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Sours v. Big Sandy Regional Jail Authority

United States District Court, Sixth Circuit

May 28, 2013

WILLIAM SOURS, Administrator of the Estate of James Sours, Plaintiff,


AMUL R. THAPAR, District Judge.

On July 13, 2010, James Sours was arrested and booked into the Big Sandy Regional Detention Center. R. 52-1. Two days later Sours was dead. R. 52-14. The tragic events that led to Sours's death are the subject of this case, instituted by plaintiff William Sours as the administrator of his brother's estate. The plaintiff believes that the defendants violated Sours's rights under the Fourteenth Amendment and state law. The defendants have now moved for summary judgment. Their motion is granted in part and denied in part.


When Sours entered the Big Sandy Regional Detention Center, the intake officer sent him to see Nurse Nancy Allison because Sours was a diabetic. R. 56-1 at 26-27. Nurse Allison was responsible for inmates' medical care when the Detention Center's physician, Dr. Sarah Belhasen, was not present. R. 58-2 at 34. Nurse Allison met with Sours to discuss his medical history. She noted that he had liver problems, high blood pressure, and diabetes. R. 51-1 at 1. His last medical evaluation for his diabetes was at least one month before his arrest.[1] R. 51-1 at 1; R. 56-1 at 41. Thus, Nurse Allison concluded that Sours's diabetic condition was not "too bad." Id. at 42-43. His last doctor had put him on a "sliding scale, " meaning that a scale indicates the appropriate insulin dosage for a particular blood sugar level. Id. at 34-35. But Sours had not taken insulin in over a month, and he told Nurse Allison that he was sometimes confused about when and if he took insulin. R. 56-1 at 42-43. Sours explicitly told Nurse Allison that he could not care for himself and had no one who could bring insulin to the jail. R. 52-2 at 1. Nurse Allison recognized that Sours's blood sugar, which dropped from 283 to 274 during this meeting, was "a little high." R. 56-1 at 45, 53. But Nurse Allison attributed Sours's high blood sugar to the influence of drugs or alcohol, which can cause a spike in blood sugar. R. 56-1 at 44-45, 106. After meeting with Sours, Nurse Allison faxed her progress notes about Sours to Dr. Belhasen, seeking instructions for Sours's treatment. R. 51-2. Nurse Allison then implemented Dr. Belhasen's standing order that diabetics receive a carbohydrate-restricted diet and left instructions for the deputy jailers to monitor Sours's blood sugar. R. 51-2; R. 56-1 at 29-30.

Sours's blood sugar remained erratic. At 6:00 a.m. the following day, Sours's blood sugar dropped to 254, only to rise at 2:30 p.m. to 327. R. 51-3 at 1. Nurse Allison attributed this blood sugar spike to the fact that Sours was detoxing. R. 56-1 at 55-56. At 5:35 p.m., Sours told Deputy Jailers Salyer and Blanton that he did not feel well. R. 51-4; R. 56-1 at 73-76. Deputies Blanton and Salyer took Sours to see Nurse Allison. R. 51-4. Sours was agitated. He told Nurse Allison that he wanted to go home, was nauseous, and had vomited. R. 56-1 at 73-76. But he denied that his blood sugar was acting up. Id. And Sours did not have the "classical symptoms" of a diabetic episode such as increased thirst, hunger, urination, or headache. Id. at 82-83. So Nurse Allison concluded that Sours was still detoxing and placed him in a medical observation cell where Sours would be monitored by video and regularly observed in person by deputy jailers. R. 51-5; R. 56-1 at 76, 142-43.

Nurse Allison did not observe anything unusual before she left that night. Id. at 77, 79. Before she left, she told the deputy jailers to monitor Sours's blood sugar level, although she noted that there was no insulin in the Detention Center for Sours. R. 51-7. Nurse Allison also noted that Dr. Belhasen had ordered blood work and would see Sours the following week. R. 51-6; R. 51-7. But Nurse Allison did not send her progress notes to Dr. Belhasen, and she did not tell Dr. Belhasen that Sours's blood sugar had spiked to 327. R. 56-2 at 8; R. 56-3 at 27-28. Nurse Allison also met with the jail administrator, Randy Madan. R. 56-1 at 112. Madan coordinates all training and supervision for the Big Sandy Regional Jail Authority ("Jail Authority"). R. 58-2 at 70. Nurse Allison told Madan that Sours was a "critical situation" because he was uncooperative. R. 56-1 at 112.

Deputy Jailers Jordan, Allen, and Adkins worked from midnight to 8:00 a.m. on July 15, 2010. R. 57-1 at 24-25, 33. Deputy Allen was the senior officer and supervisor on duty. R 52-9 at 1. The previous shift informed the deputy jailers that Sours was a diabetic in observation who was irritable and had vomited. R. 57-2 at 25; R. 57-3 at 26-28. At approximately 3:15 a.m., Sours complained to deputies Allen and Adkins that he was having chest pains. R. 57-2 at 30. Deputy Allen asked Deputy Jordan (who was monitoring Sours via video, R. 58-1 at 10) to watch Sours closely on video monitors in the control room. R. 51-10. Six minutes later, Deputy Jordan observed Sours trying to make himself throw up. R. 51-11. Then, at 6:17 a.m., Deputy Adkins went to Sours's observation cell to escort him to the medical wing so that staff could test his blood sugar. R. 51-12; R. 57-2 at 19-20. Sours refused to take his blood sugar. R. 51-12. But he did complain of chest pain and said that his blood pressure was "out of control." R. 51-12; R. 57-1 at 47; R. 57-2 at 48-49.

Deputy Jailer Paul Griffith worked from 8:00 a.m. to 4:00 p.m. on July 15, 2010. R. 57-4 at 11. Sours refused Deputy Griffith's repeated offers of medication and refused another deputy jailer's attempts to take his blood sugar. R. 51-13; R. 51-14; R. 57-4 at 11. Sours later refused Deputy Montgomery's attempts to bring Sours to the nurses' station to have his blood sugar taken. R. 51-3; R. 58-3 at 11-12. Jail guards believed that everything was "ok" until 10:15 p.m., when Deputy Blanton observed Sours attempting to make himself throw up. R. 51-17; R. 57-3 at 29. Then, at 10:45 p.m., Deputy Salyer found Sours awake and breathing but unresponsive. R. 51-21; R. 51-22; R. 57-3 at 34-35. Deputy Salyer summoned deputies Blanton and Montgomery, who arrived seven minutes later. R. 57-3 at 53. Deputy Montgomery called an ambulance six minutes after he arrived at the cell. R. 51-23; R. 58-3 at 42, 46. The ambulance arrived several minutes later, but Sours stopped breathing "just seconds before" emergency personnel entered his cell. R. 51-21; R. 52-12; R. 58-3 at 48. The medical personnel took Sours to the local hospital, where he died of diabetic ketoacidosis. R. 52-12; R. 52-14.

The plaintiff sued under 42 U.S.C. § 1983, alleging that the defendants violated Sours's Fourteenth Amendment rights. The plaintiff also believes the defendants are liable for negligence, gross negligence, and violations of 501 Ky. Admin. Regs. § 3:090. See R. 25. The defendants now move for summary judgment. R. 51.


As the moving party, the defendants must demonstrate that undisputed evidence forecloses a claim or identify an element of a claim that Sours cannot support with admissible evidence. Celotex Corp. v. Catrett, 477 U.S. 317, 323-24 (1986). If they do so, Sours must respond with "specific facts showing that there is a genuine issue for trial." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986) (quoting Fed.R.Civ.P. 56(e)). The Court then decides whether a reasonable juror could find for Sours on each of his claims when all reasonable inferences are drawn in his favor. See Scott v. Harris, 550 U.S. 372, 380 (2007). Sours's constitutional claims fail this standard, as does his claim under Kentucky's Administrative Regulations and his negligence claims against the Jail Authority, Administrator Madan, and Deputies Allen, Blanton, Montgomery, Salyer, and Griffith. However, his negligence claims against Nurse Allison survive.

I. Section 1983 Claim for Violations of Sours's Constitutional Rights

The plaintiff believes that the defendants violated his brother's Fourteenth Amendment right to adequate medical treatment. See Jones v. Muskegon Cnty., 625 F.3d 935, 941 (6th Cir. 2010) ("The Eighth Amendment forbids prison officials from... acting with deliberate indifference toward [an inmate's] serious medical needs.... [A] pretrial detainee[] is analogously protected under the Due Process Clause of the Fourteenth Amendment." (internal quotations omitted)). Constitutional claims based on the adequacy of an inmate's medical treatment turn on whether the defendant was deliberately indifferent to the inmate's serious medical needs. See Estelle v. Gamble, 429 U.S. 97, 104-05 (1976). Deliberate indifference is the "reckless[] disregard" of a "substantial risk of serious harm to a prisoner." Farmer v. Brennan, 511 U.S. 825, 836 (1994). Thus, a deliberate indifference claim has two components. First, the objective component requires a plaintiff to show "that the medical need at issue [wa]s sufficiently serious." Comstock v. McCrary, 273 F.3d 693, 702 (6th Cir. 2001) (quotation omitted). Second, the subjective component requires proof that the defendant was actually aware of the plaintiff's serious medical needs and chose to disregard that risk. Id. at 703. None of the plaintiff's constitutional claims meet this high bar.

A. Nurse Nancy Allison is Entitled to Summary Judgment

Nurse Allison rightly concedes the objective component of the deliberate indifference test. R. 51 at 7. Sours was a diagnosed diabetic. R. 52-14. Diabetes is a serious medical condition that satisfies the objective prong of the deliberate indifference test. See, e.g., Garretson v. City of Madison Heights, 407 F.3d 789, 797 (6th Cir. 2005) (finding diabetes that "required insulin injections at regular intervals" a serious medical condition). The plaintiff's deliberate indifference claim fails on the subjective component of the deliberate indifference test.

Sours believes that the following facts show Nurse Allison's knowledge of the seriousness of Sours's condition. Nurse Allison knew that Sours was diabetic. She knew that his other conditions (like liver disease) could exacerbate his diabetes, R. 56-1 at 39, that he couldn't care for himself, R. 52-2 at 1, that his blood sugar was fluctuating, and that he was nauseous. R. 56-1 at 73-76. All in all, Sours was "clearly a sick man, " R. 56-3 at 32, and Nurse Allison knew he was in a "critical situation[]." R. 56-1 at 112. And Nurse Allison moved Sours to a medical cell, indicating that she believed his condition should be monitored. Id. at 75-76.

But none of these facts without further speculation creates a material issue as to Nurse Allison's knowledge about Sours's risk for diabetic ketoacidosis, or indicate that she recklessly disregarded her knowledge about Sours's diabetic condition. Nurse Allison stated that she believed Sours was detoxing, and that this condition explained his blood sugar spikes and his nausea. See, e.g., R. 56-1 at 55. And while Nurse Allison's assumption turned out to be incorrect, deliberate indifference requires a prison official to have actual knowledge of an inmate's risks. Farmer, 511 U.S. at 837. Negligence in diagnosing a medical condition is not deliberate indifference. Jones, 625 F.3d at 945. So Nurse Allison's failure to properly diagnose diabetic ketoacidosis or provide treatment for this condition cannot constitute deliberate indifference.

The plaintiff, however, points to further failures. He believes Nurse Allison exhibited deliberate indifference when she did not order insulin (despite Sours's high blood sugar) and failed to call Dr. Belhasen or leave thorough instructions for the deputy jailers. R. 52 at 18. The plaintiff may be correct that Nurse Allison should have done those things. But her treatment of Sours was not "so cursory as to amount to no treatment at all." Terrance v. Northville Reg'l Psychiatric Hosp., 286 F.3d 834, 843 (6th Cir. 2002) (quotation omitted). Nurse Allison conducted an initial interview with Sours and concluded that his diabetes was not serious, that he was surviving without insulin, and that his blood sugar spikes were due to detoxing. R. 52-2; R. 56-1 at 42-45. She instituted Dr. Belhasen's standing order for diabetics, ordered blood work for later in the week and scheduled Sours to see Dr. Belhasen the following week. R. 56-1 at 29-30, 56-57. Nurse Allison also ordered that Sours's blood sugar be taken before meals and during her shift convinced Sours to test his blood sugar. Id. at 50-54. When Sours continued to feel ill, Nurse Allison placed him in a medical cell so he could be constantly observed. Id. at 73-76. Finally, she left instructions for guards to monitor Sours and take his blood sugar, apparently assuming that guards would call her if Sours refused to take his blood sugar. R. 51-7; R. 56-1 at 88. Where, as here, a prisoner received medical attention for his serious needs, courts are "generally reluctant" to wade into disputes over the adequacy of treatment. Graham ex rel. Estate of Graham v. Cnty. of Washtenaw, 358 F.3d 377, 385 (6th Cir. 2004) (quoting Westlake v. Lucas, 537 F.2d 857, 860 n.5 (6th Cir. 1976)).

This is not a case where Nurse Allison ignored Sours's symptoms for several weeks, or where Sours explicitly informed the defendants that he needed insulin. See, e.g., Phillips v. Roane Cnty., Tenn., 534 F.3d 531, 541 (6th Cir. 2008) (finding deliberate indifference where the decedent "exhibited life-threatening symptoms over a two-week period" but "the correctional officers' fail[ed] to transport her to a hospital" and the jail doctor failed to follow-up on tests during this period); Garretson, 407 F.3d at 798 (finding deliberate indifference where the plaintiff "informed [the defendant] at her booking that she required insulin for her condition and that she was past due for her current dose " (emphasis added)). Nurse ...

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