United States District Court, N.D. West Virginia
REPORT AND RECOMMENDATION
MICHAEL JOHN ALOI UNITED STATES MAGISTRATE JUDGE
August 17, 2017, the pro se Plaintiff, a former
federal inmate initiated this case by filing the instant
Bivens civil rights complaint. ECF No. 1. Along
with his complaint, Brown filed a motion to proceed as a
pauper. ECF No. 2. By Order entered August 22, 2017, Brown
was granted permission to proceed as a pauper without payment
of any portion of a filing fee. ECF No. 5.
April 3, 2018, the undersigned conducted a preliminary review
of the complaint, determined that summary dismissal was not
warranted at that time, and directed the Defendants to answer
the complaint. ECF No. 8. Plaintiff was given an additional
thirty days in which to identify the Bureau of Prisons
(“BOP”) John Doe defendants; and the Clerk was
directed to issue 60-day summonses and forward copies of the
complaint to the United States Marshal Service
(“USMS”) to effect service of process upon the
remaining named defendants. Id.
April 17, 2018, Defendant Mohamad Salkini
(“Salkini”) filed a motion to dismiss with a
memorandum in support. ECF No. 12.
April 19, 2018, Plaintiff filed a response, identifying the
previously-unnamed BOP defendants. ECF No. 13. Plaintiff
filed a supplemental response regarding the
previously-unnamed BOP defendants on April 20, 2018,
attaching a copy of a Freedom of Information Act
(“FOIA”) request and a copy of the Order to
Answer. ECF No. 14.
April 24, 2018, because Plaintiff was proceeding pro
se, a Roseboro Notice was issued. ECF No. 17.
On April 26, 2018, Defendant Ruby Memorial Hospital
(“RMH”) filed a Motion to Dismiss with an
attached memorandum in support and a copy of its Corporate
Disclosure Statement. ECF Nos. 23, 24. A second
Roseboro Notice was issued on May 1, 2018. ECF No.
3, 2018, a second Order to Answer was issued to the
newly-identified BOP defendants. ECF No. 27.
18, 2018, Plaintiff filed a response in opposition to
Defendant Salkini's Motion to Dismiss. ECF No. 31. On May
24, 2018, Plaintiff filed a response in opposition to
Defendant RMH's Motion to Dismiss. ECF No. 36. On May 31,
2018, Defendant RMH filed a reply. ECF No. 38. On June 4,
2018, Plaintiff filed a Motion for Default Judgment against
Defendant United States Department of Justice
“(DOJ”), Defendant Mark S. Inch
(“Inch”) and Defendant B. Von Blanckensee
(“Von Blanckensee”). ECF No. 39.
6, 2018, Defendants DOJ, Inch, Von Blanckensee, J.F. Caraway
(“Caraway”), Renee Crogan (“Crogan”),
T. Tompkins (“Tompkins”), and B. Plavi
(“Plavi”), (collectively, “the Federal
Defendants”) filed a Motion to Substitute Defendants
and Clarify Electronic Docket, to correct misspellings in
several of their names. ECF No. 41. By Order entered June 7,
2018, the Federal Defendants' Motion to Substitute
Defendants and Clarify Electronic Docket was granted. ECF No.
11, 2018, the Federal Defendants filed a Motion to Dismiss
with a memorandum in support, attaching a sworn declaration
with attachments. ECF No. 43. That same day, Plaintiff filed
a Motion for Leave to File a Motion to Strike Defendant
[Salkini's] Reply Brief to the Plaintiff's Response
Motion and Plaintiff's Response to Defendant
[Salkini's] Reply Motion. ECF No. 44. On June 12, 2018, a
third Roseboro Notice issued. ECF No. 45.
19, 2018, Plaintiff filed a Motion to Compel Discovery. ECF
No. 47. By Order entered the same day, Plaintiff's
discovery motion was denied without prejudice as premature.
ECF No. 49.
21, 2018, Plaintiff filed a “Request for Leave to Reply
to the Defendant [Salkini's] Second Attempt at
Dismissal of Plaintiff's Complaint.” ECF No. 50. On
June 22, 2018, Plaintiff filed a Response in Opposition to
the [Federal] Defendants[‘] Motion to Dismiss. ECF
No. 51. That same day, Defendant Salkini filed a Response in
Opposition to Plaintiff's Motion for Leave to File Motion
to Strike and Motion to Strike Plaintiff's Surreply. ECF
No. 52. By Order entered June 25, 2018, Plaintiff's
Request for Leave to Reply to Defendant Salkini's Second
Attempt at Dismissal of Plaintiff's Complaint was
construed as a Motion to File Surreply and denied. ECF No.
9, 2018, Plaintiff filed a “Motion for Reconsideration
of the Court's June 19, and June 25, 2018 Orders”
and an “Expert Witness Affidavit in Support of
Complaint.” ECF Nos. 55, 56.
matter is now pending before the undersigned for an initial
review and Report and Recommendation pursuant to LR PL P 2
and 28 U.S.C. § 1915.
complaint, filed without a memorandum in support, and in very
brief and general terms, without providing any detail as to
the facts, Plaintiff raises claims of denial of adequate
medical care; systemic racism and racial bias in mental
health care; medical malpractice; discrimination and
retaliation; and violation of his rights to free speech and
to be free from cruel and unusual punishment. ECF No. 1 at 7
- 9. Plaintiff's complaint indicates that the acts
complained of occurred at FCI Morgantown in Morgantown, West
Virginia. Id. at 4.
maintains that he has exhausted his administrative remedies
with regard to his claims. Id. at 4 - 5. He contends
that as a result of Defendants' actions, he is now
impotent, maimed, and suffers from depression. Id.
relief, he seeks a hearing, a jury trial, and unspecified
damages “sought in the complaint.” Id.
Defendant Salkini's Motion to Dismiss, ECF No.
Salkini argues that the complaint should be dismissed
pursuant to Fed.R.Civ. P. 12(b)(6), because
1) Plaintiff failed to comply with mandatory pre-suit filing
requirements as set forth in the West Virginia Medical
Professional Liability Act (“WVMPLA”);
2) the complaint does not allege facts sufficient to support
a cause of action for medical malpractice; despite having
referred to an attached memorandum, none was attached; and
3) the complaint should be dismissed pursuant to Fed.R.Civ.P.
12(b)(2), 12(b)(4), and 12(b)(5), because Plaintiff failed to
timely serve Dr. Salkini within ninety days of the filing of
ECF No. 12 at 1.
Plaintiff's Response in Opposition to Defendant
Salkini's Motion to Dismiss, ECF No. 31
response in opposition, for the first time, provides specific
detail regarding Defendant Salkini's alleged racism
toward Plaintiff, and the malpractice Salkini allegedly
committed before, during, and after a bladder stone removal
procedure he performed on Plaintiff on or about June 27,
2016. ECF No. 31 at 2 - 3.
Plaintiff contends that prior to his surgery, Salkini delayed
treatment for his “serious medical condition” by
“initiat[ing] a year-long billing process while the
Plaintiff suffered abdominal and leg pain, [and had]
frequent . . . blood in his urine.” Id. at 2
- 3. He contends that Salkini and his staff harbored racist
feeling against him, and the male staff appeared to
“take issue” with the size of his genitalia.
Id. at 3.
avers that after being told preoperatively that he would have
a “pin size incision in his side, ” Salkini left
him with a 6 or 7-inch incision. Id. at 3; see
also ECF No. 31-4 at 3. Plaintiff contends that his
surgery was not performed in a “standard operating room
like other non-black patients, ” but in a “back
corner dirty room.” ECF No. 31 at 3. He alleges that
after he woke up in recovery, he vomited and later that
evening, his blood pressure “surge[d] dangerously high,
” [id.] but that despite these
“post-surgery complications, ” he was discharged
without any further treatment or instruction on how to take
care of his incision or the Foley catheter that was
“surgically inserted into him.” Id. He
was told he would be seen in follow up in two weeks, but
before that, he developed an infection, so the catheter was
removed by non-hospital personnel. Id. At his
two-week follow-up visit with Salkini, “despite being
informed of Plaintiff's post-surgery complications and
illness, a nonskilled hospital employee following
Salkini's instruction . . . attempted to re-insert the
catheter without the use of anesthesia.” Id.
When Plaintiff became upset, “Salkini and the hospital
employees recognize[d] their mistake . . . called the
procedure off” and discharged him with no post-surgery
x-ray or examination of his wounds. Id.
further alleges that “during the surgery Salkini
deliberately or accidentally severed several nerves resulting
in impotence, back and lower leg pain” for Plaintiff.
Id. at 4. He implies that this was done because of
racial animus toward him. Id. These complications
caused him to develop “suicidal depression, ”
resulting in his being declared disabled by the Social
Security Administration. Id. at 5. In an attached
affidavit, he also contends that his wife, who is twenty
years younger than he, “left me due [to] my
post-surgery state of mind [and] inability to perform
sexually.” ECF No. 31-4 at 4.
asserts that “all defendants named in the complaint
either work for the . . . [DOJ] and or BOP or are paid by
them for their services.” Id. at 6. Therefore,
he concludes, because RMH and its employees, like Dr.
Salkini, have enjoyed a 30-year long multi-million-dollar
business relationship with the BOP, Salkini and RMH are
agents of the BOP. Id. at 6.
for the first time, he alleges that Salkini demonstrated
“clear deliberate indifference to his rights to free of
racial bias healthcare [sic], medical malpractice and
attaches a sworn affidavit from “Expert Witness Nicole
Farmer, LPN [ECF No. 31-1];” a copy of an April 10,
2018 FOIA request from him to the RMH Medical Records
department, seeking “copies of all public records that
show and describe the outcome of kidney stone [sic] removal
proceedings perform[ed]by Dr[.] Mohamad Salkini on a racial
base . . . [copies of] all disciplinary action taken against
Dr. Salkini over the last ten years and any [and] all racial
complaints filed against same doctor and RMH over the same
period (last ten-year)” [ECF No. 31-2 at 2]; and his
own sworn affidavit, alleging additional factual detail. ECF
No. 31-4. He also produced a thumb drive containing copies of
some of his RMH medical records. ECF No. 31-3.
Defendant Salkini's Reply, ECF No. 36
Salkini reiterates his argument that the complaint should be
dismissed for failure to state a claim upon which relief can
be granted. He asserts that the Court may not consider any
information Plaintiff provides that was not included in
Plaintiff's complaint, and that Plaintiff's
affidavit, attached to his response, must be disregarded,
because such consideration of the same would convert
Plaintiff's response into a Motion for Summary Judgment.
ECF No. 36 at 1 - 2.
Salkini notes that Plaintiff's response still fails to
address his failure to comply with the mandatory pre-suit
filing requirements of the WVMPLA; fails to allege sufficient
facts to state a medical malpractice claim; and does not even
allege that Dr. Salkini was acting under the color of federal
law when he treated Plaintiff. Id. at 1 - 6.
Salkini argues that Plaintiff's many other claims,
including his new claim of “bad faith” against
Dr. Salkini and “the
undersigned” for failing to respond to his FOIA
request, raised for the first time in his response in
opposition to Salkini's dispositive motion, should
likewise be disregarded. Id. at 2. Finally, Salkini
reiterates his argument that the complaint should be
dismissed for failure to timely effectuate service.
Id. at 7.
Defendant RMH's Motion to Dismiss, ECF No.
RMH argues that the complaint should be dismissed pursuant to
Fed.R.Civ.P. 12(b)(6) because
1) Plaintiff fails to state a Bivens claim upon
which relief can be granted against RMH;
2) Plaintiff failed to comply with the mandatory pre-suit
notice of the WVMPLA requirements before initiating suit
against RMH; and
3) Plaintiff's claims may be barred by the applicable
statute of limitations because it is unclear from the
complaint when the medical care at issue occurred.
4) Plaintiff's complaint should be dismissed pursuant to
Fed.R.Civ.P. 12(b)(2), 12(b)(4), and 12(b)(5) for
insufficient service of process.
ECF No. 23 at 1; ECF No. 23-1 at 1 - 2, 7.
Plaintiff's Response in Opposition to Defendant
RMH's Motion to Dismiss, ECF No. 35
contends that RMH's dispositive motion should be denied
because it is “based on bad faith and [is]
untrue.” ECF No. 35 at 2. He notes that RMH denied that
Dr. Salkini has any affiliation with them and therefore they
“are not responsible for his incompetence. However, on
its own web page Dr. Salkini is listed as an Associate
Professor for the hospital.” Id. Further, he
asserts that in its motion to dismiss, RMH denied having
received a copy of the complaint, “but in a letter
addressed to Plaintiff . . . [declining his offer to settle,
RMH] conceded that it . . . was in possession of the
then attempts to refute RMH's arguments, contending that
RMH is in fact subject to a Bivens action, because
Bivens actions may be brought against private
entities operating under color of federal law, in the same
manner that § 1983 actions may be brought “against
persons acting under color of state law.” Id.
at 3. He contends that that despite claiming to be a private
corporation, RMH “has little to no problem receivingg
and correcting [sic] tens of millions [of] dollars from the
federal government” including among other things, for
providing medical services to state and federal prisoners.
Id. He cites to United States v.
Day for the proposition that RMH and its
employees qualify as agents of the federal government,
providing medical service under the color of law.
states that Dr. Salkini's bladder stone removal procedure
“was an act of medical malpractice in its purest
form” and that RMH's failure to follow its own
post-surgery follow up procedure was malpractice on its part.
Id. He argues that before surgery, he was told he
would have a “pin size incision” but woke to find
a 6-inch incision. Id. at 4. Further, his surgery
was performed in a “back corner dirty room”
rather than the “standard operating room” used
for “other non-black patients.” Id. He
further avers that he became ill in the recovery room and
vomited; later, the first night after surgery, his blood
pressure “surge[d] dangerously high.”
contends that despite these “post-surgery
complications” Salkini discharged him without any
further treatment or post-operative instructions on how to
care for his wounds. Id.
avers that in the over the eighteen months Salkini treated
him, Salkini charged the government over $200, 000.00 for
spending less than 30 minutes with him. Id. He
concludes that “[n]o non-black patient has or would
have received such inadequate medical service. This was
medical malpractice.” Id. He reiterates his
claim that he was to be seen two weeks after discharge, but
because he developed an infection before that, the catheter
was removed by “non-hospital personnel.”
Id. A “non-skilled hospital employee following
Salkini's instruction” attempted to reinsert the
catheter without using anesthesia, but when Plaintiff became
upset, “Salkini and the hospital employees recognize[d]
their mistake and called the procedure off.”
Id. at 5. He avers that he was discharged without an
x-ray or examination of his wound, and “[t]o this day,
no one from . . . [RMH] has attempted to follow up
with” him about “the neglect he received”
and he still does not know whether all the stones were
removed; what caused them; whether any nerves were
accidentally or deliberately severed during the procedure;
and whether black patients are treated differently than
non-black ones. Id.
response includes an excerpt which appears to have been
copied/pasted from an unidentified source, titled
“MEDICAL TEXBOOK . . . [STANDARD]” regarding the
complications of bladder stone surgery, which includes the
statement “[y]ou will probably be asked to attend a
follow-up appointment where X-rays or a CT scan can be used
to check that all the fragments of the bladder stones have
been removed from your bladder” and a statement to the
effect that “[o]nce the bladder stones have been
removed it is necessary to treat the underlying cause to
avoid new bladder stones from forming.” Id. He
concludes that any “adequate” postoperative
“follow up treatment plan” should have included
an “ultrasound abdominal examination and or x-ray of
the surgical area.” Id. at 6. Further, he
avers that generally, “all patients are given a
discharge instruction on caring for their wounds and a[n]
emergency contact list.” Id. He states that
“[e]ither of these options were presented to the
alleges that “[a]ccording to Dr. Zia Abdi of Atlanta
Georgia” who examined him, not only were proper pre-op
and post op procedures not followed at RMH, “but during
the surgery Salkini deliberately or accidentally severed
several nerves resulting in impotence, back and lower leg
Plaintiff raises a new claim, arguing that that RMH committed
“bad faith” by failing to abide by FOIA's
mandatory release requirements when it failed to respond to
his request for “previously undisclosed documentation
of systemic racism and racial bias, medical malpractice, and
discrimination” that he sought before RMH filed its
response, so that he would “be in a best position to
properly reply[.]” Id. Instead, he contends,
RMH moved for dismissal of the complaint, which was
“nothing more than a ploy to prevent the release of
damning documentation.” Id.
again attempts to refute RMH's claim that Dr. Salkini was
not an agent, servant, or employee, by noting that on
RMH's web page, Salkini is listed as an Associate
Professor of RMH; he also includes what appears to be an
excerpt from his operative record, which was signed by a
resident of “West Virginia University Division of
Urology” and is co-signed by Salkini. Id. at 6
argues that RMH's claim that the complaint should be
dismissed for its failure to comply with the mandatory
pre-suit requirements of the WVMPLA is a “ridiculous
assertion” and that RMH is “attempting to use a
state law to take issue with the Court's administration
handling of this matter;” noting that “this is a
federal not state matter[.]” Id. at 8.
response to RMH's argument that if the medical care at
issue occurred more than two years before the complaint was
filed, Plaintiff's claims might be barred by the
applicable statute of limitations, Plaintiff contends that
the complaint was filed on August 17, 2017, and his claims
allege racial bias and medical malpractice that occurred
between September 28, 2015 through July 15, 2016, within the
two-year statute of limitations. Id.
Federal Defendants' Motion to Dismiss, ECF No.
their dispositive motion, the Federal Defendants assert that
the case should be dismissed because:
1) the complaint fails to state a claim upon which relief can
be granted [ECF No. 43-1 at 4]; and
2) the complaint fails to sufficiently allege personal
involvement by any individual federal defendant. Id.
Federal Defendants attach the sworn declaration of Howard
Williams, Legal Assistant at the BOP Mid-Atlantic Regional
Office [ECF 43-2]; a copy of Plaintiff's Public
Information Inmate Data [ECF No. 43-3 at 2 - 5]; and a copy
of Plaintiff's Inmate History. ECF No. 43-3 at 7 - 9.
Plaintiff's Response in Opposition to Federal
Defendants' Motion to Dismiss, ECF No. 51
response contends that the Federal Defendants' motion to
dismiss is “nothing more than a stall tactic to move
the Court's intention [sic] off Plaintiff's June 4,
2018, Motion for Default Judgment, ” which he filed
when the Federal Defendants did not timely file their
response. ECF No. 51 at 1. He avers that the Federal
Defendants overlook all the evidence submitted thus far, but
notes that they have not argued that Plaintiff's claims
“are false or incorrect.” Id. at 2.
Standard of Review
Motion to Dismiss
motion to dismiss under Rule 12(b)(6) tests the sufficiency
of a complaint; importantly, it does not resolve contests
surrounding facts, the merits of a claim, or the
applicability of defenses.” Republican Party of
N.C. v. Martin, 980 F.2d 943, 952 (4th Cir. 1992)
(citing 5A Charles Alan Wright and Arthur R. Miller, Federal
Practice and Procedure § 1356 (1990). In considering a
motion to dismiss for failure to state a claim, a
plaintiff's well-pleaded allegations are taken as true
and the complaint is viewed in the light most favorable to
the plaintiff. Mylan Labs, Inc. v. Matkari, 550 U.S.
544, 555 (2007) (quoting Conley v. Gibson, 355 U.S.
41, 47 (1957)).
Federal Rules of Civil Procedure “require only ‘a
short and plain statement of the claim showing that the
pleader is entitled to relief,' in order to ‘give
the defendant fair notice of what the ... claim is and the
grounds upon which it rests.'” Bell Atl. Corp.
v. Twombly, 550 U.S. 544, 555 (2007) (quoting Conley
v. Gibson, 355 U.S. 41, 47 (1957)). Courts have long
cited the “rule that a complaint should not be
dismissed for failure to state a claim unless it appears
beyond doubt that the plaintiff can prove no set of facts in
support of [a] claim which would entitled him to
relief.” Conley, 355 U.S. at 45-46. In
Twombly, the United States Supreme Court noted that
a complaint need not asserts “detailed factual
allegation, ” but must contain more than labels and
conclusions” or “a formulaic recitation of the
elements of a cause of action.” Twombly, 550
U.S. at 555 (citations omitted). Thus, the “[f]actual
allegations must be enough to raise a right to relief above
the speculative level, ” id. (citations
omitted), to one that is “plausible on its face,
” id. at 570, rather than merely
“conceivable, ” Id. Therefore, in order
for a complaint to survive a dismissal for failure to state a
claim, the plaintiff must “allege facts sufficient to
state all the elements of [his or] her claim.” Bass
v. E.I. DuPont de Nemours & Co., 324 F.3d 761, 765
(4th Cir. 2003) (citing Dickson v. Microsoft Corp.,
309 F.3d 193, 213 (4th Cir. 2002); Iodice v. United
States, 289 F.3d 279, 281 (4th Cir. 2002)). In so doing,
the complaint must meet a “plausibility”
standard, instituted by the Supreme Court in Ashcroft v.
Iqbal, where it held that a “claim had 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).
Thus, a well-pleaded complaint must offer more than “a
sheer possibility that a defendant has acted
unlawfully” in order to meet the plausibility standard
and survive dismissal for failure to state a claim.
motion to dismiss pursuant to Rule 12(b)(6) is accompanied by
affidavits, exhibits and other documents to be considered by
the Court, the motion will be construed as a motion for
summary judgment under Rule 56 of the Federal Rules of Civil
to Rule 56(c) of the Federal Rules of Civil Procedure,
summary judgment is appropriate “if the pleadings,
depositions, answers to interrogatories, and admissions on
file, together with the affidavits, if any, show that there
is no genuine issue as to any material fact and that the
moving party is entitled to judgment as a matter of
law.” In applying the standard for summary judgment,
the Court must review all the evidence “in the light
most favorable to the nonmoving party.” Celotex
Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). The court
must avoid weighing the evidence or determining the truth and
limit its inquiry solely to a determination of whether
genuine issues of triable fact exist. Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 248 (1986).
Celotex, the Supreme Court held that the moving party bears
the initial burden of informing the Court of the basis for
the motion and of establishing the nonexistence of genuine
issues of fact. Celotex, 447 U.S. at 323. Once
“the moving party has carried its burden under Rule 56,
the opponent must do more than simply show that there is some
metaphysical doubt as to material facts.”
Matsushita Electric Indus. Co. v. Zenith Radio
Corp., 475 U.S. 574, 586 (1986). The nonmoving party
must present specific facts showing the existence of a
genuine issue for trial. Id. This means that the
“party opposing a properly supported motion for summary
judgment may not rest upon mere allegations or denials of
[the] pleading, but . . . must set forth specific facts
showing that there is a genuine issue for trial.”
Anderson, 477 U.S. at 256.
“mere existence of a scintilla of evidence”
favoring the nonmoving party will not prevent the entry of
summary judgment. Id. at 248. To withstand such a
motion, the nonmoving party must offer evidence from which a
“fair-minded jury could return a verdict for the
[party].” Id. “If the evidence is merely
colorable, or is not significantly probative, summary
judgment may be granted.” Felty v. Graves-Humphreys
Co., 818 F.2d 1126, 1128 (4th Cir. 1987). Such evidence
must consist of facts which are material, meaning that they
create fair doubt rather than encourage mere speculation.
Anderson at 248. Summary judgment is proper only
“[w]here the record taken as a whole could not lead a
rational trier of fact to find for the nonmoving
party.” Matsushita, 475 U.S. at 587 (citation
Deliberate Indifference to Serious Medical
general, the Eighth Amendment prohibits “cruel and
unusual punishment.” Farmer v. Brennan, 511
U.S. 825 (1994). In order to comply with the Eighth
Amendment, prison punishment must comport with “the
evolving standards of decency that mark the progress of a
maturing society.” Estelle v. Gamble, 429 U.S.
97, 102 (1976). “A prison official cannot be found
liable under the Eighth Amendment for denying an inmate
humane conditions of confinement unless the official knows of
and disregards an excessive risk to inmate health or safety;
the official must both be aware of facts from which the
inference could be drawn that a substantial risk of serious
harm exists, and he must also draw the inference.”
Farmer v. Brennan, 511 U.S. at 837.
demonstrate that a prison official violated the Eighth
Amendment by denying medical care, an inmate must show (1)
that the deprivation alleged was objectively
“sufficiently serious” and (2) that the prison
official was “deliberately indifferent” to the
inmate's health or safety. Farmer v. Brennan,
511 U.S. 825, 834 (1994). With respect to the first element,
a medical condition is sufficiently serious if it is
“‘one that has been diagnosed by a 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.'” Jackson v.
Lightsey, 775 F.3d 170, 178 (4th Cir. 2014); see
also Gaudreault v. Municipality of Salem, Mass., 923
F.2d 203, 208 (1st Cir. 1990), cert. denied, 500
U.S. 956 (1991). A ...