United States District Court, N.D. Indiana, South Bend Division
OPINION AND ORDER
DEGUILIO JUDGE UNITED STATES DISTRICT COURT
McDandal, a prisoner without a lawyer, filed a motion to
reconsider the order denying a preliminary injunction. He
seeks adequate medical treatment for carpal tunnel syndrome
and dry skin, including pain medication, skin creme, and
wrist surgery. “The purpose of preliminary injunctive
relief is to minimize the hardship to the parties pending the
ultimate resolution of the lawsuit.” Platinum Home
Mortg. Corp. v. Platinum Fin. Group, Inc., 149 F.3d 722,
726 (7th Cir.1998). “In order to obtain a preliminary
injunction, the moving party must show that: (1) they are
reasonably likely to succeed on the merits; (2) no adequate
remedy at law exists; (3) they will suffer irreparable harm
which, absent injunctive relief, outweighs the irreparable
harm the respondent will suffer if the injunction is granted;
and (4) the injunction will not harm the public
interest.” Joelner v. Village of Washington Park,
Illinois, 378 F.3d 613, 619 (7th Cir. 2004).
alleges that that he needs medical treatment for carpal
tunnel syndrome, which causes excruciating wrist pain, and
for his dry skin condition, which causes cracked skin and
open sores. According to the complaint (ECF 18), at the
Indiana State Prison, he was diagnosed with carpal tunnel
syndrome and dry skin and received pain medication, a wrist
splint, and Minerin creme. He was also put on a waiting list
for wrist surgery. On February 9, 2017, he transferred to
Westville Correctional Facility and was placed under the care
of Dr. Liaw. Upon his arrival, Dr. Liaw refused to give him
more Minerin creme and instead advised McDandal to take
shorter showers. Dr. Liaw later explained that Minerin was no
longer necessary due to the change in weather. In July 2018,
Dr. Liaw again refused to provide Minerin creme and told him
that he could purchase it from the commissary even though
McDandal could not afford it. He also refused to recommend
wrist surgery. When McDandal threatened to sue Dr. Liaw, he
ended the examination. He also confiscated McDandal's
pain medication, removed him from the chronic care clinic,
and told him to buy over-the-counter medication even though
McDandal could not afford it.
response, the Warden submitted an affidavit and
McDandal's medical records from February 2017. ECF 38.
According to the medical records, on February 9, 2017,
McDandal arrived at the Westville Correctional Center with
diagnoses of osteoarthritis and carpal tunnel syndrome. ECF
38-1 at 318-24. On May 3, 2017, Nurse Practitioner Jody
Kupfenberg prescribed Pamelor for pain relief and recommended
that McDandal purchase non-steroidal anti-inflammatory drugs
(NSAIDS) from the commissary. Id. at 346-49. On
August 4, 2017, Nurse Practitioner Kupfenberg observed that
McDandal refused Pamelor, stating that it was ineffective.
Id. at 357-60. She found that NSAIDS were
inappropriate due to his creatinine level and recommended
acetaminophen for pain relief. Id.
October 30, 2017, McDandal complained that the pain in his
left wrist was more severe when he woke up in the morning.
Id. at 378-83. He insisted on surgery and threatened
a lawsuit. Id. Dr. Andrew Liaw advised him that he
wore his wrist splint too tightly and that wearing it at
night would improve his symptoms. Id. Dr. Liaw also
observed a dry skin condition on McDandal's legs and
prescribed Minerin. Id. On January 24, 2018,
McDandal reported that he had started working again and
requested a refill of Minerin. Id. at 385-87. Dr.
Liaw observed that the dry skin condition had improved,
renewed Minerin, and prescribed Mobic for pain relief.
Id. On April 18, 2018, McDandal reported that he did
not wear his wrist splint at night and that he felt that the
carpal tunnel syndrome had spread. Id. at 395-97.
Dr. Liaw informed McDandal that carpal tunnel syndrome does
not extend from the wrists or hands. Id. He also
observed that McDandal had no dry skin issues and declined to
renew Minerin due to warmer weather. Id.
19, 2018, McDandal requested Minerin, stating that he could
not afford lotion because he was unable to work due to a
disciplinary issue and that the lotions of the commissary
were inadequate. Id. at 139-42. Dr. Liaw observed
that McDandal had dry skin but that it had improved since
winter and that the severity did not warrant Minerin.
Id. Dr. Liaw advised McDandal to take shorter
showers and to purchase lotion from the commissary, and
McDandal threatened a lawsuit. Id. Dr. Liaw also
discontinued McDandal from the chronic care clinic for carpal
tunnel syndrome, reasoning that, since McDandal was
unemployed, he would not exacerbate the condition and that it
could be managed with the wrist splint and pain medication
from the commissary. Id.
McDandal repeatedly met with nurses to complain about dry
skin and carpal tunnel syndrome and frequently mentioned his
lawsuit. Id. at 47-66. The nurses responded that Dr.
Liaw had addressed these issues and that McDandal had no new
symptoms. Id. On January 3, 2019, in response to one
of these requests, a nurse noted that McDandal had thirty
dollars in his prison account. Id. at 48. On the
same day, a nurse also observed that McDandal had dry skin
with no cracks, fissures, redness, or flaking. Id.
January 28, 2019, McDandal reported that he remained
unemployed and requested surgery for carpal tunnel syndrome
because he felt the condition had become worse. Id.
at 173-76. Dr. Liaw asked which motions increased or
decreased the pain, and McDandal would not directly respond.
Id. Dr. Liaw examined McDandal's left arm, noted
that McDandal likely exaggerated his condition during the
examination, but found that the pain and immobility was
likely the result of a rotator cuff injury instead of carpal
tunnel syndrome. Id. Dr. Liaw referred McDandal to
physical therapy for the left shoulder and wrist and
indicated that a wrist splint replacement might be
appropriate if McDandal requested one and if the wrist splint
had lost its elasticity. Id. McDandal also requested
Minerin. Id. Dr. Liaw observed dry skin but did not
observe the open sores or the cracked skin that were present
during the previous fall and winter. Id. He
concluded that lotion for the commissary would suffice.
filed a motion to introduce evidence, which the court
construes as a reply in support of the instant motion. ECF
41. He attaches various exhibits, including medical requests,
notes including his personal observations regarding his
medical care, and correspondence. McDandal attests that, on
July 19, 2018, he was required to return his supply of Mobic
to the medication dispensary. ECF 41-2 at 1. On January 25,
2019, Thomas Hobbs, Health Services Quality Assurance
Manager, reviewed McDandal's medical history and
concluded that Dr. Liaw's examinations and treatment
plans were appropriate. ECF 41-1 at 12. The medical requests
indicate that McDandal has requested a new wrist splint and
discussed it with medical staff but that he has not received
one. Id. at 18-23.
start, the court considers whether McDandal has shown a
reasonable likelihood of success on the merits. Under the
Eighth Amendment, inmates are entitled to adequate medical
care. Estelle v. Gamble, 429 U.S. 97, 104 (1976). To
establish liability, a prisoner must satisfy both an
objective and subjective component by showing: (1) his
medical need was objectively serious; and (2) the defendant
acted with deliberate indifference to that medical need.
Farmer v. Brennan, 511 U.S. 825, 834 (1994). A
medical need is “serious” if it is one that a
physician has diagnosed as mandating treatment, or one that
is so obvious that even a lay person would easily recognize
the necessity for a doctor's attention. Greeno v.
Daley, 414 F.3d 645, 653 (7th Cir. 2005). Deliberate
indifference means that the defendant “acted in an
intentional or criminally reckless manner, i.e., the
defendant must have known that the plaintiff was at serious
risk of being harmed and decided not to do anything to
prevent that harm from occurring even though he could have
easily done so.” Board v. Farnham, 394 F.3d
469, 478 (7th Cir. 2005).
medical professional to be held liable for deliberate
indifference to a serious medical need, he or she must make a
decision that represents “such a substantial departure
from accepted professional judgment, practice, or standards,
as to demonstrate that the person responsible actually did
not base the decision on such a judgment.” Jackson
v. Kotter, 541 F.3d 688, 697 (7th Cir. 2008). A mere
disagreement with medical professionals about the appropriate
course of treatment does not establish deliberate
indifference, nor does negligence or even medical
malpractice. Arnett v. Webster, 658 F.3d 742, 751
(7th Cir. 2011).
asserts that Dr. Liaw acted with deliberate indifference by
refusing to recommend carpal tunnel surgery and by
discontinuing his pain medication and Minerin. However, the
record reflects that Dr. Liaw exercised his medical judgment
with respect to each of these decisions. To start, the record
contains no medical evidence to suggest that surgery is an
appropriate treatment option for McDandal's wrist
condition. Further, the record reflects that Dr. Liaw
discontinued McDandal's enrollment in the chronic care
clinic for carpal tunnel syndrome and Mobic prescription
because McDandal stopped working. Dr. Liaw reasoned that
McDandal was no longer required to engage in repetitive
activities that would exacerbate the wrist condition.
McDandal also alleges that Dr. Liaw has completely refused to
treat him since July 2018, but, as recently as January 2019,
Dr. Liaw thoroughly examined McDandal, diagnosed a rotator
cuff injury, and referred McDandal to physical therapy.
Dr. Liaw discontinued Minerin because McDandal's skin
condition had improved and because he anticipated that
McDandal's skin would not be as dry in warmer weather. He
continued to refuse to prescribe the skin creme based on his
assessment of the severity of the condition. Moreover, while
McDandal asserts that he cannot afford lotion or pain
medication from the commissary, he has not filed recent
prison account statements, and it appears that McDandal had
thirty dollars in his account as of January 3, 2019. Though
McDandal has not yet received a wrist splint replacement, the
record indicates that medical staff has met with him in
response to his requests for one. Without further
information, the mere absence of a wrist splint replacement
is insufficient to establish deliberate indifference.
Therefore, the court cannot conclude that McDandal is
reasonably likely to succeed on the merits of his claims.
court must also consider whether McDandal will suffer
irreparable harm which, absent injunctive relief, outweighs
the irreparable harm the defendants will suffer if the
injunction is granted. For prisoner cases, the court has
limited authority to order injunctive relief. Westefer v.
Neal, 682 F.3d 679 (7th Cir. 2012). Specifically,
“the remedial injunctive relief must be narrowly drawn,
extend no further than necessary to correct the violation of
the Federal right, and use the least intrusive means
necessary to correct the violation of the Federal
right.” Id. As a result of the court's
limited authority, even if the court decided that McDandal
was entitled to injunctive relief, the remedy would be to
order the Warden to arrange for medical professionals to
assess McDandal's carpal tunnel syndrome and dry skin
condition. However, the record reflects that Dr. Liaw has
recently assessed McDandal and that nurses regularly ...