Brown v. Inch

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

JACKSONVILLE DIVISION

PERRY BROWN,

Plaintiff,

v. Case No. 3:19-cv-997-BJD-MCR

THE FLORIDA DEPARTMENT

OF CORRECTIONS, CORIZON,

LLC, and CENTURION OF

FLORIDA, LLC,

Defendants.

ORDER

I. Status

Plaintiff, Perry Brown, an inmate in the custody of the Florida

Department of Corrections, initiated this action by filing a pro se Civil Rights

Complaint (Doc. 1) under 42 U.S.C. § 1983. He is proceeding on an Amended

Complaint (Doc. 14; AC).1 As Defendants, Plaintiff sues the Florida

Department of Corrections (FDOC); Corizon, LLC (Corizon); and Centurion of

Florida, LLC (Centurion). AC at 2-3. Plaintiff, who alleges he suffers from

1 After Plaintiff initiated this action, the Court appointed counsel to represent

Plaintiff. See Doc. 8. Plaintiff, with help from court appointed counsel filed the

Amended Complaint. The Court then granted counsel’s motion to withdraw and

deemed Plaintiff to be proceeding pro se. See Doc. 60.

Hepatitis C virus (HCV), argues that Defendants Corizon and Centurion

violated his Eighth Amendment right to be free from cruel and unusual

punishment and that Defendant FDOC violated Title II of the Americans with

Disabilities Act (ADA) and Section 504 of the Rehabilitation Act (RA) when

Defendants, under a cost-saving policy, refused to provide Plaintiff with direct-

acting antivirals (DAAs), a lifesaving HCV treatment. Id. at 15-20.

Before the Court is (1) Centurion’s Motion for Summary Judgment (Doc.

68; Centurion Motion) with exhibits (Docs. 68-1; 68-2); (2) FDOC’s Motion for

Summary Judgment (Doc. 69; FDOC Motion) with exhibits (Doc. 69-1); and (3)

Corizon’s Motion for Summary Judgment (Doc. 71; Corizon Motion) with

exhibits (Doc. 70-1). The Court advised Plaintiff of the provisions of Federal

Rule of Civil Procedure 56, notified him that the granting of a motion for

summary judgment would represent a final adjudication of this case which

may foreclose subsequent litigation on the matter, and allowed him to respond

to the Motions. See Order of Special Appointment (Doc. 15). Plaintiff filed a

Response (Doc. 72)2 to Defendants’ Motions and Corizon replied (Doc. 73;

Corizon Reply). These Motions are ripe for review.

2 Plaintiff filed no evidence nor affidavits to support his Amended Complaint

or Response.

II. Plaintiff’s Allegations

Plaintiff alleges that he entered FDOC custody on November 27, 2006.

AC at 7. He contends that when he entered FDOC custody, he suffered from

chronic HCV, a blood-borne disease. Id. at 3-7. He maintains that chronic HCV

is a serious medical need, causing liver inflammation, liver scarring or fibrosis,

cirrhosis, and possible death. Id. at 3. Plaintiff argues that he underwent a

physical exam in 2011, during which FDOC physicians informed Plaintiff that

his HCV infection had caused decompensated cirrhosis. Id. at 7. According to

Plaintiff, he underwent further medical tests in November 2012, September

2013, August 2014, February 2015, May 2016, and July 2016, all of which

confirmed that his decompensated cirrhosis had increasingly advanced. Id. at

7-8.

Plaintiff asserts that in 2013, a new class of drugs known as DAAs

became available to HCV patients. Id. at 5. He argues that DAAs are oral

medications with few side effects that cure HCV at a rate over 95%. Id.

According to Plaintiff, in 2014, the American Association for the Study of Liver

Diseases (AASLD) and the Infectious Disease Society of America (IDSA)

recommended DAA treatment for all persons with chronic HCV. Id. And since

2014, DAA treatment “has been the standard of care for the treatment of HCV

. . . .” Id. Plaintiff contends that despite DAAs becoming available in 2013,

Defendants failed to provide these lifesaving medications to thousands of HCV-

positive prisoners, in contravention of the prevailing standard of care. Id. at 6.

Plaintiff alleges that Corizon, an out-of-state corporation registered to do

business in Florida, contracted with the FDOC from in 2013 until May 2016 to

provide health care services to prisoners in FDOC custody, including Plaintiff.3

Id. at 3. Plaintiff argues that Corizon officials knew about DAAs when the

medication became available in 2013 and knew DAA treatment was the

medical standard of care and treatment for chronic HCV. Id. at 7. He also

contends that Corizon knew that thousands of FDOC prisoners suffered from

HCV, but it refused to provide DAAs or any other treatment for the virus. Id.

Plaintiff asserts that for nearly four years, Corizon knew Plaintiff had

chronic HCV but refused to provide him with DAA treatment despite knowing

that his condition prioritized him for such treatment. Id. at 8. According to

Plaintiff, Corizon denied him HCV treatment from July 2013 until May 2016

because Corizon and the FDOC “had a policy, practice, and custom of not

providing [DAAs] to patients with HCV, in part to save costs and to make

larger profits.” Id. at 9. He argues that as a result of Corizon and FDOC’s

practice, policy, and custom of refusing to treat Plaintiff with DAAs from July

3 In his AC, Plaintiff alleges that Corizon’s contract with the FDOC started in

2012, but in his response to Defendant Corizon’s motion to dismiss, Plaintiff admits

that Corizon’s contract began in 2013. Doc. 51 at 5.

2013 to May 2016, “he sustained serious damage to his health and an increased

risk of future health complication.” Id.

Plaintiff maintains Defendant Centurion replaced Corizon as the

FDOC’s contracted health care vendor in May 2016, and that Centurion and

FDOC provided health care services from May 2016 to present. Id. at 9. He

asserts that starting in May 2016, Centurion knew that thousands of FDOC

prisoner had untreated HCV and it also knew that it was the medical standard

of care to treat chronic HCV with DAAs. Id. at 9-10. But according to Plaintiff,

Centurion denied Plaintiff DAA treatment from May 2016 until October 9,

2017 pursuant to FDOC’s and Centurion’s cost-saving policy, practice, and

custom of not providing DAAs to HCV-positive inmates. Id. at 10. Plaintiff

alleges that Centurion did not provide Plaintiff with DAA treatment until after

the FDOC was sued in federal court and an injunction was entered requiring

FDOC to provide HCV-positive inmates care. Id. at 10-11. Plaintiff contends

that because Centurion and FDOC delayed his treatment, he sustained serious

damage to his health and irreparable damage to his liver. Id. at 11.

Plaintiff raises four counts for relief. See generally AC. In Counts I and

II, Plaintiff alleges that Defendants Corizon and Centurion, respectively,

violated his rights under the Eighth Amendment by delaying his HCV

treatment. AC at 12-15. In Count III, Plaintiff alleges that the FDOC violated

the ADA by discriminating against him based on his disability when it

withheld medical treatment while not withholding medical treatment from

prisoners with other disabilities or who were not disabled. Id. at 15-19. Finally,

in Count IV, Plaintiff asserts that the FDOC violated the RA when it excluded

Plaintiff from receiving lifesaving HCV treatment “solely by reason of his

disability.” Id. at 19-20. Plaintiff alleges that as a direct and proximate cause

of Defendants’ policy, practice, and custom of delaying his HCV treatment, he

has suffered and will continue to suffer harm. As relief, Plaintiff seeks

declaratory relief, compensatory and punitive damages, as well as attorney’s

fees and costs. Id. at 21.

III. Summary of Record Evidence4

a. Record of HCV Standard of Care

According to Doctor Angel Alsina’s Expert Report, HCV treatment for

inmates before 2014 “was limited to watchful waiting for evidence of

decompensation.” Doc. 68-2 at 11. Treatment with medication available at that

time “was used on inmates only in rare cases because of the high severe side

effect rate.” Id. According to Alsina, FDA approval of DAAs began in November

2013. Id. at 11. But FDA approval did not mean that DAAs were readily

4 In support of its Motion, Defendant Centurion provides Doctor Angel Alsina’s

Expert Report outlining the history of HCV care and Plaintiff’s HCV treatment, see

generally Doc. 68-2; and in support of their Motions, Defendants FDOC and Corizon

provide copies of several medical records that Dr. Alsina references in his Report, see

generally Docs. 69-1; 70-1. The Court summarizes all of Defendants’ exhibits in

concert to provide a chronological summary of the record.

available in correctional systems because of health system, clinic, and patient

barriers. Id. Indeed, “DAAs were prohibitively expensive in 2014.” Id. Further,

before 2016, private and public insurers would not approve DAA treatment

without pre-conditions, and “it was not until 2016 that the effectiveness of

DAAs became clearly evident in the general population.” Id. Thus, Alsina

states that “[p]ushing the standard of care of Hepatitis C treatment with DAAs

to 2014 would be too far back.” Id. And while the AASLD and IDSA recognized

that treatment of all HCV patients “was desirable, financial and institutional

constraints made that impossible[] [and] no guidelines by any society,

including the AASLD, ever recommended that all inmates had to be treated.”

Id.

Indeed, in 2015, the AASLD still recommended stratification of HCV

patients – “that is each system, clinic, center, or practice had to have a system

of which patients could be treated when [DAAs] became available, based on the

resources that were available, liver disease severity, comorbid conditions . . . ,

and other manifestations outside of the liver . . . .” Id. at 13. According to

Alsina, when DAAs became available, the FDOC heeded this recommendation

and fashioned guidelines to select individuals most likely to benefit from HCV

treatment and prevent harm to those most likely to be harmed by the

treatment. Id.

On June 27, 2016, the FDOC revised its HCV guidelines to stratify HCV

treatment based on severity. “In short, the more advanced cirrhotic patients or

fibrotic stages were to be treated first.” Id. at 9. According to the 2016

guidelines, prisoners with decompensated cirrhosis, transplant candidates or

recipients, HCC patients, and those with comorbid medical conditions were

grouped into the highest priority (Priority Level I). Id. Next, inmates with an

APRI score greater than 2, which predicts cirrhosis, were grouped into the

intermediate priority (Priority Level II). Id. The APRI calculation (aspartate

aminotransferase to platelet ratio) estimates the severity of liver disease in

inmates with HCV. The FDOC later revised the guidelines three times in 2017.

Id. at 10. Of import, in October 2017, the FDOC introduced the Fibrosis-4 (FIB-

4) calculation to the guidelines as another estimate for the severity of liver

disease, and noted that a APRI greater than 2 equaled a diagnosis of F4 or

cirrhosis. The revised guidelines also mentioned that “[r]esource challenged

systems may use a combination of proprietary indices and ultrasound” for

estimating severity of liver disease. Id. On December 8, 2017, the FDOC again

revised its guidelines to change the prioritization criteria for the most urgent

group (Priority Level I) to include a combination of stage 4 fibrosis/cirrhosis

(previously Level II) and decompensated patients. Id.

b. Record of Plaintiff’s Medical Care

Plaintiff was diagnosed with HCV on October 2, 2008, and was

immediately referred to the “GI Clinic.” Doc. 68-1 at 6; Doc. 68-2 at 5. Medical

continued to monitor Plaintiff for diabetes, hypertension, and HCV in 2009.

Doc. 68-2 at 5-6. And Alsina’s Report shows that the Chronic Illness Clinic

monitored Plaintiff’s HCV and liver function from 2010 to 2021. Doc. 68-2 at 8.

In August 2010, Plaintiff’s HCV RNA (viral load) measured 1.1 million IU/mL.

Id. at 6. In March 2012, Plaintiff was diagnosed with genotype 1 Hepatitis C.

Doc. 68-2 at 6. And in April 2013, Plaintiff was counseled on the prognosis of

his HCV. Doc. 68-2 at 6.

Corizon began providing medical services to certain FDOC inmates in

September 2013. Doc. 71 at 2. On September 9, 2014, medical evaluated

Plaintiff in the Chronic Illness Clinic and recorded that Plaintiff’s HCV was

“controlled” and “asymptomatic.” Doc. 70-1 at 1. Medical ordered Plaintiff to

undergo blood work and follow-up in the outpatient department in three

months and return to clinic for routine evaluation on March 3, 2015. Id.

Plaintiff returned to the Chronic Illness Clinic on March 3, 2015, and medical

documented that his HCV was still “asymptomatic.” Id. at 2. Plaintiff’s

discussed medical plan was diet and exercise, follow-up with the outpatient

department in three weeks, and return to clinic in four months. Id. According

to Alsina’s Report, Plaintiff’s medical record from February 2016 shows his

FIB-4 test was 2.26, which suggested that Plaintiff did not have advanced

fibrosis or cirrhosis. Doc. 68-2 at 6.

In April 2016, Defendant Centurion took over medical care at Plaintiff’s

correctional facility. Id. at 6 n.2. After Centurion’s takeover, Plaintiff’s APRI

scores in July 2016 and September 2016 were 0.625 and 0.6, respectively,

neither of which suggested advanced fibrosis. Id. at 6. Medical evaluated

Plaintiff at the Chronic Illness Clinic on September 6, 2016, during which

Plaintiff advised he “fe[lt] good,” and medical documented that Plaintiff’s HCV

was “well controlled,” recorded his APRI score as 0.6, and planned for Plaintiff

to return to clinic in six months. Doc. 70-1 at 3. On October 26, 2016, medical

placed Plaintiff on the list to be reviewed by a special committee to determine

his HCV treatment schedule. Doc. 68-2 at 6.

In February 2017, Plaintiff’s APRI score was 0.305 and his HCV

remained asymptomatic. Id. On March 10, 2017, medical evaluated Plaintiff in

the Chronic Illness Clinic and again documented that Plaintiff’s HCV

remained asymptomatic and his APRI score was 0.305. Doc. 70-1 at 4. Medical

then scheduled Plaintiff to return to the Chronic Illness Clinic in 180 days. Id.

On November 27, 2016, a “hepatitis screen indicat[ed] that [Plaintiff] had NO

HIV, IS NOT ON HEMODYALYSIS, HAS NO ENCEPHALOPATHY, NO

ASCITES, AND HAS HAD NO PREVIOUS HCV TREATMENT FAILURES,

thus indicating a low priority for treatment” at that time. Doc. 68-2 at 6. That

same month Plaintiff had an APRI of 0.24 and a FIB-4 of 1.3, neither of which

indicated advanced fibrosis. Id. at 7.

On November 28, 2017, Plaintiff underwent a FibroTest yielding a score

of 0.78, which suggested Plaintiff had “severe fibrosis.” Doc. 70-1 at 6.

According to Dr. Alsina, that finding did not correlate with any previous non-

invasive fibrosis test that Plaintiff underwent, nor did it correlate with any

future test that Plaintiff underwent afterward. Id. at 7. Indeed, On December

26, 2017, Plaintiff underwent an ultrasound of his liver, and no abnormalities

were identified. Doc. 70-1 at 9.

On February 26, 2018, Plaintiff’s APRI score was 0.5 and his FIB-4 score

was 1.61, neither revealed F4 fibrosis or cirrhosis. Doc. 68-2 at 7. On March

14, 2018, medical counseled Plaintiff on DAA treatment with Epclusa,

including side effects, drug interactions, and the 84-day treatment regimen. Id.

According to Dr. Alsina’s review of Plaintiff’s medical records, after medical

conducted an ultrasound of Plaintiff’s liver and confirmed no heterogeneity or

diffuse echogenicity, it ordered Plaintiff start treatment with Epclusa and

check Plaintiff’s HCV viral load twelve weeks after completion. Id.; see also

Doc. 70-1 at 10. Plaintiff began Epclusa treatment on March 20, 2018, Doc. 68-

2 at 7, and at an April 11, 2018, follow-up with medical, Plaintiff advised, “I’m

fine. I haven’t had any problems,” Doc. 70-1 at 11.

Plaintiff completed treatment on June 11, 2018. Doc. 68-2 at 7. Medical

conducted an ultrasound of Plaintiff’s liver on August 7, 2018, which showed

his liver was “mildly heterogeneous,” but otherwise revealed “no significant

findings.” Doc. 69-1 at 22. On September 4, 2018, Plaintiff’s HCV RNA (viral

load) was < 15 IU/mL, and according to Dr. Alsina, Plaintiff was considered

“cured of Hepatitis C.” Doc. 68-2 at 7; see also Doc. 69-1 at 23. About six days

later, medical evaluated Plaintiff in the Chronic Illness Clinic, during which

Plaintiff had no complaints and medical documented that his HCV was

nondetectable post treatment. Doc. 70-1 at 14. On November 1, 2018, Plaintiff

advised medical that he was “doing great.” Doc. 68-2 at 7. A month later, on

December 7, 2018, Plaintiff submitted his first grievance complaining that

Corizon and Centurion “deliberately delayed [his] medical treatment for HCV

[s]oley because they did not want to pay for DAA[] treatment.” Doc. 51 at 4.

An ultrasound taken on June 4, 2019, showed Plaintiff’s liver had normal

echotexture. Doc. 69-1 at 24. On August 13, 2019, all Plaintiff’s liver function

tests were considered normal. Doc. 68-2 at 7. On December 12, 2019, an

ultrasound of Plaintiff’s liver showed an appearance of liver contour nodularity

and suspected liver cirrhosis. Doc. 70-1 at 16. But a follow-up FibroTest taken

on February 1, 2021, showed Plaintiff had a FibroTest score of 0.5, which

suggested only moderate fibrosis, with no inflammatory activity, and no

evidence of advanced fibrosis or cirrhosis. Doc. 69-1 at 29. Further, according

to Dr. Alsina’s Report, medical conducted a follow-up evaluation of Plaintiff in

the Chronic Illness Clinic on February 11, 2021, and noted Plaintiff’s F2

fibrosis was down from F4, his APRI score was 0.232, and his FIB-4 score was

1.33, none of which showed advanced fibrosis. Doc. 68-2 at 7.

c. Dr. Angel Alsina’s Expert Opinions

After reviewing Plaintiff’s medical records from 2006 to 2021, relevant

FDOC guidelines on HCV treatment, Plaintiff’s pleadings, and relevant case

law and medical publications, Dr. Alsina’s expert opinions in relevant part are

as follows:

Mr. Brown was diagnosed with HCV in October

2008 by antibody testing. A positive HCV RNA in

August 2010 confirmed the diagnosis.

From 2007 to February of 2021, Mr. Brown had

normal synthetic function (clotting, bilirubin, and

albumin). He also has no conclusive signs of cirrhosis

on imaging, noninvasive testing, physical exam, CT

scan, MRI, MRI elastography, or liver biopsy (none of

these ever done). In fact, the evidence points to the

contrary, of absence of F4 fibrosis or advanced fibrosis

or cirrhosis. Mr. Brown has no signs of portal

hypertension. Mr. Brown has no signs of

decompensated cirrhosis as alleged in the Complaint.

He has no signs of cirrhosis at all.

Mr. Brown did not have medical tests on

September 23, 2011, November 27, 2012, September 9,

2013, August 22, 2014, February 18, 2015, May 26,

2016, July 29, 2016, that indicated that he had

decompensated cirrhosis, as alleged in the Complaint.

Not in one instance, before or after the

treatment of hepatitis C, before or after Centurion

cared for Mr. Brown, did Mr. Brown have alterations

in his liver synthetic function of bilirubin, protein

production (albumin), or clotting. Therefore, any

allegations that he has sustained serious liver damage

and that he is at increased risk of future health

complications are unfounded.

CENTURION OF FLORIDA, LLC TREATED

THE HEPATITIS C VIRUS FROM MARCH 20 TO

JUNE 18, 2018 RESULTING IN NON-DETECTIBLE

RNA (“CURE” OF THE VIRUS). By September of

2020, he is cured of HCV and his liver synthetic

function and platelets remain normal.

Other than one single biochemical Fibrotest

(composed of biochemical markers), there is no clinical

parameter, no imaging study, or high quality

elastography that has revealed or was ever obtained to

show that Mr. Brown has cirrhosis. On the contrary,

the tests obtained showed the opposite, the absence of

cirrhosis. Concluding that his liver is at risk of

complications of cirrhosis is also speculative and

inaccurate.

His liver function remains normal after the HCV

treatment.

Mr. Brown did not develop any degree of liver

fibrosis because of actions or inactions of Centurion or

its physicians.

There are claims in the Complaint that were

never found in the medical records, including: 1) that

Mr. Brown has irreparable liver damage. 2) that Mr.

Brown experiences fatigue, mild depression, joint

pain, brain fog, swelling, and pain near the liver,

irritable bowel movement, and sleep disorder. 3) that

Mr. Brown has cirrhosis, which was worsened, due to

delay of the treatment. 4) that Mr. Brown’s liver

condition is getting worse. These claims may be from

other inmates, but they are not facts or symptoms that

Mr. Brown had or now has. To the contrary, in 2019,

after HCV treatment, Mr. Brown felt great and did not

voice any complaints. He was also without symptoms

from HCV during all the years prior to his HCV

treatment.

Fibrosis scores and tests: Mr. Brown was

followed with liver function tests and other

parameters to rule out cirrhosis (platelets, liver

ultrasound). On February 26[, 2021], the APRI score

is 0.5 and Fib-4 score is 1.61, none indicating F4

fibrosis or cirrhosis. I calculated these tests to confirm

this.

. . . .

Mr. Brown had normal synthetic function before

and after the HCV treatment. This is an important

and excellent prognostic factor for him. He has no

structural changes or a stiff liver, or indications that

he will acquire complications from such. Allegations

that he is at risk for advanced liver failure or death are

unfounded.

He has no evidence of hepatocellular carcinoma

or liver cancer (HCC). His HCC risk is dependent of

the degree of fibrosis, which is not advanced at this

point. His HCC risk is not the result of the timing of

HCV treatment, or actions or inactions of Centurion or

its physicians. One more important point on his

subsequent risk of liver cancer is that Mr. Brown is

diabetic and obese. This confers him an additional

independent risk of liver cancer.

Nowhere in the records that were available to

me is there an indication that the physicians intended

not to treat him.

There is no indication from the medical records

that I reviewed that any delay in his HCV treatment

or cure caused him physical pain, mental discomfort,

alterations in his daily living, shortened his lifespan,

or caused severe emotional pain and suffering, as

claimed.

CENTURION OF FLORIDA, LLC MET THE

APPROPRIATE MEDICAL STANDARDS OF CARE

IN THE TREATMENT OF MR. BROWN'S

HEPATITIS C VIRUS.

Treatment of inmates with DAAs was done

according to guidelines that were being followed.

DAAs were not readily available in 2013, 2014, 2015,

and 2016, as claimed, for everyone. It took several

years for these drugs to be readily available, not just

to be prescribed. In 2016, of 221,090 patients that were

HCV RNA positive in this country, only 17% saw a

specialist. Nationwide, only 8% of HCV positive baby

boomers were ever treated with DAA’s

Any alleged delay in treatment with DAAs did

not cause or contribute to Mr. Brown’s fibrosis. No

Hepatitis-C or liver related injuries were suffered by

Mr. Brown and cannot be attributed to any action or

inaction of Centurion or any of its providers. It is

undisputed that Centurion was responsible for

administering the DAA therapy that cured Mr. Brown

of his HCV infection and had a beneficial impact on his

liver function. His liver fibrosis is not advanced at this

point.

I FIND NO EVIDENCE THAT CENTURION

OF FLORIDA, LLC, ACTED WITH INDIFFERENCE

TO THE MEDICAL NEEDS RELATED TO MR.

BROWN’S CHRONIC MEDICAL CONDITIONS,

MORE SPECIFICALLY AS IT REGARDS THE

DIAGNOSIS AND TREATMENT OF HEPATITIS C.

DAAs were not available in late 2013. DAAs

were not readily available to all people in late 2016

either (data for U.S. presented). The 2014 Guidelines

that are quoted by the Plaintiff recommend that

patients be treated and stratified according to severity

(AASLD/IDSA HCV Guidance Panel, 2015). It is not a

mandate to treat all patients. Very few patients in the

U.S. were treated in 2014-16. That was the standard

of care, not just for inmates, but for everyone else.

Inmates did not have preferential treatment over

everyone else, or vice versa. Mr. Brown was not in the

highest priority of treatment, per Society Guidelines.

NOTHING THAT CENTURION DID OR DID

NOT DO, CAUSED OR CONTRIBUTED TO THIS

PATIENT'S DEGREE OF LIVER FIBROSIS OR ANY

INJURY THAT COULD SUBSEQUENTLY

DEVELOP.

It is my opinion that Centurion provided Mr.

Brown with appropriate and reasonable medical care

that met the standards of care and complied with the

guidelines established by the FDOC, as well as the

AASLD/IDSA, for the treatment of HCV infection and

cirrhosis of the liver, and that under the care of

Centurion and its providers, Mr. Brown’s HCV was

cured. There is nothing in the records which leads me

to believe that Mr. Brown’s care was appreciably

different from what would have been expected in the

broader community at that time.

There is no evidence in the records that I

reviewed that Mr. Brown sustained any disability,

injury, or other adverse consequence as a result of the

manner in which he was treated by Centurion for his

Hepatitis C infection. I find no evidence that

Centurion of Florida acted indifferently to the medical

needs related to Mr. Brown’s diagnosis and treatment

of Hepatitis C and liver cirrhosis, or that its actions

caused or contributed to any injuries to him. The

medical records do not support the notion that the

treatment was intentionally withheld.

Doc. 68-2 at 16-21 (paragraph enumeration omitted).

IV. Standard of Review for Summary Judgment

Rule 56 instructs that “[t]he court shall grant summary judgment if the

movant shows that there is no genuine dispute as to any material fact and the

movant is entitled to judgment as a matter of law.” Rule 56(a). The record to

be considered on a motion for summary judgment may include “depositions,

documents, electronically stored information, affidavits or declarations,

stipulations (including those made for purposes of the motion only),

admissions, interrogatory answers, or other materials.” Rule 56(c)(1)(A). An

issue is genuine when the evidence is such that a reasonable jury could return

a verdict for the nonmovant. Mize v. Jefferson City Bd. of Educ., 93 F.3d 739,

742 (11th Cir. 1996) (quoting Hairston v. Gainesville Sun Publ’g Co., 9 F.3d

913, 919 (11th Cir. 1993)). “[A] mere scintilla of evidence in support of the non-

moving party’s position is insufficient to defeat a motion for summary

judgment.” Kesinger ex rel. Est. of Kesinger v. Herrington, 381 F.3d 1243, 1247

(11th Cir. 2004) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252

(1986)).

The party seeking summary judgment bears the initial burden of proving

to the court, by reference to the record, that there are no genuine issues of

material fact to be determined at trial. See Clark v. Coats & Clark, Inc., 929

F.2d 604, 608 (11th Cir. 1991). “When the non-moving party bears the burden

of proof on an issue at trial, the moving party need not ‘support its motion with

affidavits or other similar material negating the opponent’s claim,’ Celotex

Corp. v. Catrett, 477 U.S. 317, 323 (1986), in order to discharge this initial

responsibility.” Gonzalez v. Lee Cnty. Hous. Auth., 161 F.3d 1290, 1294 (11th

Cir. 1998). Instead, the moving party simply may show “that there is an

absence of evidence to support the nonmoving party’s case.” Id.

“When a moving party has discharged its burden, the non-moving party

must then go beyond the pleadings, and by its own affidavits, or by depositions,

answers to interrogatories, and admissions on file, designate specific facts

showing that there is a genuine issue for trial.” Jeffery v. Sarasota White Sox,

Inc., 64 F.3d 590, 593-94 (11th Cir. 1995) (internal citations and quotation

marks omitted). Substantive law determines the materiality of facts, and

“[o]nly disputes over facts that might affect the outcome of the suit under the

governing law will properly preclude the entry of summary judgment.”

Anderson, 477 U.S. at 248. In determining whether summary judgment is

appropriate, a court “must view all evidence and make all reasonable

inferences in favor of the party opposing summary judgment.” Haves v. City of

Miami, 52 F.3d 918, 921 (11th Cir. 1995) (citing Dibrell Bros. Int’l, S.A. v.

Banca Nazionale Del Lavoro, 38 F.3d 1571, 1578 (11th Cir. 1994)).

V. Defendants Corizon and Centurion’s Motions

a. Eighth Amendment

“To establish an Eighth Amendment violation, a prisoner must satisfy

both an objective and subjective inquiry regarding a prison official’s conduct.”

Oliver v. Fuhrman, 739 F. App’x 968, 969 (11th Cir. 2018) (citing Chandler v.

Crosby, 379 F.3d 1278, 1289 (11th Cir. 2004)). The Eleventh Circuit has

explained:

Under the objective component, a prisoner must

allege a condition that is sufficiently serious to violate

the Eighth Amendment. Id. The challenged condition

must be extreme and must pose an unreasonable risk

of serious damage to the prisoner’s future health or

safety. Id. The Eighth Amendment guarantees that

prisoners are provided with a minimal civilized level

of life’s basic necessities. Id.

Under the subjective component, a prisoner

must allege that the prison official, at a minimum,

acted with a state of mind that constituted deliberate

indifference. Id. This means the prisoner must show

that the prison officials: (1) had subjective knowledge

of a risk of serious harm; (2) disregarded that risk; and

(3) displayed conduct that is more than mere

negligence. Farrow v. West, 320 F.3d 1235, 1245 (11th

Cir. 2003).

Id. at 969-70. “To be cruel and unusual punishment, conduct that does not

purport to be punishment at all must involve more than ordinary lack of due

care for the prisoner's interests or safety.” Whitley v. Albers, 475 U.S. 312, 319

(1986).

As it relates to medical care, “[t]he Supreme Court has interpreted the

Eighth Amendment to prohibit ‘deliberate indifference to serious medical

needs of prisoners.’” Melton v. Abston, 841 F.3d 1207, 1220 (11th Cir. 2016)

(quoting Estelle v. Gamble, 429 U.S. 97, 102 (1976)). The Eleventh Circuit has

explained that

To prevail on a deliberate indifference claim, [a

plaintiff] must show: “(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 establish deliberate

indifference, [a plaintiff] must prove “(1) subjective

knowledge of a risk of serious harm; (2) disregard of

that risk; (3) by conduct that is more than [gross]

negligence.” Townsend v. Jefferson Cnty., 601 F.3d

1152, 1158 (11th Cir.2010) (alteration in original). The

defendants must have been “aware of facts from which

the inference could be drawn that a substantial risk of

serious harm exist[ed]” and then actually draw that

inference. Farrow v. West, 320 F.3d 1235, 1245 (11th

Cir. 2003) (quotation omitted).

Easley v. Dep’t of Corr., 590 F. App’x 860, 868 (11th Cir. 2014). “For medical

treatment to rise to the level of a constitutional violation, the care must be ‘so

grossly incompetent, inadequate, or excessive as to shock the conscience or to

be intolerable to fundamental fairness.’” Nimmons v. Aviles, 409 F. App’x 295,

297 (11th Cir. 2011) (quoting Harris v. Thigpen, 941 F.2d 1495, 1505 (11th

Cir.1991)); see also Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 1989)

(“Grossly incompetent or inadequate care can constitute deliberate

indifference, as can a doctor’s decision to take an easier and less efficacious

course of treatment” or fail to respond to a known medical problem).

Notably, the law is well settled that the Constitution is not implicated

by the negligent acts of corrections officials and medical personnel. Daniels v.

Williams, 474 U.S. 327, 330-31 (1986); Davidson v. Cannon, 474 U.S. 344, 348

(1986) (“As we held in Daniels, the protections of the Due Process Clause,

whether procedural or substantive, are just not triggered by lack of due care

by prison officials.”). As such, a complaint that a physician has been negligent

“in diagnosing or treating a medical condition does not state a valid claim of

medical mistreatment under the Eighth Amendment.” Bingham v. Thomas,

654 F.3d 1171, 1176 (11th Cir. 2011) (quotation marks and citation omitted).

Moreover, the Eleventh Circuit has stated that “[n]othing in our case law

would derive a constitutional deprivation from a prison physician’s failure to

subordinate his own professional judgment to that of another doctor; to the

contrary, it is well established that ‘a simple difference in medical opinion’ does

not constitute deliberate indifference.” Bismark v. Fisher, 213 F. App’x 892,

897 (11th Cir. 2007) (quoting Waldrop, 871 F.2d at 1033). Similarly, “the

question of whether governmental actors should have employed additional

diagnostic techniques or forms of treatment ‘is a classic example of a matter

for medical judgment’ and therefore not an appropriate basis for grounding

liability under the Eighth Amendment.” Adams v. Poag, 61 F.3d 1537, 1545

(11th Cir. 1995) (citation omitted). Even if deliberate indifference is shown, to

support an Eighth Amendment claim, the prisoner must prove harm caused by

the indifference. See Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989)

(delay in providing medical treatment does not constitute Eighth Amendment

violation unless delay was harmful).

Additionally, to prevail on a claim against Corizon and Centurion as

private entities serving a traditional public function, Plaintiff must meet the

test articulated in Monell v. Dep’t of Social Services of City of New York, 436

U.S. 658, 690-94 (1978). Accordingly, Plaintiff must show that an official policy

or custom caused the constitutional violation. Id. at 694. To make this showing,

he must demonstrate that (1) he was deprived of a constitutional right; (2)

Corizon and Centurion had a policy or custom; (3) the policy or custom

amounted to deliberate indifference to Plaintiff's constitutional right; and (4)

the policy or custom was the moving force behind the constitutional violation.

Mabe v. San Bernardino Cnty., Dep’t of Pub. Soc. Servs., 237 F.3d 1101, 1110-

11 (9th Cir. 2001). Further, if the policy or custom in question is an unwritten

one, the plaintiff must show that it is so “persistent and widespread” that it

constitutes a “permanent and well settled” practice. Monell, 436 U.S. at 691

(quoting Adickes v. S.H. Kress & Co., 398 U.S. 144, 167-68 (1970)). “Liability

for improper custom may not be predicated on isolated or sporadic incidents; it

must be founded upon practices of sufficient duration, frequency and

consistency that the conduct has become a traditional method of carrying out

policy.” Trevino v. Gates, 99 F.3d 911, 918 (9th Cir. 1996).

b. Serious Medical Need

Neither Defendant Corizon nor Defendant Centurion dispute that

Plaintiff established that his HCV constituted a serious medical need. Thus,

the Court considers only whether Defendants’ actions amounted to deliberate

indifference.

c. Deliberate Indifference

1. Corizon

Defendant Corizon argues it is entitled to summary judgment because

Plaintiff cannot establish the first element of the Monell analysis as the record

does not show that Plaintiff was deprived of a constitutional right. To that end,

Corizon asserts it did not act deliberately indifferent to Plaintiff’s serious

medical need because it consistently monitored Plaintiff’s condition and

facilitated Plaintiff’s routine consultations with a gastroenterologist. Corizon

Motion at 15. Corizon also asserts there is no record evidence that any

unconstitutional policy caused Plaintiff to suffer additional injury beyond that

of the disease. Id. According to Corizon, while Plaintiff asserts that delay in

treatment caused liver damage, there is no such evidence of liver damage,

rather the record shows Plaintiff was cured and suffered no other injury. Id.

In response, Plaintiff alleges that Defendants are aware of Plaintiff’s

heavy liver scarring and risk of liver cancer. Doc. 72 at 3. He also contends that

he is “not required to introduce verifying medical evidence concerning the

effect of the delay in treatment, because the obviousness of [his] serious

medical need is itself sufficient to satisfy the objective component of the

deliberate indifference test.” Id. at 3. In its Reply, Corizon argues that Plaintiff

has failed to meet his burden as the Response “includes no citation to the record

indicating a dispute of material fact . . .” and Plaintiff instead relies only on his

conclusory statements. Corizon Reply at 2.

Although the FDA first approved DAAs in late 2013, the record shows

that DAAs were not readily available in 2013, 2014, 2015, and 2016. Doc. 68-2

at 19. Indeed, HCV treatment before 2014 was limited to watchful waiting for

evidence of decompensation. And the record shows that Corizon routinely

monitored Plaintiff’s HCV symptoms between the commencement of its

contract with FDOC in September 2013 and the termination of its contract in

May 2016. During Corizon’s time, officials monitored Hepatitis C inmates by

conducting liver function tests and regular medical evaluations in the Chronic

Illness Clinic. The record shows that Plaintiff was followed in the Chronic

Illness Clinic for his Hepatitis C from 2010 to 2021. Doc. 68-2 at 8. Chronic

Illness Clinic records from 2014, 2015, and 2016 show that Corizon checked

the progression of Plaintiff’s HCV and during each of those assessments,

Plaintiff’s HCV was documented as “controlled” and “asymptomatic.” Doc. 70-

1 at 1-3. The record also shows that Plaintiff underwent liver function tests in

2013, 2014, 2015, and 2016, and these tests revealed he “had normal synthetic

function before and after the HCV treatment[, which] is an important and

excellent prognostic factor for him . . . [and] allegations that he is at risk for

advanced liver failure or death are unfounded.” Doc. 68-2 at 8. There is also no

evidence that medical tests completed between 2011 and 2016 revealed

Plaintiff had decompensated cirrhosis. See id. at 17.

While Plaintiff alleges that he filed several grievances complaining about

his HCV-related symptoms and requesting treatment, Plaintiff’s first

grievance related to any alleged delay was filed in December 2018. Indeed,

there is no evidence that he made any complaint about his HCV symptoms or

treatment while he was under Corizon’s care. On this record, the facts do not

show a deliberate disregard for Plaintiff’s HCV or that Corizon’s response to

Plaintiff’s serious medical need was “so grossly incompetent, inadequate, or

excessive as to shock the conscience or to be intolerable to fundamental

fairness.” Construing the facts in Plaintiff’s favor, he was cured of HCV in

September 2018 and his most recent APRI score is 0.232 and FIB-4 score is

1.33, neither of which indicates advanced fibrosis. Doc. 68-2 at 7. Thus, any

delay in treatment did not cause Plaintiff to suffer the HCV or liver-related

injuries he alleges in his Amended Complaint, and Plaintiff has not submitted

any evidence suggesting that he suffered those alleged injuries. The record

does not support Plaintiff’s claim that Corizon’s treatment amounted to an

Eighth Amendment violation, and summary judgment is due to be granted to

Defendant Corizon.

2. Defendant Centurion

Defendant Centurion argues that even if Plaintiff can show a Centurion

custom resulted in a delay of HCV treatment, his claim still fails because there

is no evidence that Centurion’s medical providers were deliberately indifferent

to his chronic HCV.5 Centurion Motion at 15. Centurion asserts that it

provided continuous care and monitoring to Plaintiff beginning in May 2016

and it continued to monitor Plaintiff’s condition until he was approved for DAA

treatment in March 2018 in accordance with the timeframe identified in

Hoffer.6 Id. According to Centurion, because of its adequate medical care,

Plaintiff was cured of his HCV. Id. at 17. Centurion also argues that Plaintiff

5 Centurion also argues that it was not the “final authority” on DAA treatment

or the “moving force” behind any policy or practice to delay DAA treatment but the

FDOC was responsible for such policy. Centurion Motion at 2. Alternatively,

Centurion argues that even if Plaintiff shows that Centurion had a policy to delay

treatment, Plaintiff has still failed to show that Centurion acted deliberately

indifferent. Id. at 15. Because the Court finds Centurion has not acted deliberately

indifferent, it need not decide whether Centurion had a policy to delay treatment.

6 The Court discusses the Hoffer litigation when addressing Defendant FDOC’s

Motion for Summary Judgment.

cannot show that he suffered any “increased physical injury” because of any

alleged delay in DAA treatment from May 2016 to March 2018. Id.

In response, Plaintiff alleges that Defendants are aware of Plaintiff’s

heavy liver scarring and risk of liver cancer. Doc. 72 at 3. He also contends that

he is “not required to introduce verifying medical evidence concerning the

effect of the delay in treatment, because the obviousness of [his] serious

medical need is itself sufficient to satisfy the objective component of the

deliberate indifference test.” Id. at 3.

Here, the evidence shows that Plaintiff received constitutionally

adequate treatment for his HCV while under the care of Centurion. The record

shows that starting in May 2016, Centurion regularly monitored Plaintiff’s

liver function and the progression of his HCV. Doc. 68-2 at 8. Centurion also

regularly evaluated Plaintiff in the Chronic Illness Clinic, where it maintained

a record of Plaintiff’s APRI score and his symptoms. Doc. 70-1 at 4. In July and

September 2016, Centurion recorded Plaintiff’s APRI scores as 0.625 and 0.6,

respectively, neither of which suggested Plaintiff was suffering from advanced

fibrosis when he came into Centurion’s care. Id. at 6. Further, per the FDOC’s

June 2016 HCV guidelines, neither of those APRI scores placed Plaintiff in the

Priority Level I group for urgent consideration of DAA treatment. Id. at 9.

Nevertheless, in October 2016, Plaintiff was logged for a special committee

review on his HCV and determination of a treatment schedule. Id. at 6.

In February 2017, Centurion recorded Plaintiff’s APRI score as 0.305

and documented that he remained asymptomatic. Id. at 6. Centurion recorded

that in November 2017, Plaintiff’s APRI score was 0.24 and his FIB-4 score

was 1.3, neither of which showed advanced fibrosis. But Centurion documented

that on November 29, 2017, for the first and only time, a FibroTest indicted a

score of 0.78, which placed Plaintiff in the “severe fibrosis” category. Centurion

immediately ordered that Plaintiff undergo a liver ultrasound, which

confirmed his liver appeared normal and further supporting that the

November 29, 2017, FibroTest score did not correlate with any prior or

subsequent test of liver fibrosis. Indeed, in February 2018, Centurion again

documented Plaintiff’s APRI score as 0.5 and his Fib-4 score as 1.61, neither of

which reflected advanced fibrosis or cirrhosis. Doc. 68-2 at 7.

Centurion approved Plaintiff for an 84-day round of DAA treatment in

March 2018, and documented Plaintiff’s progression and symptoms

throughout the treatment. Id. Plaintiff tolerated the treatment well and in

September 2018, Plaintiff’s HCV RNA (viral load) was < 15 IU/mL, which

revealed Plaintiff was cured of HCV. Id. In November 2018, Plaintiff advised

medical that he was “doing great.” Again, while Plaintiff alleges that he filed

several grievances complaining about his HCV-related symptoms and

requesting treatment, Plaintiff’s first grievance related to any alleged delay

was filed in December 2018, after he was cured. Indeed, there is no evidence

that Plaintiff made any complaint about his HCV symptoms or delay in

treatment before Centurion provided him with DAAs and cured his HCV.

These facts do not show a deliberate disregard for Plaintiff’s HCV or that

Centurion’s response to Plaintiff’s medical needs was “so grossly incompetent,

inadequate, or excessive as to shock the conscience or to be intolerable to

fundamental fairness.” The record indicates that Plaintiff has suffered no

injury because of the alleged delay in treatment. Construing the facts in

Plaintiff’s favor, his most recent tests show an APRI score of 0.232, a FIB-4

score of 1.33, and a FibroTest score of F2, none indicate advanced fibrosis. Id.

at 7. Thus, any delay in treatment did not cause Plaintiff to suffer the HCV or

liver-related injuries he alleges in his Amended Complaint, and Plaintiff has

provided no evidence to support his claim otherwise. Even though Plaintiff has

already received DAA treatment, the record shows that Centurion continues

to monitor Plaintiff’s symptoms and regularly tests him for fibrosis. The record

does not support Plaintiff’s claim that Centurion’s treatment amounted to an

Eighth Amendment violation, and summary judgment is due to be granted to

Defendant Centurion.

VI. Defendant FDOC’s Motion

a. ADA and RA

In Counts III and IV, Plaintiff sues Defendant FDOC under the ADA and

RA, respectively. Plaintiff alleges that he is a qualified individual with a

disability, “because HCV is a physiological disorder that affects one or more

body systems . . . .” AC at 14. He asserts that “[b]y withholding medical

treatment for those with HCV, but not withholding medical treatment from

those with other disabilities or those who are not disabled, Defendant FD[O]C

excluded Plaintiff from participation in, and denied him the benefits of” FDOC

services, programs, and activities because of his disability. Id. at 17-18.

According to Plaintiff, FDOC knew about the violations but failed to correct

them, exhibiting deliberate indifference to Plaintiff’s rights. Id. at 18, 20.

Defendant FDOC moves for summary judgment, arguing that Plaintiff

cannot show that it acted deliberately indifferent to Plaintiff’s HCV as to

articulate an ADA or RA claim against it. FDOC Motion at 7. FDOC asserts

that Plaintiff’s allegations that he has “severe cirrhosis” and “permanent liver

damage” are merely conclusory statements with no record support. Id. at 10-

11. Rather, according to FDOC, Plaintiff’s medical records do not show any

evidence of “hepatocellular carcinoma or liver cancer,” and there is no evidence

of “ascites or esophageal varices.” Id. at 15. Further, FDOC argues that the

record shows Plaintiff’s HCV was and is regularly monitored and any alleged

delay in treatment did not cause or contribute to Plaintiff’s fibrosis as Plaintiff

did not suffer any HCV or liver-related injuries. Id. In support of its argument

that it provided adequate medical care to Plaintiff, FDOC relies on the

Eleventh Circuit’s opinion in Hoffer v. Sec’y, Fla. Dep’t of Corr., 973 F.3d 1263,

1279 (11th Cir. 2020). FDOC Motion at 18.

To prevail on his ADA and RA claims for compensatory damages,

Plaintiff must establish that FDOC acted with “discriminatory intent” in

violating Plaintiff's statutory rights. McCullum v. Orlando Reg’l Healthcare

Sys., Inc., 768 F.3d 1135, 1146-47 (11th Cir. 2014). Plaintiff “may prove

discriminatory intent by showing that [FDOC] was deliberately indifferent to

his statutory rights.”7 See id. at 1147. “That is an exacting standard which

requires more than gross negligence.” Id. (internal citation and quotation

marks omitted). To satisfy this standard, Plaintiff must “show that [FDOC]

knew that harm to a federally protected right was substantially likely and

failed to act on that likelihood.” Id. (quotation marks and citation omitted). The

Eleventh Circuit recognizes several examples of conduct that meet this

standard, including “(1) knowledge of a serious medical need and a failure or

refusal to provide care; [and] (2) delaying treatment for non-medical reasons[.]”

Baez v. Rogers, 522 F. App’x 819, 822 (11th Cir. 2013).

7 The “deliberate indifference” standard is the same in both the Eighth

Amendment and ADA/RA contexts. Whether the deliberate indifference is to a

plaintiff's rights under the Constitution or a federal statute, “a plaintiff must show

that the defendant ‘knew harm to a federally protected right was substantially likely’

and ‘failed to act on that likelihood.’” McCullum, 768 F.3d at 1147 (citation omitted);

see also Martin v. Halifax Healthcare Sys., Inc., 621 F. App’x 594, 604 (11th Cir. 2015)

(relying on Eighth Amendment jurisprudence to articulate deliberate indifference

standard in ADA/RA context).

In the Hoffer litigation, the Northern District of Florida certified a class

consisting of “all current and future prisoners in the custody of the Florida

Department of Corrections who have been diagnosed, or will be diagnosed,

with” HCV. Hoffer v. Jones, 323 F.R.D. 694, 700 (N.D. Fla. 2017). The plaintiffs

sued the Secretary of the FDOC in her official capacity, alleging the denial of

DAAs under a cost-savings policy violated, inter alia, the Eighth Amendment.

Id. at 696. Following an evidentiary hearing, the court granted the plaintiffs’

request for a preliminary injunction and issued an opinion. See Hoffer, 290 F.

Supp. 3d at 1306. After resolving issues raised on summary judgment, the

court entered a permanent injunction mandating that the FDOC provide DAA

treatment for all HCV-positive inmates. See Hoffer v. Inch, 382 F. Supp. 3d

1288 (N.D. Fla. 2019). The Secretary appealed the court’s ruling on summary

judgment, and on August 31, 2020, the Eleventh Circuit vacated the district

court’s permanent injunction; reversed the court’s finding that the Secretary’s

treatment of F0-and F1-level HCV-positive inmates violated the Eighth

Amendment, “with instruction to award summary judgment to the Secretary

on that issue”; and remanded the rest of the district court’s order, “so that it

can make the findings required by the PLRA.” Hoffer, 973 F.3d at 1279. The

Eleventh Circuit reasoned that the Eighth Amendment does not prohibit

prison officials from considering cost in determining what type of medical

treatment to provide and since the Secretary had implemented a treatment

plan that provides “minimally adequate care,” the plaintiffs cannot say that

her conduct in treating HCV-positive inmates amounted to deliberate

indifference. Id. at 1277-78.

Defendant FDOC now relies on the Eleventh Circuit’s opinion to support

its claim that it has not acted deliberately indifferent, and the Court finds the

Eleventh Circuit’s reasoning binding. FDOC does not dispute that Plaintiff’s

HCV amounted to a serious medical need or that it knew of that serious

medical need. Rather, it argues that it, through Corizon and Centurion,

provided adequate medical care to Plaintiff and its decisions about Plaintiff’s

HCV care were not made with discriminatory intent but were based on a well-

thought-out prioritization schedule that considered the severity of Plaintiff’s

condition and the resources available to the FDOC. The Court agrees.

The record shows that starting in 2008, when Plaintiff was diagnosed

with HCV, until present day, FDOC has routinely monitored Plaintiff’s liver

function. The record also shows that DAAs did not become the standard of care

until 2016, and in June 2016, the FDOC revised its HCV guidelines to outline

a treatment and priority plan for its inmates with HCV. FDOC then revised

those guidelines in 2017 to account for more prioritization criteria. Doc. 68-2

at 9-10. As explained, FDOC, Corizon, and Centurion continuously supervised

Plaintiff based on the relevant prioritization criteria (APRI score and the FIB-

4 score), regularly evaluated Plaintiff in the Chronic Illness Clinic, and

conducted follow-up tests and ultrasounds when warranted. Per its guidelines,

Plaintiff was eventually treated with DAAs and cured of his HCV in 2018.

Plaintiff has presented no evidence that any FDOC guideline or delay in

Plaintiff’s treatment stemmed from intentional discrimination based on

Plaintiff’s HCV diagnosis.

Also, as explained, the record shows the delay in treatment did not cause

Plaintiff to suffer any liver-related injury. Plaintiff was cured of his HCV and

his most recent tests show no advanced fibrosis or cirrhosis. Indeed, all of

Plaintiff’s liver function tests are normal and FDOC continues to monitor

Plaintiff to confirm that his test results remain stable. Thus, because FDOC

has followed a treatment plan that provides “minimally adequate care,” the

Court cannot say that its conduct in treating Plaintiff’s HCV and ultimately

curing him of the virus, was so reckless as to constitute deliberate indifference.

Defendant FDOC is entitled to summary judgment on Plaintiff’s ADA and RA

claims.

Accordingly, it is

ORDERED AND ADJUDGED:

1. Defendant Centurion’s Motion for Summary Judgment (Doc. 68) is

GRANTED.

2. Defendant FDOC’s Motion for Summary Judgment (Doc. 69) is

GRANTED.

3. Defendant Corizon’s Motion for Summary Judgment (Doc. 71) is

GRANTED.

4. The Clerk is DIRECTED to enter judgment for Defendants and

against Plaintiff and CLOSE the case.

DONE AND ORDERED at Jacksonville, Florida, this 3rd day of

August, 2022.

J) é / =

fo Axons a OA

BRIAN. DAVIS

United States District Judge

Jax-7

C: Perry Brown, #044515

Counsel of record

36