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Salvani v. Corizon Health, Inc.

United States District Court, S.D. Florida

September 16, 2019

Craig Salvani, Plaintiff,
Corizon Health, Inc., and others, Defendants.



         This 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.[1]

         Now 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.

         1. Background

         Craig 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 neck. Id.

         The 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.)

         On 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.

         Four 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.)

         On 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. (Id.)

         Corizon 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.” (Id.)

         Dr. 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 ¶ 15.)

         At the 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.)

         Additionally, 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 ¶ 7.)

         2. ...

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