United States District Court, S.D. Alabama, Southern Division
REPORT AND RECOMMENDATION
Bradley Murray UNITED STATES MAGISTRATE JUDGE.
Marcus Johnson (“Plaintiff”), a prison inmate
proceeding pro se and in forma pauperis,
filed a complaint under 42 U.S.C. § 1983. (Doc. 8). This
action was referred to the undersigned pursuant to 28 U.S.C.
§ 636(b)(1)(B) and Local Rule 72(a)(2)(R), and is now
before the undersigned on Defendants' Motion for Summary
Judgment. After careful review of the pleadings, and for the
reasons set out below, it is ordered that Defendants'
Motion for Summary Judgment be granted in favor of all
Defendants and that the claims asserted against Defendants be
dismissed with prejudice.
Summary of Action.
filed this suit on January 18, 2016, against Dr. Timothy
Iliff, Dr. Calvin Johnson, Certified Registered Nurse
Practitioner Shawn Geohagan, Warden Cynthia Stewart, and
Corizon Services CEO Jay Cowan. (Doc. 8 at 5- 7). Plaintiff
alleges that he suffers from an extremely painful
softball-sized ventral hernia which Defendants refuse to
treat properly with surgical repair and instead have opted to
treat by prescribing a hernia belt and pain medication. (Doc.
8-1 at 4-5). Specifically, Plaintiff alleges Defendants Iliff
and Geohagan failed to provide him with adequate medical care
for his hernia and that Defendants Johnson and Stewart, as
supervisors,  are legally responsible for the deficient
medical treatment . (Doc. 8 at 5-7). Plaintiff requests that
the Court order the defendants to provide surgical repair of
his ventral hernia and to pay monetary damages. (Id.
at 8; Doc. 8-1 at 6).
Dr. Timothy Iliff, Dr. Calvin Johnson, Shawn Geohagan, and
Cynthia Stewart, have answered the suit and filed a Special
Report, which the Court has converted in to a Motion for
Summary Judgment. (See Docs. 42-43, 46). And,
Plaintiff has subsequently filed a Response to the motion.
(Doc. 53). After a thorough review of the record, it is
determined that this motion is ripe for consideration.
have presented the Court with sworn declarations summarizing
Plaintiff's medical condition and the history of his
treatment while imprisoned at Fountain Correctional Facility
(See Docs. 43-1 - 43-5), as well as copies of
Plaintiff's medical records dating from 2014 through
December of 2016, with the exception of the records from
Atmore Community Hospital where Plaintiff underwent a CT scan
followed by hernia repair surgery on December 9, 2016.
(See Doc. 43-6). Plaintiff has provided additional
evidence in the form of approximately five sick call requests
dating from 2004 through 2011. 
1996, Plaintiff suffered an abdominal gunshot wound and
received surgery for it; thereafter, in May 1997, he was
convicted, sentenced, and imprisoned within the Alabama
Department of Corrections for burglary and murder.
(Id. at 227; Doc. 8 at 7). While incarcerated,
Plaintiff developed a ventral hernia at the previous surgical
site and on January 16, 2003 was provided surgical repair of
the hernia. (Doc. 43-5 at 2; Doc. 43-6 at 307). As early as
June of 2004, Plaintiff again developed a ventral hernia and
began receiving treatment for the symptoms within the
prison's health care unit. (Doc. 8-1 at 10). On May 15,
2006, Plaintiff received his second hernia repair surgery
while incarcerated. (Doc. 43-5 at 2; Doc. 43-6 at 287-303).
unclear exactly when Plaintiff developed the third ventral
hernia, subject of this suit, but according to the record, on
May 28, 2011, Plaintiff reported abdominal pain when he stood
or moved and complained that the pain had been progressively
worsening for two months. (Doc. 8-1 at 12). The nursing staff
instructed him to take Tylenol for the pain and wear his
provided hernia binder. (Id.). By fall of 2014,
Plaintiff's complaints of abdominal pain, consistent with
a hernia, were frequent.
September 8, 2014, Certified Registered Nurse Practitioner
Shawn Geohagan (“Geohagan”) examined Plaintiff
for complaints of stomach pain and having blood in his stool
for four days. (Doc. 43-6 at 176). Geohagan ordered a
hemmocult card to test for the presence of blood in
Plaintiff's stool, but the results were negative for the
specimens taken on September 8 and September 12, 2014. (Doc.
43-6 at 147; Doc. 43-4 at 2-3).
September 22, 2014, Geohagan examined Plaintiff, following a
sick call request for stomach pain, swelling, and a request
for an x-ray scan. (Doc. 43-6 at 175; Doc. 43-4 at 3).
Geohagan noted Plaintiff's chronic abdominal discomfort
on the chart but indicated Plaintiff's “large
abdomen [was] due to obesity state” (Plaintiff, who
stands 5 feet 10 inches tall, is reported as weighing 290
pounds on the date of the exam) and did not order any
diagnostic imaging at that time. (Doc. 43-6 at 177).
September 25, 2014, Plaintiff was seen by a nondefendant
nurse in the Chronic Disease Clinic for routine care for his
medical conditions, and the presence of an abdominal hernia
was indicated on the chart, an abdominal binder was
prescribed to hold the hernia in to place, and a notation was
made to for the nurse to discuss with Dr. Iliff whether or
not surgical repair of the hernia was advisable. (Doc. 43-6
October 9, 2014, Dr. Iliff examined Plaintiff for complaints
of hernia pain that had been present for “years,
” and noted a “large ventral hernia” on the
right side of Plaintiff's abdominal surgical scar. (Doc.
43-6 at 12). Dr. Iliff prescribed Plaintiff Naprosyn for pain
and performed an x-ray, which indicated a diffuse ileus,
which the radiologist found to be “worse compared to
[the x-ray images of] October 11, 2012.” (Doc. 43-6 at
45). Dr. Iliff, however, indicated that the hernia was not
incarcerated at that time and did not recommend surgical
intervention due to Plaintiff's weight and risk for
increased complications. (Id. at 12).
was subsequently seen in the Chronic Disease Clinic on
October 23, 2014 and January 22, 2015, and although Plaintiff
failed to voice any complaints of abdominal pain, his hernia
was assessed and determined to be reducible at both visits.
(Doc. 43-6 at 27-28).
April 15, 2015, Plaintiff was examined in the health care
unit for complaints of hernia pain; the hernia was reducible,
but the examining nurse noted she would discuss the
possibility of surgical intervention with Dr. Iliff.
(Id. at 10, 14).
April 23, 2015, Plaintiff was seen in the Chronic Disease
Clinic with complaints of abdominal pain and swelling and was
scheduled an appointment with Dr. Iliff. (Id. at
31). Dr. Iliff saw Plaintiff the next day and again confirmed
by examination a “large ventral hernia” at the
site of past surgeries and further noted that he would
discuss Plaintiff's condition with the Regional Medical
Director. (Id. at 10).
21, 2015, Plaintiff was again seen in the Chronic Disease
Clinic and complained of abdominal pain persisting for
approximately 12 years. (Id. at 30). A week later,
Dr. Iliff examined Plaintiff on July 28, 2015, finding
Plaintiff's weight had decreased to 264 pounds and
estimated Plaintiff's hernia to be “softball”
sized. (Id. at 46-47). Dr. Iliff notes that
Plaintiff has “complained of pain regularly” and
recommends a surgical evaluation. (Id.). However,
Dr. Hood (who is not a party to this suit) denied Dr.
Iliff's request for a surgical consult on July 29, 2015,
and recommended managing Plaintiff's care on site.
(Id. at 46).
nursing staff and Dr. Iliff again examined Plaintiff on
November 2, 2015 for complaints of hernia pain. (Id.
at 11). Dr. Iliff noted Plaintiff's obese state and
chronic abdominal pain from ventral hernia. (Id.).
Plaintiff confirmed he was using the provided abdominal
binder, and Dr. Iliff assessed that the hernia was still
reducible. (Id.). Dr. Iliff determined and discussed
with Plaintiff that a conservative treatment plan of
medication and binder use was appropriate given
Plaintiff's obesity and surgical history. (Id.).
Following this examination, Plaintiff submitted a formal
When I went to see the doctor he told me I had a hernia I
have been going back and forth for several years trying to
get my stomach fixed. My stomach is constantly swelling look
like a tumor, constantly in pain. I asked the doctor was he
going to do anything to fix my stomach. And his reply was,
‘It wouldn't do any good to have it fixed, the same
thing would happen again.' He clearly stated that,
‘he wasn't going to do anything to have it
(Id. at 74).
November 9, 2015, Nurse Practitioner Shawn Geohagan examined
Plaintiff (weighing 246 pounds) and again discussed the
conservative treatment plan for the hernia with him.
(Id. at 55). Although Plaintiff disagreed with the
plan, he confirmed his understanding of it. (Id.).
December 12 and 13, 2015, Plaintiff completed sick call
request forms complaining of pain and swelling in his abdomen
and blood in his stool and requested stronger medication for
the pain. (Id. at 16-17). The requests were
received by the health care unit on December 14, 2015, and
the nursing staff examined Plaintiff on December 15. 2015,
noting pain in the right side of Plaintiff's stomach for
12 years that increased with movement and confirming normal
vital signs, active bowel sounds, and that Plaintiff had had
a bowel movement the previous day. (Id. at 15).
December 21, 2015, Geohagan saw Plaintiff for complaints of
stomach pain after eating and diarrhea. (Id. at 55).
Geohagan confirmed a soft, non-tender abdomen and diagnosed
Plaintiff with gastroesophageal reflux disease and prescribed
Zantac at 150 mg to be taken twice a day for 180 days.
again saw Plaintiff in the Chronic Disease Clinic on February
1, 2016 and May 2, 2016, where Plaintiff did not mention
complaints of abdominal pain or swelling, and Geohagan again
confirmed a soft, non-tender abdomen. (Id. at
10, 2016, Plaintiff submitted a sick call request form
complaining of a “risen” formed on the right side
of his stomach that had puss coming out of it. (Id.
at 68). The nursing staff examined Plaintiff the same day for
the complaint, and the nursing notes indicate the presence of
a “hot, red, tender, odoriferous” 10 mm bump on
the right side of Plaintiff's abdomen with slight yellow
discharge draining from the site. (Id. at 66-67).
Plaintiff was prescribed 375 mg of Naproxen to be taken twice
a day for 30 days, Bactrim to be taken twice a day for 10
days, and a follow up appointment was scheduled for one week
later. (Id. at 67).
19, 2016, Plaintiff presented to the health care unit with
complaints of stomach pains and difficulty digesting his
food. (Id. at 63, 65). Plaintiff reported to the
nursing staff that for approximately four days to a week he
not only suffered from abdominal cramping but also nausea,
vomiting, and diarrhea. (Id. at 63). When examined
on July 20, 2016 by Nurse Practitioner Geohagan, Plaintiff
complained that for three weeks he had suffered from pain in
his upper right abdominal area, that food was “souring
on stomach, ” that he was vomiting, and had seen blood
in his stool. (Id. at 55). Geohagan's
examination revealed a soft abdomen with mild tenderness, and
Geohagan prescribed Pepto-Bismol, Prilosec, and two
antibiotics for a possible infection. (Id.; Doc.
43-4 at 4).
August 3, 2016, Plaintiff filed an Inmate Request Slip
Dr. Stone, since 1997 I have been having serious problems
from a gunshot wound to my stomach. . . my food does not
properly digest, and I have blood in my bowel movements. The
pain is getting worse, and I am bleeding more. I need help.
GOEHAEN[sic] won't do anything to help.
(Doc. 43-6 at 61). Nurse Practitioner Geohagan followed up
with Plaintiff that same day and noted Plaintiff's
continued complaints of pain and dark stools. Geohagan
charted active bowel sounds, a flat and erect abdomen, and
scheduled Plaintiff an appointment with nondefendant Dr.
Karen Stone. (Id. at 56; Doc. 43-3 at 1).
Stone ordered an x-ray of Plaintiff's abdomen on August
11, 2016, which indicated “a slight, small bowel loop
dilation consistent with mile ileus” but showed no
significant bowel obstruction. (Doc. 43-6 at 44). Dr. Stone
then examined Plaintiff on August 12, 2016 for his concerns
of abdominal pain. (Id. at 56). Dr. Stone reviewed
Plaintiff's history, and her examination confirmed a
large ventral hernia which was reducible, revealed no blood
in Plaintiff's stool, but Dr. Stone detected some bowel
within the hernia. (Id.; Doc. 43-5 at 12). Dr. Stone
scheduled a follow up for assessment for Plaintiff and noted
the possibility of discussing Plaintiff's care with the
Regional Medical Director, Dr. Hood, and obtaining a possible
surgical consultation. (Doc. 43-6 at 55; Doc. 43-5 at 12).
September 10, 2016, Plaintiff was examined by the nursing
staff for complaints of hernia pain, gas, and blood in stool.
(Doc. 43-6 at 184). The chart notations indicate