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Martindale v. Rees

United States District Court, D. Montana, Helena Division

January 9, 2019

PAUL REES, M.D., Defendant.



         Plaintiff Michael Martindale, a state prisoner proceeding without counsel, filed a Complaint alleging Defendant Paul Rees, M.D. denied him adequate medical care in violation of the Eighth Amendment (Doc. 2) and a Motion for Temporary Restraining Order and Preliminary Injunction (Docs. 2-3 - 2-5). Dr. Rees has now filed an Answer (Doc. 11) and a response to the Motion for Temporary Restraining Order and Preliminary Injunction (Doc. 11). The motion for temporary restraining order should be denied.

         “A preliminary injunction is an extraordinary remedy never awarded as of right.” Winter v. Natural Resources Defense Council, Inc., 555 U.S. 7, 24 (2008) (citations omitted). It serves not as a preliminary adjudication on the merits, but as a tool to preserve the status quo and prevent irreparable loss of rights before judgment. Textile Unlimited, Inc. v. A.. BMH & Co., Inc., 240 F.3d 781, 786 (9th Cir. 2001). In reviewing a motion for preliminary injunction, “courts must balance the competing claims of injury and must consider the effect on each party of the granting or withholding of the requested relief.” Winter, 555 U.S. at 24 (citations and internal quotation marks omitted). “A plaintiff seeking a preliminary injunction must establish that he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest.” Winter, 555 U.S. at 20 (citations omitted).

         Winter does not expressly prohibit use of a “sliding scale approach to preliminary injunctions” whereby “the elements of the preliminary injunction test are balanced, so that a stronger showing of one element may offset a weaker showing of another.” Alliance/or the Wild Rockies v. Cottrell, 632 F.3d 1127, 1131 (9th Cir. 2011). The Ninth Circuit recognizes one such “approach under which a preliminary injunction could issue where the likelihood of success is such that serious questions going to the merits were raised and the balance of hardships tips sharply in plaintiff's favor.” Id. (citations and internal quotation marks omitted).

         A preliminary injunction “should not be granted unless the movant, by a clear showing, carries the burden of persuasion.” Lopez v. Brewer, 680 F.3d 1068, 1072 (9th Cir. 2012) (citations omitted, emphasis in original). A request for a mandatory injunction seeking relief well beyond the status quo is disfavored and shall not be granted unless the facts and law clearly favor the moving party. Stanley v. Univ. of S. Cal., 13 F.3d 1313, 1319-20 (9th Cir. 1994).

         In order to prove a § 1983 claim for violation of the Eighth Amendment based on inadequate medical care, a plaintiff must show “acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs.” Estelle v. Gamble, 429 U.S. 97, 106 (1976). Thus, in order to prevail, Mr. Martindale must show both that his medical needs were objectively serious, and that Defendants possessed a sufficiently culpable state of mind. Wilson v. Seiter, 501 U.S. 294, 299 (1991); McKinney v. Anderson, 959 F.2d 853, 854 (9th Cir. 1992) (on remand). The requisite state of mind for a medical claim is “deliberate indifference.” Hudson v. McMillian, 503 U.S. 1, 5 (1992).

         A serious medical need exists if the failure to treat a prisoner's condition could result in further significant injury or the unnecessary and wanton infliction of pain. Indications that a prisoner has a serious need for medical treatment are the following: the existence of an injury that a reasonable doctor or patient would find important and worthy of comment or treatment; the presence of a medical condition that significantly affects an individual's daily activities; or the existence of chronic and substantial pain. Wood v. Housewright, 900 F.2d 1332, 133741 (9th Cir. 1990) (citing cases); Hunt v. Dental Dept., 865 F.2d 198, 200-01 (9th Cir. 1989); McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992), overruled on other grounds, WMX Technologies v. Miller, 104 F.3d 1133 (9th Cir. 1997) (en banc). The Court will presume for purposes of this Order that Mr. Martindale has serious medical care needs.

         In Farmer v. Brennan, 511 U.S. 825 (1994), the Supreme Court established a very demanding standard for “deliberate indifference.” Negligence is insufficient. Farmer, 511 U.S. at 835. Deliberate indifference is established only where the defendant subjectively “knows of and disregards an excessive risk to inmate health and safety.” Toguchi v. Chung, 391 F.3d 1051, 1057 (9th Cir. 2004) (internal citation omitted). Deliberate indifference can be established “by showing (a) a purposeful act or failure to respond to a prisoner's pain or possible medical need and (b) harm caused by the indifference.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (internal citations omitted).

         A physician need not fail to treat an inmate altogether in order to violate that inmate's Eighth Amendment rights. Ortiz v. City of Imperial, 884 F.2d 1312, 1314 (9th Cir. 1989). A failure to competently treat a serious medical condition, even if some treatment is prescribed, may constitute deliberate indifference in a particular case. Id.

         Mr. Martindale alleges he suffers from neuropathy, extensive nerve damage, and lower back pain and Dr. Rees discontinued his effective pain medications for these conditions. He contends Dr. Rees ignored the medical orders of Dr. Whitney to stop prescribing anti-inflammatories to avoid liver and kidney damage. He alleges he was diagnosed with pneumonia in July 2017 and it was discovered that his diaphragm is stuck in the open position. He contends that because Dr. Rees will not prescribe effective pain medication, it is impossible for him to go outside during the coldest months of the year and as a result he has to go without eating. He also alleges that infirmary staff fails to conduct weekly blood pressure checks and forget to send blood tests to the lab. (Doc. 2-2.)

         In response, Dr. Rees filed an affidavit setting forth his treatment plan for Mr. Martindale. Dr. Rees explained that Mr. Martindale has been followed, seen and treated in a clinical setting for thyroid cancer (in remission), musculoskeletal problems, acid reflux, HIV infection, hypertension and hypotension, investigation of possible heart and kidney disease, and diaphragmatic paralysis in connection with a chronically elevated left hemidiaphragm. (Rees Affidavit, Doc. 9-1 at ¶6.) Dr. Rees testified that he and other MSP infirmary staff have addressed Mr.

         Martindale's related complaints of back pain, pain in his neck and throat area, chest pain, elbow pain, discomfort from acid reflux, discomfort from swallowing, and discomfort from an insect bite, along with discomfort from his neuropathy, including extensive evaluation and provision of medications.

         In addition to the anti-inflammatory medications Mr. Martindale admits he is provided (ibuprofen, acetaminophen, and naproxen), Mr. Martindale has also received steroidal anti-inflammatories both orally and by injection, muscle relaxing medications, and he is prescribed medication for nerve discomfort in the form of Cymbalta. (Id. at ¶16.) Mr. Martindale's complaints of pain have also been evaluated by the MSP Pain Management Committee to determine a global, multi-modal approach to managing his complaints of chronic pain. (Id. at ¶18.)

         Dr. Rees has also arranged for several specialists to be involved with Mr. Martindale's care and evaluation of his complaints of discomfort and pain, and Dr. Rees testified that recommendations from these specialists have been followed. He explained that Mr. Martindale's thyroid cancer has been successfully treated and ...

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