Paugh v. Uintah Cnty.

• Decision Date: 07 September 2022
• Docket Number: 21-4067
• Citation: 47 F.4th 1139
• Parties: Noleen PAUGH and Donald Paugh, as heirs of Coby Lee Paugh, Plaintiffs, and Tristen Calder, as personal representative of the estate of Coby Lee Paugh, Plaintiff - Appellee, v. UINTAH COUNTY ; Kori Anderson ; Dan Bunnell; Kyle Fuller; Tyler Conley; Richard Gowen, Defendants - Appellants, and Justin Riddle, Defendant.
• Court: U.S. Court of Appeals — Tenth Circuit

47 F.4th 1139

Noleen PAUGH and Donald Paugh, as heirs of Coby Lee Paugh, Plaintiffs,
and
Tristen Calder, as personal representative of the estate of Coby Lee Paugh, Plaintiff - Appellee,
v.
UINTAH COUNTY ; Kori Anderson ; Dan Bunnell; Kyle Fuller; Tyler Conley; Richard Gowen, Defendants - Appellants,
and
Justin Riddle, Defendant.

No. 21-4067

United States Court of Appeals, Tenth Circuit.

FILED September 7, 2022

Frank D. Mylar (Andrew R. Hopkins with him on the briefs), of Mylar Law, P.C., Salt Lake City, Utah, for Defendants-Appellants.

C. Peter Sorensen (Robert B. Sykes and Christina D. Isom with him on the briefs), of Sykes McAllister Law Offices, Salt Lake City, Utah, for Plaintiffs-Appellees.

Before HOLMES, BACHARACH, and PHILLIPS, Circuit Judges.

PHILLIPS, Circuit Judge.

Coby Lee Paugh died from complications related to alcohol withdrawal while being held in pretrial detention at Uintah County Jail in Vernal, Utah. His estate sued Uintah County and several of its jail officials under 42 U.S.C. § 1983, alleging violations of Paugh's constitutional rights.

The County and its jail officials—Kori Anderson, Dan Bunnell, Kyle Fuller, Tyler Conley, Richard Gowen, and Justin Riddle—moved for summary judgment, with the jail officials asserting qualified immunity. In a thorough order, the district court granted qualified immunity for Riddle,¹ but it denied qualified immunity for Anderson, Bunnell, Fuller, Conley, and Gowen (collectively, "Individual Defendants"). It also denied the County's motion for summary judgment.

The Individual Defendants and the County have now filed this interlocutory appeal. The Individual Defendants challenge the district court's denial of qualified immunity, and the County asks us to exercise pendent appellate jurisdiction and reverse the court's denial of its motion for summary judgment.

We hold that the Individual Defendants are not entitled to qualified immunity. We thus affirm the district court's denial of the Individual Defendants’ motion for summary judgment. We do not consider the County's appeal, because we lack jurisdiction to do so.

BACKGROUND

I. Factual Background²

A. Paugh's Arrest and Hospital Visit

The underlying events of this case are tragic. For years, Paugh suffered from chronic alcoholism. In March 2015, Paugh pleaded guilty to an alcohol-related offense

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and was placed on supervised probation. One condition of Paugh's probation barred him from consuming alcohol for six months.

After going on a multiday drinking binge, Paugh realized that he needed help. So in the early morning of July 24, 2015, he turned himself over to the Vernal Police Department for his probation violation. At the time of his arrest, Paugh had a blood-alcohol concentration ("BAC") of .324. This BAC veers "dangerously" close to "alcohol overdose levels." R. vol. 2 at 9.

Immediately after arresting him, Vernal police officers took Paugh to Ashley Regional Medical Center ("ARMC"), seeking medical clearance to admit him to Uintah County Jail. At about 1:30 a.m., Dr. Aaron Bradbury examined Paugh and diagnosed him as suffering from chronic alcoholism and alcohol withdrawal. Though Dr. Bradbury did not give Paugh any medication at that time, he prescribed Paugh Chlordiazepoxide (commonly known as Librium ) to help mitigate Paugh's alcohol-withdrawal symptoms.

Ultimately, Dr. Bradbury found Paugh "currently stable and safe for incarceration." Id. at 10 (citation omitted). But he warned the Vernal police officers that if Paugh's "alcohol withdrawal condition got any worse they'd have to bring him back to ARMC." Id. (internal quotations and citation omitted). Indeed, according to the discharge instructions given to the Vernal police officers, jail officials were to administer Librium to Paugh "[a]s needed" and to bring him back to the hospital if his condition worsened.³ R. vol. 3 at 190.

Around 2:10 a.m., Dr. Bradbury discharged Paugh from ARMC, and Paugh was taken to Uintah County Jail.

B. Paugh's Arrival at the Jail and Night Shift on July 24, 2015 (2:20 a.m. to 6:00 a.m.)

At about 2:20 a.m., Paugh arrived at Uintah County Jail. Three Individual Defendants—Bunnell, Anderson, and Riddle—were working a 6:00 p.m. to 6:00 a.m. shift. Only Anderson and Bunnell interacted with Paugh during this shift. It was Anderson's first night as a shift supervisor. Bunnell was the designated medical official, making him responsible for administering medication to the inmates.⁴

When the Vernal police officers turned Paugh over to Anderson and Bunnell, Paugh "was walking, talking[, and] [d]idn't seem unsteady on his feet." R. vol. 3 at 135. In fact, Anderson described Paugh as seeming "just fine."⁵ Id. at 85.

47 F.4th 1149

The Vernal police officers apprised Anderson and Bunnell that Paugh had a BAC of .324 when he turned himself in, that they had immediately taken him to the hospital, and that Dr. Bradbury had prescribed him Librium. The officers then gave Dr. Bradbury's written discharge instructions to Anderson and Bunnell, which the two placed into Paugh's file. The Vernal police officers also repeated Dr. Bradbury's instructions to Anderson. Thus, she understood that if Paugh manifested "red flags" of alcohol withdrawal, meaning that if his "condition worsened ... in any way," the staff needed to get Paugh to the hospital. R. vol. 2 at 11 (citation omitted).

Bunnell placed Paugh in a detoxification cell to let him sleep. After that, Bunnell and Anderson did not check on or interact with Paugh for the rest of their shift, even though the jail maintains a "head count" policy requiring its officials to "at least once each hour, and whenever possible, every 30 minutes," "individually observe inmates," R. vol. 2 at 29 (citation omitted).

C. Day Shift on July 24, 2015 (6:00 a.m. to 6:00 p.m.)

At 6:00 a.m., the other Individual Defendants—Gowen, Conley, and Fuller—began their twelve-hour shift at the jail. Gowen was the shift supervisor, and Fuller was the designated medical official. Jail policy requires officials from an earlier shift to brief their replacements about pertinent information when changing shifts. So during this "pass-along," Anderson, Bunnell, and Riddle needed to inform Gowen, Conley, and Fuller about Paugh's alcohol-withdrawal condition, Paugh's unfilled Librium prescription, and Dr. Bradbury's discharge instructions. Id. at 12 (citation omitted). But the night shift failed to pass this information along to the day shift. Still, Gowen, Conley, and Fuller later "reviewed at least part of Paugh's medical file or otherwise learned that" Paugh was experiencing alcohol withdrawal. Id. at 13.

At about 6:30 a.m., Conley served Paugh breakfast, but Paugh did not eat it. Despite not eating, according to Conley, Paugh "seemed normal and well." Id. at 62 (citation omitted). At 11:00 a.m., Fuller served Paugh lunch. When doing so, Fuller noticed the shakiness of Paugh's hands, so he advised Paugh to "drink fluids and stay hydrated." Id. at 13. Around the same time, Gowen also noticed that Paugh's hands were shaking, and he knew that Paugh had already "retched, or dry-heaved" "two or three times" within the last "two or three hours."⁶ Id. at 14 (citation omitted).

At about 11:30 a.m., Fuller left the jail to fill Paugh's Librium prescription after Conley realized that no one else had done so. After Fuller left, Conley started Paugh's booking and screening processes. Gowen was present in the booking area as Paugh answered questions. While answering the jail's screening questions, Paugh had to go back to his cell to vomit.

After returning to the booking area, and in response to Conley's medical-screening questions, Paugh told Conley that he was "currently going through withdrawals," that he was in "lots of pain from three broken ribs," that he had medical problems related to seizures, that he was feeling "restlessness/anxiety," and that he suffered from alcoholism. Id. at 13 (citation omitted). Jail policy requires its officials to contact medical professionals if an inmate answers "yes" to "any medical screening question." Id. at 173. Despite this policy and Paugh's affirmative answers, neither

47 F.4th 1150

Gowen nor Conley sought medical attention for him.

Fuller then returned to the jail with Paugh's Librium, which he says he gave to Paugh around 1:40 p.m. While giving Paugh his Librium, Fuller noticed that Paugh's hands shook the entire time.

After giving Paugh a dose of Librium, Fuller noticed a problem. The jail's general policy was to distribute medication three times a day at 7:00 a.m., 12:00 p.m., and 5:00 p.m. But Paugh's Librium packaging specified that two Librium capsules needed to be given "every 2 hours as needed," R. vol. 4 at 138, and Dr. Bradbury's instructions called for Paugh to receive two capsules "as needed," R. vol. 3 at 190.

To resolve the discrepancy, Fuller called physician-assistant Logan Clark ("PA Clark").⁷ PA Clark asked whether Fuller had seen "any symptoms of withdrawal," including "any shaking, any issues like that." R. vol. 2 at 75 (citation omitted). Fuller told PA Clark that he had seen no withdrawal symptoms, and he assured PA Clark that Paugh had been "walking around good," "ha[d] been eating," hadn't been throwing up, and "seem[ed] to be doing good." Id. (citation omitted). Fuller made these statements despite observing Paugh's shaking hands and knowing that Paugh had vomited earlier.⁸

Believing that Paugh was not suffering from alcohol-withdrawal symptoms, PA Clark instructed Fuller to lower Paugh's Librium dosage to one capsule three times a day to conform with the jail's standard protocol. PA Clark also told Fuller that he "expected to be notified if there was any change to Paugh's symptoms." Id. (cleaned up).

At about 4:00 p.m., Gowen served Paugh dinner. During this encounter, Paugh told Gowen that he was "feeling sick and nauseous" and that "he had not [yet] hit [the] peak" of his alcohol-withdrawal symptoms. Id. at 15 (citation omitted). While speaking to him, Gowen observed that Paugh's hands...