I.
INTRODUCTION AND PROCEDURAL HISTORY
This
case is before me on a motion (Doc. 41) for summary judgment
filed by Karen Anderson, Patricia Dettbarn, Linda Boffeli and
Jana Hacker (defendants). Plaintiff Robert Heiden has filed a
resistance (Doc. 49) and defendants have filed a reply (Doc
55). I find oral argument is unnecessary. See Local Rule
7(c).
Heiden
initiated this action by filing a pro se complaint (Doc. 1)
in the Southern District of Iowa on November 28, 2018,
seeking relief pursuant to 42 U.S.C. § 1983 for alleged
violations of his Eighth Amendment rights. The case was
transferred to this district on December 7, 2018, (Doc. 5),
and defendants filed their answer (Doc. 18) on August 13,
2019. I subsequently granted Heiden's motion (Doc. 3) to
appoint counsel.
The
following facts are undisputed except where otherwise noted:
Heiden
has been committed to the custody of the Iowa Department of
Corrections since May 11, 1990, to serve a life sentence.
Doc. 42-2 at 1. While Heiden has been housed at several
facilities in Iowa, the allegations in this case arise from
his stay at the Anamosa State Penitentiary (ASP) in Anamosa,
Iowa, and the Fort Dodge Correctional
Facility (FDCF) in Fort Dodge, Iowa. Doc 42-2 at 2. Heiden
spent time at the ASP from April 13, 2004, to July 7, 2016,
and again from July 22, 2016, to January 26, 2017.
Id. During the times relevant to this case, Boffeli
was a registered nurse at the ASP and Dettbarn was the
nursing director. Id. Since January 26, 2017, Heiden
has been serving his sentence at the FDCF. Id. at 2.
During the times relevant to this case, Anderson was a
registered nurse and the nursing director at the FDCF and
Hacker was a nurse practitioner at that facility.
Id.
At both
facilities, medical care is available to inmates 24 hours a
day. Doc. 41-2 at 2. Upon request, an inmate is seen first by
a member of the nursing staff. Id. The nurse will
then decide, sometimes after consulting with other medical
staff, whether the patient requires additional care, such as
an appointment with a physician's assistant, dentist,
nurse practitioner, psychiatrist, or doctor. Id. If
an inmate requests a visit with an outside medical
consultant, a prison medical provider (either a doctor,
dentist, nurse practitioner, physician's assistant, or
optometrist) assesses the issue and determines whether an
outside consultation is medically necessary. Id. at
2-3.
Heiden
has periodically reported right shoulder pain since he
underwent rotator cuff surgery in 2013. From 2013 to 2018, he
received the following care[1] before he discovered the
permanent impairment he now alleges is the result of
constitutionally deficient care:
. April 20, 2009: Heiden underwent an
arthroscopy on his right shoulder, which was accompanied by
rotator cuff repair. Doc. 49-3 at 13. The surgery took place
at the University of Iowa Hospitals and Clinics (UIHC).
. October 4, 2013: Heiden met with Dettbarn
to discuss his ongoing concerns for his right shoulder and
requested an appointment at the UIHC. Dettbarn told him ASP
was in the process of scheduling the
appointment. Doc. 41-3 at 9.
. December 4, 2013: Heiden underwent a
second arthroscopy on his right shoulder, again accompanied
by rotator cuff repair, at the UIHC. Doc. 49-3 at 14. Over
the next few days, Heiden received various post-operation
treatments from healthcare providers. Doc. 42-1 at 163-86.
. March 17, 2014: Heiden met with a nurse to
ask whether he had a follow-up appointment at the UIHC for
his right shoulder. He indicated he had a limited range of
motion and, based on his conversations with other inmates who
had undergone the surgery, he was concerned something was
wrong with the way his right shoulder was healing. The nurse
requested an ASP doctor review Heiden's chart, though it
appears no ASP doctor did. Doc. 42-1 at 189.
. March 20, 2014: Three days after
complaining of right shoulder pain, Heiden met with Boffeli
in a follow-up appointment at which she observed him crawling
on his hands and knees. She did not notice any expressions of
discomfort and she wrote in the encounter notes that he
displayed a full range of motion. Boffeli requested a chart
review by a doctor. Again, it does not appear an ASP doctor
performed this review. Doc. 42-1 at 190.
. April 15, 2015: Heiden reported shoulder
pain during a physical examination with an ASP doctor, who
prescribed Meloxicam in response. Doc. 42-1 at 191-95.
. January 20, 2016: An ASP doctor reviewed
Heiden's medical chart and previous providers' notes,
though it is unclear what prompted his review. He recommended
Heiden perform various low-impact shoulder exercises. Doc.
42-2 at 83.
. January 27, 2016: Heiden requested copies
of the shoulder exercises he was prescribed in 2013, as he
claimed they were never given to him and he had “done
shoulder exercises on his own” after his second rotator
cuff surgery. Doc. 42-2 at 86.
. February 1, 2016: Heiden filed his first
grievance (Grievance No. 28383) with the ASP, alleging the
medical staff had neglected him, as a medical chart review
slated to be done in March 2014 was not completed until
January 20, 2016. Doc. 41-3 at 52.
. March 17, 2016: Heiden saw an ASP doctor
for right shoulder pain. Heiden reported that he was doing
his range of motion and
strengthening exercises regularly. The doctor gave Heiden a
cortisone injection and Heiden noted relief with the
injection. The doctor advised Heiden to continue his range of
motion and strengthening exercises and to continue taking
Naproxen. Doc. 42-2 at 101.
. June 14, 2016: Heiden requested a
doctor's appointment for his right shoulder. Doc. 42-2 at
140.
. June 20, 2016: Heiden saw an ASP doctor
for his right shoulder pain. Heiden felt that the right
shoulder was weaker by 20-30 pounds than the left. The doctor
diagnosed him with bursitis of the shoulder, though he noted
Heiden had a full range of motion. The doctor advised Heiden
to alternate between placing ice and heat on his shoulder,
take Tylenol instead of NSAIDs and follow up as needed. Doc.
42-2 at 144.
. August 24, 2016: Heiden requested a
follow-up on his right shoulder, claiming his shoulder pain
had worsened over the previous few weeks. He noted that he
had started weightlifting the day before. The nurse referred
him to a doctor. Doc. 42-3 at 18.
. August 29, 2016: Heiden saw an ASP doctor
for his right shoulder pain. The doctor diagnosed Heiden with
arthritis and recommended band therapy and NSAIDs. Doc. 42-3
at 20.
. September 27, 2016: Heiden requested to
extend his physical therapy for his right shoulder, as he
believed it was helping his shoulder heal. Doc. 42-3 at 27.
. October 5, 2016: Heiden requested a
doctor's appointment for his right shoulder because,
while the physical therapy exercises had helped to some
extent, he did not have strength in his arm and his shoulder
was “numb and tingly.” Doc. 42-3 at 28.
. October 11, 2016: Heiden met with an ASP
doctor for his right shoulder pain. The doctor attributed
Heiden's pain to arthritis but also referred Heiden to
the UIHC for a consultation with their orthopedics
department. The doctor also told Heiden to continue
resistance band therapy. Doc. 42-3 at 32.
. November 4, 2016: Heiden attended an
appointment at the UIHC, where a doctor suggested Heiden
could have a recurrent or new tear in his rotator cuff or
that he suffered from early arthritis and inflammation. The
doctor recommended diagnostic shoulder injections
and suggested Heiden may require an additional MRI on his
rotator cuff in the future. Doc. 42-3 at 43.
. November 16, 2016: An ASP doctor referred
Heiden to the UIHC for a right shoulder injection. Doc. 49-3
at 10.
. December 20, 2016: A UIHC doctor performed
two diagnostic shoulder injections on Heiden's right
shoulder, which brought some reprieve. Doc. 42-3 at 58.
. January 4, 2017: Heiden saw an ASP doctor
for right shoulder pain. Heiden had numbness and tingling in
his right hand, and he had been using a hammer drill at work.
The doctor recommended he rest the shoulder and use Naproxen
as needed, as it was too soon for another steroid injection.
Doc. 42-3 at 60-61.
. January 23, 2017: Heiden went to health
services and asked whether a doctor had made another
appointment at the UIHC, as his shoulder had worsened and he
demonstrated a limited range of motion. Doc. 42-3 at 63.
. January 24, 2017: Heiden requested a copy
of his medical files from Boffeli. Doc. 42-3 at 64.
. January 26, 2017: Heiden was transferred
to the FDFC. Doc. 41-2 at 5.
. April 3, 2017: Hacker ordered various lab
work before Heiden's prison-mandated physical. Doc. 42-3
at 68.
. April 20, 2017: Hacker administered
Heiden's physical, during which he requested a follow-up
for his shoulder at the UIHC. Doc. 42-3 at 73.
. July 25, 2017: Heiden requested an
appointment with a doctor for his shoulder pain. He said he
believed his shoulder was digressing and that he needed to go
back to the UIHC “to see if something is really wrong
with my shoulder and my knee both.” A nurse referred
him to Hacker. Doc. 42-3 at 78-79.
. August 1, 2017: Heiden met with Hacker,
complaining of right shoulder pain and a limited range of
motion. Heiden alleged he had never been given access to
stretch bands or any other type of therapy after his 2013
surgery. Hacker provided stretch bands and exercises for his
shoulder. Doc. 42-3 at 81.
. September 24, 2017: Heiden complained via
the prison email system that his shoulder still hurt, he
could not sleep on his
...
