United States District Court, D. Maryland
L. RUSSELL, III, UNITED STATES DISTRICT JUDGE.
MATTER is before the Court on Defendants Holly Pierce and
Wexford Health Sources, Inc.'s (“Wexford”)
Motion to Dismiss or in the Alternative, Motion for Summary
Judgment (ECF No. 11) and Plaintiff Merrick Stedman's
Motion to Amend Pleadings or Consent Request to Defendants to
Allow Amendment or in the Alternative Motion for Leave to
Amend (“Motion to Amend”) (ECF No.
The Motions are ripe for disposition, and no hearing is
necessary. See Local Rule 105.6 (D.Md. 2018). For
the reasons outlined below, the Court will grant
Defendants' Motion and deny as moot Stedman's Motion
Stedman, a self-represented Maryland prisoner confined at
North Branch Correctional Institution (“NBCI”),
was transferred to NBCI on July 15, 2015. (Compl. at 5, ECF
No. 1). Two days later, Dr. Mahboob Ashraf and Nurse Dawn
Hawk evaluated Stedman and diagnosed him with left shoulder
pain and tonsillitis. (Id.). Stedman was otherwise
in good health. (Id.). However, after drinking the
tap water in his cell and noticing that the water
“tasted gritty, ” Stedman became concerned that
the water was contaminated. (Id.). Because of his
concern, Stedman wrote to the Environmental Protection Agency
and the City of Cumberland, Maryland asking for water quality
first began to get sick on or about November 25, 2015.
(Id.). After discovering that the nail on his big
toe had started turning grayish-white, Stedman placed a
sick-call and received antibiotics for a toe infection.
(Id.). Three months after completing the course of
antibiotics, Stedman's cellmate was diagnosed with
H-pylori. (Id.). On July 3, 2016, Stedman attended
sick-call and asked the nurse whether he should be tested for
H-pylori in light of his cellmate's diagnosis.
(Id. at 5-6). The nurse advised Stedman that he
could only contract H-pylori by “playing in feces,
contaminated water[, ] or food and that [he] had nothing to
worry about.” (Id. at 6).
began to feel ill again around September 1, 2016.
(Id. at 6). On September 10, 2016, Stedman
complained to Nurse Moyer about migraine headaches that were
becoming more frequent and more painful. (Defs.' Mot.
Dismiss Alt. Mot. Summ. J. [“Defs.' Mot.”]
Ex. 1 [“Medical Records”] at 1, ECF No. 11-4).
During his visit on September 10, 2016, Stedman's blood
pressure was slightly elevated. (Id.). Moyer
referred Stedman for follow-up after two weeks of blood
pressure checks. (Id. at 2). Moyer also prescribed
Stedman Excedrin Migraine for pain relief. (Id.).
received blood pressure checks on September 12 and 14, 2016.
(Id. at 3- 6). On or about September 15, 2016,
Stedman placed a sick-call slip, but did not know that he was
scheduled to be seen because his name was not placed on the
pass list. (Compl. at 6). Stedman received additional blood
pressure checks on September 19 and 21, 2016. (Medical
Records at 3-6). During the blood pressure check on September
21, 2016, Stedman reported to Nurse Hawk that he had been
feeling dizzy. (Id. at 6). Although Stedman's
blood pressure was elevated, his heart rate and respiration
were within normal limits. (Id.). According to
Stedman's medical records, Hawk notified Stedman's
provider about his elevated blood pressure, advised Stedman
that he had one blood pressure check left before he would be
referred to the provider, and directed Stedman to follow up
if his symptoms worsened. (Id.).
attended his provider visit the following day with Krista
Bilak. (Id. at 7). Bilak reported that Stedman's
blood pressure monitoring showed that his blood pressure was
consistently high. (Id.). As a result, Bilak
educated Stedman about hypertension, added him to the chronic
care clinic, and prescribed him Lisinopril. (Id. at
7-8). Bilak also noted that Stedman complained of heartburn
and a recurrent sore throat, so she provided him Tums and
took a throat culture. (Id.).
to Stedman, his condition continued to decline because of his
chest pains. (Compl. at 6). On September 26, 2016, Stedman
complained to Nurse Marilyn Evans about a sore throat and
night sweats. (Id. at 6; Medical Records at 9).
Stedman's tonsils were enlarged and his throat was
inflamed and red. (Id.). In Stedman's medical
reports, Evans noted that she consulted with Stedman's
provider and they were waiting for the results of the throat
culture. (Id. at 10). In the meantime, Evans
provided Stedman throat lozenges, instructed him to drink
fluids, and directed him to submit a sick-call slip if his
symptoms changed. (Id. at 10-11). Stedman returned
to sick-call on September 30, 2016, complaining of sore
throat and dizziness. (Id. at 12). Stedman's
medical reports note that his throat was inflamed, he was
dizzy, and he was having difficulty swallowing.
(Id.). After Stedman's throat culture tested
positive for candida albians, Stedman was diagnosed with a
yeast infection in his throat and was prescribed an
eight-week treatment of Diflucan. (Compl. at 6; Medical
Records at 14; Asresahegn Getachew Aff. [“Getachew
Aff.”] ¶ 8, ECF No. 11-5). Stedman alleges that no
one could explain to him how it was possible to contract a
yeast infection in his throat. (Compl. at 6). Although
Stedman's prescription for Diflucan helped clear his
yeast infection, Stedman alleges that his health continued to
saw Bilak again on October 7, 2016 because he continued to
feel dizziness upon standing. (Medical Records at 15).
Stedman's blood pressure was within normal limits and had
minimal changes when he changed positions. (Id.).
Bilak directed Stedman to follow up if his condition worsened
or did not improve within thirty days. (Id. at 16).
October 15, 2016, Stedman submitted a sick-call slip
complaining that his chest hurt and he was dizzy.
(Id. at 17). Stedman stated he believed something
was “seriously wrong” and requested lab work,
including blood, urine, and stool testing. (Id.).
During his evaluation on October 17, 2016, Stedman advised
Nurse Evans that he had been experiencing burning in his
chest for approximately one month, and that the burning came
on without warning, was not brought on by food or drink,
lasted for seconds, and went away on its own. (Id.
at 18). Stedman's throat was slightly inflamed, but his
physical examination was otherwise unremarkable.
(Id.). Nurse Evans referred Stedman to his provider
and directed him to return to sick-call if he developed
symptoms of infection or his symptoms did not subside.
(Id. at 19).
was transferred to the care of Defendant Holly Pierce,
C.R.N.P. on or about October 20, 2016. (Compl. at 6). Nurse
Practitioner Holly Pierce evaluated Stedman on October 25,
2016. (Medical Records at 19). Pierce noted that Stedman
complained of fatigue, persistent sore throat, and headache,
and that he had a history of high blood pressure.
(Id. at 19). Stedman's tonsils were enlarged,
but his respiratory and cardiovascular systems were normal.
(Id.). Pierce directed that Stedman have blood
pressure checks twice a week for three weeks. (Id.).
Pierce prescribed Hydrochlorothiazide (“HCTZ”) to
treat Stedman's hypertension, but left Stedman's
previous prescription for Prinivil in place. (Id.).
Pierce also discontinued Stedman's prescription for
Diflucan and instead prescribed Nystatin to treat his
throat. (Id.). Additionally, Pierce ordered another
throat culture, a complete blood count with differential, a
comprehensive metabolic panel, and a test of Stedman's
thyroid levels. (Id.). Stedman was scheduled for
follow-up with a provider in two weeks. (Id.).
Stedman's throat culture came back normal and his
complete blood count showed low neutrophil and high
lymphocyte counts. (Id. at 22, 25).
October 30, 2016, Stedman met with Nurse Hawk in response to
his inquiry about blood pressure checks. (Id. at
23). Stedman advised the nurse that he was supposed to
receive blood pressure checks and reported that he felt he
had an irregular heartbeat. (Id.). The nurse advised
Stedman that blood pressure checks had been ordered and were
to begin the following day. (Id.). The nurse also
noted that while listening to Stedman's heart for two
minutes, his heart rate sped up for approximately two to five
seconds on one occasion but then returned to normal.
(Id.). The nurse then contacted Stedman's
provider for further treatment and orders. (Id. at
Stedman placed numerous sick-calls complaining about his
chest and head, Nurse Practitioner Holly Pierce evaluated
Stedman on November 1, 2016. (Compl. at 6; Medical Records at
27). During this visit, Stedman reported that he was
suffering from dizziness and heart palpitations. (Medical
Records at 27). Stedman's physical exam revealed a
slightly elevated heart rate, but his results were otherwise
normal. (Getachew Aff. ¶ 11). Pierce ordered
that Stedman's prescription for HCTZ be decreased by half
and ordered an EKG. (Medical Records at 27-28).
underwent an EKG on November 13, 2016. (Compl. at 6; Medical
Records at 29). Stedman's medical records indicate the
EKG showed a “left ventricular hypertrophy
[“LVH”] with repolarization abnormality, ”
but otherwise normal sinus rhythm and no significant
abnormalities. (Id.). Stedman alleges that the EKG
reader told him he had an abnormal reading and that a
provider would speak with Stedman that day. (Compl. at 6- 7).
When Stedman did not hear from a provider about his results,
he placed a sick-call slip. (Id. at 7). Stedman also
placed a sick-call slip on November 23, 2016, requesting the
results of his EKG. (Id.). Pierce reviewed the lab
results with Stedman on November 17 and 28, 2016, informing
Stedman that LVH with repolarization abnormality does not
require any treatment. (Medical Records at 30, 33). According to
Stedman, Pierce told him that his EKG results were normal and
the EKG technician who told Stedman he had abnormal results
“did not know what she was talking about.”
(Compl. at 7). Stedman asserts that “[w]hat [Pierce]
said, how she said it[, ] and how she looked [were]
sketchy” to him. (Id.).
December 6, 2016, Stedman submitted a sick-call slip with a
note directed to Pierce that read: “I am not requesting
to see [Pierce] . . . [but] I need you to listen to what
I'm saying to you so that you can provide me with better
care.” (Medical Records at 35- 36). In his note,
Stedman disputed Pierce's explanation that his dizziness
was caused by the blood pressure medication, explaining that
that his symptoms of dizziness and difficulty walking began
before he started taking the blood pressure medication.
(Id. at 36; see also Compl. at 7). Stedman
asked Pierce to refer him to a doctor who specialized in his
symptoms. (Medical Records at 36).
evaluated Stedman on December 8, 2016. (Id. at 37).
According to his medical records, Stedman had a hacking
cough, a dull tympanic membrane in his right ear, tender
sinuses, and moderately enlarged tonsils and left and right
turbinate. (Id.). Stedman said he felt
light-headed and explained that his symptoms were aggravated
when he got out of bed and when he rose rapidly.
(Id.). Pierce prescribed Stedman Zyrtec, Nasacort,
Prednisone, and Norvasc. (Id.
at 38). Pierce left in place Stedman's prescription for
HCTZ, but discontinued the Lisinopril/Prinivil prescription
due to Stedman's cough. (Id.). Pierce ordered
another throat culture and directed Stedman to follow up in
two weeks. (Id.).
December 8, 2016, Stedman filed an Administrative Remedy
Procedure (“ARP”) against Pierce, alleging that
Pierce discussed Stedman's possible medical condition
with an officer. (Compl. at 7-8).
December 13, 2016, Stedman presented to the medical unit by
wheelchair after reporting chest pains and dizziness.
(Medical Records at 39). Nurse Tammy Buser provided Maalox
and performed an EKG. (Id.). The results of the EKG
showed no change from Stedman's previous EKG.
(Id. at 39, 41). The following day, Dr. Ashraf
evaluated Stedman for ongoing migraine headaches and
dizziness. (Id. at 42). Stedman's blood
pressure, tympanic membranes, mouth, and throat were normal.
(Id. at 42, 43). Dr. Ashraf noted that Stedman's
prescription for Lisinopril had been discontinued due to side
effects and substituted with Norvasc, but that Stedman had
stopped taking Norvasc “because it was not helping
him.” (Id. at 42). Dr. Ashraf also noted that
Stedman was on 12.5-milligram dose of HCTZ per day, and that
Stedman had stopped taking Prednisone for his
allergies because it “made his symptoms
worse[n].” (Id.). Dr. Ashraf ordered a blood
and lipid panel. (Id.). Later the same day, Stedman
submitted a sick-call slip indicating that the pressure in
his head worsened and requesting an MRI. (Id. at
46). On his sick-call slip, Stedman complained that the
medical department had been playing a “guessing game
about [his] possible illness now for approximately 3
months.” (Id. at 47). Stedman also requested
to be placed back on daily blood pressure checks.
December 20, 2016, Pierce and regional medical director Dr.
Akal evaluated Stedman. (Id. at 48). Stedman again
complained of lightheadedness, but denied having chest pain,
ear ache, or headache. (Id.). Stedman states he was
surprised to learn during this visit that his sinus issue was
the result of mucus draining in the back of his throat, but
that Pierce could not say whether this caused Stedman's
yeast infection. (Compl. at 8). Stedman had elevated blood
pressure during this visit. (Medical Records at 48).
Stedman's medical records note that Stedman's EKG
showed a normal sinus rhythm with “[l]eft ventricular
hypertrophy with repolarization abnormality.”
(Id.). Pierce and Dr. Akal referred Stedman to a
cardiologist and instructed him to avoid exercise until his
cardiology appointment. (Id.). Pierce and Dr. Akal
also prescribed Stedman 25 milligrams of Metoprolol
Tartrate. (Id. at 49). Pierce submitted a
consultation request for a CT scan on January 5, 2017.
(Id. at 50).
January 9, 2017, Dr. Barrera evaluated Stedman for nasal drip
in the back of his throat. (Id. at 53). Dr. Barrera
provided Stedman cold medication and directed him to rest and
drink plenty of water. (Id.). On January 13, 2017, a
note was entered into Stedman's medical record reflecting
the collegial decision to postpone his CT scan until after
the cardiology telemedicine was completed. (Id. at
57). On January 14, 2017, the results of Stedman's blood
work showed that he had high levels of cholesterol and
triglycerides. (Id. at 55). Stedman also tested
positive for H-pylori. (Id. at 56). On January 19,
2017, Pierce advised Stedman of the results of his blood work
and the collegial decision to delay his CT scan.
(Id. at 58). Stedman alleges he was
“surprise[d]” at his H-pylori results because he
“wasn't even aware that [he] was being tested for
the bacteria” and his past concerns about H-pylori had
been dismissed. (Compl. at 9). Pierce prescribed Stedman
antibiotics to treat H-pylori. (Medical Records at 58).
According to Stedman, Pierce instructed him to follow up
“in a couple weeks” and provide a stool sample to
assess the efficacy of the antibiotic treatment, but despite
submitting multiple sick-call slips, Stedman was not
re-tested until May 2, 2017. (Compl. at 10).
February 8, 2017, Pierce evaluated Stedman for ongoing
dizziness and lightheadedness. (Medical Records at 61).
Pierce once again advised Stedman that he would be referred
to a cardiologist and that he should avoid exercise until
that time. (Id.). Stedman's vital signs and
physical exam were normal. (Id.).
Dr. Ashok Chopra evaluated Stedman on February 13, 2017.
(Id. at 63-69). Dr. Chopra noted that Stedman's
dizziness was likely “due to orthostatic
hypotension.” (Id. at 63). Dr. Chopra
directed Stedman stop taking the diuretic and ordered blood
pressure monitoring. (Id.). Additionally, Dr. Chopra
remarked: “Check Echo and Stress test as marked EKG
abnormality. Neuro eval In progress in view of headaches and
dizziness.” (Id.). Dr. Chopra directed Stedman
to follow up in six weeks, recommended a statin
drug to treat Stedman's elevated lipid
levels, and suggested a follow-up lipid panel.
(Id.). On that same day, Pierce submitted a
consultation request for the additional testing recommended
by Dr. Chopra. (Id. at 70). The requests for the
echocardiogram and stress tests were approved on February 16,
2017. (Id. at 72).
February 18, 2017, Stedman reported to Nurse Baker that he
still needed the CT scan of his head. (Id. at 73).
Baker advised Stedman that the scan was on hold pending the
cardiology consult. (Id.). Baker also advised him
that the additional testing requested by Dr. Chopra was
pending. (Id.). Baker indicated she would follow up
regarding the need for daily blood pressure checks.
(Id.). On February 20, 2017, Pierce entered a chart
update that Stedman was to receive blood pressure checks
three times a week for three weeks. (Id. at 75).
submitted a sick-call slip on February 27, 2017, complaining
of increased dizziness, confusion, pressure in his head, and
labored breathing. (Id. at 76). Stedman indicated
that although his treatment with HCTZ had been discontinued,
he had started taking it again the day before submitting his
sick-call slip. (Id. at 77). Pierce evaluated
Stedman on March 1, 2017 for his ongoing complaints of light
headedness. (Id. at 78). Stedman's vital signs
were within normal limits and his physical examination was
unremarkable. (Id.). Pierce noted that the
cardiologist had requested a stress and echo test for
Stedman. (Id.). Pierce encouraged Stedman to
increase fluids and to avoid exercising and quick movements.
Cottrell evaluated Stedman on March 12, 2017. (Id.
at 80). At that time, Stedman requested an H-pylori test and
inquired about the status of his echocardiogram and stress
test. (Id.). Stedman also requested a prescription
for HCTZ. (Id.). Cottrell referred Stedman to the
provider. (Id.). On March 20, 2017, Stedman met with
Pierce, who advised him that the echocardiogram and stress
tests had been approved and their scheduling was pending.
(Id. at 82). Stedman underwent a stress test and
echocardiogram on March 22, 2017. (Id. at 83-86).
The stress test showed “an appropriate heartrate and
blood pressure response to exercise.” (Getachew Aff.
¶ 21). Stedman's echocardiogram showed “mild
concentric left ventricular hypertrophy” with an
ejection fraction of 65-70%, mild dilation of the left
atrium, unremarkable valves, and impaired LV relaxation.
(Medical Records at 86).
March 30, 2017, Pierce evaluated Stedman for complaints of
dizziness, headaches, and heart palpations. (Id. at
91). At that time, Stedman requested a neurology
consultation. (Id.). Pierce reviewed the results of
the cardiology testing with Stedman and noted a follow-up
with the cardiologist had been requested. (Id.).
Pierce also reviewed Stedman's history of failed
treatment for headaches and renewed the request for CT scan
of the head. (Id.). On April 5, 2017, Pierce entered
a chart update requesting blood work for Stedman.
(Id. at 93).
April 6, 2017, Dr. Ashraf evaluated Stedman for complaints of
headache pressure, dizziness, and bilateral earache.
(Id. at 94). Dr. Ashraf noted that the results of
Stedman's echocardiogram and stress test were normal and
that Stedman denied any cardiac symptoms or distress.
(Id.). Dr. Ashraf also noted that another provider
had twice recommended a CT scan of the head, but the requests
had been denied on collegial review. (Id.). Dr.
Ashraf advised Stedman to take Meclizine and Topamax daily.
(Id.). Dr. Ashraf also provided Stedman ear drops
and assured him that his providers would continue to treat
Stedman's symptoms even if the request for a CT scan was
denied again. (Id.).
had another EKG on April 23, 2017, which again noted LVH.
(Id. at 99- 100). Dr. Ashraf saw Stedman again on
April 26, 2017 for Stedman's continued migraines.
(Id. at 101). Dr. Ashraf noted that the two previous
requests for a CT scan had been denied by the collegial
review process, but indicated he would “send a reminder
to the collegial” to “reconsider” their
denial of the CT scan. (Id.). Dr. Ashraf also noted
that the request for consultation with the cardiologist had
been approved and that Stedman's providers would follow
the cardiologist's recommendations after Stedman's
follow-up consultation. (Id.).
2, 2017, Pierce evaluated Stedman for complaints of ear
infection and head pressure. (Id. at 104). At that
time, Stedman denied pain or dizziness but complained of
pressure behind his eye. (Id.). Stedman told Pierce
that the medical staff did not know what they were doing and
that he needed to see a neurologist. (Id.). Stedman
indicated “he wants off Topamax as he is not taking
it.” (Id.). Stedman also stated that he was
told he had an ear infection but did not receive the
medication and the “painless infection” was out
of control. (Id.). Pierce discontinued the Topamax
at Stedman's request and placed an order for Excedrin
Migraine. (Id.). Pierce did not prescribe an
antibiotic. (Id.). Pierce also noted that the
cardiology follow-up was pending, and that the request for a
CT scan of the head had been denied three times.
(Id.). Finally, Pierce requested an optometry exam.
6, 2017, Stedman's laboratory test results showed that
his April 27, 2017 and May 3, 2017 stool samples were
negative for H-pylori. (Id. at 106-07). On May 8,
2017, Stedman's telemedicine appointment was canceled due
to a security issue. (Id. at 108). Pierce requested
that the appointment be rescheduled. (Id.).
22, 2017, Dr. Chopra evaluated Stedman for complaints of
fullness in both ears and headaches. (Id. at
109-11). No. acute symptoms were present at that time.
(Id. at 109). Dr. Chopra noted that HCTZ had been
discontinued as of the last visit, described the results of
Stedman's stress test and echocardiogram as
“satisfactory, ” and indicated that Stedman's
dizziness was not related to cardiac abnormality.
(Id.). Dr. Chopra recommended that Stedman lose
weight, take a “statin” to treat high
cholesterol, receive a follow-up lipid panel in six weeks,
and follow up with the cardiologist in four months.
(Id. at 111). Dr. Chopra also recommended an ENT
evaluation. (Id.). Stedman asked Dr. Chopra whether
he had recommended evaluation by a neurologist during
Stedman's last visit, but Dr. Chopra advised that the
medical staff at NBCI could manage Stedman's symptoms.
(Id.). Stedman disagreed, remarking that his
symptoms had been present for “years with no
relief.” (Id.). Dr. Chopra advised he could
recommend a neurologist only after Stedman's consultation
with an ENT, if needed. (Id.).
result of the May 22, 2017 consultation, and after discussing
Stedman's case with the Regional Medical Director, Pierce
placed an order for Pravastatin, discontinued Metoprolol
Tartrate, and placed an order for Propranolol.
(Id.). Pierce also indicated that referral to an ENT
for dizziness was “not indicated” as Stedman was
not compliant with his treatment plan in that he declined
Topamax and was not taking Meclizine every day as prescribed.
(Id.). Additionally, Pierce noted that returning to
the cardiologist in four months was “not indicated at
this time” for Stedman. (Id.). Pierce directed
that Stedman's medications be issued as directly observed
therapy (“DOT”) instead of issuing him a blister
pack to self-administer. (Id.). Pierce also ordered
an x-ray of Stedman's sinuses and noted the optometry
exam remained pending. (Id. at 111, 114). Stedman
was scheduled for follow-up in one week. (Id. at
25, 2017, Stedman's laboratory test results showed that
his May 23, 2017 stool samples were positive for H-pylori.
(Id. at 113). A handwritten note on the results
indicates “*wrong test* stool is negative.”
25, 2017, an x-ray of Stedman's face and sinuses showed
no abnormalities. (Id. at 115).
29, 2017, Dr. Ashraf evaluated Stedman for complaints of
headache and ear pressure radiating towards the jaw.
(Id. at 116). Stedman informed Dr. Ashraf about his
frustration that nothing was being done with the CT scan or
ENT referral. (Id.). On examination, both of
Stedman's ears showed signs of infection. (Id.).
Dr. Ashraf prescribed Stedman amoxicillin and Neomycin.
(Id.). After Stedman told Dr. Ashraf that he had not
received the medicine that had been prescribed to him, Dr.
Ashraf called the pharmacy, which indicated that Stedman
would receive the amoxicillin that day but that the Neomycin
ear drops were non-formulary. (Id.). As a result,
Dr. Ashraf submitted a non-formulary drug request for the ear
drops the same day. (Id. at 119-20).
14, 2017, Stedman received an optometry examination.
(Id. at 122). The following day, Nurse Practitioner
Krista Self evaluated Stedman. (Id. at 123). Self
noted that Stedman requested to see an ENT but there was no
indication for Stedman to see one. (Id.). Self also
noted that while Stedman had various complaints over time,
the results of multiple diagnostic studies were unremarkable.
(Id.). Self educated Stedman on vertigo, but Stedman
disagreed with the diagnosis and plan of care.
(Id.). Stedman declined Meclizine to treat vertigo
and again requested a consultation with an ENT or
14, 2017, Dr. Ashraf evaluated Stedman and informed him that
he had tested positive for hepatitis B. (Id. at
127). Dr. Ashraf explained to Stedman the result of the
hepatitis test, which required no treatment. (Id.).
At that time, Stedman informed Dr. Ashraf about his issues
with recurrent head and ear aches. (Id.; see
also Getachew Aff. ¶ 26). Examination of
Stedman's ears was negative for infection but positive
for wax build up. (Medical Records at 127). Dr. Ashraf
prescribed Stedman ear drops. (Id.).
Medical Director Ava Joubert-Curtis examined Stedman on July
17, 2017. (Id. at 132). At that time, Stedman
presented an affidavit listing his medical concerns and
threatening to file suit. (Id.). Stedman explained
his belief that the nurse practitioner had sabotaged his care
after he submitted an ARP about medication she was supposed
to have prescribed but which he did not receive.
(Id.). Dr. Joubert-Curtis noted that she addressed
each of Stedman's concerns and highlighted “the
elevated [blood pressure] and the evidence of chronic
sinusitis on exam (despite neg x-ray of the sinuses).”
(Id.). Dr. Joubert-Curtis indicated she would
request a CT scan for Stedman's head. (Id.).
Examination showed that Stedman's ears were normal, but
his sinuses had “very swollen turbinates” and his
tonsils were enlarged. (Id. at 134). Additionally,
Dr. Joubert Curtis noted:
Headaches appear to be multifactorial, including hypertensive
and [c]hronic sinus disease. However due to the nature of the
headaches, neg sinus x-rays and headaches when BP appears to
be normal, will pursue CT r/o other vascular abno[rmalities].
The hypertension appears to be more of a chronic persistent
nature considering the LVH pattern on the EKG. He has seen
the Retinal screening specialist. This provider is not able
to interpret the findings. However, there does not appear to
be any recommendations made. We are stopping the excedrin
migraine due to the caffeine in it (elevates BP) and adding
ARB [Hyzaar] to help control the BP and will ...