Cox v. Smoak et al

Filing 83

MEMORANDUM OPINION and ORDER: ORDERED that the motion for summary judgment (doc. 73 ) is GRANTED on all claims against all Defendants. It is further ORDERED that all pending motions are DENIED as moot. A separate Final Judgment will be entered. Signed by Chief Judge Emily C. Marks on 11/22/2024. (CWL)

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF ALABAMA
SOUTHERN DIVISION
RAY COX,
Plaintiff,
v.
JASON SMOAK, et al.,
Defendants.

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CIVIL CASE NO. 1:23-cv-57-ECM
[WO]

MEMORANDUM OPINION and ORDER
I. INTRODUCTION
On January 25, 2021, James Hinson (“Hinson”) died while in custody at the
Houston County Jail (“Jail”). Plaintiff Ray Cox (“Cox”), as the personal representative
of Hinson’s estate, alleges that Jail staff were deliberately indifferent to Hinson’s serious
medical condition, which ultimately resulted in his death. Specifically, Cox claims that
Defendants Jason Smoak (“Smoak”), Catrina Burkhalter-Murry (“Burkhalter-Murry”),
Mindy Van Ackern (“Van Ackern”), Evelyn McGhee (“McGhee”), Connie Hinson,
Rhonda Rexroat, James Brazier (“Brazier”), and Kelita Moore (collectively,
“Defendants”), deprived Hinson of his Fourteenth Amendment right to due process,
pursuant to 42 U.S.C. § 1983, and negligently provided him medical care, in violation of
Alabama state law. On July 12, 2023, the Court dismissed all claims pursuant to § 1983
and Alabama state law which occurred before January 23, 2021. (Doc. 39). On August
28, 2024, the Defendants filed a motion for summary judgment, which seeks judgment on

all remaining claims against all Defendants and is now before the Court. 1 (Doc. 73). The
motion is fully briefed and ripe for review. Upon review of the briefing and record, for
the reasons that follow, the motion is due to be GRANTED.
II. JURISDICTION AND VENUE
The Court has subject matter jurisdiction over the federal law claims in this
proceeding pursuant to 28 U.S.C. § 1331 and supplemental jurisdiction over the state law
claims pursuant to § 1367. Personal jurisdiction and venue are uncontested, and the
Court concludes that venue properly lies in the Middle District of Alabama. See 28
U.S.C. § 1391.
III. LEGAL STANDARD
“Summary judgment is proper if the evidence shows ‘that there is no genuine
dispute as to any material fact and the movant is entitled to judgment as a matter of law.’”
Hornsby-Culpepper v. Ware, 906 F.3d 1302, 1311 (11th Cir. 2018) (quoting FED. R. CIV.
P. 56(a)).

“[A] court generally must ‘view all evidence and make all reasonable

inferences in favor of the party opposing summary judgment.’” Fla. Int’l Univ. Bd. of
Trs. v. Fla. Nat’l Univ., Inc., 830 F.3d 1242, 1252 (11th Cir. 2016) (citation omitted).
However, “conclusory allegations without specific supporting facts have no probative
value.” Jefferson v. Sewon Am., Inc., 891 F.3d 911, 924–25 (11th Cir. 2018) (citation
omitted). If the record, taken as a whole, “could not lead a rational trier of fact to find for
the non-moving party,” then there is no genuine dispute as to any material fact. HornsbyIn his response brief, Cox “agrees to the dismissal of all claims except for [his] deliberate indifference
claims against” Burkhalter-Murry and Smoak. (Doc. 80 at 4). Accordingly, the Court analyzes only
Cox’s deliberate indifference claims against these two Defendants.

1

2

Culpepper, 906 F.3d at 1311 (quoting Matsushita Elec. Indus. Co. v. Zenith Radio Corp.,
475 U.S. 574, 587 (1986)).
The movant bears the initial burden of demonstrating that there is no genuine
dispute as to any material fact, and the movant must identify the portions of the record
which support this proposition. Id. (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323
(1986)); FED. R. CIV. P. 56(c). The movant may carry this burden “by demonstrating that
the nonmoving party has failed to present sufficient evidence to support an essential
element of the case.” Id. at 1311. The burden then shifts to the non-moving party “to
establish, by going beyond the pleadings, that a genuine issue of material fact exists.” Id.
at 1311–12. The non-moving party “must do more than simply show that there is some
metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co., 475 U.S. at
586. Non-movants must support their assertions “that a fact cannot be or is genuinely
disputed” by “citing to particular parts of materials in the record, including depositions,
documents, electronically stored information, affidavits or declarations, stipulations . . . ,
admissions, interrogatory answers, or other materials” or by “showing that the materials
cited do not establish the absence or presence of a genuine dispute, or that an adverse
party cannot produce admissible evidence to support the fact.” FED. R. CIV. P.
56(c)(1)(A) & (B).
In determining whether a genuine issue for trial exists, the court must view all the
evidence in the light most favorable to the non-movant. Fla. Int’l Univ. Bd. of Trs., 830
F.3d at 1252. Likewise, the reviewing court must draw all justifiable inferences from the
evidence in the non-moving party’s favor. Id.
3

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) (per curiam).
IV. FACTUAL BACKGROUND
The facts, viewed in the light most favorable to the non-movant, are as follows:
On January 19, 2021, 2 Hinson was arrested and booked into the Jail. (Doc. 74-5 at
4). The following morning, January 20, Smoak, a licensed physician assistant at the Jail,
and Van Ackern, a licensed practical nurse (“LPN”) at the Jail, conducted a medical
intake examination of Hinson. (Doc. 74-1 at 6). 3 During his intake examination, Hinson
reported the following: (1) he was prescribed blood pressure medication but did not
know its name; (2) he had a history of addiction to pain pills; (3) he was opioid
dependent; (4) he was concerned about withdrawal symptoms; and (5) he previously had
thoughts of suicide or self-harm. (Id.). Van Ackern also noted that Hinson had an
amputated leg. (Doc. 74-3 at 5). Except for his mildly elevated blood pressure, Hinson’s
vitals were stable. (Id. at 7). Van Ackern obtained Suzanne Hinson’s, Hinson’s wife
(“Wife”), phone number and attempted to contact her about Hinson’s unknown blood
pressure medication, but Van Ackern could not reach her. (Id. at 6). Van Ackern also
noted that Hinson “reported pain from an open wound on the stump 4 of his right leg
which he said had been present for approximately four weeks.” (Doc. 74-3 at 5). Both
2

Unless otherwise noted, all events discussed herein occurred in 2021.

“A medical intake procedure is an initial examination of the inmate where a licensed medical
professional addresses any medical needs or concerns that an inmate may have after being booked into the
Jail.” (Doc.74-1 at 3).

3

The parties refer to the spot at which Hinson’s leg was amputated as a “stump.” For that reason, the
Court refers to it as such as well.

4

4

Smoak and Van Ackern claim that Hinson did not exhibit, complain of, or report
symptoms that suggested he was suffering from a condition requiring urgent medical
attention during his intake examination. (Doc. 74-1 at 7; doc. 74-3 at 6).
Upon completing the intake examination, Smoak determined that Hinson was at
risk of opioid withdrawal and high blood pressure. (Doc. 74-1 at 6–7). In response, he
developed a medical treatment plan. (Id. at 7). Smoak prescribed Hinson 0.10 mg of
Clonidine to reduce his elevated blood pressure and alleviate potential opioid withdrawal
symptoms. (Id.). Additionally, Smoak ordered a daily assessment of Hinson’s vitals for
the following ten days. (Id.). Finally, Van Ackern cleaned Hinson’s “leg wound, noting
the presence of a reddish-orange color, thick and sticky in consistency.” (Doc. 74-3 at 6).
On January 21 and 22, in accordance with Smoak’s medical plan, BurkhalterMurry, an LPN at the Jail, assessed Hinson’s vitals and administered his prescribed
medication. (Doc. 79-2 at 2).

She reported that “Hinson did not present with any

symptoms or complaints that caused [her] to believe that he was experiencing a serious
medical event that required emergency medical treatment” and that “[a]t no time did
Hinson request emergency or additional medical treatment.” (Doc. 74-2 at 5). Wife also
spoke with Hinson in the morning on January 22. About their phone call, she said:
[Hinson] said he was worse. He told me that he was doubled
over in pain, that his stomach was on fire, that he was
throwing up. He said he could not even keep water down.
He said that he was weak and sick. He said he was afraid he
was not going to make it. He said he could not get anyone to
help him. He told me he was begging for help.
(Doc. 79-4 at 2).
5

At some point on January 22, “[m]edical staff was notified by the floor deputy . . .
that Hinson had busted the blister on his stump causing it to bleed, and then stated the
bone was coming through and he needed to go to the hospital.” (Id.). McGhee, an LPN at
the Jail, responded to this incident, and noted that Hinson “asked to shower at that time.” 5
(Id.). McGhee says that “[a]t no time during [her] interaction with Hinson on January 22
did Hinson complain of any pain or appear to be experiencing any discomfort.” (Id. at 5).
“His primary grievance,” according to McGhee, “was that he could not shower as he was
told the pod was on lockdown due to COVID and he had failed to shower at the allotted
time.” (Id.). Later that day at approximately 6:55 p.m., McGhee was notified that Hinson
cut his wrist. (Doc. 74-4 at 4). She “entered the pod where Hinson was being housed and
found him standing in the window at this door. When [she] reached the door, he held up
his left inner wrist and stated that he needed to take a shower.” (Id.). She examined a
superficial laceration with no active bleeding on his wrist, and an open wound on the
stump of his amputated leg. (Id.). McGhee claims that “[n]o treatment was required at
that time as Hinson had self-harmed himself on two occasions to manipulate staff into
allowing him to shower[,] which led to him being placed on suicide watch.” 6 (Id.). While
Hinson was on suicide watch, members of Jail staff conducted regular wellness checks on
him throughout the day and night. (Doc. 74-5 at 4).

5

Inmates had limited shower access at the time due to COVID restrictions. (Doc. 74-4 at 5).

“Suicide watch entailed the removal of all property [from Hinson’s cell], including the mattress cover
and mat.” (Doc. 74-4 at 5). Hinson “was placed in specialized coveralls that [do] not tear easily and
contain a Velcro closure mechanism.” (Id.). Inmates refer to these coveralls as a “turtle suit.” (Doc. 745).
6

6

On January 23, Burkhalter-Murry once again assessed Hinson’s vitals and
administered his medication. Like the days prior, Burkhalter-Murry claims that “Hinson
did not present with any symptoms or complaints that caused [her] to believe that he was
experiencing a serious medical event that required emergency medical treatment” and
that “[a]t no time did Hinson request emergency or additional medical treatment.” (Doc.
74-2 at 5). Wife, once again, tells a different story about Hinson that day:
I could tell from how [Hinson] spoke that he was terribly
sick, much worse than Friday. He sounded weak and sick.
He told me that he could not even stand up to talk to me on
the phone. He had to sit on the floor. [Hinson] said he felt
like someone was sticking a knife in his stomach. He said his
stomach was on fire. [Hinson] was crying. He told me we
would not see him again. We talked about what I would need
to do if he died, about his funeral. He repeatedly said he was
not going to make it.
(Doc. 79-4 at 2).
At 1:00 a.m. on January 24, Hinson complained of chest pains to a corrections
officer. (Doc. 74-1 at 7). Hinson’s “vitals were taken immediately after reporting to the
officer[,] and [they] were deemed stable and not at a level that would dictate the need for
any emergency medical protocol.” (Id.). “He was advised to rest and request a medical
check.” (Id.). Hinson did not report abdominal pain at this time. (Id.).
Later that morning at 8:10 a.m., Burkhalter-Murry examined Hinson at a sick
call. 7 (Id. at 8). Hinson complained that—for five consecutive days—he suffered from
stomachaches, headaches, and constipation. (Id.). Burkhalter-Murry noted that Hinson’s
The Court understands a “sick call” to be a medical visit where the provider performs an examination
beyond a basic vital sign check. (Doc. 74-2 at 4).

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abdomen was tender to the touch, but not abnormally sensitive. (Id.). Additionally, she
detected bowel sounds in all four stomach quadrants and found that his blood pressure
had improved from its elevated level in the days prior. (Doc. 74-2 at 5). However,
Hinson’s heart rate increased to 121, and Burkhalter-Murry noted that his breathing was
rapid and shallow. (Doc. 79-2 at 3). She reviewed his medical records, found that his
“vital signs were stable and consistent,” and developed a course of treatment. (Doc. 74-2
at 5). Burkhalter-Murry prescribed Miralax for constipation and Tylenol for headaches,
and she recommended that Hinson continue receiving daily vital checks. (Id.). She also
requested that Hinson attend a follow-up visit in the medical clinic five days later. (Id.).
Burkhalter-Murry claims that at no time during this sick call did Hinson exhibit, present,
complain of, or report any symptoms or complaints indicating he was experiencing a
serious medical event that required emergency medical treatment. (Id.). And in Smoak’s
opinion, “Burkhalter-Murry provided the appropriate treatment consist[ent] with the
symptoms reported by Hinson.” (Doc. 74-1 at 8).
Hinson had no further contact with medical personnel. He was found dead in his
cell early in the morning of January 25. 8 In the twenty-four hours preceding Hinson’s
death, Jail staff checked on him approximately fifteen times. (Doc. 74-5 at 5). None
reported that he appeared to be suffering from a medical emergency. Brazier, who was
Jail Commander at the time, “reviewed Hinson’s jail file and learned that staff complied
with all policies in their interactions with Hinson. . . . All complaints, requests for

Cox asserts in his complaint and briefing that Hinson died from a perforated ulcer. However, Cox cites
to no record evidence in support of this assertion, and the Court did not find any.

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treatment, treatment, medical orders, [and] staff compliance with those orders, was
documented and fulfilled.” (Id. at 4).
On April 5, investigators interviewed other inmates in Hinson’s housing pod about
his demeanor in the days preceding his death. (Doc. 74-5). David Kirkland (“Kirkland”)
described Hinson as “always asking for medical” by yelling, “can you let them [Jail staff]
know I need to talk to them.” (Id. at 1). Kirkland said that Jail staff would check on
Hinson and that no one mistreated him. (Id.). He remarked that Hinson prevented him
and other inmates from sleeping by constantly yelling and banging his prosthetic leg on
items in his cell. (Id.). Jonas Smith (“Smith”) also recalled Hinson banging his prosthetic
leg, and described him as “paranoid, but normal one minute and on suicide watch the
next, wearing a turtle suit.” (Id. at 2). He says Hinson did not seem depressed and that
“his mood was up, with eyes wide open while he talked on the telephone.” (Id.). Smith
heard Hinson complain about being unable to shower, and claims that Hinson “picked at
his scab until it bled, seeking medical attention in an attempt to get released from jail.”
(Id.). Smith, like Kirkland, does not believe anyone mistreated or ignored Hinson. (Id.).
Chester Lewis (“Lewis”) 9 spoke with Hinson through their cell doors. (Id.). He
claims that Hinson did not eat his food, and that he would “bang on the door from
midnight until 3:00 a.m. yelling ‘help’ to make the guards come in and check on him.”
(Id.). According to Lewis, Staff would come check on Hinson, and he received a visit
from a nurse and his medication daily. (Id.). Lewis also recalled that Hinson “had some

9

The Court refers to Kirkland, Smith, and Lewis, collectively, as “Inmates.”
9

type of blade or something in his prosthetic leg and threatened suicide to manipulate the
jail staff.” (Id.).
On January 23, 2023, just under two years from the date of Hinson’s death, Cox
filed his complaint in this matter. (Doc. 1). On February 21, 2023, the Defendants filed a
partial motion to dismiss all claims pursuant to § 1983 and Alabama state law which
occurred before January 23, 2021, because they were barred by the applicable statute of
limitations. (Doc. 17). The Plaintiff did not oppose this motion (doc. 31), and on July 12,
2023, the Court granted the motion and dismissed the aforementioned claims with
prejudice (doc. 39). On August 28, 2024, the Defendants filed the motion for summary
judgment that is now before the Court (doc. 73), seeking judgment on all remaining
claims against all Defendants. On September 26, 2024, the Plaintiff responded that he
“agree[d] to the dismissal of all claims except for [P]laintiff’s deliberate indifference
claims” against Smoak and Burkhalter-Murry. (Doc. 80).

Because the Plaintiff has

agreed to the dismissal of all claims except for deliberate indifference against Smoak and
Burkhalter-Murry, the Court addresses only those two claims in this Opinion.
V. DISCUSSION
The Defendants 10 move for summary judgment on Cox’s § 1983 claims on the
grounds of qualified immunity. Qualified immunity protects government officials from
suit when they are “performing discretionary functions” and “their conduct does not
violate clearly established constitutional rights of which a reasonable person would have

For the remainder of the Opinion, the Court refers to Burkhalter-Murry and Smoak, collectively, as
“Defendants.”
10

10

known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982).

To determine whether

qualified immunity is appropriate, the Court first must determine whether the Defendants
were acting within the scope of their discretionary authority. See Ingram v. Kubik, 30
F.4th 1241, 1250 (11th Cir. 2022). The parties do not dispute that providing medical care
to inmates was within the scope of the Defendants’ discretionary authority. (Doc. 75 at
10–11). Because the Defendants performed discretionary functions, Cox must next point
to sufficient record evidence that the Defendants (1) “violated [Hinson’s] constitutional
right[s],” and that (2) Hinson’s constitutional rights “w[ere] clearly established at the
time of the alleged violation.” See Ingram, 30 F.4th at 1250.
The Defendants claim that they are entitled to qualified immunity because they did
not violate Hinson’s Fourteenth Amendment rights and that, even if they did, “neither the
law nor the circumstances presented gave Defendants fair warning that their actions or
inactions violated Hinson’s constitutional rights.” (Doc. 81 at 13). Cox contends that a
reasonable jury “can conclude that both [Smoak] and Burkhalter-Murry knew that Hinson
was in serious medical distress” and that “[t]he law is clearly established that an official
cannot ignore a life-threatening medical condition or fail to address the condition.” (Doc.
80 at 6–8). Here, the Plaintiff alleges that the Defendants violated Hinson’s Fourteenth
Amendment rights.

Accordingly, the Court defines the Fourteenth Amendment’s

deliberate indifference standard before applying it to the record evidence to determine
whether Burkhalter-Murry or Smoak committed a constitutional violation.

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A.

Constitutional Violation: The Fourteenth Amendment
The Fourteenth Amendment protects against, in relevant part, the state deprivation

of one’s life, liberty, or property without due process of law. U.S. Const. amend XIV.
When jail staff is deliberately indifferent to a pretrial detainee’s serious medical needs,
jail staff deprives the detainee of his life or liberty without due process of law, thereby
violating the Fourteenth Amendment. See Goebert v. Lee County, 510 F.3d 1312, 1326
(11th Cir. 2007). The Eighth Amendment, which prohibits the infliction of cruel and
unusual punishment, sets the standard which governs deliberate indifference claims by
prisoners. Id. “Technically, the Fourteenth Amendment[’s] [d]ue [p]rocess [c]lause, not
the Eighth Amendment’s prohibition on cruel and unusual punishment, governs pretrial
detainees” like Hinson. Id. “However, the standards under the Fourteenth Amendment
are identical to those under the Eighth,” and, accordingly, cases dealing with the Eighth
Amendment are informative of whether the Defendants violated Hinson’s Fourteenth
Amendment rights in this case. Id.
“To show that a prison official acted with deliberate indifference to serious
medical needs, a plaintiff must satisfy both an objective and a subjective inquiry.”
Farrow v. West, 320 F.3d 1235, 1243 (11th Cir. 2003). To satisfy the first, objective
inquiry, a plaintiff must demonstrate an “objectively serious medical need,” i.e., “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,” and, in
either instance, “one that, if left unattended, poses a substantial risk of serious harm.” Id.
“A serious medical need can also be determined by ‘whether a delay in treatment
12

exacerbated the medical need or caused additional complications.’” King v. Lawson, 2024
WL 3355179 at *3 (11th Cir. July 10, 2024) 11 (citing Taylor v. Hughes, 920 F.3d 729,
733 (11th Cir. 2019)).
To satisfy the second, subjective inquiry, a “deliberate-indifference plaintiff must
prove that the defendant acted with ‘subjective recklessness as used in the criminal law,’
and . . . in order to do so, the plaintiff must show that the defendant was subjectively
aware that his own conduct put the plaintiff at a substantial risk of serious harm.” Wade v.
McDade, 106 F.4th 1251, 1255 (11th Cir. July 10, 2024) (en banc) (citing Farmer v.
Brennan, 511 U.S. 825, 837–844 (1994) (discussing the Eighth Amendment’s deliberate
indifference standard)). 12 But, “in any event, a defendant who ‘responds reasonably’ to a
risk, even a known risk, ‘cannot be found liable’” under the Fourteenth Amendment. Id.
It is not enough to show that the defendant “should have known” of a substantial risk of
serious harm; instead, the defendant must “actually [know] of a substantial risk of serious
harm.” Id. at 1257 (emphases in original).

Further, a plaintiff must show that the

defendant official was “subjectively aware that his own conduct—again, his own actions
or inactions—put the plaintiff at substantial risk of serious harm.” Id. at 1258 (emphases
added).
Here, and elsewhere in this Opinion, the Court cites nonbinding authority.
acknowledges that these cases are nonprecedential, the Court finds them persuasive.

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While the Court

Cox argues that the subjective recklessness standard articulated by the Eleventh Circuit in Wade, 106
F.4th at 1257–58, should not apply; instead, Cox believes the objective standard that the Supreme Court
applies to excessive force claims asserted by pretrial detainees should apply. See Kingsley v. Hendrickson,
576 U.S. 389 (2015). As Cox concedes, however, “[t]he Eleventh Circuit . . . has held Kingsley does not
affect medical care cases.” (Doc. 80 at 7) (citing Nam Dang by & through Vina Dang v. Sheriff, Seminole
Cnty. Fla., 871 F.3d 1272, 1279 n.2 (11th Cir. 2017)). Accordingly, the Court will apply the subjective
recklessness standard articulated by the Eleventh Circuit in Wade.
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13

A “complaint that a physician has been negligent in diagnosing or treating a
medical condition does not state a valid claim of medical mistreatment” under the
Fourteenth Amendment. Estelle v. Gamble, 429 U.S. 97, 106 (1976) (discussing the
Eighth Amendment’s deliberate indifference standard). Conduct that amounts to mere
negligence or “an inadvertent failure to provide adequate medical care” is insufficient to
establish deliberate indifference. Estelle, 429 U.S. at 105; Farmer, 511 U.S. at 835.
Medical treatment need not be “perfect, the best obtainable, or even very good,” and “[a]
prisoner bringing a deliberate-indifference claim has a steep hill to climb.” Keohane v.
Fla. Dep’t. of Corr. Sec’y, 952 F.3d 1257, 1266 (11th Cir. 2020) (discussing the Eighth
Amendment’s deliberate indifference standard).

Notably, a “[p]laintiff’s failure to

diagnose theory . . . is insufficient to state a claim for deliberate indifference” under the
Fourteenth Amendment. Callahan v. Correct Health Care, 2018 WL 4932874, at *2
(S.D. Fla. May 8, 2018) (discussing the Eighth Amendment’s deliberate indifference
standard) (citing McElligott v. Folley, 182 F.3d 1248, 1256 (11th Cir. 1999)).
Assuming without deciding that Hinson’s condition constituted an objectively
serious medical need, the Court begins by analyzing whether Cox has presented sufficient
evidence for a reasonable jury to conclude that Burkhalter-Murry or Smoak were
“subjectively aware that [their] own conduct put [Hinson] at a substantial risk of serious
harm.” See Wade, 106 F.4th at 1255.
1.

Subjective Recklessness

To show that the Defendants were subjectively reckless, Cox must demonstrate
both that Burkhalter-Murry and Smoak (1) were “subjectively aware that [their] own
14

conduct put [Hinson] at a substantial risk of serious harm” and that they (2) did not
“respond reasonably” to that risk. See Wade, 106 F.4th at 1255. The Defendants argue
that the “Plaintiff’s evidence does not create a material dispute of fact as to whether
Defendants actually, subjectively knew their actions or inactions exposed [Hinson] to a
serious risk of harm.” (Doc. 81 at 5). Specifically, they assert that “there is simply no
evidence that indicates Hinson exhibited or complained of symptoms that were so
obvious that even a lay person would easily recognize the necessity for emergency
medical care,” and that “[a]ny assertion to the contrary is blatantly contradicted by the
medical records Plaintiff submitted in opposition to summary judgment.” 13 (Id. at 8).
Cox argues that statements from Wife and other inmates “provide confirmation that
Hinson was begging for help” and allow a reasonable jury to “conclude that both
[Smoak] and Burkhalter-Murry knew that Hinson was in serious medical distress, not just
uncomfortable from non-serious conditions.” (Doc. 80 at 2–4). The Court will analyze

As an initial matter, the Court rejects the Defendants’ argument that Hinson’s medical records can, at
the summary judgment stage, “blatantly contradict” competing evidence presented by Cox. (Doc. 81 at 8).
The question before the Court at summary judgment is “whether there is ‘sufficient evidence favoring the
nonmoving party for a jury to return a verdict for that party.’” Sears v. Roberts, 922 F.3d 1199, 1207
(11th Cir. 2019) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986)). True, the Supreme
Court has held that “[w]hen 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 (2007). “But there’s a big difference between the record evidence presented in Scott and the record
evidence proffered here. In Scott, the record evidence that blatantly contradicted the plaintiff’s version of
events was a videotape of the car chase at issue.” Sears, 922 F.3d at 1208. Here, the Defendants argue
that Hinson’s medical records have the same effect. But because medical records “involve people and all
their attendant mental infirmities, biases, and limitations in their creation,” they “are not the same as
incontrovertible video evidence that courts must accept over contradictory” evidence, such as sworn
statements from the opposing side. Sears v. Warden Okeechobee Corr. Inst., 762 F. App’x. 910, 916–17
(11th Cir. 2019). Here, the Court considers Cox’s evidence, and all other record evidence, in the light
most favorable to him.
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the claims against Burkhalter-Murry and Smoak individually, beginning with BurkhalterMurry.
a.

Burkhalter-Murry

The Court begins by analyzing whether there is sufficient record evidence for a
reasonable jury to conclude that Burkhalter-Murry was “subjectively aware that [her]
own conduct put [Hinson] at a substantial risk of serious harm.” See Wade, 106 F.4th at
1255. In her declaration, Burkhalter-Murry asserts:
[Hinson] did not present with any symptoms or complaints
that caused [her] to believe that he was experiencing a serious
medical event that required emergency medical treatment. At
no time did Hinson request emergency or additional medical
treatment. Specifically, [Burkhalter-Murry] did not take any
action to restrict, block, or delay Hinson access to medical
care or prescribed medical treatment and know[s] of no
instance where Jail staff did.
(Doc. 74-2 at 5).
Supporting this assertion are Hinson’s medical records, which contain no
indication that he complained of an emergency condition or was displaying symptoms of
an emergency to Burkhalter-Murry.

Cox submits Hinson’s medical records, Wife’s

declaration, and Inmates’ interviews, and argues that “Hinson communicated [his]
extreme symptoms to Burkhalter-Murry.” (Doc. 80 at 5).

The Court—viewing all

evidence in the light most favorable to Cox—finds the record evidence insufficient for a
reasonable jury to conclude that Burkhalter-Murry possessed the requisite subjective
knowledge.

16

The record shows that Burkhalter-Murry knew Hinson was suffering from an
ailment, but not that she knew he was suffering from an emergency or that her inaction
“put [Hinson] at a substantial risk of serious harm.” See Wade, 106 F.4th at 1255. Wife
claims that Hinson told her that he was “begging for help” but “could not get anyone to
help him” and that he was “doubled over in pain,” “throwing up,” “crying,” and so “weak
and sick . . . that he could not even stand up to talk” on the phone. (Doc. 79-4 at 2). But
Burkhalter-Murry saw Hinson on four occasions while he was incarcerated, and there is
no evidence that the severe symptoms Hinson communicated to Wife were ever
communicated to Burkhalter-Murry. The medical records, which the Defendants used to
track an inmate’s “medical requests, responses to those requests, screening, examination,
treatment, [and] any pertinent medical information obtained during screening,” show that
Hinson did not complain to Burkhalter-Murry that he was suffering from an emergency
or report that he was suffering from symptoms emblematic of an emergency. (Doc. 74-1
at 4). Inmates’ interviews also fail to suggest that the emergent symptoms Wife describes
were communicated to Burkhalter-Murry. If anything, the Inmate interviews show that
Jail staff was attentive to Hinson’s concerns and made efforts to address them, checking
on him regularly.
Cox argues that even if there is no direct evidence of Burkhalter-Murry’s
knowledge, “a factfinder may conclude that [Burkhalter-Murry] knew of a substantial
risk [to Hinson] from the very fact that the risk was obvious.” See Farmer, 511 U.S. at
842. But the evidence shows that Burkhalter-Murry “did not know of the underlying
facts indicating a sufficiently substantial danger and that [she] was therefore unaware of a
17

danger” to Hinson. See id. Assuming for the sake of argument that the symptoms Hinson
expressed to Wife and his behavior in the Jail housing unit were obviously indicative of
an emergency medical condition, Cox has presented insufficient evidence that
Burkhalter-Murry personally observed or knew of these symptoms. Without knowledge
of the facts which allegedly made Hinson’s emergency condition obvious, a reasonable
jury could not conclude that it was obvious to Burkhalter-Murry.
Even if Burkhalter-Murry was aware of these alleged emergency symptoms, Cox
has failed to demonstrate that she did not respond reasonably to the risk posed by those
symptoms. “A defendant who ‘responds reasonably’ to a risk, even a known risk,
‘cannot be found liable’” under the Fourteenth Amendment. Wade, 106 F.4th at 1255.
Burkhalter-Murry knew that Hinson was on a medical plan to address potential opioid
withdrawals.

She also knew that his vitals had remained stable all week.

During

Hinson’s sick call, the record evidence shows that Burkhalter-Murry, far from knowingly
letting his condition deteriorate, tried to help him. Hinson complained that, for five days,
he had a stomachache, a headache, and no bowel movements. (Doc. 74-1 at 8). In
response, Burkhalter-Murry examined Hinson’s vitals and abdomen. (Id.). Other than his
blood pressure, which had dropped to “within the normal range,” and his pulse, which
had risen to 121, “all other vital signs were stable and consistent.” (Id.). BurkhalterMurry found that his abdomen was tender to the touch, but that bowel sounds were
present in all four quadrants. (Id.). “Burkhalter-Murry provided treatment consistent with
the symptoms presented and complained of[,] which included Miralax for the
constipation and Tylenol for the headache.” (Doc. 74-2 at 5). Smoak said that it was his
18

“professional opinion that Burkhalter-Murry provided the appropriate treatment
consist[ent] with the symptoms reported by Hinson.” (Doc. 74-1 at 8). Under Cox’s
theory, Burkhalter-Murry could have taken all of these steps and still be held liable for a
constitutional violation because she did not identify with precision Hinson’s condition.
The Court rejects that theory. It cannot be said that, based on Hinson’s symptoms and
history of opioid abuse, Burkhalter-Murry’s response was unreasonable. And Cox has
introduced insufficient evidence to demonstrate that it was.
Ultimately, and tragically, Hinson passed away. But that conclusion cannot drive
the legal analysis here. The standard for deliberate indifference under the Fourteenth
Amendment is not akin to res ipsa loquitur.

Instead, the Plaintiff must show that

Burkhalter-Murry had actual knowledge that her conduct put Hinson at substantial risk of
serious harm. Cox fails to do so. The Fourteenth Amendment does not require that
medical care be “perfect, the best obtainable, or even very good.” Keohane, 952 F.3d at
1266. Conduct that amounts to mere negligence or “an inadvertent failure to provide
adequate medical care” is insufficient to establish a constitutional violation. Estelle, 429
U.S. at 105; Farmer, 511 U.S. at 835. Because Cox cannot establish that, even if
Burkhalter-Murry was aware of Hinson’s emergency symptoms, she failed to respond
reasonably thereto, a reasonable jury could not find that she violated Hinson’s
constitutional rights.
The record lacks sufficient evidence from which a reasonable jury could find that
Burkhalter-Murry subjectively knew of a substantial risk of serious harm her conduct
posed to Hinson. Consequently, on this record, Cox cannot show that a genuine dispute
19

of material facts exists as to whether Burkhalter-Murry violated Hinson’s Fourteenth
Amendment rights. Accordingly, Burkhalter-Murry is entitled to qualified immunity on
Hinson’s deliberate indifference claim.
b.

Smoak

The Court moves next to analyzing whether there is sufficient evidence for a
reasonable jury to conclude that Smoak was “subjectively aware that [his] own conduct
put [Hinson] at a substantial risk of serious harm.” See Wade, 106 F.4th at 1255. Smoak
saw Hinson on just one occasion: for his intake examination on January 21. Cox also
asserts that “Smoak . . .

was contacted by Burkhalter-Murry on January 24,” in

connection with the sick call. 14

Because the Court has dismissed all claims which

occurred prior to January 23, Cox argues that Smoak was deliberately indifferent to
Hinson’s serious medical condition in connection with the sick call on January 24. In his
declaration, Smoak asserts that the “medical treatment provided was consistent with the
symptoms complained of by Hinson. At no time did Hinson report symptoms to any of
the medical staff or exhibit symptoms that would have led them to believe that he was
suffering a medical condition requiring urgent medical attention.” (Doc. 74-1 at 8). Cox
presents Hinson’s medical records, Wife’s declaration, and Inmates’ interviews, and
argues that “Hinson communicated [his] extreme symptoms” to Smoak. (Doc. 80 at 5).
The Court must determine whether Cox has presented sufficient evidence to create a
Cox cites to Burkhalter-Murry’s declaration (doc. 74-2 at 5, para. 17) in support of this assertion. That
evidence, however, does not support this assertion, and the only connections the Court can find between
Smoak and the sick call is a bullet point with Smoak’s name on Hinson’s medical records and Smoak’s
statement that it is his “professional opinion that Burkhalter-Murry provided the appropriate treatment
consist[ent] with the symptoms reported by Hinson.” (Doc. 74-1 at 8).
14

20

genuine dispute of material fact on this point—whether Smoak was actually aware that
Hinson was suffering a medical emergency and that his action, inaction, or both put
Hinson at risk for serious harm. See Wade, 106 F.4th at 1255.
Like with Burkhalter-Murry, the record is insufficient to show that Smoak actually
knew Hinson was suffering from a medical emergency.

On January 20, Smoak

conducted a full examination of Hinson upon his arrival at the Jail and noted concerns
with opioid withdrawal. (Doc. 74-1 at 6).

To address those concerns, Smoak

recommended a treatment plan involving medication to aid in opioid withdrawals. (Id.).
Hinson’s medical records do not indicate that he was having a medical emergency at the
time, and the phone calls that Wife references did not begin until January 21, after Smoak
had already seen Hinson for his intake examination.
Beyond Hinson’s intake examination, the only subsequent contact Smoak
allegedly had with Hinson came indirectly on January 24, 2021, in connection with
Hinson’s sick call. All that links Smoak to this sick call is his declaration that, in his
professional opinion, “Burkhalter-Murry provided the appropriate treatment consist[ent]
with the symptoms reported by Hinson.” (Id. at 8). Accepting Cox’s contention that
Burkhalter-Murry called Smoak in connection with the sick call, Burkhalter-Murry
declared that Hinson did not present to her or complain of any symptoms which would
imply he was facing an emergency. (Doc. 74-2 at 5). And even if he did, there is further
insufficient evidence that Burkhalter-Murry communicated any such symptoms to
Smoak. Because Smoak had not seen Hinson since his January 20 intake examination,
Hinson’s emergency condition on January 24 could not have been so obvious to Smoak
21

that a reasonable jury can infer he knew thereof. Cox has thus failed to present sufficient
evidence from which a reasonable jury could conclude that Smoak was actually aware of
Hinson’s emergency medical condition, and that Smoak’s “own conduct put [Hinson] at a
substantial risk of serious harm.” See Wade, 106 F.4th at 1255.
Finally, the parties discuss McElligott v. Foley, a case in which the Eleventh
Circuit denied qualified immunity to jail medical staff who the plaintiff inmate had
alleged were deliberately indifferent to his severe stomach pains. 182 F.3d 1248 (11th
Cir. 1999). But, as the Defendants point out, the facts of McElligott are distinguishable
from the facts of this case. In McElligott, the inmate informed jail staff upon his arrival
to the facility that he had been experiencing severe abdominal pain, vomiting, and nausea
for five months. Id. at 1251. The jail doctor, without examining the inmate, prescribed
him Pepto-Bismol and a liquid diet. Id. at 1252. Approximately three weeks later, the
inmate renewed his complaint of severe intestinal pain and vomiting. Id. Once again, the
doctor chose not to examine the inmate and instead prescribed Tylenol and Pepto-Bismol.
Id. Two days later, when the doctor finally did examine the inmate, he noted that the
inmate was, in fact, in severe abdominal pain. Id. In response, he prescribed an anti-gas
medication, which soon ran out, with no option to refill. Id. Two months later, the inmate
again complained of his stomach pain and indicated that it was getting worse. Id. The
doctor refilled his anti-gas prescription. Id. Thereafter, the inmate, who by this point had
lost a significant amount of weight, wrote the doctor multiple letters and contacted prison
nurses constantly to complain of his worsening conditions. Id. at 1253. His sister called
county administrators and begged them to help. Id. The doctors and nurses, knowing of
22

the inmate’s complaints to them directly and to county administrators, declined to alter
the inmate’s course of treatment until the doctor began to suspect that the inmate was
suffering from an ulcer. Id. After prescribing Prilosec, which did not help, the doctor
finally sent the inmate off for further testing. Id. He was diagnosed with terminal
stomach cancer nearly six months after he was initially incarcerated. Id.
In denying qualified immunity to the medical defendants, the court observed that
the inmate’s “nearly constant complaints about the pain he was having, addressed to” the
doctor, and the doctor’s own “notes from his examinations, as well as his deposition
testimony, reflect that he was aware that [the inmate] was suffering from serious
abdominal pain.” Id. at 1256. Here, in contrast, Cox fails to present sufficient evidence
that Hinson’s complaints were addressed to Burkhalter-Murry or Smoak. In other words,
Cox fails to show that they knew of the complaints, and neither the Defendants’ notes nor
declarations indicate that they were aware of the severity of his condition.

The

McElligott court further highlighted that “the risk of harm to [the inmate] was obvious”
“given the extent of deterioration and weight loss” that he underwent over his six months
incarcerated. Id. While Wife claims that Hinson told her he was doubled over in pain and
crying, there is insufficient evidence that either Defendant witnessed or otherwise knew
about that physical manifestation of Hinson’s condition. Finally, the McElligott court
acknowledged that “County administration, after [the inmate’s] sister’s complaints to the
County Commissioner, notified both [defendants] of the need to look into [the inmate’s]
case.” Id. Here, there is no such evidence that the Defendants were warned of Hinson’s
condition.
23

With the benefit of hindsight, it is easy to argue that Burkhalter-Murry or Smoak
should have known Hinson was suffering from a life-threatening condition. It is not easy,
however, for medical personnel to correctly diagnose every condition, especially when
the patient complains of and exhibits symptoms that are consistent with pre-existing
conditions. The doctrine of qualified immunity acknowledges this difficulty by shielding
medical personnel from constitutional liability for mistaken diagnoses. Because the
Court concludes that Burkhalter-Murry and Smoak were not “subjectively aware that
[their] own conduct put [Hinson] at a substantial risk of serious harm,” they did not
violate the Fourteenth Amendment. See Wade, 106 F.4th at 1255.

Accordingly,

Burkhalter-Murry and Smoak are entitled to qualified immunity on the Plaintiff’s
deliberate indifference claims, and the Defendants’ motion for summary judgment is due
to be granted. 15
VI. CONCLUSION
For the reasons stated above, and for good cause, it is
ORDERED that the motion for summary judgment (doc. 73) is GRANTED on all
claims against all Defendants. It is further
ORDERED that all pending motions are DENIED as moot.
A separate Final Judgment will be entered.

Because the Court determined that neither Burkhalter-Murry nor Smoak violated Hinson’s
constitutional rights, it pretermits discussion regarding whether the law was clearly established and the
Defendants’ argument surrounding medical expert testimony.

15

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DONE this 22nd day of November, 2024.
/s/ Emily C. Marks
EMILY C. MARKS
CHIEF UNITED STATES DISTRICT JUDGE

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