The opinion of the court was delivered by: Simandle, District Judge
HONORABLE JEROME B. SIMANDLE
In this prisoner civil rights case, plaintiff Dana Andrews, a past inmate at Camden County Correctional Center (CCCF), has sued Camden County, Camden County's Sheriff, the Warden of CCCF, Corrections Medical Services (CMS), which is the private contractor providing inmate medical services at CCCF, and CMS physician Dr. Ronald Rahman, M.D. Plaintiff alleges that--while he was incarcerated at CCCF in June of 1996--defendants were deliberately indifferent to his need for treatment of a life-threatening infection, and that this indifference caused him to suffer severe injuries which nearly caused his death. Plaintiff has filed suit in this Court alleging violations of 42 U.S.C. §§ 1983, 1985 & 1986, and state common law.
Presently before the Court are the summary judgment motions of defendants Camden County, Owens and McLaughlin (collectively the "Camden County Defendants") and CMS as against plaintiff's claims arising under § 1983 in Counts I and III of the amended complaint. *fn1 The primary issue for decision in the present motions is whether there is any evidence that CMS and the Camden County defendants engaged in a pattern or practice because of which plaintiff was denied treatment for a serious medical condition, and which was a substantial factor in causing his injuries.
As discussed herein, the Court finds that plaintiff has come forward with evidence showing that he suffered from a serious medical need which manifested itself as a painful infection and developed into a near-fatal sepsis for which he received no medical treatment despite numerous requests. He has also presented evidence tending to demonstrate that, at the time he was incarcerated, CCCF was being operated without a facility Medical Director, as required by the CCCF-CMS contract and national prison health services accreditation authorities, and that CCCF was employing a substandard system of receiving and treating inmates' medical needs. The Court finds that this evidence creates a genuine issue as to (1) whether defendants knew or should have known of these deficiencies, (2) whether these deficiencies amounted to a policy or pattern of defendants' indifference to significant medical needs, (3) whether defendants were deliberately indifferent to the unreasonable risk to plaintiff's rights posed by these deficiencies, and (4) whether these breaches were a substantial factor in bringing about plaintiff's injuries. For these and other reasons discussed herein, the Court will deny defendants' motion for summary judgment against plaintiff's claims brought under § 1983.
Andrews has sued CMS and numerous other defendants under 42 U.S.C. §§ 1983, 1985, 1986 & 1988, and various state common law causes of action, alleging that the defendants' deliberate indifference to his serious medical needs while he was incarcerated at the Camden County Corrections Facility (CCCF) was a substantial factor in causing him to develop a blood infection which nearly caused his death soon after his release from jail on June 21, 1996. The facts relevant to deciding this motion, taken in a light most favorable to plaintiff as the non-movant, are as follows.
A. CCCF Medical Care Procedures
CCCF is a Camden County-maintained facility that houses persons charged with crimes pending hearings or the posting of bail, as well as some persons who have been sentenced to incarceration. By necessity, Camden County provides medical treatment to sick or injured inmates. The County has elected to delegate its duty to provide medical care, and has contracted with defendant Correctional Medical Services (CMS), a Missouri corporation in the business of providing correctional health care services, to provide licensed doctors and nurses to staff the jail's medical unit and provide medical services as needed. (Camden County Ex. 3 at 1 (CCCF-CMS contract), Pl. Ex. 3.) Among other of CMS's duties set forth in the CCCF-CMS contract is that inmates must be given a health screening upon arrival at CCCF, and must provide non-emergency care to inmates where warranted. (Camden County Exs. 4 & 5 (CCCF medical screening policies).)
Under the CCCF-CMS contract, the governing health care procedures for CCCF are outlined in the "Health Services Policy & Procedures Manual" (hereinafter the Manual or Procedures Manual), a manual generated by CMS. The Manual excerpts attached to the parties' briefs show that each individual policy entry was reviewed and signed by CCCF Warden Owens, the CCCF Medical Director, and a CMS administrator.
Under the policies outlined in the manual, final inmate healthcare decisions are made by the facility Medical Director. The Medical Director is an important position within the CMS-CCCF relationship. As stated by Warden Owens in his deposition, "each facility must have a Medical Director. That director must be a licensed physician. That is the only individual that can offer a medical opinion." (Owens Dep. at 49:6-9.)
In addition to final individual healthcare decisions, the Medical Director has the authority to make recommendations to the Warden concerning inmate healthcare policies. *fn2 (Camden County Ex. 19.) According to Warden Owens, although there may be other medical doctors at the facility, there is only one Medical Director, and that individual is the chief doctor at the facility. (Owens Dep. at 121:14 to 122:8.) Initially, plaintiff named as a defendant to this suit Dr. Ronald Rahman, M.D., whom plaintiff believed to be the Medical Director at the time he was jailed.
It is important to note, however, that Andrews now has discovered evidence showing that, during the period Andrews was jailed, Dr. Rahman actually was not the Medical Director for CMS between June 13-21, 1996, but was instead employed solely as an intake physician. Apparently, Rahman temporarily held the post of Medical Director in 1995, during which time he performed approximately thirty (30) hours of clinical physician duties as an independent contractor, and an additional ten (10) hours as a part-time medical administrator in the capacity of an employee. (Dep. of Dr. Ronald Rahman at 63:11-22, Pl. Supp. Ex. A.) In 1995, Rahman left the facility altogether, but returned in 1996 in the limited capacity of doing tuberculosis screening and intake physicals at CCCF. (Rahman Dep. at 34:6-23, 37:4-12.) During 1996, Rahman's title was that of Intake Physician, and his role was purely that of an independent contractor for CMS. (Rahman Dep. at 54:8-12; 55:4-14.) To the best of Rahman's knowledge, CCCF had no designated Medical Director at the time plaintiff was incarcerated. (Rahman Dep. at 53:2-16.) Rahman has stated that he only saw Andrews during Andrews' initial screening and follow-up.
Part of Rahman's legacy from his tenure as CCCF Medical Director is the "sick call" system of care delivery. According to Rahman, CCCF and CMS agreed to implement this system at his request when he came on board as Medical Director. (Rahman Dep. at 136:17-18.) The procedure for this system is set forth in Health Procedures Manual Procedure entry No. 38.00, "Daily Handling of Non-Emergency Medical Requests", (Pl. Ex. R), which provides:
1. Inmates of the Institution will have access to non- emergency healthcare by submitting a written request that is triaged by a qualified healthcare staff member on a daily basis.
2. A designated healthcare staff member will make rounds in segregation areas to solicit healthcare requests from segregated inmates. *fn3 (Id. at 1 (emphasis added).)
Procedure No. 38.00 also provides that "an approved Health Services Request Form will be provided in each housing unit or other designated areas", and that "[w]ritten requests will be collected daily at scheduled times in each designated area." Once the inmate medical request slips are collected, "[t]riage decisions, or inmate assessment, will be documented on Health Services Request Form or Medical Record." (Id.)
Under the above procedures, this medical request slip system allowed inmates themselves to place requests for medical care in boxes at the unit command post, or "pod", which then were emptied by nurses at the end of the day. Corrections officials do not have keys to these boxes. (Rahman Dep. at 136:17 to 138:12, 154:15 to 158:7.) Once the slips are emptied from the pod boxes, the requests are then reviewed by CMS employees acting in their capacity as CCCF health care providers.
B. Andrews' Incarceration at CCCF
It is undisputed that Andrews was held on misdemeanor drunken driving charges at CCCF, area 3 South, from June 13, 1996 until June 21, 1996. Andrews has testified that he was medically screened after his admission to CCCF, and reported no medical problems to the screening personnel. (Andrews Dep. at 95:4-25, Pl. Ex. F.) At this screening, the condition of plaintiff's teeth was listed as "good", and the condition of gums was marked as "healthy". (Pl. Ex. H at 4.) Upon admission, Andrews was given an inmate handbook, which described the procedure to follow if he needed medical attention. (Id. at 60:3-17.) Andrews has testified that he understood the handbook as providing that if he had any type of medical problems, he was to submit a medical request form. (Id. at 10-17.)
Five days after being taken into custody at CCCF, facility Counselor John Penn conducted an intake interview of Andrews on June 18, 1996. (Penn Dep. at 12, Pl. Ex. E.) Apparently, part of the social work intake interview protocol is for the interviewer to make note of inmates' medical needs. (Id.) Penn noted that Andrews was suffering from "flu symptoms", and noted this in a typed memorandum captioned "Inmates with Possible Med. Issues" addressed to Dr. Rahman. (Penn Mem. to Rahman, Pl. Ex. D.) Rahman has testified that he never received this memorandum, and that he never received any such memos from counseling staff because the sole mechanism for notifying CMS of medical needs was the above-detailed system of "sick call". (Rahman Dep. at 154:15 to 158:7.) It is unclear from the record before the Court why such memos were prepared if not for the purpose of notifying Medical Staff of inmate needs. A reasonable factfinder could conclude that Penn's memo was sent to Dr. Rahman.
Andrews has testified that, soon after his interview with Penn, he developed a severe, infected toothache, which rapidly reduced him to a sweating, weakened state. (Andrews Dep. at 98-107.) While in this weakened state, Andrews states that he saw a man he thought to be an African-American nurse or doctor wearing a cast come into his cell to check on Andrews' cellmate's hand injury . (Id. at 98:13 to 99:9.) Andrews alleges that he requested medical attention from this man, *fn4 who purportedly responded by asking Andrews if he was withdrawing from drugs. (Id. at 100:4-6.) Andrews reported that he was not, and the man left. (Id.) Andrews did not see this individual again, and received no medical care of any sort. (Id.) There is no note of this interaction in the record, and no indication that CMS personnel followed the CCCF health policy of making "rounds in segregation areas to solicit healthcare requests from segregated inmates" like Andrews, as provided in Procedure No. 38.00.
After his release from lockdown, Andrews alleges that on three separate occasions he made his way to the Unit "pod" and verbally requested medical attention from several unidentified Correctional Officers (C/Os) stationed there. While he cannot recall the specific dates or times, Andrews has testified that on each occasion he complained of his pain and illness, and a C/O then would give Andrews the proper form. Andrews states that he then would fill it out, writing that he needed to see a doctor or a dentist, and would personally put the form in the sick call box there at the pod, which was the only box present. (Id.) Despite Andrews' recollection of filling out these forms, there is no record that he did so in relevant log notes, and Andrews never received treatment at CCCF. (CCCF post logs, Pl. Supp. Ex. D.)
According to CCCF log records, Dr. Rahman was present on the block area in 3 South on June 18, 19 and 20, 1996, but never saw plaintiff. (Id.) Moreover, Rahman testified that he never received the memo addressed to him by counselor Penn, and that there was no system of delivery set up so that such a memo would be routed to him or any other Doctor on duty. (Rahman Dep. at 157-60.) According to Rahman, the counselor's job in instances where an inmate appears to be ill is to make sure that the inmate has and is able to fill out a sick call slip. Rahman also states that if a counseling "health needs" memo has been generated, the inmate more than likely already has filled out a sick call slip. (Id. at 165:5-10.)
During this period, Andrews' medical distress was obvious to his cellmate, Maurice Williams. Mr. Williams, in a signed statement, described his observations from the four days during which he shared a cell with Andrews. According to Williams, "their [CCCF's] rules are that you don't get to talk to anybody until after that 7-day period". Williams described Andrews' condition as "he had a bad toothache and kept asking for something for pain" but "[they] never gave him anything." Williams maintains that Andrews "didn't eat" and his "mouth was all swollen like it was abscessed." Williams also contends that, despite Andrews' obvious distress, the guards did nothing because they "thought [Andrews] was on drugs", and "[they didn't care what was wrong with him." (Williams Stmt. Dated December 4, 1998, Pl. Ex. G.)
Camden County released Andrews from its custody on June 21, 1996. (Id. at 115:25 to 116:2.) Apparently perceiving her son to be very ill, Andrews' mother immediately took him to the emergency room at West Jersey Hospital, Berlin Division, where he was promptly admitted and diagnosed with sepsis--an overwhelming systemic infection of the bloodstream--and multiple organ failure due to the sepsis. He remained hospitalized at West Jersey, and later at Our Lady of Lourdes Hospital, for a combined total of over four months. Hospital records indicate that during his hospitalization, Andrews had at least two operations and nearly died as a result of his sepsis and organ failure. (West Jersey Hospital Discharge Summary, Pl. Ex. P at 4.) Presently, Andrews suffers from chronic diabetes, which may or may not have been caused by the infection, and now requires dialysis due to kidney damage. (Id. at 118:3 to 130:24.)
Plaintiff filed suit in this Court on June 5, 1998, and filed his current amended complaint on September 3, 1999. Plaintiff's amended complaint claims that all defendants violated his rights under the Fourth, Fifth, Sixth, Eighth, Thirteenth and Fourteenth Amendments of the federal constitution in violation of 42 U.S.C. §§ 1983, 1985, 1986 & 1988, and asserts state law claims of negligence, intentional and negligent infliction of emotional distress against all defendants, and a claim of medical malpractice against CMS and Dr. Rahman. (Am. Compl. ¶¶ 61-119.) Plaintiff has particularly pleaded a claim that defendants engaged in a pattern, practice or custom of condoning, and/or acquiescing to the denial of necessary medical treatment by corrections officials and officers in reckless disregard of the rights of inmates. (Id. at 95.) Defendants presently challenge plaintiff's § 1983 claims on the basis that he has not come forward with evidence of willful indifference. Camden County also seeks summary judgment as against plaintiff's claims against Sheriff McLaughlin and Warden Owens, both on grounds of insufficiency of evidence and qualified immunity.
A. Summary Judgment Standard
A court may grant summary judgment when the materials of record "show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(c). A dispute is "genuine" if "the evidence is such that a reasonable jury could return a verdict for the non-moving party." See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A fact is "material" only if it might affect the outcome of the suit under the applicable rule of law. Id. Disputes over irrelevant or unnecessary facts will not preclude a grant of summary judgment. Id.
In deciding whether there is a disputed issue of material fact, the court must view the evidence in favor of the non-moving party by extending any reasonable favorable inference to that party. See Aman v. Cort Furniture Rental Corp., 85 F.3d 1074, 1080-81 (3d Cir. 1996); Kowalski v. L & F Prods. , 82 F.3d 1283, 1288 (3d Cir. 1996); Meyer v. Riegel Prods. Corp., 720 F.2d 303, 307 n.2 (3d Cir. 1983), cert. dismissed, 465 U.S. 1091 (1984). The threshold inquiry is whether there are "any genuine factual issues that properly can be resolved only by a finder of fact because they may reasonably be resolved in favor of either party." Liberty Lobby, 477 U.S. at 250; Brewer v. Quaker State Oil Refining Corp., 72 F.3d 326, 329-330 (3d Cir. 1995) ...