United States District Court, D. Massachusetts
MEMORANDUM AND ORDER ON MOTION FOR SUMMARY
ALLISON D. BURROUGHS UNITED STATES DISTRICT JUDGE
case concerns the medical treatment of Plaintiff Christopher
Michael Nassar, a state prisoner in the custody of the
Massachusetts Department of Correction (“DOC”)
who is currently incarcerated at the Massachusetts
Correctional Institution in Norfolk, Massachusetts
(“MCI Norfolk”), and was previously incarcerated
at the Massachusetts Correctional Institution in Concord,
Massachusetts (“MCI Concord”). Pursuant to the
Court's prior orders, several of the named defendants and
asserted claims have already been dismissed from this action.
[ECF Nos. 36, 45, 66]. The remaining Defendants are the
Massachusetts Partnership for Correctional Healthcare, LLC
(“MPCH”), a contractor that provides medical
services to inmates under the care and custody of the DOC,
and the following practitioners who worked at the
institutions where Plaintiff received medical care: Patricia
Ruze, M.D., Lawrence Churchville, M.D., Geraldine Somers,
M.D., Ziesl Mayaan, NP, and Byron Shoemaker, RN.
pending before the Court is Defendants' motion for
summary judgment on Plaintiff's remaining claims under 42
U.S.C. § 1983, which assert that Defendants acted with
deliberate indifference to his serious medical needs and
retaliated against him for filing this lawsuit. [ECF No. 81].
For the reasons stated herein, the motion is
Defendants filed their motion for summary judgment on May 30,
2017, Plaintiff has neither opposed the motion nor filed a
statement of material facts. The Court may therefore
“consider the summary judgment motion unopposed, and
take as uncontested all evidence presented with that
motion.” Perez-Cordero v. Wal-Mart P.R., 440
F.3d 531, 533-34 (1st Cir. 2006); see L.R., D. Mass.
56.1 (“Material facts of record set forth in the
statement required to be served by the moving party will be
deemed for purposes of the motion to be admitted by opposing
parties unless controverted by the statement required to be
served by opposing parties.”). Accordingly, the
following summary of the medical care that Plaintiff received
for his ulcerative colitis (“UC”) stems from
Defendants' statement of facts and supporting evidence.
[ECF No. 83] (“Defs. Facts”).
Plaintiffs Medical Care at MCI Concord
January 2013, Plaintiff complained of bleeding diarrhea with
mucus, which he said had begun six to seven years prior.
Defs. Facts ¶ 19. He underwent a stool analysis, which
returned negative for ova, parasites, and other bacteria.
Id ¶ 20. He also had a pending referral to the
Gastrointestinal Clinic (“GI Clinic”) at Lemuel
Shattuck Hospital (“LSH”), but on March 3,
Plaintiff refused to visit the GI Clinic, saying that he did
not wish to speak with the physicians at the GI Clinic for
any reason. Id ¶¶ 20-22. Plaintiff later
changed his mind about the GI Clinic consultation, and
Defendant Dr. Ruze rescheduled Plaintiff for an appointment
on April 9. Id. ¶ 23. On March 24, Plaintiff
conveyed in a sick slip that he did not want to visit the GI
Clinic and then refused to meet with a nurse practitioner to
discuss the sick slip. Id ¶¶ 24-25. On
April 9, he cancelled the appointment with the GI Clinic.
Id ¶ 26. Dr. Ruze asked a nurse practitioner to
discuss with Plaintiff his need for an appointment with the
GI Clinic, but he declined a visit from the nurse
practitioner. Id ¶¶ 27-28.
19, Dr. Ruze wrote a letter to Plaintiff to address the
concerns he had regarding intestinal disturbances, nausea, a
possible vitamin D deficiency, and a possible intestinal
infection. Id ¶ 30. She referenced his refusal
to attend his last two appointments with mid-level nurse
practitioners, who could diagnose and prescribe medication,
and explained that he needed to see a mid-level provider to
address his medical concerns. Id She also explained
that the primary method of diagnosing an infection in
patients with UC is to perform a colonoscopy, but before
undergoing a colonoscopy, Plaintiff needed to meet with the
GI Clinic so that his specialists could identify any unique
issues with his medical condition. Id; [ECF No. 83-3
23, in response to Plaintiffs complaints of shortness of
breath and swelling in both of his legs, a registered nurse
examined Plaintiff and observed no edema (excess of watery
fluid collecting in the tissues of the body) of his left leg,
but noted mild swelling of his right leg. Defs. Facts ¶
32. The following day, a nurse practitioner measured
Plaintiffs legs and noted slight edema of his ankles.
Id ¶ 33. On June 25, Plaintiff cut himself to
draw the attention of the medical staff to his inability to
pass urine. Id ¶ 35. A nurse practitioner
examined him and observed edema in both of his legs.
Id Labs that had been run the day before showed that
he had acute renal failure. To address the renal failure, the
nurse sent Plaintiff for urgent admission to LSH. Id
testing showed that Plaintiff had Minimal Change Disease (a
kidney disease wherein a large amount of protein is lost in
the urine) and glomerulonephritis (inflammation of the
kidney). Id. ¶ 36. The GI Clinic recommended
that, among other things, Plaintiff continue using a steroid
for three months, take Lasix as needed to achieve diuresis,
start a three-month course of Coumadin, and attend a
follow-up appointment with the GI Clinic. Id. ¶
36. Following his discharge from LSH on August 4, Plaintiff
initially refused to use prednisone, but Dr. Ruze explained
the need for prednisone and ultimately convinced him to take
the steroid. Id. ¶ 37. When Dr. Ruze examined
Plaintiff on August 26, however, he was refusing to take the
prednisone, as well as the Coumadin and Mesalamine, all of
which would have helped regulate his UC and
glomerulonephritis. Id. ¶ 38. One week later,
Plaintiff again refused to visit the GI Clinic. Id.
October 18, Plaintiff wrote a note to Dr. Ruze stating that
he did not feel well and that he feared that he had been
poisoned by a correctional officer. Id. ¶ 46.
Dr. Ruze asked that a nurse practitioner schedule an
appointment with Plaintiff. Id. ¶ 46. On
October 23, Dr. Ruze wrote a letter to Plaintiff, in light of
the recurrence of his bowel issues, and proposed collecting
stool samples to evaluate for blood, bacteria, and parasites,
and scheduling a telemedicine visit with the GI Clinic to
determine whether he was experiencing a UC flare or an
infection. Id.; [ECF No. 83-3 at 55]. Shortly
thereafter, Plaintiff transferred to MCI Norfolk and was no
longer under Dr. Ruze's care. Id. ¶ 48.
Plaintiff's Medical Care at MCI Norfolk
December 21, 2015, Plaintiff told a nurse practitioner that a
specialist said he should use narcotics to address loose
bowel movements, although no such recommendation existed in
his record. Defs. Facts ¶ 50. On January 1, 2016,
Plaintiff demanded opiates to treat his UC. Id.
¶ 51. The nurse practitioner explained to Plaintiff that
his record did not contain a recommendation for opiates and
that it was not the standard practice to prescribe opiates to
address his particular medical issues. Id Plaintiff
responded that he did not want to continue taking Remicade to
treat his UC, no longer wanted to visit with the staff at MCI
Norfolk, and refused to see the GI Clinic. Id.
January 27, Plaintiff consulted with the GI Clinic via
telemedicine and requested opiate therapy, but the GI Clinic
physicians did not feel comfortable recommending opiates,
which would not treat his underlying inflammation.
Id ¶ 52. They recommended that he provide a
stool sample for analysis, add fish oil supplements to his
medication list, increase his dosage of vitamin D, and have a
follow up appointment via telemedicine in six to eight weeks.
Id ¶¶ 52-53.
February 17, Defendant NP Mayaan prescribed Plaintiff a
one-month trial of opiate medication. Id ¶ 54.
She thought that because Plaintiffs UC had not yet been fully
controlled, pain medication might provide sufficient relief
to enable him to consider longer-term solutions. Id.
¶ 54. On March 15, Plaintiff again consulted with the GI
Clinic physicians via telemedicine. Id ¶ 55.
They recommended that he restart Remicade or another biologic
medicine that would treat his underlying UC, not just his
symptoms. Id; [ECF No. 83-3 at 64]. Plaintiff was
informed of the risks of developing colonic dysplasia,
particularly in light of stopping his UC medication, but he
declined to restart any UC medication and refused to have a
colonoscopy. Defs. Facts ¶ 55; [ECF No. 83-3 at 64-65].
On March 23, Plaintiff was found in possession of
“homebrew, ” an alcoholic drink made by inmates,
and had to begin weaning off his opiate medication, as
providers cannot prescribe narcotics to inmates found in
possession of illicit substances. Defs. Facts ¶ 57. NP
Mayaan encouraged Plaintiff to restart Remicade; Plaintiff
agreed to do so if he were also prescribed a low dose of
opiates. Id ¶ 59. He ultimately rescinded that
proposal and refused to restart Remicade altogether.
Id ¶ 60.
April 13, a registered nurse evaluated Plaintiff in response
to his claims that he was experiencing his worst UC flare and
that there was blood in his stool. Id ¶¶
63-64. That afternoon, Defendant RN Shoemaker saw Plaintiff
for complaints of rectal bleeding, and conferred with an
advance practice provider who said that she would examine
Plaintiff the next day. Id ¶ 64; [ECF No. 83-3
at 72]. The following morning, a certified physician's
assistant prescribed Plaintiff a low dose of prednisone to
alleviate the bleeding and UC flare. Defs. Facts ¶ 65.
On April 28, a certified nurse practitioner conducted a
chronic disease assessment of Plaintiff and also prescribed
him prednisone. Id ¶ 67. From May 3 to May 10,
Plaintiff was admitted to the Ambulatory Care Center at LSH
for his UC flare and had a colonoscopy, which showed moderate
intestinal inflammation. Id ¶¶ 69-70. The
GI Clinic also noted that it was considering Humira therapy
for Plaintiff and planned to follow up with him in two to
three weeks. Id ¶ 70.
after his return to MCI Norfolk, Defendant Dr. Churchville
examined Plaintiff, contacted LSH to discuss re-admitting
Plaintiff to manage his continuing pain from his UC flare,
and sent him to the emergency room at Norwood Hospital.
Id ¶¶ 74-75. Plaintiff was transferred
from Norwood Hospital to LSH where the physicians were in the
process of arranging Humira therapy for him, but they
acknowledged that there would be a delay because Plaintiff
needed to continue tapering off of prednisone. Id
According to the LSH physicians, obtaining authorization to
provide Humira to Plaintiff was also going to be
“challenging” given that Plaintiffs UC had been
“well-controlled” with Remicade for several
months until Plaintiff self-discontinued it, and then refused
to restart it, notwithstanding the GI Clinic's
recommendation that he do so. Id ¶ 76; [ECF No.
83-3 at 89]. Although Plaintiff had been told multiple times
that narcotics are not the appropriate choice for managing
inflammatory bowel pain, he demanded that the GI Clinic start
his Humira therapy and prescribe him Oxycodone or Tramadol
until he received Humira. Defs. Facts ¶ 76; [ECF 83-3 at
89]. According to the GI Clinic physicians, Plaintiff was
“demanding and manipulative when it [came] to his
medications, particularly pain medications, ” kept the
LSH staff from evaluating his bowel movements, and claimed
“that his UC symptoms [were] more severe than the
objective data demonstrate[d].” Defs. Facts ¶ 76;
[ECF 83-3 at 89].
Plaintiff returned to MCI Norfolk on May 20, he demanded pain
medication and refused all other treatment. Defs. Facts
¶ 78. He reported severe abdominal pain and numerous
bloody bowel movements, but refused to show the examining
nurse his stool. Id ¶ 81. On May 21, Plaintiff
again stated that he was in severe pain but would not let a
licensed practical nurse see his stool. Id ¶
82. The nurse noted a distended vein in Plaintiffs arm and
notified the on-call provider, who sent Plaintiff to the
Norwood Hospital emergency room. Id ¶ 82.
Plaintiff returned from Norwood Hospital that evening after
he refused medical treatment. Id ¶ 83. On May
23, Dr. Churchville observed that Plaintiff had
thrombophlebitis and ordered an ultrasound for Plaintiffs
left forearm, which was negative for deep vein thrombosis.
Id ¶¶ 86-89. Dr. Churchville ultimately
diagnosed Plaintiff with superficial thrombophlebitis and
called Dr. Ruze to discuss transferring Plaintiff to the
infirmary at Souza Baranowski Correctional Center
(“SBCC”),  in light of Plaintiff s noncompliance with
his providers' treatment recommendations, and because the
SBCC infirmary could provide closer monitoring than was
available at MCI Norfolk. Id ¶¶ 90, 92.
Dr. Ruze indicated that she would accept Plaintiff at the
SBCC infirmary so that Plaintiff could receive a
“higher level of care, ” given his behavioral
issues, UC, and the new diagnosis of superficial
thrombophlebitis. Id. ¶ 93.
Plaintiff transferred to the SBCC infirmary on May 24,
Defendant Dr. Somers examined Plaintiff and noted
thrombophlebitis in both of his arms, which she treated with
warm compresses. Id ¶ 94. Because Plaintiff
denied experiencing any abdominal pain, cramping, or loose
bowel movements, Dr. Somers provided him Motrin for comfort.
Id On May 26, Dr. Somers discharged Plaintiff ...