Opinion
Case No. 5:17-cv-00303-TES-CHW
02-25-2020
EDDIE JAMES KING, Plaintiff, v. DR LAWSON, et al., Defendants.
Proceedings Under 42 U.S.C. § 1983
Before the U.S. Magistrate Judge REPORT AND RECOMMENDATION
Before the Court is a motion for summary judgment filed by Defendant Lawson. (Doc. 64). Defendant Dr. Stifanos Almedom, the only other remaining defendant in this action, is not a party to the motion. See (id., p. 1 n.1). Because Defendant Lawson is entitled to qualified immunity from Plaintiff Eddie James King's deliberate indifference to medical needs claim, it is RECOMMENDED that the motion be GRANTED.
Plaintiff originally filed his claims against Dr. Almedom in a separate case, King v. Dr. Sharon Lewis, Case No. 5:18-cv-123-TES-CHW (M.D.Ga. Apr. 13, 2018), which was consolidated into this case on August 15, 2018. Dr. Almedom returned a waiver of service on July 10, 2019, (Doc. 52), and filed his answer on August 28, 2019 (Doc. 57).
I. BACKGROUND
Plaintiff Eddie James King, a prisoner who is proceeding pro se, filed this 42 U.S.C. § 1983 complaint, alleging that Defendant Lawson, a medical professional at Dooly State Prison, acted with deliberate indifference to his medical needs, in violation of the Eighth Amendment, by delaying treatment for his right eye. (Doc. 1). During treatment, Plaintiff complained that he experienced blurry vision and "fe[lt] like there's something covering my eye." (Decl. of Kristie Lawson, Doc. 64-3, ¶¶ 10-11). Plaintiff alleges that Lawson told him she would refer Plaintiff to a specialist, but "that never happen[ed]." (Doc. 1, p. 7). By the time Plaintiff was seen by a specialist, he had become blind in his right eye. (Id.). Plaintiff contends that, but for Lawson's "stalling," his "eye could have been save[d]." (Id.). In relief, Plaintiff requests appropriate treatment for his eye and damages. (Id., p. 8).
The parties dispute whether Lawson is a physician or a nurse practitioner, with Lawson herself claiming she is a licensed family nurse practitioner. See (Docs. 64-3, ¶ 3; 66, p. 2). For purposes of summary judgment, the distinction is not material. --------
Defendant Lawson has moved for summary judgment, asserting qualified immunity from Plaintiff's claim. (Doc. 64). Plaintiff responded to the motion, (Docs. 66, 67), Lawson replied, (Doc. 68), and Plaintiff filed a surreply, (Doc. 69). Although Plaintiff's surreply was filed without permission of the Court, see M.D. Ga. Local Rule 7.3.1 ("A party desiring to file a surreply brief must move in writing for permission to do so . . . ."), it has been considered in resolving the pending motion.
II. SUMMARY JUDGMENT STANDARD
A party is entitled to summary judgment "if the movant shows that there is no genuine dispute as to any material fact and that the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). "An issue of fact is 'material' if it is a legal element of the claim under the applicable substantive law which might affect the outcome of the case." Allen v. Tyson Foods, Inc., 121 F.3d 642, 646 (11th Cir. 1997) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). A factual dispute is "genuine" if the evidence is such that a reasonable jury could return a verdict for the nonmoving party; however, "the mere existence of a scintilla of evidence in support of the position will be insufficient." Johnson v. Bd. of Regents of Univ. of Georgia, 263 F.3d 1234, 1243 (11th Cir. 2001) (quoting City of Delray Beach v. Agricultural Ins. Co., 85 F.3d 1527, 1530 (11th Cir. 1996)).
The party moving for summary judgment bears the burden of informing the Court of the basis for its motion, and of citing "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any," that support summary judgment. Celotex Corp. v. Catrett, 477 U.S. 317, 322-24 (1986). In resolving motions for summary judgment, the Court must view the evidence in the light most favorable to the nonmoving party, see Tolan v. Cotton, 572 U.S. 650, 657 (2014), which requires the Court to believe the evidence provided by the nonmovant and draw all justifiable inferences in the nonmovant's favor, see Anderson, 477 U.S. at 255. "Inferences based on speculation," however, "will not suffice to overcome a motion for summary judgment." Melton v. Abston, 841 F.3d 1207, 1219 (11th Cir. 2016) (citation and internal quotation omitted).
III. QUALIFIED IMMUNITY
Plaintiff has not satisfied his burden at summary judgment of showing that Defendant Lawson is not entitled to qualified immunity from his deliberate indifference claim. Defendant Lawson is, therefore, entitled to qualified immunity, and summary judgment should be granted in her favor.
A. Qualified Immunity Standard
"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)). "Qualified immunity balances two important interests—the need to hold public officials accountable when they exercise power irresponsibly and the need to shield officials from harassment, distraction, and liability when they perform their duties reasonably." Id.
A threshold matter in deciding whether a defendant is entitled to qualified immunity is whether the defendant has established that "the allegedly unconstitutional conduct occurred while he was acting within the scope of his discretionary authority." Harbert Int'l, Inc. v. James, 157 F.3d 1271, 1281 (11th Cir. 1998) (citation omitted). "To establish that the challenged actions were within the scope of his discretionary authority, a defendant must show that those actions were (1) undertaken pursuant to the performance of his duties, and (2) within the scope of his authority." Id. at 1282. The parties do not dispute that Defendant's allegedly unlawful acts were performed within the scope of her respective discretionary authority. Therefore, having established that Defendant was engaged in discretionary functions during the incident in question, the burden shifts to Plaintiff to show that qualified immunity is not appropriate. Lee v. Ferraro, 284 F.3d 1188, 1194 (11th Cir. 2002).
To show that Defendant is not entitled to qualified immunity, Plaintiff must present evidence demonstrating (1) "that the official's alleged conduct violated a constitutionally protected right," and (2) "that the right was clearly established at the time of the misconduct." Melton, 841 F.3d at 1221 (citing Pearson, 555 U.S. at 232). Both elements must be satisfied to overcome a defense of qualified immunity, see id. (citing Grider v. City of Auburn, 618 F.3d 1240, 1254 (11th Cir. 2010)), and the Court's analysis of these elements may be conducted in any order, see Pearson, 555 U.S. at 236.
B. Deliberate Indifference to Medical Needs
Although Plaintiff has adequately established that his vision problems constituted a serious medical need, he has failed to show that Defendant Lawson was deliberately indifferent to that need or that any deliberate indifference on Defendant's part caused Plaintiff's vision problems. Therefore, Defendant Lawson is entitled to qualified immunity from Plaintiff's Eighth Amendment claim.
To prevail on a claim of deliberate indifference to serious medical needs, the plaintiff must show: (1) he had an objectively serious medical need; (2) the official was deliberately indifferent to that need; and (3) the official's deliberate indifference and the plaintiff's injury were causally related. See Hinson v. Bias, 927 F.3d 1103, 1121 (11th Cir. 2019).
1. Serious Medical Need
Plaintiff's deteriorating vision and eventual complete loss of vision constituted serious medical needs. "A serious medical need 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.'" 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 constitutional standards, "the medical need must be one that, if left unattended, 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 a delay in treatment exacerbated the medical need or caused additional complications." Id.
Plaintiff saw Defendant Lawson four times between June and early August 2016 before his right eye was examined by an ophthalmologist in late August. At each encounter with Lawson, Plaintiff complained about problems with his vision. In June, for example, Plaintiff complained to Lawson that he "fe[lt] like there's something covering my eye." (Decl. of Kristie Lawson, Doc. 64-3, ¶ 10). In July, Plaintiff complained of blurry vision. (Id., ¶ 11). The parties do not dispute that Plaintiff eventually went blind in his right eye. There is, however, a factual dispute as to whether Plaintiff presented with other related symptoms. Plaintiff avers that he experienced pain and his eye was "red[] and watery," (Docs. 66, p. 2; 66-1); whereas Defendant Lawson asserts that Plaintiff "did not complain of any pain in his eye, nor did I observe any visible signs of infection—redness, pain, swelling, etc," (Doc. 64-3, ¶¶ 10-11).
The record, viewed in the light most favorable to Plaintiff, indicates that Plaintiff's initial vision problems and eventual blindness were serious medical needs. Although Plaintiff's consistent complaints of blurry vision, alone, could reasonably constitute a serious medical need, see Koehl v. Dalsheim, 85 F.3d 86, 88 (2d Cir. 1996) (finding that double vision and the loss of depth perception was a serious medical need), a reasonable jury could conclude that the delay in specialist treatment exacerbated his condition, resulting in blindness, see Taylor, 920 F.3d at 733. Of course, the need to treat blindness is "so obvious that even a lay person would easily recognize the necessity for a doctor's attention." See id.; Colwell v. Bannister, 763 F.3d 1060, 1066 (9th Cir. 2014) (finding blindness a serious medical need and stating: "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."). That Plaintiff did not suffer additional physical injuries as a result of the blindness or loss of vision in his right eye, such as the type of injury that might result from a fall, see Koehl, 85 F.3d at 88, is not determinative, since Plaintiff "need not await a tragic event" before suffering harm violative of the Eighth Amendment, Helling v. McKinney, 509 U.S. 25, 33 (1993). Accordingly, Plaintiff's visual problems and blindness constituted objectively serious medical needs.
2. Deliberate Indifference
Plaintiff, however, has failed to show that Defendant Lawson acted with deliberate indifference to his vision problems. A prison official acts with deliberate indifference when she has (1) subjective knowledge of a risk of serious harm, (2) and disregards that risk (3) by conduct that is more than mere negligence. See Melton v. Abston, 841 F.3d 1207, 1223 (11th Cir. 2016). Conduct that amounts to more than mere negligence includes grossly inadequate care, a decision to take an easier but less efficacious course of treatment, and medical care that is so cursory as to amount to no treatment at all. Id. (citing Bingham v. Thomas, 654 F.3d 1171, 1176 (11th Cir. 2011)). Moreover, an official "who unreasonably fails to respond or refuses to treat an inmate's need for medical care or one who delays necessary treatment without explanation or for non-medical reasons may also exhibit deliberate indifference." Id.
Even if Defendant Lawson subjectively knew that Plaintiff's vision problems presented a risk of serious harm, Plaintiff has not shown that Lawson either disregarded that risk or acted with more than negligence in disregarding that risk. Lawson claims, and Plaintiff does not dispute, that requests for a specialist consultation must be approved by the jail medical director before the request can be submitted for processing. (Doc. 64-3, ¶ 7). Once Lawson writes and submits a request for a specialist consultation, she has no further role in the approval, disapproval, or scheduling process. (Id., ¶¶ 8, 14). As discussed above, Lawson examined Plaintiff on four occasions between June and August 2016. On three of those occasions, Lawson referred Plaintiff to a specialist, first to an optometrist, and then to an ophthalmologist. (Id., ¶¶ 10-13). Only Lawson's referral to an ophthalmologist, which was submitted for approval on August 4, was marked as urgent. (Id., ¶ 13). At the fourth and final encounter, on August 15, Lawson informed Plaintiff that she had submitted the urgent request and that Plaintiff was due to be evaluated by the specialist on August 18. (Id., ¶ 14). Plaintiff does not dispute that Lawson made these referrals. Instead, Plaintiff contends that Lawson should have acted more quickly in getting the referral approved. (Docs. 1, p. 5; 66, p. 3). Plaintiff has not shown, however, that Lawson could have done any more to obtain the referrals than she had already done. Without that showing, Plaintiff cannot establish that Defendant Lawson disregarded the risk presented by his vision problems.
Even if Defendant Lawson's conduct demonstrated a disregard for the risk to Plaintiff's health, Plaintiff has not shown that Lawson acted with more than negligence in disregarding that risk. Liberally construed, Plaintiff argues that Lawson acted with deliberate indifference to his vision problems by waiting until August to submit an urgent request for a consultation. (Doc. 67, p. 2). As discussed, Lawson had submitted two consultation requests, on June 29 and July 13, 2016, respectively, before submitting the urgent request on August 4. (Doc. 64-3, ¶¶ 10-13). Plaintiff has not shown that submitting a standard referral request, as opposed to an urgent request, was either unreasonable under the circumstances, see Melton v. Abston, 841 F.3d 1207, 1223 (11th Cir. 2016) ("A defendant who unreasonably fails to respond . . . may . . . exhibit deliberate indifference."), or grossly inadequate, see id. Accordingly, Plaintiff has not met his burden of showing Defendant Lawson acted deliberately indifferent to his medical needs.
3. Causation
Plaintiff's claim against Defendant Lawson is premised on the causal connection between the delay in referring him to a specialist for his vision problems and his eventual blindness. Plaintiff, however, has placed no "verifying medical evidence in the record to establish the detrimental effect of delay in medical treatment." Hill v. Dekalb Reg'l Youth Det. Ctr., 40 F.3d 1176, 1188 (11th Cir. 1994), overruled in part on other grounds by Hope v. Pelzer, 536 U.S. 730 (2002). Absent such evidence, Plaintiff cannot meet his burden of showing the delay in obtaining a specialist consultation for his blurry vision caused his blindness. See Owen v. Corizon Health Inc., 703 F. App'x 844, 848 (11th Cir. 2017).
In sum, although a reasonable jury could conclude that Plaintiff's vision problems presented a serious medical need, he has not met his burden of showing that Defendant Lawson acted deliberately indifferent to that need or that the delay in referring him to specialist caused blindness in his right eye. Accordingly, Defendant Lawson is entitled to qualified immunity from Plaintiff's deliberate indifference claim.
C. Clearly Established Law
Because Defendant Lawson did not violate Plaintiff's constitutional rights, she necessarily did not violate clearly established law. See Melton v. Abston, 841 F.3d 1207, 1225 (11th Cir. 2016) ("Because Dr. Fowler did not violate Melton's constitutional rights, we need not reach the second prong of the qualified immunity inquiry."). Even if Plaintiff's rights were violated, Plaintiff has failed to satisfy his burden under this prong of the qualified immunity analysis.
"[T]he burden is on the plaintiff to show that, when the defendant acted, the law established the contours of a right so clearly that a reasonable official would have understood his acts were unlawful." Post v. City of Fort Lauderdale, 7 F.3d 1552, 1557 (11th Cir. 1993) (citing Anderson v. Creighton, 483 U.S. 635, 640 (1987)). A plaintiff can make this showing by demonstrating that "the binding precedent set forth in the decisions of the Supreme Court, the Eleventh Circuit, or the highest court of the state (Georgia, here)," Melton, 841 F.3d at 1221 (citing Amnesty Int'l, USA v. Battle, 559 F.3d 1170, 1184 (11th Cir. 2009)), "either establishes a broad, applicable principle of law or has materially similar facts such that it would put [the official] on notice that his actions were unlawful," Galvez v. Bruce, 552 F.3d 1238, 1244 (11th Cir. 2008). Because Plaintiff failed to point to any evidence or caselaw that might show the law was clearly established at the time of the incident, he has not satisfied his burden at this stage.
There is, however, a narrow exception to the rule that a plaintiff must present caselaw to show that the law was clearly established at the time of the incident. Known as the "obvious clarity rule," "[t]his exception applies in situations where the official's conduct so obviously violates the constitution that prior case law is unnecessary." Melton, 841 F.3d at 1221 (internal quotation omitted) (citing Gilmore v. Hodges, 738 F.3d 266, 279 (11th Cir. 2013)). As discussed, Defendant's actions did not violate Plaintiff's constitutional rights; therefore, the exception does not apply.
CONCLUSION
Because Defendant Lawson is entitled to qualified immunity from Plaintiff's deliberate indifference to medical needs claim, it is RECOMMENDED that Defendant's motion for summary judgment (Doc. 64) be GRANTED and that judgment be entered in Defendant's favor.
Upon adoption of this Recommendation, only Plaintiff's Eighth Amendment claim against Defendant Almedom will remain. The deadline for filing dispositive motions has passed, and Dr. Almedom has not filed a motion for summary judgment. Plaintiff's claims against Dr. Almedom are therefore ripe for trial.
Pursuant to 28 U.S.C. § 636(b)(1), the parties may serve and file written objections to this Recommendation, or seek an extension of time to file objections, WITHIN FOURTEEN (14) DAYS after being served with a copy thereof. The District Judge will make a de novo determination of those portions of the Recommendation to which objection is made. All other portions of the Recommendation may be reviewed for clear error.
The parties are further notified that, pursuant to Eleventh Circuit Rule 3-1, "[a] party failing to object to a magistrate judge's findings or recommendations contained in a report and recommendation in accordance with the provisions of 28 U.S.C. § 636(b)(1) waives the right to challenge on appeal the district court's order based on unobjected-to factual and legal conclusions if the party was informed of the time period for objecting and the consequences on appeal for failing to object. In the absence of a proper objection, however, the court may review on appeal for plain error if necessary in the interests of justice."
SO RECOMMENDED, this 25th day of February, 2020.
s/ Charles H. Weigle
Charles H. Weigle
United States Magistrate Judge