Moore v. Neel et al

Filing 183

ORDER denying 176 Plaintiff's Affidavit Summary Judgment Motion; granting 177 Defendant's Motion for Summary Judgment; directions to the Clerk. Signed by Judge Timothy J. Corrigan on 8/10/2020. (JLD)

Case 3:17-cv-00503-TJC-PDB Document 183 Filed 08/11/20 Page 1 of 12 PageID 1062

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
JACKSONVILLE DIVISION
JOHN MOORE, III,
Plaintiff,
v.

Case No. 3:17-cv-503-J-32PDB

G. RAMOS,
Defendant.
ORDER
I.

Status

Plaintiff, an inmate of the Florida penal system, is proceeding on an
Amended Civil Rights Complaint (Doc. 17). The only claim that remains is
against Dr. G. Ramos, a medical doctor at Columbia Correctional Institution.1
Plaintiff claims Dr. Ramos was deliberately indifferent to his serious medical
needs on November 14, 2016. See Doc. 17 at 18.
Before the Court are the parties’ cross motions for summary judgment.
See Plaintiff’s Affidavit Summary Judgment Motion (Doc. 176); Defendant
Greto Ramos, M.D.’s Motion for Summary Judgment (Doc. 177), with exhibits

Plaintiff voluntarily dismissed the claims against Jurkash, Tomlinson, Neel,
and Jernigan. See Orders (Docs. 90, 124). Plaintiff and Defendants Dickerson,
Marteney, Wimberly, and Spitzer reached a settlement. See Order (Doc. 154).
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(Doc. 178);2 Defendant’s Response to Plaintiff’s Motion (Doc. 181); Plaintiff’s
Objection to Defendant’s Summary Judgment Motion (Doc. 182). The motions
are ripe for review.
II.

Plaintiff’s Amended Complaint

As to Dr. Ramos, Plaintiff alleges as follows:
[O]n 11-14-16 while being preconfined by
security captain Dickerson after informing him his
sergeants had me beat[,] I was seen by nurses to where
they documented my injury on [a] stick figure
diagram. I stated to the nurses that security had me
beat by another inmate and seen it happen when it
happen and threaten me not to go to medical. The
nurses examine me and I tell them that my mouth and
teeth are numb, also have pain somewhere to where I
hit the floor when I was hit and knocked out. The
nurse went and got Doctor Ramos to examine me after
they documented all the injury. Doctor Ramos asked
officer male Thomas is he going to confinement.
Security officer Thomas said yes under investigation
per the captain till [sic] we can find out what
happen[ed] by reviewing the camera. He’s going under
investigation. Doctor Ramos stated[,] peaking his head
in exam room, take him to confinement I order[ed] a[n]
emergency x-ray. At no time did Doctor Ramos
examine me as he must. He didn’t [confer] with his
nurse[s] of the[ir] preliminary examination. He never
checked my mouth to see if teeth were cracked . . . . He
should have referred me to dental . . . . As a Doctor he

The Court set the deadlines for the filing of dispositive motions and responses
as June 25, 2020, and July 27, 2020, respectively. See Order (Doc. 166).
Defendant filed his Motion on June 25, 2020. The following day, the Clerk of
Court removed exhibits A through E because the exhibits contained personal
identifiers. The Clerk notified counsel and asked counsel to properly refile the
exhibits. Counsel did so on June 26, 2020. The Court finds the Motion and
exhibits timely filed.
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failed to treat a known serious injury. He failed to even
look for a diagnosis of the various injuries complained
about. Doctor Ramos displayed gross negligence,
culpable negligence and . . . deliberate indifference.
Doc. 17 at 18 (some punctuation and capitalization modified).
III.

Summary Judgment Standard of Review

“‘Summary judgment is appropriate where there is no genuine issue as to
any material fact and the moving party is entitled to judgment as a matter of
law.’” Hinkle v. Midland Credit Mgmt., Inc., 827 F.3d 1295, 1300 (11th Cir.
2016) (quoting Jurich v. Compass Marine, Inc., 764 F.3d 1302, 1304 (11th Cir.
2014)); see Fed. R. Civ. P. 56(a). “A genuine issue of material fact exists when
the evidence is such that a reasonable jury could return a verdict for the
nonmoving party.” Bowen v. Manheim Remarketing, Inc., 882 F.3d 1358, 1362
(11th Cir. 2018) (quotations and citation omitted); see Hornsby-Culpepper v.
Ware, 906 F.3d 1302, 1311 (11th Cir. 2018) (“Where 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.” (quotations and citation omitted)). In considering a
summary judgment motion, the Court views “the evidence and all reasonable
inferences drawn from it in the light most favorable to the nonmoving party.”
Hornsby-Culpepper, 906 F.3d at 1311 (quotations and citation omitted).
“[W]hen the moving party has carried its burden under Rule 56(c), its
opponent must do more than simply show that there is some metaphysical

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doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio
Corp., 475 U.S. 574, 586 (1986) (footnote and citation omitted); see Winborn v.
Supreme Beverage Co. Inc., 572 F. App’x 672, 674 (11th Cir. 2014) (per curiam)
(“If the movant satisfies the burden of production showing that there is no
genuine issue of fact, ‘the nonmoving party must present evidence beyond the
pleadings showing that a reasonable jury could find in its favor.’” (quoting
Shiver v. Chertoff, 549 F.3d 1342, 1343 (11th Cir. 2008)). “A ‘mere scintilla’ of
evidence supporting the opposing party’s position will not suffice; there must be
enough of a showing that the jury could reasonably find for that party.” Loren
v. Sasser, 309 F.3d 1296, 1302 (11th Cir. 2002) (quoting Walker v. Darby, 911
F.2d 1573, 1577 (11th Cir. 1990) (internal quotations omitted)).
“The principles governing summary judgment do not change when the
parties file cross-motions for summary judgment. When faced with
cross-motions, the Court must determine whether either of the parties deserves
judgment as a matter of law on the undisputed facts.” T-Mobile S. LLC v. City
of Jacksonville, Fla., 564 F. Supp. 2d 1337, 1340 (M.D. Fla. 2008).
IV.

Parties’ Positions

Defendant argues that he is entitled to summary judgment in his favor
because “Plaintiff has not presented any evidence that [he] was suffering from
a serious medical need on November 14, 2016,” and regardless, Defendant
provided appropriate medical care to Plaintiff. Doc. 177 at 7-10. Defendant
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submitted an Affidavit with exhibits. See Docs. 177-1, 177-7, 178-1 to 178-6. In
his Affidavit, Defendant avers in pertinent part:
On November 14, 2016, I was serving as a
Medical Officer at the Columbia Correctional
Institution.
John Moore III is an inmate in the custody of the
Florida Department of Corrections. He is presently
serving a forty year sentence after being convicted of
Second Degree Murder and Armed Robbery. His prior
incarceration history with the Department of
Corrections includes several stints of prison time
following convictions for Sale of Cocaine, Unarmed
Robbery, and Elder Neglect.
On November 14, 2016, inmate Moore was
brought to the Emergency Room at the Columbia
Correctional Institute. Inmate Moore reported that he
was involved in an altercation with an inmate, and
was hit in the face with an unknown object on October
31, 2016. Inmate Moore had normal vital signs, was
ambulatory, alert, and oriented to person, place, time
and situation. Inmate Moore responded to questions
verbally.
On November 14, 2016, inmate Moore presented
with slight right sided swelling to his face, bruising
under his right eye and a reddened right eye.
Subjectively, inmate Moore reported numbness on the
right side of his face and a tingling sensation. Inmate
Moore further reported pain inside of his mouth, and
hearing a “clicking” noise when he chewed or opened
his mouth.
I examined inmate Moore and reviewed his
Emergency Room Record and Florida Department of
Corrections Office of Health Services Diagram of
Injury. I signed and stamped both of these records. I
ordered an x-ray of inmate Moore’s facial bones on
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November 14, 2016. On November 15, 2016, Dr. John
Thomas, M.D. read the x-ray and determined that
inmate Moore’s frontal sinuses and maxillary sinuses
were clear, inmate Moore’s nasal bones and maxillary
sinuses were intact, inmate Moore’s ethmoid air cells
and sphenoid sinuses were clear, and inmate Moore’s
inferior orbital rimes were unremarkable. Inmate
Moore’s x-ray of his facial bones was unremarkable,
and revealed no fractures.
On November 14, 2016, I further wrote a
prescription for inmate Moore for Naproxen[], a
medication used to treat facial pain.
On November 14, 2016, I diagnosed inmate
Moore with complaints of facial pain. The care I
provided to inmate Moore was appropriate for his
complaints and his presentation. The care was also
within the reasonable standard of care for a physician
treating a patient with similar minor objective injuries
and subjective complaints. I am unaware of any
additional diagnoses of injuries to inmate Moore
relating to his complaints on November 14, 2016. The
injuries I observed, if left unattended, did not pose a
substantial risk of serious harm.
Doc. 177-1 at 2-4 (paragraph enumeration and footnotes omitted).
In response, Plaintiff argues that Defendant’s counsel did not provide him
with documents requested during discovery and that counsel “unlawfully”
submitted information in his summary judgment motion that Plaintiff had
previously requested. Doc. 182 at 2. He contends that Defendant’s Motion does
not refute the arguments made in his Motion. Id. at 3. Finally, Plaintiff asserts
that “there is one fact in this case still at dispute[:] . . . Did Doctor Greto Ramos

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fail to examine Plaintiff, and did he deprive Plaintiff follow up care into still
complained injuries of nerve damage[?]” Id.
Plaintiff argues in his Motion that Defendant was deliberately indifferent
when he failed to examine Plaintiff despite knowing that Plaintiff had a serious
medical need requiring his attention on November 14, 2016. See Doc. 176 at 4.
Plaintiff further argues that Defendant should have referred him to dental,
scheduled him for follow-up care, and/or sent him to the medical unit at RMC.
Id. at 7. By not doing so, Defendant left Plaintiff in pain for 30 days. Id. Plaintiff
goes on to address discovery that was not answered by Defendant, see id. at 910, and his inmate-witness affidavits, see id. at 11.
Defendant responds by asserting that he was not deliberately indifferent
to any serious medical need and at most, Plaintiff has raised a difference of
opinion which does not rise to the level of a constitutional violation. See Doc.
181.
V.

Analysis

“To prevail on [a] § 1983 claim for inadequate medical treatment, [the
plaintiff] must show (1) a serious medical need; (2) the health care providers’
deliberate indifference to that need; and (3) causation between the health care
providers’ indifference and [the plaintiff’s] injury.” Nam Dang by & through
Vina Dang v. Sheriff, Seminole Cty. Fla., 871 F.3d 1272, 1279 (11th Cir. 2017)
(citation omitted).
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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. In the
alternative, a serious medical need is determined by
whether a delay in treating the need worsens the
condition. In either case, the medical need must be one
that, if left unattended, poses a substantial risk of
serious harm.
Mann v. Taser Int’l, Inc., 588 F.3d 1291, 1307 (11th Cir. 2009) (quotations and
citation omitted).
Deliberate indifference to a serious medical need requires “three
components: (1) subjective knowledge of a risk of serious harm; (2) disregard of
that risk; (3) by conduct that is more than mere negligence.” Farrow v. West,
320 F.3d 1235, 1245 (11th Cir. 2003) (citations omitted); see Dang, 871 F.3d at
1280; Melton v. Abston, 841 F.3d 1207, 1223 & n.2 (11th Cir. 2016). “Subjective
knowledge of the risk requires that the defendant 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.’” Dang, 871 F.3d at 1280 (quoting Caldwell v.
Warden, FCI Talladega, 784 F.3d 1090, 1099-1100 (11th Cir. 2014)).
An official disregards a serious risk by more than mere
negligence “when he [or she] knows that an inmate is
in serious need of medical care, but he [or she] fails or
refuses to obtain medical treatment for the inmate.”
Lancaster v. Monroe Cty., Ala., 116 F.3d 1419, 1425
(11th Cir. 1997), overruled on other grounds by
LeFrere v. Quezada, 588 F.3d 1317, 1318 (11th Cir.
2009). Even when medical care is ultimately provided,
a prison official may nonetheless act with deliberate
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indifference by delaying the treatment of serious
medical needs. See Harris v. Coweta Cty., 21 F.3d 388,
393-94 (11th Cir. 1994) (citing Brown v. Hughes, 894
F.2d 1533, 1537-39 (11th Cir. 1990)).[3] Further,
“medical care which is so cursory as to amount to no
treatment at all may amount to deliberate
indifference.” Mandel v. Doe, 888 F.2d 783, 789 (11th
Cir. 1989) (citations omitted). However, medical
treatment violates the Constitution only when it is “so
grossly incompetent, inadequate, or excessive as to
shock the conscience or to be intolerable to
fundamental fairness.” Rogers v. Evans, 792 F.2d
1052, 1058 (11th Cir. 1986) (citation omitted).
Dang, 871 F.3d at 1280. “‘[I]mputed or collective knowledge cannot serve as the
basis for a claim of deliberate indifference. Each individual defendant must be
judged separately and on the basis of what that person kn[ew].’” Id. (quoting
Burnette v. Taylor, 533 F.3d 1325, 1331 (11th Cir. 2008)).
Considering the parties’ positions and reviewing the evidence submitted
the Court finds that Plaintiff simply disagrees with the course of treatment
Defendant provided. The medical evidence reflects that Plaintiff had an

“Even where medical care is ultimately provided, a prison official may
nonetheless act with deliberate indifference by delaying the treatment of
serious medical needs, even for a period of hours, though the reason for the
delay and the nature of the medical need is relevant in determining what type
of delay is constitutionally intolerable.” McElligott v. Foley, 182 F.3d 1248, 1255
(11th Cir. 1999) (citation omitted). However, “[i]t is also true that when a prison
inmate has received medical care, courts hesitate to find an Eighth Amendment
violation.” Waldrop v. Evans, 871 F.2d 1030, 1035 (11th Cir. 1989) (citing
Hamm v. DeKalb Cty., 774 F.2d 1567, 1575 (11th Cir. 1985)); see Boone v.
Gaxiola, 665 F. App’x 772, 774 (11th Cir. 2016).
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altercation with another inmate on October 31, 2016. Doc. 178-2 at 2. Two
weeks later, on November 14, 2016, he reported to the emergency room and was
examined by a nurse. Id. The nurse noted that Plaintiff had slight swelling on
the right side of his face and bruising under his eye. Id. The nurse also noted
that Plaintiff complained of tingling and numbness as well as pain inside of his
mouth and a clicking sound when he chews or opens his mouth. Id. The nurse
notified Defendant. Id. That same day (November 14, 2016), Defendant ordered
an x-ray and prescribed pain medication. Doc. 178-4 at 2; Doc. 178-6 at 2. The
x-ray was read the following day by a different physician, and the results were
unremarkable. Doc. 178-5.
Whether to refer Plaintiff to a dentist or to RMC and whether to provide
a different mode of treatment is a matter of medical judgment that does not
amount to deliberate indifference. See Boone v. Gaxiola, 665 F. App’x 772, 774
(11th Cir. 2016) (“A medical decision not to pursue a particular course of
diagnosis or treatment is a classic example of a matter for medical judgment,
an exercise of which does not represent cruel and unusual punishment.” (citing
Estelle, 429 U.S. at 107-08). Likewise, Plaintiff’s disagreement with
Defendant’s course of treatment does not support a deliberate indifference
claim. See Melton, 841 F.3d at 1224 (“‘[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’ does not support a claim of deliberate indifference.”
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(quoting Harris v. Thigpen, 941 F.2d 1495, 1505 (11th Cir. 1991)). Plaintiff
received medical attention, and the evidence shows that Defendant’s treatment
was not “‘so grossly incompetent, inadequate, or excessive as to shock the
conscience or to be intolerable to fundamental fairness.’” Brennan v. Headley,
807 F. App’x 927, 935 (11th Cir. 2020) (quoting Thigpen, 941 F.2d at 1505).
Even taking all facts and inferences in the light most favorable to Plaintiff,
Defendant is entitled to entry of summary judgment in his favor.
Accordingly, it is
ORDERED:
1.

Defendant Greto Ramos, M.D.’s Motion for Summary Judgment

(Doc. 177) is GRANTED.
2.

Plaintiff’s Affidavit Summary Judgment Motion (Doc. 176) is

DENIED.
3.

The Clerk shall enter judgment in favor of Defendant and against

Plaintiff, terminate any pending motions, and close the file.
DONE AND ORDERED in Jacksonville, Florida, this 10th day of
August, 2020.

TIMOTHY J. CORRIGAN
United States District Judge

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JAX-3 8/6
c:
John Moore, III, #V02153
Counsel of Record

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