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Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 

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United States Court of Appeals

FOR THE EIGHTH CIRCUIT

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No. 06-2787

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Darin Winters, as Personal

Administrator of the Estate of

Donald Winters,

Appellant,

v.

Arkansas Department of Health and

Human Services; Keith Ferguson,

Sheriff, in his official capacity as

Sheriff of Benton County,

Arkansas; John Selig, Chief

Executive Officer of DHS,

Appellees.

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Appeal from the United States

District Court for the

Eastern District of Arkansas.

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Submitted: March 14, 2007

 Filed: June 29, 2007

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Before COLLOTON, HANSEN, and GRUENDER, Circuit Judges. 

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HANSEN, Circuit Judge.

Mr. Darin Winters, as personal administrator of the estate of his father, the late

Mr. Donald Winters (whom we will refer to as "Mr. Winters"), brought suit alleging

claims pursuant to 42 U.S.C. § 1983; Title II of the Americans With Disabilities Act

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The Honorable G. Thomas Eisele, United States District Judge for the

Eastern District of Arkansas.

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of 1990 (ADA), 42 U.S.C. § 12132; and Section 504 of the Rehabilitation Act of

1973, 29 U.S.C. § 794, after his father died while a pretrial detainee in the county jail

on a state law charge of criminal trespass. The defendants remaining in the lawsuit

are the Arkansas Department of Health and Human Services (DHS), its chief

executive officer, and the Benton County Sheriff in his official capacity. Following

a bench trial, the district court1

 entered a judgment for the defendants, accompanied

by a lengthy and thoughtful discussion of the facts, as well as a careful consideration

of the applicable law. See Winters v. Ark. Dep't of Health and Human Servs., 437 F.

Supp. 2d 851 (E.D. Ark. 2006). Darin Winters appeals.

"[W]e review the district court's factual findings for clear error and its

conclusions of law de novo." Gibson v. Caruthersville Sch. Dist. No. 8, 336 F.3d 768,

772 (8th Cir. 2003). The district court's opinion provides a detailed discussion of all

the facts of this case, see Winters, 437 F.3d at 855-88, which we will only summarize.

Mr. Winters was an acutely mentally ill person who died in a county jail on January

1, 2003, while being held on a charge of criminal trespass. The district court found

that the cause of his death was a previously undiagnosed physical ailment of

"peritonitis due to a perforated ulcer that more likely than not perforated sometime

after his arrest on December 28, 2002." Id. at 876. The district court also found that

Mr. Winters' mental illness may have played a role in his death by rendering

meaningful communication with the medical professionals who treated him almost

impossible. Absent accurate information from the patient, the medical personnel were

denied information that might have aided in their ability to timely diagnose the

perforated ulcer. 

Mr. Winters also had "multiple blunt force injuries of head, trunk and

extremities including fractured ribs." Id. at 875. Mr. Winters himself caused the

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contusions, abrasions, and fractured ribs by striking his own head, torso, and

extremities against the holding cell's toilet and by resisting and struggling against

restraints. The evidence supports the district court's finding that these injuries were

not the cause of his death. The district court concluded that the Sheriff and his

deputies "did everything within reason to protect Mr. Donald Winters from injuring

himself." Id. at 876.

On the evening of December 28, 2002, police officers were called because Mr.

Winters, who had a history of two prior psychotic episodes requiring hospitalization

and treatment, was persistently banging on a neighbor's door and would not leave.

The officers, aware of Mr. Winters' mentally ill condition, were unable to establish a

meaningful dialogue with him. They advised him to go home or he would be arrested

for criminal trespass, but Mr. Winters did not respond to the officers, except to tell

them that they were going to be executed. It was apparent that he was mentally ill and

would not go home. 

The officers arrested Mr. Winters on a charge of criminal trespass and

transported him immediately to the Bates Medical Center to have him examined and

admitted into the psychiatric ward. He had to be restrained during the examination

and did not communicate meaningfully concerning his health. The examining

physician would not admit him into Bates, even though Mr. Winters was considered

a danger to himself and others, because the psychiatric ward at Bates was not

equipped to handle violent and aggressive patients. The physician at Bates discharged

Mr. Winters to the custody of the police, and he was taken to the jail. 

After Mr. Winters injured himself by beating his head, chin, and elbows against

the toilet, officers placed Mr. Winters in a detoxification cell from which they could

monitor his actions by video. He appeared before a magistrate judge on the evening

of Sunday, December 29, 2002. The magistrate judge found that probable cause

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supported the criminal trespass charge, set bail at $500, and ordered Mr. Winters to

appear in the Benton County District Court on January 5, 2003. 

The next morning, Monday, December 30, 2002, Mr. Winters began standing

on a bench in the detox cell and exposing himself in front of the window. He was also

masturbating and smearing feces around the cell. He managed to take off a suicide

smock and continued exposing himself. Mr. Winters refused to eat or drink water,

accusing the officers of giving him acid. His son Darin visited him and convinced

him to drink three or four cups of water, but after drinking it, Mr. Winters held his

right side and complained that it was acid. The officers advised Darin that he could

take his father out of the jail if he would assume responsibility for him, but Darin

indicated that he was unable to handle his father in this condition. He signed a

petition for the involuntary commitment of Mr. Winters that day. 

On Tuesday, December 31, 2002, following an involuntary civil commitment

hearing, the presiding judge committed Mr. Winters to the Arkansas State Mental

Health System. Because no regional inpatient facility could accommodate an acutely

mentally ill patient, the court specified that Mr. Winters would be sent to the Arkansas

State Hospital in Little Rock for seven days of evaluation and assessment to determine

whether treatment for mental illness would be appropriate. The officers then

transported Mr. Winters directly to the Ozark Guidance Center, which was the

designated local receiving facility. Ozark staff determined that no beds were currently

available at the State Hospital in Little Rock, or at any other state facility that accepts

mental health commitments, and accordingly, they placed Mr. Winters' name on a

waiting list for admittance to the State Hospital. A physician at Ozark administered

two injections to calm Mr. Winters, and after an examination, returned him to the

custody of the officers, noting that Mr. Winters appeared to be severely dehydrated.

Mr. Winters fell asleep on his return to the county jail to await placement in the State

Hospital. 

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As soon as the jail's physician learned of the possible dehydration, officers

transported Mr. Winters back to the emergency room at Bates Medical Center. The

examining physician found Mr. Winters to be mildly dehydrated and administered two

liters of fluids. The physician found no significant dehydration and no indication of

any serious medical problem. He was aware that the staff at Ozark had already

evaluated Mr. Winters, and Bates was not equipped or staffed to deal with acutely

psychotic patients. Accordingly, when the physician concluded that Mr. Winters was

in a stable physical condition, he released him to the custody of the Sheriff. 

Early the next morning, on January 1, 2003, Mr. Winters refused to take the

medicine that had been prescribed for him at Ozark. He appeared to be sleeping on

a mat in the middle of the cell, fully clothed, from 8 to 10 a.m. Around 2:30 p.m., he

was observed naked in the cell and on his knees leaning over. He was sitting up

around 3:30 p.m. but was discovered on his side and with no pulse around 4:20 p.m.

Attempts to revive him were unsuccessful. 

Experts testified about the need for more psychiatric beds in inpatient facilities.

A private inpatient facility known as Highland Hall had previously accepted patients

who came to Ozark Guidance Center needing psychiatric services, but its doors closed

in April 2002 due to financial considerations. After this facility closed, there were

inadequate local facilities to attend to the needs of acutely mentally ill patients, and

the State Hospital became overburdened as regional facilities closed. Expert

testimony indicated that absent an appropriate inpatient facility capable of taking on

the patients from this region, Ozark had no choice but to return patients to jail if the

State Hospital had no open beds. Several task force reports indicated that the state

government was aware of the problems created by the shortage of beds for mentally

ill citizens. The state legislature appropriated funds for some 16 additional beds after

Mr. Winters' death, but experts opined that this remained inadequate to meet existing

needs. 

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The district court ruled in favor of the defendants, finding no official capacity

liability on the part of the Sheriff or the director of the DHS because their actions were

not the proximate cause of Mr. Winters' death, and there was no policy or custom to

deprive acutely mentally ill citizens of placement in inpatient mental health treatment

facilities. See Grayson v. Ross, 454 F.3d 802, 810-11 (8th Cir. 2006) (stating the

standard for official-capacity liability under § 1983). The district court found that the

Sheriff's officers had done everything they could to protect Mr. Winters from injuring

himself and that they were not deliberately indifferent to his serious medical needs.

Neither the Sheriff nor the doctors who had examined Mr. Winters had suspected that

a delay in admitting him to the State Hospital would adversely affect either his

physical or mental health. 

The district court also found no liability under the ADA or the Rehabilitation

Act for failure to provide mental health services. While the failure to provide

reasonable medical care to a pretrial detainee on the basis of a disability could be

considered discrimination, the district court found that there was no evidence that Mr.

Winters had been denied medical care. The Sheriff's Office had attempted to obtain

care and proper placement for Mr. Winters on three occasions. The district court

rejected as inapplicable the plaintiff's argument based on Olmstead v. L.C. ex rel.

Zimring, 527 U.S. 581 (1999) (plurality), that Mr. Winters did not receive an

appropriate placement under the ADA because jail is not the least restrictive

placement for a person with a mental illness. The Olmstead case dealt with

discrimination arising from isolating persons with mental illness in an institution when

the state's own treatment professionals have determined that a community setting

would be appropriate. See 527 U.S. at 602. The district court properly distinguished

the situation at hand, noting that Mr. Winters was awaiting transfer to the State

Hospital for a decision about his appropriate placement, and the staff at Ozark had

returned him to the custody of the Sheriff until there was an open bed at the State

Hospital because no other treatment facility could take him. (He was still under an

order requiring him to post bail on the trespass charge.) No treatment professionals

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had yet had the opportunity to evaluate him or recommend a placement for him and

consequently, the least restrictive placement standard did not come into play. See

Winters, 437 F. Supp. 2d at 892-96. 

On appeal, Darin Winters asserts that his father did not receive a proper

placement under the ADA because incarceration is not the least restrictive

environment for a mentally ill patient and that the actions and omissions of the

appellees amounted to deliberate indifference under § 1983. At oral argument, Darin

Winters' counsel clarified that he is not appealing the district court's decision that Mr.

Winter's death was not caused by deliberate indifference. Instead, he asserts that the

officials were deliberately indifferent and discriminated against Mr. Winters while he

was incarcerated prior to his death. 

No party to this suit suggests that jail is an appropriate treatment facility for a

mentally ill person. The district court agreed that county "jails should not become our

mental hospitals by default," but aptly recognized that the solution to the problem of

an inadequate number of available mental health treatment facilities requires decisions

of how to best allocate available resources, and those decisions belong to the

legislative branch. Id. at 904. In this case, although Mr. Winters was arrested on a

criminal charge, the Sheriff's Office immediately sought treatment for him and

attempted to transport him to an appropriate facility on several occasions. Mr.

Winters was not denied admittance to the State Hospital on the basis of his disability,

but for a lack of available space. While a policy of same-day or immediate admission

into an appropriate mental health facility may be desirable in the best of all worlds,

it is not mandated by the ADA, the Rehabilitation Act, or the Constitution, and it may

not always be feasible given a state's limited resources. We agree with the district

court's conclusion that Mr. Winters was not discriminated against on the basis of his

disability.

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Additionally, the district court correctly concluded that there was no deliberate

indifference to Mr. Winters' serious medical needs, and neither was there a policy or

custom to deprive mentally ill citizens of treatment. The Sheriff's officers attempted

to get Mr. Winters into a treatment facility and took measures to protect him from

personal injury when he began harming himself. We agree with the district court's

conclusion "that the Sheriff had no option but to maintain custody of Donald Winters

in order to protect him and others because neither Ozark Guidance Center, Bates

Hospital, Darin Winters or the [Arkansas State Hospital] would accept custody of

him." Id. at 897. 

Having carefully reviewed the record, we conclude that the district court's

findings of fact are not clearly erroneous and that the district court's analysis is

correct, thorough, and well-reasoned. Accordingly, we affirm the judgment of the

district court. See 8th Cir. R. 47B. 

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