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CHRISTY v. ROBINSON
August 20, 2002
MICHAEL CHRISTY, PLAINTIFF,
DR. BEN ROBINSON, CORRECTIONAL MEDICAL SERVICES, DEFENDANTS.
The opinion of the court was delivered by: Irenas, District Judge.
Presently before this Court are Defendants Correctional
Medical Services' and Dr. Ben Robinson's motion for summary
judgment on Plaintiff Michael Christy's 42 U.S.C. § 1983 claim
alleging that Defendants were deliberately indifferent to his
serious medical needs in violation of his constitutional rights
under the Eighth Amendment. This Court has jurisdiction over
this matter pursuant to 28 U.S.C. § 1331, 1343. For the reasons
set forth below, the Court will grant Defendants' motion for
Plaintiff is a prisoner at the South Woods State Prison in
Bridgeton, New Jersey.*fn1 Up until January 7, 1999, the date
of his transfer to South Woods, Plaintiff was housed at Northern
State Prison. (Plaintiffs Compl.)
Plaintiff was hospitalized in July 1994 with a rare
combination of hepatitis A, B, and C. (Christy Dep. at 11:7-13,
attached as Exh. C to Def.'s Cert. in Supp. of Mot. for Sum.
Judg. (hereinafter "Christy Dep").). Plaintiff believes that he
contracted hepatitis C in 1985, approximately nine years before
he was diagnosed. (Id. at 11:23-12:2.) Plaintiff was diagnosed
with depression in the mid-1970's, but was never treated; he
also believes he may have been diagnosed with a psychiatric
disorder in 1982. (Id. at 29:19-23; 30:1-12.) Plaintiff
testified at his deposition that he had used drugs in the past
and had, on occasion, experienced drug induced hallucinations.
(Id. at 30:23-24.)
Plaintiff brings this claim under 42 U.S.C. § 1983 claiming
that Defendants violated his Eighth Amendment rights by ignoring
the opinions of specialists, refusing treatment of his hepatitis
C and related arthritis and failing to correct a past
misdiagnosis and treat him with the proper medication.*fn2
(Compl. at 4.)
In April 1998, while at Northern State, Dr. Trevor Parks
advised the Plaintiff that he suffered from rheumatoid arthritis
("RA"). (Christy Dep. at 23:11-24.) Later in July, Dr. Sherree
Starrett*fn3 wrote a consultation request for Plaintiff to
see a rheumatologist based on the new diagnosis of RA. (Christy
Dep. at 38:18-39:12); (CMS Christy 75-76, attached as Exh. B to
Def. Mot. for Sum. Judg. (hereinafter "Exh. B").) Dr. Starrett
noted that tests revealed Plaintiff had a positive RH
factor*fn4 and suggested disease modifying medications,
Lodine*fn5 and orthotics to alleviate
Plaintiffs symptoms. Id. Dr. William Ryan*fn6 saw Plaintiff
and issued a report on August 21, 1998 which noted Plaintiff's
medical history, including hepatitis A, B, and C. Dr. Ryan
observed that Plaintiff suffered from RA in multiple joints, and
made suggestions for prescription pain relief and treatment.
(Exh. B at CMS Christy 77-79; Christy Dep. at 39:10-25.)
Plaintiff received prescriptions for Lodine in October of 1998
and January of 1999. (Exh. B at CMS Christy 81-84; 88-89.)
In January 1999, Plaintiff was transferred to South Woods
State Prison. Pursuant to a contract with the New Jersey
Department of Corrections, Defendant CMS provides medical
services to inmates at South Woods through its independent
contractors. (Gambrell Cert. at ¶ 5.) From the time of
Plaintiffs transfer to South Woods until August 3, 2001,
Defendant Dr. Ben Robinson was the director of medical services
at South Woods. (Robinson Cert. at ¶ 3.) Dr. Robinson evaluated
and treated the patient on numerous occasions. (Id.) As
Plaintiff had been diagnosed with RA before his arrival at South
Woods, Dr. Robinson continued with a course of treatment for RA,
including evaluations, medications, consultations, and offers of
Dr. Suresh Kulkarni wrote a consultation request for Plaintiff
in April 1999, and noted the RA and a positive RH factor. (Exh.
B at CMS Christy 98.) In response to this request, Plaintiff was
seen by Dr. Ryan on May 14, 1999. Id. Again, there was a
diagnosis of RA and prescriptions given for Lodine and
In January 2000, a consultation request to rheumatology was
written for Plaintiff by Nurse Practitioner Brian Kidd ("NP
Kidd") and Plaintiff was sent to see Dr. N. Tika, a
rheumatologist at Robert Wood Johnson University Hospital in New
Brunswick, New Jersey. Dr. Tika was the first doctor to diagnose
Plaintiff with hepatitis C-related arthritis. While Dr. Tika did
not comment one way or the other as to Plaintiffs eligibility
for interferon/ribavirin therapy, he did advise Plaintiff that
treatment for his hepatitis C would relieve the symptoms of
hepatitis C-related arthritis. (Christy Dep. at 28:15-22.) Dr.
Tika provided Plaintiff with Naprosyn and recommended that
Plaintiff follow up with X-rays and blood work, including liver
function tests. (Exh. B at CMS Christy 134-35; Christy Dep. at
28:2-4.) In September 2000, Dr. Tika again noted a diagnosis of
RA and hepatitis C-related arthritis. He also prescribed an
increase in Plaintiffs Celebrex*fn8 dosage to 200 mg/twice a
day. (Exh. B at CMS Christy 163.)
The record indicates that Plaintiff signed for sixty tabs of
Celebrex, 200 mg each on May 14, June 14, and July 14. (Exh B at
CMS Christy 197, 200, 210.) Defendants also contend that
Plaintiff may have at most gone a few days without Celebrex,
because he had his sixty tablets from July 14.
In July 2001, a consultation request was written and Plaintiff
was seen by Dr. Gordon.*fn10 Dr. Gordon opined that Plaintiff
suffered from either RA or chronic hepatitis C
arthralgia/arthritis. (Christy Dep. at 61:17-62:1; Plaintiffs
Br. Sum. Judg. at Exh. 1.) Plaintiff was led to believe Dr.
Gordon ordered a regimen of blood work and informed the medical
staff at the prison that he was suffering from a hepatitis
C-related condition.*fn11 (Christy Dep. at 61:5; Compl. at 6.)
Dr. Gordon's report did not advise any significant changes in
Plaintiffs course of treatment.
After his consultation with Dr. Gordon, Plaintiff returned to
the prison medical station and informed Nurse Practitioner Fran
Green ("NP Fran Green") that he was diagnosed with hepatitis
C-related arthritis. Plaintiff contends that NP Green then
denied him his medication. (Christy Dep. at 85; Pl.'s St. of
Facts at 14.) Defendants do not deny that Plaintiffs
prescription for Celebrex was put on hold and subsequently
reordered on August 9 and reinstated on August 22. During the
period that Plaintiffs medication was suspended, he suffered
severe swelling and intense pain in his hands, feet and knees,
and also suffered anxiety attacks with depression and was placed
in one to one and group counseling. (Pl.'s Opp. Br. at 1, 5-6.)
Plaintiff notes that "out of sympathy," on August 18th and 19th
Nurse Dawn Green and Nurse Alex provided him with some Celebrex
and ice. (Christy Dep. at 85.)
Plaintiff contends that NP Green stopped treatment with
Celebrex because Plaintiff continuously inquired about his
status and questioned the accuracy of his diagnosis. (Pl. Opp.
Br. at 5-6.) Plaintiff also argues that NP Green and Dr.
Robinson, after treating the Plaintiff for such a long period of
time, knew or should have known that any discontinuation of his
medication would result in severe pain and suffering.
Defendants do not deny that Plaintiffs prescription was put on
hold. However, NP Fran Green contends that she placed the
prescription on "hold" after hearing from Plaintiff that Dr.
Gordon found he did not have RA because she thought it best to
review Dr. Gordon's report to ensure that Celebrex was still
appropriate. After reviewing Dr. Gordon's report on August 9, NP
Fran Green put in a reorder. NP Fran Green found that Dr.
Gordon's report did not prescribe any significant changes in
Plaintiffs course of treatment and indicated that Celebrex would
remain as Plaintiffs primary arthritis medicine. Plaintiffs
prescription for Celebrex was briefly delayed pending approval
by NP Fran Green's supervisor, Dr. Abu Ashan.*fn12 (Def.
Reply Br. at 6.)
Dr. Ben Robinson and the staff at South Woods had noted that
Plaintiff tested positive for hepatitis C. The status of
Plaintiffs hepatitis C was monitored through various laboratory
tests. (Robinson Cert. at ¶ 8.) Dr. Ben Robinson had not changed
his opinion that Plaintiffs RA and not his hepatitis C was the
cause of Plaintiffs arthritis. Plaintiff requested specific
treatment, interferon/ribavirin, which is a relatively new drug
treatment for hepatitis C. However, Dr. Robinson determined,
based on the results of several normal liver function tests,
that Plaintiffs hepatitis C was not at a point where it needed
to be treated with intensive drug therapy and, therefore,
Plaintiffs request was denied. (Id. at ¶ 9.)
The U.S. Department of Justice, Federal Bureau of Prisons
issued a Technical Reference Manual titled "Infectious Disease
Management," dated January 26, 1999, which governs the
evaluation and treatment of prisoners with hepatitis C.
(Attached as Exh. F to Def. Mot. for Sum. Judg.) While
prescriptions for interferon alone or in combination therapy
with ribavirin are acceptable treatments for hepatitis C, there
is an algorithm for treatment and a listing of regulations a
doctor must consider before prescribing interferon or
interferon/ribavirin therapy. Id. Dr. Robinson and his staff
found that Plaintiff was not a suitable candidate for the
treatment because his hepatitis C had not progressed far enough
along to justify such an intensive program of drug therapy.
Also, since Plaintiff had normal liver function test results and
because he failed to meet certain criteria listed in the
regulations, due to the fact he had a history of depression and
psychiatric illness and could possibly be released in the next
twelve months, it was determined that Plaintiff was not eligible
for interferon/ribavirin therapy.*fn13 (Robinson Cert. at ¶
9; Def. Mot. for Sum. Judg.) Based on Plaintiffs test results
and Bureau of Prisons regulations, Dr. Robinson and his staff
determined that drug intensive treatment was not appropriate and
instead proceeded with a course of action that included close
monitoring of Plaintiffs hepatitis C.
On October 26, 2001 in response to Dr. Robinson's and CMS'
alleged denial of treatment for his hepatitis C and alleged
misdiagnosis and mistreatment of hepatitis C-related arthritis,
Plaintiff filed a complaint in the District Court of New Jersey
alleging under 42 U.S.C. § 1983 that Defendants were
deliberately indifferent to his serious medical needs in
violation of the Eighth Amendment. On November 20, 2001, this
Court ordered that CMS arrange for Plaintiff to be examined by
two independent doctors, and that those doctors address the
following questions: "(1) Does Plaintiff have RA, and if so,
what is the appropriate treatment?; and (2) is Plaintiffs
hepatitis C advanced to a stage where treatment with interferon,
et. al., is appropriate?" See Christy v. Robinson, No.
01-4062, November 20, 2001 (order directing CMS to provide two
independent evaluations of Plaintiff).
Dr. Falasca, a rheumatologist at Cooper Medical Center, met
with the Plaintiff on December 20, 2001. He initially diagnosed
Plaintiff with osteoarthritis, but was unsure if Plaintiff also
suffered from RA or hepatitis C-related arthritis. (Exh. D to
Def.'s Mot. for Sum. Judg. (hereinafter Exh. D); Christy Dep. at
In a supplement to his handwritten report dated December 20,
2001, Dr. Falasca wrote a letter dated December 31, 2001 in
which he further elaborated on Plaintiffs case. (Exh. E to
Def.'s Mot. for Sum. Judg. (hereinafter Exh. E).) He first noted
the uncertainty in the medical field regarding the proper
methods for diagnosing and treating hepatitis C. He then
expanded on his diagnosis of osteo-arthritis and stated that the
nodules which Plaintiff complained about constantly and which
were said to be RA nodules by CMS medical staff are in fact
osteo-arthritic bone spurs. (Exh. E.) Dr. Falasca opined in his
December 31st letter that "based on clinical criteria alone, Mr.
Christy would easily meet the 1990 American College of
Rheumatology criteria for rheumatoid arthritis." Id. However,
Dr. Falasca remained uncertain whether Plaintiff suffered from
RA, or if he suffered from hepatitis C-related arthritis. Dr.
Falasca explained how the medical evidence could support a
diagnosis of RA or a diagnosis of hepatitis C-related arthritis,
and concluded with a list of tests which would be helpful in
making a more definitive diagnosis. Id. Dr. Falasca also
indicated his preference for traditional courses of treatment,
which would not include interferon/ribavirin therapy. Id.
In a follow-up letter dated May 13, 2002, addressed to Mr.
Holtzman, Dr. Falasca clarified his position and stated that
"there was no doubt in [his] mind at this time that [Plaintiff]
has naturally occurring rheumatoid arthritis." (Exh. H to Def.'s
Mot. for Sum. Judg. (hereinafter Exh. H).) Dr. Falasca further
opined that even if Plaintiffs arthritis was related to his
hepatitis C, the treatment that Plaintiff requests, interferon
and/or ribavirin, would not be the preferred treatment. Id.
Dr. Falasca commented that while the hepatitis C may limit some
treatment options for Plaintiffs RA, the hepatitis C is only a
"coincidental infection." Dr. Falasca concluded that Plaintiffs
current course of treatment is appropriate and that Defendants
had not deviated from standard practice. Id.
Dr. Joseph John, a physician at Robert Wood Johnson Medical
School/UMDNJ, Division of Allergy Immunology and Infectious
Diseases, was the second expert retained. He reviewed Plaintiffs
medical files and provided a report via e-mail on January 23,
2002 and a subsequent report, via mail on May 22, 2002.*fn14
(Exh. G & I to Def. Mot. for Sum. Judg.) Dr. John stated that a
liver biopsy could show the extent of inflamation, if any at
all, which could assist in determining what type of therapy, if
any, would be appropriate. However, Dr. John concluded that a
liver biopsy is "optional and not mandatory" and "assume[d
Plaintiff had] no signs of chronic liver disease." (Exh. G.) Dr.
John found Plaintiff would not need any therapy, because
Plaintiff had the disease for so long and there was a "lack of
hepatic enzyemia at this time (normal OT, PT)." Id. In his
later report, Dr. John cited more specific medical evidence to
support his conclusions, noting, for example, that Plaintiff
showed no signs of liver enlargement or disease and Plaintiffs
test results ...