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Rouster v County of Saginaw

Case No. 13-1673 (C.A. 6, Apr. 9, 2014)

While being held in Saginaw County Jail (“Saginaw”), Jerry Rouster (“Jerry”) succumbed to sepsis and died as a result of a perforated duodenal ulcer. Before his death, he complained of stomach pain, engaged in bizarre behaviors indicative of mental-health problems, and displayed signs of agitation. His brother, Daniel Rouster (“Rouster”), as representative of Jerry’s estate, brought suit under 42 U.S.C. § 1983 against the medical staff who interacted with Jerry during the final thirty-six hours of his life, alleging that they were deliberately indifferent to his medical needs. It is unfortunate that Jerry died when prompt medical attention could have saved his life. However, we cannot conclude that the medical staff became aware of Jerry’s serious medical need and deliberately refused to provide appropriate treatment. Accordingly, we AFFIRM the judgment of the district court.


On May 7, 2007, Jerry Rouster was arrested on a misdemeanor charge of contempt of court for failing to pay court fines related to an incident of driving on a suspended license. He was brought to Saginaw to be held pending an appearance in court. The arresting officer did not notice any obvious signs that Jerry was intoxicated, such as bloodshot eyes, slurring of speech, or the odor of alcohol on Jerry’s breath. R. 99-3 (Lutz Dep. at 24) (Page ID #1858). However, the individual who conducted Jerry’s intake screening at Saginaw noted that he was “[u]nder the influence of drugs/alcohol.” R. 95-2 (Intake Screening Form) (Page ID #900). Jerry was placed in a “general population” cell with several other inmates until he appeared before a judge on the morning of May 9. The judge sentenced Jerry to an additional three days in jail, and Jerry returned to a general population cell.

A. The First Shift – Cathleen Conley

At approximately 8:00 on the evening of May 9, Jerry began complaining of stomach pains and abdominal cramping. A corrections officer (“CO”) called Cathleen Conley, the Registered Medical Assistant (“RMA”) on duty, to see Jerry in the general population cell. When Conley arrived, Jerry was lying on the floor. R. 95-3 (Conley Dep. at 29) (Page ID #942). He did not respond to her questions about how he was feeling, and he would not get up off the floor to speak to her or show her any identification. Id. at 31–33 (Page ID #944–46). Pursuant to Saginaw procedure, Conley was not permitted to enter the general population cell to examine Jerry where other inmates were present. Id. at 31 (Page ID #944). Therefore, Conley asked the COs to bring Jerry to the medical department when he got up. A few minutes later, Jerry walked into the medical clinic. Id. at 34 (Page ID #947).


Judge(s): Karen Nelson Moore
Jurisdiction: U.S. Court of Appeals, Sixth Circuit
Related Categories: Civil Remedies , Civil Rights , Constitutional Law , Criminal Justice , Education , Expert Witness , Government / Politics , Health Care , Malpractice , Torts , Transportation
Circuit Court Judge(s)
Deborah Cook
James Gwin
Karen Moore

Trial Court Judge(s)
Thomas Ludington

Appellant Lawyer(s) Appellant Law Firm(s)
Christopher Desmond Johnson Law PLC
Ven Johnson Johnson Law PLC

Appellee Lawyer(s) Appellee Law Firm(s)
Brian MacDonald Cline Cline & Griffin PC
Paul Vance Cline Cline & Griffin PC
Susan Zbikowski Siemion Huckabay PC



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abdominal complaints and his bizarre behavioral episodes. in accordance with withdrawal doctor examined a prisoner who complained of sharp stomach pains, rapid weight loss, and other │ including by using circumstantial evidence. farmer, 511 u.s. at 842. indeed, “a factfinder may tremors were all symptoms associated with withdrawal. therefore, given that jerry’s intake │ 13-1673 rouster v. saginaw cnty. et al. page 8 that the year was 1999 instead of 2007), and he was displaying “moderately anxious or guarded” one, by proving that they were unaware of the facts indicating significant danger or that they no. 1:11-cv-10986—thomas l. ludington, district judge. opinion conley did not record her observations on a ciwa form until her shifted ended, which was after jerry had adequately to detect serious medical problems, and that they were liable under state law for continued to assess his abdomen for rigidity or other signs of “acute abdomen” while he was held event is perhaps the most concerning: it seems obvious to us that anybody who has started did not share his concerns with conley or any other medical professional. id. at 118 (page id a physician when he began experiencing severe abdominal pain; at the least, they would have observation because the guards and inmates had witnessed his bizarre behaviors. r. 95-4 (marrs a. cathleen conley file name: 14a0069p.06 increase his fluid intake and lie on his side. id. at no time during this examination did jerry before her shift ended at 6:00 on the morning of may 10, but she testified that it would have been “flexed [and] wouldn’t unflex”). id. she attributed the flexing of his muscles to his attempts to and conley could easily have concluded that the medication simply needed more time to take in fact aware that jerry had a serious medical need. indeed, conley did not have one very critical “[c]ourts are generally reluctant to second guess the medical judgment of prison medical (page id #870–97); r. 97 (marrs, menchaca, and secure care mot. for summ. j.) (page id some cases the medical attention rendered may be so woefully inadequate as to amount to no before: moore and cook, circuit judges; gwin, district judge.* perhaps conley could have and should have done more, including notifying the on-call because we have affirmed the grant of summary judgment in favor of the defendants on the also r. 97-14 (goldenson dep. at 69–70) (page id #1808). another explained that a nurse who 273 f.3d at 703 (noting that a prison medical official who merely provides careless or actions based on the information that was available to them at the time. plaintiff-appellant, she was not aware. “generally, courts find deliberate indifference where there is evidence 13-1673 rouster v. saginaw cnty. et al. page 13 duodenal ulcer. before his death, he complained of stomach pain, engaged in bizarre behaviors he did not respond to her questions about how he was feeling, and he would not get up off the iii. deliberate indifference id. at 945 (internal quotation marks omitted). conley’s interaction with jerry closely parallels pursuant to sixth circuit i.o.p. 32.1(b) on duty, to see jerry in the general population cell. at 6:00 on the morning of may 10, debra marrs, a licensed practical nurse (“lpn”) of may 10, the cos informed conley that jerry had vomited. r. 95-3 (conley dep. at 50) (page nursing staff who attended to jerry while he was held at saginaw were each deliberately #1972). because a lay person without medical training was able to perceive jerry’s serious need, kalamazoo cnty., 390 f.3d 890, 894 (6th cir. 2004). summary judgment is appropriate when 13-1673 rouster v. saginaw cnty. et al. page 4 personnel who interacted with jerry provided substandard care. at a basic level, conley, marrs, believed the risk posed by known facts was insignificant). therefore, rouster has not presented prove the subjective component of the deliberate-indifference inquiry. a plaintiff satisfies the treated for an upper gastrointestinal bleed from the same ulcer the previous august. r. 96-6 dismissed as well.”). this rule accords with principles of federalism: “needless decisions of _________________ at the point when gomez claims that jerry was visibly ill, conley was aware that jerry was treated appropriately. r. 97-14 (goldenson dep. at 92) (page id #1813). short of the optimal standard of care. omitted). it is clear that jerry suffered from a serious, indeed dire, medical need while he was 466 f.3d 416, 425 (6th cir. 2006) (concluding that a genuine question of material fact existed conducted a ciwa to evaluate jerry for withdrawal symptoms. she noted that his behavior was . . . [and] trying to get out.” id. at 65 (page id #978). rouster disputes conley’s testimony by pointing to gomez’s bizarre behaviors. specifically, conley knew by the end of her first shift (1) that jerry had vomiting, agitated behavior, and physical although it was obvious to a layperson that jerry suffered from some kind of serious at approximately 2:00 in the morning, the other inmates housed in jerry’s general not a usual part.” r. 99-6 (gouge dep. at 34) (page id #1879). however, another expert symptoms, marrs calculated a total ciwa score of fifteen.2 matsushita elec. indus. co. v. zenith radio corp., 475 u.s. 574, 587 (1986). observed jerry reaching up high and bending over, and concluded that he did not have “an acute certain that she personally checked on him in the remaining four hours of her shift, she did not rouster (“rouster”), as representative of jerry’s estate, brought suit under 42 u.s.c. § 1983 95-3 (conley dep. at 48) (page id #961). she concluded that the cramps had “resolved 13-1673 rouster v. saginaw cnty. et al. page 3 alcohol withdrawal, the medical experts were unanimous in their opinion that the medical withdrawal, and she treated him appropriately for the medical needs that she believed he had. 13-1673 rouster v. saginaw cnty. et al. page 10 13-1673 rouster v. saginaw cnty. et al. page 19 toilet. during her shift the next evening, she also learned (7) that twenty-four hours after jerry food from the ground. however, jerry complained of cramping again. id. against the medical staff who interacted with jerry during the final thirty-six hours of his life, 13-1673 rouster v. saginaw cnty. et al. page 20 tending to establish that the physician is present while the inmate is in distress, that distress is 13-1673 rouster v. saginaw cnty. et al. page 2 the evening of may 10, testified that jerry looked “pale” and “sick,” and that he could tell by the 29) (page id #2247). the district court reasoned that there was no direct evidence that any of ┐ r. 95-3 (conley dep. at 65–66) (page id #978–79). shortly thereafter, both menchaca and omitted); westlake v. lucas, 537 f.2d 857, 860 n.5 (6th cir. 1976) (noting that “[o]f course, in had not observed any of jerry’s bizarre behaviors herself, and that she could not “call a doctor cos to bring jerry to the medical department when he got up. a few minutes later, jerry walked that jerry had been treated the previous year for a perforated duodenal ulcer. cf. westlake, appeal from the united states district court with her. id. at 76 (page id #1007); r. 95-3 (conley dep. at 58) (page id #971). throughout complained of “significant abdominal pain.” r. 99-6 (gouge dep. at 40) (page id #1881). jerry engaged in were indicative of alcohol withdrawal. r. 95-5 (tennessen dep. at 139) (page entitled to judgment as a matter of law.” fed. r. civ. p. 56(a). we must consider “whether the this complaint was only a few hours after jerry had taken medication to alleviate his symptoms, argued: christopher p. desmond, johnson law, plc, detroit, michigan, for appellant. │ marrs observe any behaviors that would indicate to her that he was in pain (e.g., rubbing his unconstitutional deliberate indifference. gomez also regardless of whether the rmas and lpns who saw jerry were qualified to assess jerry alleging that they were deliberately indifferent to his medical needs. it is unfortunate that jerry proceeded to discovery. cramping. r. 95-4 (marrs dep. at 76) (page id #1007). however, conley testified that she did relay information (page id #1879) (anxiety and tremors). furthermore, menchaca was unaware that jerry summary judgment in favor of conley, menchaca, and marrs on the claim that they violated 3 #1493–1519). the district court granted summary judgment in favor of all four defendants, defendants-appellees. (citation omitted); see also united mine workers of am. v. gibbs, 383 u.s. 715, 726 (1966) a. the first shift – cathleen conley * (menchaca notes) (page id #2127). she also observed that he was mumbling and talking to dep. at 92) (page id #1011). based on this information, marrs thought that alcohol abuse might of the other steps the nursing staff took in caring for jerry. they explained that, although it was way that jerry was looking and acting that “it was pretty obvious that [he] wasn’t getting better vicarious liability. id. at 818. accordingly, a plaintiff must prove both “that his or her treatment. decided and filed: april 9, 2014 a medical assistant has less formal education and training than a licensed practical nurse, and neither is drugs. id. jerry did not complain about cramping or abdominal pain at this time. deitrick’s diagnosis of obstipation. even though dr. deitrick’s initial diagnosis to be sure, medical providers may “not escape liability if the evidence showed that [they] inferred that he was clenching his muscles on purpose as he attempted to sit up and get off the no. 13-1673 she observed during her abdominal assessment. r. 95-5 (tennessen dep. at 167–68) (page id obvious.” id. bearing these principles in mind, we turn to addressing whether rouster can upon concluding that jerry was likely experiencing alcohol withdrawal, marrs called dr. jerry was known as a heavy drinker. id. at 92–93 (page id #1011). based on this information, rouster’s favor, we may infer that marrs knew that jerry had been experiencing abdominal discomfort at 8:00 the c. stella menchaca first encounter with conley, when she provided medication to treat gas and diarrhea, jerry did ‘moving force’ behind the deprivation of the plaintiff’s rights.” miller v. sanilac cnty., 606 f.3d instead, the medical attendants were obligated to go into the cell themselves or have jerry walk conley was only an rma, she lacked the medical knowledge to understand the symptoms she died when prompt medical attention could have saved his life. however, we cannot conclude counsel 13-1673 rouster v. saginaw cnty. et al. page 16 _________________ just before midnight, when conley was walking past jerry’s cell, she observed him using id. she did notice, however, that jerry was “guarding” (i.e., that his abdominal muscles were form indicated that he was intoxicated when he was admitted to saginaw, r. 100-4 (intake population cell reported to the cos that jerry was drinking out of the toilet. id. at 53 (page id medical experts generally concluded that the treatment provided by the medical staff fell far conclude that a prison official knew of a substantial risk from the very fact that the risk was for appellee conley. on brief: ven r. johnson, johnson law, plc, detroit, michigan, c. the third shift – cathleen conley and stella menchaca (“saginaw”), jerry rouster (“jerry”) succumbed to sepsis and died as a result of a perforated designation. regarding jerry’s abdominal complaints. r. 95-3 (conley dep. at 58) (page id #971). interpreting all facts in dep. at 108) (page id #1817). behaviors. r. 95-4 (marrs dep. at 104, 123–24) (page id #1014, 1019). after scoring jerry’s informed her that jerry had been placed in an observation cell because he had exhibited bizarre testified that it was “[s]ometimes” clear that jerry was in pain, and that he complained that “his held at saginaw. he had a perforated duodenum, which leaked toxic materials into his her “usual practice” to check the monitor periodically. id. at 56–57 (page id #969–70). at no abdomen.” id. at 114 (page id #1178). based on her observations, she believed that “he was id. (internal citations omitted) (quoting farmer, 511 u.s. at 835–36). the plaintiff bears the to one defendant may not be automatically imputed to the others). physician. but she clearly took appropriate steps to protect jerry. she isolated him from the judgment in favor of secure care on rouster’s claim that the private corporation failed when conley arrived, jerry was lying on the floor. r. 95-3 (conley dep. at 29) (page id #942). subjective component by “alleg[ing] facts which, if true, would show that the official being sued suffering from a more serious condition than alcohol withdrawal. cf. perez v. oakland cnty., #764). conley, marrs, menchaca, and secure care remained as defendants, and the parties breach of the standard of care. r. 95-5 (tennessen dep. at 85–88) (page id #1076). in addition, prescribed by dr. natole and conducted a third ciwa.3 deliberately ignore jerry’s needs by relying on the cos to monitor his health and behavior at burden of proving subjective knowledge, but he may do so with ordinary methods of proof, experienced by individuals going through alcohol withdrawal. r. 95-5 (tennessen dep. at 107) dep. at 139) (page id #1089). however, the majority of jerry’s symptoms were entirely sufficient evidence from which a reasonable jury could conclude that conley was deliberately marrs does not recall whether conley informed her during shift change that jerry had been assessed for stomach 40) (page id #952–53). conley concluded that jerry suffered from “abdominal pain, gas and medical malpractice. r. 1 (compl.) (page id #1–20). in his amended complaint, rouster added state prisons by operation of the due process clause of the fourteenth amendment. blackmore, adequately to train and supervise medical staff in the prison. will result.” instead, “deliberate indifference to a substantial risk of serious harm cir. 2000)); see also terrance v. northville reg’l psychiatric hosp., 286 f.3d 834, 843 (6th cir. (concluding that prison officials may show that they were unaware of a risk, even an obvious “the movant shows that there is no genuine dispute as to any material fact and the movant is observed him engaging in behaviors, such as reaching up high or bending over, that indicated he previous evening. but jerry did not complain of stomach pain or cramping to marrs during any of her interactions 2002) (“[w]hen the need for treatment is obvious, medical care which is so cursory as to amount rights were violated. therefore, we need not consider whether secure care’s staffing or training saginaw for treatment. marrs administered the prescribed medication and kept jerry under indicative of mental-health problems, and displayed signs of agitation. his brother, daniel permitted to make an independent medical decision. r. 97-14 (goldenson dep. at 39) (page id #1800). secure subjectively perceived facts from which to infer substantial risk to the prisoner, that he did in fact observed and the medical terms on the assessment forms. id. at 135 (page id #1088). however, regular intervals. defendants, alleging that their denial of medical treatment for jerry’s serious medical needs notice any obvious signs that jerry was intoxicated, such as bloodshot eyes, slurring of speech, or b. the second shift – debra marrs member or other prison official about his history of treatment for an ulcer. asked jerry whether he had an alcohol or drug abuse problem, jerry denied abusing alcohol and withdrawal symptoms. r. 95-4 (marrs dep. at 105–18) (page id #1014–18); r. 97-12 (natole the honorable james s. gwin, united states district judge for the northern district of ohio, sitting by abdominal cramping, but marrs could not remember if conley discussed jerry’s stomach pain draw the inference, and that he then disregarded that risk.” comstock v. mccrary, 273 f.3d 693, done.” williams v. mehra, 186 f.3d 685, 692 (6th cir. 1999) (en banc). we must judge their believed that abdominal pain and vomiting are consistent with alcohol withdrawal. r. 95-5 had conley been subjectively aware of the seriousness of jerry’s medical condition, her id #963). she returned to his cell, but she did not observe him vomiting. id. when conley constituted cruel and unusual punishment, that secure care had failed to train employees have been subjectively aware of it, see farmer, 511 u.s. at 842, and that she consciously supplemental jurisdiction over the remaining state-law claims. rouster may pursue his finally, conley did not display deliberate indifference when she encountered jerry to behaviors, the medical staff should have done more. r. 95-5 (tennessen dep. at 85–87) (page also wilson v. seiter, 501 u.s. 294, 300 (1990). upon entering the clinic, jerry protested that he did not want to be there, but he constitutional rights were violated and that a policy or custom of the municipality was the particularly severe on the morning of may 10, three days later. from an ulcer and needed medication and a special diet). it is true that the medical experts abdominal complaints. after her examination, conley knew that jerry suffered from stomach on may 7, 2007, jerry rouster was arrested on a misdemeanor charge of contempt of indifferent to jerry’s medical needs. court for failing to pay court fines related to an incident of driving on a suspended license. he regarding the standard of care for nursing professionals in michigan. we have held that “a however, private corporations cannot be held liable on the basis of respondeat superior or assessment (“ciwa”). r. 100-14 (marrs notes) (page id #2111). she noted several aberrant (page id #1812–13). had they received full information regarding jerry’s medical history, we acknowledged that, after the inmates told her that he had been drinking from the toilet, she 13-1673 rouster v. saginaw cnty. et al. page 6 and was deliberately indifferent to his welfare. like conley, marrs had limited information registered medical assistant (“rma”)1 defendant’s subjective knowledge should be assessed separately, and that information available of medical malpractice claims; thus, a plaintiff alleging deliberate indifference must show more with assumptions.” id. at 54 (page id #967). table. indeed, conley did not have the training to understand the significance of the symptoms diarrhea.” r. 100-7 (conley notes) (page id #2055). she gave him tums and advised him to had a significant medical problem that should be evaluated by a doctor. r. 97-14 (goldenson committed suicide when the doctor had several times previously placed a prisoner on elevated complaints of stomach cramping were consistent with the symptoms experienced by an was incorrect, negligence in diagnosing a medical condition does not constitute prisoner’s medical needs as akin to recklessness: inefficacious treatment has not been deliberately indifferent to a prisoner’s needs). in jones, a when the medical staff did personally observe jerry in his cell, their assessments were interpret the facts and draw all reasonable inferences therefrom in favor of the nonmoving party. 1 toxic materials into his stomach; he eventually became septic and died. jerry had been surgically “competent medical personnel” and failing adequately to train and supervise medical staff in │ throughout the evening did not alert her that the treatment she had already provided was determined that jerry had a perforated duodenal ulcer, which had begun bleeding and leaking ailment. furthermore, even if conley should have known that jerry’s abdominal “guarding” was with such a condition. rather, she diagnosed jerry as suffering from alcohol withdrawal and circumstantial evidence that “the risk was so obvious that defendants must have known of the 13-1673 rouster v. saginaw cnty. et al. page 14 saginaw. the experts gave varying opinions on whether jerry’s symptoms were consistent with prisoner, he has not displayed a deliberate indifference to the prisoner’s needs, but accordingly, an eighth amendment inquiry has two components, one objective and one dep. at 33–34) (page id #1734). ordinarily, an inmate who received a ciwa score greater than was not suffering from an “acute abdomen.” r. 97-13 (menchaca dep. at 110–12, 114, 119) required to show that he was literally ignored by the staff’ to prove an eighth amendment county of saginaw, et al., 13-1673 rouster v. saginaw cnty. et al. page 11 with jerry. see gray v. city of detroit, 399 f.3d 612, 616 (6th cir. 2005) (explaining that each #3). leftover food from the bag lunches given to the inmates from off the floor of the cell. id. at 51 rouster argues that conley had subjective knowledge of jerry’s need for medical iv. failure to train we review de novo the district court’s grant of summary judgment. blackmore v. notes) (page id #2061). victor gomez, a co near jerry’s cell at the time, reported that jerry than the alcohol withdrawal with which he had been diagnosed. see farmer, 511 u.s. at 844 sit up: “he was fighting me. he was trying to get up off the table.” r. 95-3 (conley dep. at 39– not a usual part [of withdrawal]. muscular cramps are, but abdominal pain, in my experience, is (page id #967). she moved him to an observation cell, where the cos could easily observe him rouster cannot prove that marrs was subjectively aware of jerry’s serious medical needs and menchaca were not trained to assess and diagnose patients. valerie tennessen, the r.n. diagnose patients conceded that they would need to screen patients to determine whether they 13-1673 rouster v. saginaw cnty. et al. page 5 (page id #1777–79). like marrs, menchaca believed that jerry was suffering from alcohol when she asked him how he was feeling at several points during the evening, he either denied eighth amendment protection against deliberate indifference extends to pretrial detainees in an adverse outcome is likely to occur.” jones, 625 f.3d at 945 (emphasis added). after jerry’s corrections corp. of am., 102 f.3d 810, 814 (6th cir. 1996) (internal quotation marks omitted). v. 13-1673 rouster v. saginaw cnty. et al. page 12 approving partial settlement) (page id #759–63); r. 73 (order dismissing natole) (page id stomach was hurting, [and that] he wanted water.” id. at 122–23 (page id #1973–74). gomez #966). at this point, conley became concerned about jerry’s mental-health status. id. at 54 his stomach was cramping, and then provided him with over-the-counter medication to treat protocols. conley also told her about jerry’s medical issues during her first shift, including his for appellant. susan j. zbikowski, siemion huckabay, p.c., southfield, michigan, for medical chart that his pain from “cramping” was “between moderate and severe.” id. at 37 (page medical staff providing proper care would have, in an abundance of caution, caused jerry to see had been assessed for alcohol withdrawal. jerry was already being treated in accordance with id #1076); r. 97-14 (goldenson dep. at 55–56) (page id #1804). one expert opined that the clearly getting worse was consistent with the course of withdrawal: marrs’s experience was that │ a substantial risk of serious harm and consciously disregarded that risk.” r. 108 (d. ct. op. at (marrs dep. at 101) (page id #1013). if jerry had consumed alcohol for the last time on may 7 by cancer. in finding summary judgment in favor of the prison doctor appropriate, we reasoned: medical need that was “sufficiently serious.” farmer, 511 u.s. at 834 (internal quotation marks they provided appropriate treatment, they were not deliberately indifferent to his medical needs. nor was conley deliberately indifferent to jerry’s medical needs later that evening at the followed. it appears that marrs miscalculated: according to the notations on the ciwa assessment, jerry actually withdrawal protocols, and indeed dr. natole was scheduled to see him within the next twelve perform a ciwa during her third shift. rouster argues that a reasonable jury could conclude aware that jerry suffered from a serious medical condition and chose to ignore his need for could easily conclude that conley, marrs, and menchaca were deliberately indifferent to jerry’s care, inc., defendant-appellee in this case, is a private company that provides medical services to saginaw, severe symptoms until her regularly scheduled medication run several hours later). this last 1 e. procedural history cannot conclude that she was subjectively aware that he continued to experience pain and needed treatment. a nursing diagnosis.” r. 95-5 (tennessen dep. at 40–41) (page id #1064–65). indeed, because failure to contact a physician when jerry was placed in the observation cell was “absolutely” a (natole dep. at 42–43) (page id #1736). however, no expert stated that the bizarre behaviors deliberate indifference to jerry’s medical needs because she responded to her concerns by eventually submitted to conley’s examination and assessment. id. conley noted on jerry’s when a prison doctor provides treatment, albeit carelessly or inefficaciously, to a rouster asserts a claim under 42 u.s.c. § 1983, arguing that the three members of the dr. deitrick’s initial diagnosis and treatment of jones with a laxative seems monitoring prisoners for serious medical conditions. r. 1 (compl. ¶¶ 53–54) (page id #11–12). before he was arrested, it would not be surprising that his symptoms of withdrawal would be morning of may 9. the judge sentenced jerry to an additional three days in jail, and jerry no record evidence indicates that any member of the nursing staff ever suspected that jerry was the toilet. she asked him if he was still experiencing any cramping, but he did not respond. r. merely refused to verify underlying facts that [they] strongly suspected to be true, or declined to condition was obvious. victor gomez, a co who observed jerry at the same time as conley on make medical complaints, jerry was found dead in the observation cell. medical examiners that the medical staff became aware of jerry’s serious medical need and deliberately refused to have described the mental state of a prison official who has been deliberately indifferent to a on the form, conley noted that jerry as having mild digestive complaints or alcohol withdrawal, the experts believed that jerry in a cell where he would be under near-constant supervision. although she cannot say for jerry had been seen drinking from the toilet, and (3) during her second shift, when jerry again prison officials provided no treatment even after the prisoner informed them that he suffered weak and ill at this point in the evening. the kinds of mental disturbances that were typical of withdrawal patients. r. 95-5 (tennessen inadequate. merely watching jerry sit in his cell was not sufficient to assess his condition; 156–57) (page id #1027). jerry did not complain to marrs that he was experiencing abdominal to touch,” that he had a “slight tremor,” and that his “gait [was] unsteady.” r. 100-16 did not complain of abdominal pain or exhibit any behaviors that indicated he was in pain. secure care, inc., cathleen conley, rma; #1972). we must interpret all disputed facts in rouster’s favor, and therefore we assume that jerry was visibly │ 625 f.3d at 945 (concluding that a doctor had not shown deliberate indifference by for the sixth circuit member of the medical staff about his previous treatment for a perforated duodenal ulcer. r. 95- leftover food from the floor, and (6) that other inmates had observed him drinking from the rouster also asserts a § 1983 claim against secure care for failing to staff saginaw with afternoon, a co told marrs that he personally knew that jerry “drinks a lot.” r. 95-4 (marrs complaint against conley, marrs, menchaca, and secure care, as well as several other scheduled visit, which coincided with the day that jerry died). jerry’s visible illness and his at approximately 8:00 on the evening of may 9, jerry began complaining of stomach there are three critical points during conley’s interactions with jerry when she might confirm inferences of risk that [they] strongly suspected to exist.” farmer, 511 u.s. at 843 n.8. #1089). malpractice and negligence claims in the appropriate state court. 13-1673 rouster v. saginaw cnty. et al. page 15 defendants, that jerry’s various complaints and ailments could be explained by alcohol withdrawal and she approximately thirty minutes later, the guards informed conley that jerry was eating the conley interpreted the symptoms as indicative of a relatively minor condition. she concluded must demonstrate a deprivation of a constitutional right caused by a state government official. federal court that has dismissed a plaintiff’s federal-law claims should not ordinarily reach the died in the observation cell. r. 95-3 (conley dep. at 62–63) (page id #975–76). appellees secure care, menchaca, and marrs. j. brian macdonald, cline, cline & looked pale and sick, that it was clear he was in pain, and that he was obviously getting worse. _________________ pains and abdominal cramping. a corrections officer (“co”) called cathleen conley, the discomfort at any time during her twelve-hour shift. id. at 158–59 (page id #1028). nor did griffin, p.c., flint, michigan, for appellee conley. at approximately 1:30 on the morning of may 11, conley gave jerry the medication stomach was feeling, he denied that he was in pain. id. at 111–12 (page id #1777). she also jerry mentioned that his stomach was cramping only at one other point that night—when conley #1096). therefore, conley did not display deliberate indifference to a known serious medical second critical point, after he had begun exhibiting bizarre behaviors indicative of mental-health retained in this case testified that conley should have called a physician whenever any inmate all, of the prisoner’s symptoms). his abdominal pain,5 the central question in this appeal is whether rouster has provided sufficient evidence to 13-1673 rouster v. saginaw cnty. et al. page 17 the odor of alcohol on jerry’s breath. r. 99-3 (lutz dep. at 24) (page id #1858). however, the the “[t]hird day is usually the worst” for patients experiencing alcohol withdrawal. r. 95-4 d. medical expert testimony r. 99-18 (gomez dep. at 99–100, 118) (page id #1970–72). however, conley observed that floor to speak to her or show her any identification. id. at 31–33 (page id #944–46). pursuant suicide watch). because jerry was not deprived of any constitutional rights, rouster cannot 13-1673 rouster v. saginaw cnty. et al. page 9 began to treat him accordingly. as explained above, we do not ordinarily second-guess a 390 f.3d at 895. however, because the eighth amendment prohibits cruel or unusual after the completion of discovery, conley, marrs, menchaca, and secure care, as the withdrawal was entirely reasonable. rouster has presented no evidence that marrs considered an ii. standard of review caused them to interpret his symptoms in a different light: at no point in time did jerry tell any marrs conducted a ciwa to assess jerry for alcohol-withdrawal symptoms. marrs concluded other inmates in a room where he could not be a danger to himself or others and positioned him from the privacy partition so that they could observe him more easily. r. 95-4 (marrs dep. at private corporations that “perform a traditional state function such as providing medical services │ estate of jerry rouster, deceased, 13-1673 rouster v. saginaw cnty. et al. page 21 prescribed an over-the-counter medication to relieve the prisoner’s symptoms. however, when (“certainly, if the federal claims are dismissed before trial . . . the state claims should be individual who conducted jerry’s intake screening at saginaw noted that he was “[u]nder the for the foregoing reasons, we affirm the district court’s judgment. over to the door and communicate with them. id. at 123–24 (page id #1085). ultimately, the response to jerry’s complaints. conley immediately evaluated him after receiving a report that changed the course of jerry’s treatment for the remaining hours of his life: a co told her that b. debra marrs i. background observation in a separate cell. at some point later in marrs’s shift, she noticed that he was lying the general population cell. him for the wrong ailment, their actions might support a negligence claim; however, the district describe any medical history. after receiving the over-the-counter medication, jerry returned to drank from the toilet). cf. dominguez v. correctional med. servs., 555 f.3d 543, 550–51 (6th merely a degree of incompetence which does not rise to the level of a to prison inmates may be sued under § 1983 as one acting under color of state law.” street v. wisneski, 266 f.3d 429, 439 (6th cir. 2001) (quoting sherrod v. lingle, 223 f.3d 605, 611 (7th decision to treat him only with over-the-counter medication might have been so cursory as to knowledge, rouster asserts that jerry’s serious medical need was so obvious that conley must │ days and other stomach pains, which could have been consistent with dr. the symptoms jerry was exhibiting could well have indicated a serious medical condition, #1081); r. 97-12 (natole dep. at 40) (page id #1735). even gomez’s conclusion that jerry was is unable to recall if marrs described those symptoms. id. at 114–16 (page id #1017); r. 97-12 consistent with those experienced by patients suffering from alcohol withdrawal. see jones, deliberate indifference if she did not know that jerry’s stomach pain was caused by a serious stomach or lying in a fetal position). id. at 161–62 (page id #1028–29). but getting worse.” r. 99-18 (gomez dep. at 99–100, 118) (page id #1970–72).4 240, 254–55 (6th cir. 2010) (citation omitted); see also savoie v. martin, 673 f.3d 488, 494 (6th parties, by procuring for them a surer-footed reading of applicable law.” gibbs, 383 u.s. at 726. r. 95-5 (tennessen dep. at 107) (page id #1081) and other changes in mental status. r. 97-12 lpns do not assess. all they do is gather information and pass it along. they don’t get to make for the eastern district of michigan at bay city to saginaw procedure, conley was not permitted to enter the general population cell to examine returned to a general population cell. than negligence or the misdiagnosis of an ailment.” id. (citing estelle, 429 u.s. at 106). we diarrhea, (4) that the cos had observed him vomiting, (5) that he had been observed eating protocols, when she delivered jerry’s medication shortly after her shift began, menchaca court determined that the allegations did not support a constitutional claim. id. the district court after jerry’s death, daniel rouster, as the personal representative of jerry’s estate, filed a on withdrawal protocols. we cannot conclude under these facts that marrs was subjectively thus, if jerry’s symptoms had been clearly inconsistent with alcohol withdrawal, marrs might it is not clear whether marrs was even aware that jerry had complained of stomach cramping at any point. during discovery, the parties retained medical experts to give opinions regarding the pain and diarrhea, and that his abdominal muscles were flexed and would not unflex. although aware of jerry’s serious medical need at the time she initially examined him in response to his furthermore, rouster acknowledges that conley did provide some level of treatment in to no treatment at all may amount to deliberate indifference.”) (internal quotation marks │ conley did not provide constitutionally deficient treatment by failing to address pain of which (page id #1007). marrs received one more critical piece of information during her shift that observed an inmate eating off of the floor or drinking from the toilet should have seen it as a argued: january 28, 2014 continued to suffer stomach pain: he did not complain of cramping to her at any time, and she became concerned that there was a “significant change in [jerry’s] mental status.” r. 95-3 5 (tennessen dep. at 14, 136) (page id #1058, 1088); r. 97-14 (goldenson dep. at 85–91) a minimal response to serious medical needs is constitutionally deficient: “‘[a] prisoner is not > the supreme court has held that “deliberate indifference to serious medical needs of prisoners in addition to the failure to contact a physician immediately, the experts were also critical vomiting. r. 100-7 (conley notes) (page id #2055). upon palpating jerry’s abdomen, conley agitated, that he appeared to be confused, and that he was experiencing physical tremors. r. 97- delivered jerry’s medication and conducted a second ciwa. she noted that his skin was “cool about jerry’s symptoms and medical history. when marrs came on duty for her shift, conley alcohol withdrawal. r. 95-3 (conley dep. at 60) (page id #973). conley also told menchaca fifteen would be sent to the hospital for closer monitoring. r. 97-12 (natole dep. at 65–66) karen nelson moore, circuit judge. while being held in saginaw county jail symptoms could be explained by withdrawal: the behavioral anomalies he exhibited were not abdominal cavity and caused internal bleeding. jerry was held at saginaw for only a few days, morning of may 9, and that it had been “like h2o,” but that he was not experiencing nausea or concluding that rouster was unable to pursue a municipal-liability theory because he had not 13-1673 rouster v. saginaw cnty. et al. page 18 summary judgment on both federal claims, the district court declined to exercise supplemental │ jurisdiction over the remaining state claims. id. at 34 (page id #2252). this timely appeal gomez’s testimony does support rouster’s argument that it was obvious as of the late evening of rouster’s remaining claims arise under state law and implicate complex questions problems. conley promptly responded to every call made by correctional staff regarding jerry’s misdiagnosing a prisoner’s medical condition when the diagnosis accounted for some, but not who testified to the appropriate standard of care for nurses, explained: “rmas do not assess. policies might have caused such a violation. the district court appropriately granted summary official acted “for the very purpose of causing harm or with knowledge that harm shown that jerry’s constitutional rights were violated. id. at 33 (page id #2251). after granting #1735). other symptoms of alcohol withdrawal identified by the experts include hallucinations, however, jones had indicated an inability to have a bowel movement for several 537 f.2d at 859 (concluding that a prisoner stated a claim of deliberate indifference because (explaining that dr. natole would ordinarily see a patient he had received a call about on his next (natole dep. at 59–61) (page id #1740–41). however, both marrs and dr. natole agree that (conley dep. at 54) (page id #967). however, we cannot conclude that conley exhibited cir. jan. 23, 2009). as discussed above, rouster is unable to prove that jerry’s constitutional jerry where other inmates were present. id. at 31 (page id #944). therefore, conley asked the drinking from a toilet is suffering from some kind of serious medical ailment. indeed, conley that conley knew that jerry suffered from a serious medical need at this point because his │ noted no distension or rebound tenderness, and she observed that his bowel sounds were normal. stella menchaca, lpn, and debra marrs, lpn, but within that time he succumbed to sepsis and died. clearly then, jerry had an objectively the medical care provided to jerry while he was held in saginaw was questionable. complained to her of stomach cramping. first, we cannot conclude that conley was subjectively │ vi. conclusion also granted summary judgment in favor of secure care on the claim for failure to train, │ to a prisoner is the equivalent of recklessly disregarding that risk.” came on duty to relieve conley. conley reported to marrs that she had placed jerry under alternative, more serious diagnosis but refused to verify that jerry’s symptoms were consistent (hosp. records) (page id #1284–87). however, at no point did jerry inform any medical staff dep. at 74) (page id #1007). conley also testified that she relayed information regarding jerry’s recommended for full-text publication needs. see johnson v. karnes, 398 f.3d 868, 875–76 (6th cir. 2005). however, “the standard is that he was in pain or refused to answer. r. 95-3 (conley dep. at 48, 68) (page id #961, 981). significance of jerry’s medical symptoms and the treatment provided by the medical staff at checked on him after he was observed eating off of the floor. id. at 51–52 (page id #964–65). officials.” jones v. muskegon cnty., 625 f.3d 935, 944 (6th cir. 2010); see also comstock, only remaining defendants, moved for summary judgment. r. 95 (conley mot. for summ. j.) regarding a prison doctor’s subjective awareness of serious medical risk to a prisoner who have been deliberately indifferent by failing to confirm that his symptoms were not indicative of condemned as the infliction of punishment.” farmer v. brennan, 511 u.s. 825, 838 (1994); see influence of drugs/alcohol.” r. 95-2 (intake screening form) (page id #900). jerry was placed _________________ “he was very strong at that time” and that “[h]e was pushing on the door . . . trying to get out.” was brought to saginaw to be held pending an appearance in court. the arresting officer did not have become aware that he suffered from a serious medical condition and needed treatment: officers made comments demonstrating that they were aware of an ongoing medical problem). 13-1673 rouster v. saginaw cnty. et al. page 7 federal-law claims, we conclude that the district court appropriately declined to exercise natole. she is unsure if she told dr. natole about jerry’s abdominal complaints, and dr. natole serious need for medical treatment. see blackmore, 390 f.3d at 897. scored a 13. r. 100-14 (marrs notes) (page id #2111). ailment, and they instead interpreted his symptoms as indicating a different condition, for which took the appropriate steps to provide treatment, including calling a physician and placing jerry officers were deliberately indifferent to a prisoner’s medical needs because the seriousness of the (page id #1742). however, because jerry’s score was just below that point, he was kept at himself. r. 97-13 (menchaca dep. at 106) (page id #1776). when she asked jerry how his approximately 2:45 on the afternoon of may 10, marrs performed an alcohol withdrawal diagnosis made by a medical provider in a prison setting. jones, 625 f.3d at 944. that jerry suffered from gas and diarrhea, and she treated him accordingly. subjective. a plaintiff satisfies the objective component by alleging that the prisoner had a at 5:45 on the morning of may 11, 2007, less than thirty-six hours after he first began to constitutes the unnecessary and wanton infliction of pain proscribed by the eighth amendment.” condition. id #950). she also noted that jerry reported that his last bowel movement had been on the may 10 that jerry was ill. in addition, conley acknowledged that jerry again complained of (tennessen dep. at 107) (page id #1081); see also r. 97-12 (natole dep. at 40) (page id indicative of a serious medical condition, she was not deliberately indifferent because she 4 “still [complained of] stomach pains [and] state[d that he] wants to go home.” r. 100-7 (conley 13 (menchaca dep. at 109) (page id #1776). these symptoms were consistent with those point during her shift did she call dr. natole, the on-call physician. conley explained that she united states court of appeals 2 even the medical experts who opined that rmas and lpns lacked the credentials to assess or state law should be avoided both as a matter of comity and to promote justice between the although they disagreed about whether certain of jerry’s symptoms were consistent with treatment because she had examined him for his abdominal complaints and was aware of his need during her first interaction with jerry, at the time he complained of stomach pain. behaviors, such as eating from the floor and drinking from the toilet. r. 95-4 (marrs dep. at 74) provide appropriate treatment. accordingly, we affirm the judgment of the district court. prove the subjective component of his claim as to each of the medical attendants who interacted id #1089). nonetheless, they concluded that, if jerry had been suffering from withdrawal, he however, jerry’s weakness at that time would not necessarily have indicated a serious medical (1) during her initial examination of jerry in the medical clinic, (2) after she was notified that 5 and conley took over for the night shift. marrs reported that she had started treating jerry for first experienced abdominal pain he again complained of stomach cramping. based upon this the prisoner was later treated at a hospital, the doctors determined that his symptoms were caused complained of stomach cramping, (2) that he displayed abdominal “guarding,” (3) that he had in a “general population” cell with several other inmates until he appeared before a judge on the inappropriate in light of jones’s substantial weight loss and sharp stomach pain; jerry’s constitutional rights by depriving him of treatment for his serious medical needs. bowel complaints, and concluded that he suffered from severe constipation. the doctor risk.” id. at 31–32 (page id #2249–50). because the defendants misdiagnosed jerry and treated those of patients experiencing alcohol withdrawal. one expert opined that “[a]bdominal pain is finally, rouster has not provided evidence to show that menchaca knew that jerry had a susan j. zbikowski, siemion huckabay, p.c., southfield, michigan, for appellees secure however, rouster argues that the risk must have been obvious to trained medical staff. see and misdiagnosed him as suffering from gas and diarrhea. conley observed jerry kicking at the glass walls of his cell and picking at screws in the door. he disregarded jerry’s needs by failing to contact a physician or provide appropriate treatment. plaintiff’s state-law claims.” moon v. harrison piping supply, 465 f.3d 719, 728 (6th cir. 2006) marrs reported jerry’s ciwa score and that dr. natole prescribed librium to treat his illness, conley was not subjectively aware that jerry was suffering from a more serious condition effect. in any event, jerry’s denial of pain when conley checked on him at several points evening of may 10, marrs informed her that dr. natole had placed jerry on withdrawal the defendants knew that jerry’s stomach pain indicated a serious medical risk. nor was there estelle v. gamble, 429 u.s. 97, 104 (1976) (internal citation and quotation marks omitted). the into the medical clinic. id. at 34 (page id #947). punishment, an official must have actually perceived a significant risk to an inmate’s health to the morning, marrs observed jerry in the observation cell and noted nothing unusual. during the is deliberately indifferent when she ignores complaints of pain that are communicated to her. jones, 625 f.3d at communicated to the physician, and the physician purposefully ignores the distress knowing that constitutional violation. on the other hand, a plaintiff need not show that the daniel rouster, as personal representative of the with him. r. 95-4 (marrs dep. at 114, 158–61) (page id #1017, 1028). as we noted above, a medical professional appropriately the relatively minor stomach ailment that she diagnosed. rouster argues that such indifferent to his medical needs. to assert a cause of action arising under § 1983, a plaintiff deliberate indifference. they were each ignorant of the single critical fact that might have appropriate to remove jerry from the general population cell once he began exhibiting bizarre concluding that “no facts establish that [the defendants] subjectively knew that mr. rouster faced themselves.” r.100-7 (conley notes) (page id #2057). at approximately 12:30 on the morning phillips v. roane cnty., tenn., 534 f.3d 531, 541 (6th cir. 2008) (concluding that correctional piece of information, which might have allowed us to draw such a conclusion: she did not know who experiences “significant abdominal pain.” r. 99-6 (gouge dep. at 40) (page id #1881); see 703 (6th cir. 2001). the subjective requirement is designed “to prevent the constitutionalization observation cell. r. 97-13 (menchaca dep. at 69) (page id #1766). at 7:30, menchaca moving jerry to an observation cell where he could be closely monitored by correctional staff. on a closed-circuit monitor. id. at 55 (page id #968). conley did not interact with jerry again a different and more serious condition. indeed, there is some evidence that not all of jerry’s care, menchaca, and marrs. r. paul vance, cline, cline & griffin, p.c., flint, michigan, furthermore, conley was not aware that jerry’s stomach continued to trouble him. because the nursing staff did not know that jerry suffered from a serious medical probably in a state of withdrawal.” id. at 109 (page id #1776). exhibited several symptoms that should have alerted the nursing staff that a physician should be when marrs’s shift ended at 6:00 on the evening of may 10, stella menchaca, an lpn, individual going through alcohol withdrawal. see r. 95-5 (tennessen dep. at 107) (page id (page id #1081) (hallucinations, abdominal pain, and vomiting); r. 99-6 (gouge dep. at 34) about jerry’s abdominal complaints and the bizarre behaviors that had led her to place him in the including scheduling the medical personnel sued as individual defendants in this case. r. 1 (compl. ¶ 7) (page id inefficacious to treat the minor ailment from which she had concluded that he suffered. amount to a conscious disregard of his needs. however, rouster has not shown that conley was in observation. however, none of the medical personnel who interacted with jerry displayed conley described jerry as being “very strong at that time,” and recalled that “[h]e was pushing on the door serious medical need which she deliberately ignored. when menchaca began her shift on the have violated his constitutional right: “[a]n official’s failure to alleviate a significant risk that he not whether there is something easy that the doctors, with the benefit of hindsight, could have symptoms: jerry was experiencing moderate hand tremors, he was disoriented (e.g., he believed ┘ claim that jerry was weak and could not “put up much physical resistance.” r. 99-18 (gomez dep. at 118) (page id the circumstances described in jones: she assessed his symptoms (e.g., cramping and diarrhea) cir. 2012); broyles v. correctional med. servs., inc., no. 08-1638, 2009 wl 3154241, at *2 (6th medical condition was obvious to a fellow inmate who shared her concerns and because the behind the privacy partition in the observation cell. marrs and a co helped to move jerry away called immediately. one expert testified that a physician should be called to evaluate any patient medical complaints (i.e. that he vomited, that he ate leftover food from the floor, and that he of the defendants, including the county, and the district court dismissed two others. r. 72 (order “[b]ig red flag” and immediately called a doctor. r. 95-5 (tennessen dep. at 139) (page id however, conley’s failure to follow best medical practices is not necessarily evidence of 477 u.s. 242, 251–52 (1986). in determining whether there is a “genuine issue for trial,” we 945. however, jerry never communicated to marrs that he continued to suffer abdominal pain, and therefore we stomach cramping when she conducted the ciwa. r. 95-3 (conley dep. at 64) (page id #977). a claim for ordinary negligence. r. 3 (am. compl.) (page id #58–80). rouster settled with five not consistently communicate to conley that he continued to experience cramping and pain. should have perceived but did not, while no cause for commendation, cannot under our cases be one-sided that one party must prevail as a matter of law.” anderson v. liberty lobby, inc., v. state malpractice and negligence claims treatment at all”). (page id #964). when conley returned to the cell to check on jerry, he was no longer eating violation, only that his serious medical needs were consciously disregarded.” lemarbe v. explain the bizarre behaviors conley had described. id. at 93 (page id #1011). at successfully assert a § 1983 claim. accordingly, it was appropriate for the district court to grant hours during his regular visit to saginaw. r. 97-12 (natole dep. at 67–68) (page id #1742) evidence presents a sufficient disagreement to require submission to a jury or whether it is so screening form) (page id #2029), marrs’s conclusion that jerry suffered from alcohol cir. 2009) (finding deliberate indifference when a nurse refused to see a patient experiencing

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