Loadholt v. Parrish et al
Filing
65
ORDER granting in full 42 Motion to Dismiss; adopting - re 53 Report and Recommendations.; dismissed without prejudice 59 Motion for Summary Judgment; Denying 59 Motion for Preliminary Injunction. The Clerk is directed to issue a scheduling notice to the parties. Signed by Judge Dudley H. Bowen on 1/25/12. (cmr)
ORIGINAL
FILED
U.S. DISTR I CT CORT
AUGUSTA D ; Y'.
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF GEORGIA 2012 JAN 25 PM 3: 39
DUBLIN DIVISION
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OLIVER C. LOADI-IOLT,
Plaintiff
V.
DR. MOORE, et al.,
Defendants.
CLERK >
SO. DSt OF GA.
CV 309-091
ORDER
Plaintiff Oliver C. Loadholt, an inmate at Macon State
Prison in Oglethorpe, Georgia,' filed this action pursuant to 42
U.S.C. § 1983. Plaintiff is proceeding pro se and in forma
pauperis. Plaintiff sued the Georgia Department of Corrections
and a number of physicians working at various correctional
facilities in Georgia, alleging that these Defendants mistreated
him and deprived him of his Eighth Amendment right to basic
medical care. All claims, with the exception of those waged
against Dr. Chaudhary of Augusta State Medical Prison and Dr.
Moore of Telfair State Prison, have been dismissed. (See doe.
nos. 16, 45.)
On October 6, 2010, Dr. Chaudhary moved to
dismiss pursuant to 12(b) (6).
1
(Doc. no. 42.)
When Plaintiff commenced this action, he was incarcerated at
Teif air State Prison in Helena, Georgia.
On March 14, 2011, the United States Magistrate Judge
entered a Report and Recommendation that the Court should grant
in part and deny in part Dr. Chaudhary's motion. (Doc. no. 53.)
After a thorough review of the applicable facts and the law, the
Magistrate Judge determined that Plaintiff had arguably stated
an Eighth Amendment claim against Dr. Chaudhary. Dr. Chaudhary
filed an objection (doc. no. 56), which is presently before the
Court. With due regard to the Magistrate Judge's
recommendation, Dr. Chaudhary's objection is SUSTAINED and his
motion to dismiss is GRANTED IN FULL. As a result, the only
remaining Defendant in the case is Dr. Moore.
I. BACKGROUND
The facts as alleged in Plaintiff's Complaint 2 are as
follows.' Plaintiff has chronic hepatitis B, a viral infection
that causes inflammation of the liver. (Compl. ¶ 6.) Since his
incarceration beginning in 2000, Georgia Department of
Corrections health care providers have monitored Plaintiff's
condition to ensure that treatment would be available should the
2
Plaintiff completed a standard prisoner form to file this action
(doc. no. 1), but supplemented the form with a handwritten document which
contains a more extensive catalogue of factual allegations (doc. no. 1-1)
The Court will refer to this supplemental document as the "Complaint"
hereinafter.
When ruling on a motion to dismiss, the Court must accept all facts
alleged in the Complaint as true and must construe all reasonable
inferences in the light most favorable to Plaintiff. See Hoffman-Pucrh v.
Ramsey , 312 F.3d 1222, 1225 (11th Cir. 2002).
2
need arise. (Id.) In March 2008, Dr. Cheney of Telfair State
Prison ("TSP") informed Plaintiff, presumably after blood
analysis, that his viral count warranted treatment. (Id. ¶ 1.)
Dr. Cheney recommended treatment with interferon, a protein
administered to suppress the virus and forestall cirrhosis, or
liver scarring.' (Id.) To receive treatment, however, Dr.
Cheney indicated that Plaintiff was required to have "a
relatively healthy liver free of c irrh [o]s i s . " (Id. ¶ 2.)
Several months after Dr. Cheney's treatment recommendation,
Plaintiff was transferred to Augusta Medical State Prison
("ANSP") for a consultation regarding treatment. (Id. ¶ 8.) He
was not treated in the interim. After his arrival at AMSP,
Plaintiff was informed by medical staff that treatment would not
proceed until he underwent a liver biopsy to evaluate the health
of his liver.
(Id. ¶ 9.)
In December 2008, Plaintiff once again consulted with
doctors at AMSP regarding treatment (i ¶ 10), and in August
2009 he was transferred to ANSP to receive the liver biopsy (id.
12). Plaintiff remained at ANSP for two weeks following the
operation and on return to TSP was examined by Dr. Moore,
another physician at TSP. ( ¶ 18.) Plaintiff indicated that
his liver was causing "constant pain," and Dr. Moore advised
Plaintiff that his liver was swollen. (Id. ¶ 19.) However, in
September 2009, Dr. Chaudhary at AMSP informed Plaintiff that
See httv://www.medicinenet.com/interferon/article.htm.
3
his liver was in fact healthy and that, as a consequence,
treatment was not necessary. (Id. ¶ 4.) Days later, Dr. Moore
informed Plaintiff that, notwithstanding any complaints of pain,
he would not be treated because his liver was healthy and his
condition did not require it. (Id. ¶ 20.)
Plaintiff filed this action in November 2009, alleging that
Dr. Chaudhary, Dr. Moore, and others were deliberately
indifferent to his serious medical needs by failing to treat his
hepatitis. Plaintiff has also alleged several state law claims.
Plaintiff is seeking damages and an injunction ordering
Defendants to provide treatment as prescribed by Dr. Cheney. In
previous orders, all claims except those against Dr. Chaudhary
and Dr. Moore were dismissed. (See doc. nos. 16, 45.) Dr.
Chaudhary moved to dismiss, and the Magistrate Judge recommended
that Dr. Chaudhary's motion be denied as to Plaintiff's claim of
deliberate indifference to medical needs. Objections to the
Magistrate Judge's Report and Recommendation have been filed,
and Dr. Chaudhary's motion is now ripe for consideration.
II. MOTION TO DISMISS STANDARD
In considering a motion to dismiss under Rule 12 (b) (6), the
court tests the legal sufficiency of the complaint, not whether
the plaintiff will ultimately prevail on the merits. Scheur v.
Rhodes,
416 U.S. 232, 236
(1974) . The court must accept as true
all facts alleged in the complaint and construe all reasonable
4
inferences in the light most favorable to the plaintiff.
Hoffman-Pugh v. Ramsey, 312 F.3d 1222, 1225 (11th Cir. 2002)
The court, however, need not accept the complaint's legal
conclusions as true, only its well-pled facts. Ashcroft v.
Igbal, 556 U.S. 662, 129 S. Ct. 1937, 1949-50 (2009)
A complaint also must "contain sufficient factual matter,
accepted as true, to state a claim to relief that is plausible
on its face.'" Id. at 1940 (citing Bell Ati. Corp. v. TwombJy,
550 U.S. 544, 570 (2007)). The plaintiff is required to plead
"factual content that allows the court to draw the reasonable
inference that the defendant is liable for the misconduct
alleged." Id. Although there is no probability requirement at
the pleading stage, "something beyond . . . mere possibility
must be alleged." Twombly, 550 U.S. at 556-57 (citing Durma
Pharm., Inc. v. Broudo, 544 U.S. 336, 347 (2005)).
III. DISCUSSION
Plaintiff alleges that Dr. Chaudhary, by denying hepatitis
treatment, was deliberately indifferent to his serious medical
needs. In his Report & Recommendation to this Court, the
Magistrate Judge found that Plaintiff had arguably stated a
claim for relief. Dr. Chaudhary objects to this finding,
contending that Plaintiff's allegations evince merely a
difference in professional judgment regarding treatment, not
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deliberate indifference to Plaintiff's medical needs.
This
Court agrees with Dr. Chaudhary's assessment.
A. Legal Standard
In the seminal case of Estelle v. Gamble, 429 U.S. 97
(1976), the Supreme Court recognized the government's
affirmative obligation to provide medical care for inmates. In
their confinement, inmates have no choice but to rely on prison
authorities for the treatment of their medical needs. And,
according to the Supreme Court, our society's "evolving
standards of decency" will not countenance the unnecessary and
wanton denial of medical care to inmates completely dependent
upon the government for sustenance. Id. at 106. After all, the
"denial of medical care [to inmates] may result in pain and
suffering which no one suggests would serve any penological
purpose." Id. at 103. The government, therefore, may not
deliberately ignore or withhold minimally adequate medical care
to those inmates stricken with serious medical needs. Id. at
103-04 ("(lIt is but just that the public be required to care
for the prisoner, who cannot by reason of the deprivation of his
liberty, care for himself.") (quoting S p icer v. Williamson, 132
S.E. 291, 293 (N.C. 1926)).
In articulating this constitutional right to basic medical
care, however, the Court in Estelle was careful to emphasize
that not "every claim by a prisoner that he has not received
6
adequate medical treatment states a violation of the Eighth
Amendment." Id. at 105. Incompetent care, "although it may
produce added anguish, is not on that basis alone to be
characterized as wanton infliction of unnecessary pain."
]4
In short, "[miedical malpractice does not become a
constitutional violation merely because the victim is a
prisoner.." Id. at 106.
The conceptual distinction drawn in Estelle between
constitutional misconduct and negligent medical treatment is an
important one, and clearly borne out by the comparatively
onerous burden placed on inmates seeking to establish an Eighth
Amendment deprivation. An inmate can only prove a
constitutional violation by setting forth evidence of: (1) an
objectively serious medical need, and (2) deliberate
indifference to that need. See Bingham v. Thomas, 654 F.3d
1171, 1175-76 (11th Cir. 2011) . Together, these criteria serve
to balance the medical requirements of inmates against the
corresponding burden placed on the penal system in such a way as
to reserve constitutional censure for genuinely egregious abuses
of the government's obligations. See Woodall v. Foti, 648 F.2d
268, 272 (5th Cir. 1981).
Medical malpractice claims, however, present a marked
contrast. In these cases, the defendant's state of mind is
irrelevant because an objective standard of care is applied. See
Johnson v. Riverdale Anesthesia Assoc., 547 S.E.2d 347, 348 (Ga.
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Ct. App. 2001) ("[T]he applicable standard of care [in medical
malpractice actionsi is that employed by the medical profession
generally .") . Moreover, the mistreatment of any medical
need, no matter how slight, may give rise to a claim. See,
e.g., Bowling v. Foster, 562 S.E.2d 776, 776-77 (Ga. Ct. App.
2002) (listing elements of medical malpractice claim in Georgia,
which do not include a severity requirement). Not so with
Eighth Amendment claims.
1. Serious Medical Need
The first element that must be proven by an inmate
asserting an Eighth Amendment claim is an objectively serious
medical need, "one that, if left unattended, pos[es] a
substantial risk of serious harm." Taylor v. Adams, 221 F.3d
1254, 1258 (11th Cir. 2000) (quotations omitted); accord Youmans
v. Gag non, 626 F.3d 557, 564 (11th Cir. 2010) ("[S]erious
medical needs are those requiring immediate medical attention."
(quotations omitted)). [T] he essential test is one of medical
necessity . . . ." Woodall, 648 F.2d at 272 (emphasis added)
Serious medical needs include those "diagnosed by a physician as
mandating treatment," or, alternatively, those that are "so
obvious that even a lay person would easily recognize the
necessity for a doctor's attention." Farrow v. West, 320 F.3d
1235, 1243 (11th Cir.2003) .
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Whether a particular ailment is "serious" or not is by
nature a fact intensive inquiry, one best answered by example.
So, to illustrate, the following conditions constitute serious
medical needs when assayed under the Eighth Amendment: swollen
ankles, inability to sleep, chills, tingling and numbness of
hands, hyperventilation, severe back and leg pain, and double
vision, Ancata v. Prison Health Serv., Inc., 769 F.2d 700, 70203 (11th Cir. 1985); severe and protracted stomach pain, spasms,
nausea, vomiting, diarrhea, and dramatic weight loss, McElliqott
v. Fol, 182 F.3d 1248, 1256 (11th Cir. 1999); swollen and
continually bleeding gums, intense pain, and weight loss from
inability to eat, Farrow, 320 F.3d at 1243-44; HIV, hepatitis C,
recurrent skin infections, severe eye pain and vision problems,
fatigue, and prolonged stomach pains, Brown v. Johnson, 387 F. 3d
1344, 1346, 1350 (11th Cir. 2004); prolonged amniotic fluid leak
severe enough to cause stillbirth, Goebert v. Lee County, 510
F.3d 1312, 1326 (11th Cir. 2007)
2. Deliberate Indifference
Even if an inmate can establish that he suffered from a
serious medical need, he must further prove that the allegedly
offending prison official acted with an attitude of "deliberate
indifference" to that need in order to succeed on his claim.
Estelle, 429 U.S. at 106. This means, as the Supreme Court
later clarified in Farmer v. Brennan, 511 U.S. 825 (1994), that
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the inmate must demonstrate that the official had subjective
knowledge of a risk of serious harm and consciously disregarded
that risk. Id. at 837 (We hold . that a prison official
cannot be liable under the Eighth Amendment for denying an
inmate humane conditions of confinement unless the official
knows of and disregards an excessive risk to inmate health or
safety . . •") . Inquiry into the prison official's state of
mind is consistent with the plain import of the Eighth
Amendment's prohibition on cruel and unusual "punishments" - not
cruel and unusual "conditions." Farmer, 511 U.S. at 837; accord
Wilson v. Seiter, 501 U.S. 294, 300 (1991) ("The source of the
[subjective] intent requirement is not the predilections of this
Court, but the Eighth Amendment itself, which bans only cruel
and unusual punishment." (emphasis in original)) . In other
words, it is the subjective culpability of the actor which
converts malprovision of care from an unfortunate incident to
punishment into the infliction of punishment. See Farmer, 51
U.S. at 837-38. "IITIJhe official 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."
Id. at 837; see also Farrow, 320 F.3d at 1246 ("[Aln official
acts with deliberate indifference when he knows that an inmate
is in serious need of medical care, but he fails or refuses to
obtain medical treatment for the inmate.").
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A review of the case law shows that Eleventh Circuit
jurisprudence has been faithful to the language and intent of
Estelle, giving "substance to [the Supreme Court] 's distinction
between 'deliberate indifference' and mere negligence."
McElllgott, 182 F.3d at 1255. A very limited number of
categories of action, or inaction, have thus far been held to
constitute deliberate indifference: care so grossly inadequate
that it shocks the conscience, easier and less efficacious
courses of treatment, cursory treatment of obvious medical
needs, or unnecessary and unjustifiable delays in treatment.
See Adams v. Poag, 61 F.3d 1537, 1544 (11th Cir. 1995) . Each of
the listed categories identifies conduct rooted in a conscious
and unjustifiable subordination of an inmate's medical
requirements, the result of which is needless suffering and,
consequently, a deprivation of Eighth Amendment rights.
B. Analysis
As indicated by the preceding, the Court's analysis has two
components. First, Plaintiff's allegations must show that he
had a serious medical need; if so, the Court will consider
whether the allegations regarding Dr. Chaudhary's response to
that need are sufficient to show deliberate indifference.
1. Serious Medical
Need
Eleventh Circuit law holds, as the Magistrate Judge noted,
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that infection with hepatitis constitutes an objectively serious
medical need. See Brown, 387 F.3d at 1351. According to the
Complaint, Plaintiff has suffered from chronic hepatitis B since
at least 2000; therefore, the Court finds that Plaintiff's
allegations establish that he suffered from a serious medical
need.
2. Deliberate Indifference
Notwithstanding Plaintiff's medical need, the Court
concludes that the factual allegations of the Complaint do not
reasonably support an inference of deliberate indifference. To
establish deliberate indifference, a prisoner must show: "(1)
subjective knowledge of a risk of serious harm; (2) disregard of
that risk; (3) by conduct that is more than gross negligence."
Goebert, 510 F.3d at 132627 (punctuation and citation omitted)
Each of these elements will be addressed in turn.
a. Subjective Knowledge of the Risks
Although the Complaint does not expressly state as much,
Plaintiff's allegation that Dr. Chaudhary declined to offer
treatment nevertheless presupposes that Dr. Chaudhary was aware
of his condition and its attendant risks. That is, Dr.
Chaudhary's consultation with Plaintiff was prompted by, and
predicated upon, precisely such awareness. Accordingly,
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Plaintiff has sufficiently alleged that Dr. Chaudhary had
the requisite knowledge to sustain a claim.
b. Disregard of the Risks
Plaintiff claims that he should have been treated in
September 2009 when Dr. Chaudhary concluded that treatment was
unnecessary. If this claim is taken as true for present
purposes, as is required, then it follows that Dr. Chaudhary's
conclusion was in error; and if in error, it is reasonable to
infer that the error was borne from a failure to properly take
account of the risks associated with Plaintiff's condition.
This second element has, therefore, been satisfied.
c. By Conduct that is More
than Gross Negligence
It is as to this last element that Plaintiff's claim fails.
Even if Dr. Chaudhary was aware of Plaintiff's condition and its
medical risks, and even if he failed to adequately consider
those risks in denying Plaintiff treatment, it does not follow
from these facts alone that his doing so amounted to something
more than gross negligence. So, as presently alleged, Dr.
Chaudhary's culpability hinges exclusively upon the additional
fact that his denial of treatment was at odds with the earlier
recommendation of Dr. Cheney. Yet this fact, which constitutes
no more than a professional medical disagreement, cannot by
itself Sustain a claim.
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Eleventh Circuit law is clear: when medical treatment
decisions are responsive to an inmate's needs and rooted in
professional, medical judgment - even if such decisions are
misguided or ineffectual - a claim for deliberate indifference
cannot be sustained. "[T]he propriety of a certain course of
medical treatment is not a proper subject for review in a civil
rights action." Enriguez v. Kearney, 694 F. Supp. 2d 1282, 1296
n. 13 (S.D. Fla. 2010); see also Estelle, 429 U.S. at 107 ( 11 [T]
question whether . . . additional diagnostic techniques or forms
of treatment is indicated is a classic example of a matter for
medical judgment."); Waldrop v. Evans, 871 F.2d 1030, 1033 (11th
Cir. 1989) (noting that "a simple difference in medical opinion"
does not constitute deliberate indifference). This limiting
principle has been consistently applied. See, e.cT., Nimmons v.
Aviles, 409 Fed. Appx. 295, 297-98 (11th Cir. 2011) (claim could
not be sustained against prison surgeon even though another
doctor later expressed concern about surgeon's treatment) ; Smith
v. Florida Dep't of Corrections, 375 Fed. Appx. 905, 910 (11th
Cir. 2010) (inmate's disagreement with prison medical staff
concerning the course of treatment did not support deliberate
indifference); Bismark v. Fisher, 213 Fed. Appx. 892, 897 (11th
Cir. 2007) (doctor's failure to adopt plan of care prescribed by
outside physician after exercising independent professional
judgment did not support deliberate indifference); Adams, 61
F.3d at 1546 (doctor's failure to administer a stronger course
14
of treatment considered a matter of medical judgment not
deliberate indifference)
To sustain his charge of deliberate indifference, then,
Plaintiff must allege facts beyond those showing a professional
disagreement. He has not done so. Plaintiff claims that he was
"maliciously" denied treatment (doc. no. 1-1 ¶ 3), but the Court
need not take account of such conclusory pronouncements. See
Igbal, 129 S.Ct. at 1949-50 (holding that respondent's
allegations that petitioners "knew of, condoned, and willfully
and maliciously [denied him of his constitutional rights]" were
not entitled to an assumption of truth). "A pleading that
offers labels and conclusions or a formulaic recitation of the
elements of a cause of action will not do."
Id. at 1949
(citation and punctuation omitted). This legal conclusion
aside, Plaintiff's Complaint is devoid of factual content from
which one might reasonably infer that Dr. Chaudhary's
recommendation to withhold treatment was based on something
other than his professional medical judgment - even if
incompetently exercised. Additional circumstantial facts which
would support an inference of culpability include a defendant's
(1) lack of professional medical training, see Woodall, 648 F.2d
at 271-72 (Sheriff refused to provide inmate with specialized
psychotherapy as recommended by prison psychiatrist), (2)
history of misconduct, see Mandel v. Doe, 888 F.2d 783, 790
(11th Cir. 1989) (evidence that a medical official had in the
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past inflicted unnecessary pain on a patient in his care
supported finding of deliberate indifference), or (3) failure to
treat an obvious and immediate medical need, see Bozeman v.
Orum, 422 F.3d 1265, 1273 (11th Cir. 2005) (fourteen minute
delay in treating an inmate who was unconscious and not
breathing supported deliberate indifference). Here, the only
allegation which might qualify as such is Plaintiff's claim that
he was in constant pain at the time treatment was denied.
(Compl. ¶ 19) . Plaintiff has not, however, indicated the
duration or severity of that pain; absent more than this
nonspecific affliction, the need for immediate treatment was not
so obvious at the time as to undergird an inference that Dr.
Chaudhary's recommendation is constitutionally suspect. Cf.
Goebert, 510 F.3d at 1327 (nine day amniotic fluid leak
constituted obvious risk requiring immediate treatment)
The United States Constitution does not entitle inmates to
medical care tailored to their preferences. See Abel v. Lapiin,
661 F. Supp. 2d 1361, 1373 (S.D. Ga. 2009) ("It is legally
insufficient to sustain a cause of action for deliberate
indifference to serious medical needs simply because the inmate
did not receive the medical attention he deemed appropriate.")
Indeed, the Eighth Amendment does not even dictate that inmates
receive professionally competent care, a point the extended
exposition above was intended to underscore. See Estelle, 429
U.S. at 106.
With these principles in mind, Plaintiff's
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grievance falls flat. The facts as alleged by Plaintiff show
that his condition was attended to by prison medical staff for
nearly a decade. Since his incarceration in 2000, Plaintiff's
ailment was monitored to ensure that treatment would be
available if necessary. He was transferred on multiple
occasions to a specialized medical facility for no other purpose
than to consult with physicians regarding his condition. He
underwent rather sophisticated testing, including blood work and
a liver biopsy, to assess the necessity of treatment.
Yet, from this long history of medical attention, Plaintiff
has isolated Dr. Chaudhary's recommendation against treatment
and juxtaposed it against a single decision that he deems more
favorable, and relies on the contrast to state his claim. But
the long and short of the claim's factual underpinning is this:
after Plaintiff's condition had been monitored for nearly a
decade, one doctor recommended treatment on the basis of a blood
test, and subsequently, another doctor rejected that
recommendation on the basis of a biopsy. Undoubtedly, one of
these decisions was more medically appropriate, but the Court
has neither the charge nor competence to arbitrate between the
two as the case now stands before it. One thing, however, is
certain conscious disregard may not be inferred from the
latter recommendation solely by virtue of this antinomy. See
Waldrop, 871 F.2d at 1033. All reasonable inferences must be
drawn in Plaintiff's favor, but inferences drawn in his favor
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are not necessarily reasonable. Accordingly, the Court finds
that Plaintiff has failed to show that Dr. Chaudhary acted with
deliberate indifference.
IV. CONCLUSION
Upon the foregoing, the Court SUSTAINS Dr. Chaudhary's
objection to the Magistrate Judge's Report and Recommendation.
(Doc. no. 56.) Accordingly, Dr. Chaudhary's motion to dismiss
is GRANTED IN FULL, and Plaintiff's Eighth Amendment claim
against him is DISMISSED. The Court declines to exercise
supplemental jurisdiction over Plaintiffs' remaining state law
claims against Dr. Chaudhary, and those claims are therefore
DISMISSED WITHOUT PREJUDICE. Only Plaintiff's claims against
Dr. Moore now remain before this Court.
Separately, because it addresses matters dealt with herein
and discovery in this case has not yet begun, Plaintiff's motion
for summary judgment (doc. no. 59) is DISMISSED WITHOUT
PREJUDICE. Plaintiff may re-file the motion at a later date,
taking into account the Court's present Order. Finally,
Plaintiff's motion for preliminary injunction (doc. no. 59) is
DENIED as it merely restates the allegations of the Complaint
and fails to demonstrate a substantial likelihood of success on
the merits. See Church v. Huntsville, 30 F.3d 1332, 1347 (11th
Cir. 1994) (holding that preliminary injunction may not be
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granted absent movant's demonstration of a substantial
likelihood of success on the merits).
With these matters resolved, the Clerk is DIRECTED to issue
a scheduling notice to the parties.
ORDER ENTERED at Augusta, Georgia, this
January, 2012.
UNITED
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day of
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