Stockton v. Milwaukee Cnty.

• Decision Date: 09 August 2022
• Docket Number: 22-1116
• Citation: 44 F.4th 605
• Parties: Gail STOCKTON, individually and as Special Administrator of the Estate of Michael Madden, deceased, Plaintiff-Appellant, v. MILWAUKEE COUNTY, et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Seventh Circuit

44 F.4th 605

Gail STOCKTON, individually and as Special Administrator of the Estate of Michael Madden, deceased, Plaintiff-Appellant,

v.MILWAUKEE COUNTY, et al., Defendants-Appellees.

No. 22-1116

United States Court of Appeals, Seventh Circuit.

Argued May 31, 2022

Decided August 9, 2022

Michael John Cerjak, Attorney, Cannon & Dunphy, Brookfield, WI, for Plaintiff-Appellant.

Samuel C. Hall, Jr., Attorney, Benjamin A. Sparks, Attorney, Steven Charles McGaver, Attorney, Crivello Carlson, S.C., Milwaukee, WI, for Defendants-Appellees Milwaukee County, Wisconsin, David A. Clarke, Jr., Richard Schmidt, Brian Piasecki, Nancy Evans.

Christopher P. Riordan, Attorney, Von Briesen & Roper, S.C., Milwaukee, WI, for Defendants-Appellees Armor Correctional Health Service, Inc., Mercy Mahaga, CaryAnne Andriano.

Benjamin A. Sparks, Attorney, Steven Charles McGaver, Attorney, Crivello Carlson, S.C., Milwaukee, WI, for Defendant-Appellee Jeffrey Andrykowski.

Before Scudder, St. Eve, and Kirsch, Circuit Judges.

St. Eve, Circuit Judge.

When Michael Madden arrived at the Milwaukee County Jail on an outstanding probation violation, he suffered from various ailments, including a history of intravenous drug abuse

and a congenital heart defect. Over the course of a month, Madden developed infective endocarditis, a serious and occasionally fatal heart infection. Although medical staff treated Madden repeatedly for numerous complaints during this period, none diagnosed the infective endocarditis. By the end of the month, Madden was dead. Gail Stockton, the special administrator of Madden's estate, filed suit asserting deliberate indifference, use of excessive force, Monell liability, and state law claims against the state actors involved with Madden's care. The district court dismissed all of Stockton's claims at summary judgment. We affirm in part and reverse and remand in part.

I. Background

A. Consent Decree and Monitoring

On March 7, 2001, Milwaukee County entered into a consent decree (the "Consent Decree") regarding conditions in the Milwaukee County Jail ("MCJ"). Among the conditions subject to the Consent Decree are the health services provided at the MCJ, including medical staffing levels and processing of inmate requests for medical attention, known as sick call slips. Dr. Ronald Shansky, a correctional healthcare expert, has monitored the MCJ's compliance with the Consent Decree and generated biannual reports since 2001.

Milwaukee County contracted with Armor Correctional Health Service, Inc. ("Armor") to provide healthcare services to MCJ inmates. The Shansky reports indicate Armor consistently struggled to meet medical staffing level expectations and process sick call slips in a timely manner. David Clarke, the Milwaukee County Sheriff during the relevant period, oversaw the MCJ and tasked Richard Schmidt, an Inspector with the Milwaukee County Sheriff's Office, with the responsibility of overseeing Armor. Nancy Evans, the Jail Commander, was responsible for the day-to-day operations in the MCJ.

B. Madden's Confinement

Michael Madden was booked into the MCJ on a warrant for an outstanding probation violation on September 29, 2016. During intake, Madden disclosed both a history of intravenous drug use and a congenital heart defect

. These characteristics placed him at risk of developing infective endocarditis

, a serious and potentially lethal heart infection. Infective endocarditis typically presents with a new heart murmur, shortness of breath, and elevated temperature. Due to Madden's drug use on the day of his arrest, the MCJ placed him on heroin withdrawal protocol for six days.

On October 5, 2016, Mercy Mahaga, a nurse practitioner employed by Armor, evaluated Madden in response to a sick call. Madden reported taking unprescribed benzodiazepine while in the MCJ and a history of heroin use. Madden's blood pressure was 101/60, his heartrate was elevated at 101 beats per minute ("BPM"), and his respiration was 18 breaths per minute ("bPM"). Mahaga noted Madden's lungs sounded normal and he appeared alert and oriented. Mahaga determined Madden was likely suffering "benzo withdrawal" and instructed him to stop using drugs and to drink more fluids.

Madden requested an emergency medical evaluation on October 11, 2016, for "heart issues" and "trouble breathing." Madden reported he was "not drinking virtually any water," experienced "dizziness when standing," and informed the nurse evaluating him of his congenital heart defect

. Madden's blood pressure was 108/53, his heartrate was 106 BPM, his respiration was 18 bPM, and his temperature was 97.9°F. Madden was transferred to the MCJ clinic and placed on intravenous fluids, after which he reported feeling "much better."

Madden sought emergency medical attention once again on October 13, 2016, because his "heart hurt[ ]." CaryAnne Adriano, a registered nursing supervisor employed by Armor, evaluated Madden. Madden reported suffering diarrhea due to benzodiazepine and heroin withdrawal, that he was not drinking water, and a history of gastroesophageal reflux disease

("GERD"). GERD may cause chest pain, even severe chest pain. During this evaluation, Madden's blood pressure was 114/62, his heartrate was elevated at 112 BPM, his respiratory rate was 20 bPM, his temperature was slightly elevated at 100.3°F, his heart rhythm was normal, and he displayed no other signs of distress. Adriano instructed Madden to take Tums and Kaolin-Pectin and to increase his fluid intake. She also scheduled him for a follow-up assessment the next day. Adriano testified she was not concerned Madden might be suffering a heart condition because his symptoms were consistent with suffering narcotics withdrawal and failure to eat and drink appropriately.

Mahaga performed Madden's follow-up the next day. During this appointment, Madden complained of watery diarrhea, inability to sleep, and dissatisfaction with the jail diet. Mahaga reviewed Adriano's notes from the previous day. Mahaga did not understand the "cp" notation as shorthand for "chest pain," did not take steps to determine what "cp" meant, and did not know Madden previously complained of chest pain. Madden appeared alert, oriented, and not in distress during the follow-up. Madden's blood pressure was 98/62, his heartrate was an elevated 108 BPM, his temperature was 97.1°F, and his respiratory rate was 17 bPM. Madden weighed 142 pounds on October 14, 2016, constituting a seven-pound loss since his intake on September 29, 2016. Mahaga also noticed a low-grade heart murmur she did not hear on October 5, 2016. The murmur was faint enough Mahaga did not consider it an emergency. Mahaga knew murmurs could be caused by infections or by insufficient fluid intake and that Madden had a congenital heart defect

, was an intravenous drug user, exhibited persistently elevated heartrates, had a low-grade fever the previous day, and had not been drinking sufficient fluids for a sustained period of time. Mahaga also knew intravenous drug users were at a heightened risk of infections and that infections could prove lethal. At the time, she understood the symptoms of infective endocarditis

and that diagnosing infective endocarditis required blood testing and an electrocardiogram. Ultimately, Mahaga determined Madden suffered "diarrhea" and instructed him to drink more fluids.

On October 25, 2016, a sick call slip was entered for Madden in which he reported:

I have severe allergies and have been experiences [sic ] bad symptoms. I've had prescriptions, but are too old. Would it be possible to get an antihistamine or some medication to alleviate symptoms. Thank you.

Madden's sick call slip was assigned the highest priority level and scheduled for a follow-up on October 26, 2016. Madden was not seen by medical staff on October 26, 2016, however. Stockton's expert, nurse Lori Roscoe, attributed this failure to MCJ's inadequate medical staffing levels.

At approximately 1:00 a.m. on October 28, 2016, Adriano, nurse Bonnie Litrenta, correctional officer Tinita Holmes, correctional officer Brian Piasecki, and correctional lieutenant Jeffrey Andrykowski responded to a medical emergency in Madden's cell. Madden was hyperventilating, complained of chest pain, exhibited difficulty breathing, and was having trouble standing and walking. Adriano and Litrenta heard Madden say he had a heart condition. Piasecki grabbed Madden by the shirt, pushed him into a chair, and yelled at him to "sit the fuck up." While in the chair, Madden vomited an orange substance. Adriano and Litrenta instructed Andrykowski to bring Madden to the medical clinic for additional treatment. The nurses did not give the correctional staff specific instructions for Madden's care during transport.

The correctional staff called for a wheelchair and attempted to move Madden closer to the cell exit while awaiting its arrival. Madden could not walk and fell to the ground, at which point Piasecki swore at him to get up, lifted him, and pulled him towards the cell exit. Piasecki propped Madden against the wall, but Madden slipped and hit his head. Piasecki repositioned Madden so he was braced on Piasecki's legs. Litrenta testified Piasecki then deliberately moved his legs so Madden fell and hit his head on the floor.

At this point, Adriano, Holmes, and Litrenta left the cell and returned to the MCJ clinic. The parties dispute whether the nurses left of their own volition or whether Andrykowski ordered them to leave. Once the wheelchair arrived, the correctional officers put Madden in the wheelchair and transported him to the MCJ clinic on an elevator. Video footage of the elevator trip, lasting approximately 40 seconds, shows Madden fully unconscious and limp but does not reveal whether Madden had a pulse or was breathing. MCJ policy dictates that if a correctional officer comes across someone who seems unresponsive, he is to tap and shout at the individual. If the individual does not react, correctional officers should then check for signs of...