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Winkler v. Madison County

United States Court of Appeals, Sixth Circuit

June 26, 2018

Charolette Diana Winkler, Administratrix of the Estate of Brandon Clint Hacker, Deceased, Plaintiff-Appellant,
Madison County, Kentucky; Doug Thomas, individually; Advanced Correctional Healthcare; Nadir H. Al-Shami, M.D., individually; Layla Troutman, ARNP, individually; Arlene Johnson, LPN, individually; Tom Jones, individually; Cory Dunning, individually; J. J. LaGrange, individually; Keith Trickler, individually; Whitney Bratcher, individually, Defendants-Appellees.

          Argued: April 25, 2018

          Appeal from the United States District Court for the Eastern District of Kentucky at Lexington. No. 5:15-cv-00045-Karen K. Caldwell, Chief District Judge.


          Jerome P. Prather, GARMER & PRATHER, PLLC, Lexington, Kentucky, for Appellant.

          D. Barry Stilz, KINKEAD & STILZ, PLLC, Lexington, Kentucky, for Madison County Appellees.

          Andie Brent Camden, O'BRYAN, BROWN & TONER, PLLC, Louisville, Kentucky, for Advanced Correctional Healthcare Appellees.

         ON BRIEF:

          Jerome P. Prather, William R. Garmer, John E. Norman, GARMER & PRATHER, PLLC, Lexington, Kentucky, for Appellant.

          D. Barry Stilz, Robert C. "Coley" Stilz III, Lynn Sowards Zellen, KINKEAD & STILZ, PLLC, Lexington, Kentucky, for Madison County Appellees.

          Andie Brent Camden, O'BRYAN, BROWN & TONER, PLLC, Louisville, Kentucky, for Advanced Correctional Healthcare Appellees.

          Before: GILMAN, COOK, and GRIFFIN, Circuit Judges.



         The tragic events in this case occurred during Brandon Clint Hacker's five-day pretrial detention at the Madison County Detention Center. Hacker arrived at the Detention Center on Wednesday, April 30, 2014, after he was arrested by local law enforcement for failure to appear at a child-support hearing. He died of a perforated duodenal ulcer five days later on Monday, May 5, 2014.

         Charolette Diana Winkler, Hacker's mother and the Administrator of his estate, brought suit against Madison County and the Detention Center's contract medical provider, Advanced Correctional Healthcare, Inc. (Healthcare), as well as against jail personnel and members of Healthcare's medical staff. She alleged several state-law tort claims in addition to a claim that the defendants violated Hacker's constitutional right to adequate medical care.

         With regard to the constitutional claim, the district court granted summary judgment in favor of all the defendants, concluding that the record would not support a jury finding that any of them were deliberately indifferent to Hacker's serious medical needs. It then declined to exercise supplemental jurisdiction over the remaining state-law claims and dismissed those claims without prejudice. Winkler appeals the grant of summary judgment. For the reasons set forth below, we AFFIRM the judgment of the district court.

         I. BACKGROUND

         A. Factual background

         1. The Detention Center and Healthcare

         The Detention Center is operated by Madison County, Kentucky. Through Jailer Doug Thomas, the County entered into an agreement with Healthcare to provide medical care to inmates housed at the Detention Center. This agreement was in effect at all times relevant to this lawsuit.

         Healthcare in turn entered into a contract with Dr. Nadir H. Al-Shami to be the staff physician at several county jail facilities, including the Detention Center. His duties included providing "on-site inmate medical care and treatment, case management and documentation, 24/7 physician call, and supervision of on-site medical staff." Dr. Al-Shami lived in Louisville, but would generally visit the Detention Center once a week. When Dr. Al-Shami was not present at the Detention Center, he was on call 24 hours a day to address inmate medical needs over the phone. Layla Troutman, a nurse practitioner living in Los Angeles, California, was available by phone as a back-up medical provider if Dr. Al-Shami could not be reached by the Detention Center staff.

         As part of its contract with the County, Healthcare was also required to provide on-site nursing coverage for up to 40 hours per week. Arlene Johnson, a licensed practical nurse (LPN), provided these nursing services, working at the Detention Center Monday through Friday from 8:00 a.m. to 4:00 p.m. Aside from Dr. Al-Shami, Nurse Troutman, and Nurse Johnson, no other medical professionals provided care at the Detention Center at any time relevant to this case.

         An inmate at the Detention Center could request medical care by filling out a sick-call-request form. These forms were collected daily by the deputy jailer on duty, who delivered them to Nurse Johnson. After Nurse Johnson received a request, she would have the inmate brought to her, and she would gather information about the inmate's complaints and take the inmate's vital signs. She would not conduct a physical examination because she was not qualified to do so as an LPN.

         Nurse Johnson would then call Dr. Al-Shami or Nurse Troutman to relay the information gathered and receive an order for treatment. (Winkler contends that the record shows that Nurse Johnson failed to contact a supervising medical provider with regard to complaints from a substantial number of inmates, but there is no dispute that she called her supervisors each time that she saw Hacker.) Nurse Johnson never created or initiated treatment plans herself. Deputy jailers were required to follow all instructions from the medical staff related to treatment, but had the authority to transport an inmate to the hospital without approval from the medical staff in the event of an emergency.

         2. April 30-May 2, 2014

         After his arrest on April 30, Hacker was transported to the Detention Center. As part of the booking process, Captain Tom Jones asked Hacker a series of medical questions. Hacker told Captain Jones that he did not have any "serious medical condition" requiring attention during his detention. He also said that (1) he had not ingested dangerous levels of drugs or alcohol, (2) he had never experienced delirium tremens or other serious withdrawal, and (3) it was not possible that he would go through withdrawal during his detention. Hacker was then placed in a cell designated for the general jail population.

         The first medical request by Hacker came two days later, on Friday, May 2. In the section of the form inquiring into the reason for the request, Hacker wrote: "very sick, stomach meds." Nurse Johnson saw Hacker at 1:50 p.m. that same day, took his vital signs, and noted on Hacker's progress note that he had elevated blood pressure and was suffering from "active tremors, body aches, [and] sweats." The progress note further stated that Hacker complained of being shaky and having chills, as well as having an upset stomach. Hacker also told Nurse Johnson that he was withdrawing from heroin, something that he had not previously disclosed to anyone at the Detention Center.

         Nurse Johnson attempted to reach Dr. Al-Shami by phone, but he was unavailable. She next called Nurse Troutman and was able to relay the information that she had gathered. Nurse Troutman diagnosed Hacker's symptoms as reflecting "possible withdrawal from heroin," so she prescribed the medications Clonidine, Vistaril, and Bentyl. She instructed Nurse Johnson to follow up as needed. The treatment plan was recorded by Nurse Johnson.

         There is no evidence in the record that Nurse Johnson or Nurse Troutman inquired into the frequency of Hacker's heroin use or the amount that he had ingested, a failure that constituted a violation of medical protocols in place at the Detention Center. Nor did they document the date of Hacker's most recent use of heroin or order an opiate-withdrawal screening to confirm his self-report.

         Hacker was subsequently returned to his cell in the general jail population with instructions to increase his rest and fluid intake. Nurse Johnson then left for the weekend without discussing Hacker's condition with jail personnel or otherwise instructing them to monitor Hacker's condition in her absence.

         In accordance with Detention Center policy, a deputy jailer reviewed a book where Nurse Johnson noted prescriptions ordered for the inmates. Hacker's prescribed medications, as well the medications for the other inmates, were then "packed" by Deputy Whitney Bratcher. These medications were provided to Hacker over the weekend by a male jailer, although records indicate that Hacker was given only half of the prescribed dose.

         3. May 3, 2014

         Hacker did not fill out a sick-call-request form on Saturday, May 3. Nor is there any evidence that he otherwise requested medical care from jail personnel. The record, however, shows that his condition deteriorated. Another inmate, Steven Denny, testified during his deposition that both he and Hacker went to the visitation room at the same time on that Saturday evening, and that he guided Hacker by the arm and helped him up the steps to the room because Hacker "was kind of weak" and "didn't feel good." As they walked to the room, they discussed the fact that Hacker had ulcers and regularly used heroin. As Denny explained, Hacker "just looked sick. I just told him it was dope or ulcers or something. Somethings killing you. Better do something."

         But Denny did not think that he needed to contact jail personnel about Hacker's condition at that time, nor did Hacker tell Denny that he wished to see the medical staff. There were no jail personnel in the room during visitation. The room, however, was visible from a control tower so that visitation could be monitored.

         Hacker's friend, James Potter, visited Hacker that Saturday night. Potter was with Hacker for 20 minutes, and he later testified that Hacker's condition appeared to be consistent with Potter's own experience of opiate withdrawal. He said that "anybody that's been through detox would know that [Hacker's condition] was detox, or would think [it]." Hacker was pale and sweaty, and he was crunched over like he was experiencing abdominal pain. When Potter asked him if he was okay, Hacker said that he was detoxing and that the detox medicine was not enough. Hacker did not tell Potter of any intention to get additional medical care, but did tell Potter that "You can't get no help around here."

         Hacker's girlfriend, Tiffany Gibson, was also housed at the Detention Center on May 3. Because she knew when Potter was going to visit Hacker, she called Potter during the visit and passed messages to Hacker through Potter. According to Gibson, Potter told her that Hacker "felt deathly ill" and "looked real bad." Gibson had seen Hacker detox on previous occasions, but was unaware that he suffered from ulcers.

         4. May 4, 2014

         On Sunday, May 4, Hacker notified jail personnel of his need for medical attention in multiple ways. He completed a sick-call-request form in which he wrote: "Blood Pressure[.] Need to see A.S.A.P. Having trouble breathing, stomach problems." The record does not reflect at what time this request was made, to whom it was given, or if the information on the form was ever reported to the medical staff.

         Around 1:00 p.m. that day, Hacker sought the attention of jail personnel at the door of his cell. Deputy Jailer Jeremy LaGrange responded, and Hacker informed LaGrange that "he wasn't feeling well[, ] that . . . he couldn't keep anything down[, ] and [that] he thought he was going to be dope sick." As a result, Deputy LaGrange brought Hacker to booking, where he explained the situation to Captain Jones. Captain Jones then instructed Deputy LaGrange to contact Dr. Al-Shami.

         Deputy LaGrange spoke with Dr. Al-Shami for about five minutes and relayed Hacker's condition and his vital signs. Dr. Al-Shami instructed Deputy LaGrange to give Hacker the medications Vistaril, Bentyl, and Phenergan. Because Hacker's blood pressure had returned to normal, the blood-pressure medication Clonidine was not prescribed. Deputy LaGrange did not personally check on Hacker again that day.

         Around 3:00 p.m., Hacker made an oral complaint to Deputy Greg Evans and Captain Jones, stating that his stomach hurt and that he "felt like he was bleeding on the inside." Captain Jones then called Dr. Al-Shami directly and relayed this information, as well as Hacker's up-to-date blood-pressure reading. Dr. Al-Shami responded by telling Captain Jones that internal bleeding does not cause pain and advised him to monitor Hacker. But Dr. Al-Shami did not provide any specifics about how to monitor Hacker or change his treatment plan. Hacker was returned to his general-population cell. Captain Jones finished his shift soon after the call, but he passed along to Deputy Evans the general instruction to monitor Hacker.

         Hacker also called his grandmother, Helen Hacker, three or four times on that Sunday afternoon. According to Ms. Hacker, he was crying and desperate. He told her, "my stomach is killing me, I need to go to the hospital." Ms. Hacker later called booking at the Detention Center and explained the phone calls that she had just had with her grandson, asking jail personnel to "please take care of him." According to Ms. Hacker, the individual on the other end of the line told her that jail personnel were "looking after" her grandson. The record does not identify this individual.

         5. May 5, 2014

         Hacker's next interaction with jail personnel occurred around 3:00 a.m. on Monday, May 5. Captain Keith Trickler was distributing the inmates' medication. (Trickler returned to the rank of Deputy, which he presently holds, in October 2014. He requested the reduction in rank so that he could work an earlier shift at the Detention Center.) When Captain Trickler went to give Hacker his medication, Hacker was sitting on a table in his cell. Captain Trickler asked what was wrong, and Hacker told him that "he was really going through it." Hackler further explained that his stomach was upset, that he had been doing drugs for a while, and that he was "pill sick" (meaning that he was suffering from withdrawal). According to Captain Trickler, Hacker's appearance was consistent, in Captain Trickler's experience, with someone going through opiate withdrawal. Hacker did not ask to see the medical staff, and the other inmates in Hacker's cell informed Captain Trickler that Hacker was already set to see the doctor later that day. As a result, Captain Trickler gave Hacker his prescribed medications but did not report their conversation to the medical staff.

         The next interaction between jail personnel and Hacker occurred several hours later, around 5:30 a.m. Deputy Bratcher was bringing breakfast to the inmates in Hacker's cell and, according to Detention Center policy, called each inmate by name to the cell door to receive his meal. Hacker was lying down on a mat on the floor and did not get up when called, so the other inmates in the cell asked Deputy Bratcher if they could get his food ...

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