Case 4:17-cv-00214-MW-CAS Document 1 Filed 05/11/17 Page 1 of 51

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF FLORIDA
Tallahassee Division

CARL HOFFER,

)

RONALD MCPHERSON, and

)

ROLAND MOLINA,

)

individually and on behalf

)

of a Class of persons

)

similarly situated,

)

)

Plaintiffs,

)

)

v.

)

)

JULIE L. JONES, in her

)

official capacity as Secretary of the

)

Florida Department Corrections,

)

)

Defendant.

)

____________________________________)

Case No.

VERIFIED CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF
Preliminary Statement 1. The Florida Department of Correction (FDC) is refusing to provide lifesaving treatment to thousands of incarcerated people with hepatitis C. This policy, practice, and custom has resulted in the suffering and probable death of numerous prisoners, and puts tens of thousands of other prisoners at serious risk of experiencing pain, liver failure, cancer, and death—despite the fact that there are medications that will cure almost all hepatitis C patients with little to no side effects,

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and the fact that the medical standard of care requires treatment for all such patients. The failure to provide treatment also creates the potential for further spreading of the disease to the general public. These actions amount to deliberate indifference to the serious medical needs of FDC prisoners with hepatitis C, in violation of the Eighth Amendment to the United States Constitution, and discrimination on the basis of disability, in violation of the Americans with Disabilities Act and Rehabilitation Act. Accordingly, Plaintiffs seek declaratory and injunctive relief on behalf of all FDC prisoners with hepatitis C, so that they can receive the treatment that they desperately need.
Jurisdiction and Venue 2. Jurisdiction of this Court is invoked pursuant to 28 U.S.C. § 1331 in that this is a civil action arising under the Constitution of the United States. 3. Jurisdiction of the Court is invoked pursuant to 28 U.S.C. § 1343(a)(3) in that this action seeks to redress the deprivation, under color of state law, of rights secured to the Plaintiffs by the Constitution and laws of the United States. 4. Plaintiffs’ claims for relief are predicated, in part, upon 42 U.S.C. § 1983, which authorizes actions to redress the deprivation, under color of state law, of rights, privileges, and immunities secured by the Constitution and laws of the United States, and upon 42 U.S.C. § 1988, which authorizes the award of attorneys’
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fees and costs to prevailing plaintiffs in actions brought pursuant to 42 U.S.C. § 1983. Plaintiffs’ claims are also brought pursuant to the Americans with Disabilities Act (ADA), 42 U.S.C. § 12132, and the Rehabilitation Act (RA), 29 U.S.C. § 794, and pursuant to 42 U.S.C. § 12205, and 29 U.S.C. § 794a, which authorize an award of attorneys’ fees and costs to the prevailing plaintiffs.
5. Declaratory and injunctive relief are authorized by 28 U.S.C. §§ 2201 and 2202, as well as Federal Rule of Civil Procedure 65.
6. Venue is proper in this district pursuant to 28 U.S.C. §1391(b) and § 1391(c), as Defendant does business in this judicial district and division, and many of the events or omissions giving rise to the claims occurred in this judicial district and division.
7. Plaintiffs seek a preliminary and permanent injunction pursuant to Rule 65, Federal Rules of Civil Procedure.
Parties 8. Plaintiff Carl Hoffer is incarcerated in the FDC system, and was at all relevant times. He suffers from hepatitis C but has not been treated for it. 9. Plaintiff Ronald McPherson is incarcerated in the FDC system, and was at all relevant times. He suffers from hepatitis C but has not been treated for it.
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10. Plaintiff Roland Molina is incarcerated in the FDC system, and was at all relevant times. He suffers from hepatitis C but has not been treated for it.
11. Plaintiffs have exhausted all available administrative remedies. 12. Defendant Julie L. Jones is the Secretary of the Florida Department of Corrections (FDC). As such, she is responsible for the overall operation of the FDC, including the operation of Florida’s prison system and compliance with the Constitution and federal laws. Defendant Jones has a non-delegable duty to provide constitutionally adequate medical care to all persons in her custody. She is sued in her official capacity for injunctive and declaratory relief. Defendant Jones may be referred to herein as the Florida Department of Corrections or FDC. 13. Defendant Jones has statutory authority to implement the relief sought in the Compliant. See Fla. Stat. § 20.315. 14. The actions of Defendant Jones and her agents were performed under color of state law and constitute state action. 15. All staff members mentioned herein were employees or agents of Defendant and acted within the scope of their employment or agency at all relevant times.
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16. The FDC is a public entity under Title II of the ADA, and receives federal financial assistance within the meaning of the RA, and has at all relevant times.
General Factual Allegations Hepatitis C and Its Symptoms
17. Hepatitis C is a blood borne disease caused by the hepatitis C virus (HCV). The virus causes inflammation that damages liver cells, and is a leading cause of liver disease and liver transplants.
18. HCV is transmitted by infected blood via several methods, including intravenous drug use and tattooing using shared equipment, blood transfusions with infected blood (typically before regular screening of donated blood began), and sexual activity. Intravenous drug use is the most common means of HCV transmission in the United States.
19. HCV can be either acute or chronic. In people with acute HCV, the virus will spontaneously clear itself from the blood stream within six months of exposure. Chronic HCV, on the other hand, is defined as having a detectable HCV viral level in the blood at some point six months after exposure. Fifty-five to eightyfive percent of infected people will develop chronic HCV.
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20. Liver inflammation caused by chronic HCV can significantly impair liver function and damage its crucial role in digesting nutrients, filtering toxins from the blood, fighting infection, and conducting other metabolic processes in the body. Liver inflammation can also cause fatigue, weakness, muscle wasting, skin rashes, and arthritis.
21. People with chronic HCV develop fibrosis of the liver, a process by which healthy liver tissue is replaced with scarring. Scar tissue cannot perform the job of normal liver cells, so fibrosis reduces liver function and results in the same symptoms mentioned above, but with greater intensity. Fibrosis can also lead to hepatocellular carcinoma (liver cancer).
22. When scar tissue begins to take over most of the liver, this extensive fibrosis is termed cirrhosis. Of those with chronic HCV, the majority will develop chronic liver disease and approximately 20% will develop cirrhosis in a 20-year timeframe.
23. Cirrhosis causes additional painful complications, including widespread itching, kidney disease, jaundice, fluid retention with edema, internal bleeding, varices (enlarged veins that develop in the esophagus or intestines, which can burst), easy bruising, ascites (fluid accumulation in the legs and abdomen), encephalopathy (mental confusion and disorientation), lymph disorders, increased
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risk of infection, seizures, and extreme fatigue. Most of these complications can occur before cirrhosis. If they go untreated, some can cause death, often from infection, bleeding, and fluid accumulation.
24. Abdominal ascites can require paracentesis, a procedure wherein a needle is inserted into the abdomen to drain the fluid. Without this periodic procedure, the fluid accumulation can decrease the available space for the patient’s lungs, thus causing shortness of breath and difficulty breathing.
25. Moreover, once an HCV patient’s liver has cirrhosis, it may not be reversible. Some patients with cirrhosis may have too much scar tissue in the liver, even if the liver can heal to some degree once the virus is eliminated by treatment. If scar tissue persists, the patient may still experience the complications of cirrhosis, including liver cancer.
26. Cirrhosis that is accompanied by serious complications is known as decompensated cirrhosis. Cirrhosis without serious complications is called compensated cirrhosis.
27. Thus, HCV is a physiological disorder or condition that affects one or more body systems, including but not limited to the digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems, and is therefore a physical impairment. This physical impairment substantially limits one or more major life
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activity, including but not limited to eating, walking, bending, lifting, concentrating, thinking, and communicating; the operation of major bodily functions such as digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems; and the operation of the liver.
28. For all FDC prisoners who have been diagnosed with HCV, there is a record of their impairment.
29. The FDC regards all prisoners with HCV as having a physical impairment that substantially limits one or more major life activity.
30. HCV is a serious medical need. General Prevalence of Hepatitis C
31. Approximately 2.7 to 3.9 million Americans have chronic HCV. 32. In 2000, the United States Surgeon General called HCV a “silent epidemic,” and estimated that as much as two percent of the adult U.S. population had HCV. 33. In 2013, HCV caused more deaths than sixty other infectious diseases combined, including HIV, pneumococcal disease, and tuberculosis. 34. Approximately 19,000 people die of HCV-caused liver disease every year in the United States. 35. HCV is the leading indication for liver transplants in the United States.
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Hepatitis C in Prison 36. The prevalence of HCV in prison is much higher than in the general
population. It is estimated that between 16% and 41% of the United States jail and prison population has HCV. Thus, incarceration is a risk factor for HCV.
37. The FDC has reported to the media and researchers that 5,000 to 5,272 of its approximately 98,010 prisoners have HCV. As of August 8, 2016, the FDC listed 4,797 prisoners as having HCV in its internal records.
38. Because the FDC does not conduct routine opt-out testing for HCV, upon information and belief, FDC is undercounting the number of prisoners with HCV.
39. In fact, because it is estimated that between 16% and 41% of incarcerated people have HCV, it is likely that between 14,700 and 40,184 FDC prisoners have HCV. The true number is likely at the higher end of that spectrum because of the high prevalence of HCV in Florida: Between 2009 and 2013, rates of acute HCV in Florida increased by 133%. Standard of Care for HCV
40. For many years, there were no universally safe and effective treatments for HCV. The standard treatment prior to 2011, which included the use of interferon and ribavirin medications, sometime required injections, had a long treatment
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duration (up to 48 weeks), failed to cure most patients, and was associated with

numerous side effects, including psychiatric and autoimmune disorders, flulike

symptoms, gastrointestinal distress, skin rashes, and severe anemia. Moreover, not

all drug regimens worked for all types of HCV, and many could not be given to

patients with other comorbid diseases.

41. In 2011, however, the Food and Drug Administration (FDA) began

approving new oral medications, called direct-acting antiviral (DAA) drugs, which

have proven to work more quickly, cause fewer side effects, and treat chronic HCV

much more effectively. At first, they were designed to work in tandem with the old

treatment regimen. But beginning in 2013, the FDA began to approve DAA drugs

that can be taken alone.

42. These DAA drugs—currently Sovaldi (sofosbuvir), Olysio

(simeprevir),

Harvoni

(sofosbuvir/ledipasvir),

Viekira

Pak

(ombitasvir/paritaprevir/ritonavir/dasabuvir), Daklinza (daclatasvir), Technivie

(ombitasvir/paritaprevir/ritonavir), Zepatier (elbasvir/grazprevir), and Epclusa

(sofosbuvir/velpatasvir)—have far fewer side effects, dramatically greater efficacy,

a shorter treatment duration (12 weeks), and are administered orally (commonly a

once-daily pill) rather than by injections. They have truly revolutionized the way

HCV is treated.

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43. Most importantly, 90 to 95% of HCV patients treated with any of these DAA drugs are cured, whereas the old treatment regime only helped roughly one third of patients.
44. For HCV, a “cure” is defined as a sustained virologic response (SVR)— i.e., no detectable HCV genetic material in the patient’s blood—for three months following the end of treatment.
45. In response to the revolutionary DAA medications, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA) formed a panel of experts to conduct an extensive, evidence-based review of the testing, management, and treatment of HCV. The results of that review have been published in a comprehensive document called the HCV Guidance, which is updated regularly and is available at www.hcvguidelines.org. The Centers for Disease Control and Prevention (CDC) encourages health care professionals to follow the evidence-based standard of care developed by the IDSA/AASLD.
46. The IDSA/AASLD guidelines set forth the medical standard of care for the treatment of HCV, which is now well-established in the medical community.
47. The IDSA/AALSD panel, through the HCV Guidance, recommends immediate treatment with DAA drugs for all persons with chronic HCV. This is the
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standard of care for the treatment of HCV, and it reflects the continuing medical research showing the safety, tolerability, efficacy, and dramatic benefits of the DAA drugs.
48. The Florida Department of Children and Families (DCF), the agency responsible for administering the Medicaid program in Florida, recently confirmed that, in determining what is medically necessary and therefore covered by the Medicaid program, DAA medications for HCV should be approved for all adult patients with an HCV diagnosis. DCF also specifically eliminated any requirement that there be any evidence of hepatic fibrosis before covering treatment. Thus, DCF has recognized that the standard of care for HCV is to provide immediate treatment with DAA drugs to all patients with HCV, regardless of the stage of the disease.
49. Under this standard of care, treatment with DAA drugs is expected to cure nearly all infected persons.
50. The benefits of immediate treatment include immediate decrease in liver inflammation, reduction in the rate of progression of liver fibrosis, reduction in the likelihood of the manifestations of cirrhosis and associated complications, a 70% reduction in the risk of liver cancer, a 90% reduction in the risk of liver-related mortality, and a dramatic improvement in quality of life.
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51. Treatment must be provided timely to ensure efficacy. Delay in treatment increases the risk that the treatment will be ineffective. Screening, Diagnosis, and Monitoring of HCV
52. Under the IDSA/AASLD guidelines, all persons with risk factors for HCV infection should be offered testing for HCV. This includes all persons born between 1945 and 1965 and all persons who were ever incarcerated.
53. A person is generally diagnosed with HCV through a rapid blood test in which the blood is examined for HCV antibodies. A follow-up blood test determines whether the genetic material of HCV remains in the blood. A third blood test can determine which variation, or genotype, of HCV a person has.
54. Although the standard of care is to treat all persons with chronic HCV with DAA drugs, it is still useful to determine the progression of fibrosis and/or cirrhosis in the liver to choose the appropriate DAA drug, to treat other conditions or complications a person may be experiencing, to screen for liver cancer, to advise patients about contraindications and drugs to avoid, and to determine whether liver transplantation is necessary.
55. There are several methods used to determine the level of cirrhosis or fibrosis, along with an evaluation of the patient’s symptoms. One such method is a liver biopsy, which is a surgery wherein a small sample of liver tissue is removed
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and histologically assessed. A typical biopsy evaluation method is a system called Metavir, which assigns a number corresponding to the amount of scar tissue on the liver, with 0 meaning no fibrosis and 4 meaning severe fibrosis or cirrhosis. A score of 2 or greater is considered significant fibrosis. Liver biopsies are generally regarded as the most accurate measure of fibrosis and cirrhosis, but they are not routinely recommended because they are invasive and potentially dangerous, and also because they are generally unnecessary, as the standard of care is to treat all HCV patients, regardless of disease progression.
56. Other methods of assessing fibrosis and cirrhosis include blood tests, such as the APRI (AST to Platelet Ratio Index) score. This score is a ratio derived by comparing the level of an enzyme in the blood called aspartate aminotransferase (AST) with the usual amount of AST in the blood of a healthy person and the number of platelets in the affected person’s blood. Generally, an APRI score greater than 0.7 indicates significant fibrosis, and a score of 1.0 or greater indicates cirrhosis. But as explained below, a low APRI score does not necessarily indicate the absence of fibrosis.
57. Another blood test is called the FIB-4, which is a ratio derived using the level of two enzymes in the blood, AST and alanine aminotransferase (ALT), as well as platelet count and the person’s age.
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58. Standard ultrasounds or sonograms of the liver are unreliable indicators of the level of fibrosis, as advanced fibrosis may not be detected by these scans. But there is a more accurate version called FibroScan, which is a type of ultrasound known as transient elastography that uses sound waves to determine the amount of fibrosis present in the liver.
59. In assessing the level of fibrosis or cirrhosis, the entire clinical picture must be taken into account. There is no one blood test, scan, or symptom that will accurately determine the extent of liver damage, and therefore relying solely on strict numerical cutoffs of any test result is inappropriate. Any abnormal test result or symptom should be taken as a sign of fibrosis or cirrhosis, but normal results in isolation cannot rule out fibrosis or cirrhosis.
60. Relying solely on the APRI score to make treatment decisions is not adequate or appropriate because APRI has significant limitations. First, when an APRI score is extremely high, it has good diagnostic utility in predicting severe fibrosis or cirrhosis, but low and mid-range scores may miss many people who have significant fibrosis or cirrhosis. In fact, in more than 90% of HCV cases, an APRI score of at least 2.0 indicates that a person has cirrhosis, but more than half of people with cirrhosis will not have an APRI score of at least 2.0. Second, where a person has been diagnosed with cirrhosis or advanced fibrosis through some other means, a
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low APRI score does not negate the diagnosis—it should be presumed the patient has cirrhosis. Third, because AST levels fluctuate from day to day, a decreased or normalized level does not mean the condition has improved, and even a series of normal readings over time may fail to accurately show the level of fibrosis or cirrhosis.
61. A health care provider must also evaluate a patient’s symptoms and determine whether the liver disease is compensated or decompensated. Once liver disease has advanced, scoring of the clinical degree of liver dysfunction is done using the Childs-Pugh (C-P) score, also termed the Child-Turcotte-Pugh score (CPT). Variables include the serum albumin and bilirubin, ascites, encephalopathy, and prothrombin time (a measure of how well the blood clots). The score ranges from 5 to 15. Patients with a score of 5 or 6 have CPT class A cirrhosis (wellcompensated cirrhosis), those with a score of 7 to 9 have CPT class B cirrhosis (significant functional compromise), and those with a score of 10 to 15 have CPT class C cirrhosis (decompensated cirrhosis).
62. Once cirrhosis has developed, patients should also be followed with twice yearly alfa fetoprotein (AFP) screens, which is a serum marker for the development of liver cancer. Increases in AFP indicate the possible presence of liver cancer.
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63. Individuals with comorbid HIV (or other immune disorders) and HCV are at a much greater risk for more rapidly progressive liver disease, and should be treated and closely followed. FDC’s Unlawful Policy and Practice of Denying Treatment for HCV
64. Despite the clear agreement in the medical community that all persons with chronic HCV should be treated with DAA drugs, the FDC does not provide these lifesaving medications to FDC prisoners with HCV. Instead, Defendant has a policy, custom, and practice of not providing DAA medications to prisoners with HCV, in contravention of the prevailing standard of care and in deliberate indifference to the serious medical needs of prisoners with HCV.
65. This policy, practice, and custom has caused, and continues to cause, the unnecessary and wanton infliction of pain and an unreasonable risk of serious damage to the health of FDC prisoners with HCV.
66. Although Defendant has a policy governing the treatment of prisoners with HCV, which is outlined in Supplement #3 to Health Service Bulletin (HSB) 15.03.09 and was promulgated on June 27, 2016, in practice almost no prisoners receive DAA medications. Instead, Defendant simply enters the names of prisoners with known HCV infection into a database and enrolls them in a gastrointestinal
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clinic—which means blood draws are taken every six to twelve months—but does not actually treat them.
67. Although the HSB states that “all patients with chronic HCV infection may benefit from treatment,” it does not require treatment for anyone. Rather, the HSB recommends treatment based on priority levels.
68. In Priority Level 1 (“highest priority”) are patients with decompensated cirrhosis measured as a 7-9 on the CTP scale, liver transplant candidates or recipients, patients with hepatocellular carcinoma and other serious comorbid medical conditions, and patients on immunosuppressant medication. In Priority Level 2 (“high priority”) are patients with an APRI score greater than 2, advanced fibrosis shown on a liver biopsy, or other comorbid diseases and infections. In Priority Level 3 (“intermediate priority”) are patients with Stage 2 fibrosis shown on a liver biopsy, an APRI score greater than 1.5, and patients with porphyria or diabetes. In Priority Level 4 (“routine”) are patients with stage 1 fibrosis shown from a liver biopsy and all others with HCV infection. There is no further guidance in the policy regarding which priority levels receive treatment, or when. And again, despite this written policy of prioritization, in practice FDC provides almost no treatment with medications.
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69. Liver biopsies are generally not performed for FDC prisoners with HCV.
70. Because the standard of care is to treat everyone, without regard to the stage of the disease, Defendant’s written policy (even if it was followed) of only providing treatment to patients with the most advanced stages of the disease amounts to deliberate indifference to serious medical needs, in violation of the Eighth Amendment. It is not consistent with the standard of care. Delaying treatment until a patient is extremely sick has the perverse effect of withholding treatment from the patients who could benefit the most from it, because the treatment is less effective for patients with the most advanced stages of the disease.
71. But even if the policy were adequate, the FDC does not follow it because it provides treatment to almost none of the HCV-positive prisoners in its custody. Indeed, despite the fact that Defendant knows of at least 4,790 patients with chronic HCV, as of July 6, 2016, Defendant has treated only five with DAA drugs. Upon information and belief, Defendant also knows, based on national estimates and the fact that FDC does not routinely test for HCV, that it is very likely that at least 14,700, and as many as 40,184 FDC prisoners have HCV.
72. In fact, the FDC’s treatment rate is among the lowest in the country for which there is reported data.
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73. And since 2013, the year the FDA approved DAA medications that cure HCV, at least 160 FDC prisoners have died of chronic liver disease, cirrhosis, and other diseases of the digestive system. Since HCV is the most common cause of liver failure in the United States, it is likely that most of these deaths were due to chronic HCV. Upon information and belief, past and current practices of the Defendant are resulting in deaths that could have been prevented through treatment of HCV.
74. Furthermore, assuming that prioritization were appropriate, Defendant’s policy is also inadequate because it relies on strict numerical cutoffs (and almost exclusively on the APRI score) rather than a holistic evaluation of the entire clinical picture to determine the level of fibrosis.
75. And assuming that using numerical cutoffs were appropriate, FDC has set them so high that it precludes treatment for all but the most advanced cases of cirrhosis and fibrosis.
76. Further, assuming that numerical cutoffs were appropriate and were set at appropriate levels, FDC is not even following them. Of the 4,790 patients identified by FDC as having chronic HCV, an analysis of their APRI scores and platelet counts indicates that almost 400 have probable cirrhosis, over 1,000 likely have advanced fibrosis, and over 1,700 likely have significant fibrosis. At the very
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least, all of these prisoners should receive treatment. Yet, only five have been treated.
77. The FDC also unjustifiably delays providing HCV treatment, even though the standard of care requires treatment as early as possible. If DAA treatment is delayed until a patient has advanced fibrosis or cirrhosis (generally, the first two FDC priority levels), these medications can be significantly less effective. Moreover, if DAA treatment is delayed until a patient develops decompensated cirrhosis (generally, the first FDC priority level), a liver transplant preceded or followed by DAA treatment is the only way to cure the patient.
78. In practice, the FDC delays treatment for virtually all patients with HCV, regardless of their disease progression, until the patient is released from prison or dies.
79. Moreover, Defendant’s policy does not address liver transplantation, the only possible cure for people with decompensated cirrhosis. Even if given DAA treatment, many of these patients will likely die without liver transplants.
80. Defendant’s policy does not address the need for liver cancer screening, which is standard medical practice once individuals have progressed to advanced fibrosis or cirrhosis. Unless there is regular surveillance to find cancers early and remove them surgically, liver cancer has a very dismal prognosis. Contrary to the
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proper and necessary medical procedures and the community standard of care, Defendant has not been screening Plaintiffs, and, upon information and belief, other HCV-positive FDC prisoners with advanced fibrosis and cirrhosis, for liver cancer.
81. The HSB does not include routine opt-out testing for HCV (i.e., requiring the test unless the prisoner affirmatively opts out). Thus, FDC does not know the full number of FDC prisoners who have HCV, even though, upon information and belief, it knows the number to be much higher based on national estimates.
82. Defendant categorically withholds treatment from FDC prisoners with HCV, but does not categorically withhold treatment from prisoners with other similar diseases or conditions (such as HIV) or from other prisoners without similar diseases or conditions.
83. The FDC has enforced the above-described policies, practices, and customs despite knowing that the failure to provide DAA medications to prisoners with HCV subjects those prisoners to an unreasonable risk of pain, liver failure, cancer, permanent damage to their health, and even death. Defendant has acted with deliberate indifference to the serious medical needs of FDC prisoners with chronic HCV.
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84. Defendant will continue its course of conduct unless enjoined by this Court. Plaintiffs have no adequate remedy at law. Public Health Benefits of Treatment in Prison
85. Providing expanded HCV screening and DAA treatment in Florida’s prisons would greatly reduce the number of new HCV cases in the community. Curing the disease while people are in prison would prevent prisoners from transmitting it when released, and testing would diagnose numerous individuals who were unaware they were infected, thus allowing them to seek treatment once released.
86. Studies have shown that providing DAA treatment to everyone with chronic HCV increases long term cost-savings. One study even found that restricting DAA treatment access until patients were in the later stages of fibrosis actually results in higher per-patient costs because, while it may be initially less expensive to delay administering DAAs, over the course of treatment, the follow-up care outweighs the initial costs.
87. Thus, early DAA treatment has the potential to both drastically reduce the incidence of HCV in the general population and also to reduce the costs associated with serious complications from untreated HCV, such as liver transplants and liver cancer.
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Allegations Regarding Named Plaintiffs Plaintiff Carl Hoffer
88. Plaintiff Carl Hoffer has been incarcerated in the FDC system since 1988. He is 70 years old. He has chronic HCV and decompensated cirrhosis.
89. His chronic HCV is a physiological disorder or condition that affects one or more of his body systems, including but not limited to the digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems, and is therefore a physical impairment. This physical impairment substantially limits one or more major life activity, including but not limited to walking, bending, sitting, lifting, and thinking; the operation of major bodily functions such as his digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems; and the operation of his liver.
90. Mr. Hoffer has a record of having an impairment that substantially limits one or more major life activity, as he has a history of such an impairment, and the FDC has diagnosed him with HCV, records some of his symptoms in his medical records, and has enrolled him in the gastrointestinal chronic illness clinic.
91. Mr. Hoffer is regarded by FDC as has having an impairment that substantially limits one or more major life activity, as FDC perceives him as having such an impairment, has diagnosed him with HCV, records some of his symptoms
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in his medical records, and has enrolled him in the gastrointestinal chronic illness clinic.
92. Mr. Hoffer meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by FDC, including but not limited to medical services.
93. Mr. Hoffer first learned he had contracted HCV around 1999, while at Florida State Prison. Mr. Hoffer requested treatment for HCV then, and was told that he did not meet the requirements for treatment.
94. Mr. Hoffer continued to request treatment at every annual checkup, but to no avail. He was told that he was not sick enough to be treated.
95. About eight years ago, while at Jackson Correctional Institution, Mr. Hoffer noticed that his ankles and calves were beginning to swell painfully. Chronic swelling of the legs and feet is a symptom of HCV.
96. Mr. Hoffer repeatedly requested treatment for this painful swelling and for HCV, but his requests were ignored. His condition continued to worsen.
97. In May and June of 2015, Mr. Hoffer’s feet, ankles, calves, knees, thighs, testicles, and stomach became painfully swollen. His shins were cracked and leaking white liquid.
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98. In June of 2015, FDC staff transferred Mr. Hoffer to the prison clinic, where he was put on antibiotics and a liquid diet. He had developed severe ascites. Mr. Hoffer remained there for approximately 28 days until his symptoms diminished.
99. Since then, while housed at Suwanee Correctional Institution, two doctors have told Mr. Hoffer that they would recommend treatment for him for HCV. However, he has never received treatment for HCV.
100. Mr. Hoffer has filed numerous grievances, complaining of his symptoms and requesting treatment, and appealed them to the Defendant Secretary’s Office, yet they have all been denied.
101. In August of 2016, Mr. Hoffer was sent to the emergency room at Memorial Hospital Jacksonville. He was diagnosed with ascites, cirrhosis of the liver, and chronic hepatitis C. Paracentesis was performed to drain the fluid, and Mr. Hoffer stayed in the hospital for 19 days.
102. Mr. Hoffer’s condition has continued to worsen. His feet, ankles, and calves are swelling again. His liver is failing. Further grievances have been denied.
103. Mr. Hoffer uses a wheelchair because of the swelling and pain associated with end stage liver disease caused by HCV. Sometimes it hurts Mr.
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Hoffer to walk or even just to sit. Mr. Hoffer also has problems remembering names, facts, and people. Mental confusion is associated with late-stage HCV.
104. If Mr. Hoffer does not receive treatment for HCV, he will likely die of liver disease. He has an approximately 10% chance of dying each year. Mr. Hoffer needs a liver transplant and DAA treatment to save his life.
105. Despite all of this, FDC’s response to Mr. Hoffer’s latest grievance, signed April 11, 2017, by the FDC Health Services Director, states that his “treatment is being deferred at this time until it becomes clinically indicated.”
106. The FDC’s deliberate indifference to Mr. Hoffer’s serious medical needs caused his liver to decompensate as early as June 2014, and his condition has been getting worse ever since. Despite Mr. Hoffer being so sick that he now qualifies as “Priority 1” for HCV treatment under FDC’s own guidelines, he continues to be denied treatment.
107. He will continue to suffer, and will likely die of liver disease, unless he receives the DAA drug treatment and a liver transplant.
Plaintiff Ronald McPherson 108. Ronald McPherson has been incarcerated in the FDC system since July of 2013. He is 53 years old. He has chronic HCV.
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109. His chronic HCV is a physiological disorder or condition that affects one or more of his body systems, including but not limited to the digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems, and is therefore a physical impairment. This physical impairment substantially limits one or more major life activity, including but not limited to performing manual tasks, walking, bending, lifting, concentrating, working, and eating; the operation of major bodily functions such as his digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems; and the operation of his liver.
110. Mr. McPherson has a record of having an impairment that substantially limits one or more major life activity, as he has a history of such an impairment, and the FDC has diagnosed him with HCV, records some of his symptoms in his medical records, and has enrolled him in the gastrointestinal chronic illness clinic.
111. Mr. McPherson is regarded by FDC as has having an impairment that substantially limits one or more major life activity, as FDC perceives him as having such an impairment, has diagnosed him with HCV, records some of his symptoms in his medical records, and has enrolled him in the gastrointestinal chronic illness clinic.
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112. Mr. McPherson meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by FDC, including but not limited to medical services.
113. At his initial physical exam in prison in July of 2013, Mr. McPherson reported to medical staff that he had HIV and HCV. Subsequent tests at Reception and Medical Center in Lake Butler confirmed this. He receives treatment for HIV, which is well-controlled.
114. Mr. McPherson has not been seen by an HCV specialist since being incarcerated in July of 2013. He has not been informed by FDC medical staff about the stage of his HCV.
115. Beginning in May of 2014 and continuing through the present, Mr. McPherson has filed numerous grievances and appeals, complaining about his HCV related symptoms and requesting treatment. They have all been denied.
116. Mr. McPherson experiences acute weakness, dizziness, chest pains, muscular spasms, nausea, and memory loss. He is anemic and bruises easily. He has difficulty eating due to his medical condition. His lab tests and medical records indicate that he has cirrhosis and is likely in liver failure.
117. In August of 2016, Nurse Juliann Dwares recommended that Mr. McPherson be treated with Harvoni (a DAA drug) for twelve weeks, due to his
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genotype, low platelet levels, APRI score of over 2.0, and HIV co-infection. But he never received the treatment.
118. In December of 2016 or January of 2017, Mr. McPherson filed another formal grievance asking for HCV treatment. It was denied and Mr. McPherson filed a timely appeal.
119. On February 10, 2017, Mr. McPherson was seen by Nurse Dwares at Columbia Correctional Institution. She again recommended that Mr. McPherson be treated for HCV.
120. On February 13, 2017, Mr. McPherson was seen by Dr. Cruz at Baker Correctional Institution. Dr. Cruz did not refer Mr. McPherson for HCV treatment and said that the only thing they would do is continue monitoring his illness. Dr. Cruz “recommended” that Mr. McPherson avoid injuries in order to maintain his health.
121. In the last six months, Mr. McPherson has passed out four times. His platelet levels are dangerously low, as is his pulse. Mr. McPherson’s blood doesn’t clot properly.
122. Despite the recommendations for DAA medication, Mr. McPherson has still not received HCV treatment. The delay in treating Mr. McPherson’s HCV has
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caused cirrhosis of his liver and has significantly decreased the possibility that the DAA drugs (if given to him) will be effective.
123. The FDC’s deliberate indifference to Mr. McPherson’s serious medical needs caused his quality of life to substantially deteriorate, has likely caused his liver to fail, and has caused him to experience the numerous symptoms described above. He is at risk for developing further symptoms, further advanced liver failure, and even death. He may not survive his five-year prison sentence. Despite Mr. McPherson qualifying for HCV treatment under FDC’s own guidelines, he continues to be denied treatment.
124. He will continue to suffer, and his liver disease will continue to advance, unless he receives the DAA drug treatment.
Plaintiff Roland Molina 125. Roland Molina has been incarcerated in the FDC system since 2004. He is 51 years old. He has chronic HCV, which he contracted by donating blood. 126. His chronic HCV is a physiological disorder or condition that affects one or more of his body systems, including but not limited to the digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems, and is therefore a physical impairment. This physical impairment substantially limits one or more major life activity, including but not limited walking and standing; the
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operation of major bodily functions such as his digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems; and the operation of his liver.
127. Mr. Molina has a record of having an impairment that substantially limits one or more major life activity, as he has a history of such an impairment, and the FDC has diagnosed him with HCV, records some of his symptoms in his medical records, and has enrolled him in the gastrointestinal chronic illness clinic.
128. Mr. Molina is regarded by FDC as has having an impairment that substantially limits one or more major life activity, as FDC perceives him as having such an impairment, has diagnosed him with HCV, records some of his symptoms in his medical records, and has enrolled him in the gastrointestinal chronic illness clinic.
129. Mr. Molina meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by FDC, including but not limited to medical services.
130. In January of 2013, Mr. Molina told FDC staff that he had been diagnosed with hepatitis 15 year ago. A hepatitis panel was ordered and Mr. Molina was diagnosed with HCV. Thereafter, FDC staff began monitoring Mr. Molina’s HCV through biannual blood draws, but has not treated his underlying disease.
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131. Mr. Molina has suffered from abnormally low platelet levels since at least 2013, caused by his untreated HCV. The low platelet levels have caused Mr. Molina to have surface bleeding, which can be seen in red blotches just underneath his skin. The condition is very painful. On a scale of one to ten, Mr. Molina would rate it a seven or eight. Mr. Molina also bruises very easily.
132. Mr. Molina’s platelet levels were so dangerously low in February of 2015 that the doctor had to order Prednisone. That caused his platelet levels to increase slightly, but within a couple of months they were at dangerously low levels again.
133. In January 2016, Mr. Molina filed a grievance asking for HCV treatment, but it was denied. He appealed the denial, but it was also denied.
134. In May of 2016, Mr. Molina’s labs indicated his APRI score was 2.652, indicating cirrhosis.
135. Mr. Molina should be found eligible for treatment under the FDC’s own guidelines due to his low platelet levels and APRI scores, which indicate liver cirrhosis.
136. In addition to suffering from surface bleeding and jaundice, Mr. Molina gets easily tired. Mr. Molina is only 51 years old and has always exercised and taken
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care of himself. However, his doctor has told him not to exercise due to his low platelet levels.
137. Mr. Molina suffers from numbness and a brown discoloration in his legs, feet, and toes. A nurse told Mr. Molina that he has cryoglobulinemia, a complication of HCV. Mr. Molina experiences severe pain through his legs, feet, and toes. The pain is constant and on a scale of one to ten, it sometimes reaches a ten.
138. The FDC’s deliberate indifference to Mr. Molina’s serious medical needs caused his quality of life to substantially deteriorate and his liver to be scarred with cirrhosis. He suffers from the above symptoms and is at serious risk for developing more symptoms, and experiencing further serious liver failure and death. Despite Mr. Molina qualifying for HCV treatment under FDC’s own guidelines, he continues to be denied treatment.
139. He will continue to suffer, and his liver disease will continue to advance, unless he receives the DAA drug treatment.
Class Action Allegations 140. Pursuant to Federal Rule of Civil Procedure 23(b)(2), Plaintiffs seek to certify a class of all current and future prisoners in FDC custody who have been diagnosed, or will be diagnosed, with chronic HCV (the “Plaintiff Class”).
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141. Upon information and belief, Defendant has the ability to identify all such similarly situated class members, through medical and other records in Defendant’s possession.
142. The requirements of Rule 23(a) are satisfied: a. Numerosity. The class is so numerous that joinder of all members is
impracticable. The FDC has identified approximately 5,000 FDC prisoners with HCV. But national estimates suggest there are likely at least 14,700 FDC prisoners with HCV, and as many as 40,184.
b. Commonality. There are questions of law or fact common to the class, including but not limited to: 1) whether HCV is a serious medical need; 2) whether Defendant’s policy and practice of not providing HCV treatment constitutes deliberate indifference to serious medical needs in violation of the Eight Amendment; 3) whether Defendant has knowingly failed to provide the necessary staging of HCV patients in accordance with the prevailing standard of care, including the pretreatment testing to determine the severity of the disease; 4) whether Defendant has knowingly employed policies and practices that unjustifiably delay or deny treatment for HCV; 5) whether Defendant has permitted cost considerations to improperly interfere with the treatment of HCV; 6) whether HCV is a disability under the ADA; 7) whether medical
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services in prison are a program or service under the ADA; and 8) whether Defendant has discriminated against FDC prisoners with HCV on the basis of their disability by categorically denying them medical treatment, while providing treatment for other diseases and conditions such as HIV.
c. Typicality. The claims or defenses of the class representatives are typical of the claims or defenses of the class. The class representatives have been diagnosed with chronic HCV but have been refused treatment, and suffer from the same kind of complications and substantial risk of serious harm that the class members suffer from.
d. Adequacy. The class representatives and class counsel will fairly and adequately protect the interests of the class. The class representatives are committed to obtaining declaratory and injunctive relief that will benefit themselves as well as the class by ending Defendant’s unconstitutional policy and practice. Their interests are consistent with and not antagonistic to the interests of the class. They have a strong personal interest in the outcome of this case and have no conflicts with class members. They are represented by experienced counsel who specialize in civil rights and class action litigation on behalf of prisoners.
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143. The requirements of Rule 23(b)(2) are satisfied, as the party opposing the class has acted and refused to act on grounds generally applicable to the class so that final declaratory and injunctive relief would be appropriate to the class as a whole. Injunctive relief will end the policy and practice for all class members, allowing them to receive proper medical evaluation and treatment for HCV.
CAUSES OF ACTION COUNT I
Eighth Amendment to the U.S. Constitution via 42 U.S.C. § 1983
144. Defendant and its policymakers know about and enforce the policies and practices described herein. Defendant and its policymakers know of Plaintiffs’ and the Plaintiff Class’s serious medical needs, yet Defendant has intentionally failed and refused to provide treatment that will address those serious medical needs, knowing that those actions have resulted, and will continue to result, in Plaintiffs and the Plaintiff Class’s continued suffering and exposure to liver failure and its symptoms, liver cancer, and death.
145. Defendant has caused the wanton infliction of pain upon FDC prisoners with HCV, and has exhibited deliberate indifference to the serious medical needs of Plaintiffs and the Plaintiff Class, in violation of the Eighth Amendment.
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146. Defendant knows, and has known, of the substantial risk of serious harm, and actual harms, faced by FDC prisoners with chronic HCV. Yet Defendant has disregarded, and continues to disregard, those risks and harms by failing to provide the very medication that would alleviate those risks and harms. Defendant has been deliberately indifferent to the substantial risk of serious harm to FDC prisoners with chronic HCV.
147. By denying Plaintiffs and the Plaintiff Class their medically needed HCV treatment, Defendant has imposed punishment far in excess of that authorized by law, contrary to the Eighth Amendment.
148. Defendant’s denial of Plaintiffs and the Plaintiff Class’s medically necessary HCV treatment violates all standards of decency, contrary to the Eighth Amendment.
149. Defendant’s actions with respect to Plaintiffs and the Plaintiff Class amount to grossly inadequate care.
150. Defendant’s actions with respect to Plaintiffs and the Plaintiff Class is medical care so cursory as to amount to no medical care at all.
151. As a direct and proximate cause of this pattern, practice, policy, and deliberate indifference, Plaintiffs and the Plaintiff Class have suffered, and continue
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to suffer from harm and violation of their Eighth Amendment rights. These harms will continue unless enjoined by this Court.
COUNT II Americans with Disabilities Act, 42 U.S.C. § 12131, et seq. 152. This count is brought under Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. § 12101, et seq. and 42. U.S.C. § 12131 – 12134, and its implementing regulations. 153. Defendant FDC is a “public entity” within the meaning of 42 U.S.C. § 12131(1) and 28 C.F.R. § 35.104. 154. All Plaintiffs and the Plaintiff Class have chronic HCV, which is a physiological disorder or condition that affects one or more body systems, including but not limited to the digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems, and is therefore a physical impairment. 42 U.S.C. § 12102(1) & (2); 28 C.F.R. § 35.108(a) & (b). This physical impairment substantially limits one or more major life activity, including but not limited to eating, walking, bending, lifting, concentrating, thinking, and communicating; the operation of major bodily functions such as digestive, gastrointestinal, immune, circulatory, cardiovascular, and hemic systems; and the operation of the liver. 42 U.S.C. § 12102(2); 28 C.F.R. § 35.108(c).
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155. All Plaintiffs and the Plaintiff Class have a record of having an impairment that substantially limits one or more major life activity, as they have a history of such an impairment. 42 U.S.C. § 12102(1)(B); 28 C.F.R. § 35.108(a)(1)(ii) & (e).
156. All Plaintiffs and the Plaintiff Class are regarded by FDC as has having an impairment that substantially limits one or more major life activity, as FDC perceives them as having such an impairment. 42 U.S.C. § 12102(1)(C) & (3); 28 C.F.R. § 35.108(a)(1)(iii) & (f). Defendant FDC has subjected them to a prohibited action because of an actual or perceived physical impairment.
157. All Plaintiffs and the Plaintiff Class are qualified individuals with a disability because they meet the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by FDC, including but not limited to medical services. 42 U.S.C. § 12131(2); 28 C.F.R. § 35.104.
158. By withholding medical treatment from those with HCV, but not withholding medical treatment from those with other disabilities or those who are not disabled, Defendant FDC excludes Plaintiffs and the Plaintiff Class from participation in, and denies them the benefits of FDC services, programs, and activities (such as medical services), by reason of their disability. 42 U.S.C. § 12132; 28 C.F.R. § 35.130(a).
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159. By withholding medical treatment from those with HCV, but not withholding medical treatment from those with other disabilities or those who are not disabled, Defendant FDC subjects Plaintiffs and the Plaintiff Class to discrimination. 42 U.S.C. § 12132; 28 C.F.R. § 35.130(a).
160. Defendant FDC fails to provide Plaintiffs and the Plaintiff Class with equal access and enjoyment of effective medical services. 28 C.F.R. § 35.130(b)(1).
161. Defendant FDC utilizes criteria or methods of administration that have the effect of subjecting Plaintiffs and the Plaintiff Class to discrimination and that defeat or substantially impair accomplishment of the objectives of medical treatment for HCV. 28 C.F.R. § 35.130(b)(3).
162. Defendant has known about the violations noted herein but has failed to correct them, thereby exhibiting deliberate indifference to the rights of Plaintiffs and the Plaintiff Class.
163. As a direct and proximate cause of these actions and omissions, Plaintiffs and the Plaintiff Class have suffered and continue to suffer from harm and violation of their ADA rights. These harms will continue unless enjoined by this Court.
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COUNT III Rehabilitation Act, 29 U.S.C. §§ 791 – 794a 164. This count is brought under Section 504 of the Rehabilitation Act (RA), 29 U.S.C. § 701, et seq. and 29 U.S.C. §§ 791 – 794, et seq., and it implementing regulations. 165. Defendant FDC is a program or activity receiving federal financial assistance. 29 U.S.C. § 794. 166. Defendant FDC excludes Plaintiffs and the Plaintiff Class—all qualified individuals with disabilities—from participation in, and denies those individuals the benefits of programs or activities, solely by reason of the individuals’ disabilities. 29 U.S.C. § 794(a); 28 C.F.R. § 42.503(a). 167. Defendant FDC subjects Plaintiffs and the Plaintiff Class—all qualified individuals with disabilities—to discrimination. 29 U.S.C. § 794(a). 168. Defendant FDC denies Plaintiffs and the Plaintiff Class—all qualified handicapped persons—the opportunity accorded others to participate in programs or activities. 28 C.F.R. § 42.503(b)(1). 169. Defendant FDC utilizes criteria or methods of administration that either purposely or in effect discriminate on the basis of handicap, and defeat or substantially impair accomplishment of the objectives of Defendant’s programs or activities with respect to handicapped persons. 28 C.F.R. § 42.503(b)(3).
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170. Defendant has known about the violations noted herein but has failed to correct them, thereby exhibiting deliberate indifference to the rights of Plaintiffs and the Plaintiff Class.
171. As a direct and proximate cause of this exclusion, Plaintiffs and the Plaintiff Class have suffered and continue to suffer from harm and violation of their RA rights. These harms will continue unless enjoined by this Court.
PRAYER FOR RELIEF WHEREFORE, Plaintiffs demand the following relief:
A. An order certifying this case as a class action, with the class defined under Rule 23(b)(2) as all current and future prisoners in FDC custody who have been, or will be, diagnosed with chronic HCV.
B. A judgment declaring that the Defendant has exhibited deliberate indifference to the serious medical needs of Plaintiffs and the Plaintiff Class and have violated Plaintiffs and the Plaintiff Class’s right to be free from Cruel and Unusual Punishment, as secured by the Eighth Amendment to the U.S. Constitution;
C. A judgment declaring that Defendant has violated the rights of Plaintiffs and the Plaintiff Class under the Americans with Disabilities Act and the Rehabilitation Act;
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D. A preliminary and permanent injunction ordering Defendant to, among other things, 1) immediately provide direct-acting antiviral medications to Plaintiffs Carl Hoffer, Ronald McPherson, and Roland Molina, 2) immediately place Plaintiff Carl Hoffer on a liver transplant list, and 3) develop and adhere to a plan to provide direct-acting antiviral medications to all FDC prisoners with chronic HCV, consistent with the standard of care;
E. A preliminary and permanent injunction requiring Defendant to, among other things, 1) properly screen, evaluate, monitor, and stage FDC prisoners with HCV (including screening for liver cancer where appropriate); 2) provide routine opt-out testing for HCV to all FDC prisoners; 3) develop and adhere to a policy allowing FDC prisoners with chronic HCV to obtain liver transplants if needed; and 4) modify the exclusions from HCV treatment based on life expectancy and time remaining on sentence to reflect an appropriate individual assessment;
F. An order enjoining Defendant from taking any action to interfere with Plaintiffs’ right to maintain this action, or from retaliating in any way against Plaintiffs for bringing this action;
G. An order retaining jurisdiction over this matter to ensure that the terms of any injunction are fully implemented;
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H. An award of Plaintiffs’ attorneys’ fees, costs, and litigation
expenses under 42 U.S.C. § 12205, 29 U.S.C. § 794a, and 42 U.S.C. § 1988;
and
I. Such other relief as the Court may deem equitable and just under
the circumstances.
Respectfully submitted,
Randall C. Berg, Jr., Esq. Fla. Bar No. 0318371 RBerg@FloridaJusticeInstitute.org Dante P. Trevisani, Esq. Florida Bar No. 72912 DTrevisani@FloridaJusticeInstitute.org Erica Selig, Esq. ESelig@FloridaJusticeInstitute.org Florida Bar No. 120581 FLORIDA JUSTICE INSTITUTE, INC. 100 S.E. 2nd Street 3750 Miami Tower Miami, Florida 33131-2309 305-358-2081 305-358-0910 (FAX)
By: s/Randall C. Berg. Jr. Randall C. Berg, Jr., Esq.
s/Dante P. Trevisani Dante P. Trevisani, Esq.
s/Erica Selig Erica Selig, Esq.
Attorneys for Plaintiffs -45-

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UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

Tallahassee Division

_________________________________

CARL HOFFER,

)

RONALD MCPHERSON, and

)

ROLAND MOLINA,

)

individually and on behalf

)

of a Class of persons

)

similarly situated,

)

)

Plaintiffs,

)

)

v.

) Case No.

)

JULIE L. JONES, in her

)

official capacity as Secretary of the

)

Florida Department Corrections,

)

)

Defendant.

)

____________________________________)

DECLARATION OF CARL HOFFER

I, Carl Hoffer, pursuant to 28 U.S.C. § 1746, make this Unsworn Declaration Under Penalty of Perjury, and declare that the statements made below are true, and state:

My name is Carl Hoffer. I have reviewed the Verified Complaint set forth above and I find the facts contained therein which pertain to me to be true and accurate to the best of my knowledge and belief.

{07145990;1}

Case 4:17-cv-00214-MW-CAS Document 1 Filed 05/11/17 Page 47 of 51

I understand that a false statement in this declaration will subject me to penalties for perjury.
I declare under penalty of perjury that the foregoing is true and correct.

Date: May 10, 2017

s/ Carl Hoffer Carl Hoffer

{07145990;1}

Case 4:17-cv-00214-MW-CAS Document 1 Filed 05/11/17 Page 48 of 51

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

Tallahassee Division

_________________________________

CARL HOFFER,

)

RONALD MCPHERSON, and

)

ROLAND MOLINA,

)

individually and on behalf

)

of a Class of persons

)

similarly situated,

)

)

Plaintiffs,

)

)

v.

) Case No.

)

JULIE L. JONES, in her

)

official capacity as Secretary of the

)

Florida Department Corrections,

)

)

Defendant.

)

____________________________________)

DECLARATION OF RONALD MCPHERSON

I, Ronald McPherson, pursuant to 28 U.S.C. § 1746, make this Unsworn Declaration Under Penalty of Perjury, and declare that the statements made below are true, and state:

My name is Ronald McPherson. I have reviewed the Verified Complaint set forth above and I find the facts contained therein which pertain to me to be true and accurate to the best of my knowledge and belief.

{07145993;1}

Case 4:17-cv-00214-MW-CAS Document 1 Filed 05/11/17 Page 49 of 51

I understand that a false statement in this declaration will subject me to penalties for perjury.
I declare under penalty of perjury that the foregoing is true and correct.

Date: May 10, 2017

s/Ronald McPherson Ronald McPherson

{07145993;1}

Case 4:17-cv-00214-MW-CAS Document 1 Filed 05/11/17 Page 50 of 51

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

Tallahassee Division

_________________________________

CARL HOFFER,

)

RONALD MCPHERSON, and

)

ROLAND MOLINA,

)

individually and on behalf

)

of a Class of persons

)

similarly situated,

)

)

Plaintiffs,

)

)

v.

) Case No.

)

JULIE L. JONES, in her

)

official capacity as Secretary of the

)

Florida Department Corrections,

)

)

Defendant.

)

____________________________________)

DECLARATION OF ROLAND MOLINA

I, Roland Molina, pursuant to 28 U.S.C. § 1746, make this Unsworn Declaration Under Penalty of Perjury, and declare that the statements made below are true, and state:

My name is Roland Molina. I have reviewed the Verified Complaint set forth above and I find the facts contained therein which pertain to me to be true and accurate to the best of my knowledge and belief.

{07145994;1}

Case 4:17-cv-00214-MW-CAS Document 1 Filed 05/11/17 Page 51 of 51

I understand that a false statement in this declaration will subject me to penalties for perjury.
I declare under penalty of perjury that the foregoing is true and correct.

Date: May 10, 2017

s/ Roland Molina Roland Molina

{07145994;1}

 
 U.S. District Court Northern District of Florida (Tallahassee) CIVIL DOCKET FOR CASE #: 4:17-cv-00214-MW-CAS

Alerts not yet Supported for this Docket

HOFFER et al v. INCH Assigned to: CHIEF JUDGE MARK E WALKER Referred to: MAGISTRATE JUDGE CHARLES A STAMPELOS related Case: 4:18-cv-00576-MW-MAF Case in other court: USCA, 18-12292-A
USCA, 18-12571-A USCA Atlanta GA, 18-14652-C Cause: 42:1983 Prisoner Civil Rights

Date Filed: 05/11/2017 Date Terminated: 04/18/2019 Jury Demand: None Nature of Suit: 555 Prison Condition Jurisdiction: Federal Question

Plaintiff
CARL HOFFER INDIVIDUALLY AND ON BEHALF OF A CLASS OF PERSONS SIMILARLY SITUATED

represented by RANDALL CHALLEN BERG FLORIDA JUSTICE INSTITUTE INC - MIAMI FL 3750 BANK OF AMERICA TOWER 100 SE SECOND ST MIAMI, FL 33131 305-358-2081 Fax: 305-358-0910 Email: rberg@floridajusticeinstitute.org TERMINATED: 02/05/2019 LEAD ATTORNEY

DANTE PASQUALE TREVISANI FLORIDA JUSTICE INSTITUTE INC- MIAMI FL 100 SE 2ND ST 3750 BANK OF AMERICA TWR MIAMI, FL 33131 305-358-2081 Fax: 305-358-0910 Email: dtrevisani@floridajusticeinstitute.org ATTORNEY TO BE NOTICED

ERICA SELIG

Plaintiff RONALD MCPHERSON INDIVIDUALLY AND ON BEHALF OF A CLASS OF PERSONS SIMILARLY SITUATED
Plaintiff ROLAND MOLINA INDIVIDUALLY AND ON BEHALF OF A CLASS OF PERSONS SIMILARLY SITUATED

3750 MIAMI TOWER 100 SE SECOND STREET MIAMI, FL 33131 786-342-6918 Email: eselig@floridajusticeinstitute.org ATTORNEY TO BE NOTICED
RAY TASEFF FLORIDA JUSTICE INSTITUTE MIAMI FL 3750 MIAMI TOWER 100 SE SECOND STREET MIAMI, FL 33131 305-358-2081 Email: rtaseff@floridajusticeinstitute.org ATTORNEY TO BE NOTICED
represented by RANDALL CHALLEN BERG (See above for address) TERMINATED: 02/05/2019 LEAD ATTORNEY
RAY TASEFF (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
DANTE PASQUALE TREVISANI (See above for address) ATTORNEY TO BE NOTICED
ERICA SELIG (See above for address) ATTORNEY TO BE NOTICED
represented by RANDALL CHALLEN BERG (See above for address) TERMINATED: 02/05/2019 LEAD ATTORNEY
RAY TASEFF

(See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
DANTE PASQUALE TREVISANI (See above for address) ATTORNEY TO BE NOTICED
ERICA SELIG (See above for address) ATTORNEY TO BE NOTICED

V.
Defendant
JULIE L JONES IN HER OFFICIAL CAPACITY AS SECRETARY OF FLORIDA DEPARTMENT OF CORRECTIONS TERMINATED: 01/15/2019

represented by STEPHANIE ALLISON DANIEL 4506 BARCLAY LANE TALLAHASSEE, FL 32309 850-509-3329 Email: Stephanie.Daniel@myfloridalegal.com TERMINATED: 01/08/2018 LEAD ATTORNEY
ALBERT BOWDEN BOWDEN LAW FIRM LLC TALLAHASSEE FL STATE OF FLORIDA 3452 WELWYN WAY TALLAHASSEE, FL 32309 850-591-1130 Email: albowdenlaw@gmail.com ATTORNEY TO BE NOTICED
KAREN ANN BRODEEN OFFICE OF THE ATTORNEY GENERAL - TALLAHASSEE FL THE CAPITOL STE PL-01 400 S MONROE ST TALLAHASSEE, FL 32399 850-414-3665 Fax: 850-488-4872 Email: karen.brodeen@myfloridalegal.com ATTORNEY TO BE NOTICED

Defendant MARK S INCH

LANCE ERIC NEFF ATTORNEY GENERAL - 107 W GAINES - TALLAHASSEE FL 107 WEST GAINES ST TALLAHASSEE, FL 32301 850-414-3633 Fax: 850-488-4872 Email: lance.neff@fdc.myflorida.com TERMINATED: 01/04/2018
represented by ALBERT BOWDEN (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
KAREN ANN BRODEEN (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
BILAL AHMED FARUQUI OFFICE OF THE ATTORNEY GENERAL PL-01 THE CAPITOL TALLAHASSEE, FL 32399-1050 850-414-3300 Email: Bilal.Faruqui@myfloridalegal.com ATTORNEY TO BE NOTICED
ERIN ELIZABETH OLIVER OFFICE OF THE ATTORNEY GENERAL - TALLAHASSEE FL THE CAPITOL PL-01 TALLAHASSEE, FL 32399-1050 850-414-3670 Email: erin.oliver@myfloridalegal.com ATTORNEY TO BE NOTICED

Date Filed # Docket Text

05/11/2017

1 COMPLAINT for Declaratory and Injunctive Relief against Julie L Jones ( Filing fee $ 400 receipt number AFLNDC-3874880.), filed by Carl Hoffer, Roland Molina, Ronald McPherson. (Attachments: # 1 Civil Cover Sheet Civil Cover Sheet) (BERG, RANDALL) (Entered: 05/11/2017)

05/11/2017 2 NOTICE of Filing Proposed Summons by Carl Hoffer, Ronald McPherson, Roland Molina (BERG, RANDALL) (Entered: 05/11/2017)

05/12/2017 3 CIVIL COVER SHEET. (tdl) (Entered: 05/12/2017)

05/12/2017 4 Summons Issued as to Julie L Jones. (tdl) (Entered: 05/12/2017)

05/12/2017

5 DOCKET ANNOTATION BY COURT TO ATTORNEY RANDALL BERG re 1 Complaint. A reminder that party names (including aliases) are to be added using ALL CAPS and NO Punctuation. (See "Style Guide for Electronic Case Filing," available on Clerk's website.) Counsel is also advised by this entry, that a Civil Cover Sheet should be filed as a separate entry using the event selection "Civil Cover Sheet" which is found under "Other Filings" under "Other Documents" The party names and civil cover sheet will be corrected by the clerk. (tdl) (Entered: 05/12/2017)

05/15/2017

6 NOTICE of Appearance by DANTE PASQUALE TREVISANI on behalf of Carl Hoffer, Ronald McPherson, Roland Molina (TREVISANI, DANTE) (Entered: 05/15/2017)

05/15/2017

7 NOTICE of Appearance by ERICA SELIG on behalf of Carl Hoffer, Ronald McPherson, Roland Molina (SELIG, ERICA) (Entered: 05/15/2017)

05/19/2017 8 SUMMONS Returned Executed JULIE L JONES served on 5/18/2017, answer due 6/8/2017. (tdl) (Entered: 05/19/2017)

05/23/2017 9 NOTICE of Appearance by LANCE ERIC NEFF on behalf of JULIE L JONES (NEFF, LANCE) (Entered: 05/23/2017)

05/23/2017

10 MOTION to Certify Class by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Internal deadline for referral to judge if response not filed earlier: 6/6/2017). (Attachments: # 1 Exhibit Koziel Declaration, # 2 Exhibit CDC Hepatitis C Overview, # 3 Exhibit CDC Florida State Profile, # 4 Exhibit FDC Inmate Mortality, # 5 Exhibit HCV Guidance, # 6 Exhibit HSB 15.01.09, # 7 Exhibit Beard E-Mail, # 8 Exhibit Hoffer Grievance Denial) (BERG, RANDALL) (Entered: 05/23/2017)

05/23/2017

11 MOTION for Preliminary Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit AHCA Letter re Hep C Medicaid Coverage) (BERG, RANDALL) (Entered: 05/23/2017)

05/23/2017

Set Deadline re 11 MOTION: Internal deadline for referral to judge if response not filed earlier: 6/6/2017 . (tdl) (Entered: 05/24/2017)

05/24/2017

12 ORDER SETTING SCHEDULING CONFERENCE - the Clerk must set a telephonic scheduling conference for Monday, June 5, 2017, at 2:00 PM. Signed by JUDGE MARK E WALKER on 5/24/2017. (tdl) (Entered: 05/24/2017)

05/24/2017 13 NOTICE OF HEARING : Telephonic Scheduling Conference set for 6/5/2017 02:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 1:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 05/24/2017)
05/25/2017 14 Corporate Disclosure Statement/Certificate of Interested Persons by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 05/25/2017)
05/26/2017 15 Consent MOTION for Extension of Time to File Response/Reply as to 10 MOTION to Certify Class , 11 MOTION for Preliminary Injunction by JULIE L JONES. (NEFF, LANCE) (Entered: 05/26/2017)

05/26/2017 16 INITIAL SCHEDULING ORDER: Rule 26 Meeting Report due by 7/10/2017. Discovery due by 9/25/2017. Signed by JUDGE MARK E WALKER on 5/26/2017. (tdl) (Entered: 05/26/2017)

05/26/2017 17 ORDER GRANTING EXTENSION TO RESPOND TO PENDING MOTIONS re ECF No. 15 . (Response to 10 & 11 Motions due by

by 7/7/2017.) Signed by JUDGE MARK E WALKER on 5/26/2017. (tdl) (Entered: 05/26/2017)

05/30/2017 18 MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM by JULIE L JONES. (NEFF, LANCE) (Entered: 05/30/2017)

05/30/2017

Set Deadline re 18 Motion: Internal deadline for referral to judge if response not filed earlier: 6/13/2017 . (tdl) (Entered: 05/31/2017)

06/05/2017

19 Minute Entry for proceedings held before JUDGE MARK E WALKER: Scheduling Conference held on 6/5/2017. Court GRANTS Ore Tenus Motion to file Reply and Sur-Reply. Response to 10 Motion to Certify Class and 11 Motion for Preliminary Injunction due on July 7, 2017. Reply of not more than 10 pages due on July 12, 2017. Sur-Reply of not more than 10 pages due on July 19, 2017. Counsel shall confer and file a Notice by July 12, 2017 re: (1) whether parties request an evidentiary hearing, (2) how long they will need for such a hearing, (3) the time frame in which counsel need to be prepared and whether they request the hearing to be in person or telephonically. Witnesses may appear via video-conference. (Internal deadline for referral to judge if response not filed earlier: 7/7/2017)., Reply due by 7/12/2017., Sur-Reply due by 7/19/2017.) ( Notice due by 7/12/2017.). (Court Reporter Judy Gagnon.) (pll) (Entered: 06/05/2017)

06/12/2017 20 RESPONSE to Motion re 18 MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 06/12/2017)

06/16/2017

21 MOTION Entry of HIPAA Qualified Protective Order and attached proposed HIPAA Order by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Text of Proposed Order Exh. A -Proposed HIPAA Order in Hoffer v. Jones, # 2 Exhibit Exh. B -- HIPAA Order in DRF v. Jones, # 3 Exhibit Exh. C -- HIPAA Order in Copeland v. Jones) (BERG, RANDALL) (Entered: 06/16/2017)

06/21/2017 22 STATUS REPORT JOINT by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 06/21/2017)

06/22/2017 23 REPORT of Rule 26(f) Planning Meeting. (BERG, RANDALL) (Entered: 06/22/2017)

06/23/2017 24 RESPONSE to Motion re 21 MOTION Entry of HIPAA Qualified Protective Order and attached proposed HIPAA Order filed by JULIE L JONES. (NEFF, LANCE) (Entered: 06/23/2017)

06/23/2017

ACTION REQUIRED BY DISTRICT JUDGE: Chambers of JUDGE MARK E WALKER notified that action is needed Re: 23 Report of Rule 26(f) Planning Meeting (tdl) (Entered: 06/23/2017)

06/26/2017

25 NOTICE of Telephonic Hearing on 21 MOTION Entry of HIPAA Qualified Protective Order and attached proposed HIPAA Order :Telephonic Motion Hearing set for 6/27/2017 02:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 1:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call (pll) (Entered: 06/26/2017)

06/27/2017

26 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 6/27/2017 re 21 MOTION Entry of HIPAA Qualified Protective Order and attached proposed HIPAA Order. Court GRANTS 21 Motion for Entry of Protective Order. Counsel to email clerk a copy of the proposed order. (Court Reporter Megan Hague.) (pll) (Entered: 06/27/2017)

06/27/2017 27 HIPAA QUALIFIED PROTECTIVE ORDER. Signed by JUDGE MARK E WALKER on 6/27/17. (pll) (Entered: 06/27/2017)

06/30/2017 28 Endorsed MOTION to Extend Time to respond to discover requests by JULIE L JONES. (NEFF, LANCE) (Entered: 06/30/2017)

07/03/2017

29 ORDER GRANTING 28 EXTENSION TO RESPOND TO DISCOVERY REQUEST. Defendant shall respond to Plaintiffs discovery requests on or before August 7, 2017, and provide any objections to discovery requests on or before July 21, 2017. Signed by JUDGE MARK E WALKER on 7/3/17. (pll) (Entered: 07/03/2017)

07/03/2017 30 SCHEDULING AND MEDIATION ORDER :( Discovery due by 12/1/2017., Dispositive Motions to be filed by 1/25/2018., Bench Trial set for 5/21/2018 08:15 AM in U.S. Courthouse Tallahassee before

JUDGE MARK E WALKER., Mediation Report due by 1/12/2018.), Case referred to mediation. Signed by JUDGE MARK E WALKER on 7/3/2017. (erl) (Entered: 07/03/2017)

07/07/2017 31 RESPONSE in Opposition re 11 MOTION for Preliminary Injunction filed by JULIE L JONES. (Attachments: # 1 Exhibit A: Whalen Declaration) (NEFF, LANCE) (Entered: 07/07/2017)

07/07/2017 32 RESPONSE in Opposition re 10 MOTION to Certify Class filed by JULIE L JONES. (Attachments: # 1 Exhibit A: Whalen Declaration) (NEFF, LANCE) (Entered: 07/07/2017)

07/12/2017 33 MOTION for Extension of Time to File Response/Reply to Defendants Motions Unopposed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 07/12/2017)

07/12/2017

34 ORDER GRANTING EXTENSION TO FILE REPLIES TO RESPONSES re ECF No. 33 . The motion is GRANTED. (Plaintiffs Replies due by 7/14/2017.) Signed by JUDGE MARK E WALKER on 7/12/2017. (tdl) (Entered: 07/12/2017)

07/14/2017

35 REPLY to Response to Motion re 10 MOTION to Certify Class filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Exh 1 - Email on In-Custody HCV Deaths, # 2 Exhibit Exh 2- VA News Release, # 3 Exhibit Exh 3 - Email on DAAs, # 4 Exhibit Exh 4 - WHO Article) (BERG, RANDALL) (Entered: 07/14/2017)

07/14/2017

36 REPLY to Response to Motion re 11 MOTION for Preliminary Injunction filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Gonzales vs. Corizon Health Care Providers, # 2 Exhibit 2 - Scott vs. Batista, # 3 Exhibit 3 Dulak vs. Corizon) (BERG, RANDALL) (Entered: 07/14/2017)

07/14/2017 37 NOTICE regarding evidentiary hearing by JULIE L JONES (NEFF, LANCE) (Entered: 07/14/2017)

07/14/2017

38 NOTICE of Plaintiffs' Regarding Evidentiary Hearing by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA re 19 Scheduling Conference,,,, Set Motion and R&R Deadlines/Hearings,,,, Set Deadlines/Hearings,,, (BERG, RANDALL) (Entered: 07/14/2017)

07/17/2017 39 Endorsed MOTION for Extension of Time to File Response/Reply as to 36 Reply to Response to Motion, 35 Reply to Response to Motion, by JULIE L JONES. (NEFF, LANCE) (Entered: 07/17/2017)

07/17/2017

40 ORDER GRANTING EXTENSION of TIME IN WHICH TO FILE SURREPLIES re ECF No. 39 . (Motion to Certify & Motion for Preliminary Injunction due by 7/24/2017.) Signed by JUDGE MARK E WALKER on 7/17/2017. (tdl) (Entered: 07/17/2017)

07/19/2017 41 MOTION for Extension of Time to File Response/Reply to Defendant's Discovery Request by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 07/19/2017)

07/19/2017 44 ORDER GRANTING ENLARGEMENT OF TIME TO RESPOND re ECF No. 41 . The motion is GRANTED. Signed by JUDGE MARK E WALKER on 7/19/2017. (tdl) (Entered: 07/20/2017)

07/20/2017

42 NOTICE of Plaintiffs Supplemental Notice Regarding Evidentiary Hearing by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA re 38 Notice (Other), 19 Scheduling Conference,,,, Set Motion and R&R Deadlines/Hearings,,,, Set Deadlines/Hearings,,, (BERG, RANDALL) (Entered: 07/20/2017)

07/20/2017 43 Endorsed MOTION to Extend Time to file objections in discovery by JULIE L JONES. (NEFF, LANCE) (Entered: 07/20/2017)

07/20/2017 45 ORDER GRANTING SECOND 43 MOTION FOR EXTENSION OF TIME TO SERVE OBJECTIONS. Signed by JUDGE MARK E WALKER on 7/20/2017. (tdl) (Entered: 07/21/2017)

07/24/2017 46 REPLY to Response to Motion re 11 MOTION for Preliminary Injunction (Surreply) filed by JULIE L JONES. (Attachments: # 1 Exhibit A: Whalen Declaration) (NEFF, LANCE) (Entered: 07/24/2017)

07/24/2017 47 REPLY to Response to Motion re 10 MOTION to Certify Class (Surreply) filed by JULIE L JONES. (Attachments: # 1 Exhibit A: Whalen Declaration) (NEFF, LANCE) (Entered: 07/24/2017)

07/24/2017 48 MOTION for Mediation by JULIE L JONES. (Internal deadline for referral to judge if response not filed earlier: 8/7/2017). (NEFF, LANCE) (Entered: 07/24/2017)

07/24/2017 49 RESPONSE to Motion re 48 MOTION for Mediation filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 07/24/2017)

07/25/2017 50 STATUS REPORT Joint by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 07/25/2017)

07/25/2017 51 ORDER ON MOTION FOR IMMEDIATE MEDIATION - This Court, without hearing, DENIES Defendant's motion for immediate mediation.

ECF No. 48 . Signed by JUDGE MARK E WALKER on 7/25/2017. (tdl) (Entered: 07/25/2017)

07/27/2017 52 NOTICE of Supplemental Authority by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit Postawko vs. Missouri Order) (BERG, RANDALL) (Entered: 07/27/2017)

08/02/2017

53 ORDER SETTING HEARING - The Clerk shall set Plaintiffs' motions, ECF No. 10 and ECF No. 11, for a four-day hearing in Tallahassee commencing on Tuesday, August 29, 2017, at 8:30 AM. (Motion Hearing set for 8/29/2017 08:30 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER). Signed by JUDGE MARK E WALKER on 8/2/2017. (tdl) (Entered: 08/02/2017)

08/02/2017

54 NOTICE of Hearing on 10 MOTION for Class Certification and 11 MOTION for Preliminary Injunction: four-day Motion Hearing commencing on 8/29/2017 at 08:30 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. 111 North Adams St., Tallahassee, Florida 32301.

NOTE: If you or any party, witness, or attorney in this matter has a disability that requires special accommodation, such as a hearing impairment that requires a sign language interpreter or a wheelchair restriction that requires ramp access, please contact Pam Lourcey at 850521-3501 in the Clerk's Office at least one week prior to the hearing (or as soon as possible) so arrangements can be made.

s/ Kimberly Westphal Deputy Clerk (kjw) (Entered: 08/02/2017)

08/04/2017

55 PETITION for Writ of Habeas Corpus AD TESTIFICANDUM ( Filing fee $ 5 receipt number AFLNDC-3943721.), filed by CARL HOFFER, ROLAND MOLINA, RONALD MCPHERSON. (Attachments: # 1 Text of Proposed Order WRIT OF HABEAS CORPUS AD TESTIFICANDUM) (BERG, RANDALL) (Entered: 08/04/2017)

08/04/2017

56 PETITION for Writ of Habeas Corpus AD TESTIFICANDUM ( Filing fee $ 5 receipt number AFLNDC-3943722.), filed by CARL HOFFER, ROLAND MOLINA, RONALD MCPHERSON. (Attachments: # 1 Text of Proposed Order WRIT OF HABEAS CORPUS AD TESTIFICANDUM) (BERG, RANDALL) (Entered: 08/04/2017)

08/04/2017 57 PETITION for Writ of Habeas Corpus AD TESTIFICANDUM ( Filing fee $ 5 receipt number AFLNDC-3943723.), filed by CARL HOFFER, ROLAND MOLINA, RONALD MCPHERSON. (Attachments: # 1 Text

of Proposed Order WRIT OF HABEAS CORPUS AD TESTIFICANDUM) (BERG, RANDALL) (Entered: 08/04/2017)

08/08/2017 58 MOTION Case Management Conference by JULIE L JONES. (NEFF, LANCE) (Entered: 08/08/2017)

08/08/2017 59 MOTION to Continue August 29, 2017 Hearing by JULIE L JONES. (NEFF, LANCE) (Entered: 08/08/2017)

08/08/2017

60 NOTICE OF TELEPHONIC Hearing ON 59 MOTION to Continue August 29, 2017 Hearing : Telephonic Motion Hearing set for 8/9/2017 02:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

The Court is in a Jury Trial and this hearing is set to accommodate that schedule. There will be no rescheduling or continuances.

You may dial into the conference call as early as 1:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 08/08/2017)

08/08/2017 61 NOTICE of Appearance by ALBERT BOWDEN on behalf of All Defendants (BOWDEN, ALBERT) (Entered: 08/08/2017)

08/08/2017

62 RESPONSE in Opposition re 59 MOTION to Continue August 29, 2017 Hearing filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Hoffer: Extension of Time Email) (SELIG, ERICA) (Entered: 08/08/2017)

08/09/2017

63 NOTICE of Filing Supplemental Declaration by JULIE L JONES re 59 MOTION to Continue August 29, 2017 Hearing (Attachments: # 1 Exhibit A: Ladele Declaration) (NEFF, LANCE) (Entered: 08/09/2017)

08/09/2017 64 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 8/9/2017. Court hears 59 Motion to Continue.

Court GRANTS 58 Motion for Case Management Conference; the Clerk is instructed to terminate the motion. Court GRANTS 59 Motion to Continue. The Preliminary Injunction hearing is reset for September 14th, 15th, 18th and 19th, 2017. Counsel shall confer and set a date for deposition of doctor by 1:00 p.m. on August 11, 2017. Depositions for review by the Court shall be filed by September 10, 2017 at midnight. Counsel for Defendant shall file the Opinion of their Expert by September 8, 2017. ( Defendant's Opinion of Expert due by 9/8/2017., Motion Hearing set for 9/14/2017 08:30 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.). (Court Reporter Megan Hague.) (pll) (Entered: 08/09/2017)

08/09/2017

65 NOTICE of Hearing on Motion 11 MOTION for Preliminary Injunction , 10 MOTION to Certify Class : Motion Hearing set for 9/14/2017 08:30 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. United States Courthouse, 111 North Adams St., Tallahassee, Florida 32301.

NOTE: If you or any party, witness or attorney in this matter has a disability that requires special accommodation, such as, a hearing impairment that requires a sign language interpreter or a wheelchair restriction that requires ramp access, please contact Pam Lourcey at 850521-3501 in the Clerk's Office at least one week prior to the hearing (or as soon as possible) so arrangements can be made.

s/ Pam Lourcey Courtroom Deputy Clerk (pll) (Entered: 08/09/2017)

08/14/2017

66 ORDER DIRECTING CLERK TO RETURN WITHOUT DOCKETING NOTICE OF PARALLEL LITIGATION BY A NON-PARTY PERSON. Signed by JUDGE MARK E WALKER on 8/14/2017. (tdl)**Pleading Returned as Instructed** (Entered: 08/14/2017)

08/16/2017 67 Writ of Habeas Corpus ad Testificandum Issued as to CARL T. HOFFER, 111369 for Thursday, September 14, 2017, at 8:30 a.m. and Friday, September 15, 2017, at 8:30 a.m. (tdl) (Entered: 08/16/2017)
08/16/2017 68 Writ of Habeas Corpus ad Testificandum Issued as to RONALD MCPHERSON, 111745 for Thursday, September 14, 2017, at 8:30 a.m. and Friday, September 15, 2017, at 8:30 a.m.. (tdl) (Entered: 08/16/2017)
08/16/2017 69 Writ of Habeas Corpus ad Testificandum Issued as to ROLAND P. MOLINA, 500942 for Thursday, September 14, 2017, at 8:30 a.m. and Friday, September 15, 2017, at 8:30 a.m.. (tdl) (Entered: 08/16/2017)

08/18/2017

70 MOTION to Compel and Request for Status Conference by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Plaintiffs' First Request for Production to Defendant, # 2 Exhibit 2 - Defendant's Responses and Objections to Plaintiffs' First Request for Production, # 3 Exhibit 3 - Defendant's Supplement to Response to Plaintiff's Request for Production, # 4 Exhibit 4 - Emails on Pending Requests for Production, # 5 Exhibit 5 - Corizon Spreadsheet Excerpt, # 6 Exhibit 6 - Centurion Contract Excerpt, # 7 Exhibit 7 - Email on Hearing Disputes) (TREVISANI, DANTE) (Entered: 08/18/2017)

08/21/2017

71 ORDER DIRECTING EXPEDITED RESPONSE - The Clerk shall set the motion for hearing after the response date but on an expedited basis. (Response to 70 Motion due by by 8/25/2017.) Signed by JUDGE MARK E WALKER on 8/21/2017. (tdl) (Entered: 08/21/2017)

08/21/2017 72 NOTICE of Hearing on 70 MOTION to Compel and Request for Status Conference : Telephonic Motion Hearing set for 8/29/2017 01:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 12:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 08/21/2017)

08/21/2017 73 MOTION for Protective Order For The Deposition of Albert Maier Noticed For September 1, 2017 by JULIE L JONES. (Attachments: # 1 Exhibit, # 2 Exhibit) (BOWDEN, ALBERT) (Entered: 08/21/2017)
08/22/2017 74 ORDER DIRECTING EXPEDITED RESPONSE re 73 MOTION for Protective Order - Response to motion due by by 8/25/2017. Signed by JUDGE MARK E WALKER on 8/22/2017. (ckm) (Entered: 08/22/2017)

08/22/2017 75 NOTICE of Hearing on 73 MOTION for Protective Order For The Deposition of Albert Maier Noticed For September 1, 2017 : Motion

Hearing set for 8/29/2017 01:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 12:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 08/22/2017)

08/22/2017 76 MOTION for Protective Order as to the Depositions of Thomas Reimers and Timothy Whalen by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 08/22/2017)

08/22/2017

77 ORDER DIRECTING EXPEDITED RESPONSE - The Clerk shall set the motion for hearing after the response date but on an expedited basis. ( Response to 76 Motion due by by 8/25/2017.) Signed by JUDGE MARK E WALKER on 8/22/2017. (tdl) (Entered: 08/22/2017)

08/22/2017

78 NOTICE of Hearing on 76 MOTION for Protective Order as to the Depositions of Thomas Reimers and Timothy Whalen : Telephonic Motion Hearing set for 8/29/2017 01:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 12:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 08/22/2017)

08/23/2017

79 RESPONSE in Opposition re 73 MOTION for Protective Order For The Deposition of Albert Maier Noticed For September 1, 2017 filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Defendant's Initial Disclosures, # 2 Exhibit 2 - Emails Between Counsel, # 3 Exhibit 3 - Tax Record, # 4 Exhibit 4 Maier Declaration in Melendez Case, # 5 Exhibit 5 - Maier Declaration in Hartley Case) (TREVISANI, DANTE) (Entered: 08/23/2017)

08/25/2017 80 NOTICE of Withdrawal of Defendant's Motion for Protective Order for the Deposition of Albert Maier Noticed for September 1, 2017 by JULIE L JONES (BOWDEN, ALBERT) (Entered: 08/25/2017)

08/25/2017 81 NOTICE of Withdrawal of Defendant's Motion for a Protective Order as to the Depositions of Thomas Reimers and Timothy Whalen by JULIE L JONES (BOWDEN, ALBERT) (Entered: 08/25/2017)

08/25/2017

82 ORDER DENYING AS MOOT 73 , 76 MOTIONS FOR PROTECTIVE ORDER - The Clerk shall cancel the hearing now scheduled for Tuesday, August 29, 2017, as it relates to those motions. Signed by JUDGE MARK E WALKER on 8/25/2017. (tdl) (Entered: 08/25/2017)

08/25/2017 83 RESPONSE to Motion re 70 MOTION to Compel and Request for Status Conference filed by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 08/25/2017)

08/28/2017

84 NOTICE OF CANCELLATION OF HEARING AS TO 73 AND 76 MOTIONS ONLY re 82 Order on Motion for Protective Order. The hearing on 70 Motion to Compel will go forward as scheduled. (pll) (Entered: 08/28/2017)

08/28/2017 85 STATUS REPORT JOINT by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 08/28/2017)

08/28/2017

Set/Reset Deadline: Status Report due by 9/27/2017. (ckm) (Entered: 09/08/2017)

08/29/2017

86 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 8/29/2017 re 70 MOTION to Compel. Court GRANTS IN PART AND DENIES IN PART 70 Motion to Compel. Counsel to file Witness List by September 7, 2017. Counsel to file a Status Report of Email Search Results and Declarations by September 8, 2017. Counsel shall file Final Expert Report by October 9, 2017. ( Status Report of Email Search Results and Declarations by 9/8/2017. Witness List due by 9/7/2017.). (Court Reporter Megan Hague.) (pll) (Entered: 08/29/2017)

09/05/2017 87 MOTION Case Management Conference by JULIE L JONES. (NEFF, LANCE) (Entered: 09/05/2017)

09/06/2017

88 ORAL ORDER GRANTING 87 MOTION Case Management Conference. The Clerk is instructed to set this for a Telephonic Status Conference. Signed by JUDGE MARK E WALKER on 9/6/17. (pll) (Entered: 09/06/2017)

09/06/2017 89 NOTICE OF HEARING : Telephonic Status Conference set for 9/6/2017 12:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 11:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 09/06/2017)

09/06/2017

90 Minute Entry for proceedings held before JUDGE MARK E WALKER: Status Conference held on 9/6/2017. Court instructs Clerk to reset Preliminary Injunction Hearing for September 18th and September 19th, 2017. Clerk to re-issue writs for witnesses. Clerk instructed to set a Telephonic Status Conference for 12:00 PM EST on September 13, 2017. ( Preliminary Injunction Hearing set for 9/18/2017 08:30 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER., Telephonic Status Conference set for 9/13/2017 12:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.). (Court Reporter Megan Hague.) (pll) (Entered: 09/06/2017)

09/06/2017 91 NOTICE OF HEARING: Telephonic Status Conference set for 9/13/2017 12:00 PM EST in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 11:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code,

enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 09/06/2017)

09/06/2017

92 Writ of Habeas Corpus ad Testificandum Issued as to CARL T. HOFFER, 111369 for Monday, September 18, 2017, at 8:30 a.m. and Tuesday, September 19, 2017, at 8:30 a.m.. (tdl)**Writs emailed to DOC Contact** Modified to correct dates on 9/6/2017 (tdl). (Entered: 09/06/2017)

09/06/2017

93 Writ of Habeas Corpus ad Testificandum Issued as to ROLAND P. MOLINA, 500942 for Monday, September 18, 2017, at 8:30 a.m. and Tuesday, September 19, 2017, at 8:30 a.m.. (tdl)**Writ emailed to DOC contact** Modified to correct dates on 9/6/2017 (tdl). (Entered: 09/06/2017)

09/06/2017

94 Writ of Habeas Corpus ad Testificandum Issued as to RONALD MCPHERSON, 111745 for Monday, September 18, 2017, at 8:30 a.m. and Tuesday, September 19, 2017, at 8:30 a.m.. (tdl)**Writ emailed to DOC contact** (Entered: 09/06/2017)

09/07/2017 95 NOTICE of Filing Declarations for Hearing by JULIE L JONES (Attachments: # 1 Affidavit Dr. Cruz, # 2 Affidavit Officer Davis) (NEFF, LANCE) (Entered: 09/07/2017)

09/07/2017

96 Joint STATUS REPORT OF EMAIL SEARCH RESULTS by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) Modified on 9/8/2017 to reflect Joint report (ckm). (Entered: 09/07/2017)

09/07/2017 97 NOTICE of Defendant's Witness List for Evidentiary Hearing by JULIE L JONES (BOWDEN, ALBERT) (Entered: 09/07/2017)

09/07/2017 98 Witness List by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 09/07/2017)

09/07/2017 99 Exhibit List by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA.. (TREVISANI, DANTE) (Entered: 09/07/2017)

09/07/2017 100 NOTICE of Filing Deposition Transcripts by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit 1 -

Koziel Deposition, # 2 Exhibit 2 - Maier Deposition) (TREVISANI, DANTE) (Entered: 09/07/2017)

09/08/2017

101 AMENDED NOTICE OF HEARING: **The hearing date and time has been moved up to allow counsel as much time as possible to ascertain travel plans in light of Hurricane Irma.** Status Conference set for 9/12/2017 03:30 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 3:25 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 09/08/2017)
09/10/2017 102 AMENDED NOTICE OF HEARING.

**This hearing is reset due to Hurricane Irma. Only one attorney from each side need appear and that further rescheduling may become necessary.**

Telephonic Status Conference reset for 9/13/2017 10:00 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 9:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 09/10/2017)

09/13/2017

103 NOTICE OF *CANCELLATION* of HEARING: The Preliminary Injunction Hearing set for 9/18/2017 08:30 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER has been cancelled. (kjw) (Entered: 09/13/2017)

09/13/2017

104 Minute Entry for proceedings held before JUDGE MARK E WALKER: Telephonic Status Conference held on 9/13/2017. The Preliminary Injunction Hearing scheduled for September 18 and September 19 has been cancelled. A Telephonic Scheduling Conference is scheduled for 9/26/2017 at 9:00 am EST. At this hearing the proposed dates for the availability of the experts is to be addressed. The three writs for the DOC do not need to be reissued at this time (per attorney Berg, he will contact), but if a court order or writs are needed then the attorney is to contact the Clerks office. (Court Reporter Megan Hague.) (kjw) (Entered: 09/13/2017)

09/13/2017

105 NOTICE OF HEARING: Telephonic Status Conference set for 9/26/2017 09:00 AM EST in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. You may dial into the conference call as early as 8:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Kimberly Westphal Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call.

09/15/2017

(kjw) Modified on 9/13/2017 to correct call in time. (kjw) (Entered: 09/13/2017)
Set/Reset Deadline: Final Expert Report due by 10/9/2017 pursuant to 86 Minute Entry. (ckm) (Entered: 09/15/2017)

09/22/2017 106 Amended Witness List by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. Amendment to 98 Witness List (Amended Witness

List). (SELIG, ERICA) Modified on 9/25/2017 to reflect document title (ckm). (Entered: 09/22/2017)

09/22/2017

107 Amended Exhibit List by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. Amendment to 99 Exhibit List (Amended Exhibit List). (SELIG, ERICA) Modified on 9/25/2017 to reflect document title (ckm). (Entered: 09/22/2017)

09/22/2017

108 NOTICE of Filing Declaration by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit A Declaration of Carlieny Gutierrez) (TREVISANI, DANTE) (Entered: 09/22/2017)

09/26/2017

109 Minute Entry for proceedings held before JUDGE MARK E WALKER: Status Conference held on 9/26/2017. Preliminary Injunction hearing reset for October 19, 2017 - October 20, 2017. Counsel shall alert Clerk by close of business tomorrow schedule for Expert Witnesses and for Writs for Witnesses in custody. Set Deadlines/Hearing as to 11 MOTION for Preliminary Injunction , 10 MOTION to Certify Class :( Motion Hearing set for 10/19/2017 08:00 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.). (Court Reporter Megan Hague.) (pll) (Entered: 09/26/2017)

09/27/2017 110 Exhibit List Amended by JULIE L JONES.. (NEFF, LANCE) (Entered: 09/27/2017)

09/27/2017 111 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 09/27/2017)

09/28/2017

Set/Reset Deadlines: Status Report due by 10/27/2017. (ckm) (Entered: 09/28/2017)

10/02/2017 112 NOTICE of Filing Amended Status Report by JULIE L JONES re 111 Status Report (NEFF, LANCE) (Entered: 10/02/2017)

10/03/2017 113 MOTION for Discovery for Enlargement of Number of Depositions by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 10/03/2017)

10/03/2017 114 Writ of Habeas Corpus ad Testificandum Issued as to RONALD MCPHERSON, 111745 for Thursday, October 19, 2017, at 8:00 a.m. and Friday, October 20, 2017, at 8:00 a.m. (tdl) (Entered: 10/03/2017)

10/03/2017 115 Writ of Habeas Corpus ad Testificandum Issued as to CARL T. HOFFER, 111369 for Thursday, October 19, 2017, at 8:00 a.m. and Friday, October 20, 2017, at 8:00 a.m. (tdl) (Entered: 10/03/2017)

10/03/2017 116 Writ of Habeas Corpus ad Testificandum Issued as to ROLAND P. MOLINA, 500942 for Thursday, October 19, 2017, at 8:00 a.m. and Friday, October 20, 2017, at 8:00 a.m. (tdl) (Entered: 10/03/2017)

10/03/2017

117 ORDER GRANTING MOTION FOR ENLARGEMENT OF NUMBER OF DEPOSITIONS - The 113 motion is GRANTED WITH QUALIFICATION. The parties are permitted to take up to fifteen (15) depositions per side. Signed by JUDGE MARK E WALKER on 10/3/17. (ckm) (Entered: 10/03/2017)

10/10/2017

ACTION REQUIRED BY DISTRICT JUDGE: Chambers of JUDGE MARK E WALKER notified that action is needed Re: 86 Motion Hearing. Final Expert Report has not been filed. (ckm) (Entered: 10/10/2017)

10/10/2017 118 NOTICE of Filing Declaration by JULIE L JONES (Attachments: # 1 Affidavit Thad E. Smith) (NEFF, LANCE) (Entered: 10/10/2017)

10/10/2017 119 NOTICE Defendant's Notice of Filing Expert Witness Report by JULIE L JONES (BOWDEN, ALBERT) (Entered: 10/10/2017)

10/12/2017

120 Joint MOTION to Enlarge Pretrial Deadlines by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) Modified on 10/12/2017 to reflect document title (ckm). (Entered: 10/12/2017)

10/12/2017 121 Unopposed MOTION to Extend Time To Respond to Plaintiffs' Discovery Requests by JULIE L JONES. (BOWDEN, ALBERT) Modified on 10/12/2017 to reflect unopposed (ckm). (Entered: 10/12/2017)

10/12/2017 122 MOTION in Limine by JULIE L JONES. (Attachments: # 1 Exhibit A: Excerpts from Maier Depo) (NEFF, LANCE) (Entered: 10/12/2017)

10/12/2017

Set Deadline as to 122 MOTION in Limine. (Internal deadline for referral to judge if response not filed earlier: 10/26/2017). (ckm) (Entered: 10/12/2017)

10/12/2017

123 ORDER GRANTING IN PART 120 JOINT MOTION TO ENLARGE PRETRIAL DEADLINES AND RESETTING TRIAL DATE - The discovery deadline is extended to 2/1/2018 and the deadline for the filing of dispositive motions shall be 2/26/2018. The bench trial now scheduled for May 21, 2018, is rescheduled for Monday, 6/18/2018 08:15 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. Signed by JUDGE MARK E WALKER on 10/12/17. (ckm) (Entered: 10/12/2017)

10/12/2017

124 ORDER GRANTING 121 EXTENSION OF TIME TO RESPOND TO DISCOVERY REQUESTS - Defendant shall respond to Plaintiffs' discovery requests on or before November 3, 2017. Signed by JUDGE MARK E WALKER on 10/12/17. (ckm) (Entered: 10/12/2017)

10/12/2017 125 ORDER DENYING 122 MOTION IN LIMINE. Signed by JUDGE MARK E WALKER on 10/12/17. (ckm) (Entered: 10/12/2017)

10/13/2017 126 Exhibit List (Second Amended) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA.. (TREVISANI, DANTE) (Entered: 10/13/2017)

10/13/2017 127 NOTICE of Filing Deposition Designations and Transcript Excerpts From the Deposition of Long Do, M.D. by JULIE L JONES (BOWDEN, ALBERT) (Entered: 10/13/2017)

10/16/2017

128 Unopposed MOTION for Case Management Conference by JULIE L JONES. (Attachments: # 1 Exhibit A: FDC Letter to Centurion) (NEFF, LANCE) Modified on 10/16/2017 to reflect unopposed (ckm). (Entered: 10/16/2017)

10/16/2017 129 NOTICE OF TELEPHONIC HEARING: Telephonic Scheduling Conference set for 10/16/2017 06:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 5:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 10/16/2017)

10/16/2017

131 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 10/16/2017 re 128 MOTION Case Management Conference. Court GRANTS 128 Motion; case management conference held. (Court Reporter Megan Hague.) (pll) Modified on 10/17/2017 (pll). (Main Document 131 replaced on 10/17/2017) (pll). (Entered: 10/17/2017)

10/17/2017 130 Exhibit List Second Amended by JULIE L JONES.. (NEFF, LANCE) (Entered: 10/17/2017)

10/17/2017 132 Exhibit List (Third Amended) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA.. (TREVISANI, DANTE) (Entered: 10/17/2017)

10/17/2017 133 NOTICE of Supplemental Authority by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit 1 Warden v. Mitchell) (TREVISANI, DANTE) (Entered: 10/17/2017)

10/19/2017

134 Minute Entry for proceedings held before JUDGE MARK E WALKER: Day 1 Motion Hearing held on 10/19/2017 re 10 MOTION to Certify Class , 11 MOTION for Preliminary Injunction . (Court Reporter Judy Gagnon.) (pll) (Entered: 10/23/2017)

10/20/2017

135 Minute Entry for proceedings held before JUDGE MARK E WALKER:Day 2 Motion Hearing held on 10/20/2017 re 10 MOTION to Certify Class , 11 MOTION for Preliminary Injunction . (Court Reporter Megan Hague.) (pll) (Entered: 10/23/2017)

10/23/2017

136 NOTICE OF HEARING : Hearing In Aid of Judgment set for 11/1/2017 01:30 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. United States Courthouse, 111 North Adams St., Tallahassee, Florida 32301.

NOTE: If you or any party, witness or attorney in this matter has a disability that requires special accommodation, such as, a hearing impairment that requires a sign language interpreter or a wheelchair restriction that requires ramp access, please contact Pam Lourcey at 850521-3501 in the Clerk's Office at least one week prior to the hearing (or as soon as possible) so arrangements can be made.

s/ Pam Lourcey Courtroom Deputy Clerk (pll) (Entered: 10/23/2017)

10/23/2017

137 Minute Entry for proceedings held before JUDGE MARK E WALKER:Day 3 Motion Hearing held on 10/23/2017 re 10 MOTION to Certify Class , 11 MOTION for Preliminary Injunction . (Court Reporter Megan Hague and Judy Gagnon.) (pll) (Entered: 10/23/2017)

10/23/2017

138 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Excerpt of Preliminary Injunction Hearing (Testimony of Dr. Margaret Koziel) held on 10/19/2017, before Judge MARK WALKER. Court Reporter/Transcriber Judy A. Gagnon, Telephone number 850-561-6822.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 10/30/2017. Release of Transcript Restriction set for 1/29/2018. (jg) (Entered: 10/23/2017)
10/23/2017 139 NOTICE of Filing Deposition Transcript of Olugbenga Ogunsanwo, M.D. by JULIE L JONES (Attachments: # 1 Deposition Of Dr. O) (BOWDEN, ALBERT) (Entered: 10/23/2017)

10/23/2017

140 NOTICE of Filing Deposition Transcript of Stephen Whitfield by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit Deposition of Stephen Whitfield) (TREVISANI, DANTE) Modified on 10/24/2017 to add deponent name (ckm). (Entered: 10/23/2017)

10/24/2017

141 Minute Entry for proceedings held before JUDGE MARK E WALKER: Day 4 Motion Hearing held on 10/24/2017 re 10 MOTION to Certify Class , 11 MOTION for Preliminary Injunction . (Court Reporter Megan Hague.) (pll) (Entered: 10/24/2017)

10/25/2017

142 Minute Entry for proceedings held before JUDGE MARK E WALKER: Evidentiary Hearing held on 10/19/17, 10/20/17, 10/23/17, 10/24/17, 10/25/17. Closing arguments to be heard on November 1, 2017 at 1:30 p.m. (Court Reporter Megan Hague and Judy Gagnon.) (Attachments: # 1 Exhibit List) (pll) (Entered: 10/25/2017)

10/30/2017 143 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 10/30/2017)

10/30/2017

Set/Reset Deadlines: Status Report due by 1/31/2018. (ckm) (Entered: 10/31/2017)

10/31/2017 144 NOTICE of Legal Authorities on Mootness by JULIE L JONES (BOWDEN, ALBERT) Modified on 11/1/2017 to clean up document title (ckm). (Entered: 10/31/2017)

11/01/2017

145 NOTICE of Other Legal Authorities by JULIE L JONES re 31 Response in Opposition to Motion, 32 Response in Opposition to Motion (NEFF, LANCE) Modified on 11/1/2017 to reflect document title (ckm). (Entered: 11/01/2017)

11/01/2017 146 Minute Entry for proceedings held before JUDGE MARK E WALKER: Closing arguments held on 11/1/2017. An Order will be issued by the Court. (Court Reporter Megan Hague.) (kjw) (Entered: 11/03/2017)

11/07/2017 147 Unopposed MOTION for Case Management Conference by JULIE L JONES. (BOWDEN, ALBERT) Modified on 11/8/2017 to reflect unopposed (ckm). (Entered: 11/07/2017)

11/08/2017 148 ORDER DENYING 147 MOTION FOR CASE MANAGEMENT CONFERENCE. Signed by JUDGE MARK E WALKER on 11/8/17. (ckm) (Entered: 11/08/2017)
11/13/2017 149 NOTICE OF FILING OF OFFICIAL TRANSCRIPT *EXCERPT* of Proceedings held on 11/1/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 11/20/2017. Release of Transcript Restriction set for 2/20/2018. (mah) (Entered: 11/13/2017)

11/13/2017 150 MOTION to Compel by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 11/13/2017)

11/13/2017

Set Response Deadline as to 150 MOTION to Compel. (Internal deadline for referral to judge if response not filed earlier: 11/27/2017). (ckm) (Entered: 11/14/2017)

11/14/2017 151 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of *EXCREPT* of Proceedings held on 10/20/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 11/21/2017. Release of Transcript Restriction set for 2/20/2018. (mah) (Entered: 11/14/2017)
11/17/2017 152 ORDER GRANTING 10 MOTION FOR CLASS CERTIFICATION. Signed by JUDGE MARK E WALKER on 11/17/2017. (tdl) (Entered: 11/17/2017)
11/17/2017 153 ORDER GRANTING 11 MOTION FOR A PRELIMINARY INJUNCTION - No later than 12/1/2017 Defendant shall file a plan

consistent with the directions this Court listed above. Signed by JUDGE MARK E WALKER on 11/17/17. (ckm) (Entered: 11/17/2017)

11/17/2017 154 ORDER DENYING 18 MOTION TO DISMISS. Signed by JUDGE MARK E WALKER on 11/17/17. (ckm) (Entered: 11/17/2017)
11/21/2017 155 Unopposed MOTION for Extension of Time to File Answer re 1 Complaint, by JULIE L JONES. (NEFF, LANCE) Modified on 11/22/2017 to reflect unopposed (ckm). (Entered: 11/21/2017)

11/21/2017

156 ORDER GRANTING EXTENSION OF TIME TO ANSWER COMPLAINT - re: 155 MOTION for Extension of Time to File Answer re: 1 Complaint. The motion is GRANTED. Defendant may file her answer on or before 12/11/2017. Signed by JUDGE MARK E WALKER on 11/21/2017. (cle) (Entered: 11/21/2017)

11/22/2017

157 RESPONSE to Motion re 150 MOTION to Compel Motion for Protective Order, and Motion for Enlargement of Time to Respond to Third Set of Interrogatories filed by JULIE L JONES. (Attachments: # 1 Exhibit Plaintiffs' 1st Request for Production, # 2 Exhibit Plaintiffs' 2nd Request for Production, # 3 Exhibit Response and Objections to Plaintiffs' 2nd Request for Production, # 4 Exhibit Plaintiffs' 3rd Request for Production, # 5 Exhibit Defendant's Objections to Plaintiffs' 3rd Request for Production, # 6 Exhibit Plaintiff Hoffer's 1st Set of Interrogatories, # 7 Exhibit Plaintiff McPherson's 1st Set of Interrogatories, # 8 Exhibit Defendant's Answers and Objections to Ronald McPherson's 1st Set of Interrogatories, # 9 Exhibit Plaintiff McPherson's 3rd Set of Interrogatories, # 10 Exhibit Notice of Taking Deposition of Julie Jones, # 11 Exhibit Notice of Taking Deposition of Centurion) (BOWDEN, ALBERT) (Entered: 11/22/2017)

11/27/2017 158 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Proceedings held on 10/25/2017, before Judge Mark Walker. Court Reporter/Transcriber Megan Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/4/2017. Release of Transcript Restriction set for 3/5/2018. (mah) (Main Document 158 replaced on 12/12/2017 and proceeding date corrected to 10/25/2017.) (kjw) (Entered: 11/27/2017)
11/27/2017 159 NOTICE of Telephonic Hearing on 150 MOTION to Compel : Motion Hearing set for 11/28/2017 02:30 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 2:25 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 11/27/2017)

11/27/2017

160 MOTION Enlarge Rule 30(b)(6) Deposition Duration by Three Hours by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit First Amended Notice of 30(b)(6) Notice of FDC) (BERG, RANDALL) (Entered: 11/27/2017)

11/27/2017 161 JOINT STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) Modified on 11/28/2017 to reflect joint (ckm). (Entered: 11/27/2017)

11/27/2017 162 Consent MOTION to Continue of Hearing on Plaintiffs' Motion to Compel by JULIE L JONES. (DANIEL, STEPHANIE) (Entered: 11/27/2017)

11/27/2017

Set Response Deadline as to 160 MOTION Enlarge Rule 30(b)(6) Deposition Duration by Three Hours. (Internal deadline for referral to judge if response not filed earlier: 12/11/2017). (ckm) (Entered: 11/28/2017)

11/27/2017

Reset Deadline: Status Report due by 12/27/2017. (ckm) (Entered: 11/28/2017)

11/28/2017 163 NOTICE OF CANCELLATION OF HEARING ON 11/28/17 re 159 Notice of Hearing on Motion. (pll) (Entered: 11/28/2017)

11/28/2017

164 DOCKET ANNOTATION BY COURT TO ATTORNEY DANIEL Re: 162 Consent Motion to Continue Hearing: Counsel should be advised by this entry that the CM/ECF address is different from the address listed on the pleading. Please update in CM/ECF. (ckm) (Entered: 11/28/2017)

11/28/2017

165 ORDER GRANTING CONTINUANCE - This Court GRANTS Defendant's motion for a continuance of the November 28, 2017 hearing on Plaintiffs' motion to compel. ECF No. 162 . The clerk shall reschedule the hearing during the week of December 4th, 2017. Signed by JUDGE MARK E WALKER on 11/28/2017. (cle) (Entered: 11/28/2017)

11/28/2017

166 ORDER SETTING HEARING - re: 160 MOTION Enlarge Rule 30(b)(6) Deposition Duration by Three Hours. The Clerk shall set this matter for a hearing at the same time as the hearing on Plaintiffs' motion to compel. See ECF No. 164 . Signed by JUDGE MARK E WALKER on 11/28/2017. (cle) (Entered: 11/28/2017)

11/28/2017

167 NOTICE of Hearing on 150 MOTION to Compel , 160 MOTION Enlarge Rule 30(b)(6) Deposition Duration by Three Hours :Telephonic Motion Hearing set for 12/6/2017 10:00 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 9:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 11/28/2017)

11/29/2017 168 MOTION to Extend TimeTo File Plan by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 11/29/2017)

11/29/2017 169 ORDER GRANTING 168 MOTION FOR THREE-DAY EXTENSION.(Defendant's Plan due on 12/6/2017.) Signed by JUDGE MARK E WALKER on 11/29/2017. (tdl) (Entered: 11/29/2017)

12/01/2017

170 MOTION to Compel Regarding Second and Third Requests for Production by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - RFP Email) (SELIG, ERICA) (Entered: 12/01/2017)

12/01/2017

Set Response Deadline as to 170 MOTION to Compel Regarding Second and Third Requests for Production. (Internal deadline for referral to judge if response not filed earlier: 12/15/2017.) (ckm) (Entered: 12/04/2017)

12/02/2017

171 NOTICE of Telephonic Hearing on 170 MOTION to Compel Regarding Second and Third Requests for Production : Telephonic Motion Hearing set for 12/6/2017 10:00 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 9:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

(pll) (Entered: 12/02/2017)

12/04/2017

172 NOTICE of Filing Plaintiffs' Consolidated Response to Defendant's Motion for Protective Order [DE 157] and Extension of Time to Respond to Plaintiffs' Third Set of Interrogatories by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA re 157 Response to Motion,,,, (BERG, RANDALL) (Entered: 12/04/2017)

12/06/2017

173 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 12/6/2017. Court DENIES as moot 150 Motion to Compel. Court GRANTS IN PART AND DENIES IN PART 160 Motion to Enlarge Time. Court GRANTS IN PART AND DENIES IN PART 170 Motion to Compel. Partial/Specific Discovery deadline due by February 3, 2018. Depositions shall be set the week of February 20, 2018 and the week of February 27, 2018. Dispositive motions extended by 60 days. Trial extended 60 days. Court orders parties will split the cost and authorizes court reporter to begin transcript. Attorney notice regarding remaining discovery issues due by December 15, 2017. Order to follow. (Attorney Notice due by 12/15/2017). (Court Reporter Megan Hague) (vkm) (Entered: 12/06/2017)

12/06/2017

174 ORDER RESOLVING DISCOVERY DISPUTES AND EXTENDING DEADLINES - Plaintiffs' motion to compel, ECF No. 150 , is GRANTED IN PART and DENIED IN PART. Defendant's motion for a protective order, ECF No. 157 , is GRANTED IN PART and DENIED IN PART. Plaintiffs' motion to extend the length of its Rule 30(b)(6) deposition of FDC, ECF No. 160 , is DENIED. Plaintiffs' motion to compel, ECF No. 170 , is GRANTED IN PART, DENIED IN PART, and TAKEN UNDER ADVISEMENT IN PART. The discovery deadline is extended to 4/2/2018. The deadline for the filing of dispositive motions is extended to 4/27/2018. The bench trial now scheduled for May 21, 2018, is rescheduled to take place in July, 2018, but no earlier than July 20, 2018. The Clerk shall schedule the trial accordingly. Signed by JUDGE MARK E WALKER on 12/6/17. (ckm) (Entered: 12/06/2017)

12/06/2017 175 NOTICE of Filing Plan of Treatment by JULIE L JONES (Attachments: # 1 Exhibit Plan of Treatment, # 2 Exhibit Exhibit A to Plan of Treatment,

# 3 Exhibit Composite Exhibit B to Plan of Treatment) (BOWDEN, ALBERT) Modified on 12/7/2017 to reflect more complete document title (ckm). (Entered: 12/06/2017)

12/07/2017 176 NOTICE OF HEARING : Bench Trial set for 8/6/2018 08:15 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. United States Courthouse, 111 North Adams St., Tallahassee, Florida 32301.

NOTE: If you or any party, witness or attorney in this matter has a disability that requires special accommodation, such as, a hearing impairment that requires a sign language interpreter or a wheelchair restriction that requires ramp access, please contact Pam Lourcey at 850521-3501 in the Clerk's Office at least one week prior to the hearing (or as soon as possible) so arrangements can be made.

s/ Pam Lourcey Courtroom Deputy Clerk (pll) (Entered: 12/07/2017)

12/07/2017 177 MOTION Plaintiff's Motion for Leave to Comment on Defendant's Plan of Treatment by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 12/07/2017)

12/07/2017

Set Response Deadline as to 177 Motion for Leave to Comment on Defendant's Plan of Treatment. (Internal deadline for referral to judge if response not filed earlier: 12/21/2017). (ckm) (Entered: 12/08/2017)

12/08/2017

178 ORDER REQUIRING THE PARTIES TO RESPOND - Plaintiffs' motion for leave to comment on Defendant's plan of treatment, ECF No. 177 , is GRANTED. Both parties shall file comments to the plan, in light of this order, no later than noon on 12/11/2017. Signed by JUDGE MARK E WALKER on 12/8/2017. (vkm) (Entered: 12/08/2017)

12/08/2017

179 NOTICE OF FILING OF OFFICIAL TRANSCRIPT *EXCERPT* of Proceedings (Dr. Maier's Testimony) held on 10/20/2017, before Judge Mark Walker. Court Reporter/Transcriber Megan Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/15/2017. Release of Transcript Restriction set for 3/15/2018. (mah) (Entered: 12/08/2017)

12/11/2017 180 NOTICE of Filing Plaintiffs' Comments and Objections to Defendant's Plan of Treatment for Chronic Hepatitis C by CARL HOFFER,

RONALD MCPHERSON, ROLAND MOLINA (TREVISANI, DANTE) (Entered: 12/11/2017)

12/11/2017

181 NOTICE of Filing Comments to Defendant's Plan of Treatment for Chronic Hepatitis C by JULIE L JONES (Attachments: # 1 Comments, # 2 Exhibit A, # 3 Exhibit B) (BOWDEN, ALBERT) (Entered: 12/11/2017)

12/11/2017 182 MOTION to Extend TimeTo File Answer and Defenses to Complaint (Unopposed) by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 12/11/2017)

12/11/2017 183 ORDER GRANTING 182 EXTENSION OF TIME TO FILE ANSWER AND DEFENSES (Answer due by 12/14/2017). Signed by JUDGE MARK E WALKER on 12/11/17. (ckm) (Entered: 12/11/2017)

12/11/2017

184 NOTICE OF FILING OF OFFICIAL TRANSCRIPT *EXCERPT* of Proceedings (testimony of Mr. Reimers) held on 10/24/2017, before Judge Mark Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/18/2017. Release of Transcript Restriction set for 3/19/2018. (mah) (Entered: 12/11/2017)

12/13/2017

185 **Dissolved pursuant to 465 ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT** ***RENEWED PURSUANT TO 380 ORDER*** ORDER ENTERING A PRELIMINARY INJUNCTION (re 175 NOTICE of Filing Plan of Treatment) - Beginning on 1/1/2018 and on the first day of each month thereafter, Defendant shall file with this Court a status report reflecting FDC's progress in complying with this Court's injunction. The bond provisions of Rule 65(c) of the Federal Rules of Civil Procedure are waived, and this preliminary injunction shall issue immediately. Signed by JUDGE MARK E WALKER on 12/13/17. (ckm) Modified on 3/12/2018 to reflect modifications (ckm). Modified on 3/30/2018 to reflect modification (ckm). Modified on 9/5/2018 to reflect renewed (ckm). Modified on 4/18/2019 (kjw). (Entered: 12/13/2017)

12/13/2017 186 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Excerpt of Third Day of Preliminary Injunction Hearing (Testimony of Thomas Reimers and Timothy Whalen) held on 10-23-2017, before Judge MARK E.

WALKER. Court Reporter/Transcriber Judy A. Gagnon, Telephone number 850-561-6822.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/20/2017. Release of Transcript Restriction set for 3/20/2018. (jg) (Entered: 12/13/2017)
12/14/2017 187 ANSWER to 1 Complaint, by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 12/14/2017)

12/15/2017 188 RESPONSE in Opposition re 170 MOTION to Compel Regarding Second and Third Requests for Production filed by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 12/15/2017)

12/18/2017 189 MOTION for Leave to File Reply by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 12/18/2017)

12/18/2017

190 ORDER GRANTING LEAVE TO FILE REPLY - This Court has considered, without hearing, Plaintiffs' Motion for Leave to Reply to Defendant's Response to Motion to Compel Regarding Second and Third Requests for Production. ECF No. 189 . The unopposed motion is GRANTED. Plaintiffs may file their reply, not to exceed 5 pages, on or before 12/22/2017. Signed by JUDGE MARK E WALKER on 12/18/2017. (vkm) (Entered: 12/18/2017)

12/18/2017

191 REPLY to Response to Motion re 170 MOTION to Compel Regarding Second and Third Requests for Production filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 12/18/2017)

12/20/2017

192 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Proceedings (*EXCERPT* - PM session) held on 10/23/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/27/2017. Release of Transcript Restriction set for 3/27/2018. (mah) (Entered: 12/20/2017)

12/20/2017 193 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Proceedings (*EXCERPT*) held on 10/24/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/27/2017. Release of Transcript Restriction set for 3/27/2018. (mah) (Entered: 12/20/2017)

12/20/2017 194 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Proceedings (*EXCERPT*) held on 10/20/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 12/27/2017. Release of Transcript Restriction set for 3/27/2018. (mah) (Entered: 12/20/2017)
12/29/2017 195 NOTICE of Filing the January 2018 Status Report by JULIE L JONES re 185 Order,,, Set Deadlines,, (Attachments: # 1 Defendant'sJanuary 2018 Status Report) (BOWDEN, ALBERT) (Entered: 12/29/2017)

01/04/2018 196 STATUS REPORT Joint for December by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 01/04/2018)

01/04/2018

Set Discovery Status Report Deadline. Status Report due by 2/5/2018. (cle) (Entered: 01/04/2018)

01/04/2018 197 Unopposed MOTION for Withdrawal of Counsel by JULIE L JONES. (NEFF, LANCE) Modified on 1/5/2018 to reflect complete document title (ckm). (Entered: 01/04/2018)

01/04/2018

198 ORDER GRANTING MOTION FOR WITHDRAWAL OF COUNSEL The Unopposed Motion for Withdrawal of Counsel filed by Lance Eric Neff, counsel for Defendant, ECF No. 197 , is GRANTED. Mr. Neff is permitted to withdraw as counsel for Defendant. Defendant shall continue to be represented Stephanie Allison Daniel and Albert Bowden. The Clerk shall disconnect the notice of electronic filing for withdrawing counsel. Attorney LANCE ERIC NEFF terminated. Signed by JUDGE MARK E WALKER on 1/4/2018. (cle) (Entered: 01/05/2018)

01/05/2018

199 MOTION for Liver Transplant Evaluation for Carl Hoffer and Request for Expedited Adjudication by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Excerpted Deposition Transcript of Dr. Dewsnup, # 2 Exhibit 2 - Excerpted Hearing Transcript of Dr. Dewsnup) (SELIG, ERICA) (Entered: 01/05/2018)

01/05/2018 200 Consent MOTION to Withdraw as Attorney , MOTION to Substitute Attorney by JULIE L JONES. (BRODEEN, KAREN) Modified on 1/8/2018 to reflect consent (ckm). (Entered: 01/05/2018)

01/05/2018

Set Deadline as to 199 MOTION for Liver Transplant Evaluation for Carl Hoffer and Request for Expedited Adjudication. (Internal deadline for referral to judge if response not filed earlier: 1/19/2018.) (ckm) (Entered: 01/08/2018)

01/08/2018

Reset Deadline re: 185 Order Entering a Preliminary Injunction - FDC Status Report due by 2/1/2018. (ckm) (Entered: 01/08/2018)

01/08/2018

201 NOTICE of Hearing on 199 MOTION for Liver Transplant Evaluation for Carl Hoffer and Request for Expedited Adjudication :Telephonic Motion Hearing set for 1/16/2018 11:00 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 10:55 AM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey (pll) (Entered: 01/08/2018)

01/08/2018

202 ORDER GRANTING WITHDRAWAL AND SUBSTITUTION OF COUNSEL - This Court has considered, without hearing, Defendant's Motion for Withdrawal and Substitution of Counsel. ECF No. 200 . The motion is GRANTED. Attorney STEPHANIE ALLISON DANIEL terminated. The Clerk shall disconnect Stephanie Daniel from the notice of electronic filing. Signed by JUDGE MARK E WALKER on 1/8/2018. (vkm) (Entered: 01/09/2018)

01/09/2018

203 ORDER ON MOTION TO COMPEL - re: 170 MOTION to Compel. This order serves to clear up any confusion and make plain that Defendant must produce the medical examiner reports and mortality reviews for all inmates listed on the document Bates numbered 004502 to 004513,

regardless of the listed cause of death. Signed by JUDGE MARK E WALKER on 1/9/2018. (cle) (Entered: 01/09/2018)

01/12/2018

204 RESPONSE to Motion re 199 MOTION for Liver Transplant Evaluation for Carl Hoffer and Request for Expedited Adjudication filed by JULIE L JONES. (Attachments: # 1 Excerpts of Dr. Dewsnup 10/25/17 testimony, # 2 Dr. Daniel Cherry Declaration, # 3 Email) (BOWDEN, ALBERT) (Entered: 01/12/2018)

01/12/2018

205 MOTION to Compel Centurion Emails by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Email Exhibit 1, # 2 Exhibit Email Exhibit 2, # 3 Exhibit Centurion Contract Excerpts) (TREVISANI, DANTE) (Entered: 01/12/2018)

01/15/2018

206 ORDER REQUIRING EXPEDITED RESPONSE - Defendant is directed to file an expedited response to Plaintiffs' 205 motion, if any, on or beforere 1/23/2018. Signed by JUDGE MARK E WALKER on 1/15/18. (ckm) (Entered: 01/16/2018)

01/16/2018

207 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 1/16/2018 re 199 MOTION for Liver Transplant Evaluation for Carl Hoffer and Request for Expedited Adjudication. Court DENIES AS MOOT 199 Motion for the reasons stated on the record. Clerk instructed to terminate motion. (Court Reporter Megan Hague.) (pll) (Entered: 01/16/2018)

01/18/2018

ACTION REQUIRED BY DISTRICT JUDGE: Chambers of JUDGE MARK E WALKER notified that action is needed Re: 30 Initial Scheduling Order. No mediation report has been filed. (ckm) (Entered: 01/18/2018)

01/18/2018 208 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Proceedings held on 12/6/2017, before Judge Mark Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 1/25/2018. Release of Transcript Restriction set for 4/25/2018. (mah) (Entered: 01/18/2018)
01/23/2018 209 RESPONSE to Motion re 205 MOTION to Compel Centurion Emails filed by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 01/23/2018)

01/26/2018 210 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 01/26/2018)

01/26/2018

Reset Deadlines: Status Report due by 2/26/2018. (ckm) (Entered: 01/26/2018)

01/31/2018

211 MOTION Modification of Preliminary Injunction re 185 Order,,, Set Deadlines,, by JULIE L JONES. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D) (BOWDEN, ALBERT) (Entered: 01/31/2018)

01/31/2018 212 NOTICE of Filing the February 2018 Status Report by JULIE L JONES (Attachments: # 1 Status Report) (BOWDEN, ALBERT) (Entered: 01/31/2018)

01/31/2018 213 NOTICE OF TELEPHONIC HEARING: Status Conference set for 2/9/2018 02:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 1:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 01/31/2018)

01/31/2018

214 ORDER MODIFYING PRELIMINARY INJUNCTION - Defendant's motion for modification, ECF No. 211 , is GRANTED in part and DENIED in part. Signed by JUDGE MARK E WALKER on 1/31/2018. (tdl) (Entered: 01/31/2018)

01/31/2018 215 NOTICE of Filing February 2018 Amended Status Report by JULIE L JONES (Attachments: # 1 Amended Status Report) (BOWDEN, ALBERT) (Entered: 01/31/2018)

02/01/2018

***ENTERED IN ERROR*** Reset Deadline: Status Report due by 3/2/2018. (ckm) Modified on 2/1/2018 to reflect error (ckm). (Entered: 02/01/2018)

02/01/2018

Reset Deadlines: Joint Status Report due by 2/26/2018 per 16 Initial Scheduling Order. FDC Status Report due by 3/1/2018 per 185 Order. (ckm) (Entered: 02/01/2018)

02/05/2018 216 ORDER GRANTING 205 MOTION TO COMPEL. Signed by JUDGE MARK E WALKER on 2/5/18. (ckm) (Entered: 02/05/2018)

02/09/2018

217 Consent MOTION for Modification of Preliminary Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Dewsnup Hearing Transcript, # 2 Exhibit 2 Koziel Hearing Transcript, # 3 Exhibit 3 - Dewsnup Deposition Transcript, # 4 Exhibit 4 - Defendant's Responses to McPherson's Second Set of Interrogatories) (TREVISANI, DANTE) (Entered: 02/09/2018)

02/09/2018

218 ORDER MODIFYING PRELIMINARY INJUNCTION - Plaintiff's motion for modification, ECF No. 217 , is GRANTED. The Preliminary Injunction, ECF No. 185 , is modified as follows: Paragraph 1(e) is added to read: "FDC must initiate treatment for all prisoners with HCV who are co-infected with HIV - regardless of fibrosis score - by December 31, 2018." Signed by JUDGE MARK E WALKER on 2/9/18. (ckm) (Entered: 02/09/2018)

02/09/2018 219 Minute Entry for proceedings held before JUDGE MARK E WALKER: Status Conference held on 2/9/2018. (Court Reporter Megan Hague.) (pll) (Entered: 02/10/2018)

02/12/2018

220 Joint MOTION for Entry of Stipulated Confidentiality Order by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Stipulated Confidentiality Order) (TREVISANI, DANTE) (Entered: 02/12/2018)

02/12/2018 221 Joint MOTION for Extension of Time to Complete Discovery and for Filing Dispositive Motions by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 02/12/2018)

02/13/2018

222 ORDER EXTENDING DISCOVERY DEADLINE AND DEADLINE FOR FILING DISPOSITIVE MOTIONS - The parties jointly move this Court to extend the discovery deadline and the deadline for filing dispositive motions by four weeks. ECF No. 221 . Their motion is GRANTED. The new discovery deadline is 4/30/2018. The new deadline for filing dispositive motions is 5/25/2018. Signed by JUDGE MARK E WALKER on 2/13/18. (ckm) (Entered: 02/13/2018)

02/13/2018 223 STIPULATED CONFIDENTIALITY ORDER (re: 220 Joint Motion for Entry of Stipulated Confidentiality Order). Signed by JUDGE MARK E WALKER on 2/13/18. (ckm) (Entered: 02/13/2018)

02/16/2018 224 MOTION for Issuance of a Second Preliminary Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 02/16/2018)

02/16/2018 225 NOTICE of Appearance by RAY TASEFF on behalf of CARL HOFFER (TASEFF, RAY) (Entered: 02/16/2018)

02/16/2018

Set Deadline as to 224 MOTION for Issuance of a Second Preliminary Injunction. (Internal deadline for referral to judge if response not filed earlier: 3/2/2018) (ckm) (Entered: 02/16/2018)

02/21/2018

226 ORDER ENTERING SECOND PRELIMINARY INJUNCTION Plaintiffs' motion for issuance of a second preliminary injunction, ECF No. 224 , is GRANTED. The Preliminary Injunction, ECF No. 185 , as subsequently modified (see ECF No. 214 ; ECF No. 218 ), shall re-issue on March 14, 2018. Signed by JUDGE MARK E WALKER on 2/21/2018. (ckm) (Entered: 02/21/2018)

02/21/2018

227 Joint MOTION for Entry of Stipulated Inadvertent Disclosure Order by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Stipulated Inadvertent Disclosure Order) (TREVISANI, DANTE) (Entered: 02/21/2018)

02/22/2018 228 ORDER GRANTING 227 JOINT MOTION FOR ENTRY OF STIPULATED INADVERTENT DISCLOSURE ORDER. Signed by JUDGE MARK E WALKER on 2/22/2018. (ckm) (Entered: 02/22/2018)

02/26/2018 229 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 02/26/2018)

02/27/2018

Reset Deadline re: 16 Initial Scheduling Order: Joint Status Report due by 3/28/2018. (ckm) (Entered: 02/27/2018)

02/28/2018 230 STATUS REPORT March 2018 by JULIE L JONES. (BRODEEN, KAREN) (Entered: 02/28/2018)

02/28/2018

Reset Deadline re: 185 Order: FDC Status Report due by 4/2/2018. (ckm) (Entered: 02/28/2018)

02/28/2018

231 Second Consent MOTION for Modification of Preliminary Injunction re 185 Order by JULIE L JONES. (Attachments: # 1 Exhibit A) (BOWDEN, ALBERT) Modified on 3/1/2018 to reflect consent (ckm). (Entered: 02/28/2018)

03/05/2018 232 ORDER DIRECTING DEFENDANT TO PROVIDE PROPOSED ORDER (re 231 Second Consented Motion for Modification of

Preliminary Injunction) - Proposed Order due by 3/9/2018. Signed by JUDGE MARK E WALKER on 3/5/2018. (ckm) (Entered: 03/05/2018)

03/08/2018

233 MOTION to Compel Deadline for Email Production, Consent MOTION for Extension of Time to Complete Discovery by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 03/08/2018)

03/08/2018

Set Deadline re 233 Motion: Internal deadline for referral to judge if response not filed earlier: 3/22/2018 . (tdl) (Entered: 03/09/2018)

03/09/2018

234 NOTICE of Telephonic Hearing on 233 MOTION to Compel Deadline for Email Production Consent MOTION for Extension of Time to Complete Discovery : Motion Hearing set for 3/13/2018 04:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 3:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 03/09/2018)

03/09/2018 235 NOTICE of Filing Proposed Order Modifying Preliminary Injunction by JULIE L JONES (Attachments: # 1 Text of Proposed Order Proposed Order) (BOWDEN, ALBERT) (Entered: 03/09/2018)

03/12/2018

236 ORDER MODIFYING PRELIMINARY INJUNCTION - Defendant's motion for modification of the Preliminary Injunction, ECF No. 231 , is GRANTED. Signed by JUDGE MARK E WALKER on 3/12/2018. (ckm) (Entered: 03/12/2018)

03/13/2018

237 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 3/13/2018 re 233 MOTION to Compel Deadline for Email Production Consent MOTION for Extension of Time to Complete Discovery . Court GRANTS IN PART AND DENIES IN PART 233 Motion. Discovery deadline extended to July 6, 2018. Order to

follow on deadlines. ( Discovery due by 7/6/2018.). (Court Reporter Megan Hague.) (pll) (Entered: 03/13/2018)

03/13/2018

238 ORDER ON MOTION TO COMPEL - Plaintiffs' motion to compel, ECF No. 233 , is GRANTED in part and DENIED in part. (Discovery extended to 7/6/2018.) Signed by JUDGE MARK E WALKER on 3/13/2018. (ckm) (Entered: 03/14/2018)

03/22/2018 239 SUGGESTION OF DEATH Upon the Record as to Carl Hoffer by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 03/22/2018)

03/27/2018 240 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 03/27/2018)

03/27/2018

Reset Deadline re: 16 Initial Scheduling Order: Joint Status Report due by 4/26/2018. (ckm) (Entered: 03/27/2018)

03/29/2018 241 STATUS REPORT April 2018 by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 03/29/2018)

03/29/2018

242 Third MOTION Modification of Preliminary Injunction re 185 Order,,, Set Deadlines,, and Incorporated Memorandum of Law by JULIE L JONES. (Attachments: # 1 Exhibit A- HSB, # 2 Exhibit B- Declaration of Dr. Daniel Cherry) (BRODEEN, KAREN) (Entered: 03/29/2018)

03/29/2018

Set Response Deadline as to 242 Third Motion for Modification of Preliminary Injunction. (Internal deadline for referral to judge if response not filed earlier: 4/12/2018.) (ckm) (Entered: 03/30/2018)

03/30/2018

Reset Deadline re: 185 Order: FDC Status Report due by by 5/1/2018. (ckm) (Entered: 03/30/2018)

03/30/2018

243 ORDER MODIFYING 185 PRELIMINARY INJUNCTION Defendant's motion for modification of the Preliminary Injunction, ECF No. 242 , is GRANTED. Signed by JUDGE MARK E WALKER on 3/30/2018. (ckm) (Entered: 03/30/2018)

04/03/2018

244 MOTION for Protective Order regarding Plaintiffs' Subpoena seeking personnel files by Ana Centurion of Florida, LLC, DANIEL CHERRY. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C) (FRANCOLIN DOLNEY, ANA) (Entered: 04/03/2018)

04/03/2018

Set Response Deadline as to 244 MOTION for Protective Order regarding Plaintiffs' Subpoena seeking personnel files. (Internal deadline for referral to judge if response not filed earlier: 4/17/2018). (ckm) (Entered: 04/04/2018)

04/04/2018

245 ORDER DIRECTING EXPEDITED RESPONSE re 244 Motion for Protective Order (Internal deadline for referral to judge if response not filed earlier: 4/11/2018.) Signed by JUDGE MARK E WALKER on 4/4/2018. (ckm) (Entered: 04/04/2018)

04/09/2018 246 MOTION to Terminate Counsel and Appoint Substitute Counsel by STEVEN A. MCLEOD. (ckm) (Entered: 04/10/2018)

04/09/2018

Set Response Deadline as to 246 MOTION to Disqualify Counsel. (Internal deadline for referral to judge if response not filed earlier: 4/23/2018.) (ckm) (Entered: 04/10/2018)

04/10/2018

247 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Excerpt of First Day of Hearing (Defense Opening Statement) held on 10/19/2017, before Judge MARK WALKER. Court Reporter/Transcriber Judy A. Gagnon, Telephone number 850-561-6822.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 4/17/2018. Release of Transcript Restriction set for 7/16/2018. (jg) (Entered: 04/10/2018)

04/11/2018

248 RESPONSE in Opposition re 244 MOTION for Protective Order regarding Plaintiffs' Subpoena seeking personnel files filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - March 25th Email, # 2 Exhibit 2 November 17th Email, # 3 Exhibit 3 - December 21st Email, # 4 Exhibit 4 - Centurion Objections to First Subpoena, # 5 Exhibit 5 - March 2nd Email, # 6 Exhibit 6 - Dewsnup Hearing Transcript, # 7 Exhibit 7 - FDC Emails, # 8 Exhibit 8 - Whalen Hearing Transcript, # 9 Exhibit 9 Closing Argument Hearing Transcript, # 10 Exhibit 10 - Prescription List, # 11 Exhibit 11 - Utilization Management Records, # 12 Exhibit 12 Maier Deposition, # 13 Exhibit 13 - Whalen Deposition, # 14 Exhibit 14 Opening Statement Hearing Transcript, # 15 Exhibit 15 - Reimers Hearing Transcript) (TREVISANI, DANTE) (Entered: 04/11/2018)

04/11/2018

249 MOTION for Leave to File Reply to Plaintiff's 248 Response in Opposition to 244 Motion for Protective Order by Ana Centurion of Florida, LLC. (Attachments: # 1 Exhibit A) (FRANCOLIN DOLNEY, ANA) Modified on 4/12/2018 to link related documents (ckm). (Entered: 04/11/2018)

04/11/2018 250 MOTION for Protective Order and to Intervene for Limited Purpose by Ayodeji Ladele. (MAYFIELD, ROBERT) (Entered: 04/11/2018)

04/11/2018

Set Response Deadlines as to 249 MOTION for Leave to File and 250 MOTION for Protective Order. (Internal deadline for referral to judge if response not filed earlier: 4/25/2018.) (ckm) (Entered: 04/12/2018)

04/12/2018

251 RESPONSE in Opposition re 249 MOTION for Leave to File Reply to Plaintiff's Response in Opposition to Motion for Protective Order filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 04/12/2018)

04/12/2018

252 NOTICE of Telephonic Hearing on 244 MOTION for Protective Order regarding Plaintiffs' Subpoena seeking personnel files and 250 MOTION for Protective Order and to Intervene for Limited Purpose: Motion Hearing set for 4/18/2018 03:30 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 3:25 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 04/12/2018)
04/13/2018 253 ORDER DENYING 249 MOTION FOR LEAVE TO FILE REPLY. Signed by JUDGE MARK E WALKER on 4/13/2018. (ckm) (Entered: 04/13/2018)
04/13/2018 254 ORDER DENYING 246 MOTION TO TERMINATE COUNSEL. Signed by JUDGE MARK E WALKER on 4/13/2018. (ckm) ***Copy mailed to McLeod*** (Entered: 04/13/2018)

04/16/2018

255 RESPONSE in Opposition re 250 MOTION for Protective Order and to Intervene for Limited Purpose filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 04/16/2018)

04/18/2018 256 Minute Entry for proceedings held before JUDGE MARK E WALKER: Motion Hearing held on 4/18/2018. Court hears 244 and 250 Motion for

Protective Order. Court GRANTS IN PART AND DENIES IN PART 244 and 250 Motion for Protective Order. Counsel shall produce documents by May 8, 2018. (Court Reporter Judy Gagnon.) (pll) (Entered: 04/18/2018)

04/26/2018 257 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 04/26/2018)

04/26/2018 258 NOTICE of Change of Address by STEVEN A. MCLEOD. (ckm) (Entered: 04/27/2018)

04/26/2018 259 MOTION to Intervene by STEVEN A. MCLEOD. (Attachments: # 1 McLeod Complaint) (ckm) (Entered: 04/27/2018)

04/27/2018

Reset Deadline re 16 Initial Scheduling Order: Joint Status Report due by 5/29/2018. (ckm) (Entered: 04/27/2018)

04/28/2018

260 ORDER DENYING 259 MOTION TO INTERVENE as to Steven A. McLeod. Signed by JUDGE MARK E WALKER on 4/28/18. (pll) ***Copy mailed to McLeod at Dade CI*** Modified on 5/29/2018 (ckm). (Entered: 04/28/2018)

04/30/2018 261 STATUS REPORT May 2018 by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 04/30/2018)

05/01/2018

Reset Deadline re: 185 Order: FDC Status Report due by 6/1/2018. (ckm) (Entered: 05/01/2018)

05/03/2018

262 MOTION for Protective Order Relating to Corporate Representative Deposition Designations by Non-Party Centurion of Florida, LLC by Ana Centurion of Florida, LLC. (Attachments: # 1 Exhibit A) (FRANCOLIN DOLNEY, ANA) (Entered: 05/03/2018)

05/03/2018

Set Response Deadline as to 262 MOTION for Protective Order. (Internal deadline for referral to judge if response not filed earlier: 5/17/2018.) (ckm) (Entered: 05/04/2018)

05/04/2018

263 ORDER REQUIRING EXPEDITED RESPONSE - Plaintiffs are directed to file an expedited response to Centurion's motion, ECF No. 262 , no later than Friday, 5/11/2018. The Clerk is directed to set this matter for a hearing after Plaintiffs response has been filed and before the deposition scheduled for May 23, 2018. Signed by JUDGE MARK E WALKER on 5/4/2018. (ckm) (Entered: 05/04/2018)

05/04/2018 264 NOTICE of Telephonic Hearing on 262 MOTION for Protective Order Relating to Corporate Representative Deposition Designations by

Non-Party Centurion of Florida, LLC :Telephonic Motion Hearing set for 5/18/2018 04:30 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 4:25 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 05/04/2018)

05/04/2018 265 MOTION to Supplement Motion to Intervene filed by STEVEN A MCLEOD. (ckm) (Entered: 05/07/2018)

05/04/2018 266 MOTION for Court Order for Movant to Communicate with Class Representatives filed by STEVEN A MCLEOD. (ckm) (Entered: 05/07/2018)

05/04/2018 267 MOTION for Reconsideration (re 254 Order Denying Motion to Terminate Counsel) filed by STEVEN A MCLEOD. (ckm) (Entered: 05/07/2018)

05/07/2018

268 ORDER DENYING STEVEN A. MCLEOD'S MOTIONS - Steven A. McLeod's motion to supplement, ECF No. 265 , is DENIED. Steven A. McLeod's motion for court order for movant to communicate with class representatives, ECF No. 266 , is DENIED. Steven A. McLeod's motion for reconsideration, ECF No. 267 , is DENIED. ***PORTION WITHDRAWN PER 301 ORDER: The Clerk is directed not to accept further filings from Steven A. McLeod in this case.*** Signed by JUDGE MARK E WALKER on 5/7/2018. (ckm) ***Copy mailed to McLeod*** Modified on 5/18/2018 (vkm). (Entered: 05/07/2018)

05/08/2018 269 NOTICE of Filing Additional Exhibits in Support of Dispositive Motions by JULIE L JONES (Attachments: # 1 Exhibit, # 2 Exhibit) (BOWDEN, ALBERT) (Entered: 05/08/2018)

05/08/2018 270 MOTION for Summary Judgment Defendant's Motion to Convert Preliminary Injunction to a Permanent Injunction and For Summary

Judgment by JULIE L JONES. (Internal deadline for referral to judge if response to summary judgment not filed earlier: 5/29/2018). (BOWDEN, ALBERT) (Entered: 05/08/2018)

05/08/2018

271 MOTION to Enforce Judgment (Preliminary Injunction Order) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Hoffer's First Set of Interrogatories to FDC, # 2 Exhibit 2 - Defendant's Answers and Objections to Hoffer's First Set of Interrogatories, # 3 Exhibit 3 - February 23rd Letter, # 4 Exhibit 4 Emails Between Counsel) (TREVISANI, DANTE) Modified on 5/11/2018 - Hard copies of this filing filed. (cle). (Entered: 05/08/2018)

05/08/2018

Set Response Deadline as to 271 MOTION to Enforce Judgment (Preliminary Injunction Order). (Internal deadline for referral to judge if response not filed earlier: 5/22/2018.) (ckm) (Entered: 05/09/2018)

05/09/2018

272 NOTICE of Telephonic Hearing on 262 MOTION for Protective Order Relating to Corporate Representative Deposition Designations by Non-Party Centurion of Florida, LLC, 271 MOTION to Enforce Judgment (Preliminary Injunction Order) : Telephonic Motion Hearing set for 5/18/2018 04:30 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 4:25 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 05/09/2018)

05/09/2018

273 MOTION for Protective Order As to Plaintiffs' Fourth Amended Notice of Taking a Fed.R.Civ.P. 30(b)(6) Deposition Beginning on May 21, 2018 by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 05/09/2018)

05/09/2018 274 ORDER REQUIRING EXPEDITED RESPONSE re 271 Motion to Enforce Judgment (Preliminary Injunction Order): Defendant response

due by 5/16/2018. Signed by JUDGE MARK E WALKER on 5/9/2018. (ckm) (Entered: 05/09/2018)

05/09/2018 275 ORDER REQUIRING EXPEDITED RESPONSE re 273 Motion for Protective Order: Plaintiffs response due by 5/16/2018. Signed by JUDGE MARK E WALKER on 5/9/2018. (ckm) (Entered: 05/09/2018)

05/09/2018

276 RESPONSE in Opposition re 262 MOTION for Protective Order Relating to Corporate Representative Deposition Designations by Non-Party Centurion of Florida, LLC filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 Emails Between Counsel) (TREVISANI, DANTE) (Entered: 05/09/2018)

05/10/2018 278 MOTION for Enforcement of Civil Contempt Order Against Class Attorney's and Florida Department of Corrections Secretary Julie Jones by SIDNEY MARTS. (tdl) (Entered: 05/11/2018)

05/11/2018

277 NOTICE OF RESCHEDULED TELEPHONIC Hearing on 273 MOTION for Protective Order As to Plaintiffs' Fourth Amended Notice of Taking a Fed.R.Civ.P. 30(b)(6) Deposition Beginning on May 21, 2018, 262 MOTION for Protective Order Relating to Corporate Representative Deposition Designations by Non-Party Centurion of Florida, LLC, 271 MOTION to Enforce Judgment (Preliminary Injunction Order) : Motion Hearing set for 5/18/2018 04:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 3:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 05/11/2018)

05/11/2018

279 **This hearing is reset pursuant to Court instruction.** AMENDED NOTICE of Telephonic Hearing on 273 MOTION for Protective Order As to Plaintiffs' Fourth Amended Notice of Taking a Fed.R.Civ.P. 30(b)(6) Deposition Beginning on May 21, 2018, 262 MOTION for Protective Order Relating to Corporate Representative Deposition Designations by

Non-Party Centurion of Florida, LLC, 271 MOTION to Enforce Judgment (Preliminary Injunction Order) : Telephonic Motion Hearing set for 5/18/2018 02:00 PM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.

You may dial into the conference call as early as 1:55 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter: 3853136#. If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking.

s/ Pam Lourcey Courtroom Deputy Clerk

The quality of the audio connection is compromised by the use of cell phones or speakerphones and counsel are requested not to use those devices during the call. (pll) (Entered: 05/11/2018)

05/11/2018 280 ORDER DENYING SIDNEY MARTS'S 278 MOTION. Signed by JUDGE MARK E WALKER on 5/11/2018. (vkm) ***ORDER PROVIDED TO MARTS*** (Entered: 05/11/2018)

05/11/2018 281 Joint MOTION to Continue Depositions by Ana Centurion of Florida, LLC, JULIE L JONES. (FRANCOLIN DOLNEY, ANA) (Entered: 05/11/2018)

05/11/2018 282 MOTION for Protective Order by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 05/11/2018)

05/13/2018

283 ORDER GRANTING 281 MOTION FOR CONTINUANCE. The Rule 30(b)(6) depositions at issue are rescheduled to take place on May 22-23, 2018. Signed by JUDGE MARK E WALKER on 5/13/18. (pll) (Entered: 05/13/2018)

05/14/2018

284 NOTICE of Correction To Defendant's Motion To Convert Preliminary Injunction to a Permanent Injunction and for Summary Judgment by JULIE L JONES re 270 MOTION for Summary Judgment Defendant's Motion to Convert Preliminary Injunction to a Permanent Injunction and For Summary Judgment (BOWDEN, ALBERT) (Entered: 05/14/2018)

05/14/2018 285 ORDER REQUIRING EXPEDITED RESPONSE re 282 MOTION for Protective Order. (Internal deadline for referral to judge if response not

filed earlier: 5/17/2018 at noon). Signed by JUDGE MARK E WALKER on 5/14/2018. (erl) (Entered: 05/14/2018)

05/14/2018

286 RESPONSE in Opposition re 273 MOTION for Protective Order As to Plaintiffs' Fourth Amended Notice of Taking a Fed.R.Civ.P. 30(b)(6) Deposition Beginning on May 21, 2018 and Request for Attorneys' Fees filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Hearing Transcript, # 2 Exhibit January 26 Email, # 3 Exhibit February 1 Email, # 4 Exhibit Draft Stipulation, # 5 Exhibit February 9 Email, # 6 Exhibit Defendant's Objections, # 7 Exhibit May 7 Email) (TREVISANI, DANTE) (Entered: 05/14/2018)

05/14/2018

287 RESPONSE to Motion re 271 MOTION to Enforce Judgment (Preliminary Injunction Order) Defendant's Response to Plaintiffs' Motion to Enforce Preliminary Injunction Order filed by JULIE L JONES. (Attachments: # 1 Affidavit, # 2 Affidavit) (BOWDEN, ALBERT) (Entered: 05/14/2018)

05/14/2018 288 MOTION for Reconsideration re 283 Order on Motion to Continue by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 05/14/2018)

05/16/2018

289 MOTION For Clarification of Date For Filing Dispositive Motions or, in the alternative, Plaintiffs' Motion for the Enlargement of Date to File Dispositive Motions by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 05/16/2018)

05/17/2018 290 RESPONSE to Motion re 282 MOTION for Protective Order Defendant's Response to Plaintiffs' Motion for Protective Order filed by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 05/17/2018)

05/17/2018 291 ORDER GRANTING 289 MOTION FOR CLARIFICATION (Dispositive Motions to be filed by 7/27/2018.) Signed by JUDGE MARK E WALKER on 5/17/2018. (tdl) (Entered: 05/17/2018)

05/17/2018

292 RESPONSE in Opposition re 288 MOTION for Reconsideration re 283 Order on Motion to Continue Joint Response in Opposition filed by Ana Centurion of Florida, LLC, JULIE L JONES. (FRANCOLIN DOLNEY, ANA) (Entered: 05/17/2018)

05/18/2018 293 MOTION to Continue the Hearing Scheduled for May 18, 2018 (Unopposed) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 05/18/2018)

05/18/2018 294 ORDER ON MOTION FOR PROTECTIVE ORDER - Defendant and Centurion's motion for a protective order, ECF No. 262 , is GRANTED in

part and DENIED in part. Signed by JUDGE MARK E WALKER on 5/18/2018. (tdl) (Entered: 05/18/2018)

05/18/2018

295 ORDER DENYING MOTION TO ENFORCE PRELIMINARY INJUNCTION - Plaintiffs' motion to enforce the preliminary injunction, ECF No. 271 , is DENIED without prejudice. Signed by JUDGE MARK E WALKER on 5/18/2018. (cle) (Entered: 05/18/2018)

05/18/2018

296 ORDER ON MOTION FOR PROTECTIVE ORDER - Defendant's motion for a protective order, ECF No. 273 , is GRANTED in part and DENIED in part. Signed by JUDGE MARK E WALKER on 5/18/2018. (tdl) (Entered: 05/18/2018)

05/18/2018

297 ORDER DENYING MOTION FOR RECONSIDERATION - Plaintiffs' motion for reconsideration, ECF No. 288 , is DENIED without prejudice to renew. Signed by JUDGE MARK E WALKER on 5/18/2018. (tdl) (Entered: 05/18/2018)

05/18/2018 298 ORDER GRANTING MOTION TO CONTINUE - Plaintiffs' motion to continue, ECF No. 293 , is GRANTED. Signed by JUDGE MARK E WALKER on 5/18/2018. (tdl) (Entered: 05/18/2018)

05/18/2018 299 NOTICE OF INTENT TO FILE JUDICIAL COMPLAINT TO THE ELEVENTH CIRCUIT JUDICIAL COUNCIL by STEVEN A. MCLEOD (tdl) (Entered: 05/18/2018)

05/18/2018 300 Letter from Steven McLeod (tdl) (Entered: 05/18/2018)

05/18/2018

301 ORDER RESPONDING TO STEVEN MCLEOD'S 300 NOTICE - This Court withdraws the portion of its prior order, ECF No. 268 , directing the Clerk not to accept further filings from Steven A. McLeod in this case. The Clerk is directed to ensure that a copy of this order and copies of ECF No. 254 , ECF No. 260 , and ECF No. 268 are mailed to Mr. McLeod. Signed by JUDGE MARK E WALKER on 5/18/2018. (vkm)***ORDERS MAILED TO MR. MCLEOD AS DIRECTED*** (Entered: 05/18/2018)

05/21/2018 302 MOTION for Issuance of Third Preliminary Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 05/21/2018)

05/21/2018 303 ORDER REQUIRING EXPEDITED RESPONSE re 302 MOTION.( Response to motion due by by 5/23/2018.) Signed by JUDGE MARK E WALKER on 5/21/2018. (tdl) (Entered: 05/21/2018)

05/23/2018

304 RESPONSE to Motion re 302 MOTION for Issuance of Third Preliminary Injunction Defendant's Response Opposing Plaintiffs' Motion for Issuance of a Third Preliminary Injunction and Incorporated Memorandum of Law filed by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 05/23/2018)

05/23/2018

305 MOTION pursuant to Rule 56(d) to Defer Ruling, or alternatively, for Enlargement of Time to Respond re 270 MOTION for Summary Judgment Defendant's Motion to Convert Preliminary Injunction to a Permanent Injunction and For Summary Judgment by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Declaration of Dante P. Trevisani) (TREVISANI, DANTE) (Entered: 05/23/2018)

05/23/2018

306 MOTION to Alter/Amend Judgment at ECF 278 w/ Motion to Alter/Amend Class Certification at ECF 152 by SIDNEY MARTS. (Internal deadline for referral to judge if response not filed earlier: 6/6/2018). (tdl) (Entered: 05/24/2018)

05/24/2018

307 ORDER RENEWING PRELIMINARY INJUNCTION - Plaintiffs' motion for issuance of a third preliminary injunction, ECF No. 302 , is GRANTED. (Modified or Renewed Motion as to 185 Motion due by 6/12/2018.) Signed by JUDGE MARK E WALKER on 5/24/2018. (tdl) (Entered: 05/24/2018)

05/24/2018

308 ORDER GRANTING DEFERRAL / EXTENSION - Accordingly, whether considered under Rule 56(d), or whether simply considered as a motion for extension of time, Plaintiffs' motion is GRANTED. (Response to 270 Motion due by by 7/27/2018.) Signed by JUDGE MARK E WALKER on 5/24/2018. (tdl) (Entered: 05/24/2018)

05/24/2018 309 ORDER DENYING SIDNEY MARTS'S 306 MOTION (AGAIN). Signed by JUDGE MARK E WALKER on 3/24/2018. (tdl) (Entered: 05/24/2018)

05/25/2018

310 ORDER DENYING MOTION FOR PROTECTIVE ORDER - Plaintiff's motion for a protective order, ECF No. 282 , is DENIED AS MOOT. Signed by JUDGE MARK E WALKER on 5/25/2018. (ckm) (Entered: 05/25/2018)

05/25/2018 311 Letter from JOHN CAREY (ckm) (Entered: 05/25/2018)

05/28/2018 312 ORDER RESPONDING TO 311 JOHN CAREY'S LETTER. Signed by JUDGE MARK E WALKER on 5/28/2018. (ckm) ***Copy mailed to John Carey*** (Entered: 05/29/2018)

05/29/2018 313 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 05/29/2018)

05/29/2018

Reset Deadline re: 16 Initial Scheduling Order: Joint Status Report due by 6/28/2018. (ckm) (Entered: 05/29/2018)

05/29/2018 314 STATUS REPORT Defendant's June 2018 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 05/29/2018)

05/29/2018

317 Letter (construed as NOTICE OF INTERLOCUTORY APPEAL as to 301 Order Responding to Steven McLeod's 300 Notice) by STEVEN A MCLEOD. (ckm) Modified on 6/4/2018 to reflect interlocutory (ckm). (Entered: 06/01/2018)

05/29/2018

321 MOTION for Leave to Appeal in forma pauperis by STEVEN A MCLEOD. (Attachments: # 1 Email from USCA) (ckm) ***Note: Motion was included within Notice of Appeal received from USCA*** (Entered: 06/04/2018)

05/29/2018

322 Expedited MOTION to Stay Proceedings in District Court Pending Appeal by STEVEN A MCLEOD. (Attachments: # 1 Email from USCA) (ckm) ***Note: Motion was included within Notice of Appeal received from USCA*** (Entered: 06/04/2018)

05/29/2018

323 AMENDED NOTICE OF INTERLOCUTORY APPEAL as to 268 Order Denying Steven A. McLeod's Motions, 260 Order Denying Motion to Intervene by STEVEN A MCLEOD. (Attachments: # 1 Cover Letter, # 2 Email from USCA) (ckm) (Entered: 06/04/2018)

05/30/2018

Reset Deadline re: 185 Order: FDC Status Report due by 7/2/2018. (ckm) (Entered: 05/30/2018)

05/30/2018

315 ORDER FOR PRETRIAL CONFERENCE - Pretrial Conference set for 7/6/2018 01:30 PM by telephone before JUDGE MARK E WALKER. Attorney Conference to take place by 6/15/2018. Pretrial Stipulation due by 6/29/2018. Jury Trial set for 8/6/2018 08:15 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. Signed by JUDGE MARK E WALKER on 5/30/2018. (ckm) (Entered: 05/30/2018)

05/30/2018 316 NOTICE OF HEARING: Pretrial Conference set for 7/6/2018 01:30 PM by telephone before JUDGE MARK E WALKER.

You may dial into the conference call as early as 1:25 PM EST. Call in number: 888-684-8852. When prompted for an access code, enter 3853136#. If you are asked to join as the host, just ignore and wait

until you are asked for a security code. When asked for a security code, enter 4565#. Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking. The quality of the audio connection is compromised by the use of cell phones or speakerphones, and counsel are requested not to use those devices during the call.

s/ Cindy Markley Courtroom Deputy Clerk

(ckm) (Entered: 05/30/2018)
06/01/2018 318 Transmission of Notice of Appeal and Docket Sheet to US Court of Appeals re 317 Notice of Appeal. (ckm) (Entered: 06/01/2018)

06/01/2018

319 Appeal Instructions re: 317 Notice of Appeal: The Transcript Request Form is available on the Internet at http://www.flnd.uscourts.gov/forms/Attorney/ECCA_transcript_form_fill able.pdf **PLEASE NOTE** Separate forms must be filed for each court reporter. Transcript Order Form due by 6/15/2018. (ckm) (Entered: 06/01/2018)

06/01/2018

Set Deadlines re 317 Notice of Appeal: Clerk to check status of Appeal on 8/30/2018. Certificate of Readiness due by 8/30/2018. (ckm) (Entered: 06/01/2018)

06/04/2018 320 USCA Case Number 18-12292-A for 317 Letter (construed as NOTICE OF APPEAL. (ckm) (Entered: 06/04/2018)

06/04/2018 324 Transmission of Notice of Appeal and Docket Sheet to US Court of Appeals re 317 Notice of Interlocutory Appeal and 323 Amended Notice of Interlocutory Appeal. (ckm) (Entered: 06/04/2018)

06/04/2018

325 Pursuant to F.R.A.P. 11(c), the Clerk of the District Court for the Northern District of Florida certifies that the record is complete for purposes of this appeal re: 323 Amended Notice of Interlocutory Appeal, 317 Notice of Interlocutory Appeal, Appeal No. 18-12292-A. The entire record on appeal is available electronically. (ckm) (Entered: 06/04/2018)

06/04/2018 326 ORDER DENYING 321 MOTION FOR LEAVE TO APPEAL IN FORMA PAUPERIS. Signed by JUDGE MARK E WALKER on 6/4/2018. (ckm) ***Copy mailed to McLeod*** (Entered: 06/04/2018)

06/05/2018 327 ORDER DENYING 322 MOTION TO STAY. Signed by JUDGE MARK E WALKER on 6/5/2018. (ckm) ***Copy mailed to McLeod*** (Entered: 06/05/2018)

06/08/2018 328 Consent MOTION to Continue Trial Date and Be Relieved from Mediation Requirement by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 06/08/2018)

06/08/2018

329 ORDER CONTINUING TRIAL DATE AND RELIEVING THE PARTIES OF THE REQUIREMENT TO MEDIATE. Plaintiffs have filed their Unopposed Motion to Continue Trial Date and Be Relieved from Mediation Requirement. ECF No. 328 . The motion is GRANTED. This Court continues the jury trial to Monday, November 5, 2018. Further, the parties are relieved of the requirement to mediate. The Clerk shall issue an amended pretrial order. Signed by JUDGE MARK E WALKER on 6/8/2018. (kjw) Jury Trial set for 11/5/2018 08:15 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. **Copy mailed to McLeod.** (Entered: 06/08/2018)

06/11/2018

330 ORDER FOR PRETRIAL CONFERENCE (Pretrial Conference set for 10/12/2018 09:00 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. Attorney Conference to take place by 9/21/2018. Pretrial Stipulation due by 10/5/2018. Jury Trial set for 11/5/2018 08:15 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER.) Signed by JUDGE MARK E WALKER on 6/11/2018. (ckm) (Entered: 06/11/2018)

06/11/2018

332 NOTICE OF INTERLOCUTORY APPEAL as to 260 Order Denying Motion to Intervene and 268 Order Denying Steven A. McLeod's Motions (and Letter to Clerk) by STEVEN A MCLEOD. (ckm) ***NOTE: This Notice is a duplicate of the 323 Amended Notice of Interlocutory Appeal. No additional action required*** (Entered: 06/13/2018)

06/12/2018 331 NOTICE OF HEARING: Bench Trial set for 11/5/2018 08:15 AM in U.S. Courthouse Tallahassee before JUDGE MARK E WALKER. United States Courthouse, 111 North Adams St., Tallahassee, Florida 32301.

NOTE: If you or any party, witness or attorney in this matter has a disability that requires special accommodation, such as, a hearing impairment that requires a sign language interpreter or a wheelchair restriction that requires ramp access, please contact Pam Lourcey at 850521-3501 in the Clerk's Office at least one week prior to the hearing (or as soon as possible) so arrangements can be made.

s/ Pam Lourcey Courtroom Deputy Clerk (pll) (Entered: 06/12/2018)
06/14/2018 335 NOTICE OF INTERLOCUTORY APPEAL as to 309 Order Denying Sidney Marts's 306 Motion. (Attachments: # 1 Email from USCA) (ckm) (Entered: 06/19/2018)

06/18/2018 333 Consent MOTION for Leave to File Excess Pages (Enlargement of the Word Limit) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 06/18/2018)

06/19/2018 334 ORDER GRANTING 333 MOTION FOR ENLARGEMENT OF WORD LIMIT. Signed by JUDGE MARK E WALKER on 6/19/2018. (ckm) (Entered: 06/19/2018)

06/19/2018 336 Transmission of Notice of Interlocutory Appeal and Docket Sheet to US Court of Appeals re 335 Notice of Interlocutory Appeal. (ckm) (Entered: 06/19/2018)

06/19/2018

337 Appeal Instructions re: 335 Notice of Interlocutory Appeal: The Transcript Request Form is available on the Internet at http://www.flnd.uscourts.gov/forms/Attorney/ECCA_transcript_form_fill able.pdf **PLEASE NOTE** Separate forms must be filed for each court reporter. Transcript Order Form due by 7/3/2018. (ckm) (Entered: 06/19/2018)

06/19/2018

Set Deadlines re 335 Notice of Interlocutory Appeal: Clerk to check status of Appeal on 9/17/2018. Certificate of Readiness due by 9/17/2018. (ckm) (Entered: 06/19/2018)

06/20/2018 338 TRANSCRIPT REQUEST by STEVEN A MCLEOD for Hearings on Motion for Preliminary Injunctions (five days ending 11/1/17) before Judge Walker. (ckm) (Entered: 06/22/2018)

06/22/2018 339 TRANSCRIPT Acknowledgment - Part II re 335 Notice of Interlocutory Appeal Court Reporter:Megan A. Hague (mah) (Entered: 06/22/2018)

06/22/2018

340 NOTICE of Filing Exhibits in Support of Motion for Summary Judgment by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit Beckman Article and Appendix, # 2 Exhibit Deposition Transcript for Albert Maier, # 3 Exhibit Deposition Transcript for Centurion 30(b)(6), # 4 Exhibit Deposition Transcript for Daniel Cherry, # 5 Exhibit Deposition Transcript for Daniel Dewsnup, # 6 Exhibit Deposition Transcript for FDC 30(b)(6), # 7 Exhibit Deposition Transcript for Long Do, # 8 Exhibit Deposition Transcript for Olugbenga Ogunsanwo, # 9 Exhibit Deposition Transcript for Stephen Whitfield, # 10 Exhibit Deposition Transcript for Thomas Reimers, # 11 Exhibit Deposition Transcript for Timothy Whalen, # 12 Exhibit Emails 1145 - 38581, # 13 Exhibit E-mails 38649 - 63035, # 14 Exhibit Emails 63064 - 71969, # 15 Exhibit E-mails 71987 - 104973, # 16 Exhibit HCV Testing and Treatment in Correctional Settings, # 17 Exhibit Hearing Transcript - Opening Statement, # 18 Exhibit Hearing Transcript for Albert Maier, # 19 Exhibit Hearing Transcript for Daniel Dewsnup, # 20 Exhibit Hearing Transcript for Thomas Reimers 10/24/17,

# 21 Exhibit Hearing Transcript for Thomas Reimers and Timothy E. Whalen - 10/23/17, # 22 Exhibit Hearing Transcript for Thomas Reimers 10/20/17, # 23 Exhibit HSB 15.03.09 Supplement #3 - Revised 4/16/18, # 24 Exhibit HSB - Prerelease Planning, # 25 Exhibit HSB - Prerelease Planning (Mental Health), # 26 Exhibit Interventions to Increasing Testing, Linkage to Care and Treatment of Hep C Infection Among People in Prisons, # 27 Exhibit Massachusetts DOC Hep C Policy, # 28 Exhibit Massachusetts DOC Settlement Agreement, # 29 Exhibit Minnesota DOC Hep C Policy, # 30 Exhibit New Mexico DOC Hep C Policy, # 31 Exhibit Stipulations Regarding Topics for Rule 30(b)(6) Deposition of Defendant, Julie Jones, # 32 Exhibit Timeline of Events, # 33 Exhibit Universal Opt-Out Screening for Hep C Within Correctional Facilities in an Effective Intervention to Improve Public Health, # 34 Exhibit Unsworn Declaration of Margaret Koziel, # 35 Exhibit Unsworn Declaration of OB, # 36 Exhibit Unsworn Declaration of TB, # 37 Exhibit Unsworn Declaration of WS) (TREVISANI, DANTE) (Entered: 06/22/2018)

06/22/2018

341 NOTICE of Filing Exhibit in Support of Motion for Summary Judgment by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA re 340 Notice (Other),,,,,,,,, (Attachments: # 1 Exhibit BOP Hep C Policy January 2018) (TREVISANI, DANTE) (Entered: 06/22/2018)

06/22/2018

342 MOTION for Summary Judgment by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Internal deadline for referral to judge if response to summary judgment not filed earlier: 7/13/2018). (TREVISANI, DANTE) (Entered: 06/22/2018)

06/22/2018 350 USCA Case Number 18-12571-A for 335 NOTICE OF INTERLOCUTORY APPEAL as to Sidney Marts. (ckm) (Entered: 06/28/2018)

06/25/2018

343 MOTION to Extend TimeDefendant's Unopposed Motion for Extension of Discovery as to Four Previously Undisclosed Inmate Witnesses and to Take Their Depositions by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 06/25/2018)

06/26/2018 344 MOTION to Extend TimeDefendant's Unopposed Motion for an Extension of Time to Produce Centurion Email by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 06/26/2018)

06/26/2018

345 ORDER EXTENDING DISCOVERY AND GRANTING LEAVE TO TAKE DEPOSITIONS - Defendant's motion, ECF No. 343 , is GRANTED. (Discovery deadline extended to 8/3/2018 for limited purpose.) Signed by CHIEF JUDGE MARK E WALKER on 6/26/2018. (ckm) (Entered: 06/26/2018)

06/26/2018

346 MOTION to Extend TimeDefendant's Amended Unopposed Motion for an Extension of Time to Produce Centurion Email by JULIE L JONES. (Attachments: # 1 Exhibit Email From Dante Trevisani) (BOWDEN, ALBERT) (Entered: 06/26/2018)

06/26/2018 347 ORDER EXTENDING TIME TO PRODUCE CENTURION EMAIL Defendant's motion, ECF No. 346 , is GRANTED. Signed by CHIEF JUDGE MARK E WALKER on 6/26/2018. (ckm) (Entered: 06/27/2018)

06/26/2018

351 USCA PROCEDURAL LETTER and CONSENT to payment of appeal fee from prison account re: 317 , 323 and 332 Notices of Interlocutory Appeal by Steven A. McLeod. USCA Appeal # 18-12292-A (ckm) (Copy to Finance) (Entered: 06/28/2018)

06/27/2018

348 Sealed Document - Unsworn Declaration of OB. (Unredacted copies of Exhibits 35, 36, and 37 re 340 Notice of Filing Exhibits in Support of Motion for Summary Judgment.) (Attachments: # 1 Unsworn Declaration of TB, # 2 Unsworn Declaration of WS, # 3 Cover Letter) (ckm) (Entered: 06/27/2018)

06/27/2018 349 Sealed Document. (Unredacted copy of 342 Motion for Summary Judgment) (Attachments: # 1 Cover Letter) (ckm) (Entered: 06/27/2018)

07/02/2018 352 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 07/02/2018)

07/02/2018

Reset Deadline re 16 Initial Scheduling Order: Joint Status Report due by 8/1/2018. (ckm) (Entered: 07/02/2018)

07/02/2018 353 MOTION to Extend TimeDefendant's Unopposed Motion for Extension of Time to Respond to Plaintiffs' Motion for Summary Judgment by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 07/02/2018)

07/02/2018 354 STATUS REPORT Defendant's July 2018 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit A) (BOWDEN, ALBERT) (Entered: 07/02/2018)

07/02/2018

355 ORDER GRANTING EXTENSION OF TIME TO RESPOND Defendant's motion, ECF No. 353 , is GRANTED. Defendant must respond to Plaintiffs' motion for summary judgment, ECF No. 342 , no later than 8/10/2018. Signed by CHIEF JUDGE MARK E WALKER on 7/2/2018. (ckm) (Entered: 07/03/2018)

07/03/2018

Reset Deadline re 185 Order: FDC Status Report due by 8/1/2018. (ckm) (Entered: 07/03/2018)

07/18/2018 356 NOTICE of Supplemental Authority by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit Chimenti Order) (TREVISANI, DANTE) (Entered: 07/18/2018)

07/23/2018

357 MANDATE of USCA as to 335 Notice of Interlocutory Appeal. USCA# 18-12571-A. Mandate: this appeal is DISMISSED for want of prosecution because the Appellant Sidney Marts failed to pay the filing and docketing fees (or file a motion in the district court for relief from the obligation to pay in advance the full fee) to the district court within the time fixed by the rules. (kdm) (Entered: 07/24/2018)

07/23/2018 359 Letter from HARRY JAMES MARSHALL (vkm) (Entered: 07/25/2018)

07/25/2018

358 UNOPPOSED MOTION to Extend Time to Respond to Plaintiffs' Motion for Summary Judgment, and for Leave to File a Memorandum in Excess of the Word Limit by JULIE L JONES. (BOWDEN, ALBERT) Modified on 7/26/2018 to reflect unopposed motion (vkm). (Entered: 07/25/2018)

07/26/2018

360 ORDER GRANTING 358 MOTION FOR EXTENSION OF TIME AND ENLARGEMENT OF WORD LIMIT - Defendant must respond to Plaintiffs' motion for summary judgment, ECF No. 342 , no later than 8/17/2018. Signed by CHIEF JUDGE MARK E WALKER on 7/26/2018. (vkm) (Entered: 07/26/2018)

07/26/2018

361 NOTICE of Filing Exhibits in Support of Response to Defendant's Motion to Convert Preliminary Injunction to a Permanent Injunction and for Summary Judgment by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit Drug Utilization Report, # 2 Exhibit California Policy, # 3 Exhibit Dr. Margaret Koziel Hearing Transcript, # 4 Exhibit Federal Register Excerpt, # 5 Exhibit ADA Amendments Act Legislative History) (TREVISANI, DANTE) (Entered: 07/26/2018)

07/26/2018

362 RESPONSE to Motion re 270 MOTION for Summary Judgment Defendant's Motion to Convert Preliminary Injunction to a Permanent Injunction and For Summary Judgment filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 07/26/2018)

07/30/2018 363 STATUS REPORT (Joint) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 07/30/2018)

07/31/2018 364 STATUS REPORT Defendant's August 2018 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 07/31/2018)

08/01/2018

Reset Deadline re 185 Order: FDC Status Report due by 9/4/2018. (ckm) (Entered: 08/01/2018)

08/02/2018 365 Emergency MOTION to Compel Defendant to Comply with 153 Preliminary Injunction to Treat Inmate Jonathan Platts filed by JONATHAN PLATTS. (ckm) (Entered: 08/02/2018)

08/02/2018

Set Deadline as to 365 Emergency MOTION to Compel (Internal deadline for referral to judge if response not filed earlier: 8/16/2018.) (ckm) (Entered: 08/02/2018)

08/03/2018

366 ORDER REQUIRING DEFENDANT TO RESPOND TO JONATHAN PLATTS'S MOTION - Defendant must file a response to Jonathan Platts's motion, ECF No. 365 , no later than Friday, 8/10/2018. Signed by CHIEF JUDGE MARK E WALKER on 8/3/2018. (ckm) ***Order mailed to Jonathan Platt*** (Entered: 08/03/2018)

08/09/2018

367 RESPONSE in Opposition to 365 Motion to Compel Defendant to Comply with Preliminary Injunction to Treat Inmate Jonathan Platts (#K68853) filed by JULIE L JONES. (Attachments: # 1 Exhibit Declaration of Dr. Nunez) (BOWDEN, ALBERT) (Entered: 08/09/2018)

08/16/2018

368 ORDER DENYING JONATHAN PLATTS'S MOTION - Mr. Platts's motion to compel, ECF No. 365 , is DENIED without prejudice to refile in the future if new facts suggest that Mr. Platts will not receive treatment within the deadlines imposedby this Court's preliminary injunction. Signed by CHIEF JUDGE MARK E WALKER on 8/16/2018. (ckm) ***Copy mailed to Platts*** (Entered: 08/16/2018)

08/17/2018

369 ***See 374 Notice for Amended Exhibit*** NOTICE of Filing Exhibits in Support of Her 370 Opposition to Plaintiffs' Motion for Summary Judgment by JULIE L JONES re 342 MOTION for Summary Judgment (Attachments: # 1 Dr. Koziel, Deposition excerpt, # 2 Cathy L. Loomis Declaration, # 3 Dr. Daniel Dewsnup Declaration, # 4 Doris Roberts Declaration, # 5 Deanna Shepard Declaration, # 6 Dr. Alvia Varona Declaration, # 7 Margaret Ralls Declaration, # 8 Clarissa Cooper Declaration, # 9 Dorothy Stewart Declaration, # 10 Dr. Jeffrey Keller Declaration, # 11 Victoria Love Declaration, # 12 Tennessee DOC Hepatitis C Policy, # 13 New Hampshire DOC Heptatis C Policy) (BOWDEN, ALBERT) Modified on 8/28/2018 to link corresponding response and to reference amended exhibit (ckm). (Entered: 08/17/2018)

08/17/2018 370 RESPONSE to 342 Motion for Summary Judgment filed by JULIE L JONES. (BOWDEN, ALBERT) (Entered: 08/17/2018)

08/23/2018 371 MOTION for Extension of Time to File Response/Reply and for Enlargement of Word Limit by CARL HOFFER, RONALD

MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 08/23/2018)

08/23/2018

Set Deadline as to 371 MOTION for Extension of Time to File Response/Reply and for Enlargement of Word Limit. (Internal deadline for referral to judge if response not filed earlier: 9/6/2018.) (ckm) (Entered: 08/23/2018)

08/23/2018

372 ORDER CANCELING PRETRIAL HEARING AND REMOVING CASE FROM TRIAL DOCKET PENDING RULING ON 342 MOTION FOR SUMMARY JUDGMENT. Signed by CHIEF JUDGE MARK E WALKER on 8/23/2018. (ckm) (Entered: 08/23/2018)

08/23/2018

373 ORDER GRANTING 371 MOTION FOR EXTENSION AND ENLARGEMENT - Plaintiffs must file their reply to Defendant's response, ECF No. 370 , no later than 8/31/2018. Plaintiffs' reply must be no longer than 5,000 words. Signed by CHIEF JUDGE MARK E WALKER on 8/23/2018. (ckm) (Entered: 08/23/2018)

08/27/2018

374 NOTICE of Filing Amended Exhibit in Support of Her 370 Opposition to Plaintiffs' Motion for Summary Judgment by JULIE L JONES (Attachments: # 1 Declaration of Dr. Varona) (BOWDEN, ALBERT) Modified on 8/28/2018 to link corresponding response (ckm). (Entered: 08/27/2018)

08/27/2018

375 ORDER of USCA as to 317 & 323 Notices of Interlocutory Appeal Appellant's June 1, 2018 and June 18, 2018 Motions to stay lower court proceedings filed by Appellant Steven A. McLeod are DENIED. USCA # 18-12292-A (ckm) (Entered: 08/27/2018)

08/29/2018 376 STATUS REPORT Defendant's September 2018 Status Report by JULIE L JONES. (Attachments: # 1 Report) (BOWDEN, ALBERT) (Entered: 08/29/2018)

08/30/2018

Reset Deadline re 185 Order: FDC Status Report due by 10/1/2018. (ckm) (Entered: 08/30/2018)

08/30/2018

Reset Deadline re 317 Notice of Interlocutory Appeal and 323 Amended Notice of Interlocutory Appeal (Clerk to check status of Appeal on 11/28/2018) (ckm) (Entered: 08/30/2018)

08/31/2018

377 NOTICE of Filing Exhibits in Support of Reply by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit 1 - Unsworn Declaration of O.B., # 2 Exhibit 2 - Corris Settlement) (TREVISANI, DANTE) (Entered: 08/31/2018)

08/31/2018 378 REPLY to Response to Motion re 342 MOTION for Summary Judgment filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 08/31/2018)

09/05/2018

379 MOTION for Issuance of Fourth Preliminary Injunction, or in alternative, to Issue a Permanent Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 09/05/2018)

09/05/2018

Set Deadline as to 379 Motion for Issuance of Fourth Preliminary Injunction, or in alternative, to Issue a Permanent Injunction. (Internal deadline for referral to judge if response not filed earlier: 9/19/2018.) (ckm) (Entered: 09/05/2018)

09/05/2018

380 ORDER RENEWING PRELIMINARY INJUNCTION - Plaintiffs' motion for issuance of a fourth preliminary injunction, ECF No. 379 , is GRANTED. The preliminary injunction entered in this case, ECF No. 185 , as subsequently modified and renewed, shall reissue on September 11, 2018. Signed by CHIEF JUDGE MARK E WALKER on 9/5/2018. (ckm) (Entered: 09/05/2018)

09/06/2018 381 MOTION to Enforce 185 Injunction by STEVEN A MCLEOD. (ckm) (Entered: 09/07/2018)

09/07/2018

382 MANDATE of USCA as to 317 , 323 and 332 Notices of Interlocutory Appeal filed by STEVEN A MCLEOD - The court DISMISSES the appeal in part, sua sponte, for lack of jurisdiction. All pending motions are DENIED as MOOT. USCA #18-12292-A (ckm) (Entered: 09/07/2018)

09/07/2018

383 ORDER DENYING STEVEN MCLEOD'S MOTION - Steven A. McLeod's motion, ECF No. 381 , is DENIED without prejudice to refile should new facts reveal that Defendant is not complying with the preliminary injunction. Signed by CHIEF JUDGE MARK E WALKER on 9/7/2018. (ckm) Modified on 9/11/2018 to reflect additional mailing to McLeod pursuant to 384 Notice of Change of Address (ckm). (Entered: 09/10/2018)

09/10/2018

384 NOTICE of Change of Address by STEVEN A MCLEOD. Address changed from Dade Correctional Institution to Martin Correctional Institution, 1150 SW Allapattah Rd., Indiantown, FL 34956. (ckm) (Entered: 09/11/2018)

09/12/2018 385 Second MOTION to Intervene by STEVEN A MCLEOD. (ckm) (Entered: 09/13/2018)

09/14/2018 386 ORDER REQUIRING DEFENDANT TO RESPOND - Mr. McLeod's second motion to intervene, ECF No. 385 , is DENIED. Defendant must

respond to Mr. McLeod's motion, ECF No. 385 , no later than 9/28/2018. Signed by CHIEF JUDGE MARK E WALKER on 9/14/2018. (ckm) (Entered: 09/14/2018)

09/27/2018

387 RESPONSE to Motion re 385 MOTION to Intervene Defendant's Response to Steven McLeod's Second Motion to Intervene filed by JULIE L JONES. (Attachments: # 1 Exhibit A, # 2 Exhibit B) (BRODEEN, KAREN) (Entered: 09/27/2018)

09/28/2018 388 STATUS REPORT Defendant's October 2018 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 09/28/2018)

09/28/2018 389 Unopposed MOTION for a Case Management Conference by JULIE L JONES. (BOWDEN, ALBERT) Modified on 10/1/2018 to reflect unopposed (ckm). (Entered: 09/28/2018)

09/28/2018

390 ORDER REQUIRING DEFENDANT TO FILE RESPONSE UNDER SEAL - re: 387 Response to Motion. So that this Court can conduct a meaningful review of the issues, Defendant is directed to file unredacted copies of her response and attachments, under seal, no later than Friday, 10/5/2018. Signed by CHIEF JUDGE MARK E WALKER on 9/28/2018. (cle) (Entered: 09/28/2018)

09/28/2018 391 Sealed. One Service Copy provided - also sealed. (cle) (Entered: 10/01/2018)

10/01/2018

Reset Deadline re: 185 Order: FDC Status Report due by 11/1/2018. (ckm) (Entered: 10/01/2018)

10/01/2018

392 ORDER GRANTING 389 MOTION FOR CASE-MANAGEMENT CONFERENCE - The Clerk is directed to schedule a thirty-minute telephonic conference on Friday, October 5, 2018, at some time between 1-4 p.m. Signed by CHIEF JUDGE MARK E WALKER on 10/1/2018. (ckm) (Entered: 10/01/2018)

10/02/2018

393 ORDER DENYING STEVEN A. MCLEOD'S 385 SECOND MOTION TO INTERVENE (re 385 Motion, 387 Response to Motion, and 391 Sealed Document). Signed by CHIEF JUDGE MARK E WALKER on 10/2/2018. (ckm) (Entered: 10/02/2018)

10/02/2018

394 NOTICE OF TELEPHONIC HEARING: Telephonic Status Conference set for 10/5/2018 01:30 PM before CHIEF JUDGE MARK E WALKER. ALL PARTIES are directed to call the AT&T Conference Line (see below) Conference Call Information

You may dial into the conference call up to five minutes before start time. Call in number: 888-684-8852 When prompted for an access code, enter: 3853136# If you are asked to join as the host, just ignore and wait until you are asked for a security code. When asked for a security code, enter: 4565# Say your name, when prompted. You are now in the conference call. Remember to mute your phone when you are not speaking. The Court also asks that counsel NOT use cell phones or speaker phones during the call as the quality of the audioconnection is comprised by these devices. Note: If you or any party, witness or attorney in this matter has a disability that requires special accommodations, such as a hearing impairment that requires a sign-language interpreter or a wheelchair restriction that requires ramp access, please contact the Clerk's Office at least one week prior to the hearing (or as soon as possible) so arrangements can be made. s/ Victoria Milton McGee Courtroom Deputy Clerk (vkm) (Entered: 10/02/2018)

10/05/2018

395 Minute Entry for proceedings held before CHIEF JUDGE MARK E WALKER: Status Conference held on 10/5/2018. Parties discuss protocol question raised by the defendant. Ruling by Court: Continue to follow current protocol without prejudice for defendant to raise the issue in the future (Court Reporter Dana Reeves). (vkm) (Entered: 10/05/2018)

10/15/2018 396 Intervenor's Reply to Defendant's Response to Steven McLeod's Second Motion to Intervene filed by STEVEN A MCLEOD. (ckm) (Entered: 10/17/2018)

10/17/2018

397 ORDER DENYING SUCCESSIVE MOTION TO INTERVENE (re 396 Reply to Defendant's Response to Steven McLeod's Second Motion to Intervene). Signed by CHIEF JUDGE MARK E WALKER on 10/17/2018. (ckm) (Entered: 10/18/2018)

10/26/2018 399 MOTION (styled as Request) to Construe Intervenor's 396 Reply as Motion for Reconsideration by STEVEN A MCLEOD. (ckm) (Entered: 10/30/2018)

10/29/2018 398 STATUS REPORT Defendant's November 2018 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 10/29/2018)

10/30/2018

Reset Deadline re: 185 Order: FDC Status Report due by 12/3/2018. (ckm) (Entered: 10/30/2018)

10/30/2018 400 NOTICE of Intent to File Chapter 16 Complaint by STEVEN A MCLEOD (ckm) ***The Court acknowledges receipt of the notice of intent; no action necessary by the Court.*** (Entered: 10/31/2018)

10/31/2018 401 ORDER DENYING 399 MOTION TO CONSTRUE REPLY AS MOTION FOR RECONSIDERATION. Signed by CHIEF JUDGE MARK E WALKER on 10/31/2018. (ckm) (Entered: 10/31/2018)

11/01/2018 402 Supplement to 400 Notice of Intent to File Chapter 16 Complaint (ckm) (Entered: 11/02/2018)

11/01/2018 403 NOTICE OF SECOND SUPPLEMENTAL (INTERLOCUTORY) NOTICE OF APPEAL as to 393 and 397 Orders by STEVEN A MCLEOD. (ckm) (Entered: 11/02/2018)

11/02/2018 404 Transmission of Notice of Appeal and Docket Sheet to US Court of Appeals re 403 Notice of Second Supplemental (Interlocutory) Notice of Appeal. (ckm) (Entered: 11/02/2018)

11/02/2018

405 Appeal Instructions re: 403 Notice of Interlocutory Appeal: The Transcript Request Form is available on the Internet at http://www.flnd.uscourts.gov/forms/Attorney/ECCA_transcript_form_fill able.pdf **PLEASE NOTE** Separate forms must be filed for each court reporter. Transcript Order Form due by 11/16/2018. (ckm) (Entered: 11/02/2018)

11/02/2018

Set Deadlines re 403 Notice of Interlocutory Appeal: Clerk to check status of Appeal on 1/31/2019. Certificate of Readiness due by 1/31/2019. (ckm) (Entered: 11/02/2018)

11/02/2018 406 Letter from Michael Ellis. (kjw) (Entered: 11/02/2018)

11/08/2018

407 USCA Case Number 18-14652-C for 403 NOTICE OF SECOND SUPPLEMENTAL (INTERLOCUTORY) NOTICE OF APPEAL as to 393 and 397 Orders as to STEVEN A MCLEOD. (kdm) (Entered: 11/13/2018)

11/21/2018

Appeal Deadlines Terminated re 403 Notice of Interlocutory Appeal filed by STEVEN A MCLEOD. Transcript order form deadline has expired. (ckm) (Entered: 11/21/2018)

11/26/2018

408 (Unopposed) MOTION for Issuance of Fifth Preliminary Injunction, or in alternative, to Issue a Permanent Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) Modified on 11/27/2018 to reflect unopposed (ckm). (Entered: 11/26/2018)

11/26/2018 411 NOTICE of Change of Address by STEVEN A MCLEOD. Address changed from Martin Correctional Institution to Hamilton Correctional

Institution. (ckm) ***This is a courtesy copy of document that was sent to USCA*** (Entered: 11/27/2018)

11/27/2018

409 ORDER RENEWING PRELIMINARY INJUNCTION. Plaintiffs' motion for issuance of a fifth preliminary injunction, ECF No. 408 , is GRANTED. The preliminary injunction entered in this case, ECF No. 185 , as subsequently modified and renewed, shall reissue on December 11, 2018. Signed by CHIEF JUDGE MARK E WALKER on 11/27/2018. (kjw) (Entered: 11/27/2018)

11/27/2018

410 ORDER REQUIRING DEFENDANT TO RESPOND. Defendant must respond to Mr. Ellis's letter, ECF No. 406 , no later than 12/7/2018. Signed by CHIEF JUDGE MARK E WALKER on 11/27/2018. (kjw) Modified on 11/27/2018 - a copy of this order was mailed to Mr. Ellis. (kjw) (Entered: 11/27/2018)

11/29/2018 412 STATUS REPORT Defendant's December 2018 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 11/29/2018)

11/29/2018 413 RESPONSE by JULIE L JONES re 406 Letter Defendant's Response to the Letter to the Court from Inmate Michael Ellis. (BOWDEN, ALBERT) (Entered: 11/29/2018)

11/29/2018

Reset Deadline re: 18 5 Order: FDC Status Report due by 1/2/2019. (amm) (Entered: 11/29/2018)

11/29/2018 414 NOTICE RE: MICHAEL ELLIS. This Court finds that no further action needs to be taken with respect to Mr. Ellis's letter 406 . Signed by CHIEF JUDGE MARK E WALKER on 11/29/18. (amm) (Entered: 11/29/2018)

12/07/2018 415 NOTICE of Supplemental Authority by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Exhibit Buffkin v. Hooks Memorandum) (SELIG, ERICA) (Entered: 12/07/2018)

12/07/2018 418 USCA Notice Of Filing - Supplemental Authority, re USCA Appeal # 1812292-A. (kdm) (Entered: 12/12/2018)

12/11/2018

416 ORDER of USCA as to 317 , 323 , 332 Notice of Interlocutory Appeal. USCA# 18-12292-A. Order: Steven A. McLeod's motion tor rehearing, which we construe as a motion tor reconsideration of our September 7, 2018 order dismissing this appeal for lack of jurisdiction, is DENIED. (kdm) (Entered: 12/12/2018)

12/11/2018 417 MANDATE of USCA as to 403 NOTICE OF SECOND SUPPLEMENTAL (INTERLOCUTORY) NOTICE OF APPEAL. USCA# 18-14652-C. Mandate: this appeal is DISMISSED for want of

prosecution because the Appellant Steven A. McLeod failed to pay the filing and docketing fees (or file a motion in the district court for relief from the obligation to pay in advance the full fee) to the district court within the time fixed by the rules. (kdm) (Entered: 12/12/2018)

12/28/2018 419 STATUS REPORT Defendant's January 2019 Status Report by JULIE L JONES. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 12/28/2018)

01/02/2019

Set Deadlines/Hearings Status Report due by 2/2/2019. (blb) (Entered: 01/02/2019)

01/14/2019 420 MOTION FOR FINDING OF CIVIL CONTEMPT by Donald Clumm. (blb) Modified as to filer on 1/22/2019 (blb). (Entered: 01/14/2019)

01/15/2019

421 ORDER REQUIRING DEFENDANT TO RESPOND re 420 MOTION FOR FINDING OF CIVIL CONTEMPT filed by CARL HOFFER, (Internal deadline for referral to judge if response not filed earlier: 1/22/2019). Signed by CHIEF JUDGE MARK E WALKER on 1/15/19. (blb) (Entered: 01/15/2019)

01/15/2019

422 NAME CHANGE ORDER. The Clerk is directed to substitute Mark S. Inch as the Defendant in place of Ms. Jones. MARK S INCH added. JULIE L JONES (IN HER OFFICIAL CAPACITY AS SECRETARY OF FLORIDA DEPARTMENT OF CORRECTIONS) terminated. Signed by CHIEF JUDGE MARK E WALKER on 1/15/19. (blb) (Entered: 01/15/2019)

01/18/2019

423 RESPONSE in Opposition re 420 MOTION FOR FINDING OF CIVIL CONTEMPT Defendant's Opposition to Inmate Donald Clumm's Motion for Finding of Civil Contempt filed by MARK S INCH. (Attachments: # 1 Affidavit) (BOWDEN, ALBERT) (Entered: 01/18/2019)

01/22/2019 424 ORDER DENYING DONALD CLUMMS MOTION. Donald Clumm's motion, ECF No. 420 , is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 1/22/19. (blb) (Entered: 01/22/2019)

01/30/2019 425 STATUS REPORT Defendant's February 2019 Status Report by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 01/30/2019)

02/05/2019 426 MOTION to Withdraw as Attorney by Randall C Berg Jr by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (BERG, RANDALL) (Entered: 02/05/2019)

02/05/2019 427 ORDER GRANTING 426 MOTION TO WITHDRAW AS COUNSEL. Attorney RANDALL CHALLEN BERG terminated. Signed by CHIEF JUDGE MARK E WALKER on 2/5/19. (blb) (Entered: 02/06/2019)

02/08/2019 428 MOTION to Intervene styled as Petition to Intervene by GEORGE W KEENAN. (blb) (Entered: 02/11/2019)

02/08/2019 429 MOTION for Joinder of Additional Party Defendants by GEORGE W KEENAN. (blb) (Entered: 02/11/2019)

02/08/2019 430 MOTION for Relief From Judgment by GEORGE W KEENAN. (blb) (Entered: 02/11/2019)

02/08/2019 431 AFFIDAVIT in Support re 428 MOTION to Intervene, 429 MOTION for Joinder, 430 MOTION filed by GEORGE W KEENAN. (blb) (Entered: 02/11/2019)

02/08/2019 432 MEMORANDUM in Support re 428 MOTION to Intervene, 429 MOTION for Joinder, 430 MOTION filed by GEORGE W KEENAN. (blb) (Entered: 02/11/2019)

02/12/2019

433 ORDER RE: GEORGE W. KEENAN. George W. Keenan's motion to intervene, ECF No. 428 , is DENIED. George W. Keenan's motion for joinder, ECF No. 429 , is DENIED. This Court construes George W. Keenan's motion for relief from judgment, ECF No. 430 , as a motion to enforce this Courts preliminary injunction. Defendant shall respond to Mr. Keenan's motion, no later than 2/26/2019. Signed by CHIEF JUDGE MARK E WALKER on 2/12/19. (blb) (Entered: 02/12/2019)

02/20/2019

434 MOTION for Extension of Time to RESPOND TO GEORGE W. KEENANS MOTION TO ENFORCE PRELIMINARY INJUNCTION by MARK S INCH. (BOWDEN, ALBERT) Modified on 2/21/2019 (blb). *To Match Title to Pleading** (Entered: 02/20/2019)

02/20/2019

435 ORDER GRANTING 434 EXTENSION TO RESPOND TO GEORGE KEENAN MOTION 430 (Internal deadline for referral to judge if response to 430 motion if not filed earlier: 3/4/2019).)Signed by CHIEF JUDGE MARK E WALKER on 2/20/19. (blb) (Entered: 02/21/2019)

02/25/2019

436 MOTION for Issuance of Sixth Preliminary Injunction, or in the alternative, a Final Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 02/25/2019)

02/25/2019

Set/Reset Deadlines as to 436 MOTION for Issuance of Sixth Preliminary Injunction, or in the alternative, a Final Injunction . (Internal deadline for

referral to judge if response not filed earlier: 3/11/2019). (blb) (Entered: 02/26/2019)

02/26/2019

437 **Dissolved pursuant to 465 ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT** ORDER RENEWING PRELIMINARY INJUNCTION. Plaintiffs' motion for issuance of a sixth preliminary injunction, ECF No. 436 , is GRANTED. The preliminary injunction entered in this case, ECF No. 185 , as subsequently modified and renewed, shall re-issue on March 11, 2019. Signed by CHIEF JUDGE MARK E WALKER on 2/26/19. (blb) Modified on 4/18/2019 (kjw). (Entered: 02/26/2019)

02/28/2019 438 STATUS REPORT Defendant's March 2019 Status Report by MARK S INCH. (Attachments: # 1 Exhibit A) (BOWDEN, ALBERT) (Entered: 02/28/2019)

03/01/2019

Set Deadlines/Hearings Status Report due by 3/2/2020. (blb) (Entered: 03/01/2019)

03/01/2019 439 RESPONSE in Opposition re 430 MOTION to Enforce the Preliminary Injunction filed by MARK S INCH. (Attachments: # 1 Affidavit) (BOWDEN, ALBERT) (Entered: 03/01/2019)

03/05/2019 440 ORDER DENYING GEORGE W. KEENANS MOTION 430 TO ENFORCE THE PRELIMINARY INJUNCTION. Signed by CHIEF JUDGE MARK E WALKER on 3/5/19. (blb) (Entered: 03/05/2019)

03/06/2019 441 Letter from Alberto Sanchez. (blb) (Entered: 03/06/2019)

03/06/2019

442 ORDER REQUIRING DEFENDANT TO RESPOND - Defendant must respond to Mr. Sanchez's letter, ECF No. 441 , no later than 3/20/2019. Signed by CHIEF JUDGE MARK E WALKER on 3/6/2019. (vkm) (Entered: 03/06/2019)

03/12/2019

443 DEFENDANTS OPPOSITION TO INMATE ALBERTO SANCHEZS LETTER TO THE COURT REGARDING PURPORTED VIOLATIONS OF THE COURT'S PRELIMINARY INJUNCTION by MARK S INCH re 441 Letter . (Attachments: # 1 Exhibit A - Declaration of Juan Nunez, M.D.) (BOWDEN, ALBERT) Modified on 3/13/2019 (blb). *Match Pleading Title* (Entered: 03/12/2019)

03/13/2019

444 ORDER RE: ALBERTO SANCHEZ 441 Letter. After reading Defendant's response, it appears that Defendant has not violated this Court's preliminary injunction with respect to Mr. Sanchez. See ECF No. 443 . Accordingly, no further action needs to be taken on Mr.

Sanchez's letter. Signed by CHIEF JUDGE MARK E WALKER on 3/13/19. (blb) (Entered: 03/13/2019)
03/18/2019 445 Letter from EUGENE JENKINS. (blb) (Entered: 03/19/2019)

03/19/2019

446 ORDER REQUIRING DEFENDANT TO RESPOND. Defendant must respond to Mr. Jenkins's motion, ECF No. 445 , no later than 3/26/2019). Signed by CHIEF JUDGE MARK E WALKER on 3/19/19. (blb) (Entered: 03/19/2019)

03/22/2019 447 MOTION for Leave to File Reply filed by GEORGE KEENAN. (blb) (Entered: 03/25/2019)

03/22/2019 448 REPLY to Objection to Motion 430 for Relief from Judgment. (blb) (Entered: 03/25/2019)

03/25/2019 449 NOTICE of Supplemental Authority by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA re 415 Notice (Other) (Attachments: # 1 Buffkin v. Hooks Order) (SELIG, ERICA) (Entered: 03/25/2019)

03/25/2019 450 Letter from Steven A. McLeod. (blb) (Entered: 03/26/2019)

03/26/2019 451 RESPONSE by MARK S INCH re 445 Letter by Eugene Jenkins by MARK S INCH. (Attachments: # 1 Exhibit Exhibit A) (BRODEEN, KAREN) (Entered: 03/26/2019)

03/26/2019 452 ORDER DENYING RECONSIDERATION RE: GEORGE KEENAN. Mr. Keenan's motion, ECF No. 447 , is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 3/26/19. (blb) (Entered: 03/26/2019)

03/27/2019 453 STATUS REPORT April 2019 by MARK S INCH. (Attachments: # 1 Exhibit A) (BOWDEN, ALBERT) Modified on 3/27/2019 (blb). *Exhibit A sealed per order 455 * (Entered: 03/27/2019)

03/27/2019 454 MOTION to Seal Document 453-1 by MARK S INCH. (Attachments: # 1 Exhibit A) (BOWDEN, ALBERT) (Entered: 03/27/2019)

03/27/2019

455 ORDER GRANTING 454 MOTION TO SEAL. The Clerk is directed to SEAL ECF No. 453 -1. This Court accepts ECF No. 454 -1 as a replacement. Signed by CHIEF JUDGE MARK E WALKER on 3/27/19. (blb) (Entered: 03/27/2019)

03/27/2019

456 ORDER RE: EUGENE JENKINS. Plaintiffs' motion is still under consideration. Accordingly, no further action needs to be taken on Mr. Jenkins's letter 445 . Signed by CHIEF JUDGE MARK E WALKER on 3/27/19. (blb) (Entered: 03/28/2019)

04/01/2019 457 Letter from ALBERTO SANCHEZ titled REQUEST TO RECONSIDER. (blb) (Entered: 04/02/2019)

04/03/2019 458 FOLLOW-UP ORDER RE: ALBERTO SANCHEZ. Mr. Sanchez's request for reconsideration, ECF No. 457 , is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 4/3/19. (blb) (Entered: 04/03/2019)

04/03/2019 459 Letter from Steven A. McLeod titled "Third Motion to Intervene". (blb) Modified on 4/8/2019 (blb). (Entered: 04/03/2019)

04/04/2019

460 ORDER REQUIRING DEFENDANT TO RESPOND. Steven A. McLeod has filed a third motion to intervene. ECF No. 459 . Defendant is ordered to respond to Mr. McLeod's motion no later than 4/18/2019). Signed by CHIEF JUDGE MARK E WALKER on 4/4/19. (blb) (Entered: 04/04/2019)

04/11/2019 461 RESPONSE in Opposition re 459 MOTION to Intervene filed by MARK S INCH. (Attachments: # 1 Attachment) (BOWDEN, ALBERT) (Entered: 04/11/2019)

04/11/2019 462 REPLY to Defendant's Response Opposing Inmate Eugene Jenkins Motion for Finding of Civil Contempt (Letter) 445 re MOTION for Leave to File Response 447 to 440 Order. (blb) (Entered: 04/11/2019)

04/12/2019 463 ORDER DENYING STEVEN A. MCLEOD'S 459 THIRD MOTION TO INTERVENE. Signed by CHIEF JUDGE MARK E WALKER on 04/12/2019. (toy) (Entered: 04/12/2019)

04/18/2019 464 MOTION for Preliminary Injunction. (filed as directed by MCR Chambers) (Attachments: # 1 Order dated 4/18/2019) (sdw) (Entered: 04/18/2019)

04/18/2019

Set Deadlines re 464 MOTION for Preliminary Injunction. (Internal deadline for referral to judge if response not filed earlier: 5/2/2019.) (sdw) (Entered: 04/18/2019)

04/18/2019

465 VACATED per ORDER 556 :ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT. The parties' cross-motions for summary judgment, ECF No. 270 and ECF No. 342 , are GRANTED in part and DENIED in part, as described in this order. The preliminary injunction entered in this case, ECF No. 185 , which was subsequently modified and renewed, see, e.g., ECF No. 437 , is hereby dissolved. No later than 5/20/2019, the parties must confer and file a jointly proposed briefing schedule regarding the entitlement to and determination of attorney's fees and costs. The Clerk is directed to provide a copy of this order to inmate Steven A. McLeod. The Clerk is directed to enter judgment stating: a. Defendant must ensure that the Florida Department of Corrections

("FDC"), FDC's employees, and FDC's agents comply with FDC's Hepatitis C Virus ("HCV") policy, HSB 15.03.09 Supplement #3, as it is revised. b. Defendant must ensure that FDC's HCV policy, HSB 15.03.09 Supplement #3, is not modified absent this Court's instruction. c. Defendant must ensure that, no later than May 20, 2019, FDC's HCV policy, HSB 15.03.09 Supplement #3, is modified as follows: i. The policy must be modified to reflect that treatment must be initiated for F0 and F1 inmates within two years of staging. ii. A section must be added to the policy requiring an explanation to anyone who refuses staging or treatment of, at least, (1) the consequences of HCV, (2) the availability, lack of side effects, and efficacy of the new medications, (3) the staging process, and (4) whether and when they will receive treatment. iii. The policy must be modified to reflect that (1) patients must be initially staged using a FibroSure test within 30 days of confirming they have chronic HCV; (2) patients who need ultrasounds must receive an ultrasound within 90 days of confirming they have chronic HCV; (3) if a patient needs to be restaged as a result of an ultrasound, the restaging must take place within 5 days of receiving the ultrasound results; and (4) staff must rely on the test, exam, or study indicating the highest fibrosis level for staging. iv. The policy must be modified to reflect that deadlines are mandatory. v. The policy must be modified to reflect that staff have the discretion to restage inmates sooner than scheduled. vi. The exclusion for time remaining on an inmate's sentence must be modified such that (1) it no longer refers to "pre-treatment evaluation"; (2) it no longer refers to "post treatment SVR assessment"; (3) it no longer includes a "12-18 months" estimate; and (4) it reflects that an inmate-who has already been staged and evaluated-simply needs to have "sufficient" time remaining on their sentence to complete a course of treatment. vii. The exclusion for high-risk behaviors must be modified to reflect that (1) high-risk behaviors only warrant a delay if there is a "medical reason" to delay treatment and (2) it only provides for temporary ineligibility, not permanent exclusion. viii. Section J.3., which refers to "chronic disciplinary issues," must be amended to reflect that chronic disciplinary issues, in and of themselves, are not sufficient to render an inmate ineligible for treatment; rather, treatment may only be delayed for medical reasons. ix. Section P, which governs referrals for liver transplants, must be modified as follows: (1) decompensation must be defined as "the presence of encephalopathy, ascites, bleeding varices, or jaundice"; (2) it must be clarified to reflect that patients will be referred if they have any one of the listed items; (3) referrals must be initiated within 30 days of any one of the triggering events; (4) it must provide that FDC must promptly comply with the transplant center's request for records and other information, and to promptly transport the inmate to and from the transplant center; and (5) it must be clarified that for individuals who have been scheduled to receive DAA medication, are undergoing DAA treatment, or who have finished DAA treatment, a referral must be made

only if the post-treatment MELD score is over 15. x. Section A.2., which refers to risk factors, must be modified to include "being born between 1945 and 1965, previous incarceration, and HIV" as risk factors. d. Defendant must ensure that FDC initiates treatment for all known chronicHCV inmates who are currently staged F0 or F1 within two years of the date of this order. e. Defendant must ensure that FDC either (1) adopts a system of opt-out testing along with an aggressive notice campaign or (2) adopts a system of opt-in testing paired with peer education. FDC must make its choice and Defendant must inform this Court of FDC's decision no later than 5/20/2019. f. Defendant must ensure that FDC forms a definite plan to make elastography available to its medical staff within a reasonably immediate timeframe. Defendant must file its proposed plan with this Court no later than 5/20/2019. g. Defendant must ensure that-for inmates who were known to have chronic HCV in December 2017, who have fibrosis stage 2, and who are eligible for treatment-FDC initiates treatment no later than December 31, 2019. Beginning on 6/3/2019, and on the first day of each month thereafter, Defendant must file with this Court a status report reflecting FDC's progress in complying with this Court's injunction. That status report must include: i. A certification regarding FDC's compliance with the applicable deadlines for prisoners known to have chronic HCV in December 2017. ii. Information regarding the total number of inmates who: 1. have been screened/tested for HCV, 2. have been identified as having chronic HCV, 3. have been identified as having chronic HCV and have been staged (which must be further broken down by stage, including F0, F1, F2, F3, F4, decompensated cirrhosis, and those with HIV), 4. have been submitted to the Hepatitis C Committee for evaluation (which must be further broken down by stage, including F0, F1, F2, F3, F4, decompensated cirrhosis, and those with HIV), 5. have begun treatment with DAAs, 6. have completed treatment with DAAs, 7. have achieved a sustained virologic response (SVR), 8. have not achieved SVR, and 9. have been deemed (temporarily or permanently) ineligible for treatment with DAAs along with the specific reason for ineligibility. Signed by CHIEF JUDGE MARK E WALKER on 4/18/2019. (kjw) **Order mailed to inmate McLeod as directed.** Modified on 11/4/2020 (blb). (Entered: 04/18/2019)

04/18/2019

466 VACATED per ORDER 556 : CLERK'S JUDGMENT entered pursuant to 465 ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT. (kjw) 90 Day Exhibit Return Deadline set for 7/17/2019. Modified on 11/4/2020 (blb). (Entered: 04/18/2019)

04/19/2019

467 ORDER DENYING STEPHEN COMBS'S MOTION. Inmate Stephen Combs filed a motion for a preliminary injunction in a separate case within this district. See ECF No. 464 . His motion was transferred to this case. This Court has since entered a permanent injunction and dissolved the preliminary injunction. ECF No. 465 . As such, Mr. Combs's motion,

ECF No. 464 , is DENIED as moot. Signed by CHIEF JUDGE MARK E WALKER on 4/19/19. (blb) (Entered: 04/19/2019)

04/26/2019 468 STATUS REPORT May 2019 by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 04/26/2019)

04/26/2019 469 NOTICE of Change of Address from Steven A. McLeod. New Address: Dade Correctional Institution, 19000 SW 377th, Homestead, Fl 33034. (blb) (Entered: 04/26/2019)

04/29/2019

Set Deadlines/Hearings Status Report due by 5/29/2019. (blb) (Entered: 04/29/2019)

04/30/2019 470 MOTION for Modification of Injunction by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 04/30/2019)

05/01/2019

471 ORDER REQUIRING EXPEDITED RESPONSE. Defendant must file an expedited response to Plaintiffs' motion, ECF No. 470 , no later than 5/10/2019). Signed by CHIEF JUDGE MARK E WALKER on 5/1/19. (blb) (Entered: 05/01/2019)

05/01/2019 472 Consent MOTION for Extension of Time to File Bill of Costs by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 05/01/2019)

05/02/2019

473 ORDER GRANTING EXTENSION TO FILE BILL OF COSTS. This Court has considered, without hearing, Plaintiffs' Unopposed Motion for Extension of Time to File Bill of Costs. ECF No. 472 . The motion is GRANTED. Plaintiffs shall file their bill of costs on or before 5/20/2019. Signed by CHIEF JUDGE MARK E WALKER on 5/2/19. (blb) (Entered: 05/02/2019)

05/02/2019

Set/Reset Deadline - Miscellaneous (Bill of Costs) Deadline by 5/20/2019. (blb) (Entered: 05/07/2019)

05/08/2019 474 MEMORANDUM in Opposition re 470 MOTION for Modification of Injunction filed by MARK S INCH. (BOWDEN, ALBERT) (Entered: 05/08/2019)

05/13/2019

475 ORDER DENYING MOTION FOR MODIFICATIONOF INJUNCTION. This Court has considered, without hearing, Plaintiffs' Motion for Modification of Injunction. ECF No. 470 . That motion is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 5/13/19. (blb) (Entered: 05/13/2019)

05/16/2019

476 NOTICE OF APPEAL by MARK S INCH. ( Filing fee $505 Receipt Number AFLNDC-4493446.) (Attachments: # 1 Order, # 2 Order, # 3 Order, # 4 Order, # 5 Order, # 6 Order, # 7 Order, # 8 Order, # 9 Order, # 10 Order, # 11 Order, # 12 Order, # 13 Order, # 14 Order) (BOWDEN, ALBERT) (Entered: 05/16/2019)

05/16/2019

Set Deadlines re 476 Notice of Appeal : Clerk to check status of Appeal on 8/19/2019. (blb) (Entered: 05/17/2019)

05/17/2019

477 Appeal Instructions re: 476 Notice of Appeal : The Transcript Request Form is available on the Internet at http://www.flnd.uscourts.gov/forms/Attorney/ECCA_transcript_form_fill able.pdf **PLEASE NOTE** Separate forms must be filed for each court reporter. Transcript Order Form due by 5/31/2019. (blb) (Entered: 05/17/2019)

05/17/2019 478 Transmission of Notice of Appeal and Docket Sheet to US Court of Appeals re 476 Notice of Appeal. (blb) (Entered: 05/17/2019)

05/17/2019 479 Joint MOTION to Extend Timeto File a Motion for Attorney's Fees, Costs and Expenses, and to File a Bill of Costs by MARK S INCH. (BOWDEN, ALBERT) (Entered: 05/17/2019)

05/17/2019 482 USCA Acknowledgment 478 Transmission of Notice of Appeal 476 and Docket Sheet to USCA, USCA Appeal # 19-11921-D. (blb) (Entered: 05/21/2019)

05/20/2019

480 NOTICE of Filing a Statement of Intention, and an Elastography Plan by MARK S INCH . (Attachments: # 1 Exhibit Elastography Plan) (BOWDEN, ALBERT) Modified on 5/21/2019 (blb). *Edit Title* (Entered: 05/20/2019)

05/21/2019

481 ORDER GRANTING JOINT MOTION FOR EXTENSION OF TIME TO FILE A MOTION FOR ATTORNEY'S FEES, COSTS AND EXPENSES. This Court has considered, without hearing, the parties' joint motion for an extension of time to file a motion for attorney's fees, costs, and expenses, and to file a bill of costs. ECF No. 479 . The motion is GRANTED. The deadline to file such a motion and a bill of costs is extended to 30 days after any appeal or other appellate challenge is resolved. Signed by CHIEF JUDGE MARK E WALKER on 5/21/19. (blb) (Entered: 05/21/2019)

05/30/2019 483 STATUS REPORT For June 2019 by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 05/30/2019)

05/30/2019 484 TRANSCRIPT REQUEST by MARK S INCH for proceedings held on 10/19/17, 10/23/17, 10/25/17 before Judge Mark Walker.. (BOWDEN, ALBERT) (Entered: 05/30/2019)

05/30/2019 485 TRANSCRIPT REQUEST by MARK S INCH for proceedings held on 10/20/17-10/25/17, 11/1/17 before Judge Mark Walker.. (BOWDEN, ALBERT) (Entered: 05/30/2019)

05/31/2019

Set Deadlines/Hearings Status Report due by 7/1/2019. (blb) (Entered: 05/31/2019)

05/31/2019 486 TRANSCRIPT Acknowledgment - Part II re 476 Notice of Appeal, Court Reporter:Megan A. Hague Transcript due by 7/1/2019. (mah) (Entered: 05/31/2019)

06/04/2019 487 Letter from Kenneth Krause. (blb) (Entered: 06/04/2019)

06/04/2019

488 ORDER REQUIRING DEFENDANT TO RESPOND. Defendant must respond to Mr. Krause's letter, ECF No. 487 , no later than 6/18/2019). The Clerk shall mail a copy of this order to: Kenneth Krause, 746223 Calhoun Correctional Institution 19562 SE Institution Drive Blountstown, FL 32424. Signed by CHIEF JUDGE MARK E WALKER on 6/4/19. (blb) (Entered: 06/04/2019)

06/07/2019 489 RESPONSE by MARK S INCH re 488 Order,, Set Deadlines, 487 Letter from inmate Kenneth Krause. (Attachments: # 1 Appendix Declaration) (BOWDEN, ALBERT) (Entered: 06/07/2019)

06/07/2019

490 ORDER RE: KENNETH KRAUSE. Inmate Kenneth Krause filed a letter noting purported violations of this Court's injunction. ECF No. 487 . This Court required Defendant to respond. ECF No. 488 . After reading Defendant's response along with the attached affidavit, ECF No. 489 , it appears that Defendant has not violated this Court's injunction with respect to Mr. Krause. Defendant is receiving treatment consistent with this Court's order. Accordingly, no further action needs to be taken on Mr. Krause's letter. The Clerk shall provide Mr. Krause with a copy of this order. Signed by CHIEF JUDGE MARK E WALKER on 6/7/19. (blb) (Entered: 06/07/2019)

06/12/2019 491 MOTION for Leave to Appeal in forma pauperis on Appeal by STEVEN A. MCLEOD. (blb) (Entered: 06/12/2019)

06/13/2019

492 ORDER DENYING LEAVE TO PROCEED IN FORMA PAUPERIS. Steven A. Mcleod, a non-party prisoner, has filed his Application to Proceed Without Prepayment of Fees. ECF No. 491 . This Court finds that the appeal is not taken in good faith and that Mr. McLeod is not otherwise

entitled to proceed on appeal in forma pauperis. Accordingly, Steven A. McLeod's motion for leave to proceed without pre-payment is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 6/13/19. (blb) (Entered: 06/13/2019)

06/26/2019

493 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume I held on 10/19/2019, before Judge Mark E. Walker. Court Reporter/Transcriber Judy Gagnon, Telephone number 8504220011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)

06/26/2019

494 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume II held on 10/20/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)

06/26/2019

495 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume III held on 10/23/2017 AM, before Judge Mark E. Walker. Court Reporter/Transcriber Judy Gagnon, Telephone number 8504220011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)

06/26/2019

496 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume IV held on 10/23/2017 PM, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)

06/26/2019

497 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume V held on 10/24/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 8504220011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)

06/26/2019

498 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume VI held on 10/25/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 8504220011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)

06/26/2019

499 NOTICE OF FILING OF OFFICIAL TRANSCRIPT of Preliminary Injunction Proceedings - Volume VII held on 11/1/2017, before Judge Mark E. Walker. Court Reporter/Transcriber Megan A. Hague, Telephone number 850-422-0011.

Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER.

Redaction Request due 7/3/2019. Release of Transcript Restriction set for 10/1/2019. (mah) (Entered: 06/26/2019)
06/26/2019 500 NOTICE of Filing Transcript (Part III) by Court Reporter in District Court - re: 476 Notice of Appeal, 486 Transcript Acknowledgment - Part II

Court Reporter: Megan A. Hague Certificate of Readiness due by 6/26/2019. (mah) (Entered: 06/26/2019)

06/26/2019 501 STATUS REPORT For July 2019 by MARK S INCH. (Attachments: # 1 Exhibit A) (BOWDEN, ALBERT) (Attachment 501-1 replaced w 504-1 on 7/8/2019) (blb). (Entered: 06/26/2019)

06/27/2019

Set/Reset Deadlines: Status Report due by 7/29/2019. (blb) (Entered: 06/27/2019)

06/27/2019

502 Pursuant to F.R.A.P. 11(c), the Clerk of the District Court for the Northern District of Florida certifies that the record is complete for purposes of this appeal re: 476 Notice of Appeal, Appeal No. 19-11921D. The entire record on appeal is available electronically. (blb) (Entered: 06/27/2019)

06/27/2019 503 NOTICE of Filing Transcript (Part III) by Court Reporter in District Court - re: 476 Notice of Appeal. Court Reporter: Judy Gagnon. (kjw) (Entered: 06/27/2019)

07/05/2019

504 MOTION for More Definite Statement To Seal ( (Internal deadline for referral to judge if response not filed earlier: 7/19/2019).), MOTION to Seal Document by MARK S INCH. (Attachments: # 1 Appendix) (BOWDEN, ALBERT) (Entered: 07/05/2019)

07/08/2019

505 ORDER GRANTING MOTION TO SEAL. This Court has considered, without hearing, Defendant's Unopposed Motion to Seal ECF No. 501 -1. ECF No. 504 . The motion is GRANTED. The Clerk shall seal ECF No. 501 -1 and replace it with ECF No. 504 -1. Signed by CHIEF JUDGE MARK E WALKER on 7/8/19. (blb) (Entered: 07/08/2019)

07/12/2019 506 NOTICE OF CONSTRUING SUPPLEMENTAL NOTICE OF APPEAL AS NOTICE OF CROSS APPEAL Filed By STEVEN A MCLEOD. (blb) (Entered: 07/17/2019)

07/17/2019

507 *WITHDRAWN*ORDER DENYING MOTION TO FILE CROSSAPPEAL. Steven A. Mcleod, a non-party prisoner, has filed his pro se Notice of Construing Supplemental Notice of Appeal as Cross-Appeal. ECF No. 506 . Construed by this Court as a motion to file cross-appeal, the motion is DENIED. This Court finds there is no appeal pending in this case for Mr. McLeod. Signed by CHIEF JUDGE MARK E WALKER on 7/17/19. (blb) (Entered: 07/17/2019)

07/18/2019

508 ORDER WITHDRAWING ORDER DENYING MOTION TO FILE CROSS-APPEAL. This Court's July 17, 2019, Order Denying Motion to File Cross-Appeal, ECF No. 507 , is hereby WITHDRAWN. To the extent Mr. Mcleod seeks relief from this Court, his motion is DENIED.

Signed by CHIEF JUDGE MARK E WALKER on 7/18/19. (blb) (Entered: 07/18/2019)

07/22/2019 509 MOTION for Leave to Cross Appeal in forma pauperis filed by Steven A. McLeod. (blb) (Entered: 07/23/2019)

07/24/2019 510 STATUS REPORT by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 07/24/2019)

07/24/2019

Set Deadlines/Hearings Status Report due by 8/23/2019. (rcb) (Entered: 07/25/2019)

07/25/2019

511 ORDER Denying 509 Leave to Proceed In Forma Pauperis. Accordingly, Steven A. McLeod's motion for leave to proceed in forma pauperis on cross-appeal is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 07/25/2019. (rcb) M (Entered: 07/25/2019)

07/29/2019 512 NOTICE to Construe Supplemental Notice of Appeal as a Cross-Appeal by Steven A McLeod. (blb) (Entered: 07/30/2019)

08/12/2019 513 Letter requesting document from Steven A. McLeod. (blb) (Entered: 08/12/2019)

08/19/2019

514 MOTION for Clarification, or, in the Alternative, for Indicative Ruling and Request for Expedited Consideration re 465 Order Dismissing Case. Set Deadlines/Hearings by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit 1 - Appellant's Brief) (SELIG, ERICA) (Entered: 08/19/2019)

08/20/2019

515 ORDER EXPEDITING CONSIDERATION OF PLAINTIFFS' MOTION FOR CLARIFICATION. Defendant shall file his response, if any, to Plaintiffs' Motion for Clarification, if any, not later than Friday, 8/23/2019). Not later than Monday, 8/26/2019, Plaintiff shall file a proposed order detailing the proposed clarification and/or indicative ruling. Not later than Monday, 8/26/2019, Defendant shall file a proposed order detailing why this Court should not make additional findings of fact and why an indicative ruling would not be appropriate. Signed by CHIEF JUDGE MARK E WALKER on 8/20/19. (blb) (Entered: 08/20/2019)

08/23/2019

516 RESPONSE in Opposition re 514 MOTION for Clarification, or, in the Alternative, for Indicative Ruling and Request for Expedited Consideration re 465 Order Dismissing Case. Set Deadlines/Hearings filed by MARK S INCH. (BOWDEN, ALBERT) (Entered: 08/23/2019)

08/26/2019 517 NOTICE of Filing Proposed Orders Detailing Clarification and/or Indicative Ruling by CARL HOFFER, RONALD MCPHERSON,

ROLAND MOLINA (Attachments: # 1 Text of Proposed Order 1 Proposed Order Granting Plaintiffs' Motion for Clarification or, alternatively, for an Indicative Ruling, # 2 Text of Proposed Order 2 Proposed Order Detailing Clarification and/or Indicative Ruling with PLRA Findings) (TREVISANI, DANTE) (Entered: 08/26/2019)

08/26/2019

518 NOTICE Of Compliance With The Court's Order Expediting Consideration Of Plaintiffs' Motion For Clarification by MARK S INCH (Attachments: # 1 Text of Proposed Order) (BOWDEN, ALBERT) (Entered: 08/26/2019)

08/27/2019

519 Pursuant to F.R.A.P. 11(c), the Clerk of the District Court for the Northern District of Florida certifies that the record is complete for purposes of this appeal re: 476 Notice of Appeal USCA No. 19-11921. The entire record on appeal is available electronically. (blb) (Entered: 08/27/2019)

08/27/2019

Set Deadlines/Hearings Appeal Status Report due by 9/27/2019. (blb) (Entered: 08/27/2019)

08/27/2019 520 STATUS REPORT by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 08/27/2019)

08/28/2019

Set/Reset Deadlines: Status Report by Defendant due by 10/1/2019, re: 465 ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT. (kjw) (Entered: 08/28/2019)

08/28/2019 521 ORDER ON PLAINTIFFS' 514 MOTION FOR CLARIFICATION OR INDICATIVE RULING. Plaintiffs' motion is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 8/28/2019. (rcb) (Entered: 08/28/2019)

09/03/2019

522 AMENDED:Pursuant to F.R.A.P. 11(c), the Clerk of the District Court for the Northern District of Florida certifies that the record is complete for purposes of this appeal re: 476 Notice of Appeal, Appeal No. 19-11921. The record on appeal is available electronically with the exception of: 142-1 EXHIBITS. (blb) (Entered: 09/03/2019)

09/12/2019

Set Deadlines re 476 Notice of Appeal, : Clerk to check status of Appeal on 12/10/2019. (rcb) (Entered: 09/12/2019)

09/27/2019 523 STATUS REPORT by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 09/27/2019)

09/27/2019

Set/Reset Deadlines: Status Report due by 10/30/2019. (blb) (Entered: 09/30/2019)

10/03/2019

Appeal Deadlines Reset re 476 Notice of Appeal filed by MARK S INCH : Clerk to check status of Appeal on 1/3/2020. (blb) (Entered: 10/03/2019)

10/28/2019 524 STATUS REPORT by MARK S INCH. (Attachments: # 1 Exhibit) (BOWDEN, ALBERT) (Entered: 10/28/2019)

10/29/2019

Set/Reset Deadlines: Status Report due by 11/29/2019. (blb) (Entered: 10/29/2019)

11/22/2019 525 STATUS REPORT by MARK S INCH. (Attachments: # 1 Exhibit November Eligibility Log) (BRODEEN, KAREN) (Entered: 11/22/2019)

11/25/2019

Set Deadlines/Hearings Status Report due by 12/25/2019. (blb) (Entered: 11/25/2019)

12/23/2019 526 STATUS REPORT by Defendant, due December 25, 2019 by MARK S INCH. (BRODEEN, KAREN) (Entered: 12/23/2019)

12/26/2019

Set Deadlines/Hearings Status Report due by 1/26/2020. (blb) (Entered: 12/26/2019)

01/16/2020

ReSet Deadlines re 476 Notice of Appeal, : Clerk to check status of Appeal on 4/16/2020. (blb) (Entered: 01/16/2020)

01/28/2020

ACTION REQUIRED BY DISTRICT JUDGE: Chambers of CHIEF JUDGE MARK E WALKER notified that action is needed Re: Deadline : Status Report due by 1/26/2020, none filed. (blb) (Entered: 01/28/2020)

01/28/2020 527 NOTICE of Filing Monthly Status Report by MARK S INCH (Attachments: # 1 Supplement Eligibility Log) (BRODEEN, KAREN) (Entered: 01/28/2020)

01/28/2020

Set Deadlines/Hearings Status Report due by 2/28/2020. (blb) (Entered: 01/28/2020)

02/24/2020 529 MOTION TO ADD PETITIONER filed by CHRISTOPHER R COLON. (blb) (Entered: 02/26/2020)

02/25/2020 528 STATUS REPORT due February 28, 2020 by MARK S INCH. (Attachments: # 1 Exhibit Eligibility Log) (BRODEEN, KAREN) (Entered: 02/25/2020)

02/26/2020

Set/Reset Deadlines: Status Report due by 3/26/2020. (blb) (Entered: 02/26/2020)

02/27/2020 530 ORDER DENYING MOTION TO ADD PETITIONER. Christopher R. Colon, a non-party prisoner, has filed his pro se Motion to Add Petitioner. ECF No. 529 . This case is closed and on appeal at the Eleventh Circuit

Court of Appeals. Any motions for leave to file in that case should be directed to the Eleventh Circuit. The Clerk shall TERMINATE the motion. Even if this matter were properly before this Court, Mr. Colon has not shown any proper basis for permissive joinder. To the extent it is properly before this Court, therefore, the motion is DENIED. Signed by CHIEF JUDGE MARK E WALKER on 2/27/20. (blb) (Entered: 02/27/2020)

03/24/2020

531 MOTION to Enforce or Amend the Injunction, or Alternatively, for Damages for Future Treatment, filed by Weston Markey. (Attachments: # 1 Copy of Order directing motion to be filed in this case.) (alb) (Entered: 03/24/2020)

03/25/2020

532 ORDER REQUIRING DEFENDANT TO RESPOND. Defendant must respond to Inmate Markey's motion as it relates to the enforcement of the injunction, (Amended Complaint) ECF No. 531 , not later than 4/9/2020). Signed by CHIEF JUDGE MARK E WALKER on 3/25/20. (blb) *Copy mailed to Weston Markey, R68492, Wakulla Correctional Institution Annex, 110 Melaleuca Drive, Crawfordville, FL 32327-4963* (Entered: 03/25/2020)

03/26/2020 533 STATUS REPORT Due March 26, 2020 by MARK S INCH. (Attachments: # 1 Exhibit Eligibility Log) (BRODEEN, KAREN) (Entered: 03/26/2020)

03/27/2020

Set/Reset Deadlines: Status Report due by 4/27/2020. (blb) (Entered: 03/27/2020)

04/03/2020 534 NOTICE of Appearance by ERIN ELIZABETH OLIVER on behalf of MARK S INCH (OLIVER, ERIN) (Entered: 04/03/2020)

04/10/2020

ACTION REQUIRED BY DISTRICT JUDGE: Chambers of CHIEF JUDGE MARK E WALKER notified that action is needed Re: 532 Order. No Response Filed. (blb) (Entered: 04/10/2020)

04/10/2020 535 Consent MOTION for Leave to File re 532 Order,, Set Deadlines, After Deadline by MARK S INCH. (Attachments: # 1 Exhibit Response) (OLIVER, ERIN) (Entered: 04/10/2020)

04/10/2020

536 ORDER GRANTING MOTION TO FILE RESPONSE AFTER DEADLINE. This Court has considered, without hearing, Defendant's Motion to File Response After Deadline. ECF No. 535 . The motion is GRANTED and this Court considers the response attached to the motion, ECF No. 535 -1 is accepted as timely filed. Signed by CHIEF JUDGE MARK E WALKER on 4/10/20. (blb) (Entered: 04/13/2020)

04/14/2020

537 ORDER DENYING MOTION TO ENFORCE OR AMEND INJUNCTION OR ALTERNATIVELY FOR DAMAGES FOR FUTURE TREATMENT. This Court has considered, without hearing, Inmate Weston Markey's Motion to Enforce or Amend the Injunction, or Alternatively, for Damages for Future Treatment, along with Defendant's Response to the motion. ECF Nos. 531 and 535 -1. Inmate Markey's Motion to Enforce or Amend the Injunction, or Alternatively, for Damages for Future Treatment is DENIED without prejudice. If Inmate Markey seeks to pursue a claim for damages, he must file a separate action. Signed by CHIEF JUDGE MARK E WALKER on 4/14/20. (blb) (Entered: 04/14/2020)

04/23/2020 538 STATUS REPORT Due April 27, 2020 by MARK S INCH. (Attachments: # 1 Exhibit Eligibility Log) (OLIVER, ERIN) (Entered: 04/23/2020)

04/24/2020

Set/Reset Deadlines: Status Report due by 5/24/2020. (blb) (Entered: 04/24/2020)

04/27/2020

Appeal Deadline Reset re 476 Notice of Appeal : Clerk to check status of Appeal on 7/27/2020. USCA #19-11921. (blb) (Entered: 04/27/2020)

05/26/2020 539 STATUS REPORT Due May 26, 2020 by MARK S INCH. (Attachments: # 1 Exhibit Eligibility Log) (OLIVER, ERIN) (Entered: 05/26/2020)

05/26/2020

Set/Reset Deadlines: Status Report due by 6/26/2020. (blb) (Entered: 05/26/2020)

06/26/2020 540 NOTICE of Monthly Status Report (due June 26, 2020) by MARK S INCH (OLIVER, ERIN) (Entered: 06/26/2020)

06/28/2020

Set/Reset Deadlines: Status Report due by 7/28/2020. (blb) (Entered: 06/28/2020)

07/28/2020 541 NOTICE of Monthly Status Report (July 2020) by MARK S INCH (Attachments: # 1 Exhibit A) (OLIVER, ERIN) (Entered: 07/28/2020)

07/29/2020

Set/Reset Deadlines: Status Report due by 8/29/2020. (blb) (Entered: 07/29/2020)

07/31/2020

ReSet Deadlines re 476 Notice of Appeal, : Clerk to check status of Appeal on 10/31/2020. USCA #19-11921 still pending. (blb) (Entered: 07/31/2020)

08/28/2020 542 NOTICE of Filing Monthly Status Report Due August 29, 2020 by MARK S INCH (Attachments: # 1 Exhibit A) (OLIVER, ERIN) (Entered: 08/28/2020)

08/31/2020

Set Deadline - Status Report due by 9/29/2020. (cle) (Entered: 08/31/2020)

08/31/2020 545 USCA OPINION as to 476 Notice of Appeal filed by MARK S INCH. USCA # 19-11921-DD. (blb) (Entered: 09/22/2020)

09/21/2020 543 NOTICE of Unavailability (Erin Oliver) by MARK S INCH (OLIVER, ERIN) (Entered: 09/21/2020)

09/21/2020 544 NOTICE of Appearance by BILAL AHMED FARUQUI on behalf of MARK S INCH (FARUQUI, BILAL) (Entered: 09/21/2020)

09/25/2020 546 BILL OF COSTS by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Documentation of Costs) (TREVISANI, DANTE) (Entered: 09/25/2020)

09/28/2020

Set 60 Day Bill of Costs Status Deadline - Deadline - by 11/28/2020. (blb) (Entered: 09/28/2020)

09/29/2020 547 STATUS REPORT by MARK S INCH. (BRODEEN, KAREN) (Entered: 09/29/2020)

09/29/2020

Set/Reset Deadlines: Status Report due by 10/29/2020. (blb) (Entered: 09/29/2020)

09/30/2020 548 Consent MOTION for Attorney Fees (to Determine Entitlement) by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 09/30/2020)

09/30/2020

549 ORDER GRANTING UNOPPOSED MOTION TO DETERMINE ENTITLEMENT TO ATTORNEY'S FEES AND EXPENSES. This Court has considered, without hearing, Plaintiff's Unopposed Motion to Determine Entitlement to Attorney's Fees and Expenses, ECF No. 548 . This Court finds that Plaintiffs are entitled to fees and the motion is therefore GRANTED. The parties are directed to confer and file a proposed briefing schedule for the issue of the amount fees to which Plaintiffs are entitled on or before 10/12/2020. Signed by CHIEF JUDGE MARK E WALKER on 9/30/20. (blb) (Entered: 09/30/2020)

10/08/2020 550 JOINT NOTICE ON BRIEFING SCHEDULE FOR ATTORNEYS' FEES (TREVISANI, DANTE) Modified to edit title on 10/8/2020 (rcb). (Entered: 10/08/2020)

10/09/2020

551 ORDER ADOPTING PROPOSED BRIEFING SCHEDULE. The parties have filed a joint notice proposing a briefing schedule on the issue of attorney's fees, costs, and expenses. ECF No. 550 . In their notice, the parties propose the following: The parties will continue to negotiate in

good faith in an attempt to reach an agreement on the amount of attorneys' fees, cost, and expenses. If they cannot reach an agreement, Plaintiffs will file their motion to determine the amount of attorneys' fees, costs, and expenses by 11/30/2020; Defendant's Response will be due 30 days after the motion is filed; and Plaintiffs' Reply will be due 21 days after Defendant's Response is filed. This Court hereby ADOPTS the parties' proposed schedule. Signed by CHIEF JUDGE MARK E WALKER on 10/9/20. (blb) (Entered: 10/09/2020)

10/29/2020 552 STATUS REPORT due October 29th by MARK S INCH. (BRODEEN, KAREN) (Entered: 10/29/2020)

10/30/2020

Set/Reset Deadlines: Status Report due by 11/30/2020. (blb) (Entered: 10/30/2020)

10/30/2020

553 JOINT MOTION TO AMEND PROPOSED BRIEFING SCHEDULE ON DETERMINING AMOUNT OF FEES, COSTS AND EXPENSES by MARK S INCH. (BRODEEN, KAREN) Modified Title on 11/2/2020 (blb). (Entered: 10/30/2020)

11/02/2020

554 ORDER GRANTING MOTION TO AMEND BRIEFING SCHEDULE. The parties have filed a joint motion to amend the proposed briefing schedule on determining fees, costs, and expenses. ECF No. 553 . The motion is GRANTED. Plaintiffs shall file their motion to determine the amount of fees, costs, and expenses on or before 12/30/2020. Defendant shall file his response no later than 30 days after Plaintiffs file their motion, and Plaintiffs shall file their reply no later than 21 days after Defendant files his response. Signed by CHIEF JUDGE MARK E WALKER on 11/2/20. (blb) (Entered: 11/02/2020)

11/02/2020 555 USCA JUDGMENT issued as MANDATE as to 476 Notice of Appeal. USCA #19-11921-DD. (blb) (Entered: 11/03/2020)

11/04/2020

556 ORDER VACATING JUDGMENT AND REQUIRING PARTIES TO SUBMIT PROPOSED ORDERS. Pursuant to the Eleventh Circuit's Mandate, ECF No. 555 , the Clerk is directed to vacate this Court's Order on Cross-Motions for Summary Judgment, ECF No. 465 , and the Clerk's Judgment, ECF No. 466 . As it pertains to mandating DAA treatment of all F0- and F1-level HCV-positive inmates, summary judgment is awarded to Defendant on this issue. As to the balance of the order, both parties must provide this Court with proposed orders on or before 11/23/2020. The proposed orders must contain detailed findings of fact with citations to the record. Signed by CHIEF JUDGE MARK E WALKER on 11/4/20. (blb) (Entered: 11/04/2020)

11/22/2020 557 Joint MOTION to Extend Timeto File Proposed Orders by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (SELIG, ERICA) (Entered: 11/22/2020)

11/23/2020

558 ORDER GRANTING EXTENSION. The parties have filed a joint motion for enlargement of time to file proposed orders. ECF No. 557 . The motion is GRANTED. Given the upcoming Thanksgiving holiday, the deadline to submit proposed orders is extended to Friday, 12/4/2020. This is more time than the parties requested. Consequently, this Court expects the parties to use the additional time to prepare the best work product they can submit. Signed by CHIEF JUDGE MARK E WALKER on 11/23/20. (blb) (Entered: 11/23/2020)

11/30/2020 559 STATUS REPORT for November 30th by MARK S INCH. (BRODEEN, KAREN) (Entered: 11/30/2020)

12/01/2020

Set/Reset Deadlines: Status Report due by 1/1/2021. (blb) (Entered: 12/01/2020)

12/04/2020

560 MOTION to Dismiss for Lack of Jurisdiction as Moot (in Part) by MARK S INCH. (Internal deadline for referral to judge if response not filed earlier: 12/18/2020). (Attachments: # 1 Exhibit 1. HSB 15.03.09 Supplement #3 - Revised 10-2017, # 2 Exhibit 2. Legislative Budget Request, # 3 Exhibit 3. Declaration of Thomas Reimers, # 4 Exhibit 4. HSB 15.03.09 Supplement #3 - Revised 5-2019, # 5 Exhibit 5. HSB 15.01.06 - Revised 3-30-2020, # 6 Exhibit 6. HSB 15.03.04 - Revised 1113-2020, # 7 Exhibit 7. HSB 15.03.05 - Revised 7-31-19) (FARUQUI, BILAL) (Entered: 12/04/2020)

12/04/2020 561 NOTICE OF FILING PROPOSED ORDER by MARK S INCH (Attachments: # 1 Text of Proposed Order) (FARUQUI, BILAL) (Entered: 12/04/2020)

12/04/2020

562 NOTICE of Filing Proposed Order by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (Attachments: # 1 Text of Proposed Order Proposed Order on Cross-Motions for Summary Judgment, # 2 Exhibit Health Service Bulletin) (TREVISANI, DANTE) (Entered: 12/04/2020)

12/07/2020

563 ORDER REQUIRING EXPEDITED RESPONSE. Defendant has filed a Motion to Dismiss as Moot (in part), ECF No. 560 . Plaintiffs shall filed an expedited response on or before Monday, 12/14/2020, and Defendant may file a reply (if he chooses to do so) on or before Monday, 12/21/2020. Signed by CHIEF JUDGE MARK E WALKER on 12/7/20. (blb) (Entered: 12/07/2020)

12/14/2020

564 RESPONSE in Opposition re 560 MOTION to Dismiss for Lack of Jurisdiction as Moot (in Part) filed by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (Attachments: # 1 Exhibit Selig Declaration) (TREVISANI, DANTE) (Entered: 12/14/2020)

12/15/2020

565 ORDER REQUIRING REPLY BRIEF. Defendant has filed a motion to dismiss the complaint as moot in part. ECF No. 560 . Plaintiffs' response, ECF No. 564 , raises the contention that Defendant's motion should be construed as a motion to terminate injunction. Accordingly, Defendant shall file its reply on or before Tuesday, 12/22/2020. Signed by CHIEF JUDGE MARK E WALKER on 12/15/20. (blb) (Entered: 12/15/2020)

12/22/2020

566 REPLY MEMORANDUM IN SUPPORT OF MOTION TO DISMISS AS MOOT (IN PART) filed by MARK S INCH. (Attachments: # 1 Exhibit 1. 2020-08-26 Email and Attachments, # 2 Exhibit 2. 2020-1030 Email and Attachment, # 3 Exhibit 3. 2020-10-09 Email, # 4 Exhibit 4. Elastography Service Agreement, # 5 Exhibit 5. 2020-10-22 Email, # 6 Exhibit 6. 2012 Spaulding Article, # 7 Exhibit 7. HCV Guidance Correctional Settings Page, # 8 Exhibit 8. 2003 CDC Report, # 9 Exhibit 9. 2014 Varan Article, # 10 Exhibit 10. 2015 Edlin Article, # 11 Exhibit 11. 2015 ACA Study) (FARUQUI, BILAL) Modified to edit title on 12/23/2020 (rcb). (Entered: 12/22/2020)

12/22/2020 567 NOTICE OF UNAVAILABILITY OF COUNSEL by MARK S INCH (FARUQUI, BILAL) Modified to edit title on 12/23/2020 (rcb). (Entered: 12/22/2020)

12/23/2020

568 ORDER PERMITTING LIMITED DISCOVERY. On or before 1/6/2021 the parties shall confer and submit a proposed discovery plan. If the parties can't agree, they shall submit proposed alternatives by that same date. Signed by CHIEF JUDGE MARK E WALKER on 12/23/2020. (kjw) (Entered: 12/23/2020)

12/29/2020 569 Consent MOTION to Stay Resolution of Attorneys' Fees and Costs by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA. (TREVISANI, DANTE) (Entered: 12/29/2020)

12/29/2020

570 ORDER STAYING RESOLUTION OF ATTORNEY'S FEES AND COSTS. This Court has considered, without hearing, Plaintiffs' unopposed motion to stay the resolution of attorney's fees and costs. ECF No. 569 . The motion is GRANTED. The resolution of attorney's fees and costs and all associated deadlines are STAYED. This Court retains jurisdiction over this issue until the funds have been paid. Plaintiffs shall immediately notify this Court once the funds are paid or the parties require further intervention by this Court. Signed by CHIEF JUDGE MARK E WALKER on 12/29/20. (blb) (Entered: 12/29/2020)

12/30/2020 571 STATUS REPORT by MARK S INCH. (BRODEEN, KAREN) (Entered: 12/30/2020)

12/31/2020

Set/Reset Deadlines: Status Report due by 1/31/2021. (blb) (Entered: 12/31/2020)

01/06/2021 572 NOTICE of Filing Joint Proposed Discovery Plan by CARL HOFFER, RONALD MCPHERSON, ROLAND MOLINA (TREVISANI, DANTE) (Entered: 01/06/2021)

01/06/2021

573 ORDER ADOPTING JOINT DISCOVERY PLAN. In accordance with this Court's order, ECF No. 568 , the parties have submitted a joint proposed discovery plan, ECF No. 572 , setting out specific deadlines for initial disclosures, written discovery, disclosure of expert reports, depositions, etc. The parties propose that all discovery must be completed by 5/14/2021. This order adopts the parties' joint discovery schedule as set out in ECF No. 572 . The parties shall notify this Court on or before 5/14/2021, whether they believe an evidentiary hearing is necessary to resolve Defendant's motion to dismiss, ECF No. 560 . Signed by CHIEF JUDGE MARK E WALKER on 1/6/21. (blb) (Entered: 01/06/2021)

01/29/2021 574 STATUS REPORT for January 2021 by MARK S INCH. (Attachments: # 1 Exhibit A) (OLIVER, ERIN) (Entered: 01/29/2021)

02/01/2021

Set /Reset Deadlines: Status Report due by 3/1/2021. (blb) (Entered: 02/01/2021)

03/01/2021 575 NOTICE of Filing Monthly Status Report due March 1, 2021 by MARK S INCH (Attachments: # 1 Exhibit A) (OLIVER, ERIN) (Entered: 03/01/2021)

03/02/2021

Set/Reset Deadlines: Status Report due by 4/2/2021. (blb) (Entered: 03/02/2021)

03/05/2021 576 Joint MOTION for Extension of Time to Complete Discovery by MARK S INCH. (FARUQUI, BILAL) (Entered: 03/05/2021)

03/05/2021

577 ORDER EXTENDING DISCOVERY DEADLINE. This Court has considered, without hearing, the parties' joint motion to extend the discovery deadline. ECF No. 576 . The motion is GRANTED. The discovery deadline is extended to 6/28/2021. Signed by CHIEF JUDGE MARK E WALKER on 3/5/21. (blb) (Entered: 03/05/2021)

04/02/2021 578 NOTICE of Monthly Status Report by April 2, 2021 by MARK S INCH (Attachments: # 1 Exhibit A) (OLIVER, ERIN) (Entered: 04/02/2021)

04/05/2021

Set/Reset Deadlines: Status Report due by 5/5/2021. (blb) (Entered: 04/05/2021)

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 Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 1 of 15

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, et al.,

Plaintiffs,

v.

Case No. 4:17cv214-MW/CAS

JULIE L. JONES, in her official capacity as Secretary of the Florida Department of Corrections,

Defendant. __________________________/

ORDER GRANTING MOTION FOR CLASS CERTIFICATION

Plaintiffs challenge the policies and practices of the Florida

Department of Corrections (“FDC”) for treating Hepatitis C. ECF

No. 1. Specifically, Plaintiffs claim that Defendant is acting with

deliberate indifference to their serious medical needs, in violation

of the Eighth Amendment, and that Defendant is discriminating

against them on the basis of disability in violation of the

Americans with Disabilities Act (“ADA”) and the Rehabilitation

Act (“RA”). Id. Presently before this Court is Plaintiffs’ motion for

class certification, in which Plaintiffs seek to certify a class of “all

current and future prisoners in FDC custody who have been

1

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 2 of 15
diagnosed, or will be diagnosed, with chronic hepatitis C virus (HCV).” ECF No. 10, at 2. To succeed in their motion, Plaintiffs must satisfy the four requirements of Federal Rule of Civil Procedure 23(a). Plaintiffs must also satisfy the requirements of Rule 23(b)(2).1 This Court finds that Plaintiffs have satisfied the necessary requirements; accordingly, Plaintiffs’ motion for class certification is GRANTED.
I. Rule (23)(a) Requirements Federal Rule of Civil Procedure 23(a) imposes four requirements on a party moving to certify a class. Specifically, the moving party must show: (1) numerosity, (2) commonality, (3) typicality, and (4) adequacy. See Fed. R. Civ. P. 23(a). This Court finds that each of these requirements has been met.
(1) Numerosity The numerosity requirement provides that a class can only be certified if “the class is so numerous that joinder of all members is impracticable.” Fed. R. Civ. P. 23(a)(1). “[W]hile there is no fixed numerosity rule, ‘generally less than twenty-one is inadequate, more than forty adequate, with numbers between varying
1 Plaintiffs could choose to qualify for any of the Rule 23(b) class-types, but they have only alleged that Rule 23(b)(2) applies, ECF No. 10, at 2.
2

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 3 of 15
according to other factors.’” Cox v. Am. Cast Iron Pipe Co., 784 F.2d 1546, 1553 (11th Cir. 1986). At the hearing on Plaintiffs’ motion, the parties presented evidence showing that the proposed class includes at least 7,000 inmates and likely includes upwards of 20,000 inmates.2 ECF No. 151, at 52–53; Test. of Dr. Dewsnup. Joining that many members would certainly be impracticable. See Williams v. Wells Fargo Bank, N.A., 280 F.R.D. 665, 671–72 (S.D. Fla. 2012). As such, Plaintiffs have satisfied the numerosity requirement.
(2) Commonality The commonality requirement provides that a class can only be certified if “there are questions of law or fact common to the class.” Fed. R. Civ. P. 23(a)(2). There is no requirement as to the number of common questions—even a single common question will do. Wal-Mart Stores, Inc. v. Dukes, 564 U.S. 338, 359 (2011). A question is “common” if it “is capable of classwide resolution— which means that determination of its truth or falsity will resolve an issue that is central to the validity of each one of the claims in one stroke.” See id. at 350.
2 “[A] plaintiff need not show the precise number of members in the class.” Evans v. U.S. Pipe & Foundry Co., 696 F.2d 925, 930 (11th Cir. 1983).
3

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 4 of 15
In this case there are several questions of law or fact
common to the class. For example, one common question of fact is
what the appropriate standard of care is for a person with chronic
HCV. Common questions of law include whether FDC’s failure to
meet that standard of care constitutes deliberate indifference
under the Eighth Amendment or discrimination under the ADA or
RA. All of these questions are subject to classwide resolution.
Defendant disputes that Plaintiffs have satisfied the
commonality requirement and argues that “[b]ased on the wide
disparity of symptoms and the decades long process in which it
takes for symptoms to occur . . . a one stroke determination by this
Court would undermine the individualized assessment and
treatment required for those with HCV.”3 ECF No. 32, at 6 n.2. But
3 Defendant repeatedly cites the Supreme Court’s decision in Wal-Mart, emphasizing that it “heightened the standards for establishing commonality” and “made it more difficult for all class action proponents to satisfy the common-issue requirement.” ECF No. 32, at 6–7 (quotations omitted). Whatever the result of Wal-Mart, Plaintiffs’ proposed class satisfies the Supreme Court’s standard. In discussing commonality, the Court explained as follows:
Commonality requires the plaintiff to demonstrate that the class members “have suffered the same injury.” This does not mean merely that they have all suffered a violation of the same provision of law. Title VII, for example, can be violated in many ways—by intentional discrimination, or by hiring and promotion criteria that result in disparate impact, and by the use of these practices on the part of many different superiors in a single company. Quite obviously, the mere claim by employees of the same company that they have suffered a Title VII injury, or even
4

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 5 of 15
Defendant misses the point. Plaintiffs’ claims are focused “on Defendant’s policy of non-treatment for HCV, which exposes every HCV patient to the same risk, regardless of their symptoms.” ECF No. 35, at 3.
Defendant’s misguidance is best illustrated through an example. Consider, for instance, a prison policy that states that every inmate with a broken bone must wait five years before they are treated. Under Defendant’s logic, inmates subject to that policy could not initiate a class action to change the policy because each inmate suffers from individualized conditions. That, of course, would be pure applesauce.4 Although each inmate may be differently situated (e.g., one may have a broken toe, and another a broken rib), they each suffer from the same injury: being subject
a disparate-impact Title VII injury, gives no cause to believe that all their claims can productively be litigated at once. Their claims must depend on a common contention—for example, the assertion of discriminatory bias on the part of the same supervisor. Wal-Mart, 564 U.S. at 349–50 (citation omitted). Here, Plaintiffs do not merely share a violation of the same provision of law; rather, they also share a “common contention”—they allege that FDC’s policies and practices for treating inmates with HCV are illegal. 4 Credit goes to the late Justice Scalia for introducing this phrase to the legal world. See King v. Burwell, 135 S.Ct. 2480, 2501 (2015) (Scalia, J., dissenting).
5

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 6 of 15
to the five-year delay. See Parsons v. Ryan, 754 F.3d 657, 678 (9th Cir. 2014) (affirming certification of statewide prisoner-class alleging deficient medical care; noting that “every inmate suffers exactly the same constitutional injury when he is exposed to a single statewide [prison] policy or practice that creates a substantial risk of serious harm”); see also Cooper v. S. Co., 390 F.3d 695, 714 (11th Cir. 2004) (“Neither the typicality nor the commonality requirement ‘mandates that all putative class members share identical claims, and . . . factual differences among the claims of the putative class members do not defeat certification.’” (quoting Baby Neal v. Casey, 43 F.3d 48, 56 (3d Cir. 1994)), overruling on other grounds recognized by SEC v. Bankatlantic Bancorp, Inc., 661 F. App’x 629, 635 (11th Cir. 2016).
If Plaintiffs were asking this Court to order Defendant to immediately give each member of the class specific medical treatment, then individualized differences might preclude class certification. But that is not what Plaintiffs are asking for. See ECF No. 1, at 43–45. Indeed, the relief that Plaintiffs seek with respect to the class as a whole is limited to changing Defendant’s
6

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 7 of 15
policies and practices.5 Defendant has not shown why differences in symptoms and treatment considerations should preclude awarding such class-wide relief. Accordingly, Plaintiffs have satisfied the commonality requirement.
(3) Typicality The typicality requirement provides that a class can only be certified if “the claims or defenses of the representative parties are typical of the claims or defenses of the class.” Fed. R. Civ. P. 23(a)(3). Claims are typical of each other if they “arise from the same event or pattern or practice and are based on the same legal theory.” Kornberg v. Carnival Cruise Lines, Inc., 741 F.2d 1332, 1337 (11th Cir. 1984). In this case, Plaintiffs’ claims arise from the very same “pattern or practice” as the class’s claims. Specifically, both groups’ claims arise from Defendant’s policies and practices for treating HCV. See ECF No. 1. Moreover, Plaintiffs’ claims are based on the exact same legal theories as the class’s claims:
5 For instance, Plaintiffs request an injunction ordering Defendant to “develop and adhere to a plan to provide direct-acting antiviral medications to all FDC prisoners with chronic HCV, consistent with the standard of care.” ECF No. 1, at 44. Ordering a change in policy (even with specific treatment in mind) is not the same as ordering a specific treatment. The distinction is that, even after the change is enacted, the policy can still take into account inmates’ individualized conditions.
7

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 8 of 15
deliberate indifference under the Eighth Amendment, and discrimination under the ADA and RA. See id.
Nonetheless, Defendant argues that this Court should not certify the proposed class because of alleged differences between Plaintiffs and other class members. See ECF No. 32, at 15 (“Because . . . a significant portion of the . . . FDC prisoners which chronic HCV have vastly different symptoms when compared to the Plaintiffs, or even have no symptoms at all, the motion for class certification should be denied.”). Again, Defendant misses the point. Although “[a] class representative must possess the same interest and suffer the same injury as the class members in order to be typical under Rule 23(a)(3),” Murray v. Auslander, 244 F.3d 807, 811 (11th Cir. 2001), “[t]he typicality requirement may be satisfied despite substantial factual differences . . . when there is a ‘strong similarity of legal theories,’” id. (quoting Appleyard v. Wallace, 754 F.2d 955, 958 (11th Cir. 1985)); see also Kornberg, 741 F.2d at 1337 (“A factual variation will not render a class representative’s claim atypical unless the factual position of the representative markedly differs from that of other members of the class.”). Here, Plaintiffs’ claims are based on the same legal theories as the class’s claims, and Plaintiffs are not in a markedly
8

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 9 of 15
different factual position than other class members (at least not in a sense that would be relevant for purposes of their claims). Accordingly, Plaintiffs have satisfied the typicality requirement.
(4) Adequacy The adequacy requirement provides that a class can only be certified if “the representative parties will fairly and adequately protect the interests of the class.” Fed. R. Civ. P. 23(a)(4). Determining adequacy “involves questions of whether plaintiffs’ counsel are qualified, experienced, and generally able to conduct the proposed litigation, and of whether plaintiffs have interests antagonistic to the rest of the class.” Griffin v. Carlin, 755 F.2d 1516, 1533 (11th Cir. 1985). There does not appear to be any dispute as to the adequacy of Plaintiffs’ counsel. Indeed, Plaintiffs note that their attorneys “have extensive experience in class action cases involving federal civil rights claims for prisoners,” ECF No. 10, at 21, and Defendant does not suggest otherwise, see ECF No. 32, at 18–19. Similarly, there does not appear to be much dispute as to Plaintiffs’ adequacy. Plaintiffs summarily state that they have “no interest antagonistic to or in conflict with the interests of the class members,” ECF No.
9

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 10 of 15
10, at 22, and Defendant summarily argues that because Plaintiffs fail typicality they also fail adequacy, ECF No. 32 at 18–19.
This Court observed all three Plaintiffs testify at the hearing on class certification. All three testified strongly about their conditions and their belief that FDC is not treating HCV properly. Moreover, all three were asked whether they would adequately represent the class (despite having already begun treatment for HCV), and all three confirmed that they will. This Court is without any doubt as to Plaintiffs’ credibility on this point. Accordingly, Plaintiffs have satisfied the adequacy requirement.
II. Rule (23)(b)(2) Requirements To certify a class under Federal Rule of Civil Procedure 23(b)(2), the moving party must show that “the party opposing the class has acted or refused to act on grounds that apply generally to the class, so that final injunctive relief or corresponding declaratory relief is appropriate respecting the class as a whole.” Fed. R. Civ. P. 23(b)(2). “The key to the (b)(2) class is ‘the indivisible nature of the injunctive or declaratory remedy warranted—the notion that the conduct is such that it can be enjoined or declared unlawful only as to all of the class members or as to none of them.’” Wal-Mart, 564 U.S. at 360 (quoting Richard
10

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 11 of 15
A. Nagareda, Class Certification in the Age of Aggregate Proof, 84 N.Y.U. L. Rev. 97, 132 (2009)). “In other words, Rule 23(b)(2) applies only when a single injunction or declaratory judgment would provide relief to each member of the class.” Id.
Here, certification under Rule 23(b)(2) is appropriate because a single injunction or declaratory judgment would provide relief to each member of the proposed class. Specifically, if this Court enters an injunction forcing Defendant to change FDC’s policies and practices with respect to HCV treatment, then each member of the proposed class will be able to enjoy those changes.
Nevertheless, Defendant argues that this Court “should be hesitant to allow a Rule 23(b) class determine the how [sic] Florida manages its prison system.” ECF No. 32, at 26. Indeed, this Court is mindful of FDC’s desire to maintain independent control of its operations. But the mere fact that FDC operates prisons is not enough to prevent class certification. In fact, class actions are common vehicles for raising the type of claims raised here. See generally Parsons, 754 F.3d at 686 (“[C]ourts have repeatedly invoked [Rule 23(b)(2)] to certify classes of inmates seeking declaratory and injunctive relief for alleged widespread Eighth Amendment violations in prison systems . . . .”); see also Postawko
11

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 12 of 15
v. Mo. Dep’t of Corr., No. 2:16-cv-04219-NKL, 2017 WL 3185155,
at *1 (W.D. Mo. July 26, 2017) (certifying Rule 23(b)(2) class of
inmates alleging “inadequate medical care for their chronic
Hepatitis C”); Graham v. Parker, No. 3-16-cv-01954, 2017 WL
1737871, at *1 (M.D. Tenn. May 4, 2017) (certifying Rule 23(b)(2)
class of inmates challenging “whether the State of Tennessee’s
policies and procedures for inmates with Hepatitis C satisfies
constitutional standards”).
Defendant also argues that class certification is unnecessary
given that Plaintiffs “have sued regarding a policy.” ECF No. 32,
at 30–31. This Court disagrees.6 Nevertheless, class actions need
not be necessary. See generally 7AA Charles Alan Wright et al.,
6 There is at least one reason why class certification is necessary in this case: to avoid a dismissal for mootness. See Hamilton v. Hall ex rel. Santa Rosa County, No. 3:10cv355/MCR/EMT, 2011 WL 2161139, at *1 (N.D. Fla. May 26, 2011) (recognizing that “a class action may not be necessary where the relief requested otherwise can be obtained” but finding that a class action was necessary to avoid the potential for mootness). A class action can proceed even if the class representatives obtain their requested relief. See Davis v. CocaCola Bottling Co. Consol., 516 F.3d 955, 968 n.28 (11th Cir. 2008) (“A class representative can have standing to continuing prosecuting a class action for relief on behalf of the class members even though he has settled his claim against the defendant and his own case is therefore moot.”), abrogation on other grounds recognized by LaCroix v. W. Dist. Ky., 627 F. App’x 816, 818 (11th Cir. 2015); see also Bishop’s Prop. & Invs., LLC v. Protective Life Ins. Co., 463 F. Supp. 2d 1375, 1377–82 (M.D. Ga. 2006) (explaining that a party cannot moot a case by giving the class representatives their requested relief before the Court rules on the motion for certification). So even though Plaintiffs have already begun receiving most of the treatment they want, or even if they leave FDC custody during the pendency of this case, the case can still go forward. This is a luxury that individual plaintiffs would not enjoy.
12

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 13 of 15
Federal Practice & Procedure § 1785.2 (3d ed. & Apr. 2017 update) (explaining that the necessity of a class action is simply a discretionary factor for a court to consider). Thus, even if class certification is unnecessary here, this Court chooses to exercise its discretion by allowing the case to proceed as a class action.
III. Subsidiary Issues The parties raise several subsidiary issues in their filings. For instance, Plaintiffs ask this Court to appoint their attorneys as class counsel pursuant to Federal Rule of Civil Procedure 23(g)(1). ECF No. 10, at 26–27. After considering the factors outlined in Rule 23(g)(1), this Court finds that Plaintiffs’ attorneys should be appointed class counsel. In her response to Plaintiffs’ motion for class certification, Defendant argues that “FDC should be allowed to complete discovery pertaining to the propriety of a class before a class is certified.” ECF No. 32, at 32. Defendant’s response was filed on July 7, 2017 (i.e., over four months ago). Since then, the parties have had ample time to conduct discovery. Moreover, this Court held a five-day hearing on Plaintiffs’ motion. Accordingly, this Court does not find that any further delay is necessary.
13

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 14 of 15
Finally, Defendant argues that certifying Plaintiffs’ proposed class would violate the Rules Enabling Act (“REA”). ECF No. 32, at 31–32. Specifically, Defendant argues that the REA forbids interpreting Rule 23 to abridge, enlarge or modify any substantive right and “[i]f Plaintiffs’ purported class of all chronic HCV inmates within FDC is permitted to go forward, plaintiffs rights will be enlarged, and the rights of the FDC will be abridged.” Id. at 31. Defendant offers no support for this argument, nor does she engage in any substantive analysis of the issue. See id. at 31– 32. Ultimately, this Court disagrees with Defendant’s conclusion and summarily rejects the argument without discussion.
Accordingly, IT IS ORDERED: 1. Plaintiffs’ motion for class certification, ECF No. 10, is
GRANTED. 2. This Court certifies a class defined as “all current and
future prisoners in the custody of the Florida Department of Corrections who have been diagnosed, or will be diagnosed, with chronic hepatitis C virus (HCV).”
14

Case 4:17-cv-00214-MW-CAS Document 152 Filed 11/17/17 Page 15 of 15
3. The class issues are: a. Whether FDC’s policies and practices for HCVtreatment constitute deliberate indifference to serious medical needs, in violation of the Eighth Amendment; b. Whether FDC’s policies and practices for HCVtreatment result in discrimination in violation of the ADA; and c. Whether FDC’s policies and practices for HCVtreatment result in discrimination in violation of the RA.
4. Plaintiffs Carl Hoffer, Ronald McPherson, and Roland Molina shall serve as class representatives.
5. This Court appoints Randall C. Berg, Jr., Dante P. Trevisani, and Erica A. Selig as class counsel.
SO ORDERED on November 17, 2017. s/Mark E. Walker United States District Judge
15

 
 Case 4:17-cv-00214-MW-CAS Document 153 Filed 11/17/17 Page 1 of 32

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, et al.,

Plaintiffs,

v.

Case No. 4:17cv214-MW/CAS

JULIE L. JONES, in her official capacity as Secretary of the Florida Department of Corrections,

Defendant. __________________________/

ORDER GRANTING MOTION FOR A PRELIMINARY INJUNCTION

The Florida Department of Corrections (“FDC”) is charged

with the care of over 98,000 inmates. At least 7,000 of those

inmates—and perhaps as many as 20,000—are infected with the

Hepatitis C virus (“HCV”). The issue in this case is whether FDC

is screening, evaluating, and treating HCV-infected inmates in a

manner that comports with constitutional requirements.

After holding a five-day hearing (including testimony from

expert witnesses, FDC officials, and FDC inmates), this Court

finds that FDC has not treated HCV-infected inmates as required

by the Constitution. Moreover, although FDC has tried to moot

1

Case 4:17-cv-00214-MW-CAS Document 153 Filed 11/17/17 Page 2 of 32
this case by promising to change its practices going forward, this
Court finds that a preliminary injunction is necessary to ensure
that inmates with HCV receive medical care in a timely manner
consistent with constitutional requirements. Accordingly,
Plaintiffs’ motion for a preliminary injunction is GRANTED.
I. Findings of Fact1
A. Hepatitis C and the Progression of Liver Disease
HCV “is a viral infection, which is spread by exposure to
blood or blood products.” Pls.’ Ex. 28, at 3.2 The most common way
of contracting HCV is through intravenous drug use, but a person
can also get infected through tattooing or blood transfusions. Id.
“The principal consequence of [HCV] infection is infection of the
liver, which causes inflammation that in turn may result in
scarring of the liver (fibrosis).” Id.
1 This Court held a five-day evidentiary hearing on Plaintiffs’ motion for a preliminary injunction. The factual statements in this section represent this Court’s findings of fact. To the extent this Court cites or quotes exhibits or testimony, it is because this Court finds said exhibits and testimony to be credible and useful references. Many of these factual statements are sourced from the declarations and in-court testimony of the parties’ expert witnesses, Dr. Koziel and Dr. Dewsnup. For the most part, the parties’ experts were in agreement with each other. Due to the expedited nature of these proceedings, this Court has not obtained certified transcripts of each witness’s testimony. Where necessary, this Court has relied on its own notes and recollection of the testimony. Consequently, certain citations do not include pincites. 2 Plaintiffs’ Exhibit 28 is the “First Amended Unsworn Declaration of Dr. Margaret Koziel.”
2

Case 4:17-cv-00214-MW-CAS Document 153 Filed 11/17/17 Page 3 of 32
Unlike a scar on your skin, scarring of the liver can have severe consequences. “Liver scarring can significantly impair liver function and damage its crucial role in filtering toxins from the blood, as well as making proteins involved in liver clotting and fighting infections.” Id. Moreover, liver scarring places patients “at risk of liver failure or liver cancer.” Id. Liver failure carries with it a host of serious symptoms, including bleeding from any site, fluid accumulation in the legs or abdomen, life-threatening infections, and failure of other organs such as the kidneys. Id. Liver cancer is essentially untreatable, and “has a very dismal prognosis.” See id.
The amount of liver scarring a patient has is usually measured on the METAVIR scale. Id. at 7–8. On this scale, a person can be classified F0 (no fibrosis), F1 (mild fibrosis), F2 (moderate fibrosis), F3 (severe fibrosis), or F4 (cirrhosis). ECF No. 138, at 166.3 The rate at which patients progress along this scale differs among the population. Defendant’s Exhibit 1 includes a useful flowchart demonstrating this difference in progression:
3 ECF No. 138 is a certified transcript of Dr. Koziel’s testimony at the evidentiary hearing.
3

Case 4:17-cv-00214-MW-CAS Document 153 Filed 11/17/17 Page 4 of 32
Def.’s Ex. 1. As can be seen in the flowchart, about 20–50% of people
infected with HCV spontaneously clear the virus within six months of infection. ECF No. 138, at 58. The remaining 50–80% who don’t clear the virus are referred to as having chronic HCV. Id.
Among those with chronic HCV, about 30% of patients maintain a stable chronic infection, 40% suffer from slow fibrosis progression, and 30% suffer from rapid fibrosis progression. See Test. of Dr. Dewsnup.4 Patients with a stable chronic infection usually only reach F1 (mild fibrosis) as long as they maintain other healthy habits such as abstaining from alcohol. See Test. of Dr.
4 According to Dr. Dewsnup, as many 6,000 Florida inmates may suffer from rapid fibrosis progression. See Test. of Dr. Dewsnup.
4

Case 4:17-cv-00214-MW-CAS Document 153 Filed 11/17/17 Page 5 of 32
Dewsnup. Patients with a slow fibrosis progression may take upwards of 20 years to reach F4 (cirrhosis). Id. Finally, patients with a rapid fibrosis progression may reach cirrhosis within as short a timeframe as one year. Id.
The extent of liver scarring a patient has does not necessarily correlate with the symptoms they are suffering. For instance, “[s]omebody can be completely asymptomatic and present with cirrhosis.” ECF No. 138, at 51. Nor do “symptoms have anything to do with what the risk is of liver failure.” Id. at 113.
Once a person reaches F4 (cirrhosis), they are further classified based on whether they are suffering from HCV-related symptoms/complications. A patient with cirrhosis and no related complications is referred to as having compensated cirrhosis. Id. at 49. On the other hand, a patient with cirrhosis that is accompanied with complications is referred to as having decompensated cirrhosis. Id. The distinction between these two groups is important because their survival rates are markedly different. Whereas the five-year survival rate for someone with compensated cirrhosis is 91%, the five-year survival rate for someone with decompensated cirrhosis is only 50%. Pls.’ Ex. 28, at
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6–7. Once a person has decompensated cirrhosis “their liver has truly failed.” ECF No. 138, at 99. At that point, “the only true curative treatment is a liver transplant.” Pls.’ Ex. 28, at 11.
B. Treatment of Hepatitis C Historically, HCV has been “difficult to treat.” Id. at 9. One old method of treatment involved the drugs Interferon and Ribavirin. ECF No. 138, at 62–63. That treatment required weekly injections and could take as long as twelve months to complete. Id.; Pls.’ Ex. 28, at 9. The side effects were “terrible.” ECF No. 138, at 62. Taking the treatment was akin to “having the flu for a year.” Id. “People’s hair fell out, they had rashes, they had chest pain, they felt suicidal, [and] some committed suicide.” Id. at 63. Despite these side effects, doctors still prescribed the treatment when patients had a high level of liver scarring because “the likelihood of getting to cure, which was still only about 30 percent, was better than those terrible side effects.” Id. But in late 2013 a new class of drugs known as direct-acting antivirals (“DAAs”) were released to market. Id. These DAAs proved to be “a revolution in medicine.” Id. Treatment with DAAs consists of taking a pill once or twice a day. See id.; see also Pls.’ Ex. 28, at 10. The treatment period with DAAs is only about
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twelve-weeks long. ECF No. 138, at 64. Moreover, DAAs have “very few” side effects. Id. Most importantly, about 95% of patients who take DAAs are cured of HCV. Id.
Unfortunately, this revolution in medicine came with a price. DAAs “are very expensive.” Id. at 74. In September of 2016, a single course of treatment with DAAs cost approximately $50,000 to $75,000. ECF No. 151, at 34.5 Even though prices have been going down as new DAAs are released, a single course of treatment may still cost $37,000 today. Id. at 45.
Despite the high cost of DAAs, the present-day standard of care is to treat chronic-HCV patients with DAAs as long as there are no contraindications or exceptional circumstances. It is inappropriate to only treat those with advanced levels of fibrosis. ECF No. 138, at 66–67, 73; see also Test. of Dr. Dewsnup. The HCV Guidance—a resource developed by the American Association for the Study of Liver Diseases (AALSD) and the Infectious Diseases Society of America (IDSA)—recommends giving DAAs to any
5 ECF No. 151 is a certified transcript of a portion of Mr. Reimers’s testimony at the evidentiary hearing.
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patient with chronic HCV (absent certain contraindications). See Pls.’ Ex. 6.6
C. The Plaintiffs The named Plaintiffs in this case are Carl Hoffer, Ronald McPherson, and Roland Molina. All three are inmates in FDC custody and are infected with HCV. Mr. Hoffer currently suffers from decompensated cirrhosis, and Mr. McPherson and Mr. Molina have compensated cirrhosis. ECF No. 138, at 136–42. FDC has known about the Plaintiffs’ conditions for years. Mr. Hoffer likely had cirrhosis as early as 2012 and likely developed decompensated cirrhosis “around the midpoint of 2014.” Id. at 136. Mr. Hoffer needs to be referred for a liver transplant evaluation. Id. at 138. Mr. Hoffer should have been treated “as early as 2012 or certainly by 2014.” Id. at 137. Mr. McPherson has HIV in addition to having chronic HCV. Id. at 139. Doctors realized that Mr. McPherson had cirrhosis during a gallbladder surgery in 2015. Id. Mr. McPherson should have been treated as soon as doctors realized he had cirrhosis. Id.
6 Plaintiffs’ Exhibit 6 is a copy of the HCV Guidance dated September 21, 2017.
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Mr. Molina likely had cirrhosis as early as 2013. See id. at 141. Although an ultrasound in April of 2016 showed that his liver was normal, doctors failed to account for his enlarged spleen, which is indicative of cirrhosis. Id.
All three Plaintiffs have been complaining about their lack of treatment for years. See Pls.’ Ex. 1; Pls.’ Ex. 2; Pls.’ Ex. 3.7 But they could only complain for so long. On May 11, 2017, Plaintiffs initiated this lawsuit against the Secretary of FDC. ECF No. 1. After months of litigating, FDC has finally begun to treat Plaintiffs with DAAs. ECF No. 138, at 136–42.
Even though Plaintiffs are receiving the treatment they want, this case is not yet over. In addition to seeking relief for themselves, Plaintiffs also moved to certify a class of “all current and future prisoners in FDC custody who have been diagnosed, or will be diagnosed, with chronic hepatitis C virus (HCV).” ECF No. 10, at 2. This Court has already granted Plaintiffs’ motion for class certification. ECF No. 152. Accordingly, this case may proceed with Plaintiffs seeking relief for the class. See, e.g., Davis v. Coca-Cola Bottling Co. Consol., 516 F.3d 955, 968 n.28 (11th Cir. 2008) (“A
7 Plaintiffs’ Exhibits 1, 2, and 3 are composites of their FDC administrative grievances and appeals.
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class representative can have standing to continuing prosecuting a class action for relief on behalf of the class members even though he has settled his claim against the defendant and his own case is therefore moot.”), abrogation on other grounds recognized by LaCroix v. W. Dist. Ky., 627 F. App’x 816, 818 (11th Cir. 2015).
D. FDC’s Long and Sordid History of Failing to Treat HCV Like prison systems in many other states, FDC decided some time ago to outsource its provision of medical care to private contractors. ECF No. 151, at 5. In 2013, those contractors were Corizon and Wexford. Id. Under FDC’s contracts with Corizon and Wexford, there were two ways that doctors could obtain drugs. Most drugs were listed on an FDC-approved list, referred to as the formulary. Id. at 6. Those drugs were readily available to doctors and were paid for directly by FDC. Id. Drugs not listed on the formulary had to be specially requested. See Test. of Dr. Maier. Specially requested drugs were paid for by Corizon or Wexford. Id. When DAAs came out in late 2013, they were not included on the formulary. ECF No. 151, at 6–7. Nevertheless, Dr. Scott Kennedy (who worked for Corizon at the time) decided to assemble twelve inmates (the “Kennedy 12”) with the goal of treating them with DAAs. See Test. of Dr. Maier. By the end of 2014, the Kennedy
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12 had been assembled and thoroughly evaluated. Id. But the Kennedy 12 were never given any DAAs because the necessary funds were not available. Id. This was so despite the fact that all twelve inmates showed signs of advanced liver damage. Id.
As the years went on, FDC officials recognized that inmates were dying from HCV because they were not being treated. Id. (discussing conversations with Dr. Long Do). Similarly, Mr. Reimers, the FDC administrator responsible for overseeing the contractors, recognized that inmates with HCV were not being treated and found the lack of treatment to be unacceptable. See ECF No. 151, at 10, 40–43. Again, the reason why inmates weren’t being treated was because of a lack of funding. See id. at 40.
By mid-2016, FDC had updated its HCV-treatment policy to acknowledge that prescribing DAAs was the standard of care. See Def.’s Ex. 8, at 6–7.8 But again, the funding was not available to treat anyone. In 2015, Mr. Reimers prepared a legislative budget request of $6.5 million to obtain DAAs for the 2016–17 fiscal year, but the request never made it out of FDC (i.e., someone in FDC denied it). See ECF No. 151, at 44–45. In 2016, Mr. Reimers
8 Defendant’s Exhibit 8 is FDC’s HCV-treatment policy dated June 27, 2016.
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prepared a $29 million request for the 2017–18 fiscal year, but that too never made it out of FDC. Id. at 46–47.
Eventually, Corizon and Wexford’s contracts with FDC ended, and FDC began a new contract with Centurion. Id. at 7. But the change in contractor did not come with a change in behavior; inmates with HCV were still not being treated. Indeed, to date only thirteen inmates have been treated with DAAs (three of those being the named Plaintiffs in this case).9 Id at 47–48; see also Pls.’ Ex. 11.10
II. Analysis Presently before this Court is Plaintiffs’ motion for a preliminary injunction. ECF No. 11. To obtain a preliminary injunction, Plaintiffs must clearly show that: (A) they have a substantial likelihood of success on the merits of their claims; (B) an injunction is necessary to prevent irreparable injury; (C) the threatened injury outweighs the harm that an injunction would
9 To put that number in context, FDC knows of at least 7,000 inmates in its custody who have HCV. ECF No. 151, at 52–53. Furthermore, FDC’s own expert testified that the true number is likely closer to 20,000. See Test of. Dr. Dewsnup. 10 Plaintiffs’ Exhibit 11 is FDC’s drug utilization list of DAAs for the period of May 1, 2013 to June 30, 2017.
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cause to Defendant; and (D) an injunction would not be adverse to
the public interest. See Wreal, LLC v. Amazon.com, Inc., 840 F.3d
1244, 1247 (11th Cir. 2016). This Court finds that Plaintiffs have
met the necessary requirements.11
A. Substantial Likelihood of Success on the Merits12
The Eighth Amendment to the United States Constitution
prohibits the government from inflicting “cruel and unusual
punishments” on convicts. Wilson v. Seiter, 501 U.S. 294, 296–97
(1991). The Supreme Court has interpreted this prohibition to
encompass “deprivations . . . not specifically part of [a] sentence
but . . . suffered during imprisonment.” Id. at 297. Accordingly, an
inmate who suffers “deliberate indifference” to his “serious medical
11 It is not a close call, particularly in light of the testimony of Defendant’s own expert. 12 To determine Plaintiffs’ likelihood of success on the merits, this Court must consider the individual elements of each of Plaintiffs’ claims. Plaintiffs raise three separate claims about FDC’s policies and practices for HCV treatment: (1) deliberate indifference to serious medical needs in violation of the Eighth Amendment; (2) discrimination on the basis of disability in violation of the Americans with Disabilities Act (“ADA”); and (3) discrimination on the basis of disability in violation of the Rehabilitation Act (“RA”). ECF No. 1. This Court finds that Plaintiffs have a substantial likelihood of success on their Eighth Amendment claim; accordingly, this Court will not address Plaintiffs’ ADA and RA claims at this stage of the case. See, e.g., Arval Serv. Lease S.A. v. Clifton, No. 3:14-cv-1047-J-39MCR, 2014 WL 12614422, at *15 (M.D. Fla. Nov. 21, 2014) (“Because the Court determines that Plaintiffs are entitled to a preliminary injunction based upon [their first claim], the Court need not address the remaining claims at this time.”).
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needs” may state a claim for a violation of the Eighth Amendment. Estelle v. Gamble, 429 U.S. 97, 104 (1976).
Plaintiffs argue that FDC’s policies and practices for HCV treatment constitute deliberate indifference to their (and the class’s) serious medical needs. ECF No. 1, at 37–39. To prevail on this claim, Plaintiffs must show (1) a serious medical need, (2) Defendant’s deliberate indifference to that need, and (3) causation between Defendant’s indifference and Plaintiffs’ injuries. Goebert v. Lee County, 510 F.3d 1312, 1326 (11th Cir. 2007). This Court finds that Plaintiffs have a substantial likelihood of proving each element.
1. Serious Medical Need “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.’” Mann v. Taser Int’l, Inc., 588 F.3d 1291, 1307 (11th Cir. 2009) (quoting Hill v. Dekalb Reg’l Youth Det. Ctr., 40 F.3d 1176, 1187 (11th Cir. 1994)). “In the alternative, a serious medical need is determined by whether a delay in treating the need worsens the condition.” Id. “In either case, ‘the medical need must be one that, if left unattended, poses a substantial risk of serious
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harm.’” Id. (quoting Farrow v. West, 320 F.3d 1235, 1243 (11th Cir. 2003)).
Plaintiffs (by diagnosis) and Plaintiffs’ class (by definition) all suffer from chronic HCV. As a consequence, Plaintiffs and Plaintiffs’ class are faced with substantial risks of serious harm, including, but not limited to, bleeding from any site in the body, accumulation of fluid in the legs or abdomen, life-threatening infections, significant pain or discomfort, organ failure, liver cancer, and death. See Pls.’ Ex. 28, at 3–4. Accordingly, it is not surprising that Plaintiffs’ expert describes HCV as “a serious medical need.” Id. at 4. Nor should it be surprising that this Court finds chronic HCV to be a serious medical need.13 Cf. Loeber v. Andem, 487 F. App’x 548, 549 (11th Cir. 2012) (unpublished) (“That Hepatitis C presents a serious medical need is undisputed.”); Brown v. Johnson, 387 F.3d 1344, 1351 (11th Cir. 2004) (“HIV and hepatitis meet either of the[] definitions [of serious medical need]. The defendants wisely do not deny that [plaintiff] has serious medical needs.”).
13 Even Defendant conceded that a subclass of HCV-infected inmates have a serious medical need within the meaning of deliberate-indifference jurisprudence.
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2. Deliberate Indifference To satisfy the deliberate-indifference prong, Plaintiffs must show Defendant’s subjective knowledge of a risk of serious harm and Defendant’s disregard of that risk by conduct that is more than mere negligence. See Goebert, 510 F.3d at 1326–27. There is no question that Defendant has knowledge of a risk of serious harm— Defendant knows that Plaintiffs and Plaintiffs’ class are diagnosed with HCV. Cf. Brown, 387 F.3d at 1351 (finding that subjectiveknowledge requirement was met because “[t]he defendants were aware of [plaintiff’s] diagnosis with HIV and hepatitis”). As such, the only issue is whether Defendant has disregarded that risk by conduct that is more than mere negligence. The Eleventh Circuit has listed several examples of conduct that is considered more than mere negligence: (1) knowledge of a serious medical need and a failure or refusal to provide care; (2) delaying treatment for non-medical reasons; (3) grossly inadequate care; (4) a decision to take an easier but less efficacious course of treatment; or (5) medical care that is so cursory as to amount to no treatment at all. Baez v. Rogers, 522 F. App’x 819, 821 (11th Cir. 2013) (unpublished). According to Plaintiffs, “Defendant has been deliberately indifferent under nearly every formulation of the
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standard.” ECF No. 11, at 17. This Court agrees. The record is
replete with evidence to support this conclusion.
This Court has already explained that FDC has a long and
sordid history of failing to treat HCV-infected inmates. See supra,
at 10–12. And this Court finds as a matter of fact that FDC’s
failure to treat was due to a lack of funding. The record is filled
with evidence demonstrating as much14:
• Dr. Carl Maier testified extensively about funding issues. See Test. of Dr. Maier. In 2014, Dr. Maier worked for Corizon as the medical director at the FDC prison where the Kennedy 12 were being assembled. Id. Dr. Maier testified that the reason why the Kennedy 12 weren’t given DAAs is because there was no funding. Id.
• Mr. Reimers testified about funding issues. In 2015, Mr. Reimers was employed by FDC as the Director of Health Services Administration. ECF No. 151, at 5. Part of his responsibilities at that time was “contract monitoring of Corizon and Wexford.” Id. During this time, Mr. Reimers spoke with a Wexford official about funding issues related to DAAs. Id. at 40–42. Mr. Reimers knew that HCVinfected inmates weren’t being treated and told the official that that was “not acceptable.” Id. Thereafter, Mr. Reimers began trying to specifically procure funds for DAAs, but those requests were denied from within FDC. Id. at 44–47.
14 Dr. Whalen testified that there were no funding issues. See Test. of Dr. Whalen. This Court finds Dr. Whalen’s testimony particularly incredible given other statements he made in sworn declarations. See Pls.’ Ex. 26, at 3 (“[T]reatment with DAA drugs . . . will be provided as resources are available.”); see also ECF No. 46-1, at 1 (“Mr. Molina and Mr. McPherson may be eligible for treatment with direct acting antiviral (“DAA”) drugs in the first wave of prisoners provided the treatment pending funding for the drugs.” (emphasis added)).
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• Defendant’s own expert, Dr. Dewsnup, also testified about funding issues. See Test. of Dr. Dewsnup. Dr. Dewsnup is employed by Centurion and is intimately familiar with HCV treatment. See id. When Centurion took over medical care for FDC, Dr. Dewsnup encouraged doctors working with FDC to refer HCV-infected inmates for DAA treatment. Id. But those doctors were unable to do so because of FDC funding issues.
Here, funding is no excuse for FDC’s failure to provide
treatment.15 Accordingly, there is no question that Defendant has
been deliberately indifferent the serious medical needs of Plaintiffs
and the class. But FDC’s past failures do not entitle Plaintiffs to a
15 See, e.g., Harris v. Thigpen, 941 F.2d 1495, 1509 (11th Cir. 1991) (“We do not agree that ‘financial considerations must be considered in determining the reasonableness’ of inmates’ medical care to the extent that such a rationale could ever be used by so-called ‘poor states’ to deny a prisoner the minimally adequate care to which he or she is entitled. . . . We are aware that systemic deficiencies in medical care may be related to a lack of funds allocated to prisons by the state legislature. Such a lack, however, will not excuse the failure of correctional systems to maintain a certain minimum level of medical service necessary to avoid the imposition of cruel and unusual punishment.”); Ancata v. Prison Health Servs., Inc., 769 F.2d 700, 705 (11th Cir. 1985) (“Lack of funds for facilities cannot justify an unconstitutional lack of competent medical care and treatment for inmates.”); but see Ralston v. McGovern, 167 F.3d 1160, 1162 (7th Cir. 1999) (Posner, C.J.) (“[T]he civilized minimum [of public concern for the health of prisoners] is a function both of objective need and of cost. The lower the cost, the less need has to be shown, but the need must still be shown to be substantial.”); Reynolds v. Wagner, 128 F.3d 166, 175 (3d Cir. 1997) (Alito, J.) (“[T]he deliberate indifference standard of Estelle does not guarantee prisoners the right to be entirely free from the cost considerations that figure in the medical-care decisions made by most nonprisoners in our society.”). Of course, this Court recognizes that issues of funding might excuse some delay. For instance, if DAAs were released yesterday, this Court would not expect FDC to wave a magic wand and suddenly treat thousands of inmates overnight. But that is not the case. FDC has had since late 2013 to respond to this problem, and it has only just recently started doing what it should have done years ago.
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preliminary injunction. See O’Shea v. Littleton, 414 U.S. 488, 495 (1974) (“Past exposure to illegal conduct does not in itself show a present case or controversy regarding injunctive relief . . . .”). Instead, there must be some evidence of ongoing or future violations. See id. at 495–96. Accordingly, this Court must focus on what FDC has promised to do going forward.16
In that light, two pieces of evidence are particularly relevant to this Court’s analysis. The first is FDC’s HCV-treatment policy. The second is a letter sent by Mr. Reimers (FDC’s current Director of Health Services) to Centurion.
a. FDC’s Treatment Policy FDC’s treatment policy for HCV is enshrined in an everevolving document titled “HSB 15.03.09 Supplement #3.” There are four different versions of the policy in the record, the earliest dating back to September 2014. See Def.’s Ex. 7; Def.’s Ex. 8; Def.’s Ex. 9; Def.’s Ex. 10. The most recent version of FDC’s policy was created in October 2017.17 Def.’s Ex. 10. Broadly speaking, it specifies how
16 Of course, this Court can still consider FDC’s past violations to place things into context. Cf. O’Shea, 414 U.S. at 496 (“[P]ast wrongs are evidence bearing on whether there is a real and immediate threat of repeated injury.”). 17 Undoubtedly in response to this litigation.
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and when doctors should screen, evaluate, and treat inmates with HCV. See id. For example, as to screening the policy notes that “[t]he preferred screening test for HCV infection is an immunoassay” and that “[s]creening will be offered to all patients, regardless of risk factors.” Id. at 2. As to treatment, the policy sets out eligibility criteria and groups patients into four priority levels based on the severity of their conditions and other considerations. Id. at 6–8. Generally speaking, patients with the most severe conditions are grouped in “Priority Level 1 – Highest Priority for Treatment,” and patients with the least severe conditions are grouped into “Priority Level 4 – Routine for Treatment.” Id.
When Plaintiffs filed this lawsuit, FDC was operating under an older version of the policy. Plaintiffs identified several shortcomings with the policy at the time, but a number of those shortcomings have been resolved. Compare ECF No. 11, at 21–23, with Def.’s Ex. 10. Nevertheless, the policy still has shortcomings.
Indeed, Defendant’s own expert, Dr. Dewsnup, admitted that the policy needs to be fixed. See Test. of Dr. Dewsnup. That admission is significant because Dr. Dewsnup is in charge of drafting FDC’s policy. Id. That is, after this litigation ensued, FDC hired Dr. Dewsnup not only to serve as an expert witness for
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purposes of the hearing before this Court, but also for purposes of guiding and advising FDC’s policies and practices for treating HCV. Id. Accordingly, this Court finds that Defendant needs to update FDC’s policy in light of the shortcomings identified by Dr. Dewsnup at the hearing.
b. Mr. Reimers’s Letter On October 13, 2017, Mr. Reimers sent a letter on behalf of FDC to the CEO of Centurion (FDC’s current medical contractor). Def.’s Ex. 20. The stated purpose of the letter “is to follow-up on a discussion” between Dr. Whalen (FDC’s Chief Clinical Advisor) and Dr. Cherry (Centurion’s medical director for FDC). Id. During that discussion, Dr. Whalen allegedly asked Dr. Cherry “to identify Priority 1 Level patients, and some Priority 2 patients, for HCV treatment in accordance with HSB 15.0.3.09 Supplement 3.” Id. (emphasis added). Mr. Reimers’s letter memorializes FDC’s intent that those inmates, “once identified as appropriate for treatment, receive DAA medications during Fiscal Year 2017/2018.” Id. The letter then continues: Going forward, we are requesting that you ensure that all patients diagnosed with HCV have been identified and properly prioritized in accordance with HSB 15.03.09 Supplement 3. It is our intent to provide treatment for thee inmates, once properly educated,
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screened, and evaluated as appropriate for treatment, in accordance with HSB 15.03.09. Supplement 3.
Id.
Ostensibly, the letter seem to be an attempt to moot this
case.18 It was drafted less than a week before this Court’s hearing,
and soon after it was written Defendant moved for a case
management conference to discuss the fact that Plaintiffs had
received the relief they wanted. See ECF No. 128. Whatever FDC’s
intended effect may have been, the letter does not moot this case.
Indeed, FDC’s own expert, Dr. Dewsnup, testified that FDC
should be treating many more inmates than what was promised in
Mr. Reimers’s letter.19 See Test. of Dr. Dewsnup. Dr. Dewsnup also
testified that FDC should be treating inmates at a faster rate than
what was promised in Mr. Reimers’s letter. Id. In fact, even if
18 Mr. Reimers, of course, disagrees. According to him, the letter served “to make it clear what the expectations are for Centurion in the short term and in the long term what their requirements are as [FDC’s] contractor to provide services for individuals with Hepatitis C.” ECF No. 151, at 25. 19 For instance, Mr. Reimers’s letter says that only “some Priority 2 patients” will be treated. Dr. Dewsnup testified that all Priority 2 patients should be treated. See Test. of Dr. Dewsnup. In fact, Dr. Dewsnup testified that more than just Priority 2 patients should be treated. Id. The way FDC has currently worded its Priority 2 class means that even patients with F3 or F4 fibrosis scores might not get treatment under FDC’s promise. Compare Def.’s Ex. 10, at 7 (requiring APRI score over 2 to qualify), with Def.’s Ex, 22, at 5 (explaining that APRI testing generally “lack[s] the power to exclude patients with advanced fibrosis to a statistically significant level”).
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FDC’s promises were good enough, Dr. Dewsnup testified that FDC
currently lacks the system capacity to be able to accomplish what
it has promised. Id. Specifically, Dr. Dewsnup testified that FDC
needs more practitioners to screen, evaluate, and treat inmates in
a timely fashion. Id.
This Court agrees with Dr. Dewsnup’s conclusions. Since the
Kennedy 12 were first assembled in 2014, up to and including of
this very litigation, FDC has been extremely slow to respond to the
serious issue of treating HCV-infected inmates.20 Even if FDC
were excused for Corizon and Wexford’s failures,21 when Centurion
came on board in mid-2016 Dr. Dewsnup specifically told Dr.
20 Plaintiffs filed their complaint on May 11, 2017, and filed their motion for a preliminary injunction on May 23, 2017. Ordinarily, this Court would rule on a motion for a preliminary injunction based on sworn declarations or affidavits so as to resolve the matter as soon as possible. But Defendant wanted a fouror five-day hearing. ECF No. 37, at 2. So this Court set one for the end of August. ECF No. 53. But then Defendant informed this Court that she had not yet retained an expert and wanted to continue the scheduled hearing. ECF No. 59. This Court reluctantly granted a continuance, ECF No. 64, and then did so again due to Hurricane Irma, ECF No. 90. When this Court finally held the hearing on Plaintiffs’ motion, it was revealed that Defendant did not hire her expert witness, Dr. Dewsnup, until sometime in August 2017. See Test. of Dr. Dewsnup. This delay is significant considering that Dr. Dewsnup is now redrafting FDC’s policy and directing FDC how to move forward with treatment. One can only wonder how long Defendant would have kicked the can down the road had Plaintiffs not filed this case.
21 Which it isn’t. See Ancata, 769 F.2d at 705 (“The federal courts have consistently ruled that governments, state and local, have an obligation to provide medical care to incarcerated individuals. This duty is not absolved by contracting with an entity . . . .” (citation omitted)).
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Cherry to develop a list of patients with HCV-inmates and to stage them appropriately. See Test. of Dr. Dewsnup. Over a year has passed, and the completion of the list and staging process has barely begun.22 Id.
This Court has no doubt that without a court-ordered injunction, FDC is unlikely to treat inmates in a constitutionally appropriate manner. In fact, Defendant’s own expert, Dr. Dewsnup, testified that an injunction is necessary for FDC to respond to this problem with the requisite alacrity. See Test. of Dr. Dewsnup. This Court finds Dr. Dewsnup’s testimony to be credible, and accordingly finds that FDC must comply with the treatment directions and timelines Dr. Dewsnup identified at the hearing with some clarifications.
3. Causation “The final requirement for a deliberate indifference claim is that a defendant have a causal connection to the constitutional harm.” Goebert, 510 F.3d at 1327. As Secretary of FDC, Defendant is ultimately responsible for FDC’s policies and practices. See
22 FDC cannot hide behind the excuse that this is a difficult or lengthy process. Dr. Dewsnup testified that inmates with the most advanced liver disease could be quickly and simply identified based on what FDC already knows about their albumin levels and through further testing with proprietary indices. See Test. of Dr. Dewsnup.
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§ 20.315(3), Fla. Stat. Accordingly, because Plaintiffs’ claim is based on inadequacies in FDC’s policies and implementation of those policies, the causation element has been satisfied. Cf. Cottone v. Jenne, 326 F.3d 1352, 1360 (11th Cir. 2003) (“[T]he causal connection may be established when a supervisor’s custom or policy . . . result[s] in deliberate indifference to constitutional rights . . . .” (alteration in original) (internal quotation marks omitted)).
4. Conclusion Plaintiffs have shown that the class suffers from chronic HCV and that chronic HCV is a serious medical need. Plaintiffs have also shown that Defendant has been deliberately indifferent to the class’s serious medical needs. Moreover, Plaintiffs have shown a causal connection between Defendant’s deliberate indifference and the class’s injuries. Consequently, Plaintiffs have a substantial likelihood of success on the merits of their Eighth Amendment claim. B. Whether an Injunction is Necessary to Prevent
Irreparable Injury “[I]njunctive relief is appropriate ‘to prevent a substantial risk of serious injury from ripening into actual harm.’” Thomas v.
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Bryant, 614 F.3d 1288, 1318 (11th Cir. 2010) (quoting Farmer v. Brennan, 511 U.S. 825, 845 (1994)). “In such circumstances, the irreparable-injury requirement may be satisfied by demonstrating a history of past misconduct, which gives rise to an inference that future injury is imminent.” Id. Here, FDC’s history of past misconduct leads this Court to believe that future injury is imminent. Specifically, this Court finds that FDC will not treat HCV-infected inmates in an appropriate and timely manner.
If these inmates are not treated, they will undoubtedly suffer irreparable injury. Although DAAs can cure a person of HCV, they do not necessarily reduce the level of fibrosis a person has already suffered. ECF No. 138, at 64. Consequently, it is important to treat patients with HCV as soon as possible so that they can be cured of the virus before their liver becomes significantly diseased. Pls.’ Ex. 28, at 11.
C. Whether the Threatened Injury Outweighs the Harm that an Injunction Would Cause to Defendant
The only harm facing FDC is that it will have to spend more money than it wants to.23 Indeed, Defendant identifies no other
23 Defendant argues that any funds required to be spent by FDC are funds taken from providing care to other inmates. ECF No. 31, at 21. But that is no excuse. FDC cannot use its constitutional duty to treat a certain group of inmates as a reason not to treat a different group. See, e.g., Williams v. Bennett,
26

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possible harm that could result in this case. See ECF No. 31, at 19– 21. “The threat of harm to the plaintiffs cannot be outweighed by the risk of financial burden or administrative inconvenience to the defendants.” Laube v. Haley, 234 F. Supp. 2d 1227, 1252 (M.D. Ala. 2002). Contrarily, Plaintiffs and Plaintiffs’ class face great injuries. The record is rife with evidence of the harmful consequences that result from untreated HCV. See supra, at 14– 15. Accordingly, this Court finds that the threatened injury facing Plaintiffs and Plaintiffs’ class outweighs any harm that the injunction would cause to Defendant.
D. Whether an Injunction is Adverse to the Public Interest Again, FDC only identifies the financial consequences it will suffer in discussing whether an injunction in this case would be adverse to the public interest. ECF No. 31, at 21–23. On the other hand, the public is undoubtedly interested in seeing that inmates’ constitutional rights are not violated. See, e.g., Laube, 234 F. Supp. 2d at 1252 (“[T]here is a strong public interest in requiring that the plaintiffs’ constitutional rights no longer be violated . . . .”).
689 F.2d 1370, 1388 (11th Cir. 1982) (“If . . . a state chooses to operate a prison system, then each facility must be operated in a manner consistent with the constitution.”).
27

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Moreover, both parties’ experts testified that treating HCV inside prisons may have great impacts on reducing the prevalence of HCV outside prisons. ECF No. 138, at 81; Test. of Dr. Dewsnup. So, if anything, it seems that an injunction in this case would actually serve the public interest. Cf. Costello v. Wainwright, 397 F. Supp. 20, 37 (M.D. Fla. 1976) (“[I]t seems clear to this Court that, in the long run, providing decent medical care and housing to inmates would serve to promote the rehabilitative goals of the criminal justice system so as to permit their re-entry into free society as upright and law abiding citizens and to prevent their re-entry into the criminal justice system.”), vacated in part on other grounds, 539 F.2d 547 (5th Cir.), rev’d, 430 U.S. 325 (1977).
III. Conclusion “Preventable deaths from HCV are occurring within the prison system.” Def.’s Ex. 22, at 1. Most of the witnesses who testified before this Court, and even Defendant’s own expert, all but admitted that Defendant has been deliberately indifferent to Plaintiffs’ (and the class’s) serious medical needs.24 Moreover,
24 When asked whether the standard of care is currently being met by FDC given so few inmates have been evaluated to date, Dr, Dewsnup responded, “I don’t believe it’s being met at all. I think those numbers that you’ve just outlined, you know, on their face is a prima facie case that it’s not being met.” See Test. of Dr. Dewsnup.
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FDC’s promises and plan for the future are simply not good enough. Relying heavily on the testimony of Defendant’s expert, Dr. Dewsnup, this Court finds that an injunction is necessary to ensure that Plaintiffs and the class receive timely and appropriate medical care in a manner that complies with the Constitution.
Accordingly, with limited exceptions, this Court is ordering Defendant to ensure that FDC complies with its own expert’s recommendations. Specifically, FDC must update its HCVtreatment policy (HSB 15.03.09 Supplement #3) in line with the shortcomings noted by Dr. Dewsnup during the hearing before this Court so that there is a clear plan for doctors and practitioners to follow.25 Moreover, FDC must formulate a plan to implement its policy by screening, evaluating, and treating inmates in line with the directions and timelines identified by Dr. Dewsnup during the hearing before this Court.26 To the extent FDC does not have the
25 Indeed, even Mr. Reimers testified that the reason he sent his letter was to make FDC’s expectations clear. ECF No. 151, at 25. Similarly, Mr. Reimers had to make FDC’s expectations clear when Corizon and Wexford weren’t treating anyone. Id. at 40–43. Enough is enough. FDC needs to clear up the loosey-goosey language in its treatment policy so that it can no longer hide behind the consequences of its own obfuscations. 26 As noted by Dr. Dewsnup during his testimony, this includes referring inmates for liver-transplant evaluation where necessary.
29

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system capacity to meet these requirements, it must increase its
capacity and outline a timetable for doing so.27
As to system capacity, Dr. Dewsnup testified that FDC will
likely only be able to evaluate inmates at a rate of 100 per month.
See Test. of Dr. Dewsnup. To the extent Dr. Dewsnup finds this
rate acceptable, this Court disagrees. Dr. Dewsnup testified that,
as long as otherwise eligible, inmates with decompensated
cirrhosis should be treated immediately, inmates with cirrhosis
should be treated within three to six months, and inmates with F2
and F3 fibrosis scores should be treated within a year. Id.
Moreover, Dr. Dewsnup testified that the balance of the infected
inmates, with F1 and F0 fibrosis scores, should continue to be
monitored, including restaging labs every six months. This Court
agrees with those timelines, and FDC needs to increase its system
capacity to be able to satisfy them.28
27 Dr. Dewsnup unequivocally stated that to gather the requisite information, screen the inmates, evaluate the inmates, and to begin treatments of the inmates to meet the appropriate standard of care will “require a massive expansion of system capacity.” See Test. of Dr. Dewsnup. He made plain that a single infectious disease nurse, “Christine,” could not update the spreadsheet being used to help prioritize the infected inmates and it would take more than one doctor, himself, to review the data with Dr. Cherry and make recommendations. 28 Dr. Dewsnup agreed there are ways to speed this process. For example, Defendant could—and should—immediately send the blood of the 500 inmates with the lowest albumin levels for lab work and proprietary testing. See Test.
30

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This Court recognizes that these directions are broad. To be clear, this was done at Defendant’s request. During closing arguments before this Court, Defendant stated that she wishes to prepare a plan in light of this Court’s directions. Accordingly, at this stage this Court is only providing overarching guidance of how it believes FDC should address HCV treatment going forward. This guidance is consistent with the opinions expressed by Dr. Dewsnup during his testimony before this Court. Defendant shall be permitted to provide a more specific plan, and this Court will consider Defendant’s plan before entering a preliminary injunction. In so ruling, this Court notes that Defendant must move with “alacrity.” This Court will not tolerate further foot dragging. If Defendant needs further direction from this Court with respect to what the proposed plan must contain then Defendant shall contact this Court no later than Monday, November 20, 2017, to schedule a telephonic hearing to be held no later than November 22, 2017. It was been represented to this Court at hearing that Defendant is already in the process of
of Dr. Dewsnup. Defendant needs to have a plan and a timetable to do the same for the other 6,500 inmates. This Court recognizes that the labs and proprietary testing costs approximately $400 per inmate but time is of the essence and the urgency is born of delays of the Defendant.
31

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formulating and implementing such a plan. Stated otherwise, Defendant has already had time to refine its plan and marshal resources to address this problem. Accordingly,
IT IS ORDERED: 1. Plaintiffs’ motion for a preliminary injunction, ECF No.
11, is GRANTED. 2. No later than December 1, 2017, Defendant shall file a
plan consistent with the directions this Court listed above. Defendant must include specific timetables. Once this Court issues its injunction, it will require Defendant to file updates to make sure such benchmarks are met. SO ORDERED on November 17, 2017.
s/Mark E. Walker United States District Judge
32

 
 Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 1 of 31

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, et al.,

Plaintiffs,

v.

Case No. 4:17cv214-MW/CAS

JULIE L. JONES, in her official capacity as Secretary of the Florida Department of Corrections,

Defendant. __________________________/

ORDER ENTERING A PRELIMINARY INJUNCTION

This Court previously granted Plaintiffs’ motion for a

preliminary injunction as to the treatment being provided by the

Florida Department of Corrections (“FDC”) to inmates infected

with the Hepatitis C virus (“HCV”). ECF No. 153. In doing so,

however, this Court noted that it was “only providing overarching

guidance of how it believes FDC should address HCV treatment

going forward.” Id. at 31. This Court did that because Defendant

specifically requested to “prepare a plan in light of this Court’s

directions” before this Court entered a preliminary injunction. Id.

1

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 2 of 31
Since then, Defendant filed her proposed plan. ECF No. 175.
This Court noted a number of deficiencies with Defendant’s plan
and asked the parties to provide comments in light of this Court’s
findings. ECF No. 178. The parties have now filed their comments.
ECF No. 180;1 ECF No. 181.2 Having considered the parties’
comments, and in light of this Court’s findings in its order granting
Plaintiffs’ motion for a preliminary injunction, this Court orders
Defendant to comply with her plan with some modifications.
1 Plaintiffs identified several shortcomings with Defendant’s plan. Some of those shortcomings need to be fixed, and are accordingly addressed in this injunction. Other alleged shortcomings (such as Plaintiffs’ concern for the “vague” standards that make an inmate ineligible for treatment) need not be addressed at this stage. This Court may revisit those issues at the conclusion of the case or upon a motion for modification. Indeed, “[n]othing prevents the plaintiffs from seeking further relief from the district court if [defendant] fail[s] to comply in good faith with the requirements of the injunction and the applicable federal standards.” Ga. Ass’n of Retarded Citizens v. McDaniel, 716 F.2d 1565, 1581 (11th Cir. 1983), vacated on other grounds by Bd. of Pub. Educ. for City of Savannah & Cty. of Chatham v. Ga. Ass’n of Retarded Citizens, 468 U.S. 1213 (1984). Moreover, it should be obvious that FDC may not circumvent this Court’s injunction by attempting to do indirectly what it may not do directly. Cf. Feikema v. Texaco, Inc., 16 F.3d 1408, 1419 (4th Cir. 1994) (Murnaghan, J., concurring) (“[W]e would not allow the plaintiffs to gain indirectly . . . what we have expressly prevented them from gaining directly through an injunction . . . .”). In other words, this Court does not expect FDC to avoid its obligation to treat inmates by unjustifiably finding inmates ineligible for treatment. This Court and Plaintiffs can be sure of this expectation because Defendant will be filing monthly status reports of FDC’s progress. Like President Ronald Reagan, this Court will “trust, but verify.”
2 Defendant addressed some of this Court’s concerns, but not all of them. In fact, Defendant created further concerns by stating that some of the deadlines she had promised to comply with in her plan were “potentially ambitious.” ECF No. 181-1, at 5. To be clear, none of the dates in this injunction are “goals”—the dates are adopted as deadlines that must be complied with.
2

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Accordingly,
IT IS ORDERED:
1. Defendant must ensure that FDC, FDC’s employees, and
FDC’s contractors comply with Defendant’s Plan of
Treatment for Chronic Hepatitis C, ECF No. 175-1,
(attached as Exhibit A to this order)3 as modified below:
3 The Federal Rules of Civil Procedure provide that “[e]very order granting an injunction . . . must . . . describe in reasonable detail—and not by referring to the complaint or other document—the act or acts restrained or required.” Fed. R. Civ. P. 65(d)(1)(C) (emphasis added). As some have recognized,
[e]ven though the express language of Rule 65(d) appears to prohibit incorporation by reference, it is undesirable to . . . set out long and verbose findings that may be found in another document since the injunction or restraining order should furnish defendant with a direct and succinct statement of the acts that have been enjoined or the conduct that must be undertaken by the defendant.
11A CHARLES ALAN WRIGHT ET AL., FEDERAL PRACTICE & PROCEDURE § 2955 (3d ed. & Apr. 2017 update). “Thus, some courts have looked to the purpose of the rule, which is to assure adequate notice to defendants of the act or acts prohibited, and have interpreted it less restrictively than the literal text of the rule might suggest is appropriate.” Id. See also, e.g., California v. Campbell, 138 F.3d 772, 783 (9th Cir. 1998); United States v. Sarcona, 457 F. App’x 811, 811–12 (11th Cir. 2012) (unpublished). Given that Defendant drafted her own plan, Defendant should have no qualms with this Court’s incorporation of that plan. Cf. Balla v. Idaho Bd. of Corr., No. CV81-1165-S-BLW, 2009 WL 1574454, at *5 (D. Idaho May 28, 2009) (“Here, Defendants drafted the plans that would govern their own actions, satisfying the notice requirement.”). If Defendant disagrees, then she is welcome to move this Court for modification and/or clarification of this injunction.
3

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 4 of 31
a. FDC must initiate treatment for all known chronic
HCV inmates, who are eligible for treatment, and
who have fibrosis stage 3, by December 31, 2018.
b. FDC must initiate treatment for all known chronic
HCV inmates, who are eligible for treatment, and
who have fibrosis stage 2, by December 31, 2018.
c. FDC must evaluate and stage all of the ~7,500
inmates it knows have chronic HCV no later than
April 30, 2018. For all other inmates, FDC must
evaluate and stage inmates within 60 days of
confirming that the inmates have chronic HCV.
d. Of the ~7,500 inmates FDC knows have chronic
HCV, FDC must stage and evaluate the 2,500
inmates who have the lowest albumin levels no
later than February 28, 2018.4
4 This order is consistent with Dr. Dewsnup’s recommendation in light of this Court’s questioning at the preliminary-injunction hearing. ECF No. 158, at 176–79. Specifically, it will ensure that inmates with the most advanced liver disease are staged and evaluated first. See id. FDC might already be employing a similar methodology, but there is no indication (or guarantee) in FDC’s plan that FDC is doing so. If Defendant has a different method in mind for identifying the inmates that should be evaluated and staged first, then Defendant is welcome to move this Court for a modification. Either way, evaluating and staging the worst 2,500 inmates (i.e., 1/3 of the ~7,500) by February 28 should not be an onerous task given that FDC already planned to evaluate all 7,500 by April 30.
4

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2. Defendant must ensure that FDC, FDC’s employees, and FDC’s contractors comply with FDC’s HCV-treatment policy, HSB 15.03.09 Supplement #3,5 as it is revised.
3. Defendant must ensure that FDC’s HCV-treatment policy, HSB 15.03.09 Supplement #3, is modified as follows: a. The policy must make clear that treatment deadlines (e.g., the 0–6 month deadline for priority level 1) begin to run from the date that an inmate is staged at a particular fibrosis level. b. The policy must make clear that FDC must evaluate and stage inmates within 60 days of confirming that the inmates have chronic HCV.6
4. Beginning on January 1, 2018, and on the first day of each month thereafter, Defendant shall file with this Court a status report reflecting FDC’s progress in complying with this Court’s injunction. That status report must detail:
5 The most recent version of this document is attached as Exhibit B to this order.
6 The other timeframes in this plan trump the policy. See supra, at ¶¶ 1(c)-(d).
5

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 6 of 31
a. The total number of inmates in FDC custody who have been screened/tested for HCV.
b. The total number of inmates in FDC custody who have been identified as having chronic HCV.
c. The total number of inmates in FDC custody who have been identified as having chronic HCV but have not yet completed evaluation and staging.
d. The total number of inmates in FDC custody who have been identified as having chronic HCV and have been staged and evaluated. This number must be further broken down by stage (i.e., F0, F1, F2, F3, F4, and decompensated cirrhosis).
e. The total number of inmates in FDC custody who have begun and/or completed treatment with direct-acting antiviral drugs (“DAAs”).
f. The total number of inmates in FDC custody who have been deemed (temporarily or permanently) ineligible for treatment with DAAs. For each such inmate, FDC must list, in summary form, the reason for ineligibility.
6

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 7 of 31 5. The bond provisions of Rule 65(c) of the Federal Rules of Civil Procedure are waived, and this preliminary injunction shall issue immediately. SO ORDERED on December 13, 2017. s/Mark E. Walker United States District Judge
7

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EXHIBIT A

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 9 of 31

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, RONALD MCPHERSON, and ROLAND MOLINA, individually and on behalf of a Class of persons similarly situated,

Plaintiffs,

vs.

Case No.: 4:17-cv-214-MW/CAS

JULIE L. JONES,

Defendant. ___________________________/

DEFENDANT’S PLAN OF TREATMENT FOR CHRONIC HEPATITIS C

Defendant Julie L. Jones, sued in her official capacity as Secretary of the Florida Department of Corrections (“FDC”), submits this plan of treatment for inmates with chronic hepatitis C, and in response to this court’s Order Granting Motion for a Preliminary Injunction (“Order”) [D.E. 153]: A. INTRODUCTION
On November 17, 2017, this court entered an order that granted the Plaintiffs’ motion for a preliminary injunction and required FDC to file a plan that was consistent with the court’s directions, and that included specific timetables [D.E. 153, page 32]. During final argument on November 1, 2017, FDC offered to
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Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 10 of 31
submit such a plan, but noted that in participating in the process of plan submission, FDC was not waiving the right to either further contest liability, or to challenge the scope of any court ordered remedy. B. POLICY REVISIONS
FDC’s medical providers are mandated to follow its health services bulletins for the care of inmates who have hepatitis C, specifically HSB 15.03.09, Supplement No. 3 (“Supplement 3”). Prior to the evidentiary hearing on Plaintiffs’ motions, Supplement 3 was revised in October 2017. In its order, the Court required the FDC to update Supplement 3 so that there is a clear plan for doctors to follow [D.E. 132, page 21 and 29].
Attached as Exhibit A is FDC’s revised Supplement 3.1 Generally, Supplement 3 now includes specific direction to providers regarding the steps to be taken in screening inmates for both the presence of hepatitis C (“HCV”) and the presence of fibrosis (pages 5-6). Additionally, once inmates are found to have chronic hepatitis C (“cHCV”), Supplement 3 contains detailed directions for their evaluation and testing, along with time periods for that (pages 6-8). With respect to treatment with direct-acting antiviral medication (“DAA” or “DAAs”), Supplement 3 now contains two priority levels for treatment with DAAs, as well as
1 This needs to be reviewed by the Correctional Medical Authority (CMA), pursuant to Sec. 945.603, Florida Statutes.
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Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 11 of 31
directions regarding the time periods for DAA treatment (pages 8-9). There is also direction for regular monitoring of the third priority level, those individuals who are at fibrosis stages F1 and FO (page 9). The new, comprehensive descriptions of tests, treatment, and time standards are consistent with the expert testimony of Dr. Dan Dewsnup at the evidentiary hearing, and this court’s direction.
Timetable: Complete. C. MONITORING AND EVALUATION OF INMATES WHO ARE KNOWN TO HAVE CHRONIC HEPATITIS C
FDC has begun the process of evaluating and staging all inmates known to have cHCV, and will complete this process for all current cHCV inmates by April 30, 2018. This process will be ongoing for all newly discovered cHCV inmates. Inmates with cHCV will be enrolled in the Gastrointestinal Clinic (“GC”) where their monitoring and evaluation will include an examination every six months, and they will receive proprietary indices and/or elastography every six months, and an abdominal ultrasound every six months if they are at fibrosis stages 2-4 (Supplement 3, pages 6-8). For those who are at fibrosis stages 0-1, they will receive an examination every 6-12 months in the GC, as well as laboratory testing every six months, and the proprietary indices and/or elastography every 12 months (Supplement 3, pages 6-8).
It is important to recognize that, based on existing information, the GC will have a patient load of approximately 7,500 inmates. Hence, FDC is prepared to
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Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 12 of 31
significantly surpass the previously suggested evaluation rate of 100 inmates per month that the court found to be deficient [D.E. 132, page 30].
Moreover, all those with cHCV will receive counseling regarding the disease, including the staging of treatment with DAAs, and the availability of peerto-peer counseling (Supplement 3, page 8).
Timetable: This began in November 2017, and will be complete for currently known cHCV inmates by April 30, 2018. The process will be ongoing for newly discovered cHCV inmates. D. TREATMENT OF THOSE WHO HAVE DECOMPENSATED CIRRHOSIS WITH DIRECT-ACTING ANTIVIRAL MEDICATION
All cHCV inmates who are known to have decompensated cirrhosis will be offered treatment with DAAs (Supplement 3, page 8).
Timetable: FDC began treating inmates with decompensated cirrhosis in August 2017, and will have initiated treatment for all known cHCV inmates with decompensated cirrhosis by December 31, 2017. This will be ongoing for newly discovered cHCV inmates with decompensated cirrhosis. E. TREATMENT OF THOSE WHO HAVE COMPENSATED CIRRHOSIS WITH DIRECT-ACTING ANTIVIRAL MEDICATION
All cHCV inmates who are known to have compensated cirrhosis will be offered treatment with DAAs within three to six months (Supplement 3, page 8).
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Timetable: FDC will begin initiating treatment for cHCV inmates with compensated cirrhosis in December 2017, and will have initiated treatment for all current cHCV inmates with compensated cirrhosis by May 2018. This will be ongoing for newly discovered cHCV inmates. F. TREATMENT OF THOSE WHO HAVE FIBROSIS STAGE 3 WITH DIRECT-ACTING ANTIVIRAL MEDICATION
All cHCV inmates who are known to have fibrosis stage 3 will be offered treatment with DAAs within 12 months (Supplement 3, page 8).
Timetable: FDC will begin initiating treatment for cHCV inmates who have fibrosis stage 3 by no later than April 1, 2018, and will have initiated treatment for all current cHCV inmates who have fibrosis stage 3 by March 31, 2019. This will be ongoing for newly discovered cHCV inmates. G. TREATMENT OF THOSE WHO HAVE FIBROSIS STAGE 2 WITH DIRECT-ACTING ANTIVIRAL MEDICATION
All cHCV inmates who are known to have fibrosis stage 2 will be offered treatment with DAAs within 24 months (Supplement 3, page 9). The timetable for treatment is directly impacted by the fact that the current number of inmates who are in fibrosis stage 2 is presently unknown. The FDC is actively evaluating the 6,500 inmates referenced in the Order to determine the fibrosis scores of 0, 1, and 2. [D.E. 153, p. 30-31]. Additionally, every year the FDC receives approximately 30,000 newly incarcerated inmates; thus, the number of inmates in fibrosis stage 2
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Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 14 of 31
is likely to increase by an unknown magnitude over the court’s proposed timetable for treatment.
Timetable: All 6,500 inmates referenced in the Order will be evaluated and staged on or before April 1, 2018. FDC will begin initiating treatment for cHCV inmates who have fibrosis stage 2 by no later than May 1, 2018, and will have initiated treatment for all current cHCV inmates who have fibrosis stage 2 by April 30, 2020. This will be ongoing for newly discovered cHCV inmates. H. STANDING ORDERS FOR THE ADMINISTRATION OF EPCLUSA, MAVYRET, AND RIBAVIRIN
Dr. Dan Dewsnup has issued standing orders for the administration of Epclusa and Mavyret, which are two commonly used DAAs, along with Ribavirin, which needs to be utilized in conjunction with DAAs in certain circumstances. The current versions of those standing orders are attached hereto as composite Exhibit B. It should be noted that the content of standing orders may need to be adjusted from time-to-time to reflect provider feedback, adjustments in administration, or new information.
Timetable: Ongoing. I. MONITORING THOSE WHO HAVE FIBROSIS STAGES 0-1
All cHCV inmates who are known to be in fibrosis stages 0-1 will be monitored regularly with both labs and proprietary indices for re-staging at least annually into a higher priority level (Supplement 3, page 9).
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Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 15 of 31
Timetable: Ongoing.
J. EXPANSION OF SYSTEM CAPACITY The FDC’s medical contractor, Centurion, will be adding a specialty
physician to assist with identification, evaluation, and staging for treatment with DAAs. Also, Centurion will be adding eleven infection control nurses whose duties are anticipated to include ordering tests and coordinating medication administration. In addition, the FDC will hire a specialty physician as a project consultant to assist with oversight and administration of this program. Moreover, existing health services staff from Centurion who are located at prisons will undergo additional HCV training, and shift responsibilities as necessary to participate in the screening, monitoring, testing, and medication administration.
Timetable: By January 31, 2018. K. TRACKING OF INMATES WHO HAVE CHRONIC HEPATITIS C
FDC has significantly enhanced its ability to identify and track those inmates who have HCV. For example, new computer codes have been created for HCV inmates that will indicate whether they have acute hepatitis or, instead, cHCV, and also indicate whether they have been treated with DAAs, and have achieved cure, i.e., a Sustained Viral Response (“SVR”).
Timetable: Complete.
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L. TRACKING OF MEDICATION ADMINISTRATION FDC has begun to produce weekly pharmacy reports that would indicate the
inmates who are receiving DAA medication. Medical administration of DAAs will also be tracked at the patient level by virtue of Medication Administration Records (MARs).
Timetable: Ongoing. M. REFERRAL FOR LIVER TRANSPLANTS
In accordance with Supplement 3, the FDC will determine the MELD score for all patients with decompensated cirrhosis. If the score meets the listing/eligibility criteria maintained by the liver transplant centers in Florida, the patient will be referred to the transplant center. Thereafter, co-management as directed by the transplant center will be instituted if the patient is listed for transplant. (Supplement 3, page 12).
Timetable: January 31, 2018, while referrals are ongoing.
Respectfully submitted, PAMELA JO BONDI ATTORNEY GENERAL
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EXHIBIT B

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 18 of 31
HSB 15.03.09 Supplement #3 – Revised 12/6/17 Hepatitis C Virus Infection Management
Page 1 of 14
MANAGEMENT OF HEPATITIS C
This guideline describes departmental recommendations for the screening, evaluation, treatment, and monitoring of patients infected with hepatitis C virus (HCV).
A. GENERAL INFORMATION REGARDING HEPATITIS C
1. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV) which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person.
2. Risk factors for infection may include, but are not limited to, injection drug use, transfusion with HCV-infected blood or blood products, tattooing, vertical transmission from mother to child, and massive exposure to HCV-infected blood during fighting or other trauma.
3. The average incubation period is six to nine weeks, with a range from two weeks to six months. Therefore, acute HCV infection usually is established within 3-6 months of the contact with the infected blood.
4. Those individuals who spontaneously clear hepatitis C usually do so within the first six months of being infected. Many patients have no symptoms of acute hepatitis.
5. Approximately 50-80% of individuals infected with hepatitis C will not spontaneously clear the virus. For them, the infection becomes chronic.
6. Chronic hepatitis C (sometimes abbreviated as “cHCV”) is characterized by the persistent presence of HCV-RNA detectable in blood/serum, i.e., the HCV viral load (HCV-VL). Those patients who are HCV-VL+ in the context of the correctional setting usually have chronic HCV disease.
7. The principal consequence of cHCV is infection of the liver, which causes inflammation that may, in turn, result in scarring of the liver, which is known as “fibrosis.” The amount of liver scarring a patient has is usually measured on the METAVIR scale. On this scale, a person can be classified as F0 (inflammation, but no fibrosis), F1 (mild fibrosis), F2 (moderate fibrosis), F3 (severe fibrosis), or F4 (cirrhosis).
8. Liver scarring can significantly impair liver function, and can place a patient at risk for several serious symptoms/complications, as well as liver failure or liver cancer.
9. For a depiction of the natural history of HCV, see Diagram 1, below.

Case 4:17-cv-00214-MW-CAS Document 185 Filed 12/13/17 Page 19 of 31
HSB 15.03.09 Supplement #3 – Revised 12/6/17 Hepatitis C Virus Infection Management
Page 2 of 14
Reproduced with permission from UpToDate, Inc. www.uptodate.com. Copyright © 2017.
B. THE PROGRESSION OF CHRONIC HEPATITIS 1. Progression of cHCV to fibrosis and cirrhosis may take years in some patients and decades in others, or, in some cases, may not occur at all. The rate at which patients progress along the METAVIR scale, and can progress toward serious symptoms/complications differs among the population, and can be influenced by a variety of factors. 2. Patients with cirrhosis may develop decompensated cirrhosis and/or hepatocellular carcinoma over time. Factors associated with rapid progression or death (less than 20 years from infection to cirrhosis) can include, but are not limited to, ALT elevation (especially if ALT>200, or “ALT flare”), active alcohol and drug abuse, grade 3 inflammation (Batts and Ludwig classification) on liver biopsy, presence of bridging fibrosis (Batts and Ludwig S3+/Metavir F3+) on liver biopsy, genotype 3 infection, HIV co-infection, HBV co-infection (those with HIV+HBV +HCV co-infection and detectable viremia of both HIV+HBV are at highest risk), hepatic steatosis and NASH, diabetes and insulin resistance, obesity, daily use of marijuana, and uncontrolled underlying liver disease. HCV risk behaviors that occur 10 or more years prior to the

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cHCV diagnsosis, the male gender, and whether an individual is age 40 or more at the time of infection, are also associated with a rapid progression, but are less significant in multivariate analysis.
3. The rapid accumulation of data since 2013 regarding hepatic fibrosis and progression to end stage liver disease (decompensated cirrhosis and hepatocellular carcinoma or primary liver cancer) has indicated that the risk for rapid progression within one year begins to be measurable when the patient reaches F2. There is an ~0.5% and ~1.0% oneyear risk of progressing to hepatocellular carcinoma and decompensated cirrhosis, respectively, once the patient can be staged as F2 (Whether this is due to underestimation of the actual stage with present staging methods or represents very rapid progression of hepatic fibrosis is unknown). The best data continues to indicate that risks of progression in one year to hepatocellular carcinoma or decompensated cirrhosis in the patient with F3 and F4 fibrosis is 1%, 2% or 1.5-2%, 4%, respectively.
4. On the other hand, the factors associated with non-progression of hepatic fibrosis are not fully understood at this time, and may be less well-studied due to treatment bias. Non progression is more likely in patients with the following characteristics: female sex, age <40yrs, BMI<30, Batts and Ludwig inflammation Grade 0-1, Batts and Ludwig S01/Metavir F0-1, IL28B genotype (with C/C and C/T genotypes less likely to be associated with advanced hepatic fibrosis), and normal ALT ( ≥75% do not have advanced hepatic fibrosis). African-American race (slower progression/histology less severe in black patients), patients whose HCV risk behaviors have happened in the recent past (usually <5-10yrs), and those without an alcohol abuse history also have less risk.
5. The contribution of sobriety/cessation of injection drug use to slowing the progression of hepatic fibrosis is also highly significant in terms of positive lifestyle behaviors associated with improved quality and length of life, especially if the patient achieves a sustained viral response (SVR), which is considered to be a cure. Additionally, statin use has been associated with a lower progression rate, and coffee (caffeinated only) consumption has been demonstrated in both retrospective and prospective trials to be associated with reduced hepatic fibrosis.
6. For a depiction of the progression of cHCV, and priority for treatment, see Diagram 2, below.

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C. THE NEED FOR COMPREHENSIVE HCV TREATMENT, NOT JUST VIRAL ERADICATION
1. Identifying patients who need treatment sooner than others, and would benefit most, is a complex task requiring evaluation of multiple and diverse factors. The positive outcomes of increased survival and improved quality of life associated with successful viral eradication and a sustained viral response (SVR) are dependent upon sobriety and positive lifestyle change.1
2. Patients have a responsibility to learn from past behaviors and interact with society positively. Evaluation and treatment of chronic health problems such as chronic HCV and substance abuse play a crucial role in patients establishing trust and developing healthy behaviors, thereby reducing their rates of substance abuse relapse and correctional recidivism.
1 For example, a long-term Danish study demonstrated an 18.2-fold increased mortality risk among younger patients with chronic HCV that was not due to their liver disease but, instead, was due to unnatural death: i.e., mortality associated with untreated mental illness and substance abuse associated suicide, homicide, and trauma. Liver related mortality only becomes more prevalent as the population ages. Therefore, sobriety is key to an overall harm reduction. (Clin Gastro and Hepatology 2011; 9:71-78).

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3. The benefits of evaluation and treatment of cHCV go beyond the immediate goal of viral eradication in the individual. cHCV treatment is one part of a multi-part strategy to promote healthy lifestyles, which in turn benefits the patient, his/her family, and society.
4. Any patients interested in cHCV evaluation should understand that further laboratory testing, liver biopsy, imaging, or another method for staging hepatic fibrosis may be required prior to and during therapy. The risk and side effects of evaluation, the proposed treatment regimen and the need for monitoring must be fully discussed with the patients.
5. If there is reasonable documented concern about a patient’s ability to adhere to and benefit from a standardized treatment regimen, and these concerns are not able to be resolved through a cooperative treatment plan, treatment should not be initiated. Patients will be reevaluated for treatment compliance in accordance with their Gastrointestinal Clinic (GC) scheduling.
6. Behavioral risk reduction and substance abuse counseling is an integral part of cHCV treatment. The use of peer educators has been shown to potentially have the greatest impact in this area. Patients should have pro-sobriety attitudes assessed and documented in the medical record. Patients with high propensity for relapse may need more extended time periods of sobriety prior to treatment as deemed appropriate by the clinical care committee or equivalent. Unfortunately, there is no evidence at this time that institutionally-mandated substance abuse programs improve outcomes over incarceration alone. However, patientdriven substance abuse treatment such as Narcotics Anonymous or Alcoholics Anonymous groups with peer educators and sponsors have demonstrated improved outcomes and decreased substance abuse relapse rates post-release. Patients should be encouraged to participate in these programs.
D. EDUCATION FOR NEWLY INCARCERATED INMATES REGARDING HCV
All newly incarcerated patients should be provided with educational information regarding prevention, transmission, risk factors, and screening of HCV. The form for this should include peer-to-peer education.
E. MONITORING OR TREATMENT FOR ACUTE HEPATITIS
1. HCV-VL shall be monitored at 6 months after the date of first diagnosis. If viremia persists after that time, continue to monitor and manage the case as a chronic infection.
2. In some cases when acute HCV infection superimposes on patients with established cirrhosis or advanced fibrosis, there may be a compelling reason to treat the acute infection as a chronic infection in order to prevent severe complications.

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F. SCREENING OF PATIENTS FOR THE PRESENCE OF cHCV, AND THE AMOUNT OF FIBROSIS
Screening for cHCV will be offered to all patients, regardless of risk factors, at multiple opportunities throughout incarceration. Patients may request screening as well. Screening should include the following components:
1. The preferred screening test for HCV infection is an immunoassay that detects the presence of antibodies to HCV antigens (referred to as HCV-Ab, or Anti-HCV).
2. If there is the presence of HCV-Ab, the specimen should be automatically analyzed for HCV-RNA (the HCV viral load, or HCV-VL) to immediately establish the presence or absence of chronic HCV.
3. In patients with a detectable viral load (HCV-VL), the specimen will also then be analyzed by a proprietary predictive index (e.g. FibroSURE), to initially assess the amount of fibrosis (liver scarring). Note: Proprietary indices that predict hepatic fibrosis stage such as FibroSURE, Fibrometer™ or FibroSPECT™ utilize a combination of age, sex, and a battery of laboratory parameters to predict the fibrosis score (F0-F4). Proprietary indices are widely utilized in the U.S. correctional system and in some communities in combination with ultrasound liver imaging to estimate the stage of hepatic fibrosis, especially in areas which are resource or access challenged, which would make routine elastography or other imaging very difficult.
4. HCV-VL+ patients who have been diagnosed to have F2, F3, or F4 will be reviewed and an abdominal ultrasound ordered to rule out the presence of portal hypertension (indicative of advanced hepatic fibrosis).
G. EDUCATION OF PATIENTS WHO ARE FOUND TO BE INFECTED WITH cHCV
Once patients are found to be infected with chronic HCV, they should be counseled by a clinician during the initial visit regarding the natural history of the infection, measures to assess the progress of cHCV, potential treatment options, and specific measures to prevent transmitting the HCV infection to others.
H. EVALUATION AND MONITORING IN THE GASTROINTESTINAL CLINIC
1. The following patients will be enrolled in the Gastrointestinal Clinic (“GC”) for evaluation and monitoring: (a) those with active cHCV who are not being treated with direct-acting antiviral medication, (b) those who have had HCV treatment failure, and (c) those who have had a relapse of HCV infection or reinfection.
2. In the GC clinic, the patient will receive the following: (a) a baseline history and physical examination; (b) labs and other tests (see below), including a proprietary predictive index, if not previously provided, and an abdominal ultrasound, if not

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previously provided; (c) an assessment and discussion with the patient of the results of the proprietary predictive index and abdominal ultrasound; (d) an evaluation and assessment of the need for preventive health interventions such as vaccines and screenings for other conditions; and (e) counseling on cHCV infection.
3. Patients who are fibrosis stage 4 (F4), or stage 3 (F3) shall be seen every six (6) months or sooner, if indicated, shall receive laboratory testing every 3-6 months, and shall receive an abdominal ultrasound for hepatocellular carcinoma (HCCa) surveillance every six (6) months.
4. Patients who are fibrosis stage 2 (F2), stage 1 (F1) or stage 0 (F0) shall be seen every six (6) months, and shall receive laboratory testing every six (6) months, and the proprietary predictive indices and/or elastography every twelve (12) months.
5. Each patient’s fibrosis stage will be recorded as F0-F4. If available, the patient’s ChildTurcotte-Pugh score will be recorded as well. In particular, consider the following:
(a) The history and physical examination: Focus on signs and symptoms of liver disease, prior alcohol consumption, and risk behaviors for acquiring HCV infection. Based on this information and the period in which the patient engaged in injection drug use or other risk behaviors, attempt to estimate earliest possible date of infection. Evaluate for other possible causes of liver disease, including alcoholism, non- alcoholic steatohepatitis (NASH), iron overload (hemochromatosis), and autoimmune hepatitis. Inquire about prior treatment for HCV infection, specific medications used, dosages and duration of treatment, and outcomes, if known.
(b) Laboratory and Other tests:
(1) This will include a complete blood count (CBC); Prothrombin time (PT) with International Normalization Ratio (INR); and a comprehensive metabolic panel (CMP).
(2) Laboratory testing consistent with cirrhosis may include elevated bilirubin, decreased albumin, and prolonged INR, but these tests are only used to quantify cirrhosis. Use of predictive indices uses laboratory markers to predict the state of hepatic fibrosis.
(3) Elastography methods (using either ultrasound or MRI) may be critical in determining the fibrosis stage. Imaging studies may also identify cirrhosis, and not require further staging. 2
2 A recent review of the use of liver imaging and biopsy in clinical practice (Use of Liver Imaging and Biopsy in Clinical Practice; Tapper EB and S.-F. Lok, NEJM 377:8:756-768) indicates that present non-invasive elastography modalities have been shown to be reliable in detecting advanced hepatic fibrosis, are cheaper, easily repeated for serial monitoring, and thus long-term outcomes may be accurately predicted.

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(4) A liver biopsy is no longer required unless otherwise clinically indicated.
(5) Abdominal imaging studies such as ultrasound or CT scan may identify findings consistent with or suggestive of cirrhosis, portal hypertension or hepatocellular carcinoma (HCC).
CTP calculators are available at: http://www.hepatitisc.uw.edu/page/clinicalcalculators/ctp
(c) Screening for other conditions: There should be screening for the Hepatitis A antibody (HAV-Ab), and the Hepatitis B surface antigen (HBsAg), unless these were already known from a prior Hepatitis Panel, and also testing for the HIV antibody (HIV- Ab). If risky behavior occurred after previously negative testing, repeat the testing. An anti-nuclear antibody (ANA) and ferritin should be ordered as screening for auto-immune hepatitis and hepatic iron overload.
(d) Counseling: Patients should be counseled regarding the progression of cHCV, the staging of treatment with direct acting antiviral medication (DAAs), other potential treatment options, the availability of peer-to-peer counseling, and specific measures to prevent transmitting HCV infection to others.
I. PRIORITIZATION FOR TREATMENT WITH DAAs
1. Although many patients with chronic HCV infection may benefit from treatment with direct-acting antiviral medication (DAAs), certain cases are at higher risk for complications or disease progression and require more urgent consideration.
2. Eligibility for DAA treatment should be established via concordance between laboratory, imaging (abdominal ultrasound, and elastography if available), and predictive scoring (proprietary indices). Resource challenged systems may use the combination of proprietary indices and abdominal ultrasound to assess for the presence of F2-F4 hepatic fibrosis.
3. Within the eligible group of patients, the following priority criteria have been established to ensure that those with the greatest need are treated first.
(a) PRIORITY LEVEL 1 - Highest Priority for Evaluation and Treatment The following individuals should receive DAA treatment within 0-6 months (subject to paragraph K, below):
(1) Fibrosis Stage 4, decompensated cirrhosis, including both symptomatic patients (e.g., with ascites, hepatic encephalopathy, esophageal varices, etc.) and asymptomatic patients with CTP scores greater than or equal to 7.

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(2) Fibrosis Stage 4, compensated cirrhosis, with CTP scores greater than 5 and less than 7.
(3) Liver transplant candidates or recipients in consultation with and co-managed by a transplant hepatologist.
(4) Hepatocellular carcinoma in consultation with a hepatologist for correct timing.
(5) Comorbid medical conditions associated with HCV, including cryoglobulinemia with renal disease or vasculitis, certain types of lymphomas, hematologic malignancies or metabolic abnormalities.
(6) Continuity of care for those entering custody already on treatment.
(7) Patients taking immunosuppressant medications for a comorbid medical condition which may cause rapid progression of hepatic fibrosis.
(8) HIV co-infection.
(9) HBV co-infection.
(b) PRIORITY LEVEL 2 - Intermediate Priority for Evaluation and Treatment The following individuals should receive DAA treatment within 12 months (subject to paragraph J, below):
(1) Fibrosis stage 3 (F3)
(2) Fibrosis stage 2 (F2).
(3) Comorbid liver disease (e.g., autoimmune hepatitis, hemochromatosis, steatohepatitis).
(4) Chronic Kidney Disease with proteinuria.
(5) Diabetes Mellitus.
(6) Patients previously staged as F0, but who advanced in staging to F1 within 1-4 years are considered to have progressive hepatic fibrosis, and should be treated in this priority group.
(c) PRIORITY LEVEL 3 – Active Monitoring for DAA Treatment The following individuals should be monitored regularly with labs and proprietary predictive indices for re-staging at least annually into a higher priority level:

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(1) Fibrosis stage 1 (F1).
(2) Fibrosis stage 0 (F0).
J. OTHER CRITERIA TO BE CONSIDERED BEFORE TREATMENT WITH DIRECTACTING ANTIVIRAL MEDICATION
1. In addition to meeting the above criteria for Priority Level 1 and Priority Level 2, patients being considered for treatment of cHCV infection should 1) have no contraindications to, or significant drug interactions with, any component of the treatment regimen, 2) have sufficient time remaining on their sentence in the Department of Corrections to complete pre-treatment evaluation, a course of treatment, and post treatment SVR assessment at 8-24 weeks, in order for patient education and system efficiencies to be evaluated (generally, this requires approximately 12-18 months), 3) have a life expectancy sufficient to achieve benefit from HCV viral eradication, and 4) demonstrate willingness and an ability to adhere to a rigorous treatment regimen and to abstain from high risk behaviors while incarcerated.
2. A cHCV patient’s attitude, functional ability to thrive within the system, and optimal treatment of mental health issues are critical for good outcomes. Patients who have chronic disciplinary issues within the system have very high substance abuse relapse rates upon release, with newer evidence indicating higher re-infection rates. Patients should be counseled and observed on a case-by-case basis, and involvement of mental health professionals is critical. It is also critical to remember that patients who have chronic behavioral management issues, common in jails/prisons, are rarely able to establish and maintain a therapeutic provider-patient relationship which results in completion of treatment and an SVR.
3. Patients who are Priority Level 1 or Priority Level 2, but who (1) are unable to demonstrate a willingness and an ability to adhere to a rigorous treatment regimen, (2) do not abstain from high risk behaviors while incarcerated, (3) have chronic disciplinary issues, or (4) have chronic behavioral management issues may not be eligible for treatment until those issues are considered to be resolved. A patient should be willing to participate in any available counseling or treatment in order to achieve the sobriety/behavior change before treatment with DAAs is initiated.
K. RECOMMENDED TREATMENT REGIMENS
1. Recommendations for HCV treatment regimens continue to evolve, and are changing rapidly as new agents become available and as evidence of the most effective ways to utilize the DAAs accumulates. Usually 8-12 week regimens are preferred due to improved adherence, lower toxicity, and cost-effectiveness.

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2. The AASLD/IDSA/IAS3 website, which is found at hcvguidelines.org, presents reliable summaries of drug treatment data and should be used to direct most treatment.
3. Expert consultation is required in patients eligible for liver transplantation.
4. Treatment of chronic HCV during pregnancy is presently not recommended due to the lack of safety data.
L. TREATMENT FAILURE FOLLOWING DAA TREATMENT
1. Treatment failure is defined as a detectable HCV-VL 12 weeks following completion of therapy.
2. If the HCV-VL is <50 copies/ml or in the “non-quantifiable” range then the test should be repeated in 4 weeks as this situation usually represents lab error or very slow clearance of virus; the repeat testing will usually be “not detected.”
3. In the case of true failure, the medical record should be reviewed for non-adherence, system failure in drug dispensing (e.g., omissions in directly observed therapy, not providing refills on time, etc.), possible drug-drug interactions, and the patient should be interviewed for illicit drug use and the ingestion of other acid-lowering medications or supplements.
4. If no interfering risk factors are identified, the possibility of viral mutation causing drug resistance (Resistance-Associated Substitutions) should be considered.
5. Further resistance testing and a secondary treatment regimen should be selected according to the principle and treatment recommendations contained in hcvguidelines.org.
M. TREATMENT MONITORING
1. The patient will have an outpatient clinic visit at 2-4 weeks after starting therapy in order to establish adherence to the prescribed regimen, and assess for side effects and the need for treatment modification. DAA regimens usually do not require routine lab monitoring, unless clinical symptoms of increased fatigue or other side effects occur.
2. A CBC and comprehensive metabolic panel (CMP) equivalent may be drawn at 4 weeks to rule out transaminase elevation due to autoimmune hepatitis or HBV reactivation. The CMP may also be used to reassure the patient that there is evidence of efficacy and encourage further adherence and program compliance.
3 AASLD (American Association for the Study of Liver Diseases); IDSA (Infectious Diseases Society of America); IAS (International Aids Society)

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3. Progressive increases in the ALT may require more frequent monitoring or early discontinuation.
4. For regimens containing RIBAVIRIN: a CBC and CMP should also be drawn 2 weeks after starting therapy, then at 4 weeks, then monthly or more frequently as clinically indicated. A Ribavirin dosage adjustment may be required. Mild (1-3x upper limit of normal) elevation of the total bilirubin may be expected as a consequence of Ribavirininduced oxidative stress and RBC Lysis. Pregnancy testing is required prior to treatment with ribavirin-containing regimen, and thereafter as risk behavior for pregnancy occurs.
N. POST-TREATMENT MONITORING
1. A post-treatment quantitative HCV-VL assessment will be drawn at 12 weeks after completion of treatment; and if HCV is undetectable, that defines a sustained viral response (SVR).
2. A patient who sustains SVR may be removed from the Gastrointestinal Clinic (GC), so long as the patient has no cirrhosis, complications, or related comorbidities.
O. OTHER HEALTH CARE INTERVENTION RECOMMENDED FOR CIRRHOSIS
1. All patients with cirrhosis shall have additional consultative co-management as follows:
(a) At first identification of a F4 diagnosis the Platelet/Spleen diameter ratio shall be computed (example: 112,000/131 (mm) = 855). All patients with values <905 shall be referred for EGD for diagnosis of esophageal varices. If varices are present, nonselective beta-blockers to prevent variceal bleeding shall be initiated. Alternatively, some selected patients may require banding of varices; however, beta-blocker prophylaxis is preferred and recommended in accordance with AASLD recommendations.
(b) Patients with decompensated cirrhosis shall be co-managed by a gastroenterologist or hepatologist. Decisions for co-management including ongoing variceal surveillance, antibiotic prophylaxis if risk factors are present for spontaneous bacterial peritonitis, optimized diuretic therapy for ascites, and optimized therapy for hepatic encephalopathy shall be addressed during the consultation.
2. In general, NSAIDs should be avoided in advanced liver disease/cirrhosis and METFORMIN should be avoided in decompensated cirrhosis. Other resources should be consulted for more specific recommendations related to management of cirrhosis.
P. REFERRAL FOR LIVER TRANSPLANTS FOR PATIENTS WITH DECOMPENSATED CIRRHOSIS

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A determination of the UNOS MELD score will be made for all patients with decompensated cirrhosis. If the score meets the listing/eligibility criteria maintained by the liver transplant centers in Florida, the patient will be referred to the transplant center. Thereafter, co-management as directed by the transplant center will be instituted if the patient is listed for transplant.
Q. HCV TREATMENT APPROVAL PROCESS
Treatment of all genotypes will be coordinated through the Regional Medical Director and if applicable, the Hepatitis C Program Director in order to determine site and mode of therapy. Patients previously unsuccessfully treated may be considered for treatment on a case by case basis.
R. REQUIRED DOCUMENTATION AND DATA ENTRY
In accordance with HSB 15.03.05 Appendix #8, patients with chronic liver disease should be enrolled in Gastrointestinal Clinic (GC) with baseline information completed prior to start of treatment using DC4-770GG-Gastrointestinal Baseline History and Procedures.
Documentation of evaluation of treatment should be entered on form DC4-701F (Chronic Illness Clinic). The encounter should be entered in the OFFENDER-BASED INFORMATION SYSTEM (OBIS) as a GC appointment using the appropriate diagnosis code as shown below.
1. GH08 – Front Page. Add the following codes as determined:
(a) For Acute hepatitis C - use ICD-10-CM Diagnosis Code B17.1 (Note: Per Section E.1. above, if viremia persists at 6 months after the date of first diagnosis, continue to monitor and manage the case as a chronic infection. This requires a change in OBIS code in accordance with R.1.b. If viremia does not persist at 6 months, remove code B17.1, but continue to monitor for other health issues.)
(b) For Chronic viral hepatitis C – use ICD-10-CM Diagnosis Code B18.2
2. GH08 – back page. Add the following action codes on the GH08 Back page (contact screen):
(a) DAA = HepC Tx Started 1. Enter start date – Required Field
(b) DAAx = HepC Tx Discontinued

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1. Enter end date – Required Field AND 2. Requires remarks (i.e., 12 weeks completed; inmate non-compliant, inmate refused, etc.) (c) SVR = Sustained Virologic Response Achieved 1. Enter date – Required Field

 
 Case 4:17-cv-00214-MW-CAS Document 214 Filed 01/31/18 Page 1 of 7

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, et al.,

Plaintiffs,

v.

Case No. 4:17cv214-MW/CAS

JULIE L. JONES, in her official capacity as Secretary of the Florida Department of Corrections,

Defendant. __________________________/

ORDER MODIFYING PRELIMINARY INJUNCTION

Defendant moves for a modification of this Court’s Order

Entering a Preliminary Injunction, ECF No. 185 (“Preliminary

Injunction”). ECF No. 211. For the reasons that follow, Defendant’s

motion is GRANTED in part and DENIED in part.

I. First Modification

In the Preliminary Injunction, this Court held that the

Florida Department of Corrections (“FDC”) “must stage and

evaluate the 2,500 inmates who have the lowest albumin levels no

later than February 28, 2018.” ECF No. 185, at 4. The reason for

that directive was to “ensure that inmates with the most advanced

1

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liver disease are staged and evaluated first.” Id. at 4, n.4. However, Defendant argues that the “use of albumin levels alone is not an effective way to determine which patients are the sickest.” ECF No. 211, at 5. Indeed, Defendant’s medical expert, Dr. Dewsnup, asserts that a better method to identify the sickest patients is to “use albumin in conjunction with the predictive scoring index (FibroSURE), other lab tests on the spreadsheet, and also the abdominal ultrasound.” ECF No. 211-1, at 3. This Court accepts Dr. Dewsnup’s statements on this issue, and will modify the Preliminary Injunction accordingly. If Plaintiffs disagree, they are free to file a motion for modification and explain why using albumin alone (or any other method) would be preferable, and this Court will set an evidentiary hearing on the matter.
II. Second Modification In the Preliminary Injunction, this Court held that “FDC must initiate treatment for all known chronic HCV inmates, who are eligible for treatment, and who have fibrosis stage 3, by December 31, 2018.” ECF No. 185, at 4. Similarly, this Court also held that “FDC must initiate treatment for all known chronic HCV inmates, who are eligible for treatment, and who have fibrosis stage 2, by December 31, 2018.” Id. Although Defendant believes
2

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that FDC is capable of treating the F3 inmates by December 31, 2018, Defendant does not believe that FDC will be able to treat the F2 inmates by then. See ECF No. 211, at 7–15. Accordingly, Defendant asks this Court to modify the Preliminary Injunction and give FDC an extra year to treat the F2 inmates. Id. at 14–15.
As Dr. Dewsnup notes, “the safest course is to treat F2s and F3s within one year.” ECF No. 211-2, at 3. Indeed, in a perfect world, this Court would wave a magic wand, and everyone would be treated immediately. Unfortunately, this world is not perfect, and this Court does not have a magic wand. As such, this Court is cognizant of reality and understands FDC’s difficulties in meeting the deadlines.
While not embraced by everyone, this Court actually values scientific evidence. And Dr. Dewsnup explains that “the best scientific evidence indicates that it is more likely than not just as safe to treat F2s within 24 months as it is to treat F3s within 12 months.” Id. at 3–4. That is, “an extension of treatment for F2s into the 12-24 month time period does not raise their mortality risk or risk of ELSD to a level beyond that which has been already deemed acceptable for F3 patients by the Court.” Id. at 5. As such, Dr. Dewsnup opines that “an up to 12-month treatment delay in
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some F2 patients is acceptable in the light of the temporary issues related to acquisition of funding, and large-scale system expansion problems that Centurion is trying to cope with.” Id. at 6.
Again, this Court accepts Dr. Dewsnup’s statements on this point, and will modify the Preliminary Injunction accordingly. This Court understands that Plaintiffs may have different feelings on this issue. Once again, Plaintiffs are free to file their own motion for modification (along with their own expert testimony) if they wish to convince this Court that a 12-month extension is inappropriate, and this Court will set an evidentiary hearing on the matter.
III. Third Modification In the Preliminary Injunction, this Court held that Defendant must file monthly status reports “reflecting FDC’s progress in complying with this Court’s injunction.” ECF No. 185, at 5. This Court further held that the status reports must detail “[t]he total number of inmates in FDC custody who have been screened/tested for HCV.” Id. at 6. Defendant argues that the requirement to list inmates that have been screened/tested should be removed because Plaintiffs were not harmed by FDC’s HCV
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testing protocols and therefore have no standing to warrant such a remedy. See ECF No. 211, at 15–17.
Defendant’s argument is patently absurd. It is clearly within this Court’s purview to ensure that a preliminary injunction is complied with. Defendants could easily avoid their obligation to treat HCV-infected inmates by simply not testing inmates for HCV. That is, FDC could willfully remain blind to the number of inmates who have HCV, not treat the inmates it doesn’t know about, and feign compliance with its obligations.1 By monitoring the number of inmates that are screened/tested, this Court is preventing precisely that type of behavior.
IV. Final Note Victoria Love, the “Regional Vice President of Operations for Florida for Centurion of Florida, LLC” stated in her signed declaration that “it will be difficult if not impossible to initiate treatment of all the F4s by the end of May.” ECF No. 211-3, at 1, 6. Yet, Defendant alleges that “FDC is complying with the Court’s order related to the treatment of inmates with fibrosis stage 4.” ECF No. 211, at 14. Moreover, Defendant has not moved for a
1 Considering FDC’s history of HCV treatment, this type of behavior is certainly not beyond the realm of possibility. See ECF No. 153.
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modification with respect to its obligation to treat F4 patients. Something is wrong. Either FDC is complying with its obligations or it is not. FDC cannot pretend that everything is ok and wait until the last minute to explain why it won’t be able to meet the deadlines. If it appears that FDC won’t be able to meet the May deadline for F4 patients, then Defendant should move for a modification (just like she did here) and justify why this Court should modify the deadline. To reiterate, “none of the dates in th[e] injunction are ‘goals’—the dates are adopted as deadlines that must be complied with.” ECF No. 185, at 2, n.2.
Accordingly, IT IS ORDERED: 1. Defendant’s motion for modification, ECF No. 211, is
GRANTED in part and DENIED in part. 2. The Preliminary Injunction, ECF No. 185, is modified as
follows: a. Paragraph 1(b) is modified to read: “FDC must initiate treatment for all known chronic HCV inmates, who are eligible for treatment, and who have fibrosis stage 2, by December 31, 2019.”
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Case 4:17-cv-00214-MW-CAS Document 214 Filed 01/31/18 Page 7 of 7 b. Paragraph 1(d) is modified to read: “Of the ~7,500 inmates FDC knows have chronic HCV, FDC must stage and evaluate the 2,500 inmates with the most immediate needs (as determined by evaluating albumin levels in conjunction with the predictive scoring index (“FibroSURE”), other lab tests on the spreadsheet, and abdominal ultrasounds) no later than February 28, 2018.”
SO ORDERED on January 31, 2018. s/Mark E. Walker United States District Judge
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 Case 4:17-cv-00214-MW-CAS Document 218 Filed 02/09/18 Page 1 of 2

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, et al.,

Plaintiffs,

v.

Case No. 4:17cv214-MW/CAS

JULIE L. JONES, in her official capacity as Secretary of the Florida Department of Corrections,

Defendant. __________________________/

ORDER MODIFYING PRELIMINARY INJUNCTION

Plaintiffs move for a modification of this Court’s Order

Entering a Preliminary Injunction, ECF No. 185 (“Preliminary

Injunction”). ECF No. 217. Specifically, Plaintiffs request that the

Preliminary Injunction be modified to require the Florida

Department of Corrections (“FDC”) “to initiate treatment for all

prisoners with Hepatitis C (HCV) who are co-infected with HIV—

regardless of fibrosis score—by December 31, 2018.” Id. at 1.

Defendant does not oppose the modification. Id. at 5. Moreover,

there is good reason to grant the modification. Indeed, both parties’

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experts confirmed that “treatment of HCV should be prioritized in those who are co-infected with HIV.” Id. at 2.
Accordingly, IT IS ORDERED: 1. Plaintiff’s motion for modification, ECF No. 217, is
GRANTED. 2. The Preliminary Injunction, ECF No. 185, is modified as
follows: a. Paragraph 1(e) is added to read: “FDC must initiate treatment for all prisoners with HCV who are coinfected with HIV—regardless of fibrosis score—by December 31, 2018.”
SO ORDERED on February 9, 2018. s/Mark E. Walker United States District Judge
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 Case 4:17-cv-00214-MW-CAS Document 465 Filed 04/18/19 Page 1 of 68

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

CARL HOFFER, et al.,

Plaintiffs,

v.

Case No. 4:17cv214-MW/CAS

MARK S. INCH, in his official capacity as Secretary of the Florida Department of Corrections,

Defendant. __________________________/

ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT

This Court previously issued a preliminary injunction

requiring the Florida Department of Corrections (“FDC”) to treat

inmates infected with the Hepatitis C virus (“HCV”). ECF No. 153;

ECF No. 185. Defendant admits most of this Court’s prior findings

and, by way of a motion for summary judgment, asks this Court to

make the preliminary injunction permanent and award no further

relief. ECF No. 270. Plaintiffs also move for summary judgment

but ask this Court to enter a permanent injunction broader in

scope than the preliminary injunction. ECF No. 342. For the

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reasons that follow, the parties’ cross-motions for summary judgment are GRANTED in part and DENIED in part.
I. Background A. Forging the Path Plaintiffs Carl Hoffer, Ronald McPherson, and Roland Molina filed this case on May 11, 2017. ECF No. 1. All three were inmates in FDC’s custody, were infected with HCV, and had been denied proper medical treatment. See id. They moved to certify a class of similarly situated plaintiffs and also moved for a preliminary injunction requiring FDC to properly treat HCVinfected inmates. ECF No. 10; ECF No. 11. To resolve Plaintiffs’ motions, this Court held a five-day evidentiary hearing beginning on October 19, 2017. See ECF No. 142. This Court heard from medical experts, FDC officials, and the named Plaintiffs themselves. See id. The parties also introduced several exhibits, the most notable of which was “HSB 15.03.09 Supplement #3,” FDC’s official written policy for managing HCV (“FDC’s policy”). Although a number of facts remained unclear, the truth uncovered at the hearing was crystal: FDC was shirking its duty to properly treat HCV-infected inmates because the treatment—
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specifically, the use of direct-acting antivirals (“DAAs”)—was too costly. By order dated November 17, 2017, this Court detailed FDC’s “long and sordid history of failing to treat HCV-infected inmates,” held that Plaintiffs were likely to succeed on their Eighth Amendment deliberate-indifference claim, and granted Plaintiffs’ motion for preliminary injunction. ECF No. 153. Moreover, having found that the necessary requirements were met, this Court granted Plaintiffs’ motion for class certification as well. ECF No. 152.
Before issuing a preliminary injunction, this Court first ordered Defendant to file a proposed treatment plan consistent with this Court’s “broad” directions. See ECF No. 153, at 28–32. After receiving Defendant’s plan, noting deficiencies with the plan, and receiving further comments from the parties, this Court ultimately issued a preliminary injunction on December 13, 2017. ECF No. 185. Simply put, the injunction requires Defendant to (1) ensure that FDC and its agents comply with the treatment plan (with modifications), (2) ensure that FDC and its agents comply with FDC’s policy (with modifications), and (3) file monthly status reports outlining FDC’s progress in complying with the injunction. Id. at 3–6.
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B. Fifteen Months Down the Road
Over fifteen months have passed since this Court issued the
preliminary injunction. Within that time, FDC has screened
55,348 inmates for HCV, identified 7,185 inmates as having
chronic HCV (“cHCV”),1 and begun or completed treating 4,901
inmates with DAAs.2 ECF No. 453. In addition to making amends,
FDC has also recognized some of its past wrongs. For instance,
FDC now admits that it “was not adequately monitoring all
inmates with cHCV prior to the preliminary injunction.” ECF No.
270, at 28. FDC further admits that “cHCV constitutes a serious
medical need” and that FDC’s “failure to treat inmates with cHCV
was due to lack of funding.” Id. at 17–18. In short, FDC admits this
Court’s finding of deliberate indifference. See id. at 18.
1 As explained in a previous order, “about 20–50% of people infected with HCV spontaneously clear the virus within six months of infection.” ECF No. 153, at 4. “The remaining 50–80% who don’t clear the virus are referred to as having chronic HCV.” Id.
2 Time has also brought much change for the named Plaintiffs. Carl Hoffer completed DAA treatment but died while still in custody and waiting for a liver transplant. ECF No. 269-1, at 2; ECF No. 342, at 19. Ronald McPherson completed DAA treatment and was later released from prison. ECF No. 269-1, at 2. Roland Molina remains in FDC custody but has completed DAA treatment, and “his post-testing indicates that he has achieved a sustained virologic response (SVR), which means that [HCV] is no longer detected in his blood.” Id. Of course, these developments do not moot this case. See, e.g., J W ex rel. Tammy Williams v. Birmingham Bd. of Educ., 904 F.3d 1248, 1265 n.4 (11th Cir. 2018).
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C. A Course for the Future Cases tend to be resolved rather quickly after a preliminary injunction is issued. That is, preliminary injunctions often get appealed, and the appellate courts’ opinions tend to be so decisive that the parties either settle or one side accepts defeat. Here, neither side appealed, and Defendant only accepted partial defeat. Indeed, although Defendant “no longer wishes to contest” the issues this Court “already resolved” and asks this Court to convert the preliminary injunction to a permanent injunction, Defendant still seeks summary judgment in his favor as to any unresolved issues. ECF No. 270, at 2. And while Plaintiffs “agree that a permanent injunction should be entered against Defendant,” they submit that “there are a number of issues that are still in dispute, and several forms of relief that Plaintiffs are requesting that are not currently required by the preliminary injunction,” ECF No. 342, at 2. Consequently, this Court is left to finish what it started when it issued the preliminary injunction almost a year and a half ago. This Court agrees with the parties that summary judgment is the right tool for that job. No triable issues of fact remain, so an evidentiary hearing is unnecessary to “convert” the preliminary
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injunction to a permanent injunction. United States v. Prater, No. 8:02-CV-2052-T-23MSS, 2005 WL 2715401, at *5 (M.D. Fla. Sep. 23, 2005). Instead, this Court may simply incorporate its prior findings and “recast” them in terms of the permanent-injunction standard. See id. Accordingly, this Court hereby expressly incorporates all findings from its prior order granting Plaintiffs’ motion for preliminary injunction, ECF No. 153.
II. Analysis This Court begins its analysis by addressing the merits of Plaintiffs’ three claims: deliberate indifference under the Eighth Amendment; discrimination under Title II of the Americans with Disabilities Act (“ADA”), and discrimination under the Rehabilitation Act (“RA”). See ECF No. 1. This Court then turns to the propriety of Plaintiffs’ additional requests for relief. Finally, this Court considers the requirements for a permanent injunction.
A. The Merits of Plaintiffs’ Claims 1. Deliberate Indifference Under the Eighth Amendment
The Eighth Amendment to the United States Constitution prohibits the government from inflicting “cruel and unusual punishments” on inmates. Wilson v. Seiter, 501 U.S. 294, 296–97 (1991). The Supreme Court has interpreted this prohibition to
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encompass “deprivations . . . not specifically part of [a] sentence but . . . suffered during imprisonment.” Id. at 297. Consequently, an inmate who suffers “deliberate indifference” to his “serious medical needs” may state a claim for a violation of the Eighth Amendment. Estelle v. Gamble, 429 U.S. 97, 104 (1976). To prevail on their claim of deliberate indifference, Plaintiffs must show (1) a serious medical need, (2) Defendant’s deliberate indifference to that need, and (3) causation between Defendant’s indifference and Plaintiffs’ injuries. Goebert v. Lee County, 510 F.3d 1312, 1326 (11th Cir. 2007).
This Court previously found that chronic HCV is a serious medical need. ECF No. 153, at 14–15. Defendant does not dispute that finding. ECF No. 270, at 17. Moreover, several other courts have since held that chronic HCV is a serious medical need. See, e.g., Stafford v. Carter, No. 1:17-cv-00289-JMS-MJD, 2018 WL 4361639, at *12 (S.D. Ind. Sep. 13, 2018); Pevia v. Wexford Health Source, Inc., No. ELH-16-1950, 2018 WL 999964, at *16 (D. Md. Feb. 20, 2018). Once again, this Court concludes that chronic HCV is a serious medical need.
This Court also previously found that Defendant was deliberately indifferent to Plaintiffs’ serious medical needs. ECF
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No. 153, at 16–24. Defendant does not dispute that either. See supra p. 4 (citing ECF No. 270). Of course, Defendant’s compliance with the preliminary injunction since its issuance does not absolve Defendant of liability. This Court may still take Defendant’s past actions into account. See, e.g., O’Shea v. Littleton, 414 U.S. 488, 496 (1974) (“[P]ast wrongs are evidence bearing on whether there is a real and immediate threat of repeated injury.”). Moreover, Defendant continues to oppose relief that this Court finds to be constitutionally required. See infra pp. 14–53. Given Defendant’s past actions as well as Defendant’s continued opposition to implementing constitutionally required relief, this Court finds that Defendant is being deliberately indifferent to Plaintiffs’ serious medical needs and that there is a real and immediate threat of repeated injury in the future.
Finally, as it did before, this Court finds that Plaintiffs have established causation. As Secretary of FDC, Defendant is ultimately responsible for FDC’s policies and practices. See § 20.315(3), Fla. Stat. As such, because Plaintiffs’ claim is based on inadequacies in FDC’s policy and the implementation of that policy, the causation element is satisfied. Cf. Cottone v. Jenne, 326 F.3d 1352, 1360 (11th Cir. 2003) (“[T]he causal connection may be
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Case 4:17-cv-00214-MW-CAS Document 465 Filed 04/18/19 Page 9 of 68
established when a supervisor’s custom or policy . . . result[s] in deliberate indifference to constitutional rights . . . .” (alteration in original) (internal quotation marks omitted)); Zatler v. Wainright, 802 F.2d 397, 401 (11th Cir. 1986) (same).
Thus, Plaintiffs have succeeded on the merits of their Eighth Amendment deliberate-indifference claim.
2. Discrimination Under Title II of the ADA3 Title II of the ADA provides in relevant part: Subject to the provisions of this subchapter, no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.
42 U.S.C. § 12132. “[T]he plain text of Title II of the ADA unambiguously
extends to state prison inmates . . . .” Pa. Dep’t of Corrs. v. Yeskey, 524 U.S. 206, 213 (1998). That is, “a disabled prisoner can state a Title II-ADA claim if he is denied participation in an activity provided in state prison by reason of his disability.” Bircoll v. Miami-Dade County, 480 F.3d 1072, 1081 (11th Cir. 2007).
3 This Court did not address Plaintiffs’ ADA claim in its order granting Plaintiffs’ motion for preliminary injunction. See ECF No. 153, at 13 n.12.
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Case 4:17-cv-00214-MW-CAS Document 465 Filed 04/18/19 Page 10 of 68
Although “the ADA . . . was never intended to apply to decisions
involving . . . medical treatment,” Schiavo ex rel. Schindler v.
Schiavo, 403 F.3d 1289, 1294 (11th Cir. 2005), the Supreme Court
has made clear that “medical ‘services’” fall within the ambit of
Title II, see Yeskey, 524 U.S. at 210. Therefore, a qualified inmate
who is denied the benefit of medical services by reason of his
disability can state a Title II ADA claim.4
Defendant does not dispute that a prison inmate can state a
Title II ADA claim for medical services. See ECF No. 270, at 28.
Rather, the only dispute regarding Plaintiffs’ ADA claim is
whether inmates can assert a disability en masse. See id. at 28–32;
ECF No. 342, at 21. This Court finds they cannot.
The ADA defines “disability” as “(A) a physical or mental
impairment that substantially limits one or more major life
activities of such individual; (B) a record of such an impairment;
4 See, e.g., Lonergan v. Fla. Dep’t of Corrs., 623 F. App’x 990, 994 (11th Cir. 2015) (unpublished) (holding that prison’s failure to give an inmate treatment prescribed by his dermatologist was “sufficient for the [inmate] to plead a prima facie ADA claim”); Stafford v. Wexford of Ind., LLC, No. 1:17-cv00289-JMS-MJD, 2017 WL 4517506, at *3 (S.D. Ind. Oct. 10, 2017) (“Plaintiffs do not complain[] about the quality of care administered by Wexford; rather, they assert that Wexford has refused to treat Plaintiffs’ disabilities, which is actionable under the ADA.”); Johnson v. Bryson, No. 5:16-cv-453-CAR-MSH, 2017 WL 3951602, at *1 (M.D. Ga. Sep. 8, 2017) (“[T]he ADA is not wholly inapplicable to claims based on deliberate indifference to an inmate’s medical condition.”).
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or (C) being regarded as having such an impairment.” 42 U.S.C. § 12102. A claimant only needs to satisfy one of those definitions. Gordon v. E.L. Hamm & Assocs., 100 F.3d 907, 911 (11th Cir. 1996). Here, Plaintiffs claim that they satisfy the first two. ECF No. 342, at 21. But Plaintiffs gloss over the mandatory individualized inquiry that accompanies both definitions.
Although Plaintiffs argue that “the case Defendant cites for the proposition that a disability determination is a highly individualized inquiry . . . was abrogated by the ADA Amendments Act of 2008 . . . and the Act’s implementing regulations,” ECF No. 362, at 13–14, the very regulations Plaintiffs rely on still require an “individualized” inquiry. Indeed, beginning with the first definition, the applicable regulation explicitly provides that “[t]he determination of whether an impairment substantially limits a major life activity requires an individualized assessment.” 28 C.F.R. § 35.108(d)(1)(vi) (emphasis added). This Court cannot ignore the plain meaning of the word “requires.”5 This is especially true given that another subsection of the same regulation also
5 “[A] regulation should be construed to give effect to the natural and plain meaning of its words.” Ala. Air. Pollution Control Comm’n v. Republic Steel Corp., 646 F.2d 210, 213 (5th Cir. Unit B May 1981).
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refers to the individualized inquiry using mandatory language.
Specifically, although a later subsection notes that “the
individualized assessment of some types of impairments will, in
virtually all cases, result in a determination of coverage,” it still
refers to the individualized assessment as being “necessary.”6 Id.
§ 35.108(d)(2)(ii).
These same requirements apply to the ADA’s second
definition of disability (i.e., the “record of” definition). Id.
§ 35.108(e)(2) (noting that “the principles articulated in paragraph
(d)(1) of this section apply”); § 35.108(d)(2)(ii) (referring to the
“‘record of’ prong). And, as Plaintiffs point out, “[b]ecause Congress
explicitly authorized the Attorney General to promulgate
regulations under the ADA . . . the regulations must [be given]
legislative and hence controlling weight.” ECF No. 362, at 15 n.8
(quoting Shotz v. Cates, 256 F.3d 1077, 1079–80 (11th Cir. 2001)).
6 It is no answer to harp on the fact that the assessment “should be particularly simple and straightforward.” 28 C.F.R. § 35.108(d)(2)(ii). No matter how easy or straightforward the “individualized assessment” is, it is still plainly “necessary.” Id.; see also Alston v. Park Pleasant, Inc., 679 F. App’x 169, 172 (3d Cir. 2017) (unpublished) (“We agree that cancer can—and generally will—be a qualifying disability under the ADA. Nevertheless, ‘[t]he determination of whether an impairment substantially limits a major life activity requires an individualized assessment.’ Although the ADAAA makes the individualized assessment ‘particularly simple and straightforward’ for diseases like cancer, an individualized assessment must still take place.” (citations omitted)).
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Because Plaintiffs assert their ADA claim as a class, and because an ADA claim requires an individualized inquiry, this Court must decertify the class as to Plaintiffs’ ADA claim. See, e.g., Stafford, 2018 WL 4361639, at *21 (decertifying class of HCVinfected inmates with respect to ADA claim because the claim requires an individualized assessment). However, given that Carl Hoffer is deceased, Ronald McPherson has been released from prison, and Roland Molina has been successfully treated, see ECF No. 269-1, at 2, the named Plaintiffs can no longer state individual ADA claims. As such, their ADA claims are denied as moot.
3. Discrimination under the RA7 “Discrimination claims under the Rehabilitation Act are
governed by the same standards used in ADA cases . . . .” Cash v. Smith, 231 F.3d 1301, 1305 (11th Cir. 2000). The only relevant difference is that the RA has a federal funding requirement. See, e.g., Badillo v. Thorpe, 158 F. App’x 208, 214 (11th Cir. 2005) (unpublished). It is undisputed that FDC receives federal funds. ECF No. 1, at 42; ECF No. 187, at 29. Accordingly, for the same reason this Court decertified the class with respect to the ADA
7 This Court did not address Plaintiffs’ RA claim in its order granting Plaintiffs’ motion for preliminary injunction. See ECF No. 153, at 13 n.12.
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claim, this Court also decertifies the class with respect to the RA claim. See supra pp. 9–13. Again, the named Plaintiffs’ individual RA claims are denied as moot.
B. Plaintiffs’ Additional Requests for Relief This Court did not address all of Plaintiffs’ requests for relief when it granted their motion for preliminary injunction. See ECF No. 185, at 2. Instead, this Court focused on what seemed to be the most pressing issues and noted that Plaintiffs were not precluded from seeking further relief later on. See id. Plaintiffs have taken advantage of this Court’s promise and now seek fifteen categories of additional relief. See ECF No. 342. This Court addresses each category in turn. 1. Routine Opt-Out Testing and an Aggressive Notice Campaign FDC uses an “opt-in” method of testing/screening inmates for HCV; i.e., inmates are asked if they want their blood tested for HCV and only receive the test if they respond affirmatively. See ECF No. 270, at 27; see also ECF No. 340-6, at 23–26. This is in contrast to an “opt-out” method, where patients are told they are going to be tested for HCV (among other things) and must explicitly ask to be excluded.
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Plaintiffs have asked for routine opt-out testing since the
inception of this case. See ECF No. 1, at 44. They claim that FDC
is knowingly undercounting the number of HCV-infected inmates
and that opt-out testing would capture a larger amount. See ECF
No. 342, at 24–27. They argue that FDC’s knowledge of the
problem and failure to remedy it constitutes deliberate
indifference:
Defendant knows that there are thousands more prisoners in its care who are infected with HCV and are at serious risk of damage to their health, but has deliberately remained ignorant of their identities, thereby ensuring they will never receive treatment. This “head-in-the-sand” approach amounts to clear deliberate indifference. See, e.g., Lancaster v. Monroe County, 116 F.3d 1419, 1425 (11th Cir. 1997).
Id. at 25.
At the evidentiary hearing in late 2017, Defendant’s medical
expert, Dr. Dewsnup, approved of opt-out testing but stated that
opt-in testing was also appropriate as long as it was combined with
“peer education.”8 ECF No. 340-19, at 46. However, FDC is only
employing peer education at two of its institutions and has no
8 Peer education consists of experienced inmates educating other inmates about HCV and its treatment. Dr. Dewsnup explained that the benefits of peer education are that inmate educators act as role models, speak the right “language,” and can be asked questions without fear of reprisal. See ECF No. 340-19, at 47.
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specified timeline for expanding the program statewide. ECF No. 340-6, at 71–77. Moreover, FDC is unaware of whether materials are given out as part of the program, how many inmate educators have been trained, or how many inmates have participated. Id. at 198.
FDC’s failure to implement peer education is also evident from the numbers. National estimates suggest that between 16% and 41% of the United States jail and prison population has HCV, translating to between 14,700 and 40,184 FDC prisoners. ECF No. 10-1, at 5, 12. Dr. Dewsnup believes the best estimate for FDC prisoners is approximately 20%. ECF No. 340-5, at 41–42. However, FDC has only identified 7,185 inmates as having chronic HCV; i.e., roughly 7%. ECF No. 453. Clearly FDC is undercounting the number of inmates with chronic HCV, and it unquestionably knows it is doing so. ECF No. 340-6, at 232–35. This struthious approach to treatment amounts to deliberate indifference as it allows FDC to avoid any further obligations simply by pretending sick inmates don’t exist.9
9 It is of no legal significance that FDC is being deliberately indifferent to inmates who are ignorant of their serious medical needs. The focus is on FDC’s knowledge, not the inmates’. See, e.g., Melton v. Abston, 841 F.3d 1207, 1224 (11th Cir. 2016) (“[A] finding of deliberate indifference requires a finding of the defendant’s subjective knowledge of the relevant risk . . . .”). To hold
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Consequently, something has to change. This Court is mindful of its role “not to supervise prisons but to enforce the constitutional rights of . . . prisoners.” Cruz v. Beto, 405 U.S. 319, 321 (1972); see also Bell v. Wolfish, 441 U.S. 520, 562 (1979) (cautioning federal courts not to become “enmeshed in the minutiae of prison operations”). However, time has also shown that FDC cannot be given free reign. Accordingly, this Court will offer Defendant two options. FDC can accept Plaintiffs’ proposal, which is to implement a system of opt-out testing along with an aggressive notice campaign. See ECF No. 342, at 24–27. Alternatively, FDC can accept the proposal of its own expert, Dr. Dewsnup, which is to undertake opt-in testing paired with peer education.10 See ECF No. 340-19, at 46.
Whichever option Defendant takes, the undertaking needs to be legitimate. FDC may not continue to use opt-in testing and only put forth a half-baked attempt at peer education. This Court is not choosing the best policy, but simply seeks to enforce the
otherwise would mean that FDC could avoid treating an insane inmate simply because he is unaware of his condition.
10 It is worth noting that Dr. Dewsnup also advised: “if it was going to cause a big kerfuffle, [he didn’t] think it’s worth the kerfuffle” to stick with optin testing. See ECF No. 340-19, at 46. Unless FDC operates under a policy of judicio-masochism, it would be wise to take the advice of its own experts.
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rights of prisoners. In sum, this Court finds that FDC is being deliberately indifferent by not following the advice of its own medical expert regarding a proper screening method.
2. Elastography “The principal consequence of [HCV] infection is infection of
the liver, which causes inflammation that in turn may result in scarring of the liver (fibrosis).” ECF No. 153, at 2. “The amount of liver scarring a patient has is usually measured on the METAVIR scale.” Id. at 3. “On this scale, a person can be classified F0 (no fibrosis), F1 (mild fibrosis), F2 (moderate fibrosis), F3 (severe fibrosis), or F4 (cirrhosis).” Id.
Both this Court and the parties have used the METAVIR scale to set appropriate medical deadlines. For instance, the preliminary injunction explicitly provides that “FDC must initiate treatment for all known chronic HCV inmates, who are eligible for treatment, and who have fibrosis stage 3, by December 31, 2018.” ECF No. 185, at 4. These deadlines are premised on the understanding that liver scarring presents serious medical consequences and that survival rates differ depending on the extent of scarring. Cf. ECF No. 153, at 3–6. As such, it is extremely important that inmates’ fibrosis levels are correctly identified.
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Currently, FDC is using FibroSure11 tests combined with ultrasounds to estimate fibrosis levels. See ECF No. 370, at 14–15. However, Plaintiffs’ medical expert, Dr. Koziel, claims that FibroSure is “only accurate about 70% of the time.” ECF No. 34034, at 1. She further notes that while FibroSure has “relatively good sensitivity and specificity for advanced fibrosis or complete lack of fibrosis, [it] is not as good for measuring patients in the middle of the spectrum.” Id. Thus, she claims “there is a significant likelihood that a patient with a FibroSure score of F1 may in fact have fibrosis in the range of F2 to F3” and that “a FibroSure test may miss fibrosis in a significant number of patients.” Id. at 1–2. Moreover, she believes that “[u]tilizing follow-up abdominal ultrasounds, while helpful, is not sufficient to identify these patients.” Id. at 2.
Instead of using the FibroSure-plus-ultrasound method, Plaintiffs want FDC to begin using elastography.12 ECF No. 342,
11 FibroSure is a “proprietary predictive index [that] utilizes a combination of age, sex, and a battery of laboratory parameters [from a blood test] to provide an estimate of the fibrosis stage.” ECF No. 369-3, at 2.
12 The parties haven’t explained what elastography is in great detail. To place things in context, this Court has taken judicial notice of certain facts that are not subject to reasonable dispute from sources whose accuracy cannot reasonably be questioned (at least not with respect to the facts at issue). Fed. R. Evid. 201(b)(2). From what this Court has gathered, elastography is a way
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at 27–29. Dr. Koziel states that “transient elastography is extremely accurate in detecting hepatic fibrosis, particularly for patients with moderate fibrosis (F1 to F2).” ECF No. 340-34, at 2. Although the gold standard for evaluating liver disease is (or, at least, was) the liver biopsy, Dr. Koziel believes that transient elastography is the “next most accurate” thing (and far less invasive). See ECF No. 361-3, at 34–35; ECF No. 10-1, at 7.
Dr. Dewsnup, on the other hand, sees things differently. Dr. Dewsnup believes “there is a lack of data to support” Dr. Koziel’s statement that FibroSure is only accurate about 70% of the time. ECF No. 369-3, at 2. While Dr. Dewsnup “would acknowledge that . . . predictive indices [(like FibroSure)] are less effective for distinguishing between those who are at Stage 2 or 3,” he believes they are “strongly predictive at identifying the individuals who have cirrhosis, and those who are at F0 and F1.” Id. Moreover, Dr.
of mapping the elastic properties of soft tissue (e.g., a liver) using various medical imaging techniques. See, e.g., Elastography, Wikipedia, https://en.wikipedia.org/wiki/Elastography [https://perma.cc/6A5K-FDUP] (hereinafter “Wiki”). One form of elastography using ultrasound imaging is referred to as “transient elastography,” which is used by the commercial system FibroScan. See id. A newer form of elastography using ultrasound imaging is referred to as point shear-wave elastography. See, e.g., Rosa M.S. Sigrist et al., Ultrasound Elastography: Review of Techniques and Clinical Applications, 7(5) Theranostics 1303, 1307–08 (2017). Finally, another form of elastography uses magnetic resonance imaging (“MRI”). See Wiki.
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Dewsnup states that “[t]he abdominal ultrasound can be used as a check to make sure that the patient is not worse than the proprietary score indicates.” Id. at 3.
From his experience, Dr. Dewsnup finds that “no one test will give you a perfect estimate of staging” and that, instead, “practitioners look for a concordance with the history, physical exam and symptoms, labs, and test results.” Id. He states that usually “there is concordance,” but “[i]n the limited circumstances in which that does not occur, . . . FDC has retained the option of using ultrasound elastography.” Id. Dr. Dewsnup “do[es] not believe [elastography] is necessary for all inmates who have cHCV, nor do[es] [he] believe that it is necessary for all inmates who are staged at F0-F2.” Id. at 4. Rather, he “believe[s] there should be physician discretion to use elastography for those inmates who are at F0 or F1 by FibroSure but have other laboratory or clinical indications that the stage may actually be higher.” Id. at 4.
After considering the statements of both sides’ experts, it seems that the propriety of using routine elastography is a matter of reasonable medical disagreement. Such disagreement does not amount to deliberate indifference. See, e.g., Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 1989) (“Mere medical malpractice,
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however, does not constitute deliberate indifference. Nor does a simple difference in medical opinion.” (citation omitted)). Accordingly, this Court finds that FDC is not constitutionally required to stage every HCV-infected inmate using elastography (despite the fact that it would probably be much better practice).
Having said that, this Court does find that FDC is constitutionally required to make the option of elastography available to its medical staff. Even Dr. Dewsnup believes that physicians should have the discretion to use elastography when necessary. ECF No. 369-3. While Dr. Dewsnup hoped that FDC
would be utilizing elastography within 6–12 months of the
preliminary-injunction hearing, id. at 5, it is this Court’s understanding that FDC is still not using any kind of elastography, see ECF No. 340-6, at 129. Instead, FDC merely has vague plans to obtain elastography machines at some unspecified time in the future. Id. at 129–30. Accordingly, this Court will require FDC to form a definite plan to make elastography available to its medical staff within a reasonably immediate timeframe and will require FDC to stick to that plan assuming this Court agrees with it.
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In sum, this Court finds that it is not deliberately indifferent for FDC to use the fibrosure-plus-ultrasound method of staging instead of elastography. However, this Court finds that it is deliberately indifferent for FDC not to have the option of elastography available to medical staff.
3. Treatment for F0 and F1 Inmates FDC is not prescribing DAAs to inmates with fibrosis scores
of F0 or F1.13 See ECF No. 340-23, at 8–10; ECF No. 340-6, at 129, 200. Instead, those inmates are only monitored. That is, they are “seen” in the clinic every six months, “receive laboratory testing” every six months, and receive “proprietary predictive indices and/or elastography” every twelve months. ECF No. 340-23, at 7.
Plaintiffs argue that F0 and F1 inmates should also be treated with DAAs. ECF No. 342, at 30–31. They claim that “[t]he only reason why FDC is electing not to provide treatment is due to the cost of treatment, which is per se deliberate indifference.” Id. at 30 (quoting Harris v. Thigpen, 941 F.2d 1495, 1509 (11th Cir. 1991)). This Court agrees.
13 Unless they have another unique qualifying condition. See ECF No. 340-23, at 8–10.
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Although Dr. Dewsnup testified that, with respect to the treatment of F0 and F1 inmates, “it’s safe to wait for a bit,” ECF No. 340-19, at 114, he never testified that F0 and F1 inmates should never be treated, see id. at 1–208. Indeed, his statement was simply made in the context of a preliminary-injunction hearing and faced with the need to triage thousands of inmates. See id. at 117–18. FDC has not put forth any medical reason (nor does the record otherwise reveal a medical reason) why F0 and F1 inmates should not be treated. Rather, as Dr. Dewsnup explicitly noted, F0 and F1 inmates must be treated eventually. Id. at 120 (“[W]e’re going to have to treat eventually even if they are Stage 0 or Stage 1 . . . .”).
Meanwhile, F0 and F1 inmates face substantial suffering and harm. Dr. Koziel explained that HCV infection can result in many symptoms, that there isn’t an “absolute correlation” between symptoms and fibrosis stage, and that even F0 and F1 inmates can suffer symptoms. ECF No. 361-3, at 45–48. And both Dr. Koziel and Dr. Dewsnup agreed that—even for F0 and F1 inmates— successful treatment of HCV tends to decrease mortality rates. ECF No. 340-40, at 58.
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While Defendant claims that this Court already “rejected” treatment for F0 and F1 inmates, ECF No. 370, at 17, that was only this Court’s holding at the preliminary-injunction stage. This Court was focused on ensuring that the sickest inmates were treated first and understood that—as a practical matter—it was unrealistic to order FDC to treat everyone immediately. See ECF No. 340-19, at 130–31. But fifteen months have passed since then, and FDC has begun or completed treating almost 5000 inmates within that time. See supra p. 4. FDC can no longer use resource limitations and implementation difficulties as an excuse to delay treatment.
This Court is not alone in recognizing that F0 and F1 inmates must be treated. Indeed, a court in Indiana granted summary judgment in favor of a class of inmates as to their deliberate-indifference claim and found that the undisputed evidence in the case showed that all inmates with chronic HCV should be treated. See Stafford, 2018 WL 4361639 at *18–20. And a court in Pennsylvania denied the prison defendants’ motion for summary judgment because it found that there was a genuine dispute of material fact as to whether they were being deliberately indifferent by not treating F0 and F1 inmates. Chimenti v. Wetzel,
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No. 15-3333, 2018 WL 3388305, at *10–12 (E.D. Pa. July 12, 2018).14 Finally, although a third court declined to order treatment of F0 and F1 inmates at the preliminary-injunction stage, it still recognized that the inmate plaintiffs “raise[d] substantial doubts” about the defendants’ failure to treat F0 and F1 inmates. Buffkin v. Hooks, No. 1:17CV502, 2019 WL 1282785, at *9 (M.D.N.C. Mar. 20, 2019). Further, that court enjoined the enforcement of the prison’s HCV policy because of the risk “that the policy might be construed to prohibit or prevent doctors from administering DAAs to any prisoner with HCV whose FibroSure score is below F2.” Id.
As far as timing, Plaintiffs propose that F0 and F1 inmates be treated within two years of staging. See ECF No. 342, at 30–31. Defendant does not propose an alternative date (other than never). See ECF No. 370. Given FDC’s progress in treating inmates within the past fifteen months, see supra p. 4, this Court finds a two-year deadline to be appropriate. Indeed, considering that FDC has been able to begin or complete treatment of almost 5000 inmates within the past fifteen months, FDC should be able to begin treating the
14 The case has since settled. See Order, Chimenti v. Wetzel, No. CV 153333 (E.D. Pa. Feb. 7, 2019), ECF No. 139.
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~4000 known F0 and F1 within the next two years. See ECF No. 453, at 2–3.
In sum, this Court finds that even F0 and F1 inmates have serious medical needs, FDC is aware of those needs, and FDC’s decision not to treat those inmates—without any medical reason for that decision—constitutes deliberate indifference.
4. Informed Refusals and Proper Education FDC’s policy provides that “[o]nce patients are found to be
infected with chronic HCV, they should be counseled by a clinician during the initial visit regarding the natural history of the infection, measures to assess the progress of cHCV, potential treatment options, and specific measures to prevent transmitting the HCV infection to others.” ECF No. 340-23, at 6. The policy does not provide for any counseling or education after an inmate rejects a procedure. See id. at 1–14. As of March 2019, 61 inmates have refused to participate in the staging process and 171 inmates have refused DAA treatment. ECF No. 453, at 2, 4.
As Plaintiffs rightfully point out, these refusal statistics “are incredibly high numbers given the 95% cure rate, absence of side effects, and devastating consequences of the disease.” ECF No. 342, at 31. Plaintiffs argue “[t]he only logical inference is that the
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vast majority of these patients were not fully informed of the above information.” Id. at 31–32. In support, Plaintiffs cite the declarations of three inmates who refused staging because they were not adequately informed of the process. Id. at 32. All three inmates state that they would have consented had they been properly informed. Id.
In response, FDC cites the declaration of Dr. Alvia Varona, who claims she personally counselled one of the three inmates Plaintiffs refer to. ECF No. 370, at 20. Dr. Varona states that during her encounter with the inmate she “explained the blood draw . . . and told him the labs were absolutely necessary in order for him to be evaluated for curative treatment for cHCV.” ECF No. 374-1, at 2. However, Dr. Varona does not state whether she told the inmate about DAAs or why his blood test was different than the others he had been offered for years. See id. And the inmate states that Dr. Varona failed to provide him that information. ECF No. 377-1.
FDC also cites the declarations of two nurses who claim that they provide educational information about HCV to newly incarcerated inmates at two of FDC’s reception centers. ECF No. 370, at 19 (citing ECF No. 369-4, ECF No. 369-5). One of the nurses
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further states that when an inmate refuses to have their blood drawn for HCV testing she “provide[s] more education to the inmate about cHCV, particularly about the risks of refusing treatment, in an effort to get them to consent to being screened.” ECF No. 369-4, at 1–2. But what the nurses don’t say is whether they educate inmates about DAAs, the significance of the new HCV tests FDC is using, and FDC’s obligations for treatment as a result of this litigation. See ECF No. 369-4; ECF No. 369-5. Moreover, the two nurses can only speak for the education they provide at their two institutions; they don’t explain what is happening at the many other institutions FDC operates.
In short, Plaintiffs have presented evidence showing that inmates are not being properly informed after refusing HCVrelated medical care. The declarations prepared by Dr. Varona and the two nurses do not create a genuine dispute of material fact as to that issue.15 And, just as FDC cannot avoid its duty to treat by knowingly undercounting inmates, see supra p. 16, FDC also cannot avoid its duty to treat by knowingly keeping inmates underinformed. Accordingly, this Court agrees with Plaintiffs that
15 Nor do the other cited declarations. See ECF No. 369-7, ECF No. 3698, ECF No. 369-9.
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“a section [must] be added to [FDC’s] policy requiring an explanation to anyone who refuses staging or treatment of, at least, a) the consequences of HCV, b) the availability, lack of side effects, and efficacy of the new medications, c) the staging process, and d) whether and when they will receive treatment.” ECF No. 342, at 32. This is so because it would be deliberately indifferent to avoid treating HCV-infected inmates by keeping them uninformed about the nature of their treatment.
Defendant can rest assured that this relief will not “usurp Centurion’s[16] medical judgment.” See ECF No. 370, at 21. It goes without saying that medical staff will still retain their independent medical judgment when informing inmates. For example, staff will not be required to tell inmates that DAAs have no side effects, but they must be informing inmates that DAAs have far fewer side effects than the previous regimen. Cf. ECF No. 153, at 6–7.
5. Shortening the Staging Deadline and Requiring Reliance on the Most Serious Test Result FDC’s policy provides that inmates must be staged within 90
days of confirming they have chronic HCV. ECF No. 340-23, at 6.
16 FDC has outsourced its provision of medical care to Centurion, a private contractor. See ECF No. 153, at 10–12.
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This Court originally set the deadline at 60 days but later extended it at Defendant’s request. ECF No. 243. This Court granted the extension because it accepted Defendant’s representation that FDC needed additional time for inmates to undergo “ultrasound or ‘EGD’ tests” with outside vendors. See id. Plaintiffs now claim that “further discovery has demonstrated that the deadline should actually be shortened to 30 days.” ECF No. 342, at 33. This Court agrees.
As Plaintiffs point out, “[s]taging is simply determining a patient’s fibrosis level.” Id. The record now reveals that FDC is relying almost exclusively on the FibroSure to determine fibrosis levels. See supra p. 19; see also ECF No. 370, at 14–15; ECF No. 340-6, at 119–20. Although Defendant claims that FDC also uses ultrasounds to stage inmates, see ECF No. 370, at 22–23, the truth is that ultrasound results can only make an inmate’s stage go up (by indicating the presence of cirrhosis). Dr. Dewsnup made clear that “the ultrasound is not used to estimate. It’s not used to estimate staging. It’s used to rule out occult portal hypertension and cirrhosis. It’s just a part.” ECF No. 340-5, at 76; see also ECF No. 340-19, at 75. Dr. Cherry, Centurion’s Medical Director for the State of Florida, testified similarly:
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Q. So everybody gets the initial staging from the FibroSure, right?
A. Right.
Q. And some portion of those patients the staging could be changed based on the results of the ultrasound?
A. No. We just go by the FibroSure only.
Q. Just by the FibroSure only?
A. Right.
Q. So –
A. It’s not as accurate, but that’s what we are doing.
Q. Okay. So the staging -- the initial staging that happens with the FibroSure is done when the FibroSure happens?
A. Right.
Q. And the follow-up ultrasounds are to screen for abnormalities?
A. Right. Well, it allows you to – you have somebody that’s an F4, okay, on the FibroSure test, you do the ultrasound, it can be absolutely normal because the FibroSure is not – does not have a hundred percent specificity obviously. So we find that kind of information.
And also if they have F4, F3, you are doing an ultrasound to see, like I said before, what’s going on with the spleen. If it’s enlarged, its an indirect indication of significant cirrhosis or some kind of fibrosis or whatever in the liver. You also use that to calculate a platelet screen ratio.
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ECF No. 340-4, at 48–49. Since inmates can be initially staged using a FibroSure, the
staging deadline must only be based on the time it takes to get those results. Indeed, it is critical that the staging deadline is only as short as necessary because treatment deadlines run from the date an inmate is staged. In other words, if the staging deadline is artificially long, then that enables FDC delay treatment for a nonmedical reason.17 “[A] deliberate delay in rendering necessary medical treatment for non-medical reasons is enough to state a deliberate indifference claim.” Melton, 841 F.3d at 1229.
Plaintiffs claim that “[i]t only takes five days from the initial blood draw to get the [FibroSure] results,” ECF No. 342, at 33, and that “[t]here is no reason why the vast majority of patients cannot simply be staged initially within 30 days,” id. at 35. In a Rule 30(b)(6) deposition, Dr. Keller, the Chief Medical Officer for Centurion, and Victoria Love, the Vice President of Operations for Centurion of Florida, also indicated that it should only take five
17 Not only does an artificially long staging deadline enable FDC to delay treating inmates, it also enables FDC to avoid treating some inmates altogether because some inmates will have insufficient time remaining on their sentences—time they would have otherwise had but for the artificially long staging period. See infra pp. 38–40 (discussing the exclusion for time remaining on sentence).
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days to obtain FibroSure results. See ECF No. 340-6, at 118–19. However, Ms. Love has since stated in a declaration that “all results are not received within that amount of time.” ECF No. 36911, at 2. Rather, she claims “[t]here is a range of time for the receipt of the FibroSure results, and five days is the soonest amount of time.” Id. Ms. Love does not state what the outer limit is for receiving results. See id.
To the extent Ms. Love’s declaration contradicts what she stated at her deposition, the declaration may be disregarded. See, e.g., Van T. Junkins & Assocs., 736 F.2d 656, 657 (11th Cir. 1984) (“When a party has given clear answers to unambiguous questions which negate the existence of any genuine issue of material fact, that party cannot thereafter create such an issue with an affidavit that merely contradicts, without explanation, previously given clear testimony.”). Regardless, Ms. Love did not state—and FDC has not otherwise shown—that FibroSure results cannot be obtained within thirty days. See ECF No. 369-11; see also ECF No. 370, at 21–23. As such, this Court finds that the staging deadline must be shortened to thirty days. Having the staging deadline any longer amounts to deliberate indifference because it delays (and in
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some cases excludes) an inmate’s necessary treatment without a medical reason.
To be clear, the thirty-day deadline does not mean that an inmate must be given an ultrasound within thirty days. As already mentioned, an inmate can be initially staged using a FibroSure.18 See supra pp. 29–31. To the extent an inmate needs an ultrasound and the ultrasound reveals that the inmate is in a worse condition, the inmate can be restaged to a higher level and placed on a shorter treatment timeline. Ms. Love states that ultrasound results can be obtained within 90 days of the date a patient is found to be positive for chronic HCV. ECF No. 369-11, at 2. Accordingly, any necessary ultrasounds must occur within 90 days of the date an inmate is diagnosed with chronic HCV. Any necessary restaging must occur within five days after the ultrasound results are obtained.
Finally, Plaintiffs are right that it must be explicit in FDC’s policy that “FDC must rely on the test, exam, or study indicating the highest fibrosis level.” ECF No. 342, at 35; see also id. (“That is, if one indicator shows F3 but another shows F2, FDC must stage the patient at F3.”). Defendant’s only counterargument is that
18 Of course, the deadline might have to be modified if FDC voluntarily switches to using elastography instead of FibroSure tests.
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Plaintiffs have failed to “supply any testimony or documents to suggest this is not already being done.” ECF No. 370, at 23. What Defendant fails to recognize is that it has a “long and sordid history” of failing to treat HCV-infected inmates. See ECF No. 153. As a result, even if FDC is already relying on the most serious test result, that requirement must be explicit in the policy to prevent any confusion or relapse in the future.
6. Shortening the Treatment Deadlines and Making them Mandatory FDC’s policy states that inmates in Priority 1 “should”
receive treatment within six months and that inmates in Priority 2 “should” receive treatment within twelve months. ECF No. 34023, at 9. Plaintiffs argue that “the policy should be edited to clarify that these are mandatory deadlines, not aspirational goals,” and that “the deadlines should be shortened.” ECF No. 342, at 36.
This Court finds that FDC’s policy needs to have mandatory deadlines. Defendant’s only counterargument is that “[c]reating mandatory deadlines would completely remove medical judgment from the treatment of the inmates, and would not account for the individual circumstances of different inmates.” ECF No. 370, at 24. But Defendant fails to adequately explain why mandatory
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deadlines would be unworkable. This Court set several deadlines in its preliminary injunction, and Defendant seems to understand those are mandatory. This Court sees no reason why the case should be any different when those deadlines are in FDC’s policy.
Moreover, contrary to Defendant’s assertion, adding mandatory deadlines to FDC’s policy does not mean that all “medical flexibility to treat the patient would be removed.” Cf. id. at 25. The policy still permits medical staff to temporarily exclude an inmate from treatment if the inmate isn’t ready for it. See ECF No. 340-23, at 10. That exclusion necessarily includes inmates who are “not cooperative with the process of being diagnosed, staged, and evaluated.” Cf. ECF No. 370, at 25.
However, this Court finds that the deadlines do not need to be shortened. While it might be ideal to have shorter treatment deadlines, Plaintiffs have failed to show that the current deadlines result in deliberate indifference. In fact, the only support Plaintiffs offer for shorter deadlines is a settlement entered into by the Massachusetts Department of Corrections. See ECF No. 342, at 36. The fact that one state’s prison system settled for a shorter deadline does mean every state must follow suit. Besides, this Court decided on the deadlines it set at the preliminary-injunction
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stage because they were supported by Dr. Dewsnup’s testimony. Plaintiffs have failed to provide any medical evidence suggesting that the deadlines should be shortened. Thus, this Court cannot conclude that the current deadlines amount to deliberate indifference.
7. Restaging F0, F1, and F2 Inmates Every 6 Months FDC’s policy provides that F0, F1, and F2 inmates shall be
“seen” and “receive laboratory testing” every six months but only be restaged every twelve months. ECF No. 340-23, at 7. Plaintiffs argue that these inmates should instead be restaged every six months. ECF No. 342, at 36–37. This Court disagrees.
While it might be better to have inmates restaged every six months, that does not make it constitutionally required. Moreover, contrary to Plaintiffs’ representation, “both Dr. Dewsnup and Dr. Koziel” did not recommend restaging every six months. Cf. id. at 37. While Dr. Koziel did make such a recommendation, ECF No. 340-34, at 2, Dr. Dewsnup simply said that “continual monitoring and serial evaluation is . . . critical.” ECF No. 340-19, at 161. When asked whether “that would include monitoring or drawing labs every 3 to 6 months,” Dr. Dewsnup replied: “That’s correct. And doing imaging studies probably every year. I think we are
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stabilizing it about a year for serial elastography.”19 Id. (emphasis added).
Additionally, Dr. Keller recommends against restaging every six months. ECF No. 369-10, at 3. He states that it would not bring “any significant medical benefit.” Id. Further, he states that he is “not aware of any medical literature that would support this request.” Id. Finally, he notes that “[i]n the rare instance in which an inmate in stages F0-F2 were to show signs of rapid progression, medical staff has the discretion to re-order a FibroSure for updated staging.” Id. at 3–4.
Consequently, this Court finds that there is reasonable medical disagreement about whether F0, F1, and F2 inmates should be restaged every six months. As previously explained, such disagreement does not amount to deliberate indifference. See, e.g., Waldrop, 871 F.2d at 1033. Therefore, this Court cannot order FDC to restage F0, F1, and F2 inmates every six months.
However, even Dr. Keller recognizes that medical staff should have the discretion to restage inmates sooner than
19 This Court understands that “imaging studies” are not the same thing as a FibroSure test. However, they are both tools for restaging. And Dr. Dewsnup has already stated that he finds them effectively equivalent. See supra pp. 20–21. Given that context, Dr. Dewsnup can be understood to be recommending restaging once a year.
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scheduled. ECF No. 369-10, at 3–4. FDC’s policy does not explicitly
allow for such discretion. See ECF No. 340-23, at 7. Given FDC’s
past and the potential for relapse in the future, it is important that
the policy include clear directives. Accordingly, this Court finds
that FDC’s policy must be amended to make clear that medical
staff have the discretion to restage inmates sooner than scheduled.
Denying such discretion amounts to deliberate indifference.
8. The Exclusion for Time Remaining on Sentence
FDC’s policy excludes from treatment anyone who does not
have sufficient time remaining on their sentence in the Department of Corrections to complete pre-treatment evaluation, a course of treatment (lasting between 824 weeks) and post treatment SVR[20] assessment at 12 weeks after treatment is completed, in order for patient education and system efficiencies to be evaluated (generally, this requires approximately 1218 months).
ECF No. 340-23, at 10.
Plaintiffs argue that this exclusion should be amended in
several respects. ECF No. 342, at 37–38. This Court agrees.
First, this Court finds that the exclusion must not refer to
“pre-treatment evaluation.” FDC only considers the exclusion after
20 SVR stands for sustained viral or virologic(al) response. See ECF No. 340-19, at 58; ECF No. 10-1, at 9. The term is used to describe the condition of having cleared a virus on a certain date after treatment. See ECF No. 340-19, at 59; ECF No. 10-1, at 9.
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an inmate has already been evaluated.21 See ECF No. 340-6, at 84, 121–22. As such, leaving in the requirement that there be time for pre-treatment evaluation will only cause confusion and increase the potential for unwarranted future exclusions. Plaintiffs are correct in noting that “it’s important for the policy to be precise and accurate because it will be relied upon by practitioners long after this case is over and therefore must be easily understood by someone unfamiliar with this case.” ECF No. 378, at 13.
Second, this Court finds that the exclusion must not refer to “post treatment SVR assessment.” The only rationale FDC offers for post-treatment testing is that it allows FDC to make sure the program is working and to make improvements to the program in the future. See ECF No. 370, at 29–32 (citing ECF No. 369-3). While that is certainly a worthwhile goal, that goal only helps make treatment generally better for inmates in the future, it’s not
21 Defendant harps on the need “to do a pre-treatment evaluation of such things as [an inmate’s] readiness and willingness to adhere to the treatment.” ECF No. 370, at 28. This Court is not holding that FDC cannot conduct such an evaluation. Rather, this Court is simply acknowledging the fact that—according to Defendant’s Rule 30(b)(6) representative—the decision to exclude an inmate for remaining time on their sentence isn’t made until after an evaluation has occurred. That is, the inmate has already been evaluated for readiness and willingness to adhere to treatment.
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a medical reason to withhold treatment from a specific inmate in the present.
Finally, this Court finds that the exclusion must not include the “12-18 months” estimate. Given that pre-treatment evaluations and post-treatment SVR assessments will no longer be taken into account, an inmate shouldn’t need twelve to eighteen months remaining on their sentence. Instead, the inmate—who has already been staged and evaluated—simply needs to have “sufficient” time remaining on their sentence to complete a course of treatment.
In sum, this Court finds that the exclusion for time remaining on an inmate’s sentence contains language that will lead to an inmate being excluded from necessary treatment for non-medical reasons. Such exclusion amounts to deliberate indifference.
9. Referrals to Health Clinics for Those Being Released Plaintiffs argue that inmates who are deemed ineligible
based on insufficient time remaining on their sentence “should be referred to community health centers to obtain treatment and testing.” ECF No. 342, at 39. However, “FDC already provides prerelease planning for inmates who need continuity of health care
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when they are released.” ECF No. 370, at 32. Plaintiffs have offered no legal basis for ordering FDC to do any more than it is already doing in that respect. Accordingly, Plaintiffs’ request is denied.
10. Exclusion for High-Risk Behaviors FDC’s policy excludes from treatment anyone who does not
“demonstrate willingness and an ability to adhere to a rigorous treatment regimen and to abstain from high risk behaviors while incarcerated.” ECF No. 340-23, at 10. Plaintiffs argue that this exclusion should be amended in several respects. ECF No. 342, at 39–41. This Court agrees in part and disagrees in part.
First, this Court finds that “not all infractions should result in automatic exclusions.” Cf. id. at 39. Treatment can only be delayed for “medical reasons.” See Melton, 841 F.3d at 1229. As such, unless there is a medical reason to exclude an inmate from treatment based on a single infraction, the inmate must not be excluded. However, the question is not—as Plaintiffs propose— simply whether the behavior has “any bearing on whether a patient will show up to the pill line every day.” ECF No. 342, at 30. Rather, as Dr. Dewsnup points out, “ineligibility is a clinical judgment that must be made by physicians who take into
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consideration many factors on a case-by-case basis.” ECF No. 3693, at 8.
Of course, it is impossible for this Court to list each and every type of behavior that might render an inmate ineligible. This Court is not a medical professional, and, as Dr. Dewsnup stated, exclusions require a case-by-case analysis. However, Defendant must be aware that the acts of consuming illicit drugs or fighting other inmates, in and of themselves, are not valid reasons to exclude treatment. This is true even if an inmate is using intravenous drugs and risks re-infecting himself with HCV.22 What matters is whether there is a “medical reason” to deny treatment. If medical staff conclude that that there is a medical reason to deny an inmate treatment because of the inmate’s illicit drug use or fighting, then so be it. If FDC begins abusing the exclusion by excluding inmates without a valid medical reason, then Plaintiffs can move this Court to find Defendant in violation of the permanent injunction.
22 Cf. Reid v. Clarke, No. 7:16-cv-00547, 2018 WL 3626122, at *4, n.2 (W.D. Va. July 30, 2018) (“Take a prisoner who cuts his own wrists. A prison would have little basis to refuse treatment on the grounds that he himself had created the harm, or that he might try to commit suicide again.”).
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Second, this Court finds that the policy must be amended to clarify that these are temporary ineligibilities, not permanent exclusions. FDC and its experts seem to agree that the exclusion is only “temporary.” See ECF No. 370, at 34–35. Although the policy already states that inmates are only ineligible “until [their] issues are considered to be resolved,” ECF No. 340-23, at 10, the policy must be amended to minimize any confusion.
Third, this Court disagrees that FDC should be required to re-evaluate inmates after a period of no more than three months. See ECF No. 342, at 41. Plaintiffs have failed to provide a legal basis for that requirement. And both Dr. Keller and Dr. Dewsnup state that the question is determined on a case-by-case basis. See ECF No. 340-6, at 125 (“I think it’s on a case-by-case basis, but as a general rule, I believe it’s six months, but that’s not a hard-andfast rule.”); ECF No. 369-3, at 8.
Finally, this Court finds that “the language in J.3 implying that patients can be excluded for vague things like ‘chronic disciplinary issues’ or ‘chronic behavioral management issues’” must be amended. See ECF No. 342, at 41. Defendant admits that FDC considers these factors to be a basis for ineligibility. ECF No. 370, at 36. As this Court just explained, FDC must be mindful of
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the fact that a history of “chronic disciplinary issues,” in and of itself, is not a valid reason to exclude an inmate. Indeed, there are plenty of disciplinary issues that do not bear on an inmates’ ability to “maintain a therapeutic provider-patient relationship.”23 Cf. id.
In sum, this Court finds that the exclusion for high-risk behaviors includes language that will lead to an inmate being excluded from necessary treatment for non-medical reasons. Such exclusion amounts to deliberate indifference.
11. Clarifying MELD Score Calculation and Liver Transplant Policy Sometimes HCV infections can cause so much damage to a
patient’s liver that the patient needs a liver transplant. See ECF No. 10-1, at 6. Indeed, “HCV is . . . the most common reason for liver transplants in the United States.” Id. at 3. Accordingly, FDC’s policy includes a section on liver transplants. ECF No. 340-23, at 13. Both sides seek to amend the section. ECF No. 342, at 41–43; ECF No. 370, at 38–40. This Court begins with Plaintiffs’ requests and then turns to Defendant’s.
23 For example, an inmate who is repeatedly found in possession of “excess photographs” could be considered to have chronic disciplinary issues. See Fla. Admin. Code R. 33-602.201(5)(a)(2). This Court can conceive of no reason how that history, in and of itself, could constitute a medical reason to deny treatment.
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First, this Court agrees with Plaintiffs that “decompensation” must be defined as “the presence of encephalopathy, ascites, bleeding varices, or jaundice.” See id. at 41. Dr. Keller states that is the “standard medical definition.” ECF No. 340-6, at 86; see also ECF No. 369-10, at 4. Moreover, Defendant does not object to including that definition in the policy. ECF No. 370, at 38.
Second, this Court agrees with Plaintiffs that “it [must] be clarified to state that patients will be referred if they have any one of the listed items.” ECF No. 342, at 41–42. Defendant does not object to that request. See ECF No. 370, at 37–43. Moreover, there is no dispute that any one of the listed conditions qualifies an inmate for referral. See id. at 38–39.
Third, this Court disagrees with Plaintiffs that “the policy should require that MELD scores be calculated every 30 days.” ECF No. 342, at 42. Dr. Dewsnup testified that MELD scores cover a three-month period. See ECF No. 340-19, at 156–57. Moreover, Dr. Keller states that “he would not recommend a 30-day recalculation of MELD for patients who have decompensated cirrhosis.” ECF No. 369-10, at 5. He explains that “inmates with anemia can ill afford a regular 30-day blood loss” and “drawing
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blood every 30 days could cause an inmates’ veins to collapse.” Id. Plaintiffs offer no contrary medical evidence. See ECF No. 342, at 41–43; see also ECF No. 378, at 18–19.
Fourth, this Court agrees with Plaintiffs that referrals “must be [initiated] within 30 days of any one of the triggering events.” ECF No. 342, at 42. There is no apparent medical reason to justify more than such a delay. And Defendant “do[es] not oppose the incorporation of a 30-day period-of-time for a referral,” as long as it only constitutes the deadline for initiation. ECF No. 370, at 40.
Fifth, this Court agrees with Plaintiffs that “the policy [must] require the FDC to promptly comply with the transplant center’s request for records and other information, and to promptly transport the inmate to and from the transplant center.” ECF No. 342, at 42–43. Defendant does not offer any medical reason why it should be permitted to delay complying with such requests. ECF No. 370, at 42. And Defendant’s long and sordid history shows that there is a risk of future harm absent clear instructions.
Finally, this Court disagrees with Defendant’s request to revise the list of qualifying conditions. See ECF No. 370, at 38–39. Defendant offers no medical reason to remove the “significant complication or co-morbidity of cirrhosis” language. See ECF No.
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370, at 39–40. Instead, Defendant simply notes that it “would be difficult for providers to interpret and apply consistently.” Id. at 40. That difficulty is not a medical reason to deny an inmate access to a liver transplant.24 Moreover, that argument is inconsistent with Defendant’s position that medical staff must be given sufficient discretion. See, e.g., id. at 10 (claiming that Plaintiffs’ requested relief “shockingly seeks to remove medical judgment and discretion”).
However, this Court agrees with Defendant that “for individuals who have been scheduled to receive DAA medication, are undergoing DAA treatment, or who have finished DAA treatment, a referral [must] be made only if the post-treatment MELD score is over 15.” Id. at 39. Dr. Keller believes that is appropriate because DAAs “have the potential of lowering one’s degree of fibrosis and the MELD score.” ECF No. 369–10, at 4. Plaintiffs have offered no evidence to the contrary. See ECF No. 342, at 41–43; ECF No. 378, at 18–19.
24 If anything, it might mean that the language needs to be further clarified.
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12. Clarifying Exclusion for Life Expectancy FDC’s policy excludes from treatment anyone who does not
“have a life expectancy sufficient to achieve a benefit from HCV viral eradication.” ECF No. 340-23, at 10. Plaintiffs argue that “the policy should state that a patient is only ineligible if he or she has a life expectancy of less than 18 months.” ECF No. 342, at 43. This Court disagrees.
The only support Plaintiffs offer for their request is the fact that the Federal Bureau of Prisons (“BOP”), Massachusetts, and Minnesota use eighteen months for their life-expectancy exclusions. See id. Neither the BOP, nor Massachusetts, nor Minnesota sets the national standard for what is appropriate. Moreover, Dr. Dewsnup states that if Plaintiffs’ request were implemented, “FDC physicians would be less able to make decisions that were individualized to the patient’s unique circumstances.” ECF No. 369-3, at 10. As such, there appears to be a medical reason to justify the current wording of FDC’s exclusion.
In sum, Plaintiffs have failed to show that the exclusion for life expectancy amounts to deliberate indifference.
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13. Correcting the Risk Factors FDC’s policy provides that “[r]isk factors for [HCV] infection
may include, but are not limited to, injection drug use, transfusion with HCV-infected blood or blood products, tattooing, vertical transmission from mother to child, and massive exposure to HCVinfected blood during fighting or other trauma.” ECF No. 340-23, at 1. Plaintiffs argue that the list of risk factors should also explicitly include “being born between 1945 and 1965, previous incarceration, and HIV.” ECF No. 342, at 43. This Court agrees. Dr. Dewsnup admitted that previous incarceration and being born between 1945 and 1965 should be included as risk factors. ECF No. 340-5, at 141. And he also stated that the co-infection rate of HCV and HIV “is somewhere between 25 and 40 percent.” Id. at 16–17.
In response, Defendant notes that screening for HCV is offered to all patients “regardless of risk factors.” ECF No. 370, at 46 (quoting ECF No. 340-23, at 6). But that argument misses the point. Risk factors affect the decision-making of an inmate who might be concerned whether he should self-select for screening. By giving inmates more risk factors, inmates can make betterinformed decisions, which should lead to greater number of HCVinfected inmates being tested. Contrarily, by minimizing the list of
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risk factors, FDC can avoid its duty to treat by keeping inmates underinformed and remaining ignorant of the true number of infected inmates. In sum, FDC’s current wording of the risk-factor language amounts to deliberate indifference.
14. Monitoring This Court’s preliminary injunction requires Defendant to
file monthly status reports outlining FDC’s progress in treating HCV-infected inmates. See ECF No. 185, at 5–6; see also id. at 2 n.1 (“Like President Ronald Reagan, this Court will ‘trust but verify.’”). The injunction requires Defendant to include specific statistics like, for example, “[t]he total number of inmates in FDC custody who have been identified as having chronic HCV.” Id. at 6. Plaintiffs claim that the reports are “not sufficient . . . to adequately ensure that Defendant is in compliance.” ECF No. 342, at 44–46. Accordingly, Plaintiffs propose several changes to the monitoring scheme. This Court agrees in part and disagrees in part.
First, this Court finds that the monthly status reports must include the total number of inmates who
(a) have been screened/tested for HCV, (b) have been identified as having chronic HCV,
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(c) have been identified as having chronic HCV and have been staged (which must be further broken down by stage, including F0, F1, F2, F3, F4, decompensated cirrhosis, and those with HIV),
(d) have been submitted to the Hepatitis C Committee for evaluation (which must be further broken down by stage, including F0, F1, F2, F3, F4, decompensated cirrhosis, and those with HIV),
(e) have begun treatment with DAAs, (f) have completed treatment with DAAs, (g) have achieved a sustained virologic response (SVR), (h) have not achieved SVR, and (i) have been deemed (temporarily or permanently)
ineligible for treatment with DAAs along with the specific reason for ineligibility.
See ECF No. 342, at 44. This information is necessary for this
Court to ensure that the permanent injunction is being complied
with and that FDC has not relapsed to its sordid past. Cf., e.g.,
Wishtoyo Found. v. United Water Conservation Dist., No. CV 17-
3869-DOC (PLAx), 2018 WL 5256099, at 75 (C.D. Cal. Sep. 23,
2018) (appointing a special master to “monitor compliance” with a
permanent injunction and retaining jurisdiction “for the purposes
of enforcing or modifying the terms of” a permanent injunction).
Second, this Court finds that Defendant’s reports must
include a certification regarding FDC’s compliance “with the
applicable deadlines for prisoners known to have chronic HCV in
December 2017.” Id. Again, this information is necessary to ensure
compliance with this Court’s permanent injunction.
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Third, this Court disagrees that Defendant must provide Plaintiffs with updated versions of its spreadsheets or “all documentation” associated with prisoners deemed ineligible for treatment or who refuse staging See id. at 45. The status reports should be sufficient to monitor compliance. If they’re not, Plaintiffs can move for a modification of the permanent injunction and explain why further information is required. Moreover, Plaintiffs can submit public-records requests for the spreadsheets and documentation if they so choose.
Fourth, this court disagrees that FDC should “be required to receive complaints from Plaintiffs’ counsel about compliance with the order.” See ECF No. 342, at 45–46. Again, the status reports should be sufficient to monitor compliance. If Plaintiffs want to initiate complaints, Plaintiffs are free to direct those to FDC. Hopefully, the parties will be able to resolve those complaints harmoniously. If not, it is Plaintiffs’ prerogative to decide whether to bring those complaints to this Court’s attention.
Finally, this Court agrees that any future changes to FDC’s policy must be submitted to this Court for approval. See id. at 46. Given FDC’s long and sordid history of neglecting HCV-infected inmates, as well as FDC’s continued opposition to the relief
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granted in this order, this Court finds that FDC must not be
permitted to unilaterally amend its policy (at least for the time
being). In the future, this Court may consider modifying the
injunction to remove that requirement.
15. Amending the Deadline for Treating F2s Who Were Known to Have Chronic HCV in December 2017
This Court’s preliminary injunction (which was entered in
December 2017) distinguished between FDC’s obligations with
respect to inmates who were known to have chronic HCV at the
time and inmates whom FDC only discovered to be infected in the
future. See ECF No. 185. Plaintiffs point out that this dual track
of deadlines presented an anomaly:
Currently, for inmates known to have chronic HCV in December 2017 who are at F2, the treatment deadline is December 2019 and the evaluation deadline is September 2019. But going forward, F2 inmates will be treated at most within 1 year of staging (although Plaintiffs have requested 6 months) and evaluated at least 30 days before treatment. This produces an anomalous result: An F2 inmate discovered tomorrow will be treated within 1 year (June 2019), or 6 months (December 2018), whereas someone known in December 2017 will have to wait until December 2019 for treatment. Thus, the December 2019 treatment deadline and September 2019 evaluation deadline for F2 inmates known in December 2017 should be deleted, and all F2 inmates should be treated according to the policy going forward. (To phase in this change, the treatment deadline can begin to run from
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the date judgment is entered, rather than the date they were staged). ECF No. 342, at 48. Plaintiffs are right that the situation they describe is anomalous. However, given the time that has passed since Plaintiffs moved for summary judgment, the anomaly Plaintiffs noted no longer exists.25 Accordingly, Plaintiffs’ request is denied as moot. 16. Concluding Note on Plaintiffs’ Requests for Relief Let it be clear: this Court is not picking and choosing what kind of treatment it personally thinks or feels Plaintiffs should get. (If it were up to this Court, every inmate would be tested for HCV and every non-contraindicated inmate with chronic HCV would be immediately treated with DAAs.) Instead, this Court is simply determining whether FDC is being deliberately indifferent by failing to provide the minimally adequate treatment that the Constitution requires. Where there was reasonable medical disagreement about a request for relief, this Court recognized that it could not order FDC to change its conduct. However, where there
25 That is, an inmate who is staged F2 today will initiate treatment by April 2020. An F2 inmate who was known in December 2017 will initiate treatment by December 2019.
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was no medical reason for particular conduct—or where even FDC’s own experts found that certain conduct was warranted but FDC still failed to comply—this Court properly concluded that FDC needed to change course.
C. The Requirements for a Permanent Injunction Having discussed the merits of Plaintiffs’ remaining claims for relief, this Court now turns to the requirements for a permanent injunction. To obtain a permanent injunction, Plaintiffs must show (1) that they have suffered an irreparable injury; (2) that their remedies at law are inadequate; (3) that the balance of hardships weighs in their favor, and (4) that a permanent injunction would not disserve the public interest. eBay Inc. v. MercExchange, L.L.C., 547 U.S. 388, 391 (2006). Plaintiffs have satisfied each factor. First, Plaintiffs have suffered an irreparable injury. “[I]njunctive relief is appropriate ‘to prevent a substantial risk of serious injury from ripening into actual harm.’” Thomas v. Bryant, 614 F.3d 1288, 1318 (11th Cir. 2010) (quoting Farmer v. Brennan, 511 U.S. 825, 845 (1994)). “In such circumstances, the irreparableinjury requirement may be satisfied by demonstrating a history of past misconduct, which gives rise to an inference that future injury
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is imminent.” Id. Here, FDC’s history of past misconduct and its continued opposition to other forms of relief leads this Court to believe that future injury is imminent. Specifically, this Court finds that FDC will not treat HCV-infected inmates in an appropriate and timely manner. If these inmates are not treated, they will undoubtedly suffer irreparable injury.
Second, remedies at law are inadequate to address Plaintiffs’ injuries. Plaintiffs suffer continued harm as well as the risk of future harm. Damages will not address those injuries.
Third, the balance of hardships weighs in Plaintiffs’ favor. The only hardship Defendant faces is that FDC will have to spend more money and treat more inmates than it wants to.26 Plaintiffs, on the other hand, face great injuries. “The threat of harm to the plaintiffs cannot be outweighed by the risk of financial burden or administrative inconvenience to the defendants.” Laube v. Haley, 234 F. Supp. 2d 1227, 1252 (M.D. Ala. 2002).
26 It is no excuse to cry that resources may be diverted from other medical programs. FDC cannot use its constitutional duty to treat one group of inmates as a reason to not treat a different group. Cf. Williams v. Bennett, 689 F.2d 1370, 1388 (11th Cir. 1982) (“If . . . a state chooses to operate a prison system, then each facility must be operated in a manner consistent with the constitution.”).
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Fourth, the permanent injunction will not disserve the public interest. Rather, the public is undoubtedly interested in seeing that inmates’ constitutional rights are upheld. Cf. Laube, 234 F. Supp. 2d at 1252 (“[T]here is a strong public interest in requiring that the plaintiffs’ constitutional rights no longer be violated . . . .”); cf. also Costello v. Wainright, 397 F. Supp. 20, 37 (M.D. Fla. 1976) (“[I]t seems clear to this Court that, in the long run, providing decent medical care and housing to inmates would serve to promote the rehabilitative goals of the criminal justice system so as to permit their re-entry into free society as upright and law abiding citizens and to prevent their re-entry into the criminal justice system.”), vacated in part on other grounds, 539 F.2d 547 (5th Cir.), rev’d, 430 U.S. 325 (1977).
Finally, the permanent injunction satisfies the Prison Litigation Reform Act (“PLRA”) because it is narrowly drawn, extends no further than necessary to effect the changes this Court concludes are constitutionally required, and is the least intrusive means of effecting such changes. See 18 U.S.C. § 3626(a)(1).
III. Conclusion This case started with three inmates facing deliberate indifference to their serious medical needs. Through persistence of
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counsel, it was uncovered that FDC was being deliberately indifferent to more than just those three inmates. Indeed, FDC turned out to have a long and sordid history of failing to adequately manage HCV in its prisons.
Nearly two years later, FDC has come a long way. But FDC’s improvement does not mean that it is no longer being deliberately indifferent to HCV-infected inmates, nor does it mean that there is no risk of such deliberate indifference reoccurring in the future. Defendant’s continued opposition to Plaintiffs’ requested relief proves just that.
This Court is entering a permanent injunction with several important deadlines. In fashioning those deadlines, this Court has been mindful to ensure that Defendant has ample time to comply while considering an appeal. This Court notes that if Defendant does appeal and seeks to stay this Court’s order, Defendant must first seek a stay with this Court. Fed. R. App. P. 8(a)(1)(A). Moreover, even if this Court denies a stay pending appeal, Defendant may also move this Court to modify the injunction pending appeal. Fed. R. App. P. 8(a)(1)(C).
Accordingly,
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IT IS ORDERED: 1. The parties’ cross-motions for summary judgment, ECF
No. 270 and ECF No. 342, are GRANTED in part and DENIED in part, as described in this order. 2. This Court retains jurisdiction for the purposes of enforcing and/or modifying the terms of this Court’s permanent injunction. 3. The preliminary injunction entered in this case, ECF No. 185, which was subsequently modified and renewed, see, e.g., ECF No. 437, is hereby dissolved. 4. No later than May 20, 2019, the parties must confer and file a jointly proposed briefing schedule regarding the entitlement to and determination of attorney’s fees and costs. 5. The Clerk is directed to provide a copy of this order to inmate Steven A. McLeod. See ECF No. 450. 6. The Clerk is directed to enter judgment stating:
a. Defendant must ensure that the Florida Department of Corrections (“FDC”), FDC’s employees, and FDC’s agents comply with FDC’s
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Hepatitis C Virus (“HCV”) policy, HSB 15.03.09 Supplement #3, as it is revised. b. Defendant must ensure that FDC’s HCV policy, HSB 15.03.09 Supplement #3, is not modified absent this Court’s instruction. c. Defendant must ensure that, no later than May 20, 2019, FDC’s HCV policy, HSB 15.03.09 Supplement #3, is modified as follows:
i. The policy must be modified to reflect that treatment must be initiated for F0 and F1 inmates within two years of staging.
ii. A section must be added to the policy requiring an explanation to anyone who refuses staging or treatment of, at least, (1) the consequences of HCV, (2) the availability, lack of side effects, and efficacy of the new medications, (3) the staging process, and (4) whether and when they will receive treatment.
iii. The policy must be modified to reflect that (1) patients must be initially staged using a 62

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FibroSure test within 30 days of confirming they have chronic HCV; (2) patients who need ultrasounds must receive an ultrasound within 90 days of confirming they have chronic HCV; (3) if a patient needs to be restaged as a result of an ultrasound, the restaging must take place within 5 days of receiving the ultrasound results; and (4) staff must rely on the test, exam, or study indicating the highest fibrosis level for staging. iv. The policy must be modified to reflect that deadlines are mandatory. v. The policy must be modified to reflect that staff have the discretion to restage inmates sooner than scheduled. vi. The exclusion for time remaining on an inmate’s sentence must be modified such that (1) it no longer refers to “pre-treatment evaluation”; (2) it no longer refers to “post treatment SVR assessment”; (3) it no longer
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includes a “12-18 months” estimate; and (4) it reflects that an inmate—who has already been staged and evaluated—simply needs to have “sufficient” time remaining on their sentence to complete a course of treatment. vii. The exclusion for high-risk behaviors must be modified to reflect that (1) high-risk behaviors only warrant a delay if there is a “medical reason” to delay treatment and (2) it only provides for temporary ineligibility, not permanent exclusion. viii. Section J.3., which refers to “chronic disciplinary issues,” must be amended to reflect that chronic disciplinary issues, in and of themselves, are not sufficient to render an inmate ineligible for treatment; rather, treatment may only be delayed for medical reasons. ix. Section P, which governs referrals for liver transplants, must be modified as follows: (1) decompensation must be defined as “the
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presence of encephalopathy, ascites, bleeding varices, or jaundice”; (2) it must be clarified to reflect that patients will be referred if they have any one of the listed items; (3) referrals must be initiated within 30 days of any one of the triggering events; (4) it must provide that FDC must promptly comply with the transplant center’s request for records and other information, and to promptly transport the inmate to and from the transplant center; and (5) it must be clarified that for individuals who have been scheduled to receive DAA medication, are undergoing DAA treatment, or who have finished DAA treatment, a referral must be made only if the post-treatment MELD score is over 15. x. Section A.2., which refers to risk factors, must be modified to include “being born between 1945 and 1965, previous incarceration, and HIV” as risk factors.
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d. Defendant must ensure that FDC initiates treatment for all known chronic-HCV inmates who are currently staged F0 or F1 within two years of the date of this order.
e. Defendant must ensure that FDC either (1) adopts a system of opt-out testing along with an aggressive notice campaign or (2) adopts a system of opt-in testing paired with peer education. FDC must make its choice and Defendant must inform this Court of FDC’s decision no later than May 20, 2019.
f. Defendant must ensure that FDC forms a definite plan to make elastography available to its medical staff within a reasonably immediate timeframe. Defendant must file its proposed plan with this Court no later than May 20, 2019.
g. Defendant must ensure that—for inmates who were known to have chronic HCV in December 2017, who have fibrosis stage 2, and who are eligible for treatment—FDC initiates treatment no later than December 31, 2019.
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h. Beginning on June 3, 2019, and on the first day of each month thereafter, Defendant must file with this Court a status report reflecting FDC’s progress in complying with this Court’s injunction. That status report must include: i. A certification regarding FDC’s compliance with the applicable deadlines for prisoners known to have chronic HCV in December 2017. ii. Information regarding the total number of inmates who: 1. have been screened/tested for HCV, 2. have been identified as having chronic HCV, 3. have been identified as having chronic HCV and have been staged (which must be further broken down by stage, including F0, F1, F2, F3, F4, decompensated cirrhosis, and those with HIV),
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4. have been submitted to the Hepatitis C Committee for evaluation (which must be further broken down by stage, including F0, F1, F2, F3, F4, decompensated cirrhosis, and those with HIV),
5. have begun treatment with DAAs, 6. have completed treatment with DAAs, 7. have achieved a sustained virologic
response (SVR), 8. have not achieved SVR, and 9. have been deemed (temporarily or
permanently) ineligible for treatment with DAAs along with the specific reason for ineligibility. SO ORDERED on April 18, 2019. s/Mark E. Walker Chief United States District Judge
68

 
 973 F.3d 1263 (2020)
Carl HOFFER, Individually and on behalf of a class of persons similarly situated, Ronald McPherson, Individually and on behalf of a class of persons similarly situated, Roland Molina, Individually and on behalf of a class of persons similarly situated, Plaintiffs-Appellees,
v.
SECRETARY, FLORIDA DEPARTMENT OF CORRECTIONS, Defendant-Appellant.
No. 19-11921.
United States Court of Appeals, Eleventh Circuit.
August 31, 2020.
Appeal from the United States District Court for the Northern District of Florida, D.C. Docket No. 4:17-cv-00214-MW-CAS.
Erica A. Selig, Raymond J. Taseff, Dante Pasquale Trevisani, Florida Justice Institute, Miami, FL, for Plaintiffs-Appellees.
Amit Agarwal, Karen Ann Brodeen, Ashley Moody, James Hamilton Percival, II, Office of the Attorney General, Tallahassee, FL, Albert J. Bowden, III, Bowden Law Firm, LLC, Tallahassee, FL, for Defendant-Appellant.
Before MARTIN, NEWSOM, and BALDOCK,[*] Circuit Judges.
1266
*1266 NEWSOM, Circuit Judge.
This case principally presents the question whether the Eighth Amendment requires Florida prison officials to treat all inmates with chronic Hepatitis C—including those who have only mild (or no) liver fibrosis—with expensive, state-of-the-art "direct acting antiviral" (DAA) drugs. The district court held that it does and entered a permanent injunction mandating across-the-board DAA treatment. We hold, to the contrary, that the officials' current treatment plan—pursuant to which they monitor all HCV-positive inmates, including those who have yet to exhibit serious symptoms, and provide DAAs to anyone who has an exacerbating condition, shows signs of rapid progression, or develops even moderate fibrosis—satisfies constitutional requirements. Accordingly, we reverse the district court's decision, vacate its injunction, and remand for further proceedings.

1267
I *1267
A
Hepatitis C—here, HCV—is a bloodborne virus that is commonly spread, among other means, by sharing contaminated needles, utilizing unsterilized tattoo equipment, and engaging in risky sexual behavior. Only about 1% of the general population suffers from the disease, but its prevalence among prison inmates is much higher. Although estimates vary, it's safe to say that thousands—and quite possibly tens of thousands—of inmates confined in Florida state prisons have HCV.
HCV primarily attacks the liver and, in particular, can cause liver scarring, or "fibrosis." Liver fibrosis can be measured, or staged, on a five-step scale, in ascending order of severity, from F0 (no fibrosis) to F1 (mild fibrosis) to F2 (moderate fibrosis) to F3 (severe fibrosis) to F4 (cirrhosis). Fortunately, many people afflicted with HCV will "spontaneously clear" the virus without treatment. At least 50% of HCV cases, though, are "chronic," meaning that they can be cured only with medication. Among chronic HCV patients, the disease's rate of progression varies: 30% are stable, meaning that they aren't currently moving up the fibrosis scale; 40% progress slowly, taking several years to advance from one level to another and more than 20 years to reach full-blown cirrhosis; and 30% progress rapidly, reaching cirrhosis in fewer than 20 years and possibly as few as one.
In years past, HCV patients were prescribed Interferon, a weekly injectable medication that had a number of drawbacks —among them that it required patients to remain sober, caused several unpleasant side effects, and succeeded in eradicating the virus only about 30% of the time. In 2013, a new HCV treatment option arrived on the scene—direct acting antivirals. These DAAs brought great promise—the once- or twice-daily pills were easily administrable, had few side effects, and boasted a 95% cure rate. Unfortunately, and not surprisingly, they also came at great cost. Although the parties dispute the exact price tag of a single 12-week course of DAA treatment—in 2017, the Secretary put it between $25,000 and $37,000 per inmate, while the plaintiffs insisted that discounts and rebates reduced that cost—all agree that DAAs are very expensive.
B
In May 2017, Carl Hoffer, Ronald McPherson, and Roland Molina—chronic —HCV inmates incarcerated in Florida prisons —sued the Secretary of the Florida Department of Corrections on behalf of a putative class in the United States District Court for the Northern District of Florida. Among other claims, the plaintiffs alleged, pursuant to 42 U.S.C. § 1983,

that the Secretary's HCV treatment plan—or, at the time, the lack thereof—was deliberately indifferent to inmates' serious medical needs in violation of the Eighth Amendment. As particularly relevant here, the plaintiffs sought a class-wide injunction requiring the FDC to "develop and adhere to a plan to provide direct-acting antiviral medication to all FDC prisoners with chronic HCV, consistent with the standard of care."
Not long after the plaintiffs filed, the Secretary hired Dr. Daniel Dewsnup to formulate a treatment plan for HCV-infected inmates. Dr. Dewsnup, who had earlier developed and implemented a similar HCV-treatment plan for the Oregon prison system, recommended treating some inmates with DAAs, but not all of them. In particular, he proposed (1) providing DAAs for all inmates at level F2 and above and (2) monitoring F0- and F1-level inmates and treating them with DAAs if they (a) have or develop an exacerbating
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*1268 condition like HIV, (b) exhibit signs of rapid fibrosis progression, or (c) advance to F2. The Secretary adopted Dr. Dewsnup's recommendations.
In October 2017, the district court held a five-day evidentiary hearing, which featured Dr. Dewsnup and the plaintiffs' expert, Dr. Margaret Koziel. The experts testified concerning a range of topics, but for present purposes our focus is on their dueling conclusions regarding the necessity of treating HCV-positive inmates who show little or no liver scarring—i.e., those at levels F0 and F1 on the fibrosis scale.
Dr. Koziel "advocate[d]" in favor of treating all HCV-positive inmates with DAAs—even, she said, F0-level inmates, who have "no fibrosis." Her view, she said, comports with guidelines published by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, which recommend DAA treatment for all chronic HCV patients, regardless of staging. Dr. Koziel further testified that "there are clearcut economic benefits to treating all-comers with Hepatitis C"—in particular, she reported that one paper she had recently reviewed estimated that "the U.S. health system would save about $13 billion by treating everybody."
Regarding medical outcomes, though, Dr. Koziel was more circumspect. As particularly relevant here, the district court judge asked her the following question: "[I]n terms of scoring, F0 to F4, ... what's the tipping point where suddenly [a patient's] chance of getting cancer is dramatically much greater [or his] chance of permanent damage in terms of liver function... is greater?" Dr. Koziel began her response by stating that "there is some increased risk of mortality even in the earlier stages" and emphasizing that she "will always advocate for people." "But," she went on, "when I really, really start to get agitated ... is about at F3, and that's when people really get into the irreversible complications because [of] the amount of scar tissue, and at that point I can no longer say to you that we are going to make you completely whole again." Even so, Dr. Koziel reiterated later in her testimony that her job as a physician "is to advocate for the best medical care" and agreed with the

district court that "treating everyone who has [HCV] with DAA medication is the best possible management."
For his part, Dr. Dewsnup opined that F0- and F1-level inmates "don't need to be treated immediately" but, rather, "can be deferred." Usually, he said, the FDC only "see[s] them for a few years." At the same time, he recognized that it's different for "lifetime prisoners," whom the FDC is "going to have to treat eventually even if they are Stage 0 or Stage 1." Dr. Dewsnup also explained that the evidence concerning the relationship between the eradication of HCV and F0-and F1-level inmates' "mortality rates" may suffer from confounding; he acknowledged Interferon-era studies that suggest a correlation between the two, but clarified that "[w]e don't have the scientific data that say[s] that it's the viral eradication that does it." The reason, he said, is because Interferon treatment required patients "to make huge lifestyle changes"—in particular, "[t]hey had to be sober." Because "substance abuse ... [is] the major reason" that HCV-positive inmates die, Dr. Dewsnup didn't believe that the correlation between Interferon treatment for F0s and F1s and decreased mortality rates established the necessary causal link.
Shortly after the hearing, the district court certified a plaintiff class of "all current and future prisoners in FDC custody who have been, or will be, diagnosed with chronic HCV" and entered a preliminary injunction. "[W]ith limited exceptions," the court ordered the FDC to "compl[y] with
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*1269 its own expert's recommendations" and to "formulate a plan" to ensure the treatment of HCV-positive inmates in accordance with a specified schedule. Later, having received the Secretary's plan, the court ordered DAA treatment for prisoners with decompensated cirrhosis (i.e., liver failure) within about a month, prisoners with F4-level cirrhosis within six months, and prisoners with F2 (moderate) and F3 (severe) fibrosis within about a year. The court's preliminary-injunction order did not require DAA treatment for F0- and F1-level inmates unless they had an exacerbating condition.
Several months later, the Secretary moved for summary judgment—in essence, against himself—seeking to make the district court's preliminary injunction permanent. As particularly relevant here, the Secretary reiterated his position that the Eighth Amendment doesn't require immediate DAA treatment of all F0- and F1-level inmates. As a general matter, the Secretary proposed to monitor F0s and F1s, to schedule infirmary visits and lab tests every six months, and, if necessary, to re-stage their fibrosis annually. F0s and F1s would be put on DAAs, however, if they (1) had or developed an exacerbating condition, (2) showed signs of rapid progression, or (3) advanced to F2. The plaintiffs cross-moved for summary judgment, seeking 15 additional forms of relief, all of which the Secretary opposed. Most significantly for present purposes, the plaintiffs asked the court to require the Secretary to provide DAA treatment for all F0- and F1-level patients, regardless of underlying comorbidities or the pace of disease progression.

The district court granted the plaintiffs' summary-judgment motion in substantial part, denying or altering only a few of their additional requests, and entered a permanent injunction. See Hoffer v. Inch, 382 F. Supp. 3d 1288 (N.D. Fla. 2019). As relevant here, the injunction requires the Secretary to treat all F0- and F1-level inmates with DAAs. In its order, the district court found that the Secretary "ha[d] not put forth any medical reason (nor does the record otherwise reveal a medical reason) why F0 and F1 inmates should not be treated." Id. at 1302. Instead, the court agreed with the plaintiffs that "[t]he only reason why [the Secretary] is electing not to provide treatment" to F0 and F1 patients "is due to the cost of treatment, which is per se deliberate indifference." Id. (first alteration in original) (quotation omitted). Accordingly, the court ordered the Secretary to begin DAA treatment of all F0s and F1s within two years of their initial staging. Id. at 1302-03.
Toward the end of its order, the district court included the following one-sentence paragraph, addressing its obligation to ensure that the injunction complied with the Prison Litigation Reform Act:
Finally, the permanent injunction satisfies the Prison Litigation Reform Act ("PLRA") because it is narrowly drawn, extends no further than necessary to effect the changes this Court concludes are constitutionally required, and is the least intrusive means of effecting such changes.
Id. at 1315 (citing 18 U.S.C. § 3626(a)(1)).
* * *
The Secretary now appeals the district court's summary-judgment order and accompanying injunction, arguing (1) that his plan for monitoring F0- and F1-level inmates, and treating them with DAAs if they develop an exacerbating condition, exhibit rapid disease progression, or advance to F2, does not violate the Eighth Amendment, and (2) that the district court's PLRA-related findings were not sufficiently particularized.[1]
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*1270 II
A
The Eighth Amendment forbids the "inflict[ion]" of "cruel and unusual punishments." U.S. Const. amend. VIII. And the Supreme Court has held that because the Cruel and Unusual Punishments Clause prohibits "the unnecessary and wanton infliction of pain," it also prohibits "deliberate indifference to serious medical needs of prisoners." Estelle v. Gamble,

429 U.S. 97, 103-04, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976) (quotation omitted). "Federal and state governments therefore have a constitutional obligation to provide minimally adequate medical care to those whom they are punishing by incarceration." Harris v. Thigpen, 941 F.2d 1495, 1504 (11th Cir. 1991).
"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 meet the first prong, the 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. (alteration adopted) (quotations omitted). To satisfy the second, subjective prong, the plaintiff must prove that the prison officials "acted with deliberate indifference to [his serious medical] need." Harper v. Lawrence Cty., 592 F.3d 1227, 1234 (11th Cir. 2010) (quotation omitted). "To establish deliberate indifference," a plaintiff must demonstrate that the prison officials "(1) had subjective knowledge of a risk of serious harm; (2) disregarded that risk; and (3) acted with more than gross negligence." Id. (quotation omitted).[2] An inmate-plaintiff bears the burden to establish both prongs. Goebert v. Lee Cty., 510 F.3d 1312, 1326 (11th Cir. 2007).
B
The Secretary seems to concede (we think wisely) that chronic HCV is, at least as a general matter, a "serious medical need" within the meaning of our precedents. See Reply Br. at 5 n.5. And although the parties spar over the subsidiary question whether chronic HCV constitutes
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*1271 a condition "that, if left unattended, poses a substantial risk of serious harm" to F0and F1-level inmates, Farrow, 320 F.3d at 1243, we find that it is unnecessary to address that issue. For the reasons that follow, we conclude that even if the plaintiffs could satisfy the objective prong of the two-part Eighth Amendment standard, they haven't shown that the Secretary's response to F0- and F1-level inmates' medical needs was deliberately indifferent in the subjective sense—in particular, that the Secretary "acted with more than gross negligence." Harper, 592 F.3d at 1234.[3]
1
We think it worth reiterating at the outset the stringency of the deliberate-indifference standard—because, it seems to us, the district court here lost track of it and impermissibly evaluated the Secretary's treatment plan against a negligence (or perhaps even more

lenient) benchmark. It's an easy enough mistake to make: Confronted with an inmate who has a serious medical condition, a reviewing court hears from experts about measures that (in their view) would provide the most effective treatment. When the court then sees evidence that prison authorities aren't taking those measures—that perhaps they could be doing more, doing better—it concludes that liability must presumably follow.
Intuitive as that line of thinking may be—especially for lawyers and judges educated and trained in the common-law tradition—it does not reflect the constitutional standard. As we recently reiterated, "deliberate indifference is not a constitutionalized version of common-law negligence." Swain v. Junior, 961 F.3d 1276, 1287-88 (11th Cir. 2020). "To the contrary, we (echoing the Supreme Court) have been at pains to emphasize that `the deliberate indifference standard ... is far more onerous than normal tort-based standards of conduct sounding in negligence,' and is in fact akin to `subjective recklessness as used in the criminal law.'" Id. (quoting, respectively, Goodman v. Kimbrough, 718 F.3d 1325, 1332 (11th Cir. 2013), and Farmer v. Brennan, 511 U.S. 825, 839-40, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994)). With respect to prisoners' medical care, in particular, we have held that the Eighth Amendment doesn't require it to be "perfect, the best obtainable, or even very good." Harris, 941 F.2d at 1510 (quotation omitted). Rather, we have emphasized, "[m]edical treatment violates the [E]ighth [A]mendment only when it is so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness." Id. at 1505 (quotation omitted).
The question here, therefore, isn't whether, in the best of all possible worlds,
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*1272 F0- and F1-level HCV-positive inmates should receive treatment with DAAs. Nor is it whether, if we were doctors, we would prescribe DAAs to all F0 and F1 patients. Nor, for that matter, is it even whether, if we were sitting as a common-law court, we might conclude that ordinary prudence requires across-the-board DAA treatment. Rather, because the plaintiffs here have invoked the Eighth Amendment, the sole question before us is whether the Secretary's approach to the treatment of F0- and F1-level inmates is so reckless—so conscience-shocking—that it violates the Constitution. As explained below, it is not.
2
We should first recap briefly what the Secretary's treatment plan is. For starters, the Secretary treats all HCV-positive inmates at the F2 level and above with DAAs. Among those at the F0 and F1 levels, the Secretary monitors their conditions and provides DAA treatment to those who either (1) have an exacerbating illness, such as HIV, (2) exhibit signs of rapid fibrosis progression, or (3) advance to F2.

So, to be clear—and contrary to misimpressions that the district court's opinion might leave, see Hoffer, 382 F. Supp. 3d at 1302-03—the Secretary isn't refusing or denying medical care to any HCV-positive inmate. He may not be providing F0- and F1-level inmates the particular course of treatment that they and their experts want—or as quickly as they want it—but he isn't turning a blind eye, either.
Two fundamental considerations— both of which reflect the steep hill that deliberate-indifference plaintiffs must climb—combine to demonstrate that the Secretary's treatment of F0- and F1-level patients is neither criminally reckless nor conscience-shocking. First, we have recognized that "[w]here a prisoner has received some medical attention and the dispute is over the adequacy of the treatment, federal courts are generally reluctant to second guess medical judgments and to constitutionalize claims which sound in state tort law." Harris, 941 F.2d at 1507 (quoting Westlake v. Lucas, 537 F.2d 857, 860 n.5 (6th Cir. 1976)); accord, e.g., Hamm v. DeKalb Cty., 774 F.2d 1567, 1575 (11th Cir. 1985) ("Although [the inmate] may have desired different modes of treatment, the care the jail provided did not amount to deliberate indifference."). Here, as already explained, the Secretary is providing "some medical attention" to F0- and F1-level inmates—diagnosing their illnesses, assessing their risk of future harm, and regularly monitoring and managing their disease progression. The plaintiffs' complaint isn't that the Secretary is providing no care, just that he isn't providing the more aggressive—and they say better— care that they desire.
To be clear, "some medical attention" doesn't necessarily demand curative care. Rather, medical intervention exists along a spectrum. At one end is ignoring medical needs entirely, which our decisions have rightly and repeatedly condemned: "`Choosing to deliberately disregard' an inmate's complaints of pain `without any investigation or inquiry,'" we have held, constitutes deliberate indifference. Taylor v. Hughes, 920 F.3d 729, 734 (11th Cir. 2019) (quoting Goebert, 510 F.3d at 1328). The plaintiffs here, understandably, demand care at the other end of the spectrum —a prompt and an effective, albeit expensive, cure. There is, though, a range of responsible treatment options between the two poles that will satisfy the Eighth Amendment.
Consider an inmate with kidney disease. Surely the Constitution doesn't require prison authorities to schedule an immediate transplant, even though that might be the most effective, and permanent, solution. Rather, even for an inmate with end-stage
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*1273 renal disease, a regular course of dialysis treatments would doubtlessly pass constitutional muster. And for those whose condition hasn't progressed to near-complete kidney failure, even less aggressive measures—say, monitoring and managing diet and exercise—would presumably suffice. Or consider an inmate in the early stages of progressive hearing loss. Prison authorities needn't jump straight to cochlear implants, or even hearing aids. At least for a spell—until his condition worsens, anyway—the inmate

may have to content himself with asking people to speak up. The long and short of it is that diagnosing, monitoring, and managing conditions —even where a complete cure may be available—will often meet the "minimally adequate medical care" standard that the Eighth Amendment imposes. Harris, 941 F.2d at 1504.
Second, and relatedly, we have emphasized—as have our sister circuits— that "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 [fails to] support a claim of cruel and unusual punishment." Id. at 1505; accord, e.g., Lamb v. Norwood, 899 F.3d 1159, 1162 (10th Cir. 2018) ("We have consistently held that prison officials do not act with deliberate indifference when they provide medical treatment even if it is subpar or different from what the inmate wants."); Kosilek v. Spencer, 774 F.3d 63, 82 (1st Cir. 2014) (en banc) ("[The Eighth Amendment] does not impose upon prison administrators a duty to provide care that is ideal, or of the prisoner's choosing."). That, at bottom, is exactly what we have here. The plaintiffs' expert, Dr. Koziel, opined that all F0- and F1-level inmates should be treated with DAAs, regardless of underlying condition or disease progression.[4] The Secretary's expert, Dr. Dewsnup, testified, to the contrary, that it is sufficient to prescribe DAAs to inmates at level F2 and above, to monitor F0- and F1-level inmates, and to provide DAAs to F0s and F1s who either have underlying co-conditions or whose disease seems to be progressing rapidly.
Because the plaintiffs here are receiving medical care—and because the adequacy of that care is the subject of genuine, good-faith disagreement between healthcare professionals—we are hard-pressed to find that the Secretary has acted in so reckless and conscience-shocking a manner as to have violated the Constitution. "Measured against constitutional minima," the Secretary's plan "evidence[s] at least tolerable and responsive medical treatment." Harris, 941 F.2d at 1507
C
In just two short pages, the district court reached the opposite conclusion. It did so principally on two bases. First, the court accepted the plaintiffs' contention that "[t]he only reason why FDC is electing not to provide [DAA] treatment is due to the cost of treatment, which is per se
1274
*1274 deliberate indifference." Hoffer, 382 F. Supp. 3d at 1302 (alteration in original) (quotation omitted). And second, it emphasized that the "FDC has not put forth any medical reason (nor does the record otherwise reveal a medical reason) why F0 and F1 inmates should not be treated." Id.

We conclude that the district court erred on both counts. We take up its errors in reverse order, because the second—concerning the Secretary's supposed failure to demonstrate a medical basis for declining DAA treatment for F0s and F1s—is easy to explain, while the first—regarding the role of "cost" in a deliberate-indifference analysis—will take bit of unpacking.
1
So first, the easy(ish) part. In stating that the Secretary "ha[d] not put forth any medical reason ... why F0 and F1 inmates should not be treated," the district court triply erred. As an initial matter, the court impermissibly flipped the burden of proof. Our precedent is clear that an inmate bears the burden of proving all aspects of his Eighth Amendment claim—as relevant here, he "must satisfy the subjective component by showing that the prison official acted with deliberate indifference to h[is] serious medical need." Goebert, 510 F.3d at 1326; accord, e.g., Hill v. Dekalb Reg'l Youth Ctr., 40 F.3d 1176, 1190 (11th Cir. 1994) (noting that the plaintiff "submitted no medical evidence explaining how the four-hour delay in taking [him] to the hospital detrimented or worsened his medical condition"), abrogated on other grounds by Hope v. Pelzer, 536 U.S. 730, 122 S.Ct. 2508, 153 L.Ed.2d 666 (2002). So it wasn't the Secretary's burden to demonstrate that treatment of F0s and F1s isn't medically necessary; it was the plaintiffs' burden to prove that such treatment is necessary. See H.C. by Hewett v. Jarrard, 786 F.2d 1080, 1086 (11th Cir. 1986) ("[T]he failure to provide diagnostic care and medical treatment known to be necessary [i]s deliberate indifference.").[5]
To compound matters, in connection with its determination that the Secretary had failed to discharge its phantom burden, the district court misconstrued Dr. Dewsnup's testimony in two key respects. First, immediately after faulting the Secretary for "not put[ting] forth any medical reason" for delaying DAA treatment for F0- and F1-level inmates, the court stated that Dr. Dewsnup had "explicitly noted... [that] F0 and F1 inmates must be treated eventually"—thereby implying that even the Secretary's own expert believed that medical considerations counsel in favor of treating all inmates. Hoffer, 382 F. Supp. 3d at 1302. Context, though, reveals the district court's error. As already explained, what Dr. Dewsnup actually said was (1) that in the main, F0s and F1s "don't need to be treated immediately" and instead "can be deferred," but (2) that "there are others who are lifetime prisoners that ... [the FDC is] going to have to
1275
*1275 treat eventually even if they are Stage 0 or Stage 1." In context, it's clear that Dr. Dewsnup simply meant to acknowledge that many inmates who are currently at F0 or F1 will, if they remain incarcerated long enough, "eventually" progress to F2 and need DAA treatment.

Second, and even more conspicuously, as part of the same discussion, the district court emphasized that "both Dr. Koziel and Dr. Dewsnup agreed that—even for F0 and F1 inmates—successful treatment of HCV tends to decrease mortality rates." Hoffer, 382 F. Supp. 3d at 1302. That is demonstrably incorrect. In fact, Dr. Dewsnup said precisely the opposite. As already explained, he testified that (1) because the only available studies were from the Interferon era, when treatment required HCV patients "to be sober," and (2) because "substance abuse ... [is] the major reason" that HCV-positive inmates die, there is simply no way to know whether it was the HCV treatment, the "huge lifestyle changes" that the Interferon regimen required, or some combination of the two that led to a decrease in mortality rates.
For all these reasons—legal and factual —we conclude that the district court erred in concluding that the Secretary had somehow failed to prove a medical justification for delaying DAA treatment to F0- and F1-level inmates.
2
Now for the tougher part—the role of "cost." Again, although the parties squabble over the exact price of a single DAA course of treatment—the Secretary pegged it at between $25,000 and $37,000 per inmate in 2017, while the plaintiffs insisted that it was lower as a result of discounts and rebates—there is no dispute that DAAs are expensive. The parties' real debate is over the legal questions whether, at what point, and to what extent the cost of a particular medical treatment should factor into an Eighth Amendment deliberate-indifference analysis.
As already noted, the district court agreed with the plaintiffs that "[t]he only reason why FDC is electing not to provide [DAA] treatment is due to the cost of treatment, which is per se deliberate indifference." Hoffer, 382 F. Supp. 3d at 1302 (alteration in original) (quotation omitted). On appeal, the parties can't even agree on how to interpret the court's order. For his part, the Secretary complains that the district court here improperly held that "consideration of the `cost of treatment' in making medical decisions is `per se deliberate indifference.'" Br. of Appellant at 16. In response, the plaintiffs insist that the district court merely—and properly—held that "[t]he Eighth Amendment prohibits the refusal of medical treatment solely because of costs." Br. of Appellees at 22. Because the issue of cost has become such a bone of contention in this case—and because the district court's decision and the parties' arguments reflect confusion about the meaning and application of our precedent—we will examine it in some detail.
The contest over cost's proper place in a deliberate-indifference analysis centers on our decision in Harris v. Thigpen. There, in the course of rejecting Eighth Amendment claims brought by HIV-positive inmates, the panel offered the following observations in dicta:

[W]e are troubled by and reject any suggestion ... that a state's comparative wealth might affect an HIV-infected prisoner's right to constitutionally adequate medical care. We do not agree that "financial considerations must be considered in determining the reasonableness" of inmates' medical care to the extent that such a rationale could ever be used by so-called "poor states" to
1276
*1276 deny a prisoner the minimally adequate care to which he or she is entitled.
941 F.2d at 1509.
We agree with the Secretary that nothing in Harris—or in any of our other decisions—precludes prison authorities from "consider[ing] ... the cost of treatment in making medical decisions." Br. of Appellant at 16 (quotation omitted). Although we have never had occasion to say so expressly, other courts have recognized the commonsense notion that "the civilized minimum" level of care required by the Eighth Amendment "is a function both of objective need and cost." Ralston v. McGovern, 167 F.3d 1160, 1162 (7th Cir. 1999).[6] Need and cost are correlated, such that the more serious and exigent an inmate's need, the more likely it is that "the civilized minimum" might be deemed to require expensive treatment—and vice versa. See id.
The First Circuit's recently addressed this very issue in Zingg v. Groblewski, 907 F.3d 630 (1st Cir. 2018). There, an inmate suffering from severe psoriasis asked prison officials to give her Humira, an injectable "systemic treatment that targets the immune system," which she had been taking before her detention and to which she had responded well. Id. at 633. The prison officials denied her requests, treating her instead—and unsuccessfully—with topical steroids. See id. Eventually, after the inmate's psoriasis continued to deteriorate, the officials approved treatment with Humira, which led to "significant improvement in her condition." Id. The inmate sued under 42 U.S.C. § 1983, alleging that by delaying the authorization of Humira, the officials had acted with deliberate indifference in violation of the Eighth Amendment. Id. at 634. The district court granted summary judgment for the officials, and the inmate appealed. Id.
As particularly relevant here, the First Circuit addressed the inmate's contention that a jury could find that the prison officials "denied Humira because of its cost and that such a finding would suffice to permit a jury to find that [the prison officials were] deliberately indifferent to her serious medical needs." Id. at 638. For support, the inmate cited evidence, for instance, that Humira "is an expensive medication," that "cost containment was important to" prison administrators, and, indeed, that she had been told—point blank—that "Humira would not be approved because of its high cost." Id. Notwithstanding that smoking-gun evidence, the First Circuit rejected the inmate's legal argument: "We are not aware of any authority ... to support the proposition that there is a per se Eighth Amendment prohibition against

corrections officials considering cost, even when considered only in the course of selecting treatment that is aimed at attending to an incarcerated person's serious medical needs." Id.
We agree. Indeed, the law could hardly be otherwise. It is surely uncontroversial that "the deliberate indifference standard... does not guarantee prisoners the right to be entirely free from the cost considerations that figure in the medical-care decisions made by most non-prisoners in our society." Reynolds v. Wagner, 128 F.3d 166, 175 (3d Cir. 1997) (Alito, J.). Every minute of every day, ordinary Americans forgo or delay beneficial—and even life-altering —medical treatment because it's
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*1277 just too expensive. A couple decides to pass on in vitro fertilization in favor of less expensive (if also less effective) fertility treatment. A woman suffering from an autoimmune condition postpones an intravenous-immunoglobulin infusion because her insurance hasn't come through. Parents opt to delay reconstructive surgery for a physically disabled child. Healthcare can be expensive—sadly, sometimes prohibitively so. What a topsy-turvy world it would be if incarcerated inmates were somehow immune from that cold—and sometimes cruel—reality. See Maggert v. Hanks, 131 F.3d 670, 671 (7th Cir. 1997) ("A prison is not required by the Eighth Amendment to give a prisoner medical care that is as good as he would receive if he were a free person, let alone an affluent free person.").
So, to be clear, the Eighth Amendment does not prohibit prison officials from considering cost in determining what type (or level) of medical care inmates should receive. Nor, correlatively, are cost considerations off-limits to reviewing courts charged with determining whether prison officials have acted in so reckless and conscience-shocking a manner as to violate the Constitution.
Now, having said that, our cases do recognize an outer limit. While it is clear that cost can (and often will) be a relevant criterion in determining what the Eighth Amendment requires in a particular circumstance —what "minimally adequate care" entails in the first instance, Harris, 941 F.2d at 1509—it is also clear that cost can never be an absolute defense to what the Constitution otherwise requires. Put differently, if a particular course of treatment is indeed essential to "minimally adequate care," prison authorities can't plead poverty as an excuse for refusing to provide it. See, e.g., Anderson v. City of Atlanta, 778 F.2d 678, 688 n.14 (11th Cir. 1985) ("Lack of funds for facilities cannot justify an unconstitutional lack of competent medical care or treatment of inmates.").
But importantly, that outer-limit principle itself has limits. Cost isn't a sufficient excuse for failing to provide "minimally adequate care" only (and precisely) because "minimally adequate care" is—as Harris itself repeatedly emphasized and as we have reiterated here—quite minimal. See Harris, 941 F.2d at 1505 (observing that an inmate's "[m]edical treatment violates the [E]ighth [A]mendment only when it is so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental

fairness" (quotation omitted)). If the Constitution required prison authorities to provide all inmates with "perfect, the best obtainable, or even very good" care, id. (quotation omitted), then a rule prohibiting the state from raising cost as a defense would be inconceivable—and unsustainable. It would also impermissibly (and perversely) create a world—already discussed and dismissed —in which incarcerated prisoners would be constitutionally entitled to medical care, at taxpayer expense, that many private citizens can't get; there are, as already explained, countless instances in which ordinary Americans forgo particular medical treatments for the sole and exclusive reason that they can't afford them.
Accordingly, the two—the constitutionally required level of care and the propriety of a cost defense—necessarily go hand in hand. Here, because we have held that the Eighth Amendment's "minimally adequate care" does not require the Secretary to prescribe DAAs to all F0- and F1-level inmates, without respect to comorbid conditions or disease progression, the issue of a cost "defense" never arises.
* * *
Because the Secretary has implemented a treatment plan that provides "minimally
1278
*1278 adequate care," we cannot say that his conduct is so reckless or conscience-shocking as to constitute deliberate indifference. Accordingly, the plaintiffs' Eighth Amendment claim fails as a matter of law. We reverse the district court's decision inasmuch as it requires DAA treatment for all F0- and F1-level inmates, vacate that portion of the injunction, and remand with instructions to grant summary judgment for the Secretary on that issue.
III
In addition to requiring DAA treatment of all F0- and F1-level HCV-positive inmates, the district court's permanent injunction also granted, in whole or in part, many of the plaintiffs' 14 other requests for relief. Although the Secretary challenged those additional items in the district court, he has narrowed his appeal (insofar as the Eighth Amendment is concerned) to the DAA issue. Even so, the Secretary maintains, with respect to all 15 items, that the district court's single "threadbare recitation" that its injunction satisfied the Prison Litigation Reform Act's narrowness, necessity, and non-intrusiveness requirements was insufficiently particularized. Accordingly, he insists, we must remand so that the district court can make (and explain) the PLRA-mandated findings with respect to all aspects of the permanent injunction other than the (now vacated) directive that all F0 and F1 inmates be treated with DAAs. We agree.[7]

Under 18 U.S.C. § 3626(a)(1)(A), a "court shall not grant or approve any prospective relief unless the court finds that such relief is narrowly drawn, extends no further than necessary to correct the violation of the Federal right, and is the least intrusive means necessary to correct the violation of the Federal right." As we have explained, § 3626(a)(1)(A) "require[s] particularized findings that each requirement imposed by the preliminary injunction satisfies each of the need-narrowness-intrusiveness criteria." United States v. Sec'y, Fla. Dep't of Corr., 778 F.3d 1223, 1228 (11th Cir. 2015). And, as we have also explained, the particularity required by § 3626(a)(1)(A) is the same as that required by § 3626(b)(3), which applies when a district court declines to lift an injunction. See id. ("We see no reason why the term `finds' in § 3626(a)(1) does not require the same particularity as the term `findings' in § 3626(b)(3).").
In Cason v. Seckinger, we considered § 3626(b)(3) and concluded that "summary conclusion[s]" regarding the required PLRA requirements are "seriously deficient." 231 F.3d 777, 785 (11th Cir. 2000). We explained that the PLRA "requir[es] particularized findings, on a provision-by-provision basis," meaning that "[p]articularized findings, analysis, and explanations should be made as to the application of each criteria to each requirement imposed." Id.
The district court's one-sentence, boilerplate paragraph here regarding PLRA compliance was "seriously deficient." Id. Even where, as in this case, a
1279
*1279 district court issues a lengthy order that carefully considers each requested form of relief on the merits, it cannot just append a rote, catch-all assertion that "the permanent injunction satisfies the Prison Litigation Reform Act ... because it is narrowly drawn, extends no further than necessary to effect the changes this Court concludes are constitutionally required, and is the least intrusive means of effecting such changes." Hoffer, 382 F. Supp. 3d at 1315. As we held in Cason, "[i]t is not enough to simply state in conclusory fashion that the requirements of the [injunction] satisfy" the PLRA's narrowness, necessity, and non-intrusiveness standards. 231 F.3d at 785. Rather, our precedent makes clear that if a district court's injunction grants 15 separate forms of relief, the court must make—and explain—15 separate PLRA-related findings.[8]
IV
For the foregoing reasons, we reverse the district court's order inasmuch as it mandates DAA treatment of all F0- and F1-level HCV-positive inmates and remand to the district court with instructions to award summary judgment to the Secretary on that issue. We likewise vacate the district court's permanent injunction to the extent that it requires such treatment. We vacate the remainder of the order and injunction and remand to the district court so that it can make the findings required by the PLRA.

Order REVERSED IN PART, injunction VACATED IN PART, and case REMANDED.
MARTIN, Circuit Judge, dissenting:
People who are incarcerated are stripped of "virtually every means of self-protection" and have no "access to outside aid." Farmer v. Brennan, 511 U.S. 825, 833, 114 S. Ct. 1970, 1977, 128 L.Ed.2d 811 (1994). Recognizing this, the Supreme Court told us decades ago that "prison officials must ensure that inmates receive adequate ... medical care, and must take reasonable measures to guarantee the safety of the inmates." Id. at 832, 114 S. Ct. at 1976 (quotation marks omitted); see also Estelle v. Gamble, 429 U.S. 97, 103, 97 S. Ct. 285, 290, 50 L.Ed.2d 251 (1976) ("[E]lementary principles establish the
1280
*1280 government's obligation to provide medical care for those whom it is punishing by incarceration. An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met.").
Our Court's ruling today reverses the District Court's ruling on summary judgment that found the Secretary of the Florida Department of Corrections (the "Secretary") to be deliberately indifferent to the medical needs of the Plaintiffs, Florida prisoners in the early stages of the chronic hepatitis C virus ("cHCV").[1] I do not share my colleagues' view of this case, and I would have affirmed the District Court. Beyond that, I am concerned that recent decisions of this Court will undermine the rights of our incarcerated citizens to maintain their health and safety while they serve their sentences.[2]
I take issue with four main points in the majority's deliberate indifference holding. First, the majority says that the disagreement between the parties' respective experts is "a simple difference in medical opinion." Maj. Op. at 1273 (quotation marks omitted). In contrast, my reading of the expert testimony reveals more agreement than disagreement. The expert offered by the Secretary affirmatively acknowledged that all cHCV-positive prisoners need treatment. Second, the majority concludes the Secretary "isn't refusing or denying medical care to any HCV-positive inmate." Id. at 1272 (emphases omitted). Yet it appears to me that refusing treatment is precisely what the Secretary is doing—at least up to a certain point. It is not until an cHCV-positive prisoner reaches the F2 stage[3] that the Secretary provides treatment. This delay in treatment ignores the progression of the disease and the underlying damage that cHCV-positive prisoners experience in the meantime. Third, I think the majority gets it wrong when it says the District Court shifted the burden of proof from Plaintiffs to the Secretary. See id. at 1273-75. As someone who once wrote opinions in a busy district court, I say the majority's judgment rests too heavily on a single sentence in the District Court's order. In directing so much attention to a summary sentence, the majority opinion fails to acknowledge the evidence of harm Plaintiffs did present to demonstrate that treatment of F0- and F1-stage patients is medically necessary.

1281
*1281 Fourth, I do not agree with the discussion in Section II.C.2 relating to the Secretary's cost arguments. My review of the record reveals no evidence of any reason, other than cost, for delaying treatment to F0- and F1-stage patients. Cost may be considered in determining whether a prison official is deliberately indifferent. However, in light of the Secretary's years-long delay in providing treatment for cost reasons, and the evidence showing the standard of care here is to treat everyone with cHCV, I would affirm the District Court's finding of deliberate indifference.
And generally, I do not join the majority's strict application of the Prison Litigation Reform Act's narrowness-need-intrusiveness requirements. It is evident when reviewing the entirety of District Court's order that the court made proper findings. I view the majority's decision to remand for the District Court to further explain its findings as elevating form over substance. I also think it ignores the findings the District Court has already made.
I.
For years, the Florida Department of Corrections ("FDOC") denied Carl Hoffer, Ronald McPherson, and Roland Molina, along with thousands of others, proper medical treatment for their cHCV.[4] The Secretary does not dispute this fact. In an attempt to remedy this wrong, the District Court ordered the Secretary to provide treatment to Florida prisoners suffering from cHCV. Everyone agreed that the proper standard of care was to treat cHCV-positive prisoners with direct acting antivirals, or DAAs.[5] So that's what the District Court ordered—at least, with respect to prisoners at the more advanced stages of cHCV, who needed to be prioritized in the treatment queue at the preliminary injunction stage. See R. 465 at 24 (explaining that Secretary's expert "never testified that F0 and F1 inmates should never be treated," and that his statement that "it's safe to wait for a bit" for the treatment of F0- and F1-stage patients "was simply made in the context of a preliminary-injunction hearing and faced with the need to triage thousands of inmates").
This record reflects that the Secretary agreed that cHCV-positive patients must be treated with DAAs, until Plaintiffs asked the District Court to order the Secretary to provide treatment with DAAs to every cHCV-positive prisoner, as opposed to just the F2-, F3-, and F4-stage patients covered by the preliminary injunction. It was only then, when the Secretary realized the cost of these treatments, that this dispute arose. The Secretary draws the line— in my view, arbitrarily and without support from this record—between prisoners at
1282
*1282 less-progressed stages of cHCV and prisoners at stages that have progressed further. See R. 270 at 8 (The Secretary says "the present-day standard of care is to treat cHCV

patients with DAAs.... There has been no showing that delaying treatment with DAAs for inmates with fibrosis scores of F0 or F1, until they reach F2, will cause harm to those inmates...."). In other words, despite acknowledging that all cHCV-positive prisoners should be treated with DAAs, and that cHCV— which all Plaintiffs and class members have—is a serious medical need to which the Secretary was deliberately indifferent,[6] the Secretary is now drawing lines between the stages of symptoms of the underlying disease.
To its credit, the majority refuses to engage in the arbitrary line-drawing for which the Secretary advocates. See Maj. Op. at 1270-71. Instead, I gather that the majority agrees with the Secretary's ultimate outcome because treating prisoners at the less-progressed stages of cHCV is the "best obtainable" care, rather than the "minimally adequate care" they are owed. Id. at 1277 (quotation marks omitted). But the majority opinion's holding that the Secretary was not deliberately indifferent overlooks one important fact: the District Court found, and the Secretary did not contest, that the only reason cHCV patients were not treated was due to lack of funding. The District Court found—twice, in fact—that the Secretary admitted the failure to treat prisoners with cHCV, a serious medical need, was based solely on cost. And now, the Secretary draws lines between what stages of cHCV should receive treatment on the same rationale: cost. So even though the District Court found that the Secretary was deliberately indifferent by not providing treatment for the underlying disease that the Plaintiffs and class members all have, the Secretary now argues that he was not deliberately indifferent to F0- and F1-stage patients. It is on this basis that the Secretary seeks to limit the injunction entered by the District Court.
The majority finds it unnecessary to rule on this argument made by the Secretary. But in making its ruling, I fear the majority is rejecting facts found by the District Court and instead providing its own interpretation of the facts in the record. See Maj. Op. at 1270-71. By reversing the District Court's order, the majority effectively denies treatment to prisoners who "plainly proved an unsafe, life-threatening [medical] condition ... on the ground that nothing yet had happened to them." See Helling v. McKinney, 509 U.S. 25, 33, 113 S. Ct. 2475, 2481, 125 L.Ed.2d 22 (1993). Because this holding offends contemporary standards of decency and is also contrary to the Secretary's own expert testimony on the proper standard of care, I cannot join it. See id. at 32, 113 S. Ct. at 2480 (citing Estelle, 429 U.S. at 103-04, 97 S. Ct. at 290-91).
A. THE PARTIES' EXPERTS AGREE THAT F0- AND F1-STAGE PATIENTS MUST BE TREATED.
The majority says that the parties' differing expert testimony reflects "a simple difference in medical opinion." Maj. Op. at 1273 (quotation marks omitted). I don't think this view properly characterizes the testimony of the Secretary's expert. Indeed, neither Dr. Daniel Dewsnup, the Secretary's expert, nor Dr. Margaret Koziel, Plaintiffs' expert, dispute that the

1283
*1283 standard of care is to treat all cHCV-positive prisoners with DAAs.
Dr. Koziel gave a statement explaining that "[a]lthough the standard of care is to treat all persons with chronic HCV with DAA drugs, the choice of the regimen is dictated by ... the progression (staging) of fibrosis and/or cirrhosis." She explained that "[t]he HCV guidelines call for all individuals with Hepatitis C to be treated [with DAAs] unless there is a contraindication to treatment."[7] She reiterated that "all" patients, including those at the F0and F1-stage, "need to be treated." However, when determining how "to set up a priority system for treatment," Dr. Koziel said that she would treat those with more advanced fibrosis and cirrhosis, which typically fall within the F3 and F4 stages, and then keep treating the next, less-advanced cHCV stages in descending order, from the F2 to F1 to F0. Dr. Koziel put it this way: "So if you have a list of 5,000 patients, it is reasonable to think I can't see 5,000 patients tomorrow. Let's find[,] of those 5,000[,] the individuals who are sickest and treat those first because they are most[ ] like[ly] to suffer the complications of liver disease."
Dr. Dewsnup's testimony seems to align with that of Dr. Koziel. Dr. Dewsnup agreed that the HCV Guidelines recommend "treating everyone with chronic hepatitis C" with DAAs, and that this recommendation represents the standard of care. He noted that "in the correctional setting," the standard of care is "a goal that we should strive for." He recognized that in practice, due to the sheer number of prisoners, patients must be triaged and then prioritized "to treat the sickest first." Dr. Dewsnup admitted "this is the reality" of things, and he would treat less-advanced cHCV-positive prisoners "as soon as we can." He suggested prioritizing treatment as follows: people with decompensated cirrhosis "need to be prioritized for urgent, immediate treatment"; people with cirrhosis (F4-stage) "need to be treated very soon"; people at the F3- and F2-stages are slotted next; and "it's safe to wait for a bit" to treat the F0- and F1-stage patients, but they would need to be treated "eventually."[8]
Based on this testimony, the experts' opinions do not differ in the ways the majority seems to think. See Maj. Op. at 1273. Rather, both experts agree that the standard of care requires treating all cHCV-positive prisoners and, while F0-and F1-stage patients need not be treated immediately, the goal is to treat them with DAAs.
B. THE MAJORITY OPINION FAILS TO ADDRESS EVIDENCE SHOWING F0- AND F1-STAGE PATIENTS ARE AT RISK DURING THE PERIOD DAA TREATMENT IS DELAYED.
I agree, based on the expert testimony described above, that the FDOC's current

1284
*1284 policy of monitoring F0- and F1-stage patients is appropriate for some period of time. Notably, however, neither expert testified that treatment with DAAs could be delayed indefinitely for the F0- and F1-stage patients. The question thus becomes whether delaying DAA treatment for F0- and F1-stage patients is "tolerable"; and that "depends on the nature of the medical need and the reason for the delay." Farrow v. West, 320 F.3d 1235, 1247 (11th Cir. 2003) (quotation marks omitted). Courts have recognized that if symptoms of a disease get progressively worse, this factors into whether the delay constitutes gross negligence. See Goebert v. Lee County, 510 F.3d 1312, 1327 (11th Cir. 2007) ("Where the prisoner has suffered increased physical injury due to the delay, we have consistently considered: (1) the seriousness of the medical need; (2) whether the delay worsened the medical condition; and (3) the reason for the delay."). Again, the Secretary admits both that cHCV is a serious medical need and the reason for the delay is the cost of treatment. See Ancata v. Prison Health Servs., Inc., 769 F.2d 700, 704 (11th Cir. 1985) (concluding prison was deliberately indifferent when "necessary medical treatment ha[d] been delayed for non-medical reasons"). We therefore must examine the risks posed to F0- and F1-stage patients when their treatment is delayed, and whether, during the delay, Plaintiffs' conditions worsen such that treatment with DAAs is medically "necessary." See id.
First, no one here disputes that the "principal consequence" of HCV is "infection of the liver, which causes inflammation that in turn may result in scarring of the liver (fibrosis)." R. 270 at 4 (quotation marks omitted); see also R. 153 at 2. Neither is there any dispute that a patient's symptoms do not necessarily match up with the extent of liver scarring they are experiencing, or that a patient's symptoms correlate to their risk of liver failure. A person "can be completely asymptomatic and present with cirrhosis." R. 270 at 6 (quotation marks omitted); see also R. 153 at 5. Consistent with this, Dr. Dewsnup testified that he has measured the progression of F2- and F3-stage patients' symptoms from none "to end-stage liver disease." This record thus shows that symptoms are not indicative of the progression of the virus and the underlying damage to the liver. This matters because the Secretary is proposing delaying treatment until a patient reaches a more advanced stage. But because there is no dispute that once a patient reaches this higher F2 stage, scarring of the liver is already present, the Secretary is in essence waiting for F0- and F1-stage patients' condition to deteriorate to begin treatment. R. Doc. 270 at 4-5 (describing the F2 stage as "moderate fibrosis" and defining fibrosis as "scarring of the liver"); Doc. 153: 2-3 (same).
The Secretary's approach does not come with a precise time frame. The delay in treatment could be one year, or it could be twenty years. Either way, the experts' testimony provides evidence that treating cHCV patients is medically necessary and, in the absence of treatment, cHCV-positive prisoners experience liver inflammation that may progress to liver scarring. The Secretary's proposed outcome, adopted in the majority opinion, banks on the chance that some F0- and F1-stage patients may not ever progress to F2 while they are incarcerated and that some may not progress to the most serious fibrosis stage—

cirrhosis—until 20 years from now. But the fact that a disease may progress slowly does not mean that prison officials may refuse to treat it. The Supreme Court has said as much, warning that prison officials cannot ignore harm "that is sure or very likely to cause serious illness and needless suffering the next week or month or year." See Helling, 509 U.S. at 33, 113 S. Ct. at 2480 (reconciling standard for conditions of
1285
*1285 confinement with deliberate indifference standard).
This record shows that all cHCV patients —no matter the stage—are at risk of suffering liver damage. At least one other circuit has reached the same conclusion based on similar cHCV evidence. In Gordon v. Schilling, 937 F.3d 348 (4th Cir. 2019), the Fourth Circuit critiqued the prison's decision to simply monitor a plaintiff diagnosed with acute HCV. Id. at 359. That court recognized that even though the plaintiff's lab tests were "normal," he "could be suffering from ongoing liver damage." Id. The Fourth Circuit concluded "it is inconsistent with the Eighth Amendment for a prison official to withhold treatment from an inmate who suffers from a serious, chronic disease until the inmate's condition significantly deteriorates." Id. I agree and would hold the same here.
The majority also takes issue with District Court's statement that the Secretary "ha[d] not put forth any medical reason... why F0 and F1 inmates should not be treated." Maj. Op. at 1274. The majority says the District Court improperly removed the burden of proof from Plaintiffs and put it on the Secretary. See id. at 1273-75. To arrive at this judgment, the majority seizes on one sentence in the District Court's order and ignores that Plaintiffs had already established that cHCV is a "serious medical need" within the meaning of our precedent. The majority's approach also overlooks that Plaintiffs did provide evidence to demonstrate that treatment of F0- and F1-stage patients is no less medically necessary—though perhaps less urgent—than treatment for F2-, F3-, and F4-stage patients. I believe the District Court properly found that Plaintiffs presented evidence sufficient to show that treatment of F0- and F1-stage patients is necessary, and that withholding necessary treatment based solely on cost demonstrates the Secretary acted with more than gross negligence. In fact, testimony from the Secretary's own expert compels this conclusion.[9]
To summarize, a review of this record, drawing all inferences in favor of the District Court's factual and credibility determinations, see Fla. Int'l Univ. Bd. of Trs. v. Fla. Nat'l Univ., Inc., 830 F.3d 1242, 1253 (11th Cir. 2016), supports the District Court's finding of deliberate indifference. I would uphold the District Court's decision to require the Secretary provide F0and F1-stage patients with DAA treatment.[10]
1286

*1286 The Secretary is here seeking to avoid paying for DAA treatment for a portion of cHCV-positive prisoners it is charged with caring for. But the Secretary should be required to fund this treatment because delaying it until the F2 stage, when a patient's condition has certainly deteriorated from liver inflammation to scarring of the liver, is inconsistent with the Eighth Amendment.
C. THE DISTRICT COURT PROPERLY APPLIED HARRIS V. THIGPEN.
Finally, the majority gives costs too large a role in determining whether the Secretary is deliberately indifferent. See Maj. Op. at 1275-78. The rule is this: nothing precludes a prison from considering cost, but "cost can never be an absolute defense to what the Constitution otherwise requires." Id. at 1277. Based on what the Secretary has actually argued in this case, it is not necessary for the majority to go to the lengths it does to emphasize the role costs play in its analysis.
The Secretary argues that the District Court incorrectly applied Harris v. Thigpen, 941 F.2d 1495 (11th Cir. 1991), when it "agree[d]" with an advocacy statement from the Plaintiffs' brief, which used the term "per se deliberate indifference." In Harris, our Court rejected "any suggestion in the [district] court's reasoning that a state's comparative wealth might affect an HIV-infected prisoner's right to constitutionally adequate medical care." 941 F.2d at 1509. The Harris court said it did "not agree that financial considerations must be considered in determining the reasonableness of inmates' medical care to the extent that such a rationale could ever be used... to deny a prisoner the minimally adequate care to which he or she is entitled." Id. (quotation marks omitted). To the extent the majority recognizes Harris as standing for this principle, see Maj. Op. at 1277, I agree.
Contrary to the Secretary's argument, the District Court's analysis was in keeping with Harris. Although the District Court reordered the Harris analysis, it said that evidence supported the finding that "F0 and F1 inmates face substantial suffering and harm." The Court then noted, as the Secretary claims is required by Harris, that FDOC did not provide "any medical reason" why, contrary to the experts' conclusions, F0 and F1 inmates should not be treated. See Appellant's Br. at 18 ("Properly understood, Harris establishes that a state's inability to pay for constitutionally required care is not a defense to an Eighth Amendment violation."). Thus, the Secretary's argument that there is no precedent supporting the idea that "there is a per se Eighth Amendment prohibition" against prison officials "considering cost" does not address the findings actually made by the District Court. See id. at 17.
The Secretary's cost justification raises the question of whether its actions amount to more than gross negligence.[11] Again, the Secretary admits that the reason for delaying

1287
*1287 treatment of F0- and F1-stage patients is the cost of DAAs. See Ancata, 769 F.2d at 704 (concluding prison was deliberately indifferent when "necessary medical treatment has been delayed for non-medical reasons"). This record contains no other medical reason for delay.[12]
* * *
I understand this record to support the District Court's factual findings that the Secretary was deliberately indifferent to the serious medical needs of F0- and F1-stage cHCV patients. I would therefore affirm the District Court's summary judgment order.
II.
The Prison Litigation Reform Act of 1995 ("PLRA") "imposes limits on the scope and duration of preliminary and permanent injunctive relief." Nelson v. Campbell, 541 U.S. 637, 650, 124 S. Ct. 2117, 2126, 158 L.Ed.2d 924 (2004). These limits include a requirement that, before issuing such relief,
[t]he court shall not grant or approve any prospective relief unless the court finds that such relief is narrowly drawn, extends no further than necessary to correct the violation of the Federal right, and is the least intrusive means necessary to correct the violation of the Federal right.
18 U.S.C. § 3626(a)(1). The Secretary argues, and the majority holds, that the District Court's order contained only a "threadbare recitation" of the PLRA's narrowness-need-intrusiveness requirements, which is insufficient as a matter of law. See Appellant's Br. at 27; Maj. Op. at 1278. I believe this holding is flawed in two respects. First, I do not agree that the Secretary has properly challenged any prospective relief other than the District Court's direction to treat F0- and F1-stage patients. Second, the record reflects that the District Court did indeed balance the concerns for redressing the Secretary's constitutional violation with the Secretary's authority to run the FDOC. I would therefore hold that the District Court met the PLRA requirements.
The first step in examining whether the District Court properly made the narrowness-need-intrusiveness findings is to determine what findings the Secretary is challenging. We do not require the District Court to make particularized findings "concerning any facts or factors about which there is no dispute" or which the Secretary has conceded. Cason v. Seckinger, 231 F.3d 777, 785 n.8 (11th Cir. 2000). Even though the majority opinion agrees that the Secretary doesn't challenge any of those additional items under the Eighth Amendment, it vacates the entire injunction and instructs the District Court to make

the narrowness-need-intrusiveness findings on all relief ordered. See Maj. Op. at 1278, 1279. And it does so without acknowledging Plaintiffs' argument that the Secretary conceded the District Court's findings satisfied the PLRA. The majority should have resolved this dispute first. Because it did not, the majority opinion is based on a flawed premise, and its resulting narrowness-need-intrusiveness analysis
1288
*1288 overturns findings the Secretary has conceded.
To properly analyze the Secretary's claim, we first must determine what findings the Secretary has properly challenged. See Cason, 231 F.3d at 785 n.8. The Secretary claims it did not concede the District Court's findings satisfied the PLRA "for any of the additional relief" ordered by the court at summary judgment. Appellant's Reply Br. at 17 n.17. The problem with this assertion is that the Secretary does not specify what "additional relief" it is actually challenging. See Thomas, 614 F.3d at 1323 (upholding injunction because, in part, "[t]he defendants d[id] not articulate any particular aspect of the injunction that they claim extends beyond the violation found by the district court"). Indeed, the Secretary's arguments focus only on whether it should be required to treat F0- and F1-stage patients. It has not referenced its challenge to any other "additional relief." It is thus clear from the Secretary's briefing that its aim in this appeal is to get the F0 and F1 patient-directive reversed, and I would analyze this claim as challenging only the portion of the order requiring the Secretary to treat F0- and F1-stage patients.
I now move to the next step of the analysis. Our Court has read the PLRA "as requiring particularized findings, on a provision-by-provision basis, that each requirement imposed by the [district court] satisfies the need-narrowness-intrusiveness criteria." Cason, 231 F.3d at 785.[13] We may look to the entire record to determine whether a district court made these specific findings. See Sec'y, Fla. Dep't of Corr., 778 F.3d at 1228 ("Neither the December 6 [preliminary injunction] order nor any of the court's later orders contained specific findings...."). After reviewing the record, I believe the District Court made the findings required by the PLRA.
As this Court has previously recognized, a district court is "keenly aware" of the PLRA narrowness-need-intrusiveness requirements when its order "seemingly has fashioned a narrow injunction" targeting the constitutional violation. Thomas, 614 F.3d at 1323. In Thomas, this Court found no flaw in the District Court's order because it discussed the balance between "redressing the constitutional violation and recognizing that it is primarily defendants'
1289
*1289 job, and not the Court's, to run the prison system." Thomas v. McNeil, 2009 WL 605306, at *1 (M.D. Fla. March 9, 2009) (unreported), aff'd sub nom. Thomas v. Bryant, 614

F.3d 1288 (11th Cir. 2010); see Thomas, 614 F.3d at 1323 (citing district court order). The District Court in Thomas explained that it asked the defendants to submit a proposal for injunctive relief and found their refusal "puzzling" because it thought the defendants "would be in the best position to suggest the least intrusive injunctive relief," and the Supreme Court has strongly encouraged soliciting the defendants' views on the scope of relief. 2009 WL 605306, at *1. Based on this discussion (and because the defendants did not point to any specific deficiency), our Court upheld the injunction imposed by the District Court in Thomas. Id. Like that court, the District Court in this case made the appropriate narrowness-need-intrusiveness findings.[14]
Here, after the District Court explained why the permanent injunction requirements were met, it summarized in one sentence that the injunction satisfied the PLRA "because it is narrowly drawn, extends no further than necessary to effect the changes this Court concludes are constitutionally required, and is the least intrusive means of effecting such changes." But in its explanation preceding that summary language, the District Court considered the balance of requiring treatment for F0- and F1-stage patients in light of the magnitude of the existing constitutional violations, the available remedial alternatives, and the prison's interest in administering its own affairs. Our Court has endorsed the very approach employed by the District Court here. See Thomas, 614 F.3d at 1323-24. Other courts have as well. See, e.g., Morales Feliciano, 378 F.3d at 54-55 (upholding injunction fashioned to remedy constitutional violations "substantial in both scope and degree" in light of the prison's "abject failure" to cure such violations).
First, the District Court acknowledged that the Secretary was taking steps to treat the prisoners, but that over 2,200 prisoners still required treatment. The District Court thus considered that "the level of improvement still falls well short of bringing serious violations into constitutional compliance." See Morales Feliciano, 378 F.3d at 55.
Next, the District Court considered the Secretary's past actions, as well as the fact that he "continues to oppose relief" the District Court found to be constitutionally required. See id. at 54 ("The constitutional violations.... have defied correction for more than two decades."). Based on these considerations, the District Court found the Secretary was deliberately indifferent. In addressing the additional relief Plaintiffs asked for, the District Court found that some forms of relief were not constitutionally required and denied them. The
1290
*1290 District Court therefore implicitly addressed the narrowness and intrusiveness of the injunction when it fashioned the scope of the injunction. And, in granting the Plaintiffs certain forms of relief, the District Court noted it was "mindful of its role not to supervise prisons but to enforce the constitutional rights of prisoners," and gave the Secretary its choice of two options in implementing a remedy. See id. at 55 (upholding choice of one of three possible remedies when second was ineffective and third was undesirable).

In ordering the Secretary to treat F0- and F1-stage patients, the District Court found that not treating those patients amounted to a constitutional violation. The Secretary's own expert never testified that F0- and F1-stage patients should never be treated. Rather, the state's expert recognized that such patients must be treated with DAAs "eventually." In light of that fact, tailoring the remedy came down to timing: how quickly should F0- and F1-stage patients be treated? Plaintiffs proposed they be treated within two years, and the District Court recognized that the Secretary never "propose[d] an alternative date (other than never)." The District Court then weighed Plaintiffs' proposed timeline against the Secretary's progress in treating prisoners to date—over 4,900 prisoners treated over a 15-month period —and found the two-year timeline to be reasonable.
Like in Thomas, the order in this case reflects that the District Court was "keenly aware" of the PLRA requirements. 614 F.3d at 1323. Rather than focusing on the District Court's summary paragraph citing to the PLRA, we should more fairly look to the record to determine if it made the required findings. See Sec'y, Fla. Dep't of Corr., 778 F.3d at 1228 (scanning the entire record for evidence of PLRA findings). This circuit, like others,[15] has upheld orders of prospective relief where the narrowness-need-intrusiveness findings are interwoven with the analysis of the facts and legal issues of the underlying case. See Thomas, 614 F.3d at 1323. Based on this record, I would affirm the District Court's injunction. This District Court did not "simply state in conclusory fashion" that the F0- and F1-stage treatment required by the injunction satisfied the PLRA requirements. See Cason, 231 F.3d at 785. Rather, it made particularized findings and explained its reasons for arriving at those conclusions. See Thomas, 614 F.3d at 1323.
The majority's holding poses practical problems by placing a rigid requirement on district courts in this circuit. It says that "if a district court's injunction grants 15 separate forms of relief, the court must make—and explain—15 separate PLRA-related findings." Maj. Op. at 1279. But district courts carry substantial caseloads and our district judges are quite busy.[16] Imposing a formulaic requirement about how district judges must set out factual findings that are not, in my view, required by the statute itself, forces courts to prioritize formalistic concerns. I view the majority's holding as impractical and wasteful of precious judicial resources.
* * *
1291
*1291 The evidence in this record shows cHCV is a progressive disease that inherently puts all patients at risk of liver complications. Even patients at the F0 and F1 stages are at a serious risk of harm without eventual treatment. The Secretary's challenge to the District Court's finding of deliberate indifference, in an attempt to ultimately limit the scope of the injunction, runs contrary to the medical testimony in this case and our precedent. Because

the majority opinion effectively allows the Secretary to withhold treatment indefinitely, I dissent.
I also dissent from the majority's holding that the District Court did not make particularized findings required under the PLRA. Although the District Court did not formulaically reference the narrowness-need-intrusiveness criteria, it performed the factual analysis our circuit and others have upheld. The majority's holding to the contrary is impractically rigid and places an unnecessary burden on our hard-working district judges.
[*] Honorable Bobby R. Baldock, United States Circuit Judge for the Tenth Circuit, sitting by designation.
[1] We review the district court's decision to grant summary judgment de novo, Ellis v. England, 432 F.3d 1321, 1325 (11th Cir. 2005), and its decision to enter an injunction for abuse of discretion, Prison Legal News v. Sec'y, Fla. Dep't of Corr., 890 F.3d 954, 964 (11th Cir. 2018). "A district court by definition abuses its discretion when it makes an error of law." Koon v. United States, 518 U.S. 81, 100, 116 S.Ct. 2035, 135 L.Ed.2d 392 (1996).
[2] We pause briefly to flag a tension within our precedent regarding the minimum standard for culpability under the deliberate-indifference standard. Although we have repeatedly noted that "a claim of deliberate indifference requires proof of more than gross negligence," e.g., Townsend v. Jefferson Cty., 601 F.3d 1152, 1158 (11th Cir. 2010) (emphasis added), another line of our cases favors the phrase "more than mere negligence," McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir. 1999) (emphasis added). A panel of this Court recently suggested that "the `more than mere negligence' standard in McElligott is more consistent with [Farmer v. Brennan, 511 U.S. 825, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994)] than the `more than gross negligence' standard in Townsend." Melton v. Abston, 841 F.3d 1207, 1223 n.2 (11th Cir. 2016). These competing articulations—"gross" vs. "mere" negligence—may well represent a distinction without a difference because, as explained below, the Supreme Court itself has likened the deliberate-indifference standard to "subjective recklessness as used in the criminal law." Farmer, 511 U.S. at 839-40, 114 S.Ct. 1970 (emphasis added). Accordingly, no matter how serious the negligence, conduct that can't fairly be characterized as reckless won't meet the Supreme Court's standard.
[3] First, a bit of housekeeping. Based on two stray statements in its summary-judgment motion, the plaintiffs assert that the Secretary has "conceded" that the Eighth Amendment requires DAA treatment for F0- and F1-level inmates. Br. of Appellees at 29. We don't think so—seems to us like a game of gotcha. As for the first statement—that the "present-day standard of care is to treat" chronic HCV patients "with DAAs as long as there are no contraindications or exceptional circumstances" —the Secretary clarified on the very same page of the very same filing its position, which squares with Dr. Dewsnup's testimony, that "[t]here has been no showing that delaying treatment with DAAs for inmates with fibrosis scores of F0 or F1, until they reach F2, will cause harm to those inmates." As for the second—that "[i]t is inappropriate to only treat those with advanced levels of fibrosis"— the plaintiffs' argument simply misunderstands the import of the word "advanced." As Dr. Koziel herself explained, "advanced fibrosis" can be distinguished from F2-level fibrosis, which is "in the middle of the spectrum." Notably, the district court didn't rely on this so-called "concession" in its summary-judgment order.
[4] The Secretary disputes the upshot of Dr. Koziel's testimony. In particular, the Secretary emphasizes (1) that all Dr. Koziel really said was that treating all HCV patients with DAAs is the "best possible management for Hepatitis C"—not that doing so is the only permissible course of action—and (2) that she acknowledged that she only "really, really start[s] to get agitated" when a patient reaches F3. See Br. of Appellant at 20. In response, the plaintiffs (1) challenge the Secretary's "implication" that Dr. Koziel's testimony suggests "that there is some other adequate form of treatment that is not the `best'"—which, they insist, "is simply untrue"—and (2) that the Secretary has taken Dr. Koziel's "agitat[ion]" remark out of context. Br. of Appellees at 35. For present purposes, the parties' debate is beside the point. We can simply assume for present purposes that Dr. Koziel believes that all HCV-positive inmates should be treated with DAAs.
[5] To be sure, our decisions have said—incanted, really—that "a defendant who delays necessary treatment for non-medical reasons may exhibit deliberate indifference." Bingham v. Thomas, 654 F.3d 1171, 1176 (11th Cir. 2011) (citing Hill, 40 F.3d at 1187). That rule, of course, isn't absolute. It seems to us inconceivable, for instance, that the

Eighth Amendment could be read to disable prison administrators from refusing an inmate's treatment request (no matter how medically sound) on the ground that it would threaten institutional security. To take just one example, would the Constitution require prison authorities to allow an inmate with severe allergies to keep an EpiPen® in his cell? If only "medical" considerations counted, then the answer would have to be yes—but of course the answer is no. In any event, none of our decisions has ever formally imposed a burden on prison officials to prove a medical reason for delaying or withholding an inmate's preferred treatment, let alone suggested that the failure to discharge that burden is fatal.
[6] Cf. also Woodall v. Foti, 648 F.2d 268, 272 (5th Cir. Unit A 1981) (holding that in deciding whether denial or deferral of medical treatment constitutes deliberate indifference, a court should "take into account a number of competing considerations," among them "the seriousness of the prisoner's illness [and] the need for immediate treatment" and the "availability and expense" of the requested care, keeping in "mind[ ] that the essential test is one of medical necessity and not simply of desirability").
[7] We respectfully disagree with our dissenting colleague, see Dissenting Op. at 1287-88, that the Secretary has in any way "conce[ded]" or "stipulate[ed]" that the district court's injunction satisfies the PLRA's narrowness, necessity, and non-intrusiveness requirements. See Cason v. Seckinger, 231 F.3d 777, 785 n.8 (11th Cir. 2000). In the district court, the Secretary vigorously (if largely unsuccessfully) challenged all 15 forms of additional relief that the plaintiffs sought on summary judgment. The fact that the Secretary has narrowed his merits appeal to the question whether the Eighth Amendment requires DAA treatment of all F0- and F1-level inmates does not mean that he must forgo his separate argument that the district court's injunction— even as it pertains to other issues—violates the PLRA.
[8] Contrary to our dissenting colleague's contention, Thomas v. Bryant, 614 F.3d 1288 (11th Cir. 2010), does not suggest otherwise. See Dissenting Op. at 1288-91. Nor could it, as the court there expressly declined to consider the question whether the injunction at issue satisfied the PLRA's particularized-findings requirement. See 614 F.3d at 1323 n.33 ("[T]he defendants do not specifically argue that the district court erred by not making the required particularized findings that the proposed injunction satisfies the PLRA's need-narrowness-intrusiveness requirement.... Because this issue is abandoned, we need not decide whether the district court's order satisfied our circuit's interpretation of § 3626(a)(1)(A).").
In response to our dissenting colleague's objection that enforcement of the PLRA's explicit findings requirement is "formalistic," see Dissenting Op. at 1290-91, we can say only (1) that the Act requires what it requires and (2) that the statute's formalism serves one of its principal (and undisputed) purposes— namely, to require district courts to dot their i's and cross their t's before issuing or maintaining injunctions that interfere with prison administration. Cf. Harrington v. Richter, 562 U.S. 86, 102, 131 S.Ct. 770, 178 L.Ed.2d 624 (2011) (observing that if 28 U.S.C. § 2254's stringent standard for habeas corpus relief "is difficult to meet, that is because it was meant to be").
One final point: The PLRA's narrowness, necessity, and non-intrusiveness requirements also defeat the plaintiffs' alternative argument that a district court can grant an injunction broader than necessary to correct an Eighth Amendment violation. Whatever "substantial flexibility" district courts may enjoy to fashion Eighth Amendment relief, Brown v. Plata, 563 U.S. 493, 538, 131 S.Ct. 1910, 179 L.Ed.2d 969 (2011), it does not countenance violation of the PLRA's explicit requirements.
[1] HCV is a viral infection, which is spread by exposure to blood or blood products. "The most common way of contracting HCV is through intravenous drug use, but a person can also get infected through tattooing or blood transfusions." R. Doc. 153 at 2. I am concerned that a reader of the majority opinion might understand it to say this disease spreads only among people who engage in risky or deplorable behavior. See Maj. Op. at 1266-67.
[2] See, e.g., Swain v. Junior, 961 F.3d 1276, 1286-89, 1294 (11th Cir. 2020) (overturning the District Court's conclusion that prison officials were deliberately indifferent to serious risk of harm posed by COVID-19 and vacating preliminary injunction); Keohane v. Fla. Dep't of Corr. Sec'y, 952 F.3d 1257, 1264-65, 1277 (11th Cir. 2020) (overturning the District Court's conclusion that prison officials were deliberately indifferent to a prisoner's gender dysphoria because prisoners aren't constitutionally entitled to medical care "that is great, or even very good" (quotation marks omitted)); Marbury v. Warden, 936 F.3d 1227, 1238 (11th Cir. 2019) (per curiam) (declining to hold a prison official was deliberately indifferent to an attack on a prisoner because to do so based on "only some risk of harm" would erode "the `subtle distinction' between deliberate indifference and mere negligence").

[3] HCV attacks the liver and, in particular, can cause liver scarring called "fibrosis." Fibrosis can be measured, or staged, on a five-step scale in ascending order of severity, from F0 (no fibrosis) to F1 (mild fibrosis) to F2 (moderate fibrosis) to F3 (severe fibrosis) to F4 (cirrhosis).
[4] Sadly, Mr. Hoffer succumbed to his illness before seeing the resolution of his case.
[5] The majority does not view the Secretary as having conceded that DAA treatment is required for F0- and F1-stage patients. See Maj. Op. at 1271 n.3. This view is apparently based on the Secretary's "clarifi[cation]" that "there has been no showing that delaying treatment with DAAs for inmates with fibrosis scores of F0 or F1, until they reach F2, will cause harm to those inmates." Id. (quotation marks omitted and alteration adopted). To support this position, the Secretary points to the purported lack or insignificance of symptoms experienced by F0- and F1-stage patients. But I cannot square either the Secretary's arguments or the majority's conclusion with the concessions the Secretary made in this case. While it may be true that some of the symptoms experienced by F0- and F1-stage patients, alone, may not rise to the level of a serious medical need requiring treatment, the Secretary has acknowledged that cHCV— which presents various symptoms that do not necessarily correlate with the seriousness of the underlining condition and risk to the health of the patient—is itself a serious medical condition. See R. 270 at 17 ("[T]he Court has concluded that cHCV constitutes a serious medical need. Defendant does not dispute this.").
[6] See R. 465 at 7-8 ("This Court previously found that chronic HCV is a serious medical need. Defendant does not dispute that finding.... This Court also previously found that Defendant was deliberately indifferent to Plaintiffs' serious medical needs. Defendant does not dispute that either." (citations omitted)).
[7] These "HCV Guidelines" refer to the report published by the American Association for the Study of Liver Disease and Infectious Disease Society of America, entitled "HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C," and available at https://www.hcvguidelines.org/contents.
[8] The majority views Dr. Dewsnup's testimony as meaning that treatment will eventually be required as a matter of disease progression, such that "many inmates who are currently at F0 or F1 will, if they remain incarcerated long enough, `eventually' progress to F2 and need DAA treatment." See Maj. Op. at 1275. This conclusion is not supported by the record. Dr. Dewsnup never testified that F0- and F1-stage patients should never be treated. And, while it might be true that many F0- and F1-stage patients may progress to the F2 stage slowly, neither expert said withholding treatment until a patient's condition deteriorates is appropriate. And, importantly, the experts did not recommend treating only F0- and F1-stage patients sentenced to longer prison terms.
[9] When asked if "it's not that big of deal" for patients at less-progressed stages to wait for medical treatment, Dr. Dewsnup responded, "I wouldn't put it exactly that way ... a medical way that we could put it [is] ..., look, I've got to treat the sickest first. You're not the sickest, but we're watching you. We're looking at your labs. We are going to do it as soon as possible.... We'll treat you as soon as we can." He further stated that, "to the extent that [the HCV Guidelines] can be applied, if we had the money and we have the system capacity, I agree with them. However, in Stage 0 and Stage 1, ... I think those people don't need to be treated immediately." This testimony does not, as the majority seems to believe, establish that the Secretary's expert thought that denying DAA treatment to F0- and F1-stage patients is a medically acceptable practice. I also disagree with the majority's comparison of F0- and F1-stage cHCV patients to people in the early stages of hearing loss. See Maj. Op. at 1273. The majority reasons that withholding treatment to F0- and F1-stage patients is like accommodating an individual with early hearing loss by speaking up. Id. Setting aside the gravity of initial hearing loss, the majority's analogy fails because Plaintiffs have established, and the Secretary admits, that cHCV is a "serious medical need" deserving of treatment.
[10] Affirming the District Court's findings of fact is especially warranted in this case, where the Secretary sought to get a final judgment by, among other things, asking the court to convert the preliminary injunction into a permanent injunction. The Secretary disputed none of the findings of facts made by the District Court at the preliminary injunction stage. See Fla. Int'l Univ. Bd. of Trustees, 830 F.3d at 1253 (applying deferential standard of review to resolution of cross-motions for summary judgment when "the parties intended to submit the case to the district court for final resolution").
[11] The majority says that because Plaintiffs are not entitled to treatment "in the best of all possible worlds," the Secretary's actions do not rise to the level of "subjective recklessness as used in the criminal law." See Maj. Op. at

1271-72 (quotation marks omitted). Even accepting the majority's formulation of the level of negligence required to show deliberate indifference, the Secretary's cost justification and lack of other evidence to support withholding treatment rises above what is required to prove an Eighth Amendment violation.
[12] To the extent the Secretary suggests Dr. Dewsnup testified about medical reasons for delaying treatment, that view misconstrues the record. As discussed above, Dr. Dewsnup testified about the practical reasons for prioritizing patients according to capacity and resources. While such a consideration is appropriate with respect to fashioning the scope of the remedy, it is not a medical reason that precludes a deliberate indifference finding. See Thomas v. Bryant, 614 F.3d 1288, 1324 (11th Cir. 2010) ("[T]he injunction appropriately balances respect for the DOC's administration of its own affairs with the need to ensure that [plaintiff] is not further subjected to [constitutional violations].").
[13] Cason applied § 3626(b)(3) of the PLRA, which describes the standards for terminating prospective relief. 231 F.3d at 785. However, this Court extended the Cason particularity requirement to the term "finds" in § 3626(a)(1), which sets forth the standards for granting prospective relief, i.e., the standard that must apply in this case. See United States v. Sec'y, Fla. Dep't of Corr., 778 F.3d 1223, 1228 (11th Cir. 2015); see also Johnson v. Breeden, 280 F.3d 1308, 1326 (11th Cir. 2002) (same).
I question the viability of this extension. Based on my reading of the statute, § 3626(a)(1) does not on its face require "written findings" in the way that § 3626(b)(3) does. Beyond that, most other circuits only apply the narrowness-need-intrusiveness findings requirement when there is a motion to terminate prospective relief under § 3626(b)(3). See Gates v. Cook, 376 F.3d 323, 336 n.8 (5th Cir. 2004) (rejecting the conclusion that § 3626(a)(1) requires particularized written findings); Morales Feliciano v. Rullan, 378 F.3d 42, 54-55 (1st Cir. 2004) (denying motion to terminate because "[t]he need for continued prospective injunctive relief is patent"); Jones-El v. Berge, 374 F.3d 541, 545 (7th Cir. 2004) ("So long as the underlying consent decree remains valid—and the defendants here have not (yet) made a § 3626(b) motion to terminate or modify the decree— the district court must be able to enforce it."). However, we are bound to follow Cason under our prior precedent rule. See United States v. Archer, 531 F.3d 1347, 1352 (11th Cir. 2008) ("[A] prior panel's holding is binding on all subsequent panels unless and until it is overruled or undermined to the point of abrogation by the Supreme Court or by this court sitting en banc.").
[14] As the majority points out, the Thomas court noted that the defendants did not argue that the PLRA findings were not particularized enough. Maj. Op. at 1279 n.8. In Thomas, the defendants made conclusory arguments that the injunction was too broad: "The defendants do not articulate any particular aspect of the injunction that they claim extends beyond the violation found by the district court or is overly intrusive." 614 F.3d at 1323. A panel of this Court reviewed the scope of the injunction anyway and upheld it. Id. In contrast to the way the majority frames the Secretary's arguments here, see Maj. Op. at 1278 n.7, the Secretary does not articulate any particular aspect of the injunction that is too broad. And this is the same as was done by the defendants in Thomas. I say the Secretary's framing of the argument matters. In light of its "failure to articulate any specific deficiency," together with the findings the District Court did make here (as explained below), the record does not support a finding that the District Court abused its discretion in fashioning the injunctive relief. See Thomas, 614 F.3d at 1323.
[15] See, e.g., Morales Feliciano, 378 F.3d at 55 ("In 2003, the district court was keenly aware of its duty to ensure that prospective remediation complies with the PLRA's requirements." (citing Morales Feliciano v. Calderon Serra, 300 F. Supp. 2d 321, 331 (D.P.R. 2004))); see also Armstrong v. Schwarzenegger, 622 F.3d 1058, 1071 (9th Cir. 2010) ("[W]e have upheld as sufficient under the PLRA overall statements by the district court that the need-narrowness-intrusiveness standard has been met....").
[16] For example, for the year ending March 31, 2020, there were over 95,000 filings in the district courts in this circuit.