Adams v. Poag, 94-8666

• Citation: 61 F.3d 1537
• Decision Date: 28 August 1995
• Docket Number: No. 94-8666,94-8666
• Parties: Jack R. ADAMS, as Parent and next of kin of Michael David Adams, deceased and Carolyn W. Adams, as Parent and next of kin of Michael David Adams, deceased, Plaintiffs-Appellees, v. Joyce H. POAG, Dr., Individually, Grant P. Carmichael, Dr., Terrence M. Martin, Physical Assistant, Individually, Marie Cody, RN, Individually, Defendants-Appellants, Barbara Lewis, RN, Individually, et al., Defendants.
• Court: United States Courts of Appeals. United States Court of Appeals (11th Circuit)

Page 1537

61 F.3d 1537

Jack R. ADAMS, as Parent and next of kin of Michael David

Adams, deceased and Carolyn W. Adams, as Parent and next of kin of Michael David Adams, deceased, Plaintiffs-Appellees, v. Joyce H. POAG, Dr., Individually, Grant P. Carmichael, Dr., Terrence M. Martin, Physical Assistant,

Individually, Marie Cody, RN,

Individually, Defendants-Appellants,

Barbara Lewis, RN, Individually, et al., Defendants.

No. 94-8666.

United States Court of Appeals,

Eleventh Circuit.

Aug. 28, 1995.

William P. Tinkler, Jr., Deana L. Simon, Decatur, GA, for appellants.

John Grey Hunter, Savannah, GA, for appellees.

Appeal from the United States District Court for the Middle District of Georgia.

Before HATCHETT, Circuit Judge, CLARK, Senior Circuit Judge, and YOUNG ^*, Senior District Judge.

HATCHETT, Circuit Judge:

Appellees, Jack and Carolyn Adams, parents of deceased inmate, Michael Adams, filed this 42 U.S.C. Sec. 1983 action against appellants, members of a prison's medical staff, alleging that the appellants' medical treatment of their son constituted deliberate indifference to his serious asthma condition in violation of the Eighth Amendment. The district court denied the appellants' motions for summary judgment based on qualified immunity. We reverse.

FACTS

Because all issues in this case are so fact specific, we recite the facts in great detail. Michael Adams began serving a prison sentence in the Bostick (Georgia) Correctional Institution (Bostick) on September 15, 1989. Bostick and Rivers Correctional Institution (Rivers) are part of the Middle Georgia Correctional Complex (MGCC). Bostick does not contain an infirmary or infirmary beds; but, it does have a sick-call station. Rivers has an infirmary. Correctional Medical Systems, Inc. (CMS) provided professional medical services to MGCC pursuant to a contract with the Department of Corrections of the State of Georgia. The contract required CMS to provide a medical director to perform administrative duties at MGCC. CMS employed appellant, Dr. Grant Carmichael, as its medical director at MGCC during the relevant time period. Dr. Carmichael also provided clinical services at MGCC pursuant to an independent contractor agreement with CMS. Appellant, Dr. Joyce Poag, served as a part-time physician at Bostick pursuant to an independent contractor agreement with CMS. Appellants, Terrence Martin, a physician's assistant, and Marie Cody, a registered nurse, were employees of CMS assigned to MGCC. Upon his arrival at Bostick, Adams, a lifelong asthma sufferer, reported this condition to the nurse who conducted his initial medical screening examination. The examining nurse did not detect any asthma symptoms. Additionally, the inmate physical profile Bostick medical staff prepared noted that Adams suffered from chronic asthma and that he had recently been hospitalized for a severe asthma attack. Dr. Poag initialed the inmate profile.

On September 16, 1989, Adams twice complained of having an asthma attack. In response to Adams's first complaint, the duty nurse consulted Dr. Poag in a telephone conversation. Dr. Poag ordered that Adams be administered an asthma treatment, Theophylline Elixir. Later that night, Adams complained to Nurse Cody of being unable to breathe. After consulting with Dr. Poag in a telephone conversation, Nurse Cody gave Adams Theophylline Elixir in compliance with Dr. Poag's orders. On September 17, 1989, at 2:30 a.m., Adams complained of an asthma attack to the duty nurse. The nurse noted that he was wheezing and had labored breathing with shortness of breath. Dr. Poag again, in a telephone conversation, ordered Adams be given Theophylline Elixir. Dr. Poag conducted her first personal examination of Adams on September 18. Dr. Poag noted wheezing and a rapid heart rate. She diagnosed acute asthma. Dr. Poag also noted that Adams's initial medical screening examination stated that he had been taking Theodur and Marax as asthma medications prior to his incarceration. Dr. Poag ordered Marax tablets, Theophylline Elixir, and ordered Adams transferred to the Rivers infirmary.

On September 18, Adams arrived at Rivers and remained in the infirmary through the following day. During his stay at Rivers, medical personnel did not notice any respiratory distress. Medical personnel checked his blood for Theophylline level. On September 19, Dr. Carmichael, without personally examining Adams, ordered discontinuation of Marax, and prescribed nebulizer treatments as a replacement. After receiving nebulizer treatments for two days at Rivers, Adams went back to Bostick.

On September 21, Adams complained to the duty nurse that he was "still having problems with asthma," and also requested Marax. Adams was not treated on this occasion though his chart was referred to a physician. On September 22 at 6:10 a.m., Adams again complained of asthma problems and requested Marax. The duty nurse noted that Adams was wheezing, was rambling in conversation, and had a hostile attitude. He was not in acute distress. The duty nurse also scheduled Adams for a chest x-ray that morning; the chest x-ray showed no significant abnormality of the chest or lungs. The duty nurse then consulted with Dr. Poag, and no additional treatment was given. On September 25 at 12:25 a.m., Adams complained that he could feel an asthma attack coming on. The duty nurse did not note any wheezing and found his lungs were clear; therefore, he was not given any treatment. At 8 a.m. on September 25, Adams again complained that he was experiencing difficulty breathing. The duty nurse did not detect any acute distress; therefore, no treatment was given. The duty nurse did, however, schedule Adams for an appointment to see a physician on September 28, 1989. On September 28 at 1:15 a.m., Adams again went to the nurse's station at Bostick complaining of asthma. The duty nurse noted some mild symptoms of asthma and gave Adams Theophylline Elixir. At 2 p.m. that same day, Dr. Poag examined Adams and detected mild wheezing. She also noted that he suffered a slight asthma attack approximately once a week. Dr. Poag added Brethine to Adams's treatment plan and referred him to the medical clinic to determine if any allergy medications were needed. In her deposition, Dr. Poag testified that Brethine is a comparable medicine to Marax.

On September 29, 1989, at 10:30 p.m., Adams again went to the nurse's station at Bostick complaining of difficulty in breathing. Nurse Cody saw him and noted no wheezing or cyanosis in his lips or fingernails. Nurse Cody noted that Adams was not in acute distress and did not provide him any additional medication because he had been administered his medications one hour earlier. On October 2, 1989, Adams again complained to the duty nurse that he could not breathe. The nurse noted slight wheezing and slightly labored breathing. The nurse did not detect cyanosis. On the order of Dr. Carmichael, Adams was given Theophylline Elixir and a nebulizer treatment. Adams's medical records state that he tolerated the nebulizer treatment well. At 7:30 that night, Adams again complained of an inability to breathe. The duty nurse did not detect any cyanosis, wheezing, or distress; however, Adams was given Theophylline Elixir.

On October 3 at 2:10 a.m., Adams again complained to Nurse Cody that he could not breathe. Nurse Cody listened to his lungs and noted that his lungs were clear, that he had good air return, and was not displaying any signs of distress. Adams was returned to his dormitory without medication. At 8 a.m. that day, Adams complained of being on the verge of a severe asthma attack. He complained of soreness of the throat and neck and of pain in the chest. He also stated that he was not responding to the medication that he was receiving. The nurse on duty did not note any acute distress and determined that no treatment was necessary. At 9:10 a.m., a physician's assistant examined Adams and noted wheezing in Adams's left lung; therefore, he administered an inhaler to Adams. When Adams began coughing and hyperventilating during the exam, the physician's assistant also ordered a Theophylline blood level check. Upon receipt of the results of the blood check, the physician's assistant ordered an increase in Adams's medication and scheduled him for a follow-up medical examination one week later. On October 4 at 8:30 p.m., another physician's assistant saw Adams and noted that Adams On October 7 at 9:40 a.m., Adams again complained that his asthma was causing breathing problems. The duty nurse noted that his chest was tight and that he was experiencing wheezing in both lungs. The duty nurse also notified Physician Assistant Martin, who was at Rivers, of Adams's condition. Physician Assistant Martin ordered Adams transferred to the Rivers infirmary for nebulizer treatment. Martin examined Adams at the Rivers infirmary, and observed that Adams seemed to be moving adequate air. Adams received the nebulizer treatment, and his medical record states that he tolerated the treatment well. Adams was then returned to Bostick. At 5:50 p.m. that evening, Adams returned to the nurse's station at Bostick complaining of breathing problems. Adams was again taken to Rivers infirmary where his blood was drawn for a Theophylline level check, and he was given a nebulizer treatment. During the next four hours, Adams complained at least twice that the treatment he was receiving was not working. The nurses noted that he was in no acute distress. The nurse also stated in Adams's medical records that no more medications were to be given until the results of his Theophylline level check results were known. At 11:50 p.m., Adams requested to see a nurse. When the nurse arrived, Adams again complained of an inability to breathe and the nurse told him that he could receive no further treatment until the results of his blood tests were known.

was having acute bronchial spasms and wheezing. The physician's...