Terrance v. Northville Regional Psychiatric Hosp.

• Decision Date: 08 April 2002
• Docket Number: No. 00-1971.,00-1971.
• Parties: Eugene TERRANCE, as Personal Representative of the Estate of Everett L. Terrance, Plaintiff-Appellant, v. NORTHVILLE REGIONAL PSYCHIATRIC HOSPITAL, et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Sixth Circuit

Page 834

286 F.3d 834

Eugene TERRANCE, as Personal Representative of the Estate of Everett L. Terrance, Plaintiff-Appellant, v. NORTHVILLE REGIONAL PSYCHIATRIC HOSPITAL, et al., Defendants-Appellees.

No. 00-1971.

United States Court of Appeals, Sixth Circuit.

Argued: October 25, 2001.

Decided and Filed: April 8, 2002.

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Jeremiah J. Kenney (argued), Tammy J. Reiss (briefed), Fieger, Fieger, Schwartz & Kenney, Southfield, MI, for Plaintiff-Appellant.

Mark S. Meadows (argued and briefed), Office of the Attorney General, Tort Defense Div., Lansing, MI, for Defendants-Appellees.

Before JONES^* and CLAY, Circuit Judges; DOWD, District Judge.^**

OPINION

NATHANIEL R. JONES, Circuit Judge.

Plaintiff Eugene Terrance ("Terrance"), father of Everett Terrance ("the decedent") and the personal representative of his estate, appeals the district court's order granting summary judgment in favor of defendants, Northville Regional Psychiatric Hospital ("NRPH"), the State of Michigan Department of Mental Health, and the named defendants, in a 42 U.S.C. § 1983 action claiming deliberate indifference to medical needs and lack of due process in violation of the decedent's rights under the Eighth and Fourteenth Amendments. The district court held that no genuine issue of material fact existed as to whether the defendants were deliberately indifferent to the decedent's medical needs. The court did not address the due process claim. On appeal, plaintiff argues that the award of summary judgment was in error. For the reasons stated below, we AFFIRM the district court as to certain defendants on the Eighth Amendment claim, but REVERSE the district court's grant of summary judgment as to other defendants on the Eighth Amendment claim and as to all defendants on the Fourteenth Amendment claim, and REMAND for further proceedings consistent with this opinion.

I. FACTS

On June 19, 1995, Everett Terrance was involuntarily committed to NRPH to receive treatment for auditory hallucinations, depression, erratic mood swings, and paranoid delusions. When the decedent arrived at NRPH, he was housed in a room located directly above a main steam line. Starting in June 1995, NRPH underwent an asbestos abatement program during which asbestos pipe insulation was removed from the steam line and later replaced with fiberglass insulation. The exposure of the bare pipe caused more heat to emanate until the new insulation was applied.

During his hospitalization at NRPH, the decedent was treated by several medical professionals. Staff psychiatrist Dr. O.R. Lee was the decedent's primary psychiatrist. Dr. Govindan Sadasivan covered the decedent's unit while Dr. Lee was on vacation. The decedent was also treated by Dr. Ardeshir Said, who was the primary internist responsible for overseeing all of the decedent's medical problems on an "as needed" basis. Dr. Said treated and had more contact with the decedent than any other physician at NRPH. The decedent was also treated by primary therapist Nurse Sherley Owens and occupational therapist Barbara Fanning. During the decedent's stay in the facility, Dr. Mehdi Almasi served as Medical Director and, as such, was responsible for drafting all of NRPH's policies and procedures.

While at NRPH, the decedent suffered from a number of medical conditions. He received a variety of treatments for psychological illness, including the administration of psychotropic medications, such as Haldol, Cogentin, and Lithium. These medications can cause hyperthermia, dehydration, heat exhaustion, and heat stroke. The decedent also suffered from pre-existing heart conditions, including hypertension and diabetes. On June 23, 1995, Nurse Owens developed a "Comprehensive Nursing Assessment" for the decedent in which she concluded that he had problems following directions and thus required staff supervision in off-ward activities. Because of the decedent's conditions and his inability to follow directions, he was kept under staff supervision during off-ward activities.

On June 27, 1995, at the direction of the medical staff, the decedent began participating in centralized activities ("CAT") in the mornings and work therapy in the afternoons. On July 6, 1995, the decedent wandered off from CAT, but was apprehended by security and returned to the ward several hours later. The decedent was then placed on "escape alert."¹ Dr Sadasivan discontinued the escape alert on July 10 after the decedent told the doctor that he did not feel like escaping. Of particular note here is that, according to hospital records, the only air conditioning unit within the ward was not working on July 10 and was not repaired until one week later.

On July 11, the decedent told Nurse Owens that he wanted to return to the CAT program. Nurse Owens determined that the decedent should not leave the ward until July 17. On July 12, the decedent complained of feeling weak. Consequently, Dr. Said ordered tests to be run on the decedent. The tests showed no signs of hyperglycemia.² Despite Nurse Owens's order, the decedent participated in outdoor activity for four hours on the afternoon of July 12. The next day, the decedent was "returned to the ward complaining of chest pain." The decedent's blood pressure was elevated and his EKG was interpreted as abnormal. Despite these results, Dr. Said's medical plan for the decedent indicated that no action needed. Dr. Said later noted that the decedent's diabetes was uncontrolled, but Dr. Said took no measures to control the decedent's glucose level at that time.

According to hospital records, between July 15 and July 17, the decedent drank a lot of water, was confused, and became agitated to the point of being non-responsive. The decedent was also observed talking to himself and responding to voices. On July 17, Dr. Lee increased the decedent's dosage of Haldol. On July 18, the staff observed the decedent drinking excessive amounts of water and was therefore kept under close observation because the staff suspected that the decedent was dehydrated.

Two days later, Dr. Lee ordered an additional daily injection of Haldol, thus increasing again the decedent's total daily dosage of the drug. At this time, Dr. Lee issued a plan to observe the decedent for risk of dehydration.

On July 25, the decedent complained to Nurse Owens that his medicine was causing him to sweat profusely and suffer stiffness. The decedent was given Cogentin to counteract stiffness and hand tremors, which are side effects of Haldol. Regarding the pipe repairs, on the same day, the maintenance personnel were installing insulation to the elbows of the bare steam pipes directly below the decedent's room, causing additional heat to emanate from the pipes into the ward above.

On July 27, Nurse Owens recorded no further complaints of reactions by the decedent and also noted the decedent began to participate in activities with staff, including occasional van rides with Ms. Fanning. On July 29, Nurse Owens noted her intention to refer the decedent back to CAT and into the centralized therapy program ("CTP") the following week.

On July 31, the temperature outside was 95 degrees Fahrenheit and the humidity level was above 90 percent. NRPH's temperature chart, which was distributed to hospital employees during the summer months, indicated that these conditions produced a heat index of 148 degrees. According to NRPH advisory guidelines, the decedent was the type of patient who should have been in a cool room and not permitted to go outdoors or to engage in strenuous activity.

At 6:30 a.m. on the morning of July 31, the decedent complained of dry mouth. Nevertheless, some three hours later, Dr Lee determined that the decedent should resume participation in more outdoor activities. At approximately 10:00 a.m., Dr. Said saw the decedent and realized that the decedent had not received his blood pressure medication over the weekend because the nurses apparently forgot to remind Dr. Said to renew the order. After two elevated blood pressure readings were obtained from the decedent, Dr. Said doubled the decedent's medication to compensate for the days that the decedent had gone without blood pressure medication. However, Dr. Said's order for this dosage was never carried out.

On that same day, no one at NRPH knew of the decedent's whereabouts from the time he was seen with Dr. Said in the morning until about 1:30 p.m. that afternoon, when the decedent was seen staggering in the hallway near the nursing station. Dr. Lee and Ms. Fanning assisted the decedent into a treatment room and observed that the decedent was sweating, hot to the touch, and complaining that he did not feel well. Dr. Lee thought that the decedent was suffering from heat stroke and needed immediate treatment, but had to consult with Dr. Said before prescribing treatment.

Dr. Lee instructed Nurse Owens to page Dr. Said "STAT."³ At approximately 1:30 p.m., Nurse Owens paged Dr. Said and explained that the decedent was sweaty, confused, had a temperature of 103.5 degrees, and was restless to the point of being uncooperative. Nurse Owens also informed Dr. Said that the decedent had been outside. Dr. Said told Nurse Owens that he was on his way to the ward where the decedent was located.

At this time, the decedent's blood pressure was elevated, and his mental state was deteriorating quickly. Dr. Lee and Nurse Owens waited approximately one hour before calling a medical emergency at 2:27 p.m. Dr. Said arrived at 2:30 p.m. Drs. Regina Pan, Ramachandran Nair, and Kijoon Kim responded to the emergency call soon thereafter, but did not provide any direct care to the decedent because Drs. Said and Almasi had already begun treating the decedent.

Upon his arrival, Dr. Said told the doctors to remove the decedent's clothing. While the doctors were removing his clothing, the decedent lost consciousness. Dr. Lee inserted an IV and placed wet towels over the...