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Pyles v. Fahim

United States District Court, Southern District of Illinois

March 14, 2014




I. Introduction

Before the Court is a motion for summary judgment (Docs. 116 and 117) filed by Defendants Magid Fahim and Wexford Health Sources, Inc. Defendants argue that they are entitled to summary judgment on Plaintiff’s deliberate indifference claims. Plaintiff has filed a Response (Docs. 127 and 129) to Defendants’ motion. Defendants have filed a Reply (Docs. 130 and 131). Plaintiff objects to the reply brief (Doc. 132). Based on the following, the Court GRANTS Defendants’ motion for summary judgment.

II. Background

On June 28, 2012, Plaintiff filed his first Amended Complaint (Doc. 13) for deliberate indifference claims against Defendants Magid Fahim and Wexford Health Sources, Inc. Plaintiff alleges that Defendants were deliberately indifferent to his serious medical needs for improper treatment of his back pain. Specifically, that Defendant Fahim failed to send Plaintiff to a specialist or order an MRI to pinpoint the source of his pain and that this failure was because of Wexford’s policy to cut costs in providing medical treatment. The following facts related to Plaintiff’s claims took place while Plaintiff was housed at Menard Correctional Center.

On July 25, 2009, at Menard Correctional Center, Plaintiff fell down stairs injuring his back. Plaintiff was transferred from the Menard Healthcare Unit to Chester Memorial Hospital and ultimately flown to Saint Louis University Hospital (“SLU”) (Doc. 117 Ex. B at pp. 14-19; Ex. A at pp. 28-29). Plaintiff remained at SLU until July 30, 2009. While there, he received four CT scans on July 25, 2009, six MRI views on July 26, 2009, an angiogram, and an additional three CT scans and three MRIs on July 29, 2009 (Doc. 117 Ex B at pp 52-60, 67, 93, 105-107, 114-16, 147-149). Plaintiff was then returned to Menard’s health care unit where he remained for five days. During the rest of 2009, he saw multiple health care staff and four different physicians. As Defendants note, Plaintiff was seen by Dr. Fuentes on August 7, 2009 and September 29, 2009; Dr. Krief on August 11, 2009, Medical Director Feinerman on August 12, 2009 and September 17, 2009, and Dr. Nwaobasi on September 9, 2009 and December 18, 2009 (Doc. 117 Ex. C at pp. 112-120, 122, 129). Plaintiff received an x-ray on September 17, 2009 which indicated degenerative changes with minimal hypertrophic spurring in his cervical spine and no facture or significant arthritic change in his lumbar spine (Doc. 117 Ex. C at pp. 120, 571).

On September 29, 2009, Defendant Fahim was placed at Menard Correctional Center to fulfill the role of Site Medical Director. The Site Medical Director position leads and oversees the medical practice at their facility to ensure high-quality medical care. One of the responsibilities of the Site Medical Director is also to identify and implement cost reduction strategies (Doc. 129 Ex. N at p.11). Fahim first saw Plaintiff on January 12, 2010 (Doc. 129 Ex. A-2). Fahim noted a normal neurological exam, motor function, and back and lower extremities. He noted no pain in a straight leg raise test and no muscle wasting. Fahim prescribed Flexeril and Ultram and educated Plaintiff on proper exercise. He set a follow-up for three months (Id.).

On January 28, 2010, Plaintiff was seen by Nurse Practitioner Pollion (Doc. 129 Ex. A-3 at p. 15). Plaintiff saw the nurse practitioner because he claimed that he wanted an MRI. Pollion noted that he had been seen by an MD on January 21, 2010 with no such recommendation, with a follow up of three months (Id.). Pollion noted in the “plan” section that the plan was to follow up per the MD’s previous order (Id.). Pollion saw Plaintiff again on February 3, 2010 with the subjective portion of Pollion’s notes indicating that Plaintiff wanted to be scheduled for a test. Pollion noted that per the previous entry, Plaintiff would be seen by Fahim (Id.).

Plaintiff was next seen by Dr. Fuentes on April 28, 2010 (Doc. 117 Ex. C at p. 151). Dr. Fuentes noted that Plaintiff had a good steady gait, but indicated that Plaintiff had a degenerative disease of his c-spine. Neurontin and Tramadol was prescribed (Id.). Dr. Fuentes noted that Plaintiff wanted to have an MRI and thus referred him to Dr. Fahim for the possible MRI (Id.). Fahim saw Plaintiff on May 18, 2010. He noted no muscle wasting or loss of sensation as well as noted a full range of movement. He observed no pain and that muscle power was normal. He questioned why Plaintiff had back pain and ordered x-rays of his cervical, thoracic, and lumbar region (Doc. 117 Ex. C at p.155). X-rays were taken on May 25, 2010 (Id. at p. 156). The x-rays noted no acute bone abnormalities with minimal degenerative changes in the lumbar spine, but mild degenerative changes in the cervical and thoracic spine (Id. at p. 572).

On August 20, 2010, Plaintiff was seen by a nurse practitioner for complaints of back pain. The nurse practitioner noted that Plaintiff wanted an MRI. He stated he had constant sharp back pain and back exercises made it worse (Doc. 117 Ex. C at p.167). The nurse practitioner noted that Plaintiff was ambulating independently and had no spine deformity and recommended warm compresses and back exercises (Id. at pp. 167-168). Plaintiff was referred to Fahim for evaluation and the nurse practitioner noted the assessment of Plaintiff as chronic back pain.

On August 26, 2010, Plaintiff overdosed on Ultram, informing health staff that he took twenty to thirty tablets, five at a time throughout the day, causing a seizure (Doc. 117 Ex. C at pp.169-70). Plaintiff noted that he was depressed and he was referred to mental health (Id. at pp. 171-172). The medical records note that Plaintiff was scheduled to be seen by an RN and psych staff in September but on both instances he refused the passes and would not come out of his cell (Id. at p. 177).

Plaintiff next saw a medtech on October 19, 2010 where he complained of back pain from his previous injury on the stairs. The medtech noted no swelling or limited movement (Doc. 117 Ex. C at p.178). Plaintiff was again seen by Defendant Fahim on October 26, 2010 for his back pain (Id. at p. 180). Fahim noted that Plaintiff had mild lower back tenderness but noted that he would not prescribe Ultram for Plaintiff’s safety as he had previously abused it. He noted a negative straight leg raising test and prescribed Prednisone, Neurontin, Flexeril, and Mobic. He also educated Plaintiff on proper exercise and stretching (Id.).

On March 16, 2011, Plaintiff saw Dr. Platt for pain to his lower spine (Doc. 117 Ex. C at p. 191). Dr. Platt prescribed him Motrin. Dr. Nwaobasi saw Plaintiff on April 23, 2011, who noted mild degenerative osteoarthritis. Nwaobasi prescribed Plaintiff Motrin, Flexeril, and Neurontin. Nwaobasi saw Plaintiff again on May 14, 2011 and against noted degenerative osteoarthritis (Id. at p. 198). Plaintiff was referred to Defendant Fahim in order to discuss what Nwaobasi noted as Plaintiff’s “demand for MRI of the spine.” (Id.). Fahim reviewed Plaintiff’s file on May 18, 2011 and noted that he did not need to be seen at that time. Fahim noted that he had seen Plaintiff on multiple occasions and other MDs had reviewed Plaintiff and none had recommended an MRI (Doc. 117 Ex. C at p.199).

Dr. Fuentes saw Plaintiff on July 27, 2011 on Plaintiff’s complaint of lower back pain (Doc. 117 Ex. C at p. 204). Fuentes prescribed Naproxen for his pain (Id.). On August 11, 2011, Fuentes changed the prescription to “DOT” which means “direct observation treatment.” (Id.). Defendants describe this as meaning Plaintiff had to be directly observed taking his medication instead of being allowed to self-medicate from a pack of pills. Defendants note that Dr. Fahim left Menard and Wexford on August 19, 2011. Although they state that neither medical director who came after Fahim, including Dr. Shepherd and Dr. ...

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