United States District Court, E.D. Michigan, Southern Division
For Charles Shehee, Plaintiff: Michael L. Pitt, Pitt, McGehee, Royal Oak, MI.
For William L. Federspiel, Saginaw County Jail, Defendants: Marian V. Ratton, Ronald W. Chapman, Chapman Law Group, Bloomfield Hills, MI.
For Saginaw, County of, Prison Health Services Inc., Defendants: Kimberley A. Koester, Marian V. Ratton, Ronald W. Chapman, Chapman Law Group, Bloomfield Hills, MI.
OPINION AND ORDER GRANTING DEFENDANTS' MOTION FOR SUMMARY JUDGMENT AND DISMISSING AMENDED COMPLAINT
Honorable DAVID M. LAWSON, United States District Judge.
When plaintiff Charles Shehee was an inmate at the Saginaw County jail, he fainted in his cell due to low blood sugar, struck his head, and broke his neck. He was transferred to a hospital nine hours later, where surgery was performed. Shehee is a diabetic, taking prescribed insulin when he was taken into custody, and his diabetes was under control. The jail doctor, Dennis Lloyd, changed his insulin prescription three months earlier when Shehee entered the jail. Shehee believes that the change was made for cost reasons, and caused his syncope and resulting injuries. He sued Saginaw County and Prison Health Services, Inc. (PHS), the private contractor that hired the jail doctor, alleging that the denial of good medical care violated the Constitution. The defendants have moved for summary judgment. Although Shehee has made out a case that jail doctor Dennis Lloyd furnished substandard medical care, Shehee faces two insurmountable obstacles to recovery
against the two named defendants: his constitutional claims against PHS and Saginaw County cannot be predicated on their vicariously liability for the acts of Dr. Lloyd; and he cannot trace his injuries to the deliberate indifference of the defendants. Therefore, the motion for summary judgment will be granted.
The quality of basic healthcare in the United States can best be described as uneven. And one would not anticipate that the best care would be found in jails and prisons. Nonetheless, it is reasonable to expect that certain fundamental practices would be followed, such as doctors actually examining patients before prescribing medication; and when a new physician comes on the scene, that doctor would look at a patient's medical records or talk to a treating doctor before changing medication prescribed by someone else. The medical practitioners in this case did not meet those expectations.
However, to prove that his constitutional rights were violated, the plaintiff must establish more than malpractice. " Medical malpractice does not become a constitutional violation merely because the victim is a prisoner." Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). " In order to state a cognizable claim, a prisoner must allege acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs." Ibid.
The plaintiff, Charles Shehee, is a 48 year-old man with Type II diabetes. He was taken into custody on May 21, 2010 to begin serving a 12-month sentence for domestic violence. On September 13, 2010, while incarcerated at the Saginaw County Jail, his blood sugar plummeted, causing Shehee to become dizzy, fall backwards, and land on his head and neck. Although nurses contacted Dr. Lloyd, the medical director for the jail, Dr. Lloyd did not leave his private medical office in Flushing, Michigan to treat Shehee. Instead, Dr. Lloyd ordered an X-ray, which revealed that Shehee may have broken his neck during the fall. Shehee was transferred to a hospital where he underwent emergency surgery to stabilize his neck the following day.
Saginaw County operates the jail. PHS is a private, for-profit corporation that provides medical services in prisons, jails, and other detention facilities. Saginaw County signed a contract with PHS, now Corizon Correctional Healthcare, to provide health care services to persons incarcerated in the Saginaw County Jail. As of 2005, the corporation provided health care for about one in every ten people incarcerated. See Paul von Zielbauer, " As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence," The New York Times, Feb. 27, 2005, dkt. #40-8.
Dennis Lloyd, an osteopathic physician under contract with PHS, is the medical director at the Saginaw County Jail; he testified that he makes all medical decisions for inmates. He is also the medical director at the Genesee County Jail in Flint, Michigan. He maintains a private practice in Flushing, Michigan. Lloyd is on site at the Saginaw County Jail once weekly, on Friday from 7:30 a.m. to 3:30 p.m. Lloyd's private practice and the Genesee County Jail are both about a forty-five minute drive from the Saginaw County Jail. The average daily population in the Genesee County Jail is over 700 people; the average daily population in the Saginaw County Jail is 500 to 600 people. It appears that Dr. Lloyd is the only doctor providing medical care at these facilities.
At his deposition, Dr. Lloyd explained that he has never gone to the jail to treat inmates when he is off site and staff has never requested his presence off hours.
Lloyd does not travel to the Saginaw County jail for emergency situations that might need his in-person attention; he simply phones in orders.
On May 21, 2010, upon his admission to the Saginaw County Jail, Shehee was entrusted to PHS's and Dr. Lloyd's medical care. Shehee was admitted on a Monday. Because Dr. Lloyd is only present at the jail on Fridays, Dr. Lloyd did not examine Shehee or contact his treating physician. Instead, PHS nurses screened Shehee and confirmed his January 2010 diagnosis for Type II diabetes. PHS nurses also confirmed his prescriptions for 30 units of Lantus, once daily, and 500 mg of Metformin, twice daily. Nurses measured Shehee's blood sugar at 145 milligrams per deciliter (mg/dl); it was under control.
On May 24, 2010, PHS nurses contacted Dr. Lloyd and told him about Shehee's diabetes. PHS policy requires inmates with a prescription medication to continue to receive the medication as prescribed upon admission to the jail unless an acceptable alternative medication is provided. However, Dr. Lloyd ordered Shehee's medication switched to 70/30 Novolin over the phone. He did not examine Shehee or speak with Shehee's doctor before changing his medication. The only medical information Dr. Lloyd had at the time was Shehee's pre-existing medications, age, weight, and other information on the intake sheet. Lloyd " ha[d] no idea" if Shehee was given any explanation why his medication regimen was changed or what the change in medication might mean for him.
Dr. Lloyd testified that he changed Shehee's insulin medication from Lantus to NPH insulin because, as a general matter, 70/30 insulin requires less supplemental insulin to keep a patient's blood sugar under control. Plus, he said,
in a jail setting, NPH insulin is preferred to synthetic flat and ultra-fast acting insulin. Generally, poorly controlled diabetes are [sic] better managed on NPH insulin until their diabetes is under control. Plaintiff was not properly managing his diabetes and it was not under control.
Lloyd dep. at 43. But later Dr. Lloyd conceded that Shehee's blood sugar was under control at admission and, in fact, " look[ed] very good." Id. at 64-65. And Dr. Lloyd testified that he is unaware of any scholarly articles or research that demonstrates that the pharmacodynamics of 70/30 insulin are preferable in the jail setting over Lantus. Further, PHS's own guidelines discourage use of 70/30 insulin " unless patients are noncompliant as they reduce the flexibility in meal and activity planning." PHS Disease Management Program, dkt. #40-2.
It appears that one of the major differences between Lantus and NPH insulin is cost. According to one professional source, " [h]uman insulins (NPH and regular)" are " the least expensive [insulins], especially when using premixed NPH-regular insulin 70/30. Their use should be considered when the cost of medication is a major concern for the patient." Dr. Marwan Hamaty, MD, MBA, Insulin treatment for type 2 diabetes: When to start, which to use, Cleveland Clinic Journal of Medicine, Vol. 78, No. 5, May 2011, at 341, dkt. #40-4, at 11. The " only time" Dr. Lloyd prescribes Lantus is if a patient goes to the hospital and the endocrinologist or the internist specifically requests Lantus when the person returns to jail. In those circumstances, Dr. Lloyd defers to their judgment. Otherwise, ...