United States District Court, E.D. Wisconsin
DECISION AND ORDER
ADELMAN UNITED STATES DISTRICT JUDGE
Luis Vasquez, a Wisconsin state prisoner who is representing
himself, filed this lawsuit under 42 U.S.C. § 1983. I
allowed him to proceed on claims that the defendants were
deliberately indifferent to his serious medical and mental
health needs. The defendants filed motions for summary
judgment, which are fully briefed and ready for my decision.
I will grant the defendants' motions and dismiss this
plaintiff is incarcerated at Waupun Correctional Institution.
Docket No. 21 at ¶ 1. The defendants are: 1) Dr. Joel
Rigueur, a psychiatrist who contracts with the Department of
Corrections (DOC); 2) Dr. Salam Syed, who works for the DOC;
3) Nancy White, a retired registered nurse who worked as the
manager of Waupun's health services unit from September
2016 until May 2017; and 4) Dr. Jeffrey Anders, the DOC's
Psychiatry Director. Id. at ¶ 2; Docket No. 51
at ¶ 69; Docket No. 28 at ¶ 2.
time period relevant to this case is August 23, 2016, through
March 20, 2017. Docket No. 21 at ¶ 4. Prior to that
time, the plaintiff was under the care of Dr. Todd Callister
(a psychiatrist who is not a defendant). Docket No. 28 at
¶ 10. The plaintiff had last seen Dr. Callister on April
26, 2016. Id. Dr. Callister reported that the
plaintiff had a history of depression and anti-social
personality disorder and that the plaintiff was taking
medication with no reported side effects. Id.
Specifically, the plaintiff was taking Duloxetine (also
called Cymbalta), which is taken to treat Major Depressive
Disorder and Generalized Anxiety Disorder, and Buspirone,
which is taken to treat anxiety. Id. Dr. Callister
also noted that the plaintiff had suffered sexual abuse as a
child and had ongoing symptoms of traumatic re-experiencing.
plaintiff had last seen his psychologist, Dr. Torria Van
Buren (who is not a defendant), on April 26, 2016. Docket No.
28 at ¶ 11. According to her report, the plaintiff had
been diagnosed in part with Major Depressive Disorder and
Anti-Social Personality Disorder. Id. The plaintiff
also had a history of suicidal ideation and poor
institutional adjustment, which included fighting with staff
and inmates and inciting a riot. Id. The plaintiff
told Dr. Van Buren that he had flashbacks and intrusive
thoughts, leading him to believe he suffered from PTSD.
Id. Dr. Van Buren decided to continue to monitor the
plaintiff for trauma-related symptoms. Id. She did
not diagnose the plaintiff with PTSD.
Rigueur saw the plaintiff for the first time on August 23,
2016, for a psychiatric evaluation after reviewing the
reports of Dr. Callister and Dr. Van Buren. Docket No. 21 at
¶ 7. The plaintiff asserts that, at that appointment, he
told Dr. Rigueur about his childhood, specifically that he
had been physically and sexually abused. Docket No. 68 at
¶ 4. The plaintiff notes that he told Dr. Rigueur he was
having nightmares once or twice a week and that he would
often wake up screaming or wrestling with his blankets.
Id. The plaintiff states that Dr. Rigueur dismissed
his statements and informed him that he had not been
diagnosed with PTSD and that he should continue to work with
his psychologist. Id. at ¶ 5. Dr. Rigueur
disputes that they discussed PTSD symptoms at this meeting.
Id. at ¶ 6. He notes that the plaintiff has
elsewhere conceded that he did not discuss his need for PTSD
treatment until after his initial meeting with Dr.
Rigueur. Id. According to the plaintiff, he told Dr.
Rigueur that this psychologist was not treating his
nightmares or his other symptoms. Id. At the
plaintiff's request, Dr. Rigueur maintained the
plaintiff's dosage of Duloxetine, increased his dosage of
Buspirone, and prescribed Trazadone at bedtime and
Atomoxetine to address the plaintiff's reported sleep
disturbances. Id. at ¶ 19; Docket No. 21 at
week later, on August 31, 2016, the plaintiff prepared a
health services request (HSR), requesting Dr. Rigueur to stop
his Buspirone and Trazadone. Docket No. 28 at ¶ 22. He
asserted that the medications were exacerbating his migraines
and causing insomnia. Id. The plaintiff also stated
that, when he tried to stop taking the medications, he
started having withdrawal symptoms and impulsive, violent
behavior. Id. He explained that, when he restarted
the medications, the withdrawal and side effects stopped, but
his migraines returned. Id. The plaintiff did not
mention PTSD or alleged symptoms of trauma in his HSR. Docket
No. 68 at ¶ 12.
Rigueur did not receive the plaintiff's HSR because
nursing staff triage HSRs. Docket No. 21 at ¶ 12; Docket
No. 28 at ¶ 31, 46. If a nurse deems an HSR to be
urgent, the patient will be scheduled to be seen as soon as
possible, typically within twenty-four hours by a nurse or
mental health professional. Docket No. 21 at ¶ 13. The
nurse who triaged the plaintiff's August 31st HSR noted
on the HSR that she referred the request to the psychiatrist,
meaning that the plaintiff was likely placed on a waiting
list to see the psychiatrist at the next available time.
Id. at ¶¶ 14-15. Nurses can flag an HSR to
be reviewed by the psychiatrist on a more immediate basis,
but there is no indication that occurred with the
plaintiff's August 31st HSR. Id. at ¶ 16.
Rigueur explains that he does not control what patients he
sees on any given day unless the HSU manager informs him of
an emergency. Docket No. 28 at ¶ 6. He states that he is
given the medical records of each patient that he is
scheduled to see that particular day, but those records do
not include HSRs. Id. at ¶ 7. HSRs are shared
with him at the discretion of health services staff.
Id. at ¶ 8.
weeks later, on September 19, 2016, the plaintiff sent
another HSR to health services. Docket No. 28 at ¶ 23.
The plaintiff again requested to see Dr. Rigueur and stated
that he wanted to stop the Buspirone and Trazadone because
they were causing frequent and persistent migraines.
Id. The nurse who triaged the HSR responded that his
request had been referred to the psychiatrist and that he was
on the list to be seen. Id.
little more than a week later, on September 30, 2016, Dr.
Syed examined the plaintiff in response to complaints of a
urinary issue. Docket No. 28 at ¶ 24. At the
appointment, the plaintiff reported that his urinary issues
had resolved but he complained of headaches and migraines
that he thought were a result of the psychiatric medications
he was taking. Docket No. 21 at ¶ 28. The plaintiff told
Dr. Syed that his headaches had been going on for years and
he had a history of migraines. Id. at ¶ 29.
Syed explains that, when a patient is under the care of a
psychiatrist, he generally does not interfere with the
psychiatrist's prescribed medications. Docket No. 21 at
¶ 30. He informed the plaintiff that a small percentage
of people who take Buspirone develop headaches; he deferred
to the plaintiff's psychiatrist what medication was
proper to treat the plaintiff's psychiatric conditions.
Id. at ¶ 32. Dr. Syed explains that it was not
necessary for him to refer the plaintiff to see his
psychiatrist because he was seeing him on a regular basis
and, according to the September 19th HSR response, he was on
a list to see him again soon. Id. at ¶ 33.
response to the plaintiff's complaints of headaches, Dr.
Syed prescribed ibuprofen and started the plaintiff on 1000mg
of Tylenol, once per day as need. Docket No. 21 at
¶¶ 35-36. Dr. Syed also explained to the plaintiff
that his blood pressure was high, which could cause
headaches. Id. at ¶ 36. Dr. Syed offered the
plaintiff blood pressure medication, but he declined to take
it. Id. at ¶ 38. He ordered weekly blood
pressure checks and a chart review in four weeks to monitor
the issue. Id. at ¶ 39. Dr. Syed continued the
plaintiff's prescription of Excedrin, which he was
already receiving to treat his migraines. Id. at
¶ 40. Dr. Syed did not increase the plaintiff's
dosage of Excedrin; the plaintiff was already receiving the
maximum dosage allowed by DOC policy. Id. at ¶
little more than a week after seeing Dr. Syed, on October 9,
2016, the plaintiff submitted another HSR asking to see Dr.
Rigueur and complaining about his migraines, which he
attributed to the Buspirone and Trazadone. Docket No. 28 at
¶ 25. The HSR discussed these symptoms as a side effect
of the medication; it did not relate the symptoms to PTSD.
Docket No. 68 at ¶17. Health services responded that the
complaint had been referred to the psychiatrist. Docket No.
28 at ¶ 25.
next day, on October 10, 2016, the plaintiff met with his
psychologist, Dr. Kristina de Blanc. Docket No. 28 at ¶
26. He told her that he was having nightmares about four time
per week and persistent migraines, which made it hard for him
to sleep. Id. Dr. de Blanc recorded that the
plaintiff looked like he was in significant pain from a
migraine. Id. at ¶ 27. She informed health
services of the migraines and the possibility that they were
related to the plaintiff's psychotropic medication.
Id. She also noted that the plaintiff was placed on
a list to consult with the psychiatrist. Id. Dr. de
Blanc's report does not diagnose PTSD; it indicates only
that she addressed the plaintiff's complaints of
medication reactions. Docket No. 68 at ¶ 14.
days later, on October 14, 2016, Dr. Rigueur performed a
psychiatric evaluation of the plaintiff. Docket No. 28 at
¶ 28. After reviewing Dr. Syed's and Dr. de
Blanc's reports and at the plaintiff's request, Dr.
Rigueur discontinued the Buspirone and Trazadone.
Id. at ¶ 29. He explains that he tries to act
cooperatively and collaboratively in prescribing medications
because it prompts voluntary usage by the patient.
Id. at ¶ 45. He also explains that, in light of
the plaintiff's history, he would have wanted to see the
plaintiff in person before deciding to discontinue
medications or start new medications. Id. at ¶
44. The plaintiff asserts that he told Dr. Rigueur that he
needed treatment for nightmares and other symptoms of PTSD,
but Dr. Rigueur sat there in silence. Docket No. 68 at
¶¶ 18-19. Dr. Rigueur disputes that they discussed
PTSD; instead, he asserts that their discussion focused on
the medication the plaintiff had been prescribed.
Rigueur asserts that he does not believe the plaintiff's
migraines were caused by the increased dosage of Buspirone.
Docket No. 28 at ¶ 35. He explains that the plaintiff
had been taking Buspirone for a long time without incident
and the increase in dosage was minor. Id. at ¶
35. He also notes that the plaintiff had been dealing with
migraines for a very long time. Id. Dr. Rigueur also
discounts the plaintiff's assertion that he suffered
withdrawal symptoms when he stopped taking Buspirone and
Trazadone within a week of Dr. Rigueur's prescription.
Id. at ¶ 36. Dr. Rigueur explains that those
medications would not cause withdrawal symptoms because they
do not induce dependence, especially in such a short amount
of time. Id. at ¶ 37.
Rigueur prescribed Tegretol (also called Carbamazepine) in
place of the discontinued medications to help address the
plaintiff's complaints of nightmares, impulsivity, and
rage. Docket No. 28 at ¶ 37; Docket No. 68 at
¶¶ 19-20. Dr. Rigueur also requested that health
services schedule a follow-up appointment for four weeks
later. Docket No. 68 at ¶ 20. He placed the order for
Tegretol that same day, and health services sent a notice to
the plaintiff to stop taking Buspirone and Trazadone. Docket
No. 28 at ¶ 30. Dr. Rigueur explains that he does not
have access to the medication room and is unable to provide
medication directly to his patients. Id. at ¶
66. The plaintiff did not receive the medication until ten
days later. Id. at ¶ 51. He asserts that he
experienced withdrawal symptoms as a result of the delay.
services failed to schedule the follow-up appointment
requested by Dr. Rigueur. Docket No. 68 at ¶ 29. Dr.
Rigueur explains that he does not personally manage his
schedule; health services is responsible for scheduling
requested appointments. Id.
little less than three months later, on January 17, 2017, the
plaintiff submitted an HSR asking to be referred to a
psychiatrist to stop Tegretol because he was gaining weight
in his stomach and chest, developing “man boobs,
” had diarrhea with dark green stool, dry mouth,
unusual movement of his eyelids, and extreme drowsiness.
Docket No. 28 at ¶ 52. Health services responded that it
would refer his request to the psychiatrist. Id.
week later, Dr. Van Buren, the plaintiff's psychologist,
met with the plaintiff. Docket No. 28 at ¶ 53. Dr. Van
Buren's report indicates that the plaintiff told her he
was experiencing a depressed mood on and off but said he was
currently feeling ok. Id. The plaintiff denies
telling her he was ok, although there is no dispute that this
is recorded in her report. Docket No. 68 at ¶ 31.
According to her report, he also said he was having
nightmares of prior trauma and was increasingly irritated
with other inmates and noise. Docket No. 28 at ¶ 53. Dr.
Van Buren decided to continue to monitor the plaintiff and
schedule him to take the “Trauma Symptom Index-2”
in a few weeks. Id. Dr. Van Buren met with the
plaintiff again on February 21, 2017, while he was in
segregation. Id. at ¶ 57. She noted that the
plaintiff reported having nightmares, but he did not say that
he was punching and kicking walls. Docket No. 21 at ...