REPORT AND RECOMMENDATION
MARTIN C. CARLSON, Magistrate Judge.
Michael Midgley is an inmate who was formerly housed in the Lackawanna County Prison. On July 17, 2013, Midgley filed a complaint with this court, which alleged in part that prison medical staff were deliberately indifferent to his serious medical needs during a period which spanned from May through July of 2013. (Doc. 1.) Midgley's complaint named five individual and institutional medical defendants: CCI Medical, Inc., the institutional health care provider at the prison, Dr. Zaloga, the prison medical director, Nurse Jackie, Nurse Kenny, and Tony Ianuzzi, a Nurse-Physician Assistant at the prison.
Liberally construed, Midgely's complaint lodged two allegations of deliberate indifference to his medical needs against these medical defendants. First, Midgley complained that prison staff improperly compelled the plaintiff, an inmate who suffered from chronic high blood pressure, to take additional blood pressure medication on May 6, 2013, when he appeared at the prison medical department complaining of a headache, and testing revealed that he had an elevated blood pressure. (Doc. 1, ¶9.) When Midgley angrily disputed this course of treatment, he alleges that he was improperly placed in a psychiatric observation cell overnight. (
The following day, May 7, 2013, Midgley contends that unnamed correctional officers then used excessive force against him when they removed him from this cell. According to Midgley this use of force resulted in the plaintiff suffering both a broken and a dislocated knee. (
The case against these medical personnel has proceeded on the basis of these allegations, allegations which the medical defendants now challenge through a thoroughly documented motion for summary judgment, which details the care, treatment and medical conditions experienced by Midgley in the Summer of 2013. (Docs. 90-92.) Midgley has responded to this motion in an erratic and largely inarticulate fashion, filing an unsworn declaration which consists of little more that denunciation of the defendants' well-documented pleadings as lies, coupled with a collection of unrelated articles apparently gleaned from the internet which discuss the hazards of generic drugs and other largely unrelated conditions at the Lackawanna County Prison. (Docs. 95 and 96.)
Statement of Facts and of The Case
With the factual record framed in this fashion, we find that the following facts are essentially undisputed in this case: Michael Midgley is a criminal recidivist who has been incarcerated at the Lackawanna County Prison on six occasions. The events which give rise to the instant case took place during a period of incarceration at this institution which spanned from July 6, 2012, to July 17, 2013. On July 17, 2013, Midgley was transferred from the Lackawanna County Prison to the State Correctional Institution (SCI) Graterford. (Doc. 91, ¶3.)
Midgley has a longstanding medical history marked by chronic complaints of high blood pressure dating back to when he was approximately 13 or 14 years old. Midgley has received on-going medical care for this high blood pressure and been taking medication for this condition since he was approximately 21 years old. (
While he was housed at the Lackawanna County Prison, Midgley also had a history of episodic non-compliance with his medication regimen. These episodes of non-compliance with health care often accompanied moments of interpersonal strife arising from the dissolution of Midgley's marriage. For example, in a letter to medical staff dated October 15, 2012, seven months prior to the events set forth in this complaint, Midgley lamented the separation from his family, claimed that he was having a nervous breakdown, stated that "I can't take this pain any more," and refused his medications, writing as follows:
(Doc. 93, Ex. F.)
In May of 2013, Midgley once again found himself confronting domestic interpersonal strife, and became non-complaint with his blood pressure medication. On the morning of May 6, 2013, Midgley was scheduled to attend a domestic relations divorce hearing. Prison medical records reveal that Midgley either refused or failed to appear to receive his blood pressure medication prior to that court appearance. (Doc. 90, ¶8.) Later that morning, Midgley was transported by Sheriff to the Lackawanna County Courthouse in order to attend an all-day divorce hearing in family court. (
At 10:00 p.m. on May 6, 2016, Midgley required, and received, further medical care and attention as documented in prison medical progress records. According to those medical records:
Approximately two hours and forty-five minutes later, in the early morning hours of May 7, 2013, the nurse recorded a further decline in Midgley's physical and emotional state and described efforts undertaken by medical personnel to ensure his safety and well-being, noting that:
Nurse to unit for med watches — I/M became belligerent — verbally abusive — refused v.s. (vital signs) stating that—(medical) is not giving the right meds — that's why he has not been taking his meds. I/M stated that he keeps falling out of bed, is having a stroke. Refused v.s. and neuro checks — belligerent — threatening to staff. I/M moved to Delta camera cell for observation.
Midgley's angry and irrational behavior continued throughout the morning of May 7, 2013, with Midgley refusing to comply with medical instructions and engaging in self-destructive and harmful behaviors. As medical personnel noted at 11:00 a.m. on May 7, 2013.
I/M in cell. Refusing meds and v.s. (vital signs) illegible. I/M placed into four point restraints. I/M stated that "I want to have a stroke . . . I'm on a hunger strike . . . I'm not taking meds or anything." Four point restraints applied. Illegible. BP 220/120. Refusing meds. Shift supervisor aware. Call into Dr. Mallik (prison psychiatrist).
Thus, the undisputed evidence shows that with respect to Midgley's health care on May 6 and 7, 2013, health care which forms the basis for his initial Eighth Amendment claim, the prison care-givers were presented with an emotionally distraught, medically non-complaint and belligerent inmate who was experiencing significant symptoms of chronic high blood pressure. Presented with this constellation of medical, emotional and psychological concerns, the nursing staff provided Midgley with additional medication to try to curb the spike in his blood pressure, instituted a 30-minute medical watch regimen, and transferred Midgley to an observation cell so his health and safety could be closely monitored. While Midgley was plainly displeased with this care and treatment, it is difficult to discern how this course of conduct—which involved on-going medical care and monitoring—could be characterized as deliberate indifference to Midgley's medical needs.
Midgley has also alleged that, when he was removed from the observation cell on May 7, 2013, by unnamed correctional staff, those unnamed staff used excessive force and he suffered a "broken left hand," and a "dislocated knee." (Doc. 1 ¶ 34, 36). Midgley further contends that the medical defendants ignored these injuries, and failed to respond to multiple sick call requests Midgley alleges that he submitted to them between May 6, 2013 and July 1, 2013. (Doc. 1 ¶ 69-71). With respect to this allegation, the second Eighth Amendment claim leveled against these defendants by Midgley, the defendants have produced all of the sick call requests from Midgley's medical chart for each and every incarceration at the Lackawanna County Prison from 2010 through the present. These records wholly undermine Midgley's claims in this lawsuit since they reveal that, while Midgley made frequent use of the sick call system, there were no sick call requests from Midgley contained in the plaintiff's medical chart from May 6, 2013, through July 1, 2013. (Doc. 91, Ex. L.)
On July 1, 2013, Midgley did undergo a lengthy medical history and physical examination at the Lackawanna County Prison which was documented in a prison medical progress note. (Doc. 91, Ex. M.) These July 1 examination results, which are not contested in any meaningful way by Midgley, are noteworthy in several respects. First, they reflect on-going care and treatment of Midgley and thus rebut any allegation of deliberate indifference to his medical needs. In addition, this progress note contradicts Midgley's claims that he had suffered both a broken hand and a dislocated knee. According to these contemporaneous medical notes in the course of this examination Midgley claimed pain in his hands and blurry vision, but:
Notably, Midgley's medical complaints could not be confirmed. Instead, based upon an examination of Midgley, medical personnel found "no current clinical indicator of significant pathology," and simply prescribed 650 mg Tylenol as needed for the plaintiff. (Doc. 91, Ex. M.) Midgley's allegations of severe injuries, including a broken hand and dislocated knee, were further undermined by other undisputed medical evidence. Thus, shortly after his transfer from the Lackawanna County Prison, on July 19, 2013, while he was housed as an inmate at SCI Graterford, Midgley underwent radiology studies of his left hand and his left orbit. Both of those x-rays were interpreted as normal with no evidence of fracture, dislocation or bony reaction. (Doc. 91, Ex. N.) Later, on April 9, 2014, while an inmate at SCI Chester, Midgley underwent an x-ray study of his left knee. That x-ray study was also interpreted as normal with no fracture or dislocation seen and only mild osteoarthritis of the left knee noted. It was stamped "NCS — not clinically significant." (Doc. 91, Ex. O.)
It is against the backdrop of this essentially uncontested medical record that we now assess the legal sufficiency of Midgley's Eighth Amendment medical deliberate indifference claims against these prison health care providers. In conducting this assessment we are mindful of three legal benchmarks: First, the standards governing summary judgment; second, the guideposts defining Eighth Amendment claims in a prison medical context; and finally, the rules governing institutional and supervisory civil rights liability under federal law. These controlling legal tenets are set forth below.
Summary Judgment Standard of Review
Rule 56 of the Federal Rules of Civil Procedure, governs motions for summary judgment, and provides that "[t]he court shall grant summary judgment if the movant shows that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law." Fed. R. Civ. P., Rule 56 (a). Through summary adjudication a court is empowered to dispose of those claims that do not present a "genuine issue as to any material fact," Fed. R. Civ. P. 56, and for which a trial would be "an empty and unnecessary formality."
The substantive law identifies which facts are material, and "[o]nly disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment."
The moving party has the initial burden of identifying evidence that it believes shows an absence of a genuine issue of material fact.
Moreover, a party who seeks to resist a summary judgment motion by citing to disputed material issues of fact must show by competent evidence that such factual disputes exist. Further, "only evidence which is admissible at trial may be considered in ruling on a motion for summary judgment."
Finally, a party who seeks to resist a summary judgment motion must also comply with Local Rule 56.1, which specifically directs a party opposing a motion for summary judgment to submit a "statement of the material facts, responding to the numbered paragraphs set forth in the statement required [to be filed by the movant], as to which it is contended that there exists a genuine issue to be tried"; if the nonmovant fails to do so, "[a]ll material facts set forth in the statement required to be served by the moving party will be deemed to be admitted." L.R. 56.1. Under the Local Rules, the failure to follow these instructions and appropriately challenge the material facts tendered by the defendant means that those facts must be deemed, since:
Eighth Amendment Deliberate Indifference Claims in a Prison Medical Context
Prison officials may also violate an inmate's rights under the Eighth Amendment to the United States Constitution by displaying "deliberate indifference" to this inmate's medical needs. To sustain such a claim, an inmate must make an exacting showing by pleading and proving facts which:
These principles apply with particular force to Eighth Amendment claims premised upon inadequate medical care. In the medical context, a constitutional violation under the Eighth Amendment occurs only when state officials are deliberately indifferent to an inmate's serious medical needs.
Deliberate indifference to a serious medical need involves the "unnecessary and wanton infliction of pain."
However, it is also clear that the mere misdiagnosis of a condition or medical need, or negligent treatment provided for a condition, is not actionable as an Eighth Amendment claim because medical malpractice is not a constitutional violation.
In short, in the context of the Eighth Amendment, any attempt to second-guess the propriety or adequacy of a particular course of treatment is disavowed by courts since such determinations remain a question of sound professional judgment.
Legal Benchmarks for Supervisory and Institutional Liability
Finally, we note that these medical defendants include CCI Medical, Inc., the institutional health care provider at the prison, and Dr. Zaloga, the prison medical director, both of whom are sued by Midgley in their institutional and supervisory capacities since Midgley simply alleges in his complaint that they are "responsible for the actions of the medical staff." (Doc. 1, ¶73.) These institutional and supervisory civil rights liability claims, in turn, implicate an additional set of legal guideposts which Midgley must satisfy in order to sustain these allegations.
At the outset, it is clear that a claim of a constitutional deprivation cannot be premised merely on the fact that one of the named defendants was a prison medical supervisor when the incidents set forth in the complaint occurred. Quite the contrary, to state a constitutional tort claim the plaintiff must show that the supervisory defendants actively deprived him of a right secured by the Constitution.
In particular, with respect to prison supervisors it is well-established that:
As the Supreme Court has observed:
Applying these benchmarks, courts have frequently held that, in the absence of evidence of supervisory knowledge and approval of subordinates' actions, a plaintiff may not maintain an action against supervisors based upon the misdeeds of their subordinates.
Likewise a plaintiff must make a specific and particularized showing in order to hold a corporate defendant, like CCI, liable for alleged civil rights violations. On this score it is well-settled that:
The Medical Defendants Are Entitled to Summary Judgment
Applying these legal yardsticks, we find that the medical defendants are entitled to summary judgment on Midgley's Eighth Amendment medical deliberate indifference claims. Indeed, on the current factual record these claims fail for at least three separate and independent reasons.
First, these claims fail as a matter of law with respect to the institutional and supervisory defendants, Dr. Zaloga and CCI, Inc. Indeed, a review of Midgley's complaint suggests that Midgley has brought this claim against these particular defendants on a legally infirm theory of liability, since Midgley essentially contends that the doctor and corporate health care provider are liable on a respondeat superior theory of culpability since they are "responsible for the actions of the medical staff." (Doc. 1, ¶73.) As a matter of law, this bald assertion is insufficient to sustain corporate or supervisory civil rights liability since it is entirely undisputed that "Government officials may not be held liable for the unconstitutional conduct of their subordinates under a theory of respondeat superior."
In the instant case, there is no evidentiary basis for concluding that Dr. Zaloga participated in, or acquiesced in, constitutional misconduct directed at Midgley. In the same vein, Midgely has not alleged, and certainly has not shown by any competent proof, that his medical care was a direct result of some constitutionally infirm policy or custom adopted by CCI. Since such proof is essential to a supervisory or institutional liability claim, this failure of proof is fatal to these claims. Thus, these supervisory and institutional liability claims simply collapse under the weight of the law and the uncontested facts and should be dismissed.
Moreover, Midgley's Eighth Amendment claims fail for a more basic and fundamental reason: There simply is no evidence of any deliberate indifference to Midgley's serious medical needs in this case. Instead, the undisputed evidence before the Court shows that Midgley was an emotionally unstable, and occasionally non-complaint prisoner who would engage in self-destructive episodes of refusing to take his medication at times of domestic strife. When one such episode took place on May 6, 2013, medical staff responded by providing Midgley with blood pressure medication, closely monitoring his condition, moving him to an observation cell when he was voicing self-destructive and harmful thoughts, and notifying the prison mental health staff of Midgley's emotional distress. While Midgley may have been displeased with aspects of this care, his displeasure does not equate with deliberate indifference to his medical needs, the constitutional benchmark in this field. Since the care provided to Midgley in May of 2013 fully satisfied these constitutional benchmarks, Midgley's Eighth Amendment claim as to this initial health care fails.
As for Midgley's second Eighth Amendment assertion that he later suffered a broken hand and dislocated knee, and medical personnel ignored his repeated requests for care between May and July of 2013, Midgley cannot sustain this claim for at least two reasons. First, the uncontradicted evidence discloses that medical officials did not receive medical request slips from Midgley during this period of time. Therefore, there is no competent evidence to support Midgley's claim that he made frequent medical complaints which were ignored. Moreover, and more fundamentally, immutable medical records reveal that when Midgley was seen by health care providers on July 1, 2013, he was not suffering from any of the injuries which he alleged in his complaint. Further, follow-up examinations at two other prisons did not disclose the injuries which Medgley has claimed in this lawsuit, a broken hand and dislocated knee. In sum, the uncontradicted evidence discloses that there is no proof of either: (1) the serious injuries now alleged by Midgley; or (2) a failure to timely respond to requests for medical treatment. Given the paucity of proof of these two essential elements of any Eighth Amendment claim, these allegations also fail as a matter of law.
This failure of proof, in turn, highlights yet another reason why summary judgment is appropriate in this case. In the face of the defendants' well-documented pleading, Midgley has neglected to meet his responsibilities as a plaintiff in contesting this summary judgment motion. As we have observed, the defendants bore the initial burden of identifying evidence that it believes shows an absence of a genuine issue of material fact.
Therefore, it was now incumbent upon Midgley to "rebut the motion with facts in the record."
In this case Midgley's response to this thoroughly-documented summary judgment motion falls well short of what the law demands. That response consists of little more than an unsworn averment by Midgley which denies what the evidence reveals, without providing any evidentiary support for those denials. Midgley then attempts to buttress this inadequate response with an array of articles of unknown provenance, and little relevance to the issues presented by the plaintiff's complaint. Simply put, much more is needed in order for Midgley to create a genuine issue of material fact that would defeat this motion for summary judgment. Since Midgley's response to this motion merely relies upon "bare assertions, conclusory allegations or suspicions"
Accordingly, for the foregoing reasons, IT IS RECOMMENDED that the defendants' motion for summary judgment (Doc. 90.) be GRANTED, and this complaint should be dismissed with respect to: CCI Medical, Inc., the institutional health care provider at the prison, Dr. Zaloga, the prison medical director, Nurse Jackie, Nurse Kenny, and Tony Ianuzzi, a Nurse-Physician Assistant at the prison.
The parties are further placed on notice that pursuant to Local Rule 72.3: