Warren v. Prime Care Med. Inc., CIVIL ACTION NO. 16-643

• Decision Date: 20 December 2019
• Docket Number: CIVIL ACTION NO. 16-643
• Citation: 431 F.Supp.3d 565
• Parties: Daniel WARREN , Plaintiff, v. PRIME CARE MEDICAL INC. , et al., Defendants.
• Court: U.S. District Court — Eastern District of Pennsylvania

431 F.Supp.3d 565

Daniel WARREN , Plaintiff, v. PRIME CARE MEDICAL INC. , et al., Defendants.

CIVIL ACTION NO. 16-643

United States District Court, E.D. Pennsylvania.

Filed December 20, 2019

David Newmann, Adrienne N. Gittens, Jessica Jacobs, Hogan Lovells U.S. LLP, Jasmeet K. Ahuja, U.S. Attorney Office, Philadelphia, PA, for Plaintiff.

John R. Ninosky, Marshall Dennehey Warner Coleman & Goggin, Camp Hill, PA, Thomas M. Caffrey, Coplay, PA, for Defendants.

MEMORANDUM OPINION

Rufe, District Judge

Plaintiff Daniel Warren filed this civil action pursuant to 42 U.S.C. § 1983 and Pennsylvania law to recover damages for injuries he suffered at the Lehigh County Jail ("LCJ"). Warren alleges that the Defendants violated his rights through their detection, treatment, and prevention of his Methicillin-Resistant Staphylococcus Aureus ("MRSA") infection. Defendants PrimeCare Medical, Inc. and Dr. Deborah J. Wilson ("PrimeCare Defendants") and Corrections Officers Jennifer Sanchez and Kurt Stametz ("Officer Defendants"), who are the remaining defendants in this case, have each filed a motion for summary judgment. The PrimeCare Defendants' motion will be granted and the Officer Defendants' motion be granted in part and denied in part for the reasons set forth below.

I. FACTUAL BACKGROUND¹

Plaintiff developed MRSA while he was a pretrial detainee at LCJ. MRSA is:

[A] drug-resistant strain of staph bacteria. MRSA is only susceptible to a limited number of antibiotics, but most MRSA skin infections can be treated without antibiotics by draining the sores. MRSA can be spread through direct contact with infected individuals or through contact with materials that have been exposed to the bacteria. Conditions frequently associated with corrections facilities—including overcrowding, shared facilities, and close contact between inmates—can increase the risk of spreading. Unsanitary conditions can exacerbate the problem.²

PrimeCare contracted with Lehigh County to provide medical services to inmates incarcerated at LCJ. To address the risk of MRSA, LCJ and PrimeCare adopted policies that required both medical and non-medical staff, as well as prisoners, to follow procedures for the prompt detection and treatment of the disease.³ These procedures included warnings that MRSA could be misdiagnosed as a spider bite.⁴

A. CO Sanchez and PrimeCare's Initial Delay in Providing Medical Care

On the evening of July 12, 2015, Warren noticed a large pus-filled blister developing on his right calf. CO Sanchez alleges that Warren told her that he had been bitten by a spider. She asserts that, in response, she twice called PrimeCare, and each time PrimeCare informed her that Warren needed to complete a sick call slip in order to be seen by the medical unit but that Warren refused to fill out a sick call slip.⁵

Warren disputes CO Sanchez's retelling of the events. He alleges that, based on the materials he had received during his intake, on warnings he received from other inmates who saw his blister, and from a comparison of his blister to pictures of MRSA posted on the walls, he reported to CO Sanchez that he had contracted MRSA and requested that she immediately contact the medical unit. Warren further alleges that CO Sanchez independently decided that the blister was only a spider bite and decided not to call PrimeCare.

However, Warren alleges that he persisted, and eventually, CO Sanchez called PrimeCare and told the responding medical staff member that Warren had a spider bite, that he refused to fill out a sick call slip, and that he did not need to be seen. CO Sanchez never told PrimeCare that Warren believed he had contracted MRSA. Warren attempted to protest this account but Officer Sanchez told him to "step away" from her podium.⁶ Several hours later, Warren tried again to persuade CO Sanchez to take him to medical to no avail.

According to Warren, later than night, two separate correctional officers noticed the condition of Warren's leg and called the PrimeCare medical staff and described Warren's symptoms.⁷ However, the PrimeCare staff refused to see Warren because he had failed to submit a sick call slip.

Warren asserts that PrimeCare and CO Sanchez's refusal to treat Warren based on his failure to complete a sick call slip had no basis in any policy. Rather, for an emergency medical problem⁸ or for a skin condition,⁹ Warren explains that he was only required to notify corrections staff.

Moreover, Warren explained that he did not want to submit a sick call slip because there was no way to know how long it would take for the slip to be picked up and he needed immediate medical attention.

Warren avers that, the next day, a sergeant intervened and demanded that PrimeCare see Warren and treat him. At this point, Warren asserts that he was unable to apply pressure to his leg and had difficulty walking on his own.

B. PrimeCare's Initial Treatment

At approximately 11:30 a.m. on July 13, 2015, Warren was taken to the medical department. PrimeCare prescribed several medications for Warren, including Tylenol

and Clindamycin, an antibiotic, for what they deemed to be possible cellulitis.¹⁰ PrimeCare also assigned him crutches because he was having trouble walking. However, Warren alleges that PrimeCare failed to take the appropriate steps to identify that Warren had contracted MRSA. PrimeCare did not culture Warren's blister. It did not fill out a "MRSA form" which is required when an inmate presents a wound, a pimple, or a boil.¹¹ Warren was not placed in medical isolation, which Warren asserts is mandated by LCJ policy when an inmate has MRSA symptoms.

Warren alleges that, each of the next two days, he returned to the medical unit because his condition had progressively worsened—his leg had become more swollen and he could barely function. However, PrimeCare still did not culture his blister or place Warren in medical isolation. Instead, PrimeCare took away Warren's crutches.

The next day, on July 16, Warren alleges that his condition had deteriorated to the point that he actually believed that he was dying. He had an extremely high temperature and was drifting in and out of consciousness. His bed was soaked from cold sweats, pus and blood oozed from his wound

, and he looked like the "elephant man."¹² At the urging of other inmates, a corrections officer called PrimeCare and requested that Warren be seen. Several hours later, PrimeCare took Warren to the medical unit in a wheelchair. Shortly thereafter, PrimeCare sent Warren to the emergency room at St. Luke's Hospital.

At St. Luke's, Warren's wound

was immediately cultured and the culture confirmed that Warren had MRSA. By this time, Warren alleges that his MRSA had spread from a 5x5 inch patch on his right calf all the way to his groin.¹³ Warren remained at St. Luke's for five days where he was treated for MRSA and underwent surgery in order to drain his abscess.

PrimeCare asserts that its actions were appropriate and met the standard of care. It has presented expert witness reports which opine that the prescribed medications were appropriate under the circumstances. PrimeCare further disputes that Warren's wound

worsened from when he was first seen and, instead, maintains that the swelling steadily improved and that his temperature was within normal limits.

PrimeCare further maintains that it was not until the evening of July 16, 2015, that Warren's condition changed. PrimeCare states that, at this point, Warren had swelling from his ankle to knee and he had a fever.¹⁴ While he was in the medical department, the swelling and temperature increased. PrimeCare then ordered that Warren be taken to the hospital.

C. PrimeCare Defendants' Care for Warren After His Return from the Hospital

Warren's discharge instructions provided by St. Luke's Hospital on July 21, 2015 included, "Pack RLE wound

with 1in plain packing and cover with 4x4 and wrap with kerlex. Change dressing 2-3 times daily."¹⁵ Packing involved placing long strips of gauze directly into Warren's open wound to keep the wound open and allow for drainage.

Warren alleges that the St. Luke's staff lightly packed Warren's leg wound

with care so as to not hurt him and to ensure that the wound would properly heal.¹⁶ Warren further alleges that St. Luke's sent discharge instructions to LCJ and PrimeCare including how to properly pack the wound.

Three days after his discharge, Dr. Wilson first examined Warren, who asserts that Dr. Wilson brought together the nurses who were in the medical unit that day to instruct them to "alter the wound

packing procedure" by packing the wound "tightly," which "was intentionally calculated to maximize Warren's pain and prevent his wound from healing."¹⁷ Warren alleges that despite his continued pleas that they pack the wound less tightly, Dr. Wilson and the PrimeCare medical staff continued with the painful method of packing for weeks.¹⁸

Although most treated MRSA wounds

heal within ten days, on August 13, 2015, Warren saw Dr. Wloczewski, another physician employed by PrimeCare at LCJ. Dr. Wloczewski made an appointment for Warren with a wound specialist at Sacred Heart because the wound was not healing "as well as [he] thought it should."¹⁹ According to Warren, following this meeting, Dr. Wloczewski instructed Dr. Wilson and the nurses to pack the wound lightly so that it could properly heal.²⁰

On August 21, 2015, Warren was examined by Dr. Hortner at Sacred Heart Hospital. Dr. Hortner gave instructions upon Warren's discharge to take care that Warren's wound

not be packed too tightly.²¹ Dr. Hortner also had Warren's calf cultured which confirmed that Warren had again contracted MRSA. Just one week after Dr. Hortner's initial examination, Warren saw Dr. Hortner again, who concluded that Warren's wound had healed and closed.²² Warren asserts that his quick recovery following his visit with Dr. Hortner was a direct result of Dr. Hortner's instructions that PrimeCare should not pack the wound too...