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
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.
P. Prather, GARMER & PRATHER, PLLC, Lexington, Kentucky,
Barry Stilz, KINKEAD & STILZ, PLLC, Lexington, Kentucky,
for Madison County Appellees.
Brent Camden, O'BRYAN, BROWN & TONER, PLLC,
Louisville, Kentucky, for Advanced Correctional Healthcare
P. Prather, William R. Garmer, John E. Norman, GARMER &
PRATHER, PLLC, Lexington, Kentucky, for Appellant.
Barry Stilz, Robert C. "Coley" Stilz III, Lynn
Sowards Zellen, KINKEAD & STILZ, PLLC, Lexington,
Kentucky, for Madison County Appellees.
Brent Camden, O'BRYAN, BROWN & TONER, PLLC,
Louisville, Kentucky, for Advanced Correctional Healthcare
Before: GILMAN, COOK, and GRIFFIN, Circuit Judges.
LEE GILMAN, CIRCUIT JUDGE.
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.
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.
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.
The Detention Center and Healthcare
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.
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.
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.
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.
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.
April 30-May 2, 2014
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.
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
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.
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.
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.
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.
May 3, 2014
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
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.
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
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
May 4, 2014
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
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.
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
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.
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
May 5, 2014
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
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 ...