United States District Court, S.D. Florida
ORDER ON THE MOTIONS FOR SUMMARY JUDGMENT
N. SCOLA, JR. UNITED STATES DISTRICT JUDGE
action arises from the medical treatment the plaintiff, Craig
Salvani, received while he was an inmate in the custody of
the Florida Department of Corrections. Salvani brings 28
U.S.C. § 1983 claims against certain prison medical care
providers whose alleged deliberate indifference to his Eighth
Amendment rights resulted in the amputation of his legs.
Specifically, Salvani sues Corizon Health, Inc.
(“Corizon”), Dr. Josue Jorge Caraballo, a
physician employed by Corizon, Stephanie G. Loznicka, a nurse
employed by Corizon, Wexford Health Sources, Inc.
(“Wexford”), and Dr. Marta Castillo, a physician
employed by Wexford.
before the Court are three motions for summary judgment: Dr.
Castillo's motion (ECF No. 117), Wexford's motion
(ECF No. 116), and Corizon, Dr. Caraballo, and Loznicka's
motion (ECF No. 110). After reviewing the parties'
written submissions and exhibits, and the applicable law, the
Court grants Dr. Castillo's motion (ECF No. 117), grants
Wexford's motion (ECF No. 116), and grants in part and
denies in part Dr. Caraballo, Loznicka, and Corizon's
motion (ECF No. 111). Summary judgment is granted as to
Corizon, and denied as to Dr. Caraballo and Loznicka.
Salvani was an inmate in the custody of the Florida
Department of Corrections (“FDOC”) when he
received the medical care giving rise to this suit. (ECF No.
110 at ¶ 1.) He entered into FDOC custody on February 6,
2014. Previously, he was incarcerated in the Lee County Jail
from January 21, 2014 to February 6, 2014. During his
detention in the Lee County jail, he was involved in an
altercation with other inmates that injured his elbow and
South Florida Reception Center conducted Salvani's
initial intake screening, where Wexford provided medical
services to inmates. (ECF No. 91 ¶¶4-6.) During his
intake screening, Salvani disclosed that he was injured in
the jail during a fight. (ECF No. 110 at ¶ 2.) Wexford
took blood and urine tests, whose results were available on
February 8, 2014. (Id. at ¶ 9.) The blood and
urine test results showed several abnormalities including
high white blood cell count and the presence of small amounts
of blood in his urine. (ECF No. 91 at ¶¶ 10-11.)
February 8, 2014, Salvani again complained of neck and back
pain, and was seen by a Wexford nurse. He had a fever of
100.00 degrees but did not have the “abnormal vital
signs that would trigger further action.” (ECF No. 91
at ¶ 12.) A temperature greater than 100.4 degrees would
have required the doctor to be notified. (ECF No. 137 at
¶ 12.) He was given ibuprofen for his neck pain. (ECF
No. 91 at ¶ 12.) Four days later, on February 12, 2014,
a Wexford nurse conducted his initial medical exam.
(Id. at ¶ 12.) Salvani's vital signs, his
temperature, pulse, blood pressure, and respirations,
appeared within the normal range. (ECF No. 91 at ¶ 14.)
The nurse reviewed the blood and urine results collected on
February 6, 2014, and she ordered ibuprofen, flu vaccine, a
cervical spine x-ray, a repeat urine and blood test to be
conducted in four weeks, and a low bunk pass. (Id.
at ¶¶ 16-17.) The cervical spine x-ray was
completed on that day. (Id. at ¶ 18.) On
February 13, 2014, the radiologist noted that
“[i]ncidentally noted nodule in the left upper
lobe…Please follow up with chest radiographs.”
(Id. at ¶ 19.) There is no indication in the
record that follow up chest radiographs were scheduled.
additional days later, on February 17, 2014, Salvani was
evaluated by another Wexford nurse due to his complaint that
he “started coughing green mucus since Friday. [His]
chest hurt when coughing. [He] feel[s] freezing.”
(Id. at ¶¶ 20-21.) The nurse found that he
had an elevated pulse at 120. Id. Salvani alleges
that he also complained that was “getting really sick,
” and that he had night sweats and was dehydrated. (ECF
No. 137 at 21.) The medical staff also noted the elevated
white blood cell count and the abnormal urinalysis from
February 6, 2014. (Id. at ¶ 22.) The nurse
notified Dr. Castillo of all of Salvani's symptoms at
2:20 on February 17, 2014, which was required because he had
a pulse higher than 110. (ECF No. 91 at ¶ 23.) The
Wexford nurse gave Salvani ibuprofen and cough syrup.
(Id. at ¶¶ 24-25.) Wexford claims that he
was instructed to return if symptoms worsened. (Id.)
Later that same day, Dr. Castillo ordered a repeat urinalysis
and an EKG. (Id. at ¶ 27.) The results of the
urinalysis were reported on February 18, 2019, which showed
abnormal indicators similar to the previous urinalysis.
(Id. at ¶ 28.) Salvani alleges the EKG also
showed he had an abnormally high heartrate. (ECF Nos. 137 at
¶ 28, 90-1 at 31.) Dr. Castillo never examined Salvani.
(ECF No. 91 at ¶¶ 30-31.)
February 20, 2014, Salvani was moved from the South Florida
Reception Center to the Reception and Medical Center in Lake
Butler, Florida. (ECF No. 110 at ¶ 6.) Loznicka
conducted Salvani's intake process. (ECF No. 134 at
¶ 9.) Loznicka and Salvani have different versions of
the events that occurred at intake. On the one hand, Loznicka
claims that the transfer summary only indicated he was being
treated for neck pain and dental problems. (ECF No. 110 at
¶ 9.) Although she did not take his temperature, all
other vital signs were within normal limits. Salvani did not
complain, and she did not think that a physician's care
was necessary. (Id.) According to Loznicka, she told
Salvani he could use a “sick call” or
“declare a medical emergency” if necessary.
(Id.) On the other hand, Salvani claims that he was
visibly very ill. (ECF No. 134 at ¶ 9.) He told
“anyone who would listen” that he had medical
issues. (Id.) He alleges that he requested medical
care at intake, stating that he was “really sick”
and that he was “supposed to see a doctor, ” but
was threatened by unnamed individuals with confinement.
(Id. at ¶ 8.) Salvani claims that Loznicka
reviewed his medical file containing his previous blood and
urinalysis reports, the EKG, and the x-ray, all containing
abnormal results. (Id. at ¶ 9.) Despite his
complaints, his appearance, and his medical reports, Loznicka
merely stamped his transfer paperwork without providing any
treatment or requesting follow up examinations.
alleges that Salvani did not make any medical complaints
between his arrival and February 24, 2014 at 1:14 a.m.
(Id. at ¶ 11.) Salvani alleges that he
complained during his intake and to a correctional officer.
(ECF No. 134 at ¶11.) His complaints were ignored.
(Id.) At 1:14 a.m. on February 24, 2014, he was
taken to the West Unit and seen by nurses who were unable to
start an I.V. (ECF No. 110 at ¶ 11.) He exhibited
shortness of breath and was barely able to speak.
(Id.) Salvani claims that Dr. Caraballo was notified
that Salvani was in critical condition at 1:14 a.m. (ECF No.
134 at ¶ 11.) Corizon alleges that Dr. Caraballo was
notified at 2:30 a.m., and he ordered Salvani to be brought
to him for examination at that time. (Id.) The
nurses told Dr. Caraballo that “Mr. Salvani has low
blood pressure” and that “he was incoherent,
” but he does not remember whether any other details
were disclosed over the phone. (ECF No. 131-3 at 42.) He did
not immediately send Salvani directly to the hospital or
otherwise provide treatment. Id. Salvani was
transported to the Main Unit, and he did not arrive until
4:20 a.m. (ECF No. 110 ¶ 12.) According to Corizon,
“[n]o one involved in this case knows why this [delay]
happened, and Dr. Caraballo remembers no other time there was
this type of delay by corrections officers.”
Caraballo evaluated Salvani at 4:20 a.m. (Id. at
¶ 13.) He found that Salvani had low blood pressure and
increased heart rate. (ECF No. 110 at ¶ 13.) He ordered
vancomycin and Levaquin because he suspected that Salvani may
have sepsis. He also ordered an x-ray, oxygen and blood
tests. (Id.) He contacted Memorial
Hospital-Jacksonville to alert them that he was sending
Salvani there. (Id.) Memorial Hospital is much
farther away than Shands Teaching Hospital, so the EMS
personnel took him to Shands instead. (ECF No. 134 at ¶
13.) The nursing staff failed to carry out Dr.
Caraballo's medication order, and Salvani never received
any medicine from Dr. Caraballo, Corizon, or any Corizon
staff. (ECF No. 110 at ¶ 14.) At 4:55 a.m., Dr.
Caraballo ordered Salvani to be sent to the hospital.
(Id. at ¶ 13.) The nursing staff contacted FDOC
staff, and FDOC staff contacted EMS. EMS crew was notified of
Salvani's emergency at 5:29 a.m. The crew arrived at 6:01
a.m. and left the prison at 6:15 a.m. Salvani did not arrive
at Shands hospital until 6:44 a.m. (Id. at ¶
hospital, the Plaintiff was diagnosed with a heart valve
infection and a septic infection. (Id. at ¶
16.) As a result of the sepsis, the Plaintiff's legs had
to be amputated. (Id. at ¶ 17.)
Salvani sets forth facts regarding the practices of Wexford
and Corizon. The Florida Correctional Medical Authority's
2015 audit of Corizon's health care made several negative
findings including that in 4 of 15 chronic illness clinic
records baseline information was incomplete or missing and
that 3 of 15 endocrine clinic records demonstrated that
abnormal labs were not addressed timely. (ECF No. 134 at
¶ 2.) In a November 2017 assessment of the South Florida
Reception Center, Wexford was cited for several inadequate
practices. (ECF No. 136-2.) Dr. Carl Meier, the
Corizon-employed medical director of the RMC Hospital from
2014 to 2015, testified that he believed Corizon and Wexford
were “not providing direct acting antivirals to inmates
with hepatitis C solely to save money” and that it was
“not providing hernia surgeries to inmates with painful
hernias in order to save money.” (Id. at