United States District Court, D. Maryland
SEAN CERTEZA, Prisoner Identification Number 411-779, SID Number 257-4895, Plaintiff,
WEXFORD HEALTH SOURCES, INC., 1 CRYSTAL JAMISON, P.A.; DR. ASHOK KRISHNASWAMY; DR. MAHBOOBEH MEMARSADEGHI; ERWIN ALDANA, REGIONAL MEDICAL DIRECTOR; RICHARD MILLER, WARDEN; PATRICIA CASPAR, ADMINISTRATIVE REMEDY PROCEDURE COORDINATOR; and MONICA STALLWORTH, M.D., Defendants.
THEODORE D. CHUANG United States District Judge
Sean Certeza, an inmate currently incarcerated at Maryland
Correctional Institution-Hagerstown ("MCI-H") in
Hagerstown, Maryland, filed a self-represented Complaint
pursuant to 42 U.S.C. ~ 1983 alleging deliberate indifference
to a serious medical need, in violation of the Eighth
Amendment to the United States Constitution based on
allegedly inadequate medical treatment of a wrist injury
sustained while he resided at Roxbury Correctional
Institution ("RCI") in Hagerstown, Maryland.
Defendants include Wexford Health Sources, Inc.
("Wexford",, the I The Clerk shall amend the docket
to reflect the proper title and spelling of the
Defendants' names, as noted in this caption. contractor
providing medical servIces at RCI; Dr. Mahboobeh
Memarsadegh;; Physicianss Assistant Crystal Jamison ("PA
Jamison"), Regional Medical Director Erwin Aldana; and
Dr. Monica Stallworth, all of whom work for Wexford
(collectively, the "Medical Defendants"); and Dr.
Ashok Krishnaswamy, an orthopedic surgeon. The Complaint also
names as Defendants RCI Warden Richard Miller and RCI
Administrative Remedy Procedure ("ARP") Coordinator
Patricia Caspar (collectively, the "Correctional
Medical Defendants and the Correctional Defendants have each
filed a Motion to Dismiss or, in the Alternative, Motion for
Summary Judgmen,, accompanied by affidavits and exhibits.
Certeza has not filed a memorandum in opposition to the
Motions. Having reviewed the submitted materials, the Court
concludes that no hearing is necessary. See D. Md.
Local R. 105.6. For the reasons set forth below, the Medical
Defendants' Motion will be granted in part and denied in
part. The Correctional Defendants' motion will be
20, 2015, Certeza injured his wrist while
playing softball. His wrist was deformed and swollen, and
Certeza was in severe pain and could not move his fingers. PA
Jamison examined Certeza, assessed that Certeza had sustained
a radius/ulnar fracture, and applied a splint. Certeza was
given an injection of Nubain, a pain reliever, and an x-ray
was ordered. The x-ray, which was read the next day, revealed
an acute fracture. When Certeza informed PA Jamison that
Nubain was ineffective in relieving his pain, Certeza was
given an injection of Toradol, and additional medications
were prescribed. On May 21, 205,, Dr. Colin Ottey examined
Certeza and arranged for an orthopedic consultation with Dr.
Krishnaswamy, an orthopedic surgeon.
27, 2015, the orthopedic consultation was approved. Although
Certeza received an appointment to see Dr. Krishnaswamy at
Bon Secours Hospital on May 29, 205,, the visit was postponed
due to a scheduling error. On June 5, 2015, more than two
weeks after the injury, Certeza was seen by Dr. Krishnaswamy,
who diagnosed an unstable fracture that would require
outpatient surgery consisting of an open reduction internal
fixation procedure ("ORIF") with the insertion of a
compression plate and screws and the application of a splint.
This surgery was to be done as soon as possible to avoid
healing in malunion.
11, 2015, Certeza reported that his medication regimen was
ineffective. PA Jamison met with him on June 17, 2015 to
reapply the splint and submit his surgery consultation
request. Certezass wrist surgery was approved on July 22,
205.. Dr. Krishnaswamy performed the surgery on September 1,
2015. Dr. Krishnaswamy observed that by the time that the
surgical authorization was obtained and the surgery was
performed, Certezass wrist was already healing in malunion.
September 2, 205, , Certeza was prescribed
acetaminophen with codeine for pain, and an orthopedic
consultation was requested. On September 30, 2015, to address
continuing pain, Certeza was prescribed Tramado..
November 3, 2015, PA Jamison removed and re-splinted
Certezass cast. When Certeza complained of pain, he was told
that his condition would be discussed with the regional
medical director. On November 4, 2015, Certezass orthopedic
follow-up consultation was approved.
November 13, 2015, Certeza was seen by Dr. Krishnaswamy.
Although the surgical wound had healed well, x-rays revealed
that the fracture was healing, and the range of motion in
Certezass left wrist was good, there were signs of
dislocation in the joint. Dr. Krishnaswamy advised Certeza to
continue range-of-motion exercises and to wear a wrist
splint. Dr. Krishnaswamy planned to remove the plate and
screws in four to six months. He noted that reconstruciion of
the radio-ulna joint might be necessary and requested to see
Certeza again in six weeks.
23, 2016, Certeza visited sick call to complain that
everything he did triggered wrist pain, which at times was at
10 on scale of 1 to 10. He said that he had trouble tying
shoes and getting dressed. The pain medication was not
working. On May 31, 2016, a consultation was ordered for Dr.
Krishnaswamy to remove the plate from his wrist. Certeza was
prescribed Tramadol for pain.
11, 2016, Certeza was seen by Dr. Stallworth. His Tramadol
prescription was renewed through September 30, 2016. He saw
Dr. Stallworth again on August 31, 2016 and complained that
he was unable to play sports or pick up a cup due to wrist
pain. Dr. Stallworth resubmitted the request for a
consultation with Dr. Krishnaswamy to remove the plate.
September 20, 206,, PA Jamison noted that the consultation
with Dr. Krishnaswamy still had not been scheduled and sent
an email to see ifthe consultation request had been
addressed. PA Jamison saw Certeza again on December 6, 2016
and noted that Certeza remained in pain and had decreased
range of motion in his wrist. Aware tha~ Dr. Krishnaswamy had
stated that the hardware in Certezass wrist needed to be
removed to prevent infection, malunion, and prolonged
recovery, she resubmitted the consultation request.
orthopedic consultation was finally approved on December 14,
2016. During a January 17, 2017 telemed conference, Certeza,
Dr. Memarsadegh,, and Dr. Krishnaswamy discussed an
outpatient procedure to remove the hardware and to perform a
modified Darrach Procedure to address the wrist deformity,
pain, and instability of the joint. A surgical consultation
request was approved on January 25, 2017.
January 27, 2017, Certeza was seen by Dr. Memarsadeghi at the
chronic care clinic and was told that the procedure had been
approved and would require splinting for four weeks as well
as physical therapy. Certezass Tramadol prescription was
renewed. The prescripiion was renewed again by Dr.
Memarsadeghi on April 21 and July 18, 2017.
August 31, 2017, Certeza complained to Dr. Maksed Choudry at
the chronic care clinic that he had chronic pain, could not
use his wrist properly, and had not yet been scheduled for
the surgery that had been approved in January. On October 14,
2017, Certeza was seen again by Dr. Stallworth, who renewed
his Tramadol prescription. On October 16, 2017, PA Jamison
conducted a pre-operaiive evaluation and cleared Certeza for
January 11, 2018, Dr. Memarsadeghi resubmitted the request
for wrist surgery that had been approved the previous year on
January 17, 2017. On February 9, 2018, however, a
consultation was approved not for surgery, but for another
orthopedic telemed conference. That conference, which
included Certeza, Dr. Memarsadeghi and Dr. Krishnaswamy,
occurred on March 14, 2018. Dr. Krishnaswamy
acknowledged that Certeza remained in pain and determined
that the plate and screws would be removed and a modified
Darrach Procedure performed within four weeks after
authorizaiion. On April 12, 2018, almost two years after it
was originally supposed to occur, Dr. Krishnaswamy conducted
the procedure to remove the hardware, but the Darrach
Procedure was deferred to see if the hardware removal alone
would decrease Certezass pain.
April 22, 2018, Certeza reported that the surgical wound was
not healing well. The wound was cleaned and dressed. The
following day, April 23, 2018, Certeza was prescribed
Tylenol-codeine No. 3 and an antibiotic, Keflex, for
infection. On April 25, 2018, Dr. Memarsadeghi examined the
wound, renewed Certezass Tramadol prescription, and noted
that a consultation with Dr. ...