Opinion
No. 7:02-CV-280-R.
October 8, 2004
ORDER
Came on this day to be considered Defendant Powell's motion for summary judgment and Plaintiff's response thereto and the Court finds and orders as follows:
This is an action brought pursuant to 42 U.S.C. § 1983 by an inmate confined in the Allred Unit of the Texas Department of Criminal Justice in Iowa Park, Texas. Plaintiff, John Edward Easter, claims that Nurse Gayla Powell was deliberately indifferent to his serious medical needs which constitutes cruel and unusual punishment, a violation of the Eighth Amendment of the U.S. Constitution. Easter states that, on August 4, 2002, he went to the Allred Unit infirmary because he had been experiencing severe chest pains for about 20 minutes. Complaint ¶ V; Plaintiff's Answer to the Court's Question No. 3. He claims that Nurse Powell took his blood pressure and told him to leave the infirmary. Id. Easter complains that, despite his well-documented history of arteriosclerotic cardiovascular disease and a previous heart attack, Nurse Powell refused to provide the nitroglycerin tablets that were prescribed for him to take when experiencing chest pain. Id; Plaintiff's Answer to the Court's Question No. 1. Easter claims that Powell told him to go to the "pill window" to get the tablets. Id. However, he claims, the "pill window" did not open for another three to four hours. Complaint ¶ V. Easter states that, despite his pleas for treatment, Powell called security and had him escorted back to his cell. Plaintiff's Answer to the Court's Question No. 3. Easter claims that he remained in his cell in severe pain until a prison security officer notified Powell's supervisor who ordered Easter to be returned to the medical department where he was immediately provided with nitroglycerin tablets. Plaintiff's Answer to the Court's Question No. 1. Plaintiff claims that he could have been suffering a heart attack, that he thought he might die and that, as a result of Powell's deliberate indifference to his serious medical need, he was forced to needlessly endure four hours of severe chest pain. Plaintiff's Answers to the Court's Questions No. 3 6. Easter seeks $4000 in monetary damages for pain, suffering and mental anguish and an additional $5000 in punitive damages for the alleged violation of his Eighth Amendment rights. Plaintiff's Answer to the Court's Question No. 6.
Plaintiff states that his daily cardiovascular medications are diltaizem 250 mg, atenolol 50 mg, enalapril 20 mg, hydrochorothiazide 50 mg, aspirin 325 mg and clonidine 0.2. Plaintiff's Answer to the Court's Question No. 3.
Nurse Powell argues that Plaintiff is not entitled to relief. In her motion for summary judgment, Powell states that she relied upon a previously prescribed plan of treatment in responding to Plaintiff's complaint of chest pain and that the instant complaint amounts to a disagreement with the nature of the treatment provided rather than an actionable claim of deliberate indifference. Defendant's Brief in Support of Her Motion for Summary Judgment p. 6. (hereinafter "Brief in Support p. ___"). Moreover, she argues, the short delay in providing Plaintiff with his medication did not result in substantial harm as required to state a viable Eighth Amendment claim. Brief in Support p. 7. Further, Defendant argues that she is entitled to qualified immunity from suit. Id. at pp. 7-10.
In order to state a colorable claim for the denial of medical care under the Eighth Amendment, an inmate must allege acts or omissions "sufficiently harmful to evidence deliberate indifference to serious medical needs." Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 292 (1976). "Deliberate indifference" under the Eighth Amendment occurs only where a prison official subjectively knows of and disregards a substantial risk to the inmate's health or safety. Farmer v. Brennan, 511 U.S. 825, 837, 114 S.Ct. 1970, 1979 (1994); Hare v. City of Corinth, Miss., 74 F.3d 633, 650 (5th Cir. 1996). A delay in medical care can, in some instances, constitute an Eighth Amendment violation if it results in substantial harm. Mendoza v. Lynaugh, 989 F.2d 191, 195 (5th Cir. 1993); Wesson v. Oglesby, 910 F.2d 278, 284 (5th Cir. 1990).
While a delay in providing treatment may rise to the level of a constitutional violation, negligent or erroneous medical treatment or judgment does not provide a basis for a § 1983 claim. Graves v. Hampton, 1 F.3d 315, 319 (5th Cir. 1993). As long as jail medical personnel exercise professional medical judgment, their behavior will not violate a prisoner's constitutional rights. See Youngberg v. Romeo, 457 U.S. 307, 322-23, 102 S.Ct. 2452, 2461-62 (1982). A disagreement over the appropriate medical treatment constitutes, at most, a possible claim of medical malpractice appropriately addressed under state law. E.g., Estelle v. Gamble, 429 U.S. at 107-08, 97 S.Ct. at 293; Varnado v. Lynaugh, 920 F.2d 320, 321 (5th Cir. 1991); Fielder v. Bosshard, 590 F.2d 105, 107 (5th Cir. 1979).
Review of the pleadings and evidence submitted in this action reflects that it is undisputed that Plaintiff is an individual with a history of cardiovascular ailments. The medical records submitted by Defendant reflect that, on August 4, 2002 at 10:15 a.m., Plaintiff entered the infirmary with a complaint of chest pain. Appendices to Defendant's Brief in Support of Her Motion for Summary Judgment p. 7 (hereinafter "Appendices p. ___"). Defendant Powell took his blood pressure and it registered 136/96. Id. His pulse was 71. Id. Plaintiff wanted to "talk to medical" but Nurse Powell "told him he was free to go." Id. Powell's notes reflect that Easter was upset and wanted treatment for the chest pain. Id. at pp. 6-7. Powell told him his blood pressure was normal and that he had been seen by a "provider" two days earlier and had been told about the treatment plan. Id. at p. 6. When Plaintiff asked about his nitroglycerin, Powell told him that his prescription was current and that he should go to the pill window where he could get 10 pills at a time as he was instructed by the "provider" two days earlier. Id. Powell noted that Easter was "still wanting to argue" and that he was "told again to leave [the] clinic." Id. Powell's final note is "Offender RTC." Id. Plaintiff states that this entry indicates "offender returned to cell." Plaintiff's Answer to the Court's Question No. 3. The next entry in Plaintiff's medical record was that same day at 2:50 p.m. when Easter was "[i]ssued 10 nitro tabs . . . KOP." Appendices p. 6. Plaintiff states that "KOP" indicates "keep on person." Plaintiff's Answer to the Court's Question No. 3.
Defendant Powell has submitted the Affidavit of David E. Potter, D.O. in support of her motion for summary judgment. Appendices pp. 1-2. In addition to reviewing the entries from the medical records discussed above, Dr. Potter states that he feels "that Nurse Powell would have listened carefully to Mr. Easter and helped him obtain his nitroglycerin pills in a different manner if Mr. Easter had not displayed such anger." Id. p. 1. Dr. Potter further states that "[Easter's] presentation did not allow Nurse Powell to evaluate both his chest pain complaint and his request for a refill of nitroglycerin at the same time." Id. Potter then mentions Easter's "difficult behavior," his "display of anger" and the resulting "increased tension in the clinic lobby" as causes contributing to incident underlying this cause of action. Id.
In his response to Defendant's motion for summary judgment, Plaintiff aptly states that Dr. Potter was not present in the infirmary on the day of the incident and, therefore, cannot possibly provide a sworn statement as to the nature of Plaintiff's conduct during the incident or as to the level of tension, if any, in the clinic lobby. Plaintiff's Response to Defendant Powell's Motion for Summary Judgment pp. 1-2 (hereinafter "Plaintiff's Response p. ___"). As discussed earlier, the medical records provided by Defendant state that Plaintiff became "upset" after being told to leave the clinic without treatment for his chest pain and that Plaintiff "wanted to argue" when told to go to the pill window to get the medication he needed. The scant medical records provided by Defendant and Dr. Potter's affidavit indicate that Plaintiff is a cardiac patient with a history of a myocardial infarction and angina serious enough to warrant keeping nitroglycerin on his person while incarcerated. This Court may take judicial notice that severe chest pains in a cardiac patient can, as Plaintiff argues, be indicative of conditions more serious than angina, such as myocardial infarction, that could result in death. See Plaintiff's Response at p. 3. Thus, it is not surprising to the Court that Plaintiff may have become somewhat persistent in seeking treatment after being told there would be none at that time.
Viewing the facts in a light most favorable to Plaintiff, as the Court must do at this stage of the proceedings, the Court bases this decision on the following:
Plaintiff has shown that Defendant Powell was aware of his cardiac condition and that she was aware he had been prescribed a course of therapy that required the administration of nitroglycerin if Plaintiff presented with severe chest pains. Powell makes no claim that nitroglycerin was not immediately available in the infirmary during the incident underlying this lawsuit. Rather than follow the prescribed course of therapy by administering nitroglycerin, Defendant Powell had plaintiff removed from the infirmary and returned to his cell. Such conduct on the part of Defendant Powell resulted in a delay in treatment thereby allegedly causing Plaintiff to suffer severe chest pain for four hours. Powell does not argue that the nitroglycerin pills were immediately available at the prison pill window. The Court finds that, assuming these facts, such conduct on the part of a Defendant would rise to the level of deliberate indifference to a serious medical need.
Defendant has not refuted Plaintiff's claim that he was suffering severe chest pain during the incident in question. The parties do not dispute that, once the nitroglycerin was administered, Plaintiff's immediate medical need was resolved. Plaintiff makes no claim of any lasting complications resulting from the delay in administering the nitroglycerin. Defendant cites Mendoza v. Lynaugh, 989 F.2d 191 (5th Cir. 1993) in support of her argument that, absent a showing of deliberate indifference resulting in substantial harm, Plaintiff cannot show an Eighth Amendment violation. This is a correct statement of the law and, because Plaintiff makes no claim of substantial harm, he has failed to show an Eighth Amendment violation as to the delayed treatment. However, because Defendant does not dispute Plaintiff's claim of severe chest pain lasting four hours after he was denied medication, Easter may recover monetary damages for the pain he has alleged to have suffered during the delay. See Hanna v. Corrections Corporation of America, 95 Fed. Appx. 531, 533, 2004 WL 180359 (5th Cir. 2004) (citing Thompkins v. Belt, 828 F.2d 298, 301 (5th Cir. 1987)).
With regard to Defendant Powell's claim to the defense of qualified immunity, the Court finds and orders as follows:
Government officials are entitled to qualified immunity from suit when performing discretionary functions unless their conduct violated statutory or constitutional rights, clearly established at the time of the alleged incident, of which a reasonable person would have known. Gibson v. Rich, 44 F.3d 274, 277 (5th Cir. 1995). The question of qualified immunity should be resolved at the earliest possible stage of litigation because it involves an entitlement to immunity from suit. Hunter v. Bryant, 502 U.S. 224, 226, 112 S.Ct. 534, 536 (1991); accord Gibson, 44 F.3d at 277. The first step in evaluating a government official's entitlement to a defense of qualified immunity is to determine both what the current applicable law is and whether it was clearly established at the time of the events giving rise to the lawsuit. Schultea v. Wood, 47 F.3d 1427, 1432 (5th Cir. 1995) (citing Siegert v. Gilley, 500 U.S. 226, 231, 111 S.Ct. 1789, 1793 (1991)). If the plaintiff has stated a violation of a constitutional right which was clearly established at the time, the court should then determine whether a reasonable official would have understood that his or her conduct violated that right. Anderson v. Creighton, 483 U.S. 635, 640, 107 S.Ct. 3034, 3039 (1987).
The pleadings and summary judgment evidence submitted by the parties in this case establish that the facts relevant to a determination on the question of qualified immunity are not in dispute. At the time of the incident underlying this lawsuit, it was clearly established that the Eighth Amendment affords individuals the constitutional right to care for serious medical needs while incarcerated. Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 292 (1976). It was also clearly established that a delay in medical care could rise to the level of a constitutional violation. Mendoza v. Lynaugh, 989 F.2d 191 (5th Cir. 1993); Thompkins v. Belt, 828 F.2d 298, 301 (5th Cir. 1987). In claiming a denial of medical care for serious chest pains, Plaintiff, a cardiac patient with a history of heart attack, has stated a violation of a constitutional right which was clearly established at the time.
Plaintiff appeared at the infirmary complaining of chest pains. Review of Nurse Powell's entry in Plaintiff's medical records from that day reflect that Plaintiff was returned to his cell without any diagnosis as to the cause of his pain at that time. Appendices pp. 6-7. The Court has taken judicial notice that severe chest pains can be indicative of a serious medical need, especially in a cardiac patient such as Plaintiff. Plaintiff claims that the medication he needed, nitroglycerin, was not readily available outside the infirmary. Defendant does not dispute this claim. Plaintiff claims that nitroglycerin has been prescribed as the medication to be administered anytime he experienced chest pains and that, if the pain persisted for 15 minutes after the medication was given, a physician was to be called. Plaintiff's Answer to the Court's Question No. 3; Plaintiff's Response to Defendant's Motion for Summary Judgment p. 2. Easter states that the label on his empty pill bottle contained this information and that he showed the bottle to Nurse Powell when he was in the infirmary. Plaintiff's Answer to the Court's Question No. 3.
Nurse Powell does not dispute Plaintiff's factual allegations. Her argument that Plaintiff had been provided with a treatment plan two days earlier and that her actions were in full compliance with that plan is unpersuasive. The Court hereby finds that a reasonable nurse would have understood that turning away a cardiac patient who was suffering severe chest pains without taking some action to provide treatment would violate that inmate's right to care for a serious medical need. While Powell may have believed Plaintiff was in no danger at the time, there is no indication as to that fact in the record. Based upon these findings, Defendant Powell is not entitled to qualified immunity from suit.
Summary judgment is proper when the pleadings and evidence illustrate that no genuine issue exists as to any material fact and that the movant is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Slaughter v. Southern Talc Co., 949 F.2d 167, 170 (5th Cir. 1991). Disputes concerning material facts are genuine if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Douglass v. United Servs. Auto. Ass'n, 79 F.3d 1415, 1429 (5th Cir. 1996) (en banc) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510 (1986)). Substantive law provides that an issue is "material" if it involves a fact that might affect the outcome of the suit under the governing law. Anderson, 477 U.S. at 248, 106 S.Ct. at 2510; Burgos v. Southwestern Bell Telephone Co., 20 F.3d 633, 635 (5th Cir. 1994). The nonmovant is not required to respond to the motion until the movant properly supports his motion with competent evidence. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2553 (1986); Tubacex, Inc. v. M/V Risan, 45 F.3d 951, 954 (5th Cir. 1995). However, once the movant has carried his burden of proof, the nonmovant may not sit idly by and wait for trial. Page v. DeLaune, 837 F.2d 233, 239 (5th Cir. 1988).
When a movant carries his initial burden, the burden then shifts to the nonmovant to show that the entry of summary judgment is inappropriate. Celotex, 477 U.S. at 322-24, 106 S.Ct. at 2552-53; Duckett v. City of Cedar Park, Tex., 950 F.2d 272, 276 (5th Cir. 1992). Although the nonmovant may satisfy this burden by tendering depositions, affidavits, and other competent evidence, "conclusory allegations, speculation, and unsubstantiated assertions are inadequate to satisfy the nonmovant's burden," Douglass, 79 F.3d at 1429, as "the adverse party's response . . . must set forth specific facts showing that there is a genuine issue for trial." Fed.R.Civ.P. 56(e). Merely colorable evidence or evidence not significantly probative, however, will not defeat a properly supported motion for summary judgment. Anderson, 477 U.S. at 249-50, 106 S.Ct. at 2510-11. Furthermore, a mere scintilla of evidence will not defeat a motion for summary judgment. Anderson, 477 U.S. at 252, 106 S.Ct. at 2512; Davis v. Chevron U.S.A., Inc., 14 F.3d 1082, 1086 (5th Cir. 1994).
Summary judgment evidence is viewed in the light most favorable to the party opposing the motion. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 1356 (1986); Rosado v. Deters, 5 F.3d 119, 123 (5th Cir. 1993). In addition, factual controversies are resolved in favor of the nonmovant, but only when both parties have submitted evidence of contradictory facts, thus creating an actual controversy. Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994) (en banc). In the absence of any proof, however, the Court does not assume that the nonmovant could or would prove the necessary facts. Id.
In making its determination on the motion, the Court looks at the full record including the pleadings, depositions, answers to interrogatories, admissions, and affidavits. Fed.R.Civ.P. 56(c); Williams v. Adams, 836 F.2d 958, 961 (5th Cir. 1988). However, "the [Court's] function is not to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial." Anderson, 477 U.S. at 249, 106 S.Ct. at 2511. The movant's motion for summary judgment will be granted if he meets his burden and the nonmovant fails to make the requisite showing that a genuine issue exists as to any material fact. Fed.R.Civ.P. 56(c); Campbell v. Sonat Offshore Drilling, Inc., 979 F.2d 1115, 1119 (5th Cir. 1992).
The summary judgment evidence presented in this case establishes that there are genuine issues of material fact remaining in this case.
For the foregoing reasons, it is ORDERED that Defendant's motion for summary judgment is GRANTED as to Plaintiff's Eighth Amendment claim related to the delay in medical care.
It is further ORDERED that Defendant's motion for summary judgment is DENIED as to Plaintiff's claim for monetary damages arising out of the pain allegedly suffered during the delay in providing medical care.
It is further ORDERED that Defendant's motion for summary judgment based on qualified immunity is DENIED.
SO ORDERED.