Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-05-01038/USCOURTS-ca8-05-01038-0/pdf.json

Parties Involved:
Roger Asheim
Appellee
Joe Harmon
Appellee
Dale Larson
Appellee
Lawrence County
Appellee
Kimberly Pietrafeso
Appellant
Bob Williams
Appellee

Document Text:

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 05-1038

No. 05-1096

___________

Kimberly Pietrafeso, as Personal *

Representative of the Estate of Rocco *

Pietrafeso, deceased, *

*

Plaintiff - Appellant/ * Appeals from the United States

Cross Appellee, * District Court for the

* District of South Dakota.

v. *

Lawrence County, South Dakota, et al., *

*

Defendants - Appellees/ *

Cross Appellants. *

___________

Submitted: February 16, 2006

Filed: July 11, 2006

___________

Before LOKEN, Chief Judge, LAY and SMITH, Circuit Judges.

___________

LOKEN, Chief Judge.

Rocco Pietrafeso (Rocco) died following an acute asthma attack while detained

at the Lawrence County Jail in Deadwood, South Dakota. His widow, Kimberly, filed

this § 1983 action alleging that Lawrence County and four County officials -- Chief

Deputy Sheriff Joe Harmon, jail administrator Dale Larson, head jailer Bob Williams,

and jailer Roger Asheim -- were deliberately indifferent to Rocco’s serious medical

needs when they delayed medical treatment and denied prescribed medications. At

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The HONORABLE RICHARD H. BATTEY, United States District Judge for

the District of South Dakota. 

2

Albuterol is a “beta 2 allergic drug” that treats asthma attacks by relaxing the

muscles in the bronchia airways so that air may pass through.

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the close of the plaintiff’s case at trial, the district court1

 granted defendants’ motion

for judgment as a matter of law. Kimberly Pietrafeso appeals. Reviewing de novo the

district court’s grant of judgment as a matter of law, we conclude that the evidence did

not permit reasonable jurors to find that any defendant was deliberately indifferent to

Rocco’s serious medical needs. See Spruce v. Sargent, 149 F.3d 783, 785 (8th Cir.

1998) (standard of review). Accordingly, we affirm.

I.

We briefly summarize the trial evidence, resolving factual conflicts in favor of

Pietrafeso. On Friday, July 28, 2000, Rocco was transferred from a correctional

facility in Sterling, Colorado, to the Lawrence County Jail, a holding facility for

pretrial detainees. The jail contracts with a local hospital for needed medical services.

Rocco arrived at the jail at 7:10 p.m. Jailer Asheim conducted the intake screening

interview, after receiving from the van driver an envelope marked with Rocco’s name,

inmate number, and the following notation in bold red letters: 

 URGENT 

Colo Inter-Correctional 

Medical Summary Transfer Report 

DELIVER TO MEDICAL DEPARTMENT 

AT ONCE

In the interview, Rocco told Asheim that he suffered from a severe asthma

condition. Rocco said he was taking a “bunch” of medications, though he brought

with him to the jail only an Albuterol2

 inhaler. Rocco did not tell Asheim that on July

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Medical professionals testified that steroids are powerful anti-inflammatory

medications that help prevent the lungs from filling with mucous; anti-anxiety drugs

are useful because stress instigates and compounds asthma attacks; Zantac is a proton

inhibitor that reduces another instigating factor; and Singulair is an immune response

medication that enhances the effect of inhalers. A nebulizer is a machine similar to

a vaporizer that helps an asthma patient inhale medications deeper into the lungs. 

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20, just eight days earlier, he was sent to the Colorado prison’s emergency clinic

suffering from a severe asthma attack. Vance Siedenburg, the physician’s assistant

who treated Rocco at the prison clinic, testified that he exhibited “difficult breathing,

sweating profusely, anxiety level very high, secondary to inability to breathe.”

Siedenburg administered steroid and adrenaline medications to alleviate Rocco’s

constricted bronchia. Siedenburg testified that he last saw Rocco on July 25, when his

asthmatic condition had stabilized. Siedenburg prescribed two steroids, Prednisone

and Beconase; two anti-anxiety medications, Ativan and Vistaril; an antihistamine,

Zantac; Singulair; an Albuterol inhaler; and nebulizer treatments as needed.3

Siedenburg testified that the Colorado correctional officials did not consult him in

preparing the Medical Summary Transfer Report that accompanied Rocco to the

Lawrence County Jail in the red-lettered envelope. 

Asheim testified that Rocco was tired when he arrived at the jail but exhibited

no wheezing, difficulty breathing, or coughing during the intake interview. After

placing Rocco in a cell with his inhaler, Asheim called Chief Deputy Harmon to ask

permission to take Rocco and the red-lettered envelope to the hospital’s emergency

room so that the “bunch” of prescriptions could be filled. When Asheim advised that

Rocco was not having any problems and had his inhaler, Harmon told Asheim to call

the hospital, explain the situation, and see if the emergency room would fill

prescriptions without seeing Rocco. Asheim called the hospital and was told that no

prescriptions would be filled without seeing Rocco. Asheim then called head jailer

Bob Williams, explained the situation, and suggested that Rocco be taken to the

emergency room Saturday morning so that his prescriptions could be filled before the

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local pharmacy closed at noon. Before leaving the jail, Asheim taped the unopened

red-lettered envelope to a conspicuous shelf in the control room. 

Rocco was not taken to see a doctor Saturday morning, and his prescriptions

remained unfilled. When Asheim came to work Saturday afternoon, Williams said he

did not remember being asked to do that. Asheim’s shift ended at 11:00 p.m.

Saturday. He could not sleep that night because he knew from a former girlfriend’s

experience that a person with severe asthma had a constant need for medications. On

Sunday morning, Asheim discussed the situation with Sheriff Rick Mowell, who said

that Rocco could wait until Monday or Tuesday to see a doctor since he was not in

apparent distress. Still concerned, Asheim then took the unopened red-lettered

envelope to physician’s assistant Kay Huhnerkoch at the hospital. 

Huhnerkoch opened the envelope and reviewed its contents. A Colorado InterCorrectional Medical Summary Transfer Report dated July 19, 2000, advised that

Rocco was last seen by a physician on July 10 and listed his current medications as

Albuterol, Ativan, and an antidepressant, Imipramine. The Report did not disclose

Rocco’s severe asthma attack on July 20, his treatment by physician’s assistant

Siedenburg, or the medications Siedenburg prescribed on July 25. The envelope also

contained a one-month “Hospital Pass” for “Breathing Treatment” every 4-6 hours.

Siedenburg described this document as a “kite” permitting a Colorado inmate to

access the prison clinic without further approval; it was not a prescription. After

reviewing these documents, Huhnerkoch advised Asheim that the inhaler was

sufficient for the weekend unless Rocco needed to use it more than three times in a

four-to-five-hour period, in which case he should be brought to the hospital’s

emergency room. Asheim returned to the jail with a note from Huhnerkoch to that

effect and personally told Rocco what the note said. Pietrafeso’s expert medical

witness at trial, a forensic pathologist, testified that Huhnerkoch’s note was prudent

because excessive use of an inhaler means that the Albuterol is not effectively treating

an asthma attack.

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Asheim testified that Rocco was not wheezing or coughing or showing signs

of discomfort and did not ask for a doctor when Asheim explained Huhnerkoch’s note.

However, a cell-mate testified that Rocco’s physical condition deteriorated over the

weekend and that he repeatedly asked the jailers for his medications. Similarly,

Rocco’s sister testified that he called her repeatedly to report that his inhaler was not

working and that he needed more medication. She reported Rocco’s complaints to jail

administrator Larson on Monday, July 31. 

Rocco was taken to see a doctor at 9:30 a.m. on Tuesday, August 1. The doctor

reported:

Rocco was seen today. He has a long-standing history of reactive airway

disease and COPD. Recently he has been incarcerated and unfortunately

he has just been able to get his Albuterol inhaler, which is keeping him

relatively stable, but he is quite uncomfortable and needs a broader

treatment program. He has noticed just a slight amount of green material

when he is coughing but this is minimally so. . . . He has had anxiety

background with Ativan and Imipramine. . . . He is at the point where

he feels that he may need some systemic steroids, which he has been on

in the past. He is not on any topical steroid at this point.

(Emphasis added.) The doctor prescribed three inhalers (Albuterol, Flovent, and

Salmeterol), Albuterol nebulizer treatments if needed, Ativan, Imipramine, and

Singulair. He noted, “I think this needs to be reviewed within a week to see that he

is stabilizing with this. If he is not, we may need to consider systemic steroids.” 

At 4:00 p.m. that afternoon, Larson picked up the prescribed medications at the

local pharmacy and delivered them to Asheim at the jail. Asheim brought them to

Rocco who said he needed to use the nebulizer. The nebulizer Asheim brought lacked

a mouthpiece and could not function. When Asheim returned with a mouthpiece,

Rocco was wheezing and in asthmatic arrest, but neither Rocco nor the jailers knew

how to mix the prescribed Albuterol solution. Rocco found a pre-mixed bottle of

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Albuterol solution in the nebulizer left by its previous user. After breathing the

nebulizer mist for a few minutes, he told Asheim it was not working. Asheim called

an ambulance which arrived at 4:30 p.m. and rushed Rocco to the hospital. Rocco

died of an acute bronchial asthma attack at 5:06 p.m. 

The forensic pathologist testified that the level of Albuterol in Rocco’s

bloodstream showed that he had taken far more than the prescribed dosage of that

“rescue” drug without overcoming the acute asthma attack. The pathologist further

testified that the Flovent and Salmeterol inhalers would not treat an acute attack

because these are maintenance drugs, not rescue drugs. “What would help him for the

acute attack would be the Prednisone,” the steroid Rocco had been given in Colorado.

Moreover, the pathologist explained, if an asthma patient’s Prednisone is abruptly

taken away, “you are going to be very likely to have a relapse and have another acute

attack.” He admitted on cross examination that Prednisone was not listed as a current

medication on the Colorado Medical Summary Transfer Report that accompanied

Rocco to the Lawrence County Jail. 

II.

On appeal, Pietrafeso primarily argues that the district court erred in granting

Lawrence County judgment as a matter of law because there was sufficient evidence

for a reasonable jury to find that the County had “grossly inadequate” policies for

dealing with transferees’ urgent medical needs that reflected a deliberate indifference

to the constitutional rights of detainee Rocco Pietrafeso. 

In Board of County Commissioners of Bryan County v. Brown, 520 U.S. 397,

407 (1997), the Supreme Court clarified the standards for municipal liability under

§ 1983. A county is liable if an action or policy itself violated federal law, or if the

action or policy was lawful on its face but “led an employee to violate a plaintiff’s

rights [and] was taken with ‘deliberate indifference’ as to its known or obvious

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consequences.” Here, Lawrence County’s policies and practices for providing

inmates with needed medical care were lawful on their face. Thus, Pietrafeso’s claim

that the policies were constitutionally inadequate required proof that at least one of the

individual defendants violated Rocco’s constitutional rights and caused the alleged

injury. See Golberg v. Hennepin County, 417 F.3d 808, 812-13 (8th Cir. 2005);

Olinger v. Larson, 134 F.3d 1362, 1367 (8th Cir. 1998). 

The Eighth Amendment protects prison inmates from deliberate indifference

to their serious medical needs. Though Rocco was a pretrial detainee, not an inmate,

Pietrafeso concedes that this substantive due process claim is governed by the same

deliberate indifference standard. To define deliberate indifference for these purposes,

the Supreme Court has adopted the criminal law subjective standard of recklessness --

“the official must both be aware of facts from which the inference could be drawn that

a substantial risk of serious harm exists, and he must also draw the inference.” Moore

v. Briggs, 381 F.3d 771, 773-74 (8th Cir. 2004), quoting Farmer v. Brennan, 511 U.S.

825, 837 (1994); see Vaughn v. Greene County, 438 F.3d 845, 850 (8th Cir. 2006).

“Deliberate indifference may include intentionally denying or delaying access to

medical care, or intentionally interfering with treatment or medication that has been

prescribed.” Vaughan v. Lacey, 49 F.3d 1344, 1346 (8th Cir. 1995). However, “[a]

showing of deliberate indifference is greater than gross negligence and requires more

than mere disagreement with treatment decisions.” Gibson v. Weber, 433 F.3d 642,

646 (8th Cir. 2006). 

Turning to the individual defendants in this case, head jailer Williams was

clearly entitled to judgment as a matter of law because Pietrafeso did not call him as

an adverse witness and thus there was no evidence that he actually knew of and

recklessly disregarded a substantial risk of serious harm to Rocco if his access to

prescribed medications was delayed over the weekend of July 29-30. The only

evidence against Williams was Asheim’s testimony that Williams forgot to take Rocco

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and the red-lettered envelope to a doctor on Saturday morning. At most, that is

evidence of negligence, not deliberate indifference.

The evidence against Chief Deputy Harmon and Jail Administrator Larson also

failed to prove subjective deliberate indifference. Harmon never saw Rocco while he

was detained at the jail. Asheim called Harmon Friday evening to discuss the redlettered envelope and the missing “bunch” of medications. When Asheim advised that

Rocco had an inhaler and exhibited no problem during the intake interview, Harmon

saw no need to take Rocco to the hospital emergency room and told Asheim to try to

get the prescriptions filled by phone. That one conversation did not prove deliberate

indifference. Larson, too, did not see Rocco over the weekend. Pietrafeso argues that

Larson must have opened the red-lettered envelope because, when Rocco’s sister

called the jail on Monday, Larson knew that Rocco needed Albuterol nebulizer

treatments every four to six hours. But by Monday, Huhnerkoch had reviewed the

envelope’s contents and advised that Rocco did not require emergency care before

seeing a doctor unless his need to use the Albuterol inhaler became too frequent.

Thus, before Rocco saw the doctor on Tuesday morning, Larson acted in accordance

with Huhnerkoch’s advice. Regarding the tragic events of Tuesday afternoon,

Pietrafeso does not argue that Larson was guilty of deliberate indifference in obtaining

and delivering Rocco’s medications to the jail just before Rocco suffered the fatal

attack.

That leaves Pietrafeso’s case against jailer Asheim. It is undisputed that

Asheim knew Rocco was a severe asthmatic with a constant need for medications.

Asheim had personal contact with Rocco every day that he was detained at the jail,

including Sunday. Though Asheim denied it, we must credit the cell-mate’s testimony

that Rocco repeatedly asked the jailers for his medications and that his condition

progressively worsened over the weekend. But the evidence is undisputed that

Asheim went to great lengths to have Rocco’s prescriptions filled. Most significantly,

Asheim took the red-lettered envelope to physician’s assistant Huhnerkoch on

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Sunday, Asheim’s day off, and then visited Rocco at the jail to tell him of

Huhnerkoch’s advice. Rocco’s sister testified that, over the weekend, “I believe

[Asheim] was trying to do everything that he could.” During the frantic minutes on

Tuesday afternoon when Rocco suffered the fatal attack, Asheim could be faulted for

bringing a nebulizer without a mouthpiece, for not knowing how to prepare the

nebulizer solution, and for allowing Rocco to inhale a prior user’s solution. But

Asheim was trying to treat the attack, not ignore it. This may be evidence of

negligence, but it was not deliberate indifference. 

The evidence viewed in the light most favorable to Pietrafeso shows

unnecessary delay in getting the red-lettered envelope to a medical professional who

could determine if Rocco had an immediate need for medications in addition to his

inhaler. But when the envelope was opened by Huhnerkoch on Sunday morning, it

contained an outdated list of “current medications” that did not include those

prescribed by Siedenburg the previous week, when Rocco suffered a severe asthma

attack at the Colorado prison. Thus, the Lawrence County medical team and jailers

never knew that, before he arrived from Colorado, Rocco had been taking Singulair,

Vistaril, and two steroids whose abrupt discontinuance could be dangerous. Rocco’s

autopsy revealed an excessive level of Albuterol in his bloodstream, confirming that

he had access to that rescue drug and overused it because it was not working

effectively. The sequence of events ended in tragedy, arguably due to the

unintentional negligence of correction officials at the Colorado prison and the

Lawrence County jail. But that is not enough to support a § 1983 claim of deliberate

indifference to serious medical needs. Accordingly, the district court did not err in

granting defendants judgment as a matter of law at the close of Pietrafeso’s case. 

The judgment of the district court is affirmed. Appellees’ cross appeal is

dismissed as moot. 

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LAY, Circuit Judge, concurring.

A prison official is deliberately indifferent to a prisoner’s serious medical needs

only if he is “aware of facts from which the inference could be drawn that a

substantial risk of serious harm exists, and he must also draw the inference.” Farmer

v. Brennan, 511 U.S. 825, 837 (1994). “In addition, prison officials who actually

knew of a substantial risk to inmate health or safety may be found free from liability

if they responded reasonably to the risk, even if the harm ultimately was not averted.”

Id. at 844. I write separately merely to emphasize that Rocco’s death, while

undisputably tragic and possibly avoidable, was not the result of deliberate

indifference by the defendants.

From Sunday on, all the defendants were following the advice of medical

professionals. The medical professionals who treated Rocco were working without

the proper documentation of Rocco’s medical history, including notation of the steroid

medication prescribed to prevent another attack. The fault in this case appears to be

that of the institution from which Rocco was transferred, not the institution in which

he ultimately died. Misinformation, not deliberate indifference, was the ultimate

cause of his death.

______________________________

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