Jail inmate wins go-ahead in medical care case

Evidence that jail officials failed to provide reasonably prompt medical care to inmate suffering from methadone withdrawal created issue of fact warranting denial of defense motion for summary judgment.

While the Constitution requires jail officials to take reasonable steps to care for the well being of jail inmates, officials are not held to the same standard as health care professionals in the private sector and cannot be held liable for mere negligence. Instead, governmental officials may be held liable only for ''deliberate indifference'' in responding to an inmate's serious medical needs.

The Column reviews a new 7th U.S. Circuit Court of Appeals decision that illustrates that the line between negligence and deliberate indifference is often difficult to identify, even for judges. Foelker v. Outagamie County, et al., No. 04-1430 (7th Cir., Jan. 7). On April 27, 2000, Richard Foelker began serving a sentence at the Outagamie County, Wis., Jail for driving under the influence of an intoxicant.

At the time, Foelker was five weeks into a methadone maintenance treatment program intended to wean people off of narcotics addictions.

On the day he reported to the jail to begin serving his sentence, Foelker had not taken his daily dose of methadone. Shortly after arriving at the jail, Foelker advised Paul Mintzlaff, a registered nurse, that he needed a dose of methadone to avoid going into withdrawal. The next morning, the jail's nursing coordinator, Marsha Allain, told Foelker that he would not receive methadone because he had already been off the drug for three days.

On Foelker's third day in the jail, another registered nurse, Brian Schertz, was advised by a jail sergeant, John Behrent, that Foelker had defecated on himself and on the floor of the holding cell, and that the stench was ''unbearable.'' Foelker was then evaluated by Diane Mandler, a social worker and supervisor of the Outagamie County Crisis Program.

She reported that Foelker was confused, disoriented and unaware that he had defecated on himself and on the floor. He said he was hearing voices.

On his fourth day in the jail, Foelker again defecated on the floor but still received no medical attention.

On his fifth day, Mintzlaff found Foelker to be disoriented. Foelker said he believed he was at ''the wedding hotel'' and was waiting to be married; he also was hallucinating that there was another person in his cell. A few hours later, Mintzlaff sent Foelker to the hospital, where he was diagnosed with acute delirium, secondary to drug withdrawal. Foelker was hospitalized for four days before being returned to the Outagamie County Jail.

Foelker later filed a federal civil rights lawsuit against several officials, contending that they were deliberately indifferent to his serious medical needs and therefore violated his constitutional rights.

Following discovery, U.S. District Judge William C. Griesbach of the Eastern District of Wisconsin granted summary judgment in favor of the remaining defendants on the ground that Foelker had failed to establish that the defendants were deliberately indifferent to his serious medical need.

Foelker appealed.

In a 2-1 ruling, the 7th Circuit reversed. Writing for the majority, Judge Terence T. Evans began by reviewing the legal standards governing Foelker's claim: ''To prevail, Foelker must show deliberate indifference to a serious medical need. See Estelle v. Gamble, 429 U.S. 97, 104 (1976). 'A ''serious'' medical need is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor's attention.' Jackson v. Illinois Medi-Car Inc., 300 F.3d 760, 765 (7th Cir. 2002).'' Initially, the appeals court agreed with the finding that Foelker had presented evidence of a serious medical need, despite the fact that he could not show he was in ''pain or extreme distress'':

''That Foelker was not in extreme distress does not necessarily mean that he did not have a serious medical need. Here, as it turns out, the opposite is true. The fact that Foelker was not distressed despite believing he was at the 'wedding hotel' and defecating on the floor of his cell and on himself is strong evidence of a severe medical need.''

The 7th Circuit then considered whether the defendants' failure to respond to that need was merely negligent or whether they were deliberately indifferent to Foelker's plight.

The court briefly set forth the high standard necessary to sustain a claim of deliberate indifference:

'' '[D]eliberate indifference' is simply a synonym for intentional or reckless conduct, and 'reckless' describes conduct so dangerous that the deliberate nature of the defendant's actions can be inferred. Qian v. Kautz, 168 F.3d 949, 955 (7th Cir. 1999).''

In reversing the summary judgment, the appeals court concluded that Foelker had presented evidence sufficient to warrant a jury trial on his claim of deliberate indifference despite the defendants' denial that they were aware of the seriousness of Foelker's condition:

''While it is true that Foelker has not presented evidence of, say, statements by Schertz and Mandler proving that they knew the severity of Foelker's condition, direct evidence is not always necessary to state a claim.

''Undisputed evidence shows that Schertz checked on Foelker the night of April 28 and again around 1:15 p.m. the next day.

He did not seek further medical attention for Foelker, even though Foelker had defecated on the floor of his cell and on himself. Although Schertz might have honestly believed, as he claims, that Foelker 'was playing the system,' a reasonable jury could consider that Schertz knew that Foelker had not taken his methadone and was exhibiting signs of withdrawal and thus conclude that Schertz knew there was something seriously wrong with Foelker. It could thus conclude that Schertz recklessly or maliciously allowed the situation to fester.

''Similarly, after examining Foelker a few hours after Schertz on April 29, Mandler found Foelker to be 'confused and disoriented' and 'unaware' that he had defecated in his cell. Although Mandler knew that Foelker might have been suffering from methadone withdrawal, she recommended only that he continue to be monitored. Again, she might not have understood the severity of the situation and might have negligently believed that Foelker did not need additional medical attention.

But drawing all inferences in Foelker's favor, as we must at this stage, a reasonable jury could also conclude that she intentionally allowed Foelker to suffer from the effects of his withdrawal.''

Dissenting, Judge Daniel A. Manion emphasized the high burden necessary to establish a violation of the Constitution:

''To be deliberately indifferent, Schertz and Mandler must have 'had a sufficiently culpable state of mind.' Jackson v. Ill. Medi-Car Inc.,300 F.3d 760, 765 (7th Cir. 2002) (internal quotation omitted). Under this subjective standard, Foelker 'must proffer evidence demonstrating that [Schertz and Mandler] were aware of a substantial risk of serious injury to [Foelker] but nevertheless failed to take appropriate steps to protect him from a known danger.' ''

Manion explained that Foelker's evidence, while perhaps sufficient to suggest negligence on the part of the defendants, was wholly insufficient to warrant a jury trial on the question of whether the conduct was deliberately indifferent:

''A reasonable jury cannot translate evidence of misjudgment or negligence into deliberate indifference. It would require much speculation to conclude that Schertz and Mandler had a culpable state of mind, i.e., that they intentionally or recklessly withheld treatment so as to inflict punishment.

Future plaintiffs should not be able to survive summary judgment by merely establishing a serious medical need and then claiming that a defendant's failure to do more to recognize or treat that need amounted to deliberate indifference.

''Although Foelker suffered some personal indignities and some serious medical problems due to the unnecessary withdrawal from his drug addiction, there is not sufficient evidence for a reasonable jury to conclude that Schertz and Mandler were deliberately indifferent to Foelker's medical needs.''

US: Sotos is a partner of the law firm of Hervas, Sotos, Condon &; Bersani P.C. in Itasca, concentrating in government representation. Sotos represents Illinois municipalities and governmental officials in federal and state litigation at the trial and appellate levels. He is a 1985 graduate of The John Marshall Law School.

By James G. Sotos posted 19 January 05

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