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Hurlbut v. Helder

United States District Court, W.D. Arkansas, Fayetteville Division

January 4, 2019




         This is a civil rights action brought by Plaintiff Daniel Hurlbut pursuant to 42 U.S.C. § 1983 contending that his constitutional rights were violated while he was incarcerated in the Washington County Detention Center (WCDC). Plaintiff proceeds pro se and in forma pauperis.

         Plaintiff maintains that his constitutional rights were violated in the following ways: (1) he was denied adequate care for serious medical and mental health needs; (2) he was denied access to the courts; (3) Defendants failed to protect him from attack by fellow inmates; (4) he was subjected to unconstitutional conditions of confinement; and (5) he was denied access to the grievance procedure. Plaintiff has named as Defendants Sheriff Tim Helder, [1] the Karas Medical Team, Dr. Karas, Nurse Veronica Dockery, Nurse Ken Hughes, Nurse Landon Harris, Nurse Regina Walker, Lieutenant Foster, Deputy Josve Velasco, Deputy Skinkis, and Deputy Uriel Parades.

         The case is before the Court on Plaintiff's Motion for Partial Summary Judgment on the failure to protect claim against Deputies Skinkis and Velasco (ECF No. 41), the Defendants Motion for Summary Judgment (ECF No. 45), and Plaintiff's Motion for Summary Judgment (ECF No. 49) on all claims. The parties have also filed responses and replies.


         Summary judgment is appropriate if, after viewing the facts and all reasonable inferences in the light most favorable to the nonmoving party, Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986), the record “shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). “Once a party moving for summary judgment has made a sufficient showing, the burden rests with the non-moving party to set forth specific facts, by affidavit or other evidence, showing that a genuine issue of material fact exists.” National Bank of Commerce v. Dow Chemical Co., 165 F.3d 602, 607 (8th Cir. 1999).

         The non-moving party “must do more than simply show that there is some metaphysical doubt as to the material facts.” Matsushita, 475 U.S. at 586. “They must show there is sufficient evidence to support a jury verdict in their favor.” National Bank, 165 F.3d at 607 (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986)). “A case founded on speculation or suspicion is insufficient to survive a motion for summary judgment.” Id. (citing Metge v. Baehler, 762 F.2d 621, 625 (8th Cir. 1985)). “When opposing parties tell two different stories, one of which is blatantly contradicted by the record, so that no reasonable jury could believe it, a court should not adopt that version of the facts for purposes of ruling on a motion for summary judgment.” Scott v. Harris, 550 U.S. 372, 380 (2007).


         Plaintiff was booked into the WCDC on January 3, 2016. (ECF No. 47-2 at 2). On September 8, 2016, Plaintiff was transferred to the Arkansas State Hospital (ASH) in accordance with an order entered in his criminal case. (Id. at 7-10). He remained there until November 7, 2016, when he returned to the WCDC. (Id. at 11-12).

         During the time he was in the WCDC, Plaintiff was transferred for short periods of time to other facilities for court proceedings. These transfers include the following: On February 8, 2016, Plaintiff was booked into the Madison County Detention Center for Court (ECF No. 49 at 54). He was transported back to the WCDC the following day. (Id.). On April 3, 2016, Plaintiff was booked into Madison County for court. (ECF No. 49 at 58). On April 4th, 2016, Plaintiff was released to the WCDC. (Id.). On April 11, 2016, Plaintiff was booked into Madison County for court. (ECF No. 49 at 60). On April 12th, 2016, Plaintiff was transferred back to the WCDC. (Id.). On May 9, 2016, Plaintiff was booked into Madison County. (ECF No. 49 at 62). He was transferred back to the WCDC the following day. (Id.). On June 29, 2016, Plaintiff was released to Benton County for court on June 30th. (ECF No. 49 at 57). Plaintiff maintains that there were at least nine separate occasions when he suffered an interruption of medication because of his transport to another location. (ECF No. 49 at 3).

         On March 21, 2017, Plaintiff a negotiated plea on multiple charges. He was sentenced to serve a total of 120 months in the Arkansas Department of Correction (ADC). On April 10, 2017, Plaintiff was transferred to the ADC. (ECF No. 47-2 at 13).


         Section 1983 does not create substantive rights. Baker v. McCollan, 443 U.S. 137, 145 n.3 (1979). Instead, it provides remedies for deprivations of rights established by the Constitution or the laws of the United States. Id. Two elements are required to establish a claim under § 1983. These elements are: (1) the deprivation of a right secured by the Constitution or laws of the United States; and (2) that the deprivation was committed “under color” of state law. Lugar v. Edmondson, 457 U.S. 922, 931 (1982).

         (A). Denial of Adequate Medical and Mental Health Care

         (1). Relevant Facts

         WCDC makes emergency medical services available to detainees twenty-four hours a day. (ECF No. 47-1 at 2).[2] Officers are trained to provide temporary lifesaving care until Emergency Medical Services or other medical personnel arrive. (Id.). Detainees may submit medical complaints via electronic kiosk for daily review by qualified medical personnel. (Id.). Nursing staff is responsible for checking the files of inmates under the medical provider's care and following all physician's orders. (Id.).

         “Since January 1, 2016, Dr. Rob Karas has been the Jail Medical Doctor and Karas Correctional Health has provided all medical care in the [WCDC] pursuant to a contract with Washington County.” (ECF No. 47-1 at 4). All decisions regarding medical care are made by the contract medical staff. (Id.). “No employee of [WCDC] is authorized to make non-emergency medical decisions on behalf of any inmate. . . . All decisions regarding medications, medical testing, or medical treatment are left to the professional medical judgment of the physician at the detention facility.” (Id.)(emphasis in original).

         According to Dr. Karas, when Plaintiff was booked in on January 3, 2016, the only medication listed was Gabapentin[3] and Plaintiff did not have it with him. (ECF No. 47-2 at 1-2). On January 22, 2016, Plaintiff's mother delivered the following medications to the WCDC: Florinef, [4] .1 mg as needed; Olanzapine, [5] one 10 mg tablet at bedtime; Venlafaxine, [6] one 150 mg tablet per day; Prednisone, [7] one 20 mg tablet per day; and Gabapentin, one 600 mg tablet in the morning and two tablets at night. (Id. at 3).

         After he was booked in, Plaintiff testified that he was suffering from opiate withdrawal symptoms. (ECF No. 47-11 at 61). Plaintiff testified that at this point in his life he “was so bad on opiates” that he was “spending more than $500 every single day just for opiates.” (ECF No. 62 at 24-25). Withdrawal made him feel like he had a severe case of the flu. (ECF No. 47-11 at 61). Plaintiff testified he thought he was going to die. (Id.). He felt like that for months. (Id.). Plaintiff testified that it was the most miserable time “I've ever experienced in my life.” (Id.).

         Dr. Karas indicates that at intake Plaintiff reported being on Ambien, [8] Hydrocodone, [9]Effexor, [10] Gabapentin, Methocarbamol, [11] and other medications he could not recall the names of. (ECF No. 47-12 at 2). According to Dr. Karas, on the day Plaintiff was booked in, Plaintiff was put on a “detox screen” for narcotic pain medication. (ECF No. 47-12 at 2). There is no precise explanation of what “detox screen” consists of. However, from Dr. Karas' affidavit, it appears it consisted of evaluating the patient's condition. (ECF No. 47-12 at 4-5). According to the medical records, the detox screen lasted from January 4, 2016, until January 8, 2016. (ECF No. 49 at 43).

         On January 5, 2016, Plaintiff was started on Citalopram, [12] Trazodone, [13] Quetiapine, [14] and Gabapentin. (ECF No. 47-12 at 3). According to Dr. Karas, between January 3, 2016, and September 8, 2016, Plaintiff was seen twenty-two times on sick or “psyc” call, eight times on provider call, and his medical care was reviewed twenty-three times. (Id.). Bloodwork was ordered on July 1, 2016, and the results were stable. (Id.).

         Dr. Karas indicates that narcotic pain medication is not routinely given at the WCDC. (ECF No. 47-12 at 3). The reasons for this are: narcotic pain medication has a high risk of diversion and abuse, a risk that is increased in the incarcerated population; receiving narcotic pain medication in the detention center can be a risk to the patient themselves, as other detainees may seek to divert the medication by coercion or force; and narcotic pain medication is not recommended for treatment of non-cancer pain, as it is not shown to improve outcomes. (Id. at 3-4).

         Dr. Karas indicates that Plaintiff's chronic pain was treated with Gabapentin (dose gradually increased to 1600 mg twice daily), Naproxen, [15] Tylenol, Prednisone, and Venlafaxine. (ECF No. 47-12 at 3). Plaintiff was also given a second mattress for most of his stay at the WCDC. (Id.). Plaintiff was told to continue stretching and to try push-ups to build and maintain bone strength. (ECF No. 47-2 at 15).

         On January 17, 2016, Plaintiff's mother contacted the WCDC and advised that Plaintiff was detoxing from drugs and was afraid he might vomit in his sleep. (ECF No. 49 at 16). Deputy Heil went to speak with Plaintiff who stated he was detoxing from heroine and methadone. (Id.). Plaintiff indicated he was afraid he would vomit in his sleep and suffocate. (Id.). Plaintiff reported that both his wives had died this way. (Id.). Plaintiff complained of chills, hot flashes, cramps, and bile in his throat as well as vomiting the past three days. (Id.). Deputy Heil stated he would talk to the nurse about Plaintiff's situation. (Id.). When Deputy Heil returned to B-pod control, he was told the nurse had already cleared Plaintiff. (Id.). At evening medication pass, Plaintiff asked Deputy Heil what the nurse had said and was told the nurse had cleared him. (Id.). Plaintiff replied that he had not talked to a nurse about the situation. (Id.). The nurse present at medication pass briefly talked to the Plaintiff and told him to put a request in the kiosk. (Id.).

         On January 25, 2016, after receipt of Plaintiff's medical records, Plaintiff was prescribed Florinef to treat his adrenal insufficiency.[16] (ECF No. 47-12 at 4). On February 1, 2016, Prednisone was added. (Id.). On August 11, 2016, Plaintiff was changed to Hydrocortisone[17]therapy. (Id.). According to Plaintiff, he was never received access to “stress dosing[18]” or an increased amount of steroid sometimes given in a shot.[19] (ECF No. 49 at 7). Plaintiff points to no periods of time when he believed either was necessary. Rather, he believed they should be available to him.

         Plaintiff was released from custody on September 8, 2016 and returned to the WCDC on November 7, 2016. (ECF No. 47-12 at 4). Plaintiff reported being on Klonopin, [20] Gabapentin, Hydrocortisone, Effexor, and other medications he could not recall the names of. (Id.). He also reported a history of schizophrenia and manic depression. (Id.).

         Plaintiff's medication reconciliation was completed on November 8, 2016. (ECF No. 47-12 at 5). Plaintiff was provided Hydrocortisone, Effexor, Omeprazole, [21] Gabapentin, and Bengay. (Id.). Quetiapine was given instead of Olanzapine. (Id.). “Soma, [22] Clonazepam, [and] Zolpidem[23][were discontinued] as these are narcotic, benzodiazepine scheduled medications with chance for abuse.” (Id.). Lidocaine patches, [24] Fioricet, [25] and Salicylic Acid Wash[26] were also discontinued “as these are not recommended for long term use.” (Id.). Dr. Karas asserts that Fioricet “can have an interaction with Hydrocortisone that lowers Hydrocortisone levels and could cause a life threatening adrenal crisis.[27]” (Id. at 7).

         Dr. Karas further notes that Plaintiff was started on detox protocol for Klonopin on November 8, 2016. (ECF No. 47-12 at 5). Dr. Karas states that Plaintiff was evaluated on November 10, 2016 and was found to have “no acute signs or symptoms of withdrawal.” (Id. at 5).

         On January 2, 2017, nursing staff requested that Plaintiff be moved to booking with a “15 minute watch on him due to him having some health concerns.” (ECF No. 49 at 77). Booking was determined not to be a suitable location. (Id.). Sergeant Morse ordered an isolation cell in B-pod be cleared out for the Plaintiff. (Id.).

         Deputies Hudgens and Edens encountered difficulties in getting Plaintiff moved. (ECF No. 49 at 77-78). Plaintiff was vomiting and “appeared worked up in a state of anxiety. He said he felt he was being set up for being a martyr and was more afraid to be left alone.” (Id. at 77). Plaintiff had good rapport with his cell mate Trey Monaco. (Id.). With Monaco's help, Plaintiff was eventually moved to the isolation cell but was showing multiple signs of paranoid behavior. (Id.). A short time later, Sergeant Morse was contacted by the nurse and told that her supervisor said the decision of where Plaintiff should be housed should be made by the detention supervisor. (Id.). Sergeant Morse determined that Plaintiff should be moved back to R-block with Monaco. (Id.).

         On February 13, 2017, Plaintiff was picked up and transported to Madison County for Court. (ECF No. 47-8 at 34). Plaintiff asked about his medications but was told that Nurse Walker had nothing to transport the medications of the various inmates with them. (Id.). Instead, the transport deputies were told that Madison County would have to have its medical staff call over to Washington County and Nurse Walker would provide them with the necessary information to obtain the medication. (Id.).

         Plaintiff remained incarcerated at the WCDC until April 10, 2017. (ECF No. 47-12 at 5-6). During this time, Dr. Karas asserts that Plaintiff was seen thirteen times on sick call, two times on “psyc” call, and five times on provider call. (Id. at 5). Further, Dr. Karas asserts that the plan for Plaintiff's medical care was evaluated twenty-three times. (Id.). Bloodwork was ordered for further assessment on two different occasions, January 10, 2017, and February 24, 2017, and the labs were stable on both occasions. (Id.). Dr. Maass, who specializes in endocrinology, was consulted on February 24, 2017, and “he confirmed [Dr. Karas's] plan of care and recommended that [Plaintiff's] Renin Level be checked as well. His recommendations for care were followed.” (Id. at 6). Dr. Maass is the doctor identified by Plaintiff as his endocrinologist. (ECF No. 47-11 at 13). Although, Plaintiff testified he had not seen him since 2012. (Id. at 14).

         Plaintiff was again booked into the WCDC on May 3, 2017 and remained there until May 23, 2017. (ECF No. 47-12 at 6). On intake, Plaintiff denied use of Benzodiazepines, narcotic pain medication, or Amphetamine use. (Id.). As a result, he was not started on detox protocol. On May 4, 2017, Plaintiff was prescribed Gabapentin, Quetiapine, Magnesium, and Tums. (Id.). On May 10, 2017, Plaintiff was prescribed Hydrocortisone and Venlafaxine. (Id.). During this period of incarceration, Dr. Karas asserts that Plaintiff was seen once on sick call and his medical care was reviewed nine times by one of the providers. (Id.).

         In connection with Plaintiff's criminal case, a forensic examination was performed by Dr. Stephen Nichols on January 15, 2016. Dr. Nichols indicated Plaintiff met the criteria for “schizoaffective disorder, bipolar type, multiple episodes, currently in acute episode.” (ECF No. 47-2 at 4). At the time of the examination, Dr. Nichols concluded that Plaintiff “lacked the capacity to understand the proceedings against him, and to assist effectively in his own defense.” (Id.).

         Dr. Nichols noted that Plaintiff had a history of abuse of opiates including oxymorphone. (ECF No. 47-2 at 6). Plaintiff had been married twice and both wives death involved “drug ingestion.” (Id.). His second wife died on January 2, 2016. (Id.). Plaintiff reported being on the Seroquel, Gabapentin, and Trazodone at the WCDC. (Id.). Plaintiff indicated the medications made him calmer. (Id.).

         Considering Dr. Nichols' report, the Circuit Court of Washington County entered an order on March 2, 2016, committing the Plaintiff to the “custody of the Arkansas Department of Human Services, for detention, care, and treatment, until restoration of Defendant's fitness to proceed.” (ECF No. 47-2 at 7-8). The ASH was directed to determine Plaintiff's mental condition and to prepare and submit “a written psychiatric or psychological report . . . indicating whether Defendant is fit to proceed, or, if not whether Defendant's mental disease or defect is of a nature precluding restoration of fitness to proceed, and also whether Defendant presents a danger to himself or to the person or property of another.” (Id. at 8).

         Medical records from the ASH indicate Plaintiff was admitted on September 8, 2016 and discharged on November 7, 2016. (ECF No. 47-4 at 48). Plaintiff's diagnoses on admission were borderline personality disorder, antisocial personality disorder, cannabis use disorder, opiate use disorder, adrenal insufficiency, back pain, and headaches. (Id.). Note was made that the Plaintiff should not be prescribed opiates due to his history of drug abuse. (Id. at 49). The aftercare report dated November 4, 2016, concluded that Plaintiff needed medication management services to continue his psychiatric medication. (Id. at 50). Plaintiff's medications on discharge were: Omeprazole, Hydrocortisone, Ambien, Salicylic Acid, Gabapentin, Bengay ultra strength, Lidocaine patch, Zyprexa, [28] Fioricet, Klonapin, Effexor XR, and Soma. (Id. at 52).

         During his incarceration at the WCDC, Plaintiff submitted multiple medical requests dealing primarily with the following issues: his medication being changed; not being treated for withdrawal; asking why a White inmate got treated for withdrawal while Plaintiff, who is Hispanic did not get treated; his Gabapentin being discontinued; not receiving proper medication and blood tests for congenital adrenal hyperplasia; not being seen by his endocrinologist or psychiatrist; not being treated for chronic joint, back, sciatica, muscle pain, and arthritis, which caused him to suffer needlessly and made it difficult to control his aggression; his need for muscle relaxers (Soma and Methocarbamol); his need for a double mat due to his chronic pain; needing his prescription for Effexor for mood and psychosis stability due to his bi-polar and depression; his paranoia, insomnia, and “voices, ” and hallucinations were getting worse; his need for proper medical treatment following his having been attacked by fellow inmates; not being able to see the doctor; and his need for pain medication for his chronic back and joint pain. (ECF No. 47-3 at 1-48).

         On March 7, 2016, Plaintiff was charged with a disciplinary violation for hoarding medication. (ECF No. 47-8 at 2-5). Plaintiff was given a pill nursing staff had cut. (Id. at 3). Plaintiff said he could not take that pill because he would not get the full amount. (Id.). The nurse asked for the pill back to throw it away. (Id.). Plaintiff did not return the pill and according to Deputy Hudgens attempted to hide the pill in his palm. (Id.). Deputy Hudgens asked Plaintiff to dispose of the pill and he did so. (Id.).

         On August 30, 2016, Plaintiff was charged with hoarding his medication. (ECF No. 47-8 at 18). Jailer Josue Velasco was present at the evening medication pass. (Id.). Jailer Velasco stated he saw the Plaintiff dropping his medication down his pant leg and then pretending to take it. (Id.). After Jailer Velasco had Plaintiff take both pant legs out of his socks, the medication fell to the ground and Plaintiff picked it up and took it. (Id.). Plaintiff was found guilty based on Deputy Velasco's report and the video of the incident. (Id. at 19). Plaintiff could be seen picking something off the floor and then consuming it. (Id). He was given five days in disciplinary segregation. (Id.).

         On March 14, 2017, Plaintiff was booked into Benton County. (ECF No. 49 at 65). He was released on March 17th to the WCDC. (Id.). Note was made that Plaintiff had is medications with him when released. (Id.).

         With respect to Sheriff Helder, Plaintiff argues he was aware of the policy of denying any medication that was not on Karas' formulary.[29] (ECF No. 62 at 1). Plaintiff further maintains Sheriff Helder knew of Plaintiff's psychiatric commitment and of Plaintiff's inability to obtain his medications when he was temporarily transferred to another facility but did nothing. (Id.).

         With respect to Dr. Karas, Plaintiff testified he should be liable for a failure to provide continuity of care whenever Plaintiff was transferred to another facility and then brought back to the WCDC. (ECF No. 62 at 36-37). Plaintiff also believed that Dr. Karas should not substitute his judgment for “specialist's such as a psychiatrist and an endocrinologist.” (Id. at 37). Plaintiff testified that Dr. Karas “did not want to do the right blood work [ACTH stimulation testing] for my adrenal disease.” (Id. at 42). Additionally, Dr. Karas did not provide Plaintiff with access to steroid shots for his adrenal disease. (Id.). Plaintiff further testified that Dr. Karas “would repeatedly avoid seeing [him] for long periods of time.” (Id.). If Plaintiff, his family, or his lawyer made “enough noise and enough racket about it, ” Dr. Karas would see the Plaintiff “a bunch of times without doing [any]o medical things. He would just come and see [the Plaintiff] for a few seconds and then go away.” (Id.).

         With respect to Nurse Veronica Dockery, Plaintiff testified she suddenly took him off Fioricet stating it was not on their formulary. (ECF No. 62 at 43). At the time, Plaintiff maintains the Fioricet was still on the cart but they would not give it to him. (Id.). Plaintiff indicated that Nurse Dockery “seemed to not want [him] to see the doctor. It was like she was trying to block [him] from seeing the doctor.” (Id.). She would either refuse his request or reply that he would be seen by the doctor but then Plaintiff was not seen. ( 43-44).

         Plaintiff testified that Nurse Landon Harris also seemed to “block” Plaintiff from seeing the doctor. (ECF No. 62 at 44). Nurse Harris replied to most of Plaintiff's requests. (Id.). Nurse Harris either denied Plaintiff's requests or would indicate Plaintiff would be seen by the doctor and that never occurred. (Id. at 46).

         With respect to Nurse Regina Walker, Plaintiff testified that she also replied to his requests. (ECF No. 62 at 46). Plaintiff believed she was trying to keep him from seeing the doctor. (Id.).

         With respect to Nurse Ken Hughes, Plaintiff testified he was trying to figure out who this was. (ECF No. 62 at 46). Plaintiff states Nurse Hughes would respond to his grievances and requests. (Id.). Plaintiff testified Nurse Hughes seemed to “have some significant control over [his] treatment.” (Id.). Plaintiff indicated Nurse Hughes had the “ability to keep [him] from seeing the doctor and to stop [his] sick calls or requests from getting where they needed to go.” (Id. at 46-47).

         Medical records from Vantage Point indicate Plaintiff was admitted there on March 26, 2015 and discharged on April 1, 2015. (ECF No. 47-4 at 1). Plaintiff was diagnosed as bipolar, with depression being his most recent episode and psychotic features. (Id. at 2). He was to be treated with Geodon[30] for psychosis and Lexapro[31] for depression. (Id.). He was also started on Vitamin D3, Ambien, Prilosec, [32] Oxycodone/APAP, [33] Prednisone, Oxycontin CR, [34] Florinef, Flexeril, Solumedrol IM[35] for self-administration for adrenal emergency, and Bactrim.[36] (Id. at 4). Note was made that Plaintiff suffered from sciatica, rheumatoid arthritis in the back, and congenital adrenal hyperplasia. (Id.).

         Medical records from the University of Arkansas for Medical Sciences (UAMS) in December of 2013, indicate a DNA sequencing test was done, and the results were consistent with a “diagnosis of, or predisposition to developing, congenital adrenal hyperplasia (CAH).” (ECF No. 49 at 28). Records indicate Plaintiff was seen at the Springdale location of UAMS on September 4, 2015. (ECF No. 42 at 1). Note was made that Plaintiff had been previously diagnosed with congenital adrenal hyperplasia and chronic low back pain. (Id. at 6). It was also noted that Plaintiff's past psychiatric diagnoses were bipolar I with psychotic features, psychogenic non-epileptic seizures (PNES), and panic disorder. (Id.). Dr. Rubenow indicated Plaintiff had a need for long term formal psychiatric follow-up due to his symptoms of bipolar disorder and panic disorder. (ECF No. 47-4 at 30). Plaintiff was also seen on October 12, 27, 2015, November 17 and 30, 2015, on December 21, 2015. (ECF No. 47-4 at 7-8, 11, 16, 20, ). Various changes were made to Plaintiff's medication during these visits. (Id. at 7-37).

         (2). Analysis of the Denial of Adequate Medical and Psychiatric Care

         By their incarceration, inmates are completely dependent on prison authorities for their medical care. Estelle v. Gamble, 429 U.S. 97, 103 (1976). The Eighth Amendment prohibition of cruel and unusual punishment prohibits deliberate indifference to the serious medical needs of prisoners. Id. at 106. The duty to provide medical care encompasses psychiatric needs. Vaughan v. Lacey, 49 F.3d 1344, 1346 (8th Cir. 1995). “Because society does not expect that prisoners will have unqualified access to health care, deliberate indifference to medical [or psychiatric] needs amounts to an Eighth Amendment violation only if those needs are ‘serious.'” Hudson v. McMilliam, 503 U.S. 1, 9 (1992). “[T]he failure to treat a medical [or psychiatric] condition does not constitute punishment within the meaning of the Eighth Amendment unless prison officials knew that the condition created an excessive risk to the inmate's health and then failed to act on that knowledge.” Long v. Nix, 86 F.3d 761, 765 (8th Cir. 1996).

         Thus, to prevail on an Eighth Amendment claim, “[t]he [Plaintiff] must demonstrate (1) that [he] suffered [from] objectively serious medical needs and (2) that the prison officials actually knew of but deliberately disregarded those needs.'” Jolly v. Knudsen, 205 F.3d 1094, 1096 (8th Cir. 2000) (quoting Dulany v. Carnahan, 132 F.3d 1234, 1239 (8th Cir. 1997)).

         No argument is made that Plaintiff did not have serious medical and psychiatric needs. He has therefore met the objective prong.

         To establish the subjective prong of deliberate indifference, “the prisoner must show more than negligence, more even than gross negligence, and mere disagreement with treatment decisions does not give rise to the level of a constitutional violation. Deliberate indifference is akin to criminal recklessness, which demands more than negligent misconduct.” Popoalii v. Correctional Med. Servs, 512 F.3d 488, 499 (8th Cir. 2008) (internal quotation marks and citations omitted).

         “The plaintiff-inmate must clear a substantial evidentiary threshold to show that the prison's medical staff deliberately disregarded the inmate's needs by administering an inadequate treatment.” Meuir v. Green Cty. Jail Emps, 487 F.3d 1115, 1118 (8th Cir. 2007). The deliberate indifference standard applies only to a narrow band of conduct. Detention Center physicians are entitled to exercise their medical judgment, and “do not violate the Eighth Amendment when, in the exercise of their professional judgment, they refuse to implement a prisoner's requested course of treatment.” Long, 86 F.3d at 761. What medication should be prescribed involves the exercise of medical judgment. While Plaintiff's medications were changed by Dr. Karas, Plaintiff was not denied medication for his conditions. He merely was prescribed different medications than his free world doctors had prescribed. Plaintiff's medical records were obtained, and changes and/or additions were made to the medications being provided to Plaintiff.

         With respect to Plaintiff's adrenal insufficiency, Plaintiff was provided medication, blood tests were run, an endocrinologist, the one identified by the Plaintiff as being involved in his treatment, was consulted, and the additional blood tests Dr. Maass suggested were done. The blood tests showed that Plaintiff's condition was stable. There is no indication that Dr. Karas chose a less efficacious course of treatment, intentionally maltreated the Plaintiff, or refused to provide essential care. Smith v. Jenkins, 919 F.2d 90, 92-93 (8th Cir. 1990). Further, whether Plaintiff should have been seen by an endocrinologist, rather than Dr. Karas consulting with an endocrinologist, is a question of medical judgment. Cf. Logan v. Clarke, 119 F.3d 647, 650 (8th Cir. 1997)(“[a]lthough the prison doctors may not have proceeded from their initial diagnosis to their referral to a specialist as quickly as hindsight perhaps allows us to think they should have, their actions were not deliberately indifferent”).

         With respect to Plaintiff's chronic pain, he was not provided with any narcotic medications because they were not used at the facility on a regular basis. This was especially true in Plaintiff's case where he was addicted to opiates. Plaintiff was given Gabapentin to relieve the pain and the dosage was adjusted upwards based on Plaintiff's complaints that he continued to suffer from chronic pain. Plaintiff was also prescribed Methocarbamol and Naproxen was authorized to have Bengay. Tylenol was also available. For most of his stay at the WCDC, Plaintiff was authorized to have a second mat. At one point, he was allowed bed rest 24/7 for a short period of time. He was given printed directions for exercises to help reduce his pain. The efforts “taken to ...

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