Facts and Background

• Facts and Background:

  Plaintiff is an incarcerated inmate. Defendant Olga Beregovskaya, M.D. is a medical doctor. On March 1, 2016, defendant’s duties were to provide medical care to inmate-patients in the Triage & Treatment Area (“TTA”) at the North Kern State Prison.

  On March 1, 2016, at around 12:00 p.m., plaintiff was escorted to the Triage and Treatment Area to receive medical treatment for his injuries from a fight. Defendant was the physician assigned to the Triage and Treatment Area. The TTA is similar to an urgent care clinic, which is equipped with basic points of care such as an X-ray but lacks the equipment to perform a CT scan. 

  Plaintiff presented with a facial half-inch laceration on his left cheek that was bleeding and required sutures. Plaintiff also complained of a neck injury and arm pain. Defendant checked plaintiff’s vital signs and found them to be stable. She conducted a physical exam of plaintiff and palpated his neck. She applied local anesthesia and then closed plaintiff’s facial wound with seven sutures. 

  Plaintiff’s medical chart stated multiple conflicting causes of the neck injury including that the neck wound was caused by another inmate’s fingernail scratch a few days earlier and perhaps the wound had become infected; and also that plaintiff had told a nurse that he had a “pimple” on his neck. Plaintiff claimed that he informed defendant that the injury to his neck was a stab wound. Upon defendant’s physical examination of plaintiff’s neck, the wound appeared to be dry and healing. There was no entrance wound, no bleeding, no local tenderness, no warmth, no redness. In her report, defendant noted “Possible infected cyst right neck.” Defendant concluded that she did not think that plaintiff had been stabbed in the neck. 

  Defendant examined plaintiff’s arm and concluded that his arm did not require urgent treatment. Defendant changed plaintiff’s antibiotic to Clindamycin. Defendant prescribed Tylenol for pain. Thereafter, defendant counseled plaintiff on the signs of infection. She also told plaintiff to follow up with his primary care physician the next day or sooner as needed and to inform the clinical or custodial staff if he were to experience worsening pain or other complications.

  Defendant ordered a facial X-ray with orbitals. She also ordered an X-ray of the right side of plaintiff’s neck to rule out a foreign body. The physician radiologist prepared a report stating, “No soft tissue abnormality identified,” and that no foreign body was identified in the plaintiff’s neck.

  Defendant did not see plaintiff after that day and did not provide any further medical treatment.

  In November 2016, a CT scan of plaintiff's neck indicated the presence of a foreign body. In March 2017, surgery was performed on plaintiff’s neck and a foreign object was removed. The surgeon believed that the object he removed was a portion of a BIC pen. The object was submitted to pathology, where it was examined. The pathologist determined that the object was “a broken tubular glass shard.”

• Plaintiff's Contentions:

  Plaintiff contended that defendant was deliberately indifferent to his medical needs. Defendant noted in her medical record from the March 1, 2016 visit that she did not believe that he was stabbed. 

  Plaintiff's retained expert, Dr. Ritter, opined that based on the location of the stab wound in the Zone 2 area of plaintiff's neck, a CT scan was necessary.  Plastic is only visible on an X-ray 15% of the time. The object was visible on the March 1, 2016 X-ray, but it was not discovered by the reading radiologist. 

• Defendant's Contentions:

  Defendant contended that she was not deliberately indifferent to plaintiff's medical needs and that she treated him appropriately. The stab wound was three days old at the time of the medical visit and appeared to be a cyst. Defendant provided appropriate medical treatment based upon her thorough examination of plaintiff and ordered a same-day X-ray to rule out a foreign body in plaintiff’s neck, even though defendant did not believe that plaintiff had been stabbed.  There were neither any “hard signs” of physical distress nor emergent signs of danger to plaintiff’s life that necessitated defendant to order an ambulance to take plaintiff to the nearest emergency room for a CT scan.

  Defendant's retained experts opined that defendant acted appropriately in ordering an X-ray to rule out the foreign body and instructing plaintiff to follow up with his primary medical provider the next day.