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Coleman v. Hakala

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

April 11, 2017

MICHAEL HAKALA, et al., Defendants.



         Plaintiff Alonzo Coleman is an inmate suffering from progressive kidney and liver diseases that are ultimately lethal and for which there is no cure. He brought this 42 U.S.C. § 1983 action against defendants Dr. Michael Hakala, Corizon State Regional Medical Director Dr. Elizabeth Conley, Corizon Health Services Administrator at SECC Phyllis Stanley, and Corizon, Inc. related to the treatment of those diseases, claiming that the defendants violated his Eighth Amendment right to be free from cruel and unusual punishment. This Court appointed counsel to represent plaintiff. Defendants have moved for summary judgment (#149). For the reasons explained below, summary judgment will be granted to defendants.

         I. Factual Background

         The following facts are undisputed unless otherwise indicated. Plaintiff became an inmate with the Missouri Department of Corrections (“MDOC”) in 1996. MDOC contracts with Corizon, Inc. to provide medical services to inmates. In 2006, while incarcerated at Crossroads Correctional Center, plaintiff was diagnosed with polycystic kidney disease (“PKD”) and polycystic liver disease (“PLD”). At the time, plaintiff had been scheduled for hernia surgery, but the surgery was cancelled due to elevated blood pressure and an abnormal EKG. Plaintiff underwent a pre-operative renal Doppler ultrasound on April 7, 2006, which suggested the presence of the polycystic kidneys. In May 2006, plaintiff underwent a CT arteriogram, which revealed non-cancerous polycystic kidneys. Plaintiff's treating physician at the time, a nonparty, discussed with plaintiff the results and PKD, including the possibility of kidney failure.

         Plaintiff had the hernia surgery and a liver biopsy in June 2006. The hospital records state that “we are considering outpatient nephrology consultation and hepatology/gastroenterology consultation as well to follow up these conditions” and that a “Dr. Matthews . . . is willing to go ahead and follow carefully” with outpatient follow-up.

         On July 31, 2006, plaintiff met with the prison physician, nonparty Dr. Gallup, who was concerned by plaintiff's GGT and creatinine levels were elevated. Dr. Gallup also noted surgeon Dr. Barton's recommendation for baseline laboratory testing along with ultrasound of liver. Although Dr. Gallup made a referral request to a renal specialist, it is unclear whether the request was withdrawn or denied.

         In November 2006, plaintiff's treating physician talked to plaintiff about the disease progression in general and informed plaintiff there was no need for a specialist unless his condition worsened. Instead, treatment for PKD includes treating the complications of the disease, including hypertension, renal insufficiency, hematuria, kidney stones, or renal infection. Monitoring kidney function consists of monitoring the glomerular filtration rate (“GFR”) and urine for signs of infection and hydration. Treatment of PLD also consists of monitoring liver function with liver function testing, lab work, and ultrasounds. Specifically, blood work to monitor liver function would include the testing of liver enzymes and other markers. Treatment of PKD and PLD might also include decompression of the cysts, which requires a surgical consultation.

         Plaintiff was transferred to Southeastern Correctional Center (“SECC”) and placed under the care of defendant Dr. Hakala in January 2009. By that point, plaintiff's lab results showed that his creatinine levels rose and GFR dropped as follows:



April 2008



August 2008



January 2009



         Creatinine level of 2.0 is indicative of renal failure. GFR indicates how well the kidneys are functioning. Dr. Hakala testified that GFR below 60 indicates cause for concern: “I may still monitor him for another six months or I might decide well, now we should have a consult and see what the opinion of a renal specialist would be. Most often I would do that, particularly for blood pressure control, too.” (Hakala Dep. at 56.) Corizon policy documents also show that a renal consult should be considered when an inmate has a GFR of 39-50.

         Plaintiff contends that although his medical condition required close monitoring of his bloodwork, lab testing was not completed as ordered, lab results were not reviewed and/or acted upon, and complete lab testing to check for liver enzymes were not conducted. For example, in March 2009, nonparty Dr. Babich ordered labs to be taken the same month, but they were not. Plaintiff says that although a basic metabolic panel was completed on August 7, 2009, no follow-up of the labs and no liver enzymes test was completed. The August 7 results were as follows:



August 2009



         Those results thus showed that plaintiff's kidney function was continuing to decline.

         On September 29, 2009, plaintiff saw nonparty Dr. Flood for a Chronic Care Clinic visit. Dr. Flood reviewed plaintiff's worsening lab results and diagnosed him with chronic renal failure. Dr. Flood instructed plaintiff to stop taking Naproxen for pain and replace it with Tylenol because the Naproxen can adversely affect his kidneys in light of the PKD diagnosis.

         Plaintiff saw defendant Dr. Hakala on January 14, 2010. Although basic vital signs were taken according to the medical record (CORIZON 722), the record does not indicate Hakala reviewed or discussed plaintiff's most recent lab results.

         Plaintiff submitted an Medical Services Request (“MSR”) on January 21, 2010 regarding a lump or cyst in or on his stomach. CORIZON 725. He was seen by a nurse on January 22, who noted that Coleman expressed pain when his stomach was touched, and Coleman said it hurt when he lies on top of his stomach. The notes say that Dr. Matthews issued a verbal order for plaintiff to see Hakala on Monday, January 25. However, Hakala did not see plaintiff again until March 17. Defendants appear to dispute that the “verbal order” was directed at Hakala; instead, they say the order was directed at plaintiff. At the same time, they state that the “nurse or appointment scheduler is responsible for scheduling physician appointments.” (See #168 at ¶ 57.) Plaintiff had bloodwork again on January 26:



January 2010



         His liver enzymes were not tested.

         On February 3, 2010, plaintiff had still not seen Dr. Hakala, so he filed another MSR to be seen regarding the lump in his stomach. Plaintiff was seen by a nurse on February 4, and she noted that plaintiff's upper right quadrant was swollen, hard, and very tender to the touch, that the “knot” is approximately eight inches in diameter, and that plaintiff has pain when he sleeps on his right side. The nurse referred plaintiff to a doctor. Plaintiff then saw Dr. Flood on February 8. Flood noted that plaintiff's symptoms had grown progressively worse over the past three years and wrote plaintiff's abdomen was “grossly distended” and there was a “risk of colangio carcinoma.” (CORIZON 730-31.) Dr. Flood's plan was to order an ultrasound of the liver, order labs, and refer plaintiff for surgical evaluation/treatment. The plan further referred to Dr. Barton's June 21, 2006 report and stated “the dx of polycystic liver disease carries a risk of colangio carcinoma and recommends yr'ly surveillance w/liver u/s, afp, cea and lfts.”

         Dr. Flood made a referral request for a liver ultrasound for plaintiff, and that request was approved. Plaintiff's February 18, 2010 lab work showed the following results:



February 2010



         The results of the ultrasound indicated on February 25, 2010 that plaintiff's liver and kidneys were “heavily involved by numerous small and large cysts, ” that the gallbladder was obscured by cysts, and a CT scan was recommended. Dr. Flood testified that based on plaintiff's history and the ultrasound, a CT would have been appropriate.

         Plaintiff filed an MSR for a follow-up of the ultrasound results on March 15, 2010 and met with a nurse the same day. The nurse's plan was to refer plaintiff to see a doctor, and plaintiff was assessed by Dr. Cooper on March 22, 2010, but Dr. Cooper did not discuss the ultrasound results with him.

         Plaintiff filed MSRs on March 18, April 14, 26, 27, and 28 regarding the pain in his abdomen. Defendant Hakala reviewed plaintiff's file on April 18 but made no contact with him until April 29, when Hakala reviewed the February 25 ultrasound results. Hakala wrote in the medical record that he planned to request a CT of plaintiff's abdomen to check for hernia and to see Coleman's gallbladder better. Hakala also noted during plaintiff's April 29 Chronic Care Clinic visit that plaintiff had chronic renal failure.

         Hakala's referral request was approved. Plaintiff's May 7, 2010 CT scan report noted that plaintiff's liver was 80% full of cysts and that the enlarged liver occupied most of plaintiff's upper abdomen. The report was provided to Hakala on May 17.

         Plaintiff submitted an MSR on May 25 for abdominal pain, and a nurse gave him Tylenol. On May 26, he filed an MSR seeking to learn the results of his CT scan. Plaintiff met with Hakala on June 1. Hakala's notes in the medical record continue to focus on plaintiff's 2006 hernia repair and the CT report's failure to mention any hernia, and Hakala requested a re-read of the CT scan. On June 3, the requested re-read produced the same report with a recommendation for a follow-up exam in a few months for further evaluation.

         Plaintiff filed another MSR for stomach pain on June 15. Although a nurse made a plan for “referral to physician, ” plaintiff states there is no clear policy as to how, when, or if the appointment should be made, nor is there a review procedure to ensure the plan was implemented. Plaintiff did not see a doctor until he saw defendant Hakala on August 26. Defendants dispute the suggestion that plaintiff was referred specifically to Dr. Hakala, but defendants do not appear to refute that plaintiff did not see a doctor for more than two months after making the request. Notably, as discussed below, plaintiff appears to have seen Dr. Hakala in the Chronic Care Clinic on July 8, but plaintiff says Hakala did not address the re-read of the CT or the cysts, pain, or weight loss for which physician referrals were made.

         On June 29, 2010, plaintiff filed another MSR for worsening pain and weight loss. He saw a nurse, and the plan was to “discuss with chronic care nurse/Dr. Hakala.” (CORIZON 758.) Plaintiff's July 30 lab work showed the following:



July 2010



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