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Nassar v. Ruze

United States District Court, D. Massachusetts

March 21, 2018

PATRICIA RUZE, et al., Defendants.



         This 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.

         Currently 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 GRANTED.


         Since 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”)[1] stems from Defendants' statement of facts and supporting evidence. [ECF No. 83] (“Defs. Facts”).

         A. Plaintiffs Medical Care at MCI Concord

         In 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.

         On June 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 at 27].

         On June 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

         At LSH, 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. ¶ 40.

         On 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.

         B. Plaintiff's Medical Care at MCI Norfolk

         On 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.

         On 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.

         On 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.

         On 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.

         The day 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].

         When 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[2] 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”), [3] 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.

         After 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 ...

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