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Dent v. Wexford Health Sources, Inc.

United States District Court, D. Maryland

March 18, 2016




Robert Dent has complained to medical staff at Roxbury Correctional Institution (“RCI”) in Hagerstown, Maryland, and Western Correctional Institution (“WCI”) in Cumberland, Maryland, [1] as well as to Wexford Health Sources, Inc. (“Wexford”), the medical contractor for the Maryland Department of Public Safety and Correctional Services (“DPSCS”), about pain in his left knee and lower back. He has filed suit under 42 U.S.C. § 1983, alleging that Wexford, along with Janice Gilmore, Colin Ottey, M.D., Peggy Mahler, R.N.P., and Robustiano Barrera, M.D., violated his rights under the Eighth Amendment to the United States Constitution by providing him inadequate medical treatment.

Pending is the defendants’ motion to dismiss or, in the alternative, motion for summary judgment. (Mot. Dismiss, ECF No. 18.) Dent has filed an opposition, (Resp. Opp’n, ECF No. 22), to which the defendants have replied, (Reply, ECF No. 25). The case is fully briefed and ripe for disposition.[2] No hearing is necessary to resolve the issues. See Local Rule 105.6 (D. Md. 2014).[3] For the reasons that follow, the defendants’ motion will be granted in part and denied in part. The claims against Wexford and Gilmore will be dismissed; summary judgment will be granted as to Mahler and Barrera; and summary judgment will be denied without prejudice as to Ottey, subject to renewal in sixty days.


Dent is an inmate in the custody of DPSCS. (Compl. 1, ECF No. 1.) He filed this complaint in January 2015, raising an Eighth Amendment claim based on the medical care he received for his left knee and lower back pain. (Id. at 3-5.) He claims he was improperly denied arthroscopic surgery on his left knee and MRIs of his knee and lumbar spine after these procedures were recommended for him in 2014. (Id.) Dent claims the defendants were aware for three years that he had knee and lower back pain, yet failed to order MRIs. (Id. at 4.) As redress, Dent is seeking a declaratory judgment that the defendants violated his constitutional rights, injunctive relief ordering the defendants to provide him medical treatment, compensatory damages in the amount of fifty thousand dollars ($50, 000) against each defendant, punitive damages in the amount of two-hundred-and-fifty thousand dollars ($250, 000) against each defendant, and “daily disability compensation” of ninety dollars ($90) against each defendant. (Id. at 5-6.)

The following facts are presented in the light most favorable to Dent, the nonmoving party.[4]

A. Treatment History

On March 6, 2011, Dent presented concerns of pain in his leg and back to Ottey, the medical director of WCI and RCI. (ECF No. 1-11, at 1; Ottey Aff. ¶ 1, ECF No. 18-4.)[5] Dent explained that he had hurt his leg and back in a car accident in 1996. (ECF No. 1-11, at 1.)

On March 9, 2011, Dent was examined by Crystal Swecker, P.A., for knee and back pain.[6] (ECF No. 1-12, at 1.) She reported finding that Dent had decreased lumbar mobility, and his spine was positive for posterior tenderness. (Id.)

On December 24, 2011, Dent was seen by Jonathan Thompson, M.D., for complaints of bilateral leg pain. (ECF No. 22-8, at 1.) Dent explained he was hit in the back playing basketball and his legs went numb, causing him to fall to the floor. (Id.) Dent complained the bottom of his feet were tender. (Id.) Dent was told to continue his medication regimen, which included aspirin and an anti-inflammatory, and to avoid work or yard activity that day. (Id. at 1-2.)

On July 1, 2012, Wexford became the medical contractor for inmates in the custody of DPSCS. (Ottey Aff. ¶ 2.) Prior to this time, Wexford was responsible for utilization management review services for the DPSCS system, and did not directly treat inmates in the DPSCS system. (Id.) As utilization review provider, Wexford was responsible solely for approving or denying specialty medical service for inmates. (Id.)

The defendants assert that Dent raised no complaints of back or leg pain between July 1, 2012, and January 22, 2014. (Mot. Dismiss Mem. Law 3, ECF No. 18-1.) Dent’s exhibits show that on August 22, 2013, Mahler saw Dent for a number of medical complaints, but none concerned lower back or left leg pain. (ECF No. 1-15, at 1.) On November 14, 2013, however, Dent presented complaints about intermittent left knee and mid-back pain to Mahler during a medical visit, which he attributed to arthritis. (ECF No. 1-16, at 1.) Mahler indicated Dent was taking Motrin, which she advised him to continue. (Id.) She also recommended stretching exercises for him and told him to follow up with another appointment if needed. (Id.)

The next time Dent complained of leg pain was at his medical appointment on January 28, 2014. (ECF No. 1-17, at 1.) Mahler evaluated Dent and indicated that Dent complained of suffering from pain in his right leg for six months. (Id. (emphasis added).) Dent described the pain as an ache that was worse in the morning and gradually improved throughout the day. (Id.) Dent stated he had arthritis, and described his pain as moderate. (Id.) Mahler noted that Dent’s condition was stable and improved with NSAIDs.[7] (Id.) Mahler prescribed Naprosyn[8] and recommended stretching exercises. (Id.)

On March 7, 2014, Ottey examined Dent for chest and right knee discomfort. (Sealed Ex. 1, at 3-4.) Ottey observed that Dent had no knee swelling, his gait was normal, and he was able to bear full weight. (Id. at 3.) Ottey instructed Dent to submit a sick call slip if his symptoms failed to improve. (Id. at 4.)

On April 28, 2014, Mahler saw Dent for complaints of left knee and lower back pain. (ECF No. 1-18, at 1.) Dent also noted “intermittent right knee pain, ” that his right knee gave out on him occasionally, and that the right-knee pain had improved with Motrin. (Id.) In terms of his left knee, he denied any surgery or injury. (Id.) Dent reported experiencing intermittent lower back pain, and that he felt a tingling sensation down his right leg when he jumped or reached straight up, which he attributed to a ball hitting him in the back while playing handball two years prior. (Id.) Dent stated he was supposed to begin physical therapy at RCI, but was transferred to WCI before it started. (Id.) Dent stated he believed he had a nerve issue in his back. (Id.) Mahler ordered x-rays of Dent’s spine and knee. (Id. at 1, 3.) The results of the spine x-ray showed mild degenerative changes, but no evidence of acute fracture or dislocation. (Id. at 4.)

On June 5, 2014, Barrera examined Dent for complaints about pain in his left leg and back. (ECF No. 1-21, at 1.) Dent reported pain shooting down his leg. (Id.) Barrera noted Dent’s reported history of a 2011 sports injury to his back. (Id.) Dent reported that the injury had resulted in almost immediate weakness in both legs, and that he was taken to the emergency room. (Id.) Dent reported that his leg function gradually returned, but he continued to experience left leg pain. (Id.) Dent told Barrera that his back pain had since returned. (Id.) While lifting weights, Dent had momentarily lost control of both legs. (Id.) Barrera indicated Dent showed clinical symptoms of a herniated disc, and referred him for physical therapy. (Id.)

On June 15, 2014, Ottey saw Dent for medication concerns. (Sealed Ex. 1, at 10-11.) Dent reported that he was to be placed on a muscle relaxer, but it had not been ordered. (Id. at 10.) Dent indicated that he was scheduled to begin physical therapy the following Tuesday. (Id.) Ottey observed that Dent limped. (Id.) He advised Dent to see the provider who recommended a muscle relaxer. (Id.)

On June 30, 2014, Dent saw Mahler for his concerns that he had yet to receive the Baclofen[9] prescribed for him. (Id. at 12.) The pharmacy department informed Mahler that Dent would be added to the medication list that day. (Id.) Dent was so advised. (Id.)

On July 9, 2014, Barrera saw Dent for a scheduled provider visit to re-evaluate his need for ongoing physical therapy. (Id. at 13-14.) Dent reported “significant improvement” regarding his back and leg pain, although he presented complaints of left knee pain with tenderness. (Id.) Barrera noted that the symptoms were compatible with tendinitis. (Id.) Barrera also observed Dent’s straight leg raising was mostly corrected. (Id.) Based on his medical findings, Barrera recommended Dent continue physical therapy. (Id.) Dent was approved for additional physical therapy. (Id. at 15.)

On July 30, 2014, Monica Stallworth, M.D., saw Dent for a chronic care visit related to his arthritis, among other issues. (Id. at 16-17.) Dent complained that NSAIDs made him ill. (Id. at 16.) Stallworth renewed Dent’s medications and prescribed Tylenol No. 3.[10] (Id. at 17.) On August 1, 2014, Ottey discontinued the Tylenol No. 3 prescription and prescribed Tylenol Extra Strength for arthritis instead. (Id. at 18.)

On August 19, 2014, Dent was seen by Mahler for a physical examination. (Id. at 19-22.) Dent reported suffering pain in his left knee for one-and-a-half years, and that he had injured his left knee playing handball in 2011. (Id. at 19.) He stated “Dr. Steve”[11] told him he had injured the cartilage in his left knee. (Id.) Dent said he was getting physical therapy for his back and left knee. (Id.) Dent also reported that Tylenol 500 mg was ineffective, but stated he did not want to take Motrin or Naprosyn because they upset his stomach. (Id.) Mahler prescribed Mobic[12] and recommended avoiding exercises that placed pressure on the knee. (Id. at 19, 24.)

On August 27, 2014, Barrera examined Dent for complaints of knee and back pain. (Id. at 25.) Dent reported improvement with physical therapy. (Id.) Barrera noted tenderness, but no swelling in the left knee. (Id.) Barrera noted a possible meniscus tear in the left knee, [13] and possible degenerative disc disease in the spine. (Id.) Barrera increased Dent’s Baclofen and recommended continuing physical therapy. (Id.)

On September 18, 2014, Barrera ordered an MRI for Dent’s continuing left knee pain. (Id. at 26.) Noting Dent’s reports were clinically consistent with a meniscus tear, Barrera ordered an orthopedic consultation with Roy Carls, M.D., an orthopedist practicing with Memorial Hospital Orthopedics. (Id. at 26-27, 95; Mot. Dismiss Mem. Law 8 n.11.)

On September 26, 2014, Dent’s non-formulary Mobic prescription was ...

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