RAYFORD

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

PENSACOLA DIVISION

DARREL LEON RAYFORD,

Plaintiff,

v. Case No. 3:25cv627-LC-HTC

CENTURION OF FLORIDA LLC, et al.,

Defendants.

_________________________________/

REPORT AND RECOMMENDATION

Plaintiff Darrel Leon Rayford, a prisoner proceeding pro se and in forma

pauperis, alleges Defendant Centurion of Florida LLC (“Centurion”) violated the

Eighth Amendment by displaying deliberate indifference to a right knee injury he

suffered while incarcerated. Doc. 15. Centurion has filed a motion to dismiss (Doc.

29) and Rayford responded in opposition (Doc. 45). After reviewing the parties’

submissions and the relevant law, the undersigned concludes the motion should be

GRANTED because: (1) Rayford failed to exhaust his administrative remedies

regarding his claim against Centurion; and (2) his factual allegations do not support

a deliberate indifference claim against Centurion.

I. Background

Rayford sues Centurion, a contractor that provides medical care to inmates in

the Florida Department of Corrections (“FDOC”), and three of its employees, Dr. E.

Hernandez-Perez, Nurse Kelley Coone, and Nurse Melanie Carter. The second

amended complaint (Doc. 15) sets forth the following factual allegations, which are

accepted as true for purposes of this Report and Recommendation.

In May 2023, Rayford injured his right knee while playing basketball at

Okaloosa Correctional Institution (“Okaloosa CI”). He heard “a pop sound” in the

knee, felt “excruciating pain,” and was unable to stand with all his weight on the

knee. Security staff immediately escorted Rayford to the medical department for an

examination.

Nurse Coone asked Rayford to try to walk; Coone observed Rayford’s knee

was “extremely swollen” and, based on his behavior and facial expression, saw that

he was in “a tremendous amount of pain.” Coone ordered x-rays, which were taken

the same day as the injury. Coone told Rayford she could find nothing abnormal on

the x-rays and an MRI would need to be conducted. About a month after the injury,

Coone and Dr. Hernandez-Perez provided Rayford with crutches.

In August 2023, Rayford was transferred to the Reception and Medical Center

(“RMC”), where medical staff informed him that Coone had scheduled him to

receive “progressive rehabilitative and physical exercise therapy.” Over a span of

three months, Rayford was forced, under threat of disciplinary action, to complete

twelve sessions of “rigorous and painful multi-training exercises.” He could not

properly complete the exercises due to pain and because “the tendons which connect

his quadriceps muscle to his kneecap was clearly disconnected.” Rayford maintains

the physical therapy sessions increased his pain and “only made his injury worse.”

In December 2023, Rayford was transferred back to Okaloosa CI in more pain

than when he suffered the knee injury in May 2023; the chronic pain interfered with

his sleep. In March 2024, Nurse Coone prescribed him 500 mg naproxen pills “for

the first time for his chronic knee pain” but he “was told to take only half to save

them money.” At various sick call visits, Rayford complained to Coone that the

naproxen did nothing to dull his chronic knee pain. Coone refused to prescribe

another, stronger pain medicine “that would work despite having access to stronger

medicine.” In April 2024, Coone and Dr. Hernandez-Perez provided Rayford a

“non-hinged type knee brace.”

Sometime after December 2023, Dr. Hernandez-Perez conducted an

independent examination of Rayford’s knee and reviewed the x-rays that Coone had

ordered in May 2023. Hernandez-Perez explained to Rayford that the lateral

collateral ligament (“LCL”) in his right knee “was completely torn.” Rayford

showed Hernandez-Perez his right knee; he pointed to the top of his kneecap and

pressed his finger down, “evidencing no connective tissue present.” Rayford then

showed Hernandez-Perez his left knee for comparison, “where the other was

obviously connected.”

Hernandez-Perez nodded his head in agreement and explained that an LCL

tear is a common injury among athletes that causes pain and other symptoms.

Rayford asked whether minor LCL tears “usually heal after 3-12 weeks … with

general management and treatment involving the use of ice packs, crutches, and …

a hinged knee brace.” Hernandez-Perez said “yes.”

Rayford looked at both his legs side by side and told Hernandez-Perez the

quad muscle in his right leg had “shrunk a lot.” Hernandez-Perez nodded in

agreement and explained that it appeared “major surgery … probably would be

required to fix it and for [Rayford] to gain full use of his leg,” but “he couldn’t say

for sure without the results of an MRI or ultrasound scan to determine the full extent

of the injury.”

Rayford immediately requested that those diagnostic tests be performed and

that he be prescribed a stronger pain medication to address the constant aching and

numbness in his leg. Rayford also indicated that when he walked, he felt like his leg

had “no balance, like it’s going to collapse on the injured side.” Hernandez-Perez

refused to prescribe different medication or order an MRI, saying “it’s not in the best

interests of company costs for stronger pain medicines or an MRI scan.”

On October 4, 2024, Hernandez-Perez told Rayford he was going to prescribe

a different treatment—therapeutic soles for his shoes and four 10-mg steroid pills a

day to help with his knee pain and minimize the swelling. Rayford asked about

surgery but Hernandez-Perez said “We gonna do one step at a time.” When Rayford

asked about an MRI, Hernandez-Perez replied, “they not gonna pay the money for

an MRI.” Rayford told Hernandez-Perez that Coone said she “put him in for an MRI

scan.” Hernandez-Perez said, “you’re like the 20th person she told that she was

gonna do something for and was lying.” Rayford asserts the steroid pills did

“nothing to dull [his] knee pain or help his knee heal itself properly.”

Between March 2024 and September 2024, Rayford filed multiple grievances

complaining about the adequacy of his treatment and requesting diagnostic imaging,

surgery, and to see a specialist. Some of these grievances were reviewed and

responded to by Dr. Hernandez-Perez and Nurse Carter. The responses denied

Rayford’s grievances and informed him that medical personnel were responsible for

determining his treatment regimen.

In February 2025, Rayford was transferred back to the RMC for an MRI “due

to multiple sick calls without relief from pain and reduced function of knee.” The

MRI was taken in March 2025, and Dr. Owens diagnosed Rayford as having a

problem with his meniscus and ordered surgery. The surgery on Rayford’s knee was

performed on July 11, 2025.

Based on the foregoing, Rayford alleges the Defendants violated the Eighth

Amendment by exhibiting deliberate indifference to his right knee injury. As relief,

he seeks compensatory and punitive damages, as well as injunctive relief.

II. Failure to Exhaust

Centurion argues Rayford’s claim against it should be dismissed because he

failed to exhaust his administrative remedies before filing this action. After

reviewing the parties’ arguments and Rayford’s grievances, the undersigned

concludes Rayford did not exhaust his deliberate indifference claim against

Centurion because he never filed a grievance asserting his inadequate treatment was

due to a custom or policy.

A. Legal Standard

The Prison Litigation Reform Act (“PLRA”) provides that “[n]o action shall

be brought with respect to prison conditions under section 1983 of this title, or any

other Federal law, by a prisoner confined in any jail, prison, or other correctional

facility until such administrative remedies as are available are exhausted.” 42 U.S.C.

§ 1997e(a). Exhaustion of all available administrative remedies is a mandatory

precondition to suit. See Booth v. Churner, 532 U.S. 731, 739 (2001). The

exhaustion requirement “applies to all inmate suits about prison life, whether they

involve general circumstances or particular episodes, and whether they allege

excessive force or some other wrong.” Porter v. Nussle, 534 U.S. 516, 532 (2002).

The requirement is not subject to waiver by a court, or futility or inadequacy

exceptions. See Booth, 532 U.S. at 741 n.6; see also Johnson v. Meadows, 418 F.3d

1152, 1155 (11th Cir. 2005) (The PLRA “entirely eliminates judicial discretion and

instead mandates strict exhaustion, ‘irrespective of the forms of relief sought and

offered through administrative avenues.’”) (citation omitted). Moreover, the PLRA

requires “proper exhaustion” so that the agency has an opportunity to address the

issues on the merits. Woodford v. Ngo, 548 U.S. 81, 93-94 (2006).

An exhaustion defense under the PLRA is treated as a matter in abatement,

which means procedurally the defense is treated like one for lack of jurisdiction,

although it is not a jurisdictional matter. Turner v. Burnside, 541 F.3d 1077, 1082

(11th Cir. 2008) (quotation marks and citations omitted). “As a result, deciding a

motion to dismiss for failure to exhaust administrative remedies is a two-step

process.” Id. “First, the court looks to the factual allegations in the defendant’s

motion to dismiss and those in the plaintiff’s response, and if they conflict, takes the

plaintiff’s version of the facts as true. If, in that light, the defendant is entitled to

have the complaint dismissed for failure to exhaust administrative remedies, it must

be dismissed.” Id. (citing Bryant v. Rich, 530 F.3d 1368, 1373-74 (11th Cir. 2008)).

“If the complaint is not subject to dismissal at the first step, where the

plaintiff’s allegations are assumed to be true, the court then proceeds to make

specific findings in order to resolve the disputed factual issues related to

exhaustion.” Id. (citing Bryant, 530 F.3d at 1373-74, 1376). “Once the court makes

findings on the disputed issues of fact, it then decides whether under those findings

the prisoner has exhausted his available administrative remedies.” Id. at 1083. “The

defendants bear the burden of proving that the plaintiff has failed to exhaust his

available administrative remedies.” Id. at 1082 (citing Jones v. Bock, 549 U.S. 199,

216 (2007)).

The grievance procedures promulgated by the FDOC generally require an

inmate to complete three steps. First, the inmate must file an informal grievance

with a designated prison staff member. Second, the inmate must file a formal

grievance with the warden’s office. Third, the inmate must submit an appeal to the

Office of the Secretary. See Fla. Admin. Code r. 33-103.005 to 33-103.007; see also

Parzyck v. Prison Health Servs., Inc., 627 F.3d 1215, 1218 (11th Cir. 2010). Medical

grievances, however, may start with a formal grievance and bypass the informal

grievance step. See Fla. Admin. Code r. 33-103.006(3)(e).

B. Rayford’s Grievances

Rayford provided the Court with two sets of grievances that are relevant to

the exhaustion analysis.1 First, on February 23, 2024, Rayford filed a formal

grievance complaining he was subjected to “deliberate indifference and medical

negligence” by Coone based on her physical therapy referral and her initial

assessment of his knee injury, including her failure to see the torn ligaments on the

same x-ray that Dr. Hernandez-Perez later reviewed. Doc. 45-1 at 6. Dr. Hernandez-

1 The parties submitted additional grievances, but the two sets discussed herein are the only ones

provided to the Court that include an appeal to the Secretary that was responded to on the merits.

Perez denied that formal grievance on March 12, 2024, stating “it is the

responsibility of your Chief Health Officer to determine the appropriate treatment

regimen for the condition you are experiencing” and “you have received adequate

medical care.” Doc. 45-1 at 5. Rayford appealed the denied of the formal grievance

to the Secretary on March 19, 2024, asserting Hernandez-Perez’s response failed to

address the substance of his complaints. Doc. 45-1 at 9. The Secretary’s office

denied Rayford’s appeal on April 16, 2024, reiterating that medical personnel were

responsible for determining his treatment regimen, stating Hernandez-Perez’s

response was appropriate, and noting Rayford received a knee brace on April 4,

2024. Doc. 45-1 at 8.

Second, on July 2, 2024, Rayford filed a formal grievance complaining that

he had repeatedly put in sick call requests regarding his knee injury, but medical staff

lied about providing him an MRI and kept giving him “the run around” about getting

his knee fixed. Doc. 45-1 at 12. He added that he had been in pain and telling

medical staff about his knee issue for 14 months, but “nothing [was] getting done.”

Id. Dr. Hernandez-Perez denied the formal grievance on August 15, 2024, advising

Rayford that: (1) specialty consults are ordered by the Chief Health Officer; (2) his

request for an MRI was sent to the Regional Medical Director (“RMD”) for review;

and (3) after reviewing his medical record, the RMD decided he would continue to

use a knee brace for three months and then be reevaluated. Doc. 45-1 at 11. Rayford

appealed the denial of the formal grievance on August 25, 2024, asserting

Hernandez-Perez’s response failed to address the concerns he raised, accusing

medical staff of deliberate indifference, and complaining that he had not received an

MRI and his knee was still causing him pain. Doc. 45-1 at 15. On October 4, 2024,

the Secretary’s office denied the appeal, stating Hernandez-Perez’s response

appropriately addressed the issues Rayford presented. Doc. 45-1 at 14.

C. Discussion

The two sets of grievances described above were not sufficient to exhaust

Rayford’s deliberate indifference claim against Centurion. While the grievances

complained about the treatment Rayford was receiving for his knee injury, nothing

in those grievances put prison officials on notice that Rayford believed the

inadequate treatment was due to a custom or policy of Centurion. The grievances

did not mention Centurion, a custom or policy, or the statements Coone and

Hernandez-Perez allegedly made about the cost of Rayford’s treatment. In other

words, nothing in the grievances alerted officials to Rayford’s claim that his

inadequate treatment was due to Centurion’s unwillingness to spend money, as

opposed to the judgment of medical personnel. See Doc. 45-1 at 9 (complaining

medical staff caused him further injury “by failing to have and use the knowledge,

skill and care ordinarily possess and employed by members of the profession in good

standing”).

Because “[a] prisoner must exhaust each claim that he seeks to present in

court,” Arias v. Perez, 758 F. App’x 878, 881 (11th Cir. 2019), and Rayford failed to

grieve his claim against Centurion, that claim is unexhausted and subject to

dismissal. See Henry v. Lutsey, 2020 WL 3470259, at *3 (E.D. Wisc. June 24, 2020)

(grievance alleging correctional officer gave inmate wrong medication did not

exhaust claim that defendant imposed a custom or policy of using correctional

officers to distribute medication when she knew the policy made inmates sick);

Goldsmith v. White, 357 F. Supp. 2d 1336 (N.D. Fla. Feb. 28, 2005) (finding inmate’s

claim of discrimination based on sexual orientation was unexhausted because inmate

filed grievances complaining that defendant took his contact lenses but never

mentioned that his sexual orientation was the reason for taking the contact lenses).

III. Failure to State a Claim

Centurion also argues Rayford has failed to state a claim because he does not

sufficiently allege Centurion had a custom or policy of deliberate indifference. The

undersigned agrees.2

2 While the undersigned concludes Rayford failed to exhaust his claim against Centurion, his

failure to state a claim provides an alternative basis for dismissal. In addition, the undersigned

notes Rayford’s response (Doc. 45) does not address the argument that his allegations fail to state

a claim for relief against Centurion under § 1983.

A. Legal Standard

“To survive a motion to dismiss, a complaint must contain sufficient factual

matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’”

Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550

U.S. 544, 570 (2007)). “A claim has facial plausibility when the plaintiff pleads

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

defendant is liable for the misconduct alleged.” Id. The Court must liberally

construe Rayford’s pro se allegations, Haines v. Kerner, 404 U.S. 519, 520-21

(1972), but conclusory allegations and legal conclusions couched as factual

allegations are not entitled to a presumption of truth. Iqbal, 556 U.S. at 681;

Papasan v. Allain, 478 U.S. 265, 286 (1986).

B. Deliberate Indifference

The Eighth Amendment prohibits government officials from exhibiting

deliberate indifference to the serious medical needs of prisoners. Wade v. McDade,

106 F.4th 1251, 1255 (11th Cir. 2024). “To prevail on a claim of deliberate

indifference, plaintiffs ‘must satisfy both an objective and a subjective inquiry’ and

must establish a ‘necessary causal link’ between the challenged conduct and their

injuries.” Stalley v. Cumbie, 124 F.4th 1273, 1283 (11th Cir. 2024) (citations

omitted).

To satisfy the objective inquiry, an inmate must establish he has an objectively

serious medical need—that is, 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. Keohane v. Fla. Dep’t of Corr.

Sec’y, 952 F.3d 1257, 1266 (11th Cir. 2020). The subjective inquiry requires a

plaintiff to demonstrate the defendant exhibited deliberate indifference; to do so, the

plaintiff must show the defendant: “(1) had subjective knowledge of a risk of serious

harm, (2) disregarded that risk, and (3) engaged in conduct that amounts to subjective

recklessness” under criminal law. Stalley, 124 F.4th at 1283.

In addition, an entity like Centurion is not vicariously liable for the actions of

its employees. See Grech v. Clayton Cnty., Ga., 335 F.3d 1326, 1329 (11th Cir.

2003) (“[L]iability under § 1983 may not be based on the doctrine of respondeat

superior.”). Instead, Centurion is only liable under § 1983 if Rayford shows: (1) his

constitutional rights were violated; (2) that Centurion had a custom or policy that

constituted deliberate indifference to that constitutional right; and (3) that the policy

or custom caused the violation.3 Grochowski v. Clayton Cnty., 961 F.3d 1311, 1321

(11th Cir. 2020) (quoting McDowell v. Brown, 392 F.3d 1283, 1289 (11th Cir. 2004)).

“In order for a plaintiff to demonstrate a policy or custom, it is ‘generally necessary

3 “When a private entity … contracts … to provide medical services to inmates, it performs a

function traditionally within the exclusive prerogative of the state” and “becomes the functional

equivalent of the municipality.” Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 1997).

to show a persistent and wide-spread practice.’” McDowell, 392 F.3d at 1290

(citation omitted).

Here, Rayford claims Centurion displayed deliberate indifference to his

medical needs “by creating a cost-saving policy that sanctioned the delay” of tests

and treatment for his knee injury. Doc. 15 at 14. To support this claim, Rayford

alleges: (1) Nurse Coone prescribed him naproxen in March 2024 and told him “to

take only half to save them money”; and (2) Dr. Hernandez-Perez said “it’s not in

the best interests of company costs for stronger pain medicines or an MRI scan” and

“they not gonna pay the money for an MRI.” Id. at 7-9.

As an initial matter, the undersigned notes prison officials are not

categorically precluded from considering costs when determining what treatment to

provide inmates. See Hoffer v. Sec’y, Fla. Dep’t of Corr., 973 F.3d 1263, 1276 (11th

Cir. 2020) (“It is surely uncontroversial that the deliberate indifference standard does

not guarantee prisoners the right to be entirely free from the cost considerations that

figure in the medical-care decisions made by most non-prisoners in our society.”)

(cleaned up) (citing Reynolds v. Wagner, 128 F.3d 166, 175 (3d Cir. 1997)). Thus,

Rayford must establish Centurion had a custom or policy of delaying or denying

medically necessary care based on costs. However, his allegations are not sufficient

to show Centurion had such a custom or policy.

To establish a custom or policy it is ordinarily necessary for a plaintiff to

identify a pattern of similar constitutional violations. Craig v. Floyd Cnty., Ga., 643

F.3d 1306, 1310 (11th Cir. 2011). “A single incident of a constitutional violation is

insufficient to prove a policy or custom even when the incident involves several

employees[.]” Id. at 1311. Here, the second amended complaint alleges only that

Rayford was denied necessary care by Centurion employees based on cost. Rayford

does not identify any other inmate who was denied treatment based on the alleged

policy. And the Eleventh Circuit has held a single inmate’s experience is not enough

to show Centurion had an unconstitutional custom or policy, even when the inmate

alleged multiple nurses denied him treatment and one nurse indicated the denial was

related to cost. See Adams v. Todd, 2024 WL 4449453, at *4-5 (11th Cir. 2024)

(finding allegations that two nurses denied inmate treatment for one medical

complaint, and one nurse told him the “chief medical officer would not spend any

money on getting him surgery,” were not sufficient to show Centurion had policy or

custom of deliberate indifference); see also Craig, 643 F.3d at 1310 (“a custom must

be such ‘a longstanding and widespread practice [that it] is deemed authorized by

the policymaking officials because they must have known about it but failed to stop

it’”) (quoting Brown v. City of Fort Lauderdale, 923 F.2d 1474, 1481 (11th Cir.

1991)).

In addition, Rayford’s claim that Centurion had a custom of delaying or

denying medically necessary treatment is undermined by his own allegations. He

admits he received an MRI in March 2025 and had surgery in July 2025, and he

admits surgeries “are regularly performed” at the RMC “by several different

doctors.” Doc. 15 at 11. Those allegations do not suggest Centurion had a custom

which prohibits its employees from scheduling those procedures. Instead, Rayford’s

allegations and grievances indicate Dr. Hernandez-Perez was the reason he did not

receive an MRI sooner. See Doc. 15 at 11 (alleging Hernandez-Perez is the RMD

and “has directly stated MRI or surgery is not needed”). Accordingly, Rayford’s

deliberate indifference claim against Centurion should be dismissed.4

IV. Conclusion

Accordingly, it is RECOMMENDED:

1. That Defendant Centurion’s motion to dismiss (Doc. 29) be

GRANTED.

4 Rayford also alleges: (1) Centurion replaced the FDOC’s prior medical contractor, Corizon

Health, Inc.; (2) Corizon had been “inundated” with lawsuits alleging it refused or delayed

treatment to save money; and (3) Centurion “maintained essentially the same employees and …

promoted the exact same policies and cost saving practices as its predecessor.” Doc. 15 at 9.

However, these allegations are not enough to establish a custom or policy. See Est. of Hand by &

through Hand v. Fla. Dep’t of Corr., 2023 WL 119426, at *6 (11th Cir. 2023) (allegation that

Centurion carried over customs or policies from Corizon that the State previously determined to

be inadequate failed to show Centurion had a custom or policy that constituted deliberate

indifference to inmate’s constitutional rights).

2. That Plaintiff’s Eighth Amendment claim against Centurion be

DISMISSED.

At Pensacola, Florida, this 9th day of March, 2026.

/s/ Hope Thai Cannon

HOPE THAI CANNON

UNITED STATES MAGISTRATE JUDGE

NOTICE TO THE PARTIES

Objections to these proposed findings and recommendations must be filed within

fourteen (14) days of the date of the Report and Recommendation.  Any different

deadline that may appear on the electronic docket is for the court’s internal use only

and does not control.  An objecting party must serve a copy of its objections upon

all other parties.  A party who fails to object to the magistrate judge’s findings or

recommendations contained in a report and recommendation waives the right to

challenge on appeal the district court’s order based on the unobjected-to factual and

legal conclusions.  See 11th Cir. Rule 3-1.