MEMORANDUM AND ORDER
Plaintiff Terrence Stevens (“Plaintiff’) brought this action based on events that occurred while he was incarcerated at Green Haven Correctional Facility (“Green Haven”). Plaintiff Stevens was originally joined in this action by Plaintiff Thomas Lynch, who has since settled his claims with Defendants and whose claims have thus been dismissed. The defendants in this action are: 1) various physicians and officials at Green Haven;
1
2) Dr. John C.
Plaintiff Stevens seeks to recover damages against all defendants under 42 U.S.C. § 1983 (2003) (“Section 1983”) for violation of his constitutional rights, specifically Defendants’ alleged deliberate indifference to his serious medical needs in violation of the Eighth Amendment’s prohibition of cruel and unusual punishment. Stevens also seeks damages against CPS for breach of contract and negligence. The Green Haven Defendants and CPS move, in three separate motions, for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure.
I. BACKGROUND
a. Factual Background
Plaintiff Terrence Stevens was an inmate at Green Haven from May 4, 1993 through February 26, 1996, and from December 2, 1996 through January 31, 2001, when he was released from custody. 2 (Defs.’ Rule 56.1 Stmt. ¶ 21.) Stevens suffers from a form of muscular dystrophy called alternatively Kugelberg-Welander Syndrome (“KWS”) and Spinal Muscular Atrophy (“SMA”) III. (Id. at ¶¶ 18-20.) The instant allegations concern the period of time from December 2, 1996 through January 31, 2001, during which time Stevens was housed at Green Haven’s Unit for the Physically Disabled (“UPD”). (Id. at ¶ 21.)
The UPD is a housing unit for inmates with substantial disabilities. (Id. at ¶ 24.) During the period in which Stevens was housed in the UPD, certain aspects of the facility were governed by the decree of Milburn v. Coughlin, 79Civ5077 (RCC), a settlement accord of a class action suit. (Id. at ¶ 25.) The Milbum decree put in place certain requirements for the operation of the UPD, including: the presence of a primary care physician from the facility medical staff for a minimum of 12 hours per week; one nurse on duty at all times and two nurses on duty during the 7am-3pm shift; physiatry services provided at the facility for at least eight hours per week for direct patient care; and an Interdisciplinary Committee intended to (1) assist in the administration of the UPD, (2) review admission and discharge decisions, and (3) develop and review programs, policies and procedures for the UPD. (Id. at ¶ 25; Plaintiff Terrence Stevens’ Response to Defendants’ Local Rule 56.1 Statement (“PL’s 56.1 Resp. Stmt.”) ¶ 25.)
During the time period at issue, Drs. Sreedharan, Poellepelle, Perri and Wein-stein and Defendant Dr. Dunkelman were private consulting physiatrists in the UPD. (Defs.’ 56.1 Stmt. ¶ 36.) Defendant Dr. Norman Selwin was the acting Facility Health Services Director at Green Haven from December 2, 1996, until March 1999, when he was replaced in this capacity by Defendant Dr. Carl Koenigsmann. (Plaintiffs Statement Pursuant to Local Rule 56.1(“PL’s 56.1 Stmt.”) ¶ 52.) Since 1992, Defendant Donald Stevens has been the Nurse Administrator at Green Haven. (Id. at ¶ 54.) The Facility Health Services Director is responsible for supervising all medical staff, and shares with the Nurse Administrator the responsibility of supervising nursing staff. (Id. at ¶ 55.) Defendant Larry Zwillinger was the Regional Health Services Administrator for the Hudson Valley Region, including Green Haven Correctional Facility, from 1991 until 2002. (Id. at ¶ 57.)
During this period, Dr. Muldover and Dr. Robert Sachs also served sequentially as administering physiatrists on the UPD interdisciplinary team. Defendants contend that Dr. Muldover, as the physiatrist heading the UPD interdisciplinary team for the majority of the relevant time period, was ultimately responsible for many of the decisions regarding Plaintiff Stevens’ treatment and care. (Defs.’ 56.1 Stmt. ¶ 37.) However, Plaintiffs medical records and deposition testimony from Defendant Dr. Dunkelman, one of Plaintiffs treating physiatrists and the only treating physiatrist to testify in this matter, suggest that Dr. Muldover had little if any direct contact with Stevens. (PL’s 56.1 Resp. Stmt. ¶ 37.)
During his time in the UPD, Plaintiff was assigned an inmate assistant to help him with basic daily functions, such as dressing, bathing, transfers from bed to wheelchair, and pushing the wheelchair, though Plaintiff contends that he was sometimes without an assistant to push his wheelchair. (Defs.’ 56.1 Stmt, ¶ 29; Pl.’s 56.1Resp. Stmt. ¶ 29.)
Defendant Dr. John Bendheim was the DOCS staff physician assigned to the UPD from the beginning of 1996 through June of 1999, when Dr. Bendheim was replaced by Defendant Dr. Lester Silver. (PL’s 56.1Stmt. ¶¶ 44, 49.) Dr. Bendheim is not board certified in any discipline, which, according to DOCS policy, makes him unqualified to work as a unit physician for the UPD. (PL’s 56.1 Stmt. ¶ 48.) Dr. Ben-dheim was replaced by Dr. Silver in part because over the course of his three-year tenure in the UPD, according to Dr. Koe-nigsmann, Dr. Bendheim’s relationship with the patients in the UPD “had deteriorated to a degree that was no longer therapeutic.” (Koenigsmann Testimony (“Koe-nigsmann”) at 77, Ex. F to Reinert Decl.)
According to the testimony of Defendants Drs. Selwin and Koenigsmann, the two Green Haven Facility Health Services Directors from the time period at issue, non-specialist DOCS doctors relied on specialist physiatrists to assign treatments for a muscular dystrophy patient, and physical therapists followed the recommendations of the physiatrists. (Defs.’ 56.1 Stmt. ¶ 34.) Dr. Bendheim describes the
Defendant Nurse Sandra Fila was the head nurse in the UPD for the entire relevant time period, and she primarily worked the day shift. (PL’s 56.1 Stmt. ¶ 50.) Defendant Nurse Dorothy Dongar-ra began working at Green Having in January 1997 and worked there until 2001. Nurse Dongarra worked exclusively in the UPD on the day shift beginning in 1999 for about a year. (Id. at ¶ 52.)
While housed at the UPD, Plaintiff repeatedly requested to be seen by a physician who was knowledgeable about muscular dystrophy. (Bates 3616, 3820, Ex. C to Schulman Decl.) However, Defendants did not permit Stevens to be evaluated by a muscular dystrophy specialist prior to April 2000, when Plaintiff was seen by Dr. Holstein. (Stevens Testimony (“Stevens”) at 70, 130, Ex. G to Reinert Decl.) Stevens also claims that while he was at Green Haven, Defendants denied him adequate physical and occupational therapy. (Plaintiffs Memorandum of August 18, 2007 at 2, 9, 15.) Stevens alleges that as a result of not receiving adequate treatment, he has suffered extreme pain and suffering, emotional distress, and permanent injury. (Second Am. Compl. ¶ 34, Ex. A to Schul-man Decl.)
Between December 1997 and December 2000, Plaintiff filed numerous grievances complaining of inadequate medical care, including Defendants’ refusal to allow him to see a Muscular Dystrophy specialist (Bates 3616, 3749, 3820, Ex. C to Schulman Decl.), nurses’ failure to renew his prescriptions in a timely fashion (Bates 3722, Ex. C to Schulman Decl.), Defendants’ failure to provide him with adequate physical therapy (Bates 3616, 3722, 3749, Ex. C to Schulman Decl.), and Defendants’ failure to adequately address his pulmonary distress (Bates 3616, 3820, 4103, Ex. C to Schulman Decl.; Stevens at 68, 73-75).
1. Plaintiffs Access to Physical Therapy
As early as 1993, a DOCS staff physician’s medical evaluation of Plaintiff indicated that he was experiencing increasing muscular deterioration as a result of his illness, and suggested that he receive passive range of motion exercises twice daily. (Pl.’s 56.1 Stmt. ¶ 229; Bates 1197, Ex. F of Pl.’s Medical Records.) A physician’s evaluation from December 10, 1996 observed that Plaintiff needed physical therapy to maintain his muscle strength and range of motion. (PL’s 56.1 Stmt ¶230; Bates 1443, Ex. I of PL’s Medical Records.) Between February 1998 and February 2000, Drs. Bendheim and Silver ordered that Plaintiff receive range of motion exercises to his lower extremities twice a week provided by nursing staff, and in November 1999 Dr. Silver indicated that, he would recommend an increase in Plaintiffs visits to the physical therapy department from weekly to three times per week. (PL’s 56.1 Stmt. ¶¶ 187, 231.) During the period from February 1998 to February 2000, Plaintiff visited the physical therapy department once per week at most. (Id. at ¶ 188.)
According to treatment records and Plaintiffs testimony, on Plaintiffs visits to the physical therapy department, he was treated by a trained physical therapist on 24 occasions between December 1996 and January 2001; otherwise, he was treated by a nurse or unlicensed physical therapy assistant. (Id. at ¶¶ 172, 235.)
For the majority of Plaintiffs time in the UPD, the nurses in the UPD were assigned to provide Plaintiff with regular
Plaintiff claims that nurses in the UPD, particularly Nurse Dongarra, consistently refused to perform the range of motion exercises that Plaintiff was prescribed. (Id. at ¶ 98.) For a period of time beginning in November 1999, Dr. Silver excused nurses from having to perform range of motion exercises on Plaintiff, instead having untrained inmate health assistants perform the exercises. (Id. at ¶ 213.) Drs. Koenigsmann, Bendheim, and Donald Stevens, as well as Nurse Dongarra, asserted in their testimony that it would have been “inappropriate” for inmate health assistants to provide range of motion exercises to Plaintiff. (Id. at ¶ 210.)
In December 1999 the physiatrist observed that Plaintiff needed more aggressive physical therapy to counteract his neck pain; in response to Plaintiffs complaints in January 2000 of leg and knee pain over the past eight to nine months, the physiatrist recommended range of motion exercises twice daily. (Id. at ¶¶232, 233.)
The UPD nurses did not receive training to perform the range of motion exercises that Plaintiff required in his physical therapy until after February 24, 2000. (Id. at ¶ 167.) Dr. Holstein, the muscular dystrophy specialist who later examined Plaintiff, described the exercises that the nurses had been performing up to this point (characterized by Plaintiff as essentially lifting his legs up and down) as inadequate treatment for Plaintiff. (Id. at ¶ 167.) Dr. Holstein stated in his testimony that proper range of motion exercises for patients with muscular dystrophy will sometimes require stretching past the point of resistance, and he acknowledged that some kind of training, formal or informal, is required to perform range of motion exercises of the type that nurses were assigned to perform for Plaintiff (Id. at ¶¶ 214, 221.) Plaintiff complained repeatedly that the nurses’ and physical therapy assistants’ failure to provide him with proper exercise resulted in persistent pain in his limbs. (Id. at ¶ 224.)
In April of 2000, Dr. Stevens referred Plaintiff to Dr. Holstein, a muscular dystrophy specialist, to evaluate his complaints of breathing difficulties and to recommend treatment to retard progression of SMA III and maximize Plaintiffs level of functioning. (Id. at ¶¶ 22, 23.) After examining Plaintiff, Dr. Holstein recommended that Plaintiff receive range of motion exercises to all four limbs on a daily basis, distal muscle strengthening exercises, creatine, chest therapy, incentive spi-rometer, pulmonary function tests, and a follow-up evaluation in three months. (Id. at ¶ 24.) Dr. Holstein recommended an emphasis on range of motion exercises in Mr. Stevens’ knees and shoulders because he identified contractures in those areas and believed range of motion exercises would reduce restriction in those areas. (Id. at ¶ 26.)
Dr. Holstein asserted that the course of therapy that he prescribed for Plaintiff in
Plaintiff asserts that during the time period at issue, between 1996 and 2001, he suffered recurrent pain in his knees and a loss of function in his right hand, a claim that is supported by his medical records. (Id. at ¶¶ 162, 249.)
2.Treatment of Plaintiffs Pulmonary Distress and Chest Pain
Medical records and Plaintiffs testimony indicate that Defendants were aware from at least as early as August 1997 that Plaintiff was suffering from scoliosis and related breathing difficulties and chest pain. (Pl.’s 56.1 Stmt. ¶ 161.) At times, Plaintiff experienced pain in his chest wall that he described as “frightening” and so painful that it felt like an electrical shock was going through him. (Id. at ¶ 250.) However, Plaintiff apparently received no comprehensive evaluation or treatment for his scoliosis or breathing difficulties and chest pain until he was seen by Dr. Holstein, a muscular dystrophy specialist, in April of 2000.
On August 2, 1999, Dr. Silver examined Plaintiff, who complained of chest wall pain and difficulty breathing, and observed by reviewing Plaintiffs chart that his chest wall pain was “longstanding”. (Id. at ¶ 251.) Dr. Silver also opined that the pain was “essentially untreatable,” a judgment that Dr. Silver was unable to account for in his deposition testimony. (Id.)
In April 2000, Dr. Holstein examined Plaintiff and prescribed an incentive spi-rometer, which Plaintiff says resulted in improvement in his chest pain and breathing difficulties. (Id. at ¶257.) Dr. Holstein expressed the opinion that severe scoliosis was the cause of Plaintiffs breathing difficulties, and he recommended chest therapy because he believed it would help alleviate the breathing difficulties. (Id. at ¶¶ 25, 27.) According to Dr. Holstein, it is common knowledge among muscular dystrophy specialists that breathing difficulties can result from scoliosis. (Holstein Testimony (“Holstein”) at 78-79, 96-97, Ex. L to Reinert Decl.) Plaintiffs respiratory difficulties decreased as a result of the treatments prescribed by Dr. Holstein. (Id. at ¶ 35.)
3. Plaintiffs Access to Occupational Therapy
The UPD staff did not provide occupational therapy to patients on the unit; occupational therapy could only have been provided through the referral process used for obtaining specialist consultations, as had been done for other patients at Green Haven. (Pl.’s 56.1 Stmt. ¶¶ 236, 237, 240.) According to Dr. Lange’s testimony, if Plaintiff had had access to occupational therapy, it is likely that the function and mobility of his right hand would be better than it is currently. (Id. at ¶ 244.)
4. CPS’ Role at Green Haven
Correctional Physicians Services is an agency outside the DOCS system that con
During the time in which CPS was the specialty care coordinator for Green Haven, physical therapy was classified as specialized care, and physical therapy referrals had to be approved by CPS. (PL’s 56.1 Stmt. ¶ 113.) During the time that CPS had contracted with DOCS to provide specialty care services at Green Haven, the physical therapist who worked at Green Haven was a CPS employee, although the physical therapy assistant throughout this time was a DOCS employee. {Id. at ¶ 114.) Under the terms of CPS’s contract with DOCS, CPS was paid a set fee, and CPS paid for the cost of any specialist consultations that they approved. {Id. at ¶ 118.)
CPS was responsible for approving or denying patient referrals to specialists, and only CPS had the authority to override a denial. {Id. at ¶¶ 113, 123.) DOCS medical administrators observed that there was an undercurrent of concern at Green Haven regarding the possibility that some CPS denials of specialist care were inappropriate. {Id. at ¶¶ 119-122.)
b. Procedural Background
Plaintiffs Terrence Stevens and Thomas Lynch filed the instant federal action on November 30,1999. 3
On November 11, 2002, the Green Haven Defendants moved to dismiss the action for failure to exhaust administrative remedies as required by the PLRA, and CPS subsequently joined the motion. The Court denied Defendants’ motion on June 16, 2003. On March 9, 2007, pursuant to a settlement agreement, the Court dismissed with prejudice the claims of Plaintiff Thomas Lynch against DOCS and CPS and the cross-claims of CPS against all other defendants in the action.
In May of 2007, Defendants filed the instant motion for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure on Plaintiff Terrence Stevens’ Eighth Amendment claim against all Defendants and breach of contract and negligence claim against Defendant CPS.
II. DISCUSSION
a. Summary Judgment Standard
Federal Rule of Civil Procedure 56(c) provides that summary judgment should be granted “if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the
In weighing a motion for summary judgment, ambiguities or inferences to be drawn from the facts must be viewed in the light most favorable to the party opposing the summary judgment motion.
See Thompson v. Gjivoje,
b. Plaintiffs Eighth Amendment Claim
Plaintiff claims that Green Haven Defendants and CPS were deliberately indifferent to his serious medical needs in violation of the Eighth Amendment’s prohibition of cruel and unusual punishment.
The Supreme Court in
Estelle v. Gamble,
The Second Circuit has observed that the objective medical need requirement of an Eighth Amendment claim is necessarily contextual and fact specific, and therefore “the serious medical need inquiry must be tailored to the specific circumstances of each case.”
Smith v. Carpenter,
In analyzing the objective element of an Eighth Amendment claim in the context of a plaintiffs claim regarding delayed provision of HIV medication, the court in
Smith
emphasized that the objective medical need inquiry will differ depending on whether a plaintiff alleges a temporary delay or interruption in the provision of otherwise adequate medical treatment or a general failure to provide treatment for a medical condition.
The Supreme Court in
Estelle
recognized the Eighth Amendment to apply both to cases of serious illnesses where deliberate indifference “may actually produce physical ‘torture or a lingering death’ ” and to “less serious cases” where the deliberate indifference “may result in pain and suffering which no one suggests would serve any penological purpose.”
In addition to the objective medical need requirement, a plaintiff alleging an Eighth Amendment violation based on deliberate indifference to a serious medical need must establish that the defendants’ actions meet a subjective standard of deliberate indifference. “An official acts with the requisite deliberate indifference when that official ‘knows of and disregards an excessive risk to inmate health or safety.’”
Chance,
To meet the deliberate indifference standard, a defendant’s actions must go beyond negligence, demonstrating a reckless disregard for the risk presented.
Farmer,
Mere disagreement over choice of treatment, or even a claim that negligence or medical malpractice has occurred, does not create a constitutional claim.
Estelle,
Second Circuit precedent holds that the doctrine of
respondeat superior
does not apply in a suit for money damages under Section 1983, and that some “ ‘personal involvement of defendants in alleged constitutional deprivations is a prerequisite to an award of damages under § 1983.’ ”
Wright v. Smith,
(1) the defendant participated directly in the alleged constitutional violation, (2) the defendant, after being informed of the violation through a report or appeal, failed to remedy the wrong, (3) the defendant created a policy or custom under which unconstitutional practices occurred, or allowed the continuance of such a policy or custom, (4) the defendant was grossly negligent in supervising subordinates who committed the wrongful acts, or (5) the defendant exhibited deliberate indifference to the rights of inmates by failing to act on information indicating that unconstitutional acts were occurring.
Colon v. Coughlin,
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Here, Defendants do not dispute that Plaintiffs underlying condition, a type of muscular dystrophy, is a serious medical condition. Defendants instead argue that they are entitled to summary judgment because much of the behavior forming the basis of Plaintiffs claims — particularly the gaps in provision of physical therapy and the delay in treating Plaintiffs respiratory problems and chest pains — constitute mere delays in treatment equivalent to the Smith plaintiffs delayed receipt of HIV medication, and therefore do not satisfy the serious medical needs requirement in the absence of evidence that the delays caused serious pain or long-term harm to Plaintiff.
Plaintiff argues that the record establishes several distinct bases for Eighth Amendment liability on the part of defendants, including: (1) Plaintiffs lack of access to appropriate physical therapy during the relevant period; (2) Defendants’ excessive delay in treating Plaintiffs chest pains and respiratory difficulties; and (3) Defendants’ failure to provide Plaintiff with occupational therapy.
1. Plaintiffs Access to Physical Therapy
Plaintiff claims that his lack of access to physical therapy while in the UPD provides the basis of a constitutional claim due to the frequent failure of DOCS medical employees to provide Plaintiff with the physical therapy, particularly range of motion exercises, prescribed for him; Plaintiffs frequent receipt of physical therapy from untrained or unlicensed providers;
Several sources of evidence, including Dr. Bendheim’s testimony regarding Dr. Muldover’s advice and evaluations by DOCS physicians from 1993 and 1996, indicate that it was generally known among Plaintiffs treating physicians that daily or twice daily physical therapy treatment would be advisable for properly treating his muscular dystrophy. (Pl.’s 56.1 Stmt. ¶¶ 229-30, 232.) Testimony from DOCS medical personnel also indicates that the lack of muscular dystrophy expertise on the part of any of Plaintiffs treating physicians or supervising physiatrists or specialists should have led Defendants to acquiesce to Plaintiffs requests for referral to a muscular dystrophy specialist prior to April of 2000.
(See
Pl.’s 56.1 Stmt. ¶¶ 58-61.) However, the medical judgment regarding the frequency of physical therapy to be prescribed- — -at least provided such therapy is being prescribed — like the decision regarding referral to a muscular dystrophy specialist, falls into the category of disputes regarding choice of treatment, which do not provide the basis for a constitutional claim.
See Estelle, supra,
at 105-06,
In contrast, Defendants’ chronic failure to provide Plaintiff with the level of physical therapy treatment that had been prescribed and repeatedly recognized as necessary by treating physicians does provide support for Plaintiffs claim of deliberate indifference to serious medical needs. For the majority of the time at issue, the UPD nurses, including Defendant Nurses Fila and Dongarra, were charged with providing Plaintiff with the physical therapy and range of motion exercises that he received outside of the physical therapy department. Medical records indicate numerous gaps in the provision of these physical therapy services to Plaintiff. In addition to many one- to two-week lapses in physical therapy provision prior to 1999, the frequency of Plaintiffs physical therapy sessions declined significantly beginning in January 1999: he received four treatments in January 1999, two treatments in February 1999, and only two treatments total between March and November 1999. (Pl.’s 56.1 Stmt. ¶ 166.) These lapses were in clear contravention of the treating physicians’ prescriptions for the period from February 1998 and February 2000, when Drs. Bendheim and Silver ordered that Plaintiff receive range of motion exercises to his lower extremities twice a week by nursing staff, in addition to weekly visits to the physical therapy department throughout this period. (Id. at ¶¶ 187, 231.)
Plaintiffs assertion that on multiple occasions nurses falsified medical records to indicate that they had provided Plaintiff with treatment when in fact they had not suggests that the pattern of failure to follow prescribed physical therapy regimens could be even more pronounced than the medical records suggest. (Id. at ¶ 199.)
Plaintiff argues that his claim is further supported by the fact that the nurses and inmate assistants who administered his physical therapy were untrained and, according to Dr. Holstein and Dr. Lange, performed the range of motion and other exercises in a manner providing little or no benefit to Plaintiff. (Pl.’s 56.1 Stmt. ¶¶ 66, 167, 220-22.) Plaintiff notes that though the provision of such exercises by an inmate assistant violated DOCS regulations (an assertion supported by Dr. Koenigs-
These failures to adhere to prescribed therapy regimens are particularly egregious in light of Plaintiffs chronic and severe pain, well documented in his medical charts and acknowledged in Defendants’ testimony, as well as the seriousness of Plaintiffs underlying condition, which necessitates that Plaintiff rely on others to provide physical therapy to slow the muscular degeneration caused by his disease. Defendants attempt to minimize the objective seriousness of the disease by arguing that the degenerative nature of the condition makes the lapses in physical therapy relatively insignificant in the long term. However, this argument is defeated by (1) the significance of Plaintiffs pain alone as a mandate for treatment, as demonstrated in case law (McKenna, supra, at 437); (2) as discussed by Dr. Lange, the functional importance to Plaintiff of even a small change in the motor function of his hands and lower extremities (Pl.’s 56.1 Stmt. ¶ 12); and (3) courts’ finding that even when no permanent injury results, a failure to properly treat can establish grounds for deliberate indifference (Boretti, supra, at 1154-55).
Defendants also improperly assert that Plaintiffs claims are undermined by the fact that, since his release, he has been assisted by untrained family members in performing range of motion exercises. The relevant inquiry for purposes of Plaintiffs Eighth Amendment claim is whether the treatment Plaintiff received in the UPD departed from professional norms and Defendants’ subjective standards sufficiently to constitute deliberate indifference to Plaintiffs serious medical needs. Plaintiffs post-release access to proper medical care is irrelevant to this evaluation.
The Court finds that Plaintiff has established the existence of a genuine issue of material fact regarding the Plaintiffs claim of deliberate indifference to his serious medical needs in Green Haven Defendants’ repeated failure to provide prescribed physical therapy treatments to Plaintiff. The repeated nature of these failures— sometimes of long duration (see Factual Background, supra) — combined with the improper provision of therapy by untrained nurses and inmate assistants demonstrate the existence of a genuine issue of material fact sufficient to defeat Defendants’ summary judgment motion as to Plaintiffs Eighth Amendment claim.
Plaintiff additionally claims that the physical therapy department failed to provide therapy consistent with the standard of care, particularly by having physical therapy assistants perform treatments. This does not provide a valid basis for the constitutional claim, however, since Plaintiff has failed to show that the standard of physical therapy provided by the department was significantly below professional standards or that employing physical therapy assistants to perform the exercises so disadvantaged Plaintiff as to rise to the
As noted above, the UPD day-shift nurses were generally responsible for providing Plaintiff with his prescribed range of motion exercises, and the frequent lapses in these treatments were primarily due to the nurses’ refusal to perform the exercises. As Nurse Fila was the head nurse and Nurse Dongarra shared responsibility for day shift duties, neither defendant can raise a colorable claim for summary judgment with respect to the failure to provide Plaintiff with prescribed exercises. The deliberate indifference shown by the nurses can additionally be imputed to those supervisory personnel responsible for overseeing the nurses, including Defendants Dunkelman, Stevens and Koenigs-mann, as well as the doctors with access to Plaintiffs medical records, such as Drs. Bendheim and Silver, as a jury may infer that those with access to the records were familiar with their contents and that the failure to correct these lapses constituted deliberate indifference. Deliberate indifference may also be imputed to supervisory personnel, with regard to the failure to train nurses to properly administer the physical therapy. Plaintiff additionally included allegations regarding mistreatment and missed physical therapy treatments in his official grievance reports, which were reviewed and responded to by Dr. Koe-nigsmann. (See, e.g. Bates 3613, 3617, 3717, 3747, and 3750, Ex. C to Schulman Decl.)
Plaintiffs constitutional claim against CPS lacks the requisite showing of deliberate indifference to a serious medical need. Plaintiff has not alleged instances in which CPS failed to approve prescribed physical therapy or cases of CPS-affiliated physical therapy professionals refusing to provide prescribed physical therapy treatments, as Plaintiff has alleged with respect to Nurses Fila and Dongarra. There is furthermore no indication that CPS was charged with any responsibility regarding the training of DOCS nurses or personnel outside the Green Haven physical therapy department in the provision of physical therapy services. The Court therefore finds no grounds for sustaining Plaintiffs Eighth Amendment claim against CPS with respect to the provision of physical therapy to Plaintiff.
2. Treatment for Plaintiffs Chest Pain and Respiratory Distress
Plaintiff further claims that Defendants’ delay in treating his scoliosis-related respiratory distress and chest pain provides an additional basis for his Eighth Amendment claim. While disagreements regarding choice of treatment are generally not actionable under the Eighth Amendment, judgments that have no sound medical basis, contravene professional norms, and appear designed simply to justify an easier course of treatment (in this case, no treatment) may provide the basis of a claim.
See Verley,
Dr. Silver provided no medical justification for his judgment on August 2, 1999 that Plaintiffs chest pain and respiratory problems were “essentially unbeatable,” either in Plaintiffs chart or in his deposition testimony. Dr. Holstein’s subsequent evaluation of Plaintiff in April of 2000 and treatment of his respiratory ailments with an incentive spirometer demonstrates that Plaintiffs condition was readily treatable by a physician familiar with muscular dystrophy and scoliosis and their attendant complications. Dr. Silver’s decision to declare Plaintiffs condition “unbeatable” rather than refer Plaintiff to a specialist,
Therefore, the Court finds that Defendants’ failure to treat Plaintiffs chest pain and respiratory distress in the period between August 2, 1999 and April of 2000, particularly given the intensity of the pain Plaintiff describes and the seriousness of respiratory and chest ailments generally, presents an additional genuine issue of material fact precluding summary judgment on Plaintiffs Eighth Amendment claim.
3. Plaintiffs Access to Occupational Therapy
As a final basis for his Eighth Amendment claim, Plaintiff argues that Defendants’ failure to provide him with any occupational therapy throughout his time in the UPD constituted deliberate indifference to his serious medical needs. However, the Court finds that Defendants’ denial of occupational therapy to Plaintiff falls squarely in the realm of disagreements regarding treatment, which do not provide valid bases for Eighth Amendment claims, though they may serve as the basis for negligence or medical malpractice claims.
4. Individual Defendants’ Liability
Several of the defendants named in this action are DOCS or Green Haven officials without direct responsibility for supervising the provision of medical care in the UPD.
Plaintiff provides little basis for a finding of liability on the part of Defendants Goord, Wright, Zwillinger, Artuz and Greiner, beyond their constructive notice of Plaintiffs grievances by way of his formal complaints. However, Plaintiff offers no evidence to suggest that these defendant prison administrators ever saw his grievance reports or participated in the decision to grant or deny particular grievances, or that these defendants’ official duties included direct oversight of the types of medical judgments at issue here.
The Eighth Amendment liability of subordinate employees is not sufficient to establish liability on the part of administrators. “[A] prison administrator is permitted to rely upon and be guided by the opinions of medical personnel concerning the proper course of treatment administered to prisoners, and cannot be held to have been ‘personally involved’ if he does so.”
Joyner v. Greiner,
Likewise, CPS is entitled to summary judgment on Plaintiffs Eighth Amendment claim because Plaintiff has failed to establish CPS’ authority or involvement in the failures to provide prescribed physical therapy services or the failure to treat Plaintiffs chest pain and respiratory distress, which the Court finds give rise to potential Eighth Amendment liability for some Green Haven Defendants.
5.Qualified Immunity
Defendants argue that even if the Court finds the existence of issues of material fact as to whether they acted with deliberate indifference to Plaintiffs serious medical needs, they should be shielded from liability under the doctrine of qualified immunity. Qualified immunity shields government employees performing discretionary functions from liability “insofar as their conduct does not violate clearly established statutory or constitutional rights
The Court finds Defendants’ position unpersuasive with respect to the surviving bases for Plaintiffs’ Eighth Amendment claim: that Plaintiff was deprived of proper physical therapy by nurses’ failure to perform prescribed exercises and by doctors’ and supervising personnel’s failure to supervise the treatments or properly train the nurses; and Dr. Silver’s failure to treat Plaintiffs respiratory distress and chest pain. Clear Second Circuit precedent under Brock v. Wright and Harrison v. Barkley dictates that significant gaps in treatment of a plaintiff with a serious, degenerative condition such as muscular dystrophy who suffers recurrent pain can suffice to state a constitutional claim, and that both treating personnel and their supervisors may be subject to liability. As medical personnel in the UPD, a facility designed to provide care to physically disabled inmates, all relevant parties were in a position to be aware of the clear potential for liability in a case such as Plaintiffs. Though the analysis in every comparable case is highly fact-specific and requires consideration both of the seriousness of the underlying condition and the egregiousness of the conduct, the facts in this case put Defendants sufficiently on notice regarding Eighth Amendment liability. With respect to Plaintiffs physical therapy requirements, virtually all Green Haven Defendants conceded in their deposition testimony that they were aware of the risks that failing to receive range of motion exercises presented to a plaintiff such as Terrence Stevens. (PL’s 56.1 Stmt. ¶¶ 75-94.)
Qualified immunity therefore does not apply to shield any of the relevant Defendants from liability.
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For the above-stated reasons, Defendants’ motion for summary judgment is granted with respect to Defendants CPS, Goord, Wright, Zwillinger, Artuz and Gre-nier. The Court denies Defendants’ motion for summary judgment as to Defendants Koenigsmann, Selwin, Bendheim, Silver, Dunkelman, Stevens, Fila and Don-garra.
c. Plaintiffs State Law Claims against CPS for Breach of Contract and Negligence
Plaintiff additionally brings claims against CPS under state law for breach of contract and negligence.
1. Plaintiffs Breach of Contract Claim
Plaintiff argues that as an inmate of Green Haven relying on the medical services that CPS has contracted with DOCS to provide in part, Plaintiff is a third party beneficiary of the contract between CPS and DOCS and may claim damages for CPS’s breach of this contract to provide prisoners with “reasonable access” to “specialty medical services.” (Contract at 2.) Defendant CPS argues that summary judgment is appropriate on Plaintiffs breach of contract claim because (1) Plaintiff cannot establish that he is an intended third party beneficiary of the contract between DOCS and CPS and (2) Plaintiff has not established any breach of the contract.
Under New York State law, a party claiming rights as a third-party beneficiary must demonstrate “(1) the existence of a valid and binding contract between other parties, (2) that the contract was intended for his benefit and (3) that the benefit to him is sufficiently immediate, rather than incidental, to indicate the assumption by the contracting parties of a duty to compensate him if the benefit is
The plain language of the contract between DOCS and CPS indicates that the contract is intended to provide specialty medical services to prisoners. The clear implication of the contract language is that prisoners in DOCS facilities are intended beneficiaries of the contract, as the medical services at issue in the contract are for their benefit.
Plaintiff argues that CPS breached its contract with DOCS by failing to provide Plaintiff with a level of physical therapy services adequate for his needs. By its terms, the contract between CPS and DOCS obligates CPS to “provide or arrange for the provision of all medically necessary specialty physician services” to Green Haven prisoners itself or through “engagement of qualified independent health care providers.” (Contract at 2.) CPS insists that its role in the provision of medical services was equivalent to that of an HMO, and that when a referral was submitted by a DOCS physician, CPS would arrange for specialty services or hospital visits through providers with whom CPS had contractual arrangements. (CPS Statement of Facts Pursuant to Rule 56.1 (“CPS’s 56.1 Stmt.”) ¶¶ 39-43.)
Plaintiffs expert, Dr. Lange, found that the physical therapy that Plaintiff received during the relevant period, including range of motion exercises from nurses and inmate assistants and treatment in the physical therapy department, was generally inadequate, noting that there was no indication that trained physical therapists were regular participants in Plaintiffs care. (Lange Report, Ex. E to Schulman declaration.) As the party responsible for reviewing specialist referrals and contracting with the physical therapist on location in the Green Haven physical therapy department, CPS could conceivably be found liable for improper denials of referrals submitted by DOCS physicians or for failure to ensure the provision of proper care by the physical therapy professional. However, Plaintiff does not allege that CPS improperly denied particular specialist referrals or that the physical therapy professional contracted by CPS failed to provide care that he or she was directed to provide. Plaintiff instead alleges general failings in the frequency and quality of physical therapy provided to him, and absent specific claims of poor care on the part of the physical therapy professional or other CPS-affiliated parties, Plaintiff cannot establish the existence of a genuine issue of material fact that would preclude summary judgment on his breach of contract claim. The responsibility for the general oversight of Plaintiffs care lies with the DOCS physicians charged with treating and monitoring his condition.
The Court therefore grants CPS’s motion for summary judgment as to Plaintiffs breach of contract claim.
2. Plaintiffs Negligence Claim
Plaintiff also claims that CPS was negligent in its provision of physical therapy services. As with Plaintiffs breach of contract claim, summary judgment is appropriate on the negligence claim because Plaintiff fails to point to specific failures on the part of CPS-affiliated professionals— either in the referral process or in the
III. Conclusion
For the foregoing reasons, Defendants’ motion for summary judgment on Plaintiffs Eighth Amendment claims is GRANTED with respect to Defendants CPS, Goord, Wright, Zwillinger, Artuz and Grenier and DENIED with respect to Defendants Koenigsmann, Selwin, Bendheim, Silver, Dunkelman, Stevens, Fila and Don-garra. Defendant CPS’s motion for summary judgment on Plaintiffs claims for breach of contract and negligence is GRANTED.
The parties are to submit a proposed joint pretrial order not later than February 29, 2008, or such other date to which they may agree in writing.
SO ORDERED.
Notes
. These officials (with John C. Bendheim, collectively "Green Haven Defendants") in-elude Glenn S. Goord, Commissioner of the
. Between February 26, 1996 and December 2, 1996, Stevens was incarcerated at the Walsh Medical Unit in Mohawk Correctional Facility. (Second Am. Compl. ¶ 19, Ex. A to Schulman Decl.)
. Plaintiffs filed an amended complaint on January 21, 2000 and a second amended complaint on May 24, 2002 pursuant to the Court’s previous ruling in this case.
See Stevens v. Goord,
No. 99 Civ. 11669,
