United States District Court, W.D. Arkansas, Fayetteville Division
MEMORANDUM OPINION AND ORDER
HOLMES, III CHIEF U.S. DISTRICT JUDGE
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.
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,  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.
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
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).
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).
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).
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
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
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).
Denial of Adequate Medical and Mental Health
makes emergency medical services available to detainees
twenty-four hours a day. (ECF No. 47-1 at 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.
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
(Id.)(emphasis in original).
to Dr. Karas, when Plaintiff was booked in on January 3,
2016, the only medication listed was Gabapentin 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,  .1 mg as needed; Olanzapine,
10 mg tablet at bedtime; Venlafaxine,  one 150 mg tablet
per day; Prednisone,  one 20 mg tablet per day; and Gabapentin,
one 600 mg tablet in the morning and two tablets at night.
(Id. at 3).
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.”
Karas indicates that at intake Plaintiff reported being on
Ambien,  Hydrocodone, Effexor,  Gabapentin,
Methocarbamol,  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
January 5, 2016, Plaintiff was started on Citalopram,
Trazodone,  Quetiapine,  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.).
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).
Karas indicates that Plaintiff's chronic pain was treated
with Gabapentin (dose gradually increased to 1600 mg twice
daily), Naproxen,  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).
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.).
January 25, 2016, after receipt of Plaintiff's medical
records, Plaintiff was prescribed Florinef to treat his
adrenal insufficiency. (ECF No. 47-12 at 4). On February 1,
2016, Prednisone was added. (Id.). On August 11,
2016, Plaintiff was changed to Hydrocortisonetherapy.
(Id.). According to Plaintiff, he was never received
access to “stress dosing” or an increased amount
of steroid sometimes given in a shot. (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.
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,  Gabapentin,
Hydrocortisone, Effexor, and other medications he could not
recall the names of. (Id.). He also reported a
history of schizophrenia and manic depression.
medication reconciliation was completed on November 8, 2016.
(ECF No. 47-12 at 5). Plaintiff was provided Hydrocortisone,
Effexor, Omeprazole,  Gabapentin, and Bengay.
(Id.). Quetiapine was given instead of Olanzapine.
(Id.). “Soma,  Clonazepam, [and]
Zolpidem[were discontinued] as these are
narcotic, benzodiazepine scheduled medications with chance
for abuse.” (Id.). Lidocaine patches,
Fioricet,  and Salicylic Acid Wash 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.” (Id. at 7).
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).
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.).
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.).
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.).
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).
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.).
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
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
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).
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,  Fioricet,
Klonapin, Effexor XR, and Soma. (Id. at 52).
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).
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.).
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.).
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.).
respect to Sheriff Helder, Plaintiff argues he was aware of
the policy of denying any medication that was not on
Karas' formulary. (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.).
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.”
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. (Id.at 43-44).
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).
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.
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
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 for psychosis and Lexapro for
depression. (Id.). He was also started on Vitamin
D3, Ambien, Prilosec,  Oxycodone/APAP,  Prednisone,
Oxycontin CR,  Florinef, Flexeril, Solumedrol
IM for self-administration for adrenal
emergency, and Bactrim. (Id. at 4). Note was made
that Plaintiff suffered from sciatica, rheumatoid arthritis
in the back, and congenital adrenal hyperplasia.
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).
Analysis of the Denial of Adequate Medical and Psychiatric
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
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)).
argument is made that Plaintiff did not have serious medical
and psychiatric needs. He has therefore met the objective
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).
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.
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
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 ...