United States District Court, S.D. Georgia, Savannah Division
CAGER A. MALEEAH, Plaintiff,
OLATUNJI AWE, et al., Defendants.
ORDER AND REPORT AND RECOMMENDATION
pro se and in forma pauperis, Cager A.
Maleeah brings this 42 U.S.C. § 1983 action against Drs.
Awe and Brown, PA Darcy, and Nurses Terry, Tyler, Green, and
Anderson (née Evans). Doc. 1. The Court now screens
his Complaint under 28 U.S.C. § 1915A.
Maleeah is incarcerated at Coastal State Prison and contends
that, beginning on May 22, 2016, his left foot hurt and was
swollen. Doc. 1 at 5. After a few hours on work detail, his
discomfort worsened, as his foot became inflamed, bright red,
and painful “like it had been dipped in acid.”
Id. When taken to the medical unit around 3:00 a.m.,
Nurse Tyler told plaintiff he could not be seen until the
following morning when a physician or physician's
assistant would be present. Id. at 5-6. While he
waited back in his cell, the pain worsened and his foot
became splotchy with purple discolorations. Id. at
6. Nurse Tyler again sent him packing, informing Maleeah he
could not “just come to medical without a call-out
slip.” Id. Nurse Green, however, examined his
foot and told him it appeared to be a spider bite, but
nothing could be done until a physician was present.
7:30 a.m. on the 23rd, Maleeah returned to medical unit to
see a physician. After waiting for a few hours, P.A. Darcy
examined him and assessed his injury as
“infected” “Athlete's foot.” Doc.
1 at 7. She declined to refer Maleeah to Dr. Awe, and instead
prescribed foot cream, antibiotics, and Motrin for the pain.
Id. Plaintiff was unable to actually get those
prescriptions, however, as they had only been
“ordered.” Id. at 7-8. By the next
morning, his foot had begun leaking “this green nasty
smelling fluid from between my toes that smelled like rotten
meat.” Id. at 8. Unable to get his prescribed
medication, Maleeah returned to the nurse's station to
ask to see Dr. Awe and was turned away by Nurse Terry after
she determined he did not appear to be in “too much
distress.” Id. at 9. That evening, “pill
call” on the 24th, Maleeah got his prescriptions for
foot cream and antibiotics, but no Motrin since “none
had been ordered.” Id. at 10. As Maleeah
returned to his cell, his pain was “off the
charts” and he noticed “pink streaks coming up
from my leg from my foot to about my knee” and
“more and more fluid” leaking from his foot.
Id. A few hours later, Nurse Green gave him some
gauze and “cleanser in a green bottle” and left
him to cleanse his own wound, while Nurse Terry again booted
him from the nurses' station because he lacked a sick
“call out” to be there. Id.
morning of the 25th, Maleeah again saw P.A. Darcy, was given
a shot (either of antiobiotics or for pain, it's unclear
from the Complaint), and was sent back to his cell where he
used a towel to catch the fluid leaking out of his foot. The
next morning, the 26th, P.A. Darcy gave him another two
shots. Doc. 1 at 11-12. Plaintiff needed help to limp back to
his dorm. Id. at 12. With pink streaks now
“coming up past his belly button” and some
shortness of breath, plaintiff decided the only way to get
immediate, meaningful care was to complain of chest pains.
Id. at 12-13. An officer called in a
“code” to get the “prisoner E.R.”
“golf cart ambulance” dispatched, and after
conferral, Nurse Jackson and P.A. Darcy called
“EMS” to come fetch Maleeah from the prison.
Id. at 13. Paramedics immediately assessed his foot
as “really infected” and took him to the
hospital, where medical staff set to work. Id. at
examination, the vascular surgeon on duty explained that the
infection had “penetrated some of the bones” in
Maleeah's foot and that it might require amputation. Doc.
1 at 15. One of the physicians told him that the infection
had spread through his body and was approaching his heart,
and that it would be a close thing if the antibiotics could
stop it. Id. at 16. Multiple bones and one toe were
removed, and the extreme round of antibiotics and painkillers
plaintiff was administered (his foot left open to continue
draining the infection) left him weak, nauseated, and unable
to eat. Id. at 17-18 (reporting he lost 17 pounds
over the course of the week following surgery). He was
discharged back to the prison and provided ongoing care and
physical therapy, but experiences ongoing nerve damage,
balance problems and resultant injuries from falling, and
pain, both physical and “phantom.” Id.
at 19-20. He's been told that he's reached maximum
recovery, and that his current pain is most likely permanent.
Id. at 20. He has been randomly denied medications
by Nurse Anderson, without explanation, even after
amputation. Id. Maleeah seeks injunctive and
monetary relief for his pain and suffering and future medical
care. Id. at 21.
advances a claim for denial of medical care in violation of
the Eighth Amendment. See Farmer v. Brennan, 511
U.S. 825, 832 (1994) (the Constitution imposes a duty upon
prison officials to “ensure that inmates receive
adequate food, clothing, shelter, and medical care.”).
“[N]ot every claim by a prisoner that he has not
received adequate medical treatment states a violation of the
Eighth Amendment.” Harris v. Thigpen, 941 F.2d
1495, 1505 (11th Cir. 1991) (quotes and cite omitted).
Rather, “an inmate must allege acts or omissions
sufficiently harmful to evidence deliberate indifference to
serious medical needs.” Estelle v. Gamble, 429
U.S. 97, 106 (1976). A prisoner must show that: (1) he had a
serious medical need; (2) defendants were deliberately
indifferent to that need; and (3) some injury was caused by
defendants' indifference. Goebert v. Lee Cty.,
510 F.3d 1312, 1326 (11th Cir. 2007).
has alleged sufficient facts to warrant service of the
Complaint on defendants P.A. Darcy and Nurses Terry, Tyler,
Green, and Anderson. While it is unclear what injury (if any)
led to the catastrophic infection, that rapidly progressing
infection was clearly a serious medical need and defendants
showed deliberate indifference to that need. Such a showing
requires: “(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 (quote omitted and alteration adopted). Here, the
risk of ignoring the rapidly progressing infection was -- or
should have been with even cursory examination --obvious, and
Coastal State Prison medical staff callously disregarded that
risk. Lindley, 652 Fed.Appx. at 805-06.
defendant may disregard a risk with more than gross
negligence by, inter alia, intentionally failing or
refusing to provide medical treatment, delaying treatment,
providing grossly inadequate or inappropriate diagnosis or
treatment, deciding to take an easier but less efficacious
course of treatment, or providing medical treatment that is
so cursory as to amount to no medical treatment at all.
McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir.
1999). While Nurse Green did take some steps to treat
Maleeah's complaint and P.A. Darcy prescribed some
medications, the Court cannot determine at this stage (at
least, without further briefing more appropriate to summary
judgment) that their care was sufficiently adequate, as to
constitute mere “negligence” or “medical
that within three days Maleeah lost a toe and several of his
metatarsal bones basically liquefied, however, the P.A. and
nurses' provision of foot cream, some gauze, and
cleansing ointment before sending Maleeah back to his cell to
literally rot suffices to meet the third (more than
“gross negligence”) prong of a deliberate
indifference showing for screening purposes. See
Lindley, 652 Fed.Appx. at 805-06; Waldrop v.
Evans, 871 F.2d 1030, 1035 (11th Cir. 1989)
(“grossly incompetent medical care or choice of an
easier but less efficacious course of treatment can
constitute deliberate indifference.”); see also
Nimmons v. Aviles, 409 Fed.Appx. 295, 297 (11th Cir.
2011) (“For medical treatment to rise to the level of a
constitutional violation, the care must be so grossly
incompetent, inadequate, or excessive as to shock the
conscience or to be intolerable to fundamental fairness. [The
plaintiff] must demonstrate that [the defendants']
response to his medical need was more than merely accidental
inadequacy, negligence in diagnosis or treatment, or even
medical malpractice actionable under state law.”)
(cites omitted). The inexplicable delay in administration of
antibiotics, either by shot or prescription, too can support
a finding of gross negligence. Lindley, 652
Fed.Appx. at 805-06 (a delay in providing antibiotics which
“allowed the infection to worsen to the point that
antibiotics were no longer effective, leading to the
extensive loss of tissue and skin” can establish
deliberate indifference to a serious medical need);
Pourmoghani-Esfahani v. Gee, 625 F.3d 1313, 1317
(11th Cir. 2010) (“Even where medical care is
ultimately provided, a prison official may nonetheless act
with deliberate indifference by delaying the treatment of
serious medical needs.”). Maleeah's claims against
P.A. Darcy and the nurses is GREENLIT for
Drs. Awe and Brown, however, Maleeah has alleged no facts
supporting a violation of his Eighth Amendment rights.
See doc. 1. He says the nurses refused to let him
see Dr. Awe, not that Dr. Awe refused to provide treatment or
provided grossly negligent treatment. He says Dr. Brown later
accompanied nursing staff on their rounds to ensure proper
treatment, not that Dr. Brown was ever involved in the care
failures that led to the amputation of his toe and removal of
necrotic tissue. Neither physician is anywhere mentioned, in
fact, as having any role whatsoever in the events forming the
basis of his Complaint. Both should therefore be
DISMISSED from the Complaint.
Drs. Awe and Brown should be
DISMISSED.Maleeah's claims for the
violation of the Eighth Amendment against PA Darcy and Nurses
Terry, Tyler, Green, and Anderson, however, are approved for
service and the Clerk is DIRECTED to forward
a copy of this Order, along with plaintiff's ...