United States District Court, D. Massachusetts
REPORT AND RECOMMENDATION ON DEFENDANTS' MOTION
FOR SUMMARY JUDGMENT (#182).
Page Kelley United States Magistrate Judge.
filed in the state superior court, this case was removed to
the federal court in November of 2014. When the complaint was
filed, plaintiff Nathan Marquis LeBaron was an inmate in the
custody of the Massachusetts Department of Corrections (DOC).
He has since been released.
Count I of the complaint, LeBaron alleges a claim for
retaliation. (#1-2 ¶¶ 153-58.) Count II
incorporates claims under the Religious Land Use and
Institutionalized Persons Act (RLUIPA) and the First
Amendment. Id. ¶¶ 160-66. A number of
federal constitutional claims under 42 U.S.C. § 1983,
and state constitutional claims under Massachusetts General
Laws chapter 12, §§ 11H and 11I, are alleged in
Count III. Id. ¶¶ 168-71. In Count IV,
LeBaron asserts a conspiracy claim under 42 U.S.C. §
1985. Id. ¶¶ 173-92.
October 24, 2017, defendants collectively filed a motion for
summary judgment, together with a memorandum in support and a
statement of undisputed material facts. (##182, 183, 184.)
LeBaron has filed no response to the dispositive motion.
extent that they are supported by the record, defendants'
material facts shall be accepted as true. Since July of
2013, defendant Massachusetts Partnership for Correctional
Healthcare (MPCH) has been under contract with the
Massachusetts DOC to provide certain medical and mental
health services to inmates in the custody of the department.
(#184 ¶ 2.) At all relevant times, defendant Lynn
Gillis, RN, was a Health Services Administrator (HSA) at
Massachusetts Correctional Institution - Shirley
(MCI-Shirley) and an employee of MPCH. Id. ¶ 3.
Defendant James Thompson, M.D., was a psychiatrist employed
by MPCH. Id. ¶¶ 5-6. Defendant Neal
Norcliffe, LICSW, was the mental health director at Old
Colony Correctional Center (OCCC) and an MPCH employee.
Id. ¶¶ 5, 9. Defendant Keelin Garvey,
M.D., was a psychiatrist at OCCC employed by MPCH.
Id. ¶¶ 5, 10. Defendant Joseph Toomey,
Ph.D., was a psychologist at OCCC and an MPCH employee.
Id. ¶¶ 5, 11. Defendant Linda Albohn,
LPN, was the prisoner Grievance and Appeals Coordinator
employed by MPCH. Id. ¶¶ 5, 13. Defendant
Paul Caratazzola was an HSA at OCCC and an MPCH employee.
Id. ¶¶ 5, 14.
grievance dated February 24, 2014, and received by HSA Gillis
on March 5, 2014, LeBaron complained that on February 15,
2014, he had urinated blood and large clots. Id.
¶ 16. Gillis responded to LeBaron on March 6, 2014,
stating that LeBaron had been evaluated by both nursing staff
and a medical provider for his symptoms, and that a doctor
would see him for a follow-up appointment. Id. On
April 11, 2014, LeBaron appealed this grievance; the appeal
was received by defendant Albohn on April 29, 2014.
Id. ¶ 17. In her May 2, 2014 response, Albohn
stated that LeBaron's urine sample had been sent to the
laboratory for testing and that a doctor would review the
results with him. Id.
June 23, 2014 grievance which was received on June 26, 2014,
LeBaron complained to HSA Caratazzola at OCCC that the HSA at
MCI-Shirley, defendant Gillis, had ignored a grievance he had
allegedly filed on April 11, 2014. Id. ¶ 18. In
his response four days later, Caratazzola informed LeBaron
that his grievance was being forwarded to the HSA at
MCI-Shirley for disposition. Id. On August 23, 2014,
LeBaron appealed this grievance. Id. ¶ 19.
Albohn received the appeal on August 28, 2014, and responded
on September 3, 2014,  stating that after a thorough
investigation, there was no evidence that plaintiff had filed
an April 11, 2014 medical grievance. Id. ¶ 19.
July 10, 2014 grievance received on July 11, 2014, LeBaron
claimed he needed dental braces. Id. ¶ 20.
Responding on July 14, 2014, Caratazzola stated that he had
reviewed LeBaron's medical file and discussed the matter
with the dental assistant. Id. Plaintiff was advised
to submit a sick call request slip to the dental assistant to
meet and discuss his concerns. Id. LeBaron appealed
this grievance on July 20, 2014; the appeal was received by
Albohn on August 4, 2014. Id. ¶ 21. Responding
two days later, Albohn advised plaintiff that after
investigation and discussion with the dental team, his
request for braces would not be granted. Id.
filed a grievance dated July 22, 2014, which was received by
HSA Caratazzola on July 25, 2014, in which plaintiff raised
issues about the mental health department. Id.
¶ 22. Caratazzola responded on July 29, 2017, explaining
that he had discussed plaintiff's concerns with defendant
Norcliffe, the Mental Health Director, and that the doctors
and the mental health team at OCCC had determined that
LeBaron's mental health case should remain open based on
clinical information and risk factors. Id.
Plaintiff's August 4, 2014 appeal of this grievance was
received by Albohn on August 25, 2014. Id. ¶
23. Responding two days later, Albohn stated that, in
accordance with the mental health team's review, his
mental health case would remain open. Id.
grievance dated July 23, 2014, that was received by HSA
Caratazzola on July 30, 2014, LeBaron took issue with certain
urology appointments and requested specific medical
treatment. Id. ¶ 24. Caratazzola responded on
July 31, 2014, noting that plaintiff had been examined by the
doctor two days previously and that the doctor had submitted
a dermatology referral which was waiting for approval.
Id. LeBaron appealed the grievance on August 14,
2014; the appeal was received by the grievance appeals
coordinator on August 25, 2014. Id. ¶ 25.
Albohn responded on August 27, 2014, stating that the request
for a dermatological consult was still pending and that
plaintiff's request for a biopsy could not be granted at
that time. Id. Albohn also enclosed a copy of the
MPCH grievance and appeal form, which included the new
address to which appeals were to be sent. Id.
August 19, 2014, plaintiff filed a grievance regarding a
cavity. Id. ¶ 26. HSA Caratazzola received the
grievance on August 21, 2014, and responded the same day,
stating that LeBaron had not reported this issue to any
medical personnel and suggested that he submit a sick call
request slip. Id. Plaintiff appealed the grievance on
August 14, 2014, which appeal was received by Albohn on
August 28, 2014. Id. ¶ 27. Albohn responded on
September 3, 2014, stating that she had learned plaintiff had
been transferred to another facility and informed him that he
must submit a sick call request slip to be seen by a dentist
at that institution. Id.
the remainder of 2014, LeBaron filed five grievances and five
appeals; Albohn responded to each appeal that was filed.
Id. ¶ 28.
Plaintiff's Medical Treatment.
February 15, 2014, LeBaron alerted MPCH staff at MCI-Shirley
that he was urinating blood. Id. ¶ 29. He gave
a urine sample that was witnessed by DOC staff, and the nurse
performed a urinalysis on it. Id. The testing showed
that the urine, which was clear yellow, had no indication of
blood or any other irregularities. Id. Later that
same day, plaintiff brought a urine cup of purple-colored
liquid to the Health Services Unit (HSU) from population.
Id. ¶ 30. The registered nurse on duty examined
this unwitnessed sample and observed that the liquid had no
characteristics of urine; the liquid was opaque, completely
purple and had no odor. Id. When a urinalysis was
performed, no blood was found. Id. LeBaron was
informed that a urine sample must be collected at, and tested
in, the HSU. Id.
days later on February 19, 2014, LeBaron was seen by the
medical staff after complaining that his “urine was
pure blood for about a minute and about 20 inches of
one-inch-thick blood clots at the end.” Id.
¶ 31, Exh. B ¶ 6, Exh. 1 at 003. LeBaron spewed
profanities and stormed out of the HSU; staff noted he had an
“odd affect.” Id. That same day, in
light of his behavior regarding his urine issues, plaintiff
met with Roselle Mann, LICSW, for a one-on-one mental health
session. Id. ¶ 32. LeBaron told Mann that he
“was pissing blood” and that the HSU staff
“tested it and said it was nothing.”
Id., Exh. B ¶ 7, Exh. 1 at 004. Plaintiff
thought the medical staff was lying to him, stating that he
was “almost bleeding to death.” Id. When
Mann empathized, LeBaron started crying. Id. Mann
was unable to dissuade plaintiff with logic, at which point
she noted that he “clearly [had] a persistent fixed
delusion and somatoform disorder, probably.”
Id., Exh. B ¶ 7, Exh. 1 at 005. Mann observed
that LeBaron “appeared his baseline self . . . but
fixed in his belief that he has a sickness and medical
doesn't care (see all notes/sick slips, past medical
work-ups that reveal no issues).” Id.
Plaintiff agreed to meet with Mann on a monthly basis; Mann
opened a mental health case on LeBaron. Id.
had a urinalysis done on March 4, 2014, that tested positive
for blood. Id. ¶ 33. The following day
plaintiff met with Dr. Hugh Silk, complaining that he had
blood and blood clots in his urine, there was a delay in
getting a urine sample and there was a conspiracy against
him. Id. Dr. Silk noted that while the urinalysis
was positive for blood, it was negative for anything else.
Id. He determined that plaintiff's blood and
urine should be retested with a follow-up in two weeks.
March 10, 2014, Elizabeth Louder, LICSW, completed a Mental
Health Status Update on plaintiff to evaluate his suitability
to go into segregation due to his involvement in a physical
altercation. Id. ¶ 35. While LeBaron had a
provisional diagnosis of delusional disorder, Louder saw no
sign of delusions during her meeting with him. Id.
Plaintiff denied suicidal ideation, intent or plan.
Id. Louder concluded that plaintiff presented with a
low risk for self-harm, but had mild paranoia at the time of
evaluation and overall displayed symptoms consistent with
somatic delusions. Id. Two days later LeBaron was
placed on a mental health watch, meaning that his mental
health was to be monitored more closely. Id. ¶
36. This change in status resulted from his expression of
delusional thinking and concern for his safety in the special
management unit (SMU). Id.
March 12, 2014, Mann completed a crisis treatment plan for
plaintiff's mental health watch. Id. ¶ 37.
She wrote that LeBaron was “beat up in a fight”
two nights earlier, and that he felt despairing, unsafe, and
“physically and emotionally dying.” Id.
Plaintiff was noted as having a history of suicidal behavior,
and he expressed belief in delusions that he was very sick
and that the DOC was conspiring to cover his illness.
Id. LeBaron believed that he had lost two quarts of
blood through his penis and that he “wouldn't mind
if God sent him on a mission to war … and [he] died
honorably in battle.” Id. While plaintiff
enjoyed a positive rapport with Mann, historically he was
paranoid with other medical and mental health staff.
Id. Mann placed plaintiff on a mental health watch
so he would be monitored until the next morning when a
psychiatrist could evaluate him for an 18(a)
admission to Bridgewater State Hospital (BSH), a
psychiatric care facility controlled by the DOC. Id.
completed an 18(a) Referral for LeBaron on March 12, 2014.
(#184 ¶ 39.) The stated reasons for the referral were
appears to have decompensated significantly with the past few
weeks with increasingly bizarre beliefs and delusions. He
appears unable to function within population or SMU, unable
to keep himself safe. . . . [He] has had long-standing ideas
about his physical ailments since 2010 that seem to have
dramatically exacerbated within the past few weeks with
persistent fixed delusions worsening.
Id. After reiterating that plaintiff appeared to be
quickly decompensating, delusional and despairing, Mann
requested that the BSH treatment team address the following
questions: 1. Is the inmate presenting with a delusional
disorder? 2. Would medication be helpful? 3. What treatment
recommendations would the team make? 4. How can this inmate
be helped to cope with prison life? Id.
was seen by Jeffrey Vanderyacht, LMHC, before his transfer to
BSH on March 13, 2014. Id. ¶ 40. Plaintiff
expressed the belief that he had a serious disease but that
the medical staff was covering it up, deliberately destroying
evidence and inciting other inmates to harass him.
Id. Vanderyacht recorded that plaintiff wanted to go
into population where he was likely to be assaulted, stating
“I'm willing to sacrifice myself for a noble cause
. . . I'd rather be beaten to a bloody pulp than
deteriorate slowly.” Id. Vanderyacht
determined LeBaron should be referred for psychiatric
evaluation to be considered for an 18(a) transfer for
evaluation and inpatient treatment. Id.
March 13, 2014, Dr. James Thompson evaluated plaintiff
pursuant to Mass. Gen. L. c. 123 § 18(a) for transfer to
BSH. Id. ¶ 41. In conducting this evaluation,
Dr. Thompson reviewed plaintiff's medical records, spoke
with Vanderyacht and interviewed LeBaron. Id. Dr.
Thompson related that in support of his alleged severe kidney
infection, plaintiff had recently presented health services
staff with a urine cup he claimed was filled with bloody
urine, but analysis revealed it contained neither blood nor
urine. Id. Plaintiff then presented a specimen he
claimed was part of his liver or a clot, but it was
neither. Id. Dr. Thompson noted LeBaron's
history of paranoid delusions as well as his belief that
there was a conspiracy to ignore his medical problems when
there was no concrete evidence of a medical problem.
Id. Plaintiff presented with these somatic
complaints and increased agitation. Id.
had been placed in SMU after a fight with a friend over a
typewriter ribbon, and he had decompensated further.
Id. Dr. Thompson noted that plaintiff had stated he
planned to put himself in a situation with other inmates
where he could get harmed or killed. Id. During his
interview, plaintiff had noticeable psychomotor agitation, he
was tangential in his thought patterns, and his judgment and
insight were impaired. Id.
Thompson agreed with the previous diagnosis of delusional
disorder and PTSD. Id. He opined that plaintiff
could not be managed in his current setting at MCI-Shirley,
and that he should be transferred to BSH for evaluation and
Berggren, M.D., is the Director of Psychiatry and Behavioral
Health for Centurion, LLC. (#184, Exh. B ¶ 1.) Dr.
Berggren is board certified in psychiatry, and is familiar
with the practice of psychiatry in the penal setting, having
worked for the contracted medical and mental health provider
for the Vermont Department of Corrections as the Director of
Psychiatry and Behavioral Health since 2015. Id.,
Exh. B ¶¶ 1-2. Dr. Berggren reviewed and was
familiar with plaintiff's medical and mental health
records from February 15, 2014 to April 4, 2014.
Id., Exh. B ¶ 3. In Dr. Berggren's clinical
The mental health providers at MCI-Shirley provided
[plaintiff] with the care clinically indicated for his
conditions and were not deliberately indifferent to
[plaintiff's] serious medical needs. After reviewing the
documents Dr. Thompson relied upon in making his 18(a)
evaluation, Dr. Thompson properly referred [plaintiff] for
further psychiatric care at BSH. [Plaintiff] received
appropriate and adequate care from the mental health staff at
MCI-Shirley from February 15, 2014 to March 13, 2014.
Id., Exh. B ¶ 17.
Bridgewater State Hospital.
March 13, 2014, LeBaron was transferred to BSH pursuant to
Mass. Gen. L. c. 123 § 18(a). Id. ¶ 43.
The Admission Note authored by Brittany Irwin, LCSW, reflects
that Vanderyacht called her at BSH before plaintiff was
transferred to report clinical issues. Id. In
addition to reviewing plaintiff's recent mental health
issues, Irwin noted that plaintiff had a provisional
diagnosis of delusional disorder and PTSD.
was evaluated by Dr. Christopher Myers upon admission to BSH
on March 13, 2014. Id. ¶ 44. According to Dr.
Myers, plaintiff told him that he had urinated two quarts of
blood and large chunks of what looked to be pieces of his
liver, and that this “evidence” had been
discarded. Id. Plaintiff presented as unstable,
hyperactive and paranoid with limited insight/judgment.
Id. He had a rapid rate of speech and a tangential
thought process. Id. He appeared agitated; presented
as emotionally labile; and was noted to have thought
disorganization and somatic delusions. Id. Dr. Myers
deemed plaintiff to be an imminent risk of serious harm to
was held in seclusion throughout the night of March 13, 2014,
into the morning of March 14, 2014. Id. ¶ 45.
At three different times during the night and early morning
hours, medical staff attempted to assess him, but he was
sleeping. Id. ¶¶ 46-48. At 8:10 a.m. on
March 14, 2014, Dr. Andrey Gagarin was able to evaluation
LeBaron. Id. ¶ 49. He communicated in an angry,
hyperverbal manner and was visibly disturbed. Id.
Plaintiff believed he had multiple injuries and no one
cared. Id. He was viewed as suffering from continued
distress and agitation surrounding his delusional beliefs.
Id. Dr. Gagarin found plaintiff was at substantial
risk of committing serious physical assault and serious
destructive behavior. Id. The doctor prescribed an
intramuscular injection of Haldol and Benadryl, and approved
the use of four point restraints to facilitate the
administration of emergency involuntary treatment for
LeBaron. Id. ¶ 50.
being placed in restraints, plaintiff was checked by a nurse,
was administered the medication fifteen minutes later, and
was monitored by a mental health worker throughout the
process. Id. He was released from the restraints
immediately after the injections; he was in the restraints
for a total of seventeen minutes. Id. Plaintiff
continued to be monitored by the nursing staff. Id.
p.m. on March 14, 2014, plaintiff was again examined by Dr.
Gagarin. Id. He was described as calm, cooperative
and apologetic. Id. The doctor concluded he had
improved sufficiently to be released from seclusion.
Id. Although Dr. Gagarin ordered Risperidone at bed
time that evening, plaintiff refused the medication and he
was not forced to take it. Id. ¶ 52.
Berggren's clinical opinion,
[A]t 8:00 AM on March 13, 2014,  [plaintiff] required
emergency psychiatric medication to prevent immediate and
substantial deterioration in his medical condition.
[Plaintiff] presented as an imminent risk of serious harm to
others, and presented with a serious threat of extreme
violence and personal injury. . . .
Dr. Gagarin acted appropriately in administering emergency
medication for [plaintiff] given that [plaintiff] had been
experiencing delusional beliefs prior to admission to BSH,
his distress had been escalating to the extent that he
required admission to BSH and was placed in seclusion, and
given the risk of continued and possibly irreversible decline
in his symptoms and mental illness. . . . Plaintiff was
unable to make informed medical decisions on his own behalf.
Dr. Gagarin provided [plaintiff] with the care clinically
indicated for his condition and was not deliberately
indifferent to [plaintiff's] serious medical needs.
Id. ¶¶ 54, 55.
April 10, 2014, LeBaron was transferred from BSH to
MCI-Shirley. Id. ¶ 56. That same day Louder
completed a mental status update on plaintiff, noting that he
stated he was on a fast. Id. ¶ 57. On April 15,
2014, plaintiff was transferred to OCCC. Id. ¶
Old Colony Correctional Center.
day he arrived at OCCC, plaintiff was interviewed by Joseph
Zimakas, LICSW. Id. ¶ 58. LeBaron stated that
he did not need mental health services and requested that his
case be closed. Id. Zimakas detailed the process by
which a mental health case was closed, and plaintiff
indicated his understanding. Id. LeBaron's
mental health case remained open. Id. The following
day plaintiff submitted a sick call request form wherein he
wrote, “Very eager to meet with the MH worker appointed
to help me work towards closing this ‘open mental
health case.'” (#184, Exh. C at 007.)
April 23, 2014, plaintiff submitted a sick call request form
about closing his mental health case so he could be
transferred to MCI-Norfolk where there was a synagogue. (#184
¶ 60.) Two days later he met with Vanessa
Martino-Fleming, LMHC, who explained the case closure
protocol and suggested plaintiff follow up with his primary
care clinician. Id. LeBaron submitted a sick call
request form on May 9, 2014, stating that he had yet to see
the clinician doctor about closing his mental health case.
Id. ¶ 62.
12, 2014, plaintiff met with Joseph Toomey, Ph.D., who
explained the health services available at OCCC. Id.
¶ 63. Dr. Toomey told plaintiff he would discuss the
status of his mental health case with the mental health
director and psychiatry so as “to make an informed
decision regarding [plaintiff's] need for mental health
services.” Id. Dr. Toomey drafted an initial
treatment plan for LeBaron on May 29, 2014. Id.
¶ 64. His primary diagnosis was adjustment disorder with
mixed disturbance of emotions and conduct. Id. The
doctor indicated that he planned to meet with plaintiff every
thirty days, and set a target date of July 23, 2014, for
resolution. Id. In the interim, plaintiff's
status would be monitored by the mental health team in order
to assess his adjustment and need for services. Id.
3, 2014, plaintiff wrote a letter to Dr. Toomey stating he
would like to meet with a psychiatrist so his mental health
case could be closed and he could be transferred to
MCI-Norfolk where he would have access to typewriters and a
law library. Id. ¶ 65. On June 9, 2014, Dr.
Toomey met with plaintiff for their monthly appointment and
gave him a copy of the initial treatment plan. Id.
¶ 66. While plaintiff understood the mental health
staff's obligation to monitor him, he disagreed ...