United States District Court, D. Maryland
J. MESSITTE UNITED STATES DISTRICT JUDGE
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 and an order requiring Defendants to
provide him with independent treatment. ECF No. 1 at pp. 4-5.
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.
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. 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.
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.
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.
September 21, 2015, Lagana was seen by Beeman and was given a
back brace. Id. at p. 6.
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.
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 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.
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.
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 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, 
Baclofen and Neurontin were renewed.
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.
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.
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.
December 8, 2016, Lagana was transferred to WCI from NBCI,
and Beeman completed the transfer summary. Id. at p.
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,
which would not expire until March 4, 2017. Id.
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.
noted that the MRI that had been recommended for Lagana's
back was approved by collegial and would be scheduled.
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.
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.
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,
Guaifenesin,  and Cepacol lozenges for 7 days, and was
advised to take warm salt water gargles. Id.
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.
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 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.
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,
Baclofen, Neurontin, Naprosyn, Tramadol and Capsaicin creme,
which were continued. Id.
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.
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.
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 ...