United States District Court, D. Maryland
DANNY D. HOSKINS, Plaintiff
WEXFORD HEALTH SOURCES, INC., BEVERLY McLAUGHLIN, WARDEN RICHARD J. GRAHAM, JR. Defendants
DEBORAH K. CHASANOW United States District Judge.
Danny Hoskins, who is an inmate at Western Correctional
Institution, is suing Defendants for allegedly providing him
inadequate medical care. He also claims that Warden Richard
Graham, Jr. failed him with respect to the administrative
remedy procedure (ARP) requests he filed about his medical
Health Sources, Inc., and Beverly McLaughlin, LPN
(collectively, the Medical Defendants) filed a motion to
dismiss or for summary judgment (ECF No. 15). Mr. Hoskins
filed an opposition and the Medical Defendants filed a reply.
ECF Nos. 18, 22. Warden Graham filed a separate motion to
dismiss or for summary judgment. ECF No. 26. Mr. Hoskins
filed an opposition on August 16, 2018. ECF No. 28. Graham
filed a reply on August 29, 2018. ECF No. 29. Mr. Hoskins
filed supplements on January 2 and January 7, 2019, and the
court granted the Medical Defendants' motion for an
extension of time to file a response. ECF Nos. 31, 32, 34.
The Medical Defendants filed the response on March 8, 2019.
Pursuant to Local Rule 105.6 (D. Md. 2018), a hearing is not
necessary at this time.
Hoskins initiated this action on December 27, 2017. He alleges
that he is receiving inadequate medical care, that his rights
under the Americans with Disabilities Act (ADA) have been
violated, and that Warden Graham has improperly handled his
Administrative Remedy Procedure requests.
Hoskins states that he has a degenerative disease, bulging
and herniated discs with bone spurs, sciatica, and has
suffered two strokes, which cause him headaches, cramps,
spasticity, and ear ringing. He is confined to a wheelchair.
ECF No. 1, pp. 1-2. He alleges that his pain medications,
Baclofen, Tramadol, and Neurontin, have been inconsistently
provided and improperly discontinued. ECF No. 1, 9, 32.
Hoskins also alleges that: 1) in late 2015, Beverly
McLaughlin told him that she was not renewing his orders for
fish oil, skin lotion, Tolnaftate (an antifungal), selenium
sulfide lotion (for dandruff and scalp infection), and
Lovastatin, a cholesterol medication, for cost cutting
reasons. ECF No. 9, pp. 2 & 3-4; 2. Ms. McLaughlin
“ignored” his stroke symptoms of facial sagging
on the right side, blurred/double vision, severe weakness
that was worse on the right side, cramps, and a severe
headache; 3) he received improper treatment for MRSA;
(methicillin-resistant staphylococcus aureus) 4) he was
not provided blood thinners or additional pain medication on
the days he suffered the strokes; 5) Ms. McLaughlin advised
she was ordering him a leg and ankle brace but did not
because she was “worried about the cost”; and 6)
“for all (3) of [his] ARPs [administrative remedy
procedure requests] the Warden's Office failed me
miserably.” ECF No. 9, pp. 2 & 6. He claims that
Ms. McLaughlin has shown “a pattern in his personal
care” by refusing to reorder his cholesterol
medication, failing to recognize his stroke symptoms, and
failing to order him leg and ankle braces because she is
worried about the cost, and says she may have been following
orders, but he is not sure. ECF No. 9 p. 8. As relief, Mr.
Hoskins asks for copies of his medical records, medical
braces, a “proper” pair of boots; and monetary
damages. ECF No. 9, pp. 6-8.
Hoskins maintains that he had always been treated for
hypertension and had been given cholesterol medication until
Ms. McLaughlin cancelled it. He states that he suffered a
stroke on January 9, 2017, and another stroke on January 10,
2017. He alleges that when he went to the infirmary, Ms.
McLaughlin ignored that the right side of his face was
sagging, his vision was blurred, he was seeing double, he was
severely weak with his right side worse, he had cramps, and a
severe headache. Instead she diagnosed him as
“hypertensive.” He faults Ms. McLaughlin for
“failing to recognize his stroke symptoms” on
January 9, 2017, and again on January 10, 2017. ECF No. 9,
pp. 2-3, 9. He complains too that he was not seen by a
physician on January 9, 2017. Mr. Hoskins states that when he
had his second stroke on January 10, 2017, Ms. McLaughlin
told him he was “faking.” Id., p. 3. It
was not until medical staff member Ryan Browning came by,
that a physician was called and then none was available to
attend Mr. Hoskins. Id. Forty-five minutes later a
doctor examined him and ordered an ambulance to take him from
the prison to the hospital. He contends that on both days when
he had strokes he was not provided blood thinners or
additional pain medication. Id. He alleges that his
strokes, the permanent loss of strength on his right side,
constant severe headaches, cramps and spasms of the right arm
and leg, and double vision are due to inaction by Ms.
McLaughlin and other medical staff. Id., p.
Hoskins claims that he was seen for a “MERSA”
infection on September 15, 2016, and again in October and
November of 2016, and was prescribed Tolnaftate and Gold
Bond Powder. When he was transferred to another prison, the
Maryland Transition Center (MTC), for physical therapy, a
physician noted an “outbreak” on his left ear.
The area was swabbed and tested with the results returning
positive for MRSA (methicillin-resistant staphylococcus
aureus). Mr. Hoskins claims that he was never properly
treated for MRSA and he still has outbreaks. ECF No. 9, pp. 2
& 6; ECF No. 32 p. 6.
Hoskins also complains about the WCI Administrative Remedy
Procedure (“ARP”) grievance process. He filed an
ARP about the delay in providing him a wheelchair and
physical therapy (WCI-0761-17). On October 1, 2016, he filed
an ARP (WCI-2202-16) to complain about the inadequate medical
treatment he had received for his boils and a rash on his
skin. On December 11, 2017, he filed ARP WCI-3108-17 to
complain that he was not receiving his pain medications
Baclofen and Tramadol. ECF No. 9, p. 10; ECF No. 26-3. He
asserts that “for all (3) of my ARPs the Warden's
Office failed me miserably.” ECF No. 9, pp. 4-6.
Hoskins filed supplements to his complaint on January 2 and
January 7, 2019. ECF Nos. 31, 32. He alleges that from
December 12 to 18, 2018, he was not given his prescribed
medications, Lisinopril (blood pressure), Lipitor
(cholesterol), and Lasix (diuretic or “water
pill”) and was just given his Tylenol after receiving
none since the first week of November 2018. He states he ran
out of Tramadol for 10 days and was told he may never get
more even though his prescription did not expire until
January 15, 2018 [2019?]. ECF No. 31, p.1. Mr. Hoskins states
a Ms. Bumni, whom he understands is employed by the state of
Maryland, is “weaning” all inmates off the pain
medications Tramadol and Neurontin, and he notes that as of
January 1, 2019, Corizon, Inc. will replace Wexford as the
contractual provider of medical services. Mr. Hoskins
maintains that his conditions are worsening, and he is
receiving less medication for worsening back pain, spasms,
and cramps. He states “[t]hey say my meds cost to[o]
much, I then had 2 strokes w/out them.” ECF No. 31 p.
2; ECF No. 32 p. 3.
Hoskins is suing Defendants in their official capacities for
acting with deliberate indifference and under the Americans
with Disabilities Act and the Rehabilitation Act for
discriminating against him by refusing to accommodate his
physical disabilities by: 1) failing to give him his
medications, including his medications for cholesterol, blood
pressure, and pain, for long periods of time potentially
causing his two strokes, cramps, spasms, headaches, pain in
his lower back, right shoulder, right arm, leg, and foot; 2)
restricting his medications due to cost, potentially causing
his January 2017 strokes; 3) failing to provide him a
wheelchair for months; 4) failing to provide physical therapy
for months; and 5) failing to properly treat his MRSA.
Id. at 5-6. He asks the court to appoint him
counsel. Id. at 6-7; see also ECF No. 35
Mr. Hoskins claims that Defendants have failed to comply with
their medical contract with the State of Maryland to provide
equal protection, proper medical care, to honor the ARP
process and notify the Commissioner. ECF No. 31 p. 6.
Hoskins says he knows that there is a “real
world” epidemic of people overdosing, but he is not
aware of any government order to stop providing Baclofen,
Neurontin, or Tramadol. ECF No. 32 p. 1. Mr. Hoskins states
that he has never been accused or issued an infraction for
abusing, hoarding, or selling his medications. Id.
He requests additional injunctive relief, including:
examination by a physician; reordering his medications;
re-evaluating his pain, cramps and spasms; consideration for
back surgery; transfer to another prison or his release; for
the medical provider to hold chronic care clinics every 90
days instead of 120 days to parallel the length of time a
narcotic such as Neurontin or Tramadol cane be prescribed at
one time; and to order “Dr. Bumni from regional
headquarters to cease dismissing the overall use of Tramadol,
Neurontin, placing inmates on antidepressants instead.”
Id. at 7-8.
Medical Defendants' Response
Medical Defendants' response is filed with verified
copies of Mr. Hoskins' medical records, Beverly
McLaughlin's affidavit, and the affidavit of Asresahegn
Getachew, M.D. ECF No. 15.
Hoskins' medical record shows that on January 9, 2017, at
9:19 am. Ms. McLaughlin, a physician's assistant and
nurse practitioner, saw him for complaints of loss of
balance, feeling like he was going to fall when he tried to
stand, numbness on the right side of his face,
“post” neck pain with tingling around the mouth
extending behind his ear up to his eye, and right arm
limpness. His blood pressure was elevated. Mr. Hoskins
reported subjective complaints of his entire right side
feeling odd and tingling. He denied chest pain and his EKG
was within normal limits. ECF No. 15-6, Medical Record.
January 9, 2017, Ms. McLaughlin discussed Mr. Hoskins'
case with Dr. Barrera, and Mr. Hoskins was admitted to the
WCI infirmary for observation. Mr. Hoskins was administered a
one-time dose of clonidine. ECF No. 15-6, Ms. McLaughlin Aff.
¶8. Defendants assert that after he was admitted to the
clinic, medical providers frequently assessed Mr. Hoskins for
signs and symptoms of a stroke. ECF No. 15-3, Ex. 1
(separately filed in paper format). Mr. Hoskins was assessed
by James Wilt, R.N. at 1:21 p.m. on January 9, 2017, his
blood pressure was checked and it was recorded that Mr.
Hoskins had “altered cardiac function.” The
medical records indicated “neurochecks” and blood
pressure checks were to be done every four hours. The next
record for January 9, 2017, was written by Keri Davis RN at
6:57 p.m. It reports that Mr. Hoskins stated, “I had a
stroke this morning.” Further, Mr. Hoskins complained
of his right side feeling different and the right side of his
face felt tingly. His “neuros” were within normal
limits. ECF No. 15-3, Ex. 1 (separately filed in paper
format. On January 10, 2017, at 4:09 a.m., Rachel Murphy,
R.N. noted that Mr. Hoskins' blood pressure was elevated,
there was no facial drooping, he had received Norvasc per
physician's order, and that he had reported having a
tingling feeling to his right side earlier. Dr. Getachew
states the assessments were “reassuring” and
monitoring continued. ECF No. 15-7; ECF No. 15-1, Affidavit
of Asresahegn Getachew, M.D., ¶¶ 3-4.
following morning, January 10, 2017, Mr. Hoskins' blood
pressure was evaluated, his right side was notably weaker
than the left, and he had visual changes and slurred speech.
Defendants assert that “[p]rior to the change in
status, the medical providers had insufficient evidence to
conclude that Mr. Hoskins was a “significant risk for a
stroke.” Id. ¶6. Once the risk of
potential stroke was revealed on the morning of January 10,
2017, a physician saw Mr. Hoskins, arranged to transfer him
by ambulance to a hospital, and the ambulance left the prison
within the hour. Id. ¶5. The medical record on
January 10, 2017, completed by James Wilt, RN, indicates that
“during morning rounds, Mr. Hoskins complained of right
sided weakness and numbness, his blood pressure was elevated,
and the right side was notably weaker than the left. ECF No.
15-3 Ex. 1 (filed in paper format). He complained of vision
changes to his right eye and his speech was slurred.”
The record shows that at 8:00 a.m. Dr. Ashraf evaluated Mr.
Hoskins. Dr. Atnafu was contacted to approve sending Mr.
Hoskins to the hospital by ambulance. The ambulance left the
prison at 8:54 a.m. ECF No. 15-3, Ex. 1 (filed in paper
McLaughlin denies ignoring Mr. Hoskins' complaints on
January 9, 2017. She states that once Mr. Hoskins was
admitted, she did not “formally assess him nor was
[she] responsible for his monitoring and assessment as this
was done by other medical providers.” ECF No. 15-4,
McLaughlin Aff. ¶8. She also denies accusing Mr. Hoskins
of “faking” his symptoms. Id.
her decision to discontinue Mr. Hoskins' fish oil
capsules, skin lotion, tolnaftate and selenium sulfide
lotion, Ms. McLaughlin states that when she saw him on June
12, 2016, he did not complain of dry skin or other issues
requiring skin lotion or selenium sulfide. Additionally,
because he was receiving Lisinopril for hypertension, fish
oil was not medically necessary. Therefore, she discontinued
the medical orders for Lubriderm Daily Moisture, selenium
sulfide, and fish oil. ECF No. 25-4 McLaughlin Aff.
states that during in 2015, 2016, and 2017, Mr. Hoskins had
active orders for the hypertension medication Lisinopril and
later, Zestril. Id. ¶5. She asserts that
contrary to Mr. Hoskins' allegations, he did not have an
ongoing diagnosis of high cholesterol nor were any
cholesterol medications discontinued as alleged in the
complaint. Id., ¶6. She states that cholesterol
medications generally are not prescribed for hypertension,
and even if such medications were discontinued, it would not
have impacted Mr. Hoskins' treatment for hypertension.
Hoskins was discharged back to WCI's infirmary on March
9, 2017. Dr. Getashew states that Mr.
Hoskins had access to infirmary wheelchairs. The following
day, March 10, 2017, he returned to his housing unit with an
order for a wheelchair. WCI housing units have wheelchairs
available to those inmates with a wheelchair order. On March
23, 2017, Mr. Hoskins asked for a personal wheelchair which
he received on May 4, 2017. ECF No. 15-7, Getachew Aff ¶
7-9; ECF No. 15-10.
he returned to WCI on March 9, 2017, Mr. Hoskins was provided
physical therapy five days per week from January 17, 2017, to
March 3, 2017, and then switched to three days of therapy per
week. ECF No. 15-7, Getachew Aff. ¶10. After he returned
to WCI he resumed physical therapy on May 25, 2017, until it
was stopped on September 14, 2017. At that point, it was
determined he had reached “optimum level of functional
mobility and obtained optimum benefit from physical
therapy” and was discharged to self-management.
Id. ¶ 11-12; see also ECF No. 15-12,
p. 30. Dr. Getachew opines that because Mr. Hoskins received
“substantial therapy” before he returned to WCI,
his recovery “was not impacted by beginning physical
therapy in May of 2017 as is demonstrated by the physical
therapy records documenting Plaintiff as having obtained
optimal functional mobility and benefit from physical
therapy.” ECF No. 15-7, Getachew Aff. ¶10. Mr.
Hoskins' medical chart notes that on September 14, 2017,
he continued to have weakness and partial paralysis
(hemiplegia and hemiparesis) and was unable to walk. ECF No.
15-12, p. 30.
Hoskins had an order for Tolnaftate in early 2016 that
expired on February 6, 2016. Defendants indicate that the
records for that time do not indicate any fungal infection or
other medical issue indicating use of Tolnaftate. Moreover,
skin lotion, antifungal cream, and dandruff shampoo are items
available in the prison commissary. ECF No. 15-5. The Medical
Defendants, however do not provide documentation about the
treatment Mr. Hoskins received for MRSA after he returned to
WCI from MTC.