Long v. County of Los Angeles

• Citation: 442 F.3d 1178
• Decision Date: 28 March 2006
• Docket Number: No. 04-55463.,04-55463.
• Parties: Philomene LONG, surviving spouse and heir-at-law of John Thomas Idlet, deceased, Plaintiff-Appellant, v. COUNTY OF LOS ANGELES, Defendant-Appellee.
• Court: United States Courts of Appeals. United States Court of Appeals (9th Circuit)

442 F.3d 1178

Philomene LONG, surviving spouse and heir-at-law of John Thomas Idlet, deceased, Plaintiff-Appellant, v. COUNTY OF LOS ANGELES, Defendant-Appellee.

No. 04-55463.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted December 5, 2005.

Filed March 28, 2006.

COPYRIGHT MATERIAL OMITTED

Robert Berke, Law Offices of Robert Berke, Santa Monica, CA, for the plaintiff-appellant.

Mildred O'Linn and Janine McMillion, Manning & Marder Kass, Ellrod, Ramirez, LLP, Los Angeles, CA, for the defendant-appellee.

Martin Stein, Alison Turner and Eric R. Cioffi, Greines, Martin, Stein & Richland, LLP, for the defendant-appellee.

Appeal from the United States District Court for the Central District of California, Dale S. Fischer, District Judge, Presiding. D.C. No. CV 03-00531 DSF (PLAx).

Before: REINHARDT and RAWLINSON, Circuit Judges, and WILKEN^*, District Judge.

WILKEN, Disrict Judge:

John Thomas Idlet, the decedent, reported to the Los Angeles County Jail on March 11, 2002, to begin a 120-day jail sentence. Mr. Idlet was seventy-one years old and suffered from congestive heart failure and other ailments. Over the next eighteen days Mr. Idlet's medical condition deteriorated. Although nurses saw him several times during that period, there is no record of a doctor's examination until the early morning of March 29, 2002, hours before he died of cardiac arrest.

Mr. Idlet's wife, the Plaintiff and Appellant in this action, filed a complaint, based on 42 U.S.C. § 1983. The district court dismissed all of the claims against all of the defendants except the County, against whom Appellant asserted municipal liability for failing adequately to train jail medical staff and failing to implement necessary medical policies, leading to the denial of adequate medical care which resulted in Mr. Idlet's death. The County moved for summary judgment.

The district court granted the County's motion and found that, while a triable issue of fact existed as to whether jail medical staff had deprived Mr. Idlet of constitutionally adequate medical care, summary judgment as to the County was appropriate because, under Monell v. Department of Social Services, 436 U.S. 658, 98 S.Ct. 2018, 56 L.Ed.2d 611 (1978), Appellant had failed to raise a triable issue as to whether the County had a policy of deliberate indifference to prisoners' medical needs. Appellant appeals the district court's grant of summary judgment, arguing that triable issues of fact exist on the matter of municipal liability.

We hold that Appellant has presented sufficient evidence to create a triable issue regarding the County's liability for Mr. Idlet's death. Accordingly, we reverse the district court's order granting summary judgment and remand for further proceedings.

FACTUAL BACKGROUND

Except as noted, the following facts are undisputed.¹ On March 11, 2002, when the seventy-one year old Mr. Idlet reported to the County Jail to begin serving his 120-day jail sentence, he weighed more than 350 pounds and, as noted above, suffered from congestive heart failure and other ailments. From 1998 until March 11, 2002, Mr. Idlet had been under the care of Dr. Kenneth Rosenfeld of the Veterans Administration Greater Los Angeles Healthcare System (VA). During that period Dr. Rosenfeld closely monitored Mr. Idlet's condition and adjusted his medications in conjunction with an overall care plan that included supervised exercise and diet. While under Dr. Rosenfeld's care Mr. Idlet had no major hospitalizations or complications of his illness.

On March 7, 2002, four days before Mr. Idlet reported to the County Jail, his attorney wrote a letter to the Director of the County Jail Medical Services Division, explaining Mr. Idlet's medical condition and his need for monitoring, listing his medications and noting Dr. Rosenfeld's assessment "that without close supervision of both medication and exercise, Mr. Idlet's death will be imminent." On March 11, 2002, the date Mr. Idlet was admitted to the County Jail, the committing superior court judge issued an order directing the County Jail to provide Mr. Idlet with a medical examination and to advise the court of the results. The court attached to the order two letters from Dr. Rosenfeld which outlined Mr. Idlet's medical needs.

On March 12, 2002, Mr. Idlet was transferred to the hospital ward at the County Jail. On that same day a jail physician ordered that he be transferred to the County Jail's Medical Services Bureau (MSB), a correctional treatment facility designated to provide health care to prisoners who do not require acute care services but are in need of professionally supervised health care. The MSB is not a licensed acute care facility. It is not staffed with physicians around the clock— they are present from 6:00 a.m. until 8:00 p.m. on weekdays, and during the remaining hours and on weekends a physician is on call—and in 2002 it did not have cardiac monitors or a radiologist available.

Mr. Idlet was admitted to the MSB on March 13, 2002. The nurses were instructed to monitor him for any changes in mental, sensory and motor functions, to assess him for signs and symptoms of acute cardiac distress such as chest pains and shortness of breath, and to notify a doctor as needed.

The parties differ in their characterization of the care received by Mr. Idlet while he was in the MSB. The County asserts that the conditions in the MSB were "not essentially different from being in a hospital bed in a hospital facility," and that the MSB medical staff consistently took care of Mr. Idlet's medical needs. Appellant presents affidavits, deposition testimony and other evidence to support the assertion that Mr. Idlet's care was inadequate, and highlights the following facts.

Upon admission to the MSB on March 13, Mr. Idlet was not assigned promptly to a bed and was forced to wait for thirty-eight hours in a wheelchair, during which time he did not receive his required medications. On March 15, the nurse called the on-call physician with a report that Mr. Idlet's feet were red and swollen with 3+ edema²; however, a physician did not see him. On March 18, the nurse recorded that Mr. Idlet was short of breath with labored respiration and a pulse of 100 beats per minute, but the nurse did not call the doctor. On March 19, the nurse recorded that Mr. Idlet claimed he got short of breath when walking a short distance and that both of his feet were swollen and slightly red, but the nurse did not refer him to a doctor.

On March 21, Mr. Idlet asked to be seen by the doctor because "[m]y leg is getting worse,7D' and the nurse recorded that he had `an enlarged abdomen, hard to touch. Noted both lower legs swollen with redness to the feet.' (Pitting edema)." Later in the day the nurse recorded increased swelling and placed Mr. Idlet on the doctor's line for evaluation, but a doctor did not see him that day. On March 22, Dr. Wallace entered a progress note that Mr. Idlet's dose of Lasix (a diuretic) was increased. The progress note does not indicate that Mr. Idlet was actually seen by a physician.

On March 25, Mr. Idlet's medications were withheld without reason. On March 26, the nurse recorded that Mr. Idlet's left foot was red and swollen and that he was coughing. A physician was called but did not see Mr. Idlet, who was instead referred for evaluation to the medical line, where his heart rate was recorded as 115. Shortly thereafter Mr. Idlet was seen by Dr. Wallace who recorded right leg swelling but did not mention the increased heart rate.

On March 28, Mr. Idlet fell while trying to get to the bathroom. There is no documented examination by a doctor and only a skin examination was conducted by the nurse, even though Mr. Idlet was on Coumadin, a blood thinner, and so would be at risk for internal bleeding after a fall. Approximately five hours later the nurse recorded that Mr. Idlet was "very swollen," that he had a bedsore on his tailbone, and that he was short of breath. The nurse's notes state that Mr. Idlet was seen by a doctor but there are no doctor's notes. Mr. Idlet was placed on high flow oxygen. At 8:03 p.m. on March 28, Mr. Idlet refused further oxygen therapy although it was offered to him by a nurse. The nurse's notes state that Mr. Idlet refused oxygen and then was presented with a release from responsibility, which he signed.

At 9:34 p.m. on March 28, the nurse recorded that Mr. Idlet had "low brown urine output" and bilateral crackles on the lung fields, but no doctor was called. According to Appellant's expert doctors, Dr. Alberta Warner, the chair of the cardiology department at the VA, and Dr. Rosenfeld, Mr. Idlet's treating physician at the VA, these signs indicate decompensated congestive heart failure. Less than one hour later, Mr. Idlet was found on the floor, having defecated on himself; three staff members were unable to get him back on the bed. The nurse's notes state that Mr. Idlet had severe ascites, or fluid, in the belly, which hindered moving him; still, no doctor came to examine him. Because the medical staff was unable to move him from the floor to his bed, Dr. Johnson, without seeing Mr. Idlet, ordered him to be moved from the floor onto an eggcrate mattress.

On March 29, the nurse recorded findings of congestive heart failure (diminished breath sounds, moist coughing, shortness of breath), a severe decrease in oxygen saturation and low blood pressure. Dr. Johnson was called and ordered Mr. Idlet's transfer to the hospital by ambulance, which occurred at 12:44 a.m. Mr. Idlet suffered cardiac arrest and died at the hospital on March 29 at 2:56 p.m. The autopsy report states that Mr. Idlet died from decompensated congestive heart failure and pulmonary edema.

When Mr. Idlet was in the MSB, written County Jail policies required physicians to write, sign and date all orders; to complete an admitting order outlining the level of care, diet, diagnosis, and level of activity for the inmate;...