Sacco v. Am. Institutional Med. Grp.

• Decision Date: 17 June 2022
• Docket Number: Civil No. 1:20-cv-447-JL
• Parties: Joanne SACCO, as administrator of the Estate of Nicholas Sacco v. AMERICAN INSTITUTIONAL MEDICAL GROUP, et al.
• Court: U.S. District Court — District of New Hampshire

609 F.Supp.3d 22

Joanne SACCO, as administrator of the Estate of Nicholas Sacco

v.AMERICAN INSTITUTIONAL MEDICAL GROUP, et al.

Civil No. 1:20-cv-447-JL

United States District Court, D. New Hampshire.

Signed June 17, 2022

Christine M. Craig, Anthony Carr, Shaheen & Gordon PA, Dover, NH, for Joanne Sacco.

Todd J. Hathaway, Abby Tucker, Elizabeth E. Ewing, Wadleigh Starr & Peters PLLC, Manchester, NH, for American Institutional Medical Group, LLC, Christopher Braga, The Estate of Christopher M. Schweiger.

MEMORANDUM ORDER

Joseph N. Laplante, United States District Judge

This case concerns whether, and to what extent, medical providers contracted to deliver and maintain reasonable and medically necessary care to pretrial detainees at a county jail may be liable if one of those detainees experiences opioid withdrawal at the jail and later dies. Plaintiff Joanne Sacco, as the Administrator of her son Nicholas Sacco's Estate (the "Estate"), filed suit against the County that operates the jail, several of its nurses who provided care to Sacco while detained, and the outside physician and physician's assistant who contracted with the County to provide medical care at the jail (as well as the entity they own). After several rounds of motion practice and some parties settling¹ , only the plaintiff's claims under 42 U.S.C. § 1983 for constitutionally inadequate medical care and common law negligence against the outside providers remain. This court has jurisdiction over the plaintiff's federal claim under 28 U.S.C. §§ 1331 and 1343 because the claim presents a federal question and arises from a federal civil rights statute, and supplemental jurisdiction over its state law claim under 28 U.S.C. § 1367(a).

The outside providers – American Institutional Medical Group, LLC, Christopher Braga, M.D., and Christopher Schwieger, PA-C² (the "AIMG Defendants") – move for summary judgment, arguing that the record evidence, even when construed in the light most favorable to the plaintiff, cannot support a claim for deliberately indifferent medical care that violates the substantive due process clause of the Fourteenth Amendment. The AIMG Defendants also argue that under these circumstances, they did not owe a tort duty of care to Sacco as a matter of law.³

After considering the parties’ submissions and hearing oral argument, the court grants the motion as to the § 1983 claim and denies it as to the negligence claim. Correctional medical care that violates the Constitution, regardless of which theory of deliberate indifference liability the plaintiff asserts, requires some degree of purposeful behavior directed at the inmate. Such intentional or purposeful conduct from Dr. Braga or PA Schweiger towards Sacco is missing from this case. Deliberate indifference is plainly not negligence. Nevertheless, viewing the record in the light most favorable to the plaintiff, the court cannot conclude that the AIMG Defendants did not owe a duty of care to Sacco under the unique facts and circumstances presented here. Dr. Braga and PA Schweiger took on a wide range of duties under the services agreement with the County, which made them generally responsible for the inmate medical care at Valley Street Jail. Defendants’ attempt to downplay its responsibilities is unavailing (at this procedural juncture). Because genuine factual disputes exist about the scope of the duty, whether the AIMG Defendants breached their duty, and whether that breach caused Sacco's untimely death, summary judgment is inappropriate on the plaintiff's negligence claim.

I. Applicable legal standard

Summary judgment is appropriate where "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). A dispute is "genuine" if it could reasonably be resolved in either party's favor at trial by a rational fact-finder, and "material" if it could sway the outcome under applicable law. Estrada v. Rhode Island, 594 F.3d 56, 62 (1st Cir. 2010). In analyzing a summary judgment motion, the court "views all facts and draws all reasonable inferences in the light most favorable to the non-moving party." Id.

Where, as here, the plaintiff bears the ultimate burden of proof, once the movant has made the requisite showing, it can no longer "rely on an absence of competent evidence, but must affirmatively point to specific facts that demonstrate the existence of an authentic dispute." Torres–Martínez v. P.R. Dep't of Corr., 485 F.3d 19, 22 (1st Cir. 2007). That is, the plaintiff " ‘may not rest upon the mere allegations or denials of [the] pleading, but must set forth specific facts showing that there is a genuine issue’ of material fact as to each issue upon which [it] would bear the ultimate burden of proof at trial." Santiago-Ramos v. Centennial P.R. Wireless Corp., 217 F.3d 46, 52–53 (1st Cir. 2000) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) ).

In the alternative, the plaintiff seeks relief under Fed. R. Civ. P. 56(d). That rule provides that "[i]f a nonmovant shows by affidavit or declaration that, for specified reasons, it cannot present facts essential to justify its opposition, the court may: (1) defer considering the motion or deny it; (2) allow time to obtain affidavits or declarations or to take discovery; or (3) issue any other appropriate order." Id.

II. Background

The following facts are undisputed, unless otherwise noted. See L.R. 56.1(b) ("All properly supported material facts set forth in the moving party's factual statement may be deemed admitted unless properly opposed by the adverse party.").⁴

A. Valley Street Jail

The County operates the Valley Street Jail in Manchester, New Hampshire and employs a staff of nurses to provide medical care to inmates and detainees at the jail. It also contracts with outside entities to provide medical services at the jail. In 2016, AIMG entered into an agreement with the County to "deliver and maintain reasonable and medically necessary medical care to the inmates" and detainees at Valley Street "in accordance with NCCHC/ACA standards, and the Policies and Procedures of the HCDOC."⁵ AIMG is a New Hampshire limited liability company comprised of Dr. Braga and PA Schwieger.

B. AIMG's Services Agreement with the County

The contractually required medical care included, "at a minimum; performing routine medical/physical exams, providing medical treatment and ordering studies, tests, and ancillary services that are required consistent with aforementioned standards and policies and procedures."⁶ The agreement also required the AIMG providers to "provide services on scheduled workdays according to" mutually agreeable times "for a minimum of 12 hours per week on site at" Valley Street.⁷ And the County agreed to "provide reasonable and necessary supplies, equipment and physical space for [AIMG's] services." In May 2019, an AIMG provider was typically present at Valley Street on Tuesdays, and the jail would set up two daily times for nurses to call an AIMG provider for routine medication orders, paperwork review, or discussing other concerns that the nurses wished to raise about particular inmates or detainees.⁸

AIMG's responsibilities under the agreement also included:

• "[R]easonably document[ing] all medical services provided by the Provider, referrals and record reviews in the inmate's medical record" and reviewing and re-evaluating "those cases requiring on-going medical and/or pharmaceutical attention, as appropriate and consistent with the aforementioned standards, policies and procedures and standard of care";

• Serving "as a member of various Facility committees, and upon reasonable request, attend[ing] meetings within the Health Services Department and HCDOC";

• Overseeing "the Facility's Quality Assurance program, and assist[ing] in establishing Quality Assurance standards and audit criteria";

• "[D]evelop[ing] and conduct[ing] in-service education programs a minimum of 2 times annually and upon reasonable request by the Facility";

• Consulting with the pharmacy and monitoring "all in-patient hospitalizations to evaluate appropriateness of admission, length of stay, and reasonable follow up care";

• Consulting and collaborating "with the Health Services Administrator, Nurse Practitioner and/or Physician's Assistant, Mental Health Staff, Dentist, and Nursing Staff, to assist in meeting the medical and/or mental health needs of the inmates"; and

• Providing "assistance and clinical input with regards to the operations of the Health Services Department."

In addition, AIMG was required to be "available to assist the Facility/Health Services Administrator, upon reasonable request[,] in the development of, and annual review of clinical policies, procedures, protocols and annual disaster plan." The agreement further obligated AIMG to recommend changes to policies, procedures and protocols "consistent with evolving standards of care and professional requirements, but the Facility will be solely responsible for such policies, etc."

Dr. Braga and PA Schwieger were "directly responsible to the [County's] Superintendent and/or his designee for the delivery of medical care," but maintained "sole responsibility and accountability for [their own] medical diagnosis’ and/or treatment decisions." AIMG also had to maintain professional liability and malpractice insurance for the duration of the agreement. Under the agreement, AIMG was entitled to service fees of $315,000 for the first year, $324,450 for the second year, and $334,183.50 for the third year.

The parties agreed that AIMG was an independent contractor of the County and nothing in the agreement would be "construed to create principal/agent, employer/employee, master/servant, lessor/lessee, partnership or joint venture relationship[s] between [AIMG] and the Facility." To that end, each party to the agreement was "solely responsible for the conduct of their own...