United States District Court, W.D. Arkansas, Fayetteville Division
HOLMES, III CHIEF U.S. DISTRICT JUDGE
Gary W. Guilliams, filed this action pursuant to 42 U.S.C.
§1983. He proceeds in forma pauperis. Although
he was proceeding pro se when he filed the original
Complaint, Plaintiff's Motion for Appointment of Counsel
was granted and an attorney, Christopher William Nanos, was
appointed to represent him (ECF No. 42).
case is before the Court on the Motion for Summary Judgment
(ECF No. 66) filed by Sheriff Helder and Major Randall Denzer
(the “County Defendants”). Plaintiff has
responded (ECF Nos. 74, 75) to the Motion.
Motion for Summary Judgment (ECF No. 69) has also been filed
by Dr. Karas and Karas Correctional Health, PLLC (the
“Medical Defendants”). Plaintiff has responded
(ECF Nos. 74, 75) to the Motion. Additionally, the Medical
Defendants filed a reply brief (ECF No. 76). The Motions are
ready for decision.
maintains he was denied adequate medical care while
incarcerated at the Washington County Detention Center
(“WCDC”). Specifically, Plaintiff maintains he
was denied adequate pain medication, a splint, a referral to
an orthopedic doctor, and surgery for his fractured right
wrist and associated numbness of his hand. Plaintiff also
brings supplemental state tort claims of negligence and
February 22, 2016, when Plaintiff was walking in front of the
IGA grocery store he “was knocked over by a person
running from the store.” (ECF No. 74-10 at 1). He hit
the ground injuring his right wrist. (Id.). That
same day, Plaintiff reported being assaulted by several
individuals from the Salvation Army at the IGA grocery store.
(ECF No. 68-11 at 9). Plaintiff was arrested for public
intoxication and transported to the WCDC where the jail nurse
decided not to accept the Plaintiff. (Id.). He was
cited and released from custody. (Id.).
Emergency Medical Services (“CEMS”) responded to
the WCDC. (ECF No. 68-7 at 5). Plaintiff told the CEMS
paramedics that “someone assaulted him, twisting his
arm behind his back.” (Id.). Swelling and a
possible deformity in the right wrist was noted.
(Id.). Plaintiff also reported lateral neck pain,
right knee pain, and being short of breath. (Id.).
Plaintiff was transported to the emergency room
(“ER”) at Washington Regional Medical Center
x-rays showed: “an impacted, mildly comminuted distal
radial fracture. No evidence of intra-articular extension.
Fracture of the ulnar styloid process. There is some dorsal
angulation of the distal radial fracture. Old fracture of the
mid scaphoid bone.” (ECF No. 68-9 at 34). Plaintiff was
intoxicated, uncooperative, and abusive to staff.
(Id. at 18-19). No attempt was made to reduce the
fracture due to his conduct. (Id.). A splint, ace
bandage, and sling were applied. (Id. at 18). His
discharge diagnosis was Colles' fracture, no reduction
required. (Id. at 16). Plaintiff was advised that
Dr. Coker, an orthopedic physician, wanted to see him in two
days. (Id. at 12). He was told to call for an
appointment time. (Id.). He was prescribed Norco.
this visit, Plaintiff testified he went to Ozark Orthopaedic.
(ECF No. 71-1 at 21-22). Because he did not have insurance,
Plaintiff testified he was turned away. (Id. at 22).
February 25, 2016, Plaintiff reported to the Fayetteville
Police Department (“FPD”) that someone
“pushed him down, causing him to hurt his right
arm.” (ECF No. 68-11 at 14). CEMS responded and
Plaintiff reported being pushed from behind and that he hurt
his arm again. (ECF No. 68-7 at 11). Plaintiff was in pain
and his right wrist was swollen. (Id.). An attempt
was made to splint his wrist but he would not let them.
was transported by ambulance to Physician's Specialty
Hospital (“PSH”). (ECF No. 68-7 at 12). It was
noted Plaintiff fell and injured his right arm and had a
previous fracture of his right wrist. (ECF No. 68-8 at 14).
It was also noted that Plaintiff had a splint after the
initial injury but took it off because it was hurting him,
and that he had the odor of alcohol. (Id.).
Plaintiff was diagnosed with fractures of the distal radius,
the ulna and scaphoid. (Id. at 22). A sugar tong
splint was applied and two four inch ace bandages.
(Id. at 14). He was also placed in a sling.
(Id.). Plaintiff was prescribed Ultram.
(Id. at 27).
February 29, 2016, Plaintiff stated a man pushed him down and
reinjured his wrist again. (ECF No. 68-7 at 17). CEMS was
dispatched. (Id.). Plaintiff indicated he had twice
been given a splint but the splints were too tight and he
removed them. (Id.). The paramedics attempted to
place an ice pack on his wrist but Plaintiff refused.
(Id.). He also refused a splint. (Id.).
Plaintiff was transported to WRMC. (Id.).
complained of right wrist swelling and pain for the last nine
days and needed his arm fixed. (ECF No. 68-9 at 45). He
stated he took the splint off because it was hurting, and he
was not wearing his sling. (Id.). He said he tried
to see the orthopedic doctor, but he was homeless and could
not pay. (Id.). He was told there was not much else
that could be done since he had already been seen there, and
that he would have to go to the lobby and wait his turn to be
seen. (Id.). Plaintiff became belligerent and the
intake worker called security. (Id.). Plaintiff left
the ER area without being treated and was found sleeping in
the chapel. (Id. at 44). Plaintiff was escorted from
the hospital by law enforcement. (Id.).
March 2, 2016, Plaintiff was seen at Ozark Orthopaedic by
Larrah Jenkins, a Physician's Assistant for Dr. C. Noel
Henley. (ECF No. 71-5 at 1). It was noted Plaintiff was not
wearing his splint because it was too uncomfortable, but he
was using an Ace wrap. (Id.). The right wrist was
noted to be mildly swollen with: “notable deformity of
the distal radius, has limited flexion and extension, limited
pronation and supination. He has good gentle range of motion
of the fingers. Sensation is grossly intact.”
(Id.). X-rays were taken and showed “a
fracture of the distal radius with some dorsal angulation
apex volar.” (Id.). The plan was to put him in
a volar splint and have him follow-up with Dr. Henley in the
next seven to 10 days. (Id.).
March 6, 2016, Plaintiff called 911 from a McDonald's
restaurant. (ECF No. 68-7 at 24). CEMS responded.
(Id.). Plaintiff complained his right wrist had been
hurting for the past two weeks since he broke it when he
fell. (Id.). Swelling was noted in the right wrist
with no other signs of injury. (Id.). Plaintiff
rated his pain as a ten out of a ten. (Id.). A sling
was applied and he was transported to WRMC. (Id.).
advised that he had been diagnosed with a right wrist
fracture, had been using the splint off and on, had not
called for a follow up with an orthopedic physician, and had
not been able to fill his Norco prescription because of lack
of money. (ECF No. 68-9 at 55). Plaintiff smelled of alcohol.
(Id.). He was diagnosed with a “mildly
comminuted distal radial fracture.” (Id. at
57). A slightly increased displacement was noted compared to
the prior study. (Id. at 63). A splint was applied
to his right forearm along with a four inch ace wrap and a
sugar tong posterior mold was applied and the wrist
immobilized. (Id. at 59). Plaintiff was told to
follow up with Dr. Heinzelmann, an orthopedic surgeon.
(Id. at 54). Plaintiff was released but would not
leave. (ECF No. 68-2 at 5). He was yelling at staff and
wandering around the waiting room. (Id.).
police were called and Plaintiff was transported to the WCDC.
(ECF No. 68-2 at 3-4; ECF No. 68-11 at 20). He was charged
with public intoxication and disorderly conduct.
(Id. at 18, 21). He was booked in at 9:57 a.m. and
released at 2:07 p.m. that same day. (ECF No. 68-2 at 3-4).
His medical complaints/injuries were listed as “broken
rt. arm in cast.” (Id.).
March 13, 2016, Plaintiff was charged with public
intoxication and criminal trespass and booked into the WCDC
at 1:05 p.m. (ECF No. 68-2 at 11; ECF No. 68-11 at 21, 25).
He was released the following day at 1:50 p.m. (ECF No. 68-2
at 12). Intake documents indicate he had three ace bandage
wraps in his possession, but no splint or sling was listed
with his other property. (Id. at 13). His medical
complaints/injuries were listed as “hurt right
April 4, 2016, CEMS responded to a call to the WRMC parking
lot for a possible arm fracture. (ECF No. 68-7 at 30).
Plaintiff complained of right wrist pain. (Id.). He
reported having broken his arm about a month ago.
(Id.). He said he had been seen at the ER and a cast
was put on. (Id.). He indicated the cast was
uncomfortable and he removed it but the pain was now getting
worse and he wanted to go to the ER again. (Id.). It
was noted that swelling and deformity of the right wrist were
present, but Plaintiff was moving it without obvious
difficulty. (Id.). Sensory and motor function in the
injured arm were found to be intact, and there was good
capillary refill in the finger tips. (Id.).
stated that Plaintiff was not permitted on WRMC property and
would have to go to Northwest Medical Center in Springdale.
(ECF No. 68-7 at 30). Plaintiff was transported to the ER at
the Northwest Medical Center. (Id.).
diagnosis was “right distal radius fracture and right
scaphoid fracture.” (ECF No. 71-7 at 29). He was given
a prescription for Tylenol with Codeine and told to follow-up
with a physician within one to two days and with Dr. John
Heim within three to five days. (Id.).
points out that during this entire time since his injury he
was homeless, had no insurance, and was suffering from major
depressive disorder. (ECF No. 74-10 at 3). He indicates he
had to carry his belongings with him, slept on the street,
and it was difficult to wear the splint because it caused his
arm to swell and it was painful. (Id.). Plaintiff
indicates he would take if off for a while and when the pain
went away he would put it back on. (Id.).
April 5, 2016, Plaintiff was identified as having run from
the woods and threatened two people with a kitchen knife.
(ECF No. 68-2 at 23; ECF No. 68-11 at 34). He was arrested by
the FPD and charged with aggravated assault, carrying a
prohibited weapon, and public intoxication. (ECF No. 68-11 at
26). He was booked into the WCDC on April 6, 2016 at 12:31
a.m. and remained there until May 19, 2016, when he was
released. (ECF No. 68-2 at 20-21).
the intake forms lists his medical complaints/injuries as:
“depression, broken rt. arm.” (ECF No. 68-2 at
30). Plaintiff was seen at booking by a jail nurse. (ECF No.
71-6 at 9). It was noted that Plaintiff's right wrist had
been broken over a month ago. (Id). Plaintiff
reported constantly being in pain. (Id.).
Plaintiff's wrist was noted to be deformed, and Plaintiff
stated he had been told it would have to be re-broken and set
back in place. (Id.). Plaintiff was able to move his
fingers. (Id.). Plaintiff was added to doctor call.
of the WCDC may submit medical complaints/requests via an
electronic kiosk. (ECF No. 68-1 at 2). The requests are
reviewed by medical personnel. (Id.). Since January
1, 2016, Washington County has contracted (ECF No. 74-4) with
Karas Correctional Health, PLLC (“KCH”) (ECF No.
74-2) to provide medical services at the WCDC. (ECF No. 68-1
at 3; ECF No. 68-5 at 2). Dr. Karas is the jail doctor, and
he or his personnel are the primary medical care providers.
(ECF No. 68-4 at 7).
submitted his first request on April 6, 2016. He stated
“broke arm [medical] help please.” (ECF No. 68-3
at 1). He was told he had submitted it incorrectly and needed
to submit the request to medical. (Id. at 2). He
submitted a second request that same day saying he was in a
lot of pain from his broken arm. (Id.). He was again
told to submit the request to medical. (Id.). The
requests were reassigned to medical. (ECF No. 68-3 at 1). On
that same day, doctor call was declined because there was
“[n]o indication for MD at this time.” (ECF No.
71-9 at 9).
April 7, 2016, Plaintiff was asked if he broke his arm before
or after he was incarcerated and whether he had told anyone
that had been passing medication. (ECF No. 68-3 at 1).
Plaintiff submitted his next request on April 7, 2016,
stating he needed to see a nurse or doctor about having his
arm re-broken because it had grown back together wrong.
(Id. at 2). Plaintiff responded to the question of
when he had broken his arm by saying that he broke it before
he was incarcerated. (Id. at 1). He also noted that
the nurse passing medication merely said she would check into
it. (Id. at 1).
April 8, 2016, Plaintiff submitted two requests saying he was
in pain and needed medical help. (ECF No. 68-3 at 3). He was
again told to write to medical and the requests were closed.
(Id.). He submitted a third request saying he needed
his broken arm “looked at ASAP.” (Id.).
He was added to doctor call. (ECF No. 71-6 at 9). He was seen
by Kelley Oliver, a nurse practitioner. (ECF No. 71-6 at 10;
ECF No. 74-3 at 71). She noted Plaintiff had been
non-compliant with the splint and was refused a visit with
the orthopedic doctor due to inability to pay. (ECF No. 71-6
at 10). She noted “right wrist deformity, increase pain
with flexion/extension, fingers pink, sensory/motor intact
and points straight, no edema/discoloration at wrist.”
(Id.). She ordered an x-ray, indicated they would
request his records from WRMC and Physicians Specialty
Hospital (“PSH”), and started Plaintiff on
Naproxen and ice. (Id.).
April 8, 2016, Plaintiff submitted a fourth request asking
for something for pain. (ECF No. 68-3 at 4). On April 11,
2016, he was told he had been added to the nurse call list.
(Id.). On April 11, 2016, Plaintiff complained that
he had been taking Tramadol, one every four hours, and at the
WCDC was only given one Naproxen in the morning and one at
night. (ECF No. 68-3 at 4). He indicated he was suffering
unnecessary pain and could not sleep. (Id.). He was
seen by a jail nurse who noted he wanted something stronger
for pain and wanted his wrist fixed now he had Medicaid. (ECF
No. 71-6 at 10). He was told he would be added to the
“doctor call, but we do not give anything stronger than
naproxen or [T]ylenol.” (ECF No. 68-3 at 4). On April
12, 2016, he was told the advance practice nurse had approved
an increase in the Naproxen dosage but that he would not be
prescribed any stronger pain medication. (Id. at 5).
He was not seen by the doctor. (Id.).
April 11, 2016, Plaintiff was asked if he was seen by a
doctor when he broke his wrist. (ECF No. 68-3 at 1). That
same day, he responded that he was seen at
“Regional.” On April 11, 2016, a notation was
made that plaintiff had been “seen via medical.”
(Id.). On April 12, 2016, Dr. Karas read the x-ray
and noted “a distal comminuted radius fracture.”
(ECF No. 71-8 at 75-76). Dr. Karas testified they treated
Plaintiff's injury as a “non-acute injury and a
non-emergent condition.” (Id. at 79). In his
“that horse was out of the barn. He'd been six
weeks without treatment of it. The procedure he would need -
the surgery he's going to need, whether we gave it to him
the first day he got in there or whether he gets it six
months later, the surgery treatment and outcome are going to
be the same.”
Karas testified they could not “fix” all the
inmates medical problems and had to be judicious about what
they treated. (ECF No. 71-8 at 80). He noted there were other
inmates in the detention center with broken bones they did
not send to an orthopedic doctor. (Id.). He stated
that Plaintiff was in and out of the jail multiple times,
fell frequently, failed to wear the splints provided, and
failed to follow-up on the recommendations made by the
different hospital physicians he had seen. (Id. at
80-81, 89). Dr. Karas testified that Plaintiff was aware that
his wrist was going to have to be re-broken and he was going
to need surgery. (Id. at 81). Dr. Karas testified
they also considered whether they were able to control an
inmate's pain, such as they did with Plaintiff, by
providing a second mat, a 24 hour mat, a second blanket, the
pain medication they had available, and an Ace wrap.
(Id. at 82-83). Dr. Karas indicated they considered
how long the inmate was going to be incarcerated
(Id. at 82), and whether the problem was one that
“once they get out and their insurance kicks back in,
they [can] go get it fixed.” (Id.). Another
consideration mentioned by Dr. Karas was whether the patient
would follow-up and take good care of themselves, go to
physical therapy or rehab, so they would have a good outcome
from the surgery. (Id. at 104). Dr. Karas testified
they tried to be fair and consistent among inmates with
similar types of injuries. (Id. at 83).
general, Dr. Karas testified that splints are a security risk
which is why they usually use Ace wraps. (ECF No. 71-8 at
84). If an inmate has a splint, they have to be in isolation
or medical holding. (Id. at 86). If there is a
question regarding a medical device's safety, Dr. Karas
testified detention center staff would look at it first.
(Id.). Dr. Karas testified detention center staff
can refuse “to allow that care” (Id. at
87); however, Dr. Karas testified that immobilizing
Plaintiff's wrist in April of 2016 might have decreased
Plaintiff's pain. (Id. at 88, 90).
April 16, 2016, Plaintiff submitted a request stating that
his arm was broken in three places and asking why he had not
been taken to an orthopedic doctor. (ECF No. 68-3 at 6).
Since he had been in jail, Plaintiff states his hand had gone
numb and his thumb felt like it was on fire. (Id.).
He asked that something be done before he lost the use of his
hand. (Id.). He stated he was in a lot of pain.
(Id.). In response, he was told to write to medical
and was asked if he could not see the medical category on the
kiosk. (Id.). Plaintiff submitted another request
that same day asking for help to get to the orthopedic
doctor. (Id.). He stated his hand was numb and his
thumb felt on fire. (Id.). That day, a prescription
was added for “24/7 bed rest on mat.” (ECF No.
71-6 at 12).
April 18, 2016, he was told he was placed on nurse call. (ECF
No. 68-3 at 6). On April 18, 2016, Plaintiff submitted a
request asking if he could keep his blanket since it was so
cold in his cell. (ECF No. 68-3 at 7). He said the cold made
his arm hurt twice as bad and that he had screws in his ankle
the cold bothered too. (Id.). He indicated he could
not sleep because he hurt from head to toe. (Id.).
April 18, 2016, Plaintiff also asked when he was going to be
taken to see his doctor at the “old regional
hospital.” (ECF No. 68-3 at 7). In response, he was
told that the nurse did not believe they took people to see
their own doctors. (Id.). Plaintiff was asked why he
wanted to see his doctor. (Id.). Plaintiff replied
that he wanted to see his doctor about his broken arm.
(Id. at 8).
April 19, 2016, he was told he was placed on doctor call.
(ECF No. 68-3 at 7). That same day, a doctor visit was
declined because Plaintiff had been put on a “24 hr
mat.” (ECF No. 71-6 at 12).
April 20, 2016, Plaintiff asked again when he would be taken
to his doctor. (ECF No. 68-3 at 8). In response, he was told
that they did not transport detainees to outside doctors.
April 22, 2016, Plaintiff was given a prescription for a
“24 hr 2nd mattress.” (ECF No. 71-6 at 14). That
same day, the prescription for 24/7 bed rest on mat was
discontinued and Plaintiff was given a prescription for a 24
hour mat instead. (Id. at 13).
April 27, 2016, Plaintiff submitted a request about a number
of issues and stated his wrist hurt and asked someone to do
something. (ECF No. 68-3 at 11). He was told to submit a
separate request to medical. (Id.). He was
reassigned to segregation by medical staff because of his
“hand issue” on April 28, 2016. (ECF No. 71-6 at
April 29, 2016, Plaintiff asked again if he could keep his
blanket during the day because his wrist hurt even more in
the cold air. (ECF No. 68-3 at 12). He was told he was on
nurse call. (Id.). He was prescribed “24/7 bed
rest on mat, ” and a “24 hr 2nd mattress.”
(ECF No. 71-6 at 14-15). His request to keep his blanket was
declined by the nurse because the “[j]ail is kept at an
adequate temp.” (Id. at 16). On May 3, 2016,
his “24 hr 2nd mattress” was discontinued and he
was prescribed again “24/7 bed rest on mattress.”
5, 2016, Plaintiff was added to doctor call. (ECF No. 71-6 at
18). On May 6, 2016, doctor call was declined.
(Id.). Notes indicate: “[t]he xray, wrmc, and
psh records were reviewed.
was instructed to have surgery prior to detention. The
detainee reported Ozark orthopedic refused to see him related
to not having a method to pay. The detainee has no compromise
to circulation, sensory and motor intact.”
6, 2016, Plaintiff was told:
“Mr. Guilliams per the provider, as you know you were
told by Washington Regional Medical Center, Physician
Specialty Hospital and Ozark Orthopaedics th[a]t you needed
surgery prior to you[r] arrest. I will start you on Seroquel
and continue Naproxen and Tylenol. . . . ...