Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_16-cv-00013/USCOURTS-almd-2_16-cv-00013-0/pdf.json

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

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IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

THURMON E. MOORE, II, #178615, )

 )

 Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:16-CV-13-WHA

)

CORIZON MEDICAL SERVICES, et al. )

)

 Defendants. )

RECOMMENDATION OF THE MAGISTRATE JUDGE

I. INTRODUCTION

This cause of action is pending before the court on a 42 U.S.C. § 1983 complaint filed by 

Thurmon E. Moore, II, (“Moore”), an indigent state inmate currently incarcerated at the Staton 

Correctional Facility (“Staton”). In the complaint, Moore alleges that the defendants have 

denied him adequate medical treatment for his osteoarthritis. Moore asserts that he suffers pain 

in his back, hips and knees due to degenerative bone spurring with deformity/swelling to the 

hands, fingers and toes for which he has been denied appropriate medication to alleviate his pain. 

In support of these claims, Moore asserts that the attending physicians will not prescribe 

narcotics nor Ultram, an opioid pain reliever, and have refused to order MRI or CRT scans to aid 

in the assessment of his condition. Moore further complains that the medical defendants refuse 

to place him in chronic care for his osteoarthritis even though it is a chronic condition and also 

challenges the assessment of co-payments for treatment provided to him for this condition. 

In the complaint, Moore seeks issuance of a preliminary injunction “ordering [the 

medical and correctional] defendants . . . to provide [him] with needed medical treatment—

medication for pain, [special needs] profiles . . . [and] M.R.I., CRT tests. Safe environment 

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A.D.A. approved.” Doc. 1 at 27. On January 11, 2016, the court entered an order directing the 

defendants to show cause why Moore’s motion for preliminary injunction should not be granted. 

Doc. 5. The medical defendants filed a response to this order on March 4, 2016, supported by 

relevant evidentiary materials including affidavits and certified copies of Moore’s medical 

records, in which they assert that Moore is not entitled to preliminary injunctive relief. Doc. 29. 

The correctional defendants filed their response on March 8, 2016 in which they adopt the 

response field by the medical defendants with respect to the treatment provided Moore for his 

osteoarthritis. Doc. 34. The correctional defendants maintain that Moore is provided 

supervision, protection and access to medical care while confined at Staton. Doc. 29-3 at 2. 

Upon careful consideration of the motion for preliminary injunction and the responses

thereto filed by the defendants, the court concludes that this motion is due to be denied. 

II. STANDARD OF REVIEW

The decision to grant or deny a preliminary injunction “is within the sound discretion of 

the district court.” Palmer v. Braun, 287 F.3d 1325, 1329 (11th Cir. 2002). This court may grant 

a preliminary injunction only if Moore meets each of the following prerequisites: (1) a 

substantial likelihood of success on the merits; (2) a substantial threat irreparable injury will 

occur absent issuance of the injunction; (3) the threatened injury outweighs the potential damage 

the requested injunction may cause the non-moving parties; and (4) the injunction would not be 

adverse to the public interest. Id. at 1329; Parker v. State Bd. of Pardons & Paroles, 275 F.3d 

1032, 1034-1035 (11th Cir. 2001); Tefel v. Reno, 180 F.3d 1286, 1295 (11th Cir. 1999); 

McDonald’s Corp. v. Robertson, 147 F.3d 1301, 1306 (11th Cir. 1998); Cate v. Oldham, 707 

F.2d 1176 (11th Cir. 1983). “In this Circuit, [a] preliminary injunction is an extraordinary and 

drastic remedy not to be granted unless the movant clearly established the burden of persuasion 

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as to the four requisites.” McDonald’s, 147 F.3d at 1306 (internal quotations omitted) (citing All 

Care Nursing Serv., Inc. v. Bethesda Mem. Hosp., Inc., 887 F.2d 1535, 1537 (11th Cir. 1989)); 

Texas v. Seatrain Int’l, S.A., 518 F.2d 175, 179 (5th Cir. 1975) (holding that a grant of 

preliminary injunction “is the exception rather than the rule,” and movant must clearly carry the 

burden of persuasion). The moving party’s failure to demonstrate a “substantial likelihood of 

success on the merits” may defeat the party’s request for injunctive relief, regardless of the 

party’s ability to establish any of the other requisite elements. Church v. City of Huntsville, 30 

F.3d 1332, 1342 (11th Cir. 1994); see also Siegel v. Lepore, 234 F.3d 1163, 1176 (11th Cir. 

2000) (noting that “the absence of a substantial likelihood of irreparable injury would, standing 

alone, make preliminary injunctive relief improper”). “The chief function of a preliminary 

injunction is to preserve the status quo until the merits of the controversy can be fully and fairly 

adjudicated.” Northeastern Fl. Chapter of Ass’n of Gen. Contractors of Am. v. City of 

Jacksonville, Fl., 896 F.2d 1283, 1284 (11th Cir. 1990); Suntrust Bank v. Houghton Mifflin Co., 

268 F.3d 1257, 1265 (11th Cir. 2001).

III. DISCUSSION

In their responses to the motion for preliminary injunction, the defendants deny that they 

have acted with deliberate indifference to Moore’s medical needs. Specifically, the defendants 

maintain that medical personnel provided treatment to Moore for his osteoarthritis and resulting 

pain in accordance with their professional judgment, and assert that referral for an MRI or CRT 

is neither necessary nor warranted at this time. 

In addressing Moore’s claims regarding treatment provided until September of 2014, Dr. 

Hugh Hood, an Associate Regional Medical Director for Corizon Medical Services provides the 

following information:

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It is my understanding from reading Mr. Moore’s Complaint that he is 

dissatisfied with the level of care afforded him at Limestone [Correctional 

Facility] and Staton in regards to chronic hip pain. Based upon my review of Mr. 

Moore’s medical records, I can state to a degree of medical certainty that Mr. 

Moore received a more than adequate degree of medical treatment during his 

incarceration at Limestone and Staton and I cannot find any reason for him to 

claim that the medical treatment afforded him has been anything less than 

complete, appropriate and acceptable in all respects.

Mr. Moore arrived at Limestone Correctional Facility in June of 2010. 

(COR016). After his arrival at Limestone, Mr. Moore underwent x-rays of his 

hips and knees in October of 2010, which indicated “modest degenerative 

spurring” at the junction of the femor and pelvis, i.e. the hip joint. (COR037). 

Bone spurring, as initially identified through these x-rays, [is] indicative of some 

degree of osteoarthritis. The standard of care for osteoarthritis and its common 

symptoms (including this form of spurring) include pain management through 

primarily non-steroidal anti-inflammatory medications. It is somewhat uncommon 

to refer patients of this nature for surgical treatment because any surgical 

procedure can leave patients with momentary relief followed by a dramatic 

decline of their condition resulting in increased [bone] spurring. As early as 

December 18, 2010, Mr. Moore began voicing complaints regarding the 

ineffectiveness of the pain medications prescribed for his on-going hip 

discomfort. (COR016). Thereafter, the medical staff monitored his condition on a 

routine basis, which included the prescription of certain pain medication including 

Lortab, and eventually, Mr. Moore received a referral for evaluation by an off-site 

rheumatologist. (COR017).

Mr. Moore saw a rheumatologist at Rheumatology Associates of North 

Alabama, P.C. in February of 2011. (COR038). The rheumatologist found no 

evidence of inflammatory synovitis (also known as “a connective tissue disease”) 

but only underlying osteoarthritis and recommended an alteration of [Moore’s] 

medications. (COR038-44). Following this diagnosis, Mr. Moore engaged in 

extended discussions with the medical staff through sick call and routine followup appointments in which he requested and received narcotic pain medication. 

(COR003-4, 045, 056-58, 060). Mr. Moore continued to receive narcotic 

medications at his request through April of 2012. (COR060). He also received 

certain “profiles” or medical authorizations allowing him to deviate from some 

standard prison protocols, including a profile limiting the amount of time spent 

standing (COR046, 048-49).

Moore submitted a sick call request related to his pain medications on 

May 17, 2012, and received an evaluation during sick call the next day. 

(COR065). In fact, the site physician saw Mr. Moore during the course of sick 

call to discuss his current medications. (COR065). After submitting another sick 

call request form and submitting to evaluation during sick call (COR066), Mr. 

Moore attended an appointment with the clinician at Limestone during which he 

complained about the recent alteration of his pain medications. (COR024). As 

indicated in these notations, Mr. Moore did show some signs of medication 

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dependence with generalized complaints of discomfort. (COR024). Overall, his 

physical examination at the time was normal. (COR024). Mr. Moore next saw the 

site physician at Limestone on May 30, 2012, at which time he was informed that 

the medication change enacted earlier in May would remain effective given his 

recent diagnosis of osteoarthritis. (COR025). Specifically, Mr. Moore was 

informed that the x-rays of his hips did not reveal any defect or deformity of any 

kind requiring any further evaluation or treatment and that his symptoms were 

primarily the result of his arthritic condition. (COR025).

Following this appointment and after consultation with the site medical 

staff and the regional medical staff, the decision was made to discontinue 

Mr. Moore’s Lortab prescription, and prescribe the non-narcotic pain medical 

Norco as an alternative pain treatment. (COR008). On May 30, 2012, Mr. Moore 

was instructed to attend a follow-up appointment with the medical staff in 

approximately 90 days. (COR009).

Mr. Moore did not voice any complaints or submit any sick call request 

forms related to his medications between May 24, 2012, and August 14, 2012. 

(COR067). Mr. Moore received and attended a follow appointment with the site 

physician at Limestone on August 14, 2012, at which time they continued to 

discuss the treatment plan for Mr. Moore’s osteoarthritis and the site physician 

confirmed the absence of any significant changes in Mr. Moore’s overall 

condition before renewing his prescription for Norco. (COR009).

In response to a sick call request form submitted on August 20, 2012, the 

medical staff summoned Mr. Moore to the health care unit at Limestone for sick 

call on August 21, 2012 (COR071-73), and a subsequent appointment with the 

clinician on August 23, 2012. During the appointment, Mr. Moore remained 

“upset” because of the medical decision to discontinue his narcotic pain regimen 

in favor of a non-steroidal anti-inflammatory medication. (COR018). As 

indicated in the medical records, Mr. Moore reported to the medical staff that he 

had received narcotic pain medications for more than two and a half years and 

that he wished to meet with the site physician. (COR018-19). During the course

of this appointment, Mr. Moore received another explanation as to the rationale 

behind the alteration of his medications. (COR018-19). Following this 

appointment, Mr. Moore received orders to undergo x-rays of his knees and hips 

dated August 23, 2012. (COR009).

Mr. Moore underwent the ordered x-rays on August 27, 2012. (COR074-

76). The x-ray results did not reveal any significant differences from the prior xrays taken in October of 2010. Mr. Moore next attended another follow-up 

appointment with the site physician at Limestone on August 28, 2012, at which 

time the physician examined Mr. Moore and again confirmed the on-going 

degenerative effects of the osteoarthritis upon Mr. Moore’s left hip joint. 

(COR027). During the course of this exam, the site physician noted some 

potential “spurring” at the femoral head and neck and discussed with Mr. Moore 

the possibility of utilizing an MRI to further evaluate this potential development. 

(COR027). Following this appointment, the site medical director requested that 

we consider whether an MRI of Mr. Moore’s left hip would be advisable, which 

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led to a series of discussions related to his condition. (COR009, 077). At that 

time, I requested and received the relevant documents from Mr. Moore’s file, 

including his prior x-ray results, which confirmed to me that there was no need 

for an MRI and that no additional information could be obtained through the use 

of an MRI that had not been previously confirmed through the x-rays taken as of 

that point in time. (COR077).

The site physician at Limestone continued to monitor Mr. Moore’s 

condition during a September 7, 2012, appointment in response to Mr. Moore’s 

requests. (COR028, 079). Mr. Moore received orders following this appointment, 

directing him to return for a follow-up appointment in 30 days. (COR010). The 

medical staff became so concerned regarding Mr. Moore’s insistence and 

apparent dependence upon pain medication that they referred Mr. Moore for 

mental health evaluation on October 4, 2012. (COR010). Mr. Moore initially 

refused to be seen, but was eventually evaluated in late October of 2012. 

(COR083).

In orders dated October 17, 2012, and November 26, 2012, Mr. Moore 

received orders for continuing anti-inflammatory medications including 

Naproxen and Tylenol. (COR010). The site physician at Limestone met with Mr. 

Moore, ADOC personnel and the attending registered nurse on duty on October 3, 

2012, to discuss the decision not to proceed with an MRI at that time. As the site 

physician explained to Mr. Moore and documented in his notes from this 

occasion, an MRI for arthritis was not indicated and, in fact, Mr. Moore had 

initially refused an MRI. As also indicated, the site physician assured Mr. Moore 

that he would consult with me, review the x-rays already taken and consider any 

available options for the treatment of his condition which would effectively 

decrease any discomfort. (COR029). The site physician continued to monitor Mr. 

Moore’s condition through appointments on November 26, 2012, January 3, 2013 

and May 16, 2013. (COR032-33). During the May 16, 2013, appointment, the

site physician again discussed with Mr. Moore the absence of any justification for 

continuing his narcotic pain medication. (COR033).

In orders dated May 16, 2013, the medical staff notified Mr. Moore that he 

would not receive any refills for any prescriptions without an appointment with 

the clinician. (COR011).

Mr. Moore received a renewal of his Naproxen prescription on June 3, 

2013. (COR011). In orders dated June 3, 2013, the medical staff notified Mr. 

Moore that he would not receive any refills for any prescriptions without an 

appointment with the clinician. (COR011). Mr. Moore did not submit any sick 

call requests during the period of time between October of 2012 and November of 

2013. He submitted his next sick call request form in December of 2013, 

complaining of pain in his hips for which he was evaluated during the course of 

sick call. (COR086-88). Mr. Moore received analgesic balm per orders entered 

following sick call dated December 4, 2013. (COR011).

Mr. Moore transferred from Limestone to Staton Correctional Facility on 

December 9, 2013. (COR089). Five days after arriving at Staton, Mr. Moore 

began submitting multiple sick call request forms [seeking] a bottom bunk profile 

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and additional pain medication. (COR093-98). In response to these initial sick 

call request forms, the Staton medical staff evaluated Mr. Moore and this 

examination did not reveal any alteration of his condition or any justification to 

alter his medication regimen at that time.

On January 16, 2014, Mr. Moore underwent an exhaustive examination by 

one of the site clinicians at Staton with respect to his complaints of continuing 

bilateral hip pain. (COR013). During this appointment, Mr. Moore specifically 

reported that a prior examination by a rheumatologist had not resulted in any 

“significant findings” which occurred “years ago.” (COR013). The physical 

examination did not reveal any muscular weakness or atrophy and he appeared to 

be able to walk without any noticeable discomfort of any kind. Mr. Moore only 

reported pain during range of motion testing when he rotated his legs outward. At 

the conclusion of this appointment, the clinician specifically directed Mr. Moore 

to engage in daily weight bearing exercise to continue to maintain his hip and 

[leg] strength and provided him with an ice pack to the extent that he experienced 

any soreness. The clinician also instructed Mr. Moore exactly how he should 

modify the process for accessing his top bunk and to report any problems that he 

might encounter in the future. (COR013). After this examination, Mr. Moore did 

not submit another sick call request form for over five (5) months. (COR102).

On May 26, 2014, Mr. Moore refused all further medical treatment, 

including a physical examination. (COR101). Almost one month later, Mr. 

Moore submitted a sick call request form related to hip pain and difficulty 

accessing his top bunk. (COR102). He received an evaluation during sick call on 

June 26, 2014, which again revealed the same symptoms previously reported 

without any worsening of his condition. (COR102-104).

Orders dated July 16, 2014, reflect the continuation of Mr. Moore’s 

prescription of Mobic. (COR012). On that same day, Mr. Moore also received 

orders to undergo certain lab work. (COR012).

Mr. Moore saw the Staton clinician again on July 30, 2014, at which time 

he reported complaints of “hip problems for years” and “bone spurs.” (COR014). 

The only change noted during the physical examination from the prior 

examination in January of 2014, entailed Mr. Moore’s reports of discomfort upon 

hip flexion or rotation, but there were no objective signs or symptoms which 

would otherwise indicate any alteration of his condition. As indicated in the notes 

from the clinician, the clinician did discuss the possibility of an MRI with Mr. 

Moore; however, his notes clearly indicate an intention to proceed with an MRI, 

only if it would provide useful information not otherwise discernible from the xrays. (COR014). Following this appointment, Mr. Moore received orders to 

undergo another battery of x-rays related to his hips. (COR012). He also received 

a renewal of his current medications, orders to undergo additional lab testing and 

an order directing him to follow-up with the Staton clinician in two to three 

weeks. (COR012). In order to attempt to assuage Mr. Moore’s concerns, the 

clinician also provided him with a bottom bunk profile for a period of 90 days, 

which remains in effect as of today. (COR105).

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Mr. Moore underwent another set of x-rays on August 8, 2014, which 

revealed only “mild osteoarthritis” in both hips. (COR107). As with the prior xrays, this most recent set of x-rays merely confirmed the absence of any 

significant changes in his medical condition since October of 2010. When the 

medical staff next evaluated Mr. Moore on August 18, 2014, he did not voice any 

complaints related to hip pain. (COR015).

Mr. Moore is currently scheduled for another appointment with the 

medical staff on October 14, 2014. (COR012). Given the extent of care provided 

to Mr. Moore at Limestone and Staton, I do not believe that the course of 

treatment Mr. Moore received was inappropriate in any way or that the conduct of 

the Limestone and Staton medical staff fell below the standard of care of that 

provided by other similarly situated medical professionals. Given this course of 

treatment, in my professional medical opinion, the Limestone and Staton medical 

staff acted appropriately in all respects. Again, based upon my review of Mr. 

Moore’s medical records, I can state to a degree of medical certainty that the 

members of the medical staff at Limestone and Staton fully satisfied the standard 

of care owed by them within the State of Alabama.

With respect to Mr. Moore’s request that the Court intervene in some 

manner related to his medical care, Mr. Moore is currently receiving excellent 

medical care. There is no evidence or objective data of any kind suggesting that 

Mr. Moore’s condition changed, worsened or declined in any way as a result of 

the care he has received during his incarceration. I cannot identify any 

meaningful diagnostic benefit of an MRI at this point. Moreover, the x-ray results 

obtained have clearly identified the cause of Mr. Moore’s current discomfort 

which is mild osteoarthritis, for which he is currently receiving treatment 

consistent with the standard of care, i.e. a regimen of non steroidal antiinflammatory medications. Any allegation by Mr. Moore that he currently does 

not have access to the medical services available to him at Staton is simply 

untrue.

Doc. No. 29-1 at 6-14 (paragraph numbering omitted) (affidavit initially filed in Moore v. 

Corizon Medical Services, et al., Case No. 2:14-CV-MHT-GMB (M.D. Ala.)). 

With respect to the treatment provided to Moore since September of 2014, Dr. Ronnie 

Herring, the Medical Director at Staton, states as follows:

I have reviewed the records pertaining to Mr. Moore’s medical treatment 

at Staton. Furthermore, I understand Mr. Moore’s complaints that, in regard to 

his osteoarthritis condition, he believes the Staton medical staff should enroll him 

in the chronic care clinic process. I also understand Mr. Moore asserts complaints 

related to his bedding assignment (i.e. a top or bottom bunk), the medications 

prescribed for him and the co-payment fees charged during his incarceration.

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First, as to his allegation regarding chronic care, the medical staff at Staton 

hold regular chronic care clinics for certain chronic conditions that require routine 

monitoring and most of the conditions which qualify for this chronic care process 

involve some level of routine lab work, such as diabetes, HIV, anticoagulation 

therapy and hepatitis C. The chronic care process is limited to this fairly narrow 

group of conditions. Arthritis and other musculoskeletal conditions are not in the 

category of chronic conditions that mandate or require the level of monitoring 

required through the chronic care clinic process and, therefore, we do not enroll 

patients with these forms of musculoskeletal conditions in the chronic care 

process because it is evident that these conditions can be managed on an asneeded basis through our sick call process. Moreover, it is clear that Mr. Moore 

simply wishes for us to create a chronic care clinic for his condition in order to 

avoid any co-payment fee, which again is unnecessary and inappropriate.

While I am not directly involved in accounting of co-payment fees, the 

policy related to co-payment fees at Staton has remained constant throughout my 

tenure at Staton. Inmates at Staton are charged a nominal fee of $4.00 on each 

occasion when they submit a sick call request form. These fees are charged to 

each individual’s personal account with the Alabama Department of Corrections; 

however, such charges are assessed only if the individual has an account balance. 

Individuals who do not possess any money in their personal accounts are not 

charged for the co-payment fee. Moreover, the members of the medical staff at 

Staton do not require any patient to make the co-payment before any appointment. 

I am not aware of any instance when any inmate at Staton was not seen by the 

medical staff during the sick call process due to his inability to satisfy the copayment fee.

Contrary to Mr. Moore’s allegation, Dr. Hood is not the individual 

responsible for the provision of medical services at Staton and, during my tenure 

at Staton, Dr. Hood has not offered any medical services directly to any patients 

or inmates at Staton. As of the date of this affidavit, I along with the other 

clinicians at Staton, are responsible for the direct provision of care to Mr. Moore.

Mr. Moore was diagnosed with osteoarthritis more than three years ago. 

(COR208). I concur with the standard course of treatment of osteoarthritis as 

outlined in the prior affidavit of Dr. Hugh Hood. Since the fall of 2014 (when 

Dr. Hood submitted his affidavit), the medical staff at Staton has continued to 

monitor and treat Mr. Moore’s medical conditions.

Mr. Moore refused to undergo an evaluation by one of the nurse 

practitioners at Staton in October of 2014—an appointment which was referenced 

in Dr. Hood’s prior affidavit. (COR222). Mr. Moore engaged in an altercation 

with another inmate on December 2, 2014, resulting in an evaluation by the 

medical staff of his injuries. (COR262, 269-270).

In February of 2015, Mr. Moore submitted a sick call request form 

requesting an evaluation for his complaints of chronic care and he was evaluated 

by the medical staff through sick call process and referred for further evaluation 

by a clinician at Staton. (COR266-268). The nurse practitioner at Staton 

evaluated Mr. Moore on February 13, 2015, related to his request for pain 

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medication. (COR248). As referenced in the nurse practitioner’s notes from this 

exam, Mr. Moore mentioned his prior lawsuit to the nurse practitioner and 

specifically requested the pain medication Ultram. (COR248). After evaluating 

Mr. Moore, the nurse practitioner entered orders for him to obtain profiles for 

bottom bunk, front of line, and cane use, all for 180 days. (COR240). The nurse 

practitioner also prescribed steroids for Mr. Moore. (COR248).

Dr. Stone—the physician who provided patient care at Staton before my 

tenure at this facility—saw Mr. Moore on February 19, 2015, at which time Mr. 

Moore continued to complain of low back and bilateral hip pain. Dr. Stone 

ordered x-rays of his lumbar spine, and continued to try to adjust Mr. Moore’s 

medications to address these complaints. (COR240). Dr. Stone also saw Mr. 

Moore on March 26, 2015 and June 2, 2015, at which time Mr. Moore continued 

to voice the same complaints and Dr. Stone continued to adjust his medication to 

attempt to minimize his complaints of discomfort. (COR249-250).

In late June of 2015, the nurse practitioner began treating Mr. Moore for a 

skin condition. At a follow-up appointment with Dr. Stone in mid-July 2015, this 

condition was identified as related to a scabies infestation. (COR251-252). 

Scabies is similar to the more commonly known—lice—in many respects. 

During the course of these evaluations, Dr. Stone discussed with Mr. Moore the 

need to reduce his reliance on medication and to increase his personal activity in 

order to attempt to reduce the development of symptoms related to his 

osteoarthritis. (COR251-252). The medical staff continued to monitor and treat 

his [skin] condition until it appeared to be resolved based upon an examination 

conducted on August 4, 2015. (COR252).

The Staton medical staff conducted their annual physical examination of 

Mr. Moore on May 13, 2015, but did not note any significant changes in his 

condition. (COR212). Approximately two weeks later (on May 27, 2015), Mr. 

Moore reported to the medical staff that he did not need to be evaluated with 

regard to his sick call request form because he simply wanted his medications 

renewed and such renewals had occurred. (COR219). In July, August and 

September 2015, Mr. Moore failed to report to sick call for evaluation despite 

submitting sick call request forms during this same timeframe. (COR216-218, 

254, 259).

When Mr. Moore submitted a sick call request form on September 17, 

2015 related to joint pain and a requested renewal of his medications and 

examination by a physician, he failed to appear for evaluation at sick call. 

(COR258). Though Mr. Moore submitted a sick call request form related to his 

complaints of joint pain and dated it September 13, 2015, the medical staff did not 

actually receive this form until September 21, 2015. (COR257). The Staton 

medical staff evaluated Mr. Moore during sick call the very next day for his 

complaints of joint pain at which time his medications were continued. 

(COR255-256).

Mr. Moore submitted another sick call request form on September 30, 

2015, complaining of pain in his joints, as well as his left elbow, and requesting to 

see a physician. (COR254). A member of the Staton nursing staff conducted the 

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sick call evaluation of Mr. Moore on October 2, 2015, at which time he voiced 

complaints related to swelling to his left elbow which had existed for 

approximately two (2) weeks. (COR242-243). Mr. Moore reported to the 

healthcare unit on October 15, 2015, at which time he saw the physician’s 

assistant who continued to evaluate him for complaints of pain in every single 

joint of his body. (COR253). During the course of the evaluation, Mr. Moore 

would not allow the physician’s assistant to conduct any range of motion 

examination and the physician’s assistant continued his medications and referred 

him to me for evaluation. (COR253). At the conclusion of this appointment, the 

physician’s assistant at Staton entered an order for Mr. Moore to see me regarding 

his complaints about his pain medication regimen. (COR235).

Mr. Moore simply failed to appear for evaluation by me on October 30, 

2015, at which time he was summoned to the clinic for evaluation. (COR253). I 

do not know why he did not appear for evaluation and I did not refuse to evaluate 

him on this occasion. However, the suggestion by Mr. Moore that he had not 

been given the opportunity to see a physician in a matter of months is simply 

untrue. Since October 30, 2015, I cannot locate any sick call request forms 

submitted by Mr. Moore requesting any treatment or evaluation of any kind.

The Staton medical staff last evaluated Mr. Moore on January 8, 2016, 

after he reported falling, but this examination did not reveal any specific injuries 

or trauma which required further treatment or any worsening of his overall 

condition. (COR244).

We have also monitored Mr. Moore’s condition through routine imagining 

studies over the course of time. Mr. Moore underwent an x-ray of his hips in July 

of 2014. (COR241). As indicated in Dr. Hood’s affidavit [set forth above], the 

August 8, 2014, x-rays of Mr. Moore’s hips indicated only “mild” osteoarthritis. 

(COR283-284). The medical staff conducted x-rays of Mr. Moore in March of 

2015, which did not indicate any specific abnormalities. (COR282). Mr. Moore 

received orders dated October 8, 2015, requiring him to report to the healthcare 

unit for x-rays at 7:00 a.m. on October 9, 2015. (COR214, 235). The x-rays 

ordered at the direction of the physician’s assistant, which were conducted on 

October 9, 2015, did not reveal any change in Mr. Moore’s condition. (COR280-

281). Therefore, there is no indication of any worsening or decline in Mr. 

Moore’s condition over the last 18 months which would necessitate any 

reconsideration of our medical evaluations and opinions related to his treatment. 

Based upon these prior studies alone and the information available to us now, I 

cannot identify any reason for any further imaging studies to be conducted now or 

in the past.

Mr. Moore’s claim that he has been denied necessary medication for his 

medical condition is also inaccurate. Since November of 2014, the medical staff 

did attempt to manage Mr. Moore’s complaints of pain with medication. 

(COR231-234). Mr. Moore’s medical records show evidence of the chronology 

of medication prescribed for him for his conditions. For example, Mr. Moore 

received a 60-day prescription for the pain medication Ultram from Dr. Stone on 

June 2, 2015. (COR230). During that same timeframe (i.e. June 2015), Mr. 

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Moore received analgesic balm to assist and control his complaints of muscular 

pain. (COR229). Mr. Moore also received a prescription for the steroid 

Prednisone on June 30, 2015. (COR228). The Staton medical staff continued to 

renew all of Mr. Moore’s medications on July 15, August 1 and August 8, 2015. 

(COR227). During the course of the process of monitoring his medications, Mr. 

Moore received a prescription for the pain medication Mobic on July 20, 2015. 

(COR226). When Mr. Moore received a renewed prescription for pain 

medication in August of 2015, at which time he was specifically instructed by the 

medical staff to begin tapering his reliance on the pain medication Tramadol, 

which is also known as Ultram. (COR225). It is also worth noting that Mr. 

Moore missed a total of 33 doses of Tramadol during the period [of time] between 

March 26, 2015, and May 24, 2015. Tramadol is an opioid pain medication used 

to treat moderate to severe pain and, unfortunately, it can be habit forming. As 

such, we attempt to prescribe Tramadol/Ultram in shorter durations and prefer 

that patients do not rely upon these types of medications over a period of years, 

though reliance for a period of consecutive months is generally not problematic.

In Mr. Moore’s case, several things are evident from a review of his 

medical records. First, Mr. Moore is never satisfied with the level of pain 

medication prescribed for him, which does suggest some level of unnecessary 

dependence upon pain medication. Secondly, the most efficient manner of 

treating Mr. Moore for his complaints of discomfort related to his osteoarthritis is 

not a continual reliance upon opioid pain medication. In my opinion, some lesser 

form of pain medication should be more than adequate to control his complaints 

and Mr. Moore would likely derive a significant benefit from increasing his daily 

activity. It is, however, important to note that there were occasions when Mr. 

Moore simply failed to appear to even receive his medications. For example, 

during the period from November 1, 2014 through November 30, 2014, Mr. 

Moore never appeared on one occasion to receive his Mobic pain medication. 

(COR300).

There is no policy or procedure of any kind which would prevent me from 

providing any necessary medication to any patient within the custody of the 

Alabama Department of Corrections. I never informed Mr. Moore that I was 

prevented from prescribing him any form of medication. On the occasions that I 

evaluated Mr. Moore, I evaluated all of his symptoms as well as his medical 

history in considering the most appropriate course of treatment. Unfortunately, 

Mr. Moore suffers from osteoarthritis which is a degenerative condition for which 

there is minimal treatment. As multiple physicians have indicated to Mr. Moore, 

the best manner of treatment related to his condition involves increased physical 

activity, which will strengthen his overall musculoskeletal system and combat the 

degenerative effects of the osteoarthritis.

Contrary to Mr. Moore’s allegations, the Staton medical staff has

consistently addressed his living condition at this facility. For example, the 

Staton medical staff provided Mr. Moore with a cane on February 17, 2015, and 

he acknowledged his receipt of this cane in writing. (COR220). At this same 

time, Mr. Moore received a “profile” also known as a Special Needs 

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Communication Form instructing the security staff to assign him to a bottom bunk 

and permitting him to skip any lines and proceed to the front of any lines within 

the facility such as the line at pill call or in the dining hall. (COR221, 240). 

These profiles have been in place as long as I have been the medical director at 

Staton and we have no intention of discontinuing these profiles at this time based 

upon Mr. Moore’s condition. (COR215, 235)

If Mr. Moore feels unsafe, such is an issue related to security, as the 

Staton medical staff does not make housing or security decisions. There is no 

indication of Mr. Moore raising such complaints or concerns with the medical 

staff. The medical staff is however aware of a number of evaluations of Mr. 

Moore after various different altercations with other inmates. (COR269-270).

Based upon my review of Mr. Moore’s circumstances, I am confident that 

he has received an appropriate level of treatment. Furthermore, I cannot see any 

reason to conclude that the course of treatment Mr. Moore received was 

inappropriate in any way or that the conduct of the our medical staff fell below 

the standard of care of that provided by other similarly situated medical 

professionals. Given this course of treatment, in my professional medical 

opinion, our medical staff acted appropriately in all respects. Again, based upon 

my review of Mr. Moore’s medical records, I can state to a degree of medical 

certainty that the members of the medical staff at Limestone and Staton fully 

satisfied the standard of care owed by them within the State of Alabama.

With respect to Mr. Moore’s continuing complaints related to his care, Mr. 

Moore is currently receiving excellent medical care. There is no evidence or 

objective data of any kind suggesting that Mr. Moore’s condition changed, 

worsened or declined in any way as a result of the care he has received during his 

incarceration. I cannot identify any meaningful diagnostic benefit of an MRI at 

this point. Moreover, the x-ray results obtained have clearly identified the cause 

of Mr. Moore’s current discomfort which is mild osteoarthritis, for which he is 

currently receiving treatment consistent with the standard of care, i.e. a regimen 

of non-steroidal anti-inflammatory medications. Any allegation by Mr. Moore 

that he currently does not have access to the medical services available to him at 

Staton is simply untrue.

Doc. No. 29-2 at 2-10 (paragraph numbering omitted).

Turning to the first and second prerequisites for issuance of preliminary injunctive relief, 

the undersigned finds that Moore fails to demonstrate either a substantial likelihood of success 

on the merits of his pending claims or a substantial threat that he will suffer requisite irreparable 

injury absent issuance of the requested preliminary injunction. Specifically, the affidavits and 

evidentiary materials submitted by the defendants indicate that Moore has received necessary 

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and appropriate treatment for his osteoarthritis—including routine evaluations, prescription of 

various medications, provision of multiple x-rays and issuance of special needs profiles—such 

that he is not substantially likely to succeed on the merits of his claims. Moreover, the evidence 

before the court indicates Moore is not now suffering or likely to suffer irreparable injury absent 

the injunction. 

The third factor, balancing potential harm to the parties, also weighs in favor of the 

defendants because the requested injunction would have an unduly adverse impact on the ability 

of medical personnel to exercise their professional judgment in determining the manner in which 

to treat inmates and would allow inmates, who have no medical training or expertise, to dictate 

the treatment they are provided. Finally, the public interest element of the equation is, at best, a 

neutral factor. 

In light of the foregoing, the undersigned concludes that Moore has failed to meet his 

burden of demonstrating the existence of each prerequisite necessary to warrant issuance of 

preliminary injunctive relief.

IV. CONCLUSION

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

1. The motion for preliminary injunction filed by the plaintiff be DENIED. 

2. This case be referred back to the undersigned for additional proceedings.

It is further ORDERED that on or before March 31, 2016 the parties may file objections 

to the Recommendation. The plaintiff must specifically identify the factual findings and legal 

conclusions in the Recommendation to which the objection is made. Frivolous, conclusive or 

general objections addressed to the Recommendation will not be considered. Failure to file 

written objections to the Magistrate Judge’s findings and recommendations in accordance with 

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the provisions of 28 U.S.C. § 636(b)(1) shall bar a de novo determination by the District Court of 

legal and factual issues covered in the Recommendation and waives the right of the plaintiff to 

challenge on appeal the district court’s order based on unobjected-to factual and legal 

conclusions accepted or adopted by the District Court except upon grounds of plain error or 

manifest injustice. Nettles v. Wainwright, 677 F.2d 404 (5th Cir. 1982); 11th Cir. R. 3-1; see 

Stein v. Lanning Securities, Inc., 667 F.2d 33 (11th Cir. 1982); Bonner v. City of Prichard, 661 

F.2d 1206 (11th Cir. 1981) (en banc). 

DONE this 17th day of March, 2016.

 /s/ Gray M. Borden 

UNITED STATES MAISTRATE JUDGE

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