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Certeza v. Wexford Health Sources, INC

United States District Court, D. Maryland

September 9, 2019

SEAN CERTEZA, Prisoner Identification Number 411-779, SID Number 257-4895, Plaintiff,


          THEODORE D. CHUANG United States District Judge

         Plaintiff 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 Defendants"..

         The 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 granted.


         On May 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.

         On May 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.

         On June 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.

         On 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..

         On 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.

         On 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.

         On May 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.

         On June 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.

         On 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.

         The 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.

         On 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.

         On 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 surgery.

         On 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.

         On 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. ...

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