United States District Court, W.D. Arkansas, Fayetteville Division
MEMORANDUM OPINION AND ORDER
HOLMES, III, U.S. DISTRICT JUDGE
civil rights action filed pursuant to 42 U.S.C. § 1983,
Plaintiff, Billy J. Davidson, contends his constitutional
rights were violated while he was incarcerated in the
Washington County Detention Center (“WCDC”).
Davidson names as Defendants Washington County Sheriff Tim
Helder, Major Randall Denzer, and the WCDC physician, Dr.
Robert Karas. Davidson contends his constitutional rights
were violated when the Defendants exhibited deliberate
indifference to his serious medical needs and when Sheriff
Helder and Major Denzer acted with deliberate indifference in
the handling of his medical grievances.
case is before the Court on the Defendants' Motion for
Summary Judgment. (ECF No. 22-24). Plaintiff has responded
(ECF No. 32) to the Motion. The Motion is ready for decision.
was incarcerated at the WCDC from October 6, 2018, until his
transfer to the Arkansas Department of Correction
(“ADC”) on February 26, 2019. (ECF No. 24-2 at 2
& ECF No. 24-4 at 57). During his incarceration, Davidson
submitted numerous grievances and medical requests about
suffering from anxiety, needing to be seen by a psychiatric
nurse, being off his medication, having a bleeding esophageal
ulcer, having blood in his stool, his need for an endoscopy,
and his need to see an orthopedic physician due to an injury
to his hand. See (ECF No. 24-4 at 71-154).
Johnathan Beckham saw Davidson on October 15th. (ECF No.
24-4 at 63). It was noted that Davidson reported a hiatal
hernia and a bleeding ulcer. Id. Davidson complained
of continuous acid. Id. Davidson requested a
prescription for Omeprazole. Id. Caregiver Beckman
noted that he would request review for the possible issuance
of a prescription. Id. The records indicate Davidson
was seen by Nurse Dockery the following day and a
prescription for Omeprazole was written.
medical records indicate Davidson was seen by
“psyc” Nurse Sheila Bryant, on October 16th. (ECF
No. 24-4 at 64). Davidson reported anxiety, agitation, mood
swings, and trouble sleeping. Id. He was prescribed
Prozac for anxiety. Id. at 47. On
October 17th, Davidson asked for a medication other than
Prozac for anxiety. Id. at 71. His request was
denied. Id. On October 18th, Davidson asked for
Buspar,  which he indicated his physician had said
was closer to Xanax. Id. He also asked that his chili
serving be substituted with other food because of the onions
and chilies. Id. His requests were denied.
Id. He was provided with a second blanket to elevate
his head. Id. He was told he could pick out the
onions and chilies unless he had a documented allergy.
submitted a second request explaining that he could not eat
onions and chilies because he had a bleeding ulcer in his
esophagus. (ECF No. 24-4 at 71). In response, he was told to
pick them out. Id. Davidson stated that Prozac was
for depression not anxiety. Id. In response,
Davidson was told that Prozac was for anxiety and panic
disorders and that he would not receive Xanax at the WCDC.
Id. at 72. On October 19th, Davidson was told his
ulcer was being treated with Omeprazole and that they did not
use Buspar for “new treatment of anxiety.”
Id. at 74. He was also told he could choose not to
eat any foods he desired to and he should provide medical
verification of food allergies. Id.
October 20th, Davidson advised medical that the Prozac was
making him feel weird and dizzy. (ECF No. 24-4 at 74). He
again requested Buspar. Id.
October 21st, Davidson submitted a grievance stating he
needed his antibiotics prescribed “months back”
by the Washington Regional Medical Center
(“WRMC”); he had a bleeding ulcer in his
esophagus and blood in his stool; and he needed an endoscopy.
(ECF No. 24-3 at 5). According to Davidson, the antibiotics
had been stolen before he could take all of them. (ECF No.
24-4 at 82). The grievance was transferred to medical. (ECF
No. 24-3 at 5). Davidson's WRMC records were requested.
(ECF No. 24-4 at 74).
WRMC records show Davidson was admitted on October 26, 2017,
and released October 28, 2017. (ECF No. 24-4 at 29). An upper
endoscopy was done and it “revealed esophagitis and an
ulcer around 30 cm along with sloughing distal to this ulcer,
nonobstructing Schatzki ring and slight oozing from the
ulcer, diffuse gastropathy in the stomach.”
Id. His discharge medications were Augmentin for ten
days, Omeprazole, Carafate,  and a daily multi-vitamin.
October 22, 2018, Nurse Practitioner Kelley Hinely stated
that she had reviewed Davidson's WRMC emergency room
records. (ECF No. 24-3 at 5). Nurse Hinely stated that
Davidson had only been placed on antibiotics for ten days.
Id. Nurse Hinely stated that the other medications
had been reordered in accordance with the emergency room
records. Id. Prescriptions were written that day for
Omeprazole and Carafate. (ECF No. 24-4 at 75-77).
was seen on October 22nd by Nurse Andrew Eisele. (ECF No.
24-4 at 78). Davidson appeared anxious and reported
increasing depression. Id. He again requested
Buspar. A review was made of positive coping skills, such as
journaling, reading something positive, physical activity
during the day, and counting when going to sleep.
Id. His prescription for Prozac was discontinued.
Id. at 78.
October 23rd, Davidson was seen by Dr. Karas. (ECF No. 24-4
at 80). Dr. Karas noted that Davidson had a long history of
anxiety. Id. Davidson reported having tried Buspar
and that it worked. Id. Dr. Karas approved the use
of Buspar and wrote a prescription for fourteen days.
Id. at 79. Prescriptions were also written for fish
oil and magnesium. Id. at 80.
submitted another grievance on October 25th. (ECF No. 24-3 at
6). He asserted that he needed the endoscopy done for his
bleeding ulcer and blood in his stool and needed antibiotics.
Id. Davidson maintained his medical rights were
being violated. Id. He also asked that he not be
given food trays with chili or onions. Id. The
grievance was reassigned to medical services. Id. On
October 26th, Davidson was seen by Nurse Dustin Sanders. (ECF
No. 24-4 at 82). Davidson's vital signs were stable.
Id. Davidson reported “coffee ground like
emesis in the morning with his reflux.” Id.
Davidson reported his ulcer was bleeding and again asked for
the antibiotics that WRMC had prescribed. Id. A
bland diet was ordered for Davidson. Id. at 82. Note
was made he could not “have spicy or onions” in
his diet. Id. On October 28th, Davidson notified
medical that the Carafate was causing stomach cramps and
diarrhea. Id. at 83. The prescription was
discontinued the following day. Id. at 84. On
October 29th, Davidson was seen by Nurse Hinely. Id.
at 83. Nurse Hinely ordered a blood check for h. pylori,
stool check for blood, and a complete blood count.
Id. at 84.
submitted a medical request on October 30th. (ECF No. 24-3 at
20). Davidson stated he was cramping and fatigued as a result
of vitamin deficiency, that his ulcer was bleeding, and he
needed one Ensure a day. Id. Davidson also indicated
he doubted medical staff had obtained his antibiotics for his
throat yet or an appointment for an endoscopy. Id.
Nurse Dominguez responded that Davidson had been brought to
medical and was being taken care of. Id.
October 31st, Davidson sent a request to Corporal Mulvaney
stating that he had gastroesophageal reflux disease
(“GERD”), there was blood in his stool, and he
needed an endoscopy done because of a life-threatening
bleeding esophageal ulcer. (ECF No. 24-3 at 15). Davidson
indicated that the prior year he had been allowed out of jail
by Judge Beaumont. Id. Davidson asked if Corporal
Mulvaney would let his public defender know of his concerns.
Id. In response, Corporal Mulvaney said he did not
get involved in medical decisions. Id. Corporal
Mulvaney printed the request and gave it to medical staff.
Id. Davidson also submitted a medical request asking
for an endoscopy to be done. (ECF No. 24-4 at 87).
November 1st, Nurse Hinely responded in writing to
Davidson's complaint about blood in his stool by
notifying him that his H. pylori test was negative. (ECF No.
24-3 at 6 & ECF No. 24-4 at 88). Nurse Hinely stated the
WRMC medical records were from October 2017. Id.
Nurse Hinely asked what antibiotic Davidson was supposed to
take. Id. Nurse Hinely also noted that they found no
history of antibiotics when they reconciled his medication.
November 1st, Davidson submitted a grievance asking to see a
throat physician as he was having trouble swallowing his
food. Id. at 7. The grievance was reassigned to
medical services and Davidson was advised that he was placed
on medical call. Id.
November 1st, a stool test was positive for blood. (ECF No.
24-4 at 86). Blood tests also showed Davidson was anemic.
Id. at 89. He was prescribed iron and Ensure.
November 1st, Davidson injured his left middle finger on a
weld on his bunk. (ECF No. 24-7 at 23). In his deposition,
Davidson testified that there was a cyst or knot of some kind
on that finger that had been there for three or four years.
(Id. at 24-27). The cut nicked the knot.
Id. at 25. He was taken to the medical office and
examined by Nurse Hinely. (ECF No. 24-4 at 89). She noted he
had a 1.5 cm cut on his left palmar surface of his left
middle finger (existing contracture noted). She closed the
cut with two sutures and applied antibiotic ointment and a
dressing. Id. Nurse Hinely noted Davidson suffered
from chronic gastric ulcer, anemia, contracture left middle
finger, laceration left middle finger, Etoh (alcohol)
dependence, and anxiety. Id. The plan was to stop
Buspar and add Olanzapine,  Omeprazole, Amoxicillin,
iron, and Ensure. Id. at 88-89.
The sutures were to be taken out in ten days and the stool
sample was to be repeated in two weeks. Id.
November 2nd, Davidson asked Lieutenant Ake if he knew what
Davidson's “OR [own recognizance] status”
was. (ECF No. 24-3 at 16). Davidson stated that he had blood
in his stool, trouble getting food down, and that the
“pain is high” in his finger. Id. In
response, Corporal Mulvaney advised Davidson that the medical
department was well aware of his “medical issues and
they are dealing with them accordingly.” Id.
With respect to his being released on OR, Davidson was
advised that he would need to speak to his attorney about
this issue. Id.
submitted a grievance on November 2nd stating that his finger
was not sealing up, the nurses said they “don't
have time, ” and he needed to see an orthopedic
physician. (ECF No. 24-3 at 8). The grievance was reassigned
to medical services. Id.
November 2nd, Davidson asked if the court was aware of his
bleeding esophageal ulcer, the cut on his finger that
required two stitches and would not hold, and his need for an
endoscopy. (ECF No. 24-3 at 23). He stated that it was
painful to eat. Id. If the court was not aware of
his medical condition, Davidson asked that it be told since
he did not have an attorney. Id. Davidson also asked
to see his orthopedic physician, Dr. David Yakin, about his
finger, which he stated was very painful. (ECF No. 24-4 at
90). Davidson submitted two other requests on November 2nd
stating he needed to see Dr. Yakin; the cut on his finger was
“coming apart” and he could not keep it from
bleeding, his pain level was “high;” and asking
if an endoscopy had been scheduled. (ECF No. 24-3 at 21-22);
(ECF No. 24-4 at 90-91). Davidson reported problems getting
his food down. (ECF No. 24-4 at 90).
November 2nd, a note was made by Dr. Karas, with regard to
Davidson's throat complaints, that Davidson was not seen
because he was recently seen by provider-in this instance,
Nurse Hinely on November 1st. (ECF No. 24-4 at 89-90). A note
was made by Nurse Hinely to recheck Davidson's complete
blood count in two weeks. Id. at 90. With regard to
Davidson's complaints about his finger, on November 3rd,
Nurse Sanders made a note in the medical records indicating
that only one stitch had come out and the wound was bleeding
only a small amount. Id. at 91. Nurse Hinely was
consulted and advised that the one stitch was sufficient so
long as the wound had not reopened. Id.
November 5th, Davidson submitted a request again asking if
the court was aware of his bleeding ulcer and the cut on his
finger. (ECF No. 24-3 at 23). If not, he asked if medical
staff could let them know. Id. He also stated he
needed an endoscopy and that it hurt to “get my food
down.” Id. On November 8th, Nurse Kelley
responded: “thanks for the update.” Id.
November 6th, Davidson wrote to Corporal Mulvaney asking why
he was not on OR. (ECF No. 24-3 at 17). Davidson indicated
that “Dr. Kelly” had recommended that he be
released on OR because of his bleeding ulcer, his hand
needing orthopedic attention, and the blood in his stool.
Id. Corporal Mulvaney responded that the medical
staff had not recommended Davidson's release on OR.
Id. In any event, even if they had, Corporal
Mulvaney pointed out it was not the medical staffs'
decision to make. Id. Davidson was advised to speak
with his attorney. Id. Corporal Mulvaney stated he
had sent Davidson's requests to the public defenders'
submitted a second request on November 6th asserting that
Nurse Kelly had recommended that he be released on his OR and
that he thought jail staff could recommend that he be
released on his OR. (ECF No. 24-3 at 18). Davidson wrote that
he was asking for help; he indicated he would sign a waiver;
and he asserted that he was unable to contact his attorney.
Id. Corporal Mulvaney responded that he had spoken
to medical provider Nurse Hinely and she had not recommended
that Davidson be “OR'd out.” Id.
Corporal Mulvaney stated that the medical staff was well
aware of his ulcer issue and his finger/hand injury and
Davidson was being treated for both. Id. Corporal
Mulvaney indicated he did not know what “waiver”
Davidson was referring to and that Davidson would have to
speak with his attorney. Id.
submitted a request on November 7th stating that medical
would not respond to his requests and reporting that his
stitches had come out. (ECF No. 24-3 at 1). The request was
reassigned to medical services. Id.; (ECF No. 24-4
at 92). On November 7th, Corporal Mulvaney noted the
following from an e-mail from Nurse Hinely: she did not
recommend OR for Davidson for any medical reason; Davidson
was being treated for chronic ulcer which was first
documented in the emergency room in October of 2017 and
reported by him during a prior detention; and Davidson was
receiving treatment for the injury to his finger. (ECF No.
24-3 at 19).
November 8th, Nurse Hinely added Davidson to the provider
call list so that his finger could be assessed. (ECF No. 24-4
at 92). Davidson's records were requested from Advanced
Orthopedics. Id. at 93. Note was made that after the
records were reviewed, they would consider referral for
evaluation of the left contracted digit. Id. at 93.
Referral to a gastro-intestinal (“GI”) physician
would also be considered if Davidson's complete blood
count was worse, there was evidence of a “GI”
bleed, or there was blood in the stool. Id. at 94.
Davidson was prescribed seven more days of protein shakes and
a double blanket. Id. at 93-94.
records from Advanced Orthopedic Specialists show that
Davidson was seen on August 2, 2017, by Dr. Yakin. (ECF No.
24-4 at 1). Davidson had a healing nondisplaced fracture of
the middle third of scaphoid bone of his right wrist and an
old ulnar styloid fracture. Id. at 7. A
“[t]humb spica exos brace” was placed to
immobilize the hand. Id. at 8. Davidson was to be
seen again in six weeks. Id. He requested narcotic
pain medicine but given that his breath smelled of alcohol,
Dr. Yakin declined and recommended the use of
was next seen on September 20, 2017. (ECF No. 24-4 at 14). He
reported having pain, stiffness, swelling, weakness and a
decreased range of motion on the right side. Id.
X-rays were taken, and Dr. Yakin noted they showed a
“displaced scaphoid fracture, becoming a non
union” due to Davidson not wearing the brace properly.
Id. at 16 & 21. Dr. Yakin concluded surgery was
needed to fix the fracture. Id. at 17. Dr. Yakin
noted the surgery could be done when Davidson was released.
Id. at 21.
October 18, 2017, Davidson saw Dr. Yakin for a follow-up
visit and complained of his right wrist swelling. (ECF No.
24-4 at 24). Davidson reported that the wrist had been
bothering him for months and that it was getting worse with
swelling, weakness and pain on the right side. Id.
X-rays showed: “loose body in right wrist and ulnar
styloid nonunion and persistent scaphoid fracture non
union.” Id. at 27. Dr. Yakin ordered a
computerized tomography (“CT”) scan of the right
wrist. Id. Davidson was diagnosed as suffering from
chronic pain syndrome. Id. Davidson was going to be
referred to another physician for pain management.
Id. at 28.
scan of Davidson's right wrist was performed on October
30, 2017. (ECF No. 24-4 at 43). The CT scan showed a
“mildly displaced scaphoid wrist fracture which
demonstrates no evidence of healing, ” osseous
fragments, a mildly displaced ulnar styloid fracture, mild
widening of the scapholunate interval suggesting ligament
injury, and mild to moderate osteoarthritis. Id. No
other medical records were submitted concerning the 2017
visits with Dr. Yakin.
November 8, 2018, Davidson submitted a grievance stating that
medical would not respond. (ECF No. 24-3 at 2). He was
advised that the grievance would be reviewed and investigated
by a sergeant. Id. With respect to medical,
Davidson was told that “[m]edical will need to clear
some of your request[s] before you will be able to
communicate with them further.” Id. Davidson
also submitted a medical request asking for his extra
blanket. (ECF No. 24-4 at 94). Additionally, he asked the
status of his hand appointment with Dr. Yakin and for an
submitted a medical request on November 9th asking if he had
an appointment with Dr. Yakin's office. (ECF No. 24-3 at
24); (ECF No. 24-4 at 94). Davidson reported that his hand
was swollen in the palm area and the edges of the cut were
not staying together. (ECF No. 23-4 at 24). He stated he was
in a lot of pain and believed he had nerve damage.
Id. Davidson also asked that his second blanket be
approved again. Id. He did not understand why it was
taken away. Id. Davidson submitted a second medical
request the same day asking about the status of his
appointment with Dr. Yakin and also whether he was going to
get an endoscopy done. Id. at 25. In response,
Davidson was placed on review. Id. Nurse Hinely
reviewed his file and decided no change in his care was
needed. (ECF No. 24-4 at 95).
November 11th, Davidson thanked Lieutenant Foster for
speaking with him the day before. (ECF No. 24-3 at 3).
Davidson indicated he would like to be released on his OR due
to his medical situation. Id. He stated he had full
coverage insurance to pay for the care he needed.
Id. He pointed out that he had a bleeding ulcer in
his esophagus and his hand was healing but something was
wrong with his hand and he needed it looked at by an
orthopedic physician. Id. Davidson stated again that
the jail was responsible for his hand since the injury was
the result of a bad weld on a bunk. Id. Lieutenant
Foster did not respond, at least not via the kiosk.
November 12th, note was made in the medical records that an
appointment should be made “for chronic 3rd middle
finger left contracture.” (ECF No. 24-4 at 96). The
appointment was noted to be non-urgent. Id. Nurse
Hinely also noted that Davidson had behavioral problems at a
prior appointment with Dr. Yakin and had been terminated as a
patient by Ozark Orthopedic. Id. An appointment was
made for Davidson to see Dr. Yakin on November 30th.
November 14th, Davidson submitted a grievance stating that
medical would not tell him if he was being scheduled to be
seen by an orthopedic physician. (ECF No. 24-3 at 10). The
grievance was reassigned to medical services. Id.
Nurse Dominguez answered that for security reasons they could
not tell him if an appointment had been made for him.
submitted a grievance dated November 15th, stating that
medical had taken away his prescription for Ensure even
though he had been told another prescription would be
entered. (ECF No. 24-3 at 11). Davidson indicated he had lost
six pounds in a week. Id. He also asserted that
nothing was being done about his swollen finger and hands.
Id. The grievance was reassigned to medical
services. Id. Davidson wrote that he was appealing
this grievance response. Id. Corporal Mulvaney
responded to the appeal stating he had spoken with Nurse
Hinely about this issue several times and that Davidson had