Mandel v. Doe
| Decision Date | 17 November 1989 |
| Docket Number | No. 88-3557,88-3557 |
| Citation | 888 F.2d 783 |
| Parties | George MANDEL, Plaintiff-Appellee, v. John DOE (name unknown, an Escambia County Prison employee), et al., Defendants, Escambia County, Florida, Defendant-Appellant. |
| Court | U.S. Court of Appeals — Eleventh Circuit |
Julius F. Parker, Jr., Parker, Skelding, McVoy & Labasky, Tallahassee, Fla., for defendant-appellant.
Daniel M. Soloway, James F. McKenzie, McKenzie & Milisap, P.A., Pensacola, Fla., for plaintiff-appellee.
Appeal from the United States District Court for the Northern District of Florida.
Before VANCE and ANDERSON, Circuit Judges, and ATKINS *, Senior District Judge.
Appellee George Mandel brought this Sec. 1983 action against Escambia County ("County"), contending that he had been injured by a physician assistant's deliberate indifference to his serious medical needs during his tenure as an inmate at a county road prison. The district court entered judgment for Mandel on a jury verdict and damage award of $500,000. The County appeals, arguing that the district court erred in directing a verdict for plaintiff on the issue of municipal liability and in denying the County's directed verdict motions as to that question and deliberate indifference. We conclude that the district court's rulings on the directed verdict motions were correct. We thus affirm the judgment of the district court.
In October 1981, Escambia County initiated a program to provide medical care to inmates at its road prison, County Road Camp No. 5, in Cantonment, Florida. As provided in a Memorandum of Understanding between the County and the County Health Department, a physician's assistant was to be located at the road prison to provide medical care to the inmates. Pursuant to this memorandum, physician's assistant Richard Hatfield was placed at the prison to provide medical care. Although it was originally contemplated that the physician's assistant would be supervised by a medical doctor, a custom and practice developed that Hatfield was subject to no supervision or review at all.
George Mandel was lawfully incarcerated at the road prison from June 1 to September 13, 1982. On July 1, 1982, Mandel jumped off the bed of a work crew pick-up truck, landed on his left leg and immediately felt a sharp pain in his left leg and hip.
Two days later, on July 3, 1982, Mandel sought treatment for his injury by filing the required medical request form with the physician's assistant, Richard Hatfield. 1 Hatfield did not see Mandel until July 18. At that time Mandel told Hatfield that something "real bad" was wrong with his leg and requested that an X-ray be performed. Hatfield failed to perform an X-ray or to provide any other treatment on this first visit. 2 Mandel filed with Hatfield another written request for treatment on July 19. He was not examined by Hatfield following this request.
On July 20, as Mandel was waiting at the road prison to be called to work, his left leg collapsed under him. A road prison guard, Captain Mike Holland, witnessed this event. Upon learning of Mandel's prior injury and his unsuccessful attempts to secure treatment, the guard told Mandel to submit another medical request form, and that he would ensure Mandel was seen by the physician's assistant. That day Mandel filed a third written request for treatment in which he stated that it was hard to walk because every step hurt.
On July 23, Hatfield examined Mandel. Mandel, who entered Hatfield's office dragging his left leg, informed Hatfield that he could not walk on his left leg or put any pressure on the left side of his body. Hatfield diagnosed Mandel's problem as inflammation of the bone and prescribed Motrin and five days of bed rest. Mandel asked to see a doctor or to be sent to a hospital to have X-rays performed. Hatfield refused both requests, saying that he was a doctor.
On July 28, Hatfield visited Mandel in the large dormitory room where he had been resting. Mandel complained that his leg was worsening--that he could barely stand on it--and again requested an X-ray. Hatfield did not examine Mandel, but ordered that he be placed in an isolated cell six feet by eight feet, with no sink or toilet. No explanation was offered for this transfer. After he was placed in the cell, Mandel's condition continued to deteriorate to the point where he could walk only by holding onto something or trying to skip so as not to place any weight on the affected leg.
Hatfield examined Mandel on August 2, and diagnosed his condition as muscle inflammation. Once again Mandel asked to be sent to a hospital for X-rays, and his request was again denied on the grounds that Hatfield was a doctor. Hatfield gave Mandel aspirin and asked whether he wanted to return to work. To avoid having to return to his six-by-eight cell, Mandel responded affirmatively and was released to work.
From the time they were notified of his injury a day or two after it occurred, Mandel's parents visited him at the road prison on a weekly basis. Mandel's mother kept apprised of his condition through Mandel, other inmates, guards and her own observations. 3 Within two weeks of the injury, Mrs. Mandel called Hatfield, under the assumption that he was a doctor, to ask about her son's condition and to request that he be taken to an emergency room to have X-rays taken. Hatfield said it was not necessary to take X-rays.
The following week, after learning that Hatfield was not a doctor, Mrs. Mandel drove to the prison to ask that her son be taken to a private doctor or an emergency room, and offered to pay for such treatment. At a meeting with Hatfield and prison superintendent Elliott, both Elliott and Hatfield laughed in response to Mrs. Mandel's request, and Elliott asked, "Do you always run interference for your son?" R8:244. 4
Shortly after that meeting, on August 3, Hatfield again examined Mandel. Hatfield observed that Mandel was virtually unable to walk, but again refused Mandel's request for X-rays, commenting that his mother was offering "interference" for him. Hatfield gave Mandel a muscle relaxant, and placed him back in the six-by-eight cell. Mandel took the prescribed muscle relaxant and stayed in bed, but experienced no improvement. Mandel continued to complain of his condition to Hatfield and to request additional treatment, but was never again examined by him.
After her disappointing meeting with Hatfield and Elliott, Mrs. Mandel and her husband made an appointment with Kenneth Kelson, Chairman of the Board of Commissioners for Escambia County. At that meeting Mr. and Mrs. Mandel explained the circumstances of Mandel's injury and Hatfield's refusal to send Mandel to be examined by a doctor. Chairman Kelson told the Mandels that he would try to get their son out of the six-by-eight cell and to secure some treatment for his injury.
Following that meeting, Chairman Kelson sent the County Administrator, Rodney Kendig, to the road prison. Kendig was successful in securing Mandel's immediate release from the cell back into the general population. However, Mandel did not receive any medical care following Kendig's intervention--no X-rays were performed, and he was not brought to see a doctor.
In a subsequent conversation with Mandel's father, Kelson said "that as far as doing anything about the medical aspect of the case that ... he had no authority whatsoever to butt into the internal affairs or any of the workings of the county government and specifically the county road camp." R8:264-65. 5
On August 10, Mandel returned to work with the authorization of Hatfield. Mandel's road crew captain gave him light work to perform, such as raking dirt. Mandel continued to request medical care from Hatfield and other personnel at the road prison, and Hatfield told Mandel that he would never receive an X-ray for his leg. Mrs. Mandel also repeatedly asked Hatfield that her son be taken to an emergency room or seen by a private physician, at her expense. Her requests were all denied.
Mandel was released from the county road prison in September 1982, upon completion of his sentence. At the time of his release, Mandel was unable to walk.
Shortly after his release Mandel was examined by Dr. Leo Flynn, a Board-certified orthopedic surgeon. Dr. Flynn took X-rays and determined that Mandel had sustained a fracture or crack in the round part of the hip joint when he jumped off the truck. According to Dr. Flynn, the failure to perform surgery following the fracture caused a collapse of the roundness of the bone and made necessary a complete prosthetic hip joint replacement, including both the ball and socket. 6
Mandel filed this action pursuant to 42 U.S.C. Sec. 1983, 7 alleging that he had suffered permanent physical impairment as a result of the deliberate indifference of the County officials in violation of the Eighth Amendment. Following the dismissal by stipulation of all individual defendants, the sole defendant at trial was Escambia County. At the close of plaintiff's case, the County moved for a directed verdict on the issues of deliberate indifference and municipal liability. The motion was denied. At the close of all the evidence, the district court denied another motion for directed verdict by the County and granted, over defendant's objection, Mandel's motion for directed verdict on the question of Monell liability. 8 The jury returned a verdict in favor of Mandel in the amount of $500,000. Following entry of judgment, the court denied defendant's motions for judgment notwithstanding the verdict or in the alternative for a new trial. The County timely appealed from the final judgment.
The County argues that the district court erred in denying its motion for a directed verdict and for judgment notwithstanding the verdict on the question of whether Hatfield's treatment constituted deliberate indifference to Mandel's serious medical needs. The...
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