JULIE SMITH, Individually and as Personal Representative of the Estate of Steven D. Smith, Plaintiff, vs. KENNETH LEJEUNE, Individually, and TANDA HICKS, Individually, Defendants. JULIE SMITH, Individually and as Personal Representative of the Estate of Steven D. Smith, Plaintiff, vs. BOARD OF COMMISSIONERS OF LARAMIE COUNTY, WYOMING, CITY OF CHEYENNE, WYOMING, ROGER ALLSOP, individually and as Sheriff of Laramie County, Wyoming, JOHN C. PEDERSON, individually, DAVID WOOD, individually, EDWARD DAVIS, individually, RICHARD LOUNSBURY, individually, THOMAS J. FLOWER, D.O., individually, KAYTHOMAS, R.N., individually, ELLEN BARBOUR, R.N., individually, PREFERRED CORRECTIONAL MEDICAL TEAM OF WYOMING, INC., WHB COMPANIES and WILLIAM H. BOLDON., Defendants.
Case No. 01-CV-026-B and Case No. 00-CV-129-B
203 F. Supp. 2d 1260
May 17, 2002, Decided
May 17, 2002, Filed
ORDER GRANTING DEFENDANTS' MOTIONS FOR
SUMMARY JUDGMENT
This action arises from the
death of Plaintiff Julie Smith's husband while in custody at the Laramie County
Detention Facility in Cheyenne, Wyoming. Now before the Court are the remaining
Defendants' Motions for Summary Judgment based on the issue of qualified
immunity. Other outstanding motions will be deemed moot by this order.
At
the time of this Order, Plaintiff had previously reached a settlement agreement
with the Board of Commissioners of Laramie County, Wyoming, and individual
Defendants Allsop, Pederson, Davis and Lounsbury; the parties have stipulated
to the dismissal of Plaintiff's claims against Sheriff Roger Allsop, in his
capacity as Sheriff, and David Wood, individually; this Court dismissed
Defendants William H. Bolden, and WHB Companies, Inc. by a previous Order on a
Motion for Summary Judgment; Plaintiff has previously accepted an Offer of
Judgment from Defendant Preferred Medical Correctional Team of Wyoming, Inc.;
Nurse Tanda Hicks was never served with a summons and Complaint and has
consequently been dismissed from suit; and Plaintiff has accepted an offer of
judgment from Defendant LeJeune. Therefore, this Order will only address
remaining Defendants, namely, Dr. Flower and nurses Thomas and Barbour, all in
their individual capacities.
After reading the briefs, hearing oral arguments, and being fully
advised of the premises, the Court FINDS and ORDERS as follows:
Statement of Parties and Jurisdiction
Plaintiff Julie Smith is a resident of Wyoming and is the widow of
Steven Smith. Defendant Flower was to provide supervision of medical care and
evaluate programs, services and the adequacy of the treatment facilities at the
Laramie County Detention Facility. Defendants Thomas and Barbour were nurses
employed at the Laramie County Detention Facility. Jurisdiction of this Court
has been invoked under 28 U.S.C. §§ 1343 and 1367. Venue is proper pursuant to
28 U.S.C. § 1391(b).
Background
Procedural Background
Plaintiff originally brought suit against Laramie County Board of
Commissioners, et al. on July 7, 2000. This case was originally set to go to
trial on July 16, 2001. The Court entered an order denying Summary Judgment on
June 18, 2001. The Court entered a Supplemental Order on Summary Judgment
on June 25, 2001. After a status
conference on July 9, 2001, the Court issued another Order which vacated the
trial date, vacated the Supplemental Order on Summary Judgment, stayed
discovery and ordered the parties to re-brief the issue of qualified immunity.
A hearing on Defendants Flower, Thomas, and Barbour's Motions for Summary
Judgment based on qualified immunity was held on February 26, 2002. The
original case was consolidated with the case by the Plaintiff against Nurses
Kenneth LeJeune and Tanda Hicks on September 13, 2001. A hearing on Defendant
LeJeune's Motion for Summary Judgment was held on April 12, 2002.
Factual Background
Steven Smith ("Smith")
died in the Laramie County Detention Facility (the "Facility") on
February 14, 1999. Former Defendant Laramie County Board of Commissioners owns
and operates the Laramie County Detention Facility. Former Defendant City of
Cheyenne contracts with the County to house prisoners at the Facility.
[*1265] On February 12, 1999,
Smith was taken into custody by Officer John C. Pederson ("Pederson")
of the Cheyenne Police Department. Pederson suspected Smith of driving under
the influence of alcohol after Smith was involved in an automobile accident.
Smith's breath alcohol concentration was tested, revealing a concentration
of .317.
Pederson took Smith to the
Facility, where Smith received a preliminary medical exam from Defendant Kay
Thomas ("Thomas"), a Licensed Practical Nurse employed at the
Facility at approximately 10:45 p.m. on February 12, 1999. Smith was then placed in a holding cell.
Deputy Ed Davis came on duty at
6 a.m. on February 13, 1999. Deputy Davis asked Defendant Nurse Ellen Barbour
("Barbour") to evaluate Smith at around 11:30 a.m. on February 13,
1999. Smith was booked by Deputy David Wood on February 13, 1999 at approximately
1 p.m. After booking, Smith was transferred to the D-Pod section of the
Facility. Between 6:00 and 10:00 p.m., Smith was in the common area of D-Pod.
During this time, Deputy Richard Lounsbury ("Lounsbury") observed
Smith. Thomas saw Smith during medical rounds at approximately 8:30 p.m. on
February 13, 1999. Other inmates also had contact with or observed Smith during
the time before the 10 p.m. lockdown. Former Defendant Nurse Hicks relieved
Thomas at the end of her shift. Between 11:30 p.m. and 2:15 a.m., Lounsbury observed Smith get
out of his bed to use the bathroom. Some time after that, but before 6:00 a.m.
the following morning, Smith died in his cell. The autopsy indicated Smith died
from an arrhythmia resulting from an electrolyte imbalance caused by fatty
liver. n1
Former Defendant Preferred
Correctional Medical Team of Wyoming ("PCMT") was under contract to
provide medical services at the Facility. PCMT contracted with Defendant Dr.
Thomas Flower ("Flower") to supervise medical care, evaluate
programs, services, and the adequacy of the treatment facilities. Former
Defendant Nurse LeJeune was to assist Flower with his duties. LeJeune was the
Medical Unit Administrator hired by PCMT. PCMT retained Nurses Thomas and
Barbour to provide nursing services at the Facility. Plaintiff contends Flower
failed to train and supervise personnel under his direction and control with
respect to the appropriate treatment of alcohol withdrawal and its severe
danger to a person suffering from its effects and that such deliberate
indifference to the serious medical needs of Smith resulted in his death.
Plaintiff contends that Nurses Thomas and Barbour were deliberately indifferent
to the serious medical needs of Smith, resulting in his death.
Plaintiff asserts claims for civil rights violations pursuant to 42
U.S.C. § 1983; state law claims pursuant to the Wyoming Governmental Claims
Act; and for medical negligence against the remaining Defendants. Defendants
have made motions for summary judgment on the basis that they are entitled to
qualified immunity from suit under 42 U.S.C. § 1983, and that the Court should
then exercise its discretion to dismiss the pendant state law claims.
Discussion
Qualified Immunity Standard
Actions for damages provide an important remedy for individuals injured
by the abuse of authority by governmental [*1266] officials. However, such
actions have the potential to subject officials to costly and harassing
litigation and inhibit officials in performing their official duties. Anderson v. Creighton, 483 U.S. 635, 638, 97
L. Ed. 2d 523, 107 S. Ct. 3034 (1987); Harlow v. Fitzgerald, 457 U.S. 800, 814,
73 L. Ed. 2d 396, 102 S. Ct. 2727 (1982). Courts recognize the affirmative
defense of qualified immunity to balance these competing interests. Qualified
immunity protects "all but the plainly incompetent or those who knowingly
violate the law." Malley v. Briggs, 475 U.S. 335, 341, 89 L. Ed. 2d 271,
106 S. Ct. 1092 (1986). The United States Supreme Court emphasized the broad protection
provided by the qualified immunity defense, explaining that it gives officials
"a right, not merely to avoid 'standing trial,' but also to avoid the
burdens of 'such pretrial matters as discovery.'" Behrens v. Pelletier,
516 U.S. 299, 308, 513 U.S. 1142, 133 L. Ed. 2d 773, 116 S. Ct. 834 (1996)
(quoting Mitchell v. Forsyth, 472 U.S. 511, 526, 86 L. Ed. 2d 411, 105 S. Ct.
2806 (1985)). Consequently, courts should resolve the "purely legal
question" of whether the qualified immunity defense is available Siegert
v. Gilley, 500 U.S. 226, 232, 114 L. Ed. 2d 277, 111 S. Ct. 1789 (1991), 'at
the earliest possible stage in litigation.'" Albright v. Rodriguez, 51
F.3d 1531, 1534 (10th Cir. 1995) (quoting Hunter v. Bryant, 502 U.S. 224, 227,
116 L. Ed. 2d 589, 112 S. Ct. 534 (1991)).
Summary judgment motions in qualified immunity cases are evaluated
differently than general summary judgment motions due to the underlying
purposes of qualified immunity. Nelson v. McMullen, 207 F.3d 1202, 1205-06
(10th Cir. 2000). After a defendant asserts a qualified immunity defense, the
burden shifts to the plaintiff to satisfy a two-part test. Scull v. New Mexico, 236 F.3d 588, 595 (10th
Cir. 2000); Adkins v. Rodriguez, 59 F.3d 1034, 1036 (10th Cir. 1995). A court
must determine whether the plaintiff has satisfied a "heavy two-part
burden." Albright, 51 F.3d 1531 at 1534. The plaintiff must first establish "that the defendant's actions
violated a constitutional or statutory right." Albright, 51 F.3d 1531 at
1534; see also Wilson v. Layne, 526 U.S. 603, 609, 143 L. Ed. 2d 818, 119 S.
Ct. 1692 (1999) (the court must first decide whether the plaintiff has alleged
a deprivation of a constitutional right). If the plaintiff establishes a
violation of a constitutional or statutory right, he must then demonstrate that
the right at issue was clearly established at the time of the defendant's
unlawful conduct. Albright, 51 F.3d
1531 at 1534. In determining whether the right was "clearly
established," the court must assess the objective legal reasonableness of
the action at the time of the alleged violation and ask whether "the right
[was] sufficiently clear that a reasonable officer would understand that what
he is doing violates that right." Wilson, 526 U.S. at 615 (citations omitted).
The
two-step analysis "is designed to 'spare a defendant not only unwarranted
liability, but unwarranted demands customarily imposed upon those defending a
long drawn-out lawsuit.'" Wilson, 526 U.S. at 609 (quoting Siegert, 500
U.S. at 232). If the plaintiff does not satisfy either part of the two-part
inquiry, the court must grant qualified immunity to the defendants. Albright, 51 F.3d 1531 at 1535. If the
plaintiff successfully establishes the violation of a clearly established
right, the burden shifts to the defendant, who must prove "'that there are
no genuine issues of material fact and that he or she is entitled to judgment
as a matter of law.'" Id. (quoting Hinton v. City of Elwood, 997 F.2d 774,
779 (10th Cir. 1993)). Although a court reviews the evidence in the light most
favorable to the nonmoving party, Nelson, 207 F.3d at 1205, the record must
clearly demonstrate the plaintiff has satisfied [*1267]his heavy two-part
burden; otherwise, the defendants are entitled to qualified immunity. Medina v.
Cram, 252 F.3d 1124, 1128 (10th Cir. 2001). In the case at bar, Plaintiff has
not satisfied her heavy two-part burden, and thus the Court must grant
qualified immunity to the remaining Defendants Flower, Thomas and Barbour.
A prison official's deliberate
indifference to an inmate's serious medical needs constitutes a violation of
the Eighth Amendment. n2 See Estelle
v. Gamble, 429 U.S. 97, 102, 50 L. Ed. 2d 251, 97 S. Ct. 285 (1976). "This
is true whether the indifference is manifested by prison doctors in their
response to the prisoner's needs or by prison guards in intentionally denying
or delaying access to medical care or intentionally interfering with the
treatment once prescribed. Regardless of how evidenced, deliberate indifference
to a prisoner's serious illness or injury states a cause of action under
section 1983." Id. (citation omitted).
In the
medical context, an inadvertent failure to provide adequate medical care cannot
be said to constitute an unnecessary and wanton infliction of pain or to be
repugnant to the conscience of mankind. Thus, a complaint that a physician has
been negligent in diagnosing or treating a medical condition does not state a
valid claim of medical mistreatment under the Eighth Amendment. Medical malpractice
does not become a constitutional
violation merely because the victim is a prisoner. In order to state a
cognizable claim, a prisoner must allege acts or omissions sufficiently harmful to evidence deliberate indifference to
serious medical needs. It is only such indifference that can offend evolving
standards of decency in violation of the Eighth Amendment.
Id. at 105-06 (internal citations omitted).
Deliberate indifference involves both an objective and a subjective
component. Sealock v. Colorado, 218
F.3d 1205, 1209 (10th Cir. 2000); Farmer v. Brennan, 511 U.S. 825, 128 L. Ed.
2d 811, 114 S. Ct. 1970 (1994). The objective component is met if the
deprivation is "sufficiently serious." Farmer, 511 U.S. at 834. A
medical need 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."
Hunt v. Uphoff, 199 F.3d 1220, 1224 (10th Cir. 1999)(quoting Ramos v. Lamm, 639
F.2d 559, 575 (10th Cir. 1980).
"The second, subjective portion of the Farmer test requires that
the prison official show "deliberate indifference" to the existence
of any risk inherent in exposure to the challenged conditions." Despain v.
Uphoff, 264 F.3d 965, 975 (10th Cir. 2001).
[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 [*1268] risk of serious harm
exists, and he must also draw the inference.
Farmer, 511 U.S. at 837. The prison official
must have this level of awareness because those officials "who lacked
knowledge of a risk cannot be said to have inflicted punishment" in a
manner that violates the Eighth Amendment. Despain, 264 F.3d at 975, (quoting
Farmer, 511 U.S. at 844). It is not enough to establish that the official
should have known of the risk of harm.
Farmer, 511 U.S. at 837. The test requires both knowledge and disregard
of possible risks, a mens rea on par with criminal recklessness. Id. at 836. "If an official is aware of
the potential for harm but takes reasonable efforts to avoid or alleviate that
harm, he bears no liability under this standard." Despain, 264 F.3d at
975; Farmer, 511 U.S. at 844; MacKay v. Farnsworth, 48 F.3d 491, 493 (10th Cir.
1995). Each of these factors will be considered separately for each
remaining Defendant in the case at bar.
I. Defendant Flower
Plaintiff contends that Flower
failed to train and supervise personnel under his direction and control with
respect to the appropriate treatment of alcohol withdrawal and its severe
danger to a person suffering from its effects, which constituted deliberate
indifference to the serious medical needs of Smith resulting in his death in violation of his constitutional rights
as protected by 42 U.S.C. § 1983.
For the purposes of this order,
it will be assumed without deciding that alcohol withdrawal is a sufficiently
serious condition in order to meet the objective portion of deliberate
indifference standard. n3 Even making this assumption, and assuming that Smith
actually suffered from alcohol withdrawal, which is hotly disputed, Plaintiff has not
sustained her burden of showing that Flower was deliberately indifferent to
Smith's medical needs.
"A supervisor is not liable under section 1983 unless an
'affirmative link' exists between the [constitutional] deprivation and either
the supervisor's 'personal participation, his exercise of control or direction,
or his failure to supervise.' " Meade v. Grubbs, [*1269] 841 F.2d 1512,
1527 (10th Cir. 1988). In the case at bar, there are no allegations that Flower
was ever actually contacted in connection with Smith's imprisonment until after
Smith's death. Plaintiff's claim against Flower is based solely on a failure to
train, supervise or implement adequate policies.
"A supervisor or municipality may be held liable where there is
essentially a complete failure to train, or training that is so reckless or
grossly negligent that future misconduct is almost inevitable." Meade, 841
F.2d at 1527, citing Hays v. Jefferson County, Ky., 668 F.2d 869, 873-74 (6th
Cir. 1982), cert. denied, 459 U.S. 833, 74 L. Ed. 2d 73, 103 S. Ct. 75 (1982).
In the case at bar, the Plaintiff attempts to paint the picture that Flower
failed to train the nurses on alcohol withdrawal by essentially mischaracterizing
Flower's deposition testimony. Plaintiff concedes that
policies and protocols were in place prior to Smith's death. n4 In his
deposition, Flower stated that he conducted monthly staff meetings, during
which time medical education was provided in addition to discussion of
particular issues in regard to inmates. See Flower Dep., p. 24. Flower also
testified that during these meetings, he and the nurses discussed medical
problems including alcohol withdrawal, and that the nurses were provided with the policies regarding alcohol
withdrawal. n5 Id. at 40-41. Flower and the nurses also discussed how to
evaluate an inmate at the time they were booked in, including with regard to
alcohol withdrawal. Id. at 45. Flower explains that the policy is a guideline for
the nurses to help them evaluate inmates being admitted with alcohol
intoxication, and that the nurses were to use their own judgment and training
to decide if they needed to call Flower. Id. at 45-46. The Court cannot say
that it is unreasonable for a doctor to rely on the training and experience of
Licensed Practical Nurses. Any other conclusion would be ludicrous, and devalue
the fact that nurses are trained professionals.
Plaintiff argues that Flower "made no investigation of their [the
nurses'] training and experience," citing to Flower's Deposition at page
54. See Plaintiff's Memorandum in Opposition to all Motions for Summary
Judgment on the Issue of Qualified Immunity, p. 28. However, Flower does not
say that he did not investigate the nurses' training and experience. In fact,
Nurse Barbour graduated from nursing school in 1970 and has worked in some
capacity as a nurse since her graduation - including twenty-one years with
United Medical Center-West and since June of 1995 at the Facility. See Barbour
Dep., p. 4-5. Nurse Thomas was licensed as a nurse in 1978 and has worked as a
nurse since that time. See Thomas Dep., p. 5-6. Reliance on such training and
experience is reasonable. Flower stated that prior to the date of Smith's
death, he had met with the nurses at the Facility and was comfortable with
their qualifications and understanding of the policies regarding procedures for
evaluating inmates who possibly suffer from alcohol withdrawal, as well as the
nurses' general competence as licensed professional nurses. See Flower
Affidavit P 7.
[*1270] Further, it was also stated at the April hearing in this matter
that Flower worked with the nurses on many occasions during the years of their
service at the Facility, and had no reason to believe that they were not
qualified to do their jobs. Plaintiff states that "Dr. Flower obviously
did not perform an adequate job of instructing the nurses...." See
Plaintiff's Memorandum in Opposition to all Motions for Summary Judgment on the
Issue of Qualified Immunity, p. 29. However, this is not the standard for
supervisor liability. As stated above, only a complete failure to train or
training that is reckless or grossly negligent will constitute the deliberate
indifference required to disqualify a state actor from qualified immunity from
suit. Meade v. Grubbs, 841 F.2d 1512,
1527 (10th Cir. 1988). The
evidence in this case shows that Flower provided protocols and policies to deal
with alcohol withdrawal, that Flower conducted monthly meetings with the nurses
during which these policies and procedures were discussed, that training was
conducted at the monthly meetings, that the nurses had many years of nursing
experience, and that nothing of this sort had ever occurred previously which
would have alerted Flower to any inadequacies in the policies or training that
he provided at the Facility. The most that Plaintiff has been able to show
through the evidence is that she disagrees with the sufficiency of the training
or policies provided by Flower, but this does not satisfy the standard for
showing the deliberate indifference of a supervisor. The evidence may support a
claim for negligence or medical malpractice, but it does not support a claim
that Flower completely failed to train or provided reckless or grossly
negligent training.
Plaintiff's expert, Dr. Gottula,
states in his deposition that if the policies put in place by Flower had been
followed, Smith's death would have been prevented. See Gottula Dep., p. 130.
Another of Plaintiff's experts, independent nurse consultant working in
correctional health care, Jacqueline Moore, states that although she would have
added things to the protocols that Flower had in place, they met the standard
of care. See Moore Dep., p. 82-83. At worst, Plaintiff's expert Dr.
Kosnett states that the "policies for medical intake screening and for
alcohol withdrawal are not sufficiently protective of the health of the inmate
with incipient or actual alcohol withdrawal because they do not set forth clear
instructions for the nursing staff or other personnel ...." See March 2,
2001 letter to Plaintiff's Counsel Tondre, Plaintiff's Exhibit Appendix No. 40.
Again, a difference of
medical opinion as to the sufficiency of a policy does not constitute the level
of gross negligence, recklessness or complete failure to train required to find
that Flower was deliberately indifferent.
Plaintiff also argues that since
minutes of the monthly meetings conducted by Flower have not been produced,
training must not have taken place at these meetings. Such a speculative
statement is not sufficient to contradict the express testimony of Flower,
Barbour, and Thomas that such meetings did take place and that training was
conducted at these meetings. Plaintiff's attempted reliance on F.R.E.
803(7) in furtherance of this allegation is also misplaced. n6 F.R.E. 803(7)
allows the [*1271] admission of evidence which demonstrates an absence or lack
of evidence to be admitted as part of the case in whole. Merely allowing this
evidence does not prove Plaintiff's assumption. Further, the lack of evidence
in this case is not specifically reliable. Though the absence of documents
which would help Defendants gives the Court a reason to pause, such speculation
cannot contradict actual evidentiary testimony which is in existence - that of
Flower, Barbour, and Thomas. The absence of minutes of the training meetings
could also easily be explained, as it was at
the April hearing, when Counsel for Defendants stated that such
documents are simply not in the control of Defendants, and thus cannot be
produced by them.
For
all of the aforementioned reasons, and relying on the standard for summary
judgment in a qualified immunity case, the Court finds that Plaintiff has not
sustained her burden of showing the subjective element of a sufficiently
culpable state of mind with regard to Defendant Flower. Flower would have had
to be "aware of facts from which the inference could be drawn that a
substantial risk of serious harm exists, and he must have also drawn that
inference." Farmer v. Brennan, 511 U.S. 825, 837 (1994). The evidence has
failed to indicate such an awareness. Flower would have to have also drawn the
above inference. Id. The evidence has also failed to show that Flower drew that
inference. It is insufficient for a plaintiff to merely establish that a
defendant should have known of a risk. Id. (emphasis added). In the present
action, Plaintiff has only produced evidence to the effect that, in hindsight,
the policies or training could have been different, or that Flower should have
known of the possible risk posed by his policies and training. This evidence
fails to sufficiently show that Flower was reckless, grossly negligent, or
completely failed to train the nurses. Plaintiff has not sustained her burden
of showing that Flower's conduct rose to the level of deliberate indifference
in order to satisfy the subjective element of an Eighth Amendment violation or
its equivalent Due Process Violation. See footnote 2. Consequently, the Court
finds that Plaintiff has failed to state a claim against Flower under the
Eighth Amendment for deliberate indifference to Smith's medical needs. Plaintiff
has not shown that any issue of fact remains as to whether Flower was
deliberately indifferent under the subjective standard, and therefore, the
Court need not reach the second prong of the two-prong inquiry as to whether
the law was clearly established. Gehl
Group v. Koby, 63 F.3d 1528, 1533 (10th Cir. 1995). The Court thus GRANTS
Defendant Flower's Motion for Summary Judgment based upon qualified immunity.
II. Defendant Thomas
Nurse Thomas performed an intake medical assessment of Smith at approximately
8:45 p.m. on February 12, 1999. See Appendix to Plaintiff's Memorandum in
Opposition to All Motions for Summary Judgment, No. 15. On this assessment
form, Thomas noted, among other things, that Smith's blood pressure was 130/80,
his pulse was 116, that he reported that he was on daily medication, that he
did not have his medication with him, that he reported medical problems, that he reported high blood
pressure, that his doctor was Dr. Bindschadler, and that Smith was very drunk.
Id. Thomas next saw Smith when she was on medical rounds the following [*1272]
day, February 13, 1999. In her treatment/progress notes (See Appendix to
Plaintiff's Memorandum in Opposition to All Motions for Summary Judgment No.
18), a late entry reports that Thomas called Smith to the medical cart to have
him sign a medical release
form for Dr. Bindschadler at approximately 8:30 p.m. During this encounter,
Thomas noted that Smith's hands and face were very puffy, and that his hands
were slightly shaking. Id. Thomas reported asking Smith if he had ever
experienced alcohol withdrawal, to which he replied that he had not. Id. She
asked how he was feeling and he told her "fine, n7 I am going to court in
the morning and going to get out. My wife talked to Dr. Bindschadler and he
said I should be fine without my blood pressure medication until I get
released." Id. Thomas took Smith's blood pressure and found that it was
160/98, to which she reports he stated, "That's not too bad for me."
Id.
At the end of her shift, Thomas
noted on her report (See Appendix to Plaintiff's Memorandum in Opposition to
All Motions for Summary Judgment, No. 16) that Smith was very puffy, that his
hands were shaking, that his blood pressure was 160/98, that he signed the
medical release form, that he was going to court the next day, and that the
medical release form should be faxed if Smith did not get released after court
the next day.
In her deposition, Thomas stated
that she followed protocol during her contacts with Smith. She stated that his
pulse of 116 at the time of intake was a little elevated, but not tachycardic.
n8 See Thomas Dep., p. 49-50. Thomas stated that Smith's blood pressure at
intake was within the normal realm. Id. Thomas stated that Smith seemed like he
had been drinking but was talking, walking and acting normal at intake. Id. at
48, 68. She stated that his breath alcohol concentration was not in the record
and that she did not know what it was, but that she knew he had been arrested
for DUI. Id. at 53-54, 68-69. Thomas admitted that she knew it was important to
prevent a patient from going into alcohol withdrawal, but that she did not
believe that Smith was in alcohol
withdrawal. Id. at 55-56. Thomas stated that when she saw Smith later on
medical rounds, his blood pressure was slightly elevated from the time of
intake, but that it was not an uncommon increase. Id. at 74-75. Thomas
considered that Smith may need his blood pressure medications but that Smith
stated that he had spoken to his wife, who had spoken to his doctor, who had
indicated that Smith would be fine until he was released from jail on Monday.
Id. at 75. Thomas could not say one way or the other whether it [*1273] would be
okay for someone to be off of blood pressure medication for three days. Id.
Thomas stated that she did not recall any other inmate speaking to her
regarding Smith's condition. Id. at 90-92.
Statements were taken from the inmates that Smith encountered in the
common area of D-pod during the evening of February 13, 1999, before and after
dinner was served. See Appendix to Plaintiff's Memorandum in Opposition to All Motions for
Summary Judgment, Nos. 26, 29, 30, 34, 38, 39, 48, 49, 50, 51. Almost every
inmate said that they observed Smith shaking. However, most inmates also
observed Smith going about a regular course of activities during the evening
before his death including sitting at a table, sitting on a couch, making his
bed, taking a nap, watching television, eating dinner, drinking liquids, having
conversations with other inmates, saying that he was "fine" in
response to inquiries by inmates, and talking with Nurse Thomas during medical
rounds. Id., see also Deposition of Rudy Hernandez, Deposition of Randy
Johnson, Deposition of Roger Reynolds. Such observations go to authenticate the
statement of Thomas that she did not think that Smith was experiencing alcohol
withdrawal.
The protocol that Thomas was to
follow said that alcohol withdrawal is characterized by shaking, nervousness,
hallucinations and seizures. Though Smith likely exhibited some shaking,
the other components of alcohol withdrawal as described in the Facility's
protocol, Policy No. 700.01, were not present. Several physicians have also
stated in this case that the symptoms of alcohol withdrawal include several
factors beyond mere shaking, and that the symptoms are progressive. See
Appendix A to Brief on the Issue of Good Faith Immunity of Defendants Kay
Thomas and Ellen Barbour (collecting and summarizing the symptoms of alcohol
withdrawal from Policy 700.01, Dr. Ted Bader, Dr. Roderic Gottula, Jacqueline
Moore, Dr. Michael Kosnett, Dr. Darryl Bindschadler, and Dr. Taylor Fithian,
see also depositions of these physicians). Some inmates stated that Smith
seemed confused (See Appendix to Plaintiff's Memorandum in Opposition to All
Motions for Summary Judgment, No. 34), or that he seemed to be antsy (See Appendix
to Plaintiff's Memorandum in Opposition to All Motions for Summary Judgment,
No. 30). Such symptoms do not prove that Thomas was deliberately indifferent to
a serious medical condition. Some inmates even said that Smith was experiencing
withdrawals or DTs n9 (See Appendix to Plaintiff's Memorandum in Opposition to
All Motions for Summary Judgment, Nos. 26, 39, Deposition of Randy Johnson).
However, it is telling to note that none of these inmates have medical degrees
and Randy Johnson even said that the only thing he actually saw Smith do
which indicated to him that Smith
was experiencing DTs was shaking, and
that since he believed DTs to be shaking and throwing up, Johnson said that he
was wrong in his prior assumption. Johnson Dep., p. 18-20.
As
explained above, Thomas had many years of nursing experience, including
experience with alcohol withdrawal, by the time that Smith came under her care.
She observed Smith's shaking, and knew that he was without blood pressure
medication for a short time. She saw that he was puffy. Even when all of the
statements by the other inmates are viewed in a light most favorable to
Plaintiff, which the Court does with the realization that all such testimony
has the potential to be fabricated, embellished, or merely the result of failed
memory, no evidence exists to show that Smith exhibited the other medically
[*1274]recognized signs of alcohol withdrawal - the disregard of which could
constitute deliberate indifference. Even assuming for the purposes of this order, without actually deciding, that
Plaintiff has shown evidence to fulfill the objective component of deliberate
indifference, namely that Smith had a medical need which was sufficiently
serious ( Sealock v. Colorado, 218 F.3d 1205, 1209 (10th Cir. 2000)), Plaintiff
has failed to sustain her burden of showing the subjective component of
deliberate indifference, namely that Thomas had the requisite state of mind, "the
knowledge and disregard of possible risks, a mens rea on par with criminal
recklessness." Farmer v. Brennan, 511 U.S. 825, 826, 128 L. Ed. 2d 811,
114 S. Ct. 1970 (1994).
Thomas may have been negligent
in her treatment of Smith, however, Plaintiff has failed to present evidence
that goes beyond mere disagreement with Thomas' assessment that Smith was not
in danger of severe alcohol withdrawal. As stated above, activity which
may state a claim for medical malpractice or negligence does not reach the level
of deliberate indifference to defeat the defense of qualified immunity.
See Estelle v. Gamble, 429 U.S. 97,
105-06, 50 L. Ed. 2d 251, 97 S. Ct. 285 (1976)(accidental or inadvertent
failure to provide adequate medical care, or negligent diagnosis or treatment
of a medical condition do not constitute a medical wrong under the Eighth
Amendment). "A fortiori, a mere difference of opinion between the prison's
medical staff and the inmate as to the diagnosis or treatment which the inmate
receives does not support a claim of cruel and unusual punishment." Ramos
v. Lamm, 639 F.2d 559, 575 (10th Cir. 1980)(citing Bowring v. Godwin, 551 F.2d
44, 48 (4th Cir. 1977); Smart v. Villar, 547 F2d 112, 114 (10th Cir. 1976)). In
the case at bar, Smith cannot dispute his own diagnosis or treatment, but the
above statement could be applied to the statements of other inmates who
observed Smith in the common area of D-Pod the evening before his death who
stated that Smith was suffering from DTs or withdrawals. Even assuming that any
one of these inmates told Thomas that they believed Smith was suffering from
DTs or withdrawal, the evidence shows that Thomas disagreed with this
assessment as Smith was not exhibiting any of the other, medically recognized
signs of withdrawal, other than shaking. Therefore, the most that Plaintiff has
shown is a difference of opinion among the inmates regarding Smith's condition
and Thomas' medical assessment of
Smith's medical condition. Such is not sufficient to sustain Plaintiff's burden
of showing deliberate indifference on the part of Thomas. "When a prisoner
does in fact receive medical care, he has no Eighth Amendment claim based
merely on his disagreement with the nature of the diagnosis." Alloway v.
Wackenhut Correctional Facility, 2001 U.S. App. Lexis 17291, 2001 WL 874183
(10th Cir. (Okla.))(unpublished) citing Ledoux v. Davies, 961 F.2d 1536, 1537
(10th Cir. 1992); Estelle v. Gamble, 429 U.S. 97, 107, 50 L. Ed. 2d 251, 97 S.
Ct. 285 (1976) ("matter[s] of medical judgment" do not give rise to §
1983 claim); Ramos, 639 F.2d at 575 (difference of opinion between inmate and
prison medical staff regarding treatment or diagnosis does not itself state a
constitutional violation), cert. denied, 450 U.S. 1041 (1981); Smart v. Villar,
547 F.2d 112, 114 (10th Cir. 1976) (same). Thomas provided her medical
assessment of Smith upon his arrival at the Facility and during medical rounds
the evening before Smith's death. She
took his pulse, measured his blood pressure, had a discussion with him, and observed
his condition. In her medical judgment, Smith was not in danger. Plaintiff has
failed to show that Thomas maintained the requisite mens rea to establish that
she acted with deliberate indifference. [*1275] Therefore, the other elements
of the qualified immunity analysis need not be examined and Thomas' Motion for
Summary Judgment based upon qualified immunity is HEREBY GRANTED.
III. Defendant Barbour
Nurse Barbour was called by Deputy Davis to evaluate Smith on February
13, 1999, and she saw Smith at approximately 11:30 a.m. that day. See Appendix
to Plaintiff's Memorandum in Opposition to All Motions for Summary Judgment,
Nos. 32, 33. Davis reported that he called Barbour "to assess for possible
detoxification." See Appendix to Plaintiff's Memorandum in Opposition to
All Motions for Summary Judgment, No. 32. In his deposition, Davis explained
that he used the word detoxification, meaning the same to him as withdrawals,
but did not believe that Smith was actually going into detoxification. Davis Dep.,
p. 25-26. In her treatment note, Barbour stated that she spoke with Smith and
that Smith told her that he had a blood disorder and hypertension, and that his
medication had recently been changed. See Appendix to Plaintiff's Memorandum in
Opposition to All Motions for Summary Judgment, No. 15. Barbour noted that
Smith's eyelids were very puffy, but that Smith stated that they "had been
that way for a while." Id. Barbour noted that Smith said that he had been
trying to quit drinking and that he asked about getting some Librium
(medication used to treat alcohol withdrawal). Id. Barbour notes that Smith
denied any history of suffering from alcohol withdrawal, and stated that he had
never stopped drinking long enough to experience withdrawal. Id.
Plaintiff argues that these
statements by Smith, when combined with the statements of Deputy Davis to the
effect that Smith was shaking at the time of Barbour's evaluation, are
sufficient to show deliberate indifference on Barbour's part to Smith's serious
medical condition. The Court disagrees. The only medically recognized symptom
of withdrawal that Smith exhibited was shaking, and in fact, Davis stated that
the shaking was slight. Davis Dep., p. 26-27. Further, Smith denied a history
of withdrawals, another medically recognized warning sign of future difficulty
with alcohol withdrawal. There has been no evidence presented that Barbour had
any reason to think that Smith was hallucinating, was exhibiting nervousness,
or was experiencing seizures. According to the medical evidence, alcohol
withdrawal does not simply have one symptom. As it appeared to Barbour, Smith's
behavior did not present a situation necessitating further medical treatment.
As stated previously with regard to
Defendant Thomas, no evidence exists to show that Smith exhibited the other,
medically recognized signs of alcohol withdrawal - the disregard of which could
constitute deliberate indifference. Again assuming for the purposes of
this order, without deciding, that Plaintiff has shown evidence to fulfill the
objective component of deliberate indifference, namely that Smith had a medical
need which was sufficiently serious ( Sealock v. Colorado, 218 F.3d 1205, 1209
(10th Cir. 2000)), Plaintiff has failed to sustain her burden with regard to the
subjective component of deliberate indifference, that Barbour had the requisite
state of mind, "the knowledge and disregard of possible risks, a mens rea on par with criminal recklessness."
Farmer v. Brennan, 511 U.S. 825, 826, 128 L. Ed. 2d 811, 114 S. Ct. 1970
(1994). As with the other remaining Defendants, Barbour's actions may state a
claim for medical malpractice or negligence, but do not rise to the requisite
level of deliberate indifference. Therefore, the other elements of the
qualified immunity analysis need not be examined and the Court HEREBY GRANTS
Defendant Barbour's Motion for Summary Judgment based upon qualified immunity.
[*1276] Plaintiff's State Law and Common Law
Claims
As
stated above, the Court has determined that Flower, Thomas, and Barbour are
entitled to qualified immunity, and therefore, the Court dismisses Plaintiff's
only federal claim, that based upon 42 U.S.C. § 1983. Therefore, the Court
HEREBY DECLINES to exercise supplemental jurisdiction pursuant to 28 U.S.C. §
1367(c) over Plaintiff's remaining state and common law claims for relief, and
they are HEREBY DISMISSED WITHOUT PREJUDICE.
Conclusion
For all of the above stated
reasons, the Court FINDS that Plaintiff has failed to sustain her heavy
two-part burden to defeat the defense of qualified immunity asserted by the
remaining Defendants. Plaintiff has not shown sufficient evidence to support
that Flower, Thomas or Barbour disregarded the requisite knowledge of a serious
medical condition to constitute deliberate indifference. Therefore, the Court
need not examine the other elements of the qualified immunity analysis.
Accordingly, the Court grants Defendants Flower, Thomas, and Barbour qualified
immunity from suit under 42 U.S.C. § 1983, and HEREBY GRANTS Defendants Flower,
Thomas, and Barbour's Motions for Summary Judgment based upon qualified
immunity, and Plaintiff's federal law 42 U.S.C. § 1983 claim is DISMISSED WITH
PREJUDICE. The Court further ORDERS that Plaintiff's state and common law
claims are DISMISSED WITHOUT PREJUDICE. Finally, all other pending motions
before this Court are hereby DENIED AS MOOT.
Dated this 17th day of May, 2002.
CLARENCE A. BRIMMER,
UNITED STATES DISTRICT JUDGE
FOOTNOTES:
n1 The actual cause of death
has been the subject of much dispute between the experts in this case. This
dispute need not be settled in order to examine the facts of this case in
accordance with the qualified immunity standards to be set out by the Court in
this Order, infra.
n2 Smith was not a prisoner, he was a pretrial detainee at the
time of his death. Pretrial detainees are protected under the Due Process
Clause rather than the Eighth Amendment. Lopez v. LeMaster, 172 F.3d 756, 759,
note 2 (10th Cir. 1999)(citing Bell v. Wolfish, 441 U.S. 520, 535 n. 16, 60 L.
Ed. 2d 447, 99 S. Ct. 1861 (1979)). In determining whether Smith's rights were
violated, however, the analysis applied is identical to that applied in Eighth
Amendment cases brought pursuant to § 1983. See Barrie v. Grand County, Utah, 119 F.3d 862, 868 (10th Cir.
1997); Hare v. City of Corinth, 74 F.3d 633, 643 (5th Cir.1996).
n3 Nonetheless, it could be
argued that Smith did not have a sufficiently serious medical need ("A
medical need 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."
Hunt v. Uphoff, 199 F.3d 1220, 1224 (10th Cir. 1999)(quoting Ramos v. Lamm, 639
F.2d 559, 575 (10th Cir. 1980)) due to the fact that Smith's regular treating
physician, Dr. Bindschadler, testified that Smith did not exhibit any of the
numerous clinical signs that a person who has drank excessive amounts of
alcohol over a long period of time would exhibit. See Bindschadler Dep., p.
16-18. Bindschadler further stated that he did not think that alcohol
withdrawal was an issue of concern for Smith (Id. at 29), and that he only
prescribed Librium for its anti-anxiety effects. Id. at 28. Therefore, there is
a reasonable argument that Smith did not have a serious medical condition which
was detectable prior to his death. In this regard, see also Deposition of
Bindschadler, Expert Opinion of Dr. Bader, Expert Report of Dr. Gottula, Expert
Report of Dr. Kosnett.
n4 See Appendix to Plaintiff's Memorandum
in Opposition to All Motions for Summary Judgment, Nos. 5, 6, 7, 8, 9, 10, 11,
12, 13.
n5 In particular, see
Appendix to Plaintiff's Memorandum in Opposition to All Motions for Summary
Judgment, No. 12: Policy No. 700.01, which states in relevant part: Alcohol
detoxification: 1. History: Inmate usually consumes large quantities of
alcoholic beverages during the few days prior to admission, and is observed for
signs of withdrawal, including shaking, nervousness, hallucinations and
seizures. a. ask inmate of previous withdrawal history, including specific
symptoms (e.g. shakes, hallucinations, seizures, last seizure). b. has inmate
taken medications for withdrawal? If so, what. c. time of last drink. d. take
vital signs. e. evaluate for signs of trauma and injury and level of
consciousness. 2. Physician: call if seizure or hallucination history or if
vital signs unstable. 3. Education: encourage meals and lots of liquids. Notify
if symptoms worsen. 4. Medication: Call Physician. a. Thiamine 100 mg po q d
for 7 days; b. Vistaril 50mg qid for 3-5 days; c. Chlordiazepoxide (Librium) 50
mg state for acute withdrawal and 25 mg QID or 50 mg AID * 3 days and/or # b.
5. Watch: Start 15/30 minute watch. Cot or lower floor if seizure history.
Record vital signs while on watch or meds. Send Inmate Behavior Report. (as
reflecting hand-written amendments).
n6 F.R.E. 803 allows certain
types of evidence to be admitted despite the heresay rule. F.R.E. 803(7)
states:
Absence of entry in records
kept in accordance with the provisions of paragraph (6). Evidence that a matter
is not included in the memoranda reports, records, or data compilations, in any
form, kept in accordance with the provisions of paragraph (6), to prove the
nonoccurrence or nonexistence of the matter, if the matter was of a kind of
which a memorandum, report, record, or data compilation was regularly made and
preserved, unless the sources of information or other circumstances indicate a
lack of trustworthiness.
n7 Additional evidence
exists to show that Smith said that he was "fine." See Interview,
Statement and Deposition of Deputy Lounsbury (Appendix to Plaintiff's
Memorandum in Opposition to All Motions for Summary Judgment, Nos. 42, 43, 44)
which states that when Lounsbury saw that Smith was awake and walking around
his cell sometime between midnight and 2:15 am on February 14, 1999, Lounsbury
inquired if everything was okay and Smith replied in a coherent manner that it
was and that he was simply up to use the bathroom. See also Deposition of Randy
Johnson, p. 19-20 which states that although Smith seemed conversant, Smith
never made any complaints about his physical condition or that he was feeling
poorly. See also Deposition of Roger Reynolds, p.8 which states that in
response to a question that Reynolds posed to Smith as to whether he was ok,
Smith responded that he was fine. See generally Bridgen v. State of Oklahoma, 129 F.3d 130 (10th Cir.
1997)(unpublished opinion)(taking into account inmate's own assessment of the
danger to himself as applicable to the state of mind of defendants).
n8 Tachycardia is one
symptom of alcohol withdrawal. See Gottula Deposition.
n9 Delirium tremens, a
component of alcohol withdrawal, are often referred to as DTs.