Chandler v. Wexford Health et al

Filing 64

MEMORANDUM OPINION. Signed by District Judge Debra M. Brown on 9/28/18. (cr)

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF MISSISSIPPI
GREENVILLE DIVISION
JOEY MONTRELL CHANDLER
V.

PLAINTIFF
NO. 4:15-CV-102-DMB-DAS

WEXFORD HEALTH, et al.

DEFENDANTS
MEMORANDUM OPINION

Before the Court is the defendants’ motion for summary judgment. Doc. #45.
I
Procedural History and Relevant Background
On or about August 11, 2015, Joey Montrell Chandler filed a complaint in this Court
against Wexford Health; the Mississippi Department of Corrections (“MDOC”); MDOC officials
Marshall Fisher, Christopher Epps, and Jerry Williams; and physicians Juan Santos, Paul
Madubuonwu, John Hochburg, Lorenzo Cabe, “Dr. Lehman,” “Dr. Brown,” and Gloria Perry.
Doc. #1 at 1–2, 5–6. At the time he filed his complaint, Chandler was incarcerated at the
Mississippi State Penitentiary in Parchman, Mississippi. Id. at 1.
In his complaint, Chandler alleged the defendants denied him adequate care for several
medical conditions, including back pain, foot pain, and a bacterial infection allegedly causing
diarrhea and “fecal leakage.” Id. at 3–4, 14–16. On or about March 9, 2016, Chandler filed a
motion to amend seeking to add Centurion of Mississippi as a defendant. Doc. #9. The motion
to amend was granted on April 13, 2016. Doc. #11.
A Spears1 hearing was held on April 14, 2016. Doc. #12. On July 20, 2016, United

1

See Spears v. McCotter, 766 F.2d 179 (5th Cir. 1985).

States Magistrate Judge David A. Sanders issued a Report and Recommendation recommending
that Chandler’s “claims regarding denial of adequate medical treatment should be dismissed for
failure to state a claim upon which relief could be granted. In addition, [Chandler’s] claim of
retaliation against Emmitt Sparkman should be dismissed for failure to exhaust administrative
remedies.”2 Doc. #16 at 10.
Chandler acknowledged receipt of the Report and Recommendation on July 26, 2016.
Doc. #18. On or about July 27, 2016, Chandler filed an untitled document addressed to Judge
Sanders stating:
On July 21, 2016 at about 9:00 am Supt. Earnest Lee allow Lt Nathan Harris to take
my walking cane for no reason on penal logical interest. This action was ill will
because of my ongoing litigation. Attach is a copy of ARP in which I will give
MDOC 14 days to return my medical prescribed can used during SI Joint flares. If
MDOC fails to comply I will file motion in the court immediately because other
inmates are having to help around.
Doc. #17 at 1.3
On or about October 8, 2016, Chandler filed a document titled, “Plaintiff’s Supplemental
Objections.” Doc. #19.

On or about February 2, 2017, Chandler filed a “Motion for Leave to

File an Amended Complaint Objection.”

Doc. #20.

Lastly, on or about March 1, 2017,

Chandler filed a “2nd Objection Amendment under Rule 15(a),” which in part is a motion to
amend. Doc. #21.
On July 11, 2017, this Court rejected the Report and Recommendation as moot, granted
Chandler’s motion to amend, and directed him to file “a single amended complaint with the

2

The Report and Recommendation notes Chandler’s allegation “that, shortly after he filed suit, Deputy Commissioner
Emmitt Sparkman asked him to dismiss it, but he would not.” Doc. #16 at 5.
3

Chandler attached to this filing a document entitled, “Administrative Remedy Request.” See Doc. #17 at 2.

2

amendments allowed by this order.” Doc. #22 at 4. On or about August 4, 2017, Chandler filed
an amended complaint stating that he “would request the court to add Defendants: Superintendant
Earnest Lee at Parchman State Prison and Medical Director Hendrik Kuiper and to maintain all
initial defendants.” Doc. #24 at 1. On February 15, 2018, Judge Sanders granted Chandler’s
motion to amend but noted that “[a]s the amended complaint neither names any other defendants
nor describes any other claims, the plaintiff must intend for his ‘amended complaint’ to be a
supplement to his original complaint.” Doc. #26 at 1. On March 7, 2018, Judge Sanders
ordered that process issue for Wexford Health, Santos, Madubuonwu, Perry, Brown, Cabe,
Hochburg, Lehman, and Kuiper.4 Doc. #30.
In his amended complaint, Chandler claims that the defendants failed to provide him with
adequate medical care for (1) sacroiliac (“SI”) joint dysfunction, which causes pain in his lower
back, leg, and foot; (2) bone spurs and plantar fasciitis;5 (3) a recurring infection of his tonsil; (4)
costochondritis, 6 which causes pain in his chest and shoulder; and (5) shoulder pain (which
medical providers suspect is related to costochondritis). Doc. #24 at 4. Chandler also claims
that the defendants failed to respond to his letters and grievances regarding his conditions and
ignored medical orders. Id. at 18–19. Further, Chandler alleges that Lee improperly searched
his belongings and forced him and other unwell inmates to carry a heavy load of around seventyfive pounds, despite medical orders that Chandler not lift more than ten pounds, id. at 14–15; and

4

On or about May 4, 2018, Chandler sought to reissue process to Wexford Health Services and Centurion of
Mississippi due to incorrect addresses. Doc. #41.

5

Plantar fasciitis is “inflammation of the plantar fascia, most usually noninfectious, and often caused by an overuse
mechanism; elicits foot and heel pain.” STEDMAN’S MEDICAL DICTIONARY 322870 (2014).

6

Costochondritis is “inflammation of one or more costal cartilages, characterized by local tenderness and pain of the
anterior chest wall that may radiate ….” Id. at 208810.

3

that medical personnel laughed at his condition and suggested that they “cut his head off to relieve
him of pain and litigation,” id. at 20–21.
On June 6, 2018, the defendants filed a motion for summary judgment. Doc. #45. On
or about June 20, 2018, Chandler responded in opposition, Doc. #52; and eight days later, the
defendants replied, Doc. #55.
II
Standard of Review
“Summary judgment is proper only when the record demonstrates that no genuine issue of
material fact exists and the movant is entitled to judgment as a matter of law.” Luv N’ Care, Ltd.
v. Groupo Rimar, 844 F.3d 442, 447 (5th Cir. 2016). “A factual issue is genuine if the evidence
is sufficient for a reasonable jury to return a verdict for the non-moving party and material if its
resolution could affect the outcome of the action.” Burton v. Freescale Semiconductor, Inc., 798
F.3d 222, 226 (5th Cir. 2015) (quotation marks omitted). In evaluating a motion for summary
judgment, a court must “consider the evidence in the light most favorable to the nonmoving party
and draw all reasonable inferences in its favor.” Edwards v. Cont’l Cas. Co., 841 F.3d 360, 363
(5th Cir. 2016).
In seeking summary judgment, “[t]he moving party bears the initial responsibility of
informing the district court of the basis for its motion, and identifying those portions of the record
which it believes demonstrate the absence of a genuine issue of material fact.” Nola Spice
Designs, L.L.C. v. Haydel Enters., Inc., 783 F.3d 527, 536 (5th Cir. 2015) (quotation marks and
alterations omitted). If the moving party satisfies this burden, “the non-moving party must go
beyond the pleadings and by her own affidavits, or by the depositions, answers to interrogatories,
and admissions on file, designate specific facts showing that there is a genuine issue for trial.”
4

Id. (quotation marks omitted). “Where the nonmoving party bears the burden of proof at trial,
the moving party satisfies this initial burden by demonstrating an absence of evidence to support
the nonmoving party’s case.” Celtic Marine Corp. v. James C. Justice Cos., Inc., 760 F.3d 477,
481 (5th Cir. 2014).
III
Analysis
Essentially, Chandler claims that the defendants provided him with inadequate medical
treatment for several of his ailments which evinced deliberate indifference and that several of his
grievances complaining of his improper treatment were rejected. See Doc. #24 at 4, 8, 18–19.
Specifically, Chandler claims he endured an unsuccessful tonsillectomy, id. at 6; a delayed referral
to specialists and prison medical staff’s refusal to follow specialists’ treatment plans, id. at 7–10,
13; generalized delays in providing medical treatment, id. at 11–12; carrying seventy-five pounds
of weight after prison security demanded he pack and move his property despite medical
professionals’ order that he not lift more than ten pounds, id. at 14–17; improper handcuffing and
confiscation of his walking cane, id. at 17; doctors’ joking that they should “cut his head off,” id.
at 21; and the failure to prescribe him the proper medication, id. at 23.
A. No Constitutional Right to Prison Administrative Grievance Procedure
Chandler brings this case under 42 U.S.C. § 1983, which provides a federal cause of action
against every person who, under color of state authority, causes the “deprivation of any rights,
privileges, or immunities secured by the Constitution and laws ….” To begin, there is no
constitutional entitlement to the existence—or adequacy—of prison grievance procedures. See,
e.g., Antonelli v. Sheahan, 81 F.3d 1422, 1430-31 (7th Cir. 1996) (any right to inmate grievance
procedure is procedural rather than substantive right and thus state’s inmate grievance procedures
5

do not give rise to liberty interest protected by due process clause); Adams v. Rice, 40 F.3d 72, 75
(4th Cir. 1994) (no constitutional right to participate in grievance procedures); Flick v. Alba, 932
F.2d 728, 729 (8th Cir. 1991) (same). The Fifth Circuit has held that “a prisoner has a liberty
interest only in freedoms from restraint imposing atypical and significant hardship on the inmate
in relation to the ordinary incidents of prison life.” Geiger v. Jowers, 404 F.3d 371, 374 (5th Cir.
2005) (alterations and quotation marks omitted). A prisoner “does not have a federally protected
liberty interest in having these grievances resolved to his satisfaction.” Id.
To the extent Chandler challenges the adequacy of the prison grievance process, including
the thoroughness of the investigation of his grievances or the lack of official response to them,
those allegations will be dismissed for failure to state a claim upon which relief could be granted.
B. Statute of Limitations
“Because no specified federal statute of limitations exists for § 1983 suits, federal courts
borrow the forum state’s general or residual personal-injury limitations period, … which in
Mississippi is three years.” Edmonds v. Oktibbeha Cty., 675 F.3d 911, 916 (5th Cir. 2012) (citing
Miss. Code Ann. § 15-1-49). However, “[f]ederal law governs when a cause of action under §
1983 accrues.” Redburn v. City of Victoria, 898 F.3d 486, 496 (5th Cir. 2018). Under federal
law, “[t]he limitations period begins to run when the plaintiff becomes aware that he has suffered
an injury or has sufficient information to know that he has been injured.” Id. (quotation marks
omitted). In this case, Chandler became aware of the level of his medical care at the time he
received it or should have received it.
The Clerk of the Court docketed Chandler’s original complaint on August 13, 2015; he
signed it on August 11, 2015. Doc. #1 at 6. Under the prison mailbox rule, a prisoner’s federal
6

complaint is deemed filed when he delivers the petition to prison officials for mailing to the district
court. Spotville v. Cain, 149 F.3d 374, 376–78 (5th Cir. 1998) (relying on Houston v. Lack, 487
U.S. 266 (1988), and its progeny). The Court presumes Chandler delivered his complaint to
prison officials on the date he signed it—August 11, 2015.7 Thus, any claims arising before
August 11, 2012—three years before Chandler signed his complaint—would fall outside the
statute of limitations for a case filed under § 1983.8 For this reason, Chandler’s claims regarding
his 2010 treatment for a bone spur in his left foot, as well as his 2011 tonsillectomy and associated
after-care, must be dismissed as barred by Mississippi’s three-year general statute of limitations.
C. Exhaustion
Congress enacted the Prison Litigation Reform Act (“PLRA”), 42 U.S.C. §1997e et seq.—
including its requirement that inmates exhaust their administrative remedies before filing suit—in
an effort to address the large number of prisoner complaints filed in federal courts. Jones v. Bock,
549 U.S. 199, 202 (2007). The exhaustion requirement is meant to distinguish frivolous claims
from colorable ones, as “[p]risoner litigation continues to account for an outsized share of filings

7
“It is generally contrary to the Prison Mailbox Rule to use a later date—such as the date the U.S. Postal Service
postmarked the envelope or the date the Court Clerk’s Office stamped the envelope ‘received’—as an incarcerated
pro se party’s filing date.” Wolff v. California, 235 F.Supp.3d 1127, 1129 n.1 (C.D. Cal. 2017). As there is no
indication when Chandler delivered his complaint to prison officials, the Court will give Chandler the benefit of the
doubt and use the earlier date on which he signed the complaint rather than the later date on which it was received by
the Clerk of Court after it had been mailed from the prison.
8

The continuing violation doctrine allows a plaintiff to defeat a statute of limitations defense. Under 42 U.S.C.
§ 1983, a continuous and ongoing constitutional violation tolls the statute of limitations period since “the staleness
concern disappears.” McGregor v. La. State Univ. Bd. of Sup’rs, 3 F.3d 850, 867 (5th Cir. 1993) (quoting Havens
Realty Corp. v. Coleman, 455 U.S. 363, 381 (1982)). The continuing violation doctrine—which is not raised by
Chandler—does not apply in this case. First, Chandler frames his claims in terms of discrete events—the treatment
of his tonsils and the treatment of his hip, foot, and back pain, among other ailments. See Doc. #24 at 4. Second,
because a wide variety of medical professionals—both MDOC personnel and medical providers practicing outside of
the prison—treated Chandler over the years, and he has not alleged that the providers, in concert, intentionally
deprived him of adequate medical care. Thus, Chandler has not alleged a continuing violation, but a series of
individual violations involving different defendants. Moreover, Chandler has not alleged that an MDOC policy exists
which caused the alleged denial of medical care, as discussed below.

7

in federal district courts” and Congress sought to ensure “that the flood of nonmeritorious claims
does not submerge and effectively preclude consideration of the allegations with merit.” Id. at
203 (quotation marks omitted).
The PLRA’s exhaustion requirement applies to actions filed under §1983. 42 U.S.C.
§1997e(a).

The exhaustion requirement protects administrative agency authority, promotes

efficiency, and produces “a useful record for subsequent judicial consideration.” Woodford v.
Ngo, 548 U.S. 81, 89 (2006). A prisoner cannot satisfy the exhaustion requirement “by filing an
untimely or otherwise procedurally defective administrative grievance or appeal [because] proper
exhaustion of administrative remedies is necessary.” Id. at 83–84; see Johnson v. Ford, 261 F.
App’x 752, 755 (5th Cir. 2008) (Fifth Circuit takes “a strict approach” to PLRA’s exhaustion
requirement); Lane v. Harris Cty. Med. Dep’t, 266 F. App’x 315, 2008 WL 116333, at *1 (5th Cir.
2008) (unpublished table decision) (under PLRA, “the prisoner must not only pursue all available
avenues of relief; he must also comply with all administrative deadlines and procedural rules”).
“[A] prisoner must … exhaust administrative remedies even where the relief sought—monetary
damages—cannot be granted by the administrative process.” Woodford, 548 U.S. at 85.
Exhaustion is mandatory and non-discretionary. Gonzalez v. Seal, 702 F.3d 785, 787 (5th
Cir. 2012). “Whether a prisoner has exhausted administrative remedies is a mixed question of
law and fact.” Dillon v. Rogers, 596 F.3d 260, 266 (5th Cir. 2010). As “exhaustion is a
threshold issue that courts must address to determine whether litigation is being conducted in the
right forum at the right time, … judges may resolve factual disputes concerning exhaustion without
the participation of a jury.” Id. at 272. The United States Supreme Court has recognized the
need for significant consequences where a prisoner deviates from the prison grievance procedural
8

rules:
The benefits of exhaustion can be realized only if the prison grievance system is
given a fair opportunity to consider the grievance. The prison grievance system will
not have such an opportunity unless the grievance complies with the system’s
critical procedural rules. A prisoner who does not want to participate in the prison
grievance system will have little incentive to comply with the system’s procedural
rules unless noncompliance carries a sanction ….
Woodford, 548 U.S. at 95.
MDOC, pursuant to Miss. Code Ann. § 47-5-801, has established a two-step
Administrative Remedy Program (“ARP”) through which prisoners may seek formal review of
their complaints or grievances while incarcerated. Threadgill v. Moore, No. 3:10-cv-378, 2011
WL 4388832, at *3 & n.6 (S.D. Miss. July 25, 2011). Under the ARP, an inmate must make a
“request to the [ARP] in writing within a 30 day period after an incident has occurred.” Inmate
Handbook, Miss. Dep’t of Corrs. (June 2016), at ch. VIII(IV)(A).9 The request is then screened
to ensure it meets certain criteria. Id. at ch. VIII(V). If the request meets the specified criteria,
it will be accepted into the ARP and proceeds to the first step. Id.
At the ARP’s first step, a prison official responds to the request using a Form ARP-2. Id.
at ch. IV. On this form, inmates can indicate whether they are dissatisfied with the outcome of
the first step by “giv[ing] a reason for their dissatisfaction with the previous response.” Id. An
inmate who timely indicates that he is dissatisfied with the first step of the ARP process proceeds
to the second step. Id. In the second step, like the first step, a prison official responds to the
ARP request. Id. If the inmate remains unsatisfied with the result, he may then file a lawsuit.

9
Available at: http://www.mdoc.ms.gov/Inmate-Info/Documents/CHAPTER_VIII.pdf. The Court takes judicial
notice of MDOC’s Inmate Handbook. See Fed. R. Evid. 201(b)(2) (“The court may judicially notice a fact that is not
subject to reasonable dispute because it ... can be accurately and readily determined from sources whose accuracy
cannot reasonably be questioned.”); see, e.g., Smith v. Polk Cty., No. 805-cv-884-24, 2005 WL 1309910, at *3 (M.D.
Fla. May 31, 2005) (judicial notice taken of inmate handbook and grievance procedures stated therein).

9

Id.
It is impossible for Chandler to have exhausted his allegations arising after the filing of this
case. Thus, his claims regarding improper after-care following his second, August 31, 2015,
tonsillectomy as well as the July 21, 2016, incident in which he alleges he was forced to carry
seventy-five pounds, will be dismissed without prejudice for failure to exhaust administrative
remedies.10
D. Sovereign Immunity
Chandler has sued all defendants in both their official and individual capacities. Doc. #24
at 24. The Eleventh Amendment protects a state’s sovereign immunity from suit and liability on
both federal and state causes of action in any federal court. Meyers ex rel. Benzing v. Texas, 410
F.3d 236, 252–53 (5th Cir. 2005). An assertion of Eleventh Amendment immunity must be
addressed before the merits of a complaint. United States v. Tex. Tech Univ., 171 F.3d 279, 286
(5th Cir. 1999). However, whether a “particular statutory cause of action … itself permits,”11
the action to be asserted against a state should be considered before “inquiring into any Eleventh
Amendment immunity.”12
“[A] State is not a person within the meaning of § 1983.” Will v. Mich. Dep’t of State

10

Though an earlier grievance regarding an ongoing policy or practice may obviate the need for filing later grievances
as to the same issue, that is not the situation in the present case. Where a § 1983 plaintiff’s complaint addresses an
ongoing problem or multiple instances of the same type of harm—arising out of a prison policy—he need not file a
new grievance in each new instance to quality for exhaustion. “Where the original grievance complains of a general
prison policy, changed circumstances will not necessarily necessitate re-exhaustion.” Moussazadeh v. Tex. Dep’t of
Criminal Justice, 703 F.3d 781, 788 (5th Cir. 2012), as corrected (Feb. 20, 2013). In his complaint, Chandler has
not claimed that an MDOC policy gave rise to the denial of medical care he has alleged. In addition, Chandler’s nonmedical care claims clearly arose after the filing of his complaint.

11

Vt. Agency of Nat. Res. v. United States ex rel. Stevens, 529 U.S. 765, 779 (2000).

12

United States ex rel. Adrian v. Regents of Univ. of Cal., 363 F.3d 398, 402 n.3 (5th Cir. 2004) (citing Stevens, 529
U.S. at 779–80).

10

Police, 491 U.S. 58, 64 (1989). This holding also applies to any “governmental entities that are
considered ‘arms of the State’ for Eleventh Amendment purposes.” Id. at 70. The State, arms
of the State, and state officials sued in their official capacity are not “persons” within the meaning
of § 1983. Id. at 70–71. Accordingly, MDOC, and its officials Fisher, Lee, Williams, and
Perry—in their official capacities—are entitled to dismissal.
E. Denial of Adequate Medical Care
As discussed above, Chandler’s claims of denial of adequate medical care occurring in
2010 and 2011 outside the statute of limitations—or after the filing of this case in 2015—cannot
be considered under § 1983. However, even if the Court considered all of Chandler’s medical
care allegations—from 2009 (the year of the first entry in his medical record regarding his
complaints) to present—his allegations fail to state a claim upon which relief could be granted.
1. Deliberate Indifference Standard
Chandler claims the defendants denied him adequate medical care and treatment for his
back, chest, foot, and hip pain, as well as the repeated infections of his right tonsil. To prevail
on an Eighth Amendment claim for denial of medical care, Chandler must allege facts which
demonstrate “deliberate indifference to [his] serious medical needs [that] constitutes the
unnecessary and wanton infliction of pain … whether the indifference is manifested by prison
doctors … or by prison guards in intentionally denying or delaying access to medical care ….”
Estelle v. Gamble, 429 U.S. 97, 104–105 (1976) (quotation marks omitted); see Mayweather v.
Foti, 958 F.2d 91, 91 (5th Cir. 1992) (inadequate medical care claim requires proof of “deliberate
indifference to serious medical needs”). The test for establishing deliberate indifference is one
of “subjective recklessness as used in the criminal law.” Farmer v. Brennan, 511 U.S. 825, 839
11

(1994). Under this standard, a state actor may not be held liable under § 1983 unless a plaintiff
alleges facts which, if true, would establish that the official “knows of and disregards an excessive
risk to inmate health or safety; the official must both be aware of facts from which the inference
could be drawn that a substantial risk of serious harm exists, and [the official] must also draw the
inference.” Id. at 837. Only in exceptional circumstances may a court infer knowledge of
substantial risk of serious harm by its obviousness. Id. at 842–43. Negligent conduct by prison
officials does not rise to the level of a constitutional violation. Daniels v. Williams, 474 U.S. 327,
328–29 (1986).
In cases, such as this, which allege delayed medical attention rather than its outright denial,
a plaintiff must demonstrate that he suffered substantial harm resulting from the delay to state a
claim for a civil rights violation. Mendoza v. Lynaugh, 989 F.2d 191, 195 (5th Cir. 1993). A
prisoner’s mere disagreement with medical treatment provided by prison officials does not state a
claim against the prison for deliberate indifference to serious medical needs. Gibbs v. Grimmette,
254 F.3d 545, 549 (5th Cir. 2001).
“Deliberate indifference is not established when medical records indicate that the plaintiff
was afforded extensive medical care by prison officials.” Brauner v. Coody, 793 F.3d 493, 500
(5th Cir. 2015) (quotation marks and alterations omitted). Nor is it established when a physician
does not accommodate either a prisoner’s requests or a prisoner’s disagreement with the treatment.
Id.; Miller v. Wayback House, 253 F. App’x 399, 401 (5th Cir. 2007). To meet his burden in
establishing deliberate indifference on the part of medical staff, Chandler “must show that [medical
staff] refused to treat him, ignored his complaints, intentionally treated him incorrectly, or engaged
in any similar conduct that would clearly evince a wanton disregard for any serious medical needs.”
12

Brauner, 793 F.3d at 498.
2. Application to Facts
The Court has reviewed the extensive, nearly 700-page record of Chandler’s medical
treatments for his various conditions and summarized those pertaining to the issues in this case in
chronological order by type of ailment.

See Ex. A.

The summary includes all treatment

Chandler received in the years before and after his filing of this case to provide a complete picture
of the level of treatment. While Chandler was treated for conditions other than those at issue
here, they are not reflected in the summary as his claims do not involve them.
Chandler was treated one hundred and six times for SI Joint Dysfunction, five times for
plantar fasciitis (which medical personnel came to believe was related to his SI Joint Dysfunction),
one hundred and fifteen times for tonsil ailments (including two surgeries to remove his tonsils),
seventeen times for costochondritis, and five times for shoulder pain (which doctors believed could
be related to costochondritis). See generally id. Thus, Chandler was examined or treated two
hundred and forty-eight times from 2009 to 2018—twenty-eight times per year on average—for
the conditions relevant to his complaint.
Early in the treatment of his various maladies, Chandler requested more aggressive
treatment and referral to a specialist. Id. at 2. However, in most cases, medical personnel chose to
initially provide more conservative treatment, moving toward more aggressive treatment when the
conservative treatment failed to provide satisfactory results.13 Medical providers also prescribed
medications—nonsteroidal anti-inflammatory drugs (“NSAIDs”), injections, and various cough

13

For example, as to Chandler’s tonsil trouble, medical personnel first prescribed a special mouthwash and gargling
with warm salty water; later, they prescribed antibiotics, and then changed to a different antibiotic when the previous
one did not work. Ex. A at 3.

13

and cold medications—to relieve the painful symptoms of Chandler’s recurring tonsil infections.
Id. at 1. They further conducted diagnostic testing, such as analyzing cultures of his tonsil
drainage. Id. at 3.

When his sinus symptoms persisted, despite the escalating treatments,

medical personnel referred Chandler to an off-site ear, nose, and throat surgeon (“ENT”), and his
tonsils were removed in 2011. Id.
Eventually, Chandler’s tonsil trouble returned, and medical personnel followed the same
escalating protocol as before, culminating in a second tonsillectomy in 2015 which removed a
“tonsil stump.” Id. at 4. Chandler’s throat problems recurred, even after the second surgery,
and the providers then conducted diagnostic testing, provided Chandler instructions on oral
hygiene, and prescribed him NSAIDs and antibiotics.

Id.

When those treatments did not

provide relief, he was again referred to an off-site ENT and, according to his statement to medical
personnel, on January 10, 2018, was recommended for a third tonsil surgery. Id. On the latest
entry in his medical records regarding his tonsils entered on March 9, 2018, Chandler was directed
to continue his medication. Id.
Chandler complains about the treatment he received after his tonsil surgery on February
23, 2011—specifically, he alleges MDOC personnel failed to provide him with a special diet and
cool environment, which he believes led to an infection at the surgery site. Id. at 3; Doc. #24 at
7. Medical records show that Chandler suffered bleeding and an infection in early March of
2011, less than two weeks after surgery, and medical personnel prescribed Chandler antibiotics.
Ex. A at 3. Chandler’s next examination regarding tonsil trouble occurred over two years later
on September 27, 2013. Id.
Chandler also claims that in 2015, he developed a bacterial infection in his right tonsil and
14

the defendants delayed treating the condition for five months. Doc. #24 at 11. However,
Chandler’s medical records show that he was examined and treated multiple times between March
31, 2015, and his surgery on August 28, 2015. Ex. A at 3–4. On March 31, 2015, medical
personnel prescribed gargling with warm salt water and medication. Id. at 3. Medical personnel
also educated Chandler on how to manage his tonsil condition. Id. Chandler then visited the
doctor two weeks later, who referred him to an ENT. Id. Chandler returned to the clinic on
April 24, 2015, and his tonsil appeared normal. Id. at 4. On May 11, 2015, Chandler returned
to the prison clinic for a follow-up examination.

Id.

He did not show up for his next

appointment on June 24, 2015. Id. During an examination on June 29, 2015, medical personnel
noted a swollen lymph node and referred Chandler to a surgeon. Id. Chandler visited the
surgeon on August 18, 2015, and the surgeon examined him and determined surgery would be
appropriate. Id. Chandler was transported to the hospital on August 27, 2015, where doctors
performed a pre-surgery examination and the next day, he underwent surgery to remove the
remnants of his right tonsil. Id.
The same pattern—medical personnel escalating treatment with the worsening of
Chandler’s symptoms—also holds true for his complaints regarding SI Joint Dysfunction. It took
time for medical providers to determine the cause of Chandler’s back, hip, and foot pain, as it was
initially diagnosed separately as sciatica14 and plantar fasciitis. Id. at 1–2. Chandler’s medical
providers subsequently determined that it was likely that all or most of his symptoms related to his
back, hip, and foot arose from SI Joint Dysfunction and bone spurs, and he was treated for those

14

Sciatica is “[p]ain in the lower back and hip radiating down the back of the thigh into the leg, initially attributed to
sciatic nerve dysfunction … but now known to usually be due to herniated lumbar disk compressing a nerve root ….”
STEDMAN’S MEDICAL DICTIONARY 801240 (2014).

15

conditions.

Id. at 1–2.

During treatment for his SI Joint Dysfunction symptoms, medical

personnel provided Chandler with diagnostic testing (including x-rays and magnetic resonance
imaging), NSAIDS, injections, physical therapy, a cane, an SI belt, and other treatments. Id. at
1–2. Medical providers also gave Chandler instructions regarding proper posture and exercises
to relieve symptoms. Id. These treatments provided Chandler partial—but not complete—
relief.
Chandler also contends that medical personnel misdiagnosed his chest pain as a symptom
of costochondritis. See Doc. #58-4 at 50. When Chandler experienced chest pain, he wanted to
ensure that the symptoms were, in fact, costochondritis—and not heart disease. See id. at 45.
Medical personnel provided Chandler with antibiotics (when it seemed the chest pain was due to
a cough), ibuprofen, Indomethacin,15 acetaminophen, injections, prednisone,16 Ketorolac,17 and
Mobic. Ex. A at 4. These treatments appear to have worked for a time but the pain returned,
and medical personnel reassured Chandler that his chest pains were not due to heart disease. Doc.
#58-4 at 45; see Ex. A at 4. Chandler is, nevertheless, skeptical of the diagnosis.
Chandler’s shoulder pain was diagnosed as Tenosynovitis, 18 although some providers
believed it was related to costochondritis. Ex. A at 5; Doc. #58-2 at 95. For his shoulder pain,
medical providers followed a course of treatment like that for costochondritis—NSAIDs and pain
medication. Ex. A. at 5.

15

Indomethacin is a “potent analgesic, antipyretic, and nonsteroidal antiinflammatory agent used to treat acute
exacerbations of various joint diseases. It is also used to produce closure of a patent ductus arteriosus in infants.” Id.
at 442720.
16
Prednisone is a “dehydrogenated analogue of cortisone with the same actions and uses; must be converted to
prednisolone before active; inhibits proliferation of lymphocytes.” Id. at 717600.
17

Ketorolac is an NSAID. Id. at 267230.

18

Tenosynovitis is defined as the “[i]nflammation of a tendon and its enveloping sheath.” Id. at 902170.

16

Over his nine years of incarceration with the MDOC, Chandler has been treated by medical
personnel on hundreds of occasions. In addition to providing Chandler with a great deal of
medical treatment for his ailments, prison medical personnel have ordered two surgeries to remove
his tonsils.
“Deliberate indifference is not established when medical records indicate that [the prisoner]
was afforded extensive medical care by prison officials.” Brauner, 793 F.3d at 500 (quotation
marks omitted). By any measure, Chandler was afforded extensive medical care by prison
officials. Chandler’s desire for more aggressive medical treatments to be administered sooner is
merely a claim that physicians did not accommodate his requests in the manner he desired—which
does not rise to the level of a constitutional violation. Id.; Miller, 253 F. App’x at 401. Based
on the summary judgment record, Chandler has not shown that medical staff “refused to treat him,
ignored his complaints, intentionally treated him incorrectly, or engaged in any similar conduct
that would clearly evince a wanton disregard for any serious medical needs.” Brauner, 793 F.3d
at 498. Rather, the summary judgment record reflects that Chandler was provided with escalating
care for his conditions—including surgery for his tonsils—until his complaints were resolved.
Accordingly, Chandler’s denial of adequate medical assistance claim is without merit and will be
dismissed.
IV
Conclusion
The defendants’ motion for summary judgment [45] is GRANTED. Accordingly:
1.

Chandler’s allegations for failure to adequately respond to grievances and denial of

adequate medical care are DISMISSED for failure to state a claim upon which relief can be
granted;
17

2.

MDOC, Marshall Fisher, Earnest Lee, Jerry Williams, and Gloria Perry, in their

official capacities, are DISMISSED with prejudice;
3.

Chandler’s claims regarding events occurring before August 11, 2012, are

DISMISSED with prejudice as barred by the applicable statute of limitations; and
4.

Chandler’s allegations regarding events occurring after the filing of this case

(including the stomping of his hand and the forced carrying of a heavy load) are DISMISSED for
failure to exhaust administrative remedies.
SO ORDERED, this 28th day of September, 2018.
/s/Debra M. Brown
UNITED STATES DISTRICT JUDGE

18

EXHIBIT A

Joey Montrell Chandler, 4:15-CV-102
Medical Treatment Relevant to Complaint (Excluding Routine Treatment or Treatment for Other Conditions)

Number of Times Treated:
SI Joint Dysfunction:
Plantar fasciitis (later determined to be SI Joint Dysfunction):
Tonsils:

106
5
115

Costochondritis:

17

Shoulder pain (later found to be Costochondritis:
Total number of times treated (all relevant medical issues):

5
248 (roughly 28 times per year)

Relevant Medical Treatment
SI Joint (Back, foot, hip pain)
Date of Treatment

Reference

Type of Visit

Treatment, comments

9/13/2010
11/7/2010
12/3/2010
12/9/2010
7/12/2011
7/15/2011
8/12/2011
8/23/2011
8/26/2011

58-2 at 1
58-3 at 109
58-2 at 52
58-6 at 46
58-3 at 101
58-2 at 72
58-2 at 70
58-3 at 99
58-2 at 68

Exam
Exam
Exam
X-ray results
Exam
Exam
Follow-up
Exam
Exam

9/2/2011
9/6/2011
9/20/2011
9/22/2011
2/17/2012
2/21/2012
4/12/2012
7/3/2012
7/18/2012
1/30/2013
4/15/2013
4/15/2013
4/29/2013
6/7/2013
6/11/2013
8/2/2013
8/2/2013
8/10/2013
8/15/2013
9/5/2013
9/13/2013
9/17/2013
10/17/2013
4/11/2014
4/18/2014
6/18/2014
6/19/2014
9/30/2014
9/30/2014
10/1/2014
10/1/2014
10/2/2014
10/7/2014
10/9/2014
10/9/2014
10/22/2014
11/5/2014
11/10/2014
11/17/2014

58-3 at 97
58-3 at 66
58-2 at 66
58-6 at 40
58-3 at 91
58-2 at 63
58-2 at 110
58-2 at 108
58-2 at 106
58-4 at 10
58-2 at 101
58-6 at 80
58-2 at 14
58-4 at 8
58-2 at 100
58-1 at 66
58-6 at 52
58-4 at 4
58-4 at 6
58-2 at 12
58-3 at 21
58-5 at 84
58-4 at 2
58-4 at 24
58-2 at 10
58-2 at 48
58-1 at 44
58-1 at 2
58-2 at 81
58-2 at 44
58-5 at 91
58-6 at 48
58-1 at 3
58-1 at 43
58-2 at 43
58-3 at 20
58-3 at 18
58-3 at 17
58-1 at 42

Exam
Exam
Exam
Exam
Exam
Exam
Follow-up
Exam
Follow-up
Exam
Follow-up
Exam
Exam
Exam
Follow-up
Return from Spinal MRI
MRI results: Spine
Exam
Exam
Follow-up
Physical therapy (PT)
Exam
Exam
Exam
Exam
Follow-up
Exam
Exam
Exam
Follow-up
Exam
X-ray results: SI joint
Exam
Exam
Follow-up
Physical therapy (PT)
Physical therapy (PT)
Physical therapy (PT)
Physical therapy (PT)

Apply warm compress to hip
MD notified; cool compresses, moist heat, avoid sports, then strength exercises
Order spine x-ray; no lifting
Minor degenerative disc disease, L5-S1; no regional bony fracture or dislocation
Refer to MD; meds per protocol, IBU
Left back/foot pain: Foot X-ray
X-ray findings, foot and back painNaproxen
Refer to MD; arch painful, x-ray normal, meds do not work
Back pain: Crutches, heat, prednisone, lower bunk profile,
no weight bearing, injection, f/u 2 weeks
Showed pt how to adjust crutches
Showed pt how to adjust crutches
Left back/foot pain: IBU
Refused treatment
IBU, refer to MD
IBU
Prescribed Medrol, APAP, alternate APAP and NSAIDS
Refill of APAP
Lower bunk profile, IBU, education
Meds given per protocol, f/u scheduled
IBU
Continue taking IBU -- with food
Change meds, IBU to APAP, teach proper back mechanics
APAP given; continue current medication regimen
Diagnosis: Sciatica
No progress of disease
Unremarkable noncontrast lumbar spine MRI
IBU given, patient assured, appt pending with MD
Referred to MD, pain meds offered but refused, scheduled MRI
Results from MRI, APAP Tabs,
Received walking cane
Refer to provider; meds per protocol, pt educated
Refer to provider
Analgesics, labs
Referral to PT
Sciatic nerve pain: SI joint x-ray (rule out sacroilitis, other pathology)
SI joint pain: PT, advised to walk w/o cane
Received Meloxicam
SI joints within normal limits
Appt scheduled
Wants PT
SI joint pain: Walking w/o cane, but pain moved to left side, send to PT

EXHIBIT A

11/17/2014
11/17/2014
11/17/2014
11/19/2014
12/1/2014
12/8/2014
12/17/2014
12/17/2014
12/18/2014

58-2 at 79
58-3 at 15
58-5 at 89
58-6 at 3
58-3 at 13
58-3 at 11
58-1 at 5
58-4 at 19
58-2 at 41

Exam
Physical therapy (PT)
Exam
Exam
Physical therapy (PT)
Physical therapy (PT)
Appt scheduled
Exam
Follow-up

2/20/2015
3/9/2015
5/4/2015
5/4/2015
5/5/2015
5/6/2015
5/14/2015
7/14/2015
7/29/2015
7/29/2015
8/13/2015
10/15/2015
10/15/2015
3/17/2016
3/18/2016
6/8/2016
6/10/2016
6/12/2016
8/14/2016
8/14/2016
9/7/2016
9/7/2016
9/7/2016
9/13/2016
9/17/2016
9/17/2016
9/20/2016
9/27/2016
10/4/2016
10/5/2016
10/11/2016
10/11/2016
10/12/2016
10/18/2016
10/25/2016
11/8/2016
11/15/2016
1/11/2017
1/12/2017
3/30/2017
3/31/2017
3/31/2017
7/12/2017
11/21/2017
11/21/2017
11/21/2017
11/21/2017
11/29/2017
11/29/2017
3/9/2018

58-4 at 43
58-6 at 6
58-1 at 11
58-4 at 38
58-3 at 123
58-6 at 7
58-2 at 125
58-6 at 8
58-1 at 15
58-4 at 34
58-2 at 122
58-1 at 16
58-4 at 30
58-4 at 67
58-2 at 120
58-4 at 65
58-2 at 118
58-6 at 58
58-1 at 23
58-4 at 56
58-1 at 24
58-1 at 40
58-4 at 54
58-3 at 10
58-1 at 25
58-4 at 52
58-3 at 8
58-3 at 7
58-3 at 33
58-2 at 32
58-3 at 32
58-6 at 14
58-6 at 87
58-3 at 30
58-3 at 29
58-3 at 27
58-3 at 25
58-6 at 17
58-3 at 23
58-4 at 47
58-2 at 112
58-6 at 18
58-6 at 77
58-1 at 29
58-1 at 35
58-1 at 57
58-6 at 57
58-1 at 82
58-6 at 19
58-1 at 31

Exam
Exam
Follow-up
Exam
Exam
Exam
Exam
Exam
Follow-up
Exam
Exam
Follow-up
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
No show
Exam
Exam
Physical therapy (PT)
Physical therapy (PT)
Physical therapy (PT)
Follow-up: back pain and shoes
Physical therapy (PT)
Exam
Exam
Physical therapy (PT)
Physical therapy (PT)
Physical therapy (PT)
Physical therapy (PT)
Exam
Physical therapy (PT)
Exam
Exam
Exam
Exam
Exam, referral
Exam
Exam
Exam
Receipt of orthopedic shoes
Exam
Exam

Right hip pain: Mobic
Received bottom bunk profile
Received Meloxicam

Follow-up with MD pending
Hip and foot pain: Insisted on CT scan; left office when request was denied.
Dr. will examine when pt returns.
Refer to MD
Received Prednisone, IBU (keep on person)
Pt education, refer to MD, avoid sports
Prescribe Prednisone, Mobic; previously tried PT
Received Prednisone, Mobic (keep on person)
Inform pt to finish prednisone pack (on day 5 of 12)
Received Meloxicam (keep on person)
Follow-up with MD
Prescribed Mobic
Cold compress, elevate leg, Acetaminophen, Ibuprofen, crutches, lay-in, refer to MD
Refer to provider for f/u
Prescribed rubber tennis shoes; no indication for bottom bunk
Checking on shoes
Renew bottom bunk profile
Ordered orthopedic shoes
Requests MRI, ortho shoes, meds ineffective. Referral to MD for MRI and shoe request
Wants orthopedic shoes
Refer to PT for ortho shoes
Request orthopedice shoes; referred to PT for shoes
Reschedule due to transporation problem
Wants orthopedic shoes, treatment by specialist, referral to specialist
Pt says Tylenol not working; refer to provider; return to clinic with any complications

DM shoes not indicated
Received orthopedic shoes
Pt received orthopedic shoes
No-show, transporation problem

Received SI belt
Renew bottom rack; appt scheduled with provider
First diagnosis of SI dysfunction; prescribe Acetaminophen
Received bottom bunk profile
Educate pt regarding disease process; lifestyle modification
Wants orthopedic shoes
Refer to PT for ortho shoes. Dr.: "Shoes are supposed to last three years."
Received orthopedic shoes
Ordered orthopedic shoes
Received diabetic shoes, 1 year
Received bottom bunk profile

Plantar fasciatis (foot pain) -- later determined to be related to SI Joint Dysfunction
11/15/2011
11/23/2011
2/19/2015
3/5/2015
3/6/2015

58-3 at 95
58-1 at 83
58-1 at 6
58-3 at 4
58-1 at 7

Exam
Exam
Exam
Exam
Exam

Refer to MD
Medication applied

58-3 at 36
58-3 at 40
58-3 at 38

Exam
Exam
Exam

Prescribed Miracle Mouthwash
Prescribed Guaifenesin, Mycostatin
Prescribed Erythromycin, Miracle Mouthwash

Prednisone, IBU, 1 year bottom bunk profile, review nutrition, exercise, medication

Tonsils
4/21/2009
8/5/2009
8/14/2009

2

EXHIBIT A

3/3/2010
3/3/2010
3/10/2010
3/17/2010
3/17/2010
4/10/2010
4/12/2010
4/22/2010
5/5/2010
5/13/2010
7/23/2010
7/28/2010
8/11/2010
8/13/2010
9/7/2010
9/9/2010
9/10/2010
9/12/2010
9/13/2010
9/13/2010
9/24/2010
9/29/2010
10/5/2010
10/6/2010

58-3 at 83
58-4 at 76
58-3 at 79
58-2 at 58
58-3 at 81
58-3 at 62
58-2 at 7
58-6 at 28
58-2 at 6
58-2 at 5
58-3 at 75
58-2 at 56
58-3 at 73
58-2 at 54
58-3 at 71
58-6 at 27
58-3 at 68
58-6 at 26
58-2 at 1
58-6 at 25
58-3 at 69
58-1 at 88
58-3 at 115
58-3 at 111

Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Follow-up
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Follow-up after 5 days bicillin injections
Exam
Exam
Follow-up after antibiotics
Exam
Exam

10/12/2010
10/12/2010
10/15/2010
10/19/2010
10/26/2010
11/2/2010
11/5/2010
11/16/2010
12/10/2010
12/15/2010
12/17/2010
12/28/2010
1/27/2011
1/27/2011
2/7/2011
2/22/2011
2/23/2011
2/23/2011
2/23/2011
2/23/2011
2/24/2011
2/24/2011
2/25/2011
3/2/2011
3/2/2011
3/2/2011
3/8/2011
9/27/2013
12/9/2013
1/31/2014
6/18/2014

58-5 at 74
58-6 at 22
58-3 at 113
58-2 at 28
58-6 at 73
58-2 at 26
58-3 at 44
58-2 at 24
58-2 at 21
58-2 at 20
58-1 at 45
58-2 at 19
58-1 at 63
58-6 at 69
58-3 at 105
58-6 at 20
58-3 at 43
58-6 at 45
58-6 at 50
58-6 at 74
58-3 at 42
58-5 at 77
58-6 at 44
58-3 at 59
58-3 at 103
58-5 at 78
58-2 at 17
58-4 at 69
58-4 at 87
58-3 at 54
58-6 at 81

Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Follow-up re: sore throat
Exam, referal to OMC
Follow-up re: tonsils bleeding
Keflex, lortab off-site Dr. Visit
Exam
Exam
Pre-surgery Exam
Exam
Post-surgery observation
Discharge summary: tonsillectomy
Exam
Exam
Exam
Post-surgery observation
Exam
Post-surgery exam
Exam
Follow-up
Exam
Exam
Exam
Exam

9/30/2014
3/24/2015
3/24/2015
3/31/2015
3/31/2015
3/31/2015
4/14/2015
4/14/2015
4/15/2015
4/15/2015
4/24/2015
5/11/2015
5/11/2015
6/24/2015
6/29/2015
6/29/2015
8/18/2015
8/18/2015
8/27/2015

58-6 at 82
58-1 at 8
58-4 at 42
58-1 at 9
58-2 at 40
58-4 at 40
58-1 at 10
58-4 at 92
58-1 at 41
58-2 at 39
58-3 at 3
58-1 at 12
58-4 at 36
58-1 at 13
58-1 at 14
58-2 at 124
58-1 at 68
58-6 at 70
58-3 at 53

Exam
No show
Exam
Exam
Follow-up
Exam
Exam
Exam
Exam
Exam
Exam
Follow-up
Exam
No show
Exam
Exam
Return from off-site visit
Pre-surgery exam
Pre-surgery

Forward Sick Call Request to MD for eval and medication
Rocephin injection
OTC medication given, return to clinic for MD evaluation
Penicillin
Referral to MD
OTC medication, spec. consult pending; gave Chlorpheniramine Maleate for congestion
Refer to ENT: Prior treatments ineffective
Blood drawn for lab work
ENT consult: Throat culture
Enlarged tonsils: Salt water gargles after food
Referral to MD, appt scheduled
Keflex
Doctor evaluation, appt scheduled
Solu-Medrol, 1 dose; prednisone
Referral to provider, antibiotic did not work
Received Bicillen injection
Bicillin injection
Received Bicillen injection
Tonsil infection
Received Bicillen injection
Referral to provider
No acute infection, no swelling
Refer to provider; Chlorpheneiramine maleate, Guaifenesin
Meds (APAP) given. Did not receive mouthwash; tonsils sore;
lymph node swelling; mild tonsil swelling
Pt refused treatment
Pt referred to MD for treatment
Schedule provider eval
Tonsils enlarged, wants tonsils removed
Prescribed Cepacol lozenges
IBU prescribed, numerous courses of PCN, Keflex, amoxicillin failed. Culture taken
Prescribed Ciprofoxacin
Infection noted, prescribed Cipro
Cepacol lozenges
Left doctor, refused advice. No active infection.
Awaiting ENT appt date
MD would like to remove tonsils
Diagnosis of chronic adenotonsillitis; surgery recommended
IBU, ctm; refer to MD; return to clinic if needed
Do not eat or drink anything after midnight
Prescribed Keflex, Lortab, Liquid diet, move to CMCF Infirmary overnight
Throat pain; given Lortab
Prescribed Keflex, Lortab
Prescribed Keflex, Lortab
Full liquid diet
Resting quietly
Prescribed warm water salt gargle, 2 weeks of soft diet
Spitting up blood; refer to MD
Chewing problems diet, 2 weeks
Tonsils removed: Infection noted; Prescribed Z-pack
Toradol injection
Toradol, Decadron injection
Replaced Indomethacin with Tylenol E.S.
Pt complained re: thryroid problem, stated x-rays were taken; none exist;
malingering, mental disorder?
Follow-up with Dr. Levine
Rescheduled, lockdown

Instructed to gargle as needed
Warm salt gargle, medication, patient education
Pt wants referral to ENT; refer to MD
Request ENT treatment
Referral to ENT
Tonsils look normal
GI disruption from tonsils: Follow-up as needed
Lymph node swollen
Refer to surgeon for consult
MD would like to remove "tonsil stumps"
Free world provider
NPO (nothing by mouth) after midnight

3

EXHIBIT A

8/28/2015
8/28/2015
8/28/2015
8/28/2015
8/28/2015
8/28/2015
8/28/2015
9/8/2015
9/15/2015
10/8/2015
10/15/2015
10/16/2015
10/17/2015
2/22/2016
2/24/2016
2/26/2016
2/26/2016
3/5/2016
3/22/2016
4/8/2016
4/8/2016
4/18/2016
6/8/2016
6/8/2016
7/7/2016
7/7/2016
7/7/2016
7/22/2016
7/22/2016
8/14/2016
8/17/2016
12/1/2016
2/3/2017
2/9/2017
3/9/2017
10/2/2017
11/21/2017
1/10/2018
3/9/2018

58-1 at 69
58-1 at 73
58-3 at 35
58-3 at 52
58-3 at 60
58-6 at 49
58-6 at 51
58-2 at 37
58-1 at 75
58-4 at 32
58-1 at 16
58-3 at 51
58-2 at 121
58-4 at 28
58-1 at 18
58-3 at 50
58-4 at 26
58-6 at 86
58-1 at 17
58-6 at 10
58-6 at 30
58-1 at 19
58-1 at 20
58-4 at 65
58-1 at 21
58-2 at 34
58-4 at 63
58-1 at 22
58-4 at 61
58-1 at 23
58-2 at 116
58-2 at 115
58-4 at 48
58-2 at 114
58-1 at 61
58-1 at 52
58-1 at 29
58-1 at 33
58-1 at 31

Post-op discharge papers
Exam, return from off-site visit
Pathology
Post-surgery treatment
Surgery
Outpatient surgery orders
Surgical instruction sheet
Post-op follow-up: tonsils swelling, bleeding
Exam, return from off-site visit
Exam
Follow-up
Exam
Follow-up
Exam
Exam
Exam
Exam
Exam
No show
Exam
Exam
Refused appointment
Follow-up
Exam
Exam
Follow-up
Exam
Exam
Exam
Exam
Exam
No-show
Exam
Exam
Exam
Exam
Exam
Exam
Exam

No complaints
Tissue from oral surgery
Prescribed Tylenol/Codeine
Removal of right tonsil

Occasional bleeding, no swelling
No complaints
Refer to provider; f/u as needed
Mild oral thrush; prescr Diflucan, Amox; ordered CBC, C-reactive protein test, Urinalysis
Prescribed Amoxicillin, Diflucan, discussed oral hygiene
Acetaminophen; return to clinic if symptoms continue
Ordered lab test of right tonsil drainage
Throat culture; antibiotic therapy; refer to provider for results; return to clinic as needed
Follow-up with provider re: lab results
School
Refused treatment (medication cleared up mouth drainage)
Refused treatment

Z-pack
Patient instructed per nursing protocol; referral to provider
Return to clinic with any complications
Prescribed Tylenol
Rescheduled, transportation issue
Refer to MD, insufficient light to see tonsil
Wants ENT consult; tonsillectomy 2011 and 2015; refer to ENT
Taught medication usage, comfort measures
Wants update on ENT appt
Refer to MD
Check on surgery date
Continue meds

Costochondritis (Chest, shoulder pain)
3/29/2012
4/11/2012
8/17/2012
9/27/2013
10/17/2013
11/8/2013
12/4/2013
12/27/2013
2/24/2014
2/27/2014
4/11/2014
4/18/2014
11/24/2016
11/24/2016
12/5/2016
4/23/2017
4/26/2017
5/26/2017

58-2 at 61
58-3 at 89
58-2 at 104
58-3 at 64
58-4 at 2
58-3 at 123
58-3 at 121
58-4 at 94
58-3 at 117
58-2 at 90
58-4 at 24
58-2 at 10
58-1 at 26
58-4 at 50
58-2 at 49
58-1 at 84-87
58-1 at 47
58-4 at 45

Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Exam
Follow-up
Exam
Follow-up
Exam
Exam
Exam

Chest pain: Amoxicillin (for cough)
IBU, refer to MD
Chest pain: IBU, Indomethacin
Chest pain: Notified Dr.
Pt educated; refer to provider; meds per protocol; Acetaminophen
Pt reassured; refer to MD; continue current medication
Pt educated; refer to provider
Prescribed Indocin
Pt reassured; refer to MD
Chest pain: Solu-Medrol injection
Refer to provider
No objective signs of costochondritis
Burning, pain; diagnosed as costochondritis
Refer to MD; Pt does not believe costochondritis diagnosis

Follow-up
Follow-up
Follow-up
Follow-up
Exam

Diagnosis: Tenosynovitis; gave injection; changed medication to APAP
Changed medication to naproxen
Changed medication from IBU to Mobic
Changed medication from IBU and Mobic to Indocin
Refer to MD; continue current pain meds

Chest pain, left arm numbness, prescr prednisone, Ketorolac
Chest pain, left arm pain
Pt reassured, refer to provider

Shoulder Pain (Suspected Costochondritis)
10/21/2013
11/21/2013
12/9/2013
12/23/2013
12/24/2013

58-2 at 98
58-2 at 97
58-2 at 96
58-2 at 94
58-3 at 119

4