United States District Court, D. Maryland
DEBORAH K. CHASANOW UNITED STATES DISTRICT JUDGE.
response to this court's Order to Show Cause, counsel for
the Division of Corrections filed a response indicating that
Plaintiff, an inmate at Roxbury Correctional Institution
(RCI), is not entitled to a preliminary injunction because
his medical needs are being addressed. ECF No.
After seeking an extension of time, which was granted,
Plaintiff filed a response. ECF No. 8. For the reasons that
follow, Plaintiff's request for preliminary injunctive
relief will be denied and this case closed.
unverified complaint solely seeking injunctive relief,
Plaintiff alleged that in 2010 he was stabbed multiple times
in his right forearm and hand resulting in his undergoing
surgery at Union Memorial Hospital. ECF No. 1, p. 1. After
his discharge, he was directed to return in 7-10 days to
begin rehabilitation of his injury but Wexford Health Source,
Inc. refused to pay for the rehabilitation at Union Memorial
Hospital and Plaintiff did not receive rehabilitation for 18
months resulting in his hand “heal[ing] wrong”
and partial paralysis. Id., p. 2.
states that he was prescribed Neurontin for over 7 years and
that, on an unspecified date, Wexford Health Care, Inc.
stopped the Neurontin and gave him Cymbalta instead. ECF No.
1, p. 2. He claims that Cymbalta caused him to suffer
nightmares of such intensity that he awoke punching the wall
in a fight with an imaginary foe. Id. He states that
Cymbalta was “[n]ot a[n] ideal medication to give [him]
especially after being diagnosed with P.T.S.D. by 4 different
board certified psychiatrist[s and it was also n]ot a good
idea to stop [his] psychological medication,
‘Prozac' to give [him] Elavil to replace [his] pain
medication Neurontin.” Id., p. 2. Plaintiff
explains that he lives with horrible pain and suffers from
the sensation of crawling up and down his forearm.
Id. Plaintiff denies being an opioid or heroin
addict. Id., pp. 2, 4.
Plaintiff states that on May 15, 2013, he passed out during
outside recreation. ECF No. 1, p. 3. The following morning he
noticed his entire foot was black. An x-ray was taken and a
hair-line fracture discovered on his left foot. Dr. Joubert
saw Plaintiff on May 19, 2013, and put his foot in a
half-cast, half-splint and advised Plaintiff that he needed
to see a doctor, but he did not see a doctor until July 19,
2013. Id. Plaintiff states that he has a metal rod
in his fibula and a metal plate over his ankle. ECF No. 1, p. 3.
He states that he suffers from deep pain and the inside of
his bones ache. Id.
states that he is not getting any pain relief and that the
pain he is suffering from is affecting his eating, sleeping,
and mental health. ECF No. 1, p. 6. He indicates that he was
scheduled to see a pain management team but that it did not
relief, Plaintiff seeks: 1) consultation with the pain
management team; 2) to be provided pain medication; 3)
disclosure of “the rule that allowed, whomever to stop
all of my medication, who what, when, and why, why,
why?” and 4) determination of whether the pharmacist is
licensed. ECF No. 1, p. 6.
response, counsel provides 105 pages of Plaintiff's
medical records (ECF 4-1) and the affidavit of Erwin Aldana,
M.D. ECF No. 4-2. The exhibits demonstrate that Plaintiff is
a chronic care patient who is regularly evaluated by
physicians and other health care providers in order to manage
his chronic medical conditions which include diabetes
mellitus, hypertension, obesity, and chronic pain syndrome
related to his 2010 right forearm surgery and 2013 left ankle
fracture and ligament tear. ECF No. 4-2, ¶¶4, 5.
Dr. Aldana explains in his affidavit that pain management for
chronic pain is individualized and as such the cause and type
of the pain must be determined in order that the most
appropriate treatment can be selected. ECF No. 4-2, ¶ 6.
Plaintiff suffers from both neuropathic (often caused by
“nerve damage or a malfunctioning nervous
system”) and musculoskeletal pain (“often caused
by injury to the bones, joints muscles, tendons, ligaments,
or nerves” or by overuse). Id., ¶¶6,
light of the age of Plaintiff's injuries and the chronic
nature of his complaints, Dr. Aldana opines that it is likely
Plaintiff will suffer life-long pain. Therefore, the goal of
his pain management plan is to manage the pain in order to
“prevent interference with physical function including
Plaintiff's regular activities of daily living.”
Id., ¶ 7.
order to manage Plaintiff's pain he has been prescribed a
number of different “pain medications including
non-steroidal anti-inflammatory medications, non-opioid
analgesics, opioid analgesics, and anti-neuropathic pain
medications (anti-depressants and anti-epileptic
medications). ECF No. 4-2, ¶ 8.
Aldena explains that the Department of Public Safety and
Correctional Services' State Medical Director has
identified Neurontin/Gabapentin (approved by the FDA as an
anticonvulsant for seizure conditions and to treat
neuropathic pain caused by herpes virus or shingles) and
Tramadol/Ultram (a synthetic opioid) “as medications
with patterns of over use and abuse.” ECF No. 4-2,
¶¶ 9, 10. The patterns of abuse include hoarding of
these medications by inmates for improper use due to their
narcotic, euphoric, and sedative like effect, or for trade to
other inmates for misuse in exchange for secondary benefits.
Id. To address these issues with regard to
Neurontin, DPSCS has sought to eliminate its use for non-FDA
approved conditions barring exceptional circumstances.
Id., ¶ 10. Neurontin is not FDA approved for
any of Plaintiff's diagnosed conditions. Id.
October 25, 2017, Plaintiff was seen in the chronic care
clinic where he reported that he was doing well “except
for pain.” ECF No. 4-1, p. 1. At that time Plaintiff
was prescribed Tylenol Extra Strength (ES), Tramadol, and
Neurontin. Id., p. 2. The doctor recommended
switching Plaintiff from Neurontin to amitriptyline (Elavil)
and a new prescription was entered with Plaintiff's
prescriptions for Tramadol and Tylenol ES continued.
Id., p. 2.
December 15, 2017, Plaintiff was seen for a regular
appointment in the chronic care clinic. He reported chronic
pain in his left foot. ECF 4-1, p. 6. His pain medications
were reviewed, his prescription for amitriptyline
discontinued, and Cymbalta prescribed. Id., p. 8.
Plaintiff's prescriptions for Tramadol and Tylenol ES
were continued. Id. Thereafter, Plaintiff underwent
an EKG to assess his cardiac function before continuing with
amitriptyline. Id., pp. 12, 14. On January 8, 2018,
the results of the EKG were reviewed. They were abnormal but
Plaintiff was asymptomatic. Id., p. 14. His
prescriptions for Extra Strength Tylenol, Cymbalta, and
Tramadol for pain management were continued. Plaintiff did
not complain at that time of ineffective pain control or of
any negative side effects from Cymbalta. Id.
February 13, 2018, Plaintiff was seen for follow up regarding
his diabetic condition. It was noted that the EKG had been
abnormal but that the abnormal reading was likely due to the
leads being placed on his leg improperly. ECF 4-1, p. 15.
Another EKG was ordered with directives to avoid placing the
lead on his leg with the metal implant. Plaintiff's