United States District Court, W.D. Virginia, Roanoke Division
Robert S. Ballon, United States Magistrate Judge.
Bristow, a Virginia inmate proceeding pro se, commenced a
civil rights action pursuant to 42 U.S.C. § 1983. The
only remaining defendant is Dr. Dulaney, who is licensed to
practice osteopathic medicine in the Commonwealth of Virginia
and is a Board Certified Family Physician. Dr. Dulaney
provided medical care to inmates at WRSP for two days per
week between August 18, 2014, and February 9, 2016. Bristow
alleges that Dr. Dulaney was deliberately indifferent to his
serious medical condition as he suffered from hemorrhoids
which caused bleeding and pain. Dr. Dulaney has filed a
motion for summary judgment along and attached a copy of
Bristow's relevant medical records relating to Dr.
Dulaney's evaluation, diagnoses, and treatment of the
hemorrhoid condition for several years. Bristow has responded
to the motion, making this matter ripe for disposition. After
reviewing the record, I grant Dr. Dulaney's motion for
summary judgment because the extensive treatment records do
not show that Dr. Dulaney acted with deliberate indifference
to Bristow's serious medical need.
are swollen veins located around the anus or in the lower
rectum and may cause itching, irritation and pain, fecal
leakage, painful bowel movements, and blood on toilet tissue
after a bowel movement. Some people also may experience
anemia, weakness, and pale skin due to blood loss. A health
care provider may diagnose hemorrhoids through both a visual
and digital rectal exam.
often go away without any treatment, but treatments are
available. Initial treatment may include pain relief, topical
treatments, and fiber supplements. If these methods are not
successful, a rubber band ligation procedure may be
performed, and if not successful, a hemorrhoidectomy may be
performed. A rubber band ligation procedure involves cutting
off the circulation to the hemorrhoid by placing a rubber
band around it, causing it to shrink and fall off within two
days. The rubber band is expected to fall off, too, which
typically indicates that the procedure was effective.
record reflects that Bristow had a ten-plus year history of
chronic, but infrequent, internal hemorrhoids before Dr.
Dulaney became his physician in August 2014. Bristow's
prison health record contains no hemorrhoid complaints
between February 2009 and January 2014.
February 2014, Bristow complained of blood in his stools. A
physician with Wellmont Medical Associates evaluated Bristol
in March 2014. That examination was negative for a prolapsed
hemorrhoid, nausea, vomiting, abdominal pain, abdominal
distention, or external abnormalities. The Wellmont Medical
physician diagnosed Bristol with internal hemorrhoids and
planned to schedule a colonoscopy and possible rubber band
ligation of the hemorrhoid. After the March 2014 examination,
however, the Wellmont Medical physician announced his
retirement scheduled for June 18, 2014, and recommended Dr.
Ernspiker, another physician at Wellmont Medical to take over
Bristow's care. A prison facility doctor, thereafter,
referred Bristow to Dr. Ernspiker on August 15, 2014.
early August 2014, Bristow reported to the medical department
at the prison facility that he had bleeding hemorrhoids. A
facility doctor examined him, determined he was anemic, and
ordered an iron supplement, a complete blood count, a
colonoscopy, and rubber band ligation. Dr. Ernspiker
performed the colonoscopy and the banding procedure, noting
that Bristow tolerated the procedure well. Bristow returned
to WRSP on August 26, 2014, and denied feeling any pain, but
reported that a rubber band had fallen out.
Dulaney first examined Bristow on August 27, 2014, after
Bristow returned from the banding procedure. Bristow was
alert, oriented, and in no apparent distress. Bristow
reported that two more rubber bands came out but denied
rectal bleeding. Dr. Dulaney confirmed with Dr. Ernspiker
that rubber bands routinely fall out after a rubber band
ligation procedure, and she informed Bristow of her
conversation with Dr. Ernspiker. Dr. Dulaney also prescribed
two tables of Tylenol, 500 mg twice per day for three days to
treat pain. A nurse noted that Bristow walked without
difficulty and with a steady gain as he left the medical
complained at the September 4, 2014 sick call of his
hemorrhoids and asked to see the doctor. The nurse's
notes reflect that Bristow maintained a steady gait, and
refused vital sign measurements. The nurse referred him to a
doctor for further evaluation.
Dulaney evaluated Bristow on September 15, 2014, in the
housing pod. Bristow reported swelling, decreased bleeding,
decreased pain, a protruding hemorrhoid, and difficulty
walking. Bristow's vital signs were stable and he was in
no apparent distress. Dr. Dulaney gave him a master pass to
come to medical for a rectal examination.
Dulaney performed a rectal examination two days later which
revealed a three-centimeter prolapsed, non-thrombosed
internal hemorrhoid. Initially, Dr. Dulaney ordered that
Bristow apply Dibucaine ointment, twice per day, take
Preparation-H suppositories, twice per day for thirty days,
and use a stool softener, 100 milligrams daily for three