Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_13-cv-00641/USCOURTS-almd-2_13-cv-00641-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

---

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

KRYSTAL RAY GRAYSON WEBSTER, )

AIS #228428, )

)

Plaintiff, )

)

v. ) CASE NO. 2:13-CV-641-TMH

) [WO] 

)

QUALITY CORRECTIONAL )

HEALTH CARE, et al., )

)

Defendants. )

RECOMMENDATION OF THE MAGISTRATE JUDGE

I. INTRODUCTION

This 42 U.S.C. § 1983 action is before the court on a complaint filed by Krystal Ray

Grayson Webster [“Webster”], an indigent state inmate, challenging the adequacy of medical

treatment provided to her during previousintermittentstints of incarceration at the Montgomery

County Detention Facility. Webster names Quality Correctional Health Care [“QCHC”], the

contract medical care provider for the Montgomery County Detention Facility, and Dr. Johnny

E. Bates and Dr.Jerry N. Gurley, physicians employed by QCHC at the jail, as defendantsin this

cause of action. Webster seeks monetary damagesfor the alleged violation of her constitutional

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rights.

The defendants filed an answer, special report and supporting evidentiary materials,

The plaintiff simply identifies the individual defendants as Dr. Bates and Dr. Gurly. In the interest of

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clarity, the court will utilize the names of these defendants as set forth in the defendants’ evidentiary materials. 

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including affidavits and certified medical records, addressing Webster’s deliberate indifference

claim. The court thereafter informed Webster that the defendants’ special report may, at a future

time, be treated as a motion for summary judgment and explained to Webster the proper manner

in which to respond to a motion for summary judgment. Order of October 18, 2013 - Doc. No.

16. Pursuant to the aforementioned order, the court deems it appropriate to treat the defendants’

report as a motion for summary judgment. Thus, this case is now pending on the defendants’

motion for summary judgment. Upon consideration of this motion and the evidentiary materials

filed in support thereof, the court concludes that the defendants’ motion for summary judgment

is due to be granted.

II. STANDARD OF REVIEW

“Summary judgment is appropriate ‘if the pleadings, depositions, answers to

interrogatories, and admissions on file, together with the affidavits, if any, show there is no

genuine [dispute] as to any material fact and that the moving party is entitled to judgment as a

matter of law.’\” Greenberg v. BellSouth Telecomm., Inc., 498 F.3d 1258, 1263 (11 Cir. 2007)

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(per curiam) (citation to former rule omitted); Fed.R.Civ.P. Rule 56(a) (“The court shall grant

summary judgment if the movant shows that there is no genuine dispute as to any material fact

and the movant is entitled to judgment as a matter of law.”). The party moving for summary

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Effective December 1, 2010, Rule 56 was “revised to improve the procedures for presenting and deciding

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summary-judgment motions.” Fed.R.Civ.P. 56 Advisory Committee Notes. Under this revision, “[s]ubdivision (a)

carries forward the summary-judgment standard expressed in former subdivision (c), changing only one word -- genuine

‘issue’ becomes genuine ‘dispute.’ ‘Dispute’ better reflects the focus of a summary-judgment determination.” Id.

“‘Shall’ is also restored to express the direction to grant summary judgment.” Id. Thus, although Rule 56 underwent

stylistic changes, its substance remains the same and, therefore, all cases citing prior versions of the rule remain equally

applicable to the current version of the rule.

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judgment “always bears the initial responsibility of informing the district court of the basis for

its motion, and identifying those portions of the [record, including pleadings, discovery materials

and affidavits], which it believes demonstrate the absence of a genuine issue [- now dispute -]

of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The movant may meet

this burden by presenting evidence indicating there is no dispute of material fact or by showing

that the nonmoving party has failed to present evidence in support of some element of its case

on which it bears the ultimate burden of proof. Id. at 322-324.

The defendants have met their evidentiary burden and demonstrated the absence of any

genuine dispute of material fact. Thus, the burden shifts to the plaintiff to establish, with

appropriate evidence beyond the pleadings, that a genuine dispute material to her case exists.

Clark v. Coats & Clark, Inc., 929 F.2d 604, 608 (11 Cir. 1991); Celotex, 477 U.S. at 324;

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Fed.R.Civ.P. 56(e)(3) (“If a party failsto properly support an assertion of fact or failsto properly

address another party’s assertion of fact by [citing to materialsin the record including affidavits,

relevant documents or other materials] the court may ... grant summary judgment if the motion

and supporting materials -- including the facts considered undisputed -- show that the movant

is entitled to it.”). A genuine dispute of material fact exists when the nonmoving party produces

evidence that would allow a reasonable fact-finder to return a verdict in its favor. Greenberg,

498 F.3d at 1263.

In civil actions filed by inmates, federal courts

must distinguish between evidence of disputed facts and disputed matters of

professional judgment. In respect to the latter, our inferences must accord

deference to the views of prison authorities [and medical personnel]. Unless a

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prisoner can point to sufficient evidence regarding such issues of judgment to

allow him to prevail on the merits, he cannot prevail at the summary judgment

stage.

Beard v. Banks, 548 U.S. 521, 530, 126 S.Ct. 2572, 2578, 165 L.Ed.2d 697 (2006) (internal

citation omitted). Consequently, to survive the defendants’ properly supported motion for

summary judgment, Webster is required to produce “sufficient [favorable] evidence” which

would be admissible at trial supporting her claim of a constitutional violation. Anderson v.

Liberty Lobby, Inc., 477 U.S. 242, 249 (1986); Rule 56(e), Federal Rules of Civil Procedure.

“If the evidence [on which the nonmoving party relies] is merely colorable ... or is not

significantly probative ... summary judgment may be granted.” Id. at 249-250. “A mere

‘scintilla’ of evidence supporting the opposing party’s position will not suffice; there must be

enough of a showing that the [trier of fact] could reasonably find for that party. Anderson v.

Liberty Lobby, 477 U.S. 242, 106 S.Ct. 2505, 2512, 91 L.Ed.2d 202 (1986).” Walker v. Darby,

911 F.2d 1573, 1576-1577 (11 Cir. 1990). Conclusory allegations based on subjective beliefs th

are likewise insufficient to create a genuine dispute of material fact and, therefore, do notsuffice

to oppose a motion for summary judgment. Holifield v. Reno, 115 F.3d 1555, 1564 n.6 (11 Cir.

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1997) (A plaintiff’s “conclusory assertions ..., in the absence of [admissible] supporting

evidence, are insufficient to withstand summary judgment.”); Harris v. Ostrout, 65 F.3d 912, 916

(11 Cir. 1995) (grant of summary judgment appropriate where inmate produces nothing beyond

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“his own conclusory allegations” challenging actions of the defendants); Fullman v. Graddick,

739 F.2d 553, 557 (11 Cir. 1984) (“Mere verification of party’s own conclusory allegations is

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not sufficient to oppose summary judgment....”); Evers v. General Motors Corp., 770 F.2d

984, 986 (11 Cir. 1985) (“[C]onclusory allegations withoutspecific supporting facts have

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no probative value.”). Hence, when a plaintiff fails to set forth specific facts supported by

requisite evidence sufficient to establish the existence of an element essential to her case and on

which the plaintiff will bear the burden of proof at trial, summary judgment is due to be granted

in favor of the moving party. Celotex, 477 U.S. at 322 (“[F]ailure of proof concerning an

essential element of the nonmoving party’s case necessarily renders all other factsimmaterial.”);

Barnes v. Southwest Forest Industries, Inc., 814 F.2d 607, 609 (11 Cir. 1987) (If on any part

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of the prima facie case the plaintiff presents insufficient evidence to require submission of the

case to the trier of fact, granting of summary judgment is appropriate.).

For summary judgment purposes, only disputes involving material facts are relevant.

United States v. One Piece of Real Property Located at 5800 SW 74 Avenue, Miami, Florida,

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363 F.3d 1099, 1101 (11 Cir. 2004). What is material is determined by the substantive law

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applicable to the case. Anderson, 477 U.S. at 248; Lofton v. Secretary of the Department of

Children and Family Services, 358 F.3d 804, 809 (11 Cir. 2004) (“Only factual disputes that

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are material under the substantive law governing the case will preclude entry of summary

judgment.”). “The mere existence of some factual dispute will not defeat summary judgment

unless that factual dispute is material to an issue affecting the outcome of the case.” McCormick

v. City of Fort Lauderdale, 333 F.3d 1234, 1243 (11 Cir. 2003) (citation omitted). To

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demonstrate a genuine dispute of material fact, the party opposing summary judgment “must do

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more than simply show that there is some metaphysical doubt as to the material facts.... Where

the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party,

there is no ‘genuine [dispute] for trial.’” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475

U.S. 574, 587 (1986). In cases where the evidence before the court which is admissible on its

face or which can be reduced to admissible form indicatesthere is no genuine dispute of material

fact and the party moving for summary judgment is entitled to it as a matter of law, summary

judgment is proper. Celotex, 477 U.S. at 323-324 (summary judgment appropriate where

pleadings, evidentiary materials and affidavits before the court show no genuine dispute as to

a requisite material fact); Waddell v. Valley Forge Dental Associates, Inc., 276 F.3d 1275, 1279

(11 Cir. 2001) (To establish a genuine dispute of material fact, the nonmoving party must

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produce evidence such that a reasonable trier of fact could return a verdict in his favor.).

Although factual inferences must be viewed in a light most favorable to the nonmoving

party and pro se complaints are entitled to liberal interpretation by the courts, a pro se litigant

does not escape the burden of establishing by sufficient evidence a genuine dispute of material

fact. Beard, 548 U.S. at 525, 126 S.Ct. at 2576; Brown v. Crawford, 906 F.2d 667, 670 (11 Cir.

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1990). Thus, the plaintiff’s pro se status alone does not mandate this court’s disregard of

elementary principles of production and proof in a civil case. In this case, Webster fails to

demonstrate a requisite genuine dispute of material fact so as to preclude summary judgment.

Matsushita, supra.

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III. DISCUSSION

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Webster served several limited terms of incarceration in the Montgomery County

Detention Facility from November 16, 2011 untilJune 20, 2013. Webster complainsthat during

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these periods of confinement the defendants failed to provide her adequate medical treatment.

Specifically, Webster asserts that the defendants failed to diagnose her as suffering from

hypothyroidism, a condition with which she was allegedly diagnosed after her most recent

transfer to the Alabama prison in the latter part of June 2013. Complaint - Doc. No. 1 at 3. In

support of this assertion, Webster asserts that the defendants should have conducted tests which

would have revealed the presence of this condition. Id. The defendants adamantly deny they

acted with deliberate indifference to Webster’s medical needs.

To prevail on a claim concerning an alleged denial of adequate medical treatment, an

inmate must, at a minimum, show that the defendants acted with deliberate indifference to her

serious medical needs. Estelle v. Gamble, 429 U.S. 97 (1976); Taylor v. Adams, 221 F.3d 1254

The evidentiary materials indicate that the alleged constitutional violation made the basis of the instant

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complaint occurred during Webster’s incarcerations in the Montgomery County Detention Facility as a convicted

inmate. Regardless of Webster’s status in the jail either as a pre-trial detainee or convicted inmate, the applicable

standard of review remains the same. Bell v. Wolfish, 441 U.S. 520, 99 S.Ct. 1861 (1979); Lancaster v. Monroe

County, Ala., 116 F.3d 1419, 1425 n.6 (11 Cir. 1997); Cottrell v. Caldwell, 85 F.3d 1480, 1490 (11 Cir. 1996)

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(citations omitted) (“Claims involving the mistreatment of arrestees or pretrial detainees in custody are governed by

the Fourteenth Amendment’s Due ProcessClause instead ofthe Eighth Amendment’s Cruel and Unusual Punishment

Clause, which applies to such claims by convicted prisoners.... However, the applicable standard is the same, so

decisional law involving prison inmates applies equally to cases involving arrestees or pretrial detainees.”); Hamm

v. DeKalb County, 774 F.2d 1567, 1574 (11 Cir. 1985), cert. denied, 475 U.S. 1096, 106 S.Ct. 1492 (1986) (For

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analytical purposes, there is no meaningful difference between the analysis required by the Fourteenth Amendment

and that required by the Eighth Amendment.); Tittle v. Jefferson County Commission, 10 F.3d 1535, 1539 (11 Cir. th

1994) (observing that “[w]hether the alleged violation is reviewed under the Eighth or Fourteenth Amendment is

immaterial.”). 

The medical records indicate that during her last term of confinement at the Montgomery County Detention

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Facility Webster was thirty years of age. 

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(11 Cir. 2000); McElligott v. Foley, 182 F.3d 1248 (11 Cir. 1999); Waldrop v. Evans, 871

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F.2d 1030, 1033 (11 Cir. 1989); Rogers v. Evans, 792 F.2d 1052, 1058 (11 Cir.1986).

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Specifically, medical personnel may not subject an inmate to “acts or omissions sufficiently

harmful to evidence deliberate indifference to serious medical needs.” Estelle, 429 U.S. at 106,

97 S.Ct. at 292; Adams v. Poag, 61 F.3d 1537, 1546 (11 Cir. 1995) (citation and internal

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quotations omitted) (As directed by Estelle, a plaintiff must establish “not merely the knowledge

of a condition, but the knowledge of necessary treatment coupled with a refusal to treat or a

delay in [the acknowledged necessary] treatment.”

That medical malpractice-negligence by a physician-is insufficient to form the

basis of a claim for deliberate indifference is well settled. See Estelle v. Gamble,

429 U.S. 97, 105-07, 97 S.Ct. 285, 292, 50 L.Ed.2d 251 (1976); Adams v. Poag,

61 F.3d 1537, 1543 (11 Cir.1995). Instead, something more must be shown.

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Evidence must support a conclusion that a prison physician’s harmful acts were

intentional or reckless. See Farmer v. Brennan, 511 U.S. 825, 833-38, 114 S.Ct.

1970, 1977-79, 128 L.Ed.2d 811 (1994); Cottrell v. Caldwell, 85 F.3d 1480, 1491

(11 Cir.1996) (stating that deliberate indifference is equivalent of recklessly

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disregarding substantial risk of serious harm to inmate); Adams, 61 F.3d at 1543

(stating that plaintiff must show more than mere negligence to assert an Eighth

Amendment violation); Hill v. Dekalb Regional Youth Detention Ctr., 40 F.3d

1176, 1191 n. 28 (11 Cir.1994) (recognizing that Supreme Court has defined

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“deliberate indifference” asrequiring more than mere negligence and has adopted

a “subjective recklessness” standard from criminal law); Qian v. Kautz, 168 F.3d

949, 955 (7 Cir.1999) (stating “deliberate indifference” is synonym for

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intentional or reckless conduct, and that “reckless” conduct describes conduct so

dangerous that deliberate nature can be inferred).

Hinson v. Edmond, 192 F.3d 1342, 1345 (11 Cir. 1999).

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In order to set forth a cognizable claim of “deliberate indifference to [a] serious medical

need ..., Plaintiff[] must show: (1) a serious medical need; (2) the defendants’ deliberate

indifference to that need; and (3) causation between that indifference and the plaintiff’s injury.”

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Mann v. Taser Int’l, Inc., 588 F.3d 1291, 1306-1307 (11 Cir. 2009). When seeking relief based

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on deliberate indifference, an inmate is required to establish “an objectively serious need, an

objectively insufficient response to that need, subjective awareness of facts signaling the need

and an actual inference of required action from those facts.” Taylor, 221 F.3d at 1258;

McElligott, 182 F.3d at 1255 (for liability to attach, defendant must know of and then disregard

an excessive risk to prisoner’s health or safety). Thus, deliberate indifference occurs only when

a defendant “knows of and disregards an excessive risk to inmate health or safety; the

[defendant] must both be aware of facts from which the inference could be drawn that a

substantial risk of serious harm exists and he must also draw the inference.” Farmer, 511 U.S.

at 837; Johnson v. Quinones, 145 F.3d 164, 168 (4 Cir. 1998) (defendant must have actual

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knowledge of a serious condition, not just knowledge of symptoms, and ignore known risk to

serious condition to warrant finding of deliberate indifference). Furthermore, “an official’s

failure to alleviate a significant risk that he should have perceived but did not, while no cause

for commendation, cannot under our cases be condemned as the infliction of punishment.”

Farmer, 511 U.S. at 838.

In articulating the scope of inmates’ right to be free from deliberate

indifference, ... the Supreme Court has ... emphasized that not ‘every claim by a

prisoner that he has not received adequate medical treatment states a violation of

the Eighth Amendment.’ Estelle, 429 U.S. at 105, 97 S.Ct. at 291; Mandel, 888

F.2d at 787. Medical treatment violates the eighth amendment only when it is ‘so

grossly incompetent, inadequate, or excessive as to shock the conscience or to be

intolerable to fundamental fairness.’ Rogers, 792 F.2d at 1058 (citation omitted).

Mere incidents of negligence or malpractice do not rise to the level of

constitutional violations. See Estelle, 429 U.S. at 106, 97 S.Ct. at 292 (‘Medical

malpractice does not become a constitutional violation merely because the victim

is a prisoner.’); Mandel, 888 F.2d at 787-88 (mere negligence or medical

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malpractice ‘not sufficient’ to constitute deliberate indifference); Waldrop, 871

F.2d at 1033 (mere medical malpractice does not constitute deliberate

indifference). Nor does 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 support a claim of cruel and unusual punishment. See Waldrop, 871

F.2d at 1033 (citing Bowring v. Godwin, 551 F.2d 44, 48 (4 Cir.1977)).

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Harris v. Thigpen, 941 F.2d 1495, 1505 (11 Cir. 1991); Taylor, 221 F.3d at 1258 (citation and

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internal quotations omitted) (To show deliberate indifference to a serious medical need, a

plaintiff must demonstrate that [the] defendants’ response to the need was more than “merely

accidental inadequacy, negligence in diagnosis or treatment, or even medical malpractice

actionable under state law.”). Moreover, “as Estelle teaches, whether government actors should

have employed additional diagnostic techniques or forms of treatment ‘is a classic example of

a matter for medical judgment’ and therefore not an appropriate basis for grounding liability

under the Eighth Amendment.” Adams, 61 F.3d at 1545; Garvin v. Armstrong, 236 F.3d 896,

898 (7 Cir. 2001) (“A difference of opinion as to how a condition should be treated does not

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give rise to a constitutional violation.”); Hamm v. DeKalb County, 774 F.2d 1567, 1575 (11 Cir.

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1985) (mere fact inmate desires a different mode of medical treatment does not amount to

deliberate indifference violative of the Constitution); Franklin v. Oregon, 662 F.2d 1337, 1344

(9 Cir. 1981) (prison medical personnel do not violate the Eighth Amendment simply because

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their opinions concerning medical treatment conflict with that of the inmate-patient). Selfserving statements by a plaintiff do not create a question of fact in the face of contradictory,

contemporaneously created medical records. See Bennett v. Parker, 898 F.2d 1530 (11 Cir.

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1990).

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The evidentiary materials filed by the defendants address the allegations made by

Webster. A thorough review of these documents demonstrates that the affidavits submitted by

the defendants are corroborated by the objective medical records compiled contemporaneously

with the treatment provided to Webster regarding the instant claim of deliberate indifference,

records which have not been disputed by the plaintiff. The affidavit filed by Dr. Gurley

describes the treatment provided to Webster for the periods of her incarceration at the

Montgomery County Detention Facility which are relevant to the claims pending before this

court.

1. During the time Ms. Webster was cared for by QCHC. she never

displayed any signs, symptoms or physicalfindings which are normally associated

with hypothyroidism and/or a thyroid goiter. The only symptom that could be

attributed to hypothyroidism would be of some depression, but [Ms. Webster’s

depression] was of a very longstanding nature extending back at least to 2010.

She had been seeing Montgomery Mental Health [while not incarcerated] and had

been seen by a psychiatrist, as well as Dr. Bates and myself. At no time did she

exhibit any of the most common symptoms of hypothyroidism, including fatigue,

weight gain, sensitivity to cold, constipation or abnormal menstrual cycles.

The most common cause of thyroid disorder is hypothyroidism and is

usually caused by Hashimoto’s thyroiditis or an autoimmune hypothyroidism, a

form of thyroid inflammation caused by one’s own immune system. It is

important to note that this probably effects more than 10 million people in the

United States alone and approximately 10% of all women over the age of 30 have

this thyroiditis. Hypothyroidism is very easily treated after establishing a correct

level of medication and rarely causes severe complications.

I have not seen the medical records from [the Alabama prison system]. It

is entirely possible that [Ms. Webster] exhibited symptoms while there, which

lead to a diagnosis of hypothyroidism. If she had exhibited such symptoms while

under the care of QCHC, she would have been treated appropriately. In any

event, however, the condition is easily treatable and rarely causes long term

problems.

2. On several of the intakes Ms. Webster was positive for illicit drugs,

particularly methamphetamine and cocaine. She was also taking antidepressant

medicine, either Zoloft or Prozac. She also went through alcohol withdrawal both

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in May of 2012 and in May of 2013, and on one occasion[] was actually placed

on suicide watch. It was notable that she was in the Autauga County Jail in

November of 2012, and had no symptoms [of hypothyroidism] while there. She

had previously been in Julia S. Tutwiler prison for women in 2007. She was seen

on several occasionsforsick calls[while incarcerated at the Montgomery County

Detention Facility], and most of these were for re-establishing her antidepressant

medication, either Zoloft or Prozac. There were also sick calls for dental pain,

wanting a flu[] shot, [complaints of] back pain, and [symptoms associated with

a] cold.

3. On two different occasions, July of 2012 and February of 2013, [Ms.

Webster] was seen at the Montgomery County Detention Facility, by Dr.

Valamanchili, a psychiatrist. He continued her on Prozac and/or Zoloft. He noted

a diagnosis of previous substance abuse. [Webster also complained of bites and

itching on February 4, 2013 with small red bumps on the left hip noted by the

attending nurse].

4. There was one occasion, in April of 2012, when Ms. Webster had an

order for a HIV test based on the request of one of the Circuit Judges. The test

was negative.

5. There were two occasions where she wasseen for mental health chronic

care by Dr. Bates, in March of 2013. She had improved on her mental health

medicines and was referred to me for a pap smear. She had no complaints on that

visit.

6. On March 31, 2013, Ms. Webster had a mental health follow up with

Dr. Bates and had no complaints at that encounter.

7. Ms. Webster was referred to me and was seen in February 2013 for a

breast exam, which showed a small nodule in the left breast and diffuse cystic

mastopathy was noted. The right was greater than the left and there was a 1.5 cm

cyst verses small fibroadenoma. Ms. Webster was informed of the findings and

was advised on instructions for self breast exams. She was to be rechecked in six

weeks. This was accomplished and there was a decrease in the size of the cyst,

but there was still some diffuse cystic mastopathy. I advised mammograms to

start at age 35. There was no prominent family history of breast cancer. Ms.

Webster was referred to me for a GYN exam and a pap smear, which was done

on March 29, 2013, and this exam was normal and her pap smear was negative.

8. Approximately 3 weeks prior to being transferred to Julia S. Tutwiler,

Ms. Webster had been seen by Dr. Bates, and had displayed no type of medical

or mental problems and was just trying to get in a mental state to cope with

having to go back to prison.

9. Throughout all her encounters, Ms. Webster’s weight never varied. Her

pulse remained low and normal and she denied any medical problems,symptoms,

[or] signs [related to a thyroid condition] on any evaluation by the nursing staff

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or physicians.

10. Ms. Webster’s medical care while at MCDF was timely, appropriate

and responsive to her mental and physicalstate and was alwaysin the best interest

for her overall well being....

Exhibit 1 to the Defendants’ Special Report (Aff. of Dr. Jerry N. Gurley) - Doc. No. 15-1 at 2-4.

The affidavit filed by Dr. Bates provides the following explanation of the treatment

afforded Webster.

1. Ms. Webster’s records show that since 2009 she has been incarcerated

numerous times and in numerous facilities. She has had multiple intake histories

performed at Montgomery County alone. Such intake histories were on May 11,

2013, May 20, 2012, May 4, 2012, November 17, 2011, April 18, 2011, and

February 10, 2011....

2. In none of those histories did [Ms. Webster] relate a history of

hypothyroidism, nor did she complain of symptoms [associated with]

hypothyroidism. She did complain of chronic depression and was continued on

an antidepressant.

3. Ms. Webster was placed in chronic care for her depression [and

received evaluations and treatment for various complaints].... She wasseen at the

mental health chronic care clinic on March 22, 2013 and on May 31, 2013. On

the March 22, 2013 exam I scheduled her for a routine pap smear.

4. Her intake weight on May 11, 2013 was 118. This is down 2 pounds

from her weight of 120 on May 22, 2012. It should be noted that weight gain [not

weight loss as experienced by Ms. Webster] is one of the [most common] signs

of hypothyroidism. Hypothyroidism is difficult to diagnose [absent associated

symptoms] and is not routinely screened for in [Ms. Webster’s] age group. In

fact, there are no clinical guidelines applicable to her.

5. Hypothyroidism is not a deadly disease and rarely causes any

significant problems, hence the difficulty making the diagnosis.

6. ... [During her confinement at the Montgomery County Detention

Facility,] the necessary screening for her age [was performed] by doing a pap

smear. We would have performed a [test to determine the level of] TSH [thyroidstimulating hormone] if it had been indicated.

7. [The article attached to this affidavit] from the Mayo Clinic

Proceedings ... states:

“Uniform national guidelinesforscreening for thyroid disease with serum

TSH levels have not been established. However, because of the high prevalence

of SCH [subclinical hypothyroidism] and associated metabolic risk factors such

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as hyperlipidemia, the American Thyroid Association recommends screening by

measurement of serum TSH beginning at age 35 years and every 5 years

thereafter.”

* * *

Defendants’ Exhibit 2 (Affidavit of Dr. Johnny E. Bates) - Doc. No. 15-2 at 1-2.

Under the circumstances of this case, the court concludes that the course of treatment

undertaken by the defendants in addressing the medical issues presented to them by Webster did

not violate her constitutional rights. The medical care Webster received was certainly not “so

grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to

the fundamental fairness.” Harris, 941 F.2d at 1505. The allegations presented by Webster fail

to establish deliberate indifference by the defendants as the record is devoid of evidence that the

defendants had knowledge that Webster suffered from hypothyroidism and with this knowledge

ignored the risk to her health. Specifically, the record contains no evidence that the defendants

were aware of any facts from which they could have drawn the inference that a substantial risk

of serious harm existed due to such condition. In addition, there is nothing before the court

which indicates that the defendants drew the requisite inference of serious risk and thereafter

ignored the risk to Webster’s health; instead, the undisputed evidentiary materials establish the

opposite. Farmer, 511 U.S. at 837 (Deliberate indifference occurs only when a defendant

“knows of and disregards an excessive risk to inmate health or safety; the [defendant] must both

be aware of facts from which the inference could be drawn that a substantial risk of serious harm

exists and he must also draw the inference.”); Johnson, 145 F.3d at 168 (A defendant must have

actual knowledge of a serious condition, not just knowledge of symptoms, and ignore known risk

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to serious condition to warrant finding of deliberate indifference.); Adams, 61 F.3d at1546 (The

plaintiff must establish both “the [defendants’] knowledge of a condition, [and] the knowledge

of necessary treatment coupled with a refusal to treat or a delay in treatment.”); Taylor, 221 F.3d

at 1258 (citation and internal quotations omitted) (Deliberate indifference to a serious medical

need requires showing of more than “merely accidental inadequacy, negligence in diagnosis or

treatment, or even medical malpractice actionable under state law.”); Hinson, 192 F.3d at 1345

(The law is well settled that neither medical malpractice nor negligence by a physician is

sufficient to provide the basis of a deliberate indifference claim.). Moreover, whether medical

personnel “should have employed additional diagnostic techniques or forms of treatment ‘is a

classic example of a matter for medical judgment’ and therefore not an appropriate basis” on

which to ground constitutional liability. Id. at 1545-1546; Franklin, 662 F.2d at 1344 (difference

of opinions between medical personnel and inmate do not violate the Eighth Amendment).

It is undisputed that the defendantsroutinely evaluated Webster’s complaints/requests for

treatment and assessed her physical condition relative to each of her complaints. After these

evaluations, the jail’s medical personnel provided treatment to Webster in accordance with their

professional judgment as indicated by the nature of the complaint presented to them and the

symptoms exhibited by Webster. Webster hasfailed to present any evidence which indicatesthat

the defendants knew that the manner in which they provided treatment created a substantial risk

to her health and that with this knowledge consciously disregarded such risk. The record is

therefore devoid of evidence, significantly probative or otherwise, showing that the defendants

acted with deliberate indifference. Consequently, summary judgment is due to be granted in

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favor of the defendants. Carter, 352 F.3d at 1350.

IV. CONCLUSION

Accordingly, it is the RECOMMENDATION of the Magistrate Judge that:

1. The defendants’ motion for summary judgment be GRANTED.

2. Judgment be GRANTED in favor of the defendants.

3. This case be dismissed with prejudice.

4. The costs of this proceeding be taxed against the plaintiff.

It is further

ORDERED that on or before December 11, 2013 the parties may file objections to this

Recommendation. Any objections filed must clearly identify the findings in the Magistrate

Judge’s Recommendation to which the party is objecting. Frivolous, conclusive or general

objections will not be considered by the District Court. The parties are advised that this

Recommendation is not a final order of the court and, therefore, it is not appealable.

Failure to file written objections to the proposed findings and advisements in the

Magistrate Judge’s Recommendation shall bar the party from a de novo determination by the

District Court of issues covered in the Recommendation and shall bar the party from attacking

on appeal factual findings in the Recommendation accepted or adopted by the District Court

except upon grounds of plain error or manifest injustice. Nettles v. Wainwright, 677 F.2d 404

(5 Cir. 1982). See Stein v. Reynolds Securities, Inc., 667 F.2d 33 (11 Cir. 1982). See also

th th

Bonner v. City of Prichard, 661 F.2d 1206 (11 Cir. 1981, en banc), adopting as binding

th

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precedent all decisions of the former Fifth Circuit handed down prior to the close of business on

September 30, 1981.

Done this 25th day of November, 2013.

/s/Terry F. Moorer

TERRY F. MOORER

UNITED STATES MAGISTRATE JUDGE

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