Caldwell v. Palmer et al

Filing 35

ORDER granting 22 Motion for Summary Judgment. Mr. Caldwell's Amended Complaint will be dismissed. Signed by Senior Judge Donald E OBrien on 6/9/14. (djs)

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF IOWA
WESTERN DIVISION
ROCKY CALDWELL
Plaintiff,

No. 12-CV-4115-DEO

vs.
CHARLES PALMER, JASON SMITH,
AND MARY BENSON

ORDER RE:
MOTION FOR SUMMARY JUDGMENT

Defendants.
____________________
I.

INTRODUCTION
Currently before the Court is Defendants’ Motion for

Summary Judgment.
1983

Complaint,

committed

patient

Docket No. 22.
Mr.
at

Caldwell,
the

Civil

In his 42 U.S.C. Section
who

is

an

Commitment

involuntarily
Unit

for

Sex

Offenders (CCUSO) in Cherokee, Iowa, argues that he was denied
appropriate medical care by the Defendants.1
appeared for hearing on January 21, 2014.

The parties

After listening to

the parties’ arguments, the Court took the matter under
consideration and now enters the following.

1

The patients at CCUSO “have served their prison terms
but in a separate civil trial have been found likely to commit
further violent sexual offenses.”
Iowa Department of Human
Services
Offer
#401-HHS-014:
CCUSO,
1
http://www.dhs.state.ia.us/docs/11w-401-HHS-014-CCUSO.pdf,
last visited June 5, 2014.

II.

BACKGROUND AND FACTS
Mr. Caldwell has been a patient committed to CCUSO since

February 2012.
2012.

Mr. Caldwell filed this case on December 27,

On January 23, 2013, the Court entered an Initial

Review Order allowing Mr. Caldwell’s claim to proceed and
appointing Robert Tiefenthaler to represent him.

Docket No.

3.
In his Amended Complaint, Mr. Caldwell alleges that he
has been denied adequate medical care regarding his headaches,
hemorrhoids,

and

heart

failure.2

The

record

contains

extensive medical records for each issue.
During his deposition, Mr. Caldwell testified that he
suffers hemorrhoids.

He testified that the hemorrhoids are

painful and cause rectal bleeding.

To address the hemorrhoid

issue, Nurse Benson prescribed Metamucil, Milk of Magnesia and
prune juice to ease Mr. Caldwell’s bowel movements and thus
reduce hemorrhoid irritation.

In April of 2013, Nurse Benson

referred him to the University of Iowa Health Center.

The

University of Iowa Health Center performed a colonoscopy and

2

As will be discussed further below, Mr. Caldwell has
abandoned his claim related to heart failure.
2

found that Mr. Caldwell did suffer from moderate internal
hemorrhoids.
recommend

However,

surgical

the

University

treatment.

In

of

August

Iowa
of

did

not

2013,

the

Defendants again sent Mr. Caldwell to the University of Iowa
Health Center. On a subsequent examination, the University of
Iowa determined that Mr. Caldwell’s anal pain was likely
caused by a fissure (similar to a boil).

The University of

Iowa prescribed a medication to deal with the fissure and
recommended that Mr. Caldwell increase his Metamucil intake to
ease bowel movements.
During his deposition, Mr. Caldwell testified that he
suffers from recurrent headaches or migraine headaches. Nurse
Benson prescribed Mr. Caldwell Topamax, a migraine medication.
He also takes Tylenol as needed.
From the medical records, it seems that Mr. Caldwell
first complained of headaches on April 20, 2012, two months
after arriving at CCUSO.

Two weeks later, Nurse Benson

prescribed Topamax to treat the headaches.

On May 25, 2012,

Mr. Caldwell reported to Nurse Benson that the Topamax had
resolved the headache issue.

In June of 2012, four months

after he arrived at CCUSO, Mr. Caldwell requested that Nurse
3

Benson increase his dosage of Topamax.

However, Nurse Benson

was hesitant to increase his pain medication because of
possible adverse effects on Mr. Caldwell’s blood pressure. On
June 20, 2012, Nurse Benson and Dr. Stephen Veit examined Mr.
Caldwell.3

They

determined

that

some

of

Mr.

Caldwell’s

headaches are caused by shoulder/neck arthritis and referred
him

for

an

examination

and

possible

therapy

at

Sports

Rehabilitation and Professional Therapy in Cherokee, Iowa.
Mr. Caldwell treated with physical therapist Dan Hasty at
Sports Rehab several times in the summer of 2012.
Therapist

Hasty

eventually

discharged

Mr.

successfully completing a therapy plan.

Physical

Caldwell

after

In early 2013, Mr.

Caldwell renewed his complaint of a recurrent headache.

On

July 26, 2013, Nurse Benson referred Mr. Caldwell to the
University of Iowa Health Center, who conducted an MRI scan on
Mr. Caldwell’s head.

The MRI showed no areas of concern and

that Mr. Caldwell had normal scan results. As of the hearing,
Mr.

Caldwell

continues

to

use

Topamax

and

Tylenol

for

headaches.

3

Dr. Veit is a physician in Cherokee, Iowa, that
regularly consults at CCUSO.
4

Mr. Caldwell has also treated for several other medical
problems while at CCUSO, but did not include those issues in
his

Amended

Complaint.

For

example,

Mr.

Caldwell

periodically complained of an underarm rash.
records

indicate

that

Nurse

Benson

prescribed

has

The medical
a

topical

steroid cream to treat the rash and instructed Mr. Caldwell to
change deodorants.

Mr. Caldwell also reported a crack on the

heel of his foot, for which he was prescribed cortisone cream.
Also during the relevant time period, Mr. Caldwell treated for
a hernia.

The records show that the hernia was surgically

repaired in 2013.
III.

STANDARD
42 U.S.C. § 1983 provides:
Every person who, under color of any
statute, ordinance, regulation, custom, or
usage, of any State or Territory or the
District of Columbia, subjects, or causes
to be subjected, any citizen of the United
States
or
other
person
within
the
jurisdiction thereof to the deprivation of
any rights, privileges, or immunities
secured by the Constitution and laws, shall
be liable to the party injured in an action
at law, suit in equity, or other proper
proceeding for redress . . . .

5

Summary judgment is appropriate only if the record shows
“there is no genuine issue as to any material fact and that
the movant is entitled to judgment as a matter of law.”
R. Civ. P., Rule 56(c).

Fed.

A fact is material if it is necessary

“to establish the existence of an element essential to [a]
party’s case, and on which that party will bear the burden of
proof at trial.”
(1986).

Celotex Corp. v. Catrett, 477 U.S. 317, 322

There is a genuine issue as to a material fact if,

based on the record before the court, a “rational trier of
fact” could find for the non-moving party.

Matsushita Elec.

Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587
(1986).
When considering a motion for summary judgment, a “court
must view the evidence in the light most favorable to the
nonmoving party . . . .”

Hutson v. McDonnell Douglas Corp.,

63 F.3d 771 (8th Cir. 1995).

This requires a court to draw

any reasonable inference from the underlying facts in favor of
the nonmoving party and to refrain from weighing the evidence,
making credibility determinations, or attempting to discern
the truth of any factual issue in a manner which favors the
moving party unless there is no reasonable alternative.
6

See

Matsushita,

475

U.S.

at

587;

and

Morris

v.

City

of

Chillicothe, 512 F.3d 1013, 1018 (8th Cir. 2008) (citing
Thomas v. Corwin, 483 F.3d 516, 526-27 (8th Cir. 2007)).
Procedurally, the movant bears the initial burden “of
informing the district court of the basis for its motion and
identifying those portions of the record which show a lack of
a genuine issue.” Hartnagel v. Norman, 953 F.2d 394, 395 (8th
Cir. 1992) (citing Celotex, 477 U.S. at 323). Once the movant
has carried his burden, the non-moving party is required “to
go beyond the pleadings” and through “affidavits, or by the
‘depositions, answers to interrogatories, and admissions on
file,’ designate specific facts showing that there is a
genuine issue for trial.’”

Celotex, 477 U.S. at 323 (citing

Fed. R. Civ. P. 56(e)).
IV.

ISSUE
In his Complaint, Mr. Caldwell alleges that he suffers

from

hemorrhoids,

congestive

heart

failure,

and

severe

headaches or migraines and that the Defendants have failed to
provide him constitutionally adequate medical care.
No. 11.

Docket

In their Motion for Summary Judgment, the Defendants

argue that they were not deliberately indifferent to Mr.
7

Caldwell’s medical condition(s) and that they are entitled to
qualified immunity.
V.

Docket No. 22.

ANALYSIS
A.

Personally Responsible

The

first

argument

the

Court

will

address

is

the

Defendants’ argument that Defendant Charles Palmer and Jason
Smith

are

violations.

not

individually

responsible

for

the

alleged

As stated by the Defendants:

A Plaintiff may bring a section 1983 claim
only against those individuals actually
responsible
for
the
constitutional
deprivation.
Doyle v. Camelot Care
Centers, [Inc.], 305 F.3d 60[3], 614-615
(7th
Cir.
2002);
De[L][a][F]ont
v.
Beckelman, 264 F. Supp. [2d] 650, 656,
(N.D. Ill 2003).
Defendants are only
liable for actions for which each is
directly responsible. Madewell v. Roberts,
909 F.2d 1203, 1208 (8th Cir. 1990).
A
general responsibility for supervising
operations is insufficient to establish the
personal involvement necessary to support
liability. Keeper v. King, 130 F.3d 1309,
1314 (8th Cir. 1997). In bringing a 1983
claim a Plaintiff may not rely on the
doctrine of respondeat superior, but must
allege
personal
involvement
in
the
wrongdoing.
Docket No. 22, Att. No. 2, p. 8-9.

In this case, the parties

generally agree that Charles Palmer was not involved in Mr.

8

Caldwell’s medical care.

Accordingly, he will be dismissed

from the case.

Additionally, Dr. Smith, Director of CCUSO,

had

involvement

no

direct

in

Mr.

Caldwell’s

treatment.

Accordingly, Dr. Smith will be dismissed from this case.
However, as will be discussed in greater detail below, Nurse
Benson was involved in Mr. Caldwell’s treatment and thus is
the proper Defendant in this case.
Finally, the Defendants briefly argue that officials of
the state are immune from money damages.
502 U.S. 21, 25 (1991).

See Hafer v. Melo,

Because the remaining Defendant is

being sued in her individual capacity for her individual
failures while operating under the color of state law, not in
her official capacity, the Defendants' argument that she is
immune from money damages is moot.
B.

Deliberate Indifference

In

his

Complaint,

Mr.

Caldwell

alleges

that

he

has

several medical issues, including headaches, hemorrhoids, and
most seriously, congestive heart failure.

The Defendant

referred Mr. Caldwell to the University of Iowa Health Center,
who evaluated him and found that he does not suffer from
congestive heart failure.

Accordingly, during the hearing,
9

Mr. Caldwell voluntarily abandoned his deliberate indifference
claim related to congestive heart failure.
In their Motion for Summary Judgment, Docket No. 22, the
Defendants argue that there is no genuine issue of material
fact, because the Plaintiff has failed to allege any facts
that would constitute deliberate indifference. At the outset,
the Court notes that, “[p]ersons who have been involuntarily
committed are entitled to more considerate treatment and
conditions of confinement than criminals whose conditions of
confinement are designed to punish.”
321-22.

Youngberg, 457 U.S. at

In the context of inmate medical-care claims, Courts

have stated that:
[t]he
Eighth
Amendment's
prohibition
against cruel and unusual punishment, which
embodies “broad and idealistic concepts of
dignity, civilized standards, humanity, and
decency,” prohibits punishments which are
incompatible with “the evolving standards
of decency that mark the progress of a
maturing society.” Estelle v. Gamble, 429
U.S. 97, 102 (1976). It thus requires that
the government provide “medical care for
those
whom
it
is
punishing
by
incarceration.” Id. at 103. The Eighth
Amendment safeguards the prisoner against
a lack of medical care that “may result in
pain and suffering which no one suggests
would serve any penological purpose.” Id.
Accordingly, “deliberate indifference to
serious medical needs” of a prisoner
10

constitutes the unnecessary and wanton
infliction of pain forbidden by the
Constitution. Id. at 104.
Rodriguez v. Plymouth Ambulance Serv., 577 F.3d 816, 828 (7th
Cir. 2009) (parallel citations omitted).

This deliberate

indifference standard is used routinely in prisoner cases
related to medical care.
Courts also apply the deliberate indifference standard to
civilly committed individuals.

See Senty-Haugen v. Goodno,

462 F.3d 876, 889 (8th Cir. 2006) which applied the deliberate
indifference standard to a medical-care claim raised by a
patient involuntarily committed as a sexually violent predator
under the 14th Amendment.
335,

339

(8th

Cir.

See also Scott v. Benson, 742 F.3d

2014),

stating,

“where

a

patient's

Fourteenth Amendment claim is for constitutionally deficient
medical care, we apply the deliberate indifference standard
from the Eighth Amendment. Senty-Haugen, 462 F.3d at 889-90.”
Under the deliberate indifference standard, Mr. Caldwell
must show the Defendants were deliberately indifferent to a
serious illness or injury.

Senty-Haugen, 462 F.3d at 889.

A

successful deliberate indifference claim is comprised of both
an objective and a subjective element. Farmer v. Brennan, 511
11

U.S. 825, 834 (1994).
that,

objectively,

First, Mr. Caldwell must demonstrate
the

deprivation

he

suffered

was

“sufficiently serious; that is, it must result in the denial
of the minimal civilized measure of life's necessities.”
Walker v. Benjamin, 293 F.3d 1030, 1037 (7th Cir. 2002).

In

the medical care context, this objective element is satisfied
when a plaintiff demonstrates that his medical need itself was
sufficiently serious.

Gutierrez v. Peters, 111 F.3d 1364,

1369 (7th Cir. 1997).

Second, Mr. Caldwell must establish

that the defendants acted with a “‘sufficiently culpable state
of mind’” to support liability under § 1983. Greeno v. Daley,
414 F.3d 645, 653 (7th Cir. 2005).
Although negligence or inadvertence will not support a
deliberate indifference claim, a plaintiff need not establish
that officials actually intended harm from the failure to
provide adequate care.

Walker, 293 F.3d at 1037.

“[I]t is

enough to show that the defendants knew of a substantial risk
of harm to [the plaintiff] and disregarded the risk.” Greeno,
414 F.3d at 653.

A successful plaintiff need not show that he

was literally ignored in his demands for medical treatment,
and a defendant's showing that a plaintiff received some
12

treatment does not resolve the issue conclusively if the
treatment was “blatantly inappropriate.”

Greeno, 414 F.3d at

653–54 (internal citations and quotation omitted).

Finally,

the Eighth Amendment “protects [a plaintiff] not only from
deliberate indifference to his or her current serious health
problems, but also from deliberate indifference to conditions
posing an unreasonable risk of serious damage to future
health.” Board v. Farnham, 394 F.3d 469, 479 (7th Cir. 2005).
“Deliberate indifference must be measured by the official’s
knowledge at the time in question, not by ‘hindsight’s perfect
vision.’”

Schaub v. VonWald, 638 F.3d 905, 915 (8th Cir.

2011) (citing Lenz v. Wade, 490 F.3d 991, 993 n.1 (8th Cir.
2007)).
As stated above, to show deliberate indifference, Mr.
Caldwell must first show that, objectively, the deprivation he
suffered was "sufficiently serious; that is, it must result in
the

denial

of

necessities."

the

minimal

civilized

measure

of

life's

Walker, 293 F.3d at 1037 (7th Cir. 2002).

In

the medical care context, this objective element is satisfied
when a plaintiff demonstrates that his medical need itself was
sufficiently serious.

Gutierrez, 111 F.3d at 1369.
13

In his

brief, Mr. Caldwell argues that he has created a fact issue on
having sufficiently serious medical need based on “collective
pain and discomfort.”

Docket No. 29, p. 2.

Mr. Caldwell’s claim and the Defendants’ Motion for
Summary Judgment is distinct from many recent deliberate
indifference cases this Court has decided.
is

able

assume

that

sufficiently serious.
et

al,

12-CV-4063,

the

complained

Often, the Court

of

medical

need

is

See, for example, Triplett v. Benson,
Docket

No.

27,

where

the

Plaintiff

complained that the Defendants ignored his cancer; see also
Scott

v.

Benson,

11-CV-4055,

Docket

No.

86,

where

the

Plaintiff complained that the Defendant ignored an infection
which

eventually

resulted

in

his

leg

being

amputated.

However, Mr. Caldwell alleges that his serious medical need is
the pain caused by hemorrhoids and headaches.

At the outset,

the Court notes that 8th Circuit has a very conservative
outlook on what constitutes a serious medical need.

See, for

example, Fourte v. Faulkner Cnty., Ark., 13-2241, 2014 WL
1193457 (8th Cir. 2014) where the 8th Circuit recently found
that high blood pressure which caused a prisoner to go blind
was not a serious medical need. Additionally, the Court notes
14

that in several cases cited by the Defendants, courts have
found

that

hemorrhoids

serious medical need.

do

not

constitute

a

sufficiently

See Docket No. 22, Att. 2, p. 7.

Thus,

there is a question of whether Mr. Caldwell has plead a
medical need that is sufficiently serious.

However, because

the Court is persuaded that the second prong of the deliberate
indifference standard is dispositive, the Court will assume
without deciding that Mr. Caldwell suffers from sufficiently
serious medical need.
Assuming that Mr. Caldwell has plead a serious medical
need, Mr. Caldwell must also establish that the Defendant
acted with a "‘sufficiently culpable state of mind'" to
support liability under § 1983.

Greeno, 414 F.3d at 653.

In

other words, Mr. Caldwell must show that the Defendant was
aware of his serious medical need but deliberately disregarded
it.

See Christian v. Wagner, 623 F.3d 608, 613 (8th Cir.

2010).

In applying the deliberate indifference standard, the

8th Circuit has stated that, “[t]he inmate must clear a
substantial evidentiary threshold to show the prison's medical
staff

deliberately

administering

disregarded

inadequate

the

treatment.
15

inmate's
(citing

needs

by

Dulany

v.

Carnahan, 132 F.3d 1234, 1239 (8th Cir. 1997)) (holding
‘inmates have no constitutional right to receive a particular
or requested course of treatment, and prison doctors remain
free to exercise their independent medical judgment’).

‘[A]

prisoner's mere difference of opinion over matters of expert
medical judgment or a course of medical treatment fail[s] to
rise to the level of a constitutional violation.’”

Nelson v.

Shuffman, 603 F.3d 439, 448-49 (8th Cir. 2010) (some internal
citations omitted.)
The Defendant argues that Mr. Caldwell has failed to
allege facts that show Nurse Benson ignored or disregarded his
medical needs.

The question of whether an institutions'

medical staff deliberately disregarded the needs of an inmate
or a patient is a factually-intensive inquiry.
Rahija, 114 F.3d 778, 784 (8th Cir. 1997).

Coleman v.

Accordingly, the

Court must review the record to determine if Mr. Caldwell has
plead a genuine issue of material fact related to deliberate
indifference.

16

In
reveals

regards
that

hemorrhoids,

to
as

hemorrhoids,
soon

Nurse

as

Benson

the

(uncontested)

record

Mr.

Caldwell

complained

of

began

treating

them.

is

He

prescribed Metamucil, Milk of Magnesia and prune juice to ease
his bowel movements and reduce hemorrhoid irritation.

He has

been prescribed standard hemorrhoid treatments such as topical
ointment and Tuck pads.

Mr. Caldwell argues he would like to

have his hemorrhoid surgically removed. However, Nurse Benson
referred Mr. Caldwell for evaluation at University of Iowa
Health Center, and the University of Iowa determined that Mr.
Caldwell did not need surgery.

Instead, they determined the

bulk of his pain was likely caused by a non-hemorrhoid anal
fissure (similar to a boil) and prescribed medicine to treat
the fissure. In short, there is no evidence that Nurse Benson
has

ignored

Mr.

Caldwell’s

hemorrhoid

issue.

She

has

prescribed a number of different treatments for Mr. Caldwell
and referred him to the University of Iowa Health Center.

At

most, Mr. Caldwell has alleged facts that he would prefer to
have surgery.

However, the University of Iowa specifically

stated that was not necessary.

As stated above, the 8th

Circuit has repeatedly held that a claim for deliberate
17

indifference cannot succeed simply because a patient desires
a different course of treatment than the one prescribed by
medical professionals.

In this case, both Nurse Benson and

the University of Iowa have determined that Mr. Caldwell does
not require surgery. The record reveals that Nurse Benson has
treated Mr. Caldwell’s hemorrhoids with the normal, common
medicines that a hemorrhoid sufferer would receive whether or
not they were a committed patient at CCUSO.

Accordingly, Mr.

Caldwell has failed to allege any facts that would show Nurse
Benson

has

been

deliberately

indifferent

to

his

serious

medical need.
Mr. Caldwell’s other claim deals with headaches.
record

shows

that

within

a

few

weeks

of

Mr.

The

Caldwell

complaining of headaches, Nurse Benson prescribed him Topamax,
which is a serious migraine medication.

When Mr. Caldwell’s

headaches returned, Nurse Benson and Dr. Veit examined him,
and

referred

treatment.

him

to

an

outside

clinic

in

Cherokee

for

When Mr. Caldwell’s headaches returned again,

Nurse Benson referred Mr. Caldwell to Iowa City for an MRI.
The MRI came back normal and did not indicate any other course
of treatment that the medical professionals could pursue.
18

However, Nurse Benson has kept Mr. Caldwell on Topamax and
Tylenol to treat the pain associated with his headaches.
Accordingly, there simply is no evidence that Nurse Benson has
ignored

or

disregarded

Mr.

Caldwell’s

headache

issue.

Instead, the record reveals that in the two years Mr. Caldwell
has been at CCUSO, Nurse Benson has repeatedly attempted to
resolve Mr. Caldwell’s headaches by: (1) prescribing Topamax,
a migraine medication; (2) referring Mr. Caldwell to Sports
Rehabilitation and Professional Therapy clinic in Cherokee;
and (3) referring Mr. Caldwell to the University of Iowa
Health Center for an MRI.
Because Mr. Caldwell has failed to allege a genuine issue
of

material

fact

that

Nurse

Benson

has

deliberately

disregarded or ignored his headaches or his hemorrhoids, the
Court must grant the Defendants’ Motion for Summary Judgment.
C.

Qualified Immunity

Defendants also argue that they are entitled to a defense
of qualified immunity.
Mr.

Caldwell

has

However, because the Court found that

failed

to

articulate

a

deliberate

indifference claim, the Court need not reach that issue.

19

VI.

CONCLUSION
For the reason set out above, the Defendants’ Motion for

Summary

Judgment

(Docket

No.

22)

is

GRANTED,

and

Mr.

Caldwell’s Amended Complaint will be dismissed.
IT IS SO ORDERED this 9th day of June, 2014.

__________________________________
Donald E. O’Brien, Senior Judge
United States District Court
Northern District of Iowa

20