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Hoskins v. Wexford Health Source, Inc.

United States District Court, D. Maryland

March 13, 2019



          DEBORAH K. CHASANOW United States District Judge.

         Plaintiff 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 treatment.

         Wexford 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.


         Mr. Hoskins initiated this action on December 27, 2017.[1] 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.

         Mr. 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.

         Mr. 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)[2] 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.

         Mr. 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.[3] 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. 4.[4]

         Mr. 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[5] 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.

         Mr. 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.

         Mr. 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.

         Mr. 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 p.2.[6] 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.

         Mr. 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.

         I. Medical Defendants' Response

         The 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.[7]

         Mr. 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.

         On 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.[8] 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[9] 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.

         On the 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 format).

         Ms. 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.

         Regarding 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. 4.

         She 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. Id., ¶8.

         Mr. Hoskins was discharged back to WCI's infirmary on March 9, 2017.[10] 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.

         Before 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.

         Mr. 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.

         II. Warden ...

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