United States District Court, E.D. Missouri, Northeastern Division
MATTHEW W. CALVERT, Plaintiff,
MIGUEL PANIAGUA, M.D., et al., Defendants.
OPINION, MEMORANDUM AND ORDER
EDWARD AUTREY, UNITED STATES DISTRICT JUDGE
a civil rights action filed by Plaintiff, pursuant to 42
U.S.C. § 1983. The matter is before the Court on
Plaintiff's Motion for Preliminary Injunction, [Doc. No.
40]. Defendants have filed a Response in opposition to the
motion, Plaintiff has filed a Reply, Defendants have filed a
Sur-Reply and Plaintiff has filed a Sur-Response. For the
reasons set forth below, the Motion is granted in part and
denied in part.
is currently incarcerated in the Crossroads Correctional
Facility in Camden, Missouri. Plaintiff claims he has been
denied medical care in violation of the Eighth Amendment.
Plaintiff's Amended Complaint alleges the following:
to January 2011 and continuing to the present, Corizon,
f/k/a/ Correctional Medical Services (“CMS”) was
retained under contract with the Missouri Department of
Corrections (“MDOC”) to provide medical services
to inmates in the MDOC penitentiary system, including
2005, the Plaintiff was diagnosed with Celiac Disease
(“CD”), which is a gluten sensitive entizopathy.
CD causes a permanent intolerance to ingested gluten.
Hemochromatosis, a hereditary disorder, too much iron is
absorbed, resulting in the accumulation of iron in the body.
Hemochromatosis is potentially fatal but usually treatable.
The gene associated with Hemochromatosis was identified and
widely published in a myriad of medical journals, including
the Journal of American Medicine (“JAMA”) prior
to 2011. The standard of community care for identifying
Hemochromatosis is through specific blood tests that measure
the levels of two substances: (a) Ferritin, a protein that
stores iron, and: (b) the iron in transferrin, the protein
that carries iron when it is not inside red blood cells. If
these levels are high, genetic tests are to be immediately
performed to confirm the diagnosis. A liver biopsy should
also be performed to determine whether the liver has been
intersects with Hemochromatosis in two ways: a. Cases have
shown the precipitation of iron overload and diagnosis of
hereditary hemochromatosis after successful treatment for CD.
b. An increased frequency in mutations in the Hemochromatosis
susceptibility gene (“HFE”) - suggesting a
protective role against iron deficiency by enhancing iron
August 2011, the Plaintiff was delivered to the custody of
the MDOC, and upon his induction he immediately disclosed to
the medical staff that he had been diagnosed with CD.
Thereafter, the Corizon medical personnel at the Fulton
Reception and Diagnostic Center further diagnosed Plaintiff
as anemic and deliberately prescribed Ferrous Sulfate (iron
pills) for anemia, albeit ingesting iron pills for anemia of
chronic disease is extremely harmful and likely fatal. These
contraindications and the potential fatality rate were not
disclosed to the Plaintiff when Ferrous Sulfate was
proscribed by Corizon staff.
the Plaintiff was transferred to the Northeastern
Correctional Center (“NECC”) and the care of that
site's Corizon medical staff, to include Dr. Archer.
January 3, 2013, Plaintiff's labs results indicated that
his iron and ferritin level were extremely low, and he was
scheduled for a doctor appointment with the chronic care
clinic physician, Dr. Archer. When examined by Dr. Archer, he
opined that he was “very concerned” about these
results and that he was going to prescribe 200 mg iron
infusions twice weekly until the Plaintiff's iron levels
returned to normal.
advised Defendant Archer at that encounter that he had
already been taking Ferrous Sulfate by mouth for
approximately one year, whereupon Dr. Archer stated that
because of the history of CD, Plaintiff was not able to
absorb iron in pill form and would have to take the IV
infusions of iron.
Archer refused to test the Plaintiff for hemochromatosis due
to the costs of the tests, albeit there were clear indicators
that Plaintiff had that disease. Dr. Archer further refused
to have Plaintiff's serum ferritin or C-reactive protein
(“CRP”) tested to differentiate between iron
deficiency anemia, where oral iron can be beneficial and
anemia of chronic disease, where oral iron should not be
given, due to the costs of the further testing.
Archer is not a Hematologist, nor did he possess any
specialized training in hematology or diseases related to
that field of medicine and refused to consult with a
specialist of this nature due to the costs of the consult.
more than a year, the Plaintiff endured increasingly painful
200 mg. iron infusions intravenously twice weekly.
Approximately six months into the first year of these
infusions, Plaintiff's iron levels returned to normal.
the entire year of 2013 the Plaintiff's Ferritin level
consistently rose into toxic and deadly ranges. Although the
Ferritin levels were consistently rising into the permanently
harmful ranges, Dr. Archer ordered the infusions continued.
Plaintiff inquired of Dr. Archer whether these infusions
should be continued in light of the fact his Ferritin levels
had reached the range of 2, 000 ng/mL or toxicity, in that
they were more than six times normal - to which he replied he
was going to continue the infusions until Plaintiff's
liver became too damaged to endure them.
same meeting, Dr. Archer admitted that Plaintiff's liver
enzymes, AST and ALT's, were elevated into the high
levels but he wasn't too worried about the levels. Dr.
Archer secreted the fact that these levels, as well as the
decreased hemoglobin and glucose levels, indicated onset of
severe organ damage by iron overload and hemochromatosis
which had become deadly.
that period of time, Plaintiff suffered from symptoms that
included extreme and relentless fatigue, weakness of his
body, weight loss, severe abdominal pain, joint aches and
joint pain, grey/bronzing of his skin, and chest pains, which
he reported to Dr. Archer repeatedly. Dr. Archer dismissed
those marked symptoms and deliberately continued the iron
Archer again refused to send Plaintiff to a hematologist,
dismissing his request for a specialist consult, although
among all iron overloading disorders, hereditary
hemochromatosis and transfusion dependent iron overload in
hereditary anemia's, are central when considering the
epidemiological impact, extent of burden and risk for iron
related morbidity and mortality.
Dr. Archer continued the iron infusions for the remainder of
August of 2013, Plaintiff's iron levels were dangerously
high, his ferritin level reaching 651 ng/mL, nearly double
the normal level, and his iron saturation levels had reached
56 - well within the high range and certainly beyond the
treatment parameters originally explained at the onset of the
infusions. Plaintiff's liver enzymes likewise were
severely elevated to 80, almost twice the normal level, a
prime indicator that the liver was beginning to fail due to
the iron saturation and overload.
September 5, 2013, Dr. Archer requested that Plaintiff be
referred to a hematologist or oncologist. This request was
denied by Dr. Bredeman, the regional Medical Director for
the fact that Plaintiff had not seen a specialist and testing
for genetic hemochromatosis had been refused, Dr. Archer
deliberately continued these iron infusions. Dr. Archer
persisted with Plaintiff's iron infusions well into 2014,
during which time his Ferritin levels, ALT's, AST's,
and iron levels remained elevated to from 3 to 7 times their
normal levels. By early 2014, his Transferrin Iron Binding
Capacity (“TIBC”) and Unsaturated Iron Binding
Capacity (“UIBC”) remained dangerously low.
Indeed, in some instances they could not even be calculated
due to the dangerously low UIBC. At this point,
Plaintiff's ferritin level had risen to over 2, 000
claims that the ultimate result was that the Plaintiff was
deliberately subjected by Dr. Archer to deadly, toxic iron
over-load, iron poisoning and iron saturation, and Dr.
Archer's unconstitutional behavior persisted in the face
of the well-established medical indicators instructing him to
cease the painful, invasive infusions or risk the
Plaintiff's death or permanent damage to his organs.
to Defendant Archer leaving his employment with Corizon,
Plaintiff began seeing Dr. Cabrera on a regular basis in
2014. Dr. Cabrera, whom had been reviewing the
Plaintiff's blood work, noticed the extremely and
dangerously high ferritin levels present in the
Plaintiff's blood and Plaintiff's unusual orange
yellow skin tinge. Dr. Cabrera asked Plaintiff if Dr. Archer
was trying to kill him by giving him these iron overloading
infusions when his ferritin levels were so high (over 2, 000
ng/mL), which indicated Plaintiff's entire body was being
poisoned by the iron infusions and couldn't eradicate the
iron from his system in such dangerously high levels. Dr.
Cabrera further opined the iron was building up in Mr.
Calvert's vital organs as a result of Dr. Archer giving
him iron overload and could be stored excessively in
Plaintiff's liver as evidenced by the high AST and ALT
levels, the spleen and bone marrow, or worse, the brain
-which would be terminal. The iron infusions were halted.
demanded to be referred to a hematologist, a specialist in
these types of diseases, cellular and molecular poisonings.
Dr. Cabrera refused to refer Plaintiff to a hematologist,
because Corizon wouldn't approve the specialist consult
due to the costs involved. At this meeting Plaintiff then
requested that Dr. Cabrera order the genetic testing to
confirm that he actually had hemochromatosis and not some
other disease, such as ACER. Again, Dr. Cabrera refused to
refer Plaintiff for genetic testing because Corizon
wouldn't approve this type of testing because the cost of
the genetic testing would be more expensive than a specialist
consult, and they would not approve these types of tests due
to the costs involved. Dr. Cabrera instead apparently had a
phone call with Dr. Waheed, a hematologist, and decided to
wait and see if Calvert's numbers would go down on their
Plaintiff continued to suffer from iron toxicity, he was seen
by Defendant Dr. Proctor. Dr. Proctor assessed
Plaintiff's condition as seizure disorder, celiac, and
anemia, failing to address Plaintiff's iron toxicity.
Plaintiff returned to Dr. Proctor to discuss his lab results,
Dr. Proctor again did nothing for Plaintiff's iron
toxicity, but merely ordered a recheck in one month.
Plaintiff's numbers remained elevated months later,
another physician, Dr. Rardin, asked that Plaintiff be
referred to a hematologist/oncologist for chelation therapy.
Defendants, Drs. Babich and Kosierowski, denied the request
for a consult or for chelation, and instead authorized
phlebotomies. Plaintiff did not receive his first phlebotomy
until December 2014.
the first six months of serial phlebotomies, Plaintiff
endured severe pain, fatigue, excessive loss of blood,
tiredness, weakness, weight loss, severe abdominal pain,
joint aches and pains, other arthritic type pain, retained
graying and/or bronzing of his skin, and suffered from
severe, excruciating chest pains, as though he was suffering
from heart attacks.
enduring six months of six hour long, serial phlebotomies
twice per month, with very little drop in the ferritin and
iron levels, and his TIBC levels remaining dangerously low,
Plaintiff demanded again to see a hematologist and a
geneticist for genetic testing to determine the origin and
extent of the intentional iron overloading, as well as the
cellular damage exacted by iron overloading. The Plaintiff
further requested that he be given treatment within the
standard of community care for iron overload, that being iron
chelation has been the industry standard prior to 2011. Iron
chelation removes iron from the blood with a chelation agent
such as: desferrioxamine (“Desferal”) or
deferasirox (“Exjade”), both of which bind with
iron in the blood and cells to excrete the iron through the
Cabrera admitted to Plaintiff that iron chelation is the
industry standard for iron overload albeit this treatment is
far too expensive and Corizon would not, under any
circumstances, pay for such costly drugs. Plaintiff literally
begged Dr. Cabrera to place an order for the drug, which he
finally agreed to.
a couple days Plaintiff was summoned back to medical and
advised by Dr. Cabrera “the iron chelation was denied
by Dr. Babich” at Corizon's corporate office,
because “‘Corizon is not going to pay for this
drug because it's too expensive.'” He then