MICHAEL P. MCCUSKEY, District Judge.
This case is about an alleged deliberate indifference to a prisoner's serious medical need of severe hemorrhoids. More specifically, this case is about the standard of care required for a managed and ongoing medical condition as compared to an acute episode arising from that condition. The issue is whether a prisoner who has an ongoing medical condition under the care of a physician may survive a motion for summary judgment if he fails to demonstrate that the defendants were made aware of any signs or symptoms that were different from or more severe than those for which he was already being treated. This court holds that he cannot.
The case is before this court on a Motion for Summary Judgment filed by Dr. Paul Talbot and Linda Daily (#67) (hereinafter "Wexford Defendants") and a Motion for Summary Judgment filed by John Jennings, John Linville, Keith Anglin, Victor Calloway, and Mary Miller (#69) (hereinafter "Danville Defendants"). The court has reviewed the briefs and evidence filed by Defendants and Plaintiff. Following this review, both Motions for Summary Judgment (#67, #69) are GRANTED.
Plaintiff has had hemorrhoids since approximately 2002. (#67 exh. C, Plaintiff's Deposition, 28:19-20; 30:8-10) (hereinafter "Dep."). While housed at Cook County Jail in 2005 or 2006, the hemorrhoids became worse until they began to bleed. (Dep., 32:8-15). Plaintiff continued to suffer from bleeding hemorrhoids when he was first incarcerated at the Robinson Correctional Center, (Dep. 34:13-15), and continued to have them after being transferred to the Shawnee Correctional Center, (Dep. 36:2-6) and then the Dixon Correctional Center (Dep. 37:16-19). Plaintiff was, in his own words, "kicked out" of Dixon around April 2008, and then transferred to the Danville Correctional Center. (Dep. 38:8-13), where he continued to suffer from bleeding hemorrhoids, (Dep. 38:16-21).
On June 12, 2009, Plaintiff, was seen by Dr. Royce Larsen. (Talbot & Daily's Motion for Summary Judgment, #67 § 10) (hereinafter "Wexford MSJ"). Dr. Larsen's notes indicated that Plaintiff had been having hemorrhoid problems for the past several years, with pain and bleeding with bowel movements. Id. A digital examination showed prolapsed circumferential hemorrhoids with no masses, but Plaintiff refused an anoscopic examination. Id. Dr. Larsen further noted that future treatments might include hemorrhoidectomy, fissurectomy, and lateral sphincterotomy. Id.
On October 26, 2009, Defendant Dr. Paul Talbot ("Talbot"), a physician with Wexford Health Sources, Inc., and the Medical Director at the Danville Correctional Center, saw Plaintiff for the first time as a patient, concerning Plaintiff's hemorrhoids and anemia. (Wexford MSJ § 11). Talbot found that Plaintiff had a history of chronic hemorrhoidal bleeding, but that Plaintiff was not bleeding at the time. Talbot ordered a complete blood count exam, a follow-up to check the anemia, and Metamucil as a fiber supplement. Id. On October 29, 2009, Talbot held a Collegial Review with other Wexford physicians. (Wexford MSJ § 12). Following this review, Plaintiff was approved to receive a hemorrhoidectomy exam and removal. Id.
On November 6, 2009, Talbot approved Plaintiff to see Dr. Dean Scavone, a GI specialist, at the Carle Clinic. (Wexford MSJ § 13). Dr. Scavone found minimal external hemorrhoidal tissue, no evidence of thrombosed hemorrhoids, a normal sphincter, no masses in the anal canal, and "relatively unremarkable hemorrhoidal tissue." (Wexford MSJ § 14). Dr. Scavone recommended a colonoscopy under IV sedation for further examination, but concluded that "Plaintiff does not have obvious external hemorrhoids that justify a hemorrhoidectomy." Id. Following a Collegial Review with other Wexford physicians, Talbot approved Plaintiff to receive a colonoscopy. (Wexford MSJ § 16).
On December 1, 2009, Plaintiff received a colonoscopy from Dr. Scavone. (Wexford MSJ § 17). Dr. Scavone concluded that Plaintiff had some very prominent Grade 3 internal hemorrhoidal veins, which were likely the source of the bleeding. Id. Dr. Scavone also noted the presence of external hemorrhoids and mild sigmoid diverticulosis. (Wexford MSJ exh. 8). Dr. Scavone's recommended plan was as follows:
The patient at this point should be on a high-fiber diet. He will have information related to his physician at the Danville Correctional Facility. If the patient has ongoing issues with bleeding despite being on appropriate bulking agents, the patient can be referred for potential banding of his internal hemorrhoids.
(Wexford MSJ exh. 8).
Upon return to the Danville Correctional Center, Plaintiff denied being in pain and indicated only that he was tired. (Wexford MSJ § 18). His medical notes indicate an absence of active bleeding. (Wexford MSJ exh. 9). The next day, on December 2, 2009, Linda Daily, R.N., ("Daily") noted that Plaintiff had no rectal bleeding and no complaints of pain. (Wexford MSJ § 21). Following this finding, Talbot ordered Daily to discharge Plaintiff, which she did. Id.
On December 3, 2009, a nurse was called to the segregation unit in response to a shift commander's request regarding Plaintiff's rectal bleeding. (Wexford MSJ § 24). Upon arrival, Plaintiff refused to allow the nurse to examine him, but the nurse noted a moderate amount of blood in Plaintiff's stool. Id.
On December 4, 2009, Talbot's notes documented that during a Collegial Review, the physicians agreed that Plaintiff was a "most difficult patient" who had engaged in "manipulative behavior which impacts on his case adversely", and also that the physicians concurred with Dr. Scavone's assessment that banding was not indicated at that time. (Wexford MSJ § 25). The continued treatment plan was to continue to document any visible blood in and on formed feces, to order a CBC, and to continue Metamucil, Colace, fiber supplements, and suppositories. Id. Also on December 4, 2009, Talbot met with Plaintiff. (Wexford MSJ § 26). Plaintiff complained that he had been bleeding again, and Talbot noted small hemorrhoidal tags, (#67 exh. 13; incorrectly, "taps" in the Wexford MSJ), at the external anal opening but no signs of lacerations or bleeding. Plaintiff provided dried blood on tissue paper, but the rectal exam showed no sign of blood. (Wexford MSJ § 26). Talbot therefore noted that the source of blood was unclear. Id. Talbot ordered triple antibiotic ointment for rectal application. Id.
On December 8, 2009, Talbot admitted Plaintiff to the infirmary following a complaint of rectal bleeding. (Wexford MSJ § 27). Talbot's notes documented Plaintiff's "long hx [medical history] of manipulating his hemorrhoids to trigger bleeding as a means of getting the cell/cellmate he wants." (Wexford MSJ exh. 14). Talbot noted that he would keep Plaintiff in the infirmary to verify bleeding. Id. Last, Talbot ordered Plaintiff to continue all current medications and to receive further blood tests. Id.
On December 10, 2009, Plaintiff was brought from segregation to the Health Care Clinic due to active hemorrhoidal bleeding. (Wexford MSJ § 29). Plaintiff testified as follows:
Warden Anglin and Calloway wanted to talk to me and they talked to me. That's why I want it on record. They talked to me and said, you know what? We'll break these two grievances. We'll get you out of here. Don't put these two grievances on us. We'll get you out of here. Where do you want to go? I want to go to Dixon closer to my house. They've got better medical, see if they can do surgery on my hemorrhoids and take care of the problem. He said okay. Don't put in no more grievance. Go in and see the doctor. Jennings, take him to see the doctor.
(Dep. 119: 20-120:8). Talbot assessed Plaintiff with a Grade 3 protruding hemorrhoid, possibly due to self-mutilation and manipulative behavior, as well as an iron deficiency. Id. Talbot noted that Plaintiff was counseled on his manipulative behavior. Id. Talbot further noted that Plaintiff had been approved for hemorrhoidal banding, but that the Dr. Scavone had instead performed a colonoscopy and indicated he was unable to complete the procedure. Id. Talbot's plan was to consult further with Dr. Scavone regarding banding. Id.
On December 11, 2009, Talbot held a Collegial Review with Dr. Agrawal and they agreed that banding would be approved with colorectal surgery. (Wexford MSJ § 30).
On December 16, 2009, Plaintiff stated that he wanted to go to the Infirmary, but did not report any active bleeding. (Wexford MSJ § 31). Talbot did not admit Plaintiff to the Infirmary and noted that no change to the plan was required. Id.
On December 17, 2009, Talbot ordered colorectal banding for Plaintiff. (Wexford MSJ § 32). Talbot further found that Plaintiff had been poorly compliant as to his iron replacement therapy, which accounted for Plaintiff's low hemoglobin and hematocrit levels, as well as continued suspected mutilation of his hemorrhoids. (Wexford MSJ exh. 21).
On December 21, 2009, a medical furlough was scheduled for Plaintiff (Wexford MSJ § 33). On December 24, 2009, Plaintiff complained that he was still bleeding and that he felt cold. (Wexford MSJ § 34). Talbot determined Plaintiff was likely dehydrated, so he ordered a stat CBC and to notify him of the results immediately, as well as for Plaintiff to receive an extra blanket, IV fluids at 200 cc per hour for five hours, and a regular food tray. Id. Upon evaluation of the CBC, which revealed a hemoglobin level of 5.5, dropping to 4.9, Talbot ordered Plaintiff to be immediately transferred to the Provena Hospital emergency room, where he received a blood transfusion of five units of blood, which increased his hemoglobin level to 11.0. (Wexford MSJ § 35; exh. 27). The hospital nurse reported that Plaintiff told her that he had had a bowel movement that evening that was "full of clots". Id. Talbot also ordered Plaintiff to be admitted to the Infirmary on return from Provena. Id.
On December 25, 2009, Plaintiff was admitted to the Infirmary. (Wexford MSJ § 36). Talbot noted that Plaintiff could not keep his hematocrit levels high due to noncompliance with his prescribed therapy. Id. Talbot further noted that Plaintiff refused to comply with a request to take his vitals. Id. Plaintiff also refused a hemoglobin test. (Wexford MSJ exh. 26). In the Infirmary, the LPN there noted that Plaintiff refused to take any medication or have his vitals taken until he "gets some ice water" and refused to sign a refusal form. (Wexford MSJ § 37). Plaintiff further refused to do anything until he was taken to see the doctor and warden. Id. When Warden Williamon [ sic ] arrived at the Infirmary 1 hour and 10 minutes later, Plaintiff took his medications. (Wexford MSJ exh. 25). Plaintiff again refused a hemoglobin blood test. (Wexford MSJ exh. 28).
On December 27, 2009, Plaintiff reported that he had blood in his stool a second time since the day before, but refused a hemaglobin blood draw. (Wexford MSJ exh. 29). Also on December 27, 2009, a nurse found medications in Plaintiff's cell that had not been taken. (Wexford MSJ exh. 30). The medical note indicated that Plaintiff had complained of further rectal bleeding, but no indications of acute distress were noted. Id. Plaintiff was ordered to retain his bowel movements and evidence of rectal bleeding to show the nurse for further observation. Id.
On December 28, 2009, Plaintiff refused his vital signs, mediations, and a hemaglobin blood draw, but refused to sign the refusal form. (Wexford MSJ § 41; Wexford MSJ exh. 32). Plaintiff also demanded a discharge from the Danville medical facility against the advice of Talbot. Id. Talbot later saw Plaintiff, and his notes also indicate that Plaintiff refused any labs, vital signs, and medication. (Wexford MSJ exh. 33). Talbot counseled Plaintiff and informed him of the need to take his FeSO4 (iron supplement) therapy. Id. Plaintiff stated that no one listened to him and demanded that he be released from segregation and transferred out of Danville. Id. Talbot's notes read further, transcribing Plaintiff's complaint: "I will not start over with another MD and if you won't get me out of seg or transfer me I refuse all medical/health care." Id. Following this conversation and the futility of proceeding with medical treatment, Talbot released Plaintiff from the infirmary. (Wexford MSJ exh. 34).
On December 29, 2009, a segregation officer called the healthcare unit and indicated that Plaintiff was exhibiting rectal bleeding. (Wexford MSJ exh. 35). Plaintiff refused to be brought to the healthcare unit, refused any medical care, and refused to sign the refusal form after three attempts. Id.; (Wexford MSJ exh. 36). The officer noted that Plaintiff did not exhibit any weakness or dizziness, but did note bright red blood of a "moderate amount" on the toilet paper next to the toilet. Id. Plaintiff stated to the officer, "I want out of Danville. Send me somewhere else." Id. On the same day, Talbot ordered Plaintiff to psychological evaluation and testing for irrational behavior that was impacting his health care and management. (Wexford MSJ exh. 37).
On December 30, 2009, Plaintiff refused his medical furlough to Carle Clinic for banding of his hemorrhoids. (Wexford MSJ § 45). On January 4, 2010, Plaintiff was transferred to Pontiac Correctional Center. (Wexford MSJ § 46). On April 12, 2011, this court received notice that Plaintiff had been transferred to Illinois River Correctional Center. (#11). On April 16, 2013, this court received notice that Plaintiff had been transferred to the Hill Correctional Center. (#84).
On January 14, 2011, Plaintiff filed his original complaint from Pontiac Correctional Center, against Warden Anglin, "John Doe", "Jennings", "Linville", and "M. Miller". (#1). On January 26, 2011, Plaintif filed a pro se motion for extension of time, (#2), which this court denied as moot in a text order on January 31, 2011 as it had already directed the clerk of the court to request trust fund ledgers from the prison.
On March 22, 2011, Plaintiff filed an Amended Complaint against Lt. Linville, Sgt. Jennings, Warden Anglin, Ass't. Warden Holloway, M. Miller, and "Dr. John Doe". (#9) ("Danville Defendants").
On March 29, 2011, this court held a § 1915A merit review. The court dismissed "Dr. John Doe", who was identified as Dr. Ameji, because Plaintiff refused health care from Dr. Ameji and wanted to see a different doctor. The remainder of the complaint was permitted to proceed. On April 12, 2011, Plaintiff filed a notice that he had been transferred to the Illinois River Correctional Center. (#11). On June 8, 2011, the Danville Defendants filed their Answer and Affirmative Defenses. (#24). On June ...