Opinion
No. 12-CV-1290 (LEK/CFH)
04-23-2015
ANGEL MALDONADO, Plaintiff, v. DR. WELLS, DR. RAMINENI, Defendants.
APPEARANCES: ANGEL MALDONADO Plaintiff Pro Se 11-A-5408 Fishkill Correctional Facility P.O. Box 1245 Beacon, New York 12508 HON. ERIC T. SCHNEIDERMAN Attorney General of the State of New York Litigation Bureau The Capitol Albany, New York 12224 Attorney for the Defendants OF COUNSEL: COLLEEN D. GALLIGAN, Esq. Assistant Attorney General
APPEARANCES:
ANGEL MALDONADO
Plaintiff Pro Se
11-A-5408
Fishkill Correctional Facility
P.O. Box 1245
Beacon, New York 12508
HON. ERIC T. SCHNEIDERMAN
Attorney General of the State of New York
Litigation Bureau
The Capitol
Albany, New York 12224
Attorney for the Defendants
OF COUNSEL:
COLLEEN D. GALLIGAN, Esq.
Assistant Attorney General
REPORT-RECOMMENDATION AND ORDER
This matter was referred to the undersigned for report and recommendation pursuant to 28 U.S.C. § 636 (b) and N.D.N.Y.L.R. 72.3 (c).
Plaintiff pro se Angel Maldonado ("Plaintiff"), an inmate in the custody of the New York State Department of Corrections and Community Supervision ("DOCCS"), brings this action pursuant to 42 U.S.C. § 1983 alleging that defendants, Dr. Wells and Dr. Ramineni, violated his constitutional rights under the Eighth Amendment. Compl. (Dkt. No. 1). Presently pending is defendants' motion for summary judgment pursuant to Fed. R. Civ. P. 56. Dkt. No. 48. Plaintiff opposes this motion. Dkt. No. 61. Defendants filed a reply. Dkt. No. 62. For the following reasons, it is recommended that defendants' motion be granted.
I. Background
All unpublished cases cited within this Report-Recommendation and Order are attached.
The facts are reviewed in the light most favorable to plaintiff as the nonmoving party. See subsection II(A), infra. At all relevant times, plaintiff was incarcerated at Mid-State Correctional Facility ("Mid-State"). Plaintiff claims that Dr. Wells and Dr. Ramineni violated his Eighth Amendment right to adequate medical care by failing to treat his possible MRSA infection and not providing him with adequate pain medication. Dkt. No. 1 at 11; Dkt. No. 48-2 at 58.
A. Statement of Facts
Plaintiff had been stabbed four times in 2001 and subsequently underwent surgery to check for internal injuries. Dkt. No. 48-2 at 44. He also suffers from asthma and hepatitis C. Dkt. No. 49-1 at 33.
On or about March 9, 2012, Dr. Wells first saw plaintiff who had complaints of abdominal pain and a history of abdominal stab wound. Dkt. No. 49 at ¶6. Dr. Wells determined that plaintiff had a ventral hernia that needed surgical repair. Id. Dr. Wells performed ventral hernia repair on April 11, 2012 at Upstate University Hospital ("Upstate"). Id. at ¶7. Upon discharge from Upstate, plaintiff was admitted to the infirmary at Mid-State, and non-defendant physician Dr. Vadlamundi prescribed plaintiff Tylenol # 3 for pain management, as well as an abdominal binder. Dkt. No. 50 at ¶¶10-11.
Upon discharge from the infirmary on April 12, 2012, plaintiff was prescribed ibuprofen for pain for three days and was scheduled to follow up with Dr. Ramineni on April 19, 2012. Dkt. No. 50 at ¶18. On April 13, nursing staff at Mid-State changed plaintiff's dressing and noted that plaintiff's staples were dry and intact. Id. at ¶20. On April 14, plaintiff was given a body check due to a fight with another inmate. Id. at ¶21. At that time, it was noted that plaintiff had a small amount of bloody drainage at his incision site, and he was admitted to the infirmary. Id. at ¶21. Non-defendant physician Dr. Vadlumondi ordered that a culture of plaintiff's wound be taken, and that plaintiff be placed on Keflex prophylactically to treat a possible infection. Id. at ¶22.
On April 16, 2012, plaintiff had no drainage, denied pain, and requested to be discharged from the infirmary. Dkt No. 50 at ¶23. Dr. Ramineni saw plaintiff that day and noted no evidence of discharge or infection from the incision site, but ordered that plaintiff continue on Keflex prophylactically and be discharged from the infirmary. Id. at ¶23. Plaintiff was seen at emergency sick call the next day, complaining of drainage from his abdominal incision, and drainage of yellow serous fluid just above his navel was noted. Id. at ¶24. Plaintiff was placed on antibiotics and was issued band aids. Id.
The drainage of serous fluid is caused by a seroma, which is a pocket of fluid that can develop after a surgical procedure. A seroma is not uncommon and usually resolves on its own. Dkt. No. 50 at ¶24.
On April 19, 2012, a culture taken from plaintiff's incision tested positive for Methicilin Resistant Staph Aureus ("MRSA"). Dkt. No. 50 at ¶25. The next day, Dr. Ramineni saw plaintiff, and noted that plaintiff's wound was clean and dry and that the staples were intact. Id. at ¶26. Dr. Ramineni noted that plaintiff's lab report was positive for MRSA. Id. He also noted that plaintiff had no discharge or other signs of infection at that time, and indicated that plaintiff should follow up within one week. Id.
MRSA is a bacterium that is resistant to many antibiotics. Dkt. No. 49 at ¶13.
Dr. Ramineni saw plaintiff on April 24, 2012, and noted that plaintiff's wound was healing and there was no evidence of infection. Dkt. No. 50 at ¶29. At that time, Dr. Ramineni removed plaintiff's staples, cleaned his wound, and applied Betadine and a large band aid. Id. Plaintiff was seen later that morning by nursing staff with a small amount of reddish, tan drainage on the suture site where staples were removed. Id. at ¶30. Plaintiff was advised to return to the infirmary if his symptoms worsened, he had a fever, or the wound drainage increased or changed. Id. Plaintiff was also given ibuprofen to be taken as needed. Id.
Later that afternoon, plaintiff was seen at emergency sick call with an approximately one inch wound dehiscence and dark bloody drainage. Dkt. No. 50 at ¶31. Plaintiff's vital signs were obtained and pressure was applied to his wound. Id. Plaintiff was sent to St. Luke's Hospital ("St. Luke's") via ambulance. Id. Plaintiff returned from St. Luke's Hospital later that day. Id. at ¶32. Upon his return to Mid-State, plaintiff's wound was still draining red blood. Id. at ¶32. Non-defendant Mid-State physician Dr. Zaki ordered that plaintiff be sent to the emergency room at Upstate for evaluation and to be seen by Dr. Wells. Id. That same day, plaintiff arrived at Upstate complaining of drainage, opening of the midline incision, and abdominal pain. Dkt. No. 49 at ¶9. General surgery was consulted, and plaintiff underwent a CT scan of the abdomen. Id. Plaintiff was diagnosed with incisional hernia wound site dehiscence and seroma. Id. Infection of the incision site could not be ruled out by the CT scan, and plaintiff was prophylactically placed on intravenous antibiotics. Id. at 12. Plaintiff was not diagnosed with an infection of the incision site. Id. Plaintiff was discharged from Upstate on April 27, 2012 with no activity restrictions other than those given to him in the postoperative period. Id. at ¶¶ 13-14. Given plaintiff's questionable history of MRSA, he was discharged with Bactrim (an antibacterial medication) to be given twice daily until his scheduled follow-up appointment with Dr. Wells. Id. at ¶13.
Upon return to Mid-State on April 27, 2012, plaintiff was admitted to the infirmary. Dkt. No. 50 at ¶37. Plaintiff was placed on contact precautions due to his history of MRSA, which included a positive culture on April 19, 2012, but negative cultures during his admission to Upstate from April 24, 2012 through April 27, 2012. Id. Upon admission to the infirmary on April 27, Dr. Ramineni ordered that plaintiff be given Tylenol # 3 as needed for three days. Dkt. No. 50 at ¶38. During plaintiff's stay in the infirmary from April 27, through May 2, plaintiff's dressings were changed daily. Id. at ¶39. Plaintiff's wound healed, and he was discharged to general population by non-defendant Mid-State physician, Dr. Rabinowitz, on May 2. Id.
Plaintiff was next seen at sick call on May 8, 2012. Dkt. No. 50 at ¶40. At that time, his wound was clean and healing well. Id. Although he had a small amount of serous drainage, according to Dr. Ramineni, it was not medically serious and was expected to resolve on its own. Id. On May 11, 2012, Mid-State received a call from Walsh Regional Medical Unit ("Walsh"), requesting to see plaintiff regarding his hernia repair. Id. at ¶42. Plaintiff was sent to Walsh that day. Id.
At Walsh, Dr. Wells saw plaintiff for a follow-up visit, at which time, plaintiff showed no signs of infection and his wound was closing with no further seroma drainage. Dkt. No. 49 at ¶15. According to Dr. Wells, "[p]laintiff indicated he still had discomfort from the hernia repair and was advised to use the support garment." Id. Dr. Wells indicated that plaintiff should be rechecked in one month. Id.
Plaintiff was next seen at sick call on May 31, 2012, complaining of pain and swelling. Dkt. No. 50 at ¶44. According to Dr. Ramineni, "[u]pon assessment no drainage was present and the wound opening was clean and dry" and "[p]laintiff's temperature was normal and [he] was advised to continue using the abdominal binder." Id. Plaintiff was next seen by Dr. Wells on June 8, 2012. Dkt. No. 49 at 16. At that time, Dr. Wells found that plaintiff had post-operative seroma, but no infection. Id. He also noted that plaintiff had a remaining area of induration over the mesh which was slowly resolving, and concluded that plaintiff could resume his work duties. Id. Dr. Wells had no further involvement with plaintiff's medical care. Id. at ¶17.
On June 21, 2012, plaintiff was seen at sick call concerned about his blood pressure and complaining of dizziness. Dkt. No. 50 at ¶47. According to Dr. Ramineni, assessment revealed that plaintiff's incision line had healed and there was no drainage. Id. Plaintiff's medical records indicate that after June 21, plaintiff made no further complaints concerning his hernia repair, no further treatment regarding his hernia repair was indicated, and no further treatment regarding his hernia repair was provided. Id. at ¶48.
II. Discussion
Plaintiff contends that defendants Dr. Ramineni and Dr. Wells were deliberately indifferent to his medical needs in violation of the Eighth Amendment through their failure to treat his possible MRSA infection and in denying him adequate pain relief medication.
A. Summary Judgment Standard
In order for a motion for summary judgment to be granted, the movant must show that (1) there is no genuine issue of any material fact, and (2) the movant is entitled to judgment as a matter of law. FED. R. CIV. P. 56(C); Celotex Corp v. Catrett, 477 U.S. 317, 323 (1986). Facts are material if they may affect the outcome of the case as determined by substantive law. Anderson v. Liberty Lobby, 477 U.S. 242, 248.
Where, as here, a party seeks judgment against a pro se litigant, a court must afford the non-movant special solicitude. See Triestman v. Fed. Bureau of Prisons, 470 F.3d 471, 477 (2nd Cir. 2006). As the Second Circuit has stated,
[t]here are many cases in which we have said that a pro se litigant is entitled to "special solicitude," . . . that a pro se litigant's submissions must be construed "liberally," . . . and that such submissions must be read to raise the strongest arguments that they "suggest," . . . . At the same time, our cases have also indicated that we cannot read into pro se submissions claims that are not "consistent," with the pro se litigant's allegations . . . or arguments that the submissions themselves do not "suggest," . . . that we should not "excuse frivolous or vexatious filings by pro se litigants," . . . and that pro se status "does not exempt a party from compliance with relevant rules of procedural and substantive law . . . ."Id. (citations and footnote omitted); see also Sealed Plaintiff v. Sealed Defendant #1, 537 F.3d 185, 191-92 (2d Cir. 2008) ("On occasions too numerous to count, we have reminded district courts that 'when a plaintiff proceeds pro se, . . . a court is obliged to construe his pleadings liberally.'") (citations omitted). However, mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly-supported motion; the requirement is that there be no genuine issue of material fact. Anderson, 477 U.S. at 247-48.
Defendants Dr. Wells and Dr. Ramineni move for summary judgment, contending that plaintiff cannot establish that (1) he suffered from a serious medical need, or (2) defendants acted with deliberate indifference to that medical need. Dkt. No. 48-3 at 1.
B. Medical Indifference
The Eighth Amendment explicitly prohibits the infliction of "cruel and unusual punishment." U.S. CONST. amend. VIII. The prohibition against cruel and unusual punishment includes the right to be free from conditions of confinement that impose an excessive risk to an inmate's health or safety. Farmer v. Brennan, 511 U.S. 825, 834, 837 (1994); Hathaway v. Coughlin, 37 F.3d 63, 66 (2d Cir. 1994). A viable Eighth Amendment claim is twofold; the plaintiff must demonstrate both objective and subjective components. Farmer, 511 U.S. at 834. The objective question asks whether the deprivation of which the inmate complains was sufficiently serious. Id. This component "requires a court to assess whether society considers the risk that the prisoner complains of to be so grave that it violates contemporary standards of decency to expose anyone unwillingly to such a risk." Helling v. McKinney, 509 U.S. 25, 36 (1993). Thus, the prisoner must show that "the risk of which he complains is not one that today's society chooses to tolerate." Id. at 36. The subjective component requires the inmate to show that the defendant demonstrated deliberate indifference by having knowledge of the risk and failing to take measures to avoid the harm. Farmer, 511 U.S. at 834. The Supreme Court of the United States has held that, "[w]hether one characterizes the treatment received by [the prisoner] as inhumane conditions of confinement, failure to attend to his medical needs, or a combination of both, it is appropriate to apply the 'deliberate indifference' standard articulated in Estelle [v.Gamble]." Wilson v. Seiter, 501 U.S. 294, 303 (1991). Deliberate indifference exists if an official "knows of and disregards an excessive risk to inmate health or safety; the official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference." Farmer, 511 U.S. at 837.
i. Serious Medical Condition
The Eighth Amendment extends to the provision of medical care. Hathaway, 37 F.3d at 66. "'Because society does not expect that prisoners will have unqualified access to healthcare,' a prisoner must first make [a] threshold showing of serious illness or injury" to state a cognizable claim. Smith v. Carpenter, 316 F.3d 178, 184 (2d Cir. 2003) (quoting Hudson v. McMillian, 503 U.S. 1, 9 (1992)). What constitutes a serious medical condition is determined by factors such as "(1) whether a reasonable doctor or patient would perceive the medical need in question as 'important and worthy of comment or treatment,' (2) whether the medical condition significantly affects daily activities, and (3) 'the existence of chronic and substantial pain.'" Brock v. Wright, 315 F.3d 158, 162 (2d Cir. 2003) (quoting Chance v. Armstrong, 143 F.3d 698, 702 (2d Cir. 1998)). The severity of the denial of care should also be judged within the context of the surrounding facts and circumstances of the case. Smith, 316 F.3d at 185.
In Whitcomb v. Todd, the Court indicated,
[I]t is clear that a reasonable medical professional would recommend treatment for this condition as Whitcomb was attended by nurses and physicians multiple times per day. Furthermore, this condition allegedly affected Whitcomb's ability to bathe and, at a minimum, required him to pause whatever he was undertaking throughout the day to undergo multiple wound dressing changes and the administration of antibiotics. While it is unclear whether the pain was substantial, there is little dispute that it was chronic.Whitcomb v. Todd, No. 04-CV-223 (LEK/DRH), 2008 WL 4104455, at *10 (N.D.N.Y. Sept. 3, 2008). Thus, the Court in Whitcomb concluded that the plaintiff's condition constituted a serious medical condition. Id.
Here, the April 19, 2012 culture tested positive for MRSA. Dkt. No. 50 at ¶25. However, the following day, Dr. Ramineni saw plaintiff and noted that he had no signs of infection, and indicated that the he should follow up within one week. Id. at ¶26. Dr. Ramineni saw plaintiff on April 24, removed plaintiff's staples, cleaned plaintiff's wound, and applied Betadine and a large band aid. Id. at ¶29. Plaintiff was seen later that morning by nursing staff, and he was given ibuprofen to be taken as needed for pain management. Id. at ¶30. Later that afternoon, plaintiff was seen at emergency sick call, and he was sent to St. Luke's via ambulance. Id. at ¶31. When plaintiff returned to Mid-State later that day, he was sent to the emergency room at Upstate to be seen by Dr. Wells. Id. at ¶32. General surgery was consulted, plaintiff underwent a CT scan of the abdomen, was diagnosed with incisional hernia wound site dehiscence and seroma, and was prophylactically placed on intravenous antibiotics. Dkt. No. 49 at ¶¶9, 12. Plaintiff was discharged from Upstate on April 27, 2012 with Bactrim to be given twice daily, until his scheduled follow up with Dr. Wells. Id. at ¶13.
Here, defendants closely monitored plaintiff, routinely cleaned the infection site and dressings, kept close watch on plaintiff with a series of follow-up appointments, and prescribed plaintiff medicine - both prophylactically and for pain management. Both the level of care and precautionary measures taken demonstrate that plaintiff's possible MRSA infection is a condition which a reasonable patient and doctor would consider "important and worthy of comment or treatment," as considered by the first factor in determining the seriousness of the inmate's medical condition. Whitcomb, 2008 WL 4104455 at *10 (citing Brock, 315 F.3d at 162-63).
Additionally, defendants Dr. Wells and Dr. Ramineni placed plaintiff on contact precautions due to his history of MRSA, which included a positive culture on April 19, 2012, but negative cultures during his admission to Upstate from April 24, through April 27. Dkt. No. 50 at ¶37. As in Whitcomb, the precautions taken and frequent medical care and follow-up demonstrate that this medical condition significantly affects plaintiff's daily activities. Whitcomb, 2008 WL 4104455 at *10.
Addressing the final factor, existence of chronic and substantial pain, that plaintiff returned to sick call several times complaining of pain, and the medical providers gave him additional medication each time, demonstrates the existence of pain as a result of plaintiff's medical conditions. Brock, 315 F.3d at 162-63. In Crum v. Marini, the Court indicated that "where there is some evidence that the severe pain the inmate complains of may be real, it is not appropriate to dismiss such complaints on the grounds that they are 'subjective.'" Crum v. Marini, No. 06-CV-0513 (GLS/DRH), 2007 WL 3104750, at *3 (N.D.N.Y. Oct. 22, 2007). Here, as plaintiff repeatedly sought medical care for his complaints of pain, there exists a question of fact as to the existence of chronic and substantial pain.
Therefore, the above facts taken together, indicate the possibility of MRSA in plaintiff's incisional wound, and constitute a serious medical condition for a medical indifference claim.
ii. Deliberate Indifference
To satisfy the subjective component for claims of inadequate medical care, the plaintiff must prove that the defendants acted with deliberate indifference. Farmer, 511 U.S. at 834. As discussed, deliberate indifference requires the plaintiff "to prove that the prison official knew of and disregarded the prisoner's serious medical needs." Chance, 143 F.3d at 703. Because the prison official must have had knowledge of the risk, the prison official must have been "intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed." Estelle, 429 U.S. at 104-05. It has been established that "[d]eliberate indifference is 'a mental state equivalent to subjective recklessness,' and requires that the defendant 'act or fail to act while actually aware of a substantial risk that serious inmate harm will result," and, therefore, "[m]ere disagreement over proper treatment does not create a constitutional claim" as long as the treatment was adequate. Crum, 2007 WL 3104750 at*4 (quoting Salahuddin v. Goord, 467 F.3d 263, 280 (2d Cir. 2006)). Thus, "disagreements over medications, diagnostic techniques (e.g. the need for X-rays), forms of treatment, or the need for specialists . . . are not adequate grounds for a section 1983 claim." Sonds v. St. Barnabas Hosp. Corr. Health. Servs., 151 F. Supp. 2d 303, 312 (S.D.N.Y. 2001).
Plaintiff contends that (1) defendant doctors knew of the presence of his infection and (2) failed to treat it adequately. The Court in Crum, found that "[t]here is no evidence, beyond [the plaintiff's] conclusory allegations, that [his] medical needs were ignored," where the plaintiff's "medical records indicate that he was evaluated by various medical personnel on numerous occasions during his time at [the correctional facility]; that he was prescribed medication for his pain; that he was given x-rays and MRIs; and that defendant [doctor] periodically reviewed his medical records." Crum, 2007 WL 3104750 at *4. Similarly, the Court in Atkinson v. Fisher, held that, where "[p]laintiff was evaluated by medical personnel frequently, prescribed pain medication, and given X-rays" and defendant doctors "periodically examined him and reviewed his medical records . . . [p]laintiff has not raised a genuine issue of material fact that [d]efendants were deliberately indifferent to his serious medical need." No. 07-CV-368 (GLS/GHL), 2009 WL 3165544, at *13 (N.D.N.Y. Sept. 25, 2009).
In the present case, defendants contend that, although an infection could not be ruled out, plaintiff was never actually diagnosed with having an infection. Dkt. No. 49 at ¶12. Further, they point out that, in response to plaintiff's "questionable history with MRSA," he was prescribed antibacterial medication, scheduled for follow-up visits, and transported between locations. Dkt. No. 50 at ¶¶ 22-25, 31, 34, 36. Additionally, defendants opine that plaintiff's cultures of his wound were continuously re-tested. Id. at ¶¶ 22-23, 25, 34. His wound was also cleaned several times and his dressing changed while he was in the infirmary. Id. at ¶39.
It is clear that defendants took measures to treat and avoid the harm of the possible infection, including prescribing pain medication, including antibacterial medication, cleaning the wound, keeping plaintiff in the infirmary for days at a time, instructing him on how to treat his wound, scheduling follow-up visits, and re-testing the incision site. Dkt. No. 50 at ¶¶29, 34, 36, 37, 39. These measures sufficiently prove that defendants did not "disregard[] the prisoner's serious medical needs," nor did they deny or delay plaintiff medical care. Chance, 143 F.3d at 703; Estelle, 429 U.S. at 104. Therefore, plaintiff had failed to demonstrate that defendants were deliberately indifference to his serious medical condition.
Insofar as plaintiff argues that the medications defendants prescribed to him for pain management were inadequate, defendants' choice to treat plaintiff's pain with Tylenol #3 and Ibuprofen, is entirely within their discretion. Sonds, 151 F.Supp at 312 (S.D.N.Y. 2001). This is merely a "disagreement over medications," and, therefore, "does not create a constitutional claim." Id.; Chance, 143 F.3d at 703 (2d Cir. 1998).
The above facts, taken together, demonstrate that defendants had knowledge of plaintiff's serious medical condition and took sufficient measures to avoid the risk of harm posed by the presence of MRSA in his incisional wound. Therefore, plaintiff fails to demonstrate that defendants were deliberately indifferent to his serious medical needs.
III. CONCLUSION
For the reasons stated above, it is hereby RECOMMENDED that defendants' motion for summary judgment (Dkt. No. 48) be GRANTED, and plaintiff's claim be DISMISSED as to all claims and all defendants; and it is further
ORDERED that the Clerk serve a copy of the Report-Recommendation and Order on the parties in accordance with local rules.
Pursuant to 28 U.S.C. § 636(b)(1), the parties may lodge written objections to the foregoing report. Such objections shall be filed with the Clerk of the Court "within (14) days after being served with a copy of the . . . recommendation." N.Y.N.D.L.R. 72.1(c) (citing 28 U.S.C. § 636(b)(1)(B)-(C)). FAILURE TO OBJECT TO THIS REPORT WITHIN FOURTEEN (14) DAYS WILL PRECLUDE APPELLATE REVIEW. Roldan v. Racette, 984 F.2d 85, 89 (2d Cir. 1993); Small v. Sec'y of HHS, 892 F.2d 15 (2d Cir. 1989); 28 U.S.C. § 636(b)(1); FED. R. CIV. P. 72, 6(a), 6(e). Dated: April 23, 2015
Albany, New York
/s/_________
Christian F. Hummel
U.S. Magistrate Judge