Sundermier v. Chapdelaine

          RULING ON DEFENDANTS' MOTION FOR SUMMARY JUDGMENT

          MICHAEL P. SHEA, U.S.D.J.

         Robert H. Sundermier (“Mr. Sundermier”) brings claims against Dr. Syed Naqvi (“Dr. Naqvi”) and Dr. Johnny Wu (“Dr. Wu”) (collectively, the “Defendants”)^[1], alleging a violation of 42 U.S.C. § 1983 based on deliberate indifference to his serious medical needs in violation of the Eighth Amendment. ECF No. 26. The Defendants filed a motion for summary judgment. ECF No. 80. For the reasons set forth below, the motion is GRANTED.

         I. Facts^[2]

         Mr. Sundermier has been incarcerated at the MacDougall Walker Correctional Institution since May 15, 2015. ECF No. 80-2 ¶ 1; ECF No. 91-1 ¶ 1. He injured his ankle and was examined by Dr. Naqvi on August 31, 2015. ECF No. 80-2 ¶¶ 2-3; ECF No. 91-1 ¶¶ 2-3. After examining him, Dr. Naqvi prescribed pain medication and ordered x-rays of the ankle. ECF No. 80-2 ¶ 4; ECF No. 91-1 ¶ 4. A few days later, on September 4, 2015, Mr. Sundermier was taken to the University of Connecticut (“UConn”) Emergency Department where Dr. John Yaylagul diagnosed him with an ankle sprain. ECF No. 80-2 ¶¶ 6-7; ECF No. 91-1 ¶¶ 6-7; Ex. 2 at 6. Back at MacDougall Walker, Dr. Naqvi examined Mr. Sundermier on September 9, 2015 and again on September 21, 2015. ECF No. 80-2 ¶¶ 8, 13; ECF No. 91-1 ¶¶ 8, 13. At the second appointment, Dr. Naqvi noted that Mr. Sundermier continued to experience pain in his left ankle and had a cold and discolored left foot. Ex. 2 at 18. The following day, Dr. Naqvi submitted a request to the Utilization Review Committee (“URC”) for Mr. Sundermier to see a vascular surgeon. ECF No. 80-2 ¶ 15; ECF No. 91-1 ¶ 15.

         The request was approved, and Mr. Sundermier was seen by Dr. James Menzoian, a vascular surgeon at UConn Health Center, on November 4, 2015. ECF No. 80-2 ¶¶ 16-17; ECF No. 91-1 ¶¶ 16-17. Dr. Menzoian took x-rays of the abdominal aorta and lower extremities as well as a CT (CAT scan) of the lumbar spine. Ex. 2 at 19. After two days, Dr. Menzoian determined that Mr. Sundermier was stable and discharged him with “no restrictions in his activities.” Ex. 2 at 19. Dr. Naqvi was surprised by Dr. Menzoian's report because he believed that Mr. Sundermier's symptoms -including that his leg was cold and blue - indicated a vascular issue rather than an orthopedic issue. Ex. 4 at 41-42 (“So although I made orthopedic appointment at some point, but that's why I sent him to vascular before because in orthopedic issue, first of all, there was no bone broken. X-ray assured that. And if there was, he wouldn't be standing up.”). On November 10, 2015, Dr. Naqvi submitted a request for a second vascular specialist. Ex. 3 at 2. He also examined Mr. Sundermier himself on November 15, 2015. ECF No. 80-2 ¶ 23; ECF No. 91-1 ¶ 23. The URC request was approved and Dr. Cloud, a vascular surgeon at UConn, examined Mr. Sundermier on December 2, 2015. ECF No. 80-2 ¶ 26; ECF No. 91-1 ¶ 26. Dr. Cloud noted that “[t]here is no vascular abnormality that would cause his symptoms” and recommended an “evaluat[ion] by orthopedic surgery ASAP.” Ex. 2 at 22; ECF No. 80-2 ¶ 27; ECF No. 91-1 ¶ 27.

         The following day, December 3, 2015, Dr. Naqvi prescribed a wheelchair and pain medication for Mr. Sundermier. ECF No. 80-2 ¶ 28; ECF No. 91-1 ¶ 28; Ex. 2 at 23. Dr. Naqvi examined him again on December 10, 2015. ECF No. 80-2 ¶ 29; ECF No. 91-1 ¶ 29; Ex. 2 at 24. He noted that Mr. Sundermier was still experiencing pain, prescribed pain medication, and wrote “needs to see ortho” in his notes. Ex. 2 at 24. In early 2016, Dr. Naqvi and Physician Assistant Kevin McCrystal began to split patients alphabetically. ECF No. 80-2 ¶ 37; ECF No. 91-1 ¶ 37. Mr. Sundermier became PA McCrystal's patient, but Dr. Naqvi also continued to see and treat him. ECF No. 80-2 ¶¶ 38-39; ECF No. 91-1 ¶¶ 38-39. PA McCrystal has not been named as a defendant in this action.

         Dr. Alaec, an orthopedic specialist at UConn, examined Mr. Sundermier on March 18, 2016. Ex. 2 at 26; ECF No. 80-2 ¶ 34; ECF No. 91-1 ¶ 34. Dr. Alaec noted that Mr. Sundermier “continues to have [a] painful dusky swollen left foot, ” and that “vascular surgery ruled out any arterial or venous problem, ” but that Mr. Sundermier “cannot bear weight and [his] ankle movements are limited and tender though x rays are fine.” Ex. 2 at 26. He also noted that, “as it is not getting better[, ] non urgent ortho opinion will be appropriate.” Id. Finally, he recommended “PT [physical therapy] for ankle [range of motion] & strengthening - self performed, ” a “rheumatology consult, ” and “foot & ankle MRI.” Id. On March 22, 2016, PA McCrystal submitted a request for an MRI to the URC. Ex. 3 at 3. The request was approved on April 2, 2016. Id. .^[3]

         On July 11, 2016, Mr. Sundermier was evaluated by Dr. Emmanuel, a vascular surgeon at UConn, who made the following recommendations: “patient to be seen by orthopedics, ” “does not need follow up with vascular surgery, ” and “no vascular surgery intervention.” Ex. 2 at 28; ECF No. 80-2 ¶¶ 42-43; ECF No. 91-1 ¶¶ 42-43. Mr. Sundermier was sent to another vascular specialist on September 12, 2016, who recommended a “foot/ankle specialist.” Ex. 2 at 29; ECF No. 80-2 ¶ 44; ECF No. 91-1 ¶ 44.

         PA McCrystal and Dr. Naqvi then examined Mr. Sundermier on October 19, 2016 and October 20, 2016, respectively, as there was still no diagnosis. Ex. 2 at 30; ECF No. 80-2 ¶ 46; ECF No. 91-1 ¶ 46. Dr. Naqvi thought Mr. Sundermier's hormone treatment-which he received because he is transgender-might be related to his foot problems. ECF No. 80-2 ¶¶ 47-48; ECF No. 91-1 ¶¶ 47-48. Dr. Naqvi discussed this with Dr. Wu and they agreed to stop the hormone treatment through the URC process. ECF No. 80-2 ¶¶ 49-51; ECF No. 91-1 ¶¶ 49-51. Dr. Wu was the medical director, but generally became more involved with a patient's care as diagnostic possibilities became more complex and uncommon. ECF No. 80-2 ¶¶ 60, 63; ECF No. 91-1 ¶¶ 60, 63.

         Dr. Mozcka, an orthopedic specialist at UConn, examined Mr. Sundermier on November 25, 2016. ECF No. 80-2 ¶ 52; ECF No. 91-1 ¶ 52. Dr. Mozcka wrote “no ortho intervention” and that the condition was “possibly CRPS.” Ex. 2 at 31. He recommended “neurology consult [illegible] CRPS.” Id. CRPS stands for complex regional pain syndrome and is sometimes also referred to as RSDS (reflex sympathetic dystrophy syndrome).^[4] On December 15, 2016, PA McCrystal submitted the following request to the URC:

53yo | ankle injury 8/31/15. Continues with cold, dusky, painful foot ? CRPS. Unable to bear weight. Has had multiple visits to ortho and vascular surgery. Has had xrays, CTA's, EMG, consultation with foot/ankle specialists, neurology, Narcotic pain medication. There has been mention of sympathetic nerve block as well as amputation. It seems there is no clear plan of care. I/M is amenable to amputation. If possible, request interdisciplinary case review. Consultation with vascular surgery and pre-op evaluation for amputation if amenable.

         Ex. 2 at 32. This request was approved on December 21, 2016. Id.

         Dr. Kristine Orion, a vascular surgeon at Yale New Haven Health, examined Mr. Sundermier on February 14, 2017. Ex. 2 at 33-36; ECF No. 80-2 ¶¶ 68, 71; ECF No. 91-1 ¶¶ 68, 71. She noted that Mr. Sundermier had seen multiple specialists and “received a diagnosis of RSDS.” Ex. 2 at 33. She wrote that “he likely has RSDS” and that she would order a CT, and would try to obtain information about whether it was safe for him to undergo an MRI. Ex. 2 at 36. She indicated that he should return to the hospital in four weeks or after the CT was completed. Id.

         On April 19, 2017, Dr. Lori-Ann Oliver, an anesthesiologist at Yale New Haven Health, evaluated Mr. Sundermier. Ex. 2 at 38. She noted that he “ha[d] chronic dystropic changes to his left foot and ankle consistent with CRPS type 1.” Id. She further wrote that “CRPS type 1 has the best prognosis if there is intervention within the first 3 months after developing [the changes experienced by Mr. Sundermier] and the most effective treatment modality to date is PT [physical therapy] and OT [occupational therapy].” Id. Dr. Orion also detailed the steps she took to address Mr. Sundermier's pain before resorting to surgery: she explained that she had performed multiple angiograms and admitted him for “regional sympathetic block and physical therapy, ” but that “all of [these approaches] failed to relieve his pain.” Ex. V at 2. She also noted that he had “a significant amount of wasting as well as complete numbness and weakness on the left foot and ankle.” Id. Finally, she wrote that he was “aware of the risks of the surgery including incomplete resolution or even worsening of his pain, ” but nonetheless requested the amputation. Id.

         Dr. Orion amputated Mr. Sundermier's left leg below the knee at Yale New Haven Health on April 28, 2017. Ex. V. Mr. Sundermier then had a revision surgery on December 21, 2017 to help his prosthetic fit better. Ex. W at 1.

         II. Legal Standards

         A. Motion for Summary Judgment

         A court may grant a motion for summary judgment only where there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(a). “A genuine issue of fact means that the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Wright v. Goord, 554 F.3d 255, 266 (2d Cir. 2009) (internal quotation marks omitted). In determining whether there is a genuine dispute of material fact, “the court must draw all reasonable factual inferences in favor of the party against whom summary judgment is sought.” Caronia v. Philip Morris USA, Inc., 715 F.3d 417, 427 (2d Cir. 2013).

         “The moving party bears the initial burden of showing why it is entitled to summary judgment.” Salahuddin v. Goord,467 F.3d 263, 272 (2d Cir. 2006). It may satisfy this burden by “point[ing] to evidence that negates its opponent's claims” or “identify[ing] those portions of its opponent's evidence that demonstrate the absence of a genuine issue of material fact, a tactic that requires identifying evidentiary insufficiency and not simply denying the opponent's pleadings.” Id. at 272-73. “Once the moving party meets this burden, the nonmoving party must set forth specific facts showing that there is a genuine issue for trial.” Jusino v. Frayne, 2018 WL 279982, at *3 (D. Conn. Jan. 3, 2018). “He must present such evidence as would allow a jury to find in his favor to defeat the motion for summary ...