United States District Court, M.D. Pennsylvania
SAPORITO MAGISTRATE JUDGE
Richard Caputo United States District Judge
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.
facts as stated in Plaintiff's SAC (Doc. 1-1) can be
summarized as follows:
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.)
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.
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. ¶¶
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.
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.
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. ¶¶
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.)
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
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
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.)
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
in September 2014, Buehl repeatedly asked Defendant Dr.
Pandya to prescribe tramadol or any other more effective
medicine to treat his shoulder pain. (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
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.)
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.
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.)
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.
¶ 82.) Defendant Oppman provided responses on several
occasions, in which he approved of the treatment that ...