ 38.) His face struck the cell's steel desk and his body slammed into a metal chair. (Id. ¶ 38.) He landed face first on the floor of the cell and sustained various injuries, including a concussion with loss of consciousness, nasal swelling, rib fractures, right hip bruising, abrasions to his ribs and knees, a right orbital rim fracture, soft tissue hemorrhage, left pleural effusion, bibasal lung atelectasis and damage to his right optical nerve. (Id.) He was taken to the Chester County Hospital emergency room. (Id. ¶¶ 38-39.)

         Koukos was discharged a few hours later with instructions to take antibiotics, apply ice to his face every twenty minutes to reduce swelling and to receive an evaluation at Ear, Nose and Throat Associates of Chester County (“ENTACC”) within two to three days. (Id. ¶ 41.) Despite these instructions, Koukos alleges that Defendants failed to provide him with antibiotics, ice and pain medication, leaving him in excruciating pain for many days. (Id. ¶ 42.) Upon his return from the hospital, he was placed in solitary confinement on the medical block where he could, ostensibly, be observed for ongoing complications. (Id. ¶ 43.) However, he alleges he was not actually monitored for any further post-concussion or withdrawal symptoms and Defendants continued to withhold the antibiotics, pain medication and ice for his injuries. (Id.)

         On August 23 Koukos was seen by Medical Doe 1, who represented that he/she was a physician assistant. Doe 1 told Koukos he would be transferred to a regular cell without further treatment or monitoring. (Id. ¶ 44.) After the transfer, Koukos requested from Correctional Doe 7 that he be provided with ice packs; however, despite observing Koukos's injuries, Doe 7 denied his request “in direct violation of the treatment regime prescribed by the physician and medical staff at Chester County Hospital.” (Id. ¶¶ 45-46.)

         Despite the discharge instruction that Koukos be seen within two to three days of his release from the ER, he was not taken to ENTACC to be examined for the ongoing pain in his right eye until September 8, 2014. (Id. ¶ 47.) At that time, he was examined by a doctor and underwent a diagnostic nasal endoscopy. (Id.) Koukos alleges that the delayed diagnostic testing and the passage of time prevented further treatment from being an option. (Id.) He was instructed to return for a follow-up exam in one month. (Id. ¶ 48.) Defendants ignored this order and did not bring him back to ENTACC. (Id.)

         Koukos alleges that despite medical directives, Defendants withheld reasonable, necessary and prescribed care, failed to ensure that he received the appropriate follow-up treatment for his injuries and allowed him to remain in significant pain for approximately nine months until he was able to seek treatment after his release. (Id. ¶ 49.) Koukos further alleges that as the result of his fall, and subsequent denial of medical care, he has suffered permanent injury: he can no longer read for more than ten minutes; experiences ongoing tenderness in his right cheekbone which disrupts sleep; suffers from chronic pain in his right hip which affects his mobility and experiences migraines and scarring under his right eye. (Id. ¶ 40.)


         To survive a motion to dismiss under Rule 12(b)(6), a plaintiff must plead factual allegations sufficient “to raise a right to relief above the speculative level . . . on the assumption that all the allegations in the complaint are true (even if doubtful in fact).” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). The “mere possibility of misconduct” is not enough. Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009). The court must construe the complaint in the light most favorable to the plaintiff. See Connelly v. Lane Constr. Corp., 809 F.3d 780, 790 (3d Cir. 2016) (citations omitted). However, a court need not accept as true inferences drawn by the plaintiff that are unsupported by facts. See Cal. Pub. Emps.' Ret. Sys. v. Chubb Corp., 394 F.3d 126, 143 (3d Cir. 2004).

         “While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the ‘grounds' of his ‘entitlement to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Bell, 550 U.S. at 555 (2007) (citations and alterations omitted); see Iqbal, 556 U.S. at 678 (2009) (“Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.”). A court should “consider only the allegations in the complaint, exhibits attached to the complaint, matters of public record, and documents that form the basis of a claim.” Lum v. Bank of Am., 361 F.3d 217, 221 n.3 (3d Cir. 2004). Whether a complaint states a plausible claim for relief is a context-specific task that “requires the reviewing court to draw on its judicial experience and common sense.” Iqbal, 556 U.S. at 679 (citations omitted).


         In Count I, Koukos asserts claims pursuant to § 1983 for inadequate medical treatment under the Eighth Amendment. To establish a prima facie case under § 1983, Koukos must first demonstrate that a person acting under color of law deprived him of a federal right. See Groman v. Twp. of Manalapan, 47 F.3d 628, 633 (3d Cir. 1995). Koukos must also show that the person acting under color of law “intentionally” violated his constitutional rights or acted “deliberately indifferent” in violation of those rights. See, e.g., Cty. of Sacramento v. Lewis, 523 U.S. 833, 843-44 (1998); Brower v. Cty. of Inyo, 489 U.S. 593, 596 (1989) (citing Hill v. California, 401 U.S. 797, 802-05 (1971)); see also Berg v. Cty. of Allegheny, 219 F.3d 261, 269 (3d Cir. 2000).

         “The Eighth Amendment's prohibition against cruel and unusual punishment protects prisoners against the ‘unnecessary and wanton infliction of pain.'” Hamilton v. Leavy, 117 F.3d 742, 746 (3d Cir. 1997) (quoting Whitley v. Albers, 475 U.S. 312, 319 (1986)). Accordingly, “the treatment a prisoner receives in prison and the conditions under which he is confined are subject to scrutiny under the Eighth Amendment.” Farmer v. Brennan, 511 U.S. 825, 832 (1994) (quoting Helling v. McKinney, 509 U.S. 25, 31 (1993)). The prohibition against cruel and unusual punishment ...

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