Williams v. Dixon

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

JACKSONVILLE DIVISION

ELMER WILLIAMS,

Plaintiff,

v. Case No. 3:22-cv-1221-MMH-MCR

RICKY DIXON, et al.,

Defendants.

_________________________________

ORDER

I. Status

Plaintiff Elmer Williams, an inmate formerly in the custody of the

Florida Department of Corrections (FDOC), initiated this action with the

assistance of counsel on November 4, 2022. See Complaint (Doc. 1).1 Williams

is proceeding on a Third Amended Complaint (TAC; Doc. 93). In the TAC, he

names the following Defendants: (1) Ricky Dixon, Secretary of the FDOC; (2)

Centurion of Florida, LLC; (3) Dr. Alexis Figueroa; (4) Dr. Kalem Santiago; (5)

Nurse Jason Howell; (6) Nurse Elizabeth Holmes; (7) Nurse Tony Abbott; (8)

Adele Johns; (9) Wendy Millette; (10) Rebecca Yates; and (11) Sergeant

Savonia Richardson-Graham. TAC at 3–6. Williams contends that Defendants

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.

delayed treatment for prostate cancer and wounds that he developed in

confinement. See generally TAC.

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

Centurion of Florida, LLC’s Motion to Dismiss (Centurion Motion; Doc. 96);

(2) Defendant Nurse Elizabeth Holmes’s Motion to Dismiss (Holmes Motion;

Doc. 97); (3) Defendant Nurse Jason Howell’s Motion to Dismiss (Howell

Motion; Doc. 98); (4) Defendant Nurse Tony Abbott’s Motion to Dismiss (Abbott

Motion; Doc. 99); and (5) Defendant Dr. Alexis Figueroa’s Motion to Dismiss

(Figueroa Motion; Doc. 100). In support of their Motions, Centurion, Nurse

Holmes, Nurse Howell, Nurse Abbott, and Dr. Figueroa (collectively Centurion

Defendants) have submitted exhibits. See Doc. 96-1. Williams filed a

Consolidated Response (Response; Doc. 104). The Motions are ripe for review.

II. Williams’s Allegations2

Williams alleges he has a “known, documented” history of prostate

cancer. TAC at 6. Following diagnosis and treatment by a urologist, his

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

the TAC as true, consider the allegations in the light most favorable to Williams, 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 TAC, and

may well differ from those that ultimately can be proved. Additionally, because this

matter is before the Court on the Centurion Defendants’ Motions, this section details

the factual allegations pertinent to them.

2

prostate-specific antigen (PSA) levels, which indicate recurrent prostate

cancer, decreased to 0.2 ng/mL in 2020. Id. As a result, Williams’s urologist

discontinued his medication in late 2020 “with instructions that he be seen

again in June 2021 to assess [his] cancer and determine whether to change the

course of action or restart medication.” Id. Williams asserts he “was never

taken by FD[O]C or Centurion staff to see the urologist” in June 2021, id., and

on September 30, 2021, a urinalysis showed his PSA levels had increased from

0.2 ng/mL to 5.21 ng/mL, “well over the 4 ng/[m]L threshold used to determine

whether prostate cancer is active, spreading, and whether further testing is

necessary,” id. at 7.

In November 2021, the FDOC transferred Williams to Suwannee

Correctional Institution (Suwannee CI). Id. After his arrival at Suwannee CI,

on November 18, 2021, Williams fell out of his bunk and injured his hip, neck,

and back. Id. at 7–8. He declared a medical emergency. Id. at 8. Sergeant

Richardson-Graham refused to call for a stretcher, and instead, she ordered

two inmates to pick Williams up and put him in another inmate’s wheelchair.

Id. Nurse Howell examined Williams in medical. Id. Williams alleges that he

informed Nurse Howell that he had hurt his neck and back, he was

experiencing numbness in his body and extremities, he was concerned about

3

paralysis, and his PSA levels had increased from 0.2 ng/mL to 5.2 ng/mL in a

“short period of time.” Id. Nurse Howell gave Williams a muscle relaxer shot.

Id. Williams alleges that during the exam, he asked Nurse Howell if he could

approve a wheelchair, to which Nurse Howell responded, “[H]ell no.” Id.

Williams asserts he questioned Nurse Howell about how he would move

around, and Nurse Howell said, “I don’t know, hold on to the wall, or you can

go to confinement.” Id.

The next day, Nurse Abbott noted that Williams’s records contained a

previous institution’s urgent urology referral from October 4, 2021, and

“questioned in his notes whether the referral was ever submitted to Utilization

Management—the internal Centurion review team, which approved referrals,

but which could also overrule clinician recommendations.” Id. at 9.

Nevertheless, Williams asserts that Nurse Abbott, Dr. Figueroa, and other

Centurion staff failed to test his blood and antigen levels. Id.

Williams further alleges that around this time, he began to experience

chest pain and breathing problems, while he continued to experience

numbness in his legs and difficulty walking. Id. These symptoms prevented

Williams from moving around the facility. Id. According to Williams, he again

“relayed” his mobility issues to Nurse Howell. Id.

4

On November 24, 2021, Williams had a callout to go to the Institutional

Classification Team for a job assignment; however, he had no assigned

wheelchair, and could not attend without a wheelchair. Id. Williams alleges

Sergeant Richardson-Graham refused to allow him to borrow a wheelchair for

the callout. Id. at 9–10. Sergeant Richardson-Graham “later” observed

Williams writing an informal grievance about her earlier refusal to call for a

stretcher and took Williams to disciplinary confinement. Id. at 10.

During a pre-confinement physical, Nurse Howell “completed a pre-

special housing form stating [Williams] complained that his legs were numb.”

Id. That same day, Williams alleges he wrote an informal grievance about

Nurse Howell’s refusal to provide a wheelchair. Id. at 10. “In response to the

informal grievance about Nurse Howell, his colleague and Centurion staff

member, Rita Corbin, wrote that [Williams’s] allegations were ‘unfounded’ and

that a wheelchair is ordered ‘per a clinician,’ not a nurse.” Id. at 10–11.

Williams asserts he was taken to confinement in a wheelchair and placed

in a cell for disabled prisoners with two beds. Id. at 11. However, he contends

staff took the wheelchair from him and did not provide him with an impaired

inmate assistant or bunkmate. Id. Williams maintains he “repeatedly”

submitted sick call requests about his medical concerns, including his need for

5

a wheelchair. Id. According to Williams, “sometimes the sick calls were not

picked up by staff or processed.” Id.

Williams alleges while he was in confinement, he lacked the strength to

pull himself up and down from his bunk or to move around to get his food. Id.

As a result, he was forced to drag himself across his cell floor to use the toilet

or to collect his food tray, id. at 11–12, as well as to urinate in cups or on the

floor and defecate on the floor, id. at 12. Williams developed sores on his ankles

from dragging himself across the cell floor that ultimately became infected. Id.

at 14. Williams further asserts that he could not shower in confinement

because he did not have a wheelchair. Id. at 13. “Eventually after more than a

week, he was given a wheelchair to shower and then returned to his cell and

the wheelchair was taken back.” Id.

Williams was released from confinement in a borrowed wheelchair on

December 20, 2021. Id. at 15. “He was told that he had to sign a refusal for

treatment upon leaving confinement”; he did not sign it “because he was

adamant that he was not refusing treatment.” Id. (emphasis omitted). Williams

asserts medical staff examined him, but refused to treat him despite his

complaints that his legs were numb and swollen and that he could not use

them. Id. According to Williams, “for more than a month, [he] had continued to

6

voice his complaints but neither FD[O]C nor staff contracted by Centurion

were doing anything about those complaints.” Id.

On December 24, 2021, Williams was evaluated in the emergency room.

Id. at 17. He told Dr. Figueroa, Nurse Abbott, and nursing staff that he could

not walk; however, they returned him to his dorm without an assigned

wheelchair or other mobility devices. Id. Williams alleges he continued to relay

his needs to medical staff during visits and in sick call requests without any

sort of relief, such as an assigned wheelchair, an inmate assistant, or other

accommodation. Id. at 18.

Nurse Howell evaluated Williams twice in January 2022. Id. at 19.

During the first evaluation, Williams complained of shortness of breath, and

Nurse Howell found that Williams had diminished lung sounds in his lower

left lung and an irregular pulse. Id. Williams was ultimately admitted to the

infirmary after the second evaluation on January 7, 2022, when Nurse Howell

determined that Williams had a new onset of bilateral ankle edema. Id. In the

infirmary, Nurse Wilson noted that Williams’s ankle wounds emitted a foul

odor, and Williams informed Nurse Wilson and Dr. Figueroa that he had not

received any wound care “in several days.” Id.

7

“Around this time,” medical staff tested Williams’s PSA levels, which had

increased from 5.21 ng/mL in September 2021 to 21.00 ng/mL. Id. at 20. “A

PSA value of greater than or equal to 4.0 ng/mL is the consensus standard at

which further evaluation for prostate cancer should occur.” Id. Williams alleges

that although Dr. Figueroa noted an October 2021 urologist referral in

Williams’s records, Dr. Figueroa neither actualized that referral, nor ordered

a “full clinical evaluation of [Williams’s] prostate cancer to see whether [his]

pain and extremity numbness were related to the rising PSA.” Id. On February

8, 2022, Williams questioned medical staff about his urology referral. Id. at 26.

According to Williams, “no one bothered to ensure that the referral was still in

place or was otherwise received or acted on by the urologist. Instead, Centurion

staff had to resubmit the referral to urology one month after Dr. Figueroa, his

staff, and Centurion knew that [Williams’s] PSA levels were alarmingly high,

and that [Williams] was having complaints regarding his lower back and legs.”

Id. (emphasis omitted).

While in the infirmary, Williams asserts he continued to submit

grievances about obtaining a wheelchair pass or other accommodation to no

avail. Id. at 22–23. Medical staff ultimately determined Williams’s foul-

smelling wounds “were the result of necrotizing fasciitis, a rare bacterial

8

infection that spread quickly in the body and can cause death.” Id. at 25. On

February 9, 2022, Williams received wound treatment on his ankles; the

wounds “had been categorized as stage 2 wounds,” which require 14 to 45 days

of treatment. Id. at 26. Nevertheless, Dr. Figueroa and Nurse Holmes began

the discharge process on February 14, 2022, “well before the time required to

allow [Williams’s] wounds to heal and despite the concerning spike in

[Williams’s] PSA and accompanied back pain and lower extremity numbness.”

Id. at 26. According to Williams, Dr. Figueroa and Nurse Holmes stated in

discharge forms that he was stable, and he would continue his treatment in

the dorm. Id. at 27.

“Just two days after his discharge from the infirmary to the dorm, lab

reports showed that [Williams’s] PSA level doubled to 43.40 ng/mL in just a

month’s time, now around nine times the level from September 2021 and about

200 times the level in June 2022.”3 Id. Williams still had not visited a urologist

or signed a consent form, which authorizes transport to a specialist outside of

the FDOC. Id. at 22, 27. He asserts that he did not have a pass for an inmate

assistant or an assigned wheelchair. Id. at 27. As a result, Williams would pay

other inmates to borrow their wheelchairs and rely on their assistance to get

3 Considered in context, it appears June 2022 is a scrivener’s error.

9

in and out of the wheelchair. Id. at 28. Additionally, he alleges that he soiled

himself in bed because he did not have diapers or anyone to assist him with

taking the diapers on and off. Id. “Despite open and obvious festering wounds,

severe bloating, his inability to move or feel his lower extremities, and his

escalating PSA levels, on or about February 23, 2022, Dr. Figueroa told

[Williams] that he was doing much better and that his symptoms were

resolved.” Id. at 29.

According to Williams, on April 1, 2022, he filed an informal grievance

“reporting that he still had to sit on the floor when he showered because he

could not walk. He requested help because of the unsanitary nature of having

to shower this way, particularly because [Williams] had deep open wounds on

his buttocks.” Id. at 29. Williams asserts his wounds continued to grow, and

despite previously noting Williams’s increased risk for developing additional

pressure sores, medical staff failed to timely treat the wounds or provide

consistent treatment. Id. at 30. Dr. Figueroa ultimately diagnosed Williams

with osteomyelistis—a bone infection—on May 24, 2022. Id. at 31. “Dr.

Figueroa again delayed any treatment for [Williams’s] serious and obvious

infection,” id.; by July 2022, Williams asserts that the sores had increased in

size and depth such that bone was visible, id. at 32. Williams alleges that

10

around this time, Dr. Figueroa dug out masses of necrotic tissue from his heel

but did not take any other action to treat the sores. Id. at 33.

According to Williams, he did not visit a urologist until “about four

months after first complaining of his mobility concerns and medical staff

realizing that his PSA levels had risen and that he had an outstanding urology

referral [from a previous institution].” Id. at 32. By June 2022, after several

visits with an oncologist and administration of Eligard, Williams’s PSA levels

had decreased to 7.2 ng/mL. Id. Physical findings revealed that his prostate

cancer was metastatic with spinal cord malignancy. Id.

In mid-August 2022, the FDOC transferred Williams to the Reception

and Medical Center (RMC), where Williams finally learned that his cancer had

metastasized and spread throughout his body “even though Dr. Figueroa knew

his cancer had metastasized back in June.” Id. at 35. Williams asserts his

prostate cancer had spread to areas where he complained of pain and

numbness. Id. Williams’s cancer is terminal, and a state panel has awarded

Williams compassionate medical release. Id. at 37.

Williams argues that the deliberate and purposeful failure to have his

PSA documented or to have him urgently seen by a urologist “is part and parcel

of Centurion’s unwritten practice and custom of delaying testing of known

11

diseases to deny prisoners their adequate medical care.” Id. at 16. He notes

other FDOC prisoners were not regularly tested for known cancer or had their

cancer treatment delayed. Id. According to Williams, Centurion also has failed

to provide prisoners with routine bloodwork or urinalyses. Id. Williams

maintains Centurion’s “final policymakers delayed testing [his] PSA or

otherwise referring [him] to a urologist so that by the time he finally received

a diagnosis it was too late to provide [him] with expensive, possibly life-saving

medication and treatment.” Id. at 35.

Based on the above, Williams raises the following claims for relief: (1)

retaliation under 42 U.S.C. § 1983 against Dr. Figueroa, Sergeant Richardson-

Graham, and Nurse Howell; (2) deliberate indifference under 42 U.S.C. § 1983

against Centurion; (3) violations of the Americans with Disabilities Act and

Rehabilitation Act against Secretary Dixon; and (4) failure to treat under 42

U.S.C. § 1983 against Dr. Santiago, Dr. Figueroa, Nurse Howell, Nurse

Holmes, Nurse Abbott, Millette, Johns, and Yates. Id. at 37–45. As relief,

Williams requests monetary damages and attorney’s fees and costs. 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.

12

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 Telecomm., 372 F.3d 1250, 1262–63 (11th Cir. 2004) (citations

omitted). Indeed, while “[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

13

“conclusory allegations, unwarranted deductions of facts or legal conclusions

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

quotations 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 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).

IV. Analysis

A. Consideration of Documents Outside the Four Corners of the TAC

The Centurion Defendants ask the Court to consider documents outside

the four corners of Williams’s TAC—specifically, 49 pages of medical records—

when ruling on their Motions. Centurion Motion at 2; Holmes Motion at 2 n.1;

Howell Motion at 2 n.1; Abbott Motion at 2 n.1; Figueroa Motion at 2 n.1; see

also Doc. 96-1. They argue Williams drafted the TAC based on discovery

responses and his deposition; therefore, it is appropriate to consider the

medical and grievance records on which Williams relied. Centurion Motion at

14

1.4 The Centurion Defendants further contend that the authenticity of the

records is undisputed. Id.

“‘Under the doctrine of incorporation by reference, [courts] may also

consider documents attached to the motion to dismiss if they are referred to in

the complaint, central to the plaintiff’s claim, and of undisputed authenticity.’”

Luke v. Gulley, 975 F.3d 1140, 1144 (11th Cir. 2020) (quoting Hi-Tech Pharms.,

Inc. v. HBS Int’l Corp., 910 F.3d 1186, 1189 (11th Cir. 2018)). As Williams

concedes in his Response, he references and quotes some medical documents

in the TAC. See, e.g., TAC at 9 (“Nurse Abbott noted in [Williams’s] records

that [sic] an urgent urology referral from October 4, 2021 at his previous

institution.”). Nevertheless, the Court is not persuaded that, at this point in

the litigation, it should consider the contents of his medical records. The

documents are not central to the claims since Williams may present witness

testimony to prove the Centurion Defendants were deliberately indifferent to

his serious medical needs. See Cineus v. Fla. Dep’t of Corr., No. 8:21-CV-1659-

4 In their Motions, Holmes, Howell, Abbott, and Figueroa duplicate the

argument in the Centurion Motion as to this issue. Therefore, the Court cites only to

the Centurion Motion.

15

MSS-SPF, 2022 WL 4448599, at *4 (M.D. Fla. Sept. 23, 2022)5 (determining

medical records were not central to plaintiff’s deliberate indifference claim

because at trial, the plaintiff could present testimony by witnesses, instead of

introducing the medical records). And, Williams contests the authenticity of

the documents. For instance, he alleges that medical staff “deliberately

misrepresented” his condition in his medical records. TAC at 27; see also

Response at 14. The Centurion Defendants also appear to have only provided

excerpts of Williams’s medical records. See Horsley v. Feldt, 304 F.3d 1125,

1135 (11th Cir. 2002) (finding that because the plaintiff disputed the

authenticity of transcripts attached to the amended answer and because the

transcripts were incomplete, they could not be considered in deciding a motion

for judgment on the pleadings); see also Legacy Ent. Grp., LLC v. Endemol

USA Inc., No. 3:15-CV-0252-HES-PDB, 2015 WL 12838795, at *4 (M.D. Fla.

Oct. 1, 2015). Under these circumstances, the Court declines to consider the

documents as the Centurion Defendants request.

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

binding, they 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

B. Eighth Amendment Deliberate Indifference

In their Motions, the Centurion Defendants argue that Williams fails to

state an Eighth Amendment deliberate indifference claim against them. See

Centurion Motion at 9–22; Holmes Motion at 4–10; Howell Motion at 8–13;

Abbott Motion at 5–12; Figueroa Motion at 9–14. 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. 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

17

‘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.,

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

18

gross negligence.” Id. (quotation omitted).[6] 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

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

fail to respond to a known medical problem).

“As applied in the prison context, the deliberate-indifference standard

sets an appropriately high bar.” Swain, 961 F.3d at 1285. Indeed, the law is

6 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).

19

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, 897 (11th Cir. 2007)7 (quoting Waldrop,

871 F.2d at 1033). Similarly, “the question of whether governmental actors

should have employed additional diagnostic techniques or forms of treatment

7 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.”).

20

‘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 argues that Williams fails to state an Eighth Amendment

deliberate indifference claim. Centurion Motion at 9. According to Centurion,

the medical records attached to its Motion show Williams received “continuous

care,” and therefore, Williams’s constitutional rights were not violated. Id. at

12. Centurion contends that even if the Court does not consider the records,

Williams fails to plead sufficient facts to suggest Centurion had a custom,

policy, or procedure that was the moving force behind a violation. Id. at 15–22.

The FDOC contracted with Centurion 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

21

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

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

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) (“[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 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 [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,

22

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”).

“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

23

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.

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

24

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, Williams must plead that an official

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

alleged federal constitutional violation.

In the TAC, Williams alleges that Centurion maintains

policies and practices in which healthcare staff

contracted by Centurion: (a) commonly disregard

reports by patients of objectively serious symptoms; (b)

refuse to provide adequate treatment to patients; (c)

refuse to timely conduct or obtain diagnostic tests and

bloodwork for patients or comply with referrals to

specialists; (d) fail to create sensible treatment plans

for patients whose health status requires the same; (e)

fail to ensure continuity of care; (f) prioritize profits at

the expense of constitutionally adequate care; (g) fail

or refuse to arrange for prisoners to be treated in

outside facilities, even when an outside referral is

necessary or proper; and (h) refuse and/or fail to

provide any medical care whatsoever for defined

medical problems.

25

TAC at 39. According to Williams, “[t]hese policies and practices were allowed

to flourish because Centurion . . . directly encouraged the very type of

misconduct at issue here and failed to provide adequate training and

supervision of healthcare and correctional employees.” Id. at 39–40. Williams

maintains that pursuant to these policies, the Centurion Defendants delayed

his PSA tests and urology referral “so that by the time he finally received a

diagnosis it was too late to provide [him] with expensive, possibly life-saving

medication and treatment.” Id. at 35. He alleges other inmates at the FDOC

and Suwannee CI “were not regularly tested for known cancer despite being

required to provide regular testing under the FD[O]C medical grading system

or have had their cancer treatment delayed by Centurion and its staff.

Centurion also has failed to provide prisoners with cancer like [Williams]

routine bloodwork or urinalysis to test their condition as part of its

unconstitutional policy, practice, or custom.” Id. at 16.

At this stage of the proceeding, the Court is required to accept the factual

allegations set forth in the TAC as true. See Iqbal, 556 U.S. at 678. Doing so,

the Court finds that Williams has sufficiently stated a claim against Centurion.

Williams asserts that Centurion had a cost-saving policy, custom, or practice

of delaying and denying appropriate medical care to inmates with cancer, and

26

that this policy, custom, or practice caused his injuries. The specific factual

allegations regarding the progression of Williams’s prostate cancer plausibly

suggest both the existence of this policy or custom and an underlying

constitutional violation.

To the extent Centurion contends that Williams’s own experience is

insufficient to establish the existence of a policy or custom, the Court is not

persuaded. In the TAC, Williams alleges other inmates at the FDOC did not

receive treatment or testing as result of Centurion’s policies. TAC at 16.

Williams is not required to prove at this stage that Centurion had a custom,

policy, or practice of delaying or denying appropriate medical care—and

whether he will ultimately be able to do so is best left for a determination on

summary judgment or at trial.8 Considering his allegations on the whole, and

taken as true, the Court finds that Williams has sufficiently alleged a claim

against Centurion. Accordingly, Centurion’s Motion is due to be denied.

8 For this same reason, the Court rejects Centurion’s argument that Williams

has not established policymaking authority lies with Dr. Figueroa or Utilization

Management staff. Centurion Motion at 18. Williams alleges in the TAC an

unconstitutional policy or custom existed and pleads facts to support its existence.

Williams need not positively identify a final policymaker at this stage of the

proceedings. See Christmas v. Nabors, 76 F.4th 1320, 1329–30 (11th Cir. 2023).

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2. Nurse Holmes

Nurse Holmes asks the Court to dismiss the deliberate indifference claim

against her. Holmes Motion at 4. She argues that the limited factual

allegations regarding her involvement in Williams’s medical care do no suggest

that she acted with a sufficiently culpable state of mind. Id. at 9. And, to the

extent Williams complains that she failed to provide him with a wheelchair

upon discharge from the infirmary, Nurse Holmes alleges she does not have

the authority to provide a wheelchair. Id. at 7–8. Last, she maintains Williams

fails to plead causation. Id. at 10. Williams opposes Nurse Holmes’s Motion,

arguing that he sufficiently alleges Nurse Holmes acted with deliberate

indifference to his “unhealing wounds” and mobility issues. Response at 21.

In the TAC, Williams makes the following allegations about Nurse

Holmes. He asserts that on February 14, 2022, “well before the time required

to allow [his] wounds to heal and despite the concerning spike in [his] PSA and

accompanied back pain and lower extremity numbness . . . Dr. Figueroa and

Nurse Holmes started [his] discharge process from the prison infirmary.” TAC

at 26. According to Williams, Dr. Figueroa and Nurse Holmes stated that he

was “clinically stable” in their discharge forms “and that he would be able to

continue his wound and other treatment in his dorm.” Id. at 27.

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The Eleventh Circuit has explained “[t]o be deliberately indifferent a

prison official must know of and disregard an excessive risk to inmate health

or safety; the official must both be aware of facts from which the inference could

be drawn that a substantial risk of serious harm exists, and he must also draw

the inference.” Franklin v. Curry, 738 F.3d 1246, 1250 (11th Cir. 2013) (quoting

Goodman v. Kimbrough, 718 F.3d 1325, 1332 (11th Cir. 2013)) (internal

quotation marks omitted). Here, considering only the TAC, the Court finds that

the limited factual allegations against Nurse Holmes fail to plausibly suggest

she knew Williams faced a substantial risk of serious harm and disregarded

that risk. As to his wound treatment, Williams alleges that he failed to receive

14 to 45 days of treatment—the requirement for stage 2 wounds—before Nurse

Holmes and Dr. Figueroa discharged him from the infirmary. TAC at 26.

However, Nurse Holmes discharged Williams with the expectation that he

would be able to continue treatment in his dorm. Id. at 27. Williams fails to set

forth any well-pled facts suggesting that Nurse Holmes knew he could not

receive treatment in the dorm, and thus, disregarded a risk of serious harm.

Similarly, Williams does not plead sufficient facts to suggest Nurse

Holmes knew about his mobility limitations. For instance, he fails to allege

that Nurse Holmes personally examined him, or that he notified her that he

29

required accommodations. While Williams asserts in the TAC that Nurse

Homes “failed to provide timely accommodation for [Williams’s] loss of motor

control,” TAC at 35, such an allegation is conclusory and not entitled to an

assumption of truth. As such, the Court finds Williams fails to state a plausible

claim against Nurse Holmes regarding her alleged failure to provide mobility

accommodations. Accordingly, Nurse Holmes’s Motion is due to be granted,

and the claim against her dismissed.

3. Nurse Howell

In his Motion, Nurse Howell argues that Williams has not alleged facts

sufficient to state a deliberate indifference claim. Howell Motion at 8. First, to

the extent Nurse Howell allegedly failed to provide a wheelchair, he contends

the claim fails because he did not have the authority to prescribe a “healthcare

appliance.” Id. at 7, 11. Next, relying on the medical records attached to his

Motion, Nurse Howell asserts that he provided constitutionally adequate care

because each time he assessed Williams’s medical complaints, he “referred

[Williams] to clinicians who could take additional action, like prescribing

medication or admitting [Williams] into the infirmary.” Id. at 12. Therefore,

he contends that Williams fails to state a claim for relief. Id. at 12–13.

30

Considering the allegations in the TAC, taken as true, the Court finds

Williams has sufficiently stated a deliberate indifference claim against Nurse

Howell. Williams alleges in the TAC that Nurse Howell knew Williams had

numbness in his legs which led to mobility issues, but Nurse Howell

deliberately disregarded these medical concerns. TAC at 8–11, 23, 35. Indeed,

Williams asserts that Nurse Howell evaluated him after he fell from his bunk.

Id. at 8. Williams allegedly explained his symptoms, including numbness in

his legs, to Nurse Howell and asked for a wheelchair, but Nurse Howell denied

his request. Id. Several days later, when Nurse Howell conducted William’s

pre-confinement physical, he noted William’s legs were numb but again did not

provide him with a wheelchair or any other accommodation. Id. at 10. Without

mobility assistance in confinement, Williams was forced to drag himself across

the cell floor, from which he developed severe sores that became infected. Id.

at 14–15. These factual allegations plausibly suggest Nurse Howell knew of a

serious risk of harm and disregarded that risk by conduct that is more than

gross negligence.

To the extent Nurse Howell asserts that he did not have the authority to

provide a wheelchair, his argument is unavailing. As support, Nurse Howell

merely cites to the definition of a “healthcare appliance” in Florida

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Administrative Code Rule 33-210.201(2)(f), which details ADA provisions for

prisoners. A healthcare appliance “refers to devices or medical support

equipment including, but not limited to, wheelchairs, canes, walkers, or

hearing aids prescribed for an inmate and approved by the Office of Health

Services or its designee.” Fla. Admin. Code R. 33-210.201(2)(f). The provision

does not detail the scope of a registered nurse’s prescriptive abilities in an

FDOC facility. Nevertheless, even assuming Nurse Howell did not have the

authority to prescribe a wheelchair, this does not necessarily foreclose his

ability to provide other accommodations, such as an inmate assistant, for

Williams’s mobility issues. Thus, based on the above, Nurse Howell’s Motion is

due to be denied to the extent it seeks dismissal of the deliberate indifference

claim against him.

4. Nurse Abbott

Nurse Abbott argues Williams fails to state a deliberate indifference

claim against him. Abbott Motion at 5–6. He asserts that, according to the

TAC, he examined Williams on only two occasions: December 20 and 24, 2021.

Id. at 8. However, Nurse Abbott argues the medical records demonstrate Dr.

Figueroa examined Williams on those dates, and Williams “received

32

constitutionally adequate medical care.” Id. at 9. Finally, Nurse Abbott argues

that Williams does not plausibly allege causation. Id. at 11–12.

The Court determines that Williams states a claim for relief against

Nurse Abbott. Williams alleges in the TAC that, as early as November 19,

2021, Nurse Abbott knew Williams’s previous institution had made an urgent

urology referral in October 2021, and Nurse Abbott was uncertain whether the

previous institution had submitted the referral to Utilization Management.

TAC at 9. Even though Williams had a documented history of prostate cancer

and experienced a drastic change in his PSA levels on September 30, 2021, id.

at 6–7, Nurse Abbott failed to act on the referral. Indeed, medical staff did not

resubmit the referral until February 2022. Id. at 26. Williams asserts that this

delay in treatment furthered Centurion’s cost-saving policy and ultimately

resulted in his prostate cancer metastasizing and becoming untreatable. Id. at

35. Based on these alleged facts, Williams states a plausible deliberate

indifference claim at this stage of the proceedings.

Moreover, as to his mobility issues, Williams alleges that Nurse Abbott

evaluated him on December 24, 2021, and he notified Nurse Abbott that he

could not walk. Id. at 17. By this time, Williams had spent over three weeks in

confinement, where he developed sores from dragging himself across the cell

33

floor because he could not walk. Id. at 11–15. And, Nurse Abbott had received

Williams’s complaints about numbness, swelling, and lack of use of his

extremities. Id. at 15. Nonetheless, Nurse Abbott did not provide Williams with

a wheelchair or other mobility accommodations on December 24th. Id. at 17.

As a result, Williams’s sores worsened and became infected. Because these

factual allegations—taken as true with all reasonable inferences drawn in

Williams’s favor—could plausibly support a finding that Nurse Abbott acted

with deliberate indifference to Williams’s serious medical needs, Nurse

Abbott’s Motion is due to be denied.

5. Dr. Figueroa

Largely relying on medical records, Dr. Figueroa argues that Williams

fails to state a deliberate indifference claim against him because he provided

constitutionally adequate medical care to Williams. Figueroa Motion at 12–14.

The Court has declined to consider the medical records that the

Centurion Defendants submitted with their Motions. Therefore, considering

only the well-pled facts in the TAC, the Court finds Williams sufficiently states

a plausible claim under the Eighth Amendment. Williams asserts that Dr.

Figueroa denied him timely and proper medical care resulting in terminal

prostate cancer and severely infected wounds on his ankles and buttocks. See

34

Goebert v. Lee Cnty., 510 F.3d 1312, 1330 (11th Cir. 2007) (“[A]n official acts

with deliberate indifference when he intentionally delays providing an inmate

with access to medical treatment, knowing that the inmate has a life-

threatening condition or an urgent medical condition that would be

exacerbated by delay.” (internal quotation marks omitted)). The Court declines

to find that these allegations if proven would fail to state a plausible claim for

a violation of the Eighth Amendment. As such, Dr. Figueroa’s Motion is due to

be denied as to Williams’s deliberate indifference claim.

C. First Amendment Retaliation

Nurse Howell and Dr. Figueroa also request dismissal of the First

Amendment retaliation claim against them. See Howell Motion at 4–8;

Figueroa Motion at 7–9. “The core of [a retaliation claim brought pursuant to

42 U.S.C. § 1983] is that the prisoner is being retaliated against for exercising

his right to free speech.” O’Bryant v. Finch, 637 F.3d 1207, 1212 (11th Cir.

2011) (citation omitted). It is firmly established that “an inmate is considered

to be exercising his First Amendment right of freedom of speech when he

complains to the prison’s administrators about the conditions of his

confinement.” Smith v. Mosley, 532 F.3d 1270, 1276 (11th Cir. 2008). An

35

inmate may pursue a cause of action against a prison official who retaliated

against him for engaging in that protected speech. Id.

To establish a retaliation claim, a prisoner must

demonstrate “that the prison official’s actions were the

result of his having filed a grievance concerning the

conditions of his imprisonment.” Farrow v. West, 320

F.3d 1235, 1248 (11th Cir. 2003) (internal quotation

marks and citation omitted). [A plaintiff] can prevail

on a retaliation claim if “(1) his speech was

constitutionally protected; (2) [he] suffered adverse

action such that the administrator’s allegedly

retaliatory conduct would likely deter a person of

ordinary firmness from engaging in such speech; and

(3) there is a causal relationship between the

retaliatory action and the protected speech.” Smith v.

Mosley, 532 F.3d 1270, 1276 (11th Cir. 2008).

Williams v. Radford, 64 F.4th 1185, 1192 (11th Cir. 2023). As to the third

prong, a plaintiff must do more than make “general attacks” upon a

defendant’s motivations and must articulate “affirmative evidence” of

retaliation to prove the requisite motive. Crawford-El v. Britton, 523 U.S. 574,

600 (1998) (citations omitted). “In other words, the prisoner must show that,

as a subjective matter, a motivation for the defendant’s adverse action was the

prisoner’s grievance or lawsuit.” Jemison v. Wise, 386 F. App’x 961, 965 (11th

Cir. 2010) (per curiam) (citation omitted).

36

1. Nurse Howell

As to the specific facts underlying his retaliation claim against Nurse

Howell, Williams alleges that he wrote an informal grievance on November 24,

2021, concerning Nurse Howell’s refusal to provide him with a wheelchair.

TAC at 10. According to Williams, Rita Corbin, Centurion staff member and

Nurse Howell’s colleague, responded that the allegations “were ‘unfounded’

and that a wheelchair is ordered ‘per a clinician,’ not a nurse.” Id. at 10–11.

Subsequently, while in confinement, Williams asserts:

[He] was also concerned that medical staff were not

helping him, he noted that ‘a lot of this neglect is

coming from ‘retaliation’ for me writing Jason Howell

up, the nurse.” In fact, Nurse Howell’s colleague, Rita

Corbin, responded to this particular grievance and

since then [Williams] has not received any further

medical treatment.

Id. at 13.

In his Motion, Nurse Howell contends that the Court should dismiss the

retaliation claim against him because: (1) no allegations suggest a causal

connection between Williams’s grievance against Nurse Howell and any

alleged adverse action; (2) Williams fails to allege an adverse action by Nurse

Howell; and (3) to the extent Williams asserts Nurse Howell retaliated against

37

him by failing to provide a wheelchair, Nurse Howell did not have the authority

to do so. Howell Motion at 4–8.

Williams responds that he has sufficiently alleged a causal connection

between the grievance and adverse action. Response at 35. In support of his

argument, he points to his allegation that after he wrote a grievance about

Nurse Howell, which was reviewed by Nurse Howell’s colleague Rita Corbin,

he was denied any medical attention in confinement. Id. at 35. Williams also

contends that other staff would have reviewed the grievance, and it is plausible

that Nurse Howell was aware of it given the “immediate” adverse action. Id.

The Court finds Williams fails to allege the requisite causal connection

between his grievance and the alleged adverse action. “The causal connection

inquiry asks whether the defendants were subjectively motivated to discipline

because [the prisoner] complained of some of the conditions of his

confinement.” Smith, 532 F.3d at 1278. Here, the alleged facts do not plausibly

suggest Nurse Howell knew about the grievance and, thus, was subjectively

motivated to deny medical care to Williams in confinement. To the extent

Williams argues other staff would have reviewed the grievance and,

presumably, informed Nurse Howell, Response at 35, this amounts to mere

speculation unsupported by the facts alleged in the TAC. Indeed, Williams does

38

not even allege Corbin, the Centurion staff member who responded to the

grievances, interacted with Nurse Howell or other medical staff at Suwannee

CI.

Further, Williams provides no well-pled facts, beyond mere supposition,

that would suggest the other Defendants or medical staff had a subjective

motive to retaliate against Williams for filing a grievance against Nurse

Howell. For instance, Williams does not allege Nurse Howell directed other

medical staff to deny or delay treatment in confinement. And, based on the

allegations in the TAC, Nurse Howell did not substantially engage in

Williams’s treatment following the grievance beyond admitting him into the

infirmary. TAC at 19. Although Williams argues he has pled temporal

proximity which suggests a causal connection between the grievance and the

adverse action, Response at 35, temporal proximity alone does not save

Williams’s claim. Without more, Williams’s claim is merely conceivable, not

plausible. As such, Nurse Howell’s Motion is due to be granted as to the First

Amendment retaliation claim against him.

2. Dr. Figueroa

Last, Dr. Figueroa asks the Court to dismiss the retaliation claim against

him. Figueroa Motion at 7. Relying on the medical records attached to his

39

Motion, Dr. Figueroa argues that Williams cannot demonstrate a causal

connection between the grievances and any adverse action. Id. at 8–9. He

further contends that even if the Court does not consider the records,

Williams’s allegations are insufficient because “[a]t most, [] Williams has made

only ‘general attacks’ and has not alleged ‘affirmative evidence’ of retaliation.”

Id. at 9 (citation omitted).

Liberally construed, the TAC includes sufficient facts to state a plausible

retaliation claim against Dr. Figueroa. Williams asserts he filed grievances

regarding his medical care, some of which Dr. Figueroa reviewed and denied.

TAC at 15, 23. He alleges Dr. Figueroa delayed treatment for his prostate

cancer, denied him a wheelchair, and delayed treatment for his wounds in part

because he filed these grievances. Id. at 17, 20–21, 23, 29, 31, 33. As such,

Williams alleges facts supporting each element of a retaliation claim.

Therefore, Dr. Figueroa’s Motion is due to be denied.

Accordingly, it is now

ORDERED AND ADJUDGED:

1. Defendants Centurion, Tony Abbott, and Alexis Figueroa’s

Motions to Dismiss (Docs. 96, 99, 100) are DENIED.

40

2. Defendant Jason Howell’s Motion to Dismiss (Doc. 98) is DENIED

in part and GRANTED in part. The Motion is GRANTED only to the extent

that Plaintiff Elmer Williams’s retaliation claim against Howell is dismissed

for failure to state a claim for relief. In all other respects, the Motion is

DENIED.

3. Defendant Elizabeth Holmes’s Motion to Dismiss (Doc. 97) is

GRANTED. Williams’s deliberate indifference claim against Holmes is

DISMISSED. Judgment to that effect will be withheld pending adjudication

of the action as a whole. See Fed. R. Civ. P. 54. The Court directs the Clerk

to terminate Holmes as a Defendant in the case.

4, Centurion, Howell, Abbott, and Figueroa must file Answers no

later than June 20, 2024.

DONE AND ORDERED at Jacksonville, Florida, this 22nd day of

May, 2024.

United States District Judge

Jax-9 5/7

Cc: Counsel of record

41