Moore v. Neel

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

JACKSONVILLE DIVISION

JOHN MOORE, III,

Plaintiff,

v. Case No. 3:17-cv-503-J-32PDB

G. RAMOS,

Defendant.

ORDER

I. Status

Plaintiff, an inmate of the Florida penal system, is proceeding on an

Amended Civil Rights Complaint (Doc. 17). The only claim that remains is

against Dr. G. Ramos, a medical doctor at Columbia Correctional Institution.1

Plaintiff claims Dr. Ramos was deliberately indifferent to his serious medical

needs on November 14, 2016. See Doc. 17 at 18.

Before the Court are the parties’ cross motions for summary judgment.

See Plaintiff’s Affidavit Summary Judgment Motion (Doc. 176); Defendant

Greto Ramos, M.D.’s Motion for Summary Judgment (Doc. 177), with exhibits

1 Plaintiff voluntarily dismissed the claims against Jurkash, Tomlinson, Neel,

and Jernigan. See Orders (Docs. 90, 124). Plaintiff and Defendants Dickerson,

Marteney, Wimberly, and Spitzer reached a settlement. See Order (Doc. 154).

(Doc. 178);2 Defendant’s Response to Plaintiff’s Motion (Doc. 181); Plaintiff’s

Objection to Defendant’s Summary Judgment Motion (Doc. 182). The motions

are ripe for review.

II. Plaintiff’s Amended Complaint

As to Dr. Ramos, Plaintiff alleges as follows:

[O]n 11-14-16 while being preconfined by

security captain Dickerson after informing him his

sergeants had me beat[,] I was seen by nurses to where

they documented my injury on [a] stick figure

diagram. I stated to the nurses that security had me

beat by another inmate and seen it happen when it

happen and threaten me not to go to medical. The

nurses examine me and I tell them that my mouth and

teeth are numb, also have pain somewhere to where I

hit the floor when I was hit and knocked out. The

nurse went and got Doctor Ramos to examine me after

they documented all the injury. Doctor Ramos asked

officer male Thomas is he going to confinement.

Security officer Thomas said yes under investigation

per the captain till [sic] we can find out what

happen[ed] by reviewing the camera. He’s going under

investigation. Doctor Ramos stated[,] peaking his head

in exam room, take him to confinement I order[ed] a[n]

emergency x-ray. At no time did Doctor Ramos

examine me as he must. He didn’t [confer] with his

nurse[s] of the[ir] preliminary examination. He never

checked my mouth to see if teeth were cracked . . . . He

should have referred me to dental . . . . As a Doctor he

2 The Court set the deadlines for the filing of dispositive motions and responses

as June 25, 2020, and July 27, 2020, respectively. See Order (Doc. 166).

Defendant filed his Motion on June 25, 2020. The following day, the Clerk of

Court removed exhibits A through E because the exhibits contained personal

identifiers. The Clerk notified counsel and asked counsel to properly refile the

exhibits. Counsel did so on June 26, 2020. The Court finds the Motion and

exhibits timely filed.

failed to treat a known serious injury. He failed to even

look for a diagnosis of the various injuries complained

about. Doctor Ramos displayed gross negligence,

culpable negligence and . . . deliberate indifference.

Doc. 17 at 18 (some punctuation and capitalization modified).

III. Summary Judgment Standard of Review

“‘Summary judgment is appropriate where there is no genuine issue as to

any material fact and the moving party is entitled to judgment as a matter of

law.’” Hinkle v. Midland Credit Mgmt., Inc., 827 F.3d 1295, 1300 (11th Cir.

2016) (quoting Jurich v. Compass Marine, Inc., 764 F.3d 1302, 1304 (11th Cir.

2014)); see Fed. R. Civ. P. 56(a). “A genuine issue of material fact exists when

the evidence is such that a reasonable jury could return a verdict for the

nonmoving party.” Bowen v. Manheim Remarketing, Inc., 882 F.3d 1358, 1362

(11th Cir. 2018) (quotations and citation omitted); see Hornsby-Culpepper v.

Ware, 906 F.3d 1302, 1311 (11th Cir. 2018) (“Where the record taken as a whole

could not lead a rational trier of fact to find for the non-moving party, there is

no genuine issue for trial.” (quotations and citation omitted)). In considering a

summary judgment motion, the Court views “the evidence and all reasonable

inferences drawn from it in the light most favorable to the nonmoving party.”

Hornsby-Culpepper, 906 F.3d at 1311 (quotations and citation omitted).

“[W]hen the moving party has carried its burden under Rule 56(c), its

opponent must do more than simply show that there is some metaphysical

doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio

Corp., 475 U.S. 574, 586 (1986) (footnote and citation omitted); see Winborn v.

Supreme Beverage Co. Inc., 572 F. App’x 672, 674 (11th Cir. 2014) (per curiam)

(“If the movant satisfies the burden of production showing that there is no

genuine issue of fact, ‘the nonmoving party must present evidence beyond the

pleadings showing that a reasonable jury could find in its favor.’” (quoting

Shiver v. Chertoff, 549 F.3d 1342, 1343 (11th Cir. 2008)). “A ‘mere scintilla’ of

evidence supporting the opposing party’s position will not suffice; there must be

enough of a showing that the jury could reasonably find for that party.” Loren

v. Sasser, 309 F.3d 1296, 1302 (11th Cir. 2002) (quoting Walker v. Darby, 911

F.2d 1573, 1577 (11th Cir. 1990) (internal quotations omitted)).

“The principles governing summary judgment do not change when the

parties file cross-motions for summary judgment. When faced with

cross-motions, the Court must determine whether either of the parties deserves

judgment as a matter of law on the undisputed facts.” T-Mobile S. LLC v. City

of Jacksonville, Fla., 564 F. Supp. 2d 1337, 1340 (M.D. Fla. 2008).

IV. Parties’ Positions

Defendant argues that he is entitled to summary judgment in his favor

because “Plaintiff has not presented any evidence that [he] was suffering from

a serious medical need on November 14, 2016,” and regardless, Defendant

provided appropriate medical care to Plaintiff. Doc. 177 at 7-10. Defendant

submitted an Affidavit with exhibits. See Docs. 177-1, 177-7, 178-1 to 178-6. In

his Affidavit, Defendant avers in pertinent part:

On November 14, 2016, I was serving as a

Medical Officer at the Columbia Correctional

Institution.

John Moore III is an inmate in the custody of the

Florida Department of Corrections. He is presently

serving a forty year sentence after being convicted of

Second Degree Murder and Armed Robbery. His prior

incarceration history with the Department of

Corrections includes several stints of prison time

following convictions for Sale of Cocaine, Unarmed

Robbery, and Elder Neglect.

On November 14, 2016, inmate Moore was

brought to the Emergency Room at the Columbia

Correctional Institute. Inmate Moore reported that he

was involved in an altercation with an inmate, and

was hit in the face with an unknown object on October

31, 2016. Inmate Moore had normal vital signs, was

ambulatory, alert, and oriented to person, place, time

and situation. Inmate Moore responded to questions

verbally.

On November 14, 2016, inmate Moore presented

with slight right sided swelling to his face, bruising

under his right eye and a reddened right eye.

Subjectively, inmate Moore reported numbness on the

right side of his face and a tingling sensation. Inmate

Moore further reported pain inside of his mouth, and

hearing a “clicking” noise when he chewed or opened

his mouth.

I examined inmate Moore and reviewed his

Emergency Room Record and Florida Department of

Corrections Office of Health Services Diagram of

Injury. I signed and stamped both of these records. I

ordered an x-ray of inmate Moore’s facial bones on

November 14, 2016. On November 15, 2016, Dr. John

Thomas, M.D. read the x-ray and determined that

inmate Moore’s frontal sinuses and maxillary sinuses

were clear, inmate Moore’s nasal bones and maxillary

sinuses were intact, inmate Moore’s ethmoid air cells

and sphenoid sinuses were clear, and inmate Moore’s

inferior orbital rimes were unremarkable. Inmate

Moore’s x-ray of his facial bones was unremarkable,

and revealed no fractures.

On November 14, 2016, I further wrote a

prescription for inmate Moore for Naproxen[], a

medication used to treat facial pain.

On November 14, 2016, I diagnosed inmate

Moore with complaints of facial pain. The care I

provided to inmate Moore was appropriate for his

complaints and his presentation. The care was also

within the reasonable standard of care for a physician

treating a patient with similar minor objective injuries

and subjective complaints. I am unaware of any

additional diagnoses of injuries to inmate Moore

relating to his complaints on November 14, 2016. The

injuries I observed, if left unattended, did not pose a

substantial risk of serious harm.

Doc. 177-1 at 2-4 (paragraph enumeration and footnotes omitted).

In response, Plaintiff argues that Defendant’s counsel did not provide him

with documents requested during discovery and that counsel “unlawfully”

submitted information in his summary judgment motion that Plaintiff had

previously requested. Doc. 182 at 2. He contends that Defendant’s Motion does

not refute the arguments made in his Motion. Id. at 3. Finally, Plaintiff asserts

that “there is one fact in this case still at dispute[:] . . . Did Doctor Greto Ramos

fail to examine Plaintiff, and did he deprive Plaintiff follow up care into still

complained injuries of nerve damage[?]” Id.

Plaintiff argues in his Motion that Defendant was deliberately indifferent

when he failed to examine Plaintiff despite knowing that Plaintiff had a serious

medical need requiring his attention on November 14, 2016. See Doc. 176 at 4.

Plaintiff further argues that Defendant should have referred him to dental,

scheduled him for follow-up care, and/or sent him to the medical unit at RMC.

Id. at 7. By not doing so, Defendant left Plaintiff in pain for 30 days. Id. Plaintiff

goes on to address discovery that was not answered by Defendant, see id. at 9-

10, and his inmate-witness affidavits, see id. at 11.

Defendant responds by asserting that he was not deliberately indifferent

to any serious medical need and at most, Plaintiff has raised a difference of

opinion which does not rise to the level of a constitutional violation. See Doc.

181.

V. Analysis

“To prevail on [a] § 1983 claim for inadequate medical treatment, [the

plaintiff] must show (1) a serious medical need; (2) the health care providers’

deliberate indifference to that need; and (3) causation between the health care

providers’ indifference and [the plaintiff’s] injury.” Nam Dang by & through

Vina Dang v. Sheriff, Seminole Cty. Fla., 871 F.3d 1272, 1279 (11th Cir. 2017)

(citation omitted).

A serious medical need is one that has been diagnosed

by a physician as mandating treatment or one that is

so obvious that even a lay person would easily

recognize the necessity for a doctor’s attention. In the

alternative, a serious medical need is determined by

whether a delay in treating the need worsens the

condition. In either case, the medical need must be one

that, if left unattended, poses a substantial risk of

serious harm.

Mann v. Taser Int’l, Inc., 588 F.3d 1291, 1307 (11th Cir. 2009) (quotations and

citation omitted).

Deliberate indifference to a serious medical need requires “three

components: (1) subjective knowledge of a risk of serious harm; (2) disregard of

that risk; (3) by conduct that is more than mere negligence.” Farrow v. West,

320 F.3d 1235, 1245 (11th Cir. 2003) (citations omitted); see Dang, 871 F.3d at

1280; Melton v. Abston, 841 F.3d 1207, 1223 & n.2 (11th Cir. 2016). “Subjective

knowledge of the risk requires that the defendant be ‘aware of facts from which

the inference could be drawn that a substantial risk of serious harm exists, and

he must also draw the inference.’” Dang, 871 F.3d at 1280 (quoting Caldwell v.

Warden, FCI Talladega, 784 F.3d 1090, 1099-1100 (11th Cir. 2014)).

An official disregards a serious risk by more than mere

negligence “when he [or she] knows that an inmate is

in serious need of medical care, but he [or she] fails or

refuses to obtain medical treatment for the inmate.”

Lancaster v. Monroe Cty., Ala., 116 F.3d 1419, 1425

(11th Cir. 1997), overruled on other grounds by

LeFrere v. Quezada, 588 F.3d 1317, 1318 (11th Cir.

2009). Even when medical care is ultimately provided,

a prison official may nonetheless act with deliberate

indifference by delaying the treatment of serious

medical needs. See Harris v. Coweta Cty., 21 F.3d 388,

393-94 (11th Cir. 1994) (citing Brown v. Hughes, 894

F.2d 1533, 1537-39 (11th Cir. 1990)).[3] Further,

“medical care which is so cursory as to amount to no

treatment at all may amount to deliberate

indifference.” Mandel v. Doe, 888 F.2d 783, 789 (11th

Cir. 1989) (citations omitted). However, medical

treatment violates the Constitution only when it is “so

grossly incompetent, inadequate, or excessive as to

shock the conscience or to be intolerable to

fundamental fairness.” Rogers v. Evans, 792 F.2d

1052, 1058 (11th Cir. 1986) (citation omitted).

Dang, 871 F.3d at 1280. “‘[I]mputed or collective knowledge cannot serve as the

basis for a claim of deliberate indifference. Each individual defendant must be

judged separately and on the basis of what that person kn[ew].’” Id. (quoting

Burnette v. Taylor, 533 F.3d 1325, 1331 (11th Cir. 2008)).

Considering the parties’ positions and reviewing the evidence submitted

the Court finds that Plaintiff simply disagrees with the course of treatment

Defendant provided. The medical evidence reflects that Plaintiff had an

3 “Even where medical care is ultimately provided, a prison official may

nonetheless act with deliberate indifference by delaying the treatment of

serious medical needs, even for a period of hours, though the reason for the

delay and the nature of the medical need is relevant in determining what type

of delay is constitutionally intolerable.” McElligott v. Foley, 182 F.3d 1248, 1255

(11th Cir. 1999) (citation omitted). However, “[i]t is also true that when a prison

inmate has received medical care, courts hesitate to find an Eighth Amendment

violation.” Waldrop v. Evans, 871 F.2d 1030, 1035 (11th Cir. 1989) (citing

Hamm v. DeKalb Cty., 774 F.2d 1567, 1575 (11th Cir. 1985)); see Boone v.

Gaxiola, 665 F. App’x 772, 774 (11th Cir. 2016).

altercation with another inmate on October 31, 2016. Doc. 178-2 at 2. Two

weeks later, on November 14, 2016, he reported to the emergency room and was

examined by a nurse. Id. The nurse noted that Plaintiff had slight swelling on

the right side of his face and bruising under his eye. Id. The nurse also noted

that Plaintiff complained of tingling and numbness as well as pain inside of his

mouth and a clicking sound when he chews or opens his mouth. Id. The nurse

notified Defendant. Id. That same day (November 14, 2016), Defendant ordered

an x-ray and prescribed pain medication. Doc. 178-4 at 2; Doc. 178-6 at 2. The

x-ray was read the following day by a different physician, and the results were

unremarkable. Doc. 178-5.

Whether to refer Plaintiff to a dentist or to RMC and whether to provide

a different mode of treatment is a matter of medical judgment that does not

amount to deliberate indifference. See Boone v. Gaxiola, 665 F. App’x 772, 774

(11th Cir. 2016) (“A medical decision not to pursue a particular course of

diagnosis or treatment is a classic example of a matter for medical judgment,

an exercise of which does not represent cruel and unusual punishment.” (citing

Estelle, 429 U.S. at 107-08). Likewise, Plaintiff’s disagreement with

Defendant’s course of treatment does not support a deliberate indifference

claim. See Melton, 841 F.3d at 1224 (“‘[A] simple difference in medical opinion

between the prison’s medical staff and the inmate as to the latter’s diagnosis or

course of treatment’ does not support a claim of deliberate indifference.”

(quoting Harris v. Thigpen, 941 F.2d 1495, 1505 (11th Cir. 1991)). Plaintiff

received medical attention, and the evidence shows that Defendant’s treatment

was not “so grossly incompetent, inadequate, or excessive as to shock the

conscience or to be intolerable to fundamental fairness.” Brennan v. Headley,

807 F. App’x 927, 935 (11th Cir. 2020) (quoting Thigpen, 941 F.2d at 1505).

Even taking all facts and inferences in the light most favorable to Plaintiff,

Defendant is entitled to entry of summary judgment in his favor.

Accordingly, it is

ORDERED:

1. Defendant Greto Ramos, M.D.’s Motion for Summary Judgment

(Doc. 177) is GRANTED.

2. Plaintiffs Affidavit Summary Judgment Motion (Doc. 176) is

DENIED.

3. The Clerk shall enter judgment in favor of Defendant and against

Plaintiff, terminate any pending motions, and close the file.

DONE AND ORDERED in Jacksonville, Florida, this 10% day of

August, 2020.

Toots (p bowie

TIMOTHY J. CORRIGAN

United States District Judge

11

JAX-3 8/6

c:

John Moore, III, #V02153

Counsel of Record