Strahan v. Rottnek, Case No. 4:13CV448 SNLJ
| Decision Date | 20 January 2015 |
| Docket Number | Case No. 4:13CV448 SNLJ |
| Parties | GEORGE STRAHAN, Plaintiff, v. DR. FRED ROTTNEK, Defendants. |
| Court | U.S. District Court — Eastern District of Missouri |
This matter is before the Court on defendant's motion for summary judgment. The matter has been fully briefed and is ripe for disposition. For the following reasons, the Court will deny the motion.
Plaintiff George Strahan filed this 42 U.S.C. § 1983 claim against defendant Dr. Fred Rottnek who was on the medical staff at St. Louis County Buzz Westfall Justice Center (the "jail") when plaintiff was incarcerated at that facility. Plaintiff alleges that Dr. Rottnek was deliberately indifferent to his serious medical needs in violation of the Eighth Amendment. Plaintiff complains that his pre-existing prescription pain medication was intentionally and abruptly withdrawn and substituted with over-the-counter medication that was insufficient to properly treat his chronic pain based solely on a policy implemented by Dr. Rottnek as opposed to a medical judgment made after individual examination. Plaintiff contends Dr. Rottnek's policy of cutting off all narcotic pain medications to inmates like plaintiff who enter the jail inflicts severe pain andsuffering on the patients and carries with it grave risks of severe withdrawal symptoms. Plaintiff also makes a state law claim for medical negligence, alleging that Dr. Rottnek was negligent in his treatment of plaintiff's chronic pain.
In support of his motion for summary judgment, defendant maintains that there is no evidence that he was deliberately indifferent to a serious medical need. Further, defendant maintains that the medical records demonstrate that plaintiff was provided with appropriate medical care. For these reasons, defendant contends that he is entitled to judgment as a matter of law in his favor.
Pursuant to Federal Rule of Civil Procedure 56(a), a district court may grant a motion for summary judgment if all of the information before the court demonstrates that "there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law." Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). The burden is on the moving party. City of Mt. Pleasant, Iowa v. Associated Elec. Co-op. Inc., 838 F.2d 268, 273 (8th Cir. 1988). After the moving party discharges this burden, the nonmoving party must do more than show that there is some doubt as to the facts. Matsushita Elec. Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). Instead, the nonmoving party bears the burden of setting forth specific facts showing that there is sufficient evidence in his favor to allow a jury to return a verdict for him. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986); Celotex, 477 U.S. at 324.
In ruling on a motion for summary judgment, the court must review the facts in a light most favorable to the party opposing the motion and give that party the benefit ofany inferences that logically can be drawn from those facts. Matsushita, 475 U.S. at 587; Woods v. DaimlerChrysler Corp., 409 F.3d 984, 990 (8th Cir. 2005). The Court may not "weigh the evidence in the summary judgment record, decide credibility questions, or determine the truth of any factual issue." Kampouris v. St. Louis Symphony Soc., 210 F.3d 845, 847 (8th Cir. 2000). The court is required, however, to resolve all conflicts of evidence in favor of the nonmoving party. Robert Johnson Grain Co. v. Chemical Interchange Co., 541 F.2d 207, 210 (8th Cir. 1976).
The Court has reviewed the parties' statements of uncontroverted material facts, the responses, and the supporting documentation, and, where appropriate, will accept facts as supported by appropriate admissible evidence. The following relevant facts1 are undisputed. Additional facts are set forth in the discussion.
Plaintiff injured his back in 1990 as a result of a fall. Plaintiff testified that he suffers from severe, chronic pain in multiple places in his body including the middle part of his back and neck "like a fire burning, just surging out," a "steady pain" in his low back, and a "sleepy numb" pain on his hip and buttocks. MRIs of his lumbar and cervical spine show multiple abnormalities throughout his spine, including Schmorl's node, discdesiccation, annular tears, disc bulges, bilateral facet arthropathies, lesions, synovial cysts, bilateral neural foraminal narrowing, and foraminal stenosis. Plaintiff's expert witness, Dr. Sturm, testified that plaintiff suffers from foraminal spinal stenosis and degenerative disc disease.
Prior to incarceration, plaintiff saw a number of physicians including pain management physicians and emergency room physicians for treatment of his chronic pain. Plaintiff's chronic pain was treated with narcotic prescription medications including Vicodin (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen). Since August 2012 until the time plaintiff was incarcerated in November 2012, he was under the care of Dr. Beyzer who had prescribed Vicodin for plaintiff's pain, one to two 10 mg hydrocodone/325 mg acetaminophen pills every six to eight hours, a prescription allowing plaintiff to take between 30 to 80 mg of hydrocodone each day.
Upon entering the jail, plaintiff came under the care of Dr. Rottnek, who is both the Medical Director and Lead Physician at the jail. During an intake assessment conducted by an intake nurse, plaintiff informed the nurse of his current prescription medications including Vicodin. Jail staff called the pharmacies where plaintiff reported he had filled prescription medications to confirm what medications he was taking. On plaintiff's second day of incarceration, the medical staff prescribed five days of Vicodin, one 5 mg hydrocodone/500 mg acetaminophen pill twice daily, for a recent wrist injury until further assessment could be done on his wrist. The jail staff had confirmedplaintiff's prescription for Vicodin for his chronic pain but he was not allowed to continue taking his medication as previously prescribed.
After expiration of the Vicodin prescription for the wrist pain, plaintiff was given Tylenol for pain control of his chronic pain issues. Plaintiff was given Tylenol in lieu of his Vicodin prescription pursuant to Dr. Rottnek's policy on pain management. Dr. Rottnek's protocol for the vast majority of inmates including plaintiff that come to the jail on chronic narcotic pain medication is to stop the prescribed medication and start them on Tylenol to see how they do.2 Dr. Rottnek describes his policy for pain management in new inmates as a stepwise progression that starts with over-the-counter medications, adding in other medications to get to an appropriate level of medication to address the patient's pain level.
Plaintiff was treated with Tylenol for over three weeks. On December 28, 2012, plaintiff was prescribed Flexeril, a muscle relaxer, in addition to Tylenol at a visit with Physician Assistant Todd Parker. The Flexeril was prescribed in response to plaintiff's complaint of continued pain. Plaintiff's first visit with Dr. Rottnek was January 18, 2013 on referral from PA Parker. At this visit, Dr. Rottnek prescribed the pain medication Tramadol. Six weeks later, on March 1, 2013, Dr. Rottnek increased the Tramadol dose. On April 25, 2013, Dr. Rottnek prescribed up to six Vicodin 5mg hydrocodone/500 mg acetaminophen per day. Dr. Rottnek also referred plaintiff to an orthopedic surgeon, Dr. George, for further evaluation of his complaints of back pain.
Plaintiff filed this lawsuit on March 8, 2013. During his deposition in this matter, plaintiff's expert witness, Dr. Sturm, testified that a conscious decision was made by Dr. Rottnek to implement a policy where inmate medication levels are reduced at the time of incarceration. Dr. Sturm testified that Dr. Rottnek's policy is equivalent to shutting off pain management completely. According to Dr. Sturm, when high potency medication is stopped, "that just runs the patient directly into withdrawal" and "almost everybody is going to go into some degree of withdrawal [because] [i]t's just side effects of not having the medication." In his opinion, it was not a wise policy to apply a general broad policy to all inmates and, instead, there should be a medical records review and a decision made on a case-by-case basis. Dr. Sturm's opinion is supported by a National Commission on Correctional Health Care (NCCHC) guideline which states, "In the case of new inmates who have been receiving long-term opioids, pain and function should be assessed at baseline prior to tapering the drug and tracked over time to assess any change." NCCHC is an organization that creates standards for correctional health care and provides educational conferences to all levels of correctional health care workers. NCCHC publishes guidelines to help a practitioner manage a particular medical condition and position statements to state the position of the organization as a whole regarding a medical issue.
Deliberate indifference to a prisoner's serious medical needs is cruel and unusual punishment in violation of the Eighth Amendment. Estelle v. Gamble, 429 U.S. 97, 106,97 S.Ct. 285, 50 L.Ed.2d 251 (1976). "To show deliberate indifference, [a plaintiff] must prove an objectively serious medical need and that prison officers knew of the need but deliberately disregarded it." Gordon ex rel. Gordon v. Frank, 454 F.3d 858, 862 (8th Cir. 2006). "'Serious medical need' has been defined as a medical need which 'has been diagnosed by a physician as requiring treatment, or one that is so obvious that even a layperson would easily recognize the necessity for a doctor's attention.'" Camberos v. Branstad, 73 F.3d 174, 176 (8th Cir. 1995) (quoting Johnson v. Busby, 953 F.2d 349, 351 (8th Cir. 1991); see also Simmons v....
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