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Jackson v. Holzmacher

United States District Court, W.D. Wisconsin

April 18, 2018




         Pro se plaintiff and prisoner Demario Jackson is proceeding on a claim that prison officials at the Wisconsin Secure Program Facility are violating his rights under the Eighth Amendment by refusing to provide treatment for his gynecomastia, a painful swelling of his breast tissue. Specifically, plaintiff alleges that defendants have refused to approve breast reduction surgery recommended by an off-site physician and have not prescribed effective pain medication. Now before the court are the motions for summary judgment filed by defendant Susan Peters, dkt. #46; defendant Tanya Bonson, dkt. #56; and defendants Lisa Allen, Burton Cox, Karl Hoffman, Scott Hoftiezer, Ryan Holzmacher and James LaBelle, dkt. #61. On March 20 and April 10, 2018, after the parties completed briefing the motions for summary judgment, plaintiff filed two motions requesting assistance in recruiting counsel. Dkt. ##74, 75.

         For the reasons explained below, I find that plaintiff has failed to show that any of the defendants acted with deliberate indifference in denying the surgery he requested for his gynecomastia. Therefore, the motions for summary judgment filed by defendants will be granted and plaintiff's motions for assistance in recruiting counsel will be denied as unnecessary.

         From the parties' proposed findings of fact and the evidence in the record, I find the following facts to be material and undisputed unless otherwise noted.


         A. The Parties and Background

         Plaintiff Demario Jackson was transferred to the Wisconsin Secure Program Facility on February 18, 2015. Since childhood, plaintiff has suffered from gynecomastia, which is a benign increase of the glandular tissue of the male breast that is often caused by obesity but may be the result of an increase in the ratio of estrogen and androgen hormone activity.

         Defendant Dr. Ryan Holzmacher was the medical director of the Department of Corrections's Bureau of Health Services from March 24, 2014 to May 15, 2017, and currently serves as the acting medical director on a limited term basis. His responsibilities include overseeing the general health of the prison inmate population with the help of the associate medical directors, developing policies and procedures that conform with community standards of care and reviewing and approving requests for testing, consultations, non-formulary medications and procedures for inmates. Department of Adult Institutions Policy #500.10.12 requires prior authorization for “Class III” medical care, which includes non-urgent conditions and surgical procedures that can be performed at the convenience of the physicians and institution. Holzmacher is a member of the “Class III Committee, ” which determines whether proposed medical treatment for certain inmates is medically necessary, and chairs weekly meetings of the committee.

         Defendant Dr. Scott Hoftiezer has been a physician at the Dodge Correctional Institution since 2002 and is an associate medical director with the Bureau of Health Services. As an associate medical director, Dr. Hoftiezer attends and participates in Class III Committee meetings.

         Defendants Dr. Karl Hoffman, Dr. Burton Cox and Dr. Lisa Allen are physicians employed by the Wisconsin Department of Corrections and were members of the Class III Committee that denied plaintiff's surgery.

         Defendants Tanya Bonson and Susan Peters are advanced practice nurse prescribers employed by Maxim Physician Resources, Inc. to work at state correctional facilities on a contract basis. Bonson worked on assignment to the Wisconsin Secure Program Facility from May 31, 2016 to May 31, 2017 and treated plaintiff during that period. Peters worked at the Green Bay Correctional Institution at all times relevant to this lawsuit and had no involvement in the medical care or treatment of plaintiff.

         Defendant James LaBelle has been a regional nursing coordinator with the Bureau of Health Services since 2012, and his primary responsibility is serving as the reviewing authority for inmate complaints related to the provision of healthcare in the state correctional institutions. Defendant Ellen Ray is an inmate complaint examiner.

         B. Department Policies Regarding Outside Medical Care and Surgeries

         If an outside consulting physician makes recommendations to the institution's treating physician concerning a course of treatment for an inmate, the treating physician may adopt or reject the recommendations based on his or her own medical judgment, security and other institutional concerns. The inmate's treating provider may request authorization for Class III or non-urgent medical care by submitting a “DOC-3436, Prior Authorization for Non-Urgent Care” form to the medical director and the Class III Committee. The Class III Committee reviews requests for chronic opioid treatment and certain types of surgeries to determine if the treatment is medically necessary and meets the community standard of care. The medical director has the final authority to approve physician and inmate requests for surgery. As medical director, defendant Holzmacher may send a case to the Class III Committee for review if he would like a second opinion, and the committee may send the request back to Holzmacher for final approval if they feel his input is necessary.

         During Class III Committee meetings, the inmate's attending practitioner presents the case to the committee members who may ask questions, give opinions, discuss alternatives, discuss whether to approve a proposed treatment, suggest other acceptable alternatives or recommend continuation of the current therapy, if any. Any practitioner who attends a committee meeting to present a case or to listen is considered a de facto committee member. Nurse practitioners attend committee meetings to present cases of inmates who are requesting proposed treatment that must be approved by ...

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