United States District Court, N.D. Alabama, Northeastern Division
K. KALLON UNITED STATES DISTRICT JUDGE
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. 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
STANDARD OF REVIEW
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”).
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).
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).
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,
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
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.
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.
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.
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.
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.
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.
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
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.
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.
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)).
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).
this framework in mind, the court now individually addresses
the claims against each Defendant.
Williams raises three primary arguments in support of his
motion for summary judgment. The court addresses them
Whether Davis Suffered from a Serious Medical Need
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 ...