United States District Court, D. Maryland, Southern Division
J. HAZEL UNITED STATES DISTRICT JUDGE.
Fadwa Safar alleges that her federal and state constitutional
rights were violated by Defendants Corizon Health, Inc. and
Nurse Mojisola Adeyemi when she suffered severe pain and
distress because she was not given a breastpump to relieve
engorged breasts during a three-day detention at the Prince
George's County Detention Center. Currently pending
before the Court is Defendants' Motion for Summary
Judgment, ECF No. 70, which Plaintiff opposed, ECF No. 71.
No. hearing is necessary. See Loc. R. 105.6 (D. Md.
2016). For the following reasons, Defendants' Motion for
Summary Judgment is granted in part and denied in part.
Plaintiff Fadwa Safar's Experience
Fadwa Safar came to the United States from Iraq in 2008 to
escape religious persecution. ECF No. 71-3 ¶ 1. In May
2013, she gave birth to her third and youngest child.
Id. ¶ 2. To complete her naturalization
application, Safar had sought a letter of good standing from
local police departments. Id. ¶ 5. However,
after she went to the Prince George's County Police
Department on December 23, 2016, six months after giving
birth, she was arrested pursuant to a mistaken arrest warrant
and, early in the morning on December 24, 2016, was taken to
Prince George's County's Adult Detention Center
(ADC). Id. ¶¶ 5-6, 9. The arrest warrant
stemmed from a mistake made a year earlier when a retailer
misread its sales data and alleged that Safar had engaged in
credit card fraud. Id. ¶ 6. Although the
retailer withdrew its allegation against Safar hours after
making it, no steps were taken to cancel the related arrest
warrant. Id. Safar remained incarcerated for three
days until she was able to appear before a judge after
Christmas, at which point the case against her was dismissed.
Id. ¶¶ 6, 10. She was still breast-feeding
her youngest child at the time of this arrest. Id.
was confused and scared, and given that she is a refugee who
had previously escaped a “tyrannical regime, ”
she acutely felt the stress of being arrested without cause.
Id. ¶ 8. By the time she was taken to ADC, she
had not expressed milk in almost 24 hours, which caused her
breasts to painfully engorge because she was lactating.
Id. ¶ 12. Engorgement results from unrelieved
normal breast fullness. ECF No. 71-5 at 6. As the milk volume
increases within the milk producing tissues and is not
removed adequately, pressure builds, causing fluid and other
milk components to leak into the surrounding tissues
(“edema”). Id. As fluid shifts from the
milk ducts into the tissues, the breasts become swollen,
hardened, and red. Id.
her intake photo was taken, Safar's breasts were in pain,
ECF No. 71-3 ¶ 15, and the photo shows her clutching
them, ECF No. 71-6. She told the corrections officer taking
her photo that her breasts hurt because she needed to express
milk. ECF No. 71-3 ¶ 16. The officer responded,
“this is not my job.” Id. The
corrections officers and medical staff responsible for intake
all work in the same room, ECF No. 71-4, and a sign hangs in
the facility stating, “If you are ill notify an officer
or a nurse, ” ECF No. 70-11 at 2, 7.
became increasingly stressed by the pain and used an ADC
phone within earshot of the intake staff, ECF No. 71-4, to
call her family for help, ECF Nos. 71-3 ¶ 17, 71-7 at
2-3. She spoke to her sister-in-law, Basma Zaiber.
Id. Zaiber had lived in the United States longer
than Safar and is naturally more assertive. Id.
Zaiber told Safar not to worry because she would take care of
getting her help expressing milk. ECF No. 71-7 at 3. While
Safar continued to seek help from within ADC, she understood
that her sister-in-law was also trying to get someone at ADC
to help her relieve her pain. ECF No. 71-3 ¶ 18. She
approached other corrections officers in the intake area-the
same room where her photo was taken and where she used the
phone-and told them she needed help “to take the milk
out.” Id. ¶ 19. The officers responded
that they could not do anything to help. Id.
point, more than one corrections officer had dismissed
Safar's requests for help, leading her to feel helpless.
ECF No. 71-3 ¶ 20. After these interactions with ADC
staff, Safar met with Defendant Mojisola Adeyemi, a licensed
practice nurse (LPN) who works for Defendant Corizon and is
responsible for medical intake screenings of inmates. ECF No.
71-3 ¶ 22. While Adeyemi asked Safar standard intake
questions, Safar interrupted to tell her that she had pain
and a burning sensation in her breasts. ECF No. 71-3 ¶
24. Adeyemi responded by directing her to take a pregnancy
test. ECF No. 71-3 ¶ 25. Adeyemi asked Safar when her
last menstrual period was; and Safar responded that she did
not know because she gave birth in May 2013 and was
breastfeeding. ECF No. 71- 3 ¶ 28. However, Adeyemi made
a notation- inconsistent with Safar's recollection of
this encounter-that Safar's last period was in May 2013.
ECF No. 71-9 at 1. Adeyemi knows that breastfeeding inhibits
menstrual periods, ECF No. 71-2 at 3, but assumed that a
delay in an inmate's menstrual period is not cause for
concern because she is aware of other situations where it is
normal for a young woman to not have a regular period,
including during use of certain forms of contraception, ECF
No. 70-7 at 11-12. Adeyemi wrote “no” next to the
intake form's question “Recent major surgical
history or hospitalization within the past year?” ECF
No. 71-9 at 1. When Adeyemi asked Safar if she was on any
medications or had any allergies, Safar again interrupted to
say that she had pain in her breast and needed help
expressing breastmilk. ECF No. 71-3 ¶ 27. Although Safar
was experiencing physical distress during the medical
screening, see e.g., ECF No. 71-3 ¶ 23-24,
there are no notations on her medical intake form regarding
her pain or Adeyemi's observation of her physical
does not recall performing Safar's medical intake, ECF
No. 71-2 at 4, but she denies that she would have ignored
Safar's call for help, ECF No. ECF No. 70-7 at 19. In a
similar instance, when a lactating woman advised Adeyemi that
she was in pain and needed medical assistance, she
reclassified the inmate to the medical unit for care. ECF No.
70-7 at 16. At the end of Safar's medical screening,
Safar was in excruciating pain. ECF No. 71-3 ¶ 29. She
signed a document, which she does not remember signing,
acknowledging that she had provided information to Adeyemi.
Id. Above the signature line on the form it says,
“It has been told and shown to me in writing what to do
if I get sick while I am in this facility.” ECF No.
70-4 at 2. Nonetheless, Safar claims that she never learned
from ADC or Corizon staff about procedures for requesting
medical assistance. ECF No. 71-3 ¶ 34.
Adeyemi finished screening other inmates, Safar tried again
to request Adeyemi's help. ECF No. 71-3 ¶ 30. Safar
told Adeyemi that she needed help and that, at the suggestion
of another inmate, she had tried applying hot water to her
breasts but that did not relieve her pain. ECF No. 71-3
¶ 20, 30. Adeyemi responded that she did not have
experience in that area. ECF No. 71-3 ¶ 30.
these fruitless attempts to get help, Safar was demoralized.
ECF No. 71-3 ¶ 31. She was then transferred to a locked
cell. ECF No. 71-3 ¶ 32. From that point on, she relied
on her family to get her help. ECF No. 71-3 ¶ 35.
Safar's sister-in-law, Basma Zaiber, came to the
detention center with Safar's criminal defense attorney
and spoke with a corrections officer sitting at the reception
desk. ECF No. 71-7 at 5. They explained that Safar was in
physical distress and needed a breastpump but were told that
the facility did not have one and that Zaiber could not bring
her one because a breastpump would not be allowed into the
facility. Id. The corrections officer told Zaiber
that she could contact the medical unit for further
assistance. ECF No. 71-7 at 6. Zaiber then repeatedly called
the medical unit on December 24 and 25. Id; ECF No.
71-13. The first time Zaiber called the medical unit, she
explained that her sister-in-law was incarcerated, in pain,
and needed a breastpump. ECF No. 71-7 at 7. Zaiber felt that
the woman answering the phone was disinterested-she did not
even ask for Safar's name-and that nothing would be done
to resolve Safar's issue. Id. 7-8. The next time
Zaiber called, she spoke with a different person who told her
“I don't think I saw anyone complaining or
crying” in response to Zaiber's plea that someone
help relieve Safar's pain. ECF No. 71-7 at 8. No. one in
the medical unit contacted Safar in response to Zaiber's
calls. ECF No. 71-3 ¶ 36.
December 26, 2016, when Safar was released from custody
around 4:30pm, her breasts had been engorged and causing her
physical distress for approximately 56 hours. ECF No. 71-3
¶ 37. As fluid accumulates in the breast, more pressure
is placed on the milk producing tissue, making removal of
breastmilk more difficult (“milk stasis”), and
causing unrelieved pain. ECF No. 71-5 at 6. Because she could
not express milk while incarcerated, Safar suffered milk
stasis. Id. After her incarceration, Safar was able
to nurse her baby for a brief period, but “a
combination of reduced flow, nausea, and psychological
blockage” led her to stop. Id. She had
breastfed her other children until they were each two-years
old without incident, and she planned to continue to
breastfeed her youngest child until he turned two. ECF No.
71-3 ¶ 3. But after her incarceration she was unable to
continue feeding her son as she had planned, which caused her
great distress. ECF No. 71-3 ¶ 38.