Miranda v. Munoz

Decision Date27 August 1985
Docket NumberNos. 84-1664,84-1757,s. 84-1664
PartiesRosa Maria Cristobal MIRANDA, et al., Plaintiffs, Appellees, v. Miguel Gimenez MUNOZ, et al., Defendants, Appellants. Rosa Maria Cristobal MIRANDA, et al., Plaintiffs, Appellants, v. Miguel Gimenez MUNOZ, et al., Defendants, Appellees.
CourtU.S. Court of Appeals — First Circuit

Jose E. Fernandez-Sein, Santurce, P.R., with whom Harvey B. Nachman, Maria H. Sandoval and Nachman & Fernandez-Sein, Santurce, P.R., were on brief for Rosa Maria Cristobal Miranda.

Doris Zoe Pons-Pagan, Asst. Sol. Gen., Dept. of Justice, San Juan, P.R., with whom Americo Serra, Acting Sol. Gen., San Juan, P.R., was on brief for Miguel Gimenez Munoz.

Before COFFIN, BOWNES and DAVIS, * Circuit Judges.

COFFIN, Circuit Judge.

These appeals follow a jury trial of a Civil Rights action under 42 U.S.C. Sec. 1983. Plaintiffs are the mother and brother of a 19-year-old epileptic who became critically ill while committed to the Arecibo District Jail as a pre-trial detainee and who died three days after being transferred to a local hospital. Plaintiffs alleged that a group of defendants exhibited "deliberate indifference" toward the decedent's medical needs, thus inflicting cruel and unusual punishment upon him in violation of the Eighth Amendment. Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). The jury returned a verdict against three defendants--the jail's doctor, warden and assistant warden--and awarded a total of $50,000 in damages against them. Four other defendants, all supervisory officials in the Puerto Rico correctional system, were granted directed verdicts at the close of evidence. Plaintiffs appeal from the district court's decision to remove these four defendants from the case, and the remaining defendants appeal from a denial of their motion for judgment notwithstanding the verdict. After a careful review of the testimony presented at trial and the relevant legal principles, we conclude that the district court properly denied judgments n.o.v. in favor of the defendants found liable but improperly granted directed verdicts for the other four defendants. We thus remand for a new trial on their liability.

I. Denial of Judgment Notwithstanding the Verdict

The principles governing our review of the denial of a motion for judgment n.o.v. are well established. We may not consider credibility, resolve conflicts in testimony, or evaluate the weight of the evidence. Judgment n.o.v. should be granted only when the evidence could lead reasonable persons to but one conclusion. Fishman v. Clancy, 763 F.2d 485, 486 (1st Cir.1985); Cazzola v. Codman & Shurtleff, Inc., 751 F.2d 53, 54 (1st Cir.1984); Rios v. Empresas Lineas Maritimas Argentinas, 575 F.2d 986, 989 (1st Cir.1978). We must view the evidence and the inferences fairly drawn from it in the light most favorable to the prevailing party. Fishman, 763 F.2d 485, 486.

We thus turn to the evidence. Carlos A. Rosario Cristobal was a 19-year-old man who had suffered from epilepsy and mental illness for a number of years. He took medication to control his epileptic seizures and psychiatric problems, and had spent the last two months of 1979 in the Forensic Psychiatric Ward of the Rio Piedras Medical Center. After his discharge from that facility, Rosario Cristobal resumed his previous outpatient treatment at the Manati Mental Health Center. His last recorded visit there was on March 6, 1980, the day before he was committed to the Arecibo District Jail when he was unable to post bail on a charge of aggravated assault.

Rosario Cristobal received no medical attention at the Arecibo District Jail through the weekend following his arrival on Friday. On Monday, March 10, a lawyer retained by his mother called the prison and informed Warden Jose A. Candelaria Alonso of Rosario Cristobal's maladies. Warden Candelaria Alonso then asked Dr. Pedro A. Mora Boneta, a physician who worked at the prison eight hours per week, to examine Rosario Cristobal. Dr. Mora Boneta, whose specialty was obstetrics and gynecology, prescribed two types of medication for him, but did not prescribe phenobarbitol, a drug Rosario Cristobal had been taking to control seizures. A medical expert for plaintiff testified that an abrupt stop of phenobarbitol could trigger a life-threatening condition known as status epilepticus, in which the person could experience repeated seizures. Dr. Mora Boneta gave Rosario Cristobal the first dosage of the medication he prescribed, but there are no records indicating that the decedent received any further medication at the jail. The responsibility for distributing medications at that time rested with the supervising prison guard on duty because the jail's full-time nurse, who usually administered drugs, was not working in March due to an accident. Although Rosario Cristobal told Dr. Mora Boneta that he had been receiving treatment at the Manati Mental Health Center, and plaintiffs' attorney had told Warden Candelaria Alonso that Carlos was receiving psychiatric treatment, no one called the Health Center for information about Rosario Cristobal.

Also on Monday, March 10, the decedent's mother, Rosa Maria Cristobal Miranda, went to the prison with her son's medication. She was not allowed to enter because it was not a visiting day. The guard at the gate took the pills from Mrs. Cristobal Miranda, but there is no indication in the record that Rosario Cristobal received them. She again brought medication to the hospital on Saturday, March 15, a visiting day, but was not allowed to give it to her son. During that visit, Rosario Cristobal told his mother that he had received no medication and was having seizures.

As a result of his examination of Rosario Cristobal on March 10, Dr. Mora Boneta had advised Warden Candelaria Alonso to schedule an appointment for Rosario Cristobal at the Forensic Psychiatric facility "as soon as possible". An appointment was made for March 20. On the morning of March 20, as Rosario Cristobal was in the van and about to be transported to the psychiatric facility, he suffered an epileptic seizure and was taken to the Arecibo District Hospital rather than to his scheduled appointment. He received an injection of anti-convulsant medication and apparently also received some treatment for a bruised eye which he suffered during the seizure in the van. He was then returned to the jail and, according to prison records, suffered a second seizure later the same day. There is no indication that anyone attempted to reschedule the appointment at the psychiatric facility.

Dr. Mora Boneta, who was not at the jail on March 20, a Thursday, because it was his day off from that job, was told the next day that Rosario Cristobal had suffered two seizures. The doctor testified that he later observed Rosario Cristobal from a distance, but never performed a follow-up examination at close-range. No follow-up notes at all appear in Rosario Cristobal's prison medical record.

Prison records show that on March 24, Rosario Cristobal suffered another seizure. On March 25, a local judge issued an order directing that Rosario Cristobal be transferred from the Arecibo Jail to the Forensic Psychiatric facility. There is some dispute in the record as to whether Rosario Cristobal actually was taken to the facility on that day or whether prison officials merely communicated with the hospital by telephone, 1 but the evidence established unequivocally that no beds were available for other than emergency patients and the prison officials were told to try again the next day.

During the night of March 25 through the morning of March 26, Rosario Cristobal suffered a series of seizures. He was taken to the Arecibo District Hospital early on the morning of March 26 and was in a semi-comatose state when admitted. He failed to respond to treatment and the next afternoon was transferred to the larger Arecibo Regional Hospital. He died there two days later, and his medical records listed his final diagnosis as "status epilepticus."

In order to establish that medical mistreatment constitutes a violation of the Eighth Amendment, a prisoner must show "acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs", Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 292, 50 L.Ed.2d 251 (1976). We have observed previously that " '[w]here a prisoner has received some medical attention and the dispute is over the adequacy of the treatment, federal courts are generally reluctant to second guess medical judgments and to constitutionalize claims which sound in state tort law' ", Layne v. Vinzant, 657 F.2d 468, 474 (1st Cir.1981) (quoting Westlake v. Lucas, 537 F.2d 857, 860 n. 5 (6th Cir.1976)). We declined to hold, however, "that treatment received may never be 'so clearly inadequate as to amount to a refusal to provide essential care' ", Layne v. Vinzant, 657 F.2d at 474 (quoting Thomas v. Pate, 493 F.2d 151, 158 (7th Cir.1974)).

We think the jury properly could find this to be a case of medical attention so inadequate that it represented "deliberate indifference" on the part of the three defendants found liable. At least by March 21, the day after he suffered the first of his seizures, all three knew that Rosario Cristobal's epilepsy was not under control. Yet neither the jail doctor nor the warden or assistant warden apparently did anything to determine the precise cause of this attack or to prevent future ones. Defendants, it could reasonably be found, did not inadvertently fail to provide adequate medical care, Estelle, 429 U.S. at 105, 97 S.Ct. at 291, or deny the decedent the right to the treatment of his choice, Ferranti v. Moran, 618 F.2d 888, 891 (1st Cir.1980). It could be found that defendants ignored a clear warning that the medical treatment they provided for Rosario Cristobal was inadequate, allowing him to deteriorate beyond recovery. We therefore...

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