Opinion
5:19-CV-161 (TES)
06-28-2024
JOHN STEPHEN RAVAN, Plaintiff, v. WROBEL, et al., Defendants.
RECOMMENDATION
THOMAS Q. LANGSTAFF, UNITED STATES MAGISTRATE JUDGE
Plaintiff was previously detained at the Houston County Detention Center (“HCDC”) in Perry, Georgia. Plaintiff alleges that during his time at HCDC, Defendants changed his medication, which allegedly resulted in Plaintiff contracting Stevens Johnson Syndrome/Toxic Epidermal Necrology (“SJS/TEN”), a serious, painful, and potentially life-threatening illness. Plaintiff contends the Defendants then failed to provide constitutionally adequate medical treatment.Presently pending before the Court are Defendants' Motions to Dismiss for failure to state a claim. (Docs. 263, 268).
Plaintiff raised other claims against other Defendants in his Amended Complaint. See generally, Doc. 213-1. However, all Defendants other than those who filed the pending Motions to Dismiss have been voluntarily dismissed from this case. See Doc. 275 (dismissing Defendants Wheeler, Thomas, and Summit Food Service, LLC); see also Doc. 278 (dismissing Defendants Freeman and Jackson). Thus, for the sake of clarity and brevity, the Court will only address the facts and procedural history relevant to Plaintiff's claims against the remaining Defendants Wrobel, Broome, Vaughn, Sprague, Cox, and Southern Correction Medicine.
I. FACTS
A. Procedural History
On April 25, 2019, proceeding pro se, Plaintiff brought the above-styled action pursuant to 42 U.S.C. § 1983. (Doc. 1). Pursuant to the Prison Litigation Reform Act (“PLRA”), the Court screened Plaintiff's claims and recommended the dismissal of Plaintiff's Eighth Amendment claims for deliberate indifference to a serious medical need against Defendants Wrobel, Cox, Broome, Sprague, Vaughn, and Southern Correctional Medicine (“SCM”). (Doc. 72 at 7-10, 13). The district judge adopted the undersigned's Recommendation, and Plaintiff's claims against these Defendants were dismissed. (Doc. 96). On February 26, 2021, the district judge entered judgment against Plaintiff. (Doc. 184). Following the entry of judgment, Plaintiff's Motion for Leave to File an Amended Complaint was docketed. (Doc. 187). Because judgment had already been entered in the case, the undersigned denied that motion as moot. (Doc. 189).
On appeal, the Eleventh Circuit appointed counsel for Plaintiff. (Doc. 201 at 3, n. 1). In its opinion, the Eleventh Circuit noted that, under the “prison mailbox rule,” Plaintiff's Motion for Leave to File an Amended Complaint was effectively filed prior to the entry of judgment. Id. at 9, n. 6. Accordingly, the Eleventh Circuit “vacate[d] the decision denying the motion to amend as moot, and.remand[ed] for consideration of whether” Plaintiff should be given leave to amend. Id. at 23.
On June 6, 2023, the Court provided Plaintiff with an opportunity to file a motion to amend. (Doc. 209). Plaintiff subsequently filed a Motion to Amend (Doc. 213) and attached a proposed Amended Complaint. (Doc. 213-1). The undersigned granted Plaintiff's Motion to Amend and deemed Plaintiff's proposed Amended Complaint the operative Complaint. (Doc. 220 at 11). The undersigned conducted an initial review of the Amended Complaint and found that Plaintiff “adequately alleged claims of deliberate indifference as to” Defendants Wrobel, Cox, Broome, Sprague, Vaughn, and SCM. Id. at 15. Accordingly, the undersigned allowed Plaintiff's claims of deliberate indifference to a serious medical need to proceed for further factual development against these six Defendants. Id. at 15, 18-19.
The undersigned also found Plaintiff had adequately alleged state law medical malpractice claims against these Defendants and allowed those claims to proceed for further factual development as well. (Doc. 220 at 15).
Defendants filed an objection to the undersigned's Order and Recommendation, arguing that the undersigned improperly granted Plaintiff's Motion to Amend and erred by allowing Plaintiff's claims against them to proceed. (Doc. 237). On review, the district judge found “no legal error that warrant[ed] diverting from” the undersigned's Order and Recommendation. (Doc. 239 at 8). Following the overruling of their objections, Defendants Broome, Sprague, Vaughn, and SCM filed a Motion to Dismiss on September 29, 2023. (Doc. 263). On October 20, 2023, Defendants Wrobel and Cox filed a separate Motion to Dismiss. (Doc. 268).
B. Facts Alleged in Plaintiff's Amended Complaint
On February 17, 2019, Plaintiff was booked into HCDC. (Doc. 213-1, ¶ 29). Prior to being incarcerated at HCDC, Plaintiff was prescribed medications to treat several pre-existing medical conditions. Id., ¶ 34. After Plaintiff arrived at HCDC, Defendant Wrobel directed that Plaintiff's medications be changed, and this change caused Plaintiff to develop SJS/TEN. Id., ¶ 35. Within days of the change in his medication, Plaintiff began exhibiting “flu-like symptoms” and developed “a painful rash on his legs and abdomen that wept pus and blood.” Id., ¶ 44. Defendant Vaughan first observed Plaintiff's symptoms on February 21, 2019. Id., ¶ 45. The following day, Plaintiff's symptoms “visibly worsened,” and he was seen by Defendants Broome and Cox. Id., ¶ 46. Defendant Wrobel declined to see Plaintiff on this day. Id. At this point, Defendants Wrobel, Vaughan, Broome, and Cox all refused to give Plaintiff any pain medication other than Tylenol. Id.
On February 25, 2019, Defendant Wrobel noted Plaintiff had “painful, generalized, red vesicles”on his body, yet prescribed nothing to treat Plaintiff's pain. Id., ¶ 50. Defendant Sprague also observed Plaintiff on this day and noted his skin condition. Id., ¶ 49. On February 28, 2019, Plaintiff requested emergency medical care, complaining of a severe burning sensation and peeling skin. Id., ¶ 52. Plaintiff was seen four times on this day but was not provided “with medication that could alleviate his pain.” Id. Defendants Broome and Sprague both saw Plaintiff on this day, and Defendant Sprague speculated that Plaintiff could be suffering from SJS/TEN. Id., ¶¶ 53-54. After receiving treatment on February 28, 2019, Plaintiff was not seen by Defendants or any other medical staff again until March 4, 2019. Id., ¶ 55.
A “vesicle” is “a small abnormal elevation of the outer layer of skin enclosing a watery liquid.” Vesicle, MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary/vesicle (last visited June 21, 2024).
On March 4, 2019, Defendant Wrobel diagnosed Plaintiff with SJS/TEN and authorized Plaintiff's transfer to general population. Id., ¶¶ 58-59. Defendant Sprague generated the form authorizing Plaintiff's transfer to general population. Id., ¶ 60. On that same day, Plaintiff informed Defendant Wrobel that a lump had developed on Plaintiff's testicle, but Defendant Wrobel “basically blew [Plaintiff] off.” Id., ¶ 76. The lump worsened and Plaintiff continued to request an examination from Defendant Wrobel. Id., ¶ 77. Defendant Wrobel denied Plaintiff's requests and told him, “I don't want to see or feel your balls again.” Id. Plaintiff suffered permanent damage to his testicle. Id., ¶ 78.
In early April, the mucous membrane of Plaintiff's right eye partially detached. Id., ¶ 79. Plaintiff had first complained about swelling and loss of vision in this eye over a month prior to this incident and repeated this complaint numerous times. Id. When the membrane detached, a non-defendant medical staff member gave Plaintiff a paper towel and a plastic bag and left Plaintiff to remove the detached membrane himself. Id. During this incident, Defendant Cox stated, “you knew this.was gonna [ sic ] happen.” Id., ¶ 79. Plaintiff is now blind in his right eye. Id., ¶ 81.
During his time in the HCDC medical unit, Plaintiff alleges the Defendants “never provided him with pain medication adequate to address his condition. They provided him only with Tylenol, Benadryl, and mouthwash.” Id., ¶ 84.
Defendant SCM had notice of the grievances that Plaintiff filed regarding his medical treatment, was aware of Plaintiff's medical condition through the individual Defendants, and did nothing to improve Plaintiff's treatment. Id., ¶¶ 69-70. Plaintiff also alleges “that other prisoners were also mistreated and failed to receive adequate medical care under the management of SCM.” Id., ¶ 72. Two of Plaintiff's fellow inmates indicate “that HCDC medical staff have been sued for cruel and unusual punishment before due to mistreating inmates.” Id. Plaintiff alleges Defendant SCM's policymakers “authorized the practice of ignoring the serious medical needs of inmates like [Plaintiff].” Id., ¶ 71.
II. DISCUSSION
A motion to dismiss can be granted only if a complaint, with all factual allegations accepted as true, fails to “raise a right to relief above the speculative level.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007).
To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to “state a claim to relief that is plausible on its face.” A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged. The plausibility standard is not akin to a “probability requirement,” but it asks for more than a sheer possibility that a defendant has acted unlawfully.Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 556, 570). A complaint must contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” FED. R. CIV. P. 8(a)(2). “Specific facts are not necessary; the statement need only give the defendant fair notice of what the . . . claim is and the grounds upon which it rests.” Erickson v. Pardus, 551 U.S. 89, 93 (2007) (internal quotations omitted) (alteration in original). However, the pleading must contain “more than an unadorned, the-defendant-unlawfully-harmed-me accusation.” Iqbal, 556 U.S. at 678 (citing Twombly, 550 U.S. at 555).
A. Considering Extrinsic Materials at the Motion to Dismiss Stage
Before determining whether Plaintiff's Amended Complaint successfully states a claim, the Court must first determine what documents outside the pleadings may be considered at this stage. Generally, “[a] court's review on a motion to dismiss is ‘limited to the four corners of the complaint.'” Wilchombe v. TeeVee Toons, Inc., 555 F.3d 949, 959 (11th Cir. 2009) (quoting St. George v. Pinellas Cnty., 285 F.3d 1334, 1337 (11th Cir.2002)). Under Rule 12(d) of the Federal Rules of Civil Procedure, “[t]he district court generally must convert a motion to dismiss into a motion for summary judgment if it considers materials outside the complaint.” Day v. Taylor, 400 F.3d 1272, 1275-76 (11th Cir. 2005).
There are several exceptions to the rule prohibiting consideration of materials outside the pleadings at the motion to dismiss stage. Defendants rely on two of these exceptions in particular: one involving documents attached to a motion to dismiss, and the other involving documents attached to a plaintiff's complaint. See Horsley v. Feldt, 304 F.3d 1125, 1134 (11th Cir. 2002) (“[A] document attached to a motion to dismiss may be considered by the court without converting the motion into one for summary judgment....”); see also Gill as Next Friend of K.C.R. v. Judd, 941 F.3d 504, 511 (11th Cir. 2019) (“[A]n attachment to a complaint generally becomes ‘part of the pleading for all purposes,' including for ruling on a motion to dismiss.”) (quoting FED. R. CIV. P. 10(c)). The Court addresses both exceptions separately.
1) Defendants' Exhibits: Tramadol Records and Treatment
Under the “incorporation by reference” doctrine, “a document attached to a motion to dismiss may be considered by the court without converting the motion into one for summary judgment only if the attached document is: (1) central to the plaintiff's claim; and (2) undisputed.” Horsley, 304 F.3d at 1134. A document is considered “undisputed” if “the authenticity of the document is not challenged.” Id.
Defendants attach two exhibits to their Motions to Dismiss. The first exhibit is a set of medical records purporting to document Defendants' distribution of Tramadol to Plaintiff. (Docs. 263-2; 268-2). According to Defendants, these records conclusively demonstrate that Plaintiff “was prescribed the narcotic opiate pain killer Tramadol twice a day from late February through May 16, 2019.” (Docs. 263-1 at 2; 268-1 at 2-3). The second exhibit is a different set of medical records documenting Defendants' treatment of Plaintiff. (Docs. 263-3, 268-3). Defendants assert these records show that they “were actively implementing treatment plans [and] prescribing medications that included steroids, antibiotics, and other medications used in the treatment of skin conditions.” (Docs. 263-1 at 2-3; 268-1 at 3). Plaintiff asserts that Defendants have filed “defective motion[s] for summary judgment” because they “have larded their motion[s] with purported new evidence” rather than “treating the allegations in the complaint as true.” (Docs. 267 at 2; 273 at 2). Plaintiff argues that the Court should not allow Defendants “to proceed directly to Rule 56 while [Plaintiff] has not yet explained why they fail at Rule 12.” Id.
The documents attached to Defendants' Motions to Dismiss may properly be considered without converting Defendants' Motions into motions for summary judgment. Plaintiff does not challenge the authenticity of these records. Furthermore, these documents are clearly central to Plaintiff's claim. Plaintiff's Amended Complaint attaches and cites medical records which, based on their pagination, appear to come from the same source as the medical records introduced by Defendants. Compare Doc. 213-1 at 197; with Docs. 263-3 at 14; 268-3 at 14. Plaintiff's repeated references to these records demonstrate that these medical records are central to Plaintiff's claims of deliberate indifference. See Turk v. Morris, Manning & Martin, LLP, 593 F.Supp.3d 1258, 1288 (N.D.Ga. 2022) (“[T]he centrality of the documents to Plaintiffs' complaint is clear given that they are precisely the same documents Plaintiffs rely on as evidence..”). Accordingly, the Court may consider the exhibits attached to Defendants' Motions to Dismiss without converting these motions into motions for summary judgment.
Plaintiff has disputed whether the contents of these documents are factually accurate. See Doc. 267 at 4 (“[Plaintiff] specifically disputes contrary representations.in those medical records.”). “But ‘[i]n this context “undisputed” means that the authenticity of the document is not challenged,' not that the evidence is free from any dispute over its content.” Robinson v. City of Huntsville, 2022 WL 3867584 at *3 (11th Cir. 2022) (quoting Day, 400 F.3d at 1276) (alteration in original); see also Perry v. Jud. Admin. of Lamar Cnty., 2022 WL 17324434 at *4 (M.D. Ga. 2022) (“While the contents of the ACSO records may be in dispute., Plaintiff does not dispute the authenticity of the ACSO records themselves.”).
2) Plaintiff's Exhibits: Defendant Vaughan's Affidavit and SCM Records
“[A]n attachment to a complaint generally becomes ‘part of the pleading for all purposes,' including for ruling on a motion to dismiss.” Gill, 941 F.3d at 511 (quoting FED. R. CIV. P. 10(c)). Thus “[a] district court can generally consider exhibits attached to a complaint in ruling on a motion to dismiss” without converting the motion into a motion for summary judgment. Hoefling v. City of Miami, 811 F.3d 1271, 1277 (11th Cir. 2016).
Defendants rely on “Exhibit D” to Plaintiff's Complaint, which includes two distinct parts. The first is the affidavit of Defendant Vaughan, attesting to the types of medical care Plaintiff received during his time at HCDC. (Doc. 213-1 at 159-176). The second is a set of medical records which are cited by Defendant Vaughan in that affidavit. Id. at 177-343. Defendants cite these exhibits throughout their briefs, alleging “[t]he medical records attached to Plaintiff's
Complaint.. .contradict Plaintiff's allegations.” Doc. 263-1 at 12; see also Doc. 268-1 at 12 (asserting Plaintiff's allegations “are clearly contradicted by medical records he attached as an exhibit to his own Complaint”). Plaintiff appears to agree that Defendants “are entitled to cite [exhibits] attached to [Plaintiff's] Amended Complaint.” (Docs. 267 at 3; 273 at 3). Thus, there is no dispute that the Court may consider these documents at the motion to dismiss stage without converting Defendants' motions into motions for summary judgment.
As with the first set of exhibits, the Parties disagree about whether the contents of these exhibits are factually accurate. The Court once again notes that the question of whether these documents must be accepted as true is separate from the question of whether these documents may properly be considered at the motion to dismiss stage.
B. Failure to State a Deliberate Indifference Claim - Defendants Wrobel, Broome, Vaughn, Sprague, and Cox
To state a claim for deliberate indifference to a serious medical need, a plaintiff must make three showings: “(1) a serious medical need; (2) the defendants' deliberate indifference to that need; and (3) causation between that indifference and the plaintiff's injury.” Mann v. Taser Int'l, Inc., 588 F.3d 1291, 1306-07 (11th Cir. 2009). To show a defendant was deliberately indifferent, plaintiff must show: “(1) subjective knowledge of a risk of serious harm; (2) disregard of that risk; (3) by conduct that is more than [gross] negligence.” Goebert v. Lee Cnty., 510 F.3d 1312, 1327 (11th Cir. 2007) (alteration in original).
An Eleventh Circuit panel held that a deliberate indifference plaintiff must show a defendant acted with “more than gross negligence,” rather than just mere negligence. Wade v. McDade, 67 F.4th 1363, 1371-74 (11th Cir. 2023) (emphasis in original). That opinion was vacated when the Eleventh Circuit voted to grant rehearing en banc. Wade v. Ga. Corr. Health, LLC, 83 F.4th 1332 (11th Cir. 2023). Because Plaintiff successfully states a claim under the more stringent “gross negligence” standard, the Court need not address which is the appropriate standard.
In the medical care context, there are several types of conduct which constitute more than gross negligence: “(1) grossly inadequate care; (2) a decision to take an easier but less efficacious course of treatment; and (3) medical care that is so cursory as to amount to no treatment at all.” James v. Robinson, 2023 WL 4399985 at *2 (11th Cir. 2023) (quoting Bingham v. Thomas, 654 F.3d 1171, 1176 (11th Cir. 2011)). Furthermore, “knowledge of the need for medical care and an intentional refusal to provide that care constitutes deliberate indifference.” Adams v. Poag, 61 F.3d 1537, 1543 (11th Cir. 1995).
None of the Defendants dispute that Plaintiff was suffering from a serious medical need, nor do they deny that they were subjectively aware of Plaintiff's serious medical need. Instead, Defendants argue that Plaintiff has failed to allege they acted with more than gross negligence. See e.g. Doc. 263-1 at 9 (“A nurse following the treatment plan.does not act with more than gross negligence.”); Doc. 268-1 at 11 (“Dr. Wrobel's treatment of [Plaintiff], most certainly does not amount to deliberate indifference. It is not conduct that is more than gross negligence....”).
Plaintiff alleges the following facts in support of his claims against these Defendants:
• Within days of having his medication changed by Defendants, Plaintiff developed painful and obvious SJS/TEN symptoms, including “‘red, raised, weeping areas' on his lower extremities and abdomen” that developed into “bursting, bleeding, and oozing” open wounds. Id., ¶¶ 44-45, 48, 50.
• After Plaintiff's developed SJS/TEN symptoms, Defendants denied Plaintiff adequate pain medication and provided him only Tylenol, Benadryl, and mouthwash. Id., ¶¶ 46-47, 84, 145, 167.
• After Plaintiff received medical treatment on February 28, 2019, Defendants “failed to see [Plaintiff] for his bleeding and peeling skin again until.March 4.” Id., ¶¶ 52, 55.
• Defendants Sprague and Broome dismissed Plaintiff's complaints about loss of vision and swelling in his right eye, which eventually resulted in a detached mucous membrane and blindness in that eye. Id., ¶¶ 56, 79, 81.
• Defendant Wrobel refused to examine a lump that developed on Plaintiff's testicle despite Plaintiff's repeated complaints, telling Plaintiff “I don't want to see or feel your balls again.” Plaintiff suffered permanent damage to his testicle. Id., ¶¶ 76-78.
These factual allegations, when taken as true, sufficiently allege that Defendants acted with more than gross negligence. Plaintiff alleges that he was left unattended for multiple days while suffering from a severe and painful medical condition. See McElligott v. Foley, 182 F.3d 1248, 1258 (11th Cir. 1999) (“[A] jury could also find deliberate indifference in defendants' failure to do anything to alleviate [plaintiff's] pain or even monitor his condition from February 5-February 10..”). Additionally, several of these allegations describe medical staff refusing to examine Plaintiff despite Plaintiff's repeated complaints of pain and requests for medical attention. See Brennan v. Headley, 807 Fed.Appx. 927, 935 (11th Cir. 2020) (reversing a grant of summary judgment where plaintiff alleged defendant “refused to listen to his further complaints about a knot on his neck[,].repeatedly refused to let [plaintiff] see a doctor or a specialist,.and refused to physically examine him”); see also Goebert, 510 F.3d at 1328 (“Choosing to deliberately disregard, without any investigation or inquiry, everything any inmate says amounts to willful blindness.”). Finally, Plaintiff alleges the Defendants refused to provide him with any pain medication besides Tylenol, despite Plaintiff's repeated complaints of severe pain. See McElligott, 182 F.3d at 1257 (concluding that “a jury could find that the medication provided to [plaintiff] was so cursory as to amount to no care at all” where defendants provided only Tylenol, Pepto-Bismol, and anti-gas medication in response to plaintiff's “repeated complaints about the pain he was suffering”). Thus, Plaintiff has sufficiently alleged that Defendants acted with more than gross negligence towards Plaintiff's serious medical condition.
Defendants appear to concede that, when all of Plaintiff's allegation are accepted as true, Plaintiff's Amended Complaint “alleges he suffered immense and unnecessary pain because he had no treatment at all.” (Docs. 263-1 at 15; 268-1 at 12). However, Defendants raise five arguments as to why these factual allegations do not sufficiently state a claim of deliberate indifference.
1) Contrary Facts in the Medical Records
Defendants assert that the medical records attached to Plaintiff's Amended Complaint and the medical records attached to their Motions to Dismiss “unequivocally contradict [Plaintiff's] claims.” (Docs. 263-1 at 2; 268-1 at 2). Defendants further assert that the contents of these medical records “control and govern over those allegations contained in [Plaintiff's] Complaint that they directly contradict.” (Docs. 263-1 at 3; 268-1 at 3). Plaintiff asserts that “Defendants' proffered rule is...wholly inapplicable” because Plaintiff's allegations are “specific, grounded in discrete facts, and tethered individually to his claims.” (Docs. 267 at 3; 273 at 3). Thus, Plaintiff contends his “allegations must be accepted as true.” (Docs. 267 at 4; 273 at 4). The Court agrees with Plaintiff for two reasons.
First, the facts contained in extrinsic exhibits will only control over the factual allegations made in a complaint when the complaint's allegations are “general and conclusory.” Griffin Indus., Inc. v. Irvin, 496 F.3d 1189, 1206 (11th Cir. 2007). “When a complaint contains specific, well-pleaded allegations that either do not appear in the attached exhibit or that contradict conclusory statements in the exhibit, we credit the allegations in the complaint.” Gill, 941 F.3d at 514. The factual allegations outlined above are all “specific, well-pleaded allegations” that directly contradict the medical records attached to Defendants' Motions and the medical records attached to Plaintiff's Amended Complaint. Id. Because Plaintiff has “plead[ed] facts to call into question the accuracy or completeness of the medical records,” the Court cannot accept the contents of these medical records as true. Cf. Kenyon v. Silverman, 2022 WL 18493113 at *7 (S.D. Fla. 2022).
Second, “[w]here a civil rights plaintiff attaches a [document] to his complaint and alleges that it is false, .. .the contents of the [document] cannot be considered as true for purposes of ruling on a motion to dismiss.” Saunders v. Duke, 766 F.3d 1262, 1270 (11th Cir. 2014). Plaintiff expressly disclaims any reliance on the factual accuracy of these medical records in the Amended Complaint. See Doc. 213-1 at 10, n. 16 (“[Plaintiff] does not agree with all assertions made...in the notes to his medical records but it is referenced here for additional context and support to demonstrate the plausibility of [Plaintiff's] allegations.”). This disclaimer, as well as the contradictory factual allegations outlined above, demonstrate that Plaintiff “has expressly disavowed or rejected as untrue” the contents of these medical records. Hoefling, 811 F.3d at 1277.
Accordingly, the Court declines to accept as true the contents of the medical records attached to Defendants' Motions and Plaintiff's Amended Complaint where those records contradict Plaintiff's concrete, factual allegations.
2) Lack of Relationship Between Testicular Condition and SJS/TEN
Defendant Wrobel insists that Plaintiff's claims regarding his refusal to examine Plaintiff's testicle fails to state a claim because “there is no documented diagnosis that the condition with [Plaintiff's] testicle has any association with SJS.” (Doc. 268-1 at 10). However, even if Plaintiff's testicular condition was unrelated to his SJS/TEN, Plaintiff's Amended Complaint would sufficiently allege a claim of deliberate indifference. The lump on Plaintiff's testicle which allegedly caused permanent damage is clearly a serious medical need. See Taylor v. Adams, 221 F.3d 1254, 1258 (11th Cir. 2000) (defining an objectively serious medical need as “one that, if left unattended, ‘pos[es] a substantial risk of serious harm'”) (quoting Farmer v. Brennan, 511 U.S. 825, 834 (1994)) (alteration in original). Additionally, Plaintiff's repeated requests to Defendant Wrobel for an examination made Defendant Wrobel subjectively aware of this medical condition. See McElligott, 182 F.3d at 1256 (“[Plaintiff's] nearly constant complaints about the pain he was having.. .were sufficient to create a question for the jury whether [defendants] were aware of a substantial risk of harm..”). Finally, as outlined previously, the refusal to even examine Plaintiff despite repeated complaints constitutes more than gross negligence. Brennan, 807 Fed.Appx. at 935. Accordingly, Defendant Wrobel's assertion that Plaintiff's testicular condition is unrelated to his SJS/TEN provides no basis for finding that Plaintiff's Amended Complaint has failed to state a claim of deliberate indifference.
3) Nurse Liabilityfor Failure to Prescribe Medication
Defendant Sprague argues that “allegations that a nurse should have prescribed or given medications not prescribed by a physician are not pursuable as a claim of deliberate indifference.” (Doc. 263-1 at 7) (citing Ireland v. Prummell, 53 F.4th 1274 (11th Cir. 2022)).
The facts of Ireland are distinguishable from the facts alleged by Plaintiff in this case. The court in Ireland held that “even if the decision not to administer [medication].was infirm., that contention cannot be maintained against [nurse defendants] who could not prescribe medication.” Ireland, 54 F.4th at 1293-94. However, the court also noted that the nurse defendants, “upon observing [plaintiff's] condition, immediately began calling [a doctor] for a prescription to treat [plaintiff's] condition.” Id. at 1294. When the first doctor could not be contacted, the nurse defendants “reached out to a second doctor and informed the second doctor of [plaintiff's] condition.” Id. Thus, the nurse defendants were entitled to summary judgment not only because of their inability to write a prescription, but also because of their diligence in seeking help from a doctor who could write a prescription.
In contrast, Plaintiff alleges that, despite his repeated requests for pain medication, “[n]one of the Medical Defendants made any significant changes to [Plaintiff's] treatment.” (Doc. 213-1, ¶¶ 65-66). If Plaintiff had alleged that Defendant Sprague was only deliberately indifferent for failing to immediately issue unprescribed pain medication, Defendant Sprague might have been entitled to dismissal. But that is not what Plaintiff alleges. Instead, Plaintiff alleges that Defendant Sprague, along with the other individual Defendants, repeatedly refused to take any action in response to Plaintiff's complaints of pain and requests for adequate pain medication.
Furthermore, Plaintiff's deliberate indifference claim against Defendant Sprague is not based solely on the failure to provide adequate pain medication. Plaintiff also alleges Defendant Sprague left him unattended for several days while he was suffering from SJS/TEN symptoms and dismissed his requests for medical examination of his eye. See id., ¶¶ 52, 55-56. Thus, even setting aside Plaintiff's allegation regarding the failure to provide adequate pain medication, Plaintiff's Amended Complaint states a claim of deliberate indifference to medical needs against Defendant Sprague.
4) Transfer to General Population
Defendants Sprague and Wrobel argue that Plaintiff's allegation regarding his movement into general population fails to state a claim against them because “[t]his Court granted summary judgment” on similar claims against other defendants “which was affirmed on appeal to the Eleventh Circuit.” (Docs. 263-1 at 10; 268-1 at 13) (emphasis in original). Defendants assert Plaintiff has failed to “allege the transfer caused him any injury.” (Docs. 263-1 at 10; 268-1 at 14) (emphasis in original).
To the extent Defendants are attempting to revive their argument that the law of the case doctrine requires dismissal of Plaintiff's claims against them, (Doc. 237 at 14-15), the Court notes that this argument was previously rejected. See Doc. 239 at 8 (“[T]he Medical Defendants disregard and omit that the portion of the Eleventh Circuit decision regarding the transfer claim (1) involved different Defendants, and (2) was at the summary judgment stage as opposed to a frivolity screening.”).
Further, the Court notes that Plaintiff's factual allegation regarding his transfer into general population is just one of several factual allegations advanced in support of Plaintiff's claim that Defendants Sprague and Wrobel were deliberately indifferent to his serious medical needs. As outlined above, Plaintiff also alleges these Defendants disregarded his requests for medical examination, denied him adequate pain medication, and left him unattended for several days after SJS/TEN symptoms had developed. See Doc. 213-1, ¶¶ 52, 55-56, 76-79, 81, 84. Thus, even if the allegations regarding transfer into general population were, standing alone, insufficient to state of claim of deliberate indifference, Plaintiff's other factual allegation would sufficiently state a claim of deliberate indifference against Defendants Sprague and Wrobel.
5) Conflicting Factual Allegations in a Superseded Complaint
Defendant Cox argues that Plaintiff's Amended Complaint fails to state a claim against her because Plaintiff's “allegation against Nurse Cox regarding his mucous membrane is contradicted by his earlier Recast Complaint.” (Doc. 268-1 at 16). This argument fails for two reasons. First, when a plaintiff files an amended complaint, that new complaint generally “supersede[s] the previous complaints and render[s] null their contradictory allegations.” Seiger by & through Seiger v. Philipp, 735 Fed.Appx. 635, 638 (11th Cir. 2018); see also Mittenthal v. Fla. Panthers Hockey Club, Ltd., 472 F.Supp.3d 1211, 1220-21 (S.D. Fla. 2020) (“Binding plaintiffs to factual averments they have abandoned would create perverse incentives for plaintiffs' lawyers in civil cases.”). Thus, whether the factual allegations in Plaintiff's Amended Complaint contradict the factual allegations in a prior complaint is irrelevant to determining whether the Amended Complaint sufficiently states a claim.
Second, even if contradictory statements in the superseded complaint were relevant, Plaintiff's allegation regarding the detachment of his eye's mucous membrane is just one of several allegations supporting Plaintiff's deliberate indifference claim against Defendant Cox. As Defendant Cox herself recognizes, Plaintiff alleges Defendant Cox “saw his condition... and failed to take any action, failed to provide [Plaintiff] with any pain medication beyond Tylenol, [and] did not refer [Plaintiff] to the hospital.” (Doc. 268-1 at 14). Additionally, Plaintiff alleges Defendant Cox and the other Defendants left Plaintiff unattended for several days after observing his SJS/TEN symptoms. (Doc. 213-1, ¶¶ 52, 55). Thus, even if the factual allegation regarding Plaintiff's mucous membrane was insufficient by itself to state a claim against Defendant Cox, Plaintiff's other factual allegations preclude Defendant Cox from being entitled to dismissal at this stage.
C. Failure to State a Deliberate Indifference Claim - Defendant SCM
Where a private corporation contracts with a county to provide medical services to inmates, the corporation is treated in the same manner as the county for the purposes of § 1983 liability. Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 1997) (per curiam) (citations omitted). “[T]o impose § 1983 liability on a municipality, a plaintiff must show: (1) that his constitutional rights were violated; (2) that the municipality had a custom or policy that constituted deliberate indifference to that constitutional right; and (3) that the policy or custom caused the violation.” McDowell v. Brown, 392 F.3d 1283, 1289 (11th Cir. 2004). A “custom” in this context is defined as “a practice that is so settled and permanent that it takes on the force of the law.” Id. at 1290 (quoting Wayne v. Jarvis, 197 F.3d 1098, 1105 (11th Cir.1999)). “A single incident would not be so pervasive as to be a custom or practice.” Grech v. Clayton Cnty., Ga., 335 F.3d 1326, 1330, n. 6 (11th Cir. 2003) (en banc).
Defendant SCM's central argument is that Plaintiff cannot allege a policy of deliberate indifference “[w]ithout underlying claims of deliberate indifference sufficient to survive 12(b)(6) scrutiny.” (Doc. 263-1 at 17). Because the undersigned has not recommended dismissal of the claims of deliberate indifference against the individual Defendants, this argument provides no basis for dismissal of the deliberate indifference claim against Defendant SCM.
Defendant SCM then briefly argues that Plaintiff “has failed to allege any sufficient similarity of incidents to merit a policy or custom claim.” Id. The Court finds this conclusory argument unavailing. Plaintiff's Amended Complaint alleges that “other prisoners were also mistreated and failed to receive adequate medical care under the management of [Defendant] SCM.” (Doc. 213-1, ¶ 72). In support of this assertion, Plaintiff alleges that two of his fellow inmates are familiar with past instances in which medical staff employed by SCM have been sued for cruel and unusual punishment. Id. Further, Plaintiff alleges that Defendant SCM “was aware, at least through its agents the individual Medical Defendants, of those Medical Defendants' neglect of [Plaintiff's] serious, excruciatingly painful, and life-threatening condition.” Id., ¶ 70.
To the extent Defendant SCM asserts that these allegations are insufficient to allege a custom of deliberate indifference to medical needs, Defendant SCM fails to provide substantial argument or authority in support of that position. See Garcia v. Casey, 440 F.Supp.3d 1282, 1285 (N.D. Ala. 2020) (“[T]he court has no burden to parse through the complaint looking for a reason to grant a defendant's motion to dismiss.”). Accordingly, the Court has no basis for departing from its prior finding that “Plaintiff has adequately alleged [a] claim[] of deliberate indifference as to...Defendant [SCM].” (Doc. 220 at 15).
D. Failure to State a Medical Malpractice Claim - All Defendants
Defendants' only argument in support of dismissing Plaintiff's medical malpractice claims is that state law claims brought in federal court through supplemental jurisdiction should generally be dismissed “when the federal claims have been dismissed.” (Docs. 263-1 at 18; 268-1 at 17). However, because the undersigned is not recommending that Plaintiff's federal claims be dismissed, Defendants have failed to identify a sufficient basis for dismissing Plaintiff's medical malpractice claims.
III. CONCLUSION
For the above stated reasons, the undersigned RECOMMENDS that Defendants' Motions to Dismiss (Docs. 263, 268) be DENIED.
Pursuant to 28 U.S.C. § 636(b)(1), the parties may serve and file written objections to this Recommendation, or seek an extension of time to file objections, WITHIN FOURTEEN (14) DAYS after being served with a copy thereof. The district judge shall make a de novo determination as to those portions of the Recommendation to which objection is made; all other portions of the Recommendation may be reviewed by the district judge for clear error. Any objection is limited in length to TWENTY (20) PAGES. See M.D. GA. L.R. 7.4.
The parties are hereby notified that, pursuant to Eleventh Circuit Rule 3-1, “[a] party failing to object to a magistrate judge's findings or recommendations contained in a report and recommendation in accordance with the provisions of 28 U.S.C. § 636(b)(1) waives the right to challenge on appeal the district court's order based on unobjected-to factual and legal conclusions if the party was informed of the time period for objecting and the consequences on appeal for failing to object. In the absence of a proper objection, however, the court may review on appeal for plain error if necessary in the interests ofjustice.”
SO RECOMMENDED.