United States District Court, M.D. Alabama, Northern Division
MEMORANDUM OPINION AND ORDER
WALLACE CAPEL, JR. CHIEF UNITED STATES MAGISTRATE JUDGE
U.S.C. § 1983 action is before the court on a complaint
and amendment thereto filed by Robert Daniel Allen, an
indigent state inmate, in which he alleges the defendants
violated his constitutional rights by failing to provide him
adequate medical treatment for his multiple myeloma and deep
vein thrombosis during his prior term of incarceration at the
Kilby Correctional Facility. Doc. 1-1 at 3. Specifically,
Allen alleges Dr. Rahming acted with deliberate indifference
to his medical needs when he discontinued his blood thinner
in October of 2016 and ignored the recall of his IVC filter.
Doc 1-1 at 2-3. Allen names Dr. Wilcott Rahming, Nurse
Valencia Lockhart, a Physician's Assistant, and Nurse
Marianne Baker, a Certified Registered Nurse Practitioner,
all medical personnel employed at Kilby during the time
period relevant to the complaint, as defendants. Allen seeks
monetary damages for the alleged violations of his
constitutional rights and requests that the defendants be
subjected to criminal prosecution. Doc. 1-1 at 3.
defendants filed a special report, supplemental reports and
relevant evidentiary materials in support of their reports,
including affidavits and certified copies of Allen's
medical records, addressing the deliberate indifference
claims presented against them. In these documents, the
defendants assert that at all times they provided medical
treatment to Allen in accordance with their professional
judgment and adamantly deny any violation of Allen's
review of the defendants' special reports and supporting
exhibits, the court issued orders directing Allen to file a
response to the arguments set forth by the defendants in
their reports and advising him that any response should be
supported by affidavits or statements made under penalty of
perjury and other evidentiary materials. Doc. 38 at 2; Doc.
52 at 2-3. These orders specifically cautioned that
“unless within fifteen (15) days from the date
of this order a party . . . presents sufficient legal cause
why such action should not be undertaken . . . the
court may at any time [after expiration of the time for the
plaintiff filing a response to this order] and
without further notice to the parties (1)
treat the special reports and any supporting evidentiary
materials as a motion for summary judgment and (2) after
considering any response as allowed by this order, rule on
the motion for summary judgment in accordance with the
law.” Doc. 38 at 3; Doc. 52 at 3 (same). Allen filed
responses to these orders and submitted exhibits in support
of his responses. See Doc. 33; Doc. 41; Doc. 54;
Doc. 57; and Doc. 69.
to the directives of the aforementioned orders, the court now
treats the defendants' special report and supplemental
special reports as a motion for summary judgment and
concludes that summary judgment is due to be granted in favor
of the defendants.
SUMMARY JUDGMENT STANDARD
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) (internal quotation marks
omitted); Rule 56(a), Fed.R.Civ.P. (“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.”). 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 [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) (holding that 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; Moton v.
Cowart, 631 F.3d 1337, 1341 (11th Cir. 2011) (holding
that moving party discharges his burden by showing the record
lacks evidence to support the nonmoving party's case or
the nonmoving party would be unable to prove his case at
the defendants meet their evidentiary burden, as they have in
this case, the burden shifts to the plaintiff to establish,
with appropriate evidence beyond the pleadings, that a
genuine dispute material to his 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 (holding
that, once a moving party meets its burden, “the
non-moving party must then go beyond the pleadings, and by
its own affidavits [or statements made under penalty of
perjury], or by depositions, answers to interrogatories, and
admissions on file, ” demonstrate that there is a
genuine dispute of material fact). 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. 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). 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);
Barker v. Norman, 651 F.2d 1107, 1115 (5th Cir. Unit
A 1981) (stating that a verified complaint serves the same
purpose of an affidavit for purposes of summary judgment).
However, “mere 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).
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 such that
summary judgment is not warranted. Greenberg, 498
F.3d at 1263; Allen v. Bd. of Pub. Educ. for Bibb
Cnty., 495 F.3d 1306, 1313 (11th Cir. 2007). The
evidence must be admissible at trial, and if the nonmoving
party's evidence “is merely colorable . . . or is
not significantly probative . . . summary judgment may be
granted.” Anderson v. Liberty Lobby, Inc., 477
U.S. 242, 249-50 (1986), Fed.R.Civ.P. 56(e). “A mere
‘scintilla' of evidence supporting the supporting
party's position will not suffice[.]” Walker v.
Darby, 911 F.2d 1573, 1577 (11th Cir. 1990) (citing
Anderson, 477 U.S. at 252). Only disputes involving
material facts are relevant, materiality is determined by the
substantive law applicable to the case. Anderson,
477 U.S. at 248.
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). “The evidence of the
non-movant is to be believed, and all justifiable inferences
are to be drawn in his favor.” Anderson, 477
U.S. at 255. At the summary judgment stage, this court should
accept as true “statements in [the plaintiff's]
verified complaint, [any] sworn response to the officers'
motion for summary judgment, and sworn affidavit attached to
that response[.]” Sears v. Roberts, 922 F.3d
1199, 1206 (11th Cir. 2019); United States v. Stein,
881 F.3d 853, 857 (11th Cir. 2018) (holding that a
plaintiff's purely self-serving and uncorroborated
statements “based on personal knowledge or
observation” set forth in a verified complaint or
affidavit may create an issue of material fact which
precludes summary judgment); Feliciano v. City of Miami
Beach, 707 F.3d 1244, 1253 (11th Cir. 2013) (citations
omitted) (“To be sure, [Plaintiff's] sworn
statements are self-serving, but that alone does not permit
[the court] to disregard them at the summary judgment stage .
. . . Courts routinely and properly deny summary judgment on
the basis of a party's sworn testimony even though it is
self-serving.”). However, general, blatantly
contradicted and merely “[c]onclusory, uncorroborated
allegations by a plaintiff in [his verified complaint or] an
affidavit . . . will not create an issue of fact for trial
sufficient to defeat a well-supported summary judgment
motion.” Solliday v. Fed. Officers, 413
Fed.Appx. 206, 207 (11th Cir. 2011) (citing Earley v.
Champion Int'l Corp., 907 F.2d 1077, 1081 (11th Cir.
1990). In addition, conclusory allegations based on purely
subjective beliefs of a plaintiff and assertions of which he
lacks personal knowledge are likewise insufficient to create
a genuine dispute of material fact. See Holifield v.
Reno, 115 F.3d 1555, 1564 n.6 (11th Cir. 1997). 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 323-24; Waddell v. Valley Forge Dental Assocs.,
Inc., 276 F.3d 1275, 1279 (11th Cir. 2001) (holding that
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 his favor).
“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).
“[T]here must exist a conflict in substantial evidence
to pose a jury question.” Hall v. Sunjoy Indus.
Group, Inc., 764 F.Supp.2d 1297, 1301 (M.D. Fla. 2011)
(citation omitted). “When opposing parties tell two
different stories, one of which is blatantly contradicted by
the record, so that no reasonable jury could believe it, a
court should not adopt that version of the facts for purposes
of ruling on a motion for summary judgment.” Scott
v. Harris, 550 U.S. 372, 380 (2007).
factual inferences must be viewed in a light most favorable
to the plaintiff 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. See Beard, 548
U.S. at 525. Thus, a plaintiff's pro se status
alone does not compel this court to disregard elementary
principles of production and proof in a civil case. Here,
after a thorough and exhaustive review of all the evidence
which would be admissible at trial, the court finds that
Allen has failed to demonstrate a genuine dispute of material
fact in order to preclude entry of summary judgment in favor
of the defendants.
alleges that the defendants denied him adequate medical
treatment for his multiple myeloma and conditions related to
his myeloma. In their responses, the defendants adamantly
deny acting with deliberate indifference to Allen's
prevail on a claim concerning an alleged denial of medical
treatment, an inmate must-at a minimum-show that the
defendant acted with deliberate indifference to a serious
medical need. 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). 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; Adams v. Poag, 61
F.3d 1537, 1546 (11th Cir. 1995) (holding, as directed by
Estelle, that 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”).
well settled law, neither medical malpractice or negligence
equate to deliberate indifference:
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 [medical care
provider'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.
order to 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 show “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 (holding that, for
liability to attach, the official must know of and then
disregard an excessive risk of harm to the prisoner).
Regarding the objective component of a deliberate
indifference claim, the plaintiff must first show “an
objectively serious medical need . . . and second, that the
response made by [the defendant] to that need was poor enough
to constitute an unnecessary and wanton infliction of pain,
and not merely accidental inadequacy, negligen[ce] in
diagnos[is] or treat[ment], or even [m]edical malpractice
actionable under state law.” Taylor, 221 F.3d
at 1258 (internal quotation marks and citations omitted). To
proceed on a claim challenging the constitutionality of
medical care “[t]he facts alleged must do more than
contend medical malpractice, misdiagnosis, accidents, [or]
poor exercise of medical judgment.” Daniels v.
Williams, 474 U.S. 327, 330-33 (1986); Estelle,
429 U.S. at 106 (holding that neither negligence nor medical
malpractice “become[s] a constitutional violation
simply because the victim is incarcerated.”);
Farmer, 511 U.S. at 836 (observing that a complaint
alleging negligence in diagnosing or treating “a
medical condition does not state a valid claim of medical
mistreatment under the Eighth Amendment[, ]” nor does
it establish the requisite reckless disregard of a
substantial risk of harm so as to demonstrate a
constitutional violation.); Kelley v. Hicks, 400
F.3d 1281, 1285 (11th Cir. 2005) (holding that “[m]ere
negligence . . . is insufficient to establish deliberate
indifference.”); Matthews v. Palte, 282
Fed.Appx. 770, 771 (11th Cir. 2008) (affirming district
court's summary dismissal of inmate's complaint
because “misdiagnosis and inadequate treatment involve
no more than medical negligence.”).
“to show the required subjective intent . . ., a
plaintiff must demonstrate that the public official acted
with an attitude of deliberate indifference . . . which is in
turn defined as requiring two separate things: aware[ness] of
facts from which the inference could be drawn that a
substantial risk of serious harm exists  and . . .
draw[ing] of the inference[.]” Taylor, 221
F.3d at 1258 (internal quotation marks and citations omitted)
(alterations in original). 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) (holding that 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. When medical personnel attempt to diagnose and
treat an inmate, the mere fact that the chosen
“treatment was ineffectual . . . does not mean that
those responsible for it were deliberately
indifferent.” Massey v. Montgomery County Detention
Facility, 646 Fed.Appx. 777, 780 (11th Cir. 2016).
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 [v.
Doe, 888 F.2d 783, 787 (11th Cir. 1989)]. 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). “[A]s 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 (internal
quotation marks and citation omitted). Moreover, the law is
clear that “[a] difference of opinion as to how a
condition should be treated does not give rise to a
constitutional violation.” Garvin v.
Armstrong, 236 F.3d 896, 898 (7th Cir. 2001);
Hamm v. DeKalb County, 774 F.2d 1567, 1575
(11th Cir. 1985) (holding that mere fact an inmate desires a
different mode of medical treatment does not amount to
deliberate indifference violative of the Constitution).
defendants submitted several affidavits and relevant medical
records in response to the complaint filed by Allen. After a
thorough and exhaustive review of the medical records
submitted in this case, the court finds that the details of
medical treatment provided to Allen as set forth by the
defendants in their affidavits are corroborated by the
objective medical records contemporaneously compiled during
the treatment process. These records also refute several
allegations made by Allen regarding his compliance in taking
prescribed medications and the orders of his free world
initial affidavit, Dr. Rahming addresses the allegations of
deliberate indifference, in relevant part, as follows:
I absolutely deny Mr. Allen's allegations, which are
completely false. Although I discontinued Mr. Allen's
Warfarin prescription on October 11, 2016, in my medical
judgment discontinuing the medication was necessary at that
time due to Mr. Allen's habitual non-compliance with the
medication, as well as with the other directives of the
providers on the Kilby medical staff, and the
medication's potential side effects. As a blood thinner,
Warfarin increases the risk of dangerous bleeding, including
both internal bleeding and in the event of trauma. As
confirmed through numerous examinations by medical providers,
Mr. Allen experienced no complications whatsoever from the
discontinuation of his Warfarin. After I learned that Mr.
Allen previously underwent the insertion of an inferior vena
cava (“IVC”) filter, I placed him back on
Warfarin on December 29, 2016. An IVC filter is a medical
device designed to catch large, potentially fatal blood clots
from traveling to the lungs, but such filters paradoxically
increase the risk of blood clotting.
Throughout Mr. Allen's incarceration at Kilby, including
in the year prior to October of 2016, he received excellent
care for his DVT. As evident from Mr. Allen's medical
records, I and other medical providers on the Kilby medical
staff diligently monitored his DVT through lab work and
regular assessments, examined him at regular intervals and
provided appropriate treatment, including medications.
However, Mr. Allen repeatedly chose not to comply with the
directives of the medical providers by routinely failing to
take his medications as prescribed for him; regularly
ignoring the providers' counseling regarding the
importance of medication compliance; and routinely failing to
appear for his scheduled visits in the chronic care clinic.
Medical providers on the Kilby medical staff monitored Mr.
Allen's DVT through the chronic care clinic process. The
medical staffs at the ADOC facilities evaluate and treat
certain pre-defined chronic medical conditions through the
chronic care clinic process. The conditions treated at the
chronic care clinics include, for example, DVT, hypertension,
hepatitis C, diabetes, gastroesophageal reflux disease,
chronic obstructive pulmonary disease, hyperlipidemia as well
as others. An inmate may be seen for multiple conditions
during a single chronic care visit. The medical staffs at the
ADOC facilities determine, based upon the condition of the
inmate, whether an inmate is seen at intervals of thirty
(30), sixty (60) or ninety (90) days. The inmates are not
charged any payment whatsoever for their visits to the
chronic care clinic.
I along with the other medical providers on the Kilby medical
staff examined Mr. Allen at the regularly scheduled chronic
care clinics in the year prior to October 11, 2016,
i.e. when I discontinued his Warfarin prescription.
During Mr. Allen's visits to the chronic care clinic,
providers and other members of the medical staff examined
him, assessed the status of his DVT and other medical
conditions, performed international normalized ratio
(“TNR”) measurements and adjusted his medications
if necessary. The INR measurement tests the coagulation or
clotting tendency of blood. For a healthy person, the normal
INR range is 0.8-1.2. For an individual taking Warfarin, his
or her INR would normally measure in the 2.0-3.0 range.
Throughout the year prior to October 11, 2016, Mr.
Allen's INR typically measured within, or just outside
of, the normal range for someone taking Warfarin.
In the year prior to October of 2016, I and other medical
providers prescribed Mr. Allen with Warfarin to treat his
DVT. Warfarin effectively treats blood clotting by thinning
the blood. However, as a blood thinner, Warfarin's side
effects include an increased risk that a patient may
experience dangerous bleeding. Throughout Mr. Allen's
incarceration at Kilby, I and other medical providers
carefully regulated his Warfarin prescription and adjusted it
periodically to ensure he took as small amount as necessary
to reduce his exposure to its side effects.
The Kilby medical staff treated not only Mr. Allen's DVT
but also his other medical conditions, including multiple
myeloma. Multiple myeloma is a cancer of the white blood
cells. I and other providers routinely referred Mr. Allen off
site for specialty treatment of his multiple myeloma and
numerous rounds of chemotherapy treatment during the period
of time between October of 2015 and October of 2016. We also
referred Mr. Allen for routine visits to his off-site
oncologist, Dr. Krishnamohan Basarakodu (“Dr.
Basarakodu”), in Montgomery, Alabama.
Despite the medical staff's diligent efforts to care for
Mr. Allen, he routinely refused to comply with the directives
entered by me and the other providers in the year prior to
October 11, 2016. For example, in the year prior to October
of 2016, Mr. Allen failed to appear for scheduled
appointments in the chronic care clinic on six (6) separate
occasions. During that same period of time, Mr. Allen was
routinely non-compliant with his medications, including
Warfarin. Mr. Allen failed to take his Warfarin on at least
twenty-six (26) separate occasions in the year prior to
October 11, 2016, including on four (4) occasions in the
month prior to that date.
The medical providers on the Kilby medical staff extensively
counseled Mr. Allen on numerous occasions regarding his
non-compliance with his medications and the directives of the
providers, but to no avail. I met with Mr. Allen on the
following occasions to counsel him regarding the importance
of taking his medications in compliance with the directives
of his providers: August 10, 2015; December 4, 2015; January
11, 2016; February 10, 2016; April 28, 2016; and July 25,
2016. In response to my counseling efforts, Mr. Allen refused