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Mandrell v. Physicians Health Partners

United States District Court, D. Colorado

April 20, 2017




         This case comes before the court on “Defendant's Motion for Summary Judgment” (Doc. No. 77 [Mot.], filed January 20, 2017). Plaintiff filed his response on February 13, 2017 (Doc. No. 83 [Resp.]), and Defendant filed its reply on February 27, 2017 (Doc. No. 84 [Reply]).


         Plaintiff, proceeding pro se, asserts claims for violations of his Eighth Amendment rights for the defendant's alleged failure to provide him proper medical care. (See Doc. No. 10 [Compl.], filed January 5, 2015). Plaintiff is an inmate in the Colorado Department of Corrections (“CDOC”). (Id. at 3.) He states in 2011, he was diagnosed with a stricture in his colon. (Id.) Plaintiff alleges gastrointestinal physicians at Denver Health Medical Center (“Denver Health”) recommended that he undergo surgery to remove the stricture. (Id. at 3-4.) Plaintiff alleges the defendant denied approval for the surgery because Plaintiff was close to his mandatory release date (“MRD”). (Id. at 4.) Plaintiff alleges he suffered for an additional year while his condition worsened and the stricture became a bowel blockage, at which time he underwent immediate surgery with removal of part of his colon. (Id. at 5-6.) Plaintiff alleges the defendant has a policy of either denying or approving surgery depending on the inmate's MRD, and that the policy violated his Plaintiff's Eighth Amendment rights. (Id. at 6.)


         Defendant CHP (“CHP”) is a Colorado corporation providing utilization management services for inmates incarcerated in the CDOC pursuant to an annual contract. (Mot., Ex. A [Mix Decl.], ¶ 2.) CHP is not a medical provider for CDOC inmates, but rather acts as an administrator, processing requests from CDOC medical providers to determine the medical necessity and propriety of requests for treatment outside of the CDOC's internal medical system. (Id.) CHP physicians review and approve requests for pre-authorizations for outside medical care. (Id., ¶¶ 1, 3.)

         CDOC inmates receive medical care within their correctional facilities from primary care providers, such as physicians, nurse practitioners or physician assistants. (Id., ¶ 4.) Inmates also may be referred by primary care providers to specialists for outside medical care, but providers are required to obtain pre-authorization for outside services, such as surgical procedures, from CHP. (Id., ¶¶ 4, 5.) Providers request pre-authorization by sending a request and supporting medical records to CHP. (Id., ¶ 5.) When a CHP physician authorizes, or approves, a request, the authorization is entered into a computer system, and CDOC is electronically notified within 24 hours. (Id., ¶ 6.) The authorization also can be reviewed by outside providers using the electronic system within 24 hours. (Id.) Neither CHP nor its physicians determine whether a request for a procedure is “urgent.” (Id., ¶ 7.) Rather, the provider making the request marks the request as urgent or routine; the CHP physician determines only whether the requested procedure is medically necessary. (Id.) After entering the authorization into the computer system, CHP and its physicians have no responsibility for scheduling the approved procedure. (Id., ¶ 8.) Scheduling is the responsibility of the CDOC and its health care providers. (Id., ¶ 9.)

         On April 15, 2011, a medical provider at Limon Correctional Facility (“LCF”), submitted a request for Plaintiff to receive a colonoscopy from Dr. James Miller. (Mot., Ex. B [Mandrell Dep.] at 29:19-25, 30:1-25, 31:1-12, Ex. 1.) CHP approved the request. (See id.) In July 2011, Dr. Miller performed the colonoscopy and determined Plaintiff had a “stricture” in his colon. (Id. at 28:22-25, 32:5-9.) On August 15, 2011, a medical provider at LCF requested CHP approve a procedure for a “radix colon barium enema” for Plaintiff at Denver Health. (Id. at 33:5-25, 34:1-5, Ex 3.) The barium enema procedure was approved by CHP (see id.) and occurred in September 2011 (id. at 32:23-25, 33:1, 34:6-10, Ex. 2). On September 21, 2011, a medical provider at LCF requested CHP's approval for Plaintiff, to receive an outpatient visit at Denver Health, which CHP approved. (Id. at 34:23-25, 35:1-23, Ex. 4.) On November 16, 2011, Plaintiff was seen at Denver Health as a follow-up to the colonoscopy and the barium enema. (Id. at 34:6-16, Ex. 2.) During the November 16, 2011 visit, it was determined Plaintiff's “descending colon [ ] has a stricture narrowing from 8 centimeters down to 1 centimeter.” (Id. at 40:20-23, Ex. 2.) The medical providers at Denver Health recommended that Plaintiff receive a colonoscopy with a pediatric scope in an effort to be better able to pass the scope through the stricture. (Id. at 41:8-21, Ex. 2.) As of November 16, 2011, the medical providers at Denver Health were not recommending surgery. (Id. at 41:22-25, Ex. 2.) On November 22, 2011, medical providers from Denver Health requested CHP's approval for Plaintiff to have a follow- up visit to Denver Health and a CT scan of his abdomen. (Id. at 42:8-25; 43:1-25, 44:1-25, 45:1-25, Exs. 5, 6.) The follow-up visit and the CT scan were approved. (Id. at 43:7-15, 45:13-25, Exs. 5, 6.) On January 5, 2012, Plaintiff received the CT scan of his abdomen, which indicated a “narrowing colon.” (Id. at 46:2-25, 47:1-7, Ex. 7.) On February 2, 2012, Plaintiff was seen at Denver Health for a colonoscopy, though the procedure was aborted prior to completion due to Plaintiff's anxiety and the inability to sedate. (Id. at 48:7-25, 49:1-25, 50:1-24 Ex. 8.)

         On May 3, 2012, a medical provider at Colorado Territorial Correctional Facility (“CTCF”) requested CHP's approval to refer Plaintiff to Denver Health for three items: (1) endoscopy, (2) colonoscopy, and (3) “unclassified” drug administration. (Id. at 55:15-25, 56:1-25, 57:1-25, Ex. 9.) All three requests were approved by CHP. (Id. at 58:1-8, Ex. 9.) The colonoscopy was to be performed with a pediatric scope under stronger anesthesia to avoid the issues encountered in the previous colonoscopy. (Id. at 59:17-25, 60:1-24, Ex. 10.) On May 29, 2012, CTCF requested approval from CHP for Plaintiff's immediate transfer to St. Mary-Corwin Hospital for inpatient care related to an inflammation in his colon. (Id. at 61:15-25, 62:1-25, 63:1-25, Ex. 11.) CHP approved the request. (Id. at 64:1-7, Ex. 11.)

         While at St. Mary-Corwin Hospital in late May 2012, Plaintiff received a colonoscopy and CT scan, which revealed the stricture. (Id. at 64:8-23.) On June 28, 2012, Dr. Susan Tiona at CTCF requested approval from CHP to refer Plaintiff to Dr. Camille Azar to receive another colonoscopy with “balloon dilation, ” which is when a balloon is inflated inside the colon to widen or expand a stricture. (Id. at 65:1-23, 66:14-25, 67:18-25, 68:1-3, Ex. 12.) CHP approved both requests. (Id. at 68:16-24, Ex. 12.) On or about August 30, 2012, Plaintiff went to see Dr. Azar for the colonoscopy and balloon dilation, but the balloon dilation procedure was not successful. (Id. at 69:21-25, 70:1-25, 71:1-25, 72:1-12, Ex. 13; see also Id. at 91:1-3.) While attempting the balloon dilation, it is believed Plaintiff's colon tore, which resulted in bleeding and repair using clips. (See id.)

         On October 11, 2012, after Plaintiff had been transferred to Fremont Correctional Facility (“FCF”), Dr. Timothy Creany requested approval from CHP to refer Plaintiff to Dr. Atul Vahil, a gastroenterologist, for a consultation. (Id. at 76:18-25, 77:1-21, Ex. 14.) CHP approved Dr. Creany's request. (Id. at 77:22-25, 78:1-3, Ex. 14.) In October 2012, Plaintiff was seen by Dr. Vahil, who performed a colonoscopy on Plaintiff “at some point” and recommended Plaintiff be referred to Denver Health. (Id. at 81:23-25, 82:1-7.)

         On November 19, 2012, after Plaintiff had been transferred to Sterling Correctional Facility (“SCF”), Dr. Maurice Fauvel requested CHP approve a request for Plaintiff to be seen at Denver Health, which was approved by CHP. (Id. at 82:16-25, 83:1-25, 84:1-5, Ex. 15.) Dr. Fauvel sent Plaintiff to Denver Health based on his recommendation Plaintiff be evaluated for a possible colectomy. (Id. at 84:10-15, Ex. 15.) The appointment was scheduled for January 16, 2013. (Id. at 88:10-23, Ex. 17.) At the January 16, 2013 appointment, the providers reviewed Plaintiff's colonoscopy results from Dr. Azar's colonoscopy on August 30, 2012, and ruled out cancer as a possible diagnosis. (Id. at 92:4-16, Ex. 17.) The providers recommended two surgical options for Plaintiff: (1) a total complete proctocolectomy with an end ileostomy and (2) a total colectomy with an ileorectal anastomosis. (Id. at 94:12-22, Ex. 18.) Plaintiff preferred not to have a colostomy bag permanently, so he and the physician decided in favor of the total colectomy with an ileorectal anastomosis and a possible diverting loop ileostomy. (Id. at 97:19-25, Ex. 18.) The physician informed Plaintiff that, before committing to surgery, he wanted to confirm Plaintiff's diagnosis of ulcerative colitis, discuss Plaintiff's pathology results with a pathologist, and discuss Plaintiff's case with other gastroenterologists at Denver Health. (Id. at 98:21-25, 99:1-7, Ex. 18.)

         On January 16, 2013, Plaintiff was “tentatively” scheduled for a laparoscopic total colectomy and ileorectal anastomosis with diverting loop ileostomy. (Id. at 99:8-15, Ex. 18.) On January 18, 2013, a medical provider at Denver Health requested approval from CHP for the surgical procedure recommended by Denver Health. (Id. at 99:17-25, 100:1-25, 101:1-3, Ex. 19). On January 24, 2013, CHP approved the surgical procedure. (Id. at 101:4-8, Ex. 19.) On February 12, 2013, Plaintiff was seen at Denver Health in follow-up to the January 16, 2013 appointment. (Id. at 101:11-25, 102:1-8, Ex. 20.) The medical provider at Denver Health informed Plaintiff that, after discussions with Plaintiff's gastroenterologist at St. Mary-Corwin Hospital, it was not clear Plaintiff had ulcerative colitis. (Id. at 102:9-13, Ex. 20.) On February 12, 2013, the medical provider at Denver Health canceled Plaintiff's scheduled surgery because he wanted Plaintiff to be seen by a gastroenterologist and receive another colonoscopy. (Id. at 102:14-21, Ex. 20.) As of February 12, 2013, the medical providers at Denver Health choose to hold-off on surgical intervention which demonstrated the recommended surgery was not emergent and was something that could wait. (Id. at 103:20-25, 104:1-8, Ex. 20.)

         On February 22, 2013, a medical provider at Denver Health requested CHP's approval for Plaintiff to receive a follow-up appointment at Denver Health for “further workup by GI prior to surgery to determine if patient carries diagnosis of ulcerative colitis.” (Id. at 104:11-25, 105:1-14, Ex. 21.) On March 1, 2013, CHP approved this request. (Id. at 105:15-20, Ex. 21.) On March 25, 2013, a medical provider at Denver Health requested CHP's approval for Plaintiff to receive another colonoscopy under anesthesia. (Id. at 107:1-25, Ex. 22). On the request there is a notation Plaintiff had received a colonoscopy in August 2012. (Id. at 106:1-4, Ex. 22.) The request was marked as “routine.” (Id. at Ex. 22.) On April 2, 2013, CHP denied the March 25, 2013 request for a colonoscopy, and on April 3, 2013, and on April 30 2013, CHP noted that the request “Remains denied. As per Dr. Mix given path[ology] provided and short MRD this procedure can reasonably be deferred until after release.” (Id. at 108:9-25, 109:1-21, Ex. 22; see ...

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