United States District Court, D. Massachusetts
MEMORANDUM AND ORDER
ALLISON D. BURROUGHS U.S. DISTRICT JUDGE
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.
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.
Plaintiffs History with Psoriasis
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.
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.
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.
Relationship Between MPCH, Dr. Groblewski, and Department of
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.
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.
Plaintiffs Treatment at MCI-Framingham
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
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." Id. ¶24; ECF No. 46, Ex. 10
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.
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.
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. ¶
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.
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.
¶¶ 32, 52, 53, 56. On July 30, 2013, a corrections