United States District Court, W.D. Arkansas, Fayetteville Division
WILLIAM CALVIN BETHEL, JR. PLAINTIFF
DR. ROBERT KARAS and SHERIFF TIM HELDER DEFENDANTS
MEMORANDUM OPINION AND ORDER
TIMOTHY L. BROOKS UNITED STATES DISTRICT JUDGE.
a civil rights action filed by Plaintiff William C. Bethel,
Jr., pursuant to 42 U.S.C. § 1983. Bethel proceeds
pro se and in forma pauperis.
claims in this case concern the medical care Bethel received
when he was incarcerated in the Washington County Detention
Center (“WCDC”) from July 11, 2017, until his
transfer to the Arkansas Department of Correction on October
19, 2017. Specifically, Bethel maintains that Dr. Robert
Karas, the contract physician for the WCDC, and Sheriff Tim
Helder violated Bethel's constitutional rights by denying
him adequate medical care.
December 19, 2018, Defendants filed a Motion for Summary
Judgment (Doc. 21). On December 27, 2018, an Order was
entered directing Bethel to file a response to the Motion for
Summary Judgment by January 17, 2019. (Doc. 24). Bethel was
advised in the Order that failure to comply with its terms
would result in: (a) all of the facts set forth by the
Defendants in the summary judgment papers being deemed
admitted by Bethel, pursuant to Rule 56.1(c) of the Local
Rules for the Eastern and Western Districts of Arkansas;
and/or (b) the dismissal of the entire case, without
prejudice, pursuant to Local Rule 5.5(c)(2). Bethel did not
file a response to the summary judgment motion.
the local rules allow the Court to deem facts admitted when a
plaintiff does not file a response specifically disputing
those facts, the Eighth Circuit has stated:
A plaintiff's verified complaint is the equivalent of an
affidavit for purposes of summary judgment, and a complaint
signed and dated as true under penalty of perjury satisfies
the requirement of a verified complaint, 28 U.S.C. §
1746. Although a party may not generally rest on his
pleadings to create a fact issue sufficient to survive
summary judgment, the facts alleged in a verified complaint
need not be repeated in a responsive affidavit in order to
survive a summary judgment motion.
Roberson v. Hayti Police Dep't., 241 F.3d 992,
994-995 (8th Cir. 2001). Therefore, the Court will
“piece together [Bethel's] version of the facts
from the verified complaint.” McClanahan v.
Young, 2016 WL 520983, at *1 (D.S.D. Feb. 5, 2016). The
Court also has the benefit of Bethel's deposition, which
is attached to the motion. Accordingly, the Court will deem
admitted those portions of the Defendants' statement of
material facts that do not conflict with either Bethel's
verified complaint or his deposition.
Bethel's Account of His Medical History
testified that he was diagnosed in 2015 with severe chronic
obstructive pulmonary disease (“COPD”) and sleep
apnea by Dr. Kalyan of Northwest Physicians. (Doc. 23-6 at
25, 27). Dr. Kalyan prescribed oxygen, twenty-four hours a
day and seven days a week; the use of a
CPAP/BIPAP machine; Prednisone as needed; two
inhalers (Symbicort and Coventolin); an Albuterol updraft
machine; and an Albuterol inhaler. Id. at 25, 27,
32-33. Bethel stated that he did not use the oxygen as
directed because he was worried he would become dependent on
oxygen. Id. at 25. When Bethel's deposition was
taken on November 12, 2018, he testified that he only used
oxygen on an as-needed basis, which he estimated was now more
than 50% of the time. Id. at 26. He indicated that
he possessed a portable oxygen bottle in a carrying case with
a nasal cannula. Id. Bethel also testified that he
used the CPAP/BIPAP machine when he slept. Id. at
27. He admitted that there were periods of time in his life
when he could not afford to lease the CPAP machine.
Id. at 27-28. Further, despite his COPD diagnosis,
Bethel testified that he still smoked about a pack of
cigarettes a day. Id. at 49.
point, Bethel was diagnosed with a blood clot (a deep vein
thrombosis (“DVT”)) in his right leg and was
placed on Coumadin. Id. He claims that Dr. Hayward of
Highlands Oncology took him off Coumadin due to an adverse
reaction and prescribed Lovenox injections instead. Bethel
testified that he currently gives himself Lovenox injections
in the stomach. Id. at 38-39. He maintains
that in 2017, he was also diagnosed as having pulmonary
embolisms in his lungs, specifically three or four blood
clots. Id. at 38, 41.
Bethel claims that he was diagnosed with pulmonary
hypertension in 2010. This condition was not treated.
Id. at 43. He testified that his bicuspid valve and
his mitral valve have moderate leakage. Id. at
43-44. He further claims that he was diagnosed with
hypertension at some point in time, and doctors treated that
condition with blood pressure medication. Id. at 43.
Bethel claimed to have “borderline diabetes, ”
which he claims to monitor himself by testing his sugar
levels daily. He also testified that he has
neuropathy in his legs and hands and at one point was
prescribed “nerve medication, ” i.e.,
Gabapentin or Klonopin. Id. at 44-45.
with respect to his mental health, Bethel claims he has
severe anxiety, depression, and bipolar disorder. He believes
he was diagnosed with bipolar disorder by Dr. Bonner in 2016.
Id. Bethel was also prescribed
Adderall for ADD/ADHD. Id. at 50.
Bethel was arrested in July of 2017, he claims he was taking
Hydrocodonefor the neuropathy in his legs and for
arthritis in his elbows, wrists, and knees. Id. at
51. Several months before his arrest, in March of 2017, he
was incarcerated in the WCDC for a few days was prescribed
the following medications: Albuterol; Gabapentin; Metoprolol;
Amlodipine; Lisinopril; Lipitor; Furosemide; Enoxaparin
Sodium; a steroid inhaler; and Potassium. (Doc. 23-4 at 143).
Bethel's Documented Booking and Medical History
was booked into the WCDC in the late evening hours on July
11, 2017. (Doc. 23-2 at 1). His intake papers indicate that
he was in possession of the following: Amphetamine
salt; Lovenox; Lisinopril;
Amlodipine; Albuterol inhaler; Hydrocodone;
Adderall; and a steroid inhaler. Id. at 2. Bethel
reported to the intake officer that he had a history of heart
and breathing problems. Id. A nurse came to the
booking area and asked where Bethel's medical records
could be obtained. (Doc. 23-6 at 56). Bethel testified that
he advised the nurse that the WCDC could obtain his medical
records from Drs. Bonner, Howard, Kalyan, and Fish.
Id. at 56-57.
13, 2017, the WCDC received medical records for Bethel from
Mission Family Practice. These records showed that Bethel had
a history of COPD, ADD/ADHD, generalized anxiety disorder,
depression, and personality disorder. (Doc. 23-4 at 8-13).
His prescribed medications included Adderall,
Combivent, Hydrocodone, Klonopin, Lasix,
Lipitor, Lisinopril, Lovenox (subcutaneous injection),
Norvasc, Potassium Chloride, Prednisone, ted hose for daily
wear, Trazodone,  Tussionex,  Ventolin (inhaler), and
19, 2017, the WCDC received Bethel's records from
Northwest Health System. He had been treated there for the
following conditions: a minor finger laceration on July 12,
2015, id. at 17-27; and cellulitis following a
hernia repair on November 25, 2015, id. at 28-38.
19, 2017, the WCDC received Bethel's records from
Highlands Oncology. From these records, it appears that on
December 15, 2016, Bethel was diagnosed with acute embolism
and thrombosis of an unspecified vein, anxiety disorder,
polyneuropathy, other pulmonary embolism, bipolar disorder,
COPD, pain in the right lower leg, personality disorder,
major depressive disorder, and ADHD. Id. at 61.
Bethel was switched from the drug Coumadin to the drug
Xarelto, for treatment of his deep vein thrombosis
condition.Id. The medical records noted
that Bethel had a “very complicated history involving
primarily lungs and now a question of pulmonary
emboli.” Id. at 63.
was next seen by Highlands Oncology on December 28, 2016,
complaining of rectal bleeding following initiation of
Xarelto. Id. at 56. Bethel refused to consider
having a colonoscopy but agreed to see a gastroenterologist.
Id. A note was made in his file that Bethel's
father had died of breast cancer at the age of 42.
Id. at 57. Bethel was told to stop taking Coumadin
and Xarelto and was given a prescription for Lovenox.
Id. at 59.
also seen at Highlands Oncology on May 11, 2017, just two
months before his July incarceration at the WCDC. On May 11,
he complained of pain in his legs, knees, and hips; fatigue;
daily diarrhea; and restless sleep. His chart noted that he
had several clots in the right lower lobe of his lung,
chronic swelling of his right lower extremity, and possible
pulmonary emboli. Id. at 41, 43. He was on
“oxygen chronically” and took Prednisone 10 mg
daily, a Ventolin inhaler, Warfarin,  Norvasc,
Potassium Chloride, and Combivent. Id. at 41. It was
also noted that he had “diagnoses of a major
depressive, personality disorder and attention deficient
disorder” for which he took Klonopin and Adderall.
Id. Dr. Hayward prescribed Lovenox injections and
noted that the following medications had previously been
prescribed to Bethel: Accu-Check Compact Test, Adderall,
Chantix, Combivent Respimat solution for inhalation,
Doxepin, Hydrocodone, Klonopin, Lasix, Lipitor,
Lisinopril, Lopressor, Lunesta, Lyrica,
Maxzide, Norvasc, Potassium Chloride, Symbicort
inhaler, Tramadol, Trazodone, Ventolin inhaler, and
Xarelto. Id. at 41-43.
Medical Treatment at the WCDC
January 1, 2016, Dr. Karas has been the WCDC's doctor for
all inmates, and Karas Correctional Health has provided all
medical, dental, and mental health care coordination for
inmates in the WCDC. “All matters of judgment regarding
health services are made within the sole province of the
contract medical staff. No. employee of the [WCDC] is
permitted to make non-emergency medical decisions on behalf
of any inmate.” (Doc. 23-1 at 3).
are required to submit all non-emergency medical requests
through an electronic kiosk. Medical staff then review the
medical requests that the inmates submit. The nursing staff
is responsible for checking the files of inmates under care
and for following all physician's orders that are noted
in the file. According to Dr. Karas's Affidavit:
No one in the Sheriff's office, including the
Sheriff, makes any decision as to whether or
not [to] provide a particular medication, diagnostic testing,
or medical treatment based on the cost of the medication,
testing, or treatment. All decisions regarding medications,
medical testing, or medical treatment are left to the
professional medical judgment of the providers at the
(Doc. 23-7 at 1-2) (emphasis in original).
WCDC has adopted procedures for handling inmates who are
prescribed medications while in the facility and who are
admitted with medications on their persons. According to Dr.
Karas, “[i]t is common practice of the WCDC medical
staff to request a patient's medical records prior to
prescribing medications.” Id. at 2.
11, 2017, the day of Bethel's arrest, Corporal Patrick
Bzoski submitted an incident report which read as follows:
On July 11, 2017 at approximately 10:57 p.m., Officer Hayden
from the Fayetteville Police Department Brought in Detainee
Bethel, William . . . for false imprisonment. Prior to their
arrival they were at the hospital because Detainee Bethel
complained he was having a heart attack. The hospital
medically cleared him and then Detainee Bethel made the
statement that he wanted to kill himself. Once the intake was
complete, Officer Hayden informed me of Detainee Bethel's
I notified the medical staff and Nurse Melissa responded. She
spoke with Detainee Bethel and asked him if he wanted to
commit suicide and he responded no. Nurse Melissa had
Detainee Bethel sign a “No Harm Contract” and
concluded from her evaluation [that] Detainee Bethel did not
need to be put on suicide watch.
(Doc. 23-5 at 1).
12, 2017, medical staff reviewed Bethel's current
medications and performed a medication reconciliation. (Doc.
23-4 at 89). They were able to verify his prescriptions for
Hydrocodone, Tramadol, and Adderall at the Southgate
Pharmacy. It appeared to staff that Bethel had not filled his
prescriptions at the Southgate Pharmacy for Wellbutrin,
Clonazepam,  Lipitor, Ventolin inhaler, Furosemide,
Triamterene-HCTZ,  Warfarin, Metoprolol,  Amlodipine,
Gabapentin, Atorvastatin,  or Lisinopril for some time,
and he had no refills left on any of those prescriptions.
Id. at 90-93. In short, Dr. Karas and his staff
concluded that Bethel had not been taking many, if any, of
his heart medications and blood thinners since sometime in
2016. (Doc. 23-7 at 3). However, records from Bethel's
March 2017 incarceration at the WCDC showed that he was
prescribed at least Lovenox-a drug used to treat and prevent
blood clots-during that several-day window. In fact,
according to documents submitted by the Defendants, March 14,
2017 “was the last confirmed record of Lovenox
administration” at the jail facility. Id. at
after Dr. Karas received some of Bethel's medical records
from his free-world providers, he ordered Bethel to begin
taking aspirin (162 mg.) on July 19, 2017, to serve as a
blood thinner. (Doc. 23-4 at 98). Dr. Karas had concerns
about the lack of detail in the medical records that would
explain or justify why certain anticoagulant medications had
been prescribed. He stated in his affidavit:
The records from Dr. Bonner did not give a thorough history
of Bethel's diagnoses, and did not detail why he was
taking the Lovenox. Further information was request[ed] from
Walker Heart, who stated that the patiend [sic] had not been
there since 2015 . . . . Medical records were received from
Northwest medical Center on 7/19/16 and reviewed the same
day. These records did not contain any information regarding
(Doc. 23-7 at 3-4). In the meantime, Bethel refused to take
the aspirin, and the prescription was discontinued on July
26, 2017. Id. at 99. Bethel later testified that he
refused to take aspirin because he knew it would not help his
medical conditions. (Doc.
59 On July 20, 2017, Bethel submitted a medical request
complaining that he was being charged for medical services,
but none had been provided to him. On July 24, 2017, Bethel
again asked for his money back because no medical services
had been rendered. Nurse Hughes responded that Bethel
“has more medical personnel trying to get all your
medical history than most people.” (Doc. 23-6 at 65).
She noted that he had listed very serious medications in his
history, and staff were trying to get his medications
started. She also noted that they had been “unable to
verify” Bethel's medications and asked if he had
“the bottles we can use them to get yours filled. Can
you have them brought to us?” Id. Bethel
testified that his bottles were brought to the jail as
requested. Bethel indicated he did not receive the
medications even after this was done. Id.
29, 2017, Bethel submitted a grievance stating that he was
not being given his medication, “which is
life-threatening medicine, which violates [his] inmate
rights.” (Doc. 23-6 at 62). The nurse responded by
asking if he wanted to sign a medical refusal form since he
had refused the treatment they had tried-the treatment being
aspirin, presumably. Id. Bethel responded by asking
that staff contact his attorney, as he could not speak about
“this matter.” Id. Bethel testified he
responded this way because ...