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. STATE OR FLORIDA | seen
. DEPARTMENT OF CORRECTIONS
canmasrumeammaob ee ec =v ED
bro: [2] Warden] Assistant Warden (By Secretary, Hori
[Prom: jocher, Michael vw 978668 |
Last First’ «= Middle Initial “Number .
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peest mw July of 2007 F leas just aKout
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“DATE:

SIGNATURE | ‘OF ORIBVANT AND D.C. #

|paY EXTENSIONS: Or Trach golly,
on # . ‘Signature

SIGNATURE, INMATE AGREES TO THE FOLLOWING # OF 30.

* INSTRUCTIONS

form is used for Ming a forma! griewance ut due institution or facifity level ns well as for fling,
ry 8 copy of the Initial

oa Adminstaive Code, Wen an appeal is made tothe
he inmase ets tht be maybe adverely wee by the mbna of 6 pvance athe ink
‘by Chapter'33-10G to Ble a dzect gieraace be may addtess his grisvance diecy to the Seectary's Office, The giicvance may be sealed inthe envelope by the

Kip tote eat e ety nrc Rae 05,
except as stated below).

pitnional level because ofthe sensitive nahite of the grievance, ors

OPACHORIVANCE IR
Document in IRIS (Inmate Records Imaging System)

11-303 (Revised 2/05)



FQ-21UL STATE OF FLORID:
: . DEPARTMENT OF CORRE\

Ma ‘esha

Warden O Assistant Warden O Secretary, |

(CTIONS

Fron. as ! ichaed. J a5 bb8
Middle Initial er

O8lR- 11-038

Florida Deparment of Constepe ETE)
Wakudl

nstit on

nal Geievance, uss

STANT WARDEW OF PAI

— al. Stoked that hos
ign 1/0/08

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Lips Loy pRoress to FOC

nee re mis

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Reg.ues:

fen, bMaediote URonic. Cags in

*BY SIGNATURE, INMATE AGREES TO THE FOLLOWING # OF 30-D,

JAY EXTENSIONS:_ t
#

Signature

PARTB RESPONSE

SEE ATTACHMENT

‘BIGNATURE AND TYPED OR PRINTED NAME

‘SIGNATURE OF WARDEN, ASST, WARDEN, OR
_OF EMPLOYEE RESPONDING ‘SECRETARY'S REPRESENTATIVE

DATE

SeuaALs TOERETIRNED T GREVANT AFTER COMPLEMONOF ACTER

PARTC-RECEIPT (TOBE COMPLETED: ype STAFF)

‘RETURN TO: {
TAT 7 SADDLE TIAL

| ACKNOWLEDGE RECED'T THS DATE OF A GRIEVANCE FROM THE ABOVE INMATE IN REGARD Tt

"RUM

0 THE FOLLOWING SUBSET:

\

Oh Média

pasrmuatior insniTunonrActaTy Desrmaurion: crnveat. onrice
WHITE COPY Inmate COPY ‘COPY DIMATE COPY
CANARY COPY INMATES FILE CANARY COPY INMATE'S FILE - INST/FACILITY
PINK CORY INMATE COPY PINK CORY (C.O.INMATE FILE
‘GOLDENROD Cor? RETAINED BY OFFICIAL RESPONDING GOLDEN}OD cory [RETAINED BY OFFICIAL RESPONDING
DC1-303 (Revised 8-00)

Document in IRIS

Inmate Records Imaging System)

Ab


PARTB+ merase
LOEBER, MICHAEL B95668__0B12~ 0812118038
TRMATE "RUMBER “GRIEVANCE LOG NUMBER “HOUSING LOCATION —~

Your Request for Administrative Remedy or Appeal has been recelved| reviewed and evaluated.

[After a review of your chart and scheduled follow-ups, you are currently enrolled in the Gastro Clinic as indicated by your
(diagnosis. If you are having @ problem, you may address it through sick-call, A $4.00 ¢o-pay will apply and does not
Iguerantos medication, passes 07 seeing a provider. Yau have alsp bean referred toa gasiroenterologiat ax procedure
requires. Your raquest for reatment outside of scheduled follow-up vaio taecad 1s dont

[Based on the abave information, your Request for Administrative Remedy or Appeat is denied,
|You may obtain further administrative review of your complaint by soa form DC1-903, Request for Administrative

Remedy or Appeal, completing the form, providing attachment(s) as required by-Chapter 33-103.007, and forwarding your
|complaint to the Bureau of Inmate Grievance Appeais, 2601 Blair Stone Road, Tallahassee, Florida

D, Torres, CHO Henry W. Boyd, AWOP
1D. TORRES-GONZALEZ
CHO i
Ee eae

. come remain sSTUTOM FAGRTY cory bernAUrion -ex¥TnA OFFICE

{2 Copias} inmate {t Copy}!

(teu nase (von Fe- mse
~ (1 Copy} Retained by Offidal Responding (1.Copy) 6.0. Inmate Fila

(1 Copy) Retained by oft Responding Ss

Document in IRIS (Inmate Records Imaging System)

es


PART B- RESPONSE

LOEBER, MICHAEL 895068 __ 09-6.22583 HOUMES Gi. Fy2z3
TNMATE NUMBER “GRIEVANCE LOG NUMBER {RENT INMATE LOGATION HOUSING LOCATION

ICONFIDENTIAL HEALTH RECORD/CARE INFORMATION INTENDED FOR ADDRESSEE(S) ONLY.
UNAUTHORIZED RELEASE OR DISCLOSURE MAY VIOLATE STATE AND FEDERAL LAW.

Your request for Administrative Remedy or Appeat has not been filed in compliance with Chapter 33-103.006, Inmate
Grievance Procedure. You did not provide this office with a copy of tha|formal grievance filed at the institutional level as
required by rule or the reason you provided for by-passing that level of{the grievance procedure Is not acceptable.

When filing @ medical grievance, you are required to submit a formal gilavance (0C1-303 form) to the Warden prior to
filing to this office.

lUpon receipt ef this response, you are allowed an additional 15 days from the date this rasponse was mailed (date
[stamped in upper left corner) to resubmit your griavance al your current location in compliance with Chapter 33-103,
inmate Grievance Procedure. Attach a copy of this response to your ré-filed grievance.

Based on the foregoing information, your grievance Is returned withoutlaction.

|G, WELLHAUSEN
af)
7 A AST Zafe yj

SORATRE ETP OR FTES id SicuATORS SPARSE SST MORO OF ee
Beourvovee Reson Saeavoneneeeane :

COPY NETREUTION .NSTITETON ACIITY cor} bietRiBUTION «CENTRAL OFFICE

(acephs| mate (ace fnmate

{1 co mat Fle (i coplpnates Fes raty

{1 Oop Raney et expo {\Cop/6.0. tonal

(1 Copy) Retained by Ocal Responding

Document in IRIS {Inmate Records Imaging System)

A)


DEFENDANTS’ COMPOSITE EXHIBIT A

Declaration of Ashley Stokes
with attachments
Grievance Log #09-6-02017
Grievance Log #09-6-22583


_ \aLae clea

ELISEE EB. =

Aichaethoelen —
Fed = 2 LE

Document in IRIS

(Inmate Records Imaging System)

Ht


t . '

STATE OF FLORIDA

DEPARTMENT OF CORI

ro: 1) Warden oO assisant Waten [Sf Secretary,

From: Loeber Michael / g LISECEE

Last First = Middle Initial Non

Institation

Rart A = Inte Grievance! Pi-6-090'1

[Far
ith ay EP ara oF. Hepatitys - C.T 2s

ire ee, Fla. A De. Wille sn ¢ becom ancsca szdf |

At Start treatment art al amedinatina callech |
tfete ferpnAbod 2weeks atter Trace Paws:

[PT weas arrested before T cali start my £
Series of freat preat ‘ a

Site —themw Anryy Hepatitis s hes gatten accor Se |
eme ti : :

however to woe avai] any emedt-a) meed: we aot

lheenc amet “While amy ebraditiay gets worseT have
te Lf L, i 7

posi

Fhe axhale Purpose of thr: Formal Appee! ts

2_get the “Protest awal Medieal” Assitaxce T |
i ed ww a pe ip chful, praser, aed
Ihummase utay tau ards any Cond trae. Pracid a thet
fT could “eb G CELL AC. ore acherferon- treatments
Doctor to Peed ony fife cwnuld ve (conti ced)

DATE : SIGNATURE OF GRIEVANT AND D.C.
° ~
BY SIGNATURE, INMATE AGREES TO THE FOLLOWING # OF 30-DAY .
EXTENSIONS: . { )
. # ‘Signmure
INsrRUCTIONS

“This torn fe wd
Florida Adan

sya foenst prevance a the institution or Fuctity level us well us for Gling appeals wo ihe Office uf the Secretary in accunistice with Rute 33-103,

fe. When no appl is mde 1 the Seta. copy of he inal respons phe gravance must be tached (xcept a sisted below).

‘Wn the inte ees hat he nay be adveraly effete by the submission of prevance a the istihtiona! level because ofthe sensitive nature of the grovanes ois
‘cutited by Chapter 33-103 to Me a diewet grievance he may axdress his griewonce ireily othe Seevelay’s Offic. Te pierre nin ee inthe envelupe by the

furans and prices onstage frat through rou ist bis revue othe enn
fwcion, iC nian: does uo avi a ral sosoan ot

Tmt atari nonisascone 4 ’ ig
ipa SM
ee tvetnnn | ng te
{Dit 7 nat price {Received By)
DISTRIGUTION: INSTYTUTIONFACILITY CENT! A . -
mam memeer RL momcuny CULAR OE
Teittcuemerne ——cammcgunine

‘CENTRAL OFFICE GRIEVANCE FILE
DCI-308 (Revised 2/05) .
Document in IRIS (Inmate Records Imaging System)


MAILED | Fite.

WITHAGENCY CLERK .
JAN 9 6 208
et enc taa
PART B - RESPONSE!
LOEBER, MICHAEL 895668 __09-6-02017 WAKULLA C.l. G2stib
INTE ‘WOMBER  ~ GRIEVANCE LO NOWEER GORRENT INDEATETOCATION Base
CONFIDENTIAL HEALTH RECORD/CARE INFORMATION INTENGE® FOR ADDRESSEE(S) ONLY.
UNAUTHORIZED RELEASE OR DISCLOSURE MAY VIOLATE STATE AND FEOERAL LAW.

{Your request for administrative appeal has been received in non-c
{that the appas! mus! be received in the Office of the Secretary within

{Chapter $3-103.006(9), F.A,C. makes provisions for appealsyg

linstitution/facllity in order to facilitate your need to submit yaur appeal
have your grievance receipted locally may have contributed to your fall

|Therefore, your gievance is being returned withaut action.
S. MILLIKEN

ote Secretary to be receipled at the local

if you feel you need medical attention, contact the institutional modical department via the sick calt/emergency process.

nes with Chapter 33-103.014(1), which states
calendar days of the institutional response.

the established time frames. Your failure to
to fle the grievance timely.

‘wn
THGRATORE AND TYPED OR PRINTED NAME ‘SIGNATURE OF 7 WARDEN OR hee
OF EMPLOYEE RESPONDING SECRETARY'S REPRESENTATIVE.
COPY DISTRIBUTION «INSTITUTION / FACILITY CaF /DRTRIGUTION CENTRAL OFFICE
(2 Copies) Inmato . (1 Copy) inmate
{1 Copy, inmate's File . 41 Copy) File = ins.lFaciity
{1.Copy Ratalnad by Offi Responding {1.6opy) 6.0. temoin Fle

{1 Capy)i

by Official Responding

Document in| RIS {li

Inmate Records Imaging System)

AL


UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
PANAMA CITY DIVISION
MICHAEL J. LOEBER DC#895668,

Plaintiff,

v. . Case No. 5:09cv402-RS/MD
DEPARTMENT OF CORRECTIONS, ET AL.,

Defendants.

/

DECLARATION OF ASHLEY STOKES

STATE OF FLORIDA )
COUNTY OF LEON )

I, Ashley Stokes, am an Administrative Assistant in
the Bureau of Inmate Grievances of the Florida Department of
Corrections. I have access to the Department of Corrections’
automated database that tracks grievances appealed to the Office
of the Secretary under Florida Administrative Code Chapter 33-
103. I have been asked to locate all grievances related to
medical care filed with the-Office of the Secretary by inmate
Michael J. lLoeber DC#895688 since April 2008 when he was
received into the custody of the Department of Corrections.

A review of the automated grievance logs reveals that
the .inmate Loeber filed a total of five grievances with the
Office of the Secretary between April 2008 when he was received
and March 2010 when he was released from custody. Of those five
grievances, only two dealt with medical care. True and correct
copies of those grievancés are attached to this declaration and
are grievance log #09-6-02017, which was filed with the Office
of the Secretary on January 22, 2009, and grievance log #09-6-
22583 which was filed July 21, 2009.

: I-am competent ‘to testify to the facts stated in this
declaration and I ‘have personal: knowledge of these facts. Ir
declare under penalties of perjury that the foregoing statements
in this declaration are true and correct.

Dated: G 7

Al