# Williams v. Dixon

> District Court, M.D. Florida · May 23, 2024

URL: https://www.frixlaw.com/law-library/cases/10116136

## Case

- **Court:** District Court, M.D. Florida
- **Decided:** May 23, 2024
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10116136

## How later opinions describe it (automated extraction)

- 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
- 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”
- explaining that 13 “conclusory allegations, unwarranted deductions of facts or legal conclusions masquerading as facts will not prevent dismissal”
- 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.”

## Opinion text

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).
27
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.
28
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
31
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

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10116136. Public record. Not legal advice.