Cady v. Walsh

• Decision Date: 04 June 2014
• Docket Number: No. 13–2040.,13–2040.
• Citation: 753 F.3d 348
• Parties: Katherine M. CADY, as Personal Representative of the Estate of Paul Victor Galambos, III, Plaintiff, Appellee, v. Barbara WALSH; Michael Trueworthy; Linda Williams, Defendants, Appellants.
• Court: U.S. Court of Appeals — First Circuit

753 F.3d 348

Katherine M. CADY, as Personal Representative of the Estate of Paul Victor Galambos, III, Plaintiff, Appellee,

v.Barbara WALSH; Michael Trueworthy; Linda Williams, Defendants, Appellants.

No. 13–2040.

United States Court of Appeals, First Circuit.

June 4, 2014.

Michael E. Saucier, with whom Robert C. Hatch, Hillary J. Bouchard, and Thompson & Bowie were on brief, for appellants.

Eric M. Mehnert, with whom Hawkes & Mehnert, LLP was on brief, for appellee.

Before LYNCH, Chief Judge, SELYA and KAYATTA, Circuit Judges.

LYNCH, Chief Judge.

Katherine Cady, on behalf of the estate of her son, Paul Victor Galambos, III, brought this 42 U.S.C. § 1983 action after Galambos's death from self-inflicted injuries that he suffered while he was a pretrial detainee at the Cumberland County Jail (CCJ). The action alleged that employees of Corizon, Inc., the private companyproviding healthcare services at CCJ, were deliberately indifferent to Galambos's serious medical needs in violation of his Fourteenth Amendment rights. The defendants sought summary judgment, arguing that they were within a category of private employees protected by qualified immunity by virtue of their duties, and were also entitled to immunity on the particular facts.

The district court assumed dubitante that the employees fell into a category of private employees eligible for qualified immunity, and denied the summary judgment motions filed by defendants Michael Trueworthy, Barbara Walsh, and Linda Williams, all employees of Corizon. It reasoned, after a detailed review of the facts, that there remained material and disputed issues of fact as to the claims against all three individuals which precluded the grant of immunity at this point.

The three defendants now appeal, arguing that they are entitled to qualified immunity. The plaintiff, noting there are material issues of fact in dispute, including conflicts in the opinions of expert witnesses, argues that there is no appellate jurisdiction under the doctrine of Johnson v. Jones, 515 U.S. 304, 115 S.Ct. 2151, 132 L.Ed.2d 238 (1995), even if the defendants were theoretically eligible for the protections of qualified immunity. Like the district court, we bypass the question of whether qualified immunity is categorically unavailable to these defendants, because the district court's denial of immunity turned on findings that there remain disputed issues of material fact and inference. We do not have jurisdiction over this interlocutory appeal under Johnson. We dismiss this appeal for want of appellate jurisdiction.

I.

We have jurisdiction over an interlocutory appeal of a denial of summary judgment on qualified immunity only insofar as the appeal rests on legal, rather than factual grounds. See Johnson, 515 U.S. at 313, 115 S.Ct. 2151. We therefore summarize the facts in the light most favorable to the non-moving party, taking as unchallenged any inferences that the district court drew in that party's favor.

A. Background and Named Defendants

Corizon is a private independent contractor that provided healthcare services to inmates at CCJ under a contract with CCJ effective January 1, 2007 through December 31, 2009.¹ Corizon was responsible for healthcare at CCJ, and to that end developed a set of governing policies and procedures. Corizon was also required to regularly confer with the Cumberland County Sheriff or his designee concerning both existing healthcare procedures and any changes to those procedures.

1. Michael Trueworthy

Defendant Michael Trueworthy, a psychiatric Nurse Practitioner, worked as a per diem employee of Corizon from August through December 2008, and reported directly to Dr. Alfonso Corona, Corizon's psychiatrist for CCJ. Trueworthy saw inmates for medication evaluation and management, and renewed prescriptions for inmates who had already been prescribed those medications. He was never on-call during his employment at CCJ, and was not present at the facility for all emergencies. Generally, social workers at CCJ would provide Trueworthy with lists of inmates for him to attend to during his shifts.

2. Barbara Walsh

Defendant Barbara Walsh, a Registered Nurse, became Corizon's director of nursing in 2006, and she was employed in that position during the 2008 events that gave rise to this case. She supervised the infirmary and the nursing staff. She described CCJ as “chaotically busy.” She reported directly to Corizon's Health Services Administrator, Diane North. North is not a named defendant. Walsh was a party to the “constant discussion among the Corizon staff” regarding sending inmates out to the emergency room (ER). The cost of having an inmate transported to a local ER by ambulance had risen dramatically, and was nearly $3, 000 in the fall of 2008. Corizon apparently wanted to keep costs contained, and also assure that nurses were performing only medically necessary actions. In light of these concerns, Walsh instructed the nursing staff to contact her at any time, even when she was not on duty, so that she could assess a given situation before deciding to send an inmate out to the ER for additional care. According to the parties' stipulated facts, the reason given for this policy was that “the [staff nurses'] excuse of their nursing licenses being at risk was not an acceptable basis for a decision to send an inmate out to the ER.”

3. Linda Williams

Defendant Linda Williams, a Licensed Clinical Social Worker, was responsible for assessing inmates' current mental health status. She undertook these health assessments from outside inmates' cells, and never entered Galambos's cell to assess him. When Galambos first came to CCJ, Williams took part in his intake and initial evaluations and subsequent evaluations. From December 2 through December 11, 2008, Williams observed Galambos each day and spoke with him on some days.

B. Events at CCJ

Galambos entered CCJ as a pretrial detainee on August 3, 2008, following his arrest for robbery, refusal to submit to arrest, and violation of bail conditions. He had an extensive history of mental illness and substance abuse, was diagnosed at the time with schizoaffective disorder, had a history of suicide attempts, and had previously received in-patient psychiatric treatment.

On his arrival at CCJ, Galambos resisted being fingerprinted and headbutted an intake officer. His condition was described by the plaintiff's expert as “actively psychotic,” ² and a jury could so conclude. He initially refused his medications and he was placed on suicide watch, where he remained for a few days. At this point, Corizon's mental health staff, including Williams, was aware of Galambos's history of mental illness. They had access to his past records, including from his stay at an in-patient treatment program at Spring Harbor Hospital called ACCESS, where Galambos had been admitted in the past, most recently in June 2008. Dr. Grassian, one of the plaintiff's experts, said the record shows no evidence that Trueworthy ever reviewed those records.

Galambos agreed to take an oral dose of Haldol on August 6, at which point he was “stepped down” to “psych” watch from suicide watch. He was taken off psych watch on August 10.

During September 2008, Galambos underwent additional evaluations that resulted in a medication recommendation. Trueworthy offered a recommendation and medication plan on September 12, which recommended continued use of the medications he was on when he entered CCJ: Zyprexa (for psychosis) and Cogentin (for potential side effects of Zyprexa). Trueworthy was aware that Galambos had a history of suicide attempts and believed that Galambos's prognosis was poor without proper medication management. Nonetheless, Trueworthy said he believed that because Galambos was “logical and involved” as of September 12, Trueworthy did not need to see him regularly. The plaintiff's expert, Dr. Grassian, has noted that on September 9, Galambos was observed to be actively psychotic; Dr. Grassian opined that Trueworthy's September 12 plan, which left Galambos's medication regimen unchanged, was a violation of “any standard of care.” He also opined that the failure of the record to note Galambos's activity from September to November was unacceptable.

By November, Williams did note that Galambos exhibited a pattern of irregular acceptance of his medication. There is a dispute over whether CCJ could forcibly administer medication to inmates. On November 8, Galambos submitted a medical request slip asking that he be given Seroquel instead of Zyprexa. There was no response and, according to the plaintiff's expert, the record contains no explanation for ignoring Galambos's request. Trueworthy and Dr. Corona had previously discussed safety issues surrounding prescribing Seroquel in a correctional setting, but it was listed on Corizon's medication formulary at the time.

On November 8, Galambos was placed in maximum security after assaulting another inmate, and he remained there until November 12. During this period, Galambos asked to see the psychiatrist and reiterated his medication change request. On November 11, Debra Konieczko, a Licensed Clinical Social Worker who had treated Galambos when he was in the ACCESS program, visited Galambos in CCJ. After meeting with Galambos and observing that he was “highly agitated and anxious,” “demonstrating psychomotor agitation,” and was “difficult to interrupt,” Konieczko spoke with a Corizon social worker about Galambos. The Corizon social worker met with Galambos and reportedly did not observe the problems that Konieczko noted. After Galambos was allowed out of maximum security on November 12, he continued to ask to switch to Seroquel, saying that Zyprexa made him feel sedated in the morning and unable to sleep at night.

On November 15, Corizon accepted from Galambos a signed “release of responsibility” form that allowed him to refuse the Zyprexa. On November 17, he again asked to see a psychiatrist for a change in...