ROBERT J. SHELBY, District Judge.
This case arises out of a ten-day delay in obtaining an x-ray procedure for an inmate whose hip was fractured while incarcerated at the Utah County Jail in March 2010. The plaintiff, Laurie Jenkins, filed suit under § 1983, alleging Defendants acted with deliberate indifference to her medical needs in violation of the United States Constitution. Ms. Jenkins seeks to recover against two municipal entities, a private medical contractor, and numerous individuals.
All of the parties move for summary judgment on liability. For the reasons stated below, Plaintiff's Amended Motion for Partial Summary Judgment on Liability
Ms. Jenkins asserts three causes of action in her Second Amended Complaint: (1) Deliberate Indifference — Failure to Provide Proper Medical Care; (2) Deliberate Indifference — Inflicting Wanton and Unnecessary Pain; and (3) "Monell" Violations of the Eighth and Fourteenth Amendment.
The Second Amended Complaint names several entities as defendants. Defendants Utah County and Utah County Jail are named in an official capacity. Defendant Schryver Medical, Inc., an independent contractor that provided limited medical services to inmates, was named as a defendant in its individual, official, and corporate capacity.
Ms. Jenkins also names numerous individual Defendants, including Todd McAllister, Alan Harris, Vickie Nostrom, Dale Bench, and Heidi Duke. During the relevant time period, Mr. McAllister and Mr. Harris worked as nurses at the Utah County Jail. Ms. Nostrom worked as an office specialist at the Utah County Jail. Mr. Bench worked as Utah County Jail's Health Services Administrator. Schryver employed Ms. Duke as a radiology technician. Ms. Jenkins named these defendants in their individual and official capacities.
Ms. Jenkins moves for partial summary judgment under two theories.
Defendants Utah County, Nurse McAllister, Nurse Harris, Ms. Nostrom, and Mr. Bench ("Jail Defendants") move for summary judgment under five theories: (1) Utah County and official-capacity defendants cannot be liable under § 1983 because of the high standard for municipal liability; (2) Ms. Jenkins fails to show a causal link between Mr. Bench and her injury;
(3) none of the Defendants acted with deliberate indifference; (4) qualified immunity immunizes the individual employees; and (5) the statute of limitations bars Ms. Jenkins's claims.
Defendant Schryver also moves for summary judgment.
For the most part, the parties do not dispute the nature of Ms. Jenkins's injury, the date of the treatment, or the general timeline of events. The court will first address the timeline of relevant events and then turn to the factual issues that remain in dispute.
The timeline of events is central to the required analysis. Ms. Jenkins was injured and received treatment over a period of ten days in March 2010. The events that culminated in this case began on March 21, when Ms. Jenkins was arrested and booked into Utah County Jail.
On March 22, Ms. Jenkins fell from the upper bunk in her cell and landed on her left side. She reported her fall to a deputy, who in turn notified a nurse. Later that morning, a nurse escorted Ms. Jenkins to an appointment with Dr. Keith Hooker, who examined Ms. Jenkins, prescribed 800 mg of Motrin, and instructed the clinical nurse, Nurse McAllister, to order an xray to "rule out a fracture." Dr. Hooker did not request an emergency x-ray or transfer of Ms. Jenkins to the hospital. At that time, Nurse McAllister did not notice anything distinctive about Ms. Jenkins's leg or hip or see any obvious medical injury. Dr. Hooker did not provide Ms. Jenkins with crutches, and she walked to and from her cell and the clinic. Shortly thereafter, Ms. Jenkins received Motrin. Later that day, Nurse McAllister entered the x-ray order into the Jail's computer system, which in turn generated an x-ray order form.
On March 23, Ms. Nostrom, an office specialist who processes x-ray requests, came to work and discovered that Ms. Jenkins had not been x-rayed on March 22. Ms. Nostrom faxed an order to Schryver, scheduling the x-ray for March 24. That same day, Ms. Jenkins submitted a medical request form to Ryan Harris, who worked as a nurse in the Jail.
On March 24, Ms. Nostrom left the Jail for a personal appointment with her doctor. She did not return to work for approximately five days. On that same day, Heidi Duke, a radiology technician employed by Schryver, visited Utah County Jail and attempted to complete the x-ray order for Ms. Jenkins. But Ms. Duke was unable to conduct the x-ray because Ms. Jenkins was "out to court" at the time of her visit. Ms. Duke's log attributes the cancellation of the order to Nurse McAllister.
On March 26, Ms. Jenkins requested and received another medical request form.
Ms. Jenkins submitted a second medical request form on March 27. Ms. Jenkins wrote: "See Doc about Leg — X-ray????/Nerve Pain/Nerve Spasems [sic]." The form was returned to Ms. Jenkins with a request for additional information.
On March 28, Ms. Jenkins resubmitted the form with additional information. She wrote, "[F]eel [sic] off the Top Bunk first night I came in still haven't been checked hurt really bad you [sic] guy is doing nothing about it." The form was marked received on March 29. The response to the inmate request reads: "On the list for the Dr."
Ms. Nostrom returned to the Jail on March 29, after four-and-a-half days of personal leave. She discovered an x-ray order on her desk. Ms. Nostrom contacted Nurse McAllister to discuss the order. Although there is a dispute over whether Nurse McAllister contacted Schryver to learn whether the x-ray had been completed, Ms. Nostrom's conversation with Nurse McAllister led her to believe that the x-ray had been completed, and the Jail was awaiting the results. Ms. Nostrom indicated this in the records by changing the order status to "completed."
Ms. Nostrom purportedly refaxed the x-ray order to Schryver on March 30.
On March 31, Nurse McAllister, who typically does not conduct follow-ups on x-ray orders, viewed the physician's list, which indicated that Ms. Jenkins's procedure was still incomplete.
Schryver's report, which was delivered later that day, showed a sub-capital femoral neck fracture to Ms. Jenkins's hip. After receiving notice of the fracture, Dr. Hooker ordered that Ms. Jenkins be transported to the hospital for immediate treatment.
In March 2010, the Utah County Jail's internal process for ordering a non-emergent x-ray involved three steps: (1) an employee input the order into an internal computer program; (2) an employee selected a particular date in the program; and (3) an employee printed out the order and faxed it to Schryver. Once the order was submitted, Schryver would send a technician to take the x-ray.
Schryver's view of internal practices and procedures differs slightly from the perspective proffered by Utah County Jail. The parties do not dispute that Schryver's contract with Utah County Jail provided for routine x-ray procedures and STAT x-ray procedures. A STAT x-ray must be called into Schryver and specifically identified. According to Schryver, a regular x-ray order would typically be completed "if not the next day, the day after" the request. In contrast to Jail Defendants, Schryver maintains that an x-ray order would be automatically cancelled if the inmate was in court, and that Utah County Jail was responsible for reordering the procedure if the inmate returned to the facility and the procedure was still necessary.
At the time of these events, Mr. Bench acted as Health Services Director at Utah County Jail. As part of his duties, Mr. Bench supervised Ms. Nostrom and also reviewed and revised policies and procedure for inmate health services. Because he is not a licensed physician, Mr. Bench does not supervise physicians. His responsibilities require him to understand whether there were any problems with the overall delivery of medical care at the Jail. He had no personal involvement in Ms. Jenkins's treatment, and he first became aware of the lapse in her treatment after March 31. The parties dispute whether Mr. Bench was a final policymaker, and whether Mr. Bench was aware of any deficiencies in physician care or nursing treatment.
James Tracy served as elected Sheriff of Utah County at the time of the incident. Sheriff Tracy signs and approves all Jail policies. He does not personally supervise administration of the Jail, the other defendants, or administration of medical care. Sheriff Tracy had no personal involvement with Ms. Jenkins. The parties dispute whether Sheriff Tracy is Utah County's final policymaker or is ultimately responsible for administration and management of the Jail.
Finally, the parties dispute whether Schryver left CDs containing x-rays at the Jail after completing procedures, as well as the inference that should be drawn from the possibility that CDs had been left in other cases. Citing Ms. Duke's testimony, Ms. Jenkins argues that Schryver was required to leave a CD for every completed x-ray before leaving the Jail. But according to Nurse McAllister, Schryver would not leave a CD in every case, and if there was an "abnormal emergent finding," it would be communicated to a physician or clinical nurse on duty, which would not necessarily be Nurse McAllister. Moreover, Ms. Nostrom testified that receipt of a final radiology report from Schryver signaled that the x-ray had been completed.
The disputes in this case center mainly around three areas: (1) the dates on which Jail Defendants sent orders to Schryver; (2) internal practices for cancelling x-ray procedures and the effect of an inmate's court appearance; and (3) the employees' knowledge of both Ms. Jenkins's pain and the status of the x-ray order during the relevant ten-day period.
The parties dispute the exact dates that Jail employees ordered x-ray procedures for Ms. Jenkins. According to Jail Defendants, Nurse McAllister or another employee faxed the initial order to Schryver on March 22, and Ms. Nostrom resent the order on March 23. In support of this theory, Jail Defendants provide testimony from employees and cite the print date listed on the order form generated by the Jail's computer. Ms. Jenkins, in contrast, contends that the date listed on the order form was the date of its creation—not the date that Schryver actually received the form. Accordingly to Ms. Jenkins, Schryver has no record of receiving an order until March 24, two days after the injury occurred.
A similar dispute surrounds the date Jail employees purportedly sent a second x-ray order to Schryver after Ms. Jenkins's missed her first appointment due to her court appearance. Jail Defendants contend that an employee of Utah County Jail sent another x-ray order to Schryver on March 30. Citing the fact that Schryver does not have any paper record of a March 30 order, Ms. Jenkins maintains that the final order was not sent until March 31.
The parties also dispute the significance that should be attached to language in the x-ray order sent to Schryver. According to Jail Defendants, all orders were marked "today," even though they often would not be completed on the day they were sent. In contrast, Ms. Jenkins maintains that the fact an order was marked "today" underscores its urgency.
The parties dispute whether a court appearance on March 24 automatically cancelled Ms. Jenkins's procedure. For example, if an inmate was unavailable due to a court appearance, Jail Defendants contend that the inmate's x-ray procedure would be automatically rescheduled or attempted until Schryver completed the order. Jail Defendants also maintain that only physicians could cancel procedures. In contrast, Ms. Jenkins and Schryver maintain that if a procedure did not occur, Utah County Jail was responsible for rescheduling or reordering the procedure if the x-ray was still necessary.
Similarly, the parties dispute whether Nurse McAllister cancelled the procedure on the date of Ms. Jenkins's court appearance. Ms. Jenkins maintains that Nurse McAllister signed Ms. Duke's log on March 24 and cancelled the procedure. Nurse McAllister denies both of these allegations.
The undisputed facts show that neither Mr. Bench nor Sheriff Tracy had knowledge of Ms. Jenkins's injury or the missed x-ray appointment. In their papers, the parties do not seriously dispute the knowledge of Ms. Duke or Nurse Harris. Instead, the central dispute is the extent to which Ms. Nostrom or Nurse McAllister possessed knowledge of Ms. Jenkins's injury or suffering.
For example, the parties dispute whether Ms. Nostrom possessed knowledge of Ms. Jenkins's injury. Ms. Nostrom submitted an affidavit denying personal knowledge of the injury, other than the need to get an x-ray scheduled. Ms. Nostrom was also absent from the Jail from March 24 to March 29. In response to Ms. Nostrum's absence, Ms. Jenkins contends that the initial x-ray order, the change on Ms. Nostrom's log, and her interactions with Nurse McAllister on March 29 suggest that Ms. Nostrum knew of Ms. Jenkins's pain and suffering.
The parties dispute Nurse McAllister's state of mind in two significant respects. First, Nurse McAllister denies being aware of any change in scheduling the procedure from March 22 to March 24. He also denies knowledge of any missed appointments prior to March 31. In response, Ms. Jenkins argues that there is evidence suggesting that Nurse McAllister cancelled the procedure on March 24. According to Ms. Jenkins, Nurse McAllister also knew of the delay because Ms. Nostrom inquired about the status of the x-ray after returning to work on March 29.
Second, although the parties agree that Nurse McAllister never received any inmate medical requests on March 23 or March 28, they dispute whether or not he understood that Ms. Jenkins was suffering as she awaited the x-ray. Jail Defendants believe that Nurse McAllister could not and should not have been aware of the missed appointment because it would have been a common procedure for another on-duty nurse to learn the results of an x-ray. In response, Ms. Jenkins argues that Jail employees should have been aware of the court appointment.
The court grants summary judgment when "there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law."
In this case, the three motions for summary judgment raise five significant issues: (1) whether Schryver acted under color of state law by contracting to provide x-ray services to Utah County Jail; (2) whether Utah County, Utah County Jail, Schryver, or any official-capacity defendant may be liable under § 1983; (3) whether any of the individual Defendants are entitled to qualified immunity; (4) whether, as a matter of law, the undisputed facts demonstrate the individual Defendants possessed the requisite state of mind; and (5) whether Utah's statute of limitations bars Ms. Jenkins's claims. The court will address each of these issues in turn.
As a threshold matter, Schryver argues that it is entitled to summary judgment because an independent contractor who provides medical services to a jail, but lacks supervisory control over an inmate, does not act under color of state law, an element of liability under § 1983.
To act under color of state law, a defendant must have "exercised power possessed by virtue of state law and made possible only because the wrongdoer is clothed with the authority of state law."
This principle is reflected in the holding of West v. Atkins.
Similar considerations apply to the contractor in this case. Here, Schryver entered into a contractual relationship with Utah County. By virtue of this relationship, Schryver received authorization to perform x-ray services on inmates, who in turn necessarily relied almost solely on Schryver to provide "adequate" radiological services.
Schryver argues that West and similar cases are distinguishable because Schryver lacked control over Ms. Jenkins's treatment. The court disagrees. Schryver relies on cases that predate the Supreme Court's careful analysis of state action in an analogous context in West.
In other words, Schryver's proposed bright-line approach is a restrictive, inflexible standard inconsistent with existing case law. Instead, the proper inquiry is whether Ms. Jenkins demonstrated that Schryver's provision of medical services was exercised by virtue of state authority such that defects in medical diagnosis are fairly attributable to state actors. Ms. Jenkins made this showing. Accordingly, Schryver is not entitled to summary judgment under § 1983 on the basis that it provided limited medical services to inmates as an independent contractor.
The parties dispute whether the official-capacity defendants and municipal entities are liable for Ms. Jenkins's injuries as matter of law.
Ms. Jenkins has named several entities and individuals as official-capacity defendants, including Utah County, Utah County Jail, Mr. Bench, Nurse McAllister, Ms. Nostrom, Nurse Harris, Schryver Medical, and John and Jane Does.
An official-capacity suit against an individual is essentially a suit against the entity that employs the individual.
In this case, the parties' briefing illustrates the confusion that often arises out of attempting to establish liability against both the entity and individual defendants in an official capacity. For the purpose of clarity, the court will treat the official-capacity claims against the individual Defendants as claims against their respective employers. Accordingly, the central issue raised by Ms. Jenkins's official-capacity claims at this stage is whether the undisputed facts prove that municipal or entity liability attached to Utah County, Utah County Jail, or Schryver.
Section 1983 does not impose liability on a municipality or entity merely because one of its employees violated another's constitutional rights while acting under color of state law.
To satisfy the first element, a plaintiff must identify an official policy or custom, which may include "a formally promulgated policy, a well-settled custom or practice, a final decision by a municipal policymaker, or deliberately indifferent training or supervision."
The Tenth Circuit has made two additional observations about municipal liability claims relevant to this court's analysis. When evaluating whether the decision of a final policymaker gives rise to liability, "proof of a single incident of unconstitutional activity is ordinarily not sufficient" unless the plaintiff demonstrates "the particular illegal course of action was taken pursuant to a decision made by a person with authority to make policy decisions."
In her opening brief, Ms. Jenkins argues that Utah County and Utah County Jail violated the Eighth Amendment by failing to adopt a policy that would ensure completion of every x-ray order for inmates. In subsequent filings, Ms. Jenkins expands on this theory by advancing other failures to act: (a) failure to have sufficient staff; (b) failure to adequately train employees; or (c) failure to create redundancies that would ensure that every x-ray was completed.
The court will assume for the purposes of its analysis that Ms. Jenkins has identified a policy or custom capable of supporting liability under § 1983.
In response, Ms. Jenkins appears to argue that the policy in this case was "obviously deficient or non-existent."
In concluding that no reasonable jury could find municipal liability in this case, the court is mindful of the principle that a single incident may, but often does not, form an appropriate basis for municipal liability.
It is not clear from the briefing whether the parties understood that the Monell standard applies with equal force to Schryver if, as the court has concluded, Schryver acted under color of state law.
After careful consideration, the court concludes that Ms. Jenkins failed to demonstrate the requisite state of mind for imposing liability on Schryver. Specifically, there is no evidence that Schryver had actual or constructive notice that its policy or custom was "substantially certain" to result in this type of injury, especially where Ms. Jenkins fails to proffer any specific evidence of this type of error occurring prior to this incident. Moreover, no reasonable jury could find Schryver's internal practices at the time or its failure to adopt a more demanding company policy caused a violation of Ms. Jenkins's rights under the Tenth Circuit's "rigorous" standard where, as here, Schryver's role in this case was limited to performing non-emergent x-rays on inmates in the custody and control of Utah County Jail at the direction of its employees. In other words, Schryver's circumscribed role in the medical treatment of inmates, its inability to impose policies on Jail Defendants, and its limited access to Ms. Jenkins compel the conclusion that no jury could find the requisite causal nexus between Schryver's conduct and Ms. Jenkins's injury.
Ms. Jenkins nevertheless maintains that Schryver's policies and training were deficient.
The court disagrees with Ms. Jenkins's broad application of City of Canton. Subsequent cases have suggested that its reach is limited.
To the contrary, according to Schryver and Ms. Jenkins, Schryver adopted internal policies that placed on Jail employees the onus of ensuring that absent inmates later received xrays if necessary. Under this approach to the facts, Schryver cannot "reasonably be said to have been deliberately indifferent" to an obvious need.
In sum, because no reasonable jury could conclude that Schryver acted with deliberate indifference or adopted a policy or custom that bore a direct relationship to Ms. Jenkins's injury, Schryver is entitled to summary judgment.
The third issue is whether the individual employees are entitled to qualified immunity. According to Defendants, Ms. Jenkins's injuries resulted from a miscommunication between Utah County Jail and Schryver, and none of the employees had the requisite state of mind to impose liability under § 1983. Ms. Jenkins disagrees, arguing that several of the employees acted with deliberate indifference to Ms. Jenkins's pain and suffering.
Qualified immunity shields government officials performing discretionary functions when an implicated constitutional right is unclear or the officer performs reasonably in light of the constitutional context.
For a right to be clearly established, it must be sufficiently clear that a reasonable officer would understand that the conduct constitutes a constitutional violation.
When considering whether a right has been violated at the summary judgment stage, a district court must "examine the facts . . . in the light most favorable to the plaintiff, to determine individual defendant possessed the requisite state of mind for imposing liability given the circumstances. Accord. Harris v. Coweta Cnty., 21 F.3d 388, 394 (11th Cir. 1994) (noting that delay may constitute deliberate indifference). whether they amount to a violation of a clearly-established right."
Although courts often start the qualified immunity analysis by asking whether a right has been violated, a district court may begin with the clearly established inquiry.
In this case, Ms. Jenkins satisfied her burden of demonstrating the existence of a clearly established right. The Supreme Court and Tenth Circuit have recognized that a "prison official's deliberate indifference to an inmate's serious medical needs violates the Eighth Amendment."
(2) a prison official preventing an inmate from receiving medical treatment or denying access to medical personnel capable of evaluating the inmate's condition."
Given the Tenth Circuit case law on this point, Jail Defendants' argument that the right was not clearly established is unavailing. Here, a reasonable employee of a jail in the Tenth Circuit would have understood that delaying access to medical diagnosis or treatment for a serious medical condition, such as a possible broken bone, may rise to the level of deliberate indifference and constitute a violation of the Eighth Amendment. This is especially true where, as here, one or more employees are responsible for facilitating access to personnel capable of providing treatment ordered by a physician. Tenth Circuit case law involving deliberate indifference and medical treatment in this context is not so general as to deprive reasonable employees of notice of their constitutional obligation. Ms. Jenkins satisfied her burden of demonstrating a clearly established right in the context of this case.
Although the Eighth Amendment imposes an obligation on prison officials to care for the medical needs of inmates, an inmate seeking to establish a constitutional violation under § 1983 must present evidence of objective and subjective deliberate indifference.
The Tenth Circuit's decision in Sealock v. Colorado is instructive. In Sealock, an inmate experiencing sweating, vomiting, chest pain, trouble breathing, and a pale appearance requested a correctional officer.
The inmate sued Officer French, Sergeant Barrett, Nurse Huber, and P.A. Havens. The district court granted summary judgment in favor of the individual defendants on the basis of qualified immunity.
The Tenth Circuit reversed summary judgment for Sergeant Barrett and P.A. Havens, but affirmed summary judgment for Nurse Huber.
The Tenth Circuit held that Sergeant Barrett "knew of and disregarded" excessive risk when he observed heart attack symptoms but refused to take the inmate to the hospital and instructed him not to die on shift.
More recently, the Tenth Circuit characterized the burden for demonstrating a culpable state of mind in this context as follows: "The [state of mind] may be demonstrated by a showing of [the state actor's] (a) conscious disregard of a substantial risk of serious harm arising from [the inmate's symptoms], or (b) actual knowledge of [the inmate's condition] and refusal to order further treatment."
In this case, the court finds that Dr. Hooker's diagnosis of a possible hip fracture, his order for a diagnostic x-ray, and the pain and suffering accompanying delay in obtaining the xray and diagnosis satisfies the objective component of the deliberate indifference test. The court will now consider each of the Jail employees individually and analyze whether Ms. Jenkins can satisfy the subjective component of the deliberate indifference inquiry.
The court will first identify the facts from which a reasonable jury could conclude that Nurse McAllister was deliberately indifferent to Ms. Jenkins's medical needs. According to Ms. Jenkins, Nurse McAllister failed to order the x-ray in a timely manner. Although the parties dispute the inferences that should be drawn from Ms. Jenkins's physical symptoms, Nurse McAllister possessed awareness of the injury, the clinic appointment, the x-ray order, and a ten-day delay in completing the procedure. While Nurse McAllister insists that either he or another Jail employee faxed the order to Schryver shortly after the clinic appointment, Schryver's records suggest it first received a faxed order for Ms. Jenkins on March 24, with a second order on March 31. There is at least some evidence or testimony that Nurse McAllister may have cancelled the procedure on March 24. Finally, setting explanations aside, Nurse McAllister did not check or follow-up on the status of the order until at least March 29.
By presenting this evidence, Ms. Jenkins satisfied her burden of demonstrating a right was violated at least for the purposes of the qualified immunity analysis. A reasonable jury could find that Nurse McAllister knew of an excessive risk to Ms. Jenkins's safety because he interacted with Ms. Jenkins, participated in the clinic appointment, possessed knowledge of the possibility of a fracture, knew an x-ray had been ordered, and received an inquiry about the procedure five days after the initial clinic appointment. Similarly, a jury could conclude Nurse McAllister, as the gatekeeper responsible for submitting the initial order on March 23, disregarded an excessive risk by (a) failing to timely order the x-ray, (b) cancelling the procedure on March 24, or (c) failing to ensure Schryver completed the x-ray after receiving some notice that the order remained outstanding days after the initial appointment. In this respect, Nurse McAllister is analogous to Sergeant Barrett or P.A. Havens in the Sealock decision, where qualified immunity was denied to jail personnel with knowledge of an inmate's potentially serious medical condition and there was significant delay in providing treatment to the inmate.
For all of the reasons above, a reasonable jury could find Nurse McAllister's failure to respond actively or effectively on several occasions throughout a ten-day period constituted deliberate indifference. Because Ms. Jenkins presented sufficient evidence of a constitutional violation, Nurse McAllister is not entitled to qualified immunity.
The court next identifies the facts relevant to Ms. Nostrom's claim of qualified immunity. Ms. Nostrom testified she was responsible for scheduling x-ray procedures. Ms. Nostrom knew that a physician had ordered an x-ray for Ms. Jenkins's hip. Although the hip injury occurred on March 22, Ms. Nostrom scheduled the procedure for March 24. In doing so, Ms. Nostrom either failed to verify or ignored a court appearance scheduled on March 24. Along a similar vein, there is evidence that Schryver's practice was to automatically cancel an order when an inmate was out for court. Schryver maintains that Jail employees must resubmit an x-ray order after any cancellation. Ms. Nostrom found an order form for an x-ray for Ms. Jenkins on her chair five days after March 24. The form did not indicate whether the procedure had been completed. Ms. Nostrom testified that she ordinarily learned whether Schryver completed a procedure when she received a faxed radiologist report from Schryver. Despite this testimony and Ms. Jenkins's court date, Ms. Nostrom's initial response after returning to work on March 29 was limited to asking Nurse McAllister about the status of the procedure. She ordered another x-ray on March 30 or March 31. When Ms. Nostrom learned Schryver had not received the renewed order on March 31, she took additional steps to ensure that a Schryver technician completed the x-ray that day.
After careful consideration of these facts, the court concludes that Ms. Jenkins provided sufficient evidence for a jury to find that Ms. Nostrom possessed the requisite state of mind to establish a constitutional violation. Although Ms. Nostrom lacked medical training or any personal interaction with Ms. Jenkins, internal records demonstrate that Ms. Nostrom knew that a physician ordered an x-ray for Ms. Jenkins. A reasonable jury could find that Ms. Nostrum acted as the gatekeeper to radiological services by virtue of her responsibilities at the Jail. Although the evidence is largely circumstantial, a reasonable jury could conclude Ms. Nostrom disregarded an excessive risk of harm when she scheduled the procedure on March 24 but failed to verify whether Ms. Jenkins would be in court on that date.
Moreover, there is no evidence before the court that Ms. Nostrum made arrangements for anyone at the Jail to follow-up on Ms. Jenkins's procedure during her personal absence. This supports an inference that Ms. Nostrum failed to notify another employee about the x-ray order during an extended absence. In this respect, a reasonable jury could find that Ms. Nostrum's failure to take adequate steps to ensure the completion of x-rays during her absence reflects a conscious disregard of a significant risk of harm to Ms. Jenkins.
Finally, Ms. Nostrom failed to verify the status of Ms. Jenkins's procedure after returning to work on March 29. Because Ms. Nostrum did not find a final report when she returned to her office after an extended absence, the evidence supports at least an inference that Ms. Nostrom should have done more to investigate, prioritize, or expedite Ms. Jenkins's care. A jury could also draw an inference of deliberate indifference where, as here, Ms. Jenkins did not receive an x-ray until March 31, two days after Ms. Nostrom returned to work and ten days after the injury. For all these reasons, a jury could find Ms. Nostrom knew of and disregarded an excessive risk to Ms. Jenkins's health and safety in violation of the Eighth Amendment.
In response, Jail Defendants argue Ms. Nostrom was not deliberately indifferent because she never interacted with Ms. Jenkins and lacked personal knowledge of her medical condition. The court disagrees. Although Ms. Nostrom's liability is a close case, Ms. Nostrom was the Jail's primary gatekeeper for radiological services. In this respect, her involvement is analogous to P.A. Havens in the Tenth Circuit's Sealock decision.
In sum, a reasonable jury could find that Ms. Nostrum possessed the requisite state of mind to establish a constitutional violation, and she is not entitled to qualified immunity.
The facts relevant to Nurse Harris's invocation of qualified immunity are as follows. Nurse Harris encountered Ms. Jenkins on March 23. He observed Ms. Jenkins walking with a limp. Ms. Jenkins approached Nurse Harris and informed him that she had fallen from her bunk, her hip hurt, and that an x-ray had been ordered. Nurse Harris responded by telling Ms. Jenkins: "It probably isn't broken because you're walking on it, but . . . the only way to know for sure is to do the x-ray and I'll go check and make sure and find out why the x-ray didn't happen."
The court concludes that Ms. Jenkins failed to demonstrate that Nurse Harris possessed the requisite state of mind for a violation of her rights under the Eighth Amendment. In contrast to Ms. Nostrom and Nurse McAllister, Nurse Harris's role in treatment and his knowledge of the x-ray order were limited. In this respect, the Tenth Circuit's decision to affirm summary judgment in favor of Nurse Huber in the Sealock decision is persuasive. Both Nurse Huber and Nurse Harris had limited interactions with an inmate. Conceivably, both nurses may have negligently misdiagnosed symptoms. But both defendants took steps to ensure the person responsible for treatment would be aware of the inmate's need for medical attention. In this case, Nurse Harris responded to the treatment request by providing medication and investigating whether the x-ray procedure had been scheduled. Given his limited role, no reasonable jury could conclude that his response rose to the level of deliberate indifference, which requires more than mere negligence.
In her papers, Ms. Jenkins waived her claim for supervisor liability against Mr. Bench.
Jail Defendants, Schryver, and Ms. Jenkins all move for summary judgment on liability. In their respective motions, the parties argue that the material facts are undisputed and the court should determine whether there was deliberate indifference as a matter of law.
Jail Defendants and Schryver argue the court should grant summary judgment in their favor because neither the entities nor individual employees acted with deliberate indifference.
In contrast, Ms. Jenkins moves for summary judgment on liability under two theories. Ms. Jenkins first theorizes that a ten-day delay in obtaining an x-ray procedure constitutes per se deliberate indifference and results in general liability for Jail Defendants. Next, Ms. Jenkins argues Jail Defendants exhibited deliberate indifference: (1) by delaying the x-ray between March 22 and March 24; (2) by cancelling the x-ray on March 24; (3) by failing to re-order the x-ray between March 24 and March 28; and (4) by delaying the procedure between March 29 and March 31. In her papers, Ms. Jenkins does not distinguish between individual Defendants, but instead requests summary judgment against all Jail Defendants.
As an initial matter, Ms. Jenkins's suggestion that a ten-day delay constitutes deliberate indifference as a matter of law does not square with the case law or legal standard that this court is required to apply. To the contrary, courts consider whether the subjective component of the deliberate indifference standard has been satisfied for each defendant based on the individual's role and the facts known by each at the time of the conduct.
As discussed above,
Relying on many of the same facts detailed in the court's qualified immunity analysis above, Ms. Jenkins argues the court should grant summary judgment in her favor. However, genuine issues of material fact preclude summary judgment on Nurse McAllister's liability. A reasonable jury could find Nurse McAllister reasonably attempted to respond to medical needs based on his understanding at the time of the conduct, or at worst acted negligently. For example, Jail Defendants maintain that Nurse McAllister or an unidentified Jail employee submitted the initial order shortly after the clinic appointment. Nurse McAllister denies cancelling the order and testified that he believed it would remain open until cancelled by a physician.
Similarly, Nurse McAllister testified that he contacted Schryver after Ms. Nostrom returned to the office and was told that Schryver was in the process of evaluating Ms. Jenkin's xray. Nurse McAllister also testified he could assume the procedure had been completed because another nurse on duty may have received the results and Nurse McAllister was assigned to the clinic. Finally, the parties dispute the appropriate inferences to be drawn from Ms. Jenkins's visible appearance, her ability to walk without crutches, Dr. Hooker's diagnosis, the frequency with which Schryver left CDs containing x-rays at the Jail after completing procedures, and the fact that Dr. Hooker ordered a regular, as opposed to emergent, x-ray procedure.
Resolution of these disputed facts is central to understanding Nurse McAllister's state of mind and the reasonableness of his conduct. And because a reasonable jury could find Nurse McAllister was or was not deliberately indifferent based on the resolution of these factual issues, the court can grant summary judgment to neither Ms. Jenkins nor the Jail Defendants.
Similarly, genuine issues of material fact preclude summary judgment on Ms. Nostrom's liability. As discussed above, the parties dispute which interpretation of internal practices for cancelling and rescheduling x-ray orders is correct. This conflicting account of the practice at the time of Ms. Jenkins's injury, taken together with competing inferences from the initial order, clinical notes, and delays in treatment, bear directly on Ms. Nostrom's state of mind at the time of her conduct. In particular, Ms. Nostrom testified she never experienced prior issues with scheduling and that she reasonably relied on Nurse McAllister's representations about the status of the x-ray when she returned to work on March 29.
Based on the resolution of these disputed facts, a reasonable jury could conclude that Ms. Nostrom behaved reasonably in light of the information available, acted only negligently by not taking additional steps after returning to work, or failed to adequately perform her constitutional obligation as a gatekeeper to medical services for an inmate. Indeed, a reasonable jury could determine that Ms. Nostrom was deliberately indifferent to an excessive risk to Ms. Jenkins, or was merely negligent in performing her duties. Because there remain genuine issues of material fact, the cross-motions for summary judgment on Ms. Nostrom's liability are denied.
Schryver originally moved for summary judgment on liability.
The facts demonstrate, at best, that Ms. Duke acted reasonably or negligently. Unlike Jail employees, Ms. Duke's ability to affect Ms. Jenkins's treatment or schedule was limited by virtue of her status as a technician employed by a private contractor. Relevant to the claim here, Ms. Duke visited Utah County Jail once, but she never came into contact with Ms. Jenkins because of the court appearance. On its face, there is nothing in this scenario that would permit a reasonable jury to conclude that Ms. Duke knew of and disregarded an excessive risk to Ms. Jenkins. Moreover, to the extent that Schryver and Ms. Jenkins agree on internal practices at Schryver and the Utah County Jail, no reasonable jury could find Ms. Duke acted unreasonably or was otherwise deliberately indifferent when she followed Schryver's internal practices for non-emergent procedures. Here, the evidence is that Ms. Duke learned she would be unable to complete the procedure, contacted dispatch, indicated a court date prevented her from completing the procedure, and left Utah County Jail.
Ms. Jenkins, however, insists that Ms. Duke acted with deliberate indifference insofar as she may have cancelled the procedure, contrary to Utah County Jail's internal practices. Ms. Jenkins argues that a dispute over the governing internal practices precludes summary judgment on Ms. Duke's liability. The court disagrees. Even if Ms. Duke improperly cancelled the procedure based on her understanding at the time, her limited role and knowledge of internal Jail procedures suggests that a reasonable jury could, at best, find negligence.
The final issue presented by the parties is whether Utah's two-year statute of limitations and the notice provision of the Utah Governmental Immunity Act bar Ms. Jenkins's claims.
Federal courts apply a forum state's statute of limitation to § 1983 claims.
After considering the relevant legal authorities, the court concludes that Utah's four-year statute of limitation applies to Ms. Jenkins's claims.
But even more importantly, the court concludes that the reasoning of Arnold v. Duchesne County is controlling.
The court further finds that the Utah Governmental Immunity Act's notice provision does not apply to this suit. Because state statutes conferring general immunity do not apply to federal cases arising under § 1983, the Utah Governmental Immunity Act's notice provision does not operate as a bar to the claims in this case.
Accordingly, Jail Defendants are not entitled to summary judgment because of the Utah Governmental Immunity Act or Utah's two-year statute of limitations.
The court concludes that Ms. Jenkins failed to establish a basis for municipal liability as a matter of law. With respect to the individual Defendants, while qualified immunity bars the suit against Nurse Harris, neither Nurse McAllister nor Ms. Nostrom are entitled to qualified immunity. Similarly, although Ms. Duke is entitled to summary judgment, genuine issues of material fact preclude summary judgment in favor of or against Nurse McAllister and Ms. Nostrom.
Accordingly, for all the reasons stated above, Plaintiff's Amended Motion for Partial Summary Judgment on Liability
