Loadholt v. Moore
Loadholt v. Moore
Opinion of the Court
ORDER
Plaintiff Oliver C. Loadholt, an inmate at Macon State Prison in Oglethorpe, Georgia,
On March 14, 2011, the United States Magistrate Judge entered a Report and Recommendation that the Court should grant in part and deny in part Dr. Chaudhary’s motion. (Doc. no. 53.) After a thorough review of the applicable facts and the law, the Magistrate Judge determined that Plaintiff had arguably stated an Eighth Amendment claim against Dr. Chaudhary. Dr. Chaudhary filed an objection (doc. no. 56), which is presently before the Court. With due regard to the Magistrate Judge’s recommendation, Dr. Chaudhary’s objection is SUSTAINED and his motion to dismiss is GRANTED IN PULL. As a result, the only remaining Defendant in the case is Dr. Moore.
The facts as alleged in Plaintiffs Complaint
Several months after Dr. Cheney’s treatment recommendation, Plaintiff was transferred to Augusta Medical State Prison (“AMSP”) for a consultation regarding treatment. (Id. ¶ 8.) He was not treated in the interim. After his arrival at AMSP, Plaintiff was informed by medical staff that treatment would not proceed until he underwent a liver biopsy to evaluate the health of his liver. (Id. ¶ 9.)
In December 2008, Plaintiff once again consulted with doctors at AMSP regarding treatment (id. ¶ 10), and in August 2009 he was transferred to AMSP to receive the liver biopsy (id. 12). Plaintiff remained at AMSP for two weeks following the operation and on return to TSP was examined by Dr. Moore, another physician at TSP. (Id. ¶ 18.) Plaintiff indicated that his liver was causing “constant pain,” and Dr. Moore advised Plaintiff that his liver was swollen. (Id. ¶ 19.) However, in September 2009, Dr. Chaudhary at AMSP informed Plaintiff that his liver was in fact healthy and that, as a consequence, treatment was not necessary. (Id. ¶ 4.) Days later, Dr. Moore informed Plaintiff that, notwithstanding any complaints of pain, he would not be treated because his liver was healthy and his condition did not require it. (Id. ¶ 20.)
Plaintiff filed this action in November 2009, alleging that Dr. Chaudhary, Dr. Moore, and others were deliberately indifferent to his serious medical needs by failing to treat his hepatitis. Plaintiff has also alleged several state law claims. Plaintiff is seeking damages and an injunction ordering Defendants to provide treatment as prescribed by Dr. Cheney. In previous orders, all claims except those against Dr. Chaudhary and Dr. Moore were dismissed. (See doc. nos. 16, 45.) Dr. Chaudhary moved to dismiss, and the Magistrate Judge recommended that Dr. Chaudhary’s motion be denied as to Plaintiffs claim of deliberate indifference to medical needs. Objections to the Magistrate Judge’s Report and Recommendation have been filed, and Dr. Chaudhary’s motion is now ripe for consideration.
II. MOTION TO DISMISS STANDARD
In considering a motion to dismiss under Rule 12(b)(6), the court tests the legal
A complaint also must “contain sufficient factual matter, accepted as true, ‘to state a claim to relief that is plausible on its face.’ ” Id. at 1940 (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). The plaintiff is required to plead “factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. Although there is no probability requirement at the pleading stage, “something beyond ... mere possibility ... must be alleged.” Twombly, 550 U.S. at 556-57, 127 S.Ct. 1955 (citing Dura Pharm., Inc. v. Broudo, 544 U.S. 336, 347, 125 S.Ct. 1627, 161 L.Ed.2d 577 (2005)).
III. DISCUSSION
Plaintiff alleges that Dr. Chaudhary, by denying hepatitis treatment, was deliberately indifferent to his serious medical needs. In his Report & Recommendation to this Court, the Magistrate Judge found that Plaintiff had arguably stated a claim for relief. Dr. Chaudhary objects to this finding, contending that Plaintiffs allegations evince merely a difference in professional judgment regarding treatment, not deliberate indifference to Plaintiffs medical needs. This Court agrees with Dr. Chaudhary’s assessment.
A. Legal Standard
In the seminal case of Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976), the Supreme Court recognized the government’s affirmative obligation to provide medical care for inmates. In their confinement, inmates have no choice but to rely on prison authorities for the treatment of their medical needs. And, according to the Supreme Court, our society’s “evolving standards of decency” will not countenance the unnecessary and wanton denial of medical care to inmates completely dependent upon the government for sustenance. Id. at 106, 97 S.Ct. 285. After all, the “denial of medical care [to inmates] may result in pain and suffering which no one suggests would serve any penological purpose.” Id. at 103, 97 S.Ct. 285. The government, therefore, may not deliberately ignore or withhold minimally adequate medical care to those inmates stricken with serious medical needs. Id. at 103-04, 97 S.Ct. 285 (“[I]t is but just that the public be required to care for the prisoner, who cannot by reason of the deprivation of his liberty, care for himself.”) (quoting Spicer v. Williamson, 191 N.C. 487,132 S.E. 291, 293 (1926)).
In articulating this constitutional right to basic medical care, however, the Court in Estelle was careful to emphasize that not “every claim by a prisoner that he has not received adequate medical treatment states a violation of the Eighth Amendment.” Id. at 105, 97 S.Ct. 285. Incompetent care, “although it may produce added anguish, is not on that basis alone to be characterized as wanton infliction of unnecessary pain.” Id. In short, “Medical malpractice does not become a constitutional violation merely because the victim is a prisoner.” Id. at 106, 97 S.Ct. 285.
The conceptual distinction drawn in Estelle between constitutional misconduct
Medical malpractice claims, however, present a marked contrast. In these cases, the defendant’s state of mind is irrelevant because an objective standard of care is applied. See Johnson v. Riverdale Anesthesia Assoc., 249 Ga.App. 152, 547 S.E.2d 347, 348 (Ga.Ct.App. 2001) (“[T]he applicable standard of care [in medical malpractice actions] is that employed by the medical profession generally .... ”). Moreover, the mistreatment of any medical need, no matter how slight, may give rise to a claim. See, e.g., Bowling v. Foster, 254 Ga.App. 374, 562 S.E.2d 776, 776-77 (Ga.Ct.App. 2002) (listing elements of medical malpractice claim in Georgia, which do not include a severity requirement). Not so with Eighth Amendment claims.
1. Serious Medical Need
The first element that must be proven by an inmate asserting an Eighth Amendment claim is an objectively serious medical need, “one that, if left unattended, pos[es] a substantial risk of serious harm.” Taylor v. Adams, 221 F.3d 1254, 1258 (11th Cir. 2000) (quotations omitted); accord Youmans v. Gagnon, 626 F.3d 557, 564 (11th Cir. 2010) (“[S]erious medical needs are those requiring immediate medical attention.” (quotations omitted)). “[T]he essential test is one of medical necessity .... ” Woodall, 648 F.2d at 272 (emphasis added). Serious medical needs include those “diagnosed by a physician as mandating treatment,” or, alternatively, those that are “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).
Whether a particular ailment is “serious” or not is by nature a fact intensive inquiry, one best answered by example. So, to illustrate, the following conditions constitute serious medical needs when assayed under the Eighth Amendment: swollen ankles, inability to sleep, chills, tingling and numbness of hands, hyperventilation, severe back and leg pain, and double vision, Ancata v. Prison Health Serv., Inc., 769 F.2d 700, 702-03 (11th Cir. 1985); severe and protracted stomach pain, spasms, nausea, vomiting, diarrhea, and dramatic weight loss, McElligott v. Foley, 182 F.3d 1248, 1256 (11th Cir. 1999); swollen and continually bleeding gums, intense pain, and weight loss from inability to eat, Farrow, 320 F.3d at 1243-44; HXV, hepatitis C, recurrent skin infections, severe eye pain and vision problems, fatigue, and prolonged stomach pains, Brown v. Johnson, 387 F.3d 1344, 1346, 1350 (11th Cir. 2004); prolonged amniotic fluid leak severe enough to cause stillbirth, Goebert v. Lee County, 510 F.3d 1312, 1326 (11th Cir. 2007).
2. Deliberate Indifference
Even if an inmate can establish that he suffered from a serious medical need, he must further prove that the allegedly offending prison official acted with an attitude of “deliberate indifference” to that need in order to succeed on
A review of the case law shows that Eleventh Circuit jurisprudence has been faithful to the language and intent of Estelle, giving “substance to [the Supreme Court]’s distinction between ‘deliberate indifference’ and mere negligence.” McElligott, 182 F.3d at 1255. A very limited number of categories of action, or inaction, have thus far been held to constitute deliberate indifference: care so grossly inadequate that it shocks the conscience, easier and less efficacious courses of treatment, cursory treatment of obvious medical needs, or unnecessary and unjustifiable delays in treatment. See Adams v. Poag, 61 F.3d 1537, 1544 (11th Cir. 1995). Each of the listed categories identifies conduct rooted in a conscious and unjustifiable subordination of an inmate’s medical requirements, the result of which is needless suffering and, consequently, a deprivation of Eighth Amendment rights.
B. Analysis
As indicated by the preceding, the Court’s analysis has two components. First, Plaintiffs allegations must show that he had a serious medical need; if so, the Court will consider whether the allegations regarding Dr. Chaudhary’s response to that need are sufficient to show deliberate indifference.
1. Serious Medical Need
Eleventh Circuit law holds, as the Magistrate Judge noted, that infection with hepatitis constitutes an objectively serious medical need. See Brown, 387 F.3d at 1351. According to the Complaint, Plaintiff has suffered from chronic hepatitis B since at least 2000; therefore, the Court finds that Plaintiffs allegations establish that he suffered from a serious medical need.
2. Deliberate Indifference
Notwithstanding Plaintiffs medical need, the Court concludes that the factual allegations of the Complaint do not reasonably support an inference of deliberate indifference. To establish deliberate indifference, a prisoner must show: “(1) subjective knowledge of a risk of serious
a. Subjective Knowledge of the Risks
Although the Complaint does not expressly state as much, Plaintiffs allegation that Dr. Chaudhary declined to offer treatment nevertheless presupposes that Dr. Chaudhary was aware of his condition and its attendant risks. That is, Dr. Chaudhary’s consultation with Plaintiff was prompted by, and predicated upon, precisely such awareness. Accordingly,
Plaintiff has sufficiently alleged that Dr. Chaudhary had the requisite knowledge to sustain a claim.
b. Disregard of the Risks
Plaintiff claims that he should have been treated in September 2009 when Dr. Chaudhary concluded that treatment was unnecessary. If this claim is taken as true for present purposes, as is required, then it follows that Dr. Chaudhary’s conclusion was in error; and if in error, it is reasonable to infer that the error was borne from a failure to properly take account of the risks associated with Plaintiffs condition. This second element has, therefore, been satisfied.
c. By Conduct that is More than Gross Negligence
It is as to this last element that Plaintiffs claim fails. Even if Dr. Chaudhary was aware of Plaintiffs condition and its medical risks, and even if he failed to adequately consider those risks in denying Plaintiff treatment, it does not follow from these facts alone that his doing so amounted to something more than gross negligence. So, as presently alleged, Dr. Chaudhary’s culpability hinges exclusively upon the additional fact that his denial of treatment was at odds with the earlier recommendation of Dr. Cheney. Yet this fact, which constitutes no more than a professional medical disagreement, cannot by itself sustain a claim.
Eleventh Circuit law is clear: when medical treatment decisions are responsive to an inmate’s needs and rooted in professional, medical judgment—even if such decisions are misguided or ineffectual—a claim for deliberate indifference cannot be sustained. “[T]he propriety of a certain course of medical treatment is not a proper subject for review in a civil rights action.” Enriquez v. Kearney, 694 F.Supp.2d 1282, 1296 n. 13 (S.D.Fla. 2010); see also Estelle, 429 U.S. at 107, 97 S.Ct. 285 (“[T]he question whether ... additional diagnostic techniques or forms of treatment is indicated is a classic example of a matter for medical judgment.”); Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 1989) (noting that “a simple difference in medical opinion” does not constitute deliberate indifference). This limiting principle has been consistently applied. See, e.g., Nimmons v. Aviles, 409 Fed.Appx. 295, 297-98 (11th Cir. 2011) (claim could not be sustained against prison surgeon even though another doctor later expressed concern about surgeon’s treatment); Smith v. Florida Dep’t of Corrections, 375 Fed.Appx. 905, 910 (11th Cir. 2010) (inmate’s disagreement with prison medical staff concerning the course of treatment did not support deliberate indifference); Bismark v. Fisher, 213 Fed.Appx. 892, 897 (11th Cir. 2007) (doctor’s failure to adopt plan of care prescribed by outside physician after exercising independent professional judgment did not support deliberate indifference); Adams, 61 F.3d at 1546 (doctor’s failure to administer a stronger course of treatment considered a matter of medical judgment not deliberate indifference).
To sustain his charge of deliberate indifference, then, Plaintiff must allege facts
The United States Constitution does not entitle inmates to medical care tailored to their preferences. See Abel v. Lappin, 661 F.Supp.2d 1361, 1373 (S.D.Ga. 2009) (“It is legally insufficient to sustain a cause of action for deliberate indifference to serious medical needs simply because the inmate did not receive the medical attention he deemed appropriate.”). Indeed, the Eighth Amendment does not even dictate that inmates receive professionally competent care, a point the extended exposition above was intended to underscore. See Estelle, 429 U.S. at 106, 97 S.Ct. 285. With these principles in mind, Plaintiffs grievance falls flat. The facts as alleged by Plaintiff show that his condition was attended to by prison medical staff for nearly a decade. Since his incarceration in 2000, Plaintiffs ailment was monitored to ensure that treatment would be available if necessary. He was transferred on multiple occasions to a specialized medical facility for no other purpose than to consult with physicians regarding his condition. He underwent rather sophisticated testing, including blood work and a liver biopsy, to assess the necessity of treatment.
Yet, from this long history of medical attention, Plaintiff has isolated Dr. Chaudhary’s recommendation against treatment and juxtaposed it against a single decision that he deems more favorable, and relies on the contrast to state his claim. But the long and short of the claim’s factual underpinning is this: after Plaintiffs condition had been monitored for nearly a decade, one doctor recommended treatment on the basis of a blood test, and subse
IV. CONCLUSION
Upon the foregoing, the Court SUSTAINS Dr. Chaudhary’s objection to the Magistrate Judge’s Report and Recommendation. (Doc. no. 56.) Accordingly, Dr. Chaudhary’s motion to dismiss is GRANTED IN FULL, and Plaintiffs Eighth Amendment claim against him is DISMISSED. The Court declines to exercise supplemental jurisdiction over Plaintiffs’ remaining state law claims against Dr. Chaudhary, and those claims are therefore DISMISSED WITHOUT PREJUDICE. Only Plaintiffs claims against Dr. Moore now remain before this Court.
Separately, because it addresses matters dealt with herein and discovery in this case has not yet begun, Plaintiffs motion for summary judgment (doc. no. 59) is DISMISSED WITHOUT PREJUDICE. Plaintiff may re-file the motion at a later date, taking into account the Court’s present Order. Finally, Plaintiffs motion for preliminary injunction (doc. no. 59) is DENIED as it merely restates the allegations of the Complaint and fails to demonstrate a substantial likelihood of success on the merits. See Church v. Huntsville, 30 F.3d 1332, 1347 (11th Cir. 1994) (holding that preliminary injunction may not be granted absent movant’s demonstration of a substantial likelihood of success on the merits).
With these matters resolved, the Clerk is DIRECTED to issue a scheduling notice to the parties.
. When Plaintiff commenced this action, he was incarcerated at Telfair State Prison in Helena, Georgia.
. Plaintiff completed a standard prisoner form to file this action (doc. no. 1), but supplemented the form with a handwritten document which contains a more extensive catalogue of factual allegations (doc. no. 1-1). The Court will refer to this supplemental document as the "Complaint” hereinafter.
. When ruling on a motion to dismiss, the Court must accept all facts alleged in the Complaint as true and must construe all reasonable inferences in the light most favorable to Plaintiff. See Hoffman-Pugh v. Ramsey, 312 F.3d 1222, 1225 (11th Cir. 2002).
. See http://www.medicinenet.com/interferon/ article.htm.
Reference
- Full Case Name
- Oliver C. LOADHOLT v. Dr. MOORE
- Cited By
- 4 cases
- Status
- Published