United States District Court, W.D. Washington, Tacoma
REPORT AND RECOMMENDATION
KAREN L. STROMBOM, Magistrate Judge.
Defendants G. Steven Hammond, J. David Kenney, and Sara Smith move for summary judgment on Plaintiff John Steiner's Eighth Amendment claims against them. Dkt. 49. The Court recommends that the motion be granted.
Mr. Steiner filed an amended complaint against the Defendants regarding his medical care while he was incarcerated at Stafford Creek Corrections Center (SCCC). Mr. Steiner alleges that the Defendants violated his Eighth Amendment rights when they denied him adequate medical care for gastroenterological issues. Dkt. 33. Mr. Steiner did not file any pleadings in response to the Defendants' motion. Therefore, the facts presented below were obtained from other sworn pleadings filed by Mr. Steiner.
STATEMENT OF FACTS
Since 1996, Mr. Steiner has experienced difficulties with severe acid reflux disease. Dkt. 24, Declaration of John Steiner, ¶ 4. In February 1997, a gastric emptying study showed he had "diminished emptying of his stomach and a second gastric study showed a distal esophageal stricture, hiatal hernia, and gastroesophageal reflux disease with Barrett's Esophagus." Id., ¶¶ 5, 6. In May 1997, Mr. Steiner underwent surgery to repair his hiatal hernia and a laproscopic Nissen Fundoplication surgical procedure to reduce his gastroesophageal reflux. Id., ¶ 7. Thereafter, for the next thirteen years, Mr. Steiner was "fine" and managed symptoms of mild acid reflux with medications. Id., ¶ 8.
In March 2010, Mr. Steiner reported to his SCCC medical provider complaining of abdominal pain, increased acid reflux, and difficulty swallowing food. His provider prescribed a medication for gastrointestinal disorders to go along with his Prilosec prescription. Dkt. 24, Steiner Decl., ¶ 10. In November 2010, Mr. Steiner returned to sick-call with complaints of increased abdominal pain and a small, slightly painful, lump in his upper abdomen. Over the next couple of months, his provider increased his Prilosec dosage and gave him a wedge support and Maalox to help reduce his acid reflux. His provider also gave him an abdominal support belt for his suspected hernia. Id., ¶¶ 11-12. According to Dr. Sara Smith, Mr. Steiner's prescription medication was changed at this time to Omeprazole. Dkt. 49-2, Ex. 2, Declaration of Sara S. Smith, M.D., ¶ 5; id., Attachment B (Mr. Steiner's medical records from February 9, 2010 through April 3, 2011). On December 22, 2010, Mr. Steiner returned to see medical staff with similar complaints. He was prescribed a more frequent dose of Omeprazole and provided with a wedge for the head of his bed. Mr. Steiner was seen a number of times in the following months. Id., Attachment B (Mr. Steiner's medical records from February 9, 2010 through April 3, 2011.) In February, 2011, Mr. Steiner told his provider that the medications and medical equipment were not relieving his symptoms. He was referred to Dr. David Owens, a gastroenterological specialist. Dkt. 24, ¶ 13; Dkt. 49-2, Exh. 2, Smith Decl., ¶ 5.
On April 14, 2011, Mr. Steiner was seen by Dr. Owens of Gastroenterology Associates, and was scheduled for an endoscopy to explore the causes of his claimed symptoms. The endoscopy found no major abnormalities, with some mild inflammation and Barrett's esophagus, a condition affecting the lining of the esphogaus which is relatively common in long term sufferers of gastroesophageal reflux disease (GERD), such as Mr. Steiner. Mr. Steiner was also switched from Omeprazole to Protonix in an attempt to alleviate his GERD symptoms. Dkt. 49-2, Smith Decl., Ex. 2, ¶ 6; id., Attachment C. Dr. Owens recommended a follow-up visit in July 2011. Dkt. 24, Steiner Decl., ¶ 15; Exhibit C. In a letter dated May 23, 2011 to Mr. Steiner, Dr. Owens noted that his endoscopy showed "Barrett's esophagus and some mild inflammation, but no infection." Dkt. 24, at 97.
Mr. Steiner states that between May 2011 and March 2012, he made numerous requests for care and asked that he be allowed to follow-up with Dr. Owens. He also informed his SCCC medical provider that his stomach pain was increasing and that he was beginning to have difficulty swallowing his food due to the pain in his throat. Id., ¶ 16; Exhibit D.
Mr. Steiner's records indicate that nurses at the facility's pill line contacted Mr. Steiner's medical provider because he was not picking up the Protonix medication which had been recommended by Dr. Owens. On June 16, 2011, during a clinic visit, Mr. Steiner explained that he had not been taking the medicine because he did not want to stand in line to get the medication and DOC policies required Protonix to be provided at pill line and not kept in the cell. Because of his refusal to follow Dr. Owens' recommended treatment plan, Mr. Steiner's previously scheduled follow-up visit with Dr. Owens was cancelled in July of 2011. On August 17, 2011, Mr. Steiner was seen by his medical provider and his refusal to take the prescribed Protonix was again discussed and noted. Dkt. 49-2, Smith Decl., Ex. 2, ¶ 6; id., Attachment C.
In mid-October 2011, Mr. Steiner returned to the SCCC clinic for follow-up care for his claims of esophageal burning and gastrointestinal discomfort. When Mr. Steiner complained that his condition had worsened on November 23, 2011, his provider recommended another followup with a gastroenterologist. This was presented to the Care Review Committee (CRC) and approved the following week. Dkt. 49-2, Ex. 2, Smith Decl., ¶ 7.
According to Dr. G. Steven Hammond, DOC's Chief Medical Officer, the CRC is a group of DOC primary care physicians, physician assistants (PACs), and advanced registered nurse practitioners (ARNPs), constituted according to the DOC Offender Health Plan (OHP) to review the medical necessity of proposed health care within a cluster of DOC facilities. Medical CRC meetings are convened weekly to review medical issues that arise at various DOC prisons. In some instances, providers will come to the CRC requesting the CRC's consultation on their cases. In other instances, providers present cases to the CRC in which they are requesting proposed intervention. All final CRC decisions are made based on a simple majority vote of all CRC members who participate in the discussion. The CRC votes to either authorize or not authorize proposed interventions. The decision of the CRC is recorded on the Care Review Committee Report, but the individual votes of the members are not recorded. In making recommendations, the CRC relies on the professional judgment of the medical professionals who make up the CRC concerning whether the proposed treatment is medically necessary. In making this determination, reference is made to the OHP, which includes the Washington DOC Levels of Care Directory. Dkt. 49-1, Ex. 1, Declaration of G. Steven Hammond, MD, Attachment A (DOC Health Services Offender Health Plan).
The OHP sets forth three Levels of Care: Level 1, care that is medically necessary, which is authorized; Level 2, care that in some cases as determined by CRC is medically necessary; and Level 3, care that is not medically necessary and not authorized. The conditions listed in the Levels of Care Directory are not intended to be all-inclusive; but are intended to be a guide for clinical decision-making to help ensure uniformity for decisions about common medical conditions. Primary determinants of medical necessity, according to the OHP, are whether the treatment is "essential to life or preservation of limb" or is necessary to treat intractable pain, or is necessary to preserve the ability to perform Activities of Daily Living (ADLs). If intervention for these purposes is not necessary at the present, a medical intervention can be authorized if it is determined to be highly likely that the proposed intervention will be required in the future in order to treat intractable pain or to preserve the ability to perform ADLs and that delay of care would make future care or intervention for intractable pain or preservation of ADLs significantly more dangerous, complicated, or significantly less likely to succeed. Activities of daily living are defined as basic self-care activities such as feeding, dressing, and cleaning oneself.
Consultants may make recommendations that are not medically necessary as defined in the OHP. In fact, the OHP specifically lists as Level 3 care, "Consultant recommendations (including instructions and orders), when not a Level 1 intervention." When a consultant makes a recommendation, the recommendation may be referred to CRC to decide whether it is medically necessary to implement the recommendation. If it is found to be not medically necessary, the condition is categorized as a Level 3 condition and the recommendation is denied. Id., Ex. 1, Hammond Decl., Attachment A at 15, 25.
As noted above, another follow-up with a gastroenterologist was approved by the CRC. Dkt. 49-2, Ex. 2, Smith Decl., ¶ 7. Mr. Steiner was seen by Dr. Owens on March 5, 2012. At this visit, Dr. Owens requested a number of lab tests and an abdominal CT scan. Id., Attachment D. Mr. Steiner states that at the time he saw Dr. Owens in March 2012, he had lost approximately 15 pounds and his symptoms of cramps, stomachaches, constipation, heartburn, and difficulty swallowing had increased. Dkt. 24, Steiner Decl., ¶ 17. In a letter dated May 4, 2012 to Mr. Steiner, Dr. Owens states that he had not yet received the results of the lab work and CT scan "and cannot complete your evaluation without this information, nor can I rule out any potentially life-threatening conditions." Dkt. 24, at 98.
The tests ordered by Dr. Owens, including the CT scan done on May 14, 2012, were performed but did not identify the cause of Mr. Steiner's claimed symptoms. Dr. Owens noted that the CT was normal. Dkt. 49-2, Ex. 2, Smith Decl., ¶ 7; id., Attachment D. In a letter dated May 16, 2012 to Mr. Steiner, Dr. Owens stated: "Your recent CT Scan shows: normal findings (no abnormalities seen)." Dkt. 24, at 99. Mr. Steiner acknowledges that the CT scan results were normal, although food was noted in his stomach, and ...