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Smith v. Chaney

United States District Court, S.D. Georgia, Dublin Division

July 16, 2018

ROBERT FRANK SMITH, Plaintiff,
v.
DAVID CHANEY, Medical Doctor, Defendant.

          MAGISTRATE JUDGE'S REPORT AND RECOMMENDATION

          BRIAN K. EPPS, UNITED STATES MAGISTRATE JUDGE.

         Plaintiff, an inmate at Telfair State Prison (“TSP”) in Helena, Georgia, filed this civil rights case and is proceeding pro se. Presently before the Court are Plaintiff's motion for a preliminary injunction and temporary restraining order (doc. no. 8), Plaintiff's motion to hold in contempt of court (doc. no. 19), and Defendant's motion to revoke Plaintiff's in forma pauperis (“IFP”) status (doc. no. 18). For the reasons set forth below, the Court REPORTS and RECOMMENDS Plaintiff's motion for injunctive relief be DENIED, Plaintiff's motion to hold in contempt be DENIED AS MOOT, and Defendant's motion be GRANTED.

         I. BACKGROUND

         A. Plaintiff's Allegations

         Plaintiff alleges he has Chronic Hepatitis C (“HCV”), which causes him to suffer chronic headaches, fatigue, itching, nausea, insomnia, loss of appetite, loss of weight, loss of physical movement, rashes, extreme diarrhea, fever, high levels of “bowel toxic, ” and severe pain. (Doc. no. 1, p. 5; doc. no. 10, p. 3.) His viral count is in the millions per liter of blood. (Doc. no. 1, p. 5) He has sought treatment from Defendant Chaney since February 21, 2018, but Defendant Chaney refuses to treat him “with (HCV) medication or anything else.” (Id.)

         B. Georgia Department of Corrections' HCV Treatment Policy

         The Georgia Department of Corrections (“GDC”) has partnered with Augusta University's Digestive Health Center and Infectious Disease Department to develop treatment guidelines for inmates with HCV. (Chaney Aff., doc. no. 17-1, ¶ 7; HCV Treat. Pol., doc. no. 17-1, Attch. C.) These guidelines were most recently updated in August 2016. (HCV Treat. Pol. at 50.)

         While twenty-five to thirty percent of people infected with HCV clear the virus spontaneously, seventy to seventy-five percent develop Chronic HCV. (Id. at 50-51.) Of these Chronic HCV patients, the majority are asymptomatic. (Id. at 50.) However, Chronic HCV is unpredictable, characterized by fluctuations in Alanine Aminotransferase (“ALT”) levels that may or may not indicate liver disease. (Id.) Approximately one-third of Chronic HCV patients have some laboratory or biopsy evidence of liver disease, and approximately ten to twenty percent of patients develop progressive fibrosis of the liver leading to Cirrhosis. (Id. at 50-51.) Once a patient develops Cirrhosis, there is a one to four percent risk of hepatocellular carcinoma (“HCC”) and liver failure. (Id.)

         GDC guidelines provide priority levels of treatment in accordance with the seriousness of an inmate's HCV. (Id. at 53-54.) Priority 1 inmates are those with a high level of pathology (F3 or F4), are co-infected with HIV, had previous HCV treatment without a sustained viral response, or also have a designated comorbid condition such as cryoglobulinemia, lymphoma, or hepatic carcinoma. (Id. at 53.) Priority 2 and 3 inmates are those with minimal pathology (F1 or F2), no co-infection with HIV, and no comorbid conditions. (Id. at 54.) If a Priority 2 or 3 inmate's condition worsens or the degree of pathology advances, he will be moved to Priority 1 status. (Id.)

         The guidelines also provide treatment and monitoring protocols based on Priority Level. (Id. at 55-56.) Priority 1 inmates are referred to AUGH Hepatology or AU HIV Satellite Clinic at ASMP for a confirmatory Fibroscan and possible treatment options. (Id. at 55.) Priority 2 and 3 inmates are monitored in the GDC's Chronic Illness Clinics and given annual Fibro tests to evaluate liver fibrosis and inflammation, Alpha Feto-Protein screens, and a calculated APRI Score. (Id.) If these tests reveal a progression of the disease or fibrosis, the inmate's Priority Level should be increased. (Id.)

         C. Plaintiff's HCV Diagnosis and Treatment

         Plaintiff was diagnosed with HCV in 1997. (Pl.'s Med. R., doc. no. 17-1, Attch. A, p. 24). Prior to his arrival at TSP, Plaintiff underwent significant testing, screening, and treatment for his HCV. A 2014 ultrasound of Plaintiff's abdomen showed possible gallstones, but no evidence of Cirrhosis. (Id.) A July 2016 test of alpha fetoprotein was within normal limits, showing no evidence of liver cancer or precancerous activity, and Plaintiff's December 2016 HCV RNA test indicated his viral load count was 9.8 million IU/L4, which is unconnected to the severity of his infection or symptoms. (Id. at 18, 20; Chaney Aff., doc. no. 17-1, ¶ 19.) Labs from December 21, 2016, June 12, 2017, and November 8, 2017 showed Plaintiff's Bilirubin (measuring liver process), Albumin (measuring liver function), AST (liver enzyme), ALT (liver enzyme), ALK Phos (measuring blockage of the liver duct), and Gamma GT (measuring cell inflammation) were within normal ranges. (Pl.'s Med. R. at 19, 21, 23; Chaney Aff. ¶¶ 20-22.) Plaintiffs June 12, 2017, Fibro Test score was F1-F2, indicating minimal fibrosis, and his Acti Test was A0, indicating no activity. (Pl.'s Med. R. at 22.)

         On February 21, 2018, TSP conducted a medical intake upon Plaintiffs transfer to the facility. (Id at 25-27.) Plaintiff reported his blood pressure was “probably high, ” and the intake form listed his HCV as one of his documented medical problems. (Id at 25.) Six days later on February 27, 2018, TSP conducted lab work indicating Plaintiff had normal Protein, Albumin, Bilirubin, AST, ALT, ALK Phos, and CBC (blood count, which can be indicative of liver scarring). (Id at 28-29; Chaney Aff. ¶ 24.) Thus, per GDC protocol, Defendant treated Plaintiffs HCV as Priority 2, and Plaintiff has been followed regularly in the Chronic Care Clinic for his HCV in addition to several other chronic medical issues. (Chaney Aff. ¶¶ 6, 37.)

         Since his transfer to TSP, Defendant and other medical staff have regularly treated Plaintiff for a host of medical complaints. A ...


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