638 F.3d 905 (8th Cir. 2011), 10-1280, Schaub v. VonWald
|Citation:||638 F.3d 905|
|Opinion Judge:||BENTON, Circuit Judge.|
|Party Name:||Phillip David SCHAUB, Appellee, v. Steven VONWALD, Appellant.|
|Attorney:||Gregory James Griffiths, argued, Rochester, MN, for appellant. Anthony J. Colleluori, argued, Melville, NY, Victor A. Carr, on the brief, Woodbury, NY, for appellee.|
|Judge Panel:||Before SMITH, BEAM, and BENTON, Circuit Judges. BEAM, Circuit Judge, dissenting.|
|Case Date:||April 26, 2011|
|Court:||United States Courts of Appeals, Court of Appeals for the Eighth Circuit|
Submitted: Nov. 17, 2010.
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After a bench trial, the district court 1 found that Steven C. VonWald, the director of the Minnesota facility in which Philip D. Schaub was incarcerated, was deliberately indifferent to Schaub's serious medical needs in violation of the Eighth Amendment. The court awarded Schaub $214,000 in compensatory damages and $750,000 in punitive damages. VonWald appeals both the judgment and the award of punitive damages. Having jurisdiction under 28 U.S.C. § 1291, this court affirms.
In 1984, Schaub became a paraplegic at age 21 in a car accident. On November 20, 2002, Schaub pled guilty before Minnesota District Judge Jodi L. Williamson, and was sentenced to serve 180 days in the Olmsted County Adult Detention Center (" ADC" ) as part of his sentence. The
ADC is a detention facility connected to the County Government Center in Rochester, Minnesota. At the time of Schaub's confinement, the ADC director was VonWald.
Schaub has several serious medical conditions. Due to the atrophy of his muscles from the chest down, he has very little cushion in his legs and buttocks to protect his feet, legs, coccyx (tail bone), and sacrum (lower back), which easily become bruised or affected by pressure sores. Pressure (bed) sores are lesions caused by unrelieved compression of tissues between bone and surrounding surfaces. Bed sores are slow-healing and can be fatal if untreated. Proper treatment is to relieve pressure by turning the patient at least every two hours, and keeping the wounds free of bacteria and dead tissue (because bacteria grow in dead tissue and can greatly compromise wound healing). Schaub also has edema (an abnormal accumulation of fluid beneath the skin) in his feet, which creates pressure that can exacerbate any bed sores. Treatment requires him to elevate his feet above his head at night in order to drain excess fluid.
Schaub also suffers from severe spasticity— involuntary muscle contractions that cause lower-body muscles to jump and jerk. Because he has sensation down to his knees, his spasticity causes pain and interferes with sleep. The spasticity, which prevents Schaub from sleeping completely flat, is treated by elevating both his legs and upper body with the aid of an adjustable hospital bed. In addition, he has an intrathecal pump under his skin that administers the drug baclofen directly into his cerebral spinal fluid (baclofen dampens the spasticity).
When Schaub came to the ADC in March 2003 to begin his sentence, he was assigned to a handicapped-accessible cell in the work-release unit. In work release, detainees work outside the ADC at regular jobs during business hours, then return for overnight detention. For full-time prisoners, the ADC contracts with the local public health department to staff the ADC medical unit and provide health-care services. Detainees on work release, however, are responsible for their own medical care and may obtain medical care while away from the ADC. Both full-time and work-release detainees are sent to an outside hospital for emergency care. During Schaub's stay, the medical unit was staffed by nurses during business hours Monday through Friday. A part-time physician was supposed to be present for a half-day twice a week. The medical staff was supervised by Robin G. Molella, M.D., a Mayo Clinic physician working under a contract between the county and the clinic.
Schaub's handicapped-accessible cell had a privacy wall adjoining the toilet. The toilet had grab bars nearby at an angle, neither horizontal nor vertical. The cell had an emergency call button near the bed, not reachable from the toilet. Immediately upon entering the cell at intake, Schaub notified the sergeant that the cell was inadequate for his needs. Schaub said the toilet was so low that he could fall when transferring between it and his wheelchair, and the shower was unusable because the shower bench was made of hard metal. He also objected to the metal bed common to all ADC cells, which could cause pressure sores.
The sergeant attempted to accommodate Schaub. He was authorized to take an additional two hours of work-release time to go home to shower and use the bathroom (Schaub's apartment had a shower with a padded seat and hand-held showerhead, and the toilet had a padded seat). The sergeant authorized two mattresses and additional pillows for Schaub's bed.
A short time after arriving, Schaub developed pressure sores on his legs; the
additional pillows were insufficient to raise his legs high enough to drain fluids out of them.2 Compounding the problem, the bed had no grab bars, so he could not change his body position in order to prevent pressure sores.
During his time at the ADC, Schaub continued to see his regular doctors at the Mayo Clinic while on work release. On April 7, 2003 (one month into his sentence), Dr. Kathryn A. Stolp wrote Director VonWald after treating Schaub for a pressure sore on his heel. She stated:
To prevent skin breakdown, decrease dependent edema (which leads to breakdown of his feet if not controlled), and for spasticity management, he [Schaub] requires a padded toilet seat, adequate accessible shower with padded shower bench, and a mechanism for elevating his legs as well as pressure-relieving mattress on his bed. He cannot sleep completely flat without exacerbating his spasticity. He has now developed a pressure sore on his left heel.
I would appreciate your assessment as to whether his care needs can be met at the jail.... If the above conditions cannot be met, I guess I would advocate for him to be on home electronic monitoring.
The letter was reviewed by Dr. Molella, the physician in charge of ADC health care. She entered notes in Schaub's file stating that the standards set by Dr. Stolp " will be extremely difficult to reliably provide in ADC," and that " the bed situation is still suboptimal." Because Schaub was then in work release and still responsible for his own health care, Dr. Molella did not meet with him or treat him.
On April 29, Schaub broke his femur after falling to the floor while trying to transfer from the toilet to his wheelchair. While he usually used the toilet at his apartment, on this occasion he " felt a deep personal urge," in the district court's words. The cell's only panic button was above the bed, out of his reach. His calls for help went unheard. After ten minutes or so, Schaub was able to pull himself up into the wheelchair and summon the guard. He was released to drive himself to the hospital. Schaub was admitted to the hospital for about a week, and had surgery to place a pin in his upper thigh.
After the fall, his attorney petitioned Judge Williamson for a sentence modification so Schaub could serve the rest of his sentence on electronic home-monitoring. The attorney specifically alleged that the ADC could not adequately meet his physical and medical needs. Schaub filed an affidavit detailing his health issues and the inadequacies of his cell at the ADC. The Olmsted County Attorney's Office opposed the request. Judge Williamson wrote ADC Director VonWald on May 13, inquiring whether the ADC could adequately accommodate Schaub's needs. Judge Williamson enclosed Schaub's affidavit, the April 7 letter from Dr. Stolp to VonWald, and a summary of his condition prepared by Dr. Stolp.
On May 15, Director VonWald wrote Judge Williamson. He said it was his belief that the ADC had addressed all of Schaub's needs " except the bed issue." VonWald noted that Schaub was given extra work-release time outside the ADC to address his medical and personal-hygiene issues, and that he had been instructed to
bring in a toilet lift for use when he needed to use the bathroom at the ADC. VonWald added:
We also instructed him to bring in whatever mattress and cushions he needed to take care of the lower and upper extremity problems he experiences. Certainly, we don't have a hospital bed that can be electronically adjusted but we felt that by allowing whatever he thought he needed in mattresses and cushions would fulfill the Doctor's orders.
... My staff and I are of the opinion, with participation and cooperation from Schaub he can serve out his sentence without his medical condition deteriorating simply because he is staying in the ADC.
On May 16, Judge Williamson denied the request to modify Schaub's sentence. She appended VonWald's letter to her order, which incorporated it by reference.
On July 15, Schaub returned to the ADC from home recovery. When he returned, he had a cast on his leg and open pressure sores on his thighs and heels. He was no longer eligible for work release, as he had lost his job. Therefore, he was placed in the general population of full-time detainees, so his medical care was the responsibility of the ADC. VonWald testified that he noticed " first thing in the morning" that Schaub had returned to the ADC and was placed in the general prison population, not in the work-release unit. While VonWald asked his prison staff to ask the medical staff to " check" with Schaub, he did not make any inquiry to the ADC medical staff to find out whether the ADC could fully provide for Schaub's care...
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