United States District Court, N.D. Indiana, South Bend Division
OPINION AND ORDER
P. Simon United States District Judge.
Howard Smith, a prisoner without a lawyer, filed a motion for
preliminary injunction seeking treatment for his heart
condition and ongoing mini-strokes. I ordered the Warden to
file a response with a sworn statement (and supporting
medical documentation as necessary) explaining how Smith is
receiving constitutionally adequate medical care, and he has
now done so. Smith has not filed a reply.
preliminary injunction is an extraordinary and drastic
remedy, one that should not be granted unless the movant,
by a clear showing, carries the burden of
persuasion.” Mazurek v. Armstrong, 520 U.S.
968, 972 (1997) (emphasis in original). To obtain a
preliminary injunction, the moving party must show that: (1)
he will suffer irreparable harm before the final resolution
of his claims; (2) available remedies at law are inadequate;
and (3) he has a likelihood of success on the merits. See
BBL, Inc. v. City of Angola, 809 F.3d 317, 323-24 (7th
Cir. 2015). The court then “weighs the competing harms
to the parties if an injunction is granted or denied and also
considers the public interest.” Korte v.
Sebelius, 735 F.3d 654, 665 (7th Cir. 2013). An
injunction ordering the defendant to take an affirmative act
rather than merely refrain from specific conduct is
“cautiously viewed and sparingly issued.”
Graham v. Med. Mut. of Ohio, 130 F.3d 293, 295 (7th
Cir. 1997) (quotation marks and citation omitted).
It is a
truism that every inmate is entitled to receive
constitutionally adequate medical care. Estelle v.
Gamble, 429 U.S. 97, 104-05 (1976). But before an inmate
can obtain injunctive relief, he must make a clear showing
that the medical care he is receiving violates the Eighth
Amendment prohibition on cruel and unusual punishment.
See Westefer v. Neal, 682 F.3d 679, 683 (7th Cir.
2012); Mazurek, 520 U.S. at 972.
who is currently housed at the Westville Correctional
Facility, alleges he has been denied medical care and
medication for his heart condition and ongoing mini-strokes
since November of 2018. According to Smith,
“[p]hysicians at the Westville Correctional Facility
like Dr. Jackson refuse to see, treat, or even follow up on
the Plaintiff's heath care needs.” ECF 1 at 2. He
claims that prison officials at Westville are providing him
with “zero” care. Id. If true, I would
undoubtedly be inclined to grant Smith's motion for
preliminary injunctive relief.
according to the Warden's affidavit and the medical
records submitted with it (which Smith does not dispute),
Smith has been seen by Dr. Jackson for chronic care visits
five times and by various nurses on at least ten occasions
since November of 2018. See ECF 10-1; ECF 10-2. For
example, on intake he was examined by a nurse who noted that
Smith had a history of heart disease including second-degree
blockage, high blood pressure, and diabetes. ECF 10-2 at 4.
He was prescribed aspirin, lisinopril (an ACE inhibitor),
atorvastatin (a cholesterol medication) and glipizide (an
anti-diabetic medication). Id. at 14. Later, on
November 27, 2018, Dr. Jackson acknowledged Smith's
history of cardiac issues (syncope with bifasicular block),
but upon examination noted normal cardiovascular findings
with “Regular rhythm” and “No murmurs,
gallops, or rubs.” Id. at 21, 23. All
medications were continued with a plan to change Smith from
glipizide to metformin in the future. Id. at 21.
Similarly, on December 28, 2018, Dr. Jackson noted that Smith
had no chest pain, edema, or jugular vein distention, normal
PMI findings, and a regular heart rate and rhythm with no
extra sounds or murmurs. Id. at 31. The medications
were continued with metformin replacing the glipizide.
Id. at 32.
January of 2019, Smith reported problems walking during nurse
visits, and he was given a cane to assist with stability.
Id. at 33-37. According to comments in his chart,
Smith reported that he “does ambulate very slowly, but
is steady, has no issues other than he is 71 years old and
doesn't ‘move as fast as I used to' [and]
reports no problems getting to chow or meds.”
Id. at 36. On January 28, 2019, Dr. Jackson again
examined Smith and noted that his cardiovascular exam was
normal and that his blood pressure and diabetes were
well-controlled. Id. at 39-41.
medical care continued into late winter and spring of this
year. For example, on February 6th, Smith's chart was
updated to show his current medications including aspirin,
atorvastatin, lisinopril, and metformin, and on April
2nd, he visited the nurse who renewed those
medications. Id. at 43, 46. On April
24th, Dr. Jackson noted that Smith had a gait
disturbance along with decreased pulses in the dorsalis pedis
and posterior tibial but described his cardiovascular exam as
normal. Id. at 48-49. A May 7th chart update
indicated that he remained on the same medications, and
several tests were ordered including a lipid (cardiac) panel.
Id. at 51-52. Smith submitted a request for health
care form on June 12th stating that he had not
received his medication for three weeks. ECF 10-3 at 1. A
response from staff indicated that “all meds were
picked up on 6/16/19.” Id. Smith was seen by a
nurse on July 2nd, and no additional issues or
concerns were noted. ECF 10-2 at 56-57.
had an annual screening on July 23, 2019, and his
cardiovascular and vascular exams were normal. Id.
at 62-63. A comment from that screening indicates that Smith
was worried about his “foot repair per the VA, ”
but no mention was made of any concerns regarding his heart
condition or mini-strokes. Id. at 65. On August 1st,
Smith was seen by Dr. Jackson for a chronic care visit.
Id. at 72. Dr. Jackson noted that Smith
“states he has cad-but denies any angina and states
post release he will go to VA for further cardiac
w/up.” Id. The results of Smith's
cardiovascular and vascular exam were normal. Id. at
74. The medications listed above were continued, and Dr.
Jackson ordered a comprehensive metabolic panel. Id.
at 75. On August 19th, Smith was brought to urgent
care and assessed by a nurse after a fall; according to
Smith, his shoes got stuck to the floor and he lost his
balance. Id. at 78. The nurse noted that there was
no bruising, red areas, breakdown, or complaints of
significant discomfort. Id. at 80. Smith, who stated
that he was “slightly sore to my right hip” but
could “walk okay, just taking it slow, ” was
advised to return if his symptoms did not subside or became
more severe. Id. There is no indication that Smith
returned to medical or filed a request for health care prior
to filing this lawsuit approximately nine days later.
is now asking to be taken to the Veteran's Administration
for medical care, but “the Constitution is not a
medical code that mandates specific medical treatment.”
Snipes v. DeTella, 95 F.3d 586, 592 (7th Cir. 1996).
Inmates are “not entitled to demand specific care [nor]
entitled to the best care possible.” Forbes v.
Edgar, 112 F.3d 262, 267 (7th Cir. 1997). While Smith
claims that health care professionals at Westville are
refusing to see him and have provided him with zero care, the
undisputed medical records described above show otherwise.
Nurses and physicians have acknowledged his heart condition
among other chronic ailments, prescribed medication, and
performed cardiovascular examinations which resulted in
normal findings on numerous occasions. Smith has been seen by
Dr. Jackson regularly throughout his time at Westville.
Although Smith alleges that his ongoing mini-strokes have
been ignored, there is no evidence that he experienced any
stokes during the time period in question. None of the six
health care requests forms Smith submitted since his arrival
at Westville mention heart issues or strokes, and all were
responded to in kind. See ECF 10-3.
Smith has failed to show a likelihood of success on the
merits of his claim for injunctive relief because the record
demonstrates that he is receiving medical treatment that
reflects professional judgment, practice, and standards.
See Jackson v. Kotter, 541 F.3d 688, 697 (7th Cir.
2008) (“[M]edical professionals are not required to
provide proper medical treatment to prisoners, but rather
they must provide medical treatment that reflects
professional judgment, practice, or standards.”)
(internal quotation marks and citation omitted).
Additionally, because the record indicates that Smith has
been receiving ongoing medical treatment at regular
intervals, I find it unlikely that this treatment will be
discontinued or that he would suffer irreparable harm absent
immediate court intervention. Put simply, Smith has not shown
that a preliminary injunction is warranted at this time.
See BBL, Inc., 809 F.3d at 323-24.
Gerald Howard Smith's motion for preliminary ...