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Horton v. Wexford Health Sources Inc.

United States District Court, D. Maryland

May 29, 2019



          Paula Xinis United States District Judge

         Plaintiff Larry Horton brings this civil rights action, alleging that substandard medical care has subjected him to cruel and unusual punishment in violation of the Eighth Amendment to the United States Constitution. ECF No. 1-2. Horton, an inmate at Western Correctional Institution in Cumberland, Maryland, initially filed this Complaint in the District Court for Allegany County, Maryland, alleging that Defendants' wrongful failure to renew his pain medications, Ultram and Neurontin, amounted to medical malpractice, “cruel and unusual punishment, ” and deliberate indifference to his medical needs. ECF No. 1-2 at 1, 6, 8, 13, 14. As relief, Horton requests renewal of his Ultram and Neurontin prescriptions, monetary damages, and for Defendant, Dr. Asresahegn Getachew, to receive education on the dangers of failing to renew Ultram. ECF No. 1-2 at 1, 8, 10.

         Defendants Wexford Health Sources, Inc. and Dr. Getachew, M.D. (collectively the Medical Defendants) with the consent of Defendant Warden Richard Graham, removed the case to this Court. ECF No. 1, ECF No. 1-3. The Medical Defendants have filed a Motion to Dismiss or, in the Alternative, Motion for Summary Judgment. ECF No. 6. Horton opposed the motion. ECF No. 8. Warden Graham filed a separate Motion to Dismiss, or in the Alternative, Motion for Summary Judgment. ECF No. 15. Horton was provided an opportunity to respond to Graham's dispositive motion, but he has not done so. ECF No. 16.[1]

         In his Opposition to the Medical Defendants' Motion, Horton contends that he had no intention to raise a civil-rights claim and that he instead wishes to bring only common law tort claims against the Defendants. Horton seeks remand to Alleghany County District Court. ECF No. 8 at 1-3. The Complaint, however, clearly asserts the very allegations that he now disavows. ECF No. 1-2 at 8, 10, 13, 14. Accordingly, the Court will address the merits of the constitutional claims. The issues have been briefed and the Court now rules because a hearing is not necessary. Local Rule 105.6 (2018). For the reasons that follow, the Court grants summary judgment in Defendants' favor on the constitutional claims, and remands the state common law claims.

         I. Background

         Horton includes in the Complaint copies of three Administrative Remedy Procedure (ARP) requests that set out the following series of events. October 30, 2017, Plaintiff complained that he had not received his evening dose of Ultram for three weeks. ECF No. 1-2 at 4 (ARP #WCI-274317). The institution responded that Horton's request was “meritorious” and that he was to receive “Ultram 50 mg at bedtime.” But by the time the formulary responded to the medical request for this prescription, Horton was only approved by the medical staff “for a tapering dose.” The response concluded with informing Horton that his sick call slips have been received at he will be monitored through the sick call process. ECF No. 1-2 at 4.

         According to the next ARP dated January 14, 2018, Horton complained that Terri Davis, a Wexford employee, changed the renewal date for his Ultram prescription without his knowledge. ECF No. 1-2 at 6. This change, Horton asserts, amounts to cruel and unusual punishment. ECF No. 1-2 at 6, 8. No. response is evident on the documents in the record.

         On February 1, 2018, Horton complained in the third ARP that his Ultram was stopped on January 8, 2018 because Terri Davis changed the prescription expiration date without his knowledge. ECF No. 1-2 at 9-10 (ARP# WCI-0273-18). Horton noted that Ultram is the only medication that relieves his chronic pain in his back and from his arthritis, and that he has been on the medication “for years.” ECF No. 1-2 at 10. Horton also related that when the Ultram was tapered, he went through withdrawal, his pain worsened, and he had a seizure. ECF No. 1-2 at 10. The Court did not receive any response to this ARP.

         Horton suffers from peripheral neuropathy, chronic back pain, anxiety disorder, and combined drug dependencies. Getachew Decl. ECF No. 6-5 ¶ 4-5. He has complained for many years of lower back pain which radiates down his legs to his feet, arising from an injury sustained while he was in the military. He has, in the past, received Neurontin and Tramadol as treatment. Getachew Decl. ECF No. 6-5 ¶¶ 4-5; Medical Records ECF No. 4 at 2-6, 8, 25. However, neither Neurontin or Tramadol are medically indicated for long-term chronic pain management. Getachew Decl. ECF No. 6-5 ¶ 15.[2]

         Further, the Department of Public Safety and Correctional Services (DPSCS) has identified Neurontin and Tramadol as medications “with patterns of overuse and abuse” and has sought to eliminate their use for non-Federal Drug Administration (FDA) approved conditions unless exceptional circumstances exist. Getachew Decl. ECF No. 6-5 ¶¶ 6, 7. Such abusive and potentially dangerous practices by inmates include hoarding medications for improper use or trading them to other inmates for misuse. Getachew Decl. ECF No. 6-5 ¶ 6. The DPSCS recommends that prescriptions for such medications be limited to 14-day periods. ECF No. 6-4 at 64. The prescription may be extended only after review and approval from a multidisciplinary pain management team. ECF No. 6-4 at 64.

         As of August 2017, Horton was taking Neurontin (800 mg. twice daily) and Tramadol ER (200 mg. twice daily), and Tramadol (50 mg. at night). ECF No. 6-4 at 2, 4-5. On October 6, 2017, Horton complained of pins and needles in his feet. He was kept on the Tramadol at night and Tramadol ER and was prescribed insoles which Horton says he never received. ECF Nos. 6-4 at 8, 10; 8 at 3. Four days later, the medical director denied the request to renew Horton's Tramadol prescription for the evening and instead approved a tapering dose. Horton was taking 27 different medications at the time, prompting concern from the medical staff who called an interdisciplinary team meeting to discuss Horton's treatment plan. ECF No. 6-4 at 14, 17-18, 22, 24.

         On November 1, 2017, Dr. Getachew approved tapering Plaintiff's Neurontin and increased the prescribed dosage of Elavil. ECF No. 6-4 at 24. On November 6, 2017, the medical team, who included Ava Joubert-Curtis, M.D., Karen Brown, RN, Naa Odifie, Pharm. D., and representatives from the correctional case management staff, met to discuss Horton's long-term use of Tramadol ER. ECF No. 6-4 at 2-5. Horton was invited to the meeting but declined to attend. The meeting participants noted that Horton had declined surgery for his back and that his self-medication resulted in overuse of NSAIDs (nonsteroidal anti-inflammatory drugs) which caused kidney problems. The team also reviewed Horton's history of substance abuse, and ultimately determined that maintaining Horton on his current pain medication would be medically imprudent. ECF No. 6-4 at 25. The team recommended physical therapy with self-management, tapering Neurontin, and possible decrease in his Elavil dosage. ECF No. 6-4 at 25. The team also approved a CT scan of Horton's abdomen because of his history of colonic polyps and blood in the stool and considered an MRI of his lower back. ECF No. 6-4 at 25. Horton thereafter refused to meet with medical personnel to discuss the treatment plan and instead signed a Release of Responsibility (ROR) form. ECF No. 6-4 at 25.

         In November and early December, Horton complained of pain in his feet and legs and requested Tramadol ER which was prescribed. ECF No. 6-4 at 29. On December 12, 2017, x-rays were taken of Horton's spine and showed no evidence of acute fracture, dislocation, or acute bone abnormality. ECF No. 6-4 at 35. On January 12, 2018, Dr. Getachew denied the request to renew Horton's prescription for Tramadol, noting Horton's normal spine x-ray. ECF No. 6-4 at 36, 40. Dr. Getachew directed the medical staff to discuss with him any further desires to prescribe such medication due to its increased risks of addiction.

         Horton complained in January about the continued burning in his feet and requested Tramadol again. ECF No. 6-4 at 41. In response, Nurse Practitioner Mahler confirmed with a physician that Horton would be placed on a Tramadol taper, begin physical therapy, and receive Tylenol 500 mg and an increased Horton's dosage of Elavil. She discussed prescribing ...

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