Eddie King v. Dr. Lawson

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[DO NOT PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 21-14492

____________________

EDDIE JAMES KING,

Plaintiff-Appellant,

versus

DR LAWSON,

Dooly State Prison,

Defendant-Appellee,

DR SHARON LEWIS

MEDICAL DIRECTOR OF GDC, et al.,

Defendants.

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2 Opinion of the Court 21-14492

____________________

Appeal from the United States District Court

for the Middle District of Georgia

D.C. Docket No. 5:17-cv-00303-TES-CHW

____________________

Before ROSENBAUM, NEWSOM, and MARCUS, Circuit Judges.

MARCUS, Circuit Judge:

Eddie James King appeals from the district court’s order

granting Nurse Kristie Lawson’s motion for summary judgment on

King’s deliberate indifference claim. On appeal, King argues that

the district court erred in finding that Lawson was entitled to qual-

ified immunity because she violated King’s constitutional rights

and the law was clearly established. After careful review and with

the benefit of oral argument, we affirm.

I.

In 2016, Kristie Lawson worked as a family nurse practi-

tioner in the infirmary at Dooly State Prison. As a nurse practi-

tioner, Lawson was not a specialist in any particular medical field.

As a result, part of her job at the prison was to determine whether

an inmate needed medical treatment by a specialist. If so, Lawson

would write a consult request for an inmate to see a specialist, but

after that point, she played no further role in the approval, appoint-

ment, or transportation process. Instead, her request had to be re-

viewed by the prison’s medical director. If approved, it was then

examined by the Georgia Department of Corrections (“GDC”)

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Utilization Management (“UM”) team, which would, in turn, de-

cide whether to grant it, and if so, where and when to schedule the

appointment.

On June 29, 2016, Eddie King, an inmate at Dooly State

Prison, visited Nurse Lawson at the prison infirmary to address

concerns he had about his right eye. According to Lawson’s treat-

ment notes, King told her that day that it felt like something was

covering his right eye and he needed “to see the eye doctor.” King

adds -- in his briefing in district court and in this Court -- that from

his first appointment onward, his right eye was “red and watering”

and he complained of eye pain. Lawson promptly filled out a phy-

sician’s order request directing the prison to schedule an appoint-

ment for King to see an optometrist, noting that he “must see” the

optometrist at his or her “next visit” to the prison. Nothing came

of that request.

On July 13, 2016, King returned to the prison infirmary and

told the nurse that his vision was blurry and he was still having

problems with his right eye. Again, Lawson recommended that

King see the optometrist and put another note in his chart recom-

mending this course of conduct to her superiors.

On August 3, 2016, King saw Lawson once again and King

told her that the vision in his right eye was worse -- he now com-

plained of floaters and black lines in his line of vision -- and he had

still not yet seen the optometrist. After this meeting, Lawson sub-

mitted a request for King to see an ophthalmologist from outside

the prison and this time, the nurse marked the request as “urgent.”

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The prison medical director, and then the GDC UM team, ap-

proved the request by the next day, August 4, 2016, and scheduled

King for an ophthalmology appointment on August 18, 2016.

Before his ophthalmology appointment, however, King’s vi-

sion deteriorated further and he returned to Nurse Lawson on Au-

gust 15, 2016, complaining that he could not see out of his right

eye. Lawson told King she had already put in the ophthalmology

request for him and that she had no control over scheduling the

appointment. King saw the ophthalmologist on August 18, as the

prison team had directed, but by the time of that appointment, he

says -- again, in his briefing -- that he was blind in his right eye. King

has since said in his briefing that the retina of his right eye had be-

come detached due to a delay in his treatment and had caused

blindness in that eye.

Proceeding pro se, King sued Nurse Lawson in the Middle

District of Georgia for violating 42 U.S.C. § 1983 for deliberate in-

difference to King’s medical needs, in violation of the Eighth

Amendment. 1 Lawson later moved for summary judgment, argu-

ing that King could not prove deliberate indifference or, in the al-

ternative, that she was entitled to qualified immunity. The district

court agreed. It found that while King had adequately established

that his vision problem constituted a serious medical need, he failed

1 King also raised deliberate indifference claims against other state officials, in-

cluding GDC Medical Director Sharon Lewis, physician’s assistant Stifanos

Almedom, and the prison medical director, Jennifer Mason. Only his claim

against Nurse Lawson, however, is before the Court in this appeal.

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to show that Lawson was deliberately indifferent to that need, or

that any such indifference caused his vision loss.

King timely appealed, and a panel of our Court appointed

counsel for King on appeal. 2

II.

We review a district court’s decision on summary judgment

de novo and apply the same legal standard used by the district court.

Smith v. Owens, 848 F.3d 975, 978 (11th Cir. 2017). Summary judg-

ment is appropriate if, after drawing all reasonable inferences in

King’s favor, “there are no genuine issues of material fact.” Id. To

survive summary judgment, then, King must identify some “‘af-

firmative evidence’ that would allow a reasonable jury to rule for

him” on his deliberate indifference claim. Hinson v. Bias, 927 F.3d

1103, 1116 (11th Cir. 2019) (quoting Anderson v. Liberty Lobby, Inc.,

477 U.S. 242, 257 (1986)). “A mere scintilla of evidence in support

of the nonmoving party will not suffice to overcome a motion for

summary judgment.” Young v. City of Palm Bay, 358 F.3d 859, 860

(11th Cir. 2004).

III.

To invoke qualified immunity, a public official must first es-

tablish that she was acting within the scope of her discretionary au-

thority. Maddox v. Stephens, 727 F.3d 1109, 1120 (11th Cir. 2013).

2 Attorney Carolyn Burch was appointed to represent King. We commend

Attorney Burch for accepting this appointment and representing her client

with vigor and care.

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The term “discretionary authority” covers “all actions of a govern-

mental official that (1) were undertaken pursuant to the perfor-

mance of [her] duties, and (2) were within the scope of [her] au-

thority.” Jordan v. Doe, 38 F.3d 1559, 1566 (11th Cir. 1994) (internal

quotation marks omitted).

Once the defendant establishes that she was acting within

the scope of her discretionary authority, the burden shifts to the

plaintiff to demonstrate that qualified immunity is inappropriate.

Maddox, 727 F.3d at 1120. Overcoming the defendant’s qualified

immunity defense involves a two-part inquiry. Skop v. City of At-

lanta, 485 F.3d 1130, 1137 (11th Cir. 2007). The plaintiff must show

that: (1) “the defendant’s conduct violated a statutory or constitu-

tional right,” and (2) “the violation was clearly established.” Id. (in-

ternal quotation marks omitted). We can decide these issues in ei-

ther order, but the plaintiff must make both showings in order to

survive a qualified immunity defense. Hinson, 927 F.3d at 1116.

First, the parties do not dispute that when King visited Nurse

Lawson in the prison infirmary about his eye problem she was act-

ing within the scope of her discretionary authority. So, the burden

shifts to King to demonstrate that qualified immunity is inappro-

priate. Maddox, 727 F.3d at 1120. King argues that Lawson violated

his Eight Amendment rights by acting with deliberate indifference

to his medical needs and that his rights were clearly established at

the time.

The Eighth Amendment governs the conditions under

which convicted prisoners are confined and the treatment they

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receive when they are incarcerated. Farmer v. Brennan, 511 U.S. 825,

832 (1994). The Supreme Court has interpreted the Eighth Amend-

ment to prohibit “deliberate indifference to serious medical needs

of prisoners.” Estelle v. Gamble, 429 U.S. 97, 104 (1976). To succeed

on an Eighth Amendment deliberate indifference claim, a prisoner

must: (1) “satisfy the objective component by showing that [he] had

a serious medical need”; (2) “satisfy the subjective component by

showing that the prison official acted with deliberate indifference

to [his] serious medical need”; and (3) “as with any tort claim, . . .

show that the injury was caused by the defendant’s wrongful con-

duct.” Goebert v. Lee County, 510 F.3d 1312, 1326 (11th Cir. 2007).

Applying this well-recognized three-part test to King’s claim,

we agree with the district court that he has not established a con-

stitutional violation. We begin, however, by recognizing that King

has shown that the blindness in his right eye is a “serious medical

need” under the first part of the test. “A serious medical need is

‘one that has been diagnosed by a physician as mandating treat-

ment or one that is so obvious that even a lay person would easily

recognize the necessity for a doctor’s attention.’” Taylor v. Hughes,

920 F.3d 729, 733 (11th Cir. 2019) (quoting Mann v. Taser Int’l, Inc.,

588 F.3d 1291, 1307 (11th Cir. 2009)). Either way, to violate consti-

tutional standards, “the medical need must be one that, if left un-

attended, poses a substantial risk of serious harm.” Id. (alteration

omitted) (quoting Farrow v. West, 320 F.3d 1235, 1243 (11th Cir.

2003)). A serious medical need can also be determined by “whether

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a delay in treatment exacerbated the medical need or caused addi-

tional complications.” Id.

Of course, the need to treat a serious eye infirmity, let alone

blindness is “so obvious that even a lay person would easily recog-

nize” it. See id.; Colwell v. Bannister, 763 F.3d 1060, 1066 (9th Cir.

2014) (“Although blindness in one eye is not life-threatening, it is no

trifling matter either. It is not a bump or scrape or tummy ache.

Monocular blindness is the loss of the function of an organ.”).

And, in fact, Nurse Lawson assumes on appeal that “King’s eye con-

dition presented an objectively serious risk of injury.”

But even if we accept that King’s eye condition in his right

eye presented a serious medical need under the first part of the de-

liberate indifference test -- as we do -- he still must satisfy the re-

maining two parts of the test. Both are necessary. We need only

address the last one, however -- whether there is a genuine dispute

of material fact concerning whether Lawson’s treatment, or delay

in treatment, caused King’s injury -- in order to decide this appeal.

On the record before us, there is not. King has offered no evidence

of causation, let alone medical evidence.

Our inquiry into causation asks “whether an official’s acts or

omissions were the cause -- not merely a contributing factor -- of”

the constitutional violation. LaMarca v. Turner, 995 F.2d 1526, 1538

(11th Cir. 1993). A causal connection may be established by prov-

ing that the official was personally involved in the acts that resulted

in the constitutional deprivation. Goebert, 510 F.3d at 1327. Where,

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as here, a prisoner argues that his injury was caused by a delay in

treatment, he “must place verifying medical evidence in the record

to establish the detrimental effect of [the] delay in medical treat-

ment.” Hill v. Dekalb Reg’l Youth Det. Ctr., 40 F.3d 1176, 1188, 1190

(11th Cir. 1994) (requiring medical evidence to “establish the detri-

mental effect of delay in medical treatment”), overruled in part on

other grounds by Hope v. Pelzer, 536 U.S. 730 (2002); see also Goodman

v. Kimbrough, 718 F.3d 1325, 1331 (11th Cir. 2013) (“To survive sum-

mary judgment in a case alleging deliberate indifference, a plaintiff

must produce sufficient evidence of[, among other things,] causa-

tion.”) (internal quotation marks omitted)).

Here, King has not offered any evidence, let alone medical

evidence, to establish that Nurse Lawson’s conduct caused the

blindness in his right eye. As we’ve already laid out, Nurse Lawson

took steps to address King’s complaints about his eye from the very

beginning, at every visit, responding each time by recommending

to her superiors that King be referred to an eye specialist. At each

of King’s first two appointments, he complained about blurry vi-

sion and requested “to see the eye doctor.” Lawson immediately

put in a requested order that King “must see” the optometrist on

his or her next visit to the prison, and Lawson added another one

for good measure two weeks later. King returned to the infirmary

in three weeks, reporting not only blurry vision but also having

“floaters or black lines in line of vision.” This time, Lawson

changed course, submitting an “urgent” request for a consultation

with an ophthalmologist. Within two weeks, King was transported

to be evaluated by Dr. Lane Ulrich, an ophthalmology specialist.

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The medical records before us thus detail King’s appoint-

ments with Nurse Lawson, and they detail the steps she took to

secure the appropriate treatment for him. They do not, however,

indicate that her conduct caused his vision loss.

For starters, King has not presented any evidence in the rec-

ord to explain what caused his vision loss or what could have pre-

vented it. Thus, by way of example, there is no evidence in the

record to establish that King in fact suffered a detached retina, and

if so, how it may have arisen or whether it caused his blindness.

Nor do we know that Lawson’s initial referrals to the optometrist

could not have addressed his eye problem, had an appointment

taken place. Nor is there any evidence that an appointment with

the ophthalmologist, when Lawson first requested it, could not

have addressed the issue. Nor is there anything to suggest that

Lawson could have accelerated an appointment with either special-

ist by making an “urgent” request sooner. Rather, the undisputed

record reflects that Lawson played “no . . . role” in securing treat-

ment after she referred the prisoner to a specialist, so it is unclear

whether an urgent request, without any significant medical history

to accompany it, would have moved the process along. Nor, most

importantly, do we even know if an ophthalmology appointment

when King first went to the infirmary could have prevented his vi-

sion loss. The bottom line is, even if it were within Nurse Lawson’s

power to have immediately secured an appointment with an eye

specialist for King during his first or second visit, there is no evi-

dence that it would have made a difference.

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Furthermore, King has offered no evidence that Lawson

could have done something more herself to treat him. As the un-

disputed record confirms, Lawson was not an eye specialist, and

King has not proposed any particular treatment she could or should

have offered herself. A defendant cannot be causally responsible

for a plaintiff’s injury if the injury “could not have been alleviated

by her.” Hill, 40 F.3d at 1190. And on this record, we cannot see

how Lawson herself could have done anything more than she did

to alleviate King’s eye condition.

King’s brief offers only conclusory statements in response.

He insists, for example, that Lawson’s “delay in referring him to a

specialist caused blindness in his right eye” and her “lack of treat-

ment for five weeks caused [him] to continue to suffer eye pain.”

But setting aside that the injury at issue is King’s blindness -- not his

eye pain -- we’ve already explained that, according to the undis-

puted record, Lawson did treat him by making prompt requests for

referrals, and he’s presented no evidence that, had she taken other

or quicker avenues, his right eye would not have gone blind.

It’s also worth noting that “[s]tatements . . . in briefs are not

evidence.” Travaglio v. Am. Express Co., 735 F.3d 1266, 1270 (11th Cir.

2013) (citation omitted). As we’ve said:

When a motion for summary judgment has been

made properly, the nonmoving party may not rely

solely on the pleadings, but by affidavits, depositions,

answers to interrogatories, and admissions must

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show that there are specific facts demonstrating that

there is a genuine issue for trial. Fed. R. Civ. P. 56(c),

(e). Although we must view factual inferences favor-

ably toward the nonmoving party and pro se com-

plaints are entitled to a liberal interpretation by the

courts, we hold that a pro se litigant does not escape

the essential burden under summary judgment stand-

ards of establishing that there is a genuine issue as to

a fact material to his case in order to avert summary

judgment.

Brown v. Crawford, 906 F.2d 667, 670 (11th Cir. 1990) (citations omit-

ted) (affirming the grant of summary judgment in a § 1983 case

where the plaintiff had “not submitted a doctor’s diagnosis or any

medical evidence supporting his allegations that the City of Miami

drinking water at Dade County Jail caused his stomach pains and

headaches”).

This means that the conclusory claims King makes about

causation in his brief on appeal -- that the five weeks of “no treat-

ment” must have caused his eventual right-eye blindness -- do not

raise a “genuine issue” about causation for purposes of summary

judgment. Nor can we find anything in the trial court record to

support the argument. On appeal, he cites only to his own briefing

in the district court, which similarly does not raise a “genuine is-

sue” about causation. Id.

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What’s more, even if we were somehow able to consider the

statements in King’s briefing for purposes of summary judgment,

they would not carry the day. In his filings, King includes claims

that, for example, “[t]he retina had detach[ed] from the eyeball”

and “we all know the longer you prolong a problem the worse it

get[s],” and “[his] retina detach[ed] from the eyeball because of de-

lay.” But as we’ve explained many times, “[c]onclusory allegations

and speculation” like those found in King’s briefing are legally “in-

sufficient to create a genuine issue of material fact” and prevent

summary judgment. See, e.g., Valderrama v. Rousseau, 780 F.3d 1108,

1112 (11th Cir. 2015) (citing Cordoba v. Dillard’s Inc., 419 F.3d 1169,

1181 (11th Cir. 2005) (“Speculation does not create a genuine issue

of fact; instead, it creates a false issue, the demolition of which is a

primary goal of summary judgment.”)); see also Harris v. Pub. Health

Tr. of Miami-Dade Cnty., 82 F.4th 1296, 1306 (11th Cir. 2023) (per

curiam); Ellis v. England, 432 F.3d 1321, 1326 (11th Cir. 2005) (per

curiam). This is especially true in this case, where, in order to de-

feat summary judgment on his deliberate indifference claim, King

needed to “place verifying medical evidence in the record to estab-

lish the detrimental effect of [the] delay in medical treatment.”

Hill, 40 F.3d at 1188. He has not done so.

The most King can say is that “doctors will testify that the

delay in treatment caused his blindness in his right eye.” Presuma-

bly, he is claiming that he could later provide the testimony of a

doctor at a trial. But although King was acting pro se in district

court, that did not absolve him from offering competent evidence,

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including medical opinions, to defeat Lawson’s motion for sum-

mary judgment. Brown, 906 F.2d at 670. The only record support

for his general and vague claim about potential medical opinions is

found in a citation to one of his briefs presented in the district

court, which again only offers the same conclusory and unsup-

ported statement. Again, this is not evidence. See id.; Travaglio, 735

F.3d at 1270.

In short, there is no genuine dispute of material fact concern-

ing whether Nurse Lawson caused King’s right-eye blindness, nor,

in turn, whether she violated King’s constitutional rights. As a re-

sult, we need not and do not reach the second part of the qualified

immunity inquiry. See Hinson, 927 F.3d at 1116. Accordingly, we

affirm the district court’s grant of summary judgment in favor of

Nurse Lawson.

AFFIRMED.