United States District Court, D. Maine
ORDER ON MEDPRO DEFENDANTS' MOTION FOR SUMMARY
A. WOODCOCK, JR. UNITED STATES DISTRICT JUDGE
plaintiff in this civil rights action under 42 U.S.C. §
1983 alleges that the medical provider at a county jail acted
with deliberate indifference in providing care that
ultimately resulted in the amputation of one of his toes. The
Court concludes that the plaintiff has withstood summary
judgment because the record contains no evidence as to the
extent to which the defendant advocated on behalf of the
plaintiff with jail officials who were denying recommended
March 6, 2015, Joseph Edward Bovin Belskis filed a complaint
in this Court against various federal, county, and individual
actors, including a medical contracting business and several
of its employees, alleging that they violated his civil
rights while he was a federal prisoner housed at the Somerset
County Jail (SCJ). Compl. (ECF No. 1). Mr. Belskis
amended his complaint on October 14, 2015. First Am.
Compl. (ECF No. 59) (Am. Compl.). Mr. Belskis
began this legal action acting pro se; however, once he
survived a motion to dismiss and motion for judgment on the
pleadings and faced motions for summary judgment, the Court
asked Attorney Jon Haddow to represent Mr. Belskis and on
March 31, 2016, Attorney Haddow entered his appearance on Mr.
Belskis' behalf. Notice of Appearance (ECF No.
January 13, 2017, the so-called Medpro Defendants filed a
motion for summary judgment, Mot. for Summ. J. by Medpro
Defs. (ECF No. 232) (Medpro Mot.), together
with a statement of uncontested material facts. Statement
of Material Fact in Support of Mot. for Summ. J. by Medpro
Defs. (ECF No. 233) (DSMF). Mr. Belskis, who at the time
was not represented by counsel, failed to respond.
2, 2017, Attorney Haddow filed a consent motion to extend the
time for Mr. Belskis' response to the Medpro
Defendants' motion for summary judgment to May 23, 2017
and on May 2, 2017, the Court granted the motion.
Pl.'s Mot. to Extend Deadline to Resp. to Medpro
Defs' Mot. for Summ. J. (ECF No. 259); Order
Granting Mot. to Extend Time (ECF No. 263). On May 23,
2017, Mr. Belskis, through Attorney Haddow, filed another
motion to extend time to June 1, 2017, which the Court
granted on May 23, 2017. Pl.'s Mot. to Extend
Deadline to Resp. to Medpro Defs.' Mot. for Summ. J.
(ECF No. 268); Order Granting Mot. to Extend Time
(ECF No. 271). On June 1, 2017, Mr. Belskis filed what was
termed a final motion to extend time, this time to June 16,
2017. Pl.'s Final Mot. to Extend Deadline to Resp. to
Medpro Defs.' Mot. for Summ. J. (ECF No. 270). On
June 1, 2017, the Court granted this final extension.
Order Granting Mot. to Extend Time (ECF No. 271).
16, 2017, Mr. Belskis responded to the Medpro Defendants'
motion for summary judgment, Pl.'s Mem. in Opp'n
to Medpro Defs.' Mot. for Summ. J. (ECF No. 272)
(Pl.'s Opp'n), and filed a responsive
statement of undisputed material facts, Pl.'s Resp.
to Medpro Defs.' Statement of Material Fact (ECF No.
273) (PRDSMF) as well as a statement of additional material
facts. Id. Attach. 1, Pl.'s Statement of
Additional Material Facts in Opp'n to Mot. for Summ.
J. (ECF No. 273) (PSAMF). On July 6, 2017, the Medpro
Defendants filed a reply to Mr. Belski's response to
their motion for summary judgment, Reply to Pl.'s
Opp'n to the Mot. for Summ. [J.] by Medpro Defs.
(ECF No. 277) (Medpro Reply) and a response to Mr.
Belskis' additional statement of material fact.
Medpro Defs.' Resp. to Pl.'s Additional
Facts (ECF No. 275) (DRPSAMF).
Joseph Belskis' Amended Complaint
Belskis has brought this civil rights action against Medpro
under 42 U.S.C. § 1983 and under 5 M.R.S. §§
4651, et seq. Am. Compl. at 1. In the October
14, 2015 Amended Complaint, Mr. Belskis claims that Medpro
created policies, practices and customs that affected the
delivery of medical care, treatment, and services and that
violated his constitutional rights. Id. at 22. He
also alleges that Medpro violated his Eighth Amendment
guarantee against cruel and abusive treatment and his
Fourteenth Amendment right to due process of law.
Id. at 22-23.
THE STATEMENT OF FACTS
Joseph Belskis and Diabetes
Belskis is a diabetic with a history of lower extremity
ischemic vascular disease including two prior toe amputations
and a history of diabetic foot ulcers. DSMF ¶ 4; PRDSMF
¶ 4. Mr. Belskis arrived at the Somerset County Jail
(SCJ) with a history of poorly controlled diabetes,
peripheral vascular disease, and previous amputations of the
left and right great toes. Id. He also had a history
of substance abuse. Id. One of the foundations for
the care of diabetes and prevention of the risks of
development of other conditions is the close monitoring of
the hemoglobin HgB AIC level. DSMF ¶ 28; PRDSMF ¶
Joseph Belskis, Diabetic Footwear, the Androscoggin County
Jail, and the Transfer to the Somerset County Jail
Belskis was arrested in May 2012 and incarcerated at the
Androscoggin County Jail (ACJ). PSAMF ¶ 1; DRPSAMF
¶ 1. Mr. Belskis was on federal probation when he was
arrested. PSAMF ¶ 2; DRPSAMF ¶ 2. During his
incarceration at the ACJ, Mr. Belskis was allowed to wear a
pair of diabetic shoes that he had made in 2011. PSAMF ¶
3; DRPSAMF ¶ 3. These shoes were a brown leather type
diabetic shoe with expanding laces like a rubber band with
metal eyelets, similar to a hiking shoe. PSAMF ¶ 4;
DRPSAMF ¶ 4.
The Somerset County Jail Booking Process
November 5, 2012, Mr. Belskis was transferred to the SCJ,
where he remained for approximately ten months. PSAMF ¶
5; DRPSAMF ¶ 5. Specifically, the SCJ received Mr.
Belskis on November 5, 2012 and transferred him on August 30,
2013. DSMF ¶ 1; PRDSMF ¶ 1. Mr. Belskis was
transferred from ACJ to SCJ as a federal prisoner and was
being held at the SCJ as a federal prisoner on behalf of the
United States Marshal Service in connection with criminal
charges pending against him in United States District Court
for the District of Maine. DSMF ¶ 3; PRDSMF ¶ 3.
Mr. Belskis was transferred from the ACJ to SCJ, he was
wearing his diabetic shoes. PSAMF ¶ 6; DRPSAMF ¶ 6.
SCJ correctional staff denied Mr. Belskis the use of his
diabetic shoes on his entry into the jail as part of the
initial booking process, DSMF ¶ 5; PRDSMF ¶ 6, and
upon entry to the sally port, the corrections officer took
Mr. Belskis' diabetic shoes on intake. PSAMF ¶ 7;
DRPSAMF ¶ 7. Mr. Belskis told the corrections office
staff who were booking him into the SCJ that he needed his
diabetic shoes and he would have a problem if he could not
wear them. DSMF ¶ 6; PRDSMF ¶ 6. The corrections
officers told Mr. Belskis that they were taking his shoes for
safety reasons and that his shoes were not allowed through
the door. PSAMF ¶ 8; DRPSAMF ¶ 8. At booking, the
corrections officers gave Mr. Belskis canvas shoes with
Velcro laces. PSAMF ¶ 9; DRPSAMF ¶ 9. After the
initial denial by SCJ, Medpro staff members made three
separate requests of SCJ staff to obtain Mr. Belskis'
diabetic shoes, which his previous jail, ACJ, had permitted,
and were denied on all three occasions by SCJ correctional
staff, including Jail Administrator David Allen. DSMF ¶
7; PRDSMF ¶ 7.
Medpro's Initial Dealings with Joseph Belskis
the booking, the corrections officers told Mr. Belskis that
he needed to address the issue of his diabetic shoes with the
medical staff. PSAMF ¶ 8; DRPSAMF ¶ 8. Medpro is a
wholly-owned subsidiary of DT Developers, Inc. which does
business as Medpro Associates and serves as the medical
provider at SCJ. PSAMF ¶ 2; DRPSAMF ¶ 2. On
November 5, 2012, Mary Patterson, a nurse with Medpro, saw
Mr. Belskis. PSAMF ¶ 10; DRPSAMF ¶ 10; DSMF ¶
8; PRDSMF ¶ 8. Nurse Patterson executed a “medical
intake questionnaire” form concerning her examination
and determined that Mr. Belskis was medically and mentally
stable at the time. DSMF ¶ 8; PRDSMF ¶ 8. During
the medical screening, Mr. Belskis told Nurse Patterson that
he had diabetes, toe amputations, bone amputations, renal
failure, diabetic shoes, appendicitis, and that his first
metatarsal toes was just healing. PSAMF ¶ 11; DRPSAMF
¶ 11. Mr. Belskis also mentioned that the corrections
staff had denied him diabetic shoes. PSAMF ¶ 12; DRPSAMF
Mr. Belskis was transferred to the SCJ, his feet were in good
shape, except there was a red spot under the first metatarsal
that looked like a healed-up wound. PSAMF ¶ 13; DRPSAMF
¶ 13. Nurse Patterson noted a light dime-sized spot on
Mr. Belskis right great toe area and a pink area on the
metatarsal area. DSMF ¶ 10; PRDSMF ¶ 10. She
questioned whether the provider should review the matter but
did not place Mr. Belskis on the sick call book to be seen by
the provider. Id. Nurse Patterson's observations
were of a previous wound that had completely healed. DSMF
¶ 11; PRDSMF ¶ 11. On November 5, 2012, Nurse
Patterson submitted a “keep on person” (KOP)
authorization for Mr. Belskis' diabetic shoes that had
been taken from him during the booking intake. DSMF ¶
12; PRDSMF ¶ 12. On November 5, 2012, the corrections
office staff denied Nurse Patterson's KOP authorization.
DSMF ¶ 13; PRDSMF ¶ 13.
policy requires that an inmate seeking medical attention must
under normal circumstances submit an “Inmate Request
Form” (IRF). DSMF ¶ 145; PRDSMF ¶ 145.
Inmates are instructed by Medpro staff concerning the use of
the form. Id. Consistent with Medpro standard
practice, Nurse Patterson documented that she made Mr.
Belskis aware that if he had any medical issues, he could
submit a request for medical treatment either the IRF or one
captioned “Inmate Medical Request” (IMR). DSMF
¶¶ 9, 145; PRDSMF ¶¶ 9, 145.
November 6, 2012, Mr. Belskis filled out a request to
medical, saying that he “would like to be taken out to
have diabetic soft shoes made because [he had been told that]
my street diabetic shoe is a security risk at SCJ.”
DSMF ¶ 21; PRDSMF ¶ 21; PSAMF ¶ 14; DRPSAMF
¶ 14. Mr. Belskis understood that the SCJ
corrections staff did not permit diabetic shoes he was
wearing on admission because they presented a security risk.
DSMF ¶ 22; PRDSMF ¶ 22. On November 8, 2012, Lisa
Cates, RN, Medpro nursing supervisor, responded to Mr.
Belskis' IRF, writing that “this is not something
the jail will do; you can have another pair dropped off,
normally only jail-issued shoes are allowed.” PSAMF
¶ 15; DRPSAMF ¶ 15; DSMF ¶ 23; PRDSMF ¶
23. Nurse Cates' intent was to make Mr. Belskis aware
that his best course of immediate action was to have another
pair of shoes brought in to determine whether they would
comply with SCJ corrections staff's security
requirements. DSMF ¶ 24; PRDSMF ¶ 24. Nurse Cates
understood that as a federal prisoner, Mr. Belskis would be
subject to the United States Marshal Service's (USMS)
procedures for obtaining medical care and it would require a
doctor's order before an outside appointment or other
medical need was submitted. DSMF ¶ 25; PRDSMF ¶ 25.
Mr. Belskis never responded to Nurse Cates' note of
inquiry of November 8, 2012 and Nurse Cates was not aware he
was having foot problems until it was brought to her
attention that he had made oral and written requests about
foot issues on November 30, 2012 and December 1, 2012
respectively. DSMF ¶ 26; PRDSMF ¶ 26.
on November 7, 2012, the Medpro medical provider, Robert
Ellis, PA-C, reviewed Mr. Belskis' medication list and
medical records on November 7, 2012. DSMF ¶ 14; PRDSMF
¶ 14. Physician's Assistant Ellis believed that
Nurse Patterson's findings concerning Mr. Belskis were
not indicative of any medical problem. DSMF ¶ 15; PRDSMF
¶ 15. Consistent with standard Medpro practice, Mr.
Belskis' medical records from the ACJ were received. DSMF
¶ 17; PRDSMF ¶ 17. The ACJ medical records
revealed, among other things, that Mr. Belskis had an annual
physical examination at the ACJ on May 9, 2012. DSMF ¶
18; PRDSMF ¶ 18. Consistent with Medpro standard
practice, Mr. Belskis had an updated annual examination at
the SCJ on May 8, 2013. Id. Given his stable
condition on entry and the prior physical examination at the
ACJ in May 2012, Mr. Belskis would not be scheduled to see
the provider, namely Physician's Assistant Ellis, unless
he was having a specific problem that was brought to the
attention of the Medpro staff. DSMF ¶ 19; PRDSMF ¶
19. Mr. Belskis was aware of the need to submit written
request forms because of his prior incarcerations and because
he demonstrated his knowledge of this procedure by filing
several IRFs unrelated to his feet, including his glasses
(11/6 and 11/12), an eyeglass prescription change (11/19/12),
and complaints for charges for seeing the provider
(12/25/12). DSMF ¶ 20; PRDSMF ¶ 20.
Belskis had worn specially-made footwear for his diabetes
while at the Piscataquis County Jail a few years before and
he still had this footwear. PSAMF ¶ 16; DRPSAMF ¶
16. Mr. Belskis arranged to have his mother bring the
footwear to the SCJ and she delivered the shoes to a nurse at
the SCJ a few days after his arrival. Id. The SCJ,
however, denied his request to wear this footwear as well.
Medpro's Treatment of Joseph Belskis' Diabetes: An
Mr. Belskis had a chronic condition of diabetes, he had no
active complications of diabetes. DSMF ¶ 27; PRDSMF
¶ 27. Specifically, there were no signs or symptoms of
infection or loss of skin integrity; Mr. Belskis requested
and received a routine follow-up and monitoring for his
insulin dependent diabetes, including foot checks.
Id. One of the foundations for the care of diabetes
and prevention of the risks of development of other
conditions is the close monitoring of the hemoglobin HgB AIC
level. DSMF ¶ 28; PRDSMF ¶ 28. From November 5,
2012 onward, the Medpro medical staff saw Mr. Belskis on a
daily basis for purposes of insulin treatment for his
diabetes. DSMF ¶ 29; PRDSMF ¶ 29. Mr. Belskis was
in the medical unit four times a day for his diabetes sugar
checks: before breakfast, lunch, and dinner and before
bedtime. Id. Mr. Belskis received long-acting
insulin twice a day, before breakfast and before bedtime, and
he received insulin on an “as needed” basis
otherwise during the first three daily visits depending on
his insulin levels. DSMF ¶ 30; PRDSMF ¶ 30. Mr.
Belskis' HgB AIC levels at the SCJ were markedly better
than those at ACJ. Id.
Joseph Belskis' Initial Foot Complaints
Belskis did not complain about his feet until November 30,
2012. DSMF ¶ 31; PRDSMF ¶ 31. The Medpro medical
records do not reveal any complaint about foot problems by
Mr. Belskis until an oral complaint of November 30, 2012 and
his written follow-up on December 1, 2012. DSMF ¶ 32;
PRDSMF ¶ 32. On Friday, November 30, 2012, Mr. Belskis
complained to a Medpro staff member about foot problems
during a routine blood sugar check and he was advised to
submit a medical slip. DSMF ¶ 33; PRDSMF ¶ 33. On
Saturday, December 1, 2012, Mr. Belskis made out an IMR,
requesting to be seen by a doctor for diabetic footwear.
PSAMF ¶ 17; DRPSAMF ¶ 17; DSMF ¶ 34; PRDSMF
¶ 34; PSAMF ¶ 17; DRPSAMF ¶ 17. Mr. Belskis
submitted his December 1, 2012 IMR in response to the
November 30, 2012 oral exchange with Medpro staff. DSMF
¶ 34: PRDSMF ¶ 34. In his December 1, 2012 IMR
form, Mr. Belskis described his “problem” as the
need “to be seen by the [Doctor] for diabetic
ulcer-proper diabetic footwear in [the SCJ] property [locker]
. . . .” Id. Nurse Cates was not aware of Mr.
Belskis' foot complaint until she returned for a full day
of work on December 4, 2012. DSMF ¶ 35; PRDSMF ¶
35. By the time Nurse Cates returned to work on December 4,
2012, another member of the nursing staff had already placed
Mr. Belskis on the next available sick call day-December
4-and PA-C Ellis saw him that day. Id.
December 4, 2012, PA-C Ellis saw Mr. Belskis for the first
time. DSMF ¶ 36; PRDSMF ¶ 36. PA-C Ellis observed
that Mr. Belskis had evidence of a hyperkeratotic area
consistent with a healing chronic ulcer on the plantar aspect
of the right foot, first metatarsal, and two small areas of
redness from shoe irritation, one on the right fifth toe.
Id. He demonstrated no signs of skin breakdowns and
no signs of infection at that time. Id. PA-C Ellis
noted on December 4:
Mr. Belskis is a diabetic who has had amputations of toes and
chronic diabetic ulcers. He wears orthotic shoes and this was
discontinued upon his arrest. [H]e would like to wear them so
I'm going to ask the nursing staff to discuss this with
the administrative staff to see if they will allow his
Id. As of December 4, 2012, Mr. Belskis did not have
a serious medical need or condition related to his right
foot. DSMF ¶ 37; PRDSMF ¶ 37. After seeing PA-C
Ellis on December 4, 2012, Mr. Belskis left the visit with
the understanding that the nursing staff was going to make a
request to correctional staff to see if he could get his old
diabetic shoes. PSAMF ¶ 18; DRPSAMF ¶ 18.
December 5, 2012, at PA-C Ellis' request, Nurse Cates
asked the on-duty SCJ booking staff if a property person was
in to obtain Mr. Belskis' shoes and was advised
“no”. DSAMF ¶ 38; PRDSMF ¶ 38.
December 6, 2012, Mr. Belskis completed an IRF for the
issuance of prescriptive diabetic shoes or the return of his
own diabetic shoes, which had been taken at his admission to
the SCJ. DSMF ¶ 39; PRDSMF ¶ 39. On December 6,
2012, Nurse Cates discussed the diabetic shoe issue with PA-C
Ellis and SCJ Corrections Sergeant Theresa Brown. DSMD ¶
40; PRDSMF ¶ 40. Sergeant Brown was made aware of the
link between the need for specialized footwear and Mr.
Belskis' diabetes. Id. Later that day, another
Medpro staff member responded to Mr. Belskis, advising him
that “we are checking into it”. Id.
Friday, December 7, 2012, Nurse Cates executed another KOP
slip and submitted it to SCJ corrections staff. DSMF ¶
41; PRDSMF ¶ 41. SCJ Sergeant Elijah Munn was advised
that Mr. Belskis' shoes were worn at ACJ and that Mr.
Belskis needed them because of his diabetes and potential
medical complication. Id. Later on December 7, 2012,
Nurse Cates advised Mr. Belskis that “[SCJ] security
looked at [his shoes] again and denied [the KOP] due to
laces, metal and condition [of the footwear].” DSMF
¶ 42; PRDSMF ¶ 42. Sergeant Munn issued the denial.
Id. Mr. Belskis never grieved the denial of his
diabetic footwear by SCJ corrections staff. DSMF ¶ 43;
PRDSMF ¶ 43. Nurse Cates personally made SCJ corrections
staff aware that Mr. Belskis needed his diabetic shoes
because of his diabetic condition and that if he did not have
his shoes, this could lead to problems with his feet. DSMF
¶ 44; PRDSMF ¶ 44.
Saturday, December 8, 2012, Mr. Belskis submitted an IRF,
asking Medpro “to check 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.” DSMF ¶ 45; PRDSMF
¶ 45. Another nursing staff member referred the IRF to
the provider. Id.
Belskis was on the sick call list to be seen by the provider
concerning his request for diabetic footwear on the next
regularly scheduled day, Tuesday, December 11, 2012. DSMF
¶ 46; PRDSMF ¶ 46. For some reason, he was not seen
that day. Id. Rather than wait until the next sick
call day, Nurse Cates called provider PA-C Ellis on
Wednesday, December 12, 2012, and explained Mr. Belskis'
request. DSMF ¶ 47; PRDSMF ¶ 47. PA-C Ellis issued
a verbal order for the prescription for diabetic shoes.
December 12, 2012, Nurse Cates contacted Pine Tree Orthopedic
(PTO) to receive a cost for the consultation, which is
required by the United States Marshal Service (USMS) protocol
for submission of outside services. DSMF ¶ 48; PRDSMF
¶ 48. On Thursday, December 13, 2012, Nurse Cates
received a quote for the consultation from PTO and submitted
a request to the USMS, requesting approval of a consult with
PTO in Livermore Falls, Maine “upon recommendation of
R. Ellis, PA . . . [as Mr. Belskis] has initially been
diagnosed with diabetes [and] needs consult for diabetic
[shoes].” DSMF ¶ 49; PRDSMF ¶ 49. After USMS
approval, Nurse Cates contacted PTO and made what she
understood was the first available appointment for Mr.
Belskis for December 27, 2012. Id. The appointment
for the initial consult for diabetic footwear was made three
days before Mr. Belskis' initial foot problems on
December 16, 2012. DSMF ¶ 50; PRDSMF ¶ 50. For some
reason, Mr. McDonald did not see Mr. Belskis on December 27,
2012, but on December 28, 2012. Id.
Mr. Belskis' Development of a Serious Medical Condition
and the Medpro Response
Sunday, December 16, 2012, Mr. Belskis noticed something
wrong with his fifth metatarsal. PSAMF ¶ 19; DRPSAMF
¶ 19. This was the first time Mr. Belskis had noticed a
problem with his right foot. DSMF ¶ 52; PRDSMF ¶
52. On December 16, 2012, Mr. Belskis submitted an IMR to see
the medical provider concerning his foot sores. DSMF ¶
51; PRDSMF ¶ 51. Mr. Belskis also stated that he
“would like clog-type shower shoes.” Id.
On December 16, 2012, he saw Licensed Practical Nurse Rhonda
Walters and he reported his concern to her. PSAMF ¶ 19;
DRPSAMF ¶ 19. This was the first time Mr. Belskis had
reported a foot wound to Medpro personnel. DSMF ¶ 53;
PRDSMF ¶ 53. Other than the pink area on the metatarsal
area that Nurse Patterson noticed on November 5, 2012, the
medical treatment of Mr. Belskis establishes that he did not
have a serious medical condition related to his right foot
until December 16, 2012, at the earliest, when he complained
of problems to the medical staff. DSMF ¶ 54; PRDSMF
¶ 54. PA-C Ellis saw Mr. Belskis in a timely
fashion on December 18, 2012. Id.
standard procedure requires the nursing staff to make an
initial contact with the inmate concerning any written inmate
request for medical services. DSMF ¶ 55; PRDSMF ¶
55. The reasons for this procedure include the need for the
nursing staff to make a preliminary assessment and to provide
additional details to the provider. Id. Mr. Belskis
initially refused to be seen by the nursing staff on December
16, 2012, but later that day, Nurse Rhonda Walters saw Mr.
Belskis and he told her that the “croc [type shoe which
was available at SCJ] would work.” DSMF ¶ 56.
Medpro nursing staff checked with SJC Corrections Major David
Allen and Major Allen advised that a medical order would be
required to obtain a croc-type shoe for Mr. Belskis. DSMF
¶ 57; PRDSMF ¶ 57.
Tuesday, December 18, 2012, PA-C Ellis saw Mr. Belskis on
follow-up to the December 16, 2012 written IMR. PSAMF ¶
20; DRPSAMF ¶ 20; DSMF ¶ 58; PRDSFM ¶ 58. This
was the first opportunity for Mr. Belskis to see the provider
in regard to the problem he also wrote about on December 16,
2012. Id. On December 18, 2012, PA-C Ellis noted
that Mr. Belskis “has been unable to wear his
orthopedic footwear as it is not jail approved” and
that Mr. Belskis has “been in standard Velcro top
sneaker which was irritating his foot.” DSMF ¶ 59;
PRDSMF ¶ 59. By December 18, 2012, Mr. Belskis had
developed a sore, which was blistered and oozing, on his
fifth metatarsal. PSAMF ¶ 21; DSMF ¶ 21.
Ellis observed a one centimeter pressure spot on the right
distal fifth metatarsal and a healing chronic two centimeter
spot on the second metatarsal. Id. PA-C Ellis
submitted a written order for the croc-type shoes and
required the nursing staff to begin applying dry dressings
daily. Id. With the hope that a change in footwear
would be less traumatic until his new diabetic shoes were
available, PA-C Ellis asked that Mr. Belskis be issued a pair
of croc-type shoes generally available only to the female
inmates. DSMF ¶ 60; PRDSMF ¶ 60. PA-C Ellis noted
that a referral for an orthopedic shoe had already been made
and was pending. Id.
December 18, 2012, PA-C Ellis considered Mr. Belskis to have
a serious medical condition or need regarding his right foot
and PA-C Ellis recommended daily wound checks with a dry
dressing by the nursing staff. DSMF ¶ 61; PRDSMF ¶
61. The purpose of the daily wound dressing was to pad the
area and provide protection. DSMF ¶ 62; PRDSMF ¶
62. PA-C Ellis also recommended that Mr. Belskis wear socks
to provide additional foot protection. Id. The
dressing was a dry gauze taped on, as jail regulations will
not allow the use of roll gauze because of safety concerns;
this resulted in the bandage being easily displaced.
Id. The Medpro staff applied daily dressing changes
to Mr. Belskis' foot for foot ulcers from December 19,
2012 through January 17, 2013. DSMF ¶ 70; PRDSMF ¶
70; DSMF ¶ 73; PRDSMF ¶ 73.
nursing staff reported increasing improvement at daily
dressing changes in the fifth metatarsal lesion with
decreasing redness and no pain. DSMF ¶ 74; PRDSMF ¶
December 18, 2012, Nurse Cates received a memorandum from SCJ
corrections staff, Compliance Manager Sean Maguire. DSMF
¶ 63; PRDSMF ¶ 63.Mr. Maguire confirmed the denial
of Mr. Belskis' previous diabetic footwear for security
reasons. Id. Mr. Maguire's December 18, 2012
Inmate [Belskis'] diabetic shoes were denied due to metal
eyelets and long shoelaces. Inmate Belskis has been issued a
set of crocs and instructed to wear these with socks. The
denial of the shoes was reviewed by [Major Corey] Swope and
found to meet jail policies on contraband.
¶ 64; PRDSMF ¶ 64. Mr. Maguire also noted that Mr.
Belskis was not compliant with the request to wear socks for
additional protection and that SCJ policy requires all
inmates to wear socks as part of the jail uniform, regardless
of the type of footwear. DSMF ¶ 65; PRDSMF ¶ 65.
Thurlow is a principal, owner, and the health services
administrator of Medpro Associates. See DSMF, Attach.
4, Aff. of Terry Thurlow ¶ 66. Mr. Thurlow
contacted various SCJ personnel and made them aware of the
importance of Mr. Belskis having his own diabetic
shoes. DSMF ¶ 66; PRDSMF ¶ 66. Mr.
Thurlow made SCJ corrections staff, Jail Administrator David
Allen and Compliance Officer Sean Maguire, aware that Mr.
Belskis needed his diabetic shoes because of his diabetic
condition and that if he did not have his shoes, it could
lead to problems with his feet. DSMF ¶ 67; PRDSMF ¶
December 19, 2012, SCJ corrections staff provided Mr. Belskis
with a croc-type shoe. DSMF ¶ 68; PRDSMF ¶ 68. On
December 20, 2012, Mr. Belskis was seen by Medpro staff
“with new croc style shoes on. [Mr. Belskis] reported
he likes them and they don't rub as much.” DSMF
¶ 69; PRDSMF ¶ 69. Mr. Belskis did not wear his
socks only for brief periods of time; however, on December
20, 2012, when the other Medpro nurse saw Mr. Belskis, he was
non-compliant with the request to wear socks. DSMF ¶
71; PRDSMF ¶ 71. When yet another Medpro nurse saw Mr.
Belskis on December 21, 2012, he was compliant with the
request to wear socks. DSMF ¶ 72; PRDSMF ¶ 72.
Generally, during the time the medical staff at the SCJ was
dressing the sore on Mr. Belskis' foot, he did wear
socks, though he would not wear them for the walk between the
shower and his cell, a short distance. PSAMF ¶ 33;
DRPSAMF ¶ 33. Otherwise, Mr. Belskis routinely wore
socks for the entire time he was at SCJ.Id.
Friday, December 28, 2012, Mr. Belskis was escorted to Bruce
MacDonald's office at PTO in Livermore Falls, Maine at
which time, Mr. MacDonald assessed him to see if he needed
diabetic shoes. PSAMF ¶ 22; DRPSAMF ¶ 22; DSMF
¶ 75; PRDSMF ¶ 75. Mr. MacDonald did not have any
shoes in stock for Mr. Belskis and so he was going to have
some made. PSAMF ¶ 23; DRPSAMF ¶ 23. Mr. Belskis
was transported back to SCJ with a note that read:
“[Mr. MacDonald] will send [a] letter with
recommendations.” DSMF ¶ 75; PRDSMF ¶ 75. ...