Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-06-03900/USCOURTS-ca8-06-03900-0/pdf.json

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

___________

No. 06-3900

___________

Jela D. Jones, as Trustee for the heirs *

of Brenda Diane Jones, deceased, *

*

Plaintiff – Appellant, *

* Appeal from the United States

v. * District Court for the District

* of Minnesota.

Minnesota Department of Corrections, *

Rick Hillengass, Heidi Gillies, Laura *

Westphal, Kathy Duklet, Troy Hedtke, *

Dave Knutson, Kevin Fors, Schahara *

Schutte, Marla Prescott, Katie Ziegler, *

Dave Hergott, Darryl Galloway, and *

Pamela Smith, each individually and in *

their official capacities, *

*

Defendants – Appellees. *

___________

Submitted: October 19, 2007

Filed: January 9, 2008

___________

Before LOKEN, Chief Judge, GRUENDER, and BENTON, Circuit Judges.

___________

BENTON, Circuit Judge.

Jela D. Jones sued the Minnesota Department of Corrections and individual

prison officials for allegedly violating his mother’s Eighth Amendment rights, by

deliberate indifference to her serious need of medical care, causing her death. The

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 The Honorable Richard H. Kyle, United States District Court for the District

of Minnesota.

2

 The autopsy reported that Jones was morbidly obese, weighing 285 pounds

at 5'1" tall.

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district court1

 granted summary judgment to the defendants. Jones appeals. Having

jurisdiction under 28 U.S.C. § 1291, this court affirms.

I.

On November 4, 2003, Brenda Diane Jones was sentenced to 33 months in

prison for aiding and abetting a controlled substance crime. She was then held at the

Blue Earth county jail for three days awaiting transfer to the Minnesota Department

of Corrections facility in Shakopee. Blue Earth officers told Shakopee officers that

Jones had been “fine” until told of the transfer, at which point she became “violently

sick” and “uncooperative.” As suggested by Blue Earth, Shakopee had extra officers

to assist Jones from the vehicle. Jones arrived at Shakopee at 9:45 a.m., during the

second watch shift. Officers directed her to exit the vehicle. She did not respond,

mumbling and exhibiting a blank stare. As two officers tried to help Jones out of the

vehicle, she swung her legs to the side as if attempting to exit.2

 One officer pushed

Jones from behind, another pulled from the front, in order to remove her from the

vehicle. Jones had an unpleasant odor, like urine or body odor, which was noted by

various officers throughout the intake process. 

Once outside the vehicle, she sat down on the floor of the intake garage. Jones,

mumbling, did not comply with instructions to stand up. One officer applied a

pressure-point technique to make Jones comply, which produced no response.

Officers called for more assistance. One officer described Jones as grunting and

rolling around on the floor. Many officers described Jones’s breathing as “heavy,”

“labored,” and “fast paced.” No officer thought Jones was having trouble catching her

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breath. Most officers stated that her breathing was rapid as if she had been exerting

herself. One officer said that her breathing sounded like his breathing used to sound

when he was overweight. One officer thought Jones might be over-medicated. 

Another officer would have called for an A-team response and medical, but did not

because the A-team and watch commander were already there. The officers lifted

Jones into a wheelchair, transporting her to the Mead Unit for the intake process. 

By policy, inmates must be screened for medical, dental, and mental health

within 24 hours of arrival at Shakopee. Lt. Westphal – concerned that, due to her size,

Jones could not walk or stand during intake – started the screening immediately.

Nurse Pamela Smith began the evaluation, but did not complete it because Jones did

not answer her questions. Nurse Smith did take Jones’s pulse (which was normal) and

respiration (which was three times faster than normal). Nurse Smith stated that

Jones’s respiration returned to normal by the end of the examination, but her records

do not indicate a second respiration rate. Jones drank two glasses of water after Nurse

Smith offered her a drink. Nurse Smith noted that Jones appeared “uncomfortable,”

grunting, with dried blood on her mouth and lips. Lt. Westphal also noticed severe

chapping and cracking of her lips. Nurse Smith’s records indicate that Blue Earth had

not noted any heart problems, and that she planned to re-examine Jones in “a day or

so” when she might be more cooperative. Nurse Smith told officers that Jones was

able to proceed with intake.

By policy, inmates must submit to an unclothed body search as part of intake.

Told of the search, Jones replied “you want me to do what?” Asked to remove her

clothing, Jones took one arm out of her jail uniform, but did not respond to further

requests. Officers stated that Jones seemed unwilling or unable to get out of the

wheelchair, commenting that her feet hurt and she wanted to remove her socks. One

officer helped remove her socks, looked at her feet and legs, but did not think they

appeared swollen. Because Jones would not cooperate with the unclothed body

search, four female officers performed a staff-assisted unclothed body search. She

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moaned and grunted throughout the search, saying her neck and arm hurt when the

officers held them. When one officer inquired whether Jones was “ok,” she grunted

in response.

A medical examination is required after a staff-assisted unclothed body search.

Sgt. Hedtke asked Nurse Smith to perform the examination. Nurse Smith claims she

performed the examination, finding no signs of injury. Two officers and another

inmate stated, however, that Nurse Smith was in the cell with Jones for only 15

seconds, telling her, “this is what happens when people don’t listen to officers,”

without asking Jones any medical questions. 

Shortly after the body search, the second watch officers left due to a shift

change. Lt. Westphal briefed the watch commander for the third shift on the

occurrences of the day. During the third shift, inmates reported that Jones was

moaning in her cell. Officer Eskelson – noticing Jones’s eyes appeared strange and

were darting back and forth – asked Nurse Smith if she was planning to look in on

Jones during her rounds (although not required by policy since Jones was not on

medication). Nurse Smith responded that she had seen Jones earlier in the day and

nothing was wrong with her. As part of her rounds, Officer Eskelson checked on

Jones every half hour; each time it appeared Jones was resting. Later, Officer

Eskelson sent an email stating, “This new one on the bed naked – no one cares.”

Eskelson found Jones unresponsive in her cell at 9:03 p.m. Emergency medical staff

performed CPR. Jones was pronounced dead at 9:35 p.m, about 12 hours after

arriving at Shakopee. Autopsy revealed she died of a pulmonary edema. During her

12 hours at Shakopee, Jones never told anyone that she needed medical attention; only

complaining that her feet hurt, and that her neck and arm hurt during the search. 

Jela Jones, as trustee for his mother’s heirs, sued the Minnesota Department of

Corrections, individual officers, and Nurse Smith. In addition to the Eighth

Amendment claims, Jones also brought state-law claims for excessive force and

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wrongful death. The district court dismissed the claims against the Department and

the individual defendants in their official capacity, based on the Eleventh Amendment.

The court granted summary judgment to the individual defendants in their personal

capacities, finding that Jones did not suffer from an objectively serious medical need,

the defendants were not subjectively aware of a serious medical need, and the

defendants did not deliberately disregard a serious medical need. The court declined

supplemental jurisdiction over the state law claims, dismissing them without

prejudice. Jones appeals the grant of summary judgment to the individual defendants

in their personal capacities.

II.

This court reviews de novo a grant of summary judgment. See RSBI

Aerospace, Inc. v. Affiliated FM Ins. Co., 49 F.3d 399, 401 (8th Cir. 1995).

Summary judgment is appropriate if, taking the facts in the light most favorable to the

non-moving party, there are no genuine issues of material fact and the moving party

is entitled to judgment as a matter of law. See Fed. R. Civ. P. 56(c); Celotex Corp.

v. Catrett, 477 U.S. 317, 323 (1986). A genuine issue of material facts exists if there

is a dispute about a fact material to the outcome of the case, and the dispute is genuine

in that a reasonable jury could return a verdict for either party. See RSBI, 49 F.3d at

401. 

“It is well established that the Eighth Amendment prohibition on cruel and

unusual punishment extends to protect prisoners from deliberate indifference to

serious medical needs.” Gregoire v. Class, 236 F.3d 413, 417 (8th Cir. 2000). In a

deprivation of medical care case, the inmate must show (1) an objectively serious

medical need; and (2) the defendants actually knew of the medical need but were

deliberately indifferent to it. See Grayson v. Ross, 454 F.3d 802, 808-09 (8th Cir.

2006). 

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An objectively serious medical need is one that either has been diagnosed by

a physician as requiring treatment, or is so obvious that even a “layperson would

easily recognize the necessity for a doctor’s attention.” See Coleman v. Rahija, 114

F.3d 778, 784 (8th Cir. 1997), quoting Camberos v. Branstad, 73 F.3d 174, 176 (8th

Cir. 1995). “ ‘To establish a constitutional violation, it is not enough that a reasonable

official should have known of the risk.’ Rather, a plaintiff must demonstrate the

official actually knew of the risk and deliberately disregarded it.” Vaughn v. Greene

County, Ark., 438 F.3d 845, 850 (8th Cir. 2006), quoting Farmer v. Brennan, 511

U.S. 825, 837 (1994). The determination that prison officials had actual knowledge

of a serious medical need may be inferred from circumstantial evidence or from the

very fact that the risk was obvious. See Farmer, 511 U.S. at 842. If prison officials

have actual knowledge of a serious medical need, and fail to take reasonable measures

to address it, they may held liable for deliberate indifference. See id. at 847.

“However, ‘[a] showing of deliberate indifference is greater than gross negligence and

requires more than mere disagreement with treatment decisions.” Pietrafeso v.

Lawrence County, S.D., 452 F.3d 978, 983 (8th Cir. 2006), quoting Gibson v. Weber,

433 F.3d 642, 646 (8th Cir. 2006). 

A.

The determination that a medical need is objectively serious is a factual finding.

See Rahija, 114 F.3d at 784. If there is a dispute, and a reasonable jury could return

a verdict for either party, then summary judgment is not appropriate. Here, Jones was

not diagnosed by a physician as requiring treatment. Therefore, Jones’s condition

must have been so obvious that a layperson would easily recognize the need for

treatment. On the undisputed facts of this case, no reasonable jury could find that

Jones suffered from an objectively serious medical need. 

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 The record does not support the assertion that Jones was “bleeding from the

mouth.” The record does show that she had dried blood and cuts on her lips.

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This court has found a serious medical need that was obvious to a layperson

where an inmate: was pregnant, bleeding, and passing blood clots, see Pool v.

Sebastian County, Ark., 418 F.3d 934, 945 (8th Cir. 2005); had swollen and bleeding

gums and complained of extreme tooth pain, see Hartsfield v. Colburn, 371 F.3d 454,

457 (8th Cir. 2004); experienced excessive urination, diarrhea, sweating, weight loss,

and dehydration related to known diabetes, see Roberson v. Bradshaw, 198 F.3d 645,

647-48 (8th Cir. 1999); or exhibited signs of early labor and her medical records

clearly documented a history of rapid labor and delivery, see Rahija, 114 F.3d at 785.

The determination whether a medical need is sufficiently obvious cannot be

analyzed in a vacuum. The prison officials’ background knowledge is part of the

analysis. See Roberson, 198 F.3d at 647-48 (describing the deputy’s knowledge of

inmate’s diabetes and complaints in determining whether inmate suffered from

medical condition obvious to a layperson); Rahija, 114 F.3d at 784-85 (discussing

inmate’s medical records which indicated previous rapid delivery in finding it would

have been obvious to a layperson that inmate required medical attention for pre-term

labor). In each of the cases cited, the inmate exhibited physical symptoms related to

known medical issues or to complaints of pain. 

Jones claims that his mother “was unable to stand or walk under her own

power, was ‘google-eyed’ and unresponsive, was rolling on the ground while grunting

and groaning, was bleeding from the mouth,[3] smelled as if she had urinated on

herself, and was breathing at a very rapid rate” which made it obvious to a layperson

that his mother needed medical attention. Jones’s symptoms are not a sufficiently

obvious medical issue. Unlike passing blood clots while pregnant; bleeding gums

with complaints of extreme tooth pain; excessive urination, dehydration, sweating, and

weight loss; and signs of early labor – which all obviously indicate a medical issue –

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Jones’s symptoms are not easily recognizable medical issues. See Grayson, 454 F.3d

at 809-10 (not obvious to a layperson that pre-trial detainee needed medical treatment

where detainee was found in a creek, soaking wet; was combative; gave nonsense

answers to questions; began screaming while in the holding cell; and officers were

aware that detainee had taken meth). Importantly, in this case the prison officials had

no background knowledge that made it obvious that these symptoms required medical

attention. True, Blue Earth staff checked the “medical problems” box on the form sent

to Shakopee, but they also checked all the other boxes: behavioral problems,

psychological problems, and incompatibility with other inmates. The form also

indicated that Jones was a “difficult inmate” and that Blue Earth staff would “send

all applicable incident reports.” There was no elaboration on any medical problems.

Blue Earth staff told Shakopee officers that Jones had become violently sick and

uncooperative, but only upon learning of her transfer to Shakopee. Blue Earth also

informed Shakopee that Jones was able to move around and partake in day-to-day

activities before hearing of the transfer. Taking Jones’s symptoms in context, and

given that Jones never expressed a need for medical attention, a reasonable jury could

not find that Jones had a medical need so obvious that a layperson would easily

recognize the need for a doctor’s immediate attention. 

Jones relies on Johnson v. Hamilton, 452 F.3d 967, 973 (8th Cir. 2006), where

this court found that a fractured finger was an objectively serious medical need. In

Johnson, however, there was a tentative diagnosis that the finger was fractured, so that

case did not address the “so obvious a layperson would easily recognize it” prong.

Similarly, in Bryan v. Endell, 141 F.3d 1290, 1291 (8th Cir. 1998), an inmate’s broken

hand had been treated, and therefore there was no discussion of whether a broken hand

is sufficiently obvious. 

Jones also argues that “certain medical conditions are per se serious, such as

conditions resulting in death.” No doubt, a diagnosis of pulmonary edema would

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constitute a serious medical condition. See Robinson v. Hager, 292 F.2d 560, 564

(8th Cir. 2002) (assuming that a stroke is a “serious medical harm, the risk of which

was substantial in plaintiff’s case” due to known hypertension). The question here,

however, is not, in hindsight, whether Jones had a serious medical condition, but

rather, whether the condition was so obvious that a layperson would have easily

recognized the need for medical treatment. While some medical conditions that result

in death are obvious to a layperson, not all are. See Grayson, 454 F.3d at 809-10 (no

objectively serious medical need because it would not have been obvious to a

layperson that an inmate required immediate medical attention even though

intoxication resulted in death). A medical condition is not per se obvious to a

layperson because it later results in death. 

B.

There is no genuine dispute that any of the defendants were deliberately

indifferent to Jones’s known medical need. Jones claims that the defendants had

actual knowledge of a serious medical need, but on this record no reasonable jury

could find that they did. 

No circumstantial evidence supports the inference that any defendant believed

Jones had a serious medical issue. Jones points to Lt. Westphal’s suspicions that there

were “medical issues.” Describing Jones’s behavior in the intake garage, Lt. Westphal

stated that she “couldn’t tell [] if it was a withdrawal thing or whether it was a medical

issue.” Lt. Westphal described Jones’s grunting as “sighing, oh poor me[,] I am here

and I don’t want to be.” She also stated that “when I addressed [Jones] and gave her

her options, it instantaneously stopped.” When Lt. Westphal spoke with the nurses

about performing the medical screening immediately, she stated, “I can’t imagine that

there is not something medical because of her weight.” Lt. Westphal told the nurses

that she needed to know “can this person walk, can she not walk, can she do the intake

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process by herself or do I need to figure out a different way of doing this.” Taken as

a whole, Lt. Westphal’s statements do not show that she believed Jones had an

objectively serious medical need. The most generous inference from this evidence is

that Lt. Westphal thought Jones may have long-term medical issues due to her weight.

The evidence does not support the inference that Lt. Westphal believed Jones required

immediate medical attention. 

Since Jones’s medical issues were not obvious, actual knowledge cannot be

inferred from the obviousness of the need. “[A]n official’s failure to alleviate a

significant risk that he should have perceived but did not, while no cause for

commendation, cannot under our cases be condemned as the infliction of

punishment.” Farmer, 511 U.S. at 838. At most, the Shakopee staff was negligent

in not recognizing a medical need, which does not rise to the level of deliberate

indifference. See James ex rel. James v. Friend, 458 F.3d 726, 730 (8th Cir. 2006)

(“A review of appellees’ conduct in this case, however arguably negligent it may now

appear in the clear light of hindsight, does not reveal the existence of deliberate

indifference.”).

C.

Jones asserts that the defendants are not entitled to qualified immunity.

Government officials are entitled to qualified immunity for discretionary decisions

unless they violate a clearly established constitutional right. See Gordon ex rel.

Gordon v. Frank, 545 F.3d 858, 862 (8th Cir. 2006). “Officials are not liable for bad

guesses in gray areas; they are liable for transgressing bright lines.” See Vaughn, 438

F.3d at 852. Because (as determined above) the defendants did not violate Jones’s

Eighth Amendment rights, they are entitled to qualified immunity. See Grayson, 454

F.3d at 808 (“If the answer [to whether a constitutional right was violated] is no, we

grant qualified immunity.”).

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Jones contends that Nurse Smith is not entitled to qualified immunity because

her duty to examine his mother was ministerial, not discretionary. Qualified immunity

is defeated, however, only where the violation of the ministerial duty gives rise to the

cause of action. See Sellers ex rel. Sellers v. Baer, 28 F.3d 895, 902 (8th Cir. 1994)

(“[P]laintiffs make no claim that they are entitled to damages simply because the

regulations they cite were violated. Instead, they seek damages based on their claims

that the Fifth and Fourteenth Amendments were violated. Thus, the issue before us

is whether the officers’ conduct violated any clearly established constitutional rights,

not whether the officers may have violated departmental regulations.”). Jones’s claim

is based on a violation of his mother’s Eighth Amendment rights, not violations of

Department directives and guidelines on medical screenings. Therefore, even if Nurse

Smith violated one of her ministerial duties to examine Jones (which this court need

not decide), she is entitled to qualified immunity. 

III.

The judgment of the district court is affirmed.

______________________________ 

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