Pringle v. Wexford Med. Sources
| Decision Date | 12 January 2022 |
| Docket Number | Civil Action 20-00294-KD-B |
| Parties | EDWARD L. PRINGLE, Plaintiff, v. WEXFORD MEDICAL SOURCES, INC., et al., Defendants. |
| Court | U.S. District Court — Southern District of Alabama |
REPORT AND RECOMMENDATION
Plaintiff Edward L. Pringle, an Alabama prison inmate proceeding pro se and in forma pauperis, filed a complaint under 42 U.S.C. § 1983. (Doc. 1). This action has been referred to the undersigned Magistrate Judge pursuant to 28 U.S.C. § 636(b)(1)(B) and S.D. Ala. GenLR 72(a)(2)(R) and is now before the Court on Defendants' motion for summary judgment. (Docs. 13, 17, 20). After careful review of the pleadings, and for the reasons set forth below, it is recommended that the motion for summary judgment be GRANTED, and that this action be DISMISSED with prejudice.
Plaintiff Edward L. Pringle (“Pringle”) brings this action against Defendants Wexford Health Sources, Inc. (“Wexford”) and Dr. Manuel Pouparinas, M.D. (“Dr. Pouparinas”) for inadequate medical care while within the custody of the Alabama Department of Corrections (“ADOC”).[2]
In Pringle's operative amended complaint (Doc. 7), he brings claims against Dr. Pouparinas and Wexford for failing to adequately treat his infected left middle toe, which he alleges resulted in the amputation of his left lower leg. (See id. at 4-8). Pringle also attaches a “Statement of Facts” setting forth legal and medical arguments, descriptions of his treatment before and after his below-knee amputation, and references to various complaints and grievances he filed regarding his medical treatment and conditions. (See id. at 11-17).
According to Pringle, his left middle toe became infected in January 2018 while he was under the care of Dr. Pouparinas, who was the Medical Director at Holman Correctional Facility (“Holman”), where Pringle is incarcerated. (Doc 7 at 4; Doc. 17- 1 at 2). Pringle alleges that Dr. Pouparinas and Wexford[3] acted with deliberate indifference by failing to timely and adequately treat his toe to prevent it from developing gangrene and to prevent the gangrene from spreading, thereby resulting in the amputation of Pringle's left lower leg in July 2018.[4] (Doc. 7 at 4-8).
Pringle claims that Wexford's corporate policy of requiring approval of “any medical tools, including surgeries and treatments . . . before any medical procedures begins” in order “to save money, ” created “long delays from diagnosis until treatment, ” which, in turn, caused his toe to develop gangrene and allowed “the gangrene to spread and invade the lower left leg.” (Id. at 4-5).
In his attached “Statement of Facts, ” Pringle refers to various complaints and grievances he submitted regarding his medical treatment after the amputation, including alleged failures to timely provide him with physical therapy after the surgery, to furnish him a properly fitting prosthetic leg, to order “reconstructive surgery” to help him wear his prosthesis, and to provide the prosthetic shoes he requested. (See id. at 14-17). Pringle seeks damages from Defendants in the amount of $300, 000. (Id. at 10).
Defendants Dr. Pouparinas and Wexford have answered Pringle's suit and deny the allegations against them. (Doc. 13). They have also provided a special report in support of their position. (Doc. 17). The special report includes the declaration of Dr. Pouparinas, pertinent medical records of Pringle, and Pringle's inmate movement history. (Docs. 17-1, 17-2, 17-3, 17-4, 17-5, 17-6, 17-7, 17-8, 17-9).
The medical records submitted by Defendants reflect that Pringle's medical history includes diagnoses of hypertension, hepatitis C, ischemic vascular disease, and blood clots. The records reflect that Pringle underwent five surgeries between May 2016 and December 2017 to address problems with left leg circulation. Specifically, the medical records reflect that Pringle had the following surgeries: a left superficial femoral artery balloon angioplasty with stenting on May 23, 2016; a left femoral-popliteal below-the-knee bypass graft on April 26, 2017; a left femoral-popliteal thrombectomy and bovine pericardial patch on August 3, 2017; a left femoral-popliteal above-the-knee bypass graft vein inadequate on November 20, 2017; and a left femoral- popliteal below-the-knee reverse saphenous vein bypass graft harvest vein from right leg on December 26, 2017. (Doc. 17-4 at 15). Before the December 2017 surgery, Dr. Pouparinas assessed Pringle with three left leg thrombi.[5] (Doc. 17-2 at 5; Doc. 17-4 at 15). Following the surgery, Pringle was admitted to Holman's infirmary on December 30, 2017 and was discharged on January 22, 2018. (Doc. 17-2 at 6).
On January 25, 2018, Pringle reported in a sick call request that his left middle toe was swollen and black and did not look right. (Id. at 117). He was seen that day by a nurse, who noted necrosis and tenderness to his left third toe. (Id. at 119). In a sick call request dated January 30, 2018, Pringle reported pain and swelling in his left foot and soreness under his left middle toe. (Id. at 122). He was seen by a nurse and referred to a practitioner. (Id. at 123-24). On February 2, 2018, Pringle submitted another sick call request and reported infection of his left middle toe with odor. (Id. at 126).
Pringle was seen at Holman's health care unit on February 6, 2018 and reported that his toe had been infected for approximately two weeks. (Id. at 127). Dr. Pouparinas admitted Pringle to the infirmary for necrosis of the left third toe[6] and started him on oral and topical antibiotic therapy.[7] (Doc. 17-2 at 128; Doc. 17-3 at 6-7, 10, 12-13). Pringle was also given daily IV infusions of the antibiotic Vancomycin. (Doc. 17-3 at 90).
On February 9, 2018, Dr. Pouparinas submitted a consultation request for Pringle to see his vascular surgeon. (Id. at 32). In the request form, Dr. Pouparinas noted that Pringle had an “open distal 3rd toe vascular wound with eschar and necrosis” and continued to receive antibiotic medication and daily wound care. (Id.). On February 14, 2018, left foot x-rays were taken, which showed degenerative changes but no acute osseous abnormality. (Id. at 60). The following day, Pringle was seen offsite by his vascular surgeon, Rip Pfeiffer, M.D. (Id. at 64-66). Dr. Pfeiffer examined Pringle's left foot and directed that the affected toe be cleaned with alcohol twice per day and left open to air. (Id. at 64-65). In a letter to Dr. Pouparinas dated February 15, 2018, Dr. Pfeiffer stated: (Id. at 66).
On February 21, 2018, Dr. Pouparinas noted that Pringle's wound was improved, with no drainage and no signs of infection. (Id. at 107). He discharged Pringle from the infirmary, listed Pringle's discharge status as improved and stable, and ordered the continuation of daily wound care and a follow-up appointment in one week. (Id.). At discharge, Pringle's medications included fourteen-day prescriptions for the antibiotic Cipro and the pain medication Ultram. (See id. at 107, 109-10).
Pringle submitted a sick call request on March 4, 2018. (Id. at 112). He reported pain and swelling in his left foot and ankle and changing coloration around his heel. (Id.). He was seen the next day in the chronic disease clinic by Dr. Pouparinas, who assessed Pringle with severe peripheral vascular disease and a vascular ulcer in the second distal toe.[8] (Id. at 113). Pringle's list of current medications on that date included Ultram, Vancomycin, Tylenol, the anticoagulant Coumadin, [9] and the nerve pain medication Neurontin. (See id.). On March 19, 2018, Pringle placed a sick call request which stated: (Id. at 115). He was evaluated that day by a nurse practitioner, who noted a necrotic third toe and +1 edema to the left lower extremity and referred him “to MD for ongoing problem.” (Id. at 116).
On April 3, 2018, Pringle reported lower extremity edema. (Id. at 70). He acknowledged that he only wore his TED hose at night and was counseled to “wear while up in daytime.” (Id.). At the chronic disease clinic in April 2018, Pringle reported dry skin and frequent nighttime urination. (Id. at 118). A physical examination of his extremities revealed only dry skin, and his list of current medications at that point no longer included Vancomycin, Ultram, or Tylenol. (See id.). Significantly, on April 24, 2018, the medical records reflect that the area to Pringle's left third toe had resolved, that the eschar was completely removed, and that the new skin was pink. (Id. at 70).
On May 15, 2018, Pringle presented to the chronic disease clinic and reported ongoing nerve pain in his left foot. (Id. at 129). It was noted on examination that Pringle had a necrotic third toe, dry skin, and no edema. (Id.). It was further noted that Pringle had been noncompliant with his Gabapentin and Coumadin prescriptions. (Id.). A comprehensive metabolic panel was ordered, and Pringle was directed to continue his current medications and weekly INR testing for blood clotting. (Id.).
On May 28, 2018, Pringle submitted a sick call request for his left ankle, left heel bone spurs, and left middle toe infection. (Id. at 127). Pringle stated that his medication was not helping and reported pain running from tip of his toe to his knee. (Id.). He was seen by a nurse, who noted mild swelling around the ankle and a left foot that was cool to the touch. (Id. at...
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