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Tramel v. Wilson

United States District Court, M.D. Alabama, Northern Division

February 18, 2015

LELA MARIAMA B. TRAMEL, #260392, Plaintiff,
v.
OFFICER BRIAN WILSON, et al., Defendants.

RECOMMENDATION OF THE MAGISTRATE JUDGE

WALLACE CAPEL, Jr., Magistrate Judge.

I. INTRODUCTION

This 42 U.S.C. ยง 1983 action is before the court on a complaint filed by Lela Mariama B. Tramel ("Tramel"), an indigent state inmate, challenging actions taken against her at the Tutwiler Prison for Women ("Tutwiler") from January 8, 2011 until August 1, 2011. Complaint - Doc. No. 1 at 2. Tramel names Brian Wilson, Samuel Foster and Karla Jones, correctional officials employed at Tutwiler during the time relevant to the complaint, CMS and Corizon, the former and current medical care provider for the state prison system, and physicians Emmett Roe and Hugh Hood as defendants in this cause of action. Tramel seeks monetary damages and injunctive relief for the alleged violations of her constitutional rights.

The defendants filed special reports and relevant supporting evidentiary materials, including affidavits and medical records, addressing Tramel's claims for relief. Pursuant to the orders entered in this case, the court deems it appropriate to construe the aforementioned reports as motions for summary judgment. Order of March 26, 2013 - Doc. No. 107. Thus, this case is now pending on the defendants' motions for summary judgment. Upon consideration of these motions, the evidentiary materials filed in support thereof, the sworn complaint and the plaintiff's responses to the reports, including sworn statements, the court concludes that: (i) Defendant Wilson is due to be dismissed from this case because service was not perfected within the requisite period of time; (ii) The claims against Dr. Roe are subject to dismissal as they do not implicate a constitutional violation; (iii) The motion for summary judgment filed by defendants CMS, Corizon and Hood is due to be granted; (iv) Defendant Jones is entitled to summary judgment on the excessive force claim presented against her; and (v) Defendant Foster's motion for summary judgment as to the excessive force claim lodged against him is due to be granted in part and denied in part.

II. SUMMARY JUDGMENT STANDARD

"Summary judgment is appropriate if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show there is no genuine [dispute] as to any material fact and that the moving party is entitled to judgment as a matter of law.'" Greenberg v. BellSouth Telecomm., Inc., 498 F.3d 1258, 1263 (11th Cir. 2007) (per curiam) (citation to former rule omitted); Fed.R.Civ.P. 56(a) ("The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.").[1] The party moving for summary judgment "always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of the [record, including pleadings, discovery materials and affidavits], which it believes demonstrate the absence of a genuine issue [- now dispute -] of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986); Jeffery v. Sarasota White Sox, Inc., 64 F.3d 590, 593 (11th Cir. 1995) (moving party has initial burden of showing there is no genuine dispute of material fact for trial). The movant may meet this burden by presenting evidence indicating there is no dispute of material fact or by showing that the nonmoving party has failed to present appropriate evidence in support of some element of its case on which it bears the ultimate burden of proof. Celotex, 477 U.S. at 322-24.

Defendants Foster, Jones, CMS, Corizon and Hood assert they have met their evidentiary burden and demonstrated the absence of any genuine dispute of material fact with respect to the claims presented by the plaintiff. Based on the foregoing, the burden shifts to the plaintiff to establish, with appropriate evidence beyond the pleadings, that a genuine dispute material to her case exists. Clark v. Coats & Clark, Inc., 929 F.2d 604, 608 (11th Cir. 1991); Celotex, 477 U.S. at 324; Fed.R.Civ.P. 56(e)(3) ("If a party fails to properly support an assertion of fact or fails to properly address another party's assertion of fact by [citing to materials in the record including affidavits, relevant documents or other materials] the court may... grant summary judgment if the motion and supporting materials - including the facts considered undisputed - show that the movant is entitled to it."); Jeffery, 64 F.3d at 593-94 (internal quotation marks omitted) (Once the moving party meets its burden, "the non-moving party must then go beyond the pleadings, and by its own affidavits [or sworn statements], or by depositions, answers to interrogatories, and admissions on file, " demonstrate that there is a genuine dispute of material fact.). This court will also consider "specific facts" pled in a plaintiff's sworn complaint when considering his opposition to summary judgment. Caldwell v. Warden, FCI Talladega, 748 F.3d 1090, 1098 (11th Cir. 2014). A genuine dispute of material fact exists when the nonmoving party produces evidence that would allow a reasonable fact-finder to return a verdict in its favor. Greenberg, 498 F.3d at 1263; Allen v. Bd. of Pub. Educ. for Bibb Cnty., 495 F.3d 1306, 1313 (11th Cir. 2007).

In civil actions filed by inmates, federal courts
must distinguish between evidence of disputed facts and disputed matters of professional judgment. In respect to the latter, our inferences must accord deference to the views of prison authorities [and medical personnel]. Unless a prisoner can point to sufficient evidence regarding such issues of judgment to allow him to prevail on the merits, he cannot prevail at the summary judgment stage.

Beard v. Banks, 548 U.S. 521, 530 (2006) (internal citation omitted). Consequently, to survive the defendants' properly supported motions for summary judgment, Caldwell is required to produce "sufficient [favorable] evidence" which would be admissible at trial supporting his claims of constitutional violations. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986); Fed.R.Civ.P. 56(e). "If the evidence [on which the nonmoving party relies] is merely colorable... or is not significantly probative... summary judgment may be granted." Anderson, 477 U.S. at 249-50. "A mere scintilla' of evidence supporting the opposing party's position will not suffice; there must be enough of a showing that the [trier of fact] could reasonably find for that party." Walker v. Darby, 911 F.2d 1573, 1576-77 (11th Cir. 1990) (citing Anderson, 477 U.S. at 250). Conclusory allegations based on subjective beliefs are likewise insufficient to create a genuine dispute of material fact and, therefore, do not suffice to oppose a motion for summary judgment. Holifield v. Reno, 115 F.3d 1555, 1564 n.6 (11th Cir. 1997) (A plaintiff's "conclusory assertions..., in the absence of [admissible] supporting evidence, are insufficient to withstand summary judgment."); Harris v. Ostrout, 65 F.3d 912, 916 (11th Cir. 1995) (grant of summary judgment appropriate where inmate produces nothing beyond her "own conclusory allegations" challenging actions of the defendants); Fullman v. Graddick, 739 F.2d 553, 557 (11th Cir. 1984) ("Mere verification of party's own conclusory allegations is not sufficient to oppose summary judgment...."); Evers v. Gen. Motors Corp., 770 F.2d 984, 986 (11th Cir. 1985) ("[C]onclusory allegations without specific supporting facts have no probative value."). Hence, when a plaintiff fails to set forth specific facts supported by requisite evidence sufficient to establish the existence of an element essential to her case and on which the plaintiff will bear the burden of proof at trial, summary judgment is due to be granted in favor of the moving party. Celotex, 477 U.S. at 322 ("[F]ailure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial."); Barnes v. Sw. Forest Indus., Inc., 814 F.2d 607, 609 (11th Cir. 1987) (If on any part of the prima facie case the plaintiff presents insufficient evidence to require submission of the case to the trier of fact, granting of summary judgment is appropriate.); Chapman v. AI Transport, 229 F.3d 1012, 1023 (11th Cir. 2000) (en banc) (summary judgment appropriate where no genuine dispute of material fact exists). At the summary judgment stage, this court must "consider all evidence in the record... [including] pleadings, depositions, interrogatories, affidavits, etc. - and can only grant summary judgment if everything in the record demonstrates that no genuine [dispute] of material fact exists." Strickland v. Norfolk S. Ry. Co., 692 F.3d 1151, 1154 (11th Cir. 2012).

For summary judgment purposes, only disputes involving material facts are relevant. United States v. One Piece of Real Prop. Located at 5800 SW 74th Ave., Miami, Fla., 363 F.3d 1099, 1101 (11th Cir. 2004). What is material is determined by the substantive law applicable to the case. Anderson, 477 U.S. at 248; Lofton v. Sec'y of the Dep't of Children and Family Servs., 358 F.3d 804, 809 (11th Cir. 2004) ("Only factual disputes that are material under the substantive law governing the case will preclude entry of summary judgment."). "The mere existence of some factual dispute will not defeat summary judgment unless that factual dispute is material to an issue affecting the outcome of the case." McCormick v. City of Fort Lauderdale, 333 F.3d 1234, 1243 (11th Cir. 2003) (citation omitted). To demonstrate a genuine dispute of material fact, the party opposing summary judgment "must do more than simply show that there is some metaphysical doubt as to the material facts.... Where the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no genuine [dispute] for trial.'" Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). In cases where the evidence before the court which is admissible on its face or which can be reduced to admissible form indicates there is no genuine dispute of material fact and the party moving for summary judgment is entitled to it as a matter of law, summary judgment is proper. Celotex, 477 U.S. at 323324 (summary judgment appropriate where pleadings, evidentiary materials and affidavits before the court show no genuine dispute as to a requisite material fact); Waddell v. Valley Forge Dental Assocs., Inc., 276 F.3d 1275, 1279 (11th Cir. 2001) (To establish a genuine dispute of material fact, the nonmoving party must produce evidence such that a reasonable trier of fact could return a verdict in her favor.).

Although factual inferences must be viewed in a light most favorable to the nonmoving party and pro se complaints are entitled to liberal interpretation, a pro se litigant does not escape the burden of establishing by sufficient evidence a genuine dispute of material fact. Beard, 548 U.S. at 525; Brown v. Crawford, 906 F.2d 667, 670 (11th Cir. 1990). Thus, the plaintiff's pro se status alone does not mandate this court's disregard of elementary principles of production and proof in a civil case. The court has undertaken a thorough and exhaustive review of all the evidence contained in the record. In this case, Tramel, through the submission of her sworn complaint and responsive statements has demonstrated a genuine dispute of material fact in order to preclude entry of summary judgment on her excessive force claim against defendant Foster. Defendants Jones, CMS, Corizon and Hood, however, are entitled to summary judgment on Tramel's remaining claims for relief. Moreover, dismissal of the claims against Brian Wilson are appropriate as service could not be perfected on this individual and the complaint likewise fails to state a basis for relief against defendant Roe.

III. DISCUSSION[2]

In her complaint, Tramel alleges that Officer Samuel Foster subjected her to excessive force on the morning of January 8, 2011, by forcefully removing her from day room area of her assigned dorm. Complaint - Doc. No. 1 at 3. Tramel further asserts that Foster, without justification, subsequently slammed her against the side of the building and choked her by placing his forearm against her throat. Id. At this time, Officer Wilson approached Tramel and grabbed her by the right wrist at which time both officers turned Tramel around pinning her "against the wall face first.... Wilson held my arm straight and applied pressure to my elbow area until it popped. Then he eased pressure but did not discontinue it until Lt. [Ferrell] arrived." Id. Lt. Ferrell placed Tramel in handcuffs and Foster and Wilson escorted her to the administrative building. Memorandum in Opposition to Special Report of Correctional Defendants - Doc. No. 36 at 8. Tramel and Foster were interviewed by Lt. Ferrell. Id. at 8-9. After speaking with Tramel, Lt. Ferrell ordered that the handcuffs be removed from Tramel and that she be escorted to the health care unit for an examination. Id. at 9.

Tramel also asserts that on January 21, 2011 defendant Jones, the assistant warden at Tutwiler, "snatched on [her] left arm" in an attempt to have Tramel respond to an order. Complaint - Doc. No. 1 at 5; Memorandum in Opposition to Special Report of Correctional Defendants - Doc. No. 36 at 12. Finally, Tramel complains that health care personnel failed to provide adequate medical treatment for the injury suffered to her right elbow. Complaint - Doc. No. 1 at 3-5. In support of this claim, Tramel alleges she received "easier and less efficacious means of treatment than was appropriate." Id. at 4.

A. Dismissal for Lack of Service

Tramel names Brian Wilson as a defendant in this cause of action. The court attempted service on Wilson at various addresses provided by Tramel. Service, however, could not be perfected on this individual at any of these addresses. Thus, in accordance with Richardson v. Johnson, 598 F.3d 734, 740 (11th Cir. 2010), the court ordered that "the United States Marshal for the Middle District of Alabama shall make a reasonable effort to locate Brian Wilson, a former employee of the Alabama Department of Corrections at the Julia Tutwiler Prison for Women whose last known address was in Wetumpka, Alabama." Order of February 13, 2012 - Doc. No. 26. Despite extensive efforts by the United States Marshal, the Marshal was unable to perfect service on Brian Wilson.

Under Rule 4(m) of the Federal Rules of Civil Procedure, "[i]f a defendant is not served within 120 days after the complaint is filed, the court -... on its own after notice to the plaintiff - must dismiss the action without prejudice against that defendant.... But if the plaintiff shows good cause for the failure, the court must extend the time for service for an appropriate period." When a plaintiff fails to perfect service of process within the 120-day period, dismissal is mandatory unless the plaintiff can show good cause or establish sufficient grounds for an extension of this time period. Schnabel v. Wells, 922 F.2d 726, 728 (11th Cir. 1991) (interpreting the 120-day period as it appeared in Rule 4(j), Federal Rules of Civil Procedure, the predecessor to Rule 4(m), Federal Rules of Civil Procedure ); In re Cooper, 971 F.2d 640, 641 (11th Cir. 1992) (Absent a showing of good cause, a district court has no discretion to salvage an action in the event of a violation of Rule 4(m)); Horenkamp v. Van Winkle & Co., 402 F.3d 1129, 1132 (11th Cir. 2005) (A court may grant an extension to serve process for either "good cause" or another sufficient ground). "[C]ourts have found good cause' under Rule 4[m] only when some outside factor such as reliance on faulty advice, rather than inadvertence or negligence, prevented service." Prisco v. Frank, 929 F.2d 603, 604 (11th Cir. 1991).

The 120-period for service expired in May of 2012. Tramel, however, was allowed extensions until September 18, 2012 to provide a correct address for Wilson so that service might be perfected Brian Wilson. The court provided Tramel notice of the lack of service on Brian Wilson and the impending requisite dismissal of Wilson from this cause of action if service could not be perfected on this individual. Order of August 21, 2012 - Doc. No. 62. Consequently, Tramel's claims against Brian Wilson are subject to dismissal without prejudice as service has not been perfected on Wilson within the time allowed by the court.

B. Absolute Immunity - Defendants Jones and Foster

To the extent Tramel sues defendants Jones and Foster in their official capacities, they are immune from monetary damages. Official capacity lawsuits are "in all respects other than name, ... treated as a suit against the entity." Kentucky v. Graham, 473 U.S. 159, 166 (1985).

A state official may not be sued in his official capacity unless the state has waived its Eleventh Amendment immunity, see Pennhurst State School & Hospital v. Halderman, 465 U.S. 89, 100, 104 S.Ct. 900, 908, 79 L.Ed.2d 67 (1984), or Congress has abrogated the state's immunity, see Seminole Tribe v. Florida, [517 U.S. 44, 59], 116 S.Ct. 1114, 1125, 134 L.Ed.2d 252 (1996). Alabama has not waived its Eleventh Amendment immunity, see Carr v. City of Florence, 916 F.2d 1521, 1525 (11th Cir. 1990) (citations omitted), and Congress has not abrogated Alabama's immunity. Therefore, Alabama state officials are immune from claims brought against them in their official capacities.

Lancaster v. Monroe Cnty., 116 F.3d 1419, 1429 (11th Cir. 1997).

In light of the foregoing, the defendants Jones and Foster are state actors entitled to sovereign immunity under the Eleventh Amendment for claims seeking monetary damages from them in their official capacities. Lancaster, 116 F.3d at 1429; Jackson v. Ga. Dep't of Transp., 16 F.3d 1573, 1575 (11th Cir. 1994); Parker v. Williams, 862 F.2d 1471 (11th Cir. 1989).

C. Medical Treatment - Defendants CMS, Corizon, Hood and Roe

Tramel asserts that, after suffering an injury to her right elbow in January of 2011, she received inadequate medical treatment for this injury from defendants CMS, Corizon, Hood and Roe. Complaint - Doc. No. 1 at 3-5. Specifically, Tramel alleges that from the time she suffered the injury and for several months thereafter health care personnel provided minimal treatment for the injury and refused to refer her to a free world orthopedic surgeon for evaluation.

To prevail on a claim concerning an alleged denial of adequate medical treatment, an inmate must, at a minimum, show that the defendants acted with deliberate indifference to her serious medical needs. Estelle v. Gamble, 429 U.S. 97 (1976); Taylor v. Adams, 221 F.3d 1254 (11th Cir. 2000); McElligott v. Foley, 182 F.3d 1248 (11th Cir. 1999); Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 1989); Rogers v. Evans, 792 F.2d 1052, 1058 (11th Cir.1986). Specifically, medical personnel may not subject an inmate to "acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs." Estelle, 429 U.S. at 106, 97 S.Ct. at 292; Adams v. Poag, 61 F.3d 1537, 1546 (11th Cir. 1995) (citation and internal quotations omitted) (As directed by Estelle, a plaintiff must establish "not merely the knowledge of a condition, but the knowledge of necessary treatment coupled with a refusal to treat or a delay in [the acknowledged necessary] treatment.").

That medical malpractice-negligence by a physician-is insufficient to form the basis of a claim for deliberate indifference is well settled. See Estelle v. Gamble, 429 U.S. 97, 105-07, 97 S.Ct. 285, 292, 50 L.Ed.2d 251 (1976); Adams v. Poag, 61 F.3d 1537, 1543 (11th Cir. 1995). Instead, something more must be shown. Evidence must support a conclusion that a prison physician's harmful acts were intentional or reckless. See Farmer v. Brennan, 511 U.S. 825, 833-38, 114 S.Ct. 1970, 1977-79, 128 L.Ed.2d 811 (1994); Cottrell v. Caldwell, 85 F.3d 1480, 1491 (11th Cir. 1996) (stating that deliberate indifference is equivalent of recklessly disregarding substantial risk of serious harm to inmate); Adams, 61 F.3d at 1543 (stating that plaintiff must show more than mere negligence to assert an Eighth Amendment violation); Hill v. Dekalb Regional Youth Detention Ctr., 40 F.3d 1176, 1191 n.28 (11th Cir. 1994) (recognizing that Supreme Court has defined "deliberate indifference" as requiring more than mere negligence and has adopted a "subjective recklessness" standard from criminal law); Qian v. Kautz, 168 F.3d 949, 955 (7th Cir. 1999) (stating "deliberate indifference" is synonym for intentional or reckless conduct, and that "reckless" conduct describes conduct so dangerous that deliberate nature can be inferred).

Hinson v. Edmond, 192 F.3d 1342, 1345 (11th Cir. 1999).

In order to properly establish "deliberate indifference to [a] serious medical need..., Plaintiff[] must show: (1) a serious medical need; (2) the defendants' deliberate indifference to that need; and (3) causation between that indifference and the plaintiff's injury." Mann v. Taser Int'l, Inc., 588 F.3d 1291, 1306-07 (11th Cir. 2009). When seeking relief based on deliberate indifference, an inmate is required to establish "an objectively serious need, an objectively insufficient response to that need, subjective awareness of facts signaling the need and an actual inference of required action from those facts." Taylor, 221 F.3d at 1258; McElligott, 182 F.3d at 1255 (for liability to attach, the official must know of and then disregard an excessive risk to the prisoner). Thus, deliberate indifference occurs only when a defendant "knows of and disregards an excessive risk to inmate health or safety; the [defendant] must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists and he must also draw the inference." Farmer, 511 U.S. at 837; Johnson v. Quinones, 145 F.3d 164, 168 (4th Cir. 1998) (defendant must have actual knowledge of a serious condition, not just knowledge of symptoms, and ignore known risk to serious condition to warrant finding of deliberate indifference). Furthermore, "an official's failure to alleviate a significant risk that he should have perceived but did not, while no cause for commendation, cannot under our cases be condemned as the infliction of punishment." Farmer, 511 U.S. at 838.

In articulating the scope of inmates' right to be free from deliberate indifference, ... the Supreme Court has... emphasized that not "every claim by a prisoner that he has not received adequate medical treatment states a violation of the Eighth Amendment." Estelle, 429 U.S. at 105, 97 S.Ct. at 291; Mandel, 888 F.2d at 787. Medical treatment violates the eighth amendment only when it is "so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness." Rogers, 792 F.2d at 1058 (citation omitted). Mere incidents of negligence or malpractice do not rise to the level of constitutional violations. See Estelle, 429 U.S. at 106, 97 S.Ct. at 292 ("Medical malpractice does not become a constitutional violation merely because the victim is a prisoner."); Mandel, 888 F.2d at 787-88 (mere negligence or medical malpractice not sufficient' to constitute deliberate indifference); Waldrop, 871 F.2d at 1033 (mere medical malpractice does not constitute deliberate indifference). Nor does a simple difference in medical opinion between the prison's medical staff and the inmate as to the latter's diagnosis or course of treatment support a claim of cruel and unusual punishment. See Waldrop, 871 F.2d at 1033 (citing Bowring v. Godwin, 551 F.2d 44, 48 (4th Cir. 1977)).

Harris v. Thigpen, 941 F.2d 1495, 1505 (11th Cir. 1991); Taylor, 221 F.3d at 1258 (citation and internal quotations omitted) (To show deliberate indifference to a serious medical need, a plaintiff must demonstrate that the defendants' response to the need was more than "merely accidental inadequacy, negligence in diagnosis or treatment, or even medical malpractice actionable under state law."). Moreover, "as Estelle teaches, whether government actors should have employed additional diagnostic techniques or forms of treatment is a classic example of a matter for medical judgment' and therefore not an appropriate basis for grounding liability under the Eighth Amendment." Adams, 61 F.3d at 1545; Garvin v. Armstrong, 236 F.3d 896, 898 (7th Cir. 2001) ("A difference of opinion as to how a condition should be treated does not give rise to a constitutional violation."); Hamm v. DeKalb Cnty., 774 F.2d 1567, 1575 (11th Cir. 1985) (mere fact inmate desires a different mode of medical treatment does not amount to deliberate indifference violative of the Constitution); Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981) (prison medical personnel do not violate the Eighth Amendment simply because their opinions concerning medical treatment conflict with that of other medical professionals or the inmate-patient). Self-serving statements by a plaintiff do not create a question of fact in the face of contradictory, contemporaneously created medical records. See Bennett v. Parker, 898 F.2d 1530 (11th Cir. 1990). In addition to the above described requisite elements, when an inmate's deliberate indifference claim alleges a delay in treatment, this court must also consider "(1) the seriousness of the medical need; (2) whether the delay worsened the medical condition; and (3) the reason for the delay." Goebert v. Lee Cnty., 510 F.3d 1312, 1327 (11th Cir. 2007).

After the altercation with correctional officers on January 8, 2011, Tramel was escorted to the health care unit for examination. The attending nurse observed "only superficial injuries.... No acute distress." Exhibit A to the Special Report of Defendants CMS, Corizon and Hood (Medical Records of Tramel) - Doc. No. 24-2 at 42. The injuries noted by the nurse included "swelling to [right] elbow area outer aspects. Also... sm[all] contusion to [right] great toe and sm[all] laceration to [left] chin area." Id. During this examination, the nurse determined that Tramel was "able to raise [right] arm, difficult to bend [right] elbow area [without complaining of] pain during movement of [right] elbow area." Id. at 37. The assessment from the examination indicated "[a]n alteration in musculoskeletal system [related to] possible sprain of [right] elbow area and also... contusion to [right] great toe and sm[all] laceration to [left] chin area." Id. at 42. The nurse applied an ace bandage to Tramel's right arm and provided "an ice pack [for use by Tramel] to decrease swelling." Id. Tramel refused pain medication and was instructed to return to the health care unit on the morning of January 10, 2011, to see the site physician for re-evaluation of her right elbow area. Id. The nurse also advised Tramel to "[r]eturn to the HCU for any changes in [her] condition." Id. Due to increased pain and swelling in her right arm, Tramel returned to the health care unit at approximately 4:00 a.m. the next morning. Id. at 112; Plaintiff's May 17, 2013 Response - Doc. No. 127 at 6. Tramel was prescribed Tylenol to be taken twice a day for three days and "told to keep follow up appointment with the [doctor] the next day." Exhibit A to the Special Report of Defendants CMS, Corizon and Hood (Medical Records of Tramel) - Doc. No. 24-2 at 112.

Upon her return to the health care unit on January 10, 2011, Dr. Roe conducted an examination of Tramel's right arm at which time he "stated [the] arm appeared broken [or] dislocated and needed to be x-rayed." Complaint - Doc. No. 1 at 4. Dr. Roe immediately ordered an x-ray of Tramel's right arm and the x-ray was performed on January 12, 2011, at the Elmore County Hospital. Id. He also prescribed Ibuprofen as KOP, i.e., Keep on Person, and a sling for use by Tramel. Id. The results of the x-ray indicated "no fracture or dislocation and no radiographically detectable soft tissue abnormality. Normal right forearm. There is no fracture or dislocation and no radiographically detectable soft tissue abnormality. Normal right elbow." Exhibit A to the Special Report of Defendants CMS, Corizon and Hood (Medical Records of Tramel) - Doc. No. 24-2 at 104; Complaint - Doc. No. 1 at 4. ("X-ray came back negative for breaks or dislocation."). On January 13, 2011, Dr. Roe conducted a follow-up examination of Tramel regarding pain and immobility in her right arm. Exhibit A to the Special Report of Defendants CMS, Corizon and Hood (Medical Records of Tramel) - Doc. No. 24-2 at 35. At this time, Dr. Roe gave Tramel a Cortisone injection which provided "immediate relief of pain but [patient] still had an immobile joint." Id. Dr. Roe advised Tramel to "avoid use of her [right] arm except in school." Id. He also provided Tramel with a special ...


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