Scott v. Dixon

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

JACKSONVILLE DIVISION

PAUL W. SCOTT,

Plaintiff,

v. Case No. 3:22-cv-679-MMH-PDB

RICKY DIXON, et al.,

Defendants.

________________________________

ORDER

I. Status

Plaintiff Paul W. Scott, an inmate in the custody of the Florida

Department of Corrections (FDOC), initiated this action on June 17, 2022, by

filing a pro se Civil Rights Complaint (Complaint; Doc. 1)1 with attachments

(Docs. 1-1 through 1-9) pursuant to 42 U.S.C. § 1983. In the Complaint, Scott

names as Defendants: (1) FDOC Secretary Ricky Dixon; (2) Warden Travis

Lamb; (3) Centurion of Florida, LLC; (4) Nurse Wendy Hall; and (5) Nurse

Patricia McDonald. Complaint at 2-3. He asserts that Defendants acted with

deliberate indifference in violation of the Eighth Amendment when he received

1 For all pleadings and documents filed in this case, the Court cites to the

document and page numbers as assigned by the Court’s Electronic Case Filing

System.

an overdose of insulin on June 16, 2020. See id. at 3-7. Scott requests

declaratory relief and monetary damages. Id. at 8.

This matter is before the Court on the following Motions: (1) Centurion

of Florida, LLC’s Motion to Dismiss (Centurion Motion; Doc. 17); (2) Secretary

Dixon and Warden Lamb’s Motion to Dismiss (FDOC Motion; Doc. 24)

(collectively FDOC Defendants); and (3) Nurses McDonald and Hall’s Motion

to Dismiss (Nurses Motion; Doc. 25) (collectively Nurse Defendants). Scott filed

responses in opposition to the Motions. See Centurion Response (Doc. 22);

FDOC/Nurses Response (Doc. 35). Defendants’ Motions are ripe for review.

II. Plaintiff’s Allegations2

Scott alleges that he has diabetes, and on June 16, 2020, he was

scheduled to receive an insulin shot during “medication call” at Union

Correctional Institution (UCI). Complaint at 3. According to Scott, when Nurse

McDonald arrived at his cell in P-Dorm to administer the shot, he “noticed she

had a hard time reading the labels on the bottles.” Id. at 4. Scott told Nurse

McDonald the amount of regular and “N.P.H.” insulin that he should receive.

2 In considering the Motions, the Court must accept all factual allegations in

the Complaint as true, consider the allegations in the light most favorable to Scott,

and accept all reasonable inferences that can be drawn from such allegations. Hill v.

White, 321 F.3d 1334, 1335 (11th Cir. 2003); Jackson v. Okaloosa Cnty., 21 F.3d 1531,

1534 (11th Cir. 1994). As such, the facts recited here are drawn from the Complaint,

and may well differ from those that ultimately can be proved.

2

Id. Nurse McDonald allegedly responded, “I know how to do my job, and I don’t

need you trying to tell me how to do it,” and then administered the shot. Id.

Scott avers that approximately 30 minutes after Nurse McDonald

administered the shot, “[he] felt [his] blood sugar drop drastically,” and he

began to sweat, shake, and vomit. Id. During the next security check, Officer

Middlebrooks observed Scott’s symptoms and told Nurse McDonald that Scott

“was in medical distress and that she needed to come check on [him].” Id. She

allegedly refused. Id. Scott avers that Officer Middlebrooks then contacted the

urgent care office, after which Scott was “immediately” placed in a wheelchair

and transported to the urgent care building. Id.

The urgent care nurses discovered that Scott had low blood sugar, so

they gave him food and a tube of glucose. Id. at 4-5. When the nurses checked

his blood sugar fifteen minutes later, it was 87. Id. at 5. According to Scott, his

pulse was 162, and his blood pressure had increased from 198 over 109 to 200

over 100. Id. Scott also continued to experience nausea, vomiting, blurry vision,

and confusion. Id. He alleges that because UCI could not provide the necessary

treatment, he was transported to Shands Hospital, where the staff stabilized

and admitted him for treatment. Id. He was discharged from Shands on June

18, 2020. Id.

3

According to Scott, Nurse McDonald “overdosed [him] with insulin by

giving [him] the amount of regular insulin for N.P.H. and the amount of N.P.H.

for regular insulin.” Id. at 6, He contends that “through conversation with

medical staff and nurses[,] [] it is common knowledge that [he] was

administered an overdose of regular insulin.” Id. Scott avers that “[u]pon

information and belief this is not the first time that Nurse M[]cDonald

overdosed an inmate with insulin. There have been several inciden[ts].” Id. As

a result of the alleged overdose, Scott now suffers from memory loss,

diminished eyesight, loss of taste, and diminished capacity for comprehension.

Id.

III. Motion to Dismiss Standard

In ruling on a motion to dismiss, the Court must accept the factual

allegations set forth in the complaint as true. See Ashcroft v. Iqbal, 556 U.S.

662, 678 (2009); Swierkiewicz v. Sorema N.A., 534 U.S. 506, 508 n.1 (2002); see

also Lotierzo v. Woman’s World Med. Ctr., Inc., 278 F.3d 1180, 1182 (11th Cir.

2002). In addition, all reasonable inferences should be drawn in favor of the

plaintiff. See Randall v. Scott, 610 F.3d 701, 705 (11th Cir. 2010). Nonetheless,

the plaintiff must still meet some minimal pleading requirements. Jackson v.

BellSouth Telecomms., 372 F.3d 1250, 1262-63 (11th Cir. 2004). Indeed, while

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“[s]pecific facts are not necessary[,]” the complaint should “‘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) (per curiam) (quoting Bell Atlantic

Corp. v. Twombly, 550 U.S. 544, 555 (2007)). Further, the plaintiff must allege

“enough facts to state a claim to relief that is plausible on its face.” Twombly,

550 U.S. at 570. “A claim has facial plausibility when the pleaded factual

content allows the court to draw the reasonable inference that the defendant

is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678 (citing Twombly,

550 U.S. at 556).

A “plaintiff’s obligation to provide the grounds of his entitlement to relief

requires more than labels and conclusions, and a formulaic recitation of the

elements of a cause of action will not do[.]” Twombly, 550 U.S. at 555 (internal

quotations omitted); see also Jackson, 372 F.3d at 1262 (explaining that

“conclusory allegations, unwarranted deductions of facts or legal conclusions

masquerading as facts will not prevent dismissal”) (quotations, citation, and

original alteration omitted). Indeed, “the tenet that a court must accept as true

all of the allegations contained in a complaint is inapplicable to legal

conclusions[,]” which simply “are not entitled to [an] assumption of truth.”

Iqbal, 556 U.S. at 678, 680. Thus, in ruling on a motion to dismiss, the Court

5

must determine whether the complaint contains “sufficient factual matter,

accepted as true, to ‘state a claim to relief that is plausible on its face[.]’” Id. at

678 (quoting Twombly, 550 U.S. at 570). And, while “[p]ro se pleadings are held

to a less stringent standard than pleadings drafted by attorneys and will,

therefore, be liberally construed,” Tannenbaum v. United States, 148 F.3d

1262, 1263 (11th Cir. 1998), “‘this leniency does not give a court license to serve

as de facto counsel for a party or to rewrite an otherwise deficient pleading in

order to sustain an action.’” Campbell v. Air Jamaica Ltd., 760 F.3d 1165, 1168-

69 (11th Cir. 2014) (quoting GJR Invs., Inc. v. Cnty. of Escambia, 132 F.3d

1359, 1369 (11th Cir. 1998), overruled in part on other grounds as recognized

in Randall, 610 F.3d at 709).

IV. Summary of the Arguments

In its Motion, Centurion argues that Scott’s claim against it should be

dismissed because he fails to state an Eighth Amendment deliberate

indifference claim upon which relief can be granted. See Centurion Motion at

7-8. In their Motion, the FDOC Defendants request that the Court dismiss

Scott’s claims against them because: (1) they are entitled to Eleventh

Amendment immunity; (2) Scott fails to state an Eighth Amendment claim

upon which relief can be granted; (3) he fails to state a cause of action against

6

them; (4) the Complaint is a shotgun pleading; and (5) they are entitled to

qualified immunity. See FDOC Motion at 4-15. The Nurse Defendants also

argue that Scott’s claims against them should be dismissed because: (1) he fails

to state an Eighth Amendment claim upon which relief can be granted, and (2)

they are entitled to qualified immunity. See Nurses Motion at 7-12. In

response, Scott argues that he states plausible Eighth Amendment claims

against all Defendants. See Centurion Response at 3-7; FDOC/Nurses

Response at 10-11.

V. Analysis

A. Federal Rule of Civil Procedure 8

The FDOC Defendants argue that Scott’s Complaint is a “shotgun

pleading” that violates Federal Rule of Civil Procedure 8(a)(2). See FDOC

Motion at 10-13. A civil rights complaint must include a short and plain

statement of the claim showing that the plaintiff is entitled to relief. Fed. R.

Civ. P. 8(a)(2). While not required to include detailed factual allegations, a

complaint must allege “more than an unadorned, the-defendant-unlawfully-

harmed-me accusation.” Iqbal, 556 U.S. at 678. Indeed, a complaint is

insufficient “if it tenders ‘naked assertion[s]’ devoid of ‘further factual

enhancement.’” Id. (quoting Twombly, 550 U.S. at 557). To avoid dismissal for

7

failure to state a claim on which relief can be granted, a complaint must include

“factual content that allows the court to draw the reasonable inference that the

defendant is liable for the misconduct alleged.” Id. Moreover, “[w]hile legal

conclusions can provide the framework of a complaint, they must be supported

by factual allegations.” Id. at 679. Notably, a “shotgun pleading” is a complaint

that fails to comply with Rule 8(a)(2) because it contains numerous causes of

action adopting the factual allegations of all preceding counts; is “replete with

conclusory, vague, and immaterial facts not obviously connected to any

particular cause of action”; does not separate causes of action into separate

counts; or asserts multiple claims against multiple defendants while failing to

specify which defendants are responsible for which acts or omissions. Weiland

v. Palm Beach Cnty. Sheriff’s Off., 792 F.3d 1313, 1322 (11th Cir. 2015).

Here, Scott identifies Secretary Dixon as the person who “is legally

responsible for the over-all operation of the Department and each Institution

under its jurisdiction, including Union Correctional Institution.” Complaint at

2. He also sues Warden Lamb who is “legally responsible for the operation of

Union Correctional Institution and for the welfare of all the inmates at that

prison.” Id. However, beyond these descriptors, Scott fails to specify any acts

or omissions for which the FDOC Defendants are responsible. See generally id.

8

He also does not assert any facts as to how they violated his federal

constitutional rights or were involved in the alleged overdose or his subsequent

treatment. See id. As such, the Court finds the Complaint does not set forth a

short and plain statement of Scott’s entitlement to relief such that the FDOC

Defendants have fair notice of the claims against them and the facts

underlying those claims. See Twombly, 550 U.S. at 555 (noting that the

purpose of Rule 8(a)(2) is “to give the defendant fair notice of what the . . . claim

is and the grounds upon which it rests”) (alteration in original) (citation

omitted). Thus, the FDOC Motion is due to be granted on this basis.

B. Eleventh Amendment Immunity

The FDOC Defendants next assert that they are entitled to Eleventh

Amendment immunity because Scott sues them “by virtue of their positions

only.” FDOC Motion at 5.

The Eleventh Amendment provides that “[t]he

Judicial power of the United States shall not be

construed to extend to any suit in law or equity,

commenced or prosecuted against one of the United

States by Citizens of another State, or by Citizens or

Subjects of any Foreign State.” U.S. Const. amend. XI.

It is well established that, in the absence of consent, “a

suit in which the State or one of its agencies or

departments is named as the defendant is proscribed

by the Eleventh Amendment.” Papasan v. Allain, 478

U.S. 265, 276 (1986) (quotation omitted). The Eleventh

Amendment also prohibits suits against state officials

9

where the state is the real party in interest, such that

a plaintiff could not sue to have a state officer pay

funds directly from the state treasury for the wrongful

acts of the state. Summit Med. Assocs., P.C. v. Pryor,

180 F.3d 1326, 1336 (11th Cir. 1999).

Hayes v. Sec’y, Fla. Dep’t of Child. & Fams., 563 F. App’x 701, 703 (11th Cir.

2014).3 In Zatler v. Wainwright, 802 F.2d 397, 400 (11th Cir. 1986) (per

curiam), the Eleventh Circuit noted:

It is clear that Congress did not intend to

abrogate a state’s eleventh amendment immunity in

section 1983 damage suits. Quern v. Jordan, 440 U.S.

332, 340-45, 99 S.Ct. 1139, 1144-45, 59 L.Ed.2d 358

(1979). Furthermore, after reviewing specific

provisions of the Florida statutes, we recently

concluded that Florida's limited waiver of sovereign

immunity was not intended to encompass section 1983

suits for damages. See Gamble,[4] 779 F.2d at 1513-20.

Accordingly, in Zatler, the court found that the FDOC Secretary was immune

from suit in his official capacity. Id.

The Eleventh Amendment bars suit against the FDOC Defendants for

monetary damages in their official capacities. Here, the Complaint does not

3 The Court does not rely on unpublished opinions as binding precedent;

however, they may be cited in this Order when the Court finds them persuasive on a

particular point. See McNamara v. GEICO, 30 F.4th 1055, 1060-61 (11th Cir. 2022);

see generally Fed. R. App. P. 32.1; 11th Cir. R. 36-2 (“Unpublished opinions are not

considered binding precedent, but they may be cited as persuasive authority.”).

4 Gamble v. Fla. Dep’t of Health & Rehab. Servs., 779 F.2d 1509 (11th Cir.

1986).

10

identify the capacities in which the FDOC Defendants are being sued, see

generally Complaint, and Scott requests monetary relief under § 1983, which

would not be available if he sued the FDOC Defendants in their official

capacities only. In an abundance of caution, the Court will construe the

Complaint as raising claims against the FDOC Defendants in their individual

and official capacities. Therefore, the FDOC Motion is due to be granted only

as to Scott’s claims against the FDOC Defendants in their official capacities.

C. Eighth Amendment Deliberate Indifference

Pursuant to the Eighth Amendment of the United States Constitution,

“Excessive bail shall not be required, nor excessive fines imposed, nor cruel

and unusual punishments inflicted.” U.S. Const. amend. VIII. The Eighth

Amendment “imposes duties on [prison] officials, who must provide humane

conditions of confinement; prison officials must ensure that inmates receive

adequate food, clothing, shelter, and medical care, and must ‘take reasonable

measures to guarantee the safety of the inmates.’” Farmer v. Brennan, 511

U.S. 825, 832 (1994) (quoting Hudson v. Palmer, 468 U.S. 517, 526-27 (1984)).

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

objective and subjective inquiry regarding a prison official’s conduct. Swain v.

11

Junior, 961 F.3d 1276, 1285 (11th Cir. 2020) (citing Farmer, 511 U.S. at 834);

Chandler v. Crosby, 379 F.3d 1278, 1289 (11th Cir. 2004).

As it relates to medical care, “the Supreme Court has held that prison

officials violate the bar on cruel and unusual punishments when they display

‘deliberate indifference to serious medical needs of prisoners.’” Keohane v. Fla.

Dep’t of Corr. Sec’y, 952 F.3d 1257, 1265 (11th Cir. 2020) (quoting Estelle v.

Gamble, 429 U.S. 97, 104 (1976)). 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 show that a prison official acted with

deliberate indifference to serious medical needs, a

plaintiff must satisfy both an objective and a

subjective inquiry.” Farrow v. West, 320 F.3d 1235,

1243 (11th Cir. 2003). To meet the first prong, the

plaintiff must demonstrate an “objectively serious

medical need”—i.e., “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,” and, in either

instance, “one that, if left unattended, poses a

substantial risk of serious harm.” Id. (alteration

adopted) (quotations omitted). To satisfy the second,

subjective prong, the plaintiff must prove that the

prison officials “acted with deliberate indifference to

[his serious medical] need.” Harper v. Lawrence Cnty.,

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592 F.3d 1227, 1234 (11th Cir. 2010) (quotation

omitted). “To establish deliberate indifference,” a

plaintiff must demonstrate that the prison officials “(1)

had subjective knowledge of a risk of serious harm; (2)

disregarded that risk; and (3) acted with more than

gross negligence.” Id. (quotation omitted).[5] An

inmate-plaintiff bears the burden to establish both

prongs. Goebert v. Lee Cnty., 510 F.3d 1312, 1326

(11th Cir. 2007).

Hoffer v. Sec’y, Fla. Dep’t of Corr., 973 F.3d 1263, 1270 (11th Cir. 2020)

(footnote omitted). Importantly, for allegedly inadequate 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.’” Hoffer, 973 F.3d at 1271 (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

5 The Eleventh Circuit previously recognized “a tension within [its] precedent

regarding the minimum standard for culpability under the deliberate-indifference

standard.” Hoffer v. Sec’y, Fla. Dep’t of Corr., 973 F.3d 1263, 1270 n.2 (11th Cir.

2020). Regardless, the court stated that the “competing articulations–‘gross’ vs. ‘mere’

negligence”–may be “a distinction without a difference” because “no matter how

serious the negligence, conduct that can’t fairly be characterized as reckless won’t

meet the Supreme Court’s standard.” Id.; see also Patel v. Lanier Cnty., 969 F.3d

1173, 1188 n.10 (11th Cir. 2020). The court has resolved that tension by unequivocally

instructing that an Eighth Amendment deliberate indifference claim requires a

showing that a defendant “acted with more than gross negligence.” Wade v. McDade,

67 F.4th 1363, 1374 (11th Cir. 2023) (emphasis omitted).

13

easier and less efficacious course of treatment” (internal citation omitted) or

fail to respond to a known medical problem).

While the bar to establishing an Eighth Amendment deliberate

indifference claim is high, the Eleventh Circuit Court of Appeals has instructed

that it is “appropriately high.” Wade v. McDade, 67 F.4th 1363, 1378 (11th Cir.

2023). Indeed, 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.”). 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) (quotations and citation omitted).

Moreover, the Eleventh Circuit has noted 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,

14

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).

1. Centurion

Centurion asks the Court to dismiss Scott’s Eighth Amendment claim

against it because he fails to identify a custom or policy of Centurion that

amounted to deliberate indifference or caused a federal constitutional

violation. Centurion Motion at 8. Notably, Centurion contracted with the

FDOC to provide medical services to inmates within the State of Florida.

Although Centurion is not a governmental entity, “[w]here a function which is

traditionally the exclusive prerogative of the state . . . is performed by a private

entity, state action is present” for purposes of § 1983. Ancata v. Prison Health

Servs., Inc., 769 F.2d 700, 703 (11th Cir. 1985). Indeed,

“[w]hen a private entity . . . contracts with a county to

provide medical services to inmates, it performs a

function traditionally within the exclusive prerogative

of the state” and “becomes the functional equivalent of

the municipality” under section 1983. Buckner v. Toro,

116 F.3d 450, 452 (11th Cir. 1997). “[L]iability under §

15

1983 may not be based on the doctrine of respondeat

superior.” Grech v. Clayton Cnty., Ga., 335 F.3d 1326,

1329 (11th Cir. 2003) (en banc).

Craig v. Floyd Cnty., 643 F.3d 1306, 1310 (11th Cir. 2011); see Denham v.

Corizon Health, Inc., Case No. 6:13-cv-1425-Orl-40KRS, 2015 WL 3509294, at

*3 n.1 (M.D. Fla. June 4, 2015)6 (“[W]hen a government function is performed

by a private entity like Corizon, the private entity is treated as the functional

equivalent of the government for which it works.”) (citation omitted), aff’d 675

F. App’x 935 (11th Cir. 2017).

Where a deliberate indifference medical claim is brought against an

entity, such as Centurion, based upon its functional equivalence to a

government entity, the assertion of a constitutional violation is merely the first

hurdle in a plaintiff’s case. This is so because liability for constitutional

deprivations under § 1983 cannot be based on the theory of respondeat

superior. Craig, 643 F.3d at 1310 (quoting Grech, 335 F.3d at 1329); see Denno

v. Sch. Bd. Of Volusia Cnty., 218 F.3d 1267, 1276 (11th Cir. 2000). Instead, a

government entity may be liable in a § 1983 action “only where the

6 The Court notes that although decisions of other district courts are not

binding, they too may be cited as persuasive authority. See Stone v. First Union

Corp., 371 F.3d 1305, 1310 (11th Cir. 2004) (noting that, “[a]lthough a district court

would not be bound to follow any other district court’s determination, the decision

would have significant persuasive effects.”).

16

[government entity] itself causes the constitutional violation at issue.” Cook

ex. rel. Estate of Tessier v. Sheriff of Monroe Cnty., 402 F.3d 1092, 1116 (11th

Cir. 2005) (citations omitted). Thus, a plaintiff must establish that an official

policy or custom of the government entity was the “moving force” behind the

alleged constitutional deprivation. See Monell v. Dep’t of Soc. Servs. of N.Y.,

436 U.S. 658, 693-94 (1978).

In Monell, the Supreme Court held that local governments can be held

liable for constitutional torts caused by official policies. However, such liability

is limited to “acts which the [government entity] has officially sanctioned or

ordered.” Pembaur v. City of Cincinnati, 475 U.S. 469, 480 (1986). Under the

directives of Monell, a plaintiff also must allege that the constitutional

deprivation was the result of “an official government policy, the actions of an

official fairly deemed to represent government policy, or a custom or practice

so pervasive and well-settled that it assumes the force of law.” Denno, 218 F.3d

at 1276; see Hoefling v. City of Miami, 811 F.3d 1271, 1279 (11th Cir. 2016)

(stating Monell “is meant to limit § 1983 liability to ‘acts which the

municipality has officially sanctioned or ordered’”; adding that “[t]here are,

however, several different ways of establishing municipal liability under §

1983”).

17

“A policy is a decision that is officially adopted by the [government entity]

or created by an official of such rank that he or she could be said to be acting

on behalf of the [government entity].” Sewell v. Town of Lake Hamilton, 117

F.3d 488, 489 (11th Cir. 1997) (citation omitted). The policy requirement is

designed to “‘distinguish acts of the [government entity] from acts of employees

of the [government entity], and thereby make clear that [governmental]

liability is limited to action for which the [government entity] is actually

responsible.’” Grech, 335 F.3d at 1329 n.5 (quotation and citation omitted).

Indeed, governmental liability arises under § 1983 only where “‘a deliberate

choice to follow a course of action is made from among various alternatives’” by

governmental policymakers. City of Canton v. Harris, 489 U.S. 378, 389 (1989)

(quoting Pembaur, 475 U.S. at 483-84). A government entity rarely will have

an officially-adopted policy that permits a particular constitutional violation,

therefore, in order to state a cause of action for damages under § 1983, most

plaintiffs must demonstrate that the government entity has a custom or

practice of permitting the violation. See Grech, 335 F.3d at 1330; McDowell v.

Brown, 392 F.3d 1283, 1289 (11th Cir. 2004). A custom is an act “that has not

been formally approved by an appropriate decisionmaker,” but that is “so

widespread as to have the force of law.” Bd. Of Cnty. Comm’rs of Bryan Cnty.

18

v. Brown, 520 U.S. 397, 404 (1997). The Eleventh Circuit has defined “custom”

as “a practice that is so settled and permanent that it takes on the force of law,”

see Sewell, 117 F.3d at 489, or a “persistent and wide-spread practice” of which

the entity is aware, see Denno, 218 F.3d at 1277. Last, “[t]o hold the

[government entity] liable, there must be ‘a direct causal link between [its]

policy or custom and the alleged constitutional deprivation.’” Snow ex rel. Snow

v. City of Citronelle, 420 F.3d 1262, 1271 (11th Cir. 2005) (quoting Canton, 489

U.S. at 385). Because Centurion’s liability under § 1983 would be based on its

functional equivalence to the government entity responsible for providing

medical care and services to inmates, Scott must plead that an official policy

or a custom or practice of Centurion was the moving force behind the alleged

federal constitutional violation.

Here, Scott neither identifies an official Centurion policy of deliberate

indifference nor an unofficial Centurion custom or practice that acted as a

moving force behind the alleged constitutional violation. In fact, Scott’s

Complaint is devoid of any specific claims against Centurion as opposed to

Nurse McDonald. His factual allegations relate only to a single incident at UCI

in which Nurse McDonald allegedly gave Scott an overdose of insulin.

However, even assuming Nurse McDonald’s actions amounted to deliberate

19

indifference, “[a] single incident of a constitutional violation is insufficient to

prove a policy or custom . . . .” Craig, 643 F.3d at 1311. Upon review, the Court

concludes that Scott has not alleged facts sufficient to state a plausible Eighth

Amendment claim for relief against Centurion, and Centurion’s Motion is due

to be granted.

2. FDOC Defendants

The FDOC Defendants contend that Scott “fails to state any cognizable

claims against [them] or how the actions of other Parties are attributable to

[them].” FDOC Motion at 9. They assert that Scott did not have an objectively

serious medical need, and the factual allegations in the Complaint

demonstrate that Scott received immediate medical care. Id. at 6-7. According

to the FDOC Defendants, Scott pleads no facts from which the Court could

plausibly infer that they ignored his medical condition or provided him with

inadequate treatment. See id. at 9.

From a review of the Complaint, it appears that Scott sues Warden Lamb

and Secretary Dixon based on their supervisory positions. See Complaint at 2.

The Eleventh Circuit has held that “[i]t is well established in this Circuit that

supervisory officials are not liable under § 1983 for the unconstitutional acts

of their subordinates on the basis of respondeat superior or vicarious liability.”

20

Cottone v. Jenne, 326 F.3d 1352, 1360 (11th Cir. 2003), abrogated in part on

other grounds by Randall v. Scott, 610 F.3d 701 (11th Cir. 2010). To establish

individual liability for supervisory conduct, a plaintiff must show “that the

supervisor either directly participated in the unconstitutional conduct or that

a causal connection exists between the supervisor’s actions and the alleged

constitutional violation.” Keith v. DeKalb Cnty., 749 F.3d 1034, 1047-48 (11th

Cir. 2014).

Causation “may be established and supervisory

liability imposed where the supervisor’s improper

custom or policy results in deliberate indifference to

constitutional rights.” Id.[7] (alterations adopted)

(internal quotation marks omitted). “A plaintiff can

also show that the absence of a policy led to a violation

of constitutional rights.” Piazza,[8] 923 F.3d at 957.

“Either way, though, to prove that a policy or its

absence caused a constitutional harm, a plaintiff must

point to multiple incidents, or multiple reports of prior

misconduct by a particular employee.” Id. (citation

omitted). And allegations of a single incident of

unconstitutional conduct cannot state a claim for

supervisory liability, even when the conduct involves

several subordinates. Id. at 957-58.

Ingram v. Kubik, 30 F.4th 1241, 1254 (11th Cir. 2022).

7 Hartley v. Parnell, 193 F.3d 1263 (11th Cir. 1999).

8 Piazza v. Jefferson Cnty., 923 F.3d 947 (11th Cir. 2019).

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Any supervisory claim against the FDOC Defendants fails because Scott

has not alleged sufficient facts to show that they were personally involved in,

or otherwise causally connected to, the alleged violation of his Eighth

Amendment rights. Indeed, in the Complaint, Scott sets forth no factual

allegations about the FDOC Defendants’ involvement in the underlying

incident. As pled, Scott’s allegations amount to no “more than an unadorned,

the-defendant-unlawfully-harmed-me accusation.” Iqbal, 556 U.S. at 678.

Thus, the FDOC Defendants’ Motion is due to be granted to the extent that

they assert Scott fails to state an Eighth Amendment claim for relief against

them as supervisory officials. The Court will dismiss without prejudice the

claims against the FDOC Defendants.9

3. Nurse Defendants

In their Motion, the Nurse Defendants argue that Scott has failed to

state an Eighth Amendment deliberate indifference claim against them.

Nurses Motion at 7-11. They assert that he presents no allegations as to how

Nurse Hall violated Scott’s federal constitutional rights or injured him. Id. at

9 For this same reason, because Scott’s allegations fail to state a claim for a

constitutional violation, the FDOC Defendants’ assertion of their right to qualified

immunity would provide an alternative basis for dismissal.

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7. And they argue that Scott’s allegations against Nurse McDonald amount to

no more than gross negligence. Id. at 10.

The Court finds that Scott does not allege sufficient facts to raise an

Eighth Amendment claim against Nurse Hall. Although Scott names Nurse

Hall as a Defendant, he provides no allegations that associate her with the

alleged overdose. And insofar as Scott attempts to hold her liable based on her

supervisory position, he has not pled sufficient facts to do so. See Ingram, 30

F.4th at 1254. Therefore, the Nurse Defendants’ Motion is due to be granted

as to the contention that Scott fails to state a claim against Nurse Hall. See

Douglas v. Yates, 535 F.3d 1316, 1322 (11th Cir. 2008) (affirming district

court’s dismissal of claims against certain defendants where prisoner’s

complaint did not set forth any factual allegations that associated those

defendants with the alleged constitutional violation).

As to Nurse McDonald, Scott’s allegations do not support a claim that he

received medical care “so grossly incompetent . . . as to shock the conscience.”

Hoffer, 973 F.3d at 1271. Even assuming Nurse McDonald administered the

incorrect dosage of insulin, Scott offers no facts from which the Court can infer

that McDonald acted intentionally or “‘callously and deliberately’ administered

the wrong dose.” Pasco v. Carter, No. 3:22CV559-LC-HTC, 2022 WL 1913015,

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at *5 (N.D. Fla. May 13, 2022), report and recommendation adopted by No.

3:22CV559-LC-HTC, 2022 WL 1910122 (N.D. Fla. June 3, 2022); see Pacheco

v. Charlotte Cnty. Jail, No. 2:16-CV-863-FTM-99MRM, 2016 WL 7440873, at

*3 (M.D. Fla. Dec. 27, 2016) (dismissing prisoner’s “negligence-based claims

against the defendants for failing to ensure the correct insulin dosage.”).

Notably, Scott asserts that Nurse McDonald appeared to have “a hard time

reading the labels on the [insulin] bottles.” Complaint at 4. Such an allegation

instead supports the conclusion that Nurse McDonald misread the insulin

types10 and did not intentionally overdose Scott. Although Scott alleges “upon

information and belief” that Nurse McDonald has overdosed another inmate,

his speculation unsupported by any well-pled factual allegations does not

satisfy the applicable pleading standard. See Mann v. Palmer, 713 F.3d 1306,

1315 (11th Cir. 2013) (stating that the court did not have to take as true

plaintiff’s allegations upon information and belief that Florida possessed a

supply of pentobarbital that was expired, illegally obtained, or compounded);

Smith v. City of Sumiton, 578 F. App’x 933, 935 n.4 (11th Cir. 2014) (noting

that for purposes of a Rule 12(b)(6) motion to dismiss, the court did not have

10 In the “Discharge Summary” attached to the Complaint, Dr. Mohamad Taha

notes that Scott reported “he takes NPH insulin twice a day and at correction facility

the nurse gave him regular insulin instead of NPH insulin.” Doc. 1-8 at 4.

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to take as true pretrial detainee’s allegation that “[u]pon information and

belief, other individuals have been subjected to the same sexual assault and

sexual abuse”) (citation omitted). Scott’s assertions sound in negligence, if at

all, which “does not state a valid claim of medical mistreatment under the

Eighth Amendment.” Estelle, 429 U.S. at 106.

To the extent Scott also contends that Nurse McDonald violated the

Eighth Amendment when she refused to check on him at Officer

Middlebrooks’s request, he still does not state a claim for relief. No facts

support the conclusion that Nurse McDonald’s refusal caused a delay in

treatment that led to or exacerbated his injuries. In the Complaint, Scott

alleges that after Nurse McDonald refused to check on Scott, Officer

Middlebrooks contacted the urgent care office and he “was immediately placed

in a wheelchair and taken to the urgent care building.” Complaint at 4

(emphasis added). At urgent care, Scott received food and a tube of glucose and

medical checked his blood pressure and blood sugar. Id. at 4-5. According to

the exhibits attached to the Complaint, an EKG was administered to Scott that

produced abnormal results, at which time medical transferred him to Shands.

Doc. 1-7 at 13. Scott does not allege any causal connection between Nurse

McDonald’s refusal to see him and his injuries, and as such, he has failed to

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plead facts sufficient to nudge his claim of deliberate indifference “across the

line from conceivable to plausible.” Twombly, 550 U.S. at 570. Therefore, the

Nurse Defendants’ Motion is due to be granted.11

C. Scott’s Request in his Response

In response to Centurion’s Motion, Scott “requests a lawyer to amend

[the Complaint].” Centurion Response at 8 (emphasis omitted). He asserts that

on July 15, 2022, doctors at Shands discovered that Scott had kidney damage.

Id. According to Scott, during his hospitalization in 2020, doctors had

recommended that Scott should stop taking two diabetes medications because

they could result in kidney damage; however, UCI medical staff ignored the

recommendation. Id.; FDOC/Nurses Response at 5-6.

Initially, the Court notes that Scott asks to amend the Complaint to raise

claims properly brought in a separate action. See Centurion Response at 8;

Fed. R. Civ. P. 20(a)(2) (providing that a plaintiff may not join unrelated claims

and various defendants unless the claims arise “out of the same transaction,

occurrence, or series of transactions or occurrences” and if “any question of law

or fact common to all defendants will arise in the action”). Nevertheless, to the

11 For these same reasons, because Scott’s allegations fail to state a claim for a

constitutional violation, the Nurse Defendants’ assertion of their right to qualified

immunity would provide an alternative basis for dismissal.

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extent Scott seeks leave to amend the Complaint, his request is not properly

before the Court. A request for affirmative relief is not properly made when

simply included in a response to a motion. See Fed. R. Civ. P. 7(b); see also

Rosenberg v. Gould, 554 F.3d 962, 965 (11th Cir. 2009) (“Where a request for

leave to file an amended complaint simply is imbedded within an opposition

memorandum, the issue has not been raised properly.” (quoting Posner v.

Essex Ins. Co., 178 F.3d 1209, 1222 (11th Cir. 1999))). Thus, the Court will not

entertain Scott’s request for relief included in the Response.

Accordingly, it is now

ORDERED:

1. Defendant Centurion of Florida, LLC’s Motion to Dismiss (Doc.

17); Defendants Ricky Dixon and Travis Lamb’s Motion to Dismiss (Doc. 24);

and Defendants Patricia McDonald and Wendy Hall’s Motion to Dismiss (Doc.

25) are GRANTED to the extent provided in the Order.

2. Plaintiff Paul W. Scott’s Complaint (Doc. 1) is DISMISSED

without prejudice.12

12 Although Defendants request dismissal with prejudice, the Court dismisses

the case without prejudice to Scott filing a complaint in a new action that cures the

deficiencies identified in this Order.

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3. The Clerk shall enter judgment dismissing the case without

prejudice, terminate any pending motions, and close the case.

DONE AND ORDERED at Jacksonville, Florida, this 25th day of

July, 2023.

MARCIA MORALES HOWARD

United States District Judge

Jax-9 7/6

C: Paul W. Scott, #071615

Counsel of record

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