Coleman v. Rahija, IMCC--O

• Decision Date: 05 June 1997
• Docket Number: No. 96-1351,IMCC--O,96-1351
• Citation: 114 F.3d 778
• Parties: Gloria COLEMAN, Appellee, v. Nurse Ruth RAHIJA, Nurse atakdale, Appellant.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 778

114 F.3d 778

Gloria COLEMAN, Appellee, v. Nurse Ruth RAHIJA, Nurse at IMCC--Oakdale, Appellant.

No. 96-1351.

United States Court of Appeals,

Eighth Circuit.

Submitted Oct. 22, 1996.

Decided June 5, 1997.

Gordon E. Allen, argued, Des Moines, Iowa, for appellant.

Jeffrey M. Lipman, argued, Des Moines, Iowa, for appellee.

Before RICHARD S. ARNOLD, Chief Judge, and FLOYD R. GIBSON and McMILLIAN, Circuit Judges.

McMILLIAN, Circuit Judge.

Gloria Coleman brought this action in the United States District Court for the Southern District of Iowa, pursuant to 42 U.S.C. § 1983, claiming that Ruth Rahija was deliberately indifferent to her serious medical needs in violation of her Eighth Amendment right to be free from cruel and unusual punishment. Rahija now appeals from the district court's final order, following a bench trial, holding that Rahija was deliberately indifferent to Coleman's serious medical needs and awarding Coleman $1,000 in compensatory damages and $3,500 in punitive damages. Coleman v. Rahija, No. 4-91-CV-50260 (S.D.Iowa Jan. 2, 1996) (Coleman ). For reversal, Rahija argues that the district court erred in finding that (1) Coleman had a serious medical need; (2) Rahija had sufficient knowledge of Coleman's serious medical need to justify a finding of deliberate indifference; (3) Coleman suffered actual harm as a consequence of Rahija's actions; and (4) Rahija's conduct was sufficiently callous to support an award of punitive damages. For the reasons discussed below, we vacate the award of punitive damages and affirm the order of the district court on the remaining issues.

I. Background

The factual background is primarily based on the findings of the district court. Id. at 1-10. On January 15, 1991, Coleman, an inmate, was transferred from the Iowa Correctional Facility for Women in Mitchellville, Iowa, to the Iowa Medical and Classification Center (IMCC) in Oakdale, Iowa. At that time, Coleman was twenty-eight years old and approximately seven months pregnant. She was transferred to IMCC to facilitate closer monitoring of her pregnancy. Rahija was a registered nurse employed by IMCC. ¹

Upon Coleman's arrival at IMCC, the IMCC Health Services Department (Health Services) conducted a "health screen" and documented Coleman's health history, including the fact that Coleman had five prior pregnancies. Dr. Timothy Pflederer, a Health Services physician, conducted a routine physical examination of Coleman on January 23, 1991, and noted in his examination notes that Coleman had a long history of problematic pregnancies. In 1980, Coleman prematurely delivered twins who were either stillborn or died shortly after birth. Of Coleman's subsequent four pregnancies, three involved precipitous labors lasting less than one hour and one resulted in a premature delivery. Based on this information, Dr Pflederer referred Coleman to the University of Iowa Hospitals and Clinics Obstetrical Unit (the University) for an evaluation. On January 30, 1991, Dr. Katherine Stevenson, a University resident physician, examined Coleman and discovered that her cervix was one to two centimeters dilated. She reported that Coleman's obstetric history was "significant" and recommended that Coleman remain at IMCC due to its proximity to the University and Coleman's history of pre-term deliveries.

On January 31, 1991, a notation was made in the Health Services records that Coleman had been examined at the University and was to remain at IMCC until after the baby was born. On February 2, 1991, at approximately 8:45 a.m., Coleman awoke and went to Health Services, complaining that her "water" was "leaking." A Health Services nurse examined Coleman and determined that Coleman's amnion had not ruptured. Instead, the nurse determined that Coleman was experiencing normal mucous vaginal discharge which commonly occurs during the later stages of pregnancy. The nurse gave Coleman sanitary napkins and instructed her to notify Health Services if her condition worsened.

On February 14, 1991, Coleman returned to Health Services complaining that she "had a bloody show." At that time, Health Services transferred Coleman to the University for an examination. The University physicians determined that Coleman was not in active labor but noted that her cervix was dilated one to two centimeters and she was having minimal contractions. The University physicians instructed Health Services to return Coleman to the University if her contractions became painful, regular, and separated by ten minutes or less. ²

On February 15, 1991, Coleman awoke early in the morning and noticed some spotting of blood. She complained of bleeding, back pain, and stomach pain to a guard, who sent her to Health Services. She notified Health Services of the spotting and decided not to attend her required school classes that day. At approximately 10:30 a.m., Coleman again reported to Health Services complaining of more bleeding and back pain. Although Coleman denied being terribly uncomfortable, Coleman's symptoms were recognized signs of labor and led the IMCC nursing staff to call the University. Dr. Alvina Driscoll, a University resident physician, determined that the bleeding was likely due to cervical changes and was not a concern unless it increased or was associated with cramping or contractions. The IMCC nursing staff recorded in Coleman's medical chart that she was to be monitored for increased bleeding or signs of labor. The bleeding was to be monitored by inspecting Coleman's sanitary napkins. Coleman returned to Health Services at approximately 2:00 p.m. to complain of more bleeding and show a nurse a sanitary napkin with blood on it. After looking at the sanitary napkin, the nurse threw it in the garbage.

At approximately 7:00 p.m., Coleman was watching television when she stood to use the bathroom and felt an extreme pain in her lower abdomen causing her to double over. Coleman's pain began to subside when another inmate, Felicia Allen, attempted to comfort her. Sometime thereafter, Coleman went to Health Services and was seen by Rahija, who had come on duty at 3:00 p.m. Without taking Coleman's vital signs, performing a vaginal examination, or attempting to monitor the baby's heart tones, Rahija sent Coleman back to her living unit and told her to return when the contractions were six to seven minutes apart.

At approximately 9:30 p.m., Coleman's pain worsened. She returned to Health Services and reported to Rahija that she was still bleeding, she hurt "down there," pointing to her abdomen, and her contractions were six minutes apart. Rahija placed her hands on the exterior of Coleman's abdomen and noted that she was unable to feel any contractions. ³ Rahija monitored the baby's heart tones, which were 142 beats per minute. At that time, Coleman denied experiencing low back pain or rupturing of her amnion. Despite concluding that Coleman was in "possible early labor," Rahija sent Coleman back to her living unit and instructed her to return to Health Services if the bleeding increased or the contractions increased in severity or regularity.

Following Rahija's instructions, Coleman returned to her living unit. ⁴ Coleman sat on the edge of her bed in increasing pain until 11:25 p.m., when she began to scream from the intense pain and moved to the cement floor, where she laid in a fetal position. A correctional officer allowed Allen and another inmate to enter Coleman's living unit to attempt to calm her by talking to her and rubbing her back and stomach.

At that point, a correctional officer called Health Services to summon Rahija and Grace Schwickerath, also a registered nurse, to attend to Coleman. When they arrived, Coleman stated that she was in pain and felt "like pushing." The nurses observed that Coleman appeared to be "bearing down." Both nurses placed their hands on the exterior of Coleman's abdomen and were unable to feel any contractions. One of the nurses monitored the baby's fetal heart tones, which were 120 beats per minute. The nurses asked Coleman to stand to allow them to inspect her sanitary napkin. As Coleman stood, she "grunted" and expelled approximately 15cc of dark red blood. Coleman's sanitary napkin indicated that she had been spotting previously. Coleman stated that she "should go ahead [and] just have this baby [and] that would teach you for not listening." Id. at 9. ⁵ At that point, the nurses agreed that Coleman should be transported to the University and Schwickerath went to make the necessary arrangements. Rahija stayed with Coleman and noted that Coleman was probably in premature labor. However, Schwickerath noted that Coleman was in "questionable labor." Id.

At approximately 11:45 p.m., Coleman was transported from IMCC to the University. While transporting Coleman, the attending medical professionals repeatedly called Coleman's name to prevent her from falling asleep. Coleman constantly felt the urge to push and, sometime during the ride, expelled another 20cc of blood. Shortly after arriving at the University, Coleman delivered a premature baby boy at 12:20 a.m. on February 16, 1991, although she was later unable to remember the delivery. Neither Coleman nor the baby suffered any complications during the delivery. Coleman returned to IMCC on February 18, 1991, and the baby was later released from the hospital to the care of Coleman's mother.

On March 3, 1991, Coleman completed a form complaint used by prisoners to file complaints under the Civil Rights Act, 42 U.S.C. § 1983, alleging that Rahija violated Coleman's Eighth Amendment right to be free from cruel and unusual punishment by being deliberately indifferent to Coleman's complaints that she was in labor, which caused her to suffer both physically and emotionally. Coleman's complaint was filed in the United States District Court for the Southern District of Iowa on April 29, 1991.

On September 27-28, 1994, this matter was tried to the district court,...