Milton v. Turner
| Decision Date | 19 August 2011 |
| Docket Number | No. 10-11955,D.C. Docket No. 5:07-cv-00432-WTH-GRJ,10-11955 |
| Parties | JESSIE MILTON, Plaintiff-Appellant, v. KATHRYN TURNER, Individual Capacities, BLANCA CAMPOS, Individual Capacities, R. MOORE, Sergeant, Individual Capacities, T. NEAL, Individual Capacities, Defendants-Appellees. |
| Court | U.S. Court of Appeals — Eleventh Circuit |
[DO NOT PUBLISH]
Non-Argument Calendar
Appeal from the United States District Court
for the Middle District of FloridaBefore WILSON, MARTIN and ANDERSON, Circuit Judges.
Jessie Milton, proceeding pro se, appeals the district court's dismissal of his 42 U.S.C. § 1983 suit, which alleged that Kathryn Turner, Blanca Campos, R. Moore, and T. Neal, all employees of the Florida Department of Corrections, acted with deliberate indifference to his serious medical needs in violation of the Eighth Amendment. On appeal, he argues that the district court failed to properly construe his claims and consider all allegations in the complaint.
We review de novo a dismissal for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6), accepting the allegations in the complaint as true and construing them in the light most favorable to the plaintiff. Redland Co. v. Bank of Am. Corp., 568 F.3d 1232, 1234 (11th Cir. 2009) (per curiam). The complaint must "state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly, 127 S. Ct. 1955, 1974 (2007). "A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Ashcroft v. Iqbal, 129 S. Ct. 1937, 1949 (2009). The complaint need not include detailed factual allegations, but it must set forth "more than labels and conclusions, and aformulaic recitation of the elements of a cause of action will not do." Twombly, 127 S. Ct. at 1964-65. We no longer apply a heightened pleading standard to claims brought pursuant to § 1983. Randall v. Scott, 610 F.3d 701, 709-10 (11th Cir. 2010). Further, "pro se pleadings are held to a less strict standard than pleadings filed by lawyers and thus are construed liberally." Alba v. Montford, 517 F.3d 1249, 1252 (11th Cir. 2008).
To state a claim under § 1983, a plaintiff must allege: (1) a violation of a specific constitutional right or federal statutory provision; (2) was committed by a person acting under color of state law. Doe v. Sch. Bd. of Broward Cnty., 604 F.3d 1248, 1265 (11th Cir. 2010). Prison officials violate the Eighth Amendment when they act with deliberate indifference to an inmate's serious medical needs. Estelle v. Gamble, 97 S. Ct. 285, 291 (1976). To state a claim of deliberate indifference, a plaintiff must allege: (1) a serious medical need; (2) deliberate indifference to that need by the defendants; and (3) causation between the defendants' indifference and the plaintiff's injury. Youmans v. Gagnon, 626 F.3d 557, 563 (11th Cir. 2010) (per curiam).
The seriousness of a medical need is an objective inquiry. Kelley v. Hicks, 400 F.3d 1282, 1284 (11th Cir. 2005) (per curiam).
A serious medical need is one that has been diagnosed bya 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. In the alternative, a serious medical need is determined by whether a delay in treating the need worsens the condition. In either case, the medical need must be one that, if left unattended, poses a substantial risk of serious harm.
Mann v. Taser Int'l, Inc., 588 F.3d 1291, 1307 (11th Cir. 2009) (citations omitted) (internal quotation marks omitted).
Whether the defendants acted with deliberate indifference is a subjective inquiry. Kelley, 400 F.3d at 1284. Each defendant is "judged separately and on the basis of what that person knows." Burnette v. Taylor, 533 F.3d 1325, 1331 (11th Cir. 2008). To establish deliberate indifference, a plaintiff must allege: "(1) subjective knowledge of a risk of serious harm; (2) disregard of that risk; (3) by conduct that is more than [gross] negligence." Youmans, 626 F.3d at 564 (alteration in original) (internal quotation marks omitted). In determining whether an individual exercised gross negligence, we have considered: (1) indifference by prison doctors in their response to the prisoner's needs; (2) prison guards intentionally denying or delaying access to medical care; and (3) interference with treatment once proscribed. See Brown v. Johnson, 387 F.3d 1344, 1351 (11th Cir. 2004). Relevant factors include: "(1) the seriousness of the medical need; (2) whether the delay worsened the medical condition; and (3) the reason for thedelay." Goebert v. Lee Cnty., 510 F.3d 1312, 1327 (11th Cir. 2007).
In order for a denial of medical care to rise to the level of deliberate indifference, the treatment must be more than "medical malpractice actionable under state law." Taylor v. Adams, 221 F.3d 1254, 1258 (11th Cir. 2000) (alteration omitted) (internal quotation marks omitted). Accordingly, a "simple difference in medical opinion" does not constitute deliberate indifference. Waldrop v. Evans, 871 F.2d 1030, 1033 (11th Cir. 1989).
Milton alleged three distinct medical problems: (1) low blood sugar, resulting from his diabetes; (2) an infected hallux1 ; and (3) skin removal on his inner thighs, groin, and penis. Assuming, arguendo, that low blood sugar in a diabetic is a serious medical need, Milton did not allege that any delay in treating this need worsened his condition, nor contend that any defendant interfered with his treatment. Likewise, Milton failed to allege that the defendants' alleged indifference to his low blood sugar caused any injury. At most, Milton alleged that he was afraid something would happen to him. Accordingly, Milton fails to state a plausible claim against any defendant based on deliberate indifference tohis low blood sugar.
With respect to his two remaining medical conditions, Milton correctly argues that his claims against Turner, Moore, and Neal are delayed-treatment claims, not inadequate-treatment claims, which the district court did not acknowledge in its order dismissing the complaint. As explained below, the pro se complaint could also be liberally construed to allege interference-with-treatment claims against Moore and Neal. We next address these claims in turn.
Milton's allegations state a plausible claim against Moore and Neal for interference with the treatment of his infected hallux. Milton alleged that he first had his hallux examined on February 12, 2007, when he complained of "foot sores," as well as chafing on his inner thighs.2 The nurse diagnosed an infected hallux, provided foot powder and ibuprofen, and told Milton to tell Moore and Neal to give him work boots for use when he was on mower squad. Milton alleged that he told Moore and Neal "what the nurse had just told [him] at sickcall," but that they refused to issue him work boots. By February 20, Milton alleged that his hallux was swollen with pus and that he could barely walk on it.
Milton claims that his infected hallux presented a serious medical need. We agree. In Mann, we explained that a medical need is sufficiently serious if a delay in treatment worsens the condition, an argument we find applicable here. Mann, 588 F.3d at 1307. Milton's allegations support the inference that his condition worsened between February 12 and February 20. And Milton has also plausibly demonstrated that the condition posed a substantial risk of serious harm if left unattended. Here, one could reasonably infer that an infected hallux, if left untreated, would pose a substantial risk of harm, especially in a diabetic. In addition, Milton's hallux ultimately did need to be drained and required antibiotics and ten days of bed rest,3 which supports the inference that it posed a substantial risk of harm.
Since the complaint reflects the existence of an objectively serious medical need, the issue then turns to the subjective inquiry of whether the defendants were deliberately indifferent to that serious medical need. Milton plausibly alleged that Moore and Neal had the requisite subjective knowledge of a risk of serious harm.Milton told Moore and Neal "just what the nurse told him"—that he had an infected hallux and needed work boots. He also told them that his hallux may have to be amputated because of his diabetes. Under the facts as alleged, it is plausible that Moore and Neal had subjective knowledge of an obvious serious risk of harm, due to Milton's infected hallux, if Milton did not receive his work boots.
Milton also sufficiently alleged that Moore and Neal "interfered" with his treatment by refusing to provide work boots. And finally, Milton alleged a plausible "causal connection" between Moore's and Neal's refusal to provide work boots and his injury, as he alleged that the condition of his hallux worsened by February 20. Based on the foregoing, we vacate in part and remand as to the interference-with-treatment claims against Moore and Neal.
The complaint may also be read as attempting to state claims against Moore and Neal for delayed treatment. Reading the allegations in the complaint in the light most favorable to Milton, on February 20, Milton's hallux had swollen with pus and he could barely walk on it, and the skin on his inner thighs had scraped off and he was in much pain. Milton "explained his problem" to Neal, but Neal forced him to start working on the mower squad. Milton could not keep up withthe squad, Neal screamed at him to speed up, and Milton stopped mowing and grabbed his groin. When Neal asked him what he was doing, Milton responded that he was "hurting." Neal threatened Milton with lock-up if he did not keep mowing, Milton declared a medical emergency, Neal refused, and Milton worked for 20-30 more minutes. When Milton told Moore that Neal refused medical attention,...
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