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Buchanan v. Kapur

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

September 11, 2017

HARI KAPUR, M.D., et al., Defendants.



         Missouri state prisoner Stephanie Marie Buchanan brings this civil rights action under 42 U.S.C. § 1983 claiming that defendant Dr. Hari Kapur, a prison doctor, was deliberately indifferent to her serious medical needs when he failed to properly diagnose and treat spinal and other injuries she suffered while incarcerated, in violation of the Eighth Amendment. Buchanan also claims that defendant Corizon, LLC, [1] promotes such deliberate indifference through its policies, customs, and procedures of ignoring medical conditions and denying treatment to inmates in order to limit costs and maximize profits. In addition to her constitutional claims of deliberate indifference, Buchanan also brings supplemental state law claims of medical negligence against both defendants. Because there are no genuine issues of material fact and the undisputed evidence shows no deliberate indifference, I will grant defendants' motion for summary judgment on Buchanan's constitutional claims. I decline to exercise supplemental jurisdiction over her state law claims.


         Buchanan entered the Women's Eastern Reception, Diagnostic Correctional Center (WERDCC) in February 2011. At the time she entered WERDCC, Buchanan had a back condition for which she wore a back brace during periods of prolonged standing. Buchanan was required to surrender the back brace upon her incarceration; she was then assigned a wheelchair to assist her when she moved from building to building. In May 2011, Buchanan fell from her wheelchair. Believing she was injured from this fall, Buchanan sought medical treatment on June 1 for low back pain and was hospitalized in WERDCC's transitional care unit (TCU). X-rays were taken and she was released back to her housing unit three days later. Buchanan claims that she received no treatment or medication for her injury. She currently is wheelchair-bound.

         In July 2012, Buchanan experienced what she believed were symptoms of a heart attack. She sought treatment but was unable to see a doctor until two days later. Buchanan claims that the doctor she saw, defendant Dr. Kapur, provided no treatment or medication for her heart attack symptoms. An EKG performed later in July showed that Buchanan had previously suffered a heart attack, but testing could not determine when it actually occurred. Buchanan claims that despite this confirmation of a heart attack, Dr. Kapur continued in his failure to provide medication or treatment for her cardiac injury. Buchanan also claims that Dr. Kapur threatened to take away her wheelchair if she continued to complain about having a heart attack. Buchanan continued to undergo cardiac testing until October 2012. Buchanan claims that despite abnormal results from these tests, she was never provided medication or treatment for her cardiac injury.

         In October 2012, a physical therapist at WERDCC trained Buchanan on a home exercise program for her neck, stating that he had been given doctor's orders to do so. Buchanan claims she had no medical issues with her neck at that time. Buchanan claims that while she was later performing neck exercises on her own, she felt a snap in her neck and experienced severe pain. Buchanan claims that despite going to sick call and reporting this incident to Dr. Kapur, she has yet to receive any treatment or medication for this injury.

         In addition to her claims regarding these specific alleged injuries, Buchanan contends generally that defendants' failure to properly treat her conditions leaves her vulnerable to additional cardiac and spinal injuries, which could be life-threatening and/or cause her to never walk again.

         Defendants Kapur and Corizon move for summary judgment, arguing that the undisputed evidence shows that Buchanan received continuous and adequate care for her medical complaints and conditions and thus that they were not deliberately indifferent to her serious medical needs. Defendants further argue that Buchanan's mere disagreement with the course of medical care does not give rise to deliberate indifference. Buchanan has not responded to the motion.[3]

         Summary Judgment Standard

         When considering a motion for summary judgment, I must view the facts and inferences from the facts in the light most favorable to the nonmoving party. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). As the moving parties, defendants must establish that there is no genuine issue of material fact and that they are entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). Once the moving parties have met this burden, the nonmoving party may not rest on the allegations in her pleadings, but by affidavit or other evidence must set forth specific facts showing that a genuine issue of material fact exists. Fed.R.Civ.P. 56(e). A verified complaint is equivalent to an affidavit for summary judgment purposes. Hanks v. Prachar, 457 F.3d 774, 775 (8th Cir. 2006) (per curiam).

         At the summary judgment stage, courts do not weigh the evidence and decide the truth of the matter, but rather determine if there is a genuine issue for trial. Anderson, 477 U.S. at 249. However, summary judgment may be appropriate “[w]hen opposing parties tell two different stories, one of which is blatantly contradicted by the record, so that no reasonable jury could believe it[.]” Scott v. Harris, 550 U.S. 372, 380 (2007). In such circumstances, the mere existence of some alleged factual dispute will not serve to defeat summary judgment; instead, the factual dispute must be “genuine.” Id.

         The evidence before the Court, including Buchanan's verified complaint, shows that defendants were not deliberately indifferent to Buchanan's serious medical needs, and no genuine issue of material fact exists for trial. For the following reasons, defendants have shown that they are entitled to judgment as a matter of law on Buchanan's claims of deliberate indifference, and I will grant their motion for summary judgment.

         Evidence Before the Court on the Motion

         In 1998, several years before her incarceration, Buchanan underwent back surgery for her diagnosed conditions of advanced degenerative disc disease of the lumbar spine and spinal stenosis.[4] In April 2008, three years before her incarceration, Buchanan visited Washington University Orthopedics with complaints of a new onset of left-sided neck, arm, back, and leg pain. She also complained of left-sided weakness. Buchanan reported that she could walk for no more than ten minutes and had increased pain when bending forward. She reported taking anti-inflammatory and narcotic medication. It was determined that Buchanan was not a good candidate for surgery and it was recommended that she see a neurologist.[5]

         When Buchanan was received into WERDCC in February 2011, she reported to medical personnel that she had chronic back pain because of a spinal injury for which she had undergone surgery. She reported that she had previously been prescribed physical therapy for her condition and was currently taking naproxen, Tylenol, and Neurontin. It was determined that Buchanan would be enrolled in the Chronic Care Clinic for her chronic back pain and she first saw a doctor in the clinic in March 2011, at which time she was prescribed Tylenol and Neurontin. Upon Buchanan's request, she was also prescribed salsalate for pain. A wheelchair was provided for her to use for long distances. Because of Buchanan's chronic condition and need for long-term care, narcotic medication could not be prescribed because of its addictive quality.[6]

         WERDCC's medical records show that Buchanan continually visited doctors and other medical personnel since she entered WERDCC. She underwent repeated x-rays, laboratory testing, and other diagnostic testing; was referred for outside consultations; was consistently prescribed medications that were refilled and adjusted as needed; had medical restrictions placed on work and other activities; and was provided certain requested medical accommodations such as a lower bunk, placement on the first floor, and continued use of a wheelchair.[7] Buchanan admits that she saw medical personnel and/or had medical procedures done over 300 times since arriving at WERDCC.[8]

         With respect to the specific claims raised in Buchanan's complaint, the evidence shows the following:

         May 2011 Spinal Injury

         Buchanan fell from her wheelchair on May 31, 2011. The following day, she self-declared a medical emergency, complaining that she was experiencing numbness and tingling in her left arm and leg. Examination showed weak grip strength in the left hand. No edema was noted and Buchanan was able to move all extremities. X-rays taken that same date showed cervical spondylosis at the C5-6 and C6-7 levels and degenerative disc disease at the L3-4 level, mild levorotoscoliosis, and previous interbody fusion at the L4-5 level. Upon examination, it was determined that the event was not a medical emergency, but Buchanan was admitted to TCU for observation.[9] On June 2, Buchanan had no complaints. She was examined by Dr. Kulkamthorn - a physician at WERDCC - and reported that she no longer had any numbness or any new symptoms, and her grip strength was the same as before the fall. Dr. Kulkamthorn diagnosed Buchanan with a sprain of the left hand and leg and released her from TCU. Buchanan was instructed to follow up in seven days.[10]

         Buchanan returned to Dr. Kulkamthorn on June 10 who noted that Buchanan's symptoms were the same as before the fall. He diagnosed Buchanan with chronic pain of the lumbar spine and neck pain and increased her dosage of salsalate.[11]

         Buchanan had other medical calls in June and July 2011 involving gastrointestinal issues, allergies, and an acute hand injury from getting her hand caught in a locker. None of these calls involved complaints of musculoskeletal pain or other symptoms associated with the May 2011 fall. Throughout this period, Buchanan was continued on her medications as prescribed by the Chronic Care Clinic, that is, acetaminophen and salsalate, and she continued to be authorized to use a wheelchair.[12]

         July 2012 Cardiac Complaints

         Dr. Kapur began his employment at WERDCC in March 2012 and first saw Buchanan in April 2012 in the Chronic Care Clinic.[13]

         During the morning of July 5, 2012, Buchanan visited Dr. Kapur and complained of continued back pain, cervical pain, and numbness in the left arm. Dr. Kapur reviewed x-rays that had been taken in June 2012 and noted them to show no change from the previous year. He also noted Buchanan's history of lumbar surgery and determined that cervical radiculopathy was to be considered. He noted that Buchanan had been taking salsalate and Tylenol and that analgesic balm and alpha lipoic acid were recently added.[14] He instructed Buchanan to continue on her medications and referred her to orthopedic services. Dr. Bredeman, a medical administrator with Corizon, determined that an orthopedic consult was not medically necessary and recommended that Buchanan undergo a physical therapy consult instead.[15]

         Later that same day, July 5, Buchanan self-declared an emergency and reported to the responding nurse that she had pain in her neck that travelled to her shoulder. Buchanan contends in her complaint that she also told the nurse that she was having severe chest pain and that she was nauseous, sweating, crying, and asking for hospital care, but these additional complaints are not reflected in the medical record. The medical record shows that Buchanan exhibited no neurological deficits, her respiration was even and non-labored, she had full range of motion, and no swelling was noted. The nurse determined the matter to be a non-emergency event. Buchanan made another emergency call for chest pain on July 10 and reported having pain for two months that was increasing in intensity. She described the pain as starting at her left ear and radiating down her entire left side. Examination showed reproducible pain upon palpation and slight swelling about the left hand, which Buchanan said was normal. Otherwise, examination was unremarkable. Warm compresses were applied to the affected area, and Buchanan was instructed to return if the pain worsened.[16]

         Dr. Kapur examined Buchanan on July 16 in relation to her chronic back pain. Buchanan avers in her complaint that she attempted to talk to Dr. Kapur about the chest pain she had been experiencing, but he refused to address the issue because the scheduled appointment was not for chest pain.[17] The medical notes of this appointment do not mention chest pain.[18]

         On July 30, Buchanan underwent an EKG to establish a baseline reading. The results of the EKG were abnormal in that it showed an anteroseptal myocardial infarction-age undetermined, and possible inferior ischemia.[19] Dr. Michael Hakala - a physician at WERDCC - ordered that Buchanan's troponin level be checked, and Buchanan was admitted to TCU for observation. While in TCU, Buchanan complained of pain in her head, chest, neck, back, shoulder, and arm, but she was observed to be in no distress and to rest quietly. A troponin check and recheck were both negative. Dr. Kapur discharged Buchanan from TCU on August 1, noting that she no longer had any complaints. He instructed her to continue on her current medication regimen, which included Zocor, salsalate, acetaminophen, and alpha lipoic acid.[20]

         A repeat EKG was performed on August 4 in response to Buchanan's renewed complaints of pain. The results of this EKG were the same as those reported on July 30. Buchanan's vital signs were normal, she was neurologically intact, and her respiration was even and non-labored. Buchanan was instructed to follow up if her symptoms worsened.[21] On August 10, Dr. Kapur readmitted Buchanan to TCU to undergo an additional EKG for her ongoing complaints of pain in her chest, neck, arm, and face. While in TCU, Buchanan was observed to be in no distress nor to exhibit any discomfort. By 8:00 p.m., Buchanan reported that she felt fine and asked what the doctor's orders were.[22] On August 11 and 12, she refused her medication, stating that it did not do her any good. She also complained of chest congestion and renewed her complaint that she had pain in her head that radiated down her arm. But she was able to wheel herself up and down the hallway for fifteen minutes with no reported chest pain.[23] On August 12, Buchanan asked to be released to her housing unit and Dr. Kapur released her the following day, noting that an EKG showed no change from the other studies and that her symptoms had improved.[24]

         During a follow up appointment on August 15, Dr. Kapur referred Buchanan for an outside cardiology consultation. He instructed Buchanan to continue with her medications and to continue to use her wheelchair.[25] In her complaint, Buchanan claims that Dr. Kapur threatened to revoke authorization for her wheelchair if she continued to claim that she had a heart attack.[26]

         Buchanan had two additional medical encounters in August regarding her complaints of chest pain, including a repeat EKG that showed the same results as previous studies. During follow up on September 6, Buchanan reported to Dr. Kapur that she was experiencing no new symptoms.[27]

         On September 10, 2012, Buchanan underwent a cardiac stress test at St. Mary's Health Center upon referral from Dr. Kapur. Dr. Conrad S. Balcer conducted the study and reported that it yielded normal results. Dr. Balcer concluded that the study indicated “a low likelihood of the presence of hemodynamically significant segmental coronary artery disease and at this time, [Buchanan] appears to be at low risk of future cardiac events.”[28] Although Buchanan states in her complaint that she believes the stress test showed severe cardiac injury and poor cardiac health, [29] she has produced no evidence that conflicts with Dr. Balcer's report. Upon review of the ...

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