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DONALD
PELLETIER, as Personal Representative of the Estate of Ronald H. Pelletier,
Plaintiff v. MARTIN A. MAGNUSSON, et al., Defendants
Civil No. 00-212-B-K
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MAINE
201 F. Supp. 2d 148
MEMORANDUM OF DECISION n1
Donald Pelletier (Pelletier),
the personal representative for the estate of Ronald Pelletier (Ronald), filed
a complaint in the Maine courts seeking damages pursuant to 42 U.S.C. § 1983.
Pelletier claims that the defendants' failure to prevent Ronald from committing
suicide on October 3, 1998, while he was an inmate at the Maine [*150] State
Prison violated his constitutional rights. The matter was removed to this
court. (Docket No. 1.) The defendants in the action break down into two
distinct groups: "the medical defendants" and "the State
defendants." Pelletier alleges that the defendants were deliberately
indifferent to Ronald's safety in violation of the Eighth Amendment
proscription of cruel and unusual punishment. In this decision I consider the
summary judgment motion by the medical defendants: Michael Tofani, Bert
Beverly, Cecelia Blake, and Allen Briggs. For the reasons articulated below, I
GRANT the motion for summary judgment as to all the medical defendants.
DISCUSSION
During the relevant time period, these four defendants were employees of
Correctional Medical Services (CMS), a private contractor for the Maine State
Prison (MSP). At the times relevant Doctor Michael Tofani was a licensed
psychiatrist who treated patients on the Mental Health Stabilization Unit
(MHSU) on a weekly basis. Cecelia Blake was a social worker working full-time
during the weekdays on the MHSU at MSP. Doctor Bert Beverly was a medical
doctor provided to the prison by CMS and treated Ronald at times. Allen Briggs
was the regional supervisor of medical services for CMS and attended the Mental
Health Clinic Meetings that addressed MHSU inmate care.
A. Summary Judgment Standard and State of the
Record
As
movants, the defendants are entitled to summary judgment if "the
pleadings, depositions, answers to interrogatories, and admissions on file,
together with the affidavits, if any, show that there is no genuine issue as to
any material fact and that the moving party is entitled to a judgment as a
matter of law." Fed. R. Civ. P. 56(c). Pursuant to Local Rule 56, I limit
my consideration of record materials to the parties' statements of material
facts that are supported by citation to the record. D. Me. Loc. R. 56
("The court shall have no independent duty to search or consider any part
of the record not specifically referenced in the parties' separate statement of
facts."). In evaluating whether a genuine issue is raised I view all facts
in the light most favorable to Pelletier, drawing all reasonable inferences in
his favor. Santiago-Ramos v. Centennial
P.R. Wireless Corp., 217 F.3d 46, 52 (1st Cir. 2000).
However, I do not give weight to every fact that Pelletier has attempted
to place before the court in his response to the defendants' motion. As both
these and the State defendants point out (see Reply Mem. to Med. Defs.' Mot.
Summ. J. at 2 n.1; Reply Mem to State Defs.' Mot. Summ. J. at 1-2 & n.1),
Pelletier's opposing statement of material facts does not contain a separate
section of additional facts set forth in numbered paragraphs in a separate
section. See D. Me. Loc. R. 56(c). Consequently, the defendants' replies to
Pelletier's opposing pleadings do not include an opposing statement of material
fact as envisioned by subsection (d) of Local Rule 56. To the extent that
Pelletier has propounded additional facts that do not qualify or dispute the
defendants' statements of fact I have disregarded them for purposes of passing
on these motions. n2
[*151] B. Facts Not Disputed and In Dispute
It
is not disputed that Ronald Pelletier hung himself with his belt on Saturday,
October 3, 1998, in his cell on the stabilization corridor of the MHSU at the
MSP.
1. The Correctional Medical Services
Personnel
a.
Not disputed
Doctor Michael Tofani is a
psychiatrist who has been licensed to practice in Maine since 1978. In addition
to maintaining a private practice since 1978 he has worked in correctional
mental health at MSP as a consultant and then for CMS and Prison Health
Services, after privatization of some parts of the health care delivery at the
prison. While Ronald was at MSP Tofani provided consulting psychiatric services
for the prisoners, including Ronald, under his contract with CMS. His
responsibilities included evaluating inmates, initiating treatment, accepting
consultation referrals from members of the mental health team, and consulting
with the team.
The mental health team included, minimally,
a member of the nursing staff, a mental health social worker, and a
representative of the security staff. Before State defendant Doctor Stuart
Zubrod went on medical leave, a psychologist headed the team.
Defendant Cecelia Blake worked for the
Maine Department of Corrections from 1973 until 1998. At first she was a nurse
in the infirmary of MSP and from 1988 until 1998 she was a social worker. When
she retired as a Maine State employee she resumed work at the prison as an
employee of CMS, which employed Blake in the middle of August of 1998. n3
Blake's duties as a CMS employee were to be available to the inmates housed on
the MHSU, to transcribe orders given by Tofani when he consulted at the prison,
and to make sure the inmates were safe and took their medications.
b.
Disputed or qualified
The defendants assert that defendant Allen Briggs' CMS responsibilities
were "purely administrative." Pelletier qualifies this description,
asserting that those administrative duties included participating in clinic meetings
where decisions about patient care were made (Tofani Dep. at 32-33; Pl.'s Resp.
State Defs.' SMF Tab 5 at 26-31) and discussing with Tofani whether there
should be increases in psychiatric care (Tofani Dep. at 11). n4
2. Staffing of the MHSU
a.
Not disputed
Doctor Zubrod, a psychologist,
was the clinical director of the MHSU. He went on [*152] a health-related leave
of absence in June 1998 and Paul Lipman, a licensed clinical social worker,
assumed his responsibilities. n5 Zubrod and Lipman are state defendants. Blake
and Lipman were the only two clinicians assigned full-time to the MHSU. The
MHSU had a maximum capacity of thirty beds. Blake was the medical department's
representative on the "treatment team," and Lipman was the representative
of the mental health department. n6 Blake worked weekdays, but not evenings and
weekends.
b.
Disputed or qualified
The
defendants assert that Lipman, like Blake, worked weekdays but not evenings or
weekends. However Lipman was on-call when he was not present at the prison.
Pelletier qualifies the representations about coverage, noting that Lipman testified that the
on-call system was relatively new during the period at issue here and that this
newness might have impacted the exercise of the prison staff's judgment as to
whether or not to call in mental health staff. (Lipman Dep. at 14-16.)
Pelletier also asserts that there were no mental health workers on the MHSU in
the late afternoon, evenings, and throughout the night. (Lipman Dep. at 32-33.)
There were no mental health workers assigned to the MSHU other than Blake and
Lipman. (Blake Dep. at 12; Lipman Dep. at 9.) Pelletier cites to testimony in
the record that indicates that Diane White, a nondefendant licensed social
worker, came in "some Saturdays" (Stewart Dep. at 25; see also Lipman
Dep. at 16), "usually" on Saturdays (Lipman Dep. at 32-33), but that
she was not in on a Saturday in September when Lipman was called-in because of
Ronald's mental state (Lipman Dep. 16.) With respect to this final assertion,
it appears that Lipman was actually testifying that White was not there on
October 3, 1998.
The
defendants assert that Blake was satisfied that there was adequate coverage
because of the availability of members of the prison health care staff on
weekends. I agree with Pelletier that the referenced testimony is equivocal.
(See Blake Dep. at 19-20.) n7 Blake professed a lack of familiarity with the
specifics of the evening and weekend availability of mental health staff and
admitted that there were discussions regarding the lack of coverage on
weekends. (Id. at 19-20, 34-35.)
The
defendants assert that Blake at all times reported to a superior, first Zubrod
then Lipman, both employees of the Maine Department of Corrections. Pelletier
qualifies this assertion, citing deposition testimony by Blake that described
the period in which Zubrod took his leave as "very difficult" and the
question of who was her immediate supervisor as "a very difficult
question." (Blake Dep. at 11-12.)
[*153] 3. The Structure of the MHSU
a.
Not disputed
On
the MHSU there were four levels of supervision and care broken down into four
distinct corridors. The acute corridor was for inmates who were extremely
psychotic and who were an immediate danger to themselves or others. The
prisoners were not allowed clothing although at times they were provided with a
"safety garment" and a "safety blanket." Inmates were under
constant camera monitoring and were either monitored continuously or in
fifteen-minute physical checks.
The
sub-acute corridor was for inmates who were no longer in acute crisis and were
not a current danger to themselves or others. Staff physically checked the
inmates every fifteen minutes but there was no camera monitoring. These inmates
wore state-issued clothing with no belts. They were allowed an hour of exercise
on the corridor each day.
Inmates were placed on the stabilization corridor when it was determined
that they would benefit from a more therapeutic environment, with more light,
more freedom of movement, and more privileges. Cells were monitored by guards
at thirty-minute intervals and were not monitored with cameras. The inmates
could interact in an open corridor and had access to a television, exercise
equipment, and game tables. They were allowed their personal clothing,
including belts.
The
respite corridor was for inmates who were ready to return to the general population.
These inmates could go back and forth between MHSU and the general population.
With regards to MHSU placement decisions, in addition to members of the
treatment team, a guard would have the authority to make a temporary transfer
of an inmate to a more secure location if a crisis arose. Doctor Beverly had no
role in determining Ronald's housing placement during Ronald's time at MSP.
b.
Disputed or qualified
The
defendants assert that decisions about where inmates are to be housed from time
to time are made exclusively by the treatment team, who are the people "on
site." Doctor Tofani had nothing to do with setting up the MHSU, provided
no input into its structure, and was not included on these teams. Pelletier
acknowledges that Tofani had no input into the set-up or design of the MHSU,
but states that Tofani's duties included consulting with the team and that he
was in fact a member of these teams. (Tofani Dep. at 6, 12-13.) n8
The
defendants also assert that Briggs had no role in determining Ronald's housing
placement. Pelletier states that Briggs' authority and involvement in these
decisions included participation in the treatment team meetings where these
placement decisions were made. (Tofani Dep. at 32-33; Pl.'s Resp State Defs.' SMF Tab 5 at 26-31.)
[*154] 4. Training of the Correctional and
Security Staff
a.
Not disputed
Doctor Zubrod was the medical or clinical director of the MHSU from its
inception.
b.
Disputed or qualified
The
defendants assert that the MSP correctional staff must take a comprehensive
six-week training course on correctional practices when they are hired.
(Bartlett Dep. at 9; Stewart Dep. at 4-5.) As part of this comprehensive
training course correctional staff are trained to recognize the risks of inmate
suicide. (Bartlett Dep. at 10; Stewart Dep. at 5.) The training received by the
staff of the MHSU was "a fairly high level" vis-a-vis mental health
knowledge and recognition of people at risk. (Peterson Dep. at 65-66.) After
State defendant Officer Stewart started work on the MHSU he received additional
verbal training from the mental health staff on how to recognize the suicidal
tendencies of inmates. (Stewart Dep. at 6.) When State defendant Bartlett was
assigned to work in the MHSU he received some additional training respecting
inmate restraints and recognizing the effects of certain medications on
inmates. (Bartlett Dep. at 11.) Additionaly, members of the treatment team gave
informal training to MHSU guards. (Lipman Dep. at 11.) Tofani had no role in
training the employees of the Department of Corrections, and never had a
contractual obligation or assumed any responsibility for training of the
correctional staff. (Tofani Dep. at 13; Tofani Dep. at PP 3-4.)
Pelletier contests the defendants' factual assertions vis-a-vis training
sessions for the new unit conducted by Maine's Department of Mental Health,
Mental Retardation, and Substance Abuse, sessions that the defendants state
covered suicide. (See State Defs.' SMF P 16.) He also disputes the assertion
that defendants Roach and Zubrod oriented the MHSU staff on January 1, 1998, to
"the physical structure, security post orders, the working alliance of the
mental health personnel and security staff, procedures for handling emergency situations,
and suicide detections, prevention and
intervention." (State Defs.' SMF P 17.) Pelletier cites to Stewart's
deposition indicating that when he was posted to the unit he had no additional
mental health training to supplement the initial six-week training he received
when he first qualified as a corrections officer. (Stewart Dep. at 5, 7-8, 72.)
Stewart received only information on a day-to-day basis and had not seen
written policies prior to this litigation. (Id. at 6-7, 71-72.) Defendant
Bartlett had never seen the "MHSU Suicide Prevention and Intervention
Policy" prior to this suit and his only training in suicide prevention had
been when he first joined the Department of Corrections. (Bartlett Dep. at
9-12, 52-53.) Defendant Lipman, who was clinical director for the MHSU during
Ronald's detention, was hired to teach the initial training module on suicidal
ideation for the Department of Corrections. (Lipman Dep. at 8, 11-12.) The only
training on the MHSU Lipman speaks of providing was "informal," such
as describing schizophrenia and its symptoms. (Id. at 11.) He also was vague as
to whether there were written policies available. (Id. at 28-29.) With respect
to Tofani and training, Pelletier does not dispute that Tofani had no
contractual obligation to train the correctional staff but asserts that, while
he did not formally train staff members he did have conversation with them
about what to watch for in certain
inmates. (Tofani Dep. at 73-74.)
With respect to the defendants' assertion that prior to Ronald's suicide
there [*155] had been no suicides or attempts on the MHSU (see Bartlett Dep. at
60-61), Pelletier observes that the MSP does not keep statistics on attempted
suicides (see Pl.'s Resp. State Defs.' SMF, Merrill Interog. 13).
5. Communication Between Correctional and
Mental Health Staff
a.
Not disputed
During the times relevant to this suit, when starting their shift on the
MHSU incoming guards would be briefed by the guards they replaced. The incoming
guards would also review one log book maintained by Blake and two separate log
books maintained by correctional staff. n9 Sometimes the guard would speak with
Lipman or Blake who would tell them if there was anything out of the ordinary
going on and identify inmates who were having a bad day. The correctional staff
was also expected to inform the mental health staff about their interactions
with the MHSU inmates.
b.
Disputed or qualified
The
defendants describe Officer Bartlett as being under the impression that Blake
tried to keep a close eye on how the MHSU inmates were doing so that she could
keep the guards informed. (Bartlett Dep. at 72-73.) Pelletier responds by
disputing whether this impression had any basis. He notes that Bartlett stopped
working on the MHSU in August of 1998 and worked the MHSU on October 3 only as
a fill-in for another guard. (Bartlett Dep. at 8-9.)
6. The Clinical Operations of the MHSU
a.
Not disputed
Within twenty-four hours of an inmate's admission to the MHSU the
treatment team would meet to review his records. (Lipman Dep. at 35-36.) n10
The treatment team of the MHSU would typically create a treatment plan for each
inmate housed in the unit; this plan would consist of, among other things, the
goals of treatment, the medication regimen, recommendations for group
activities and outdoor exercise, and other matters related to a particular
inmate. n11 Members of the mental health team would meet every Thursday. One
representative from the security staff would attend. In the meeting they would
discuss mental health concerns people present had about any inmate in the
correctional system.
Tofani visited the MSP at least once a week, on Tuesdays, and was
available on-call in the event of a crisis. He was always responsive to the mental
health needs of the inmates when called by the treatment team. Members of the
treatment team would decide which inmates needed Tofani's attention during his
weekly visits. Tofani would be given a schedule that identified the patients to
be seen and that indicated their presentation and the [*156] team's concerns.
Tofani could also arrange to see an inmate if he received a page or a call
outside his regular visiting time.
Tofani prescribed psychotropic medications for certain inmates. His
standard practice was to limit the amount of time that would elapse between
visits with an inmate who was receiving psychotropic medication. His contact
would be frequent enough to monitor the inmate's response to the medications.
Doctor Beverly's role on the MHSU was limited to being a back-up for
Tofani if he was unavailable. n12
b.
Disputed or qualified
The
defendants assert that the treatment team would hold monthly meetings with
inmates on the MHSU during which they would inquire into the inmates' needs and
concerns. (Blake Dep. at 49.) They also state that individual and group
therapies were made available to all inmates on the MHSU. (Lipman Dep. at 29.)
Pelletier counters that this assertion is in dispute in light of the
missing documentation for the meetings
that were supposed to be documented. (Pl.'s Resp. State Defs.' SMF P 40; Tofani
Dep. at 29.)
The
defendants claim that Briggs "had no clinical responsibility whatsoever on
the MHSU." (Lipman Dep. at 75) Pelletier reasserts that Briggs
participated in the clinic meetings where treatment decisions were made and
that he had authority to approve increases in psychiatric care. (Tofani Dep. at
11, 32-33; Pl.'s Resp State Defs.' SMF Tab 5 at 26-31).
7. Treatment of Ronald Pelletier on the MHSU
a.
Through August 1998
i.
Not disputed
Ronald was transferred to MSP
from the Maine Correctional Center on July 30, 1998. The mental health team
spent more time working with Ronald than with most inmates on the MHSU.
Upon Ronald's admission to the MHSU the
treatment team met to review his medical records. n13 Ronald was first seen by
Tofani on Sunday evening, August 2, 1998. Ronald presented as a patient with a
history of severe mental illness who had been in treatment, was continuing
treatment, and appeared stable. On that first visit and throughout his
admission to the MHSU he exhibited a severe thought disorder marked by paranoia
and delusions. Tofani saw Ronald again on August 3, at which time Ronald was
agitated and experiencing auditory hallucinations and Tofani learned that
Ronald had been experiencing these problems for some time. Tofani entertained a
provisional diagnosis of schizoaffective disorder, which describes a severe
thought disorder marked by delusions and hallucinations along with lability of
mood. On August 3, 1998, Tofani wrote an order for Lorazepam, a muscle relaxant
and [*157] sleep inducer, to supplement the Haldol and Cogentin that Ronald was
already receiving. n14
On
August 5, 1998, Doctor Beverly ordered intramuscular injections of long acting
Haldol for Ronald. Ronald was also receiving daily doses of short-acting
Haldol. The use of both long-acting and short-acting Haldol was an appropriate
choice of medication to address Ronald's psychotic symptoms.
Tofani next saw Ronald on August 18, 1998. Ronald was despondent and
continued to hear voices, but was capable of communicating with Tofani about
the hallucinations and could be distracted from them by engaging in human
interaction. At this point Tofani discontinued the Tegretol that Ronald was receiving
and ordered Amitryptilene. He discontinued the anticonvulsant Tegretol because
he thought that it was no longer necessary, seeing no history of a genuine
seizure disorder and suspecting that this medication had initially been ordered
to treat seizures associated with detoxification. Blake notified Tofani by
phone on August 20 that Ronald felt that the newly prescribed Amitryptilene was
making him too sleepy during the day; as a result Tofani ordered it
discontinued.
As
already noted, Blake commenced work as a CMS employee on the MHSU in the middle
of August 1998. When she first encountered Ronald he was very frightened and
emotional, and would easily cry. Blake spent a great deal of time trying to
calm Ronald, help him adjust to prison life, and help assure he took his
medications. Blake saw Ronald's condition change on a day-to-day basis and
sometimes during the course of the day. During his entire stay on the MHSU
Ronald cycled rapidly from one emotional state to another. Most often he
presented to Blake as a patient who was frightened and needy, requiring and
receiving a great deal of attention. However, he was able to function quite
well at times. Ronald consistently said things that either overtly or
implicitly expressed his desire to die.
When
Ronald showed signs of being imminently self-destructive he was placed under
constant watch on the acute corridor. When he told the staff that he was
feeling better and when he exhibited behavior that was not psychotic he was
moved to a less restrictive and healthier environment. n15
Blake believed that Ronald
generally did best and was most stable when he was on the stabilization
corridor. The increased [*158] activity and opportunity for social interaction
on this corridor was perceived by the treatment team to be beneficial to
Ronald. To try and prevent Ronald from harming himself, Blake attempted to
remind him "that he was a good person, that he was loved and what he did
was bad, but that he was not a bad person." She took Ronald out for walks
as often as possible. She perceived that the attention that she gave him and
the opportunities to interact with other inmates in the general prison
population made him feel special. When Ronald refused to eat his meals Blake
would sometimes go into his cell and sit with him to persuade him to eat.
The
guards on the MHSU sometimes placed a radio outside Ronald's cell to give him
comfort.
ii.
Disputed or qualified
The
defendants state that Ronald was on the acute corridor from the time he was
admitted until August 8, 1998, at which time he was transferred to the subacute
corridor. (Lipman Dep. at 43-44.) On August 10, he was moved to the
stabilization corridor where he remained until August 16, at which point he was
transferred to the acute corridor. (Id. at 45.) Pelletier disputes this
description of Ronald's transfers. He states that the records show that Ronald
was transferred from acute (notated as MH-4) to subacute (notated as MH-3) on
August 3 and back to acute on August 4. (Lipman Dep. Ex. 7.) On August 7 he was
transferred to subacute. (Id.) He was transferred to MH-1 on August 10, and to
acute on August 16. (Id.) On the next day, August 17, he was transferred to
MH-1 then to acute on August 20. (Id.) He was back on MH-1 on August 31 and was
moved the same day to the subacute corridor. (Id.) On September 2, Ronald was
on the acute corridor again, and was moved back to subacute on September 4,
then back to acute on September 5. (Id.) On September 8 he was moved to subacute
and then back to acute. (Id.) On September 9 he went to the subacute corridor.
(Id.) On September 14 he was transferred to the acute corridor and was moved to
the subacute corridor on September 16. (Id.) On September 18 he made his final
transfer to MH-1 where he stayed until his death. (Id.) (There are also record
references that after September 18 there were brief stays back on the more
restrictive corridors.)
The
defendants assert that after his August 18 session Tofani next saw Ronald on
August 25, at which time Ronald was somewhat improved. He was eating, sleeping
better, and cooperating in taking his medications. (Tofani Dep. at 36-38.) At
this point Tofani's short-term goal for Ronald was to help him improve to the
point where he could safely be housed in an area other than the acute corridor.
(Id. at 41.) There were no windows on the acute corridor, and Tofani wanted
Ronald exposed to some sunlight in order for him to pay attention to his normal
biological rhythms and to be distracted somewhat from the frightening thoughts
that otherwise preoccupied Ronald's mind. (Id. at 43.) Tofani also felt it was
important for Ronald to have enhanced opportunities for exercise and human
interaction and to be relieved from the indignities and deprivations attendant
with being on the acute corridor (factors that could make Ronald's condition
worse). (Tofani Aff. PP 6-7; Tofani Dep. at 84.)
Pelletier "does not admit" this characterization of Ronald by
Tofani. His record disputation is that at the time of the August 25 session,
Ronald was on the acute corridor. (Pl.'s Resp. Med. Defs.' SMF PP 68, 72.) At
this time Ronald could not tolerate a lot of stimulation and the
stabilization [*159]corridor was very
noisy and chaotic. (Tofani Dep. at 44-46.)
The
defendants assert that during this time period Blake's interactions with Ronald
became more frequent overtime. And, as the guards became more familiar with
Ronald they called Blake more frequently to let her know that Ronald needed to
be seen. (Blake Dep. at 83.) Pelletier retorts that the contradictions in the
various logs render any information in the logs suspect, (see Spiller Dep. Ex.
1 at 188), and that there is no documentation of the more frequent calls from
the guards.
b.
September 1 through September 15
i.
Not disputed
Tofani next saw Ronald on September 1. Ronald was having a difficult
time coping with the level of auditory stimulation on the unit. Although Tofani
wanted Ronald to have the opportunity for human interaction he recognized that the
environment could overwhelm hin. Consequently, while Tofani did not want to
move Ronald back to the more restrictive environment he sought to find ways to
decrease Ronald's physical stimulation. At this point Tofani changed the time
when Ronald received his Lorazepam to bedtime.
Tofani saw Ronald again on September 8. Ronald's condition had
deteriorated and he was becoming self-destructive. As of this date Tofani was
not sure whether the conditions under which Ronald was living had contributed
to the return of his symptoms or whether additional time was required to see
whether the Haldol would work for him. On September 8, to compliment the
Haldol, Tofani ordered "Respiridone," "a newer generation
atypical antipsychotic" with which Tofani had enjoyed a great deal of
success. This change was made because Ronald was constantly concerned about his
medications and their side effects. Tofani believed that he could make Ronald
feel better without increasing the Haldol by making this medication change particularly
because the Respiridone could be administered in a liquid form.
On
September 14 Ronald was on the acute corridor. He complained that the voices in
his head were getting louder, that he wanted to die because doctors had made
him gay. He also stated that he wanted to have a normal life.
As
of September 15 Ronald was suffering miserably, awakening from sleep frightened
and screaming. On September 15 he scratched his skin with a plastic fork and as
result was moved from the subacute to the acute corridor. n16 On the 15th
Tofani reviewed and changed Ronald's medications. He added an extra dose of
Cogentin, calculated to alleviate "Parkinsonian-type side effects" of
the anti psychotics; Tofani thought that these side effects might have been
contributing to Ronald's agitation. Additionally, Tofani changed the schedule
for administering Lorazepam to Ronald. He also gave Ronald an injection of
Haldol. Tofani did not see Ronald again.
ii.
Disputed or qualified
The
defendants state that as of September 15, Tofani determined that it was worth
considering a drug named Clorazil for Ronald. Ultimately Tofani chose not to
order Clozaril for Ronald. He had two reasons. One, he did not believe that Ronald
was capable of giving fully informed [*160] consent to the administration of a
medication with potentially life-threatening side effects. Two, the
administration of Clozaril requires cooperation from the patient and weekly
blood draws, a procedure to which Tofani was confident that Ronald would not
agree. (Tofani Dep. 63, 91.) Tofani understood that Ronald's mental illness
meant that he had a great deal of difficulty agreeing to changes in his
medications and that he could not be relied upon to comply faithfully with
medication orders. (Tofani Aff. P 6.)
Advancing a claim that financial concerns motivated the Clozaril
decision, Pelletier admits that these two reasons against administration
existed but also alleges that Tofani had previously met resistance from CMS
vis-a-vis prescribing this drug due to the expense. (Tofani Dep. at 51-52.) n17
The
defendants assert that after September 15, Ronald was not put on Tofani's weekly
schedule because the mental health team perceived that Ronald was doing well.
(Tofani Dep. at 62-63.) Tofani, who respected and trusted Blake's and Lipman's
professional judgment, relied on Lipman and Blake in identifying the patients
that needed to be seen each week. (Tofani Dep. at 82; Lipman Dep. at 78.) On
September 15 Ronald slept through the night and there were no reports of
inappropriate or disruptive behavior. (Blake Dep. at 44.) n18 After September
15 Ronald's agitation was decreased but he still complained of voices telling
him what to do. (Id.) He was not floridly psychotic. Although he continued to
hear voices, he had a presence of mind to know that it was a voice he was
hearing, and was able to function and interact well. (Lipman Dep. at 51-52,
56-57.)
Pelletier asserts that other considerations were at work after September
15 in determining that Tofani would not see Ronald at his weekly visit. He
cites to the following record evidence to suggest that, in fact, Ronald was not
doing well. The Clinic Meeting Notes from September 15 indicate that Ronald was
becoming very time consuming and remained acute; was very ill, suicidal, and in
continuing crisis; complained of not sleeping well and hearing voices; and was
already heavily medicated. (Pl.'s Resp. Med. Defs.' SMF P 100; Pl.'s Resp.
State Defs.' SMF PP 53, 63; Pl.'s Resp. State Defs.' SMF Ex. 5 at 30.) Tofani
was never told that Ronald was agitated, which in Tofani's view was a concern
given Ronald's history of suicidal behavior (Tofani Dep. at 74.) n19 Tofani
believed that based on his experience with Ronald he would expect him to be
angry, [*161]agitated, hallucinating, and a suicide risk at all times. (Tofani
Dep. at 80.) He also indicated that someone in Ronald's state could not
"contract for safety" because of constant swings back and forth
between ideas and emotions. (Tofani Dep. at 84-85.) Finally, with respect to
the defendants' representations concerning this period, Pelletier complains
that the records are incomplete and therefore what documentation exists is of
dubious value. (See Spiller Dep. Ex 1 at 188.)
c.
September 16 and after
i.
Not disputed
On
September 16 Ronald was moved from the acute corridor to the subacute corridor.
On September 18 Ronald was moved from the subacute to the stabilization
corridor. Tofani had nothing to do with these moves; he felt comfortable with
Lipman and Blake making Ronald's housing arrangements. On September 18 Lipman
took Ronald for a long walk. At this point Ronald was not actively psychotic
and he seemed to be doing well. n20 On September 19 Ronald had an episode of
acting-out during which he cried that he did not want to be in jail.
Consequently he was moved briefly to the subacute corridor. Shortly thereafter
he was returned to the stabilization corridor.
ii.
Disputed or qualified
The
defendants state that on September 28 the mental health treatment team noted
that while Ronald had been very anxious and hearing voices on the previous day
he had been stable over the past few weeks. (Med. Defs.' SMF P 110; Blake Dep.
at 15, 54.) Although Ronald did not like participating in group therapy when he
first came onto the MHSU he did participate in a session on September 28, a
development that the treatment team took as healthy. (Lipman Dep. 67-68.) Blake
perceived Ronald to being doing "quite well" during the last two weeks
of his life in that he was interacting with other inmates, adjusting to being
on the unit, and taking his medications. She understood that his auditory
hallucinations were ongoing and remained a concern. (Blake Dep. at 54-55,
83-84.) She believed, based on her impression that he was generally doing well,
that the medications that Ronald was taking during his final two weeks were
working for him. (Id. at 84.)
Nothing that the mental health treatment team observed in Ronald's
behavior in the period leading up to his death aroused any suspicion that he
was an immediate danger to himself. (Lipman Dep. at 65-66.) Tofani perceived
the relationship between the treatment team and Ronald to be one of genuine
care, humanity, nurturing, and support. (Tofani Dep. at 83-84.) Tofani believed
that the environment that existed in the acute corridor, the most secure area
of the MHSU, interfered with Ronald's ability to recover or improve, that it
actually made his condition worse, and that keeping him in this environment for
his own safety was "inhumane." (Tofani Dep. at 84, 94.) Lipman
believed that keeping Ronald on the acute corridor for a lengthy period of time
would have been "traumatic," equivalent to torture. (Lipman Dep. at
77.)
Pelletier counters that the fact that the written records are
contradictory renders all the logs suspect. (Spiller Dep. Ex. 1 at 188.) He
repeats his allegations that the records for the MHSU are "incomplete,
incoherent, and have been tampered with." (Pl.s' Resp. State Defs.' SMF P
40.) He also notes that there is no mention of [*162] Ronald from September 25
through September 27 in the Daily Report Sheet or the Daily Log other than that
he had been seen by an LPN on Saturday night, September 26, and no reason for
the visit is given. (See State Defs.' SMF Ex. 2 at 530.) He observes that the
clinical meeting notes for September 29 indicate that on September 28 Ronald
was "very anxious and hearing voices." (Pl.'s Resp. State Defs.' SMF
Ex. 5 at 31.) Furthermore, Blake testified that Ronald expressed that "he
did not want to live" and that they heard these sentiments
"repeatedly every day." (Blake Dep. at 71.)
With respect to the defendants' allegations that Lipman and Tofani
believed that the acute corridor was detrimental to Ronald's mental health,
Pelletier cites Tofani's testimony about a pre-September 15 assessment of
Ronald and his conclusion that the stabilization corridor was overwhelming to
Ronald because he could not tolerate a lot of stimulation. (Tofani Dep. at 45,
47.) Tofani also believed that by
September 8 Ronald, continuing to deteriorate, had become
"self-destructive." (Tofani Dep. at 50, 54.) By September 15 he had
degenerated further, was as sick as Tofani had seen him, and was on a
"downward curve." (Id. at 57, 59.) Pelletier notes that the clinical
meeting notes for September 15 describe Ronald as being suicidal. (Pl.'s Resp.
State Defs.' SMF Ex. 5 at 30.)
Discussion
A. Has the Plaintiff Demonstrated the
Presence of a Genuine Issue of Material Fact as to the Asserted Constitutional
Violation that Prevents the Entry of Summary Judgment in Favor of the Medical
Defendants?
1. The Deliberate Indifference Standard
The fact that Ronald was able to
commit suicide in the prison while under the care of the medical defendants does
not make out a prima facie constitutional violation. The constitutional
protection that Pelletier asserts was infringed is the Eighth Amendment's
prohibition against cruel and unusual punishment. In cases such as this the
inquiry is whether the defendants were deliberately indifferent to Ronald's
medical needs (in this case his mental health and attendant physical safety).
Two
cases by the United States Supreme Court frame the deliberate indifference
inquiry: Estelle v. Gamble, 429 U.S. 97 (1976) and Farmer v. Brennan, 511 U.S.
825 (1973). The Estelle Court identified in the Eighth Amendment protection the
"government's obligation to provide medical care for those whom it is
punishing by incarceration." 429 U.S. at 103. It observed: "An inmate
must rely on prison authorities to treat his medical needs; if the authorities
fail to do so, those needs will not be met." Id. Unnecessary suffering
caused by denial of medical care is "inconsistent with contemporary
standards of decency." Id. The Court stated:
We
therefore conclude that deliberate indifference to serious medical needs of
prisoners constitutes the "unnecessary and wanton infliction of
pain," proscribed by the Eighth Amendment. This is true whether the
indifference is manifested by prison doctors in their response to the
prisoner's needs or by prison guards in intentionally denying or delaying
access to medical care or intentionally interfering with the treatment once
prescribed. Regardless of how evidenced, deliberate indifference to a prisoner's
serious illness or injury states a cause of action under [ § ] 1983.
Id. at 104-05 (footnotes and citation
omitted).
[*163] Estelle made clear that "inadvertent failure to provide
adequate, medical care" does not rise to the level of a constitutional
violation; "Medical malpractice does not become a constitutional violation
merely because the victim is a prisoner." Id. at 105-06. "In order to
state a cognizable claim, a prisoner must allege acts or omissions sufficiently
harmful to evidence deliberate indifference to serious medical needs." Id.
at 106.
In
Farmer the Court more clearly articulated the standard a plaintiff must meet to
hold a prison official liable under the Eighth Amendment. It identified two
prongs. First, the deprivation alleged must be "objectively 'sufficiently
serious."' 511 U.S. at 834 (quoting Wilson v. Seiter, 501 U.S. 294, 298
(1991)). Second, the defendant must have a culpable state of mind, which means in prison conditions cases, that
the defendant was deliberately indifferent to the inmate's health or safety.
Id.
The
first prong of this analysis is readily satisfied by Pelletier; the deprivation
suffered in Ronald's case is a "serious harm" by any measure. The
Seventh Circuit recently articulated the obviousness of this conclusion in a
prison suicide case. See Sanville v.
McCaughtry, 266 F.3d 724, 733 (7th Cir. 2001) ("It would be difficult to
think of a more serious deprivation than to be deprived of life, and thus plaintiff's
claim clearly satisfies the first element [of Farmer]."). That panel also
observed that in a case such as Ronald's there can be other injury prior to the
death, such as the failure to provide treatment for mental illness can be a
"serious harm" in and of itself.
Id. at 734.
With respect to this second prong, the Farmer Court clarified that the
requisite state of mind is reckless disregard of the risk, a terrain that is
somewhere between negligence and acting with the purpose of harming the inmate.
511 U.S. at 836. ("It is, indeed, fair to say that acting or failing to
act with deliberate indifference to a substantial risk of serious harm to a
prisoner is the equivalent of recklessly disregarding the risk."). It is a
subjective standard: the defendant must have consciously disregarded a substantial
risk of serious harm. Id. at 839-40.
With respect to the defendants' awareness of the risk the Court stated:
"An official's failure to alleviate a significant risk that he should have
perceived but did not, while not a cause for commendation, cannot under our
cases be condemned as the infliction of punishment." Id. at 838.
"Whether a prison official had the requisite knowledge of a substantial
risk is a question of fact subject to demonstration in the usual ways,
including inference from circumstantial evidence," "and a factfinder
may conclude that a prison official knew of a substantial risk from the very
fact that the risk was obvious." Id. at 842. Furthermore, Pelletier need
not prove that the defendants were subjectively cognizant of the danger of the
precise harm that befell him. Id. at
843-44.
Under the reasoning of Farmer if Pelletier can present evidence that
there was a substantial risk that Ronald was a danger to himself that was
"'longstanding, pervasive, well-documented, or expressly noted by prison
officials in the past'" and the circumstances suggest that the defendants
were exposed to the information concerning the risk, there would be sufficient
evidence for the trier of fact to find that the defendants had actual knowledge
of the risk. Id. at 842-43 (quoting
Brief for the Respondents). If the defendants merely refused to verify
underlying facts or refrained from confirming [*164] inferences of a risk
though they had a strong suspicion of impending harm, liability would still
attach. Id. at 843 n.8. Conversely, the
defendants might be able to show "that they did not know of the underlying
facts indicating a sufficiently substantial danger and that they were therefore
unaware of a danger, or that they knew the underlying facts but believed
(albeit unsoundly) that the risk to which the facts gave rise was insubstantial
or nonexistent." Id. at 844. What is more, the defendants escape liability
if they demonstrate that they were aware of the risk but responded reasonably to
the risk even though they did not ultimately avert the harm. Id.
In
cases decided before Farmer, the First Circuit has articulated a deliberate
indifference standard that is tailored to cases involving in-custody suicide.
In Manarite v. Springfield, 957 F.2d 953 (1st Cir. 1992) the Court articulated a suicide specific deliberate
indifference three-pronged standard:
The
cases also indicate that, when liability for serious harm or death, including
suicide, is at issue, a plaintiff must demonstrate "deliberate
indifference" by showing (1) an unusually serious risk of harm
(self-inflicted harm, in a suicide case), (2) defendant's actual knowledge of
(or, at least, willful blindness to) that elevated risk, and (3) defendant's
failure to take obvious steps to address that known, serious risk. The risk,
the knowledge, and the failure to do the obvious, taken together, must show
that the defendant is "deliberately indifferent" to the harm that
follows.
Id. at 956. Accord Bowen v. City of Manchester, 966 F.2d 13, 17 (1st Cir. 1992);
see also Elliott v. Cheshire County,
940 F.2d 7, 10 (1st Cir. 1991) (a deliberate indifference suicide case requires
a showing of a "strong likelihood, rather than a mere possibility, that
self infliction of harm will occur," citation and internal quotation marks
omitted). The First Circuit has yet to wrestle in a published decision with
Farmer in the context of an Eighth Amendment deliberate indifference claim
involving a custodial suicide. See Davis v. Rennie, 264 F.3d 86, 101 (1st Cir.
2001) (discussing Farmer and the deliberate indifference standard, finding it
an "awkward fit" for an excessive force claim by a mental institute
patient); Hasenfus v. LaJeunesse, 175 F.3d 68, 71-72 (1st Cir. 1999) (dicta in
student suicide case concerning deliberate indifference standard in prison (and
mental institute) cases, citing Farmer); Consolo v. George, 58 F.3d 791, 793
& n.1 (1st Cir. 1995) (reviewing for plain error jury instructions on an
arrestee's deliberate indifference to medical needs claim, rejecting argument
that trial court should apply Farmer in context of the Fourteenth Amendment
claim of a pretrial detainee).
The
Manarite three-step analysis accords with the approach taken to in-custody
suicide claims by the Seventh Circuit post-Farmer. To wit, the second Farmer
prong requiring a showing that the subjective mental state of the official was
one of deliberate indifference to the inmate's safety becomes a two prong
analysis in which the court inquires whether there was, one, an awareness of
the substantial risk, and, two, whether the defendants took reasonable steps to
prevent the inmate from committing suicide. Sanville, 266 F.3d at 737-39.
Accord Turbin v. County of Wood, 226
F.3d 525, 529 (7th Cir. 2000) ("In order to be liable under the Eighth
Amendment, a prison official must be cognizant of the significant likelihood
that an inmate may imminently seek to take his own life and must fail to take
reasonable steps to prevent the inmate from performing this act."). In Brown
v. Harris, 240 F.3d 383 (4th Cir. 2001) the [*165]Fourth Circuit reflected that
it was fair to extrapolate a "reasonable response" inquiry from
Farmer vis-a-vis prison suicide claims:
While the [Farmer] Court left open the question of whether the
"reasonable response" prong of Farmer is part of the state of mind
requirement or whether it instead stems from the duty to "ensure
reasonable safety," id., this prong nonetheless protects officials who act
reasonably in response to a known risk. To the extent that the "reasonable
response" prong is part of the state of mind requirement, an official who
responds reasonably to a known risk has not "disregarded an excessive risk
to inmate health or safety," Farmer, 511 U.S. at 837, and has therefore
not acted with deliberate indifference.
Brown 240 F.3d at 389.
2. Spoliation of Evidence
Before addressing whether this record demonstrates a sufficient factual
dispute over whether or not any of the defendants were deliberately indifferent
under the standard articulated above, I must first address Pelletier's
spoliation of the evidence argument for it is integral to what the record does
and does not show. Pelletier states that there are nine categories of
documents, not including medication records, that are generated by the MHSU
staff and medical personnel that are missing and/or have been destroyed. (1) A
treatment plan was supposed to be created and updated for each inmate with
specific treatment plans and goals, medication review, and recommendations for
the future. The staff reports that there was such a plan for Ronald but it has
not been produced. (Blake Dep. at 21-22; Tofani Dep. at 40.) (2) Progress notes
for inclusion in the medical record were kept on each prisoner but pages nine
and ten documenting Ronald's last weeks were removed. (Lipman Ex. 5 & Pl.'s
Resp. State Defs. SMF Tab 3.) (3) Progress notes were kept by the clinical
workers on each MHSU inmate and kept at the unit. The last entry for Ronald was
September 28, 1998 even though the September 29, 1998, clinical notes record
that Ronald was "very anxious and hearing voices" on September 28,
1998. (Lipman Dep. Ex. 2.) (4) Blake prepared a daily log of her activities and
a daily report on each inmate. In the daily report other correction officers and
mental health workers would make entries. Pelletier emphasizes that entries for
October 2 and 3 are missing, though he recognizes that Blake was not at the
MHSU on October 2 and was not scheduled to work on October 3. (5) Tofani
dictated notes concerning Ronald. (Pl.'s Resp. State Defs.' SMF Tab 4.) (6)
CMS, clinical members of the MHSU, and other supervisors of the MSP attended
mental health clinic meetings (which it seems that Pelletier believes were
somehow documented more completely than through the notes received in
discovery). (Pl.'s Resp. State Defs.' SMF Tab 5.) (7) Corrections officers kept
a daily log that recorded the activities of the unit. (Blake Ex. 2 at 225-530.)
(8) A "constant watch log" was kept that recorded the activity of each
fifteen-minute check. However, the defendants have produced the watch log for
only up to August 4, 1998. (Blake Ex. 2 at 217-24.) (9) An activity or shower
log was maintained but it is missing the entries from October 1 through October
3. (Pl.'s Resp. State Defs.' SMF Tab 6.)
Pelletier asserts that all of Ronald's records were removed by security
after his death and the treatment plan and certain notes were never returned.
He sites to the deposition testimony of Lipman and Blake acknowledging that
documents are missing (Blake Dep. at 21; Lipman Dep. [*166] at 54-55) and to
the Department of Correction's subsequent report on Ronald's suicide that
recognized that documents were missing (Spiller Dep. Ex. 1 at 154, 156).
Pelletier argues that because probative records in this case were deliberately
removed from files pertaining to Ronald and this evidence is still missing the
court should draw a negative inference that the documents contained evidence
beneficial to Pelletier and detrimental to the defendants.
I have
reviewed the nine categories of records asserted by Pelletier to be incomplete
or tampered with. The following four categories identified by Pelletier raise a
concern:
1. The treatment plan for Ronald is missing
though medical defendants Blake and Tofani have testified that one existed.
(Blake Dep. at 21-22; Tofani Dep. at 41.)
2. At least one, maybe two pages, from the
medical record progress notes that are kept on each prisoner are missing. These
pages might contain information about
Ronald from the period of September 14 through October 3. (Pl.'s Resp. to State
Defs.' SMF Tab 3 at 16-17, 19.) I say maybe two because the page bate stamped
"17" which ostensibly is page nine of the progress notes, is in an
entirely different pre-printed format than the other pages in this sequence. It
has the beginning of an entry for September 15 scratched out and then one entry
for September 28, about an assessment per request, then a large space-filling
"X." The numbers "9" and "pg 10" in the right
hand top corner are scratched out. There is no "ID Number" space on
this form as there are on all the other odd numbered pages in the sequence, and
Ronald's number, 28050, nowhere appears on this sheet. The first entry on the
next page, bate stamped 19, is on October 3, at 6:00 p.m., and concerns the
suicide.
3. The progress notes kept on the MHSU on
each MHSU inmate by clinical workers ends on September 28, 1998. (Lipman Dep.
Ex. 2.) And while most gaps in this sequence are at most a couple of days
(appearing to fall on the weekend), there are no entries for the five final
days of Ronald's life. n21
4. The stabilization unit also keeps a
separate daily activity log on each inmate. (Pl.'s Resp. to State Def. SMF Tab
6.) The defendants have not produced the log sheet recording October 2 and 3.
The
remaining categories are not on their face suspect. Three other categories of
records identified by Pelletier -- Tofani's dictated notes, mental health
clinic meeting notes, and a daily log of activities on the MHSU -- do not have
any apparent gaps. Pelletier's complaint about two other categories of records
seems to fall off the mark. Pelletier asserts that there are "missing
pages" for October 2 and 3 from a daily report "blue book" kept
by Blake. He concedes that Blake was not at work on Friday, October 2, and was
not scheduled to work October 3. In an effort to support his contention that
pages are "missing," Pelletier contends that this blue [*167] book
also contains some entries by corrections officers and other mental health
workers, identifying only two times when this happened in the period between
August 19 and October 1. He also contends that the MHSU keeps a "constant
watch log" recording the activity for each fifteen minute check. He
complains that the defendants have produced pages covering only July 30, July
31, and August 4. (Blake Dep. Ex. 2 at 217-24.) However, this record appears to
represent a log of a specially ordered constant watch covering Ronald and
another inmate only, and is not something kept on each inmate (or Ronald alone)
on a regular basis.
Because none of these CMS defendants had any direct involvement with
Ronald during October 2 or 3, only those "missing" records from
earlier in time could have any relationship to them. Of those records that have
"gone missing" the only one probative as to these defendants is the
missing treatment plan. The parties
have testified to the treatment plan they had in place and the fact that the
written plan cannot be located could, at best, permit an inference that they
negligently failed to reduce their plan to writing. There is no inference that
can reasonably be drawn from the missing records that would be relevant to the
issue of whether these defendants were deliberately indifferent to Ronald's
serious medical needs.
3. Pelletier's Argument Concerning the
Medical Defendants' Liability
a.
Cecelia Blake
Pelletier argues that, while
Blake might have had good intentions, she was not prepared for her job
responsibilities and was inattentive to Ronald's needs. He argues that a jury
could infer deliberate indifference by juxtaposing the fact that she made so
many entries in the logs prior to September 15 with the fact that there are so
few in the record thereafter. However, that Blake's testimony concerning the
relative improvement in Ronald's condition during that period was accurate is
an equally supportable inference to be drawn from the fact that there are fewer
entries. It is not the sort of evidence that supports a finding of deliberate
indifference.
Pelletier also urges that after September 15 all the members of the
treatment team knew that Ronald's psychosis was not under control yet no one,
Blake included, took steps to determine the reasons for his weekend
decompensation. However, the record supports Blake's testimony that Ronald's
condition was changeable and that some days he appeared to interact
appropriately. The last entry in her log was September 30 when she went out to
the yard to exercise with Ronald and another inmate. Blake worked October 1 and
made no entry regarding Ronald. She never saw him again. The most damaging
statement to be made against Blake is that she never recognized a pattern of
decompensation occurring over the weekends that Dr. Peterson and Spiller both
discovered during the post-mortem reviews. Blake's relatively short time in the
position, her undisputed "good intentions," and her lack of personal knowledge
about Ronald's state in the last two days of his life negate the benefit of any
inference that her failure to detect a "clear" pattern of weekend
decompensation might generate. Pelletier's claim against Blake does not amount
to deliberate indifference to serious medical needs.
b.
Michael Tofani
Pelletier charges Tofani with
administrative [*168] negligence. n22 He states that Tofani knew that Ronald
was psychotic and suicidal at all times; that he was incapable of contracting
for safety; that he decompensated on the weekends; and that as of September 15
he was the sickest Tofani had seen him, the clinic meeting notes for that date
describing him as suicidal. Yet Tofani did not attempt to monitor Ronald or to
verify that Ronald was stable. Pelletier tethers Tofani's lack of
follow-through to CMS cost constraints. In support of his argument he points to
Defendant Briggs's attendance at the meeting at which the consensus was that
Ronald was becoming time consuming, remained acute, was very ill, was suicidal
and in continuing crisis, complained of not sleeping and of hearing voices, all
despite his heavy medication. At this meeting no treatment plan was discussed.
There is no further indication in the logs and notes that Tofani's suggestion
of Clozaril be pursued. After September 15, Pelletier asserts, the treatment
and records fall off significantly.
Pelletier contends that it is fair to draw the inference that Tofani
made a deliberate decision to scale down Ronald's care for financial and administrative
reasons, rather than medical reasons, and that if that inference were drawn it
would suffice to establish deliberate indifference. The theory that Tofani
acted to please undisclosed CMS personnel when he decided not to pursue
Clozaril or other treatment alternatives is nothing more than a theory. There
is nothing in this record by way of evidence that supports the argument that
any decision was made by the treatment team in this case as the result of
financial considerations. Lipman and Blake did not request that Tofani see
Ronald again after September 15 and he never seized the initiative to do so,
although the record does support Pelletier's contention that Tofani could have
exercised his independent judgment about which inmates he saw during his weekly
visit. Tofani's decision to abide by Lipman and Blake's conclusions about Ronald's generally improving, or
at least stable, condition might have been ill advised and professionally
unsound given what he knew about Ronald. However, on this record his conduct
does not support a finding of deliberate indifference under the Farmer
standard.
c.
Bert Beverly
Pelletier admits that the record against Beverly is "sparser."
He states that he was the first and last physician to treat Ronald. He is also accountable
in Pelletier's view because he was the Medical Director of CMS, a member of the
treatment team, and he had authority to order an inmate placed on the acute or
subacute corridors. Somewhat
halfheartedly he asserts that Beverly's "level of knowledge and the nature
of his obligations should be determined by a jury." Beverly had no
significant role in the mental health treatment decisions regarding Ronald and
there is no evidence to support a finding against him.
d.
Allen Briggs
Finally, with
respect to Briggs, Pelletier argues that he should be liable because he
participated in the mental health clinic meetings during which treatment
decisions were reviewed and he had the authority to approve of increases in
psychiatric care. He speculates that, as the regional supervisor of medical
services for CMS, Briggs "would have provided the [*169] 'resistance' to
more costly forms of medication." Once more Pelletier returns to his "theory"
that financial considerations drove the post-September 15 treatment decisions
regarding Ronald. There is no evidence of Briggs applying any pressure on
Tofani or anyone else regarding treatment decisions and allowing a factfinder
to speculate about such conduct by Briggs would be impermissible, especially in
a case where the record evidence reveals that Lipman, a state defendant and not
an employee of CMS, was the actor who had primary control over the treatment
and placement decisions regarding Ronald during the pivotal last weeks of his life. Of course denying needed medical treatment purely because
of cost considerations would indeed amount to deliberate indifference to
serious medical needs in a situation were the defendant either knew of or
consciously disregarded a serious risk of self-inflicted harm. The problem for Pelletier is that
there is no evidence, director circumstantial, to support the conclusion that
Briggs or any of the other medical defendants acted as they did because of
financial considerations.
Conclusion
Based upon the foregoing,
summary judgment is GRANTED to Tofani, Blake, Beverly, and Briggs.
So
Ordered.
Dated April 17, 2002
Margaret J. Kravchuk
U.S. Magistrate Judge
FOOTNOTES:
n1 Pursuant to Federal Rules
of Civil Procedure 73(b), the parties have consented to allow the United States
Magistrate Judge to conduct any and all proceedings in this matter.
n2 In his reply to these
defendants Pelletier refers to his responses to the State defendants' statement
of material fact on the grounds that it saves space and repetition. This
practice makes the Court's job very difficult and time consuming. I have done
my best to consider properly supported cross-referenced factual assertions when
there is a disputation or qualification (see, e.g., Pl.'s Resp. Med. Defs.' SMF
P 5; Pl.'s Resp. State Defs.' SMF P 35) as opposed to an additional fact that
is not set forth in a separate statement as required under the rules (see,
e.g., Pl.'s Resp. Med. Defs.' SMF P 3; Pl.'s Resp. State Defs.' SMF P 30).
n3 Without admitting or
denying this paragraph, Pelletier refers to his response to the State
defendants' statement of material facts in which he asserts that Blake was
allowed to become a social worker on the condition that she do two years of
supervised work under a social worker with a Master's degree. (Pl.'s Resp. Med.
Defs.' SMF P 5; Pl.'s Resp. State Defs.' SMF P 35.) It is hard to read this as
a qualification of the defendants' assertion about Blake's background.
Similarly, Pelletier's assertion that the first notes in her handwriting on the
MHSU appear around August 18, 1998, is unremarkable given the defendants'
assertion that this was the time period during which Blake commenced work for
CMS.
n4 Pelletier also asserts
that Briggs, as regional supervisor of medical services for CMS, would be the
person to resist more costly medications, citing pages 52 and 53 of Tofani's
deposition. This testimony does not refer to Briggs's role.
n5 Cross-referencing a reply
to the State defendants' statement of material facts, Pelletier attempts to
insert additional facts about Lipman's training and work history. (Pl.'s Reply
State Defs.' SMF P 33.) See footnote 2. I disregard these.
n6 Pelletier attempts to
dispute this statement of fact by citing to Lipman's deposition testimony
describing the treatment team as including security and medical staff members.
(Pl.'s Reply State Defs.' SMF P 36.)
n7 The defendants assert
that there was always at least one member of the healthcare staff available in
the MSP at night and on the weekend if an inmate needed to be seen. However the
cited deposition testimony by Blake does not support the conclusion that on
evenings and weekends there was always a mental healthcare staff member present
at the prison. (See Blake Dep. at 18.) Though Pelletier attempts to qualify
this statement by reference to his response to a similar factual assertion made
by the State defendants (Pl.'s Resp. State Defs.' SMF § 13) the connection is
too attenuated for this court to draw.
n8 As with the response to
the State defendants' statement of material fact Pelletier argues that key
documentation is missing. He states that Tofani testified that there was
documentation on every formal treatment team meeting (see Tofani Dep. at 29),
that if Tofani ordered a change in security he would have to document this
(id.), and because this is missing it is not clear what Tofani's role was in
the decision to move Ronald. (Pl.'s Resp. Med. Defs.' SMF P 28.) However, I am
not sure what documentation it is that Pelletier is talking about in this
response. If Tofani never ordered a change in security there would be no
documentation. Other entries in the record show that Ronald moved to different
corridors without formal treatment team documentation.
n9 With respect to these log
books Pelletier cites to the fact that documentation is missing. There does not
appear to be any relevant "missing" documentation in the Cecelia
Blake log as the last day she worked prior to Ronald's death was October 1 and
those entries are in the log.
n10 Pelletier denies that this practice was carried out. However
the cross-referenced support for his dispute does not contravene the limited
scope of the defendants' assertion. (See Pl.'s Resp. State Defs.' SMF PP
47-48.) The facts asserted are in the nature of additional facts that should
have been asserted in a separate statement of material fact in accordance with
Local Rule 56.
n11 Pelletier admits this
assertion but states that no treatment plan for Ronald has been produced.
n12 Pelletier attempts to
qualify this statement suggesting the cited testimony by Lipman was limited to
representing that Beverly was there as a back-up if there was a need to prescribe
drugs for someone like Ronald. I think the record supports the assertion made
by the defendants (see Lipman Dep. at 74-75) and the fact that Beverly was the
medical director of MHSU (see Tofani Dep. at 18) does not qualify or dispute
this statement (Pl.'s Reply Med. Defs.' SMF P 59).
n13 Pelletier responds to
these two statements by cross-referencing additional facts in his response to
the State defendants' statement of material facts. (Pl.'s Resp. State Defs.'
SMF PP 46-48.) These are all additional facts to which the defendants did not
have the opportunity to respond so I do not consider them for purposes of this
motion.
n14 Pelletier adds to these
facts. He states that Ronald suffered the entire time he was on the MHSU from
severe thought disorder, delusional thought, and paranoid thoughts. (See Tofani
Dep. at 26.) He remained psychotic for the entire time he was on the MHSU. (See
id. at 46, 72.) Though ultimately relevant to his case Pelletier's assertions
that Ronald tried to commit suicide on August 4, that no mental health worker
was notified, and that he was only seen by an LPN who was not licensed to make
nursing assessments in Maine (see Spiller Dep. Ex 1 at 169-70) goes beyond
qualifying or disputing the defendants' statements concerning Tofani's initial
assessments.
n15 With respect to this
assertion Pelletier, cross referencing his response to the State defendants'
statement of material fact, states that the medical doctors recognized that
Ronald's comments and behavior were not reliable gauges of what was going on in
his head. (Pl.'s Resp. Med. Defs.' SMF P 81; Pl.'s Resp. State Defs.' SMF PP
64, 118.) He also asserts that Ronald was transferred for reasons unrelated to
his safety. (Pl.'s Resp. Med. Defs.' SMF P 81; Pl.'s Resp. State Defs.' SMF P
53.) The only portion of this response that relates to the transfers and that
can be fairly characterized as a qualification of the defendants' statement of
fact is that Spiller picked up a pattern of transferring Ronald to a lower
level of supervision on Fridays. (Spiller Dep. Ex. 1 at 188-89.)
n16 Pelletier admits these
assertions and proffers the additional fact that Ronald attempted suicide on
September 14. (Spiller Dep. Ex. 1 at 193, referencing logs.) I accept this as a
qualification as to the date of the incident though it is not apparent how this
is material to the outcome of the
motion.
n17 Pelletier also asserts
that the prison resisted the expense but the cited deposition testimony does
not support this assertion; Tofani was asked if the Department of Corrections
resisted this suggestion and he testified, "No, it was my understanding
the resistance was from Correctional Medical Services. (Tofani Dep. at 52.)
n18 Blake seems to be
referring to notes that she took when giving this deposition testimony.
Pelletier asserts that the general contradictions and disappearance of logs and
notes casts suspicion over any information in the notes and logs turned over.
(Spiller Dep. Ex. 1 at 188.)
n19 Pelletier asserts that
Tofani was never told that Ronald had been moved on and off the subacute
corridor in the two weeks after September 15. The cited deposition testimony
does not support such an unequivocal statement, in that Tofani asserts only
that he did not know of one transfer on September 21. (Tofani Dep. at 70.) What
is more, just prior to this statement he testified in response to a question of
whether he was aware of a September 19 transfer that he didn't have a
"specific memory of dates and times," but that he was aware that
Ronald "along with a number of other people would move quite often from
one part of the unit to the other as part of a plan." (Id. at 69.)
n20 Though Pelletier denies
the assertion in this sentence the referenced paragraphs in his response to the
State defendants' statement of material fact do not contradict this statement
of fact.
n21 I note that there are no
entries for August 1 through August 6. However, though the bate stamp for this
period goes in sequence from 74 to 75, page 74, chronicling July 30, through
July 31, is on a different pre-printed form than the remaining sheets and
perhaps a sheet got lost in the shuffle. The last page bearing a single entry
for September 28 is the only page in this sequence that does not have Ronald's
MDOC number on it.
n22 Pelletier mentions supervisory liability in connection to
Tofani but has not provided anything upon which this court could base a
conclusion that Tofani had supervisory responsibilities.