United States District Court, E.D. Missouri, Northern Division
MEMORANDUM AND ORDER
A. ROSS UNITED STATES DISTRICT JUDGE.
Taylor Mayes ("Plaintiff'), proceeding pro
se, brings this action for monetary damages and
injunctive relief pursuant to 42 U.S.C. § 1983 against
Trinidad Aguilera, M.D.
("Defendant"). Plaintiff alleges Defendant was
deliberately indifferent to his serious medical needs in
violation of the Eighth Amendment. Specifically, Plaintiff
alleges he was provided inadequate treatment for his infected
and ingrown toenail. Defendant moves for summary judgment on
the grounds that there is no genuine issue as to any material
fact and that he is entitled to judgment as a matter of law.
(Doc. No. 17). The motion is fully briefed and ready for
disposition. For the following reasons, the motion will be
February 14, 2017, Plaintiff submitted a Health Services
Request complaining of an infected toe. (SOF at ¶ 11).
He was seen by Nurse Ashlee Skaggs who noted redness at the
nail bed and a slightly swollen right great toe. (SOF at
¶ 12). On February 15, 2017, Dr. Alan Weaver ordered a
ten-day prescription of the antibiotic Keflex for Plaintiff.
(Id.). Plaintiff made no complaints concerning his
toe at appointments with Nurse Kerri Stoner on February 22,
2017, or with Dr. Weaver on March 3, 2017. (SOF at ¶
complained of ongoing toe symptoms to Nurse Skaggs on March
9, 2017. (SOF at ¶ 15). On March 13, 2017, Plaintiff saw
Nurse Jobea Parker in sick call for complaints of an infected
toe. (SOF at ¶ 16). Nurse Parker noted a large portion
of skin growing over Plaintiffs toenail on the inside of the
nail, macerated red or purplish skin, and swelling. She
consulted with Defendant, who ordered another round of
Keflex, a follow-up appointment, and details for no work, no
recreation, shower shoes, and dressing changes once per week.
March 17, 2017, Plaintiff saw Dr. Weaver for complaints of an
infected toe which had not resolved after one round of
antibiotics. (SOF at ¶ 17). Dr. Weaver noted that
Plaintiff had developed a granuloma, which he reported was
painful and bled easily with pressure. A granuloma is a
result of the body attempting to contain an infection by
walling it off from the rest of the body. Dr. Weaver observed
no purulence (pus). Dr. Weaver assessed Plaintiff with an
ingrown toenail and prescribed another antibiotic, Neomycin,
to supplement Plaintiffs Keflex prescription. Dr. Weaver then
removed one-third of the nail on Plaintiffs right great toe
without complications and noted that, if the granuloma did
not resolve naturally, a surgical removal could be
considered. If an infection is progressing, it is appropriate
to remove part of the ingrown toenail so that the area can
drain and reduce the infection. This helps reduce swelling
and inflammation. (Id.). On March 18, 2017,
Plaintiff refused his dressing change. (SOF at ¶ 18).
April 11, 2017, Plaintiff saw Nurse Audrey Ford for
complaints of a big toe infection which caused discomfort and
showed no improvement. (SOF at ¶ 19). Upon examination,
Nurse Ford noted a slightly swollen right great toe with
redness around the left side of the toenail. She referred
Plaintiff to a physician for reassessment. (Id.).
April 26, 2017, Plaintiff saw Nurse Tina Neer for complaints
of an infected toe. (SOF at ¶ 20). Nurse Neer noted a
red and swollen right great toe nail with serosanguinous
(containing blood) drainage. She obtained a verbal order for
Betadine foot soaks for ten days from Dr. Weaver and
instructed Plaintiff to report any changes to the medical
staff. Dr. Weaver ordered Keflex 500mg for 14 days and foot
soaks for 10 days. (Id.).
April 27, 2017, Plaintiff saw Nurse Rhonda Burge for a
Betadine foot soak. (SOF at ¶ 21). Nurse Burge noted
that Plaintiffs right great toe was red and swollen. On April
28, 2017, Plaintiff saw Nurse Burge for a Betadine foot soak.
Nurse Burge noted some improvement. Plaintiff was scheduled
for an appointment with Defendant, but he complained about
waiting, left, and did not want to reschedule.
(Id.). On April 29 and 30, 2017, Plaintiff did not
report for his Keflex or foot soaks. (SOF at ¶ 22). On
May 1 and 2, 2017, Plaintiff reported for his foot soaks, but
not for his Keflex. (Id.).
3, 2017, Nurse Burge saw Plaintiff for a foot soak and noted
some improvement. (SOF at ¶ 23). Nurse Neer observed
signs of healing on May 4, 2017, and Plaintiff reported
improved pain. (SOF at ¶ 24). On May 5, 2017, Plaintiff
did not show for his foot soak. (SOF at ¶ 25). On May 6,
2017, Plaintiff saw Nurse Burge for a foot soak. At that
time, Nurse Burge noted some swelling around Plaintiffs right
great toe. (SOF at ¶ 26). On May 12, 2017, Plaintiff saw
Nurse Kerri Stoner for continued toe complaints. (SOF at
¶ 27). She referred him to a doctor for further
16, 2017, Defendant first saw Plaintiff, who complained of an
infected toenail to the right great toe. (SOF at ¶ 28).
He stated he ripped an ingrown toenail out about three months
ago. Defendant noted that Plaintiff had been treated with
Betadine soaks and Keflex and exhibited good healing of the
wound. Defendant also observed a hypertrophic scar on the
medial, right great toe with moderate redness and induration
at the proximal nail bed. Defendant assessed Plaintiff with
an infected ingrown toenail right great toe that was healing
well and prescribed ibuprofen for pain and inflammation,
Clindamycin (an antibiotic), and continued foot soaks for ten
5, 2017, Plaintiff saw Nurse Parker for complaints of an
infected toe. (SOF at ¶ 29). Nurse Parker noted
Plaintiffs great right toe was red, swollen, some macerated
skin (skin in contact with moisture for too long) around the
edge of the toe. Nurse Parker also noted bloody drainage on
the dressing around Plaintiffs toe. She advised Plaintiff to
leave the wound open to air when he was not in his cell.
Nurse Parker discussed Plaintiffs care with Defendant, who
ordered twice-daily Betadine foot soaks for ten days and
Clindamycin for ten days. (Id.).
reported for foot soaks on June 6 and 8, 2017, but skipped
one of the two foot soaks on June 7, 9, 10, 11, 12, 13, 14,
and 15, 2017. (SOF at ¶ 30). On June 14, 2017, Plaintiff
told the nurse he did not want to do them. (Id.). On
June 16, 2017, Plaintiff had a foot soak at 8:30 a.m. (SOF at
¶ 31). He later saw Dr. Weaver to assess his toe. Dr.
Weaver noted that the right first nail medial side had a
granuloma formation on the nail and that the toe appeared red
and purulent with tenderness. Dr. Weaver assessed Plaintiff
with an ingrown toenail of the first toenail medially with
infection. He again removed a portion of Plaintiffs toenail,
prescribed Augmentin (an antibiotic), and ordered foot soaks
once daily with Epsom salts and once daily with Betadine. Dr.
Weaver noted that, if the ingrown toenail recurred, Plaintiff
would need complete removal with nail growm plate ablation
and removal of granulation tissue. Plaintiff was issued a
soak pan and Epsom salts. (Id.).
appeared for foot soaks between June 17, 2017, and June 25,
2017. (SOF at ¶ 32). On July 12, 2017, Nurse Parker saw
Plaintiff and noted some improvement but continued issues
such as swelling and macerated skin. (SOF at ¶ 29).
18, 2017, Plaintiff saw Nurse Practitioner ("NP")
Laurel Davison for a follow up on his toe. (SOF at ¶
34). Plaintiff reported the toenail had grown back in. Upon
examination, NP Davison noted a mild ingrown toenail. She
advised Plaintiff to use shower-soaks to stretch skin flap
away from the ingrowing nail and educated him on nail
trimming techniques. She determined there was no indication
for complete nail removal and no overt infection and advised
him to report to sick call as needed. (Id.).
August 3, 2017, Plaintiff saw Nurse Stoner and stated his big
toe was infected again. (SOF at¶ 35). Nurse Stoner noted
some serosanguinous (yellowish with small amounts of blood)
drainage and redness. She discussed Plaintiffs condition with
Defendant, who ordered a wound culture to determine the