United States District Court, D. Maine
ORDER ON MOTION TO DISMISS AND FOR JUDGMENT ON THE
A. WOODCOCK, JR., UNITED STATES DISTRICT JUDGE.
federal inmate claims that various federal, municipal, and
individual actors, including a medical contracting business
and several of its employees, violated his civil rights in
connection with his pretrial detention at the Somerset County
Jail pending the resolution of his federal criminal charges.
In particular, the inmate alleges that these actors failed to
address his serious medical condition in violation of the
Eighth Amendment. The medical contracting business'
employees and its parent corporation move for judgment on the
pleadings under Federal Rule of Civil Procedure 12(c).
Because the medical defendants have failed to address whether
their actions were sufficient in view of the potentially
serious medical consequences of inaction, the Court denies
the motion, preferring to address the liability issue in the
context of a motion for summary judgment with a more fully
developed factual and legal record.
March 6, 2015, Joseph Belskis filed a complaint against Terry
Thurlow, doing business as Maine MedPro Associates (MedPro),
as well as the State of Maine Board of Corrections, the
County of Somerset, and the United States Marshals Service.
Compl. (ECF No. 1). MedPro filed a motion
to dismiss on June 30, 2015. Def.'s Mot. to
Dismiss (ECF No. 32). Mr. Belskis subsequently moved to
amend his Complaint on July 23, 2015. Letter Mot. to
Amend Compl. (ECF No. 39). Additionally, he filed a
notice dismissing all medical negligence claims against
MedPro on July 27, 2015. Notice of Voluntary
Dismissal (ECF No. 41). On August 11, 2015, MedPro filed
a limited opposition to the motion to amend the Complaint.
Obj. to Pl.'s Mot. to Amend Compl. (ECF No. 50).
August 31, 2015, the Magistrate Judge issued a recommended
decision advising the Court to (1) grant Mr. Belskis'
motion to amend his Complaint, (2) dismiss as moot the
portion of MedPro's motion to dismiss relating to Mr.
Belskis' medical negligence claims, and (3) deny the
remainder of MedPro's motion to dismiss. Recommended
Decision (ECF No. 53). The Court adopted the Magistrate
Judge's Recommended Decision on October 14, 2015.
Order Affirming the Recommended Decision of the
Magistrate Judge (ECF No. 57). That same day, Mr.
Belskis filed an amended complaint. Am Compl. (ECF
No. 59). The Amended Complaint added several individual
MedPro employees as defendants, including Robert Ellis, Lisa
Cates, Mary Patterson, Rhonda Walters, and Trina Littlefield,
as well as a Jane Doe and John Doe. Am Compl. (ECF
and its employees filed an answer to the Amended Complaint on
December 4, 2015. Answer, Defenses and Affirmative
Defenses to Pl.'s First Am. Compl. (ECF No. 80)
(Answer). On December 11, 2015, MedPro and its
employees filed a motion to dismiss and for judgment on the
pleadings. Mot. to Dismiss and for J. on the
Pleadings (ECF No. 84) (Mot. for J.). Mr.
Belskis filed a response in opposition to the motion on March
18, 2016. Pl.'s Opp'n to Mot. to Dismiss
(ECF No. 102) (Pl.'s Opp'n). On the same
day, Mr. Belskis also filed a motion to amend the Amended
Complaint to substitute DT Developers Inc. for Maine MedPro
Associates and its principal, Terry Thurlow. Mot. to
Amend the Compl. (ECF No. 103). On March 22, 2016,
MedPro filed a limited objection to clarify that DT
Developers Inc. is the parent corporation of Maine MedPro
Associates. Def.'s Limited Obj. to Pl.'s Mot. to
Amend (ECF No. 104). On March 24, 2016, the Magistrate
Judge granted the motion to substitute DT Developers Inc. in
place of both Maine MedPro Associates and its principal,
Terry Thurlow. Order Granting Without Obj. Mot. to Amend
Compl. (ECF No. 105). The Magistrate Judge instructed
the parties that there was no need to file an amended
complaint or additional responsive pleadings. On March 29,
2016, DT Developers Inc. and the individual MedPro employees
filed a reply to Mr. Belskis' opposition to their motion
to dismiss. Def.'s Reply to Pl.'s Obj. to Mot. to
Dismiss and for J. on the Pleadings (ECF No. 107)
Belskis is a resident of the state of Maine. Am.
Compl. at 15. At the time of the events alleged in the
Complaint, he was in the legal custody of the United States
Marshals Service and in the physical custody of the state of
Maine Department of Corrections at the Somerset County Jail.
Developers Inc. is the parent corporation of Maine MedPro
Associates. Mot. to Amend the Compl. at 1;
Def.'s Limited Obj. to Pl.'s Mot. to Amend
at 1. MedPro is a private medical contractor that provides
medical services to state and federal inmates at the Somerset
County Jail. Am. Compl. at 15.
time of the events alleged in the Complaint, MedPro employed
Robert Ellis as a physician assistant and Lisa Cates, Mary
Patterson, Rhonda Walters, and Trina Littlefield as
registered nurses. Id. at 20-21; Mot. for
J. at 15-20. These individual defendants provided
professional medical care to inmates at the Somerset County
Amended Complaint also alleges that MedPro employed a
“Jane Doe” and “John Doe.” Both Jane
Doe and John Doe appear in the caption of the case and the
body of the Complaint identifies Jane Doe as
“Barbara” and John Doe as “John, ”
both as nurses employed by MedPro. Am. Compl. at
20-21. However, Mr. Belskis never makes any specific
allegations against them in the Amended Complaint. MedPro, in
turn, fails to mention the claims against Jane and John Doe
in its motion; Mr. Belskis fails to mention them in his
response; and MedPro does not mention them in its reply.
absence of any mention of the Doe Defendants by the parties
in the pending motion, the Court is reluctant to assume that
Mr. Belskis, who is acting pro se, either has no or could
obtain no information that would allow for a claim against
these Defendants. Typically, discovery reveals the true
identity of Jane and John Doe defendants and their exact
actions. The Court, therefore, concludes that it is more
appropriate for their liability to be resolved in the context
of a motion for summary judgment.
The Alleged Facts
Belskis was diagnosed with diabetes in 1998. Am.
Compl. ¶ 5. His treatment regimen includes insulin,
metformin, and specialized footwear. Id. Diabetes
can cause foot ulcers that, if left untreated, can lead to
osteomyelitis, an infection of the bone. Id.
¶¶ 5-6. Mr. Belskis previously required two
amputations due to the effects of osteomyelitis. Id.
3, 2012, Mr. Belskis was taken into custody and placed at the
Oxford County Jail. Id. ¶ 7. At the time of his
arrest, Mr. Belskis was wearing his diabetic footwear.
Id. ¶ 8. The staff at the Oxford County Jail
permitted Mr. Belskis to continue wearing his specialized
shoes. Id. The following day, the United States
Marshals Service took custody of Mr. Belskis and transferred
him to the Androscoggin County Jail. Id. ¶ 9.
The staff at the Androscoggin County Jail initially took away
Mr. Belskis' diabetic shoes but returned them the
following day. Id. At first, the staff administered
Mr. Belskis' insulin irregularly. Id. Mr.
Belskis soon developed sores on the bottom of his feet that
required debridement at a local medical center. Id.
at 9-10. Thereafter, Androscoggin staff provided Mr. Belskis
with bandages to care for the sores and permitted Mr. Belskis
to wear his diabetic shoes for the remainder of his time at
the facility. Id. ¶¶ 11-12.
Transfer to Somerset County Jail
November 5, 2012, the Marshals Service transferred Mr.
Belskis to the Somerset County Jail (SCJ). Id.
¶ 13. Mr. Belskis arrived in his diabetic footwear with
his diabetes medications. Id. Shortly after his
arrival, the SCJ corrections staff confiscated Mr.
Belskis' diabetic shoes because they violated jail
security policies. Id.
hours later, Nurse Patterson examined Mr. Belskis.
Id. She told Mr. Belskis that his diabetes
medications would change and informed him that he had a red
spot on the bottom of a foot. Id. Mr. Belskis
believed that the wounds that had developed during his
incarceration at the Oxford and Androscoggin facilities had
healed. Id. Nurse Patterson also submitted a written
request to the SCJ corrections staff, asking them to permit
Mr. Belskis to retain his diabetic shoes. Answer
Attach. 1 Exhibit Medical Intake at 11 (ECF No. 79)
(Intake). The SCJ corrections staff denied Nurse
Patterson's request. Id.
November 6, the day after the SCJ corrections staff
confiscated his diabetic shoes, Mr. Belskis wrote to the
medical staff to ask that the jail provide him with diabetic
shoes that would not run afoul of the jail's security
policies. Answer Attach. 6 Exhibit Medical
Chart-General at 1 (ECF No. 79) (Medical
Chart). Two days later, Nurse Cates, a medical
supervisor, responded in writing that “[t]his is not
something the jail will do. You can have another pair dropped
off. Normally only jail issued shoes are allowed.”
Id. That same day, Nurse Cates made an entry in the
medical file about Mr. Belskis' amputation history
resulting from past cases of osteomyelitis. Am. Compl.
November 8, Mr. Belskis orally requested that the medical
staff return his diabetic shoes, but his request was again
denied. Id. Without his diabetic shoes, Mr. Belskis
had no choice but to wear prison-issued footwear.
Id. ¶ 15. This footwear created pressure on his
feet and caused additional red spots to appear. Id.
Development of Foot Ulcers
December, the red spots on his feet had developed into wounds
and ulcers. Id. ¶ 16. On December 1, Mr.
Belskis submitted a written medical request to obtain proper
diabetic footwear and to see a doctor about his diabetic
ulcers. Medical Chart at 2. Three days later, on
December 4, Physician Assistant Ellis (P.A. Ellis) examined
Mr. Belskis. Id. at 3. P.A. Ellis noted that:
Mr. Belskis is a diabetic who's had amputations of toes
and chronic diabetic foot ulcers. He [wears] orthotics
shoe[s] and this was discontinued upon his arrival here. [He]
[w]ould like to wear them so I'm going to ask the nursing
staff to discuss this with administrative staff to see if
they will allow his specialized shoes.
Id. On December 6, Mr. Belskis submitted another
medical request seeking an update on his diabetic shoes.
Id. at 5; Am. Compl. ¶ 16. The same
day, a MedPro employee responded, “We are checking into
it.” Medical Chart at 5. On December 7, Nurse
Cates notified Mr. Belskis in writing that the SCJ
corrections staff again refused to allow Mr. Belskis to wear
his original diabetic shoes. Id.
December 8, Mr. Belskis asked in writing if “the
Federal Bureau of Corrections would pay for a pair of
diabetic soft shoe sneakers for my ongoing problem with
diabetic ulcers on my feet. So these shoes would not
be a security risk at any facility I have to enter.”
Id. at 11 (emphasis in original). Five days later,
on December 13, P.A. Ellis requested that the Marshals
Service approve an appointment for Mr. Belskis with Pine Tree
Orthopedics. Id. at 17. The Marshals Service
approved the request the same day. Id.
December 16, Mr. Belskis reported oozing blisters on his
little toe to the medical staff. Am. Compl. ¶
18. He showed the blisters to Nurse Walters and explained
that the blisters were symptomatic of the onset of
osteomyelitis. Id. ¶¶ 18- 19. He also
stated that he “would like clog type shower
shoes.” Medical Chart at 18. On December 18,
P.A. Ellis examined the blisters, but he informed Mr. Belskis
that the blisters were not the result of tissue breakdown.
Am. Compl. ¶ 19. P.A. Ellis ordered daily dry
dressing changes and a pair of Crocs for Mr. Belskis.
Id. During Mr. Belskis' visit to medical staff
on December 20, he reported that he liked the Crocs because
they did not rub as much. Answer Attach. 2
Exhibit Nursing Notes at 2 (ECF No. 79) (Nursing
to Mr. Belskis, Crocs are not prescription footwear for
diabetics. Am. Compl. ¶ 19. Mr. Belskis
maintains that P.A. Ellis knew that ordering Crocs was
inappropriate and contrary to the medical need for diabetic
shoes. Id. ¶ 20. Mr. Belskis asserts that P.A.
Ellis knew that Mr. Belskis required diabetic shoes but
ordered Crocs instead because of the jail's security
policy. Id. Starting December 19, MedPro staff began
changing Mr. Belskis' dressings daily and cleaning his
wounds with normal saline. Nursing Notes at 2-3.
Visits to Specialists
December 28, Mr. Belskis attended an appointment with Dr.
Bruce MacDonald at Pine Tree Orthopedics. Am. Compl.
¶ 26. Mr. Belskis presumed that the purpose of the
appointment was to obtain proper diabetic footwear.
Id. By this point, Mr. Belskis' toe was very
painful. Id. ¶ 27. Dr. MacDonald expressed
concern regarding the advancement of osteomyelitis,
id. ¶ 26, and recommended that Mr. Belskis see
“a wound care specialist immediately.”
Medical Chart at 24. He also advised Mr. Belskis not
to wear the Crocs. Am. Compl. ¶ 26. Although
Dr. MacDonald did not have any diabetic shoes that would fit
Mr. Belskis in stock, he said that he could order and
manufacture a custom pair for the inmate. Medical
Chart at 24.
days later, on January 2, 2013, P.A. Ellis wrote to the
Marshals Service seeking authorization for Mr. Belskis to see
a wound care specialist. Id. at 30. On January 4,
MedPro staff scheduled an appointment at the Maine General
Hospital Wound Clinic for January 10. Id. at 25. In
the meantime, the MedPro staff continued to clean his wound
with saline and change his dressings daily. Nursing
Notes at 4- 7. However, medical notes reflect that on
the morning of January 4, a nurse reported that Mr.
Belskis' entire foot was swollen and “extremely
firm and warm, ” and that Mr. Belskis reported pain
extending into his shin. Id. at 6. The nurse
recorded the condition and changed the dressing. Id.
that day, Mr. Belskis returned to the medical staff
complaining of an “infected foot with pain in his
shin.” Id. at 7. The medical notes indicate
that the medical staff began administering antibiotics on the
night of January 4. Id. According to Mr. Belskis,
however, MedPro staff did not provide antibiotics until
January 7, 2013. Am Compl. ¶¶ 27, 29. At
this point, he had three open wounds on his foot, and the
foot was swollen and painful. Id. ¶¶
27-28. The nursing staff continued to clean Mr. Belskis'
wounds with saline and change his dressings daily.
Nursing Notes at 7-9.
January 10, Mr. Belskis attended his wound care appointment,
where Dr. Lisa Sauer examined the infected foot, debrided the
wounds, ordered an MRI, and treated the infection. Am.
Compl. ¶ 29. Mr. Belskis states that Dr. Sauer
indicated in her medical notes from the January 10
appointment that his wounds resulted from improper footwear.
Id. Later that day, Dr. Sauer contacted Nurse
Walters at the jail to inquire about the status of Mr.
Belskis' diabetic shoes. Nursing Notes at 9.
Nurse Walters informed Dr. Sauer that “orthopedic
approval goes through corrections administration.”
Id. Nurse Walters also assured Dr. Sauer that Mr.
Belskis “is not being neglected here…we are
doing what is medically necessary under corrections [and]
U.S. Marshal guidelines.” Id. at 9-10. From
January 10 through January 18, the nursing staff continued to
tend to Mr. Belskis' wound with saline. Id. at
10-11. The nursing staff also switched to an Aquacel dressing
per Dr. Sauer's instructions. Id. By January 18,
Mr. Belskis' wound had sealed, so the nurses discontinued
the daily dressings. Id. at 11.
days after his wound care appointment, Mr. Belskis wrote to
MedPro staff to follow up on his appointment with Pine Tree
Orthotics and to inquire about his MRI appointment.
Medical Chart at 32. On January 15, Nurse Cates
responded, “As explained to you by myself last week I
am working with Pine Tree Orthopedic and wound care about
your shoes. You are scheduled for an MRI. You will follow up
with wound care clinic after MRI.” Id. That
same day, MedPro staff wrote to the Marshals Service seeking
funding for Mr. Belskis' diabetic shoes. Id. at
Belskis returned to Pine Tree Orthopedics on January 17,
2013, to make molds of his feet, presumably to manufacture
new footwear. Am. Compl. ¶ 30. That same day,
Mr. Belskis made an additional written request for wound care
because Dr. Sauer's wound treatment was temporary and
required aftercare. Id. ¶ 31.
Diagnosis of Osteomyelitis
January 18, Mr. Belskis underwent an MRI. Id. ¶
32. Dr. Anthony Van Dyck interpreted the results and
confirmed that Mr. Belskis suffered from a bone infection
consistent with the presence of osteomyelitis. Medical
Chart at 34. Mr.
saw Dr. Sauer on January 30 to discuss the results further.
Am. Compl. ¶ 34. Dr. Sauer informed Mr. Belskis
that the infection had not improved and that lack of
treatment within the jail exacerbated his condition.
Id. ¶ 32. She discussed his treatment options,
Medical Chart at 37, and advised Mr. Belskis that
there was a high likelihood that the infected areas and bones
would require amputation. Am. Compl. ¶ 34.
Despite Dr. Sauer's assessment, Mr. Belskis ...