Woodward v. Correctional Medical Services

Decision Date17 May 2004
Docket NumberNo. 03-3147.,03-3147.
Citation368 F.3d 917
PartiesHarriett G. WOODWARD, Special Administrator of the Estate of Justin Farver, deceased, Plaintiff-Appellee, v. CORRECTIONAL MEDICAL SERVICES OF ILLINOIS, INC., Defendant-Appellant.
CourtU.S. Court of Appeals — Seventh Circuit

Peter R. Coladarci (Argued), Chicago, IL, for Plaintiff-Appellee.

Andrew R. McGaan (Argued), Kirkland & Ellis, Chicago, IL, for Defendant-Appellant.

Before POSNER, RIPPLE, and EVANS, Circuit Judges.

TERENCE T. EVANS, Circuit Judge.

After 23-year-old Justin Farver hanged himself with a bed sheet while a pretrial detainee at the Lake County (Illinois) jail, Harriett Woodward, his grandmother and the special administrator of his estate, sued Correctional Medical Services ("CMS," a private contractor hired by Lake County to provide medical and mental health services at its jail), CMS agents — nurse Karen Dean, social worker Joel Mollner, and Dr. Michael Fernando — the sheriff of Lake County, and Alan Myres, a Lake County deputy sheriff, under 42 U.S.C. § 1983 and an Illinois wrongful death statute. During pretrial proceedings, the Lake County sheriff and deputy Myres settled with the estate and the estate dismissed its state law wrongful death claims against the remaining defendants.

After a 3-week trial, a jury found that CMS and its social worker, Mollner, acted with deliberate indifference to Farver's health and safety. The jury exonerated the other two CMS agents, nurse Dean and Dr. Fernando. Compensatory damages of $250,000 and punitive damages against CMS totaling $1.5 million were awarded.

After the jury's adverse verdict, CMS and Mollner moved for judgment as a matter of law under Rule 50(b) and for a new trial and a remittitur under Rule 59. The district court (Judge Robert W. Gettleman) denied the motions. Citing the deliberate indifference test for § 1983 liability under Farmer v. Brennan, 511 U.S. 825, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994), the judge found that the estate "presented abundant evidence from which the jury could conclude that Mollner and CMS met these standards." The judge also specifically found that the trial testimony "allowed a reasonable jury to conclude that [Mollner] was not credible" and that he "was deliberately hostile to suicidal inmates including Justin." Judge Gettleman also concluded that CMS's "management's deliberate indifference to its staff's violations" of CMS's written policies and procedures was "sufficient to allow a jury to conclude that CMS tolerated if not encouraged the custom or practice that encompassed deliberate indifference to the substantial danger posed to the life and health of suicidal inmates including Justin."

The judge also rejected evidentiary challenges to the testimony of the estate's expert, Dr. Robert Greifinger, finding that "his testimony alone, in my view, would have supported the jury's verdict." The judge also held that it was proper to admit evidence that CMS nurses reported for duty while under the influence of drugs and alcohol and that CMS's management was aware of that misconduct and condoned it. In denying CMS's motion for a remittitur, Judge Gettleman found that punitive damages were reasonable and "not out of line." Both CMS and Mollner appealed, but Mollner has settled up with the estate. So the only matter before us at this time is CMS's challenge to the verdict against it. We view the facts, in this fact-intensive case, in the light most favorable to the jury's verdict.

In 1996, Lake County published a "request for proposals" seeking bids from private contractors to provide medical and mental health services to the inmates at its jail. Because incarcerated inmates present a well-recognized risk of suicide, the county's request for proposals mandated that any service provider that contracted to provide mental and medical health services at the jail would conduct preliminary screening of inmates to identify those who presented a suicide risk. Lake County also required immediate assessment of all high-risk inmates in its request for proposals.

CMS submitted a bid proposal which contained detailed representations of preliminary screening and assessment services, including screening for potential suicide risks. CMS represented to Lake County that health-trained personnel would perform all such screenings. Specifically, CMS's proposal promised that:

CMS will utilize a suicide identification form approved by Lake County Jail officials to be completed by medical personnel at the time of intake. Developed in 1985 by jail suicide specialist Joe Rowan and adopted for CMS's use in 1986, this program has drastically reduced the number of attempted and successful suicides in jail populations.

If an inmate has been identified as suicidal or potentially suicidal, immediate referral to the mental health staff will be made so that appropriate housing and intervention can be started.

Mr. Mollner will monitor inmates identified as at-risk for self-harm frequently until he is able to verbalize that they are no longer suicidal.

Training sessions will be offered to facility staff to support suicide prevention efforts.

In order to implement effectively its suicide prevention program, CMS represented to Lake County that CMS would recruit and hire trained and experienced employees, hopefully ones with prior experience working in jails.

CMS, as it turned out, was the successful bidder, and soon a contract was agreed to whereby it would be the sole provider of mental and medical health services to inmates at the Lake County jail. The contract incorporated the terms and conditions set forth in Lake County's request for proposals and CMS's responsive bid. In particular, CMS agreed to provide a detailed and rigorous suicide risk identification and prevention program.

CMS promulgated its suicide identification and prevention program in a policy and procedures manual. The manual directed CMS employees to implement CMS's procedures to identify and treat potentially suicidal inmates at the earliest possible moment. Specifically, CMS mandated that inmates be screened for suicide potential immediately upon admission to the jail. CMS medical personnel were required to perform the initial screening by completing a mental health intake screening form designed to detect potential suicide risks. The directive in CMS's manual was clear: "Whenever an inmate ... reports a risk of self-destructive behavior, immediate assistance will be provided."

CMS's mental health intake screening form consisted of a single page divided into six sections: Suicide Potential Screening, Psychiatric Screening, Behavioral Observations, Summary, Disposition, and Comments. CMS policy dictates that any employee administering the mental health screening and completing the CMS form was required to be qualified to do so. CMS even produced an instructional videotape that detailed how the form was to be used and described the danger suicide potential presented in jail settings. All CMS medical personnel were supposed to complete suicide identification and prevention training as part of their job orientation, and a critical portion of that training was to watch the videotape. In the videotape, according to a transcript of it admitted during the trial, CMS employees are told:

Suicide is the tenth major cause of death in the United States. Some studies indicate the risk among inmates is 5 times higher than that within the community.

We are responsible for the care and supervision of the inmates in our custody. Care includes protecting the inmate from himself or herself and from others. Care includes ensuring access to needed medical treatment. Since inmates are removed from their community support systems, it is our responsibility that they have support within the facility.

Do not take the easy way and mark a line through all the no's. It can be difficult to convince a jury that the screening was completed in a thoughtful manner, or the documentation suggests a cursory approach to the screening process.

The intake mental health screening has been designed to assist in identifying at-risk inmates upon admission to the facility so appropriate measures can be taken to minimize self-destructive... behavior. The purpose of the screening process is to identify inmates requiring further evaluation. If there is any doubt, the inmate should be referred.

Expresses thoughts about killing self. Directly ask the inmate, "Are you thinking about killing yourself?" Although you may be uncomfortable asking this question, research indicates that the most accurate way of differentiating a suicidal from a nonsuicidal person is by simply asking the person about suicidal thoughts. Even if the inmate does not make direct suicide statements, such as "I am thinking of killing myself" or "I want to die," you should be alert to indirect suicide statements, such as "I won't be a burden anymore," "I have nothing to live for," or "No one will miss me while I am gone." These feelings should be explored by asking the additional questions about potential suicidal thoughts. Any direct or indirect suicidal statement should be scored a yes. When this question is scored a yes, notify your shift commander and refer to mental health.

If there are any circles in the shaded areas or the total number of yes's is 8 or more, your shift commander should be alerted and the inmate referred for further evaluation. If mental health staff are not on site, the inmate should be placed in a protective environment until the evaluation can be completed.

The intake screening form directed medical personnel to alert the jail's shift commander and to refer an inmate for mental health evaluation whenever an inmate responded "yes" to certain critical questions, including question number eight: "Expresses thoughts about killing self." When an inmate expressed thoughts of killing himself to the intake...

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