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Johnston v. Correctional Medical Services

December 23, 2008


The opinion of the court was delivered by: Simandle, District Judge



Plaintiff, formerly an inmate at South Woods State Prison ("South Woods"), has brought suit against his South Woods medical providers alleging that they were deliberately indifferent to his severe, and rare, congenital disease in violation of the Eighth Amendment's prohibition of cruel and unusual punishment.*fn1

Defendants Correctional Medical Services, Inc. ("Defendant CMS"), David Meeker, Regional Vice President of CMS ("Defendant Meeker"), Dr. Lionel Anicette, Medical Director of CMS for New Jersey ("Defendant Anicette"), and Dr. Abu Ahsan, Plaintiff's primary doctor ("Defendant Ahsan"), now move for summary judgment on grounds that Plaintiff has submitted no evidence which tends to show deliberate indifference on the part of Defendants [Docket Item 70].*fn2 The Court finds, for the reasons set forth below, that summary judgment is appropriate as to Plaintiff's claims against Defendants CMS, Meeker, and Anicette, but the Court will grant only partial summary judgment to Defendant Ahsan, because material facts are in dispute regarding Plaintiff's Eighth Amendment claim for refusal to provide necessary surgeries and pain medication.


A. Facts

Plaintiff suffers from bladder exstrophy, a congenital condition in which the bladder is exposed because of a poorly developed abdominal wall.*fn3 (Pl. Ex. A at 33; Ahsan Dep. at 50.)

It is an exceedingly rare disorder, appearing in one in 30,000 people. (Anicette Dep. at 97.) As part of his treatment for this condition, Plaintiff uses a reconstructed bladder, made from his intestines, though he retains his original bladder. (Pl. Dep. at 28-29; Ahsan Dep. at 51-52.) Plaintiff must drain his Koch pouch himself, by inserting a catheter into an opening in his abdomen, called a "stoma." (Pl. Dep. at 29; Ahsan Dep. at 40.) This new bladder is known as a "Koch pouch" and has had required numerous surgical revisions as part of its maintenance. (Pl. Dep. at 17-19; Ahsan Dep. at 51-52.) In total, Plaintiff underwent twenty-six surgeries to his abdominal area prior to his incarceration at South Woods. (Pl. Dep. at 17, 19.) All of these surgeries, and in fact all of Plaintiff's medical treatment, were performed by Dr. Terry Hensle, at Columbia Presbyterian Medical Center. (Id. at 17, 27.)

Plaintiff's condition is prone to various complications. In addition to bladder revisions, Plaintiff is at risk for urinary tract, bladder, and kidney infections. (Id. at 27-28.) He is in danger of a urinary obstruction, which if not treated immediately could lead to kidney failure. (Id. at 55-56.) Further, the repeated insertion of a catheter causes built up scar tissue, called "stenosis," that must be removed so that Plaintiff can continue to catheterize himself. (Id. at 29-30.) Plaintiff also has "fistulas," which are tracts that connect cavities in the body, but are not naturally occurring. (Pl. Dep. at 28; Ahsan Dep. at 118-19.) Instead, fistulas result, inter alia, from infection, surgical complication, and poor circulation. (Ahsan Dep. at 119.) On July 2, 2008, when Plaintiff arrived at South Woods, a fistula had developed from his lower abdomen, near an old incision site, and migrated into his bladder. (Pl. Ex. 1 at 15.)

Plaintiff received extensive medical treatment, of some form, while held at South Woods, and as evidenced by his voluminous medical records. Though he began his incarceration in the South Woods general population, on September 29, 2003, his primary care doctor at the time, Dr. Hoey, moved him to the Extended Care Unit ("ECU").*fn4 (Pl. Ex. 1 at 133.) From July 3, 2003, until he was released on July 26, 2006, doctors and nurses at South Woods regularly treated and tested Plaintiff for abdominal problems. (Pl. Exs. F-I.) In addition, South Woods staff brought him to various hospitals fifty-eight times over the course of his incarceration. (Pl. Dep. at 71-72.) During those visits he had radiology and urology consults, treatment for problems with his catheter, and testing and evaluation of his abdominal issues, including an endoscopy and a colonoscopy. (Def. Ex. E.)

Plaintiff does not dispute the facts of this course of care, but instead argues that it was deliberately inadequate. For ease in analysis, the Court will set out the facts as to Defendant Ahsan, and then turn to Defendants CMS, Meeker, and Anicette.

1. Defendant Ahsan

Sometime in April 2004, Defendant Ahsan became Plaintiff's primary treating physician. (Pl. Ex. 1 at 433-45.) Plaintiff was Defendant Ahsan's first and only patient with bladder exstrophy and he learned about the condition from free medical web sites. (Ahsan Dep. at 52-54, 56.) Though he does not know all the possible complications for Plaintiff's conditions, he's aware of at least the major risk - obstruction of the urinary tract which can lead to kidney failure. (Id. at 55-56.) Defendant Ahsan concedes that he is not an expert in Plaintiff's condition and that he does not know the details of Plaintiff's medical history. (Id. at 52, 55.) For this reason, Defendant Anicette explained that CMS primary care doctors when dealing with a rare condition like bladder exstrophy, "would be more reliant on the advice and recommendations coming from [] specialist[s]." (Anicette Dep. at 113.)

Among Defendant Ahsan's duties was the regulation of Plaintiff's pain medication. (Ahsan Dep. at 156, 161-62.) This was an important part of Defendant Ahsan's job, because, among other things, Plaintiff cannot self-catheterize without sufficient pain management. (Pl. Ex. 1 at 230.) From April 2004 through July 2004, Plaintiff had difficulty with pain. (Id. at 435-591.) From the record it appears that each time Plaintiff complained of pain, medical providers at South Woods gave him medication or increased the dosage of his pain medication, either the same day or within two days.*fn5 (Id.)

The Oxycontin appears to have effectively managed Plaintiff's pain, because from November 14, 2005 through April 13, 2006, Plaintiff only reported abdominal pain on four occasions. ...

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