Edwards v. Graham County Jail et al

Filing 33

ORDER granting Defts' 25 Motion for Summary Judgment, and this action is dismissed with prejudice. Signed by Chief Judge Frank D. Whitney on 11/29/2017. (Pro se litigant served by US Mail.) (ejb)

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF NORTH CAROLINA
ASHEVILLE DIVISION
1:16-cv-315-FDW
BILLY JOSEPH EDWARDS,

)
)
Plaintiff,
)
)
vs.
)
)
GRAHAM COUNTY JAIL, et al.,
)
)
Defendants.
)
___________________________________ )

ORDER

THIS MATTER comes before the Court on a Motion for Summary Judgment by
Defendants Kevin Crane, Kim Holloway, and Kenneth Hyde. (Doc. No. 25).
I.

BACKGROUND

A.

Procedural Background

Pro se Plaintiff Billy Edwards filed this action on September 21, 2016, pursuant to 42
U.S.C. § 1983, alleging claims of deliberate indifference to serious medical needs as to various
Defendants based on an alleged delay in treatment after Plaintiff allegedly suffered a heart attack
while a pre-trial detainee at the Graham County Detention Center (“the jail”) in Robbinsville,
North Carolina. (Doc. No. 1). On December 22, 2016, following its initial review of Plaintiff’s
Complaint pursuant to 28 U.S.C. § 1915(e) and § 1915A, the Court entered an Order, holding
that Plaintiff’s claims of deliberate indifference against Hyde, Crane, and Holloway were
sufficient to survive the Court’s initial review, but dismissing the remaining Defendants. (Doc.
No. 7). On March 14, 2017, Hyde, Crane, and Holloway filed their Answer, denying liability
and asserting several affirmative defenses. (Doc. No. 14). On March 23, 2017, the Court

1

entered a Pretrial Order and Case Management Plan, setting a discovery deadline of July 21,
2017, and a deadline for dispositive motions of August 21, 2017. (Doc. No. 15). The parties
exchanged written discovery. On July 5, 2017, the Court entered an Order granting leave to
Defendants to take Plaintiff’s deposition, (Doc. No. 22), which was conducted on July 14, 2017.
The moving Defendants filed their pending summary judgment motion on August 21,
2017. Defendants’ summary judgment materials include Exhibit 1, titled “Plaintiff’s Release of
Documents,” and Plaintiff’s deposition. See (Doc. Nos. 24-1; 26-1). On August 24, 2017, this
Court entered an order in accordance with Roseboro v. Garrison, 528 F.2d 309 (4th Cir. 1975),
advising Plaintiff of the requirements for filing a response to the motion for summary judgment
and of the manner in which evidence could be submitted to the Court. (Doc. No. 28). Plaintiff
has responded to the summary judgment motion by submitting his own sworn statement and an
affidavit of prior Graham County jail inmate Terry Buchanan. See (Doc. Nos. 29, 29-1). This
matter is therefore ripe for disposition.
B.

Factual Background

The evidence on summary judgment shows the following:
Plaintiff is a North Carolina inmate currently incarcerated at Avery-Mitchell Correctional
Institution in Spruce Pine, North Carolina. (Doc. No. 24-1 at p. 15: Pl.’s Dep.). At the time of
the events forming the basis of this action, Plaintiff was a pretrial detainee at the Graham County
jail, and Defendants were each employed by the Graham County Sheriff’s Office at the jail—
Hyde was employed as a Corporal and Day Shift Supervisor; Crane was employed as a transport
officer; and Holloway was employed as a detention officer.

2

On September 19, 2015,1 Plaintiff requested medical attention due to complaints of chest
pain, dizziness, and shortness of breath. (Doc. No. 24-1, Ex. 4). Graham County’s jail does not
have any medical staff, so inmates needing medical attention are transported to outside
healthcare providers. (Doc. No. 24-1 at pp. 25, 48-49, 85). Jail employee Charlene West
transported Plaintiff to an urgent care clinic and then to Murphy Medical Center. (Id. at pp. 7879, 88). Upon evaluating Plaintiff, Murphy Medical Center transported him to Mission Hospital
in Asheville, North Carolina, where he was medically evaluated and received treatment
involving the placement of stents. (Id. at pp. 51-52, 107). Following treatment at Mission
Hospital, Plaintiff was released from Graham County’s custody on bond, but was subsequently
arrested again for violations of that bond. (Id. at pp. 58-60, 62; Ex. 5). Plaintiff remained
incarcerated until his trial in January 2016, when he was convicted and taken into the custody of
the North Carolina Department of Public Safety. (Doc. No. 24-1 at p. 15).
Plaintiff alleges and testified that on the date in question, there was a period of delay
from the time he first requested medical attention until he was ultimately transported by jail
personnel for medical evaluation and treatment. (Doc. No. 1; Doc. No. 24-1 at pp. 54-55).
Based on Plaintiff’s own allegations and testimony, Plaintiff’s contentions as to the precise
length of this alleged delay are unclear,2 and Defendants have not stipulated to Plaintiff’s
assertions as to the same. Defendants contend, in any event, that when the questions and
inconsistencies within Plaintiff’s allegations and testimony are resolved and viewed in the light

1

The Complaint alleges the events at issue took place on September 22, 2015. Based on jail
records produced by Defendants in discovery, however, Plaintiff acknowledges that this was
probably an error and agrees that September 19, 2015, is the actual date in question. (Doc. No.
24-1 at pp. 35-36).
2 See (Doc. No. 1 IV(1), IV(3), IV(4), IV(7); Doc. No. 24-1 at pp. 25, 32, 46, 48-49, 52, 55, 87).
3

most favorable to him, the delay was at most about 10½ hours—from 7:30 a.m. until 6:00 p.m.3
See (Doc. No. 24-1 at pp. 54-55).
Plaintiff alleges that he first complained of chest pains, left arm pain, and breathing
problems to Holloway at 7:30 a.m., although he does not expressly allege he requested medical
attention at that time. (Doc. No. 1 ¶ IV(1)). Plaintiff alleges that Holloway checked his blood
pressure, informed him it was “very high,” and instructed him to go lay down on his bunk. (Id.).
Around 8:00 a.m., Plaintiff told jail personnel that he was “hurting bad” and needed to go to the
doctor. (Doc. No. 24-1 at p. 87). At or around this time, another inmate at the jail, Charles
Goodson, fell and also requested medical attention. (Doc. No. 1 ¶ IV(3); Doc. No. 24-1 at pp.
25, 89-90). Both Plaintiff and Goodson filled out Medical Request Forms to be taken for
medical treatment sometime between 11:30 a.m. and noon. (Doc. No. 24-1 at pp. 25, 45, 100;
Ex. 4). Plaintiff understood that filling out this form “was the first step to me being . . . taken . . .
to the doctor.” (Id. at pp. 48-49). Plaintiff contends that Hyde informed Plaintiff that he and
Goodson would be transported for medical treatment “around noon,” but that around 1:00 p.m.,
the transport officer Crane told him he could not watch both Plaintiff and Goodson at the same
time, and transported Goodson for treatment before him. (Doc. No. 1 ¶¶ IV(3) and (4)); Doc.
No. 24-1 at pp. 91-92, 124).
Plaintiff testified that he told Hyde that he thought he was having a heart attack, although
he did not specifically allege this in his Complaint, nor did he write it on his Medical Request
Form. (Doc. No. 24-1 at pp. 92-93, 104, Ex. 4; Doc. No. 1). At no time did Plaintiff tell
defendants to “call 911” for him. (Doc. No. 24-1 at p. 103). Plaintiff testified that he kept

3

As discussed, infra, Defendants contend that, for purposes of summary judgment, any delay—even the varying
periods of delay as put forth by Plaintiff—are immaterial to the basis on Defendants contend they are entitled to
summary judgment.

4

asking whether anyone was going to take him every time the jail personnel made their rounds,
and was eventually told that there was not anyone available to take him and that he would have
to wait until Charlene West’s son was finished playing a football game sometime after 5:00 p.m.
(Id. at pp. 100-01). Around 6:00 p.m., Charlene West transported Plaintiff to an urgent care
clinic. (Id. at p. 52). The urgent care clinic then referred him to Murphy Medical Center. (Id. at
p. 106).
Plaintiff testified that medical testing performed at Murphy Medical Center indicated he
had experienced “multiple heart attacks.” (Id. at p. 107). Plaintiff was then transported from
Murphy Medical Center to Mission Hospital. (Id.). He underwent testing at Mission the next
morning, on September 20, 2015. (Id. at pp. 51-52). Plaintiff testified that cardiologist William
Thomas Maddox evaluated him and diagnosed him as having had a heart attack. (Id. at pp. 50,
107). According to Plaintiff, Dr. Maddox advised him that “there was some bad stuff going on”
and that he had “blockages.” (Id. at pp. 52-53). Dr. Maddox recommended bypass surgery.
(Id.). Plaintiff testified he was “scared to death” at the thought of heart surgery, and he asked Dr.
Maddox whether there were any less serious treatment alternatives. (Id.). Dr. Maddox informed
him about a stent procedure as an alternative to bypass surgery. (Id.). Plaintiff decided on the
stent procedure instead of bypass surgery. (Id. at p. 53).
A doctor other than Dr. Maddox performed the stent procedure. (Id. at pp. 53-54).
Plaintiff is unable to identify this doctor. (Id.). After the stent procedure, Dr. Maddox checked
on Plaintiff. (Id. at p. 54). Dr. Maddox told him that the stents were not permanent, and that he
would “have trouble out of them eventually.” (Id. at p. 55). Plaintiff told Dr. Maddox he was
thinking about filing a lawsuit over the alleged delay by the jail in getting him medical attention.
(Id. at p. 54). According to Plaintiff, Dr. Maddox told him that “excessive delay has caused you
5

severe heart damage,” and that if Plaintiff needed his help with anything to contact him. (Id. at
p. 55). Dr. Maddox prescribed Plaintiff’s medications following the stent procedure, but
Plaintiff only takes aspirin now. (Id. at pp. 66-67). Plaintiff has not been seen by a cardiologist
since being treated by Dr. Maddox in September 2015. (Id. at p. 58).
Plaintiff testified he has written Dr. Maddox at Asheville Cardiology three times since
filing suit, asking whether he would testify on Plaintiff’s behalf. (Id. at pp. 74-75). He has not
received any response, and has not had any communications with Dr. Maddox since speaking
with him in the hospital. (Id. at pp. 75-77). Plaintiff testified he has also requested his medical
records from Mission Hospital, but he has not received any response. (Id. at pp. 77-78).
II.

STANDARD OF REVIEW

Summary judgment shall be granted “if the movant shows that there is no genuine dispute
as to any material fact and the movant is entitled to judgment as a matter of law.” FED. R. CIV. P.
56(a). A factual dispute is genuine “if the evidence is such that a reasonable jury could return a
verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).
A fact is material only if it might affect the outcome of the suit under governing law. Id.
The movant has the “initial responsibility of informing the district court of the basis for
its motion, and identifying those portions of the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the affidavits, if any, which it believes
demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S.
317, 323 (1986) (internal citations omitted).
Once this initial burden is met, the burden shifts to the nonmoving party. The nonmoving
party “must set forth specific facts showing that there is a genuine issue for trial.” Id. at 322 n.3.
The nonmoving party may not rely upon mere allegations or denials of allegations in his
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pleadings to defeat a motion for summary judgment. Id. at 324. The nonmoving party must
present sufficient evidence from which “a reasonable jury could return a verdict for the
nonmoving party.” Anderson, 477 U.S. at 248; accord Sylvia Dev. Corp. v. Calvert County,
Md., 48 F.3d 810, 818 (4th Cir. 1995).
When ruling on a summary judgment motion, a court must view the evidence and any
inferences from the evidence in the light most favorable to the nonmoving party. Anderson, 477
U.S. at 255. “‘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 issue for trial.’” Ricci v. DeStefano, 129 S.Ct. 2658,
2677 (2009) (quoting Matsushita v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)).
III.

DISCUSSION

A. Plaintiff’s Claim of Deliberate Indifference to Serious Medical Needs As to
Defendants in their Individual and Official Capacities
As noted, Plaintiff alleges in this action that Hyde, Crane, and Holloway violated his
constitutional rights by acting with deliberate indifference to his serious medical needs by
ignoring his complaints about chest pain and delaying treatment for a heart attack. Claims under
42 U.S.C. § 1983 based on an alleged lack of or inappropriate medical treatment fall within the
Eighth Amendment’s prohibition against cruel and unusual punishment.4 Estelle v. Gamble, 429

Because Plaintiff was a pre-trial detainee at all relevant times, his deliberate indifference claim
is properly brought under the Fourteenth Amendment, rather than the Eighth Amendment, but
the analysis is the same. See City of Revere v. Mass. Gen. Hosp., 463 U.S. 239 (1983); but see
Kingsley v. Hendrickson, 135 S. Ct. 2466, 2473, 2475 (2015) (holding that the test for excessive
force claims brought by pretrial detainees under the Fourteenth Amendment differs from the test
for excessive force claims brought by convicted prisoners under the Eighth Amendment). This
Court observes that even if the Fourth Circuit were to apply to pre-trial detainees’ deliberate
indifference claims the Kingsley v. Hendrickson “objective unreasonableness” standard that
currently applies to pre-trial detainees’ excessive force claims and apply that standard to
deliberate indifference claims, Plaintiff has still not presented sufficient evidence to withstand
7
4

U.S. 97, 104 (1976). To state a claim under the Eighth Amendment, a plaintiff must show a
“deliberate indifference to serious medical needs” of the inmate. Id. “Deliberate indifference
requires a showing that the defendants actually knew of and disregarded a substantial risk of
serious injury to the detainee or that they actually knew of and ignored a detainee’s serious need
for medical care.” Young v. City of Mt. Ranier, 238 F.3d 567, 575-76 (4th Cir. 2001) (citations
omitted). “To establish that a health care provider’s actions constitute deliberate indifference to
a serious medical need, the treatment must be so grossly incompetent, inadequate, or excessive
as to shock the conscience or to be intolerable to fundamental fairness.” Miltier v. Beorn, 896
F.2d 848, 851 (4th Cir. 1990).
Allegations that might be sufficient to support negligence and medical malpractice claims
do not, without more, rise to the level of a cognizable Section 1983 claim. Estelle, 429 U.S. at
106; Grayson v. Peed, 195 F.3d 692, 695 (4th Cir. 1999) (“Deliberate indifference is a very high
standard—a showing of mere negligence will not meet it.”). To be found liable under the Eighth
Amendment, a prison official must know of and consciously or intentionally disregard “an
excessive risk to inmate health or safety.” Farmer v. Brennan, 511 U.S. 825, 837 (1994);
Johnson v. Quinones, 145 F.3d 164, 167 (4th Cir. 1998). “[E]ven if a prison doctor is mistaken
or negligent in his diagnosis or treatment, no constitutional issue is raised absent evidence of
abuse, intentional mistreatment, or denial of medical attention.” Stokes v. Hurdle, 393 F. Supp.
757, 762 (D. Md. 1975), aff’d, 535 F.2d 1250 (4th Cir. 1976). The constitutional right is to
medical care. No right exists to the type or scope of care desired by the individual prisoner. Id.
at 763. Therefore, a disagreement “between an inmate and a physician over the inmate’s proper

Defendants’ summary judgment motion.
8

medical care [does] not state a § 1983 claim unless exceptional circumstances are alleged.”
Wright v. Collins, 766 F.2d 841, 849 (4th Cir. 1985) (dismissing the plaintiff’s § 1983 claim
against a defendant physician for allegedly discharging the plaintiff too early from a medical
clinic, as such claim did not rise to the level of deliberate indifference but would, “at most,
constitute a claim of medical malpractice”).
First, to the extent that Plaintiff has sued Defendants in their official capacities, a local
government may be held liable under 42 U.S.C. § 1983 only if the plaintiff proves a “policy or
custom” of the entity was a moving force behind a violation of constitutional rights. Monell v.
New York City Dept. of Soc. Servs., 436 U.S. 658, 694 (1978). The Complaint does not allege,
however, that Plaintiff’s constitutional rights were violated pursuant to an unlawful policy or
custom of the jail. Generally, the failure to allege a specific policy or custom is fatal to an
official capacity claim against a government unit. See Alvarez v. Corr. Med. Servs., Inc., Civ.
No. WDQ-10-179, 2015 WL 7012654, at *5 (D. Md. Nov. 12, 2015).
Next, to the extent that Plaintiff has sued the moving Defendants in their individual
capacities, he has not raised a genuine dispute of fact as to his deliberate indifference claim to
overcome Defendants’ summary judgment motion.5 The Court first finds that, contrary to
Defendants’ arguments, there is undisputed evidence on summary judgment showing that
Plaintiff was suffering from a serious medical need on September 19, 2015. In the context of
deliberate indifference claims, a medical need is serious if it is one that has been diagnosed by a
physician as requiring treatment, or one that is so obvious even a lay person would easily

5

Furthermore, to the extent that Plaintiff seeks injunctive and declaratory relief against
Defendants, his claims are moot because he has been transferred away from the Graham County
jail.
9

recognize the necessity for a doctor’s attention. See Iko v. Shreve, 535 F.3d 225, 241 (4th Cir.
2008). It is undisputed that, on September 20, 2015, a doctor at Mission Hospital performed
surgery on Plaintiff to place stents in his heart. Thus, Plaintiff must have been suffering from a
heart condition that was serious enough for a doctor to determine that stents should be placed in
his heart. The Court agrees with Defendants, however, that Plaintiff has not produced any
competent, medical evidence establishing that he suffered from heart attack, or a series of heart
attacks, as he contends, while he was waiting to be treated. Most significantly, and fatal to his
claim, is that Plaintiff has presented no objective medical evidence whatsoever to show that a
delay in treatment resulted in damage to his heart that he would not have suffered but for the
delay.
Here, Plaintiff alleges in his Complaint, and he testified in deposition, that on the day in
question, he was diagnosed as having had a heart attack (or “a continuing heart attack,” or
“multiple heart attacks”). (Doc. No. 1 ¶ IV(7); Doc. No. 24-1 at pp. 50, 107). Plaintiff alleges
and testified that there was a deliberate delay in transporting him for medical treatment, and that
this delay caused “severe heart damage” he would not have suffered but for the delay. (Doc. No.
1 ¶ IV(8); Doc. No. 24-1 at pp. 54-55). Aside from the Complaint’s allegations and his own
deposition testimony, Plaintiff has submitted no supporting medical evidence, including any
medical records, nor has he identified any medical expert witness to testify in support of his
claim. Instead, these essential elements of his claim are based solely on alleged conversations
with Dr. Maddox—inadmissible hearsay—and Plaintiff’s own unqualified layman’s opinion.
Thus, there is no admissible evidence in the record of a doctor’s diagnosis of a heart attack, or a
serious of heart attacks, and this is not the type of medical condition that would be so obvious as
to be recognized by a lay person.
10

Plaintiff did not produce any medical records in response to Defendants’ request for them
in discovery. (Doc. No. 24-1 at pp. 108-09; Ex. 7). His responses to Defendants’ request for
medical records merely states that “Mission Hospital has not yet complied to the court’s orders
to compel production.”6 (Id.). Plaintiff testified that he has requested medical records from
Mission Hospital, but he has received no response. (Doc. No. 24-1 at pp. 77-78). Moreover,
although he testified that Murphy Medical Center performed testing and informed him he had
experienced multiple heart attacks, Plaintiff has not requested any records from it. (Id. at p. 10708). Plaintiff also testified that he does not possess any of his medical records. (Id. at pp. 7273).
Defendants also requested Plaintiff to identify any expert witness he intended to call at
trial through written interrogatories. (Doc. No. 24-1, Ex. 7). Plaintiff responded, “See Affidavit
of Evidence.” (Id.). However, the “Affidavit of Evidence” to which Plaintiff’s response refers
discloses no expert witnesses at all, and instead merely restates Plaintiff’s conclusory allegations
as to how he contends his rights have been violated. (Id.). While Plaintiff’s response does state
that he “intends to subpoena and/or doctors and/or affidavits and jail inmates named below,” no
such individuals are named. (Id.). Moreover, in response to Defendants’ request for documents
relating to Plaintiff’s expert witnesses, Plaintiff states “[t]he court has not ordered the expert jury
and medical witnesses to be provided yet.”7 (Id.). Without medical records or expert testimony,

Before Defendants’ service of its written discovery requests on Plaintiff, Plaintiff served on
defense counsel a document titled “Release of Documents 3rd Party Production F. R. Civ. P R.
26-37,” directed to “Mission Hospital Records” and “Doctor William T. Maddox” which states,
“Pursuant to the Rules of Federal Civil Practice your Petitioner Billy Edwards makes request for
the production of medical records and any notes thereof, of the cardiac medical care on or about
September 21st, 2015 and thereafter.” (Doc. No. 26-1, Ex. 1). Presumably, this is the Court’s
“Order” to which Plaintiff’s discovery response refers.
7 As to any contention that plaintiff has somehow effectively disclosed Dr. William Maddox as a
11
6

the only potential evidence on which Plaintiff can rely in support of his claim is his own
testimony. However, Plaintiff’s testimony about his alleged heart attack is not competent
evidence.
A nonexpert is not permitted to give expert testimony. See FED. R. EVID. 702. Rule
701(c) of the Federal Rules of Evidence only permits opinion testimony by lay witnesses when it
is not based on “scientific, technical, or other specialized knowledge.” FED. R. EVID. 701(c).
The diagnosis of a myocardial infarction is an issue requiring such specialized knowledge, which
Plaintiff lacks. (Doc. No. 24-1 at p. 10). Moreover, while Plaintiff’s testimony about physical
symptoms he experienced likely constitutes admissible evidence, his testimony purporting to
diagnose or assume the existence of a heart attack does not. Such testimony is inadmissible lay
opinion testimony. See FED. R. EVID. 701(c).
Last, Plaintiff’s testimony about allegedly being told he had been diagnosed with having
had a heart attack is inadmissible hearsay. See FED. R. EVID. 801(c), 802. Such statements were
allegedly made by Dr. Maddox and other declarants not testifying at trial, and they are offered
for the truth of the matter asserted in them. See FED. R. EVID. 801(c). In short, the sum total of
Plaintiff’s evidence as to whether he suffered from a heart attack or a serious of heart attacks
consists solely of alleged statements made by Dr. Maddox and unnamed persons at Murphy
Medical Center. (Doc. No. 24-1 at pp. 50, 107).

testifying expert, such conclusion is entirely inconsistent with Plaintiff’s deposition testimony.
Plaintiff testified he has written Dr. Maddox multiple times seeking confirmation that the doctor
was willing to testify on his behalf in court, but has received no response. (Doc. No. 24-1 at pp.
72-79). Additionally, Plaintiff testified he would also want the doctor who performed the stent
procedure to testify, but he does not know his identity. (Id. at p. 77). In any event, Plaintiff
testified that Dr. Maddox is the only medical doctor who stated to him that the alleged delay in
treatment caused him to suffer damage he would not have otherwise suffered. (Id. at p. 79).
12

Even if it were assumed that Plaintiff has successfully established that he suffered from a
heart attack or a series of heart attacks, he has presented no competent evidence in the record
showing the alleged delay in treatment for this condition resulted in any resultant harm or a
worsened condition.8 To survive summary judgment, an inmate asserting a deliberate
indifference claim “must produce evidence of a serious or significant physical injury resulting
from the challenged conditions.” Strickler v. Waters, 989 F.2d 1375 (4th Cir. 1993).
Intentionally delaying access to medical care may demonstrate deliberate indifference, but only
if the delay results in some substantial harm. See Webb v. Hamidullah, 281 Fed. Appx. 129, 166
& n.13 (4th Cir. 2008) (citing Sealock v. Colorado, 218 F.3d 1205, 1210 (10th Cir. 2000)).
To demonstrate this resulting injury, a deliberate indifference inmate who contends “that
delay in medical treatment rose to a constitutional violation must place verifying medical
evidence in the record to establish the detrimental effect of delay in medical treatment to
succeed.” Hill v. Dekalb Reg’l Youth Det. Ctr., 40 F.3d 1176, 1188 (11th Cir. 1994). To
withstand a motion for summary judgment, the non-moving party is required to forecast expert
medical evidence in order to show proof of causation—that is, whether the alleged delay in
treatment caused any injury. See Alberson v. Norris, 458 F.3d 762, 765-66 (8th Cir. 2006)
(“Where the complaint [asserting a Section 1983 claim for inadequate medical treatment]
involves treatment of a prison’s sophisticated medical condition, expert testimony is required to
show proof of causation.”). Without expert testimony pertaining to causation, a layperson cannot

8

The Court acknowledges that Plaintiff is pro se and also incarcerated, and his response is
entitled to a less stringent standard than a response filed by a licensed attorney. Hall v. Bellmon,
935 F.2d 1106, 1110 (10th Cir. 1991). This does not, however, excuse Plaintiff from the burden
of coming forward with evidence to support his claims as required by the Federal Rules of Civil
Procedure and this Court’s local rules. Furthermore, this Court may not assume the role of
advocate for a pro se litigant. Hall, 935 F.2d at 1110.
13

determine the nature of Plaintiff’s medical condition as it existed on September 19, 2015, the
available treatments for it, the probable medical outcomes for each such treatment, or the
detrimental effect, if any, of the alleged delay on those outcomes.9 An average juror has no basis
in common knowledge or ordinary experience to determine whether delays in treatment or other
factors caused or exacerbated the injury about which Plaintiff complains. It would be entirely
speculative for a jury to decide that a delay in transporting Plaintiff for medical care earlier
would have resulted in a different result.
As with the requirement of showing the existence of a serious medical question, the sum
of Plaintiff’s evidence as to whether the alleged delay in transporting him for medical attention
caused him any injury consists of statements allegedly made by Dr. Maddox, and Plaintiff’s own
opinions. Plaintiff testified that the day after he was admitted to Mission Hospital, testing was
performed and Dr. Maddox informed him that he had blockages in his coronary arteries. (Doc.
No. 24-1 at pp. 51-53, 107). Dr. Maddox advised him that he could perform heart surgery
(described as “some kind of bypass”), or alternatively, have stents inserted. (Id. at p. 53).
Plaintiff chose the stent procedure. (Id.). Indeed, Plaintiff testified that Dr. Maddox did not
actually perform the stent placement procedure—another doctor did—but Plaintiff cannot
remember this doctor’s name. (Id.). Plaintiff testified that following the stent procedure, Dr.
Maddox visited to check on him, and Plaintiff told Dr. Maddox that he was considering filing a
lawsuit over the delay in treatment he had experienced. (Id. at p. 54). According to Plaintiff, he
asked Dr. Maddox what he thought about his plans to sue, and Dr. Maddox responded that

9

Defendants note that, despite complaining about the alleged 10½ hour delay on September 19,
Plaintiff testified even after arriving at Mission Hospital the evening of September 19, he did not
undergo testing or the stent procedure until the next day. (Doc. No. 24-1 at p. 51-52, 107).
14

“excessive delay has caused you severe heart damage.” (Id. at pp. 54-55). The Complaint
alleges that Plaintiff’s “doctor reviewed the chart . . . and stated that due to the excessive delay in
[plaintiff] being given proper medical treatment [plaintiff] now suffer[s] from a severe heart
disease and this is a chronic condition.” (Doc. No. 1 ¶ IV(8)). Without objective medical
evidence, Plaintiff’s testimony about what Dr. Maddox allegedly told him about the medical
effect of the delay fails to sufficiently demonstrate causation. See Buchanan v. Kapur, No. 2:15
CV 5 CDP, 2017 WL 3978377, at *8 (E.D. Mo. Sept. 11, 2017) (where the plaintiff alleged that
a delay in treating her heart attack symptoms adversely affected her condition, stating that
“[Plaintiff’s] failure to provide verifying medical evidence of an adverse effect of delayed
diagnosis or treatment defeats the objective component of showing deliberate indifference”).
The Court recognizes that the Fourth Circuit Court of Appeals has stated that, in certain
circumstances, a deliberate indifference plaintiff does not need expert medical testimony to
survive summary judgment. In Scinto v. Stansberry, 841 F.3d 219 (4th Cir. 2016), the Fourth
Circuit held that expert testimony was not required in a deliberate indifference claim alleging
that prison officials deprived the plaintiff—a diabetic—of insulin. The court found that expert
testimony was not necessary to establish a deliberate indifference claim because the risk of
diabetes and the failure to provide insulin to a diabetic would be apparent even to laypersons. Id.
at 230. The facts in Scinto, however, are very different from the facts in this action. First,
unlike this case, in Scinto, “lengthy prison medical records” for plaintiff were in evidence
establishing a serious medical condition of a diabetes diagnosis that was “longstanding,
pervasive, well-documented, [and] expressly noted by prison officials,” including the defendant
doctor. Id. at 229 (citation omitted). Moreover, the Scinto court noted several supporting
decisions from other circuit courts pertaining to the precise factual circumstances present in that
15

case—prison officials depriving inmates diagnosed with diabetes of insulin—without requiring
the submission of expert testimony. Id. at 230 (citing various cases for the proposition that “it is
a ‘[w]ell-known’ fact that diabetes is a ‘common yet serious illness that can produce harmful
consequences if left untreated for even a short period of time’”). Finally, in Scinto, the Fourth
Circuit emphasized that a jury would be capable of understanding the risks of failing to provide
insulin to a diabetic and of a medical doctor’s denial of a “diabetic’s known need for insulin”
without the aid of expert testimony. Id.
By contrast to the facts in Scinto, there are no medical records in evidence in this case
and no prior diagnosis. Moreover, this case involves far more sophisticated medical issues than
those in Scinto which, without the aid of expert testimony, would result in pure conjecture by a
jury as to numerous complex medical questions about which there is no competent medical
evidence in the record and that are within the province of medical expert opinion. As
Defendants note, for instance, these questions include Plaintiff’s clinical medical condition on
September 19, 2015, at the following times: (1) when Plaintiff alleges he first requested medical
attention; (2) when inmate Goodson was transported instead of Plaintiff; (3) when Crane
returned from transporting Goodson; (4) when Plaintiff was told he would have to wait for
Officer Charlene West to arrive after her son’s midget football game; and (5) when he was
ultimately transported for medical attention. As Defendants note, the jury would be tasked with
answering these questions without the aid of expert testimony. Moreover, in answering these
questions, the jury would then be charged with the even more complex task of determining the
various treatment options for Plaintiff’s clinical condition at each of these times, along with the
risks and likely prognosis associated with each. Most critically, the jury would be tasked with
determining the likely medical outcome of the alleged delay in treatment and whether the delay
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was detrimental to an outcome absent the delay—an issue that is squarely within the province of
medical expert opinion, and for which Plaintiff has presented no objective medical evidence
whatsoever. That is, although Plaintiff alleges that his heart is irrevocably damaged because of
the delay, he has presented no objective medical evidence supporting this allegation.
Additionally, as noted by Defendants, the only evidence in the record on summary judgment as
to Plaintiff’s current condition shows that he has not seen another cardiologist or communicated
with Dr. Maddox since being treated by him in September 2015, and he currently takes only
aspirin. See (Doc. No. 24-1 at pp. 58, 66-67).
The Court further finds that even if the failure to produce any competent medical
evidence supporting his claim is overlooked, Plaintiff has still failed to forecast sufficient
evidence to survive summary judgment. Plaintiff’s allegations in his Complaint and his
deposition testimony demonstrates that he believes he should have been transported for medical
attention before Goodson—the inmate who fell and was transported for medical evaluation
before Plaintiff. He testified in his deposition that he was obviously the more ill inmate, that he
should have had priority over Goodson in being transported to the hospital, and that the medical
staff at the jail should have been better trained to recognize heart attack symptoms. See (Doc.
No. 24-1 at 95-96; 100-02; 113-14; 114-15). Even when viewed in the most favorable light to
him, Plaintiff’s evidence at best only supports a claim of negligence. Under Section 1983, this is
not enough. Furthermore, in opposing summary judgment, Plaintiff has submitted only his
sworn affidavit where he asserts, again, without any supporting medical evidence, that he
suffered injury to his heart because of the delay in treatment. (Doc. No. 29 at 2 (“What the
doctor told me was that if I had been promptly treated—aspirin/blood thinners, anti-blockers
would have could have prevented the major damage done to my heart caused by unexcusable
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delays in getting me to treatment.”)). He has also submitted an affidavit of a former fellow
inmate at the jail, who testified only that another inmate died in the jail at some point because of
the jail’s lack of medical attention. (Doc. No. 29-1). This evidence is not enough to raise a
genuine issue of material dispute as to whether Defendants were deliberately indifferent to
Plaintiff’s serious medical needs. Therefore, the moving Defendants are entitled to summary
judgment as to Plaintiff’s deliberate indifference claim.
IV.

CONCLUSION

In sum, for the reasons stated herein, the Court grants the summary judgment motion by
Defendants.
IT IS, THEREFORE, ORDERED that:
1. Defendants’ Motion for Summary Judgment, (Doc. No. 25), is GRANTED, and this
action is dismissed with prejudice.
2. The Clerk is respectfully instructed to terminate this action.

Signed: November 29, 2017

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