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Buehl v. Wexford Health Sources, Inc.

United States District Court, M.D. Pennsylvania

March 7, 2017

ROGER BUEHL, Plaintiff,
WEXFORD HEALTH SOURCES, INC., et al., Defendants.



          A. Richard Caputo United States District Judge

         Presently before the Court is the Report & Recommendation of Magistrate Judge Saporito (Doc. 10) to a Partial Motion to Dismiss (Doc. 3) filed by Defendants Correct Care Solutions, LLC, Wexford Health Sources, Inc., Dr. Adrian Harewood, and Dr. Haresh Pandya (the “Medical Defendants”), and a Motion to Dismiss (Doc. 5) filed by Defendants Christopher Oppman, Vicki Stanishefski, R.N., and Mary Alice Kuras, R.N. (the “Corrections Defendants”). Plaintiff Roger Buehl brings this action pursuant to, inter alia, 42 U.S.C. § 1983 for a violation of his rights under the Eighth Amendment to the United States Constitution. The Medical Defendants seek dismissal of Counts I and V of Plaintiff's Second Amended Complaint (“SAC”) (Doc. 1-1) for failure to state a claim. The Corrections Defendants seek dismissal of all Counts for failure to state a claim. Magistrate Judge Saporito recommended that Count I of Plaintiff's SAC, which raises Plaintiff's only federal-law claim, be dismissed against all Defendants for failure to state a claim, and that the Court decline to exercise supplemental jurisdiction over Plaintiff's state-law claims raised in Counts II-V. For the reasons that follow, the Magistrate Judge's Report and Recommendation will be adopted in part and rejected in part.

         I. Background

         The facts as stated in Plaintiff's SAC (Doc. 1-1) can be summarized as follows:

         Plaintiff Roger Buehl has been an inmate under the continuous care, custody, and control of the Pennsylvania Department of Corrections (“DOC”) since 1983. (SAC ¶ 10.) Healthcare staff at SCI Smithfield, SCI Mahanoy, and SCI Frackville have been responsible for Buehl's healthcare from June 2007 to date. (Id.) Buehl began experiencing pain and losses of both strength and range of motion in his right shoulder prior to 2009. (Id. ¶ 11.) In 2009, Buehl was diagnosed by DOC healthcare staff with rotator cuff tendinitis in his right shoulder. (Id. ¶ 12.) DOC healthcare staff began treating Buehl with ibuprofen and both oral and injected steroids. (Id.) In late 2009, Buehl was hospitalized for failure of renal function. (Id. ¶ 13.) By early 2010, routine blood lab results suggested that Buehl's loss of renal function was attributable to long-term use of ibuprofen and other non-steroidal anti-inflammatory medicines. (Id. ¶ 14.) The DOC healthcare staff explored various alternative medications for treating Buehl's shoulder pain, and by mid-2011 Buehl was receiving Neurontin, both oral and injected steroids, and low-dose ibuprofen. (Id. ¶¶ 15-16.) However, in early 2012 Buehl began experiencing increases in the severity of pain and greater losses of strength and range of motion in his right shoulder. (Id. ¶ 17.) In March 2012, after performing an x-ray on his shoulder, the DOC healthcare staff diagnosed Buehl with glenohumeral degenerative joint disease. (Id. ¶ 18.)

         In late 2012 or early 2013, DOC healthcare staff began treating Buehl with tramadol, a non-narcotic opioid, along with Neurontin, oral and injected steroids, and low-dose ibuprofen. (Id. ¶ 19.) On July 26, 2013, another x-ray of Buehl's shoulder confirmed that he had moderate degenerative joint disease of the right shoulder. (Id. ¶ 23.) DOC healthcare staff changed Buehl's medications, and prescribed Tylenol with Codeine No. 3 instead of tramadol. (Id. ¶ 24.) Buehl informed DOC healthcare staff that he did not want the acetaminophen or narcotic in the Tylenol, and instead preferred tramadol for managing his pain. (Id.) At that time, the staff advised Buehl that a regional medical director imposed new restrictions on tramadol prescriptions. (Id.) Through early 2014, DOC healthcare staff prescribed Tylenol with Codeine No. 3 or oxycodone, along with Neurontin, ibuprofen, and occasionally steroids to treat Buehl's shoulder pain. (Id. ¶ 25.) Buehl was eventually prescribed hydrocodone and then, at Buehl's request, he was provided tramadol again. (Id.)

         Sometime in 2013, Defendant Christopher Oppman, in his capacity as Director of the Bureau of Healthcare Services, approved and implemented clinical practice or pharmaceutical guidelines (the “Guidelines”), which applied to most pain medications that could be prescribed for inmates and effectively curtailed the authority of DOC healthcare staff to exercise their independent professional judgment in prescribing pain medications. (Id. ¶¶ 26-27, 78.)

         On January 30, 2014, Dr. Lisiak noted that Buehl was “recently changed from oxycodone to Norco” and that Buehl claimed the Norco was “not effective in relieving his pain.” (Id. ¶ 29.) Dr. Lisiak also noted that Buehl had been “changed to Ultram [tramadol] and Neurontin (as was effective in the past), ” but that Buehl claimed that this regimen was “not effective in relieving pain, [and was] asking about oxycodone.” (Id.) Dr. Lisiak requested Buehl be evaluated by the regional medical director. (Id.)

         On February 5, 2014, Buehl was examined by Dr. Anthony Chiavacci, Wexford's Regional Medical Director, regarding Buehl's request to alter his medications. (Id. ¶ 30.) Buehl requested to have his tramadol dosage increased. (Id. ¶ 31.) However, Dr. Chiavacci instead “planned to discontinue” Buehl's tramadol treatment, tapered off his Nuerontin, and placed Buehl on Motrin 600 mg three times a day. (Id.) Buehl's prescriptions for tramadol and Nuerontin were reduced and then terminated in early 2014 pursuant to Dr. Chiavacci's orders. (Id. ¶ 33.) Subsequently, DOC healthcare staff provided Buehl with ibuprofen and Nortriptyline, a tricyclic antidepressant, which were ineffective in treating his shoulder pain. (Id.)

         In February 2014, Dr. Chiavacci approved an orthopedic consult for Buehl. (Id. ¶ 34.) On March 21, 2014, Dr. Thomas Martin, an orthopedist, examined Buehl. (Id. ¶ 35.) After conducting several x-rays, Dr. Martin diagnosed Buehl with advanced glenohumeral osteoarthritis, complete erosion of the cartilage, and development of at least one humeral head spur in Buehl's right shoulder. (Id.) According to Dr. Martin, the only option for treatment of the underlying condition was a total shoulder replacement. (Id.) In the alternative, Dr. Martin recommended tramadol and intermittent courses of steroids for treatment of the pain. (Id.) On April 3, 2014, Buehl saw Nelson Iannuzzi, CRNP, and noted that he was still experiencing severe right shoulder pain, but wanted to defer surgery as long as possible. (Id. ¶ 37.) Iannuzzi noted a treatment plan that decreased Buehl to 400mg of Motrin three times a day and provided Nortriptyline. (Id. ¶ 38.) Five days later, Buehl went to the MD line at SCI Mahanoy and saw Dr. Lisiak, who continued Buehl's current medication, Motrin, and directed him to follow up in one to two weeks. (Id. ¶¶ 39-41.)

         On April 14, 2014, Buehl was transferred from SCI Mahanoy to SCI Frackville. (Id. ¶ 42.) Beginning in May 2014, Buehl repeatedly asked Defendant Dr. Harewood to prescribe him tramadol, as recommended by the orthopedist, or any other more effective medicine to treat his shoulder pain. (Id. ¶ 47.) However, Dr. Harewood provided Buehl with only ibuprofen and “one short course of steroids.” (Id.) On May 23, 2014, Buehl was evaluated by a physical therapist, after which Dr. Harewood assessed that Buehl had “frozen shoulder” and noted that the physical therapist recommended “surgical intervention/evaluation.” (Id. ¶ 48.) Dr. Harewood accordingly proposed a consultation for orthopedic surgery, which was approved. (Id.)

         On June 5, 2014, Buehl saw Dr. Harewood again and requested tramadol for pain. (Id. ¶ 49.) Dr. Harewood planned for Buehl to follow-up with the orthopedic department, recommended he continue with his current medications, and noted there was “[n]o need for narcotic medications.” (Id.)

         On June 13, 2014, Dr. Martin performed an orthopedic evaluation of Buehl and noted that Buehl had “pretty significant glenohumeral arthritis.” (Id. ¶ 50.) Dr. Martin spoke with Buehl about the prospect of a shoulder replacement, to which Buehl expressed “appropriate reservations.” (Id. ¶ 51.) Dr. Martin noted that Buehl was “not an ideal candidate” for a shoulder replacement, and stated that he thought Buehl “would be better treated with Tramadol.” (Id.) Dr. Martin also stated that Buehl's diagnosis “[w]arrant[ed] this level of pain medicine.” (Id.)

         On July 1, 2014, Dr. Harewood declined to prescribe Buehl with tramadol and instead planned to continue Buehl on Motrin and prescribed Buehl with “Prednisone (steroid) 60 mg daily for 5 days.” (Id. ¶ 52.) When Buehl pointed out that ibuprofen had caused renal insufficiency problems in the past, and that his renal function should be monitored by diagnostic testing, Dr. Harewood terminated all medications and treatment. (Id. ¶ 53.)

         On July 10, 2014, Dr. Harewood saw Buehl who again requested Ultram (tramadol) for his shoulder pain. (Id. ¶ 54.) Dr. Harewood denied Buehl's request, and instead told Buehl to “. . . take over the counter pain medications as needed” and “[r]ecommended exercise and strengthening.” (Id.)

         Beginning in September 2014, Buehl repeatedly asked Defendant Dr. Pandya to prescribe tramadol or any other more effective medicine to treat his shoulder pain.[1] (Id. ¶ 55.) Buehl informed Dr. Pandya that the medicines currently provided were not helpful in managing his pain. (Id.) However, Dr. Pandya did not provide anything to treat Buehl's pain other than ibuprofen or acetaminophen. (Id.)

         On December 2, 2014, labs were taken which revealed that Buehl had “. . . decreased kidney function probably related to his prolonged use of Motrin.” (Id. ¶ 57.) The labs specifically revealed that Buehl had “[i]ncreased BUN (blood urea nitrogen) and serum Creatinine, ” as well as “[d]ecreased GFR (glomerular filtration rate).” (Id.) On December 30, 2014, additional labs were conducted which revealed Buehl had “[i]ncreased BUN, serum Creatinine, and deceased GFR.” (Id. ¶ 58.)

         On January 9, 2015, Dr. Pandya examined Buehl again, at which time Buehl gave Dr. Pandya a copy of the orthopedist report and requested effective treatment for his shoulder pain. (Id. ¶ 59.) Dr. Pandya read the record, and confirmed the presence of those records in Buehl's medical file. (Id.) Dr. Pandya then informed Buehl that the orthopedist recommendations were appropriate, but that the Guidelines precluded him from prescribing tramadol or any similar medication to treat Buehl's pain. (Id.) Dr. Pandya once again prescribed ibuprofen and acetaminophen on a long-term basis. (Id. ¶¶ 59-60.)

         Beginning in May 2014, Buehl repeatedly submitted written Request to Staff communications to Defendant Stanishefski, RN and Healthcare Administrator at SCI Frackville, in which Buehl asked Defendant Stanishefski to review his pain treatment, refer him to another physician, and require DOC healthcare staff to provide him with treatment consistent with community standards of care. (Id. ¶¶ 7, 63, 75.) Defendant Kuras, RN and Registered Nurse Supervisor at SCI Frackville, provided written responses to each written request that Buehl addressed to Defendant Stanishefski, and those responses typically instructed Buehl to “sign up for sick call, ” file an official inmate grievance, or otherwise indicated that no remedial action would be taken. (Id. ¶¶ 8, 64, 76.)

         Between May 2014 and December 2014, numerous communications about Buehl's shoulder condition and related medical treatment were directed to Defendant Oppman's attention. (Id. ¶¶ 81, 83.) Each communication requested review and remedial action to ensure Buehl was provided with medical treatment and pain management consistent with the community standard of care. (Id. ΒΆ 82.) Defendant Oppman provided responses on several occasions, in which he approved of the treatment that ...

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