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Zingg v. Groblewski

United States District Court, D. Massachusetts

September 29, 2017

JENNA ZINGG, Plaintiff,



         This case concerns the medical treatment of Plaintiff Jenna Zingg, who was held pending trial in the Massachusetts Correctional Institute-Framingham ("MCI-Framingham") for approximately six months. She has sued Defendants Thomas Groblewski and the Massachusetts Partnership for Correctional Healthcare ("MPCH") for common law negligence and under 42 U.S.C. § 1983, alleging that they acted with deliberate indifference to her serious medical needs in violation of the Eighth and Fourteenth Amendments by failing to adequately care for her psoriasis and psoriatic arthritis. Defendants now seek partial summary judgment on the § 1983 claim For the reasons that follow, Defendants' motion is ALLOWED.

         I. BACKGROUND

         Because this is Defendants' motion for summary judgment, the Court must construe the facts in the light most favorable to Plaintiff, drawing all reasonable inferences in her favor. See Feenev v. Corr. Med. Servs., Inc., 464 F.3d 158, 161 (1st Cir. 2006). Accordingly, the factual summary that follows is culled from Plaintiffs statement of facts ("PI. Facts") [ECF No. 56] and those portions of Plaintiffs response to Defendants' facts ("PI. Resp.") [ECF No. 55] that indicate the lack of a factual dispute. Additional facts are reserved for later discussion.

         A. Plaintiffs History with Psoriasis

         Plaintiff was a pretrial detainee in MCI-Framingham from March 12, 2013, to September 5, 2013. PI. Facts ¶ 1. Before entering that facility, she had a long history of severe psoriasis dating back to 2003. Id. ¶2. Psoriasis is a chronic inflammatory condition that causes red, scaly plaques to form on the skin. Id. ¶¶ 3-A. These plaques are often itchy and painful. Id. ¶4. Plaintiff had suffered from numerous forms of psoriasis that at times covered up to 30 percent of her skin. Id. ¶ 6-7. She also had a history of joint pain and swelling, which was probably a form of psoriatic arthritis. Id. ¶¶ 14-15.

         There are at least two types of drugs used to treat psoriasis: topical medications, which are applied to the skin, and "systemic" medications, which are internal and target the immune system See Mi ¶¶ 9, 11. Prior to entering MCI-Framingham, Plaintiff had tried various topical treatments for her condition, including one weaker drug, a vitamin D analog called Dovonex, and one stronger drug, a steroid called clobetasol. Id. ¶9. These topical treatments failed to control her psoriasis. Li ¶ 10. She had also tried a systemic drug called methotrexate, but it caused her severe gastrointestinal side effects. Id. ¶ 11.

         Plaintiff responded well, however, to a systemic drug called Humira. Id. ¶ 12, 19. Humira works by suppressing the immune system Li ¶ 13. Although this increases a patient's risk of infection, with proper screening and monitoring Humira can be used safely. Id. While on Humira, Plaintiffs psoriasis was well-controlled and her skin was mostly clear of plaques. Id. ¶ 12, 19. Plaintiffs joint pain and swelling also subsided when she was on Humira. Id. ¶ 15, 19. Plaintiff had been taking Humira continuously for approximately 10 months when she entered MCI-Framingham Id¶ 18.

         B. Relationship Between MPCH, Dr. Groblewski, and Department of Corrections

         During Plaintiffs pretrial detention, two different contractors oversaw the medical care for prisoners housed at Department of Correction ("DOC") facilities, including MCI-Framingham. See PI. Resp. ¶¶ 2-5. Prior to July 1, 2013, UMass Correctional Healthcare ("UMass"), which is not a party to this case, was the medical contractor. Id. ¶¶2-3. As of July 1, 2013, Defendant MPCH took over those duties, entering into a contract with DOC to provide all medical and mental health services to those being held in DOC facilities. Id. ¶4.

         Defendant Groblewski is the statewide medical director for MPCH and has held this position since July 1, 2013. Id. ¶ 6. Prior to this position, Dr. Groblewski was the statewide medical director for UMass. Id. Thus, at all times relevant to this case, Dr. Groblewski was the statewide medical director for the contractor in charge of providing medical services to those housed in DOC facilities. See id.

         C. Plaintiffs Treatment at MCI-Framingham

         Plaintiffs first medical examination at MCI-Framingham occurred about nine days after she entered the facility, on March 21, 2013. PI. Facts ¶ 20. During this exam, a nurse practitioner noted Plaintiff s history of failed psoriasis treatments and that her condition was "well-control led on Humira." Id. It was also noted that Plaintiff was due for her next Humira shot on March 26, 2013.14

         On April 1, 2013, Patricia Casella, a physician's assistant ("PA"), submitted a request to refer Plaintiff to a rheumatologist at Lemuel Shattuck Hospital for the purpose of developing a plan of care, to include treatment for her psoriasis. Id. ¶ 21. On April 19, 2013, this request was denied, although it is unclear on this record by whom, with the recommendation that Plaintiff continue with on-site medical treatment "using an existing formulary."[1] Id. ¶24; ECF No. 46, Ex. 10 at 36.

         PA Casella appears to have been Plaintiff s primary point of contact with prison medical services during her period of incarceration. At a visit on April 25, 2013, PA Casella observed small spots of psoriasis on both of Plaintiff s elbows and noted that Plaintiff reported experiencing elbow pain since being offHumira. PL Facts ¶25. By this time, PA Casella had received Plaintiffs medical records from her regular dermatologist, which documented Plaintiffs history of failed psoriasis treatments and her positive response to Humira. Id. ¶¶ 26, 74-76. PA Casella nonetheless wrote that her plan was to prescribe clobetasol and a prescription shampoo. Id. ¶27.

         Meanwhile, between April and August 2013, Plaintiff submitted at least 15 "sick call request" forms-or "sick slips"-that described her worsening condition. Id. ¶¶ 22, 23, 30, 31, 32, 46, 48. The first, submitted on April 10, 2013, noted that she was two weeks overdue for her scheduled Humira shot and that her psoriasis had already begun to return. Id. ¶ 22. By early July 2013, she described plaques "all over" her body, covering her arms, armpits, thigs, hands, ears, feet, vaginal area, buttocks, and other areas, such that it hurt to walk or shower. Id. ¶ 31.

         PA Casella saw Plaintiff on July 12, 2013, noting the extensive presence of psoriatic plaques and joint pain. Id. ¶¶ 33-34. After this visit, PA Casella prescribed two medications, Humira and Dovonex, neither of which was on the drug formulary used by Defendant MPCH. Id. ¶ 35. In order to obtain approval for each of these drugs, PACasella was required to-and did- fill out non-formulary request forms. Id. Each form described Plaintiffs history of moderate to severe psoriasis, her lack of success on clobetasol over the prior months, her positive response to Humira before entering MCI-Framingham, and the severity of her then-current condition. Id. ¶ 36-37.

         As part of his job, Dr. Groblewski reviewed virtually all non-formulary requests made by MPCH practitioners, including the two just described. Id. ¶ 38-39. On July 15, 2013, he approved the request for Dovonex, but denied the one for Humira. Id. ¶ 41. This was Dr. Groblewski's first contact with Plaintiffs case. At this point, Dr. Groblewski had not examined Plaintiff or reviewed her medical records, and he knew nothing about her other than what PA Casella had included in the non-formulary request forms. Id. ¶¶ A2-A3, 69, 73.

         Plaintiffs condition continued to worsen. Id. ¶ 45. By late July 2013, Plaintiff s psoriasis had begun to interfere with her daily activities. Idi¶49. She experienced pain when sitting, walking, washing herself, and getting dressed. Id. ¶¶ 49, 50. Plaintiff also began to exhibit changes in behavior and mood. Id. ¶ 51. She became depressed, had trouble sleeping, and generally avoided others. Id. ΒΆΒΆ 32, 52, 53, 56. On July 30, 2013, a corrections ...

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