Opinion
NO. 3-00-CV-0039-R.
April 30, 2002
FINDINGS AND RECOMMENDATION OF THE UNITED STATES MAGISTRATE JUDGE
Defendant Dallas County, Texas has filed a motion for summary judgment in this prisoner civil rights case. For the reasons stated herein, the motion should be granted.
I.
On October 25, 1998, Plaintiff Kevin Reid Althouse was booked into the Dallas County Jail on charges of aggravated assault and unauthorized use of a motor vehicle. (Plf. Compl. at 3, ¶ 8; Def. App. at 56). At that time, plaintiff advised the intake officer and a jail nurse that he was taking a variety of medications for a bi-polar disorder. These drugs included Lithium, Thorazine, Cogentin, and Ultram. Plaintiff also reported that he suffered from lower back pain. (Plf. App. at 1-2, ¶ 2). Despite sending at least 10 kites to the medical department, plaintiff states that he did not receive any treatment for his back and was denied his medications for more than a month. (Plf. Compl. at 3, ¶ 10). Once his drug therapy resumed, plaintiff alleges that he was overmedicated on Thorazine. ( Id. at 3, ¶ 12). Plaintiff also complains that the nursing staff did not give him enough Motrin to relieve his back pain. (Plf. App. at 3, ¶ 7).
Plaintiff was released to the TDCJ-ID on March 8, 1999. (Def. App. at 18). Eight months later, he returned to the Dallas County Jail on a bench warrant. Plaintiff reminded jail officials that he was taking medication for a psychiatric condition. However, he did not receive any of his medications for 12 days. (Plf. Compl. at 4, ¶ ¶ 19-20). As a result of these treatment delays, plaintiff claims that he experienced physical pain, blackouts, and memory loss. (Plf. Ans. to First Spears Quest. #4, 11).
By this action, plaintiff sues Dallas County, Texas for civil rights violations under 42 U.S.C. § 1983. Defendant has filed a motion for summary judgment as to all claims and causes of action. The motion has been briefed by the parties and is ripe for determination.
In his original pro se complaint, plaintiff asserted a variety of claims against the Dallas County Jail Medical Department, Dallas County, Texas, Sheriff Jim Bowles, Dr. Steven Bowers, and Nurse Beth Rimes. The magistrate judge determined that plaintiff had sufficiently alleged a civil rights claim against Dallas County, Texas for delays in the receipt of prescription medication as a result of an official policy, custom, or practice. All other claims against all other defendants were dismissed as frivolous. See FINDINGS REC. OF MAG. JUDGE, 3/6/00. The district judge affirmed this recommendation in part. However, plaintiffs overmedication claim was reinstated based on the allegation that:
[B]efore incarceration Plaintiff was receiving 500 milligrams daily of Thorazine, in five separate doses of 100 milligrams each, (at 8:00 a.m., noon, 4:00 p.m., 8:00 p.m., and between 10:30 p.m. and midnight). During his incarceration, he initially received a single dose of 500 milligrams of Thorazine once a day at 8:00 p.m. After he complained, the regimen was altered to one dose of 200 milligrams in the morning and one dose of 300 milligrams in the evening. Althouse also alleges that he complained to various nurses about the Thorazine dosages, but no action was taken until February 9, 1999, after he had been in jail for over three months.See Order, 7/9/01 at 2-3, ref. Plf. Ans. to First Spears Quest. #6. Counsel for plaintiff now concedes that "[t]he facts upon which [the district judge] relied in reinstating Althouse's claim, particularly that before his incarceration Althouse was receiving 500 milligrams daily of Thorazine and five separate dosages, have not been substantiated during the investigation of this case." (Plf. Resp. Br. at 17).
II.
Summary judgment is proper when there is no genuine issue as to any material fact and the movant is entitled to judgment as a matter of law. FED. R. CIV. P. 56(c); Celotex v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). A dispute is "genuine" if the issue could be resolved in favor of either party. Matsushita Electric Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986); Thurman v. Sears, Roebuck Co., 952 F.2d 128, 131 (5th Cir.), cert. denied, 113 S.Ct. 136 (1992). A fact is "material" if it might reasonably affect the outcome of the case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986); Matter of Gleasman, 933 F.2d 1277, 1281 (5th Cir. 1991).
A movant who does not have the burden of proof at trial must point to the absence of a genuine fact issue. Tubacex, Inc. v. M/V Risan, 45 F.3d 951, 954 (5th Cir. 1995). The burden then shifts to the non-movant to show that summary judgment is not proper. Duckett v. City of Cedar Park, 950 F.2d 272, 276 (5th Cir. 1992). The parties may satisfy their respective burdens by tendering depositions, affidavits, and other competent evidence. Topalian v. Ehrman, 954 F.2d 1125, 1131 (5th Cir.), cert. denied, 113 S.Ct. 82 (1992). A pro se plaintiff's verified complaint and sworn interrogatory answers can be considered as summary judgment evidence to the extent that such pleadings comport with the requirements of Rule 56(e). See King v. Dogan, 31 F.3d 344, 346 (5th Cir. 1994); Tucker v. Mata, 2002 WL 655528 at *2 (N.D. Tex. Apr. 19, 2002) (Kaplan, M.J.). All evidence must be viewed in the light most favorable to the party opposing the motion. Rosado v. Deters, 5 F.3d 119, 122 (5th Cir. 1993).
Rule 56(e) provides, in relevant part:
Supporting and opposing affidavits shall be made on personal knowledge, shall set forth such facts as would be admissible in evidence, and shall show affirmatively that the affiant is competent to testify to the matters stated therein.
FED. R. CIV. P. 56(e).
III.
Plaintiff sues Dallas County, Texas for denial of adequate medical care in violation of his rights under the Eighth and Fourteenth Amendments to the United States Constitution. In support of his claim against the County, plaintiff alleges that:
It is normal for inmates to wait long periods for medical and psychiatric treatment at the Dallas County Jail because there is not enough staff and a big enough facility to adequately treat the inmate population at Dallas County Jail. This is a result of the deliberate actions of Sheriff Jim Bowles and the County of Dallas not to hire enough staff to adequately treat inmate needs.
* * *
When an inmate asks for medical help, he or she is ignored deliberately because this is the common policy of the operations of the jail.
(Plf. Ans. to First Spears Quest. #18). Defendant moves for summary judgment on the grounds that there is no evidence of deliberate indifference on the part of the jail medical staff or an official policy, custom, or practice that led to treatment delays or the overmedication of inmates. Because plaintiff has failed to establish the existence of an official policy or a pattern of practice that resulted in a constitutional violation, defendant is entitled to judgment as a matter of law.
A.
A civil rights claim based on the denial of adequate medical care arises under the Eighth Amendment to the United States Constitution. U.S. CONST. amend. VIII; Estelle v. Gamble, 429 U.S. 97, 104-05, 97 S.Ct. 285, 291, 50 L.Ed.2d 251 (1976). Plaintiff must show that defendants acted with deliberate indifference to a serious medical need such as to cause the "unnecessary or wanton infliction of pain." Estelle, 97 S.Ct. at 292. This, in turn, requires proof that jail officials were subjectively aware of a substantial risk of serious harm and failed to take reasonable measures to abate that risk. Hare v. City of Corinth, 74 F.3d 633, 649 (5th Cir. 1996), citing Farmer v. Brennan, 511 U.S. 825, 847, 114 S.Ct. 1970, 1984, 128 L. Ed 2d 811 (1994).
Ordinarily, a governmental entity is not liable for the constitutional torts of its employees. See Monell v. Department of Social Services of New York, 436 U.S. 558, 690-94, 98 S.Ct. 2018, 2035-37, 56 L.Ed.2d 611 (1978); Benavides v. County of Wilson, 955 F.2d 968, 972 (5th Cir.), cert. denied, 113 S.Ct. 79 (1992). However, liability may be imposed under 42 U.S.C. § 1983 where an official policy results in the deprivation of a federally protected right. Monell, 98 S.Ct. at 2037-38. A plaintiff must show that: (1) the policy was inadequate; (2) the policymakers were deliberately indifferent to the constitutional rights of its citizens; and (3) the policy directly caused the injury. City of Canton v. Harris, 489 U.S. 378, 390-92, 109 S.Ct. 1197, 1205-06, 103 L.Ed.2d 412 (1989); Benavides, 955 F.2d at 972. In cases where the course of action was deliberately chosen by a decisionmaker with final authority to establish policy, a single act is sufficient to give rise to a civil rights violation. See Pembaur v. City of Cincinnati, 475 U.S. 469, 480-81, 106 S.Ct. 1292, 1299, 89 L.Ed.2d 452 (1986).
A different standard applies where the challenged conduct relates to an informal policy or a custom of behavior among government employees. In such cases, a single constitutional violation is not actionable under section 1983. City of Oklahoma City v. Tuttle, 471 U.S. 808, 820-24, 105 S.Ct. 2427, 2434-36, 85 L.Ed.2d 791 (1985). A plaintiff must establish "a pattern of similar incidents in which citizens were injured or endangered by intentional or negligent [misconduct] or that serious incompetence or misbehavior was general or widespread . . ." Languirand v. Hayden, 717 F.2d 220, 227-28 (5th Cir. 1983), cert. denied, 104 S.Ct. 2656 (1984). The critical inquiry is whether the governing body or official policymaker had actual or constructive knowledge of persistent and widespread violations of constitutional rights. See Bennett v. City of Slidell, 728 F.2d 762, 768 (5th Cir. 1984), cert. denied, 105 S.Ct. 3476 (1985).
B.
The summary judgment evidence, viewed in the light most favorable to plaintiff, shows that jail officials were aware that he was taking prescription drugs for a psychiatric disorder and suffered from lower back pain as early as October 25, 1998. (Plf. App. at 1-2, ¶ 2, 7-14). Yet he did not receive any of his medications or see a doctor until late November or early December 1998. ( Id. at 3, ¶ 7; Def. App. 7-9, 15, 101-02). When plaintiff was finally placed back on Thorazine, his dosage was inexplicably increased. (Plf. App. at 3, ¶ 8; Def. App. at 15). As a result, plaintiff had hallucinations and exhibited "zombie-like behavior." (Plf. App. at 3, ¶ 8, 89; Plf. Ans. to First Spears Quest. #6). Plaintiff also was deprived of his psychiatric and pain medications for 12 days in November 1999. (Plf. Ans. to First Spears Quest. #8; Def. App. 38, 40-41).
Much of this evidence is controverted by the affidavits of Nurse Mary Boyd, Deputy Sheriff Danny Chandler, and Dr. Michael Pittman. (Def. App. at 1-2, 53-54, 101-02). Plaintiff contends that various statements contained in these affidavits are conclusory, not based on personal knowledge, and constitute improper expert opinions by unqualified witnesses. (Plf. Resp. at 2-6, ¶ IV). As none of the evidence objected to by plaintiff is necessary to the disposition of the summary judgment motion, his objections are overruled as moot.
Assuming arguendo that these actions constitute deliberate indifference on the part of the jail medical staff, plaintiff has failed to adduce any evidence establishing a direct causal link between official jail policy and the violation of his constitutional rights. Instead, plaintiff relies on perceived "systematic inadequacies" in addressing the medical needs of inmates generally. For example, plaintiff points out that his vital signs were never taken at any time during his incarceration. He further argues that the nursing staff is unable to answer requests for medical treatment on a daily basis and has no formal process for prioritizing such requests. Nor does the jail have specific guidelines for dispensing psychotropic medications or monitoring inmates taking these drugs. Plaintiff attributes these deficiencies to inadequate staffing, facilities, and recordkeeping procedures. This, plaintiff suggests, is evidence of a custom or widespread practice of deliberate indifference to the medical needs of inmates. (Plf. Resp. Br. at 10-16).
Several courts have held that deliberate indifference can be shown by "proving there are such systemic and gross deficiencies in staffing, facilities, equipment, or procedures that the inmate population is effectively denied access to adequate medical care." Wellman v. Faulkner, 717 F.2d 269, 272 (7th Cir. 1983), quoting Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir. 1980), cert. denied, 68 L.Ed.2d 239 (1981). See also Todaro v. Ward, 565 F.2d 48, 52 (2d Cir. 1977).
The Court disagrees. The summary judgment evidence shows that most requests for medical treatment "are triaged by the nurses all around the clock." (Plf. App. at 27). Requests are prioritized based on urgency. ( Id. at 73). This clearly constitutes an adequate policy of addressing inmate requests. The evidence further demonstrates that the procedures for dispensing psychiatric medications are the same as for other prescription drugs. ( Id. at 78-79). Boyd, Inmate Health Services Manager for the Dallas County Jail, testified that the nursing staff is experienced in this regard and "know[s] what side effects to look for with certain drugs." ( Id. at 79). Dr. Michael Pittman, one of plaintiffs doctors, confirmed that nurses regularly look for side effects when dispensing medication. ( Id. at 54-55). As for staffing concerns, the record shows that the jail employed three full-time doctors and several after hour care physicians in 1998-1999. ( Id. at 29-30). There also were 80 full-time nursing positions during that period. ( Id. at 86). Although the jail, like other healthcare facilities, has experienced a nursing shortage, Boyd testified that there always were a sufficient number of nurses to timely and adequately meet the medical needs of the jail population. ( Id. at 85).
Official jail policy provides, in relevant part:
All medication ordered by physicians will be passed by a licensed nurse. Medication will be passed to every tank area at least twice a day. Medications will be passed more frequently in the infirmaries, behavioral observation and medical tanks.
(Def. App. at 51).
Plaintiff has failed to adduce any evidence that staffing shortages led to "systematic inadequacies" in handling inmate requests, dispensing and monitoring medications, and providing medical care to prisoners in the Dallas County Jail. While the implementation of official jail policy may have been inadequate in plaintiffs case, there is no evidence of "a pattern of similar incidents in which [inmates] were injured or endangered by intentional or negligent [misconduct] or that serious incompetence or misbehavior was general or widespread." Languirand, 717 F.2d at 227-28. See also Fraire v. City of Arlington, 957 F.2d 1268, 1278 (5th Cir.), cert. denied, 113 S.Ct. 462 (1992) (custom or policy requires pattern of similar incidents). This is fatal to plaintiff's claim against the County.
During discovery, plaintiff requested various documents pertaining to other inmates incarcerated in the Dallas County Jail from October 1, 1998 through December 31, 1999. According to plaintiff, this information was necessary "to establish a custom or policy of overmedication and the denial of medical treatment . . ." (Plf. Mot. to Compel at 3). Defendant objected to this discovery as unduly burdensome. In support of this objection, defendant submitted evidence showing that it would take 30 days to review approximately 33, 200 files in order to identify all inmates incarcerated with plaintiff during the relevant time period. Based on this evidence, the Court determined that "the burden and expense of obtaining this information far outweighs any probative value." See ORDER, 3/5/02.
RECOMMENDATION
There is no genuine issue of material fact as to whether Dallas County, Texas was deliberately indifferent to the medical needs of plaintiff through an official policy or a widespread and persistent custom or practice. Accordingly, defendant's motion for summary judgment should be granted.