Williams v. Mehra

• Decision Date: 05 February 1998
• Docket Number: No. 97-1118,97-1118
• Citation: 135 F.3d 1105
• Parties: Ruth Ann WILLIAMS, Personal Representative of the Estate of Anthony Wade, Deceased, Plaintiff-Appellee, v. T.N. MEHRA; Dr. Cabrera; Dr. Rodriguez, Defendants-Appellants, John Jabe, Warden; Gerald Hofbauer, Deputy Warden; John Fisher, Security Guard; Jane Doe, Nurse, Defendants.
• Court: U.S. Court of Appeals — Sixth Circuit

Page 1105

135 F.3d 1105

Ruth Ann WILLIAMS, Personal Representative of the Estate of Anthony Wade, Deceased, Plaintiff-Appellee, v. T.N. MEHRA; Dr. Cabrera; Dr. Rodriguez, Defendants-Appellants John Jabe, Warden; Gerald Hofbauer, Deputy Warden; John Fisher, Security Guard; Jane Doe, Nurse, Defendants.

No. 97-1118.

United States Court of Appeals Sixth Circuit.

Argued Oct. 20, 1997.

Decided Feb. 5, 1998.

James W. McGinnis (argued and briefed), Detroit, MI, for Appellee.

E. Michael Stafford, Asst. Attorney Gen., Office of the Attorney General, Corrections Division, for Defendants.

Erica Weiss Marsden (argued and briefed), Office of the Attorney General of Michigan, Mental Health Division, Lansing, MI, for Defendants-Appellants.

Before: KEITH, BOGGS, and COLE, Circuit Judges.

KEITH, J., delivered the opinion of the court, in which COLE, J., joined. BOGGS, J. (pp. 1116-22), delivered a separate opinion concurring in part and dissenting in part.

OPINION

KEITH, Circuit Judge.

Defendants-Appellants, Dr. Mehra, Dr. Cabrera, and Dr. Rodriguez, appeal the district court's denial of summary judgment on the grounds of qualified immunity on Plaintiff's Eighth Amendment claim of deliberate indifference brought pursuant to 42 U.S.C. § 1983. For the reasons stated herein, we AFFIRM in part and REVERSE in part the decision of the district court.

I. Factual Background

Plaintiff, Ruth Ann Williams, is the personal representative of the estate of decedent, Anthony Wade. Decedent committed suicide while incarcerated at the State Prison of Southern Michigan (hereinafter "SPSM"). Defendants-Appellants, Mehra, Cabrera, and Rodriguez, are psychiatrists for SPSM, and each evaluated decedent prior to his death. The relevant facts are as follows.

Decedent was convicted of second degree murder and conspiracy to commit murder on August 4, 1993. Decedent was sentenced to serve a 25-60 year prison term. Prior to decedent's commitment to SPSM, decedent was a pre-trial detainee in Wayne County Jail (hereinafter "WCJ"), from April 24, 1992 to August 20, 1993. During decedent's detainment in WCJ, he was diagnosed as suffering from clinical depression with psychotic features. Decedent remained in the WCJ's medical ward and received various forms of psychotherapy treatments. At various times throughout decedent's incarceration, decedent stated that he was depressed and that he heard voices. On several occasions decedent wavered about whether he wanted to end his life--stating that he did not want to live anymore, that he thought about suicide, that he was tired, and that he was in jail for something he did not do. Yet, when questioned as to whether decedent had suicidal ideation, decedent denied that he would actually take his life.

To counteract the voices in decedent's head, decedent was prescribed the psychotropic medication, Thorazine, which is used to manage manifestation of psychotic disorders. In December 1992, decedent attempted suicide by overdosing on twenty of the Thorazine tablets. Decedent had hoarded the pills for his suicide attempt. Decedent was thereafter taken off the tablets, placed on liquid psychotropic medication, and provided additional therapy sessions. Nevertheless, decedent's condition worsened, and on February 18, 1993, he was transferred to Northville Regional Psychiatric Hospital (hereinafter "Northville").

Initial diagnosis at Northville revealed that decedent was severely depressed with suicidal thoughts. Decedent had a poor appetite, a sleep disorder, low energy, and a poor libido. Doctors prescribed the anti-depressant, Sinequan, in liquid form and administered individual and group psychotherapy. Decedent's condition marginally improved. Decedent continued to suffer from major depression, yet, he denied having any suicidal thoughts or hallucinations. Decedent did, however, verbalize that he planned to overdose on pills when given the opportunity. Decedent was continued on Sinequan liquid 225mg, and Lithium citrate 300 mg to counteract the depression.

Decedent's prognosis at the time of discharge was reflected as, "poor to guarded for patient to be maintained in the Wayne County Jail. Major risk factor for this patient is non-compliance with discharge medication and/or patient's condition deteriorating in response to the stress of being incarcerated in the Wayne County Jail and facing his legal problems." ¹

Upon return to WCJ, decedent was maintained on the same liquid medication and received psychiatric intervention at least once a week. On August 20, 1993, decedent was transferred from WCJ to SPSM to begin his sentence term for the convictions. During decedent's final interview at WCJ, decedent admitted to medical personnel that he had repeated thoughts of suicide and that he had a suicide plan but refused to share it with anyone. This information was duly noted in decedent's discharge summary.

Although it is disputed as to what information was available to Defendants upon decedent's arrival at SPSM, it is undisputed that the following items were available: 1) the Pre-Sentence Investigation Report, 2) the Wayne County Discharge Planning-Referral Form, and 3) the Sheriff's Questionnaire.

The Pre-Sentence Investigation Report, in addition to stating that decedent had psychiatric problems, included the following:

While in WCJ, the defendant attempted suicide one week prior to Christmas, by taking 20 Thorazine tablets. He states that he did so, because he is locked up for something that he did not do. He further stated that he still thinks about suicide on occasion. He said, "I still think of suicide on occasion. I am going to prison for something I didn't do. I was trying to keep from killing the girl.

The Wayne County Discharge Planning-Referral Form stated that decedent was diagnosed as suffering from "[m]ajor depression 296.3 with psychotic features." It also stated that decedent's current medications were "Sinequan 200 m.g. (conc)," "Lithium Citrate;" and "Prolixin HCL." ²

The Discharge Planning-Referral Form also stated that decedent had repeated suicide thoughts and that decedent stated that he "may as well wait until after sentencing on Thursday." ³ The form further stated "[i]nmate reports [of] a plan but refuses to share with therapist."

The Sheriff's Report was devoid of any information.

On August 20, 1993, the same day of decedent's transfer to SPSM, decedent was seen by Nurse Keller. Decedent completed a health form stating that he heard voices and that he was currently taking Thorazine. Keller called WCJ to verify decedent's medication; however, she was informed that decedent was taking Sinequan at bedtime. Keller noted this information in decedent's file.

On August 25, 1994, decedent was seen by psychologist, Harold Duckworth. A written psychological test indicated that decedent was suffering from depression. Duckworth's report indicated that decedent had no psychiatric history or suicide ideation attempts. No follow-up action was recommended.

On August 30, 1993, another psychologist, Marie Alcala-Cardew, interviewed decedent because his psychological screening tests had been red-flagged. Cardew's report, dictated September 2, 1993, indicated:

[decedent's] psychological history consists of his being treated for depression while he was in the county jail. He was on Sinequan. His suicide history consists of his making a suicide attempt while in the county jail. He obtained some psychotropic medications by telling medical staff that he was hearing voices. He then used the psychotropic medications to overdose. ⁴

Cardew's clinical impression indicated that decedent was depressed. Her diagnostic impressions denoted that decedent suffered from adjustment disorder with depressed mood, and that decedent had a personality order with antisocial personality disorder. Cardew's global assessment of decedent's overall ability to function had decreased four points from his past assessment. Decedent's adjustment "within his community" and "to his incarceration" was labeled as "guarded." Although Cardew's report stated that decedent "is not suicidal, but he is depressed; and he is being treated for this [depression] by the Outpatient Mental Health Team," she also determined decedent to be "a moderate potential risk for suicide." ⁵

The same day that decedent was seen by Cardew, decedent was interviewed by Defendant Mehra. Defendant Mehra's Comprehensive Psychiatric Evaluation stated:

This is a 31-year old single black male who is evaluated today because he was in Wayne County Jail, and placed on medication at that facility for depression. On interview, the patient states that since being locked up in jail he began feeling depressed, unable to eat and unable to concentrate, and has sleeping difficulties. He states he was seen by the psychiatrist in the County Jail, and was put on Sinequan, 200 mg. h.s. He has been taking this medication since 2-93. On further interview, the patient states that while he was in the County Jail he began hearing voices of laughter of different people. He was placed on Thorazine. He said the voices ended, and he was placed on Sinequan because he was feeling depressed. The patient admits having heard voices while he was out in the community. He states the voices did not bother him, so he did not seek treatment.

The patient denies being seen by a psychiatrist or of being treated at any psychiatric facility in the past.

Based on decedent's representations and Defendant Mehra's interview impressions, Defendant Mehra recommended that decedent be maintained on Sinequan tablets, 200 mg. h.s. (at bedtime) for thirty days and that his medication be reviewed after thirty days. This was Defendant Mehra's sole contact with decedent.

On September 3, 1993, decedent was removed from the intake unit and transferred to central prison population. Thereafter, Decedent was given monthly appointments to meet with Defendant Cabrera. On September 14, 1993, decedent's first...