Opinion ID: 2745400
Heading Depth: 2
Heading Rank: 2

Heading: Easley’s Medical Care from 2009-2011

Text: Easley was a DCI inmate from September 2009 until December 2011. He is now at another prison. The events below relate only to his time at DCI. Upon arrival at DCI, Easley was medically evaluated and was diagnosed as suffering from diabetes, hypertension, and chronic back pain. Subsequently, he was diagnosed with anxiety, depression, and obesity. The DCI Healthcare Providers took a variety of steps to address Easley’s medical needs. These included: (1) providing Easley with a cane, a low bunk pass, and a pass to avoid prolonged standing; (2) placing Easley on a special 2800calorie diet to address his diabetes and weight issues; (3) referring Easley to an outside orthotics specialist and then providing Easley with special orthopedic shoes; 2 (4) securing an evaluation with an outside orthopedic surgeon, who recommended a surgical remedy for his back pain, spinal fusion surgery, which 1 The Secretary of the Department of Corrections was originally a defendant but was dismissed from the case and is not a party to this appeal. 2 Because Easley was sent multiple times to medical specialists with offices outside the prison, we refer to them as “outside” specialists or “outside” doctors. 3 Case: 13-14257 Date Filed: 10/24/2014 Page: 4 of 21 Easley refused; (5) offering Easley the option of sleeping in the infirmary and advising that he regularly do stretching exercises; (6) ordering an MRI to aid in diagnosing Easley’s back problems; (7) ordering physical therapy; (8) prescribing and administering Ultram, a narcotic, as well as aspirin and ibuprofen for relief of Easley’s pain; and (9) prescribing and administering other medicines, including Lisinorpil (for high blood pressure), Glucophage (for diabetes), Zocor (for cholesterol), Flexeril (a muscle relaxer), and Diphenhydramine (Benadryl). Separately, the DCI mental health department prescribed Prozac and Elavil (or the generic, amitriptyline), both for depression. C. Easley’s Claims Against the DCI Healthcare Providers Easley argues the steps taken by the DCI Healthcare Providers were insufficient, delayed, or terminated, rendering his medical care inadequate. Easley accurately notes that his special diet was twice terminated. The formal policy (of the Florida Department of Corrections) required the cessation of a special diet where an inmate missed more than 10% of his meals. Easley had missed 33% of his special diet meals when that diet was first cancelled in March 2010. It was subsequently reinstated, and then again cancelled when Easley missed 71% of his special diet meals in October 2010. The special diet was not renewed and Easley was given a disciplinary report for failure to comply. 4 Case: 13-14257 Date Filed: 10/24/2014 Page: 5 of 21 After being sent to an outside orthotics specialist, Easley received special orthopedic shoes in June 2010. Easley complains, however, that he was not given a new pair of the same shoes on an annual basis. Defendants respond that no policy requires annual replacement of the specially ordered shoes, and that Easley was given replacement orthotic inserts in January 2011. Moreover, as with a number of Easley’s other medical treatments, the authorization or denial of replacement shoes did not rest with the individual defendants. Rather, the defendants would file a request with Utilization Management, a division of Florida’s Department of Corrections based in Tallahassee and a non-party. In August 2011, defendant Dr. Poveda requested that Utilization Management approve Easley being seen again by an outside orthotics specialist. Easley does not dispute that Dr. Poveda made this request, but avers that defendant Nurse Dwares “refused to properly write referrals to get a renewal pair” of orthopedic shoes. Dwares avers that he was not “involved in [Easley] receiving or not receiving a new pair of shoes,” but that Dr. Poveda did in fact make the appropriate request to Utilization Management. The DCI Healthcare Providers referred Easley to an outside physician, Dr. Amar Rajadhyaksha. 3 Dr. Rajadhyaksha, an orthopedic surgeon, saw Easley on 3 The defendants consistently refer to this appointment as an evaluation with a neurologist, but nothing in the record indicates Dr. Rajadhyaksha is a neurologist, and his stamp in the medical records indicates that he is an orthopedic surgeon specializing in spinal surgery. 5 Case: 13-14257 Date Filed: 10/24/2014 Page: 6 of 21 June 16, 2010, and recommended corrective surgery to resolve Easley’s back pain. Easley refused surgery and requested other, more conservative treatment. After Easley saw Dr. Rajadhyaksha and refused surgery, the DCI Healthcare Providers ordered outside consultations for epidural injections to block the pain. Easley met with Dr. Polanco on October 8, 2010, and with Dr. Escandor on December 22, 2010, both at Kendall Regional Medical Center (“Kendall”). In his sworn affidavit, Dr. Poveda stated that Easley received two epidural injections, one on October 8, 2010, and one on December 22, 2010. In his affidavit, Easley avers that the epidural injections never occurred during his time at DCI. And as Easley notes, the Kendall documents from these appointments show that Easley was seen but do not state whether epidural injections were actually administered on the alleged dates. Nevertheless, it is undisputed that Easley’s back-pain condition received significant attention. Throughout his stay at DCI, Easley was prescribed the narcotic Ultram, to be given three times a day as needed. Affidavits from the DCI Healthcare Providers and accompanying medical records show that he was regularly evaluated and treated by the medical staff. Several of these evaluations resulted in referral to outside specialists. In April 2010, Easley was referred to an orthopedic surgeon. That appointment, where Dr. Rajadhyaksha recommended surgery to Easley, occurred in June 2010. 6 Case: 13-14257 Date Filed: 10/24/2014 Page: 7 of 21 Easley was separately evaluated by the DCI Healthcare Providers twice in July 2010. In September 2010, Easley was sent out for an MRI and his prescription for the narcotic Ultram was renewed. Easley was evaluated twice by the DCI Healthcare Providers again in October 2010, at least once in November 2010, and had follow-ups specifically addressing back pain management in December 2010 and February 2011. In March 2011, Easley was recommended for and began physical therapy. 4 Easley was evaluated for his back pain twice in April 2011 and again in May 2011. The medical notes from the May 2011 appointment note that Easley “state[d] that the Ultram is working very well on his pain.” Medical records from May 2011 and June 2011 also show that Easley refused a referral for an outside pain management consult and again refused surgery. Both refusal forms acknowledge that Easley refused these treatments against the advice of the DCI Healthcare Providers. 5 Easley also complains that the DCI Healthcare Providers required him to wait eight hours between doses of Ultram, the narcotic pain reliever. Easley’s 4 In the district court, Easley disputed the ready availability of physical therapy, alleging that he was improperly removed from the physical therapy program. He raises no issues related to physical therapy on appeal. Easley’s Healthcare Providers contend that the cessation of physical therapy was due to Easley’s non-compliance. Despite the therapist observing that Easley walked briskly and without his cane, Easley at times would not attend physical therapy or perform required exercises without greater access to pain medication. 5 A separate June 2011 examination showed that Easley’s treatment for diabetes, hypertension, and high cholesterol had been effective. In his deposition, Easley acknowledged that the medications prescribed for his diabetes while at DCI brought the condition under control. 7 Case: 13-14257 Date Filed: 10/24/2014 Page: 8 of 21 prescription allowed administration of Ultram three times a day, as needed. The DCI Healthcare Providers admit that they did not provide Easley with Ultram on demand and required him to wait eight hours between doses. The defendants aver that (1) Ultram is a narcotic that must be administered under direct observation and (2) standard medical practice treats a thrice-daily dose as being appropriate every eight hours, once in the morning, once in the afternoon, and once at night. Medical records show that, in late July 2011 and early August 2011, Easley on numerous occasions attempted to get his next dose of Ultram before the prescription would allow. Easley also consistently refused the DCI Healthcare Providers attempts to take vital signs to get an objective assessment of his pain level. In addition, Easley was also taking Prozac at the time. The DCI Healthcare Providers aver that because Prozac can potentially have life-threatening interactions with Ultram, close monitoring was especially warranted. Easley also makes a separate claim that he was unfairly forced to wait fortyfive minutes in the medical unit after many of his Ultram doses. The DCI Healthcare Providers respond by explaining the common practice of “cheeking” in the prison environment. Cheeking is where inmates will attempt to store medication in their cheeks and later sell their medication. The DCI Healthcare Providers often require inmates to wait after receiving their medication to ensure the medication has dissolved. 8 Case: 13-14257 Date Filed: 10/24/2014 Page: 9 of 21 D. Easley’s Claims Against the DCI Officers Separately, Easley argues that the DCI Officers denied him access to medical care by not allowing him to go to the medical unit despite his medical pass. Easley’s primary claim is that the DCI Officers failed to honor his pass for “noon time” treatment. Easley’s medical pass, however, never prescribed dosage of Ultram at “noon time” and the DCI Officers offer at least two explanations for appropriately denying Easley’s request to go to the medical unit at noon. Either the compound was not opened up for “call outs,” which would allow inmates to go to work, chapel, medical, etc., or an inmate would not be allowed to go to the medical unit at noon because the medical staff was regularly on lunch break between noon and 1:00 pm. E. October-November 2011 Retaliation Against Easley Though Easley alleges that the denial of access to medical care by the DCI Officers and the failure to provide adequate medical care by the DCI Healthcare Providers may have had a retaliatory element, he states a separate claim against the DCI Officials which sounds entirely in retaliation. Easley alleges that he was placed in administrative confinement on October 14, 2011, and then transferred from DCI to Everglades Correctional Institution on December 9, 2011, in retaliation for filing grievances as to his medical treatment at DCI. 9 Case: 13-14257 Date Filed: 10/24/2014 Page: 10 of 21 In October 2011, a DCI corrections officer was assaulted in Section I of the prison (which included the DCI prison library). Because the identity of the officer’s assailants was unknown, all 100 inmates present in Section I of the prison on that day, including Easley, were placed in administrative confinement. 6 The Office of the Inspector General of Florida, rather than the DCI Officials, conducted the investigation into the assault. Because the subsequent investigation could not determine the officer’s assailants, all DCI prisoners then housed in administrative confinement (whose whereabouts at the time of the attack could not be confirmed) received “non-negative” transfers to other facilities for safety and security reasons. Easley also asserts that he lost “gain time” as a result of his placement in administrative confinement. The record shows, however, that Easley received seven days (of a possible ten days) of gain time in October 2011 and that he received ten days of gain time in December 2011. Easley forfeited any gain time for November 2011 not for being placed in administrative confinement, but for receiving an unrelated disciplinary report. F. District Court Proceedings 6 For at least two weeks in November 2011, however, Easley was not in administrative confinement, but was transferred to the South Florida Reception and Medical Center, where he was seen by Dr. Gama, a neurologist. Dr. Gama’s notes from this meeting acknowledge Easley’s refusal of surgery and recommend weight reduction, stretching exercises, and symptomatic pain management with ibuprofen. Though Dr. Gama also recommended another referral to pain management, he notes discussing the risks of epidural shots with Easley. Easley’s deposition testimony concedes that the neurologist did not recommend epidural shots. 10 Case: 13-14257 Date Filed: 10/24/2014 Page: 11 of 21 The district court referred the case to a magistrate judge. On December 28, 2011, the magistrate judge granted Easley’s motion to proceed in forma pauperis. Following Easley’s amendment to his complaint,7 service on the defendants, and defendants’ Answers, the magistrate judge issued a scheduling order stating that discovery would conclude on December 17, 2012. Defense counsel deposed Easley on November 15, 2012. Defense counsel also brought documents covered by Easley’s requested discovery to the prison for Easley to review. After the defendants responded to Easley’s discovery requests, Easley filed several motions to compel. In particular, on November 26, 2012, Easley moved to compel the copying of documents presented to him in his prior meetings with defense counsel. Easley essentially requested that the Florida Department of Corrections provide these copies to him at no cost or with a bill for future payment. Easley’s prison account lacked sufficient funds to pay for the copying costs. The statement of charges provided by defense counsel shows that Easley sought 923 copies, for which he would have been charged $138.45. The defendants objected, asserting that the Federal Rules did not require a party served with a request for production (or a non-party) to make copies free of charge. 7 The district court directed the clerk of court to combine Easley’s amended complaint and supplement into a single document, which the court stated it would treat as the operative complaint. 11 Case: 13-14257 Date Filed: 10/24/2014 Page: 12 of 21 Separately, on November 1, 2012, Easley sought production of video recordings from administrative confinement, for the period of October 14, 2011 through November 2011. Easley alleges that these videos would demonstrate the involvement of the DCI Officials in the decision to place Easley in administrative confinement in retaliation for his grievances. The magistrate judge struck Easley’s motion to compel for failure to comply with the local rules. On December 4, 2012, Easley filed a motion to extend the time to complete discovery by 60 days. The magistrate judge denied this motion on December 6, 2012. Easley then moved, on December 12, 2012, for spoliation sanctions in connection with the destruction of the video recording, which he alleged was in bad faith. The magistrate judge denied the sanctions motion. Discovery expired on December 17, 2012. On January 18, 2013, all defendants moved for summary judgment, filing affidavits, a transcript of Easley’s deposition, and various exhibits. Easley also moved for summary judgment in his favor. He submitted a variety of records, including an array of grievances and grievance responses, as well as several affidavits, two from himself, several from other inmates, and one from corrections officer Sergeant Christy Sturtevant.8 Easley also moved to strike the defendants’ 8 Sergeant Sturtevant’s affidavit indicates that she observed Easley being returned from a failed attempt to go to the medical unit. Sturtevant filed a subsequent affidavit stating that she thought Easley was attempting to go to medical to receive insulin for his diabetes, that she was 12 Case: 13-14257 Date Filed: 10/24/2014 Page: 13 of 21 summary judgment motions because of his inability to obtain copies of the defendants’ discovery documents. The magistrate judge issued a report and recommendation that the district court grant all defendants’ motions for summary judgment and deny Easley’s summary judgment motion. The district court adopted the report and recommendation, denied Easley’s various motions, and granted summary judgment in favor of all defendants. Easley timely appealed.