Opinion
Case No. 16-CV-2221
2020-07-20
Felita MCGEE, as Independent Administrator of the Estate of Michael Carter, Sr., deceased and as next-of-kin, Plaintiff, v. MACON COUNTY SHERIFF'S DEPARTMENT ; Decatur Memorial Hospital; Robert Braco, MD; Jo Bates, LPN; Randell West; Larry Parsano; Terry Collins; Michael Patton; and Joshua Page, Defendants.
Rahsaan Akim Gordon, Law Office of Rahsaan A. Gordon, Chicago, IL, for Plaintiff. William W. Kurnik, Susan Jacqueline Eberhardt, Knight Hoppe Kurnik & Knight Ltd., Rosemont, IL, for Defendants Macon County Sheriff's Department, Terry Collins, Michael Patton, Joshua Page, Larry Parsano. Michael J. Kehart, Regan Lewis, Kehert Peckert Wise Toth & Lewis, Decatur, IL, for Defendant Decatur Memorial Hospital. Regan Lewis, Kehert Peckert Wise Toth & Lewis, Decatur, IL, for Defendant DMH Corporate Health Services. Michael J. Kehart, Kehert Trimble Wise Anderson & Booth, Regan Lewis, Kehert Peckert Wise Toth & Lewis, Decatur, IL, for Defendant Robert Braco. Peter R. Jennetten, Matthew Allen Warner, Quinn Johnston Henderson Pretorius & Cerulo, Peoria, IL, for Defendant Jo Bates. Keith Eric Fruehling, Brian Michael Smith, Bryan Jeffrey Vayr, Jay E. Znaniecki, Heyl Royster Voelker & Allen, Champaign, IL, for Defendant Randell West. William W. Kurnik, Susan Jacqueline Eberhardt, Knight Hoppe Kurnik & Knight Ltd., Rosemont, IL, Michael B. Baggett, Macon County States Attorney, Decatur, IL, for Defendant County of Macon Illinois.
Rahsaan Akim Gordon, Law Office of Rahsaan A. Gordon, Chicago, IL, for Plaintiff.
William W. Kurnik, Susan Jacqueline Eberhardt, Knight Hoppe Kurnik & Knight Ltd., Rosemont, IL, for Defendants Macon County Sheriff's Department, Terry Collins, Michael Patton, Joshua Page, Larry Parsano.
Michael J. Kehart, Regan Lewis, Kehert Peckert Wise Toth & Lewis, Decatur, IL, for Defendant Decatur Memorial Hospital.
Regan Lewis, Kehert Peckert Wise Toth & Lewis, Decatur, IL, for Defendant DMH Corporate Health Services.
Michael J. Kehart, Kehert Trimble Wise Anderson & Booth, Regan Lewis, Kehert Peckert Wise Toth & Lewis, Decatur, IL, for Defendant Robert Braco.
Peter R. Jennetten, Matthew Allen Warner, Quinn Johnston Henderson Pretorius & Cerulo, Peoria, IL, for Defendant Jo Bates.
Keith Eric Fruehling, Brian Michael Smith, Bryan Jeffrey Vayr, Jay E. Znaniecki, Heyl Royster Voelker & Allen, Champaign, IL, for Defendant Randell West.
William W. Kurnik, Susan Jacqueline Eberhardt, Knight Hoppe Kurnik & Knight Ltd., Rosemont, IL, Michael B. Baggett, Macon County States Attorney, Decatur, IL, for Defendant County of Macon Illinois.
ORDER
COLIN S. BRUCE, U.S. DISTRICT JUDGE Plaintiff Felita McGee filed a complaint on behalf of the decedent Michael Carter, Senior. Carter died of diabetic ketoacidosis while in custody as a pre-trial detainee at the Macon County Jail. Plaintiff brought a variety of claims against the jail, the jail officers, the hospital contracted to provide medical care at the jail, and the treating physician and nurse.
Pending before the court are several motions for summary judgment from Defendants and from Plaintiff. The witnesses testified to competing versions of the events in question, often suggesting that another co-defendant was more responsible for decisions that Plaintiff asserts contributed to Carter's death. Different witnesses also observed different portions of events that occurred over the course of several days.
At this stage, the court does not attempt to determine the truth of the matter and recites the facts and makes inferences that are most favorable to the non-movant for each individual motion. Indeed, the court's "account of the facts therefore is not necessarily accurate in an objective sense but reflects the evidence through the lens of summary judgment." Shields v. Ill. Dept. of Corr. , 746 F.3d 782, 786 (7th Cir. 2014).
For the reasons stated below, Defendant Jo Bates's Motion for Summary Judgment (#172) is denied, Defendants Terry Collins, Joshua Page, Larry Parsano, and Michael Patton's Motion for Summary Judgment (#175) is denied, Defendant Macon County Sheriff's Department's Motion for Summary Judgment (#176) is granted in part and denied in part, Defendant Randell West's Motion for Summary Judgment (#177) is denied, Plaintiff's Motion for Partial Summary Judgment (#178) is denied, and Defendant Decatur Memorial Hospital's Motion for Summary Judgment (#179) is denied.
I. BACKGROUND
A. Overview
Michael Carter, Senior spent the last five days of his life in the Macon County Jail where he died due to complications from diabetic ketoacidosis at the age of thirty-five. The administrator of his estate sued in federal court, alleging violations of Carter's federal constitutional rights and state law. Two of the named defendants, Nurse Jo Bates and Dr. Robert Braco, were employees of Defendant Decatur Memorial Hospital ("DMH"), which was under contract to provide medical services to the inmates at the Macon County Jail. Defendants Terry Collins, Joshua Page, Larry Parsano, Michael Patton, and Randell West were all correctional officers, employed at the Macon County Jail, who interacted with Carter in some fashion on the day that he died.
Plaintiff explains that despite Carter identifying himself as a diabetic when he was first booked on Monday, July 13, 2015, and his mother calling the jail on Friday evening to beg that he receive medical attention for his diabetes, Carter's blood sugar levels were not checked by anyone until late Saturday morning. Earlier than this time, it should have been clear that Carter was in need of urgent medical attention. Even after Nurse Bates found Carter on the floor of his cell a little after 9 a.m. on Saturday morning, she did not immediately call Dr. Braco or check Carter's blood sugar. Instead, she described in her deposition that she believed he was "playing possum." Corporal West testified that Nurse Bates told him Carter was "faking."
The parties submitted a video of officers then dragging Carter from his cell in the medical unit, into a wheelchair, purportedly at the direction of Nurse Bates on Dr. Braco's orders. The parties agree that they moved Carter to "Deadlock," the segregation cell unit used for uncooperative inmates. Corporal West testified that he placed Carter in the segregation cell because Nurse Bates described Carter as being "uncooperative" and faking his illness. Nurse Bates checked Carter's blood sugar and contacted Dr. Braco only after Carter was moved to Deadlock and after the urging of some correctional officers.
Certain officers and Doctor Braco testified that Nurse Bates did not treat this incident with appropriate urgency and Corporal Austin, a non-defendant officer, testified that she persisted in trying to inspire a sense of urgency in Nurse Bates and insisted that Nurse Bates arrange for emergency transport to the hospital.
Nurse Bates, Dr. Braco, several correctional officers, and a corporal at the jail all testified that they were not permitted to call an ambulance. Bates stated she needed permission from Dr. Braco, Dr. Braco was under the impression that he needed to tell the correctional officers that transportation was needed and the jail would decide whether an ambulance or squad car was needed, and the correctional officers testified that they could not call an ambulance, but had to defer to medical. Plaintiff points to this failure to have a communicated policy and appropriate training as a factor that delayed Carter's emergency medical transfer.
Approximately two and a half hours after Carter was removed from his medical cell, his heart stopped beating. Only then did Nurse Bates agree that the correctional officers could call an ambulance. Carter was declared dead at the hospital.
Plaintiff argues that reckless mismanagement by the health service providers led to Carter's death. She argues that the lack of training, the lack of written protocols, and the lack of supervision of Licensed Practical Nurses (LPNs) who DMH and the Macon County Sheriff's Department encouraged to practice beyond their licensure, amounted to deliberate indifference to Carter's well-being. Plaintiff argues that the Macon County Sheriff's Department failed to oversee the healthcare contract properly and failed to train its employees appropriately. Plaintiff argues that Nurse Bates and Dr. Braco are liable for constitutional violations for exhibiting deliberate indifference to Carter's medical needs and that the individual officers are liable for failing to intervene and forcibly removing Carter from his medical cell when he was in distress. Plaintiff further argues that Corporal West used unwarranted force when attempting to arouse Carter from the medical unit.
Plaintiff brings a Denial of Medical Care claim pursuant to the Fourteenth Amendment and 42 U.S.C. § 1983 against all Defendants (Count I); a Monell claim pursuant to 42 U.S.C. § 1983 against Macon County Sheriff's Department (Count II); a Monell claim pursuant to 42 U.S.C. § 1983 against Decatur Memorial Hospital (Count III); an Institutional Negligence Claim against Macon County Sheriff's Department (Count IV); a Medical Malpractice/Wrongful Death claim against DMH, Dr. Braco, and Nurse Bates (County VI); a Medical Malpractice/Survival Action claim against DMH, Dr. Braco and Nurse Bates (Count VII); a Negligent Supervision, Retention, and Training claim against Macon County Sheriff's Department (Count VIII); and a Battery claim against Randell West and Macon County Sheriff's Department (Count XI).
Monell v. New York City Dept. of Social Services , 436 U.S. 658, 98 S.Ct. 2018, 56 L.Ed.2d 611 (1978).
The court previously dismissed Plaintiff's claims against DMH Corporate Health Services and dismissed Plaintiff's Count V, institutional negligence by DMH. The court also dismissed Counts VI and VII to the extent that they allege institutional negligence on behalf of DMH but permitted those claims to move forward against DMH to the extent they alleged vicarious liability. See Order (#64) entered February 20, 2018.
Dr. Braco did not move for summary judgment. DMH filed a motion for partial summary judgment as to the Monell claim in Count III, but DMH does not argue for summary judgment as to other claims against it. (#179; #180). The other Defendants filed motions for summary judgment seeking full judgment in their favor.
B. General Jail Administration
Plaintiff paints a picture of a chaotic and underfunded prison healthcare system where LPNs were pushed to practice far outside of the scope of their licenses due to the lack of available supervision. The only supervising physician was on call "24/7" for years on end, and he slept on the floor of the jail during understaffed weekends.
Plaintiff explains that DMH bid on the contract to provide healthcare at Macon County Jail in 2011 without having any experience in providing prison healthcare. DMH had a Corporate Health Services Department that provided offsite medical services to various companies for occupational matters. Debbie Acciavatti was the Corporate Health director and administratively supervised the medical staff. Tim Stone, DMH's Executive Vice President, directed her to bid on the jail contract, apparently because he believed this contract was a good fit for the Corporate Health team. When Stone told Acciavatti to bid on the contract, she had no prior experience negotiating, bidding, or understanding a contract for the provision of healthcare services in a correctional setting. Stone testified that DMH did not perform a needs assessment to determine how DMH would actually deliver healthcare services at the jail.
DMH was awarded the contract and Stone signed the 16-page healthcare delivery services agreement on behalf of DMH. Stone never read the contract and he did not know if anyone at DMH read it before he signed it. Linda Fahey, DMH's 30(b)(6) witness and the Chief Nursing Officer at the time the contract was signed in 2011, and who remained in that role until 2017, also did not recall reading the contract until one week before her discovery deposition in 2019.
The contract required that DMH provide sixty hours a week of licensed practical nursing (LPN) services, forty hours a week of registered nurse (RN) services, four hours a week of physician on site services, and on call coverage twenty-four hours a day, seven days a week. The contract also required that all physicians and nursing staff be trained in accordance with the National Commission on Correctional Health Care (NCCHC). DMH was also required to establish a training program for the county deputies and jailers.
Doctor Robert Braco worked for DMH at this time and Acciavatti told him that he was going to be required to be the doctor responsible for the Macon County contract. Dr. Braco was the only physician Acciavatti assigned to cover the jail. Dr. Braco believed that he was the only person trained in correctional health, so there was nobody knowledgeable to give him direction about how to carry out his job at the jail. He had some experience working at a jail facility while he was in residency but did not have any paid experience after residency.
In the years leading up to Carter's death, Dr. Braco was the only doctor assigned to the jail and he was required to be on call twenty-four hours a day, seven days a week, even when he was on vacation. Moreover, even though Dr. Braco was the sole doctor assigned to the jail, he maintained his position with Corporate Health as its Medical Director and ran its day clinic. He was also the Chief Medical Officer for several companies who used the Corporate Health department of DMH for their medical care. When asked how Dr. Braco could possibly always be on call every minute of every day for years, Acciavatti responded that Braco "accepted that responsibility." (#198-9 at 40). She explained that if he was on vacation he was still on call and that if he left the country, he would have made his phone international to remain on call. Doctor Braco testified that Acciavatti told him she was recruiting another doctor to help Dr. Braco cover the jail, but no additional doctor was hired.
There was no courier for the jail, so Dr. Braco personally brought medications and supplies to the jail, meaning he made a trip to the jail nearly every evening. At one point, he complained to Acciavatti about being the sole person making all deliveries because there was no backup plan when he went out of town. There were also approximately eight holidays where there were no nurses present at the jail, so Dr. Braco passed out all the medications himself. He testified that on some of those occasions, he slept on the floor of the jail. He asked for a variety of equipment and personally spent several thousand dollars on medical equipment so that the jail had what it needed. He also raised the issue of needing good nurse coverage for admissions and discharges with Acciavatti at some point. He also raised the issue at the jail that three medical beds were not enough to meet the needs of the jail.
Dr. Braco never saw or read the contract and did not receive an employee manual. He was never consulted about the formation of the contract and DMH told him to stay out of the running of the business. Dr. Braco was also not asked his opinion on the hiring of nurses and testified that the sheriff also told him to stick to medical and not interfere in the management of the jail.
i. Failure to Develop Protocol Regarding Emergency Transport
The contract required DMH and the County to adhere to the standards forth by the National Commission on Correctional Health Care ("NCCHC"). NCCHC called for jails and those delivering health services to have a written plan for the emergency transport of those detained and in need of some type of emergency medical assistance. The NCCHC standard explains that planning ahead for emergencies can help minimize bad outcomes. To that end, the standard required a written plan that includes arrangements for emergency transport and use of an emergency vehicle when necessary. Fahey testified that DMH had no medical policies at the jail. Lieutenant Donald Harold Hotwick, the jail warden, similarly testified that there was no written policy to inform the jail staff who is authorized to call an ambulance and under what circumstances.
Confusion among staff regarding who had the authority to call an ambulance was evident. Fahey, DMH's 30(b)(6) witness, was not aware of any DMH plan relating to the coordination of emergency transport of detainees at Macon County Jail. Fahey was also not sure if DMH nurses were authorized to call an ambulance without approval from Dr. Braco. Corporal Austin and Officer Page testified that generally, only medical staff could call an ambulance. Officer Patton testified that a command officer had been disciplined for calling an ambulance.
Dr. Braco, on the other hand, testified that the sheriff told him that jail staff would determine whether a patient is transferred by ambulance or squad car. The sheriff explained to Dr. Braco that medical should advise jail staff if a detainee was too sick for confinement, and that the jail would determine transport decisions.
Nurse Bates, however, was under the impression that she needed permission from Dr. Braco to call an ambulance and Bates communicated that understanding to Corporal Austin. Sergeant Ronald Atkins testified that Macon County staff had the authority to call an ambulance if it was obvious that a person was in medical distress but suggested the officers may not have known that at the time.
Plaintiff argues that this confusion contributed to Carter's delay in transfer to the hospital for emergency treatment.
ii. Failure to Develop Diabetes Protocol
Regarding diabetes protocol, Plaintiff asserts that there was no consistent practice or policy for monitoring diabetes, as required by NCCHC. Fahey testified that DMH did not have a written policy in 2015 to coordinate care of individuals who were diabetic. DMH agrees that it did not have a written policy regarding diabetes protocol. (#180 at 7). The sheriff similarly testified that he was not aware of any written policies, procedures, or training of medical or correctional staff regarding diabetes.
Due to this lack of policy, it appears that there was confusion among the healthcare team about who was responsible for what in the care and management of diabetic inmates. Edna Morgan, an LPN and the nurse manager for the jail, testified that she taught the nurses to test diabetics’ blood sugar twice a day for the first three days.
Dr. Braco similarly thought the nurses were doing blood sugar tests independent of any order from him. Nurse Bates, however, testified that she received no instruction from DMH about testing diabetics’ glucose levels or when to call a doctor. She was under the impression she should only check glucose levels when she had a specific order to do so. Moreover, despite Nurse Morgan's representations about regularly checking blood sugar, she did not check Carter's blood sugar levels even though she was on duty during his first few days of incarceration.
iii. LPNs not Adequately Supervised or Trained
Plaintiff also complains that DMH failed to staff the jail with Registered Nurses (RNs), as the contract required. DMH was to provide forty hours of RN staffing and sixty hours of LPN staffing per week. An LPN generally has one year of nursing education while an RN has either two or four years of nursing education and may even have a master's degree.
The parties agree that an RN has more extensive education and a higher level of practice that includes some medical judgment. An LPN cannot assess or diagnose based on their scope of practice. An LPN is licensed to perform care within a scope that includes collecting data, but an LPN is not licensed to assess or make full determinations for a plan of care for an individual. Plaintiff argues that due to DMH's failure to appropriately staff the jail, LPNs were consistently compelled to practice beyond the scope of their license. At times, LPNs provided medication without an order from Dr. Braco. Dr. Braco also testified that when he was out of town, he would sometimes rely on nurses to determine whether a detainee could be transferred from the medical unit.
Moreover, neither Dr. Braco nor DMH accepted responsibility for training the nursing staff. Dr. Braco testified that DMH did all of the hiring and training of nurses. When asked about Nurse Bates's training, he explained that his general understanding is that DMH had a procedure and orientation that included shadowing a more experienced nurse but said that he "[didn't] know anything" about Nurse Bates's specific training. (#179-4 at 55). He did not have any input into who the hospital hired and Acciavatti conducted formal reviews of the nurses. Braco stated that he advised the nurses for medical delivery but believed that they had a separate director of nursing from the hospital.
On the other hand, Acciavatti testified that Dr. Braco was responsible for training the nurses. One of Plaintiff's medical experts, Dr. Chad Zawitz, stated that according to NCCHC guidelines, Braco was responsible for the training of the nurses. Dr. Zawitz asserted that the fact that Braco did not conduct trainings and seemed unaware that NCCHC guidelines placed that responsibility on him suggests "he was not familiar or implementing practice based on NCCHC guidelines." (#200-5 at 17). Dr. Zawitz further said that it was "concerning" that Braco did not provide any nursing training and assumed that DMH was handling it. (#200-5 at 17).
iv. Failure to Train Jail Staff
As the responsible health authority, NCCHC guidelines required Dr. Braco to establish a medical training program for all the correctional officers who work with inmates. The officers should receive training on recognizing emergency situations, including acute manifestations of certain chronic illnesses. Plaintiff explains this was particularly important because the jail was without medical staff at least eight hours a day, requiring that the officers take responsibility for inmates’ health. Plaintiff also points to Macon County Sheriff's Department's failure to ensure that correctional officers were properly trained to address predictable health issues.
C. Timeline of Carter's Health Decline at the Jail
Plaintiff asserts that as a result of the underfunded and poorly managed health system described above, Carter died an entirely preventable death from diabetic complications. Plaintiff provides a detailed timeline, arguing that this poorly managed health system and the failure of Nurse Bates and Dr. Braco to provide adequate care resulted in his untimely death.
i. Booking on July 13, 2015
Carter was booked into Macon County Jail on July 13, 2015. On the intake questionnaire, the booking officer marked that Carter had diabetes and high blood pressure. (#179-1 at 1). Carter brought his prescription Metformin medication with him and Walmart pharmacy confirmed that Carter also had a prescription for Glyburide. The U.S. Department of Justice Prisoner Custody Alert Notice shows that Carter had diabetes and diverticulitis and took Metformin and Glyburide for diabetes. On the same day, Nurse Edna Morgan completed a Medical Administration Record (MAR) indicating that Carter was a Type 2 diabetic and that he was prescribed Metformin and Glyburide. Carter never received his Glyburide, and on multiple occasions he was not provided his Metformin. Nurse Morgan testified that Dr. Braco should be contacted if a detainee was booked without his medication so the medication should be ordered. The record reflects, however, that Dr. Braco was not contacted and that Carter never received his Glyburide.
The MAR indicates that Nurse Bates saw Carter on the day he was booked when she gave Carter his Metformin at 7:00 p.m. Nurse Morgan and Dr. Braco both testified that nurses should check the blood glucose level of new inmates, which Nurse Bates did not do.
ii. Carter's Health Complaints on July 16th
On July 16th, Nurse Morgan documented that Carter had been complaining of nausea and vomiting since July 15th. While Nurse Morgan was aware that Carter was diabetic, the records reflect that she did not perform any examination, obtain his vital signs, or test his blood sugar. There is also no documentation that Dr. Braco was notified of Carter's symptoms. Nurse Morgan administered a dose of Zofran, an anti-nausea medicine. Per Nurse Morgan's note, Carter did not respond well to the medicine, so she transferred him to the medical observation unit.
Plaintiff's expert, Dr. Zawitz, explains that there are no notes indicating any monitoring, evaluation, or involvement by any medical staff for the 26 hours that Carter was in the medical observation unit. (#200-5 at 7). There is no indication that Carter's blood glucose was checked, or his vital signs documented. (#200-5 at 7). Moreover, Dr. Braco was not informed that a nurse had escalated Carter's care to place him in the medical unit. It appears Carter's care was exclusively in the hands of an LPN.
iii. Family Concerns about Carter's Health on July 17th
On July 17th, Carter called his fiancé Quachee Parson and said he could not breathe, was vomiting, had abdominal pain, and was not getting medical help. The parties provided an audio recording of Carter's conversation with Parson that confirms Plaintiff's characterization of this interaction. Parson testified that she called Carter's mother, Sheila Lockett, while she was on the phone with Carter—the court does not have a recording of this conversation. Parson was crying and scared when she spoke to Lockett and Parson believed Carter sounded confused and short of breath. Lockett called the jail and spoke with a nurse who identified herself as Jo, who Plaintiff contends was Nurse Jo Bates. Lockett explained her concern that Carter was not eating, was in pain and throwing up, and sounded confused on the phone. Nurse Bates replied that there was nothing wrong with him and he was "just anxious." Lockett then explained that she was a nurse as well and knew that it was inappropriate for Bates to give a medical diagnosis because that "is for the doctor to do." (#198-5 at 16). Upon hearing this admonishment, Bates's attitude improved, and she assured Lockett that the doctor would see Carter later that night.
Lockett said she begged Nurse Bates to send Carter to the hospital because she believed that Carter needed an IV with insulin. Bates kept responding that she would ensure that the doctor would see him. Lockett testified that she felt that Bates was becoming irritated by her. Lockett told Bates she would call back later to make sure the doctor saw him and asked Bates again to send Carter to the hospital. Lockett called back to Medical that same evening, but her call kept getting cut-off—Lockett stated she believed that Bates was either ignoring or intentionally hanging up on her. Lockett was concerned that Bates was not going to properly address Carter's health concerns.
This conversation apparently prompted Nurse Mattingly, another LPN, to be called to Carter's medical observation room to check on him. Nurse Mattingly documented that Carter was "anxious" and advised him to calm down. (#200-5 at 7). Plaintiff's expert notes that Carter had a "markedly elevated heart rate of 123 beats per minute," a "critically low blood pressure" given Carter's history of hypertension, and a "markedly rapid respiration." (#200-5 at 7). Nurse Mattingly did not appear to take Carter's temperature or test his blood sugar. (#200-5 at 7). She reported that she "reassessed" Carter two hours later and noted that he was laying on his bunk and that no distress was noted. However, Plaintiff's expert criticized that she did not repeat his vital signs despite the abnormal vital signs from two hours earlier. (#200-5 at 8). She also apparently did not examine or talk to Carter. She noted: "Inmate lying on bunk in medical resp calm no distress noted at this time." (#200-5 at 8).
iv. Exam with Dr. Braco on July 17th
Dr. Braco was not notified of Carter's jail admittance, that Carter was diabetic, or that Carter was having any health complaints until the evening of July 17th. Dr. Braco also testified that he did not know that Carter's mother had called suggesting that Carter might be suffering from complications from his diabetes. There is no documentation in Carter's medical records as to the purpose of his visit with Braco. Dr. Braco testified that he had spent approximately thirty minutes with Carter, and likely took his history, checked vitals, examined his heart and lungs, and examined his respiratory tree, and reviewed anything else Carter cared to mention. However, the court reviewed the available video footage and confirmed that Carter left his cell that evening at 21:58 and walked back into his cell by 22:06, barely more than eight minutes later.
Dr. Braco testified that he asked Nurse Bates for various medical documents related to Carter but that it took over thirty minutes for her to find them. Dr. Braco also testified that no one, including Carter, mentioned that Carter had been seen earlier in the week.
Dr. Braco was apparently not primarily focused on Carter's potential issues with diabetes, but with Carter's breathing. Dr. Zawitz's expert report explains that based on Dr. Braco's notes from the examination, he did not indicate he had reviewed any charted records, including the abnormal vital signs from a few hours earlier or Carter's active medications. (#200-5 at 8). Dr. Braco did not acknowledge Carter was a diabetic or that nurses had documented two days of vomiting. Braco's notes also do not indicate that he completed his own medical history of Carter. Braco noted an abnormal pulse and a low temperature but he did not check Carter's blood pressure despite the low value from earlier and he did not request a glucometer reading. Plaintiff's expert complains that Dr. Braco's treatment plan "was inexplicably to administer albuterol syrup and Vistaril (an antihistamine)." (#200-5 at 8). Dr. Zawitz found that "these failures were all well below the standard of care an ordinarily reasonable doctor would exercise under similar circumstances." (#200-5 at 8).
Dr. Braco testified that he only saw Carter's medication sheet after his appointment with Carter and he then decided to do a urine test for ketones. Dr. Braco also said that Carter initially refused the urine test but that he did not write that in his notes because "[n]o one likes their notes to read that patient refused this or patient refused that." (#179-4 at 45). There are no written or verbal orders indicating Dr. Braco made such a request, but he testified that he would have written these orders on a "sticky note." (#179-4 at 93). He said that the sticky notes are usually thrown away. (#179-4 at 93). A urine sample was never collected.
Dr. Braco also testified that he was under the impression Nurse Bates would check Carter's blood sugar without a specific order from him and thus, did not specifically order a blood sugar test. Even after two days of vomiting and Carter's mother calling to beg that Carter be sent to the hospital, no one checked Carter's blood sugar.
v. Nurse Bates Failed to Provide Prescription on July 18th
On July 18th, Nurse Bates documented that she administered Carter's Metformin medication at 8 a.m. The court has a copy of the video feed from Carter's medical cell from the evening of July 17, through the morning of July 18, which indicates that Carter's door was not opened around 8 a.m. On the video, his meal is dropped off close to 8:30 a.m., but not by Nurse Bates. The video shows that Nurse Bates does not enter his cell until after 9 a.m. on July 18, and she does not appear to administer Metformin at that time. She could not explain that discrepancy in her deposition.
vi. Removing Carter from Medical Cell
Nurse Bates explained in her deposition that on the morning of July 18th she removed Carter from his medical cell "per the doctor's orders." (#179-5 at 11). Dr. Braco, however, denied giving Nurse Bates permission to remove Carter from the medical cell and testified that he expected to visit Carter in the medical unit when he visited the jail on the afternoon of the 18th.
Corporal West testified that Nurse Bates told him that Carter could be moved from the medical unit around 7:15 in the morning and that they planned to move him after breakfast. He directed Officer Parsano to move Carter back to the general population. Corporal West explained that he did not question this decision further.
Certain Defendants still characterize Carter's behavior on the morning of July 18th as uncooperative. However, the court has video of Carter in his medical cell and a video from the same time that shows the medical office and staff entering and exiting Carter's cell, from which a reasonable factfinder could conclude that Carter was in medical distress as opposed to being uncooperative. The video feeds start a few minutes after 9 a.m., with Carter standing in the door of his shower. He appears to rock back and forth at times. An officer opens Carter's cell door for Nurse Bates, and Carter falls to the ground. Carter is slumped in a seated position with his head and upper body resting against the wall. His cell door remains open while Nurse Bates is in the office apparently gathering supplies. A few minutes after his fall, Nurse Bates enters the cell with a cotton swab of smelling salts. In response to the smelling salts, Carter briefly lifts his head from the wall and touches his hand to his nose before resting his head back on the wall. Bates places the salt under his nose again and Carter moves more slightly this time.
The video shows that as Carter is sitting propped against the wall, Corporal West contacts Plaintiff's side with his foot. The parties disagree about whether to characterize this contact as a kick or closer to a nudge. Over the course of a few minutes, West contacts Carter's side approximately nineteen times with varying degrees of force. At another point, Corporal West steps on Plaintiff's hand and twists his foot while apparently applying pressure.
After several minutes, Nurse Bates appears to attempt to place a pulse reader on Carter's finger, but a reasonable factfinder could determine that Bates was not successful in obtaining a read. Officer Page testified that Bates retrieved the pulse-ox after he raised concerns that Carter was cool to the touch and might be having a cardiac issue. After this attempt, the correctional officers begin to drag the limp Carter out of the cell.
Carter eventually is situated in a seated position, and with a great deal of effort and assistance from several officers, Carter unsteadily rises to his feet. He takes a few uncertain steps backwards and falls back into the available wheelchair. When Carter rises to his feet, Bates is in the medical office and raises her fists in the air and tilts her head, appearing to signal to one of the guards. A slumped-over Carter is wheeled away and the record reflects he is taken to a segregation cell for being "uncooperative." Corporal West explained in his deposition that he made the decision to move Carter to housing based on Nurse Bates's representation that Carter was "faking" and that she had determined that Carter was "fine." (#220-3 at 8).
Officer Parsano, Officer Collins, Officer Patton, Officer Page, and Corporal West participated in removing Carter from his cell and transporting him to the segregation unit. Brandon Wallar was a correctional officer assigned to Deadlock the morning of July 18th. Wallar observed that Carter was incoherent, sick, and pale and stated that he told West, Collins, and Parsano that Carter needed to go back to medical where he could be better monitored.
vii. Glucose Tests
Officer Parsano testified that he returned to clean Carter's cell and noticed that Carter had not eaten his breakfast or dinner and that his tray was marked "diabetic." Officer Parsano told Officer Collins his concern that Carter may be having an issue with his blood sugar level given the uneaten meals. Collins testified that he found Nurse Bates within a few minutes and the two went to check Carter's blood sugar.
Dr. Braco testified that Bates called him around 10:15 a.m. to tell him that Carter had a blood sugar of 500 but that Carter was responsive, that his vitals were good, and that Carter was walking and talking. Accordingly, Braco told Bates to give Carter a dose of insulin and to recheck Carter's blood sugar in an hour and call him back. Nurse Bates documented that Carter was alert and oriented.
Corporal Austin testified that around 11:15 a.m. Officer Collins asked her to come check on Carter, apparently because he was concerned about his health. They met Nurse Bates on the way who said that she was going to take Carter's vital signs. When Corporal Austin entered the cell, she observed that Carter was on the bed, leaning against the wall and that he appeared to be in a daze and sweating. Nurse Bates checked Carter's blood sugar and the meter read over 500, but because the blood sugar test only read to a maximum of 500, Nurse Bates could not say how high Carter's blood sugar was. Corporal Austin saw the blood sugar reading and combined with Carter's lethargic state, Austin considered the situation to be a medical emergency and told Nurse Bates that Carter needed to go to the hospital. Corporal Austin explained that she was diabetic herself and felt that Carter needed an IV drip on insulin at the hospital. Corporal Austin testified that Nurse Bates said that she was not authorized to send Carter to the hospital and that she needed to call the doctor.
Nurse Bates called Dr. Braco again at around 11:15 a.m. to report that Carter's blood sugar was still at 500. Dr. Braco testified that Nurse Bates again told him that Carter was still walking, talking, and coherent. When Dr. Braco asked if it was an emergency or could wait until Dr. Braco got to the hospital, Nurse Bates said that Carter was "fine." (#179-4 at 52). Dr. Braco's understanding was that there was no emergency.
Corporal Austin testified that as Nurse Bates was on the phone, she said that Dr. Braco would see Carter when he came in at 3 p.m. Corporal Austin responded that Carter would not be alive by then and that Carter needed to go to the hospital immediately. Nurse Bates then related that Dr. Braco said that he is not paying a thousand dollars for an ambulance ride. Corporal Austin testified that she insisted Carter needed to go now and Nurse Bates said that Carter could go in the squad car but not by ambulance.
Dr. Braco's memory of this conversation differs slightly. He asserts that Nurse Bates asked if he wanted to call an ambulance and he testified that he tried to explain that the jail would arrange transport if Nurse Bates thought that Carter was experiencing a medical emergency. He also told her that if it was not an emergency then "it's not worth a thousand-dollar ambulance run." (#179-4 at 56). However, he said he left it to her judgment about whether it was an emergency.
Dr. Braco did, however, call the DMH emergency room to tell them that they were getting an inmate from the jail with high blood sugar. (#179-4 at 57). He also said that because transporting an inmate to the hospital requires the presence of one or two officers, "it's been like pulling teeth to get anyone transported from the jail to the hospital just universally." (#179-4 at 57).
Dr. Braco testified that he complained to Acciavatti that it was a "circus" trying to call an ambulance to the jail. (#179-4 at 59). Dr. Braco also explained that he thought that calling an ambulance can often take longer than having officers transport the inmates due to the numerous security doors that the medics need to go through, the fact that medics want the inmate brought to them instead of walking through the jail, and the amount of information the medics want before they take the inmate. (#179-4 at 58–59).
While the officers began preparing to transport Carter, Nurse Bates was allegedly trying to leave her shift early to go boating. Bates was called back to Carter's cell before she left, and the officers had Carter hooked up to an automated external defibrillator (AED) machine and eventually started performing CPR. Carter was pronounced dead upon his arrival at the hospital.
Nurse Bates did not attempt to prepare any continuity of care sheet to send with Carter at the hospital. She also did not fully brief Nurse Morgan, who was taking over her shift. She sent a text message to Nurse Morgan saying that someone she worked on may not "make it" without identifying the name of the individual. Morgan tried to text and call her, but her calls went unanswered. Lieutenant Hotwick testified that Bates seemed like she was in a hurry to leave and that she said something to the effect that she would be boating and partying if they needed her. He told Acciavatti later that week that he did not want Bates back at the jail. Bates was fired and did not return to a shift at the jail. D. Expert Opinion
Plaintiff presents Dr. Chad Zawitz as an expert to opine on matters including DMH's performance. Dr. Zawitz reviewed a number of documents and depositions to form his opinion. He stated that he did not "see any evidence of documentation to support routine supervision and monitoring of contractual obligations." (#200-5 at 15). He offered his opinion "DMH's policies, procedures, training, and staffing relating to its agreement to deliver healthcare services to those detained at Macon County Jail was deficient and a substantial departure from the standard care of an ordinarily careful healthcare institution." (#200-5 at 15). He also cited numerous failures to comply with NCCHC guidelines. He more thoroughly explained his opinion in his deposition and expert report, but in short, Dr. Zawitz observed that the intake screener did not meet the NCCHC requirements, that there was no evidence of written policies or procedures, and that there was no evidence of training or monitoring of the written policies or staff training, all serious failures. (#200-5 at 19). He further noted that there is no evidence of monitoring the screening process to determine the safety and effectiveness of that process. (#200-5 at 19).
Dr. Zawitz was also critical of Acciavatti and DMH's failure to monitor their compliance with the contractual guidelines, including the NCCHC guidelines. He points out that in her deposition, Acciavatti initially denied having any knowledge of the NCCHC guidelines and that it did not appear that she had any functional knowledge of the actual guidelines. As the administrative supervisor, he stated that it was her responsibility to know the contractual obligations, which included following NCCHC guidelines. In his opinion, Acciavatti was deficient in her duties as the administrative supervisor, and DMH's policies, procedures, training, and staffing were a substantial departure from the standard of care of an ordinarily careful institution.
Dr. Zawitz also outlined that Carter's intake screener form was only partially complete. No medications were listed, and many screening questions were left blank. He found this is a substantial departure from NCCHC standards. (#200-5 at 20). He also noted that Nurse Bates's decision to "move the generally incapacitated body of Mr. Carter" from the medical to the segregation unit was a substantial departure from correctional and medical standards of care. (#200-5 at 21).
II. LEGAL STANDARD
Summary judgment is appropriate "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a) ; see also Celotex Corp. v. Catrett , 477 U.S. 317, 322-23, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). In ruling on a motion for summary judgment, a district court "has one task and one task only: to decide, based on the evidence of record, whether there is any material dispute of fact that requires a trial." Waldridge v. Am. Hoechst Corp. , 24 F.3d 918, 920 (7th Cir. 1994). "[T]he district court's function is not to weigh the evidence and determine the truth of the matter, but to determine whether there is a genuine issue for trial." Winters v. Fru-Con, Inc. , 498 F.3d 734, 744 (7th Cir. 2007). In making this determination, the court must construe the evidence in the light most favorable to the nonmoving party and draw all reasonable inferences in favor of that party. Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 255, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) ; Singer v. Raemisch , 593 F.3d 529, 533 (7th Cir. 2010). However, a court's favor toward the nonmoving party does not extend to drawing "[i]nferences that are supported by only speculation or conjecture." Singer , 593 F.3d at 533, quoting Fischer v. Avanade, Inc. , 519 F.3d 393, 401 (7th Cir. 2008).
"The mere existence of an alleged factual dispute will not defeat a summary judgment motion; instead, the nonmovant must present definite, competent evidence in rebuttal." Butts v. Aurora Health Care, Inc. , 387 F.3d 921, 924 (7th Cir. 2004). Summary judgment "is the ‘put up or shut up’ moment in a lawsuit, when a party must show what evidence it has that would convince a trier of fact to accept its version of events." Koszola v. Bd. of Educ. of City of Chicago , 385 F.3d 1104, 1111 (7th Cir. 2004) (quoting Johnson v. Cambridge Indus., Inc. , 325 F.3d 892, 901 (7th Cir. 2003) ). Specifically, to survive summary judgment, "the nonmoving party must make a sufficient showing of evidence for each essential element of its case on which it bears the burden at trial." Kampmier v. Emeritus Corp. , 472 F.3d 930, 936 (7th Cir. 2007), citing Celotex Corp. , 477 U.S. at 322-23, 106 S.Ct. 2548.
III. ANALYSIS
A. Plaintiff Sufficiently Pleaded that DMH and Macon County Sheriff's Department Failed to Promulgate Appropriate Policies.
Defendants DMH and Macon County Sheriff's Department argue that Plaintiff attempted to inappropriately amend her Amended Complaint by raising additional policies or practices in her response to summary judgment that were not included in her Amended Complaint.
Defendant DMH argues that Plaintiff did not include allegations in her Amended Complaint that DMH: was required to adopt healthcare policies; authorized or encouraged LPNs to practice beyond the scope of their licensure; failed to develop a protocol regarding treatment of diabetes; failed to train its staff in caring for diabetic inmates; failed to train its medical or correctional staff; failed to adequately staff the hospital; was remiss in allowing Braco to consider cost-saving in deciding whether to call an ambulance; failed to implement appropriate record-keeping policies; and failed to appropriately address health concerns expressed by family of detainees.
Defendant Macon County similarly complains that Plaintiff's Amended Complaint did not sufficiently allege: facts about training LPNs; that jail staff needed medical training beyond CPR and first aid; that the County allowed nurses to practice beyond the scope of their practice; that the County should have had protocol regarding treatment of diabetes; or any claim about record keeping.
Defendants DMH and Macon County argue that the court should ignore these allegations in considering their summary judgment motions.
A plaintiff opposing summary judgment may not inject "new and drastic factual allegations," but instead must adhere to the complaint's "fundamental factual allegation[s]." Whitaker v. Milwaukee Cnty. , 772 F.3d 802, 808 (7th Cir. 2014). However, plaintiffs are "entitled to refine [their legal] theory at summary judgment based on evidence produced in discovery." CMFG Life Ins. Co. v. RBS Sec., Inc. , 799 F.3d 729, 743 (7th Cir. 2015) (citing Whitaker , 772 F.3d at 807–09 ). This latitude is in keeping with Rule 8(a)’s pleading requirement that a complaint provide "a short and plain statement of the claim showing that the pleader is entitled to relief." Fed. R. Civ. P. 8(a)(2). To determine whether Defendants’ assertion that Plaintiff failed to properly plead the appropriate facts is correct, the court must examine the factual allegations in Plaintiff's Amended Complaint.
In her Amended Complaint, Plaintiff asserts that the Defendant officers’ actions were a "direct consequence of policies and practices of Decatur Memorial Hospital." (#31 at 12). Plaintiff specifically complained that DMH had "policies practices, customs, and usages" of "encouraging jail staff to ignore signs of medical distress involving individuals detained in its custody;" discouraging employees and contractors from "calling necessary medical rescue personnel to the jail in order to save costs;" refusing to properly train or supervise staff and agents to "utilize a proper protocol concerning summoning emergency medical personnel to the jail;" establishing a policy of confiscating bona fide prescription medication; and that those policies led employees to believe that their "actions or inactions would not be properly monitored" and misconduct would not be investigated. (#31 at 13–14).
Plaintiff similarly alleges that Macon County Sheriff's Department had an independent duty to supervise and ensure that medical care was provided safely by their employees or agents of the jail. (#31 at 14). Plaintiff stated that the Macon County Sheriff's Department had policies or practices of "encouraging jail staff and medical to ignore obvious signs of medical distress involving individuals detained in jail custody;" "discouraging staff, employees, contractors, and/or agents from calling necessary medical rescue personnel to the jail in order to save costs;" failing to "properly train, monitor, supervise or ensure staff and/or agents or utilize a proper protocol concerning summoning emergency medical personnel to the jail;" having a practice of confiscating bona fide prescription medicine; and that those policies led jail staff to believe that their "actions or inaction would not be investigated or sanctioned." (#31 at 14).
In short, Plaintiff clearly alleged that Defendants DMH and Macon County Sheriff's Department's policies or lack of policies and training regarding medical care contributed to Plaintiff's death. Plaintiff's Amended Complaint provided specific details to support that allegation, and then she refined her allegations based on the information she discovered during discovery. Defendants DMH and Macon County Sheriff's Department were ultimately on notice of Plaintiff's claims and the additional details about which policies or lack of policies Plaintiff found objectionable do not amount to an attempted amendment of Plaintiff's Amended Complaint. To the extent Defendants move to strike factual allegations, for failure to appropriately plead the claims, that motion is denied.
B. Plaintiff did not Sufficiently Plead that Defendants West, Parsano, Page, Collins, and Patton Failed to Prevent another Officer's Unconstitutional Use of Force.
In Plaintiff's response to Defendant Officers Parsano, Page, Collins, and Patton's Motion for Summary Judgment (#212) and in her response to West's Motion for Summary Judgment (#215), Plaintiff complains that the other officers failed to intervene when West stepped on and kicked Carter, and when Parsano used a pressure point. Defendants assert that there is "no suggestion in the First Amended Complaint of a failure to prevent another officer's use of unconstitutional force." (# 234 at 41).
Indeed, Plaintiff labeled her cause of action "Denial of Medical Care." (#31 at 9). She references officers’ failure to address Carter's medical needs. There is no mention of a failure to intervene in the use of force. Here, Plaintiff is not simply refining a legal theory, but attempting to insert a wholly distinct factual allegation related to use of force. This is an inappropriate attempt to amend a complaint through a response to a motion for summary judgment and the court does not consider these allegations in deciding this motion.
C. The Court Will Not Strike Plaintiff's Evidence from the Record.
Several Defendants objected to many of Plaintiff's proffered facts, arguing that Plaintiff was supporting her motion with inadmissible hearsay evidence and that some facts were irrelevant or repetitive. While a party "may object that the material cited to support or dispute a fact cannot be presented in a form that would be admissible in evidence," Defendants fail to argue that the purported hearsay could not be presented in some form that would be admissible at trial. See Fed. R. Civ. P. 56(c)(2). For this reason, Defendants’ motion to strike any statements as hearsay are denied.
Moreover, Defendant Bates mislabels certain statements as hearsay. Many of Nurse Bates's objections are about statements that witnesses heard personally and attribute to Bates. The rule is clear that statements by an opposing party are not hearsay. Fed. R. Evid. 801(d)(2). Additionally, hearsay is evidence that is offered to prove the truth of the matter asserted in the statement. Fed. R. Evid. 801(c)(2). Plaintiff attributes several statements to Bates that Plaintiff claims are lies. Fed. R. Evid. 801(c)(2). Thus, Defendant's assertion that certain statements should not be considered because they are hearsay is wrong.
Nurse Bates further asserts that the opinions of certain correctional officers are irrelevant because those officers are not medical professionals. In particular, Corporal Austin testified that Carter was sweating and appeared in a daze. When Corporal Austin saw how high Carter's blood sugar registered, she told Nurse Bates that Carter needed to go to the hospital.
First, medical expertise is not needed when a layperson can understand the symptoms without the assistance of an expert. Gil v. Reed , 381 F.3d 649, 659 (7th Cir. 2004) ("no expert testimony is needed when the symptoms exhibited by the plaintiff are not beyond a layperson's grasp"). The Seventh Circuit has also acknowledged that there are scenarios where "the need for [medical] treatment would be obvious to a layperson." Pyles v. Fahim , 771 F.3d 403, 409 (7th Cir. 2014). Here, it is not beyond the understanding of a layperson that a diabetic individual who is unresponsive and experiencing a blood sugar level too high for the glucose test to register a number was experiencing a medical emergency. The court is not persuaded that the officers are precluded from testifying about their observations and understanding of Carter's health presentment.
The court will not rule on each of Defendants’ individual objections, some of which are more appropriately raised at trial. However, the court summarized those facts that are relevant and appropriately considered for the purposes of this motion and did not reference those not appropriately considered.
D. The Court Will Not Again Consider Defendant West's Argument that He Was Not Timely Served.
Defendant West again argues in his Motion for Summary Judgment that he was never timely served and that the case should be dismissed on that ground. The court has already denied that motion (#26) and then denied Defendant West's Motion for Reconsideration (#29). The court will not dedicate any additional time to this argument and refers Corporal West to its previous decisions on this issue.
E. Summary Judgment is not Warranted on the Denial of Medical Care Claims Against the Officers.
Defendants West, Collins, Page, Parsano, and Patton were responsible for transporting Carter from the medical cell to the segregation unit. These correctional officers interacted with Carter in various levels before and during the transport and then throughout the rest of the morning. Plaintiff argues that Carter's distress should have been clear and that it should have been equally clear that Nurse Bates was not providing appropriate care. Accordingly, in Count I, Plaintiff seeks to hold these correctional officers liable under § 1983 for violating Carter's constitutional rights to receive appropriate medical care.
To succeed on a claim for denial of medical care in the pretrial detainee context, a plaintiff "must demonstrate that the officers’ actions were objectively unreasonable under the circumstances, a less demanding standard than the Eighth Amendment's deliberate indifference standard." Estate of Perry v. Wenzel , 872 F.3d 439, 453 (7th Cir. 2017) (internal quotations and citations omitted).
"When detainees are under the care of medical experts, non-medical jail staff may generally trust the professionals to provide appropriate medical attention." Miranda v. County of Lake , 900 F.3d 335, 343 (7th Cir. 2018). An exception exists where jail officials had reason to know that the medical staff was failing to treat or was inadequately treating an inmate. Id.
Here, whether the officers had reason to know that the medical staff was failing to treat or was inadequately treating Carter is a highly disputed question of fact. At this stage, the court must view the facts and inferences in favor of Carter. In viewing the facts and evidence in that manner, Defendants have not met their burden of demonstrating that there is no material factual dispute.
The video shows Carter's condition as the officers stand around looking on, and as they actively participate in moving him out of the heavily monitored medical unit to a much more isolated cell in the disciplinary unit. The video also suggests that Bates did not actually obtain any readings of Carters’ vitals during that time before the move to Deadlock. Other evidence of the possible obviousness of the inadequacy of Bates’ treatment of Carter includes officer testimony about Carter's sluggish, lethargic, pale, very sick, and incoherent condition and officer testimony that he was cool to the touch and sweaty and had labored breathing while still in the medical unit shortly before the officers took him to Deadlock and immediately upon his arrival in Deadlock. An officer testified that Carter's demeanor did not warrant him being placed in Deadlock.
The officers were not handing care over to medical personnel, but instead participating in moving Carter off the medical unit and away from monitoring and any oversight Nurse Bates would be providing in the medical unit. They left Carter in Deadlock despite Officer Wallar confronting them about Carter needing to go back to medical based on his very sick condition. Looking at Carter's condition on the video combined with other facts and inferences, Plaintiff has shown that the jury must decide her claim of denial of medical care against the officers.
The qualified immunity doctrine does not change this result. Qualified immunity "protects public servants from liability for reasonable mistakes made while performing their public duties." Findlay v. Lendermon , 722 F.3d 895, 899 (7th Cir. 2013). "Defeating qualified immunity requires (1) conduct violating the plaintiff's constitutional or statutory rights that is (2) clearly established at the time of the violation such that a ‘reasonable official would understand that what he is doing violates that right.’ " Id. (quoting Denius v. Dunlap , 209 F.3d 944, 950 (7th Cir. 2000) ).
A reasonable jury could find that the officers all failed to do anything to obtain adequate medical treatment for Carter while the need for such treatment was obvious in the medical unit and upon arrival at Deadlock. Instead, they physically removed Carter from the medical unit, deposited him on the floor of the disciplinary unit, and left him there. It was sufficiently clear that failing to take any action in light of a serious medical need was unconstitutional at the time of Carter's death. See Wenzel , 872 F.3d at 460 ("And, if by 2010, it was clearly established that an officer or prison nurse's actions were judged by the objectively reasonable standard of the Fourth Amendment, the failure to take any action in light of a serious medical need would violate that standard.").
Accordingly, Parsano, Collins, Patton, and Page's Motion for Summary Judgment (#175) is denied. Corporal West's Motion for Summary Judgment (#177) is denied as to Count I. Count I may also proceed against Defendant Macon County Sheriff's Department. Defendant Macon County Sheriff's Department's Motion for Summary Judgment (#176) is thus denied as to Count I.
F. Defendant Randell West is Not Entitled to Immunity on the Battery Claim.
Corporal West moves for summary judgment as to Plaintiff's battery claim. While Corporal West was removing Carter from his cell, he used his foot to contact Carter's side approximately nineteen times. Video further shows that he then stepped on Carter's hand and appears to lean forward to apply pressure and twist his foot. He later used one of his hands to apply a pressure point under Carter's chin. West argues that he is entitled to immunity because he was authorized to use such force and his conduct was not willful and wanton.
Under Illinois law, the unauthorized touching of another person constitutes a civil battery. Wilson v. City of Chicago , 758 F.3d 875, 879 (7th Cir. 2014). To be liable for battery, a defendant must intend to cause harmful or offensive contact, and in fact cause such harmful or offensive contact. See Bakes v. St. Alexius Med. Ctr. , 352 Ill.Dec. 902, 955 N.E.2d 78, 86 (Ill. App. Ct. 2011) (citations omitted). Plaintiff argues West made harmful or offensive contact when West stepped on Carter's hand, placed Carter in a "chokehold," and repeatedly kicked Carter's side with his foot. West asserts that, under Section 2-202 of the Tort Immunity Act, he can only be liable for "willful and wanton" conduct. The court finds that there is a disputed factual issue on whether West exhibited willful and wanton conduct.
Accordingly, West's Motion for Summary Judgment (#177) is also denied as to the other claim against him, Count IX. In short, West's Motion (#177) is denied in its entirety.
G. Plaintiff is Not Entitled to Summary Judgment on Her Battery Claim Against West and Macon County Sheriff's Department.
Plaintiff also moves for summary judgment on Count IX against West for battery and against Macon County Sheriff's Department under the doctrine of respondeat superior. In assessing Plaintiff's motion for summary judgment, the court must view the facts and make inferences in favor of West, the non-movant.
West argues that he is authorized to use some force in the face of non-compliant inmates and that Nurse Bates induced him to believe he was addressing an uncooperative inmate. West has proffered that his foot contact fell more on the side of a nudge rather than a kick and that he only did so because he was afraid that Carter could harm him if he put himself in a more vulnerable position at Carter's level. He stated that his "chokehold" was a valid pressure point move that is not intended to cause pain but is used to induce a detainee to comply. He similarly asserts that he "pressed" his foot into Carter's hand to prompt a response and avoid dragging Carter out of the cell.
Looking at the video of what West did to Carter as Carter lay on the floor of the medical unit cell largely unresponsive, a jury could certainly conclude that West's conduct was willful and wanton. A jury could alternatively conclude that West was following authorized procedures to elicit a response from an inmate feigning a medical need. At the summary judgment stage, the court must view the facts and inferences in favor of West. In short, this too is a jury question and Plaintiff has not reached her burden of demonstrating that there is no factual dispute that West's action was willful and wanton such that he is not protected under the state's immunity statute. Plaintiff's Motion for Partial Summary Judgment (#178) is therefore denied.
H. Macon County Sheriff's Department is Entitled to Immunity for Negligence Claims.
Plaintiff also brings state law claims against Macon County Sheriff's Department for institutional negligence (Count IV) and failure to properly train, monitor and supervise staff (Count VIII). Plaintiff asserts that Macon County Sheriff's Department is liable for having policies and practices that encouraged staff to ignore signs of medical distress and discouraging staff from calling emergency medical personnel. (#31 at 15).
Macon County Sheriff's Department argues that it is entitled to absolute immunity under the Illinois Tort Immunity Act. It argues that Section 4-103 of the Act ( 745 Ill. Comp. Stat. 10/4-103 ) applies to the institutional negligence claims. That section provides:
Neither a local public entity nor a public employee is liable for failure to provide a jail, detention or correctional facility, or if such facility is provided, for failure to provide sufficient equipment, personnel, supervision or facilities therein.
Macon County Sheriff's Department argues that as to the negligent supervision claims, Section 2-201 of the Tort Immunity Act also provides absolute immunity. This section ( 745 Ill. Comp. Stat. 10/2-201 ) provides:
Except as otherwise provided by Statute, a public employee serving in a position involving the determination of policy or the exercise of discretion is not liable for any injury resulting from his act or omission in determining policy when acting in the exercise of such discretion, even though abused.
Plaintiff argues that because the actions were willful and wanton, immunity does not apply. However, as Defendant points out, these sections do not contain any exceptions for willful and wanton conduct. See Payne for Hicks v. Churchich , 161 F.3d 1030, 1044 (7th Cir. 1998) ("Illinois courts have held that the immunity afforded by § 4–103 was intended by the Illinois legislature to be absolute"); Monson v. City of Danville , 425 Ill.Dec. 526, 115 N.E.3d 81, 88 (Ill. 2018), reh'g denied (Sept. 24, 2018) ("Read together, [ section 2-109 and 2-201 ] immunize a public entity from liability for the discretionary acts or omissions of its employee"); Thomas v. Sheahan , 499 F. Supp. 2d 1062, 1100 (N.D. Ill. 2007) (stating that under Section 4–103 of the Tort Immunity Act there "is no exception to this provision for willful or wanton conduct as alleged by Plaintiff").
Accordingly, Defendant Macon County Sheriff's Department's motion for summary judgment (#176) is granted as to the negligence claims asserted in Counts IV and VIII.
I. Plaintiff's Monell Claims Against DMH and Macon County Sheriff's Department Survive Summary Judgment.
Plaintiff brings Monell claims against DMH (Count III) and Macon County Sheriff's Department (Count II). Under § 1983, a municipality may be held liable for a constitutional violation due to an official policy (or lack thereof), a widespread practice or custom, or acts of an official who has final policy-making authority. Monell v. New York City Dept. of Social Services , 436 U.S. 658, 690, 98 S.Ct. 2018, 56 L.Ed.2d 611 (1978). Thus, to recover under Monell , Plaintiff must establish that (1) Carter suffered a deprivation of a constitutional right; (2) as a result of either an express municipal policy, widespread practice that is so permanent and well-settled as to constitute a custom with the final force of law, or deliberate act of a decision-maker with final policymaking authority; (3) which proximately caused the harm. See Lewis v. City of Chicago , 496 F.3d 645, 656 (7th Cir. 2007).
Counties cannot shield themselves from § 1983 liability by contracting with medical services providers. King v. Kramer , 680 F.3d 1013, 1020 (7th Cir. 2012). "The underlying rationale is not based on respondent superior , but rather on the fact that the private company's policy becomes that of the County if the County delegates final decision-making authority to it." Id.
To succeed on a failure to train claim, Plaintiff must show that the Defendants’ "failure to train its employees in a relevant respect evidences a ‘deliberate indifference’ " to the rights of inmates. Cornfield by Lewis v. Consolidated High School Dist. No. 230 , 991 F.2d 1316, 1327 (7th Cir. 1993) (quoting City of Canton v. Harris , 489 U.S. 378, 389, 109 S.Ct. 1197, 103 L.Ed.2d 412 (1989) ). The Supreme Court reasoned that policymakers are deliberately indifferent when "the need for more or different training is so obvious, and the inadequacy so likely to result in the violation of constitutional rights." Id. (quoting Canton , 489 U.S. at 389, 109 S.Ct. 1197 ). A municipality can be liable for failure "to train its employees with respect to a clear constitutional duty implicated in recurrent situations that a particular employee is certain to face." Id. (citing Canton , 489 U.S. at 390 n.10, 109 S.Ct. 1197 ).
The failure to develop or implement necessary policies or procedures can constitute a policy or custom for the purposes of Monell , if that failure causes a constitutional violation. Harris v. City of Marion, Ind. , 79 F.3d 56, 58 (7th Cir. 1996). "In addition, the [corporation's] inaction must amount to deliberate indifference, so that it is fair to infer that the inaction is itself a ‘policy.’ " Id. at 59. The Supreme Court has defined deliberate indifference as resting "somewhere between the poles of negligence at one end and purpose or knowledge at the other" and it is often equated with recklessness. Farmer v. Brennan , 511 U.S. 825, 836, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994) ; see also Duckworth v. Ahmad , 532 F.3d 675, 679 (7th Cir. 2008) (deliberate indifference is more than negligence but "less than purposeful").
i. Plaintiff provides sufficient evidentiary support for her claim that DMH and Macon County Sheriff's Department failed to properly train their staff and promulgate appropriate policies.
Accepting the facts in the light most favorable to Plaintiff, a reasonable factfinder could determine that there was a serious failure to train and promulgate appropriate policies by DMH and Macon County Sheriff's Department. DMH admits there were "no policies related to health care at the jail during the relevant timeframe in 2015." (#180 at 9). Plaintiff argues that, accordingly, there was a failure to appropriately monitor Carter's health and to appropriately coordinate his emergency transport.
Specifically, Plaintiff presented evidence that confusion was rampant among the jail staff and medical staff about who was authorized to call an ambulance. Dr. Braco also communicated to Nurse Bates about the cost of an ambulance ride and stated that the sheriff warned him to not call an ambulance, but to let his staff decide how to transport inmates.
Accordingly, Plaintiff points to this as evidence that Defendants inappropriately encouraged medical staff to take cost into consideration when determining appropriate treatment. Acciavatti testified that she had previously counseled Dr. Braco that she would worry about the budget and he should focus on providing the best medical care.
Dr. Braco and DMH also pointed at one another as the responsible parties for training new nurses. Dr. Braco asserted that he had no input on hiring new nurses and that DMH was responsible for training nurses. Acciavatti, however, claimed Dr. Braco was largely responsible for training new nurses. Nurse Bates described that she only received some on-the-job training.
DMH produced Fahey as its 30(b)(6) witness concerning policies and protocols at the jail. Although Fahey was the highest-ranking nurse at DMH during the relevant contract years, she testified she was unaware as to what training the nurses may have had or what protocols were in place. She also said it was Dr. Braco's responsibility to train the nurses.
Plaintiff suggests that training and policies were particularly important here, where LPNs were often at the jail without any supervision. Plaintiff presents evidence that DMH allowed LPNs to practice outside the scope of their licensure by providing medication without a prescription from Dr. Braco, and by deciding whether an inmate was fit to be released from the medical unit when Dr. Braco was not available. Plaintiff argues that placing LPNs in positions without tools to appropriately address medical situations that they will inevitably encounter at the jail predictably led to violations of the constitutional rights of detainees. Plaintiff argues that the indifference is even more extreme because DMH had no healthcare policies, diabetes protocol, or coordinated plan for emergency transport for detainees. Under the facts Plaintiff presented, a jury could find that the unconstitutional consequences of the failures to train LPNs and to promulgate appropriate healthcare policies are "plainly obvious" such that DMH and Macon County should be liable. Bryan Cty. v. Brown , 520 U.S. 397, 412, 117 S.Ct. 1382, 137 L.Ed.2d 626 (1997). Plaintiff also complains that DMH failed to adopt any healthcare policies to coordinate the care of patients with chronic diseases. The Seventh Circuit has stated that when "regulations are required to remedy a potentially dangerous practice, the County's failure to make a policy is also actionable." Thomas v. Cook County Sheriff's Dept. 604 F.3d 293, 303 (7th Cir. 2010) ; see also King , 680 F.3d at 1021 (where a municipality has "actual or constructive knowledge that its agents will probably violate constitutional rights, it may not adopt a policy of inaction").
DMH also appears to argue that Plaintiff failed to present evidence that different policies would have made a difference in the outcome, particularly as to calling an ambulance. (#180 at 16; #237 at 102). However, in Dr. Zawitz's expert report, he opines that around 10:15 a.m. on July 18th was likely Carter's last chance of survival and Carter required an emergency transport to the hospital to save his life. Dr. Zawitz also explains that by the afternoon of July 17th when Nurse Mattingly checked Carter's vital signs, Carter was likely in a state of ketoacidosis. He asserts that if Carter's vitals had been recognized as critical or a blood sugar check had been obtained, Carter likely could have received a timely medical assessment by Dr. Braco. When Dr. Braco conducted an eight-minute assessment of Carter later in the day, Dr. Zawitz opined that Carter would have had a reasonable chance of survival because he was awake, alert, and mobile. By 9 a.m. the next morning when Carter fell, Dr. Zawitz explained that his ketoacidosis was likely so severe that emergency medical transport would have been necessary to save his life. Accordingly, Dr. Zawitz's report supports Plaintiff's argument that failure to develop appropriate policies and train the necessary parties resulted in Carter's death.
ii. Plaintiff presents sufficient evidence to show that there is a policy at issue rather than a random event.
Defendants argue that because there is no evidence of other inmates dying or sustaining a serious illness as a result of the referred to customs and practices, Plaintiff's claim must fail.
The Seventh Circuit has explained that healthcare providers do not get "one free [death] pass." Woodward v. Corr. Med. Servs. of Illinois, Inc. , 368 F.3d 917, 929 (7th Cir. 2004). A plaintiff can establish a "single violation of federal rights, accompanied by a showing that Defendants failed to train their employees to handle recurring situations." Bryan County , 520 U.S. at 409, 117 S.Ct. 1382. The likelihood that a particular situation will recur and the high predictability that an officer lacking specific tools to handle the situation will violate citizens’ rights may justify a finding that a policymaker's decision to not train the employee reflects deliberate indifference to the obvious consequences of failure to train. Id. at 409, 117 S.Ct. 1382.
Plaintiff provides sufficient evidence to support her position that there were institutional failures and that "there is a policy at issue rather than a random event." Thomas , 604 F.3d at 303. Plaintiff points to the failure to appropriately coordinate the care of chronically ill patients, encouraging LPNs to practice outside their limited scope of practice, and the failure to appropriately train medical and jail staff on the issue of transporting inmates during a medical emergency.
This case is distinguishable from Hahn v. Walsh , 762 F.3d 617 (7th Cir. 2014), which Macon County cites to support its claim that Plaintiff must provide an example of another inmate suffering as a result of a gap in policy. There, the jail had policies for treating diabetic inmates and had a policy of not forcing medical care on a resistant inmate. Id. at 621–622. Medical staff repeatedly urged the inmate to allow them to check her blood sugar levels throughout the day. Id. at 625. Officers checked on the inmate sixty-one times during the night and began administering emergency medical care around 6:30 in the morning. Id. The inmate died later at the hospital due to diabetic ketoacidosis. Id. The alleged failure was not having a policy about how to address a diabetic inmate who refused to eat and refused to allow for blood sugar tests. Id. at 636. The court explained there was no evidence of previous problems to bring this particular risk to the attention of the policymakers. Id. at 637.
There, the municipality faced an unusual situation and the court found it could not be considered at fault for not having a policy when it did not know that it needed a policy. Here, the issue is that jail staff and medical staff did not know who could call an ambulance and in what circumstances, LPNs received very little training because it was not clear who should be training them, LPNs were compelled to practice beyond the scope of their licensure, and there was no clear, articulated policy about how to manage the treatment of diabetic inmates. The law requires that LPNs practice within the scope of their practice and NCCHC guidelines put the jail on notice that these policy gaps, failure to train, and customs were inappropriate.
Defendant DMH is not entitled to summary judgment on Count III, the Monell claim against it. DMH's Motion for Partial Summary Judgment (#179) is denied.
Defendant Macon County Sheriff's Department is not entitled to summary judgment on Count II, the Monell claim against it. Its Motion for Summary Judgment (#176) is denied as to Count II.
J. Plaintiff Provided Sufficient Support for her Claims Against Nurse Bates.
Against Defendant Bates, Plaintiff brings medical malpractice claims (Counts VI and VII) and a delay or denial of care claim under § 1983 (Count I). Defendant Bates seeks summary judgment in her favor on all the claims against her.
i. Plaintiff's expert is qualified to render an opinion on the nursing standard of care.
Defendant Bates filed a Motion in Limine to exclude Kimberly Pearson's expert opinion (#200-4). In a separate Order (#243), the court denies that motion. The court will consider Pearson's opinion where relevant to the summary judgment motions.
ii. Plaintiff provides sufficient evidentiary support for her malpractice claim.
To sustain an action for medical negligence, the plaintiff must establish (1) the standard of care in the medical community by which the medical professional's treatment is measured; (2) negligent failure by the medical professional to comply with the standard of care; and (3) the resulting injury was proximately caused by the deviation from the standard of care. Purtill v. Hess , 111 Ill.2d 229, 95 Ill.Dec. 305, 489 N.E.2d 867, 872 (1986) ; Wiedenbeck v. Searle , 385 Ill.App.3d 289, 324 Ill.Dec. 352, 895 N.E.2d 1067, 1069 (2008). Generally, each element of a medical malpractice claim must be proven by expert testimony. Alm v. Loyola Univ. Med. Ctr. , 373 Ill.App.3d 1, 310 Ill.Dec. 641, 866 N.E.2d 1243, 1248 (2007). a. Plaintiff provides sufficient evidence of the standard of care and Nurse Bates's failure to meet the standard of care.
Taking the facts in the light most favorable to Plaintiff, Nurse Bates first violated the standard of care by failing to communicate to Dr. Braco that on the evening of July 17th Carter's mother called describing the symptoms of diabetic ketoacidosis. Nurse Bates's own expert, Nurse Muse, agreed that if Bates failed to communicate that information to Dr. Braco, it would violate the standard of care. (#198-4 at 34).
Then, on the morning of July 18th, Bates failed to give Carter his prescription Metformin for managing diabetes, despite writing down that she provided the medicine. She then exceeded the scope of her license by determining that Carter was faking his illness when he appeared unable to stand on his own or make any meaningful response to outside stimuli. Based on her assessment that Carter was "faking," Bates had Carter moved from his medical cell and induced a corporal to determine that a segregation unit was appropriate due to Bates reporting that Carter was fine and simply being uncooperative.
In her deposition, Nurse Bates even admitted that it would be beyond the scope of her practice to determine whether an individual was faking an illness. Nurse Muse observed that, based on the videos, it was obvious that Carter had medical needs. (#198-4 at 36). She further explained that, based upon what she was able to see, the standard of care for a nurse would have been to take Carter's vital signs and report to a medical practitioner with a higher level of practice. (#198-4 at 37).
Instead, Nurse Bates moved Carter, even though Dr. Braco expected Carter to remain in the medical unit until Dr. Braco visited him again that next day. The video depicts the guards essentially dragging Carter from his cell while he is unresponsive. Nurse Bates does not contact the doctor or check Carter's blood sugar, and she does not appear to check any of his vital signs or to try to assess Carter's health before having him removed from the cell. Even after one of the officers complains that Carter is cool to the touch, Bates does little to investigate whether Carter is in good health.
Nurse Bates only checked Carter's blood sugar at the urging of a correctional officer which prompted her to call Dr. Braco. During this conversation, she did not provide a complete description of the situation. Dr. Braco felt that based upon his review of the video of Carter in his medical cell on the morning of July 18th, Nurse Bates significantly diminished the seriousness of Carter's symptoms. He testified that he was shocked by the video and felt that Nurse Bates misled him about Carter's health. He said that Bates never told him that she found Carter on the floor. He said he would have ordered immediate medical transport based upon what he saw in the video.
Plaintiff also points to the testimony of several correctional officers who testified that, contrary to Nurse Bates's report to Dr. Braco, Carter was not walking or talking that morning. Instead, their description of him was that he was largely unresponsive and never walked on his own. Dr. Braco also testified that he gave Nurse Bates permission to call an ambulance if she felt that it was an emergency, but she then insisted to officers that per Dr. Braco's orders, Carter could only be transported to the hospital in a squad car. Nurse Pearson explained that as an LPN, the standard of care required Nurse Bates to report accurate information to treating physicians. Bates also failed to create a transfer summary or pull together any medical paperwork that might go with Carter to the hospital. Nurse Pearson explained that nurses transferring a patient to another facility are to create a transfer summary that provides information to the receiving facility about the patient's general condition, diagnoses, and medications. Moreover, when nurses have a patient that is in serious medical need, a reasonably careful nurse would stay with the patient until they are taken over by another provider. Instead, Nurse Bates was trying to leave early from her shift to go boating. Officers found Carter unresponsive and called Nurse Bates back to the cell as she was attempting to leave the building early. Accordingly, Plaintiff has provided sufficient evidence of the standard of care and Nurse Bates's failure to meet that standard.
b. Plaintiff provided sufficient evidence to support her position that Nurse Bates's failure to provide adequate care proximately caused Carter's death.
In malpractice claims, the element of proximate cause must be established through expert testimony to a reasonable degree of medical certainty. Simmons v. Garces , 198 Ill. 2d 541, 566, 261 Ill.Dec. 471, 763 N.E.2d 720 (2002). To establish proximate cause, the plaintiff must provide evidence that the defendant's negligence "more probably than not" caused the plaintiff's injury. Holton v. Memorial Hospital , 176 Ill.2d 95, 223 Ill.Dec. 429, 679 N.E.2d 1202, 1209 (1997). Proximate cause may be established where the defendant's conduct "increased the risk of harm" to the patient or "lessened the effectiveness" of the patient's treatment. Id. , 223 Ill.Dec. 429, 679 N.E.2d at 1206-07. Generally, establishing proximate cause is "fact specific and therefore uniquely within the jury's determination." Id.
The above-mentioned standard of care violations related to treating and managing Carter's diabetes. As Carter's death was due to diabetic ketoacidosis, there is sufficient evidence to create a factual dispute on the issue of whether Nurse Bates's failures more probably than not increased Carter's risk of harm or lessened the effectiveness of treatment.
Nurse Bates's motion is therefore denied as to the medical malpractice claims against her, Counts VI and VII.
iii. Plaintiff provided sufficient evidentiary support for her claims that Bates delayed or denied Carter's access to treatment.
Plaintiff also brings a claim against Nurse Bates for delay or denial of care under § 1983 (Count I). To show that a delay in providing treatment is actionable, a plaintiff must provide evidence that the delay exacerbated the injury or unnecessarily prolonged pain. Williams v. Liefer , 491 F.3d 710, 716 (7th Cir. 2007) (delay actionable where medical records showed that delay unnecessarily prolonged the plaintiff's pain and high blood pressure ); Gil v. Reed , 381 F.3d 649, 662 (7th Cir. 2004) (hours of needless suffering can constitute harm); Dobbey v. Mitchell-Lawshea , 806 F.3d 938, 940 (7th Cir. 2015) ("A dentist demonstrates deliberate indifference by failing to treat the patient promptly, thus prolonging the patient's pain while knowing that the patient may well be in serious pain that is treatable"); Rowe v. Gibson , 798 F.3d 622 (7th Cir. 2015) (limiting the administration of heartburn medication to certain times of day could amount to deliberate indifference given prisoner's alleged severe pain, which could have been avoided if medication had been administered earlier). Taking the facts in the light most favorable to Plaintiff, Nurse Bates: failed to test Carter's blood sugar in his first four days in custody and only did so on Carter's final morning at the urging of an officer; failed to tell Dr. Braco about Carter's mother's call relaying his symptoms of distress and concern about his diabetes; failed to give Carter his Metformin on July 18th; practiced outside her scope by assessing Carter as faking his condition; failed to accurately communicate Carter's deteriorating health to Dr. Braco; failed to coordinate emergency transport; and failed to stay with her patient who was in medical distress, instead trying to leave work early.
The video shows that Nurse Bates was barely in Carter's cell the morning of July 18th, providing support for Plaintiff's position that Bates could not have adequately evaluated Carter before she indicated to officers that Carter was fine and telling Corporal West that Carter was faking his illness.
Plaintiff sufficiently supports her claims that Bates delayed or denied Carter's access to treatment, so Nurse Bates's motion is also denied as to the claim against her in Count I. Because all the claims against her now survive summary judgement, Bates's motion (#172) is denied in its entirety.
IV. CONCLUSION
IT IS THEREFORE ORDERED THAT:
1) Defendant Jo Bates's Motion for Summary Judgment (#172) is DENIED;
2) Defendants Terry Collins, Joshua Page, Larry Parsano, and Michael Patton's Motion for Summary Judgment (#175) is DENIED;
3) Defendant Macon County Sheriff's Department's Motion for Summary Judgment (#176) is GRANTED in part as to Counts IV and VIII and DENIED in part as to Counts I, II, and IX;
4) Defendant Randell West's Motion for Summary Judgment (#177) is DENIED;
5) Plaintiff's Motion for Partial Summary Judgment (#178) is DENIED;
6) Defendant Decatur Memorial Hospital's Motion for Partial Summary Judgment (#179) is DENIED.
7) This matter remains set for a final pretrial conference on July 27, 2020 at 11:00 a.m., and a jury trial to begin on September 8, 2020 at 9:00 a.m.