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Belskis v. DT Developers Inc.

United States District Court, D. Maine

September 27, 2016

DT DEVELOPERS INC., et al., Defendants.



         A 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.

         I. BACKGROUND

         A. Procedural History

         On 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).

         On 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 No. 59).

         MedPro 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) (Def.'s Reply).

         B. Factual Allegations

         1. The Parties

         Joseph 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. Id.

         DT 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.

         At the 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 Jail. Id.

         The 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.

         In the 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.[1]

         2. The Alleged Facts[2]

         a. Background

         Mr. 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. ¶ 6.

         On May 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.

         b. Transfer to Somerset County Jail

         On 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.

         A few 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.

         On 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. ¶ 14.

         On 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.

         c. Development of Foot Ulcers

         By 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.

         On 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.

         On 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 Notes).

         According 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.

         d. Visits to Specialists

         On 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.

         Four 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.

         Later 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.

         On 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.[3] 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.

         Four 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 34.

         Mr. 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.

         e. Diagnosis of Osteomyelitis

         On 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.

         Belskis 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. ΒΆ 34. Despite Dr. Sauer's assessment, Mr. Belskis ...

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