Brawner v. Scott Cnty.

• Decision Date: 22 September 2021
• Docket Number: No. 19-5623,19-5623
• Citation: 14 F.4th 585
• Parties: Tammy M. BRAWNER, Plaintiff-Appellant, v. SCOTT COUNTY, TENNESSEE, Defendant-Appellee.
• Court: U.S. Court of Appeals — Sixth Circuit

14 F.4th 585

Tammy M. BRAWNER, Plaintiff-Appellant,

v.SCOTT COUNTY, TENNESSEE, Defendant-Appellee.

No. 19-5623

United States Court of Appeals, Sixth Circuit.

Argued: June 1, 2020

Decided and Filed: September 22, 2021

Richard Everett Collins, II, STANLEY, KURTZ & COLLINS, PLLC, Knoxville, Tennessee, for Appellant. Caitlin C. Burchette, TAYLOR & KNIGHT, GP, Knoxville, Tennessee, for Appellee. ON BRIEF: Richard Everett Collins, II, STANLEY, KURTZ & COLLINS, PLLC, Knoxville, Tennessee, for Appellant. Caitlin C. Burchette, Arthur F. Knight, III, TAYLOR & KNIGHT, GP, Knoxville, Tennessee, for Appellee.

Before: CLAY, WHITE, and READLER, Circuit Judges.

HELENE N. WHITE, Circuit Judge.

Tammy Brawner appeals the district court's grant of judgment as a matter of law under Rule 50(a), arguing that she presented sufficient evidence for a jury to find that the multiple seizures she suffered while a pretrial detainee in the Scott County jail were the result of Scott County's unconstitutional policies or customs. Because Brawner presented sufficient evidence for a jury to find Scott County liable for her injuries based on two of its policies, we REVERSE and REMAND IN PART, and otherwise AFFIRM.

I.

We begin with a brief explanation of relevant state law, county policy, and county custom.

Initial Medical Screenings. Tennessee law requires certain jails to screen all newly arrived detainees for serious medical conditions. Tenn. Comp. R. & Reg. 1400-01-.13(8)(a)-(e). Scott County implemented these state regulations through a written questionnaire. Among other things, the questionnaire asked whether the detainee has a serious medical condition, whether the detainee needs to continue prescribed medication, and whether the detainee is currently thinking about suicide. According to Scott County policy, if a detainee answers yes to any of these questions, medical staff, if on duty, should respond; otherwise, EMS should be notified. The questionnaire also asks the administering officer to determine whether the detainee is capable of understanding the questions asked. If the officer believes the detainee is incapable of doing so, the form instructs the officer to call the medical staff if the detainee's incapacity is caused by mental-health issues, suicidal thoughts, intellectual disability, acquired brain injury

, substance abuse, or some combination thereof.

There is no written policy stating which particular jail staff member should conduct this screening. The custom at the Scott County jail was for the booking officer (who was not medically trained) to do so. The practice was for the officer to create two copies of the completed intake form and send one to the jail nurse, who would place the form in the detainee's individual medical file.

Prescribed Medication . The Scott County jail had a general policy against administering controlled substances to detainees. Prescribed medications were permitted to be administered to detainees only if expressly ordered by the jail doctor; all controlled substances were banned, even when a detainee had been taking the substance pursuant to a prescription.

Physical Examination . Tennessee law requires all detainees to undergo a more complete medical examination within fourteen days of admission. Among other conditions, the examiner must check for "medications taken" and "special health requirements." Tenn. Comp. R. & Reg. 1400-01-.13 (9)(b). In Scott County, a jail nurse customarily conducts the examination, with the results reviewed by a jail doctor.

II.

Brawner Is Detained and Screened . Following revocation of her bail, Brawner was detained at the Scott County jail on June 29, 2016. Upon her arrival, Brawner was medically screened by the booking officer. On a written questionnaire, Brawner answered that she needed to continue her prescription medications, listing the four medications she had been taking, including three controlled substances: suboxone

, clonazepam, and gabapentin. At the same time, she denied having a serious medical condition that required attention and denied having epileptic seizures. The officer noted that Brawner did not appear capable of understanding all the questions asked.

There is conflicting evidence about whether Brawner's intake form ever made it to the jail nurse, Nurse Massengale. The County stipulated that "[i]t is the Jail's longstanding practice for the booking officer, [Tucker], to print two copies of the Inmate Medical Form listing prescription medication or other medical issues. One copy is placed in the inmate's custodial (or jail) file, and the second copy is placed in Nurse Massengale's ‘box’ ...." R. 155, PID 1063. But at trial, Nurse Massengale claimed that she did not see the list of Brawner's medications until over a week after the initial screening.

Brawner's Seizures . On July 7, eight days after her booking, Brawner suffered multiple seizures and was taken to a local hospital. A treating physician diagnosed her with epilepsy

, recommended that she see a physician within two days, and prescribed Phenobarbital, an antiepilepsy medication, for her seizures. The hospital was informed that Brawner had four prescribed medications but apparently was not told that Brawner had not been permitted to take those medications. Upon returning to the jail the same day, Brawner was examined by Nurse Massengale. At the jail doctor's instruction, Nurse Massengale discontinued Brawner's Phenobarbital and instead administered daily doses of Dilantin, an anti-seizure medication the doctor believed would better treat Brawner's condition.

Four days later, Brawner suffered another seizure. The seizure occurred early in the morning, when Nurse Massengale was not present. A corrections officer called the jail doctor, who directed the officer to record Brawner's vitals and administer Dilantin

.

A day later, July 12, (and within fourteen days of Brawner's initial detention), Nurse Massengale performed the state-required physical examination. She noted that Brawner suffered from a "seizure disorder or cerebral trauma

." R. 207, PID 1401. The jail doctor was not personally involved in the examination but reviewed and signed off on it.

Two days after the exam, officers observed Brawner acting erratically, including by drinking out of the toilet. Believing that this behavior could be related to Brawner's history of mental-health issues, Nurse Massengale contacted a licensed social worker. The social worker, who was aware of Brawner's previous seizures, conducted an evaluation, and concluded that Brawner's symptoms were most likely the result of drug withdrawal. It does not appear that Nurse Massengale consulted with the jail doctor after receiving the evaluation.

Early the next morning, officers observed Brawner experience another seizure. The officers did not call 911. One hour later, Brawner's cellmates reported yet another seizure. The officers again did not call 911, as they recorded that Brawner's blood pressure and pulse appeared to be normal. The officers gave Brawner her daily dose of Dilantin

.

Another hour passed and Brawner's cellmates again reported that Brawner was experiencing seizures. By this point, Nurse Massengale had arrived at the jail. She placed Brawner under 15-minute-interval medical observation. Within an hour, Brawner suffered six more seizures. Nurse Massengale called the jail doctor, who in turn instructed her to give Brawner a dose of valproic acid

. Not long after, Brawner had three more seizures, at which point Nurse Massengale called 911. Brawner suffered three more seizures at the hospital before being transported by helicopter to another hospital's intensive-care unit.

Brawner Files Suit Against Scott County and County Employees. Brawner sued Scott County and various County jail staff alleging inadequate medical care and that corrections officers tased her in response to her seizures. Brawner claimed that as a result of prolonged seizure activity, she suffered permanent and debilitating injuries while being held by Scott County, making Defendants liable under § 1983 for violating her Fourteenth Amendment rights to adequate medical care and to be free from excessive force. Brawner and her husband also brought state-law claims.

Before trial, the parties stipulated to the dismissal of the individual defendants, leaving Scott County as the sole defendant. And during trial, the parties agreed to dismiss the state-law claims against Scott County, so that all that remained were Brawner's claims alleging that Scott County violated her Fourteenth Amendment rights.

After Brawner presented her case at trial, the district court granted Scott County's Rule 50(a) motion for judgment as a matter of law. As to Brawner's medical-care claim, the district court first addressed whether Brawner had presented sufficient evidence to establish that any individual violated her constitutional rights by being deliberately indifferent to her serious medical needs. The court held that Brawner's medical need was sufficiently serious to satisfy the objective component of a deliberate-indifference claim, but she failed to show that the jail staff were subjectively deliberately indifferent to her serious medical need because she did not show that the staff were actually aware of facts from which an inference could be drawn that there was a substantial risk of serious harm. Nor, according to the district court, did the jail staff actually draw that inference—the staff followed standard booking procedure and responded to Brawner's seizures by monitoring her and calling for medical aid. And because seizure suppression was not the most prevalent use of Brawner's medications, those medications, the district court explained, were not evidence from which the staff should have inferred that Brawner was at risk of seizures. The district court therefore concluded that Brawner's medical-care claim against the County could not succeed because she had not established that any individual had violated her...