The opinion
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
SOUTHEASTERN DIVISION
GEORGE F. ALDRIDGE, JR., )
)
Plaintiff, )
)
v. ) Case No. 1:18-cv-00259-SNLJ
)
NINA HILL, )
)
Defendant. )
MEMORANDUM AND ORDER
Plaintiff, a prisoner in the Missouri Department of Corrections (“MDOC”), filed
this lawsuit under 42 U.S.C. § 1983 alleging violations of his constitutional rights
pertaining to medical care he received from defendant nurse practitioner Nina Hill.
Currently pending before the Court are defendant Hill’s motion for summary judgment
[Doc. 49] and plaintiff’s motion to strike [Doc. 62].
Plaintiff has spent more than a year delaying his response to the motion for
summary judgment, which was filed June 25, 2020. He requested and received from this
Court an extension of discovery and served subpoenas on Anne Precythe, the Director of
MDOC, and he obtained an extension of time in which to file his response to summary
judgment.
On December 14, 2020, this Court, while investigating whether and when the
subpoenas had been served on Precythe, advised plaintiff that his “response shall be due
21 days after the subpoenaed parties provide documents to the plaintiff” and “plaintiff
shall notify the Court if he does not timely receive a response to the subpoenas after
receiving confirmation that the subpoenas had been served.” [Doc. 85 at 3.]
On February 25, 2021, this Court learned that the subpoenas in question had in
fact been served on October 29, 2020. Thus, the Court advised plaintiff he should advise
whether he had received a response and, if not, he should file a motion to enforce the
subpoenas. In fact, the Office of the General Counsel for MDOC represented that
Precythe had responded by letter to plaintiff dated November 10, 2020. The letter
generally advised plaintiff to seek the documents from other sources and constituted
MDOC’s response to the subpoenas. Counsel for MDOC also contacted the Court when
advised of the dispute and explained that although he had sent his letter response to
plaintiff, that he could not be sure plaintiff had received the response. Plaintiff moved to
enforce the subpoenas, which this Court granted in party and denied in part. Counsel for
defendant Hill and MDOC Counsel were ordered to each file a written update with the
Court regarding their efforts to provide plaintiff with the relevant documents by April 30,
2021.
Defendant and MDOC counsel so-responded and assured the Court that
appropriate documents had been sent to plaintiff. Plaintiff was dissatisfied and again
filed motions to obtain the documents he sought, and he also complained that he was
missing other, unrelated property and documents. Only some of the documents appeared
to involve this case. It appeared that defendant and MDOC had responded appropriately
to the Court’s order. However, to avoid future complaints regarding the availability of
the exhibits to defendant’s summary judgment motion, the Court ordered the Clerk to
provide plaintiff with a complete copy of the briefing and exhibits for defendant Hill’s
motion for summary judgment.
Plaintiff continued to complain about his lack of access to documents [e.g., Doc.
139, Doc. 140] and sought to delay filing his response to summary judgment until after
his subpoenas were “enforced.” Plaintiff maintained that MDOC was wrongfully
withholding documents and that he was unable to respond to summary judgment. This
Court required defendant and MDOC to respond to his allegations [Doc. 141]. It was
revealed that plaintiff had access to all of his legal materials and is permitted to take one
cubic foot of materials to his cell at a time. Plaintiff was simply choosing not to take any
documents. This Court offered plaintiff an addition extension of time in which to file a
response memorandum and advised plaintiff that, if he chose not to do so, then the Court
would rule on the motion without plaintiff’s response. [Doc. 147.]
Plaintiff filed an interlocutory appeal and has filed numerous other documents, but
he did not respond to the motion for summary judgment. The Court will thus proceed
with ruling on the remaining motions.
I. Factual Background
Plaintiff claims that defendant Nurse Practitioner Nina Hill failed to provide
appropriate medical treatment for numerous medical conditions, including high blood
pressure, hyperlipidemia, an enlarged prostate, a leaking bladder, osteoporosis, a growth
on his left knee, joint pain in his left elbow, right knee, and lower back, a stroke, migraine
headaches, neuropathy in the feet and legs, dizziness, blackouts, right testicular pain,
diabetes, hearing loss, sleeping problems, numbness in the pubic area, a concussion, and
a urinary tract infection. Plaintiff claims Hill purportedly refused to render appropriate
treatment because he was in administrative segregation. Plaintiff claims defendant Hill
failed to provide an extra pillow for his back pain as well as other lay-ins, including lay-
ins for a knee brace, front cuffing, Depends, and orthotics. Plaintiff seeks monetary
damages and injunctive relief in the form of specialist consultations.
Plaintiff failed to respond to defendant’s Statement of Uncontroverted Material
Facts (“SUMF”), and they are admitted for the purpose of summary judgment as a result.
Mo. E.D. L. R. 4.01(E). The facts are summarized as follows:
Plaintiff was transferred to SECC on August 20, 2015. SECC is a level 5, or
maximum security, facility. The lay-ins a medical provider may prescribe for a
patient are subject to the discretion of the correctional staff. Defendant Hill does not have
discretion to override security decisions pertaining to a patient’s lay-ins. Hill did not
have the authority to provide plaintiff with an extra pillow and, in any event, he could
have used items such as additional clothing for cushioning as needed. Hill also did not
have the authority to provide plaintiff with his desired “no kneeling” lay-in but, even so,
did not believe that limited kneeling of twenty to thirty seconds would present an
excessive risk to plaintiff’s health.
Benign prostatic hyperplasia (“BPH”), also known as prostate gland enlargement,
is a common age-related condition in which the prostate becomes enlarged. BPH may
cause issues with urine flow. Treatment for BPH includes monitoring of symptoms with
lifestyle changes, including exercises to strengthen the pelvic floor muscles, medications
to reduce the symptoms associated with BPH, or, if medically indicated, surgery to
remove all or part of the prostate. A digital rectal examination (“DRE”) is also necessary
to assess the prostate. Laboratory tests measuring a patient’s prostate-specific antigen
(“PSA”) are used to determine the risk of prostate cancer. If a patient exhibits significant
abnormalities such as escalating PSA levels over a period of time or a prostate tumor, an
on-call oncologist is consulted to assess the next steps for treatment, which may include a
biopsy or urology assessment. Most patients can be actively monitored through
laboratory testing and DREs. In plaintiff’s case, defendant Hill determined a consultation
with the oncologist was not medically necessary because plaintiff’s PSA levels did
not consistently increase over a period of time. A DRE also revealed no significant
prostate abnormalities, such as a mass.
Plaintiff did not require a lay-in for diapers, mesh pads, or similar items for his
purported leaking bladder. Neither defendant Hill nor SECC medical staff observed
objective evidence, such as urine stains or smells, supporting plaintiff’s claims of a
leaking bladder at any time. Although defendant Hill understands that plaintiff says his
glasses were confiscated, Hill did not confiscate his glasses. After Plaintiff’s glasses
were confiscated, Hill consulted with plaintiff’s optometrist, Dr. Lee Browning,
regarding plaintiff’s eye concerns, and referred plaintiff to Dr. Browning for further
evaluation.
Plaintiff’s medical records do not reflect that he complained of “blackouts” to Hill
during his treatment at SECC, nor did Hill observe “blackouts.” Plaintiff did not
complain to Hill of symptoms suggestive of neuropathy in his feet and legs. His
complaints pertaining to his feet and legs were musculoskeletal (rather than neuropathic)
in nature. Plaintiff did not complain to Hill of numbness in his pubic area. Plaintiff also
did not complain to Hill of difficulty sleeping, or insomnia. In any event, insomnia is not
a condition that is pharmacologically treated in the prison setting. If plaintiff had
complained to Hill of insomnia, Hill would have advised him as to appropriate sleep
hygiene or referred him to mental health to help determine the cause of his insomnia.
Plaintiff also exhibited no symptoms of osteoporosis and Hill was not aware of any
concerns regarding osteoporosis.
Plaintiff’s medical records do not reflect that he suffered a stroke during Hill’s
treatment of him at SECC. Plaintiff’s medical records also do not reflect that he suffered
a concussion at any time during Hill’s treatment of him. Degenerative joint disease
(“DJD”), which is also referred to as osteoarthritis, is an irreversible condition which
refers to age-related degenerative changes in the joints. At plaintiff’s age, the vast
majority of patients have experienced deterioration of their joints. DJD and arthritis are
treated conservatively first, through pain medications such as acetaminophen and
nonsteroidal anti-inflammatory drugs (“NSAIDS”), and adopting healthy lifestyle choices
such as a healthy diet and remaining physically active. If the joint deteriorates
significantly and/or a patient is unable to perform activities of daily living (“ADLs”),
more invasive methods of treatment can be pursued, such as injections or surgery.
However, considering the complications that can arise from surgery are often irreversible,
medical professionals typically start with conservative treatment first. Defendant Hill
prescribed a course of conservative treatment for plaintiff’s complaints of chronic joint
pain, including those related to his left elbow, knees, and lumbar spine, which consisted
of examinations, lay-ins for a bottom bunk and no squatting, medications, including
Meloxicam, Prednisone, analgesic balm, aspirin, and Zonisamide, and x-rays. Hill
believed lay-ins for a knee brace, front cuff, and orthotics were not medically necessary.
Hill evaluated the nodule on plaintiff’s left knee on March 30, 2017. She ordered
an x-ray of the left knee which showed that the nodule was a fluid-filled cyst that
required no further medical intervention.
Diabetes is a condition characterized by too much sugar in the blood. Type
2 diabetes is a chronic condition that can develop over time. Diabetes is usually
diagnosed with the hemoglobin A1c test, which measures the average blood sugar level
for the past two to three months. Normal levels are below 5.7%, and a result between
5.7% and 6.4% is considered prediabetes. An A1c level of 6.5% or higher means a
patient has diabetes. If a patient has prediabetes, no medication is necessary. Rather, a
patient should implement lifestyle changes, such as weight loss, healthy eating, and
regular exercise. Plaintiff’s hemoglobin A1c levels did not exceed 6.5% at SECC, and
Hill advised him to adopt healthy lifestyle choices in order to prevent the development of
diabetes.
Hill did not refuse to treat plaintiff for any urinary tract infection (“UTI”). Hill
also treated plaintiff’s high blood pressure and hyperlipidemia. Hill sought to
prescribe Lisinopril (an ACE inhibitor that treats hypertension) for plaintiff’s high blood
pressure on October 26, 2015, but he refused. Hill ordered laboratory testing to assess
plaintiff’s cardiovascular condition on May 10, 2016, put plaintiff refused the tests.
Plaintiff agreed to laboratory testing on November 15, 2016, and Hill ordered laboratory
testing (though Plaintiff continued to refuse medications). Plaintiff then agreed to take
Lisinopril and, on January 9, 2017, Hill prescribed it. Hill also monitored Plaintiff’s
hyperlipidemia through chronic care appointments and laboratory testing (when plaintiff
agreed) and prescribed Atorvastatin (a medication which treats high cholesterol and
triglyceride levels) when plaintiff’s laboratory testing showed elevated triglycerides. It is
Hill’s opinion that plaintiff’s reported dizziness was vasovagal in nature and arose
from dehydration and sudden movements. Hill therefore advised plaintiff to hydrate and
as to appropriate positional changes.
On June 29, 2016, Hill saw plaintiff for complaints of difficulty hearing. Plaintiff,
however, had no difficulty understanding conversational speech. Plaintiff similarly
exhibited no hearing issues at an appointment with Dr. Ashokkumar Chada on June 29,
2017.
On November 16, 2017, Dr. Philip Tippen saw plaintiff, who reported a right
testicular lump. Dr. Tippen did not palpate a lump and did not order diagnostic testing or
medications. Plaintiff was transferred to Eastern Reception, Diagnostic and Correctional
Center in or around December 23, 2017.
Hill avers that she provided plaintiff with appropriate medical treatment for his
medical conditions and that she did not base her treatment of plaintiff on his housing
assignment. Hill did not refuse to prescribe pain medications for him because, as he
alleges, he is a “recovering drug addict.” Hill did not deny plaintiff pain medication or
any other treatment due to cost. In addition, plaintiff was not harmed or injured by the
medical treatment Hill rendered him.
II. Legal Standard
Pursuant to Federal Rule of Civil Procedure 56(c), a district court may grant a
motion for summary judgment if all of the information before the court demonstrates that
“there is no genuine issue as to material fact and the moving party is entitled to judgment
as a matter of law.” Poller v. Columbia Broadcasting System, Inc., 368 U.S. 464, 467
(1962). The burden is on the moving party. City of Mt. Pleasant, Iowa v. Assoc. Elec. Co-
op., Inc., 838 F.2d 268, 273 (8th Cir. 1988). After the moving party discharges this
burden, the nonmoving party must do more than show that there is some doubt as to the
facts. Matsushita Elec. Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986).
Instead, the nonmoving party bears the burden of setting forth specific facts showing that
there is sufficient evidence in its favor to allow a jury to return a verdict for it. Anderson
v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986); Celotex Corp. v. Catrett, 477 U.S. 317,
324 (1986).
In ruling on a motion for summary judgment, the court must review the facts in a
light most favorable to the party opposing the motion and give that party the benefit of
any inferences that logically can be drawn from those facts. Buller v. Buechler, 706 F.2d
844, 846 (8th Cir. 1983). The court is required to resolve all conflicts of evidence in favor
of the nonmoving party. Robert Johnson Grain Co. v. Chem. Interchange Co., 541 F.2d
207, 210 (8th Cir. 1976).
III. Discussion
Plaintiff claims that his Eighth Amendment right to be free from cruel and unusual
punishment was violated by defendant’s actions. A prisoner’s Eighth Amendment rights
are violated if prison officials exhibit deliberate indifference to the prisoner’s serious
medical needs. Estelle v. Gamble, 429 U.S. 97, 104 (1976); Farmer v. Brennan, 511 U.S.
825, 828 (1994). It is a violation of the Eighth Amendment to deny medical care for a
serious medical need that results in pain and suffering. Estelle, 492 U.S. at 103. A claim
of deliberate indifference involves both an objective and subjective standard. Id. It is the
plaintiff’s burden to demonstrate: (1) he suffered objectively serious medical needs and
(2) prison officials actually knew of but deliberately disregarded those needs. Jolly v.
Knudsen, 205 F.3d 1094, 1096 (8th Cir. 2000).
“To be objectively serious, a medical need must have been ‘diagnosed by a
physician as requiring treatment’ or must be ‘so obvious that even a layperson would
easily recognize the necessity for a doctor’s attention.’” Barton v. Taber, 820 F.3d 958,
964 (8th Cir. 2016). Under the subjective standard, an official is deliberately indifferent if
she knows of and disregards an excessive risk to inmate health or safety; the official must
be aware of facts from which the inference could be drawn that a substantial risk of
serious harm exists, and she must also draw the inference. Farmer, 511 U.S. at 837.
Medical malpractice, inadvertent failure to provide adequate medical care, or simple
negligence do not amount to a constitutional violation. Dulany v. Carnahan, 132 F.3d
1234, 1239, 1243 (8th Cir. 1997).
Further, a mere difference of opinion between plaintiff and his physician about
which treatment is appropriate does not give rise to an Eighth Amendment claim. Warren
v. Fanning, 950 F.2d 1370, 1373 (8th Cir. 1991). “Inmates do not have a constitutional
right to any particular type of treatment.” Toney v. Hakala, No. 4:10-cv-20156-JAR,
2013 WL 5406448, at *19 (E.D. Mo. Sept. 25, 2013).
First, not all of plaintiff’s complaints constitute objectively serious medical
conditions. Defendant concedes that plaintiff’s high blood pressure, hyperlipidemia,
BPH, joint pain, headaches, prediabetes concerns, urinary tract infections, and eye-related
complaints constitute objectively serious medical conditions. Other of plaintiff’s
complaints, however, do not. In particular, there is no evidence that plaintiff suffered
from osteoporosis, stroke, neuropathy, blackouts, sleeping problems, or a concussion
while housed at SECC. Plaintiff’s “bare assertion[s]” are insufficient to demonstrate that
he had objectively serious medical needs. Kayser v. Caspari, 16 F.3d 280, 281 (8th Cir.
1994). Plaintiff further did not exhibit objective evidence to support claims of a leaking
bladder, so he could not have a serious medical need for diapers or similar
accommodations.
Plaintiff’s right testicle complaints, purported dizziness, alleged hearing loss, and
left knee cyst are also not objectively serious medical needs. Plaintiff did not require
medications or diagnostic testing for his right testicle. Plaintiff also did not require
treatment for his reported dizziness but instead was advised to hydrate and make
appropriate positional changes. Plaintiff also did not require treatment for the fluid-filled
cyst on his left knee. While plaintiff complained of difficulty hearing, he did not exhibit
any significant difficulty hearing on June 29, 2016, to Hill, or on June 29, 2017, to Dr.
Chada, and these providers determined no medical intervention was necessary.
As for plaintiff’s vague allegations that he suffered from numbness in the pubic
area, he did not complain of such numbness when Dr. Chada performed a DRE or when
Dr. Tippen examined plaintiff’s testicles. It is also not clear that vague allegations of
numbness would rise to the level of an objectively serious medical need, but it is certain
that plaintiff has not shown defendant knew of and disregarded any excessive risk to
plaintiff’s health.
Indeed, it is apparent and undisputed that Hill provided constitutionally adequate
medical care for plaintiff. Hill’s treatment was not based on plaintiff’s housing
placement as he alleges. Hill saw plaintiff at least 25 times while he was housed at
SECC, and she rendered treatment—diagnosing, prescribing medication, and ordering
tests—for plaintiff’s numerous medical complaints including his chronic joint pain,
hypertension,, high blood pressure, and BPH.
Although plaintiff claims Hill denied him treatment for a UTI, medical records
show Hill prescribed antibiotics for his UTIs. Hill saw plaintiff in follow-up
appointments and his UTIs had resolved. Plaintiff claims his diabetes was untreated, but
medical records show that his blood tests reflected that he did not require medication or
other medical treatment.
Defendant Hill also treated plaintiff’s complaints of chronic joint pain. She
examined plaintiff for complaints regarding his left elbow, right knee, and lower back,
and she ordered treatment including x-rays, lay-ins, and medications. His diagnostic
results confirmed he had degenerative osteoarthritis, which could be treated
conservatively. Hill provided a lay-in for plaintiff when he reported he had difficulty
squatting. Plaintiff’s allegations regarding loss of range of motion in his joins are not
supported by the medical record; when non-party Dr. Chada examined plaintiff on June
29, 2017, he noted no knee abnormalities and normal range of motion in plaintiff’s left
elbow, ankles, and feet. A nurse observed plaintiff walking with a brisk, steady gait,
knees bending freely, on July 11, 2017.
As for plaintiff’s allegations regarding his enlarged prostate, the records show Hill
implemented a thorough course of treatment for plaintiff’s BPH which included
evaluations, laboratory testing, urine cultures and PSA tests, an x-ray of plaintiff’s
abdomen, a DRE (which plaintiff required a different provider to administer), and
Tamsulosin. Defendant continuously monitored plaintiff’s BPH symptoms and PSA
levels, which did not escalate over the course of Hill’s treatment but instead decreased
from May to August, 2017. Hill thus determined that an oncology consult was not
required.
The medical records also show defendant Hill appropriately addressed plaintiff’s
complaints of dizziness. She explained to plaintiff that the dizziness was vasovagal in
nature and arose from dehydration and sudden movements. She thus educated plaintiff
regarding how to avoid dizziness, that is, by increasing fluid intake and standing up
slowly.
Plaintiff disagrees with Hill’s medical judgments regarding lay-ins, but such
disagreement does not constitute an Eighth Amendment violation. Estate of Rosenberg v.
Crandell, 56 F.3d 35, 37 (8th Cir. 1995). Plaintiff does not have a constitutional right to
any particular type of treatment or accommodation. Toney, 2013 WL 5406448 at *19.
Plaintiff’s medical records show that Hill thoroughly assessed plaintiff and determined
that he did not require a knee brace, a lay-in for front cuffs, diapers, orthotics, or an extra
pillow. Moreover, as Hill explained, she was unable to provide a lay-in for no kneeling or
an extra pillow due to security restrictions. Plaintiff cannot hold Hill liable for the
perceived acts or omissions of others. Ashcroft v. Iqbal, 556 U.S. 662, 663 (2009).
Regardless, it is apparent from the ample record that Hill did not disregard plaintiff’s
medical conditions; she provided plaintiff lay-ins which she believed were medically
necessary, such as lay-ins for a bottom bunk and no squatting. Hill’s refusal to implement
plaintiff’s preferred course of treatment does not violate the Constitution, particularly
where Hill based her decisions on plaintiff’s objective clinical symptoms and her medical
knowledge. Vaughn v. Gray, 557 F.3d 904, 909 (8th Cir. 2009).
Plaintiff’s claim that Hill had his prescribed glasses confiscated appears to be
without support. Hill explains that the glasses were confiscated by others because he
misused his lay-in. Hill referred plaintiff to his optometrist. There’s no evidence that
Hill ignored a risk of harm to plaintiff.
As for all of plaintiff’s allegations pertaining to non-serious medical needs,
described above, the evidence shows defendant Hill did not ignore the medical needs
about which she knew. Defendant was unaware of plaintiff’s complaints of neuropathy,
numbness, blackouts, and insomnia. Although plaintiff reported a fall on October 4,
2016, Hill opines that any alleged fall resulted form plaintiff’s self-imposed hunger strike
and dehydration, not “blackouts.” Nonparty Dr. Birch noted no neurological
abnormalities suggestive of a concussion of plaintiff’s purported fall. Plaintiff also
exhibited no signs of a stroke at SECC.
Although Hill was aware of plaintiff’s hearing loss complaints, Hill and other
providers determined there was no hearing problem.
Additionally, Hill’s and other providers’ efforts to treat plaintiff’s medical
complaints were impeded by plaintiff’s frequent refusals of care and failures to follow
medical advice. Plaintiff complains that Hill failed to treat his high blood pressure, but
records show he refused Hill’s offer to prescribe Lisinopril and other medication.
Plaintiff also refused testing and treatment for his hyperlipidemia. When plaintiff
complained of headaches and requested Anacin, Hill offered an alternative of aspirin with
caffeine, which contains the same ingredients as Anacin. Plaintiff refused, and he also
refused her offers to prescribe other medications. Hill also offered plaintiff medication to
treat his weak urine stream, but he refused.
To the extent plaintiff complains of delayed medical treatment, he has provided no
verifying medical evidence to establish the detrimental effect of any perceived delay.
Moots v. Lombardi, 453 F.3d 1020, 1023 (8th Cir. 2006). But moreover, there is simply
no evidence in the record tending to show that Hill was ever subjectively aware of a
substantial risk of serious harm to plaintiff and then ignored that risk.
This Court has thoroughly considered defendant’s substantial, detailed motion,
memorandum, and SUMF and exhibits. As indicated above, despite numerous
opportunities to do so, plaintiff has not filed a response. Instead, plaintiff complained
about documents pertaining to the pillow restrictions for which he blames Hill. Even if
plaintiff had such documents, they would not change the deliberate indifference analysis.
Plaintiff’s only direct response to Hill’s motion for summary judgment is a motion
to strike her affidavit in support and her SUMF as “perjured.” [Doc. 62.] As an initial
matter, the federal rules do not provide a mechanism for striking portions of defendant’s
summary judgment filing. See Stockdale v. Stockdale, No. 4;08cv1773 CAS, 2010 WL
1329593, at *1 (E.D. Mo. April 6, 2010). “Motions, briefs or memoranda, objections, or
affidavits may not be attacked by the motion to strike.” 2 James W. Moore, et al.,
Moore's Federal Practice § 12. 37[2] (3rd ed. 2010). Even so, the Court will address
plaintiff’s improper motion in the interests of justice.
Plaintiff first argues that the declaration is perjured because certification of his
medical records was executed on a date after Hill’s execution of her declaration. He also
believes, without support, that his medical records were altered. As explained in
defendant Hill’s response in opposition [Doc. 65 at 3], plaintiff’s arguments are based on
a misunderstanding of the records attached to her declaration.
As for plaintiff’s argument that the declaration and medical records constitute
inadmissible hearsay, they are admissible under the business records exception set forth
in Federal Rule of Evidence 803(6). Further, certain statements in the records plaintiff
contends are “hearsay upon hearsay” are not offered to prove the truth of the matter
asserted but rather the reasoning behind treatment decisions.
Plaintiff’s motion to strike will be denied.
Accordingly,
IT IS HEREBY ORDERED that defendant Nina Hill’s motion for summary
judgment [Doc. 49] is GRANTED.
IT IS FURTHER ORDERED that plaintiff's motion to strike [Doc. 62] is
DENIED.
So ordered this 18th day of February, 2022.
J □ _ 4
/ LSLAZ Aled □□□
STEPHEN N. LIMBAUGH, JR.“
SENIOR UNITED STATES DISTRICT JUDGE
17