Opinion
CIVIL 1:21-cv-880-JL Opinion 2022 DNH 130
10-19-2022
Stephanie Martel, as Administrator for the Estate of Robert Martel v. Hillsborough County, et al.
Lawrence A. Vogelman, Esq. Brittani Schanstine, Esq. Donald L. Smith, Esq. Todd J. Hathaway, Esq. Abby Tucker, Esq.
Lawrence A. Vogelman, Esq.
Brittani Schanstine, Esq.
Donald L. Smith, Esq.
Todd J. Hathaway, Esq.
Abby Tucker, Esq.
MEMORANDUM ORDER
Joseph N Laplante, United States District Judge.
In a lawsuit stemming from an unfortunate inmate death at the Valley Street Jail, the defendants ask the court to test the allegations in the complaint against the demanding standards for constitutionally inadequate medical care, Monell liability, and government employee immunity. Robert Martel reported to Valley Street for a brief incarceration and began experiencing alcohol withdrawal symptoms soon thereafter. After receiving medical treatment from the Jail's nursing staff, Martel was later found unresponsive in his cell and died unexpectedly. Martel's Estate filed suit against Hillsborough County (the municipal entity that operates Valley Street), three County nurses who treated Martel during his incarceration, and a correctional officer who briefly interacted with Martel (the “County Defendants”). The Estate later amended its complaint to add the Jail's outside medical providers as defendants (the “AIMG Defendants”). This court has jurisdiction over the plaintiff's federal claims under 28 U.S.C. §§ 1331 and 1343 because the claims present federal questions and arise from federal civil rights statutes, and supplemental jurisdiction over its state law claim under 28 U.S.C. § 1367(a).
The individual defendants move to dismiss the plaintiff's complaint, arguing that the well-plead factual allegations, and all reasonable inferences drawn therefrom, cannot support claims for deliberately indifferent (and thus constitutionally inadequate) medical care. The County further argues that absent an underlying constitutional violation by one of its employees, the plaintiff's municipal liability claim is unsustainable. As to the negligence claim, the nurses argue that the factual allegations show that they believed in the legality of their actions, and they are therefore immune under N.H. RSA § 507-B:4, while the AIMG Defendants ask the court to decline to exercise supplemental jurisdiction over this claim.
After considering the parties' submissions and twice hearing oral argument, the court grants the motions as to the federal claims. The allegations against the individual defendants at most show a disagreement as to Martel's course of treatment, as opposed to purposeful denial of care, delayed care, lack of care intended to punish Martel, or care so inadequate that it amounts to a refusal of care. Disagreements over appropriate medical care, and “misjudgment, even negligent misjudgment, [are] not deliberate indifference.” Ramos v. Patnaude, 640 F.3d 485, 490 (1st Cir. 2011). And, aside from unsupported legal conclusions or speculation, the plaintiff has failed to plead sufficient facts to sustain a deliberate indifference claim against the AIMG Defendants under theories of supervisory liability or willful blindness. Moreover, absent an underlying constitutional tort or violation, the plaintiff's municipal liability claim against the County must be dismissed. Finally, because the court is dismissing the plaintiff's federal claims at an early stage of the litigation, it declines to continue exercising supplemental jurisdiction over the state law negligence claim and dismisses that claim without prejudice.
I. Applicable legal standard
To defeat a Rule 12(b)(6) motion, the plaintiff must plead “factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Martinez v. Petrenko, 792 F.3d 173, 179 (1st Cir. 2015). This standard “demands that a party do more than suggest in conclusory terms the existence of questions of fact about the elements of a claim.” A.G. ex rel. Maddox v. Elsevier, Inc., 732 F.3d 77, 81 (1st Cir. 2013). In ruling on such a motion, the court accepts as true all well-pleaded facts set forth in the complaint and draws all reasonable inferences in the plaintiffs favor. See Martino v. Forward Air, Inc., 609 F.3d 1, 2 (1st Cir. 2010). The court may also consider judicially noticed documents, matters of public record, and documents introduced by the plaintiff in her objection to the motion to dismiss or concessions in that objection, without converting the 12(b)(6) motion into a motion for summary judgment. See Breiding v. Eversource Energy, 939 F.3d 47, 49 (1st Cir. 2019); Greene v. Rhode Island, 398 F.3d 45, 49 (1st Cir. 2005).
IT. Background
The court draws the relevant factual background from the plaintiffs Second Amended Complaint.
On May 7, 2021, Martel was ordered to serve a 10-day sentence at Valley Street Jail in Manchester, New Hampshire. The County operates, and houses detainees and inmates at Valley Street, and employs correctional officers, nurses, and other staff there. At the time of Martel's incarceration at Valley Street, the County contracted with American Institutional Medical Group, LLC to provide medical care to inmates and detainees at Valley Street. AIMG was then comprised of Christopher Braga, M.D. and Christopher Schwieger, PA-C. PA Schwieger has since passed away and the plaintiff is suing his estate in this lawsuit.
Around 6:00 pm on May 10, Martel reported to Valley Street to serve his sentence.Several hours later, Defendant Bryanna Gue, RN screened Martel during the booking process.During the screening, Martel told Nurse Gue that he drank a bottle of vodka per day, and had consumed a bottle of vodka earlier that day. Martel then signed a consent to treatment form, which authorized County medical providers and their subcontractors to provide medical treatment to Martel. Nurse Gue did not obtain Martel's medical history, physically assess him, take his vital signs, complete a screening assessment or “problem list,” or conduct a “Clinical Institute Withdrawal Assessment for Alcohol” (CIWA) during Martel's booking. Nurse Gue noted that Martel was not “apparently under the influence of alcohol or drugs” and was not “showing signs of withdrawal” at that time.
Nurse Gue nevertheless placed Martel on detoxification watch or “detox watch” at approximately 10 pm that night. When an inmate is placed on detox watch, the nursing staff and corrections officers must “closely and frequently” monitor the inmate and assess symptoms and vital signs to determine whether further medical intervention is required. After placing Martel on detox watch, Nurse Gue did not assess his symptoms or take his vital signs. Nor did she contact Dr. Braga or PA Schwieger. Instead, she instructed that Martel not use the gym or engage in other recreation yard activities. She also arranged for him to have a lower bunk and a mattress for the floor due to seizure concerns. After booking, Jail officials placed Martel in the unit where detox-watch inmates are housed.
Defendant Erica Gustafson, LPN next visited Martel just after midnight on May 11.She noted that Martel was at risk for detox, but he refused to have his vital signs taken and refused a “CIWA” assessment. Nurse Gustafson's notes do not show that she informed Martel of the potential adverse medical consequences of his refusal to be assessed. Eight hours later, an unidentified nurse visited Martel's cell and he again refused to be assessed for alcohol withdrawal and refused to have his vital signs taken.
Defendant Katelyn Hrubiec, LPN checked on Martel around 9:40 am. She observed him experiencing symptoms of alcohol withdrawal, including sweating, agitation, and restlessness.Martel told Nurse Hrubiec that he struggled with chronic alcohol abuse, drank 750 mL of Vodka each day, and had consumed that amount on the day he reported to Valley Street. Martel also informed Nurse Hrubiec that he used fentanyl daily and experienced serious withdrawal problems when he stopped using drugs. Nurse Hrubiec then took Martel's vital signs and assessed his withdrawal symptoms using the CIWA scale. She noted that Martel was sweating profusely, becoming increasingly agitated, and experiencing chills and tremors. Nurse Hrubiec assigned Martel a CIWA score of 13, which indicated that he was experiencing mild to moderate withdrawal. She also noted that Martel was experiencing Stage 1 hypertension. Following Nurse Hrubiec's assessment, the nursing staff, on orders of Dr. Braga, placed Martel on the jail's “EtOH Alcohol Withdrawal Protocol.”
Nurse Gustafson again saw Martel in the late afternoon of May 11. Nurse Gustafson noted Martel's reported complaints of sweats, chills, body aches, restlessness, anxiety, agitation, nausea, and vomiting and assigned him a CIWA score of 5 based on her assessment. She also charted Martel's blood pressure as 142/88 (sitting) and 144/90 (standing), indicating that he was experiencing Stage 2 hypertension.