United States District Court, E.D. Missouri, Southeastern Division
MEMORANDUM AND ORDER
STEPHEN N. LIMBAUGH, JR. UNITED STATES DISTRICT JUDGE
pro se, is a prisoner incarcerated in the Missouri Department
of Corrections. He brought this 42 U.S.C. § 1983 lawsuit
alleging violations of his constitutional rights related to
the treatment of an alleged tumor in his nostril. Defendant
Dr. Mina Massey has moved for summary judgment.
claims that defendant Dr. Massey failed to properly treat a
“tumor” that was growing in his nose. The first
time plaintiff reported any issues regarding his nose was
February 9, 2014. He told a nurse that his nose would become
dry and bleed. Plaintiff saw defendant for the first time on
February 23, 2014, for multiple complaints, including
nosebleeds. He did not mention any lump in his nose.
Defendant ordered nasal saline spray for 180 days to moisten
plaintiff's nasal passages and eliminate the nosebleeds.
April 7, plaintiff submitted a Medical Services Request
(“MSR”) form complaining of a lump in his nasal
passage that smelled bad, was draining, and was bleeding.
Defendant saw plaintiff on April 10 to follow up on
plaintiff's earlier ear complaints. At that visit,
plaintiff told defendant about the bump inside his right
nare. Plaintiff reported that three months earlier, he bit a
staple in half, stuck it on an ink pen, and used it to remove
the lump. Plaintiff said he thought it was a booger. But he
also stated it was like a piece of flesh. Since that time,
plaintiff reported that he had nasal congestion and drainage
from his right nare.
examined plaintiff's right nare and noted mild erythema,
swelling, and yellow purulent discharge, but no masses.
Plaintiff's left nare and throat were normal. Defendant
diagnosed rhinosinusitis, which is an inflammation of the
nasal passages and sinus cavities, usually caused by allergy
or infection. She prescribed an antibiotic for 10 days and
told plaintiff to submit an MSR if he did not improve.
submitted MSRs on April 22, April 27, and May 3. He
complained he had a lump in his nasal passage and could
barely breathe at times. A nurse examined plaintiff on May 7
and noted he had no drainage or lump. On May 25, plaintiff
declared a medical emergency for a nosebleed and was sent to
the emergency room at Missouri Delta Medical Center.
Plaintiff admitted to the ER doctor that he picked his nose
to induce bleeding. The ER doctor wrote a prescription for an
antibiotic, and, as an alternative treatment plan, suggested
that plaintiff follow up with an otolaryngologist, which is
an ear, nose, and throat specialist (“ENT”).
Notably, the ER staff did not document that there was any
nasal mass, tumor, or cancer. After reviewing the records,
defendant did not believe an ENT visit was necessary. She
believed that plaintiff's nosebleeds were caused by his
picking his nose to induce bleeding, and no appointment was
made with an ENT.
3, plaintiff saw nonparty Dr. Garcia to follow up on his trip
to the ER. Plaintiff reported he had a problem with chronic
nosebleeds and admitted he had a problem with picking his
nose in order to cause bleeding. Dr. Garcia noted that
nothing was found in ER and that “if the issue
continues will need to see ENT.” On June 11, plaintiff
saw a nurse for complaints of a nosebleed and was sent to the
ER again. Nonparty ER doctor Mansell performed an anterior
nasal packing/cauterization of the right nare and applied a
nasal tampon and rhino rocket. He was discharged several
hours after arriving. Plaintiff claims he “coughed
up” a “tumor” during placement of the rhino
rocket and gave it to a nurse, but there is no record of such
Mansell prescribed narcotic pain medicine, Norco, for
plaintiff and provided him with four tablets on discharge.
Plaintiff also received Zofran to prevent nausea and morphine
in the ER. Narcotics are generally not prescribed in the
prison setting. Dr. Massey determined that, based on the
cauterizations she has performed on patients, that Tylenol
was sufficient to control pain post-procedure. Dr. Massey
states that most pain occurs during the procedure. Had
plaintiff still had pain, she would have prescribed Tramadol,
a narcotic pain reliever, but she wanted plaintiff to try the
was placed in the prison infirmary after he returned from the
ER. Approximately 12 hours after his discharge from the ER,
defendant Massey saw plaintiff for followup. Plaintiff was
agitated, as he wanted the Norco tabs and other followup care
he thought he needed. Plaintiff would not stop yelling to
allow defendant to explain her treatment plan. Defendant
believed it was unsafe for her to enter his room at that
time, so she walked away. Plaintiff became more agitated and
pulled the nasal tampon out of his nose, inducing bleeding.
Defendant instructed nurses to re-pack the nostril and apply
and ice pack after plaintiff regained control of himself.
Plaintiff refused treatment. Plaintiff was kept under
observation until bleeding resolved on its own the next day,
and he was returned to his cell.
again saw plaintiff on June 17, four days after being
discharged from the infirmary, and she was again unable to
examine plaintiff due to his belligerence. She noted,
however, that plaintiff had no active bleeding and his blood
counts were normal.
again self-declared an emergency for a nosebleed on August 3.
No. active bleeding was observed, but the nurse packed the
nostril and provided an ice pack. The nurse instructed
plaintiff to refrain from taking ibuprofen and to start
taking his blood pressure medicine.
August 20, defendant saw plaintiff after mental health
referred him to medical for nosebleeds. A psychiatrist had
apparently looked in plaintiff's nose and saw an
ulceration and believed defendant should examine him.
Defendant observed a small amount of dried mucus but no
ulceration or source of bleeding. Plaintiff insisted on an
ENT referral as recommended earlier by the ER doctor.
Defendant attempted to explain that the ER recommendation was
not a referral, but plaintiff would not listen. That was the
last visit defendant had with plaintiff about nosebleeds,
though she did see plaintiff again in September and October
2014 for scabies.
alleges that in summer 2015, a nurse found a dime-sized hole
in his right nostril, but no such encounter exists in the
medical records. The medical records show he told other
providers about the “tumor” ...