Crowson v. Wash. Cnty. of Utah

• Decision Date: 29 December 2020
• Docket Number: No. 19-4118, No. 19-4120,19-4118
• Citation: 983 F.3d 1166
• Parties: Martin CROWSON, Plaintiff - Appellee, v. WASHINGTON COUNTY State of UTAH; Cory Pulsipher, acting Sheriff of Washington County; Michael Johnson, Defendants - Appellants, and Judd LaRowe ; Jon Worlton, Defendants. Martin Crowson, Plaintiff - Appellee, v. Judd LaRowe, Defendant - Appellant, and Washington County State of Utah; Cory Pulsipher, acting Sheriff of Washington County; Michael Johnson; Jon Worlton, Defendants.
• Court: U.S. Court of Appeals — Tenth Circuit

983 F.3d 1166

Martin CROWSON, Plaintiff - Appellee,

v.WASHINGTON COUNTY State of UTAH; Cory Pulsipher, acting Sheriff of Washington County; Michael Johnson, Defendants - Appellants,andJudd LaRowe ; Jon Worlton, Defendants.

Martin Crowson, Plaintiff - Appellee,

v.Judd LaRowe, Defendant - Appellant,andWashington County State of Utah; Cory Pulsipher, acting Sheriff of Washington County; Michael Johnson; Jon Worlton, Defendants.

No. 19-4118

No. 19-4120

United States Court of Appeals, Tenth Circuit.

FILED December 29, 2020

Frank D. Mylar (Andrew R. Hopkins with him on the briefs), Mylar Law, P.C., Salt Lake City, Utah, for Defendants - Appellants Michael Johnson, Washington County, and Sheriff Cory Pulsipher.

Gary T. Wight (Shawn McGarry and Jurhee A. Rice with him on the briefs), Kipp and Christian, P.C., Salt Lake City, Utah, for Defendant - Appellant Judd LaRowe, M.D.

Devi Rao, Roderick & Solange MacArthur Justice Center, Washington, D.C. (Megha Ram, Roderick & Solange MacArthur Justice Center, Washington, D.C.; Ryan J. Schriever, The Schriever Law Firm, Spanish Fork, Utah; David M. Shapiro, Roderick & Solange, MacArthur Justice Center, Northwestern Pritzker School of Law, Chicago, Illinois, on the briefs) for Plaintiff - Appellee Martin Crowson.

Before MATHESON, BACHARACH, and McHUGH, Circuit Judges.

McHUGH, Circuit Judge.

Martin Crowson was an inmate at the Washington County Purgatory Correctional Facility (the "Jail") when he began suffering from symptoms of toxic metabolic encephalopathy

. Nurse Michael Johnson and Dr. Judd LaRowe, two of the medical staff members responsible for Mr. Crowson's care, wrongly concluded Mr. Crowson was experiencing drug or alcohol withdrawal. On the seventh day of medical observation, Mr. Crowson's condition deteriorated and he was transported to the hospital, where he was accurately diagnosed. After Mr. Crowson recovered, he sued Nurse Johnson, Dr. LaRowe, and Washington County¹ under 42 U.S.C. § 1983, alleging violations of the Eighth and Fourteenth Amendments.

The district court denied motions for summary judgment on the issue of qualified immunity by Nurse Johnson and Dr. LaRowe, concluding a reasonable jury could find both were deliberately indifferent to Mr. Crowson's serious medical needs, and that it was clearly established their conduct amounted to a constitutional violation. The district court also denied the County's motion for summary judgment, concluding a reasonable jury could find the treatment failures were an obvious consequence of the County's reliance on Dr. LaRowe's infrequent visits to the Jail and the County's lack of written protocols for monitoring, diagnosing, and treating inmates.

Nurse Johnson, Dr. LaRowe, and the County filed these consolidated interlocutory appeals, which raise threshold questions of jurisdiction. Nurse Johnson and Dr. LaRowe challenge the district court's denial of qualified immunity, while the County contends we should exercise pendent appellate jurisdiction to review the district court's denial of its summary judgment motion.²

For the reasons explained below, we exercise limited jurisdiction over Nurse Johnson's and Dr. LaRowe's appeals pursuant to the exception to 28 U.S.C. § 1291 carved out for purely legal issues of qualified immunity through the collateral order doctrine. See Mitchell v. Forsyth , 472 U.S. 511, 524–30, 105 S.Ct. 2806, 86 L.Ed.2d 411 (1985). We hold Nurse Johnson's conduct did not violate Mr. Crowson's rights and, assuming without deciding that Dr. LaRowe's conduct did, we conclude Dr. LaRowe's conduct did not violate any clearly established rights.

Our holding on Nurse Johnson's appeal is inextricably intertwined with the County's liability on a failure-to-train theory, so we exercise pendent appellate jurisdiction to the extent Mr. Crowson's claims against the County rest on that theory. See Moore v. City of Wynnewood , 57 F.3d 924, 930 (10th Cir. 1995). However, under our binding precedent, our holdings on the individual defendants' appeals are not inextricably intertwined with Mr. Crowson's claims against the County to the extent he advances a systemic failure theory. See id. We therefore reverse the district court's denial of summary judgment to Nurse Johnson and Dr. LaRowe, as well as to the County on the failure-to-train theory, and we dismiss the remainder of the County's appeal for lack of jurisdiction.

I. BACKGROUND

A. Factual History³

On June 11, 2014, Mr. Crowson was booked into the Washington County Purgatory Correctional Facility for a parole violation. On June 17, due to a disciplinary violation, Mr. Crowson was placed in solitary confinement, known as the "A Block."

"On the morning of June 25, while still in solitary confinement, Jail Deputy Brett Lyman noticed that Mr. Crowson was acting slow and lethargic." App., Vol. I at 205. Deputy Lyman asked Nurse Johnson to check Mr. Crowson. "As a registered nurse, Nurse Johnson could not formally diagnose and treat Mr. Crowson." App., Vol. I at 205. Rather, Nurse Johnson assessed inmates and communicated with medical staff. The medical staff available to diagnose were Jon Worlton, a physician assistant ("PA"),⁴ and Dr. LaRowe, the Jail's physician.

At all relevant times, PA Worlton was the Jail's health services administrator and also handled mental health care for the inmates. PA Worlton spent half to three quarters of his time in clinical practice at the Jail, primarily in booking. Dr. LaRowe was responsible for diagnosing and treating inmates, but he visited the Jail only one or two days a week, for two to three hours at a time. Dr. LaRowe relied heavily on the Jail's deputies and nurses. Jail deputies checked on inmates who were in medical observation cells at least once every thirty minutes, and the deputies would notify a Jail nurse when an inmate was "not acting right" or "having problems." App., Vol. I at 219 (quoting App., Vol. II at 504). "Jail nurses—who, by law, could not diagnose inmates—generally spent five to ten minutes with" inmates in medical observation cells once every twelve-hour shift, "to take the inmate's vital signs and conduct follow-up checks." App., Vol. I at 219. If an inmate exhibited symptoms of a cognitive problem, the nurse would inform Dr. LaRowe and PA Worlton. There are no written policies or procedures regarding inmate medical care in the record.

When Nurse Johnson evaluated Mr. Crowson on June 25, he noted Mr. Crowson had normal vital signs and some memory loss. Specifically, "Mr. Crowson was ‘dazed and confused,’ and ‘unable to remember what kind of work he did prior to being arrested.’ " App., Vol. I at 213 (quoting App., Vol. II at 374). Nurse Johnson "admitted in his declaration that, despite recording normal vital signs, he ‘was concerned [Mr. Crowson] may be suffering from some medical problem.’ " App., Vol. I at 213 (alteration in original) (quoting App., Vol. II at 317). Nurse Johnson ordered Mr. Crowson moved to a medical observation cell following the examination. He also "entered a request in the medical recordkeeping system for PA Worlton to conduct a psychological evaluation." App., Vol. I at 205.

When Jail Deputy Fred Keil moved Mr. Crowson to a medical observation cell, he noticed that Mr. Crowson appeared "unusually confused." App., Vol I at 205. After conducting a visual body cavity search of Mr. Crowson, Deputy Keil ordered Mr. Crowson to re-dress. Mr. Crowson put on his pants and then put his underwear on over his pants.

Nurse Johnson checked Mr. Crowson again that afternoon. "Mr. Crowson's pupils were dilated but reactive to light" and "Mr. Crowson appeared alert and oriented." App., Vol. I at 206. Nurse Johnson left the Jail at the end of his shift on June 25 without conducting further assessments of Mr. Crowson or contacting Dr. LaRowe. PA Worlton never received Nurse Johnson's file notation requesting a psychological examination of Mr. Crowson.

Nurse Johnson did not work at the Jail on June 26 and 27. There is no documentation in the Jail's medical recordkeeping system for these days to show that medical personnel checked on Mr. Crowson.

On June 28, Nurse Johnson returned to work and visited Mr. Crowson in the early afternoon. "Mr. Crowson seemed confused and disoriented and had elevated blood pressure. He gave one-word answers to Nurse Johnson's questions, and understood, but could not follow, an instruction to take a deep breath." App., Vol. I at 206. At this point, "Mr. Crowson's symptoms had persisted beyond the expected timeframe for substance withdrawal." App., Vol. I at 213.

Following the June 28 examination, Nurse Johnson called Dr. LaRowe and informed him of some of his observations. But Nurse Johnson did not tell Dr. LaRowe that Mr. Crowson had been in a medical observation cell for three days and had been in solitary confinement for nine days before that. Dr. LaRowe ordered a chest x-ray

and a blood test. "The blood test, known as a complete blood count, could have detected an acid-base imbalance in Mr. Crowson's blood, a symptom of encephalopathy." App., Vol. I at 206.

Nurse Johnson attempted to draw Mr. Crowson's blood, but he was unsuccessful due to scarring on Mr. Crowson's veins and Mr. Crowson's unwillingness to hold still. Nurse Johnson reported this unsuccessful blood-draw attempt to Dr. LaRowe. Ultimately, the chest x-ray

and blood test were never completed. Dr. LaRowe made no further attempts to diagnose Mr. Crowson at that time.

On the morning of June 29, Nurse Johnson took Mr. Crowson's vital signs and noted an elevated heart rate. "Mr. Crowson was still acting dazed and confused, and was experiencing delirium tremens

, a symptom of alcohol withdrawal." App., Vol. I at 206–07. Nurse Johnson reported his observations to Dr. LaRowe, who prescribed Librium and Ativan to treat substance withdrawal. Dr. LaRowe directed Nurse Johnson to administer a dose of Ativan.⁵

"An hour later, Nurse Johnson checked on Mr. Crowson, who was sleeping, and noted that his vital signs had returned to...