Liscio v. Warren
| Decision Date | 12 April 1990 |
| Docket Number | No. 716,D,716 |
| Citation | 901 F.2d 274 |
| Parties | Dennis LISCIO, Plaintiff-Appellant, v. Thomas WARREN, William Tuthill and Robert E. Lebson, M.D., Individually and in their official capacities as Officials of the Connecticut Department of Correction, Defendants-Appellees. ocket 89-7799. |
| Court | U.S. Court of Appeals — Second Circuit |
John R. Williams (Williams and Wise, New Haven, Conn., Jeffrey J. Drewniany, of counsel), for plaintiff-appellant.
Robert F. Vacchelli, Asst. Atty. Gen. (Clarine Nardi Riddle, Atty. Gen., Hartford, Conn., of counsel), for defendants-appellees.
Before LUMBARD, FEINBERG, and PRATT, Circuit Judges.
Dennis Liscio appeals from a summary judgment of the District Court for the District of Connecticut (Cabranes, J.), dismissing his complaint. Liscio v. Warren, 718 F.Supp. 1074 (D.Conn.1989). The complaint alleged that defendant Dr. Robert E. Lebson and others, in violation of 42 U.S.C. Sec. 1983 (1982), were deliberately indifferent to Liscio's serious medical needs while Liscio was undergoing drug and alcohol withdrawal as a pretrial detainee at the New Haven Correctional Center, resulting in serious physical injury. At the time, Dr. Lebson was the contract physician in charge of the medical unit at the Center. Although the district court dismissed all claims as to all defendants, Liscio appeals only the dismissal of the claims against Dr. Lebson. Because we think there was a factual dispute as to whether Dr. Lebson's conduct constituted deliberate indifference, and not mere negligence, we reverse.
The facts alleged in the complaint and in affidavits submitted in support of and in response to the motion for summary judgment are as follows:
On June 18, 1985, Liscio was booked into the Union Avenue Detention Center in New Haven. During intake screening he told the booking officer that he was undergoing heroin withdrawal but mentioned no other substance abuse. The officer noted on the intake form that Liscio was placed on drug withdrawal medication though, as the district court found, there is no evidence that such was then administered. Id. at 1077 n. 6. On Friday, June 21, at 12:05 a.m., while at the Union Avenue facility, Liscio began behaving in a bizarre manner and appeared to be hallucinating. About 1:00 a.m., the warden transferred him to the infirmary at the New Haven Correctional Center, where the examining nurse noted that Liscio was a "poor historian" of his condition, that he denied any drug abuse other than his heroin addiction, and that he had "trac marks" on both arms. He was placed in "two-point restraints" (i.e., handcuffs) and checked every fifteen minutes. A third restraint was added at 3:10 a.m. because of "aggressive behavior." The medical records indicate he was repeatedly yelling and talking to himself. At 10:05 a.m., a fourth restraint was added, and it was noted on Liscio's chart that he was having "DT's" (delirium tremens), the clinical term for psychotic or bizarre behavior associated with alcohol withdrawal.
At 10:35 a.m., Dr. Lebson examined Liscio, noted his agitation, and ordered a withdrawal regimen and psychiatric evaluation. The psychiatrist, Dr. August, refusing to evaluate Liscio because his problem was medical, referred the case back to Dr. Lebson, who did not examine Liscio again until three days later, on Monday, June 24.
Meanwhile, Liscio's agitation and yelling continued. He refused lunch and dinner on June 21. The next day, Saturday, he refused breakfast, though he later drank a high protein mixture and eight ounces of water. His left arm swelled from pulling on the restraint and was placed in a cloth passive restraint. Still hallucinating, he was kept isolated and in four-point restraints until June 24, when Dr. Lebson transferred him to St. Raphael's Hospital in New Haven for "assessment of hydration & fluid if necessary." Upon arrival, Liscio was put in an intensive care unit for emergency treatment of renal failure, dehydration, and delirium caused by withdrawal from alcohol abuse as well as from heroin addiction. Later evaluation revealed that Liscio was an alcoholic who drank approximately one case of beer per day. It was also determined that Liscio was suffering from rhabdomyolysis, damage to kidneys caused by products released from injured muscle; he sustained such muscle injury from pulling at his restraints during the previous three days. On June 27, he was discharged to the New Haven Correctional Center, having sustained no permanent damage.
In response to Dr. Lebson's motion for summary judgment, Liscio submitted, inter alia, an affidavit from Dr. Bruce J. Rounsaville, Associate Professor of Psychiatry at Yale Medical School and Director of Research for the Substance Abuse Treatment Unit of the Connecticut Mental Health Center. According to Dr. Rounsaville it is crucial that medical personnel at correctional facilities distinguish between heroin withdrawal, which is uncomfortable but not life-threatening, and alcohol withdrawal, which has a "serious" mortality rate. Indeed, before modern alcohol withdrawal treatment, the mortality rate for delirium tremens was 10-20%. The basis for distinguishing the two withdrawals, Dr. Rounsaville stated, is that "psychosis bizarre behavior or delirium" is commonly associated with alcohol withdrawal but not with simple heroin withdrawal. Liscio was obviously suffering from delirium, which, when of unknown origin, is a medical emergency that obligates the treating physician to inquire into its cause. Instead of pursuing this course, Dr. Lebson, according to the affidavit, erroneously presumed the cause of Liscio's condition to be heroin withdrawal.
Dr. Rounsaville opined that Dr. Lebson had "severely mismanaged" Liscio's case, causing "unnecessary injury and suffering, and placing him in a life-threatening condition." This mismanagement, he continued, was especially unacceptable because it occurred in a correctional facility, where alcohol and drug withdrawal cases are common.
The affidavit stated, however, that the most alarming lapse was neither the initial misdiagnosis of alcohol withdrawal as heroin withdrawal nor the failure to respond immediately to Liscio's delirium. Rather, it was that Liscio.
was allowed to remain delirious and to have his mental and physical condition deteriorate for 3 full additional days before he was given more adequate...
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