Edwards v. Abbett

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE

MIDDLE DISTRICT OF ALABAMA, EASTERN DIVISION

MARCUS EDWARDS, )

)

Plaintiff, )

) CIVIL ACTION NO.

v. ) 3:13cv871-MHT

) (WO)

SHERIFF JIMMY ABBETT )

(in his individual )

capacity), et al., )

)

Defendants. )

OPINION

Pursuant to 42 U.S.C. § 1983, plaintiff Marcus

Edwards brought this lawsuit stemming from his

incarceration in the Tallapoosa County Jail, asserting

that the defendants violated his Eighth and Fourteenth

Amendment rights by denying him treatment for several

medical conditions. The defendants are Tallapoosa County

Sheriff Jimmy Abbett, Jail Administrator Blake Jennings,

and Chief Nurse Cathy Dubose. They are sued in their

individual capacities. This court has jurisdiction

pursuant to both 28 U.S.C. § 1331 (federal question) and

§ 1343 (civil rights). The case is now before this court

on the defendants’ motion to dismiss. For the reasons

that follow, the motion will be granted in part and denied

in part.

I. MOTION-TO-DISMISS STANDARD

In considering a defendant’s motion to dismiss, the

court accepts the plaintiff’s allegations as true, see

Hishon v. King & Spalding, 467 U.S. 69, 73 (1984), and

construes the complaint in the plaintiff’s favor, see

Duke v. Cleland, 5 F.3d 1399, 1402 (11th Cir. 1993).

“The issue is not whether a plaintiff will ultimately

prevail but whether the claimant is entitled to offer

evidence to support the claims.” Scheuer v. Rhodes, 416

U.S. 232, 236 (1974). To survive a motion to dismiss, a

complaint need not contain “detailed factual

allegations,” Bell Atl. Corp. v. Twombly, 550 U.S. 544,

545 (2007), “only enough facts to state a claim to relief

that is plausible on its face.” Id. at 570. “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.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).

“The plausibility standard is not akin to a ‘probability

requirement,’ but it asks for more than a sheer

possibility that a defendant has acted unlawfully.” Id.

(quoting Twombly, 550 U.S. at 556).

II. BACKGROUND

Edwards's third amended complaint is far from a model

pleading. Nevertheless, “accepting the facts alleged in

the complaint as true and drawing all reasonable

inferences therefrom in the plaintiff's favor,” Chesser

v. Sparks, 248 F.3d 1117, 1121 (11th Cir. 2001), it sets

forth the following facts.

Edwards was incarcerated in the Tallapoosa County

Jail for about five and a half months in 2011. Defendant

Sheriff Abbett was responsible for the administration and

supervision of the Tallapoosa County Jail. Defendant

Jail Administrator Jennings was also responsible for

administration and supervision in the jail. Defendant

Chief Nurse Dubose was responsible for providing medical

care to the inmates.

Before his incarceration, Edwards had been diagnosed

with Major Depressive Disorder, Post-Traumatic Stress

Disorder (PTSD), and Adult Attention Deficit

Hyperactivity Disorder (ADHD), and was being treated with

medications. He also had been diagnosed with sleep apnea

and used a continuous positive airway pressure (CPAP)

machine for treatment of his condition. Finally, the

prior year, he had been in a serious accident and

fractured his leg severely. At the time of his

incarceration, he was still under medical treatment and

was prescribed pain medication and physical therapy for

the injured leg.

Edwards and his family repeatedly notified each of

the defendants of his medical conditions and of the need

for him to receive treatment for his conditions.

However, he never received the prescribed treatment for

his leg injury. He also never received treatment for his

ADHD and PTSD. He was allowed to use his own CPAP machine

for sleep apnea, but at some before the end of his

incarceration, Nurse Dubose broke the machine and did not

fix or replace it, leaving his condition untreated for

“weeks.” Third Amended Complaint (doc. no. 43) at 4,

¶¶ 25 & 28.

Edwards was released from jail on November 27, 2011,

at 5:55 a.m. He filed this lawsuit two years later, on

November 27, 2013. In his complaint, he sues only for

the harm he suffered during the period of midnight to

5:55 a.m. on that day. See id. at 1, ¶ 2; id. at 7,

¶¶ 43 & 44.

III. DISCUSSION

In his third amended complaint, Edwards brings one

count for violation of the Eighth and Fourteenth

Amendments by failing to provide him with adequate

medical care for the above-described conditions. The

defendants move to dismiss on one ground only: qualified

immunity. See Motion to Dismiss (doc. no. 45) at 1.

A. Qualified Immunity Doctrine

“The doctrine of qualified immunity protects

government officials ‘from liability for civil damages

insofar as their conduct does not violate clearly

established statutory or constitutional rights of which

a reasonable person would have known.’” Pearson v.

Callahan, 555 U.S. 223, 231 (2009) (quoting Harlow v.

Fitzgerald, 457 U.S. 800, 818 (1982)). “For a

constitutional right to be clearly established, its

contours ‘must be sufficiently clear that a reasonable

official would understand’” that the conduct violates

that right, thereby giving fair and clear warning to

government officials who may engage in such behavior.

Hope v. Pelzer, 536 U.S. 730, 753 (2002) (quoting

Anderson v. Creighton, 483 U.S. 635, 640 (1987)). “This

is not to say that an official action is protected by

qualified immunity unless the very action in question has

previously been held unlawful ... ; but it is to say that

in the light of pre-existing law the unlawfulness must

be apparent.” Id.

A defendant who invokes qualified immunity has the

initial burden of showing that he or she "was acting

within the scope of his or her discretionary authority

when the challenged action occurred.” Patel v. City of

Madison, Alabama, 959 F.3d 1330, 1338 (11th Cir. 2020)

(citing Maddox v. Stephens, 727 F.3d 1109, 1120 (11th

Cir. 2013)).1 There is no dispute that the defendants

were acting within their discretionary authority here.

Once the defendants establish that they were acting

within their discretionary authority, "the burden shifts

to the plaintiff to show that qualified immunity is not

appropriate.” Lee v. Ferraro, 284 F.3d 1188, 1194 (11th

Cir. 2002).

1. “The term ‘discretionary authority’ ‘include[s]

all actions of a governmental official that (1) were

undertaken pursuant to the performance of his duties, and

(2) were within the scope of his authority.’” Patel, 959

F.3d at 1338 (quoting Jordan v. Doe, 38 F.3d 1559, 1566

(11th Cir. 1994)).

B. The Eighth and Fourteenth Amendment Standard

Edwards contends that the defendants violated his

constitutional rights under the Eighth and Fourteenth

Amendments by denying him the medical care prescribed for

several diagnosed conditions.

While constitutional claims of denial of medical care

for pretrial detainees are brought under the Fourteenth

Amendment’s due process clause, those for convicted

prisoners are brought under the Eighth Amendment’s

protection against cruel and unusual punishment. See

City of Revere v. Massachusetts Gen. Hosp., 463 U.S. 239,

244 (1983). Edwards’s complaint does not make clear

whether he was a pretrial detainee or was serving a

sentence during his time in jail, or if he changed from

one status to the other at some point. In any case, the

same standard applies to a claim for denial of medical

care whether brought under the Eighth or the Fourteenth

Amendment. See Hamm v. DeKalb County, 774 F.2d 1567,

1574 (11th Cir. 1985) (“This court holds that in regard

to providing pretrial detainees with such basic

necessities as food, living space, and medical care the

minimum standard allowed by the due process clause is the

same as that allowed by the eighth amendment for

convicted persons.”).

To plead an Eighth Amendment claim for denial of

medical care, a plaintiff “must sufficiently allege ‘both

an objectively serious medical need and that a Defendant

acted with deliberate indifference to that need.’”

Harper v. Lawrence Cty., Ala., 592 F.3d 1227, 1234 (11th

Cir. 2010) (quoting Burnette v. Taylor, 533 F.3d 1325,

1330 (11th Cir. 2008)). The standard has both objective

and subjective components.

A medical need is objectively ‘serious’ if it “has

been diagnosed by a physician as mandating treatment or

... is so obvious that even a lay person would easily

recognize the necessity for a doctor's attention.”

Farrow v. West, 320 F.3d 1235, 1243 (11th Cir. 2003)

(quoting Hill v. Dekalb Reg'l Youth Det. Ctr., 40 F.3d

1176, 1187 (11th Cir. 1994)). In addition, the medical

need must be “one that, if left unattended, ‘pos[es] a

substantial risk of serious harm.’” Taylor v. Adams, 221

F.3d 1254, 1258 (11th Cir. 2000) (quoting Farmer v.

Brennan, 511 U.S. 825, 834 (1994)).

To satisfy the ‘deliberate indifference’

requirement, a plaintiff must plead facts showing the

defendant’s “(1) subjective knowledge of a risk of

serious harm... [and] (2) disregard of that risk ... (3)

by conduct that is more than mere negligence.”2 Bingham

v. Thomas, 654 F.3d 1171, 1176 (11th Cir. 2011) (quoting

Brown v. Johnson, 387 F.3d 1344, 1351 (11th Cir. 2004)).

“[K]nowledge of the need for medical care and intentional

refusal to provide that care constitute[s] deliberate

indifference.” Harris v. Coweta Cty., 21 F.3d 388, 393

(11th Cir. 1994).

2. While it makes no difference to the outcome here,

the court notes that some panels of the Eleventh Circuit

have described the third prong as “more than gross

negligence,” rather than “more than mere negligence.”

See, e.g., Townsend v. Jefferson Cty., 601 F.3d 1152,

1158 (11th Cir. 2010). But see Melton v. Abston, 841

F.3d 1207, 1223 n.2 (11th Cir. 2016) (explaining that the

“more than mere negligence” standard appears to be the

correct one).

C. Edwards’s Claims

With these precepts in mind, the court will now

examine each medical need identified by Edwards in the

complaint. For the reasons discussed below, the court

will grant the motion to dismiss as to the claimed denial

of treatment for Edwards’s mental-health conditions and

sleep apnea, but will deny the motion as the denial of

medical care for his leg injury.

1. The Leg Injury

Edwards has adequately pleaded a clearly established

constitutional claim regarding the denial of treatment

for his leg injury.

First, Edwards’s leg injury clearly meets the

definition of a serious medical need. According to the

complaint, at the time of his incarceration, he was still

suffering from the effects of a severe femoral shaft

fracture caused by a serious accident the year before.

The fracture was serious enough to require inpatient

surgery and the use of rods and screws to fuse his

shattered femur back to together. Edwards was still

under the treatment of a physician for the injury at the

time of his incarceration, and the physician had

prescribed pain medication and physical therapy for the

condition. Due to the lack of treatment he received in

the jail, he suffered “intense pain,” Third Amended

Complaint (doc. no. 43) at 2, ¶ 10, and his physical

condition deteriorated, id. at 7, ¶ 46, and the jail’s

own contract physician repeatedly admonished Nurse Dubose

to transport Edwards to his orthopedic surgeon for

treatment on his leg.

The defendants argue that Edwards’s medical

condition cannot be considered a serious medical need

during the approximately six-hour period before he was

released for which Edwards has sued for damages. See

Defendants’ Brief in Support of Motion to Dismiss (doc.

no. 46) at 10 (“[T]he Third Amended Complaint is devoid

of any reference that for this narrow scope of time that

is its basis, Plaintiff suffered any injury and certainly

not a serious medical condition. As a result,

Plaintiff’s claims should be denied”).

As an initial matter, it is inaccurate to say that

Edwards did not suffer from any injury during those six

hours. The complaint states that Edwards suffered

intense pain due to the lack of treatment for his leg

injury and sleeplessness due to that pain, and that the

pain was incessant. One can reasonably infer that during

the nighttime hours of the day he was released, he

suffered the same pain and insomnia he had suffered

throughout his incarceration.

But the bigger problem with this argument is that it

appears to cabin Edwards’s claim improperly. Viewing the

complaint in the light most favorable to Edwards, and

drawing reasonable inferences from the allegations, his

complaint states a claim for a “continuing tort” of

unconstitutional denial of medical care that began when

the defendants learned of his medical needs and failed

to provide for them and continued until he was released

from jail. See Lavellee v. Listi, 611 F.2d 1129, 1132

(5th Cir. 1980)3 (“[T]he allegation of a failure to

provide needed and requested medical attention

constitutes a continuing tort, which does not accrue

until the date medical attention is provided.”). The

references in the complaint to the six hours on the date

of his release simply indicate the portion of the

violation of his rights for which seeks recovery--that

is, the six-hour period within the two-year statute of

limitations.4

3. In Bonner v. City of Prichard, 661 F.2d 1206,

1209 (11th Cir. 1981) (en banc), the Eleventh Circuit

Court of Appeals adopted as binding precedent all of the

decisions of the former Fifth Circuit handed down prior

to the close of business on September 30, 1981.

4. Moreover, the only issue before the court now is

the issue of qualified immunity, not the statute of

limitations. The issues the court must resolve are

whether the factual allegations of the complaint are

sufficient to state a claim for a constitutional

violation, and whether that violation was clearly

established at the time of the events in question. The

defendants’ argument--in contrast--goes to the impact of

the statute of limitations on Edwards’s claim. That

issue is beyond the scope of the qualified-immunity

analysis, but the defendants are free to raise it in a

new motion.

Turning to the remaining requirements for his claim,

the court finds that Edwards has plausibly pleaded that

Nurse Dubose was deliberately indifferent to his pain

from his leg injury. Edwards and his family repeatedly

informed Dubose of his leg injury and that he needed his

prescribed pain medication for his leg. Edwards’s mother

even went to the jail and showed Dubose his medical

records verifying the need for treatment, as well as his

prescriptions and medications for the injury. The jail’s

contract physician admonished Dubose on multiple

occasions to transport Edwards to his orthopedic surgeon

for treatment of his leg, but Dubose ignored the

physician’s orders. Edwards experienced intense pain

from the injury, and when he complained to her about it,

she ridiculed and harassed him. In spite of her knowledge

of his injury and his ordered treatment, Dubose denied

him his prescribed pain medication, did not allow him to

attend appointments with his orthopedic surgeon or his

physical therapist, and called and cancelled his

appointments with the surgeon. In an effort to overcome

the defendants’ unwillingness to provide the required

care, Edwards’s wife made arrangements to pay out of

pocket for him to be transported to the orthopedic

surgeon, and she and his mother notified Dubose that none

of the costs for treatment and medication would be

incurred by the jail. Nevertheless, Dubose never

provided the prescribed treatment.

These allegations are sufficient to show that Dubose

was subjectively aware of a substantial risk of serious

harm and that she disregarded that risk with conduct that

was more than mere negligence. Unnecessary pain can

constitute serious harm. See McElligott v. Foley, 182

F.3d 1248, 1257 (11th Cir. 1999) (explaining that “prison

officials may violate the Eighth Amendment's commands by

failing to treat an inmate's pain” and citing cases); see

also Boretti v. Wiscomb, 930 F.2d 1150, 1154–55 (6th Cir.

1991) (“a prisoner who suffers pain needlessly when

relief is readily available has a cause of action against

those whose deliberate indifference is the cause of his

suffering.”). Furthermore, a jail employee who knowingly

violates a doctor’s orders for treatment may be found to

be deliberately indifferent. See Young v. City of

Augusta, Ga., Through DeVaney, 59 F.3d 1160, 1170–71

(11th Cir. 1995) (explaining with regard to the liability

of jail employees who provided medication, that if “[the

inmate] did not receive medication as prescribed,” that

could “lead to a finding that her rights were

violated.”); see also Aldridge v. Montgomery, 753 F.2d

970, 972 (11th Cir. 1985) (explaining that a plaintiff

may establish that deliberately indifference by showing

that defendants have “intentionally interfer[ed] with the

treatment once prescribed”) (quoting Estelle v. Gamble,

429 U.S. 97, 105 (1976)); Bingham, 654 F.3d at 1176.

Taking the allegations as true, Dubose knew that there

was a substantial risk that Edwards would unnecessarily

suffer intense pain from his leg injury were he denied

treatment, and she disregarded that risk. The fact that

she ignored the doctor’s order to take Edwards to the

orthopedic surgeon and belittled and harassed him when

he complained of pain makes it plausible that she acted

recklessly or worse.

Edwards also seeks to hold Sheriff Abbett and Jail

Administrator Jennings liable for the denial of treatment

for his leg injury. The court assumes that Edwards seeks

to hold them liable on a theory of supervisory liability.

“It is well established in this Circuit that supervisory

officials are not liable under § 1983 for the

unconstitutional acts of their subordinates on the basis

of respondeat superior or vicarious liability.” Cottone

v. Jenne, 326 F.3d 1352, 1360–61 (11th Cir. 2003)

(citations omitted), abrogated in part on other grounds

by Randall v. Scott, 610 F.3d 701 (11th Cir. 2010).

“Supervisory liability occurs either when the supervisor

personally participates in the alleged constitutional

violation or when there is a causal connection between

actions of the supervising official and the alleged

constitutional deprivation.” Brown v. Crawford, 906 F.2d

667, 671 (11th Cir. 1990) (citations omitted). A causal

connection can exist “when a history of widespread abuse

puts the responsible supervisor on notice of the need to

correct the alleged deprivation, and he fails to do so;

[or] ... when a supervisor’s custom or policy ...

result[s] in deliberate indifference to constitutional

rights or when facts support an inference that the

supervisor directed the subordinates to act unlawfully

or knew that the subordinates would act unlawfully and

failed to stop them from doing so.” Cottone, 326 F.3d at

1360 (internal citations and quotation marks omitted).

The complaint adequately pleads that Abbett and

Jennings knew that Dubose was behaving unlawfully by

denying treatment for Edwards's leg injury and failed to

stop her from doing so. According to the complaint,

Edwards’s family members provided Abbett and Jennings

with the same documentation of his injury and prescribed

treatment that they provided to Dubose. After becoming

aware of Dubose’s denial of care and mistreatment,

Edwards’s family informed Abbett and Jennings of the

nurse’s refusal to follow the contract jail physician’s

orders to send Edwards to the orthopedic surgeon.

Edwards suffered intense pain, insomnia, and hypersomnia

as a result of the lack of treatment. The family

contacted Abbett and Jennings several times a week to

notify them of Edwards’s urgent need for pain treatment,

and even informed them that the cost of treatment would

be covered by Edwards’s wife’s insurance. In spite of

all this, Abbett and Jennings did not have Edwards taken

to the orthopedic surgeon or ensure that Dubose provided

pain medication or other treatment for his leg injury

during the five and half months of his incarceration, and

more specifically, during the six hours before his

release from jail. These allegations make it plausible

that Abbett and Jennings were subjectively aware of a

substantial risk that Edwards would suffer serious,

unnecessary pain from a lack of treatment for his leg and

disregarded that risk with conduct that was more than

negligence.

The court now turns to whether the law was clearly

established in 2011 that the defendants’ denial of

treatment for Edwards’s leg injury was unconstitutional.

For purposes of qualified immunity, a constitutional

right may be clearly established in several different

ways: “(1) case law with indistinguishable facts clearly

establishing the constitutional right; (2) a broad

statement of principle within the Constitution, statute,

or case law that clearly establishes a constitutional

right; or (3) conduct so egregious that a constitutional

right was clearly violated, even in the total absence of

case law.” Hill v. Cundiff, 797 F.3d 948, 979 (11th Cir.

2015) (quoting Lewis v. City of W. Palm Beach, Fla., 561

F.3d 1288, 1291–92 (11th Cir. 2009)) (internal quotation

marks omitted). Edwards seeks to travel on the second

route, citing multiple cases which establish the broad

statements of principle that govern prisoner cases

alleging a denial of prescribed medical care for serious

medical needs.

There are several statements of general principles

in Eleventh Circuit case law, issued prior to September

2011, that clearly established that a jail official’s

deliberately indifferent failure to provide treatment for

an inmate’s serious pain violates the Eighth Amendment.

Well before the time of Edwards’s incarceration in 2011,

“it was clearly established that ‘knowledge of the need

for medical care and intentional refusal to provide that

care constituted deliberate indifference.’” Harris v.

Coweta Cty., 21 F.3d 388, 393 (11th Cir. 1994) (quoting

Mandel v. Doe, 888 F.2d 783, 788 (11th Cir. 1989));

Lancaster v. Monroe County, Ala., 116 F.3d 1419, 1425

(11th Cir. 1997) (“an official acts with deliberate

indifference when he or she knows that an inmate is in

serious need of medical care, but he fails or refuses to

obtain medical treatment for the inmate.”). More

specifically, in 1999, the Eleventh Circuit explained,

“A core principle of Eighth Amendment jurisprudence in

the area of medical care is that prison officials with

knowledge of the need for care may not, by failing to

provide care, delaying care, or providing grossly

inadequate care, cause a prisoner to needlessly suffer

the pain resulting from his or her illness.” McElligott,

182 F.3d at 1257 (emphasis added).

Furthermore, the case of Aldridge v. Montgomery, 753

F.2d 970 (11th Cir. 1985), made clear that correctional

officials may violate the Constitution when they deny

pain care ordered by physicians. In that case, an inmate

plaintiff had a one-and-a-half inch cut above his eye

sutured at the hospital, and the hospital doctor ordered

that the inmate receive icepacks and aspirin for pain

upon his return to the jail. The Eleventh Circuit

reversed the district court’s entry of a directed verdict

for the defendant correctional officers on the claim that

they had violated the inmate plaintiff’s constitutional

rights by failing to provide him with the icepacks and

aspirin prescribed by the doctor for pain. Id. at 972-73.

The court explained that “[d]eliberate indifference is

shown not only by failure to provide prompt attention to

the medical needs of a pre-trial detainee, but also by

‘intentionally interfering with the treatment once

prescribed.’” Id. at 972 (quoting Estelle v. Gamble, 429

U.S. 97, 105 (1976).

“Qualified immunity is a guarantee of fair warning.”

Id., 182 F.3d at 1260. Based on the facts pleaded in the

complaint, the broad principles noted above, and the

Aldridge case, no reasonable nurse or correctional

officer, knowing that the inmate was in intense pain from

a severe leg injury for which he had been prescribed pain

medication and other treatment by a physician, and having

been informed that the jail’s own doctor recommended that

the inmate see a specialist for treatment of the injury,

could have thought it was constitutional to completely

ignore the physicians’ orders and deny treatment to the

inmate for that pain for five and half months.

The defendants contend that Edwards must show that

it was clearly established that denying treatment for

five hours and 55 minutes--the length of time he was

incarcerated within the statutory limitations period--

was unconstitutional. As noted earlier, the complaint

sets forth a claim that the defendants violated Edwards’s

rights over the course of his incarceration but seeks to

impose liability only for the harm he suffered during the

early morning hours of November 27, 2011--the period

within the statute of limitations. Proof of Edward’s

claim relies in large part on actions and events that

took place before that date. The defendants cite no

cases that would require the court to ignore those

earlier actions and events in identifying whether the

defendants’ actions violated clearly established law.

The defendants’ suggested approach, if followed, would

improperly cabin the qualified-immunity analysis.

The motion will to dismiss will be denied as to the

Edwards’s claim that he was unconstitutionally denied

treatment for his leg injury.

2. Mental-Health Conditions

“[I]t is established that psychiatric needs can

constitute serious medical needs and that ... the quality

of psychiatric care one receives can be so substantial a

deviation from accepted standards as to evidence

deliberate indifference to those serious psychiatric

needs.” Steele v. Shah, 87 F.3d 1266, 1269 (11th Cir.

1996). See also Thomas v. Bryant, 614 F.3d 1288, 1312

(11th Cir. 2010) (quoting Gates v. Cook, 376 F.3d 323,

332 (5th Cir. 2004) (“The case law establishes that

‘mental health needs are no less serious than physical

needs’ for purposes of the Eighth Amendment.”); Rogers

v. Evans, 792 F.2d 1052, 1058 (11th Cir. 1986) (noting

that the “[f]ailure to provide basic psychiatric and

mental health care states a claim of deliberate

indifference to the serious medical needs of prisoners.”

(Emphasis added)). Nevertheless, Edwards’s claim fails

because he has not sufficiently pleaded that the

defendants were subjectively aware of a substantial risk

of serious harm.

First, there is no indication that the defendants

were subjectively aware of a substantial risk of serious

harm from denial of Edwards’s medication for ADHD. ADHD

is “a disorder marked by an ongoing pattern of

inattention and/or hyperactivity-impulsivity that

interferes with functioning or development.”

Attention-Deficit/Hyperactivity Disorder, National

Institute of Mental Health (Nov. 2, 2020),

https://www.nimh.nih.gov/health/topics/attention-

deficit-hyperactivity-disorder-adhd/index.shtml. While

lack of treatment for ADHD theoretically could place an

inmate at substantial risk of serious harm--for example,

if an inmate were so impulsive and hyperactive that he

kept getting into physical altercations with other

inmates--there is no indication in Edwards’s complaint

of such severe symptoms here. Indeed, the complaint

contains no information as to the symptoms Edwards

suffered as a result of his ADHD, let alone that the

defendants were aware of those symptoms and knew that

Edwards was at a substantial risk of serious harm if the

condition were not treated. Accordingly, to the extent

Edwards seeks to hold the defendants liable for the

denial of medication for ADHD, the claim will be

dismissed.

Second, the complaint does not plausibly plead

deliberate indifference to a substantial risk of serious

harm from Edwards’s Major Depressive Disorder, primarily

because it does not allege facts showing that he was

denied treatment for the disorder.5 The complaint’s fact

section contains only one allegation related to Edwards’s

depression, stating that Edwards’s family and healthcare

providers notified and provided medical documentation to

the defendants of his diagnosis for PTSD, Major

Depressive Disorder, and ADHD, and “of the need for him

to take medications prescribed by his doctors.” Third

Amended Complaint (doc. no. 43) at 3, ¶ 18. Multiple

other factual allegations mention his other mental-health

conditions but not his depression. See id. at 1, ¶ 3

(stating that defendants were informed of need for

treatment for PTSD); id. at 2, ¶ 6 (stating that Edwards’s

5. It is worth noting that it is not clear that

Edwards actually seeks to hold the defendants liable for

denial of treatment of his Major Depressive Disorder.

The complaint’s second paragraph clearly states that he

is suing for all harm he suffered due to the defendants’

failure to provide medications for ADHD and PTSD and

other conditions, but fails to mention Major Depressive

Disorder. See Third Amended Complaint (doc. no. 43) at

1, ¶ 2. Nevertheless, because in the section of the

complaint setting out his cause of action, see id. at 7,

¶ 46, he seems to indicate otherwise, the court will

address this possible claim.

mother showed the defendants prescriptions and medicines

that he was required to take for ADHD and PTSD); id. at

4, ¶ 22 (stating that defendants failed to provide

medication and sufficient treatment for PTSD and ADHD) &

¶ 27 (stating that defendants were told about need for

him to take medications for ADHD and PTSD); id. at 7,

¶ 44 (stating the defendants failed to provide plaintiff

with medications for ADHD and PTSD on November 27, 2011)

& ¶ 45 (stating defendants had a duty to provide

treatment for ADHD and PTSD). The clear implication of

these allegations is that the defendants failed to treat

only his ADHD and PTSD, not his depression. It seems

evident that, had Edwards meant to convey that the

defendants denied him treatment for depression, he would

have mentioned it in at least some of these allegations.

Confusion arises from the section of the complaint

where he sets forth his one count for violation of the

Eighth and Fourteenth Amendments. There he states that

the defendants “failed and/or refused to on numerous

occasions . . . provide” him with medication not only for

his PTSD and ADHD, but also for his Major Depressive

Disorder. See Third Amended complaint (doc. no. 43) at

7, ¶ 46. No other factual allegations in the remainder

of the complaint support this statement, which is

otherwise consistent with the rest of the complaint.

Accordingly, the court finds that Edwards has not

sufficiently pleaded that the defendants failed to treat

his depression. And, because Edwards has not pleaded

that the defendants denied him care for his depression,

he also has not pleaded that they were deliberately

indifferent to a substantial risk of serious harm posed

by failure to treat the condition. His possible claim

for denial of such treatment must be dismissed.

Edwards’s claim for denial of treatment for PTSD is

also insufficiently pleaded. PTSD undoubtedly can be a

serious medical need. See, e.g., Brannan v. Owens, No.

5:13-CV-454 (MTT), 2014 WL 840018, at *3 (M.D. Ga. Mar.

4, 2014) (Treadwell, J.) (finding that prisoner could

state a claim for Eighth Amendment violation due to

denial of treatment for PTSD and other mental-health

conditions). People diagnosed with PTSD suffer from a

variety of symptoms, including re-experiencing a

traumatic event through flashbacks or dreams, avoidance

of thoughts or reminders of the event, arousal and

reactivity symptoms such as feeling tense, being easily

startled, difficulty sleeping, and angry outbursts, and

cognition and mood symptoms such as negative thoughts

about oneself or the world, distorted feelings of guilt

or blame, and loss of interest in enjoyable activities.

See Post-Traumatic Stress Disorder, National Institute

of Mental Health (Nov. 1, 2020),

https://www.nimh.nih.gov/health/topics/post-traumatic-

stress-disorder-ptsd/index.shtml. Clearly, treatment

for PTSD may in many circumstances be vitally important

for prisoners and necessary to avert serious

psychological pain, depending on the particular symptoms

a prisoner experiences.

Here, however, the complaint fails to plausibly plead

that Edwards’s PTSD was a serious medical condition

because the allegations do not make clear that his PTSD,

if left unattended, posed a substantial risk of serious

harm. See Hill, 40 F.3d at 1187. The complaint contains

no discussion of the severity of Edwards’s PTSD or of the

symptoms he experienced as a result of it. Without some

indication that Edwards regularly suffered painful

symptoms of PTSD, the complaint does not sufficiently

state a claim for a violation of the Eighth Amendment.

3. Sleep Apnea

Finally, the court finds that Edwards has failed to

state a constitutional violation based on the temporary

denial of a functioning machine to treat his sleep apnea.

This is so because Edwards has not sufficiently pleaded

that any of the defendants were deliberately indifferent

to his need for a CPAP machine for his sleep apnea.

According to the complaint, Nurse Dubose initially

allowed Edwards the use of a CPAP machine, then somehow

broke it and failed to replace or fix it for some period

of time afterwards. The problem is that the complaint

does not make sufficiently clear when during his

months-long incarceration this occurred or, relatedly,

how long Dubose allowed Edwards to go without the

machine. The complaint simply says that he went “weeks”

without a functioning machine. As noted above, the court

must draw all reasonable inferences from the facts in the

complaint in Edwards’s favor, but it would not be

reasonable for the court to guess at the number of weeks

he meant.6 This is a problem because the length of time

he went without the CPAP machine is legally significant.

To be held liable for a denial of medical care, a

defendant must have acted with more than negligence.

Without any indication of how long she left Edwards

without a functioning machine, the complaint does not

plausibly plead that Dubose acted with more than

negligence. Had Edwards gone for months without a

replacement machine, the inference that Dubose had a

sufficiently culpable state of mind would be far

stronger. But a couple weeks without the machine is much

6. That said, it seems likely that, had he gone a

month or more without the machine, he would have said so

instead of saying “weeks.”

more open to innocent possibilities--it could have taken

that amount of time just to get a replacement machine,

or to get the machine repaired. Of course, if the

complaint contained facts that showed that Dubose simply

chose not to provide a functioning CPAP machine--such as

comments to that effect--then that could support a

finding of deliberate indifference at this stage. But

without a better indication of how long Edwards went

without a functioning machine, and absent specific

allegations reflecting Dubose’s motivation for not fixing

or replacing the machine sooner, the complaint does not

adequately plead that Dubose acted with deliberate

indifference.

In addition, it is not clear that the denial of a

treatment for sleep apnea for two or three weeks would

create a substantial risk of serious harm. While Edwards

alleges that the lack of a CPAP machine caused him to

choke and gag, kept him from sleeping, and made him

extremely tired during the day, many risks from sleep

apnea appear to be longer term: it increases the risk of

several serious medical conditions, such as cancer,

hypertension, and Type II diabetes. See Sleep Apnea,

National Heart, Lung, and Blood Institute, National

Institutes of Health (Nov. 1, 2020),

https://www.nhlbi.nih.gov/health-topics/sleep-apnea.

Had the defendants denied him any treatment for the five

and a half months he was incarcerated, the complaint

might very well state a constitutional violation.

However, with the possibility that he was without his

machine for only two weeks, the complaint does not

plausibly plead that the denial of treatment for that

period created a substantial risk of serious harm.

Edwards’s claim stemming from the temporary denial of

treatment for his sleep apnea will be dismissed.

An appropriate order will be entered.

DONE, this the 2nd day of November, 2020.

/s/ Myron H. Thompson

UNITED STATES DISTRICT JUDGE