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Bowers v. Mullen

United States District Court, E.D. Missouri, Eastern Division

August 30, 2016

MARK BOWERS, Plaintiff,
DAVID A. MULLEN, et al., Defendants.



         This matter is before the Court on Defendants' Motion for Summary Judgment (Doc. 36). Plaintiff submitted a response in opposition to Plaintiffs' Motion for Summary Judgment with supporting exhibits (Doc. 41 & Attach.). Defendants filed their reply (Docs. 42-43). The motion is fully briefed and ready for disposition. For the following reasons, the motion will be granted.

         I. Background

         On June 30, 2014, Bowers, a Missouri inmate, filed this action under 42 U.S.C. § 1983 (Doc. 1.) His verified complaint, as amended, seeks damages against Defendants David Mullen, a physician at the Eastern Reception, Diagnostic and Correctional Center (“ERDCC”); John Williams, a physician at the Missouri Eastern Correctional facility (“MECC”); Karl Hardman, the Health Services Administrator at the Tipton Correctional Center (“TCC”); and T. Bredeman, the Medical Director for Corizon Medical Services (Am. Comp. (Doc. 5) at 5, 14). Bowers initially alleged that all Defendants had, with deliberate indifference, provided him constitutionally inadequate medical care for osteoarthritis in his left hip; he has since conceded his claims against Drs. Mullen, Williams, and Hardman, leaving only his claim against Dr. Bredeman (Id. at 8; Docs. 41, 41.1).

         The summary judgment evidence establishes the following. Before he was imprisoned, Bowers suffered a lower back injury for which he had undergone surgery; he had also suffered a gunshot wound to his lower left leg (Doc. 38.1 at 3, 15). In January 2009, while he was incarcerated at ERDCC, Bowers presented to Dr. Mullen, complaining of, inter alia, chronic left hip and knee pain. Dr. Mullen prescribed Bowers shoe inserts, and gabapentin and amitriptyline for his pain (Doc. 38.1 at 3). In March 2009, Bowers told a nurse practitioner that he had pain and discomfort in his hip, knee, and ankle (Id. at 4-5). The nurse practitioner noted that Bowers was favoring his left leg when he walked, and that he had equal strength in leg pushes and pulls. The nurse observed no deformities, and referred Bowers to the chronic pain clinic where his medications were renewed (Id. at 5-6).

         In April 2009, Dr. Mullen examined Bowers, renewed his gabapentin prescription, and gave him a new prescription for naproxen (Id. at 9). Dr. Mullen also ordered an x-ray which revealed “moderately advanced degenerative changes of the hips” which had progressed slightly when compared to an x-ray of Bowers's hips taken in February 2008 (Id.). During an August 2009 follow-up appointment at the ERDCC chronic pain clinic, Bowers rated his pain as a five on a scale of one to ten; reported that he had increased pain with bending, stooping, or standing for too long; and stated that his pain prevented him from sleeping (Id. at 11). Dr. Mullen renewed Bowers's gabapentin prescription in October 2009 (Id. at 13). At a December 2009 follow-up appointment, Bowers was prescribed meloxicam for his knee and hip pain; his gabapentin was also renewed (Id. at 15-17). Dr. Mullen refilled Bowers's gabapentin prescription again in April 2010 (Id. at 21).

         In June 2010, Bowers self-declared a medical emergency, claiming that he needed an x-ray to determine whether his “degenerative joint problems” had worsened (Id. at 22). He reported sharp throbbing pain in his left hip and knee, that his pain medications were not helping, that he could barely put on his pants without falling, that he slept in his pants and socks because it hurt too much to take them off, and that he could not raise his leg because of the pain (Id. at 22-23). Dr. Mullen examined Bowers, renewed his meloxicam prescription, and ordered an x-ray of his knee, which did not reveal arthritic changes (Id. at 24-26). Bowers was treated primarily for his knee pain until October 2010 (Id. at 32-36).

         In January 2011, Bowers requested surgery on his left hip and right knee (Id. at 37). Dr. Mullen renewed Bowers's existing pain medications, and added prescriptions for acetaminophen and an analgesic balm (Id. at 38). In March 2011, Bowers again complained of hip pain that prevented him from putting on his socks or tying his shoes (Id.). Dr. Mullen prescribed meloxicam, and referred Bowers for an orthopedic consult (Id. at 38-39). Dr. Mullen noted that Bowers had reported chronic pain in his left hip, that x-rays had revealed moderate to severe degenerative changes in his hip, that he had difficulty walking and secondary pain in his right knee related to his abnormal gait, that his pain was interfering with his activities of daily life, and that conservative treatments had been unsuccessful (Id. at 39). An April 2011 x-ray of Bowers's left hip showed moderate degenerative changes and “bony sclerosis with loss of joint space narrowing superiorly” (Id. at 41). An MRI was then ordered “to evaluate for avascular necrosis of [the] femoral head”; however, the MRI was cancelled when the technician realized Bowers had bullet fragments in his leg (Id. at 44, 47; Doc. 41.3 at 4). In August 2011, a CT-scan revealed “advanced osteoarthritis of [Bowers's] left hip without avascular necrosis or fracture” (Docs. 38.1 at 47; 41.3 at 5).

         Less than two weeks later, Bowers was transferred to MECC, where he was referred to the chronic care clinic (Id. at 49). During his September 1, 2011 chronic-care intake examination, Bowers reported, inter alia, a history of arthritis in his left hip and back surgery. He also stated that he had been riding bicycles and trying to work out (Id. at 54-56). A nurse noted that Bowers ambulated with a limp and had trouble getting in and out of a chair (Id. at 55-56). Bowers was prescribed meloxicam and aspirin for pain (Id. at 55-56).

         On September 10, 2011, Bowers was examined by Dr. Justin Cutler (Id. at 57). Dr. Cutler observed that Bowers walked with only a minor antalgic gait, stood with a mild flexion at his waist, and was only able to flex his hip forty-five degrees (Id. at 57-58). He reviewed Bowers's x-rays and CT-scan, concluding that Bowers had severe joint space narrowing consisted with severe osteoarthritis in his left hip (Id. at 58). Dr. Cutler recommended treatment with pain medications, which Bowers refused, and discussed the option of fluoroscopic guided hip injections (Id.). Bowers requested and was provided a cane. Dr. Cutler advised Bowers to walk the prison track and to ride a stationary bike on a daily basis, and to avoid stairs. He also informed Bowers that he would likely need a total hip arthroplasty in the future to treat his pain (Id.). During a September 29, 2011 chronic care follow up appointment, Bowers stated that he wanted left hip replacement surgery, rated his left hip pain as a ten on a scale of one to ten, and noted that he was pleased that he had recently lost weight. He also reported that he had been walking approximately one mile around the prison track and riding a stationary bicycle, but that he experienced left hip pain after exercising (Id. at 60). In November 2011, Dr. Williams discontinued Bowers's meloxicam prescription-at Bowers's request-and replaced it with acetaminophen (Id. at 63).

         During a December 2011 follow-up appointment, Bowers returned his cane to the MECC medical department, reporting that he no longer needed it, that he was attempting to control his pain with medication, and that he had some left hip discomfort that radiated to his groin and left thigh (Doc. 38.2 at 2-3). Dr. Williams recommended that Bowers continue to ambulate as much as he could, and take acetaminophen as needed for his pain (Id. at 3). In March 2012, Bowers again complained of hip pain, but refused pain medication (Id. at 6-8).

         Bowers next complained of hip pain on July 9, 2012, and Dr. Williams prescribed Bowers indomethacin for his pain (Id. at 10). The prescription was cancelled on August 3, 2012, after Bowers failed to take it for ten days (Id. at 11). On August 29, 2012, Dr. Williams requested that Bowers be referred back to the orthopedic specialist for reevaluation of his left hip (Id. at 15). In support of his request, Dr. Williams noted that x-rays and a CT-scan of Bowers's left hip taken the year prior had revealed degenerative joint disease, that his hip pain had persisted despite use of a cane and modifications to his daily activities of living, that he was unable to bend to tie his shoes, and that he had little extension, no eversion, and painful inversion of his left hip (Id.).

         On August 30, 2012, Dr. Bredeman denied the referral request, concluding that a medical need for the referral had not been established. He instead concluded that Dr. Williams should follow up with Bowers, optimize pain management, encourage him to use a cane, and consider physical therapy and Velcro shoes (Id.). Dr. Williams then requested a physical therapy evaluation and Velcro shoes for Bowers, both of which Dr. Bredeman approved (Id. at 16-17). In late September 2012, Bowers injured his rib cage while speed walking on a treadmill, and was prescribed ibuprofen (Id. at 17-18). Bowers was transported to a September 26, 2012 physical therapy session, and a physical therapist provided him a home exercise plan. On October 9, 2012, Dr. Williams refilled Bowers's indomethacin prescription (Id. at 19-20).

         On October 12, 2012, Bowers submitted a medical services request, complaining of pain in his upper back (Id. at 21). A nurse responded, and Bowers informed her that he had injured himself doing sit-ups with “too much weight on it” (Id.). The nurse encouraged Bowers to modify his exercise routine, and prescribed him ibuprofen (Id. at 22). During an October 15, 2012 follow-up appointment, Bowers complained of left hip pain, but was able to ambulate without using a cane. Dr. Williams advised Bowers to continue with the home exercise plan his physical therapist had provided (Id. at 22-23). Dr. Williams saw Bowers again on October 26, 2012; Bowers stated that he continued to experience hip pain, especially after exercising, but told Dr. Williams that he had not been taking his indomethacin prescription (Id. at 23). In December 2012, Dr. Williams replaced Bowers's indomethacin prescription with a prescription for acetaminophen, after Bowers claimed that the indomethacin was not helping with his pain (Id. at 26-27). In February 2013, Bowers complained to nurse in the chronic care clinic about pain in his left hip, but stated that he was not taking any ...

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