Brown v. Dist. of Columbia, Civil Action 14-750 (RC)

CourtUnited States District Courts. United States District Court (Columbia)
Writing for the CourtRUDOLPH CONTRERAS, United States District Judge
Docket NumberCivil Action 14-750 (RC)
PartiesMOZELL BROWN, Individually and as the Personal Representative of the Estate of Reuel Griffin, Plaintiff, v. DISTRICT OF COLUMBIA, et al., Defendants.
Decision Date11 January 2022

MOZELL BROWN, Individually and as the Personal Representative of the Estate of Reuel Griffin, Plaintiff,

DISTRICT OF COLUMBIA, et al., Defendants.

Civil Action No. 14-750 (RC)

United States District Court, District of Columbia

January 11, 2022


RE DOCUMENT NOS. 282, 284, 285, 286





RUDOLPH CONTRERAS, United States District Judge


Plaintiff Mozell Brown, representing the estate of Reuel Griffin, brings this action against the District of Columbia and several other Defendants based on the care Griffin received during his commitment to Saint Elizabeths Hospital.[1] Three groups of Defendants brought motions for summary judgment. First, the District moves for partial summary judgment of Plaintiff's claim for denial of substantive due process under the Fifth Amendment and 42 U.S.C. § 1983 based on causation.[2] Second, several higher-level hospital employees move for summary judgment of Plaintiff's 1983 claim based on qualified immunity, and of Plaintiff's negligence claim based on


failure to prove duty or breach.[3] Third, several lower-level hospital employees move for summary judgment of Plaintiff's 1983 claim based on qualified immunity.[4] Plaintiff moves for partial summary judgment on liability of the 1983 and negligence claims against the District and several individual Defendants.[5] For the reasons given below, the qualified-immunity defenses succeed and the motions are granted to that extent, but the motions are otherwise denied.


A. Saint Elizabeths' Payments for External Care

Saint Elizabeths Hospital “is the public psychiatric hospital for the District of Columbia” operated by the D.C. Department of Behavioral Health (“DBH”). Pl.'s Statement of Undisputed Material Facts (Corrected) (“Pl.'s SUMF”) ¶¶ 1, 3, ECF No. 289-2. During the relevant time, the following individuals held the following roles at Saint Elizabeths: Patrick Canavan: CEO; Anthea Seymour: COO; Bernard Arons: Medical Director; Edger Potter: Supervisory General Medical Officer. For patients' medical care, some routine medical services are provided on site,


but patients must be referred to external providers for “non-psychiatric specialty medical services.” Id. ¶ 8.

As part of the scheduling process for external medical appointments, “[t]he hospital routinely provided a Not Guilty By Reason Of Insanity patient's Medicaid or Medicare [sic], if the patient had a Medicaid or Medicare number.” Defs.' Resp. Pl.'s Statement of Material Facts (“Defs.' SUMF Resp.”) ¶ 27, ECF No. 293-2 (quoting District's interrogatory response). Antoinette Quander-Clemons was responsible for scheduling outside appointments but was not responsible for billing; nurse Bernadeane Greene acted as Quander-Clemons's assistant during the relevant time. Defs.' Lower-Level SUMF ¶¶ 31, 38, ECF No. 282-3. Greene scheduled the August 4, 2011 appointment discussed below for which Griffin was not seen due to lack of insurance. Id. ¶ 39.

The federal Medicaid statute has an exclusion for institutions for mental diseases (“IMD exclusion”). Under the IMD exclusion, Federal Financial Participation (“FFP”)-funds paid by the federal government to states for Medicaid expenditures-is generally unavailable for “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases.” Virginia Dep't of Med. Assistance Servs. v. HHS, 678 F.3d 918, 919 (D.C. Cir. 2012) (quoting 42 U.S.C. § 1396d(a)(B)). The parties agree that the IMD exclusion applies to Saint Elizabeths. Defs.' SUMF Resp. ¶ 22. Several high-level officials at Saint Elizabeths were aware of the IMD exclusion before and during the relevant events. See, e.g., Pl.'s SUMF ¶¶ 26. Despite the IMD exclusion, the D.C. Department of Healthcare Finance (“DHCF”) “generally paid” outpatient medical claims for IMD patients because DHCF does not track whether claims are submitted for IMD patients. Pl.'s Higher-Level SUMF Resp. ¶ 4, ECF No. 295-1.


An “issue regarding Medicaid federal fund participation availability (FFP) . . . arose in late Spring 2011 when the Hospital had difficulty scheduling external appointments.” Defs.' SUMF Resp. ¶ 34; see also Id. ¶ 36 (acknowledging that some “emails do suggest that Saint Elizabeths was having difficulty scheduling outside medical appointments”). Multiple individuals testified that external providers refused to accept Medicaid as the payment method for Saint Elizabeths patients. See, e.g., id. ¶¶ 32-34. Plaintiff points to numerous alleged instances of patients experiencing delays in receiving external medical treatment throughout 2011 and 2012, though Defendants dispute the cause of delays for many of these. See Defs.' SUMF Resp. ¶¶ 37-38. Between April 2011 and April 2012, many emails among Saint Elizabeths and District employees, including upper management at Saint Elizabeths, refer to difficulties getting external medical appointments because Medicaid was not being approved or accepted. See Pl.'s SUMF ¶ 41. The District “did not generally obtain financing or payment for external medical care before scheduling or transporting patients to external medical appointments until it was notified that it needed to pay for its IMD patients.” Id. ¶ 42. Defendants cite evidence showing efforts from Saint Elizabeths and District personnel to figure out how to pay for external care for IMD-exclusion patients. See, e.g., Defs.' Higher-Level SUMF ¶¶ 15, 17, ECF No. 285-3.

In September 2011, another method to pay for external medical care was developed: Purchase Cards (“P-Cards”), which were essentially credit cards, could be used. Pl.'s SUMF ¶ 44. P-Cards were used to pay for at least one instance of external care in 2011, although there is testimony that the P-Cards had problems, such as some external providers not accepting it. Id. In June 2013, Saint Elizabeths began using Letters of Financial Responsibility (“LOFR”) to


directly pay for external care. Id. ¶ 45. “Today, the LOFR remains the protocol in place to pay for external care.” Id.

B. Griffin's Care Relating to External Appointments

“Reuel Griffin was involuntarily committed to St. Elizabeths Hospital in 1983 pursuant to D.C. Code § 501(d)(1) after he was adjudicated Not Guilty By Reason of Insanity (NGBRI) on charges of Destroying Property and Assault.” Pl.'s SUMF ¶ 47. Griffin was transferred to D.C. Jail in March 2010 on charges of inappropriately touching a staff member, and he returned to Saint Elizabeths on February 24, 2011. Defs.' SUMF Resp. ¶¶ 48, 51. While at the Jail in mid-November 2010, Griffin suffered a Lisfranc fracture in his left foot. Id. ¶ 49.[6] Also while in Jail, Griffin's Medicaid coverage lapsed and was not renewed. Pl.'s Higher-Level SUMF Resp. ¶ 2.[7]On the day Griffin returned to Saint Elizabeths, Dr. Danilo Garcia did a physical evaluation of Griffin in which he “noted that Griffin had gait abnormality and walked with a limp.” Pl.'s SUMF ¶ 51. “On February 25, 2011, Dr. Garcia made a referral for an x-ray and an orthopedic consult for Griffin's foot and knee because he believed Griffin needed medical treatment from orthopedics. The x-ray was performed onsite at Saint Elizabeths Hospital and showed abnormal widening between the 1st and 2nd metatarsal.” Id. ¶ 52 (citations omitted).

Subsequently, Dr. Richard Smith became Griffin's primary doctor. Id. ¶ 54. “On March 1, 2011, Dr. Smith reviewed the x-ray of Mr. Griffin's left foot and ankle, and noted that it showed ‘some probable effusion of the ankle joint and chronic changes of the foot including


arthritis of the M-P joint.'” Id. Smith referred Griffin for an orthopedics appointment, but it was not scheduled.[8] Id. On May 25, 2011, “Smith observed that Griffin was experiencing ‘increasing discomfort in his knees' and requested an MRI for both of Mr. Griffin's knees.” Id. ¶ 55. The MRI appointment was not made. Id. “On July 30, 2011, after noting that there was increased swelling and pain in Mr. Griffin's left foot, Dr. Smith sent Mr. Griffin to the Emergency Room at Washington Hospital Center for evaluation. The x-ray at WHC confirmed the lisfranc fracture.” Id. ¶ 56. “[A]n orthopedics consult to WHC was placed by Dr. Smith on July 31, 2011, but the referral to the WHC orthopedic clinic never occurred . . . .” Id. ¶ 57. On August 4, 2011, Smith sent Griffin out for an MRI of his knees, but Griffin was not seen because he did not have insurance. Defs.' SUMF Resp. ¶ 58 (not disputing that Griffin “was rejected because he did not have insurance”). On October 6, Smith requested an orthopedics referral for Griffin's knees and foot. Pl.'s SUMF ¶ 59. “On October 25, 2011, Dr. Garcia saw Griffin and noted the continuing left foot deformity and his foot fracture.” Id. ¶ 60. On January 11, 2012, Potter recommended an orthopedic referral “to determine whether Griffin would benefit from a knee replacement.” Defs.' SUMF Resp. ¶ 61. Griffin never received surgery for his Lisfranc fracture. Id. ¶ 65. There is evidence that Griffin had difficulty walking during this time. Id. ¶ 66. Griffin died on January 31, 2012, as discussed in more detail below. Pl.'s SUMF ¶ 69.

C. Griffin's Internal Care at Saint Elizabeths

Numerous individuals participated in Griffin's care relevant to the asserted claims. “Dr. [Peter] Thura prescribed ‘600 milligram PO3 times a day as-needed for joint pain'” on


September 25, 2011. Defs.' Lower-Level SUMF ¶ 6, ECF No. 282-3. Potter treated Griffin on November 10, 2011, and January 11, 2012. Id. ¶ 1. “Dr. Potter examined...

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