Opinion ID: 712598
Heading Depth: 2
Heading Rank: 1

Heading: Summary Judgment in Favor of Dr. Jumao-as.

Text: 9 In his complaint, Del Raine alleges a series of failures to diagnose and treat flare-ups of his colitis by Dr. Jumao-as from January 7 to December 31, 1992. Throughout this period and afterward, Del Raine frequently saw Dr. Jumao-as or his assistants for a variety of ailments, including pneumonia and rhinitis, for which he received medications. He was also admitted to the U.S. Medical Center for Federal Prisoners in Springfield, Missouri, to have an operation for an inguinal hernia on October 30, 1992, and he was discharged from that hospital on December 10, 1992. Although the defendants emphasize the overall amount of medical attention that Del Raine received, which appears to be substantial, we will focus on whether Dr. Jumao-as demonstrated deliberate indifference to his patient's colitis. 10 The factual summaries in this order derive from Del Raine's medical records and the affidavits of Dr. Jumao-as and Del Raine, which are construed in Del Raine's favor. Prior to January 7, 1992, Del Raine had suffered from colitis intermittently for many years, and he had received medication for the condition. By July 9, 1991, Dr. Jumao-as was participating in Del Raine's medical care. Del Raine complained to Dr. Jumao-as of rectal bleeding on December 20, 1991. The results of a rectal examination and blood tests were normal. 11 Del Raine states that from January through June 1992, he suffered various symptoms of colitis. He saw the prison physician on February 7, 1992, and a rectal probe revealed no bleeding. Medical records from that date indicate that Dr. Jumao requested stool for occult blood x3. (R. 22 (Chronology of Medical Care).) Thereafter, a physician's assistant made entries in Del Raine's chart on February 10, 11, and 12, 1992, stating [s]tool specimen obtained for guiac [sic], 3 and indicating a positive result. (Id.) On February 18, 1992, Del Raine saw Dr. Jumao-as about his pneumonia. The doctor declined to give him steroids because they would interfere with the medication for his pneumonia. According to Del Raine, the steroids were for treating his colitis. On March 10, 1992, during another examination, Del Raine again complained of bleeding, but the blood test and rectal examination were negative. Dr. Jumao-as refused his patient's offer to provide him with a bloody stool sample. On May 21, 1992, after Del Raine informed his doctor that he was bleeding, the physician performed another rectal exam, which showed nothing, and performed another blood test. The blood count was normal. The prisoner met with Dr. Jumao again on June 25, 1992, for an evaluation of some test results. When he informed the doctor of his symptoms, Dr. Jumao-as said that Del Raine did not have ulcerative colitis and that  '[h]e doesn't know what he's talking about....'  (R. 19 at 6.) The doctor found that Del Raine's blood count was normal, except that his hemoglobin was slightly below the normal range, but not alarmingly so. A radiologist was present to perform a barium enema, but since Del Raine had not been told not to eat in advance, he could not take this diagnostic test. Del Raine submitted six written complaints to Dr. Jumao-as concerning his colitis on January 29, February 4, February 5, March 4, March 8 and April 4 of 1992. 12 According to the complaint, Del Raine's colitis went into remission in July 1992. Once in July, he refused to sign a consent proffered by a physician's assistant for a barium enema because the assistant incorrectly described it as a treatment, rather than a diagnostic test. On August 14, 1992, Dr. Jumao-as met with Del Raine, who, according to the prisoner's affidavit, refused a barium enema because it was not treatment. Del Raine's complaint indicates that he refused it because his colitis was in remission. Del Raine does not point to any further attacks of colitis until December 12, 1992, although the medical records from the U.S. Medical Center at Springfield indicate that he listed colitis as one of his medical problems. An entry in his U.S. Medical Center chart on November 11 indicates that he was referred to the medical clinic in reference to his colitis. A transfer summary prepared by a physician's assistant on December 3, 1992 states: Patient was also referred to our Medical Clinic regarding his history of ulcerative colitis. Patient has had no symptoms for some time now; however, it was recommended by Dr. Nelson to consider Azulfidine therapy if symptoms return. (R. 22 (U.S. Medical Center at Springfield Transfer Summary).) 13 On December 12, while still at the U.S. Medical Center, Del Raine's colitis recurred. Two days later, he showed a guard and a nurse blood in his toilet. Over the following week, while he was transferred to federal penitentiaries in El Reno, Oklahoma and Terre Haute, Indiana, he suffered further attacks. He returned to Marion on December 21, 1992 after leaving a Hemoccult test 4 at Terre Haute. He informed Dr. Jumao-as in writing that he suffered from bleeding again and that he had left behind a blood sample. On December 31, Dr. Jumao-as performed another rectal examination, which was negative. The results of a blood test from December 29, 1992 had not significantly changed from one measured on February 7, 1992; it did not show excessive blood that would indicate sulfa or steroid medication. The progress notes indicate that the chronic ulcerative colitis was not active. 14 The record also contains evidence of events subsequent to those alleged in Del Raine's complaint. Dr. Jumao-as met with his patient on February 18, 1993, but Del Raine refused a rectal examination. Del Raine informed the doctor that Del Raine's blood test at Terre Haute had been positive, to which Dr. Jumao-as responded Hemoccult is only for detecting small amounts of blood! (R. 19 (Aff. of Feb. 27, 1993).) On May 18, 1993, the results of a follow-up blood test were normal. Dr. Jumao-as conducted another follow-up examination for colitis on May 24, 1993, during which Del Raine had no complaints. Del Raine says that he was bleeding again on June 13, 14, and 23. A blood test on June 15, 1993 was normal. On June 25, 1993 he showed a physician's assistant blood in his toilet. He also submitted a written complaint to Dr. Jumao-as on that day. On June 30, 1993, blood tests revealed mild anemia, and on July 12, 1993, in response to the prisoner's complaint's of non-bloody diarrhea and further evidence of mild anemia, the doctor prescribed Cortenema. According to Del Raine, after finishing two packages of Cortenema, his ulcerative colitis cleared up. 15 Del Raine claims that Dr. Jumao-as violated his Eighth Amendment rights by failing to provide him with treatment instead of mere diagnostic tests. However, a physician does not violate the Eighth Amendment by denying treatment after a reaching a negative diagnosis, unless he acted with deliberate indifference in examining the patient. See Farmer, 114 S.Ct. at 1982 n. 8; Estelle, 429 U.S. at 106. Furthermore, a medical decision concerning whether or not to order an additional diagnostic test or form of treatment, which is a classic example of a matter for medical judgment, does not by itself constitute cruel and unusual punishment, even if it is negligent. Estelle, 429 U.S. at 107. Even if Dr. Jumao-as repeatedly negligently misdiagnosed Del Raine as not suffering from active colitis, such malpractice would not constitute a constitutional violation. Although a string of negligent acts, regardless of how lengthy, cannot by itself amount to a violation of the Eighth Amendment, it may provide evidence of the magnitude of the risk created by the defendants' conduct and the knowledge of the risk by the defendant. Sellers v. Henman, 41 F.3d 1100, 1103 (7th Cir.1994). The more negligent acts they commit in a circumscribed interval, the likelier it is that they know they are creating some risk.... Id. However, the overall series of negative test results in this case, even if negligently chosen or administered, does not create a pattern that would indicate knowledge of a need for treatment. 16 We find the propriety of granting summary judgment a close call in this case because not all of the tests performed yielded negative results. Laboratory tests for fecal blood on February 10-12, 1992, yielded positive results, and a week later, Dr. Jumao-as allegedly refused to prescribe steroids because it would interfere with his antibiotic treatment for pneumonia. Del Raine interpreted this statement to imply that the doctor would have provided treatment for his colitis if he had not had pneumonia. Even construed in the light most favorable to Del Raine, the events of February and March indicate positive test results, a valid reason not to prescribe treatment, and then negative test results followed by no treatment. This pattern does not evince deliberate indifference. Although we find the doctor's refusals to accept offers of bloody stool samples quite troubling, see Farmer, 114 S.Ct. at 1982 n. 8 (noting that prison official may not escape liability of obvious risk by refusing to verify strong suspicion of its existence), Dr. Jumao-as used other means, such as blood tests and digital examinations, to verify the existence of flare-ups and found nothing. He also personally attempted to use a barium enema test on at least two occasions, but was unable to do so for various reasons. Later, in 1993, when positive evidence was produced, Del Raine eventually received treatment, which was successful. There is no evidence that the doctor purposely blinded himself to the attacks of colitis. 17