Bowling v. Holder et al

Filing 126

OPINION MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that Defendants Bob Holder and Jered Morgan's Motion for Summary Judgment, [Doc. No. 88], is granted;IT IS FURTHER ORDERED that Defendant Joseph Coronado's Motion for Summary Judgment, [Do c. No. 99], is granted; IT IS FURTHER ORDERED that Defendants Correctional Medical Services, Milo Farnham and John Williams Motion for Summary Judgment, [Doc. No. 112], is granted. A separate judgment will be entered upon the conclusion of all pending issues herein. Signed by District Judge Henry E. Autrey on 3/13/2013. (JMC)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
SOUTHEASTERN DIVISION
JACKEY BOWLING,
Plaintiff,
vs.
BOB HOLDER, et al,
Defendants.

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No. 1:11CV43 HEA

OPINION, MEMORANDUM AND ORDER
This matter is before the Court on Defendants Bob Holder and Jered
Morgan’s Motion for Summary Judgment, [Doc. No. 88], Defendant Joseph
Coronado’s Motion for Summary Judgment, [Doc. No. 99], and Defendants
Correctional Medical Services, Milo Farnham and John Williams’ Motion for
Summary Judgment, [Doc. No. 112]. Plaintiff opposes the Motions. For the
reasons set forth below, the Motions are granted.
Introduction
Plaintiff brought this action for an alleged violation of his Constitutional
rights during his confinement at the Dunklin County Jail. Plaintiff’s Complaint
and Amended Complaint1 alleges that Defendants violated his constitutional
1

Plaintiff filed a Motion for Leave to File an Amended Complaint on April 15, 2011,
wherein Plaintiff included a paragraph against Joe Doe or Jane Doe # 6 regarding an alleged
diagnosis of kidney

rights by delaying medical treatment while he was a pre-trial detainee in the
Dunklin County Jail and that he did not receive certain diagnostic tests before he
was transferred to the Missouri Department of Corrections. Plaintiff claims these
actions constitute deliberate indifference to his medical needs.
Facts and Background
Plaintiff resides in Kennett, Missouri. Defendant Holder is the Sheriff of
Dunklin County, Missouri and has been such since 1996. Defendant Morgan
was a correction officer at the Dunklin County Jail.. Defendant Coronado is a
licensed practical nurse. Defendant Corizon, Inc., f/k/a Correctional Medical
Services, Inc., (CMS), is a private entity which provides medical services to
inmates through physicians, nurses and allied health care providers within the
Missouri Department of Corrections. Defendants Williams and Farnham work as
independent contractors for Corizon and provide medically necessary services to
inmates in the Missouri Department of Corrections system.
Prior to Plaintiff’s incarceration in the Dunklin County Jail in 2009,
Plaintiff had spent 21 months in the Missouri Department of Corrections and had
been released on parole in February of 2009. Plaintiff was re-arrested on January
24, 2009 for driving while intoxicated. Plaintiff plead guilty to driving while
intoxicated and also had his parole revoked and had about four years and four
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months left on his prior time to serve in the Department of Corrections. Plaintiff
returned to the Department of Corrections in May of 2009 because he would
not plead guilty to the DWI at the time, but then was returned in July of 2009 to
Dunklin County and then back to the Department of Corrections after his guilty
plea. Plaintiff was released from the Department of Corrections August 6, 2011.
Prior to January of 2009, Plaintiff had had no medical care for any
condition related to his heart nor had he been treated by any physician for
anything related to his heart. Up until 2008, and for about 12 years prior to that
time, Plaintiff was a cocaine user. Plaintiff was using crack and regular cocaine.
When Plaintiff was booked into the Dunklin County Jail on January 24,
2009, he was asked questions on a medical questionnaire including if he was on
any medications. Plaintiff also indicated that he had no heart condition. When
Plaintiff was booked into the jail in January of 2009 he was also on a hold
because of a parole violation.
Between January and March of 2009, Plaintiff did not ask for any medical
request forms because he didn’t think it was a wise idea due to his legal situation
because he was in the middle of a plea bargain and he did not want to cause any
trouble. The only thing Plaintiff did between January 24, 2009 and March 20,
2009 was to request the nurse to see a doctor and that was in March of 2009. The
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jail does have medical request forms along with grievance forms available for
inmates and are given out by the corrections officers. Plaintiff stated that he had
not filed any grievance forms with the Sheriff’s Department during the January to
March 2009 time frame because he was not aware of their existence. However,
Plaintiff did execute a medical information sheet.
On March 21, 2009 Plaintiff complained of having some issues relative to
nausea and vomiting. The incident occurred on March 21, 2009 at approximately
2:30 a.m. At that time, Plaintiff indicated he had intensive pressure across the
entire width of his chest and radiating pain down both arms, having difficulty
breathing, was nauseous, felt faint. Defendant Coronado has no specific
recollection of having been called by a corrections officer on March 21, 2009.
Plaintiff asked to see a physician when the nurse arrived the next Monday.
Defendant Coronado saw plaintiff on March 23, 2009. Plaintiff did request to go
to the hospital, not see a physician nor have a nurse evaluate him because he had
little faith in the jail doctor.
Everyone that comes into the jail is asked about medical information. In
addition, each inmate is given a grievance policy and procedure sheet.
The Dunklin County Jail contracts with Advanced Correctional Health
Care to provide medical treatment to the inmates. ACHC provides the nurses, the
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doctors and personnel to evaluate and treat detainees. No corrections officers
provide medical treatment or make medical decisions concerning when to
transport an inmate or detainee to a hospital. The ACHC doctor makes treatment
decisions and transport decisions. The ACHC doctor is in the jail weekly and the
nurses are in the jail five days per week.
Defendant Coronado was a nurse with ACHC. The Sheriff’s Office does
not prescribe medication, tests or approval of such. Those must be scheduled and
approved by ACHC nursing personnel. The Sheriff’s Department does not
prescribe medication or order tests or have tests approved.
On March 23, 2009, Plaintiff saw Defendant Coronado and Defendant
Coronado made what Coronado designated as an assessment at that time.
Plaintiff disagrees that Coronado’s actions constituted an assessment. Coronado
also met with Plaintiff on March 24, 2009 and returned Plaintiff to general
population in the jail at Plaintiff’s request. Plaintiff was given an aspirin or
Tylenol during the two days in March of 2009. Plaintiff does not specifically
recall being given aspirin or Tylenol.
Plaintiff did not file any medical request forms at the Dunklin County Jail
from March 24, 2009 until May 9, 2009. Plaintiff did not file any grievances with
the Dunklin County Jail that he was not getting medical treatment during the time
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of March 24, 2009 through May 29, 2009.
On May 9, 2009, Plaintiff had another episode and was transported to the
Twin Rivers Medical Center by jail personnel. During this episode, Plaintiff
experienced high blood pressure and a high pulse rate. While at Twin Rivers
Medical Center Plaintiff was first seen by a nurse and then a doctor who squirted
three doses of nitroglycerin underneath Plaintiff’s tongue and the doctor
performed some cardiac assessment tests on him. After various tests Plaintiff was
returned to the Dunklin County Jail on the evening of May 9, 2009. Plaintiff was
given orders for 325 milligrams of aspirin, nitroglycerin tablets as needed and it
was recommended that an electrocardiogram be performed and a full stress test if
Plaintiff could stand it.
Dr. Tomescu, who treated Plaintiff at the hospital, ruled out that Plaintiff
had had a myocardial infarction. No doctor in May of 2009 diagnosed Plaintiff
with having had a heart attack.
On May 10, 2009, Plaintiff was transported to the Missouri Department of
Corrections. Plaintiff does not know why he was sent to the Department of
Corrections even though he was represented by a private attorney at the time.
Defendant Holder testified that he was never aware of any medical
conditions of Plaintiff while Plaintiff was in the Dunklin County Jail. Plaintiff
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testified that he spoke with Holder about being denied nitroglycerine by another
officer. Plaintiff does not specifically identify the date of this conversation.
Defendant Holder was not aware of any diagnostic testing or stress tests
that were ordered for Plaintiff. Defendant Holder testified that he was not aware
of Plaintiff’s episode on March 21, 2009.
On July 7, 2009, Plaintiff was returned to the Dunklin County Jail. When
Plaintiff was booked back into the Dunklin County Jail, he signed a
medical authorization statement, as well as the inmate grievance policy.
Plaintiff was back in the Dunklin County Jail for two or three days for court and
to plead guilty to driving while intoxicated, a misdemeanor. During the period of
July 7-10, 2009, Plaintiff did not file any medical request forms. Plaintiff did not
file any inmate grievances during the July 7-10, 2009, period that he was in the
Dunklin County Jail. On July 10, 2009, Plaintiff was returned to the Department
of Corrections.
Defendant Williams provided direct medical care and treatment to Plaintiff
on thirty seven separate occasions between July 17, 2009 and June 29, 2010,
while Plaintiff was incarcerated at Missouri Eastern Correctional Center.
Defendant Morgan, the corrections officer, according to Plaintiff, really did
not do a great deal as far as violating Plaintiff’s constitutional right except
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Defendant Morgan did not seem to have the fortitude to disagree with the
decision of his fellow officers. Defendant Morgan’s alleged violation was just
simply acting in agreement with the other officers’ decisions. Plaintiff cannot
state who made the direct decision not to send him to the hospital after he
requested twice or not to provide a paramedic after his request because Plaintiff
wasn’t allowed to hear the conversation between the nurse and the other officer
on the telephone.
One of the other officers was on the phone with the nurse to determine
whether or not Plaintiff should go to the hospital or not. The nurse made the
decision that Plaintiff was not going to the hospital in March of 2009.
Plaintiff made a conscious decision not to file any request to go to the
hospital between March 24 and May 9 and took no action on his part to request to
go to a hospital between March 24 and May of 2009.
In rendering medical treatment to Plaintiff, Defendant Williams examined
and monitored Plaintiff, prescribed a variety of medications, ordered diagnostic
studies, consulted with outside physicians, educated Plaintiff regarding his
medical needs and treatment, and formulated therapeutic treatment
Defendant Farnham is a physician licensed to practice medicine in the State
of Missouri. Defendant Farnham provided direct medical care and treatment to
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Plaintiff on thirty-five (35) separate occasions in the twelve (12) month period
between August 13, 2010 through August 8, 2011 while Plaintiff was
incarcerated at Western Missouri Correctional Center (“WMCC”). In rendering
medical treatment to Plaintiff, Defendant Farnham examined and monitored
Plaintiff, prescribed a variety of medications, ordered diagnostic studies,
consulted with outside physicians, educated Plaintiff regarding his medical needs
and treatment, and formulated therapeutic treatment.
On July 13, 2009, Plaintiff was transferred from ERDCC to Missouri
Eastern Correctional Center (“MECC”) where Defendant Williams assumed
primary management of Plaintiff’s medical care and treatment. Williams first
examined and treated Plaintiff on July 23, 2009. Williams performed history and
physical examination, evaluated the efficacy of the medications Plaintiff was
receiving, made necessary medication adjustments, adding Isordil to the treatment
regimen. Williams assigned Plaintiff to the chronic care clinic to provide him
closer observation for any cardiology related issues, reviewed Plaintiff’s medical
records, noted he was awaiting records and follow-up from the cardiologist, Dr.
Balcer, ordered diagnostic studies and formulated a clinical plan of care on behalf
of Plaintiff Bowling, scheduling him for a follow-up examination
On August 18, 2009, Williams again saw Plaintiff during the follow-up
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appointment. Plaintiff reported improvement in his exercise tolerance ever since
beginning the Isordil, which Williams prescribed at the first visit. Plaintiff did not
have chest pain during this visit, but reported mild fatigue and mild headaches he
associated with the Isordil and Nitroglycerin (“TNG”). Williams ordered Tylenol
to treat these mild headaches. Williams noted in the record that he still awaited
the report from the cardiologist, Dr. Balcer, and requested same from Dr. Balcer’s
office.
On September 11, 2009, Williams saw Plaintiff during a follow-up visit
during which Plaintiff informed Williams that the nitrates were “doing OK” and
resulting in a decrease in Plaintiff’s exertional chest discomfort and noting that
Plaintiff had been noncompliant in taking Metropolol since July 20, 2009.
Williams informed Plaintiff of the results of his laboratory studies and reviewed
the report from the cardiologist received by facsimile. Williams refilled
Plaintiff’s prescription for Metropolol as recommended by Dr. Balcer, the
cardiologist, and ordered weekly blood pressure measurements.
On October 6, 2009, Williams examined Plaintiff, noted that Plaintiff
reported his breathing was okay at rest, and his exercise tolerance improved, with
Plaintiff being able to walk to meals and medical without any shortness of breath.
Williams evaluated Plaintiff’s vitals signs, evaluated his medications, ordered
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Zocor to treat Plaintiff’s elevated cholesterol and lipids, prescribed Nitroglycerin
as needed, and prescribed the flu vaccine for Plaintiff.
On October 30, 2009, Williams evaluated Plaintiff for complaints of blood
from his rectum and complaints of chest pain across his sternum without
shortness of breath, sweating or lightheadedness. Plaintiff had taken his
Metropolol and Isordil late that day and reported habitually taking his
medications late. Williams ordered an electrocardiogram (“EKG”), which
Williams read as unchanged from the EKG done on May 9, 2009. Plaintiff’s vital
signs were normal, his lungs were clear, his heart rate was regular. Williams
examined Plaintiff and diagnosed with internal hemorrhoids, estimated the size of
his prostate, and diagnosed the sterna pain as costochondritis, an inflammation of
the cartilage connecting the ribs to the sternum, which can mimic the pain
associated with cardiac pain. Williams prescribed Acetaminophen as needed for
the pain, ordered laboratory studies for PSA and scheduled a follow-up
appointment for Plaintiff.
Williams recommended that Plaintiff undergo a stress test and
echocardiogram on November 6, 2009.
Plaintiff underwent a stress test and an echocardiogram on December 4,
2009 at St. John’s Mercy Medical Center as ordered by Williams.
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On December 8, 2009, Plaintiff was seen by Williams in follow-up from
his last visit and after undergoing an echocardiogram and a stress test. The results
of both tests remained pending at that time. Williams noted Plaintiff’s complaints
of chest pain when he reached for something without shortness of breath,
palpitations or dizziness. Williams assessed this as atypical chest pain and
ordered Plaintiff to continue with the previously prescribed medications, ordered
laboratory studies and await results of the diagnostic studies recently performed
On January 5, 2010, Williams examined Plaintiff in a follow-up visit
during which Plaintiff expressed concern with his job duties and “lay-ins” for no
recreation because Plaintiff wished to go outside. Williams noted that the reports
from St. John’s regarding Plaintiff’s echocardiogram and stress test were not yet
available and contacted St. John’s for the reports. Plaintiff denied any change in
his condition and said he had no problem walking to his appointment that day.
Plaintiff described what Williams assessed as pleuritic discomfort during
coughing or sneezing. A full physical examination, clinical history, vital signs
and medication assessment was performed. Williams increased Plaintiff’s dosage
of Zocor based upon his laboratory results, and encouraged Plaintiff to improve
his compliance with medication orders. Williams continued Plaintiff’s “lay-ins”
for limited activity and scheduled a follow-up appointment.
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Williams obtained the results of Plaintiff’s echocardiogram and stress test
on January 6, 2010, and recommended referral to a cardiologist for re-evaluation
based upon the results, showing that the left ventricular size was at the upper
limits of normal. Overall left ventricular systolic function was normal. Left
ventricular ejection fraction was estimated to be 55%. There was no diagnostic
evidence of left ventricular regional wall motion abnormalities. Left ventricular
wall thickness was at the upper limits of normal. Right ventricular size was
normal. Right ventricular systolic function was normal. The estimated peak right
ventricular systolic pressure was mildly increased.
On January 8, 2010, Williams’ recommendation for cardiology referral for
re-evaluation was approved by the Regional Medical Director of Corizon. On
January 11, 2010, Plaintiff was brought to the medical unit by nurses after
complaining of chest pain reporting that he developed symptoms after walking
from “watch-take” medication administration to his housing unit. Williams noted
that Plaintiff had the same type of symptoms on January 9, 2010 after receiving a
conduct violation for missing his medication. Williams ordered an EKG which
revealed a fast heart rate, but no new changes since October 20, 2009. Plaintiff
claimed he had been compliant with his heart medications that morning. Williams
reviewed the medication cards for Plaintiff’s Metropolol, Isordil and Zocor, and
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noted discrepancies in the remaining numbers of these medications compared to
Plaintiff’s claim of being compliant. Williams prescribed an additional dose of
Metropolol, ordered Troponin laboratory tests to determine whether Plaintiff had
had a “heart attack,” ordered a D-Dimer, moved Plaintiff’s housing unit
assignment to decrease the distance to the medical unit and placed Plaintiff on
oxygen pending the results of the Troponin studies. Williams changed Plaintiff’s
Metropolol from “keep on person” to “watch-take” to more carefully monitor
Plaintiff’s compliance. Troponin results were negative, indicating that Plaintiff
had not experienced a cardiac event or “heart attack”.
On January 18, 2010, Plaintiff was seen by Williams and Plaintiff reported
chest discomfort, specifically, the sharp pain previously reported when he brings
his arms in toward his chest, as well as a popping feeling in the midsternal area
when lying on his back and rolling to his left side. Plaintiff denied any pain
contemporaneous to this examination, and no shortness of breath. Vital signs
were normal. After conducting a physical examination, Williams ordered that
Plaintiff proceed with the cardiology scheduled consultation and for Plaintiff to
follow-up with Williams thereafter. Copies of the echocardiogram and stress test
were sent to the cardiologist, Dr. Balcer in anticipation of Plaintiff’s scheduled
visit.
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On January 21, 2010, Plaintiff refused his medications and did not show up
for “watch-take” of Metropolol and Isordil. The nurse informed Williams and
referred Plaintiff to Williams.
Again on February 2, 3 and 4, 2010 Plaintiff refused medications and did
not show-up for his “watch-take” medications, Isordil and Metropolol. The nurse
discussed Plaintiff’s refusal and noncompliance with Williams, and Williams
agreed to reduce the Metropolol dosage owing to Plaintiff’s complaints of side
effects.
On February 15, 2010, Plaintiff was examined by Williams complaining of
having had a throbbing feeling in his left chest approximately three times within a
four week period, and that the symptoms were relieved by taking two (2)
Nitroglycerin (“TNG”). After a full examination, Williams educated Plaintiff on
the results of his stress test and echocardiogram, reordered medications and
scheduled a follow-up appointment
On February 21, 2010, Plaintiff refused his medications and was a no-show
for medication administration, which was discussed with Williams. On this same
date, Plaintiff submitted a Medical Services Request (“MSR”) requesting that his
medications be given to him to take unsupervised and claimed that the
Department of Corrections caused his condition and failure to make prescription
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appointments.
On March 1, 2010, Plaintiff was sent out of the prison for a visit with the
cardiologist, Dr. Balcer for a re-evaluation ordered by Williams and approved by
Corizon. Dr. Balcer noted that Plaintiff now describes a “squeezing tearing pain”
that occurs mostly when he leans back or turns in his sleep. Plaintiff reported
spending 80% of his time in bed and claims he is lightheaded when he sits up
abruptly. Plaintiff reported improvement in chest pressure during walking
compared to the June 2009 visit with Dr. Balcer. Dr. Balcer reviewed the stress
test and echocardiogram reports sent to him by Williams. Physical examination
was unremarkable. Dr. Balcer stated, “I think it would be reasonable to proceed
with cardiac catheterization at this time to definitively define his coronary
anatomy, and if intervenable disease is present this would help plan that course.
Alternatively, if no intervenable disease is identified then aggressive medical
management would be the best approach.” Dr. Balcer recommended, among other
things, that Plaintiff’s Metropolol be titrated upward to a maximum tolerated dose
or 200 mg. Dr. Balcer arranged no cardiology follow-up
On March 2, 2012, Williams recommended Plaintiff undergo a cardiac
catheterization consistent with Dr. Balcer’s recommendations. On March 3, 2010,
Corizon’s regional medical director issued an approval for the recommended
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cardiac catheterization.
On March 2, 2012, Plaintiff, again, refused his medication and did not
show up for medication administration.
On March 8, 2010, Williams examined Plaintiff in follow-up to Plaintiff’s
cardiology appointment. Williams advised Plaintiff of the cardiac catheterization
to be scheduled and continued Plaintiff’s medications as prescribed.
On March 14, 2010, Plaintiff refused his medication and was counseled on
the risks associated with his ongoing non-compliance with medical instructions.
On March 18, 2010, disciplinary action was taken for failing to report on
time for “watch-take” medication administration. Plaintiff states, “the medication
causes brain ischemia. This causes short-term memory loss. I would like the
medicine returned.”
On March 25, 2010, Plaintiff was examined by Williams in follow-up to
his last appointment. Williams advised Plaintiff that the cardiologist, Dr. Balcer
recommended an increase in the Metropolol, Plaintiff said that he feels this
medication is contributing to his fatigue and has no desire to increase the dose as
recommended. Plaintiff did not have any dyspnea on exertion or shortness of
breath and insisted that the Metropolol would cause excess fatigue resulting in
making him bedridden during waking hours. Ultimately, Plaintiff refused to take
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an increased dosage of Metropolol as recommended by his cardiologist. Williams
ordered a fasting lipid profile. Plaintiff refused his medications and was a “no
show” for medication pass.
On April 7, 2010, Plaintiff filed a Medical Services Request complaining
of back pain and headache even at rest with numbness on left face, neck, and arm,
with lip twitches. On April 13, 2010, Williams conducted a physical examination
of Plaintiff owing to these complaints. Williams considered possible vertebral
basilar insufficiency, perhaps relating to Plaintiff’s history of cocaine abuse, or
possible degenerative joint disease of the cervical and lumbar spine. Williams
ordered cervical and lumbar spine X-rays, ordered a hepatitis panel, and
scheduled a follow-up appointment for Plaintiff.
On April 19, 2010, Plaintiff was transported to Capital Region Medical
Center and underwent a cardiac catheterization, as ordered by Williams. The
results showed, “hemodynamically significant coronary atherosclerosis including
the ostial, LAD, and ramus intermedius branches, as well as proximal right
coronary artery stenosis.” Cardiology consulted with the cardiovascular surgery
department and scheduled surgery for coronary arterial bypass graft (“CABG”)
surgery, which Williams recommended to Corizon, and was immediately
approved.
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On April 20, 2010, Plaintiff underwent CABG surgery at Capital Region
Medical Center for triple vessel coronary artery disease by Dr. Crouch. Postoperatively, Plaintiff was taken to Jefferson City Correctional Center (“JCCC”)
on April 24, 20120 where he continued his recovery under the supervision of
Corizon physician, Dr. Thomas Baker and Dr. Michael Hakala and the Corizon
nursing staff. Plaintiff was discharged to return to MECC on April 27, 2010.
On April 29, 2010, Williams conducted a physical examination of Plaintiff
in follow-up to the CABG surgery. Plaintiff complained of incisional discomfort,
but no shortness of breath or angina symptoms. Plaintiff reported only taking his
Metropolol onetime per day since April 27, 2010. Plaintiff’s surgical wounds
were healing normally. Williams documented Plaintiff’s continued postoperative medication non-compliance, and as a result, ordered all Plaintiff’s
medications be administered “watch-take” to assure compliance as much as
possible. Plaintiff was continued in the chronic care clinic and scheduled for a
follow-up examination.
On May 17, 2010, Plaintiff reported to the medical unit nurse that he began
having chest pain “three days ago” while standing in line for the canteen. Plaintiff
reported taking a Nitroglycerin tablet 10 minutes before the nurses arrived, and
upon arrival, the nurses noted Plaintiff’s blood pressure could not be palpated,
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and he appeared pale and diaphoretic. Shortly thereafter, they obtained a blood
pressure of 124/94, and his oxygen level dropped temporarily. Plaintiff
complained of a feeling of being choked or smothered. Williams was notified,
and he notified the emergency medical services (“EMS”). Williams ordered
oxygen, was administered another Nitroglycerin tablet, and sent by ambulance to
St. John’s Mercy Hospital in St. Louis. Williams contacted Dr. Ferrara,
cardiologist, who performed a repeat cardiac catheterization identifying a postoperative 90% occlusion of one of the vein grafts, with the other grafts remaining
patent. The occluded graft was stented and Plaintiff remained in the hospital
overnight.
On May 18, 2010, Plaintiff returned to MECC from his hospitalization,
repeat cardiac catheterization, and stent placement. Williams examined Plaintiff,
spoke with the cardiologist who attended to Plaintiff overnight at St. Johns (Dr.
Sohn), who reported that Plaintiff was symptom free throughout the night and
stated that he felt better today. Williams ordered Plavix daily for one year.
Williams examined Plaintiff again on May 19, 2010, and discussed
Plaintiff’s case with cardiologist, Dr. Balcer. Plaintiff’s medications re-ordered on
a “watch-take” basis.
On May 26, 2010, Plaintiff was seen by his cardiovascular surgeon, Dr.
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Crouch outside the prison, and also by Williams. Plaintiff continued to complain
of chest pain of a different character than before the surgery and post-operative
cardiac catheterization, and Dr. Crouch noted his belief that this discomfort was
pleuritic pain only and recommended Tylenol for this discomfort. Williams
ordered a “lay-in” for an elevator pass for Plaintiff.
On June 5, 2010, Plaintiff went to the medical unit complaining of chest
pain, and claimed that he had had chest pain on and off ever since his surgery.
Plaintiff took four (4) Nitroglycerin tablets, and thereafter complained of
weakness, dizziness, shortness of breath, palpitations, and feelings of being
choked and smothered. Plaintiff was examined, his vital signs were stable, and his
heart rate was regular. The nurse observed anxiety and confusion. Corizon
physician, Dr. Arthur Keiper ordered three (3) sequential Troponin levels, to
determine whether Plaintiff was experiencing a coronary event, or “heart attack.”
The results of all three (3) tests were negative. Plaintiff was monitored in medical
overnight and released on May 6, 2012.
On June 7, 2010, Plaintiff was seen by Williams, and reported that during
several hot days he took more Nitroglycerin than usual. Plaintiff noted to still
have pleuritic symptoms. Vital signs were normal. Williams ordered laboratory
studies which were performed on June 8, 2010. Williams recommended a follow- 21 -

up appointment with cardiologist, Dr. Balcer, which was approved by Corizon
Regional Medical Director on June 9, 2010. Williams ordered laboratory studies
which were performed on June 8, 2010
On June 12, 2010, Plaintiff “self-declared” an emergency reporting that his
chest hurt. Plaintiff had not taken Nitroglycerin for chest pain as needed. Nurse
noted that this was not an emergent or urgent situation, administered said
medication and placed Plaintiff in observation for one hour, after which he
reported feeling better and was released to his housing unit.
On June 23, 2010, Plaintiff again declared an emergency related to chest
pain. Williams ordered an EKG and Troponin testing to rule out the possibility of
a coronary event or “heart attack.” Williams conducted a physical examination of
Plaintiff and noted the Plaintiff experienced sharp left sided chest pain during
exertion before examination which was relieved with Nitroglycerin. The EKG
revealed improvement in the lateral ischemic changed compared to the tracing
done on June 4, 2010, and the Troponin testing was negative for any coronary
event. Williams placed Plaintiff in observation and scheduled a follow-up visit in
one-week.
On June 29, 2010, Williams saw Plaintiff in follow-up, conducted a history
and physical, which was not remarkable, and ordered follow-up.
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On July 27, 2010, Plaintiff was transferred from MECC to WMCC, and
Defendant Farnham assumed the primary care of Plaintiff beginning on August
13, 2010, when he first examined him as part of the cardiovascular clinic, noting
his history, medication regimen, surgery and post-operative course, and reviewed
the cardiologist’s records. Plaintiff complained of burning pressure when he
bends over, lies down or rolls over on his stomach, and indigestion after meals.
Farnham prescribed Prilosec for suspected gastroesophageal reflux disease
(“GERD”), and recommending avoiding NSAIDS for discomfort to prevent
aggravating the GERD. Other medications continued
On August 23, 2010, Plaintiff left the prison for a follow-up evaluation by
cardiologist, Dr. Balcer. Dr. Balcer doubted Plaintiff’s continued complaints of
chest pain are ischemic, but rather related to the sternotomy performed during the
CABG surgery. No further follow-up ordered.
On September 7, 9 and 13, 2010, three (3) different nurses noted “health
seeking behavior” by Plaintiff.
On September 16, 2010, Plaintiff was examined and treated by Farnham.
On September 20, 2010, Plaintiff declared an emergency related to chest
pain. EKG performed, vital signs were stable, clinical picture unremarkable.
Farnham ordered a “GI Cocktail,” Troponin levels, and observation for four (4)
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hours. Dr. Farnham examined Plaintiff, reviewed the EKG, found no evidence of
a coronary event or “heart attack” and released Plaintiff back to his housing unit.
On October 15, 2010, Farnham examined Plaintiff, who added Norvasc for
Plaintiff’s elevated blood pressure and scheduled a one month follow-up
examination.
On November 15, 2010, Farnham examined Plaintiff during his follow-up
appointment. Plaintiff complained of leg pain from knees down every night.
Plaintiff’s blood pressure was somewhat elevated after being changed to Norvasc,
so Farnham added HCTZ and a scheduled a follow-up appointment.
On December 15, 2010, Farnham examined Plaintiff at a follow-up
appointment. Plaintiff’s blood pressure improved, but medication increased.
Plaintiff complained of feet going numb especially when he lies down. Farnham
noted weak peripheral pulses and that vein taken from left leg in which pulses are
weaker. Farnham held the Zocor to evaluate whether leg pain was a side effect of
this medication.
On January 14, 2011, Farnham examined Plaintiff who reported no change
in leg pain after holding the Zocor, so Farnham restarted this medication and
prescribed walking twice daily and follow-up in cardiovascular clinic.
On January 18, 2011, Plaintiff reported to medical and complained of chest
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pain for which he had taken numerous Nitroglycerin to relieve. Nurse
Ramsbottom noted left lung “rales,” examined Plaintiff, performed vital signs,
which were normal. Troponin levels were performed. Later, Plaintiff returned to
medical as instructed by nursing and stated, “I’m feeling better, I didn’t even
want to come back here.” Plaintiff observed overnight in medical. Farnham
examined Plaintiff, noted that the EKGs were unchanged, the Troponin levels
were normal, and treated Plaintiff with oxygen therapy and “GI Cocktail,” which
did not help his symptoms, and noted that Plaintiff’s lips were cyanotic. Farnham
contacted Dr. Balcer to discuss Plaintiff’s condition and care, and a repeat cardiac
catheterization was recommended by Farnham and approved by Corizon’s
Regional Medical Director. Plaintiff was transported to Capital Regional Medical
Center via ambulance.
On January 20, 2011, Plaintiff underwent a third cardiac catheterization for
recurrent angina, or chest pain. Dr. Balcer’s report on the catheterization showed
an apparent occlusion of all saphenous vein bypass grafts, a widely patent LIMA
graft to the LAD, normal hemodynamics, and recommended a stress test,
aggressive treatment of lipids and hypertension. The stress test was performed
also on January 20, 2012, which revealed a mildly abnormal study.
On January 21, 2011, Plaintiff returned to WMCC, and Farnham
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documented that the stress test was better than expected even though the cardiac
catheterization showed occlusion of three arteries.
Plaintiff remained in medical observation at WMCC until January 24,
2011, when Farnham confirmed with Dr. Balcer that Plaintiff believed it was safe
to release Plaintiff into “population.” Farnham educated Plaintiff regarding the
meaning of blockages and about using antacids for chest burning rather than
Nitroglycerin. Farnham reviewed Dr. Balcer’s report, prescribed a wheelchair as
needed and scheduled a follow-up appointment for one week later.
On January 24, 2011, Plaintiff approached nursing inquiring about the
criteria for medical parole, and was advised that his condition does not meet the
criteria.
On January 27, 2011, Plaintiff declared an emergency based upon chest
pain worsening over two hours unimproved by the administration of two (2)
Nitroglycerin. Reported sweating and feeling faint. Blood pressure low at 79/52,
and skin was cool and clammy. Plaintiff reported having a cough for two days,
and feeling like something is stuck in his throat, with associated upper gastric and
right upper quadrant pain intermittently. Farnham ordered Plaintiff to be
maintained in observation over night, ordered an EKG, held the HCTZ,
Metropolol, Amlodipine and Lisinopril, and prescribed a “GI Cocktail.”
Plaintiff’s blood pressure returned to normal, he became alert, with a normal
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physical assessment, and stated that the pain did not feel “like cardiac pain.”
Plaintiff had hyperactive bowel sounds and reported improvement in the pain
after “GI Cocktail.” Farnham examined Plaintiff the next morning, January 28,
2011 in observation, noted his vital signs were stable. Farnham noted that
Plaintiff had a recent orthostatic hypotensive episode and severe coronary artery
disease. Plaintiff’s medications restarted, and dosages reduced by Farnham.
Plaintiff’s brother contacted nursing about possible medical parole.
Nursing advised brother that Plaintiff did not meet the criteria for medical parole.
On February 9, 2011, Farnham examined Plaintiff in the cardiovascular
clinic. Farnham ordered a “pill cam” examination of esophagus, increased the
dosage of Prilosec for GERD, reordered Plaintiff’s cardiovascular medications
and ordered a follow-up visit following the “pill cam” examination. Farnham
noted that Plaintiff has cardiac angina but also has symptoms of acid reflux and
dysphagia for which he is taking Nitroglycerin.. Farnham recommended “pill
cam” examination and it was approved by Corizon’s Regional Medical Director.
On February 16, 2011, Plaintiff reported to nurse that he has been having
“barely controlled heart pains,” chest pressure and dizziness, and stated, “I feel this
would have been fatal. I am now certain that without remedial intervention that my
heart problems will end my life in a matter of days, not weeks.” Plaintiff further
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stated, “I don’t know what I need today. I have no pain now.” Vitals signs were
stable, examination was unremarkable. Nurse noted Plaintiff smiled freely during
conversation about his medical problems, and noted that Plaintiff has anxiety about
his health problems.
One month later, on March 16, 2011, Plaintiff reported to medical with
complaints of left, dull pain radiating to shoulder and back, worse with exertion.
Plaintiff’s vital signs were normal, he was calm and talkative, and his skin was
pink, warm and dry. His assessment was unremarkable. Farnham ordered an EKG
which was unchanged showing only an old infarction, and Troponin levels, which
were negative. Plaintiff received a “GI Cocktail” with no pain relief after fifteen
(15) minutes. Farnham ordered Atropine and placed Plaintiff in observation, to
have the Troponin repeated after forty eight (48) hours.
On March 17, 2011, Farnham examined Plaintiff and noted that he was in
observation overnight for chest pain helped by Nitroglycerin only after about 1015 minutes, that his pain gradually lessened after receiving "GI Cocktail," atropine,
and antacids, but at no time has he appeared ill upon examination. Plaintiff’s EKGs
and Troponin levels all were normal except for the old inferior-antero septal “MI.”
Farnham noted that Dr. Balcer advised the Plaintiff was not a candidate for PTCA
or repeat CABG. Farnham considered this non-cardiac chest pain, increased
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Plaintiff’s Isordil dosage and discharged him from medical observation to followup in one week.
On March 18, 2011, Plaintiff again declared an emergency related to sterna
chest pain, for which Plaintiff too four (4) Nitroglycerin. The nurse advised
Plaintiff that he had taken too many Nitroglycerin. The examination was
unremarkable and his vital signs were normal. Patient argumentative and states
that the pain he is experiencing is his “heart because his heart is turning to “fat”
and it’s already enlarged.” Farnham was notified of self-declared emergency.
Farnham instructed Plaintiff on how to properly take his medication, and how
many Nitroglycerin he is limited to.
On March 25 and 28, 2011, Plaintiff was again admitted to medical
observation complaining of chest pain. Physical examination and vital signs
normal. Farnham examined Plaintiff and ordered Vistaril. Plaintiff later released
from observation after improvement and instructed to continue current plan of
care.
On April 1, 2011, Plaintiff requests “nitro patches” and Farnham discussed
this treatment option with Plaintiff and contacted Dr. Balcer regarding his
recommendations.
On April 14, 2011, Plaintiff reported to Farnham complaining of shortness
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of breath. Plaintiff had “pill cam” examination on April 8, 2011 and results
pending. He discussed with Plaintiff that Dr. Balcer advised Farnham that there
was no vessel in Plaintiff’s heart that he could dilate, and that Plaintiff is not a
candidate for repeat surgery because the danger of the second surgery would
outweigh the minimal benefits that might be achieved. Farnham added Digoxin to
regimen and ordered a chest X-ray and Digoxin level.
On April 15, 2011, Plaintiff reported to the medical unit complaining of
chest pain, dyspnea and hypertension. Examination and vital signs normal.
Farnham ordered Vistaril and when improved, Plaintiff was returned to his housing
unit.
On April 16, 2011, Plaintiff returned to the medical unit reporting that he
had a shot in the ER. Vital signs remain normal and Plaintiff was admitted to the
observation unit. Plaintiff reported that the “shot has already started to relieve the
pain and discomfort.” Shortly thereafter, Plaintiff stood up and voiced that the pain
was better and he was ready to return to his housing unit, which was done.
On April 17 and 18, 2011, Plaintiff again self-declared an emergency
voicing that he was tachycardic because “they won’t give me my Metropolol there
at the window.” Plaintiff’s heart rate elevated to 123. Farnham ordered Troponin
levels which were negative, and ordered Vistaril for anxiety. Plaintiff observed in
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medical unit. Farnham re-issued the watch-take order for Metropolol and
increased the dosage.
Results of “pill cam” reviewed by Farnham on April 28, 2011. Farnham
noted that the “pill cam” suggested Barrett’s esophagus of the distal esophagus
Farnham recommended an EGD with biopsy as follow-up to the “pill cam”
examination, and this was approved by Corizon’s Regional Medical Director.
On July 14, 2011, Farnham reviewed the results of Plaintiff’s EGD that he
underwent at Capital Regional Medical Center on May 24, 2011, which showed no
lesions. Dr. Brand, who performed the EGD, dilated the esophagus, which he
believes may have lessened the frequency of Plaintiff’s pain. Plaintiff reported that
ice water relieves his pain now.
On July 21 and 29, 2011, Plaintiff self-declared an emergency for chest pain
when lying down. The examination and vital signs were normal. The EKG was
unchanged. Pain resolved spontaneously and Plaintiff returned to housing unit on
July 21, 2011.. Plaintiff was given a “GI Cocktail” on July 29, 2011 and returned
to cell.
On August 3, 2011, Plaintiff against self-declared an emergency for chest
pain. Dr. Mullin ordered Troponin levels, which were negative, prescribed oxygen,
Atenolol, and kept Plaintiff under observation until results of Troponin levels
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received and Plaintiff improved.
Plaintiff again self-declared emergencies on August 5, 8, 11, 24, 2011, all
which were treated with examinations, ordering Troponin levels and EKGs, with
normal results.
Farnham last encountered Plaintiff on August 10, 2011, for a cardiovascular
clinic follow-up. Farnham performed a full history and physical examination, and
in his assessment, noted that Plaintiff has dyslipidemia, hypertension, ischemic
heart disease, poor cardiac control, symptomatic with the maximum medical care,
and that Plaintiff’s condition was stable.
During the May 17, 2007 medical evaluation, the nurse at ERDCC observed
in the “Objective” section of her documentation that Plaintiff’s blood pressure was
elevated, he was overweight, had a history, at that time, of drug abuse for thirteen
(13) years, and of alcohol abuse for thirty five (35) years.
Plaintiff had demonstrated a pattern of noncompliance to medical
instructions and refusal to follow medical directions while under the care of
Defendants Williams, Farnham and Corizon, including the following dates:
1. May 26, 2009
2. November 2, 2009
3. January 5, 2010
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4. January 9, 2010
.January 11, 2010
6. April 29, 2010
7. September 16, 2010
8. October 30, 2009
9. January 1, 2010
10. January 21, 2010
11. February 2, 2010
12. February 21, 2010
13. March 2, 2010
14. March 8, 2010
15. March 25, 2010
16. March 30, 2010
17. September 16, 2010
18. March 18, 2011.
Discussion
Summary Judgment Standard
The standard for summary judgment is well settled. In determining whether

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summary judgment should issue, the Court must view the facts and inferences from
the facts in the light most favorable to the nonmoving party. Matsushita Elec.
Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986); Woods v.
DaimlerChrysler Corp., 409 F.3d 984, 990 (8th Cir. 2005). The moving party has
the burden to establish both the absence of a genuine issue of material fact and that
it is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 247 (1986); Celotex Corp. v. Catrett, 477 U.S.
317, 322 (1986); Enter. Bank, 92 F.3d at 747. Once the moving party has met this
burden, the nonmoving party may not rest on the allegations in his pleadings but
by affidavit or other evidence must set forth specific facts showing that a genuine
issue of material fact exists. Fed.R.Civ.P. 56(e); Anderson 477 U.S. at 256; Krenik
v. Le Sueur, 47 F.3d 953, 957 (8th Cir. 1995). “‘Only disputes over facts that might
affect the outcome of the suit under the governing law will properly preclude the
entry of summary judgment.’ Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248,
106 S.Ct. 2505 (1986).” Hitt v. Harsco Corp. 356 F.3d 920, 923 (8th Cir. 2004).
An issue of fact is genuine when “a reasonable jury could return a verdict for the
nonmoving party” on the question. Anderson v. Liberty Lobby, Inc., 477 U.S. at
248; Woods v. DaimlerChrysler Corp., 409 F.3d at 990. To survive a motion for
summary judgment, the “nonmoving party must ‘substantiate his allegations with
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sufficient probative evidence [that] would permit a finding in [his] favor based on
more than mere speculation, conjecture, or fantasy.’ Wilson v. Int’l Bus. Machs.
Corp., 62 F.3d 237, 241 (8th Cir. 1995)(quotation omitted).” Putman v. Unity
Health System, 348 F.3d 732, 733-34 (8th Cir. 2003). “[A] complete failure of
proof concerning an essential element of the nonmoving party’s case necessarily
renders all other facts immaterial.” Celotex, 477 U.S. at 323. The Court will
review the facts in this case with the stated standard in mind.
Plaintiff’s claims arise from his status as a pre-trial detainee and as an
inmate in the Missouri Correctional system. Pretrial detainee § 1983 claims are
analyzed under the Fourteenth Amendment's Due Process Clause, rather than the
Eighth Amendment prohibition of cruel and unusual punishment. See Kahle v.
Leonard, 477 F.3d 544, 550 (8th Cir.2007) (stating “[t]his makes little difference
as a practical matter, though: Pretrial detainees are entitled to the same protection
under the Fourteenth Amendment as imprisoned convicts receive under the Eighth
Amendment.”). Holden v. Hirner, 663 F.3d 336, 340 -341 (8th Cir. 2011). Thus,
the Court’s analysis is based on the standards set out under the Eighth
Amendment.
“The Eighth Amendment prohibits the infliction of cruel and unusual
punishment. The treatment a prisoner receives in prison and the conditions under
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which he is confined are subject to scrutiny under the Eighth Amendment.” Schaub
v. VonWald, 638 F.3d 905, 914 (8th Cir.2011) (citing Helling v. McKinny, 509
U.S. 25, 31 (1993)). To prevail on a claim of deprivation of medical care, an
inmate must show that the prison official was deliberately indifferent to the
inmate's serious medical needs. Id. (citing Coleman v. Rahija, 114 F.3d 778 (8th
Cir.1997)). This requires a two-part showing: (1) the inmate suffered from an
objectively serious medical need; and (2) the prison official knew of the need, yet
deliberately disregarded it. Id.; See also Farmer v. Brennan, 511 U.S. 825, 837
(1994); Estelle v. Gamble, 429 U.S. 97, 105 (1976). Whether an inmate's
condition is a serious medical need and whether an official was deliberately
indifferent to the inmate's serious medical need are both questions of fact.
Coleman, 114 F.3d at 785.
First, the objective component requires a serious medical need be
established by the inmate-plaintiff. A serious medical need is “one that has been
diagnosed by a physician as requiring treatment, or one that is so obvious even a
layperson would easily recognize the necessity for a doctor's attention.” Von Wald,
638 F.3d at 914 (citing Camberos v. Branstad, 73 F.3d 174, 176 (8th Cir.1995)).
If the need is obvious to a layperson, there is no requirement to verify this by
medical evidence. Id. (citing Hartsfield v. Colburn, 371 F.3d 454, 457 (8th
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Cir.2004)). The determination that a medical need is objectively serious is a
factual finding. See Coleman, 114 F.3d at 784. The determination of whether a
medical need is sufficiently obvious cannot be analyzed in a vacuum and
background knowledge of the inmate's medical condition or medical records is part
of the analysis. Jones v. Minnesota Dept. of Corrections, 512 F.3d 478, 482 (8th
Cir.2008).
Second, the subjective component requires a plaintiff to show that the
defendant actually knew of, but deliberately disregarded, such need. Grayson v.
Ross, 454 F.3d 802, 808–809 (8th Cir.2006); Moore v. Jackson, 123 F.3d 1082,
1086 (8th Cir.1997). Prisoners alleging deliberate indifference must show more
than negligence, even more than gross negligence, and must establish a “mental
state akin to criminal recklessness: disregarding a known risk to the inmate's
health.” Jolly v. Knudsen, 205 F.3d 1094, 1096 (8th Cir.2000); Gordon v. Frank,
454 F.3d 858, 862 (8th Cir.2006). “This is true whether the indifference is
manifested by prison doctors in their response to the prisoner's needs or by prison
guards in intentionally denying or delaying access to medical care or intentionally
interfering with the treatment once prescribed .” McRaven v. Sanders, 577 F.3d
974 at 979 (8th Cir.2009) (citing Gamble, 429 U.S. at 104–105). “The inmate must

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clear a substantial evidentiary threshold to show the prison's medical staff
deliberately disregarded the inmate's needs by administering inadequate
treatment.” Nelson v. Shuffman, 603 F.3d 439, 448–449 (8th Cir.2010). The
Supreme Court has held prison officials may not be held liable if they prove that
they were unaware of even an obvious risk or if they responded reasonably to a
known risk, even if the harm ultimately was not averted. Farmer, 511 U.S. at 826.
Deliberate indifference “must be measured by the official's knowledge at the time
in question, not by ‘hindsight's perfect vision.’” VonWald, 638 F.3d at 915
(quoting Jackson v. Everett, 140 F.3d 1149, 1152 (8th Cir.1998)). The
determination that prison officials had actual knowledge of a serious medical need
may be inferred from circumstantial evidence or from the very fact that the risk
was obvious. See Farmer, 511 U.S. at 842. However, “a prisoner's mere difference
of opinions over matters of expert medical judgment or a course of medical
treatment fail[s] to rise to the level of a constitutional violation.” Taylor v. Bowers,
966 F.2d 417, 421 (8th Cir.1995).
A serious medical need is “one that has been diagnosed by a physician as
requiring treatment, or one that is so obvious that even a layperson would easily
recognize the necessity for a doctor's attention.” Coleman, 114 F.3d at 784 (citing

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Branstad, 73 F.3d at 176). Yet, “[n]ot every ache and pain or medically recognized
condition supports a claim of Eighth Amendment violation and the claim must
involve a substantial risk of serious harm to the inmate.” Williams v. Arkansas
Dept. of Correction, 207 S.W.3d 519, 523–524 (2005) (citing Roberson v.
Goodman, 293 F.Supp.2d 1075 (2003). “To evaluate a claim for medical need, the
civilized minimum of public concern for the health of prisoners is determined,
striking a balance between objective need and cost.” Id., citing Ralston v.
McGovern, 167 F.3d 1160.
Plaintiff complains that Defendant Holder was deliberately indifferent to his
serious medical needs by not responding to Plaintiff’s notifying Holder that
Plaintiff did not receive nitroglycerin at some point. Holder denies knowledge of
this conversation, however, assuming the facts in the light most favorable to
Plaintiff, as the Court must, the Court assumes the conversation did in fact occur.
Even so, Plaintiff’s claim against Holder based solely on this assertion must fail.
The record establishes that Plaintiff received the nitroglycerin. Plaintiff has not
presented any evidence that any delay in receiving the nitroglycerin had any
adverse affect on Plaintiff’s health.
With respect to Defendant Coronado, Plaintiff claims that Coronado

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informed the deputies that Plaintiff must remain in isolation until Coronado
reported for work on Monday and that Coronado refused to order that he be taken
to the hospital in March, 2009. Further, Plaintiff claims that Coronado informed
Plaintiff that he would see the doctor on Thursday. Plaintiff claims that there was
damage to his heart that could have been avoided with treatment in the first three
to six hours following the incident.
Plaintiff claims that Defendant Williams was informed of prescribed tests
from the Department of Corrections cardiologist and then informed plaintiff that he
felt it was his duty to his company in July, 2009 to treat Plaintiff as a regular
chronic care patient. Plaintiff further claims that Defendant Williams became
hostile and defied the medical reports.
Plaintiff claims Defendant Farnham told him there was nothing wrong with
him and that Farnham continued to ignore and disregard the cardiologist’s
directives as to Plaintiff’s medical condition. Further, Plaintiff claims that
Defendant Farnham refuses to follow section 217.250 RSMo., “Terminal or
Shortened Life Directives.” According to Plaintiff, Defendant Farnham has stated
that Correctional Medical Services will not provide remedial treatment, and that
Plaintiff’s life will end as a result of this denial within days, if not weeks or

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months.
Although Plaintiff had no previous indication of any heart condition, it can
be assumed for the purposes of these motions that chest pains and numbness can
be a serious medical condition. However, when an inmate’s claim is based upon a
delay in treatment, as Plaintiff’s is here, the objective seriousness of the alleged
deprivation is also measured by reference to the effect of that delay on his
condition. Therefore, to succeed on his claim, Plaintiff must place in the record
verifying medical evidence to establish the detrimental effect of the delay.
Coleman, at 784 (citing Crowley, at 502). Plaintiff must show that the Defendant’s
alleged delay of medical care adversely affected his heart condition. See Coleman,
at 784; Crowley, at 502; Sentry-Haugen, at 890.
To prevail on a claim that a delay in medical care constituted cruel
and unusual punishment, an inmate must show both that: (a) the
deprivation alleged was objectively serious; and (b) the prison official
was deliberately indifferent to the inmate's health or safety. Beyerbach
v. Sears, 49 F.3d 1324, 1326 (8th Cir.1995). When the inmate alleges
that a delay in medical treatment rises to the level of an Eighth
Amendment violation, “the objective seriousness of the deprivation
should also be measured ‘by reference to the effect of delay in
treatment.’ ” Id. (quoting Hill v. Dekalb Regional Youth Detention
Ctr., 40 F.3d 1176, 1188 (11th Cir.1994)). To establish this effect, the
inmate “must place verifying medical evidence in the record to
establish the detrimental effect of delay in medical treatment ...”
Crowley v. Hedgepeth, 109 F.3d 500, 502 (8th Cir.1997) (quoting
Hill, 40 F.3d at 1188).
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Laughlin v. Schriro 430 F.3d 927, 929 (8th Cir. 2005).
In response to Defendants Motion for Summary Judgment, Plaintiff has
presented no medical records showing that any of the alleged actions by these
Defendants had any adverse effect on his heart condition. There is no verifiable
medical evidence showing that Plaintiff’s heart condition worsened because of the
alleged delay in treatment. Plaintiff merely states that his condition was worsened
and that according to him, his life has been shortened. To the contrary, the record
before the Court establishes that each of these Defendants reacted in a manner
which was proper at the time and in response to Plaintiff’s condition. Therefore,
Plaintiff has failed to establish that the Defendant’s alleged delay in medical
treatment adversely effected his heart condition. This failure precludes Plaintiff's
claim that the Defendants’ delay in providing him the medical attention he believes
he was entitled to receive amounted to deliberate indifference to his medical needs.
Conclusion
In conclusion, the Court finds that, in viewing the facts in the best light for
Plaintiff, a reasonable jury could not conclude that these Defendants violated
Plaintiff’s constitutional rights. Summary Judgment is therefore warranted.
Accordingly,

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IT IS HEREBY ORDERED that Defendants Bob Holder and Jered
Morgan’s Motion for Summary Judgment, [Doc. No. 88], is granted;
IT IS FURTHER ORDERED that Defendant Joseph Coronado’s Motion
for Summary Judgment, [Doc. No. 99], is granted;
IT IS FURTHER ORDERED that Defendants Correctional Medical
Services, Milo Farnham and John Williams’ Motion for Summary Judgment, [Doc.
No. 112], is granted
A separate judgment will be entered upon the conclusion of all pending
issues herein.
Dated this 13th day of March, 2013.

_______________________________
HENRY EDWARD AUTREY
UNITED STATES DISTRICT JUDGE

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