1The body of Knowles’ complaint does not list any individual

defendants, but refers to the New Hampshire State Prison (“NHSP”)

medical department and the New Hampshire Department of

Corrections (“DOC”) Commissioner or Agent Superior. Knowles has

submitted summons forms for William Wrenn and Stephen Curry, the

current and former DOC Commissioners, DOC Medical Director Robert

McLeod, Nurse Practitioner Neculai, and Nurse Practitioner Judy

Baker. 

UNITED STATES DISTRICT COURT FOR THE

DISTRICT OF NEW HAMPSHIRE

William J. Knowles

v. Civil No. 05-cv-363-PB

William Wrenn, Commissioner,

New Hampshire Department of

Corrections, et al.1

REPORT AND RECOMMENDATION

William Knowles has filed a complaint pro se pursuant to 42

U.S.C. § 1983 alleging that the defendants, employees of the New

Hampshire Department of Corrections (“DOC”), have violated his

Eighth Amendment right to adequate medical care during his

incarceration. The matter is before me for preliminary review to

determine, among other things, whether Knowles has stated any

claim upon which relief might be granted. As discussed herein, I

find that Knowles has stated a claim upon which relief might be

granted against defendants Curry, Wrenn, and McLeod, and I

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 1 of 13
2

recommend the dismissal of any claim against defendants Neculai

and Baker from this action. 

Standard of Review

Under this court’s local rules, when an incarcerated

plaintiff commences an action pro se and in forma pauperis, the

magistrate judge is directed to conduct a preliminary review and

to prepare a report and recommendation advising the district

judge whether the action, or any portion thereof, should be

dismissed because:

(i) the allegation of poverty is untrue, the action 

is frivolous, malicious, or fails to state a claim 

upon which relief may be granted, or seeks monetary 

relief from a defendant who is immune from such 

relief under 28 U.S.C. § 1915A(b); or 

(ii) it fails to establish subject matter 

jurisdiction under Fed. R. Civ. P. 12(b)(1).

United States District Court for the District of New Hampshire

Local Rule 4.3(d)(2). In conducting the preliminary review, the

Court construes pro se pleadings liberally. See Ayala Serrano v.

Lebron Gonzales, 909 F.2d 8, 15 (1st Cir. 1990) (following

Estelle v. Gamble, 429 U.S. 97, 106 (1976) to construe pro se

pleadings liberally in favor of the pro se party). “The policy

behind affording pro se plaintiffs liberal interpretation is that

if they present sufficient facts, the court may intuit the

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 2 of 13
2Glaucoma is “a group of eye diseases characterized by an

increase in intraocular pressure which causes pathological

changes in the optic disk and typical defects in the field of

vision.” Dorland’s Illustrated Medical Dictionary (28th ed.

1994) at 697.

3

correct cause of action, even if it was imperfectly pled.” Ahmed

v. Rosenblatt, 118 F.3d 886, 890 (1st Cir. 1997), cert. denied,

Ahmed v. Greenwood, 522 U.S. 1148 (1998).

At this preliminary stage of review, all factual assertions

made by the petitioner and inferences reasonably drawn therefrom

must be accepted as true. See Aulson v. Blanchard, 83 F.3d 1, 3

(1st Cir. 1996) (stating the “failure to state a claim” standard

of review and explaining that all “well-pleaded factual

averments,” not bald assertions, must be accepted as true). This

review ensures that pro se pleadings are given fair and

meaningful consideration. See Eveland v. Dir. of C.I.A., 843

F.2d 46, 49 (1st Cir. 1988).

Background

William Knowles was incarcerated at the New Hampshire State

Prison (“NHSP”) from March of 1987 until October of 2003, when he

was released on parole. During the 1990s, Knowles was diagnosed

with glaucoma.2 While he was incarcerated prior to being

paroled, Knowles was regularly sent for tests and medical

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 3 of 13
3Although not named in the body of the complaint, I presume

that Knowles refers to Nurse Practitioners Neculai and Baker, for

4

checkups for the condition. Knowles asserts that he continued to

get regular checkups for his glaucoma on his own once he was

released on parole.

In March of 2004, Knowles was returned to the NHSP on a

parole violation. Between March of 2004 and August of 2005,

Knowles was checked on a number of occasions by Optivan, an eye

care service that contracted with the DOC to provide vision care

to DOC inmates. During these examinations, Knowles was given eye

examinations and evaluated for glasses and for changes in his

glaucoma or for other special vision needs. 

On at least three occasions when Knowles was examined by

Optivan personnel they sent instructions to the NHSP medical

department that Knowles needed to be sent to an outside

specialist for a “Field Test,” which is a specialized test given

regularly to glaucoma patients to determine the nature and extent

of damage to a glaucoma patient’s eyes. The “Field Test” aids in

detecting minute changes in the condition of the eyes so that

corrective measures can be taken before the problems progress to

severe eye damage. Knowles was advised by two nurse

practitioners3 that he was on a list to be taken to see a

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 4 of 13
whom he has submitted summons forms.

5

specialist for a “Field Test,” but he was never taken for the

test. 

On August 31, 2005, Knowles had a blood pressure test. He

advised the nurse administering the test that he had had slight

blurriness in his left eye for several days. The nurse advised

Knowles to report to sick call if the problem persisted. On

September 2, 2005, Knowles reported to sick call at 7:50 a.m. to

report that the problem with his left eye was quickly worsening. 

Late that afternoon, Knowles was taken outside of the prison to

see a specialist, Dr. Ford. Dr. Ford advised Knowles the damage

to his left eye was permanent. Dr. Ford prescribed additional

medication and other follow-up measures for Knowles, and directed

that Knowles be seen again after two weeks. As of October 11,

2005, Knowles had not been returned to Dr. Ford’s office for

follow-up. In that time, Knowles reports the condition of his

left eye worsened to the point where it is almost entirely nonfunctional and he must cover his left eye in order to see clearly

with his right eye. Further, Knowles reports that he has still

not received a “Field Test” on either eye.

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 5 of 13
6

Knowles alleges that the lack of attention to his known and

serious eye condition caused it to worsen to the point where his

vision has been severely and permanently damaged. Knowles claims

that although he has received some medical care, the care he has

received has been inadequate to meet his serious known medical

needs as he was denied prompt access to an eye specialist and to

a “Field Test” which was a necessary tool in properly diagnosing

and treating Knowles’ glaucoma.

Discussion

I. Medical Care Claim

The Eighth Amendment protects prison inmates from prison

officials acting with deliberate indifference to their serious

medical needs. See Farmer v. Brennan, 511 U.S. 825, 831 (1994). 

To assert a viable cause of action for inadequate medical care,

an inmate must first state facts sufficient to allege that the

plaintiff has a serious medical need for which adequate care has

not been provided. Farmer, 511 U.S. at 831; Rhodes v. Chapman,

452 U.S. 337 (1981); Estelle, 429 U.S. at 106. The inmate must

then allege that a responsible prison official was aware of the

need or of the facts from which the need could be inferred, and

still failed to provide treatment. Estelle, 429 U.S. at 106. A

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7

serious medical need is one that involves a substantial risk of

serious harm if it is not adequately treated. Barrett v. Coplan,

292 F. Supp. 2d 281, 285 (D.N.H. 2003); Kosilek v. Maloney, 221

F. Supp. 2d 156, 180 (D. Mass. 2002) (citing Farmer, 511 U.S. at

835-47); see also Gaudreault v. Municipality of Salem, Mass., 923

F.2d 203, 208 (1st Cir. 1990), cert. denied, 500 U.S. 956 (1991)

(defining a serious medical need as one “that has been diagnosed

by a physician as mandating treatment, or one that is so obvious

that even a lay person would easily recognize the necessity for a

doctor’s attention.”). 

Courts have recognized glaucoma as a serious medical

condition, as it can result in the deterioration of vision or

blindness. See, e.g., Todaro v. Ward, 565 F.2d 48 (2d Cir. 1977)

(finding that medical conditions such as glaucoma and eye

infections constitute serious ailments); Cox v. District of

Columbia, 834 F. Supp. 439, 441 (D.D.C. 1992); Flores v. N.Y.

City Health & Hosps. Corp., 2003 WL 21709512, at *3 (S.D.N.Y.

July 21, 2003) (“Courts consider evidence of a diagnosable eye

condition to be significant in determining whether a plaintiff

has alleged a serious medical condition.”). Accordingly, I find

that Knowles has alleged that he has a serious medical condition.

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8

“Adequate medical care” is treatment by qualified medical

personnel who provide services that are of a quality acceptable

when measured by prudent professional standards in the community,

tailored to an inmate’s particular medical needs, and that are

based on medical considerations. United States v. DeCologero,

821 F.2d 39, 42-43 (1st Cir. 1987). This does not mean that an

inmate is entitled to the care of his or her choice, simply that

the care must meet minimal standards of adequacy. Deliberate

indifference may be found where the medical care provided is “so

clearly inadequate as to amount to a refusal to provide essential

care.” Torraco v. Maloney, 923 F.2d 231, 234 (1st Cir. 1991). 

Constraints inherent in a prison setting may affect the choice of

care provided, and may be relevant to whether or not prison

officials provided inadequate care with a deliberately

indifferent mental state. Wilson v. Seiter, 501 U.S. 294, 302

(1991). Delay in the provision of medical care may evidence

deliberate indifference. Estelle, 429 U.S. at 104-05.

Knowles has alleged that he has a serious medical condition,

glaucoma, and that the DOC officials were aware of his condition

and his need for treatment. He has alleged that, in fact, he

received some treatment, but that his medical care was in many

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 8 of 13
9

ways inadequate to meet his needs. Knowles specifically alleges

that he was denied timely access to a specialist and a “Field

Test” and thus did not receive adequate treatment and assessment

for his glaucoma, and that as a result, his vision was severely

impaired. Knowles further alleges that this type of specialized

test is part of a regularly administered medical care plan for

glaucoma patients. 

Finally, Knowles alleges that DOC officials were notified of

his medical condition and needs not only by Optivan professionals

who conducted eye exams on Knowles, but by Knowles himself, who

states that he attempted to obtain the help he needed through the

administrative grievance procedure in place at the prison. 

Accordingly, Knowles alleges that the indifference to his medical

condition and treatment needs therefore was knowing and

deliberate. 

Because Knowles has alleged a serious condition, a known

need for treatment, treatment that was inadequate to meet those

needs, and deliberate indifference to his medical condition and

needs on the part of the defendants, he has sufficiently alleged

that he was denied medical care to which he is constitutionally

entitled. Accordingly, I will direct service of Knowles’ Eighth

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4In a letter submitted to the Court with his summons forms,

Knowles states that he included the nurse practitioners as

defendants because he believes they will be of help in

determining who is responsible for his injuries. 

10

Amendment claim against the appropriate defendants in an Order

issued simultaneously with this Report and Recommendation.

II. Choice of Defendant

A. The Nurse Practitioners

Knowles has named DOC Nurse Practitioners Neculai and Baker

as defendants to this action. Knowles has only alleged, however,

that the nurse practitioners advised Knowles that he was on a

list to go for a Field Test. Knowles has not alleged that the

nurse practitioners were in any way responsible for assuring that

he receive such a test.4 Accordingly, I recommend that the nurse

practitioners be dismissed from this action.

B. The Supervisory Defendants

“Supervisory liability under § 1983 cannot be predicated on

a respondeat theory, but only on the basis of the supervisor’s

own acts or omissions.” Aponte Matos v. Toledo Davila, 135 F.3d

182, 192 (1st Cir. 1998) (internal citations omitted). A

supervisor must be either “a primary actor involved in, or a

prime mover behind, the underlying violation.” Camilo-Robles v.

Zapata, 175 F.3d 41, 43-44 (1st Cir. 1999). There must be “an

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 10 of 13
11

affirmative link, whether through direct participation or through

conduct that amounts to condonation or tacit authorization.” Id.

at 44.

1. The DOC Medical Director

Knowles names Robert McLeod, the DOC Medical Director to

this action as the individual responsible for his medical care. 

Although Knowles has not at this time listed specific acts or

omissions taken by McLeod regarding Knowles’ care, I find that

Knowles has sufficiently alleged that McLeod, in his position as

Medical Director at the DOC, would have been aware of Knowles’

medical condition and the lack of care he was receiving, if not

as a result of his personal involvement in Knowles’ case, than as

a result of Knowles’ request slips and administrative grievances

filed regarding his medical care. Accordingly, I find that

Knowles has adequately stated a claim against McLeod to allow

this matter to proceed against him at this time. I will direct

this action to be served on McLeod in the Order issued

simultaneously with this Report and Recommendation.

2. The Commissioner of Corrections

Knowles has named both former DOC Commissioner Stephen Curry

and present DOC Commissioner William Wrenn as defendants to this

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 11 of 13
5If there are other defendants to be named to this action,

Knowles must obtain the names of the other defendants in

discovery in order to pursue his claims against them. After

obtaining the names, Knowles will have to properly move to amend

his complaint. To this end, upon service of this claim on the

defendants listed, Knowles can serve those defendants with

interrogatories to obtain the full names of any appropriate

defendants that are not presently named in the complaint,

pursuant to Fed. R. Civ. P. 33(a) which states in pertinent part:

Without leave of court or written stipulation, 

any party may serve upon any other party 

written interrogatories, not exceeding 25 in 

number including all discrete subparts, to be 

answered by the party served or, if the party 

served is a public or private corporation or a 

partnership or association or governmental 

agency, by an officer or agent, who shall 

furnish such information as is available to 

the party. 

Further, if Knowles is not in possession of the names of

12

action. Knowles claims that these officials were aware of his

condition and the lack of medical care he received because he

grieved these issues through the administrative grievance

process. These officials, despite holding the ultimate

responsibility for his care while in the custody of the DOC, did

nothing to correct the problem or see to his medical care. 

Because he has adequately alleged his Eighth Amendment claim

against Curry and Wrenn, I will direct that this action proceed

against them in an Order issued simultaneously with this Report

and Recommendation.5

Case 1:05-cv-00363-JL Document 10 Filed 04/12/06 Page 12 of 13
particular medical care providers within the DOC, he is entitled

to receive a copy of his medical records, which should contain

the names of the DOC medical personnel responsible for his care

and treatment.

13

Conclusion

For the reasons discussed herein, I recommend that the

claims against defendants Neculai and Baker be dismissed. In an

Order issued simultaneously with this Report and Recommendation,

I will direct that Knowles’ Eighth Amendment medical care claim

be served on defendants Curry, Wrenn and McLeod. Any objections

to this Report and Recommendation must be filed within ten (10)

days of receipt of this notice. Failure to file objections

within the specified time waives the right to appeal the district

court’s order. See Unauthorized Practice of Law Comm. v. Gordon,

979 F.2d 11, 13-14 (1st Cir. 1992); United States v. ValenciaCopete, 792 F.2d 4, 6 (1st Cir. 1986). 

_________________________________

James R. Muirhead

United States Magistrate Judge

Date: April 12, 2006

cc: William J. Knowles, pro se

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