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Lagana v. Wexford Health

United States District Court, D. Maryland

August 20, 2018




         On June 20, 2017, self-represented Plaintiff Joseph Robert Lagana, presently incarcerated at the Western Correctional Institution (“WCI”) in Cumberland, Maryland, filed this civil action pursuant to 42 U.S.C. § 1983 against the prison healthcare provider Wexford Health (“Wexford”), nurse practitioner Peggy Mahler, nurse supervisor Bill Beeman, medical records clerk Christine Butler, and medical director Dr. Ava Joubert (collectively, “Defendants”). ECF No. 1. He filed an amended complaint on July 7, 2017. ECF No. 4. Lagana claims that for at least the past three years, Defendants have denied him medical care and treatment, and have withheld medication for his chronic diseases, in violation of constitutional standards. ECF Nos. 1 & 4. He seeks monetary damages totaling $2.2 million[1] and an order requiring Defendants to provide him with independent treatment. ECF No. 1 at pp. 4-5.

         On January 16, 2018, Defendants filed a Motion to Dismiss or, in the Alternative, Motion for Summary Judgment. ECF No. 25. Pursuant to Roseboro v. Garrison, 528 F.2d 309 (4th Cir. 1975), the Court informed Lagana that the failure to file a response in opposition to Defendants' Motion could result in dismissal of the Complaint. ECF No. 26. On April 6, 2018, Lagana filed a self-styled Response to Opposition and Motion for Summary Judgment (ECF No. 33), which he supplemented on April 18, 2018 (ECF No. 37). On April 30, 2018, Lagana filed a Motion for Summary Judgment with Lien (ECF No. 39), which Defendants opposed (ECF No. 40). After review of the record, exhibits, and applicable law, the Court deems a hearing unnecessary. See Local Rule 105.6 (D. Md. 2016). Defendants' Motion shall be construed as a Motion for Summary Judgment and shall be granted. Lagana's Motions for Summary Judgment and for Summary Judgment with Lien shall be denied.[2]


         Lagana's claims arise out of the alleged actions of his prison health care providers. ECF No. 4. Specifically, he asserts that Defendant Mahler, a nurse practitioner who was assigned to monitor his treatment on a bi-weekly basis, discontinued numerous medications that had been on his treatment plan, refused to order orthotics, and refused him pain management. Id. at p. 2.[3] Next, Lagana alleges that Defendant Beeman delayed treatment, denied, substituted, or discontinued medication, and falsified medical documentation. Id. at p. 3. He claims that Defendant Butler concealed documents and “triaged then held” his sick calls and other requests, thus causing delays in treatment. Id. at p. 4. Lagana also alleges that Defendant Joubert routinely discontinues medication or treatment, and restarts it at a later time when his symptoms are progressively worse. Id. at p. 5. Lastly, he claims that Defendant Wexford has allowed its untrained agents to “willfully with malice deny treatment, delay treatment and circumvent formal grievance policy, ” has failed to implement supervisory controls, and has failed to investigate violations of chronic care treatment contract violations. Id. at p. 6.

         Defendants provide verified business records which include Lagana's medical records along with Joubert's and Butler's declarations. ECF Nos. 25-4 (medical records); 25-5 (Joubert Decl.); 25-6 (Butler Decl.). All of Lagana's encounters with Joubert, Mahler, and Beeman relevant to his Complaint are presented below.

         Lagana has a medical history significant for bipolar disorder, general osteoarthrosis, benign prostatic hyperplasia, sinusitis, esophageal reflux, constipation, hyperlipidemia, and prostatitis. See generally ECF No. 25-4. On August 4, 2015, while Lagana was incarcerated at North Branch Correctional Institution (“NBCI”), Beeman updated Lagana's chart and noted that his cell had been searched and that Lagana had two brand new knee sleeves. Id. at p. 2. On August 6, 2015, Lagana was seen by Beeman at sick call. Id. at p. 3. At that time, Lagana stated that his medication was current, but was complaining that he had not received knee sleeves. Id. Lagana was reminded that he had refused the pair given to him and that a new pair of sleeves had been found in his cell. Id.

         On September 21, 2015, Lagana was seen by Beeman and was given a back brace. Id. at p. 6.

         On November 30, 2015, Lagana was seen by Beeman at sick call after complaining that he had blood in his stool. Id. at p. 7. Lagana was given stool cards to complete on his own. Id.

         On February 8, 2016, Lagana was seen by Beeman at sick call. Id. at p. 10. Lagana complained that he had a sinus infection and right knee pain, and stated that he needed a medical cell and medical shower. Id. At that time, Lagana was able to complete all of his ADLs[4] and was noted to have a bottom bunk order, although the provider he had last seen stated that a medical cell and shower were not medically indicated. Id. at p. 11.

         On June 8, 2016, Lagana was seen by Beeman to review issues raised by Lagana in a letter. Id. at p. 13. Lagana asked for a back brace and an increase in his Ultram, and was advised that such decisions were left for the medical providers. Id. Lagana was also informed that knee braces and gel insoles had been ordered but had not yet arrived. Id. Lagana requested a medical cell and was advised that there was no medical indication for a medical cell. Id. Lagana became agitated and left. Id.

         On August 12, 2016, a patient care conference was held. Id. at p. 15. In attendance were Lagana, Krista Bilak, N.P., the clinical pharmacist, the administrative contract coordinator, a social worker, the regional medical director, the assistant director of nursing (“ADON”), NBCI providers, the quality assurance physician, and the sergeant of the housing unit in attendance. Id. A team approach plan of care was determined to include referral to behavioral health and psychiatry, visits every two weeks with the same provider for continuity of care, and an increase in Lagana's Neurontin[5] prescription to 1200 mg twice daily, in conjunction with Lagana being compliant with physical therapy. Id. Lagana was educated on the effects of pain management and the effects of chronic long term use of pain medication. Id. His Naprosyn, [6] Baclofen[7] and Neurontin were renewed.

         On December 1, 2016, Lagana was seen by Holly Pierce, N.P. and the ADON for his 2-week visit. Id. at p. 18. Lagana had submitted no sick call slips and complained that he was told by “Angie” he “could not place sick calls as she ‘holds' them.” Id. The ADON explained that he could place them and that they are reviewed when received. Id. In response, Lagana stated that his legal team would take care of the problem. Id.

         Lagana asked about the results of his hip x-ray taken on August 9, 2016, and he was advised that it revealed mild degenerative joint disease, but was otherwise normal. Id. Lagana then stated that he was not receiving his Visine and Capsaicin. Id. He was advised that Visine was not intended for long term use and that he had refused lubricating eye drops during his last visit. Id. Lagana agreed to the lubricating eye drops and his Capsaicin was renewed. Id.

         Next, Lagana stated that he had not had a knee injection in 18 months. Id. When informed that a knee assessment was necessary, Lagana became upset, immediately jumped up, and left the room. Id. He was called back in order to complete a questionnaire for an upcoming MRI. Id. When Lagana returned, he refused a knee assessment. Id. Because Lagana stated that he was not wearing his knee braces, the knee braces were discontinued. Id.

         On December 8, 2016, Lagana was transferred to WCI from NBCI, and Beeman completed the transfer summary. Id. at p. 20.

         On December 14, 2016, Lagana was seen by Mahler for a chronic care clinic. Id. at p. 25. Lagana's lab result reflected a poor low/high density lipid ratio and he was offered a low fat diet, which he refused. Id. Lagana complained of knee pain and stated that he needed knee braces. Id. He was advised that the knee braces had been taken because he did not wear them, and that they would not be renewed at that time. Id. Lagana's February 2, 2016 right knee x-ray revealed no acute disease. Id. On exam, Lagana had bilateral mild knee pain with passive range of motion to 45 degrees. Id. There was stiffness in the right knee, no crepitus bilaterally, no swelling, no increased warmth, no skin discoloration, and no bone deformity. Id. He walked without a limp or any assistive devices. Id. His Naprosyn, Capsaicin creme, Neurontin, and Baclofen were renewed, and he was advised to continue taking Tramadol, [8] which would not expire until March 4, 2017. Id.

         Lagana was given a renewal of his bottom bunk, back brace, non-wool blanket, and gel insoles for one year. Id. Lagana told medical staff at WCI that he had a medical cell at NBCI, but this was refuted by the NBCI ADON. Id.

         Mahler noted that the MRI that had been recommended for Lagana's back was approved by collegial and would be scheduled. Id.

         Lagana reported to WCI staff that he was not getting his eye drops and his Claritin was not helping his allergies. Id. The eye drops were renewed and a prescription for Nasacort was issued. Id.

         Lagana then requested antibiotic ointment for his thumbs, but the request was declined as there were no symptoms of infection. Id. Instead, A & D ointment was recommended. Id. On December 15, 2016, Lagana's non-formulary request for Capsaicin creme and Neurontin were submitted. Id. at p. 31.

         On December 29, 2016, Lagana was seen by Mahler at provider sick call. Id. at 34. Lagana complained of sore throat, nasal congestion, blood-tinged mucous, nonproductive cough, frontal headache, and sinus pain. Id. Lagana stated that he had a history of sinus infections and this was his sixth infection Id. He was prescribed Augmentin, [9] Guaifenesin, [10] and Cepacol lozenges for 7 days, and was advised to take warm salt water gargles. Id.

         At the time of the sick call, results of Lagana's December 19, 2016 MRI were not yet available. Id. Lagana claimed at that time that he had fallen in his cell a month prior and his right hand would not close. Id. On exam, there was mild tenderness noted and Lagana could not close his right fist or flex his right wrist up or down. Id. An x-ray of the right hand was ordered. Id. Lagana asked for knee braces again and was advised that they were taken by the NBCI ADON because he had not worn them to sick call. Id. Lagana responded that there was no obligation to wear them to sick call, and Mahler informed him that she would look further into the matter. Id.

         On January 23, 2017, Lagana was seen by Mahler for a scheduled provider visit, at which time Lagana's MRI results were reviewed. Id. at p. 38. The impression was moderately severe central spinal stenosis[11] at ¶ 4-L5. Id. The L5-S1 degenerative disc space was narrowing with osteophyte (bone spurs) formation and disc bulge. Id. Masses in the left and right kidneys were also detected, and a CT scan with and without IV contrast, as well as an MRI with contrast, was recommended. Id. It was noted that a neurosurgery consult and a consult for an abdominal/pelvic CT with and without contrast for the bilateral renal masses was approved by collegial on January 12, 2017. Id.

         Lagana complained of low back pain with numbness and tingling in his legs when bearing down, with pain radiating down his legs to his feet. Id. He also stated that the pain was greater in the left leg, his right foot goes flat when walking, and he has noticed weakness in his right foot for two years. Id. Lagana was prescribed Topamax, [12] Baclofen, Neurontin, Naprosyn, Tramadol and Capsaicin creme, which were continued. Id.

         On January 27, 2017, Lagana was provided a pharmacy medication treatment plan. Id. at p. 41. With regard to pain medication, it was recommended that he discontinue Baclofen and Gabapentin and continue Naproxen, Tramadol, and Capsaicin. Id. For Lagana's chronic rhinitis, the recommendation was to discontinue Nasacort and start Ipratropium nasal spray. Id.

         On January 30, 2017, Lagana's chart was updated by Mahler. Id. at p. 42. The pharmacy medication plan recommendations were implemented except for Neurontin, which needed a tapering plan. Id. The tapering plan for Neurontin was 1200 mg twice daily for 2 days, 600 mg twice daily for 3 days, 600 mg once daily for 3 days, 600 mg every other day for four doses over 7 days, before stopping. Id. The tapering plan was discussed with Lagana and implemented on January 31, 2017. Id.

         On February 8, 2017, Lagana was seen by Mahler at a scheduled provider visit. Id. at p. 47. He complained of pain radiating down the right leg, right upper buttock, and right groin, and left leg weakness. Id. Lagana stated that he had an abdominal/pelvic CT at Western Maryland Hospital the week prior. Id. His medication plan was discussed and Lagana stated that he never agreed to tapering off Neurontin; however, he was advised that his Neurontin could not be renewed. Id. Lagana was also advised that custody had video of him from February 7, 2017, showing him walking up and down steps normally without difficulty or assistive devices. Id. In response, Lagana stated that the video was misinterpreted and that his back “went out yesterday, started to spasm.” Id. Lagana was advised that he could ...

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