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Davis v. Madison County

United States District Court, N.D. Alabama, Northeastern Division

July 31, 2018

ROY LEE DAVIS, Plaintiff,



         This case arises out of Roy Lee Davis' brief pretrial detention in the local jail for Madison County, Alabama. Davis asserts, via § 1983, that the County, Sheriff Blake Dorning, numerous employees of Advanced Correctional Healthcare, Inc. (ACH), a private corporation providing medical services at the Jail, and Dr. Arthur M. Williams, the Jail's medical director, were deliberately indifferent to his serious medical needs in violation of the Fourteenth Amendment of the United States Constitution.[1] The Defendants have now each moved for summary judgment, docs. 127; 130; 133; and 136, contending that Davis received constitutionally adequate medical care, and, that with respect to Davis' claim against Sheriff Dorning and Dr. Williams, qualified immunity applies. Those motions are now fully briefed. Docs. 128; 131; 134; 137; 143; 147; 149; 152. After careful consideration of the record, the briefs, and the applicable law, the court concludes that each motion is each due to be granted.


         Summary judgment is proper “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.” Fed.R.Civ.P. 56(a). A dispute about a material fact is genuine “if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). Thus, “a party opposing a properly supported motion for summary judgment . . . must set forth specific facts showing that there is a genuine issue for trial.” Id. at 256. However, “[t]he evidence of the non-movant is to be believed, and all justifiable inferences are to be drawn in [her] favor.” Id. at 255. Indeed, it is explicitly not the role of the court “to weigh conflicting evidence or to make credibility determinations.” Mize v. Jefferson City Bd. of Educ., 93 F.3d 739, 742 (11th Cir. 1996); see also Anderson, 477 U.S. at 255 (explaining “[c]redibility determinations, the weighing of the evidence, and the drawing of legitimate inferences from the facts are jury functions, not those of a judge”).

         “[M]ere conclusions and unsupported factual allegations are legally insufficient to defeat a summary judgment motion.” Ellis v. England, 432 F.3d 1321, 1326 (11th Cir. 2005). Nor will “a . . . scintilla of evidence in support of the nonmoving party . . . suffice.” Melton v. Abston, 841 F.3d 1207, 1219 (11th Cir. 2016) (quotation omitted). In short, if “the record taken as a whole could not lead a rational trier of fact to find for the non-moving party, there is no genuine issue for trial, ” and summary judgment is appropriate. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) (quotation omitted). Thus, the nonmovant must demonstrate more than the existence of “some metaphysical doubt as to the material facts.” Scott v. Harris, 550 U.S. 372, 380 (2007) (quotation omitted).

         As is particularly significant here, although reasonable inferences are to be drawn in favor of the nonmoving party “an inference based on speculation and conjecture is not reasonable.” Ave. CLO Fund, Ltd. v. Bank of Am., N.A., 723 F.3d 1287, 1294 (11th Cir. 2013) (quotation omitted). In other words, “[t]hough factual inferences are made in the [nonmovant's] favor, this rule applies only ‘to the extent supportable by the record.'” Penley v. Eslinger, 605 F.3d 843, 853 (11th Cir. 2010) (quoting Scott, 550 U.S. at 381 n.8) (emphasis original). So, “the mere fact that the record, when viewed in the light most favorable to Plaintiff, is theoretically not inconsistent with [her] narrative, is not enough to survive summary judgment.” Hammett v. Paulding Cty., 875 F.3d 1036, 1050 (11th Cir. 2017). Instead, “the plaintiff must present affirmative evidence in order to defeat a properly supported motion for summary judgment, ” Anderson, 477 U.S. at 257, and may not normally rely on “discredited testimony” to create a genuine issue of material fact. Id. at 256-57 (quotation omitted).

         II. FACTS

         The following facts are based primarily on the medical records rather than Davis' own testimony. In fact, Davis has no recollection of his time in the Jail, and testified that he neither suffered from delirium tremens nor required medical attention while detained. Doc. 132-1 at 14-17, 19.[2]

         Davis, an alcoholic, turned himself in to the Jail on July 17, 2014 after violating his probation. Id. at 7-8, 11, 17; Doc. 138-10 at 2, 4. During the booking process, Davis completed a screening interview which included questions regarding whether Davis had recently ingested “dangerous levels” of drugs or alcohol or had ever suffered from “serious withdrawal symptoms.” Doc. 138-10 at 23-24. Davis answered both questions in the negative. Id.

         At around the same time, Nurse Sherri Hakes completed a medical screen and health history for Davis. Doc. 138-16 at 2-3. While Davis denied a history of alcohol abuse to Hakes, he did disclose that he drank three beers four times a week and had last consumed alcohol the previous day. Id. at at 3-4. Davis also told Hakes about a recently suffered thumb injury, prompting Hakes to clean and dress the wound and to instruct Davis to complete a sick-call request in order to receive additional treatment. Id. at 3. Hakes also noted that Davis' vital signs were normal, and that he did not appear intoxicated. Id. at 3-4.

         Following the medical screening, Davis was placed in general population without incident. Id. at 4. Roughly four days later, Nurse Maria Sanchez assessed Davis in his cell. Doc. 138-19 at 2-3. Sanchez documented that although Davis was awake, alert, and breathing normally, his blood pressure was elevated and he was exhibiting signs of confusion. Id.; Doc. 138-11 at 14. Consistent with Jail protocol, Sanchez telephoned Dr. Williams, who ordered the completion of various diagnostic tests and instructed the nursing staff to check on Davis three times a day. Doc. 138-19 at 3.

         Later that same day, Davis submitted a request to receive medication for his injured thumb. Doc. 138-17 at 3. Nurse Rose Moore examined Davis and noted that he was now suffering from severe hand tremors, confusion, and hallucinations, in addition to his previously recorded high blood pressure. Id. at 2-3; Doc. 138-11 at 15. Moore contacted Dr. Williams and relayed this information, as well as Davis' history of alcohol use. Doc. 138-17 at 3. Dr. Williams instructed Moore to provide Davis with a 50 mg dose of Librium, a drug used to treat the symptoms of withdrawal, as well as additional medication for Davis' blood pressure. Id. at 3-4. Moore also advised detention officers to transfer Davis to the medical unit for further observation. Id. at 4. That evening, Nurse Dee Florence examined Davis, noting that his vital signs were normal, but he was still hallucinating and exhibiting minor tremors in his extremities. Doc. 138-18 at 2-3. Florence followed up with Dr. Williams, who instructed her to administer another 50 mg dose of Librium to Davis immediately and prescribed a 25 mg dose of Librium for Davis provided three times a day for the next three days. Id. Florence also scheduled an appointment for Davis with Dr. Williams. Id.

         After this point, Jail records indicate that detention officers and medical personnel periodically checked on Davis during the night, and that Davis received his scheduled 25mg dose of Librium in the morning. Docs. 138-10 at 14; 138-11 at 9. However, because Davis appeared to still be suffering from hallucinations, the ACH nursing staff again contacted Dr. Williams, who directed the staff to administer a 100 mg dose of Librium and to increase Davis' prescription from 25 mg to 50 mg of Librium administered three times daily. Docs. 138-11 at 20; 138-21 at 2-3. Davis remained in the medical unit under observation and continued to receive his scheduled medications. Doc. 138-11 at 9-11.

         The following morning, roughly two days after Davis first presented with symptoms of alcohol withdrawal, Dr. Williams personally examined Davis. Doc. 138-11 at 23. Dr. Williams found Davis calm, and he noted that Davis no longer appeared to be suffering from tremors or psychiatric issues. Id. Dr. Williams testified that he believed Davis' symptoms were mild, at worst, and that Davis was not experiencing delirium tremens, or any other serious medical issues. Doc. 132-3 at 5, 8-10. Dr. Williams reduced Davis' Librium prescription to twice a day and also prescribed additional medications to control Davis' blood pressure. Docs. 138-11 at 23; 132-3 at 4, 8-9. Davis remained under medical observation following his appointment with Dr. Williams. Docs. 138-11 at 23; 132-3 at 4.

         The next afternoon, Davis was released from the Jail following a court hearing in his case. Doc. 132-9 at 29; 132-2 at 9-10. At the hearing, Davis was trembling and unable to walk without assistance. Doc. 132-2 at 9-10. Davis' brother testified that court personnel at the hearing, including the judge, noticed that Davis' condition appeared to require medical attention, and that although Davis was alert and orientated at the hearing, “he was really, very highly confused . . . [and] out of it.” Id. at 10.

         After Davis' release from the Jail, his family took him directly to Madison Hospital. Id. at 10. Davis' brother noted that Davis displayed signs of confusion and disorientation during the trip to the Emergency Room, and that Davis was trembling and unable to walk on his own. Id. at 10, 12-13. At the E.R., Dr. Daniel Ingram noted that, although Davis lacked visible tremors, he was unsteady and confused. Doc. 132-11 at 14, 16. Dr. Ingram administered a dose of Librium, id. at 8, and arranged for Davis' admission to a different hospital based on “an emergency medical condition.” Id. at 5. Medical records from that hospital indicate that, although Davis was stable and not displaying the symptoms of delirium tremens, he was still confused and experiencing other psychological issues. Id. at 9-10. Davis received IV fluids and was placed in the hospital's alcohol protocol for additional testing. Id. at 9-11. Davis was discharged the next day reportedly feeling much “better.” Id. at 11.

         III. ANALYSIS

         The court turns now to Davis' § 1983 deliberate indifference claims alleging that Dr. Williams, Sheriff Dorning, ACH, and numerous ACH employees provided constitutionally inadequate medical care while Davis was detained. “Deliberate indifference to a prisoner's serious medical needs is a violation of the Eighth Amendment.” Goebert v. Lee Cty., 510 F.3d 1312, 1326 (11th Cir. 2007). However, as a pre-trial detainee, the Due Process Clause of the Fourteenth Amendment rather than the Eighth Amendment technically applies to Davis' claim. Snow ex rel. Snow v. City of Citronelle, 420 F.3d 1262, 1268 (11th Cir. 2005). In either event, “the standards under the Fourteenth Amendment are identical to those under the Eighth.” Goebert, 510 F.3d at 1326.

         To survive summary judgment, Davis must “produce sufficient evidence of (1) a substantial risk of serious harm; (2) the defendants' deliberate indifference to that risk; and (3) causation.” Hale v. Tallapoosa Cty., 50 F.3d 1579, 1582 (11th Cir. 1995). “[A]lcohol withdrawal is a serious or urgent medical problem that requires immediate medical attention.” Lancaster v. Monroe Cty., 116 F.3d 1419, 1425-26 (11th Cir. 1997) overruled on other grounds by LeFrere v. Quezada, 588 F.3d 1317, 1318 (11th Cir. 2009)). Thus, the court finds that Davis' withdrawal symptoms created the requisite substantial risk of serious harm to satisfy the first prong of the inquiry.

         To fulfill the second element, i.e., deliberate indifference, “[Davis] must prove three things: (1) [the jail official's] subjective knowledge of a risk of serious harm; (2) disregard of that risk; (3) by conduct that is more than [gross] negligence.” Bozeman v. Orum, 422 F.3d 1265, 1272 (11th Cir. 2005) abrogated on other grounds by Kingsley v. Hendrickson, 135 S.Ct. 2466 (2015) (quotation omitted). “[T]he official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and . . . must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). An official's disregard of the risk exceeds mere negligence when she “knows that an inmate is in serious need of medical care, but . . . fails or refuses to obtain medical treatment for the inmate.” McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir. 1999) (quotation omitted). Similarly, “where medical care is ultimately provided, a prison official may nonetheless act with deliberate indifference by delaying the treatment of serious medical needs . . . [or through] grossly inadequate care [or] by a decision to take an easier but less efficacious course of treatment.” Id. Importantly, however, “[m]ere medical malpractice . . . does not constitute deliberate indifference . . . [n]or does a simple difference in medical opinion.” Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 1989) (citing Estelle v. Gamble, 429 U.S. 97, 106 (1976)).

         Finally, causation, the third element of a deliberate indifference claim, requires the plaintiff to show that the defendant has a causal connection to the constitutional harm alleged. See Hale, 50 F.3d at 1582. Critically, “[i]t 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.” Hartley v. Parnell, 193 F.3d 1263, 1269 (11th Cir. 1999) (quotation omitted). Instead, a supervisor is liable either “when [she] personally participates in the alleged unconstitutional conduct or when there is a causal connection between the actions of a supervising official and the alleged constitutional deprivation.” Cottone v. Jenne, 326 F.3d 1352, 1360 (11th Cir. 2003). This causal connection exists when: “1) a history of widespread abuse puts the responsible supervisor on notice of the need to correct the alleged deprivation, and he or she fails to do so; 2) a supervisor's custom or policy results in deliberate indifference to constitutional rights; or 3) facts support an inference that the supervisor directed subordinates to act unlawfully or knew that subordinates would act unlawfully and failed to stop them from doing so.” Valdes v. Crosby, 450 F.3d 1231, 1237 (11th Cir. 2006) (quotation omitted). “The standard by which a supervisor is held liable in her individual capacity for the actions of a subordinate is extremely rigorous.” Gonzalez v. Reno, 325 F.3d 1228, 1234 (11th Cir. 2003) (quotation omitted). Moreover, in considering a deliberate indifference claim, “[e]ach individual Defendant must be judged separately and on the basis of what that person knows.” Burnette v. Taylor, 533 F.3d 1325, 1331 (11th Cir. 2008).

         With this framework in mind, the court now individually addresses the claims against each Defendant.

         A. Dr. Williams

         Dr. Williams raises three primary arguments in support of his motion for summary judgment. The court addresses them below.[3]

         1. Whether Davis Suffered from a Serious Medical Need

         Dr. Williams contends that there is no evidence that Davis suffered from delirium tremens and that alcohol withdrawal alone does not qualify as a serious medical need. However, Dr. Williams' focus on the absence of delirium tremens is misplaced. As explained, 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.” Goebert, 510 F.3d at 1326 (quotation omitted). Here, the record reflects that Davis was hallucinating, exhibiting signs of confusion, experiencing high blood pressure, had “severe” hand tremors, and was otherwise in enough distress that lay people, including his brother, were immediately able to recognize his need for medical treatment. Doc. 138-11 at 14-15; 132-2 at 9-10. Also, at an unrelated sick call, a nurse noted Davis' disorientation and tremors and immediately contacted Dr. Williams for assistance. Doc. 138-11 at 15. Based on this record, even if Dr. Williams is correct about the absence of delirium tremens, it is apparent that Davis was in obvious medical distress, even from a lay perspective. Therefore, the court reaches the unremarkable conclusion that, at the ...

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