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Hoskins v. Wexford Health Sources, Inc.

United States District Court, D. Maryland

May 30, 2018

DANNY CARROLL HOSKINS, #180134 Plaintiff,



         On December 27, 2017, the court received for filing a motion for temporary restraining order from state inmate Danny Carroll Hoskins, who is currently housed at the Western Correctional Institution (“WCI”). The motion alleges that Hoskins receives pain medication[1] for a degenerative disease, bulging and herniated discs with bone spurs, sciatica and strokes, which have caused him major headaches, cramps, spasticity, and ear ringing. He states that he is currently confined to a wheelchair. ECF No. 1, pp. 1-2. Hoskins contends that his pain medication (Tramadol and Baclofen) ran out by December 2, 2017, and, in response to his complaints, he was informed that the Baclofen was being discontinued altogether and that he was being “weaned off” another medication, Neurontin, due to inmate abuse and cost. Hoskins stated that he has increased pain, cramps, and headaches and has suffered the loss of proper mobility on his right side. ECF No. 1, p. 3. As relief, he asks the court to order Wexford immediately to continue his prescriptions for Baclofen, Neurontin, Tramadol, and Tylenol at prescribed dosages “until this matter can be deemed closed by this Court.” Id.[2]

         The motion was instituted as a new 42 U.S.C. § 1983 action for injunctive relief and Defendant Wexford Health Sources, Inc. (“Wexford”) was ordered to file a show cause response. ECF No. 2. Hoskins, who informed the court that he was preparing a § 1983 cause of action against Wexford was granted additional time to file a formal complaint and indigency motion. Id.

         On March 12, 2018, Wexford filed a show cause response, indicating that prior to December, 2017, Hoskins was receiving the medications Baclofen, Tramadol, Neurontin and Tylenol. ECF No. 8-1.[3] Wexford maintains that Hoskins has not had his pain medications improperly discontinued and, as of the filing date of its show cause response, he remains on a Tylenol and Tramadol regimen, and recently had Naproxen[4] added to his pain treatment, but is no longer receiving Neurontin and Baclofen “pursuant to reasonable and appropriate medical judgment of his health care providers and [Hoskins] continues to receive all necessary pain medications.” Id.

         The medical record provided by Wexford shows that in August of 2017, Hoskins reported lower back pain, non-radiating from a prior motor vehicle accident and right shoulder pain from a football injury. His Neurontin, Tramadol, Baclofen and Tylenol were renewed. ECF No. 8-1, pp. 3-6. Hoskins was seen in the Chronic Care Clinic and for periodic examinations to monitor his cardiovascular conditions and pain. His Baclofen was discontinued because Hoskins had no muscle spasms and Baclofen interacts with Ultram. ECF No. 8-1, pp. 9-11. On November 29, 2017, a non-formulary drug request form was submitted for Gabapentin (Neurontin) and Tramadol, and was completed on December 7, 2017. ECF No. 8-3, pp. 2-4.

         According to Nurse Brenda Reese, the Director of Nursing at WCI, as of November 29, 2017, Neurontin was no longer medically necessary for Hoskins because “Neurontin does not treat any of [Hoskins'] ongoing causes of chronic pain and [Hoskins] did not have any ongoing muscle spasms necessitating the use of Baclofen.” ECF No. 8-2, Reese Aff., ¶ 3. Reese affirms that on December 29, 2017, Hoskins was offered, but refused, 60 Tylenol pills. When half that medication was offered to Hoskins for the month of January 2018, they were accepted. Id., Aff., ¶ 6.

         Wexford maintains that Hoskins has continued to receive Tramadol for the months of December, 2017 and January, 2018, and in February of 2018, Naproxen was added to Hoskins' pain regimen. ECF No. 8-2, Reese Aff., ¶¶ 6 & 7.

         According to Medical Administration Records (“MAR) provided by Wexford, in November, 2017, Hoskins received Neurontin, Tylenol, Tramadol, Baclofen, along with other medications. ECF No. 8-4, pp. 2-3. In December, 2017, he was prescribed Tramadol, Tylenol, and Neurontin. The Baclofen was discontinued. ECF No. 8-4, pp. 4-9. In January, 2018, Hoskins received Neurontin, Tylenol, and Tramadol. Id., pp. 10-11.

         Hoskins filed an answer to the show cause response claiming that his Tramadol medication was discontinued before the prescription expired. ECF No. 13. He complains that he receives an inadequate number of prescription tablets to complete the prescription period, and he is forced to follow a burdensome prescription process by submitting a sick-call slip to be “seen and have a new order processed.” ECF No. 13. Hoskins disputes Wexford's response, stating that he did not receive his medications for several days in December, 2017 and March, 2018, and his medications were discontinued with his seeing a physician. He contends that he only has two medications for pain, Tramadol and Tylenol, and although he was informed he would be seen in late March, the appointment did not occur. ECF No. 13, pp. 1-5. Wexford's counsel has filed a reply contending that Hoskins' answer confirms their statements regarding his current pain medication regimen and his Naproxen has been discontinued due to Hoskins' history of stroke. Wexford further argues that the MAR submitted shows that Hoskins was receiving his Tramadol in December, 2017. ECF No. 14.

         A preliminary injunction is an “extraordinary and drastic remedy, ” Munaf v. Geren, 553 U.S. 674, 689-90 (2008), that requires a movant demonstrate: 1) that he is likely to succeed on the merits; 2) that he is likely to suffer irreparable harm in the absence of preliminary relief; 3) that the balance of equities tips in his favor; and 4) that an injunction is in the public interest. See Winter v. Nat. Resources Def. Council, Inc., 555 U.S. 7, 20 (2008); The Real Truth About Obama, Inc. v. Fed. Election Comm'n, 575 F.3d 342, 346 (4th Cir. 2009), vacated on other grounds, 559 U.S. 1089 (2010), reinstated in relevant part on remand, 607 F.3d 355 (4th Cir. 2010) (per curiam). “Issuing a preliminary injunction based only on a possibility of irreparable harm is inconsistent with [the Supreme Court's] characterization of injunctive relief as an extraordinary remedy that may only be awarded upon a clear showing that the plaintiff is entitled to such relief.” Winter, 555 U.S. at 22, citing Mazurek v. Armstrong, 520 U.S. 968, 972 (1997) (per curiam). A movant must show that the irreparable harm he faces in the absence of relief is “neither remote nor speculative, but actual and imminent.” Direx Israel, Ltd. v. Breakthrough Medical Group, 952 F.2d 802, 812 (4th Cir. 1991) (citation omitted).

         In a response supported with copies of Hoskins' medical records and Brenda Reese's affidavit, Wexford denies that Hoskins' pain medications were discontinued improperly. The record shows that Hoskins continues to be treated for his chronic pain, receives medication, and the medications that were discontinued were deemed not medically necessary for him. He cannot show he is likely to succeed on the merits or suffer irreparable injury without the relief he seeks. Hoskins' request to compel his receipt of medications deemed by medical provider to be no longer medically necessary for his treatment and potentially contraindicated, does not serve the the public interest or tip the balance of equities in Hoskins' favor. Consequently, the court will deny Hoskins' request for preliminary injunctive relief.

         On March 12, 2018, the same day Wexford filed its show cause response, Hoskins filed a supplemental complaint additionally naming Licensed Practical Nurse Beverly McLaughlin[5] and WCI Warden Richard J. Graham as defendants. ECF No. 9. Service has been accepted on behalf of McLaughin. ECF No. 10. Service will proceed on Warden Graham.

         Hoskins alleges that when seen by McLaughlin in late 2015 to early 2016, she informed him that she was not going to renew his fish oil, skin lotion, Tonaftate (antifungal treatment), selenium sulfide lotion (treatment for dandruff and certain scalp infections), and cholesterol-lowering medication (Lovastatin) for cost-cutting reasons. ECF No. 9, p. 2 & 3-4.

         Hoskins claims that he was first seen for a MERSA [sic][6] infection on September 15, 2016, and again seen in October and November of 2016, and was prescribed Tonaftate and Gold Bond Powder. He states that he was transferred to another prison for physical therapy and a physician noted an “outbreak” on his left ear. The area was swabbed and test results proved positive for MRSA. Hoskins claims ...

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