Ci rc ui tJ udge Evans di ed o n Augus t10 , 20 11 , an d did n ot  par t i c i pat e i n the d ecision ofthi s c as e, whi c h i s be i ng re so lv ed b y a q u o ru m o f th e p a n el u n d er 28 U .S.C . § 4 6 (d ).



## In the 

# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N os. 09

- 2804 & 10

- 2389 E S TATE OF N I CHOL ASD . R I CE , d ec ea se d , by: R I CKD . R I CE a nd D I ANE J. W A L DROP, co - perso nal re prese ntati ves, Plai nt i f f

-Appe l l ant, v.
C OR R EC T I ONALM ED I CAL S ERVICES, a M iss ou ri co rp or at ion, etal. , D efend a nts-A pp ellees

.
A pp ealsfr o m the United S t ates Di strictC our t fo r the N o rthernDi stricto f Indian a, S outh Bend D ivisi on. No s. 06 C 697 and 09 C319

—Rob ert L. Miller, Jr. ,

and RudyL ozano, Judg es . A RGUED D ECEMBER 3, 2010

— D ECIDED M AR CH 20, 2012

Befo re F LA UM, R OV NER, a nd E VANS , C ircu it Judges . 2 N os. 09

- 2804& 10

- 2389 R OV NER, Cir cu i tJudg e . N ic ho l as D. Ri ce di ed i n the Elkha r tCo un t y J a i l i n De c e mbe r 2 0 0 4 , n e a r l y fi ft een m o nths a fte r he was b o o k ed atthe j ai l pe ndi ngt r i alo n a charg e of att em pted bank r obbe ry . Ri ce was know n to s uffe r fr o m s c hi z o ph r e ni a , a nd s ho r t l y b e f o r e h i s de ath a jud ge h ad fou n d h im inc om p et en t t o st an d tria l. A lth ou gh h e w as se en by m en ta l h ea lth p ro fes sio n als w hi l e h e wa s b e i ngde t a i ne d, R i c e fr e qu e nt l y r e fus e d t o tak e hi s pre scr ibed m ed i cati ons, co oper ate with m edi cal p e r s o n n e l a t th e j a i l, e a t h i s me a l s , o r b a th e h i ms e l f

. He w as bri efl y ho spi tal i zed atpsychi atr i c and other m edi cal f a c i litie s o n se ve ra l oc c as ion s d u rin g t h e p er iod of h is co nfi ne m en t, a nd a t th e ti m e o fhi s dea thhe wa s awai ting pl ac ementa t a st ate ps y ch i at r i c f ac i l i typur su an t to the j ud ge’ s fi nd i ng o fi ncom pet en c e. Ric e di ed as a r esul t o f psychog eni c pol ydi psi a ( excess i ve w ate r dri nki ng) , wh i ch i s a di so r derkno wn to mani fest i n a min o r i tyo fpe r so ns w i th sc hi zophre ni a. Fo l l owing Ric e’ s death, hi s par ents, re prese nti ng hi s e sta te ( the “ Estate ”) , fil ed sui t in federa l cour t pursuant to 42 U
. S. C. § 1 983, al l eging am ong othe r thi ngs that j ai l o ffi ci al s a nd m edi calper so n n el had dep rived R ice ofdu e proc ess by ex hibitin g d eliberat e ind if

fer en ce to h is de cl i ni ngment ala nd phy si ca l c o ndi ti o n. The di st r i ctc o ur t en te r ed su m m ary j udg m en t ag ains t th e Estate on i ts sect i on 1983 cl ai m s, fi nd i ng i n p ar t t hat c or re c tio n al a n d m ed ica l p er so n n el h ad n otco n sc iou sly disr ega rded Ri ce’ s m edi calneeds a n d that the ult i m ate cause ofhi s death w as n ot re aso nabl y for ese eabl e t o th em . E st a t e of R ice ex rel. Ric e v. C o rrectio na l M ed. Serv s. , No
. 0 6 C 6 9 7, Op i ni o n & Or de r, 2 0 0 9 WL 1 74 8 0 5 9 ( N. D. I nd

. J un e 1 7, 2 0 0 9 ) ( M i l l e r, J
. )
. T he Es tat e t he n fi l e d aN os. 09

- 2804& 10

- 2389 3

se c o nd fe de r a l s ui t, i nv o k i ngthe c o ur t ’ s di v e r s i t y j uri sdict i on, i n w hi ch i t r eas ser ted the st ate wrongful d eath cl ai m s that the ju d ge i n the fi rs t s uithad dis m i sse d w i thout prej ud i ce a fterdi sposi ng o fthe federa l cl ai m s. The j ud ge i n the seco nd sui t dism isse d that c ase o n th e b as is of c olla te ra l es to p p el, rea so n in g t h at h is c oll eague’ s fi nd i ng as t o the f or ese eabi l i ty ofthe cause of Ric e’ s deat h p re cl ud ed re cove ryo n any ofthe sta te c laim s. E stat e of R ice ex rel. Ric e v . C o r r ectio na l M ed. Serv s. , N o. 09 C 3 1 9 , O r d er (N .D . In d . M ay 17, 201 0) (L oz an o, J.) ( un pu b l i s he d)

. T he Es t a t e a pp e a l s b o th j ud g men t s . On re vi ew o fthe re cor d, w e co ncl ud e that a m ate ri aldi spute o ff ac t p reclude s su m m ar y j udg m en t o n o ne o fthe Est at e’ s se ction 198 3 cl ai m s: tha t hi s co ndi ti o ns o fc o nfi ne m en t wer e i nhumane

. W e al so co nc l ude tha t th e d i s t r i c tc o u r te r r e d i n d i s mi s s i n gh i s s t a t e cl a i ms . We ther ef or e a ffi rm i n partand re ver se i n part
.
I. On M ar ch 5, 20 03, Ri ce, then tw en ty yea rs o l d, w al ked i nto the Ke y Ba nki n Nap pa ne e , Ind i a na, a nd a nn o un c ed to a te ller t h at h e h ad a b om b th at h e w o u l d d et on at e if he was no t g i ve n mone y . The n, wi th o ute xpl an atio n a nd w i thout havi ng ta ken a ny m oney, Ri ce wal ked o ut o f the b ank. H e m ade hi s way bac k t o hi s ho m eto w n of S te ve ns vi l l e, M i ch i g an, i n a ca r he ha d st o l entha t m o r ni ng f ro m a nei ghbor

. A s he drove bac k into St eve n svil l e, th e o wnero fthe car spo tt ed Ri ce a nd s um m o ne d the pol i c e . Ri c e wa s j a i l e d i n Be r r i e n Co un t y, M i c hi g a n, o n a char ge ofauto theft.4 N os. 09

- 2804& 10

- 2389 I t s oo n beca m e a pp ar ent to the M i chi gan a uthor i ti es that Ric e had m entaldi ffi cul ti es. Ri ce had be gun to ex h ibit m en ta l p ro b le m s w h ile h e w as in h igh sc h oo l, an d he w as even tu all y d iagnose d a s su ffering from un d if

fer en tia t e d sc h izo p h re n ia. Sc h izo p h re n ia is a ch ro n ic m entali l l ness w hi ch i nter fer es w i th a perso n’s abi l i ty to accura tel y per cei ve w hat i s g oi ng o n ar ou n d h i m , to dist i ngui sh f act f ro m f antas y, and to r egul ate hi s em otio n s. A lth ou gh R ice w as p re sc rib ed m ed ica tio n s fo r h is i l l ne s s , h e di d n o tt a k e the m co ns i s t e nt l y a nd s t o pped tak i ng the m alt oge thero nce he w as no l onge r cove re d by hi s par ents’ hea lth insurance. N ot l ong afterhe was j ai l ed i n M i chi gan, var i ous physi caland m entalpro bl e ms

— i ncl ud i ng weight l oss , u n responsi venes s, and l ack o fhy g i en e

— r es ul te d i n Ri ce ’ s ho spi ta l i za ti o n, a fi ndi ng th at h e w a s n otco m p et en t t o s ta n d tria l, an d ev en tu ally hi s co m m itm ent t o the Kal am azo o Psychi atr i c H ospi tal f o r a pe r i o d o fne ar l y t wo months

. The the r apya nd m ed ic at i o n tha t Ri ce r ec ei ve d dur i nghi s co m m i tment r es ul te d i n a mar k ed i m pr o ve m en t in hi s co ndi ti o n. H i s m othe r w oul d l ate r tes ti fy that Ri c e was i n the best c o n d i t i o n h e h a d b e e n i n f o r qu i t e s o me t i me . B y th e t i me R i c e w as d isc h ar ge d from th e p sy c h iat ric h os p ita l in lat e A u gu st 20 03 , In d ian a a u th or it i e s h ad id en tifie d h im as the s uspect in the K eyB ank r obbe ry, and a b ench w ar ra nt was i ssu ed f orhi s a rr est
. A fterthe M i chi gan charg es aga i nst hi m were re so l ved, Ri ce was t ra nsfer re d to the El khar t County J ai l i n I nd i ana, wh er e he w as boo ked on a char ge ofat tem pted ro bber y o n Se ptem ber8, 2003
. H i s ba i l was setat$2 0, 000.N os. 09

- 2804& 10

- 2389 5 The Elk h ar t County J ai l had an o ngoing co ntra ct wi th Co r r e c t i o na l M e di c a l S e r v i c e s ( “ CMS ” ) t o p r o v i de c om p re h en siv e h ea lth c a r e s er vic es to inm at es of th e jail. To se rv e the ge nera l m edi calnee d s ofthe j ai l ’ s inm ate p op u lat ion, C M S p ro vid ed th e jail w ith a st aff w h i c h, in 20 04 , in c l u d e d th e e q u iva len t o f ap p ro x im at ely six fu llti m e l i censed pra cti calnurse s, o ne full

- ti m e r egi ste re d nur se , o ne ha l f

- ti m e so ci alwor k er, a nd a phy si ci anwho se r ve d a s th e j ail ’s medi ca l di r ec to r . CM S i n tur n c o ntr ac te d wi thOa k l awn P sy ch i at r i c Cen te r i n Go sh en, I nd i ana, to pro vi de psychi atr i c se rv ice s to j ai li nm ate s as needed. Pursuant to th at contra ct, m entalheal th tr eat
m ent deci si ons w er e r ese rv ed t o Oakl aw n and one o f i t s p hysi c i a ns , Dr
. Br y c e B. R o hr e r . R o hr e r i s b o a r dce r ti fi ed i n f ami l y m edi cine r athe r th an psy ch i atry, but h e h as p ra c tic ed fam ily p sy c h iat ry for m an y y ea rs (h is s p e c i a l t y i s d r u ga n d a l c o h o l a d d i c t i o n ) , a n d b y th e t i me of R ice ’s d et en tio n h e h ad be en p ro vid in g p sy c h iat ric ser vi ces to the j ai l f orthe previ ous t en ye ar s. Rohr er ge n er ally sp en t o n e-h alf d ay p er w ee k a t t h e jail. The CM S m edi ca l per so nne l w ho pe r f o r m ed a sc r ee ni ng up on Ri ce’s ar ri valatthe j ai l had acce ss to hi s m edi cal r ec o r ds an d wer e awar e o fhi s psy ch i at r i c hi st o r y a nd the psy chotr opi c m edi cati ons he ha d b een pr escr ibed f o r h i s s ch i z o p h r e n i a . D r . R o h r e r me twi th R i c e t wo d a y s a f t e r he w a s b o o k e d i n t o th e j a i l a n d w r o t e h i m a presc ri pti on f orS er oqu el, an a nti

- psychoti c m edi cati on th at h e h ad be en ta kin g p rior to h is t ra n s f e r f ro m M ich igan. W hen Rohrer exam i ned Ric e s eve ra l weeks l ate r, Ri ce had been pl aced i n the j ail’ s “ tank” bec ause he was not com m unica ti ng. Rohrer ’ s note s i nd i cate that Ric e w as not taking h is prescribed m ed ication bu t w as p rac t icin g self

-6 N os. 09

- 2804& 10

- 2389

Su b sequ en tly, in D ecem b er 20 03 , C en icero s w as ask ed to 1 evaluate R ic e’ s com p et en cy to st and tr ial

. H e c oncluded that R ice w as co m p eten t. ca r e. Ro hr erwas no t su r e i fhe wa s ea ting . Ro hr erc o nc lu ded thatRi ce’ s be havi orwas l i kel y e xplai ned by psy ch o si s, a t r au m at i c ev en t, orm al i ng er i ng( i
. e. , fei g ni ng i l l ness f orse condaryga i n) an d n ot ed hi s intent to hospit al i ze Ric e at Oakl aw n i f further obs er vati on re veal ed that Ric e was notea ti ng o r w as outwardlypsycho ti c. I n l ate Octobe r, Rohr erpeti ti oned an I nd i ana s tat e cour t to i nvol untari l y com m i t Ric e to a m entalfac ili ty f ora peri od o fse venty
- tw o hours, expl ai ni ng tha t Ri ce w as “r efusi ng p sy c hotr opi c m edi cati on a nd r efusi ng to eat, r efusi ng to co m m unica te m osto f[ the] ti m e, di agno sed as s ch i zo phr en i c. ” R. 1 98

- 70 a t 3. The c o ur t g r an te d the peti ti on, and Ri ce was adm itt ed to Oakl aw n. H e was given an i ntra m uscul ari nj ecti on o fH al dol, a psychotr op ic m ed ica ti o n, up on h is a rriv al a t O ak law n, bu t h is tr ea t i n g p h ys icia n th er e, D r. Salv ad or C en ice ro s, w h o is bo ar d- ce r ti fi ed i n b o thps y ch i at ry a nd ne ur o l o g y, c o nc lu d ed i n shor t o rderthatther e was no probabl e ca use t o b e l i e v e th a t R i c e me t th e c r i t e r i a f o r i n v o l un t a r y c o mm i tm ent o r f or ced m edi cati on . Ceni cer os w oul d l ate r tes ti fy that Ri ce s how ed no s i gns of p sychosi s, answered hi s quest i ons pla i nl y a nd c oher entl y, i nter acte d w i th oth e r s a pp r o pr i a t e l y, wa s e a t i ng a nd dr i nk i ng, a nd acce pte d m edi ca ti o n v o l unt ar i l y . At Ce ni ceros’ i ns truct i o n, Ri ce was di sc ha r g ed ba ckt o the j ai l l es s th ant wenty - f o ur ho ur s a ft e r h e wa s a dmi t t e d. 1N os. 09

- 2804& 10

- 2389 7 I n the f o l l o wi ngmonths , R ic e co nt i nue d t o e xhibi t th e so rto fbehav i oratthe j ai l wh i ch had l ed Rohre r to see k hi s i nv o l unt ar y c o m m i tmentt o Oa k l awn in Oc tobe r. Rohrer ’ s no tes fr om N ove m ber20 03 and Ja nuary 2004 i nd i cate d that a l though a t t i m es Ric e was co m m unica tive an d a ppea r ed to b e do i ng be tt er, a t o th ert i m es he w as re fusi ng to ta ke h i s m edi cati on a nd uncom m unica

tive and that his psy ch otic disord er ap p ea red to be w orse n in g. On Nov embe r 1 6, 2 003, Ri ce s truckhi s ce l l m at e i n the ey e, c au sing the c el l m at e to s ee kmedi ca l a tt en ti o n. W he n Ri ce s ubs eque nt l y r efus ed ani ns truct i o n b y the cor r e c t i o na l s t a fft o s t e p o uto fthe c e l l, Offi c e r J e nn i f er Shel ton dir ecte d her coll ea gu e, J aso n K oo ntz, to spra y Ric e’ s f ace w i th pepper f oam , and Ri ce was th en pl aced i n a r est ra i nt chai r. N urse s Ci n d y Lam bri ght a nd J oy Bel l wer e pr es en t when Ri ce was peppe r - spr ay ed, and they hel ped ri nse h is fa ce a nd ey es. Ri ce l ate r re fused m ult i ple i nvi tat i ons to l eave the re str ai nt chai r and rem a i n e d th er e fo r a p er iod of ov er eigh te en h ou rs . U ltim a t e l y h e w as d ra gg ed from th e c h air an d int o a ce ll by j ailstaff. I n m i d-N ove m ber, Rohr ero rder ed the nursi ng st aff to adm i ni ste r an i n tram uscul ari nj ecti on o fH al dol to Ri ce ev ery f o urwee k s pr o vi ded th athe di d noto bj ec t. One such shotwas gi ven t o R i ce, i n ear l y Dece m ber

. Ri ce subsequentl y a ske d Rohrerto put h i m bac k o n Se ro quel i nstea d, and Rohreracc eded. But in Ja nuary 2004, Rohr er note d that Ri c e w as ag ai n uncom m unica ti ve and som eti m es re fused to ta ke hi s m edi catio n. Rohr eri ncre ase d8 N os. 09

- 2804& 10

- 2389 Ric e’ s pre scr ibed dosag e o f S er oqueland dir ecte d that h e b e returned to H al dol i nj ecti ons i fhe r efused to ta ke th e Se ro q u el. Rohrerdi d not s ee Rice fro m Februar y 1 0

— w hen Ric e wa s a g a i n r e fus i ng hi s med i c a t i o n, a nd Ro hr e r had to vi si t Ric e i n hi s cel l because Ric e othe rwis e re fu se d to see Rohr er

— unt il M ay 11 , 2 00 4. Dur i ngtha t ti m e, the nursi ng st affsa w hi m r egul ar l y a nd o bser ved m or e o f the s am e be havi orthatRohr erhi m sel fhad docum ented previ ousl y. N urse Lam bri ght no ted i n Februar y that Ric e r efused to t ake hi s m edi cati ons orto wear c l othi ng. Hi s c o n t i n u i n gr e fu s a l t o t a k e me di c a t i o n s b e c a me a f r eque ntr efr ain in the s ubs eq ue nt no ta ti o ns o fthe j ail ’s m ed ical staff. By Apri l, j ai l o ffi ci al s, i n a ppar en t rec o g ni ti o n o fthe parti cul archal l enges t hat Ri ce pr ese nted, were re q u es tin g t h at h is c on d itio n a n d be h av ior b e t h or ou gh ly d ocu m en ted

. T h a t m ont h, Ca p tain B rad Roge rs, th e j ail ’s com m an der, a sk ed th athe b e updat ed o n Ri ce ’ s st atus at the j ai l

. In re sponse to that re quest, N urse Rebec ca H ess , a regi onalm anage r f orCM S w ho s up er vi sed nurses atbo th the El khar t County J ai l and otherf aci l i ti es, wro te a one - pag e m emor an dum to Ro g er s an d Li eu te na nt F r ed Cal l, the j ai l ’ s war den, c onci se l y s um m ar i zing Ric e’ s hi sto ryatthe j ai l

. H ess not ed thateff or ts had b e e n ma d e t o mo n i t o r R i c e ’ s w e i g h tb e g i n n i n gi n D e c e mber20 03 du e t o hi s peri odi c r efusalto ea t. S he added th at th ere had bee n n o significant cha ng es in Rice’s w ei ght s i nc e that t i m e, al though he f re quentl y r efused to be wei ghed . Rice al so continued to r efuse hi s m edi ca-N os. 09

- 2804& 10

- 2389 9 ti o ns a nd o fte n r efus ed to see Ro hr er . In a ddi ti o n, he re fused to l eave hi s cel l f or vi si ts w i th f am i l y orw i th hi s at to r ne y . On Apri l 1 5, Ca l l e m ai l ed a m emor an dum to the j ai l ’ s su per vi so r y s ta ffdi r ec tingtha t al l o ut -of -the o r di na r y oc cu r r en ce s i nv o l vingRi ce b e vi deo ta ped an d orr epor ted, bo th to d ocum ent Ri ce’ s be havi oro n thes e oc c as ion s a n d to as sis t h is a tt or n ey in t ak in g a p p ro p riat e a c t i o n. “ I ’ m a t t e mpt i ng t o wo r k wi th the pu b l i c defen d er offic e t o s h ow th is p er so n m [a]y n ee d

. . . h elp

. . . . S o Iwo u l d a p p r e c i a te y o u r r e p o r t s . T h e s o o n e r we c an ge t thi s ind i vi du alhel p the be tte r offf oral l o fus.” R
. 198-80 at 20. A s a r e s ult of that d irective, the record i nc l ude s vi deo r ec o r di ng s o fs ev er al ins ta nc es i n the ensui ng m onths i n w hi ch j ai l st afff or cibl y r em ove d R i c e fr o m h i s c e l l a n d s h o we r e d h i m. By the end of A pri l, Ric e’ s condi ti on appears to h ave det er iorate d fur th er . In a n Apr i l 3 0 no te , La m br i g ht re port ed that offi cer s had to p h ysic al l y r em ove Ri ce f ro m hi s ce l l duri ng a “ shake dow n” wh en he re fused to l eave the cel l o n hi s o w n. L am bri ght no ted thatRi ce wa s u nab l e t o s t a nd , tha th i s e nt i r e b o dy wa s j a un di c e d, that he had a l ar ge, thr ee- i nc h ar ea ofdarksk i n ove r hi s c o c c y x, a nd tha twh e n o ffi c e r s p i c k e d h i m up , dead s k i n c e l l s s l o u g h e d of fhi s b o d y i n l a r g e n u mb e r s . He re fu se d to sp ea k. R ice re p ea te d ly re fu se d to se e h is p ar en ts w h en th ey ca m e t o th e jail. Dr. PaulJ
. Yoder, a psychol ogi st at Oakl aw n, ev al uated Ric e o n A pri l 28 , 20 04, atthe re quest of Rice’ s a tto rney . B ased on Rice’s cata ton ic an d un resp ons ive b e h avior, Ric e’ s co unselw as concerned that he was not abl e t o10 N os. 09

- 2804& 10

- 2389

ass i st i n hi s defense, not w i thsta nd i ng the p ri orfi nd i ngs by t wo ps y c hi a t r i s t s ( i nc l ud i ng Ce ni c e r o s ) tha t Ri c e was com petent to stand tr i al

. Ri ce was l ar gel y unre sponsi ve w hen Yoder i nter vi ew ed hi m . I t w as cl earto Yoder t h a t Rice su ffered from sch izoph renia, an d that Rice’s func ti o ni ngi m pr o ve d whenhe t o o khi s m edi cat i o ns an d worse ned w hen he di d not. In hi s r epor t o fM ay 4, 2004, Yode r consi dered wh etherthe cata toni a Ri ce di sp lay ed m igh t be d u e to m alin ge rin g rat h er th an t o h is m entali l l ness. Th er e w er e r epor ts f ro m the j ai l sugges ti ng tha t Ri ce a l ter ed hi s be havi ord epending on w hethero r not h e w as bei ng o bser ved. Ri ce m i ght b e fei gni ng ca tat oni a in the ho pe thathe c oul d avoi d tri alo r be found notgui l ty by re aso n ofi nsani ty, Yoder posited. “H ow ever, gi ven N icholas’ doc u m en ted history o fpo o r func ti o ni nga nd p o o r i ns i g htwhenno t be i ng tr eat ed, thi s s eem s v er y unlik el y a s a m oti vating f acto r f o r h i s c ur r e ntbehavi o r . ” R
. 1 9 8

- 1 2 7a t7

- 8
. Y o de r c o ns i der ed other potenti alm oti ves f orRi ce t o p re tend he was m or e i l l than he was, but ult i m ate l y w as s keptica l o f th e n ot ion th at R ice w as int en tio n ally an d ge n u in ely ma l i n g e r i n g . H e p o i n t e d o u tth a t t h e o v e r ts y mp t o ms of s c h izo p h re n ia c a n w ax an d w an e e ve n w h en on e is not bei ng tr eat ed. “Reg ar dle ss [ of ] [ Ric e’ s] actual m oti ve and w hethero r not he i s a w ar e o fi t, i t doe s no t ap p ear that he i s e ngage d i n thi s type o fm al i nger i ng be havi or w hen hi s i l l ne s s i s b e i nge ffe c t i v e l y t r e a t e d. As a r e s ult, i t i s m y op in ion thatthe m al i nger i ng i s i tse l fthe product of his m e n tal i llne ss.” R. 198-127at 8. Yod er therefore concl ud ed that Ric e was notcom p etent to as si st hi s a ttorney with hi s defense. “The r eco rd i s cl earthatN i chol asN os. 09

- 2804& 10

- 2389 11 i s s e v e r e l y me n t a l l y i l l

. ” R
. 1 9 8

- 1 2 7 a t8
. Y o d e r r e c o mmen de d th a tth e c o u r tc o n s i d e r o r d e r i n gR i c e ’ s c o mpli ance with psychi atr i c tr eat m ent ( i
. e. , thathe b e for c ibly m ed ica te d ), an d n ot ed th at giv en h ow w ell Ri ce r es po nde d t o i nv o l unt ar y t r ea tmenti n Mic hi g an, it w as likely th at R ice ’s s ym p to m s w ou ld rem it w ith in fou r to six w ee ks . “A t t h at p oin t i t s h o u ld be p os sib le to m or e cl ear l y di stingui sh be tw een s ym ptom s o fschi zophreni a a nd o ngoing m al i nger i ng. ” R. 19 8- 127 at 8. O n M ay 11 , Ro h re r c on c lu d ed th at R ice sh ou ld ag ain be c om m i tte d to a p sychi atr i c f aci l i ty f oro bser vati on and eval uati on f orthe possibility o fi nvol untarym edi cati on. Rohr er ’s notes i nd i cate thatRi ce was r efusi ng to se e hi m , r efusi ng hi s m ed icati ons, di d not co m m unica te, did notprac ti ce self

- car e, at e o nl y j unk f oo d i n l i eu o f re gul arm eals, a nd appeare d to be deve l opi ng be dsore s. I n h is petition to th e c o u r t f or an ord er of involun tary com m i tm ent a nd f or ced m ed i cati on, Rohr ernot ed that R ice w as “p sy c h ot ic” an d “u n ab le t o p e r f o rm se lf-ca re .” R. 1 92

- 9 at4 7. The c o ur t g r an te d the pe ti ti o n. Ric e was tr ansfer re d to Oakl aw n thatsa m e day. On arr i valatthe f ac il i ty, he was ca tat oni c and had to be lifte d ou t o f th e t ra n sp or t v an . H ow ev er , on c e a ga in h is b eh av ior a p p ea rs to h av e c h an ge d d ra m at ica lly foll owing hi s a rr i valatthe hospi tal

. Cen ice ro s no ted that Ri ce was c ooper at i ng, s ho wer i ng, e at i ng, dr i nk i nga nd agr eeing to ta ke hi s pre scr ibed m edi cati on. Ceni cer os su r m i se d tha t Ri ce was mal i ng er i ngi n o r derto g eto ut ofj ai l, and he a gain concl ud ed that ther e was “no pro babl e ca use to bel i eve that[ Ric e] m eet s the cr i ter i a f or12 N os. 09

- 2804& 10

- 2389 i nvol untaryco m m i tm ent. ” R. 19 2- 9 at 50
. H e di agnose d Ri ce w i th und i ffer enti ate d s chi zophre ni a a n d/or m al i nger i ng, and f ort h e second ti m e di schar ged Ri ce ba ckt o the j ai l l es s th ant wenty - f o urh ou rs a fte r he was c o m m itt ed. Hi s di sc ha r g e no te s co nc l ude d wi ththe f ol l owing obs er vati ons: “Thi s m or ni ng [ Ric e] i s a l er t, co o per at i ve , a nd ori en te d x 3. He de ni es a ny c ur r en t su i c i d a l o r h o mi c i d a l i d e a t i o n . T h o u g h t s a r e l i n e a r a nd go a l d ire c te d

. . . . H e a lso d en ies h allu c in at ion in a ll fi ve s en se s. The r e i s no l o o se ne ss o fa ss o ci ati on or fl i g ht ofi deas no ted. Intel l i gence appears t o b e aver age bas ed o n fund o fkno wl edg e an d v o cabul ary; j udg m en t an d i nsi ght a pp ear[ to be] i ntact.
. . . ” R. 19 8- 145 at 16. Sh or tly aft er h is re tu rn t o t h e jail, R ice w as p lac ed in th e ad m inistrative segregation un it, k n ow n as W ard O n e, w h er e h e c ou ld b e o b se rv ed m or e c los ely . Pr ev iou sly Ric e h a d b e e n ho us e d i n the med i c a l wa r d a s we l l as othe r ar eas o fthe j ai l, but acco rdi ng to Roge rs , m edi cal perso nnel atthe j ai l h ad a ske d that Ri ce no t be r etur ned to the medi ca l war d g i ve n his p o o r hy g i en e an d c o nd u ct
. In Wa r d O n e , h e wa s a s s i g n e d t o c e l l n u mb e r 5 A, w hi ch w e a re to l d w as the c el l m os t easi l y v i ew ed fro m the fi rs t- fl oo r c on tr olr oo m acr oss fro m W ar d On e. Because the cel l s i n W ar d One w ere s ingl e- occupancy uni ts , Ri ce ha d no c el l m at e. He was a l low ed o uto fthe cel l o n e hour per day. Ri ce r em ai ned i n the adm i ni str ative segregation un it unt ilhis de ath seven m ont hs l ater. I n J une 200 4, an Ind i ana ci rcui t co urt judge f ound that R ice w as com p eten t to sta n d trial on the ba nk robbery charg e. A t the i nvi tat i on o fand w ith t he ag re em ent o fN os. 09

- 2804& 10

- 2389 13 the par ti es, the j ud ge m ade that fi nd i ng witho ut a hear i ng and bas ed so l el y o n hi s r evi ew o fthe w ri tte n re port s o fth e thre e pr ofess i onal s ( i ncl ud i ng Ceni cer os and Yoder) wh o had eval uated Ri ce. A fterexam i ni ng al l r epor ts th e C ou rt fi nd s the Defen dan t to b e com p etent to a ss i sthi s co uns ela nd fur th e r n o t e s th a tth e D e fe n d a n twa s ab l e t o c o nve r se wi ththe p re si di ngj udg e i n o penc o ur t an d ex press hi m sel fand answer quest i ons appropri ate l y. The Co ur tfur the r n o t e s tha tP a ulJ
. Y o de r ’ s wr i t ten re porti nd i cates ther e i s s om e r eas onabl e be l i ef that thi s Defendant m ay be f aking hi s ca tat oni c st ate sinc e he was r epo r te d t o s l ee p o n a to p b unka nd th e o ffi ce r s di d no t puthi m the r e. Addi ti o na ll y, he ha s be ens ee n o uto fhi s ce l l o n a numbe r [ o f ] o cc as i o ns an d a s so o n a s he s po ts a n o ffi cer he fr ee ze s an d beco m es unrespo nsi ve. The Courtnot es that he was re sp on siv e in op en co u rtan d ap p ea re d to be w e l loriented on th e d ate of hearing h erein (J un e 10, 2004 ). R. 19 8- 51 a t 2-3 . The c ourtse t Ri ce’ s ca se f ortr i alo n Decem ber6, 20 04. Des p ite the com petency fi nd i ng, Ri ce c onti nued to ex h ibit ab n or m al b eh av ior a t t h e jail: – C a pt a i n Ro g e r s wo ul d l a t e r t e s t i fy tha tb y J une, “Ithi nk we w er e a l l co ncer ned about his m ental capaci ty
. . . . ” R. 19 8- 20 at 18, Roge rs Dep. 10 9. – O n Ju n e 2 5, 20 04 , an o t h e r i n m at e a ss au lte d R ice in his c el l bypoking hi m i n the gr oi n w i th a bro om sti ck thro ugh the bar s o fhi s celldoor

. Ratherthan m ove14 N os. 09

- 2804& 10

- 2389 i n or der t o avo i d the br oo m sti ck, Ri ce sim plyst oo d i n pla ce, cat ato ni c, wh i l e he w as ass aul ted. The at tack l eft v i sibl e wel ts on hi s ba ck, butto cks, and si de.

– On A ugust 2 , 20 04, Ri ce c ut h is n ec k w i th a dispos

ab l e r a z o r f r o m wh i c h h e h a d b e n t o r b r o k e n o f ft he pl as ti c g ua r d i n or dert o e xpo se a po r ti o n o fthe b lade. Lam bri ght, o n bei ng sum m oned to Ri ce’ s cell, f ound him hol ding a t owel ove r the wound

. The o nein c h lac er at ion, alth ou gh loc a t e d ov er h is c ar ot id ar ter y, was superfici al

. Ri ce l ate r tol d N urse Shar ro ne J ones , wh o becam e the j ai l ’ s c harg e nurs e i n 2 00 4, “ Ij us t hur t m y se l f, ” R. 1 98

- 37a t 26 , a nd w hen ask ed w hy by N urse Lam bri ght, he rem ar ked “I j ust f e l tl i k e i t, ” R
. 1 9 8

- 1 4 a t1 1
. He wa s t a k e n to Gos he n Ge ne r alHos pi ta lf o r t r ea tm enta nd the w oun d was suture d. Ric e deni ed any eff or t t o c om m it s u icid e , a n d th e p h ys icia n w h o t re at ed h im i n the hospi tal ’ s e m er gencyr oo m , Dr. Da vid E
. Van R yn , agr ee d th at h e w as n otge n u in ely su icid al. U p on be in g re tu rn ed to th e jail, R ice w as p lac ed in a re st ra in t c h a i r for a p er iod of eig h te en h ou rs , evid en tly to en su re th at h e w ou ld n oth ar m h im se lf ag ain. W he n Ro hr ermet wi thRi ce the f oll o wi ng day, Ri ce t ol d him , “Iw on ’t ta lk to you. I ’ m notpsycho. ” R. 1 98

- 37 at 27. Rohr erind i cate d i n hi s no tes that he tho ught Ri ce m i ght b e m al i nger i ng. A fter i nvest i gat i ng th e i nci dent, N urse H ess co ncl ud ed that Ric e had notat tem pted to ki l l hi m sel f

. Giv en that conclu sio n, nei therCM S northe j ai l f ol l owed thei r sui ci de preve nti on p ol i ci es by pla ci ng Ri ce u n d er h eig h te n ed ob se rv at ion
.N os. 09

- 2804& 10

- 2389 15 – S hor tl y a fterthi s inci dent , Ri ce e xperi enced a dizz y sp e l l an d h it h is h ea d on h is c ell d oo r, res u ltin g in a one -i nc h laceration betw een his eye s . C M S personneltr eat ed the w ound, but o ther t han l ab work, no a ddi ti o na l a ct i o n was t ak en .

–R i c e ’ s ab y s mall a c ko fhy g i e ne c o nt i nu e d. On A u gu st 1 8 , 2 00 4, L ieu te n an t C all em aile d se ve ra l j ail sta ffm em ber s ind i cating tha t “ [ i ] t’ s t i m e forM r. Ri ce to g eta no th ers ho wera nd ha ve hi s r o o m c l ea ne d. ” R. 19 8-1 22 at2. W h en co rre c tio n al off ice r St e p h an ie Sny d er em ail ed l ater th at d ay to rep o r t th at “[i] t w as a ve rydi rty job b u t w e a ccom pli shed i t, ” R. 19 8- 122 at2 , Ca pta i n Ro g er s r epl i ed to tha nkthe o ffi c e r s i n v o l v e d

. “ A p e r s o n h a s t o fe e l s o me em pathy t oward som eone l i ke N i ck Ric e, wh o has t o b e in su c h a p at h et ic sta te of m in d to allo w h i m s e lf to geti nto such a dir ty p h ysi calst ate and to behav e as he does

. ” R. 19 8- 122 at 2. D u ring thi s t i m e per i od, Ri ce was notea ti ng r egul ar m eal s. In J uly20 04, Roge rs em ai l ed a m em or andu m to the j ai l ’ s s up er vi sor y o ffi cer s instr ucti ng the m to be m or e p ro ac tiv e in en su ri n g t h at food w as m ad e a va ilab l e to i nm at es l i k e Ri ce ( whom h e ci te d by nam e) w ho exhibi ted a relu c ta n ce t o eat
. H e a dm oni shed sta ffnot to c o ns t r ue a n i nma t e ’ s s i l e nc e a tme a l di s t r ibuti on tim es a s a r efusalto ea t. H e a l so dir ecte d that foo d be l eft i ns i de r athe r tha n o ut si de o fa n inm ate’s ce l l, no ting that “[ i ] fthe m eali s l eft insi de, Ri ce wil l ty p ica ll y e at i t. ” R. 98

- 118 at 2. By the F a l l o f 2 0 0 4 , ho we v e r, Ri c e ’ s we i g hthad dropped si gni fi cantl y. A vi deo o fhi m be i ng sho w er ed16 N os. 09

- 2804& 10

- 2389 on S eptem ber30 r eve al s hi m to have been quit e thi n, i fnot ga u n t. A s of the beginning of October, Ric e, w ho w as six feet, two i nches t al l, w eig hed j ust 1 32 pound s, so m e fi fty p ou n d s le ss th an h e d id atth e t im e o f h is a d m iss ion in 20 03 . A nurse note d the pre sence ofa sor e o r sor es on hi s hi ps. On O c tober5, Rohr ernot ed that Ric e had l ost a s i gni fi cant a m ount o fweight, was sti l l r efusi ng to ea t o r t o t ak e m edi ca ti o n, a ppea r ed to b e ex hibi tingthe ea r l y o ns eto fb eds o r es , a nd r equi r ed m edi ca l a tt en ti o n. F o r th e th i r d an d fi na l ti m e, Ro hr er so ug ht Ri ce’ s in

vo lu n ta ry co m m itm en t t o a n inp at ien t p sy c h iat ric f ac i l i tyf o r a ddi ti o na l c ar e. In suppo r t o fthe pe ti ti o n, Ro hrer wr o t e tha t“ [ Ri c e ] i s s e r i o us l y me di c a l l y [ a nd ] p sych iatr[i cally] i llan d n e ed s inten sive m ed ical care as w ellas [the ] availabil ity ofps ych iatri c care.” R. 192-9 at 56. “Oakl aw n H osp[ i tal ] would n ot b e abl e t o provi de the i ntensi ve m edi calcar e, ” he add ed. R. 19 2- 9 a t 56
. Ro hr ere xpl aine d tha t i n a ddi ti o n t o ha ving ser i ous psy chi atr i c d i ffi cul ti es, Ri ce was “dying fro m m alno ur i sh m en t. ” R. 1 92

- 9 at5 4. The c o ur t g r an te d a no th ers eventy-two h o urc o m m i tment
. The o r deri den

tifie d fou r h os p ita ls a t w h ich R ice co u l d be p lac ed , in th e dis cr et i o n o fthe S he r i ff : Oa k l awn, Go sh enGe ner alH ospi tal, Bow en Center, and Elkh ar t Gener al H osp ital for B eh avioral M ed icine (“E lkhart Ge ne ral”). R. 19 2- 9 a t 5 7. Rohrerhad re quested thatRi ce b e co m m i tte d t o a h o s p ita l w h er e p sy c h iat ric ca re w as av aila b le, an d it w as R oh re r’s int en t t h at h e b e t ak en to E lkh ar t G en er al, w hi ch had an i npati ent psy chi atri c uni t. H owever, thatN os. 09

- 2804& 10

- 2389 17 hospi talr efused Ric e’ s a dm i ssi on in th e m i sta ken b elie f th at it d id n oth av e a co n tr ac t w ith th e jail. In st ea d , Ric e w as ta ke n to G o sh en G en er al H os p ita l, w h ich u n like E lkh ar t G en er al h ad n o p sy c h iat ric uni t. He was a dm i tt ed an d obs er ve d b y Dr
. Al l i so n P
. M a the w, wh o f o un d him to b e s uffe r i ngfr o m s y mptom s o fdehydrat i on a nd m i l d m al nutri ti on. A fterr ehydrating R ice and encour aging hi m to ea t, Dr. M athew co nc l ude d that h e ha d b ee n medi ca l l y s tabi l i ze d. S he ass um ed that up on di schar ge, he woul d be “ sent b ack to Oakl aw n f orfurt h erpsychi atr i c ev al uati on a nd m anage m ent. ” R. 19 8-4 5 at 27. But w hen she consul ted byte l ephone the f ol l ow in g m or ni ng with Dr. Ceni cer os at O ak law n, he op in ed i n ligh t o f w h at D r. M at h ew to ld hi m thatRi ce di d not pos e a n i m m i nent dangerto hi m sel fo r othe rs . A ccor ding to M athew, Ceni cer os add ed that he would notacc ept Ri ce forad m iss ion to Oakl aw n i n vi ew o fh i s pre vi ous c oncl usi on that Ric e was m al i nger i ng, al though Ceni cer os denie s that he s ai d thi s. Dr
. M athe w di sch arged Ri ce b ac kt o the j a i l o n Oc t o b e r 6 wi th i ns t r uc t i o ns tha th e b e e nc oura ged t o e a t, g i v e n h i g h p r o t e i n s h a k e s i fh e w o u l d t a k e th e m, co nt i nue o n h i s cu rre ntmedi ca ti o ns , a nd f o l l o w up w ith th e O aklaw n p sych iatri st (presu m ably Roh rer) w i thi n a week. Up on Ri ce ’ s r etur n t o the j ai l, CM S s ta ffmade va r i o us eff or ts to i m prove R ice ’ s nutr i ti on a nd m or e g ener al l y t o con vince hi m to ea t m or e foo d. N urse J ones i nstr ucted th e jail’s fo od se rv ice to p ro vid e R ice w ith h igh

- p ro te in R e s o u r c e He a l th S h a k e s t wi c e d a i l y, a l o n gwi th t wo

® m i l ks a ta l l me a l s a nd e xt r a j ui c e f o r b r e a k f a s t
. When18 N os. 09

- 2804& 10

- 2389 the j ai l ’ s m edi caldi re cto r, Dr. A lan B ier l ei n, as ses sed R ice o n Octobe r 25, he i ssued a seco nd o rderthatRi ce b e provi ded with e xtra f oo d. I t appears that ther e was som e del ay i n obt ai ni ng hi gh- prot ei n shake s a n d that Ri ce i ni ti al l ywas pr o vi ded wi th Ca r na ti o n Ins ta nt ® Br ea kf astdri nks in l i eu o fthe presc ribed prot ei n shake s, buto th er wi se he w as pr o vi ded wi the xt r a f o o d b y the j ail’s food se rv ice as ins tr u c te d . In ad d itio n, th er e is evi dence that CM S nurses saw Ri ce seve ra l ti m es d aily f ol l owing hi s re tu rn fro m the hospi tal

. A s they ha d sinc e his weight l oss was fi rs t no ted, the nurses br o ug hthi m e xt r a sn ac k s, e nc o ur ag ed him to e at, a nd urge d him to t ak e his m edi cati ons. These eff or ts m et w i th m i xed res ult s. Ri ce c onti nued to r efu se m any o f h is m ea ls. O n th e o th er h an d , he freq u en tly d id ea t h is bre akf ast, and th e re cor d i nd i cate s that Ri ce di d not l ose additio na l wei g htf o l l o wi nghi s r etur n t o the j ai l

. And i n m ar ked co ntra st to h is typi cal l y r ecl usi ve and unresponsiv e b eh avi or, Ri ce j ust three days bef or e hi s death w al ked o uto fh i s c e l l a nd s ho we r e d h i mse l fwhen i nvi ted to do s o. O th er p ro b lem s p er sis te d , ho w ev er . Ric e re gu lar ly r e fu s e d t o t a k e h i s me d i c a t i o n . H e w a s o ft e n u n c o mm un icative. H e typ icall y d id n ot bath e him self or otherw i se att end to hi s o w n hygi ene. J oshua Shaw , an inm ate w ho w as h ou sed i n the cel l next to Ric e, i nd i cate d that Ri ce was “ al way s na k ed, he ha d unb el i ev ab l e o dor due to hi s to ta l l ac k o f hy g i en e, fec es o n hi s bo dy, urine th r o u g h o u th i s c e l l, a l s o r o t t i n g, u n e a t e nf o o d s t r e wn th ro u gh ou t h is c ell.” A c c or d in g t o Sh aw , Ric e ra re ly spoke , o therthan to m um bl e “ go aw ay , g o aw ay, go aw ay, go away. ” R. 27 7- 105 at 3.N os. 09

- 2804& 10

- 2389 19 W hen Rohre r saw Rice o n N ov em ber9, 20 04, he wrot e: “Refuses to com m unica te and cl ose s hi s e yes . I s observe d at ti m es get ting up [ and] e ati ng [ and] c an r un thro ugh [ the ] u ni t( di d thi s r e c e nt l y ) , b utr e fus e s a l l h e l p [ a nd ] ha s to pr a c ticall y be carried to get show er by staff. U ncom pt. cak ed feces, r efusi ng al l m eds. ” R. 19 8- 37 at 34 . Ro h re r or d er ed t h e n u rs es to d isc on tin u e R ice ’s a n tipsychoti c m ed ica ti ons ( w hi ch he was notta ki ng) and to as khi m wee k l y whethe r he woul d res um e ta k i ng th em. Ro hr erpl anne d t o s ee hi m a g ain in a month. O n D ecem ber 6 , 2004, the j ud ge p residing over Rice’s cr i m i na l c as e r ev er se d hi s ea r l i erc o m pet en cya sses sment and fo und Ri ce incom petent to sta nd tr i al

. The j ud ge c om m i tte d Rice to the custo dy ofthe I nd i ana Di vi si on ofM entalH eal th and or d er ed Sher i ffM i chaelE. Book s to de l i ve r Ri ce t o a f ac i l i tyde signat ed bythe Di vi si o n. The D ivis i on in turn desi gnate d the Loga nsportS tat e H ospi ta l, a psychi atr i c f aci l i ty, wh i ch acce pted Rice f or ad m iss ion . H ow ev er , b e c au se th er e w as n o b ed av aila b le at that ti m e, Ri ce r em ai ned a t the j ai l unti l space o pe ne d u p. Unfo r t un a t e l y, Ri c e di e d b e f o r e tha th a pp e ne d. Late in the eve ni ng o f D ecem ber17, 20 04, i nm ate Sh aw h ea rd R ice gu lp in g w at er an d vo m itin g in h is c e l l. I n the e ns ui ngho ur s, S ha w and o th eri nm at es i n the ad m in ist ra tiv e s eg re ga tio n u n it “ m u le-k i c ke d ” t h eir ce ll do o rs in ane ff o r t to g ets o m eo ne ’ s at te nt i o n, b ut a c c o r di ngto S ha w’ s a c c o un t, n o o ne e v e r r e s po nd e d. J ai l pol i cy re quir ed the guar ds to cond uct hour l y c hecks ofal l i nm ates i n the adm i ni str ati ve seg re gat i on uni t, but cr edi ti n g Sh aw ’ s a ccount, o ne m ay i nfe r that nei ther20 N os. 09

- 2804& 10

- 2389 a gua rd nor an yon e else on du ty in the ove rnigh t hou rs eve r checke d on Ri ce. A t a pp ro xi m ate l y 4 : 30 a. m . o n Decem ber18
. Ri ce was f ou n d d ea d i n hi s ce l l

. A fro thy pi nk di schar ge w as note d near hi s m outh. A utopsi es w oul d l ate r reveal that Ric e d ied o facute car diacar rhythm i a t ri gge re d by a l ethaldecl i ne i n t h e sodi um l eve l i n hi s bl oo d, w hi ch w as i n turn caused byhi s e xcessiv e co nsum pti on o f wat eri n the ho ur s pr i o r t o hi s dea th

. Psychog eni c p ol ydi psi a, a diso rderchar acte ri zed by excess i ve th i rs t a nd co m pu l si ve w ate r dri nki ng, i s a poor l y unders too d ph enom enon that o ccurs i n bet w een si x a nd twenty per cent ofpati ents w i th psychi atr i c di sor ders, and m ostco m m onl y i s s een in pati ents w i th sc h izo p h re n ia. B ria n D u n d as , M .D ., M e l i s s a H ar ris , B .S., an d M ee ra N ar as im h an , M .D ., P sychogenicPo lydipsi a Rev i e w: Etiol ogy, D i

f f e r e nt i al, an d Tr e at m e nt, 9 C URR EN T P SYCH IATRY R EPORTS23 6, 23 6 ( 2007 ). I t i s undis pu ted in thi s ca se that the di sor der c an o ccur both i n i nd ivid u al s who ar e t aking m edi cati on f orthei r schi zophre nia and t h ose wh o ar e no t, and that unle ss an i nd i vi du al h as p re vio u sly ex p er ien c ed a b ou t o f p sy c h og en ic pol ydi psi a, ther e a re no known warni ng si gns that enabl e m edi calpro fess i onal s t o predi ct whether orwh en he o r she wil l ev ersufferfro m thi s di sor d er. H ow gre at th e r i ski s th ata s ch i zo phr en i c i ndi vi duals uffer i ng f ro m psycho genic pol ydi psi a wil l i n turn experi ence hyponatr em i a, so m eti m es described col l oqui al ly as “w at er to x icit y,” is a m at te r of d isp u te on th e re c or d in th i s c a s e . D r . J o h n P l e s s , a f o r e n s i c p a th o l o g i s twh oN os. 09

- 2804& 10

- 2389 21 offe re d ev id en c e o n be h alf ofth e d efe n se , w ro te in h is re portth at i napp ro pri ate hor m one secr eti on, wh i ch ca us es a c o m pul sive wat erdr i nk ert o r et ain wat era nd ex cr et e el ec tr o l y te s, thus c au singo ne ’ s bl o o d s o di um l eve l to drop, i s “co m m onl y see n” i n peopl e w i th schiz ophreni a. R. 16 9- 5 a t 2
. A l though he tr i ed to withdraw that stat ementi n a s ubs eque nta ffi dav i t ( i n whi chhe as se rt ed t h at th e p h en om en on is “e x c ee d in gly rar e,” R. 2 81

- 10 a t 3 ¶ 20 , a nd tha t th e o dd s o fde ath due to e xc e s s i v e wa t e r i nt a k e we r e o ne i n a mi l l i o n, R
. 2 81- 10 at 3 ¶ 21) , the dist rict co urt excl ud ed the re tr acti on f ro m ev i dence. Our r es ear ch i nd i cate s that o fal l tho se i nd i vi du al s who do experi ence psych og eni c pol ydi psi a, onl y te n to t w enty perce nt exper i ence hyponatr em i a a s a re su lt of t h eir co m p u lsiv e w at er d rin kin g. P sycho g enic P o lyd ipsia R eview , 9 C URR ENT P SYCH IATRY R EP O RTS at 23 6. The autopsi es al so supp or t the co ncl usi on that Ri ce was t o s o m e deg r ee unde r wei g hta nd mal no ur i sh ed ( th e p ar tie s’ e x p er ts d iffer as to th e d eg re e) a t t h e t im e o f h is death. Defense expertDr. Danie l S cherb i nd i cat ed that Ric e’ s re c or ded weight atdeath was s eve nty- fi ve to ei ghtyp e r c e nto fwh a two ul d b e i de a l

. Al tho ugh a tl e ast one expertf orthe Es ta te opi ned that m al nutri ti on pla yed a ro l e in Ri ce’ s d ea th , other s found no evi dence that thi s was t ru e, and based o n the ar gum ents that th e pa rties m ad e on su m m ary j ud gm en t, th e d istri ct cou rt fou n d th er e t o b e n o d isp u t e t h at R ice d ied as a re su lt o fc o m pul si ve wat erdr i nk i ngr athe r tha n mal nut r i ti on. 2009 W L 17480 59, at* 5 & n
. 5. The Estat e doe s no t q u ar re l w ith th is fin d in g on ap p ea l.22 N os. 09

- 2804& 10

- 2389 The Estate br ought thi s su it under 42 U
. S. C. § 1 983 aga i nst j ai l o ffi ci al s ( i n both thei r officia l and ind i vi du al capaci ti es) , j ai l guar ds, CM S and Oakl aw n, CM S nurses w ho work ed at the El khar t County j ail, a nd Drs. Rohr er an d C eni cer os, am ong othe rs . The Estat e co ntended that j ai l o ffi ci al s a nd st affha d s ubj ec te d Ri ce t o i nhumane condi ti ons ofco nfinem ent, used ex c essi ve f or ce a gainst hi m, f a i l e d t o p r o t e c th i m f r o m ha r m i nfl i c t e d b y o ther i nm ate s, em plo yed pol i ci es and custom s that r eflec ted i nsti tu tional i nd i ffer ence to the c onst i tuti onalr i ght o f a m en ta l l y i ll i nm at e to a dequa te medi ca l ( i nc l udi ng p s y c h i a t r i c ) c a r e a n d p r o t e c t i o n fr o m s e l f

- i n fl i c t e d h a r m, and i nd i vi du al l y di spl aye d deliber ate i nd i ffer ence to hi s wel l

-bei ng. The Estat e a l l ege d t h at CM S and Oakl a wn a l s o f o l l o we d p o l i c i e s a nd c us t o ms tha tr e fl ecte d d elib er at e ind iffer en c e to th e plig h t of m en ta lly i ll i nm ate s who l ack the abi l i ty to car e forthem sel ves. The nur se s empl o y ed by CM S to ca r e f o r i nm ates at the j ailw ere all eged to have m an ifested de liberat e ind if

fer en ce t o Ric e’ s decl i ni ng hea l th and se l f

- destr ucti ve tendenci es. The E sta te charg ed Drs. Rohr erand Cenic er os w ith d eliberat e ind ifferenc e t o Rice’s nee d f or m ore i nt en s i v e a n d p r o a c t i v e p s y c h i a t r i c t r e a t me n tth a n he coul d obta i n at the j ai l

. In additi on t o the fe deralcl ai m s, th e E sta te ass er ted wrongful death cl ai m s under I nd i ana l aw ag ai nst a l l defendants. Fol l owing tw o ye ars o fexte nsi ve disc ove ry, the defendants m ove d fo r sum m ar y j ud gm ent. J ud ge M i l l er gr anted thei r m oti ons as to each of the sect ion 19 83 claim s. W e sha ll d iscus s the pa rticular all egation s un d erlyi ng thes e claim s, an d the grou nd s on w hich the cou rtN os. 09

- 2804& 10

- 2389 23

en te re d su m m ar y jud gm en t, as w e a d d re ss ea c h cla im i n tur n b el o w. As we ha ve no te d, the c o ur t al so r el i nq u i s h e d j u r i s d i c t i o n o v e r the wro n g fu l d e a th c l a i ms prem i sed o n sta te l aw . W hen the Estate subse quentl y r efi l e d th e w r o n g fu l d e a thc l a i ms

— no w l i m i te d to the CM S de fend an ts a l o ne

— i n fede r alc o ur t, J udg e Lo za no dism i sse d them o n the basis o fJ ud ge M i l l er ’ s dete rm i nati on that t he par ti cul arcause o fRi ce’ s death w as not re aso nabl y for ese eabl e t o the defendants.

II. A. C ONDIT IONS OF C ON F I NE MEN T T he Es tate con ten d s t h a t ow ing to the d eliberat e ind if

fer ence ofj ai l o ffi ci al s a nd st aff, fro m S heri ffBook s o n d ow n t o the g ua r ds, Ri ce ’ s co ndi ti o ns o fc o nfi ne m en t w er e in h u m an e . In p ar tic u lar , th e E st at e a lleg es th at h is cel l was often fi l thy a nd unsani tar y, t hat uneat en f oo d w as l eft t o ro t there , thathi s s ki n w as som eti m es cake d wi th hi s ow n fe c e s , tha th e h a d a n e xt r e mel y f o ulb o dy odoro w i ng to the l ong p eri ods o fti m e duri ng wh i ch he went unbathed, and th at he ei therdevel oped or w as on th e v er ge of d ev elo p i n g b ed so re s o n m u ltip le o cc as i o ns ( al th o ug h a ppar en tly the se wer e he al i nga t th e ti m e o fhi s death). A l though there m ay be unr eso l ved q u es tio n s a s t o h ow oft en an d for h ow lon g t h es e c on d itio n s occ u rre d , th er e is n o ge n u in e d isp u te th at t h e y d id i n f act oc c u r. They a re docum ented noto nl y in the declar at ion from inm at e Jo sh u a S h aw , w h o w as h ou se d in the a dm i ni str ati ve seg re gat i on uni t in the cell next to Ri c e ’ s , b uta l s o i n v a r i o us n o t a t i o ns and memo r a nd a24 N os. 09

- 2804& 10

- 2389

w rit te n by D r. R oh re r, th e n u r s i n g s ta ff, an d j ail offi c i a l s , a nd t o s o me e xt e nt i n the v i de o r e c o r di ng s o f the instance s in 200 4 in w h ich Ri ce was r em ove d fr om hi s ce l l a nd s ho wer ed byj ai l s ta ff

. Nor is ther e an y m yst er y a s to w hy the se condi ti ons occur re d: Ric e typ ically r e fu sed to show er or perform any sort of self

c ar e w h at so ev er , l eft m u c h of th e food d eliv er ed to h is ce l l unt o uch ed, an d l ay na k ed an d unmov i ngo n h i s bun k f orm osto fthe ti m e. The r eco rd ( i ncl ud i ng the vi deos) re veal s that the j ai l di d i nter vene on o ccasi on t o cl ean both Ri ce a nd hi s ce l l ( ther e i s s om e evidence that Ric e w as eve ntual l y s how er ed on a weekl y b asi s, al though ne ither th e jai l’ s show er l og nor th e videos confirm th is) , bu t the gi s t o f t h e E state ’s cl aim i s tha t the re w ere signifi can t pe riods of tim e d uring w hich the j ail ’s staff m em ber s s i m plytur ned thei r backon the condi ti on o f R ice ’s p er so n an d ce ll, kn ow in g t h at h e w as livin g in hi s o wn fi l th

. I ncarc er ate d perso ns a re enti tl ed to co nfinem ent under hum ane c ondit i ons w hi ch pro vi de f orthei r “bas i c hum an needs. ” Rhode s v. Chapman , 45 2 U.S . 3 37 , 3 47, 10 1 S
. Ct. 23 92 , 239 9 (1 98 1); s e e also Fa r m e rv. Br e nna n , 51 1 U.S
. 82 5, 832, 11 4 S . Ct. 19 70, 19 76 ( 1994 ) ; Helling v. M cK inn ey, 50 9 U .S. 2 5, 33 , 1 13 S . C t. 24 75 , 248 0-8 1 (1 99 3); G illis v. Litsch er, 468 F. 3d 488, 49 3 ( 7th Ci r. 20 06) ( pri son has duty t o provid e, in te r alia , ad eq u at e s an ita tio n an d h yg ien ic m at er ials ); Board v. Fa rnham , 39 4 F
. 3d 469, 48 2- 83 ( 7th Ci r. 20 05) ( perso nal hyg i en e item s)
. Because Ric e was a pretr i al detai nee, it is t h e due pro cess cl ause ofthe Four tee nth A m endm ent r athe r th an the Eighth A m endm ent’ s pro sc ri pti on a gainst c rueland unusual pu ni shm ent whichN os. 09

- 2804& 10

- 2389 25 is t h e s ou rc e o f th is rig h t. See B ell v. Wo lfish , 441 U
. S. 5 2 0 , 5 3 5

- 3 7, 9 9 S
. Ct. 1 8 6 1 , 1 8 7 2

- 7 3 ( 1 9 7 9 )
. Ho weve r, co urts st i l l l oo k to Ei ghth Am endm ent c ase l aw i n addressing the cl ai m s o fpre tr i al d et ain ees , gi ven that th e pr o te ct i o ns of the F o ur te en thAm en dm en t’ s due pr o ce ss c l au se a r e atl east as b r o ad as tho se tha t th e E igh th A m e n d m en t a ffor d s t o c on vic te d p ris on er s, C ity o f R e v e r ev . Mas s . G e n . Ho s p. , 46 3 U.S
. 23 9, 24 4, 10 3 S
. Ct. 29 79 , 29 83 (1 9 83 ); Brown v. Budz , 39 8 F
. 3d 904, 91 0 ( 7th C ir. 20 05 ); C ollignon v. M il w auk eeCo unty, 16 3 F
. 3d 982, 98 8 (7th C ir. 1998), an d the Su p rem e C ou rt has not yet d eterm ined j us t how m uc h ad d itio n al protec tion th e Fourte en th A m en d m en t g i v e s t o p re tr ial d et ain ee s. Wol os zyn v. C ounty of Law rence, 396 F.3d 314 , 319 n.5 (3d C ir. 2005 ) ; E s t a t eo

f C ol e by P a r d u ev . F r o mm , 94 F. 3d 254, 25 9 n .1 (7t h C ir. 19 96 ); s ee also Weiss v . C o o ley, 23 0 F
. 3d 1027, 1032 ( 7th Ci r. 20 00) ( “t h er e is l i ttl e pr acti caldi ffer ence b et w een the two st andards”)

. A cl ai m thatthe cond itio n s o f an inm at e’s co n fin em en t w er e c on st i t u tio n ally i n a d e q u a t e p r o c e e d s th r o u g h a t w o - s t e p i n q u i r y . We c o n s i d e r fi r s tw h e th e r th e a d v e r s e c o n d i t i o n s c o mpl aine d o f wer e “s uffi ci en tly se r i o us , ” su ch that the acts o r om iss ion s o fpri son offi ci al s g i vi ng r i se to these c o nd i t i o ns de pr i v e d the p r i s o ne r o fa “ mi ni malc i v i l i zed m eas ure ofl i fe’s necess i ti es. ” Fa rm er, 51 1 U.S
. at83 4, 11 4 S. C t. at 19 77 ; Chapm an , 45 2 U.S
. at34 7, 10 1 S . C t. at23 99. I fthe a nsw erto thatquesti on i s y es, we consi der w hetherpri son offi ci al s were del iber ate l y ind i ffer ent t o th e a d ve rs e c on d itio n s. Fa rm er, 511 U
. S. at 834, 114 S. C t. at 19 77 ; Wilso n v . Seiter, 501 U
. S. 294, 302- 04, 111 S. C t. 2321 , 2326- 27 (1991). A n offi cial is deliberately ind if

-26 N os. 09

- 2804& 10

- 2389 fer ent when he i s s ubj ecti vel y a w are of the c ondit i on o r danger com pla i ned of, but consci ousl y di sr ega rds i t. Fa rm er, 511 U .S. at 83 7, 11 4 S. C t. at 19 79 ; M inix v. C ana re cci, 59 7 F .3d 82 4, 83 1 (7 th C ir. 20 10 ); Sa n v i l le v. M cC a ug htry, 26 6 F .3d 72 4, 73 4 (7 th C ir. 20 01 ); s e eals o Conn i ckv. Thom ps on , 131 S. Ct
. 1350, 1360 (2011). The dis tr i ct c ourtdi spose d ofthi s cl ai m l ar gel y o n th e groun d that R ic e h im self create d the u ns an itary co nditi ons . The j ai l di d no t pr ev en t Ri ce fr o m s ho wer i ng ork e e pi ngh i s c e l l c l e a n a nd , o n o c c a s i o n, s how er ed him and cleaned out h is c ellf or him

. In th e cou rt’s vi ew , thi s i s what dis ti ngui shed the i nstant c ase fro m Vin ni ng- El v
. Lo ng, 48 2 F
. 3d 923, 92 4 (7t h C ir. 20 07) ( per curi am ) , i n w hi ch w e hel d that a ssi gni ng an i nm ate to a cell i n whi ch, i nt era l i a, fec es a nd b l o o d c o ve r ed th e wal l, pr es en ted a tri ab l e i ss ue o ff ac t as t o whethe r he was d el ibe r at ely de pr i ve d o fhi s Ei g hth Am en dm en t ri ght to i ncarc er ati on i n hum ane condi ti ons. H er e, by con trast, “[t] he cond iti ons M r. Rice en d ure d w e r e self

infl icted and don ’t gi ve rise to a claim of d e liberat e ind if

fer ence. ” 2 009 W L 17480 59, at* 11 ( ci ting Isb y v. C la rk, 10 0 F
. 3d 50 2, 5 05

- 06 ( 7th Ci r . 1 99 6) ( no tingtha t i fthe i n ma t e i s t h e c a u s e o fth e c o n d i t i o n s o fw h i c h h e c o mpl ains , hi s Ei g hth Am en dm en t cl ai m i s t en uo us ) )
. The cour t di d acknowle dge that“M r. Ri ce’ s be havi orwas dri ven byhi s m en ta l il l ness, ” but chose to acc ount f or th a t f a c t o r i n c o ns i de r i ng hi s ne e d f o r men t a l heal th tr e a t m en t rathe r than w he th er j ailoffici als w ere d eliberat ely ind iffer en t t o th e c on d itio n s o f h is c on fin em en t. Id. The cour t a lso added, som ew hat m or e crypti cal l y, that “[u ]n d er th e c irc u m st an c es of th is c as e, M r. R ice ’s u n sa n i-N os. 09

- 2804& 10

- 2389 27 tar y c ondit i on wasn’tsuffi ci entl y s er i ous t o const i tute a co nsti tuti onalvi ol ati on. Pri son condi ti ons m ay be hars h and uncom f or table witho ut vi ol ati ng the Ei ghth A m endm ent’ s pro hibi ti on a gains t c rueland unusual pu ni shm ent. ” Id. W e co ncl ud e, co ntra ryto the dist ri ct cour t, that w hether j ail o f f icia ls w er e d elib er at ely ind iffer en t t o R ice ’s c on d iti ons ofco nfinem ent pr ese nts a m ate rial d isp ute o ff act that the f actfinder m ust r eso l ve at tr i al

. That Ri ce h im se lf c re at ed th e un sa n ita ry c on d itio n s of w h ich h is E s t a t e c o mp l a i n s c e r t a i n l y i s a f a c tr e l e v a ntto th i s c l a i m, as o urde ci si o n in Is bym ake s cl ear . 10 0 F
. 3d at 505-0 6. Bu t g i ven Ri ce’ s m entalco nd i ti on, it b y n o m eans f or ec los es the c l ai m , as the dist ri ct c ourtappears to have a s s u me d

. As we n o t e d i n Fre e m an v. Be rge, 44 1 F
. 3d 543, 5 4 6 ( 7 th Ci r. 20 0 6 ) , a nd Hal l v. Ryan , 95 7 F
. 2d 402, 40 6 ( 7th Ci r. 19 92) , pri son offi ci al s hav e a n obl i gat i on t o interven e w h e n they know a prisone r suffers from self

destr ucti ve tendenci es. There i s e vi dence thatRi ce m ay have been m al i nger i ng, and i t i s p os sibl e that a factfind er m ight con clud e tha t Rice’s fai lure of self- care was kno wi ng, v o l unt ar y, a nd de l ibe r at e ra the r tha n the product o fhi s m entali l l ness. But ther e i s a l so a weal th of evi d en ce in th e record tha t w o u ld sup p ort a cont rary fi ndi ngtha t Ri ce t r ul y b ec ame inc apabl e o fc ar i ng for h im se lf as a re su lt of h is s c h i zo p h re n ia a n d th at j ail offi ci al s were w el l aware ofth is. In li ght o fthatev i dence, a f actfi nd err eas onabl y c ould c onclude thatRi ce was n otres p on sib le for th e c on d itio n s o f h is c ell an d h is perso n, and that pri son offici al s, wh o w er e a w ar e o f th es e c on d itio n s a n d of R ice ’s illn es s, w er e re sp on sib le28 N os. 09

- 2804& 10

- 2389 for th em in t h e sen se th at th ey d id n otm ak e m or e c on sc ie n t i o u s e ff o r t s t o b a th e R i c e a n d t o c l e a n h i s c e l l

. No d ou b t R ice ’s b eh av ior p lac ed th e jail in a d ifficu lt p os itio n ; an d a fac tfin d er m igh t c o n c l u d e t h at ev en if j ail offi ci al s co uld have d one m or e, theywere not del iber ate l y ind i fferent t o the c l eanl i ness ofRi ce’ s per son an d ce ll. Fo r ex am p le, th e rec or d d oe s c on firm th at j ail st aff d id sh ow er R ice an d c lea n ou t his c e l l o n m u ltip le o cc as i o ns . H ow eve r, i n v i ew o fe vi den ce s ug g es ting th at u ne aten f ood w as all ow ed to accu m ulate in R ice’s cel l, tha t he wentf o r l o ngpe r i o ds wi th o utb eing shower e d, a nd tha tthe s t e nc h o fh i s c e l l a nd h i s p e r son w er e o ver w hel m i ng, thi s cl ai m cannotbe re so lve d o n sum m ar y j ud gm ent. Forthe sa m e r eas ons, we cannot susta i n the dist ri ct cour t’ s a l ternati ve concl usi on that the co nd i tion s of Ri c e ’ s c o nfi ne men twer e n o ts uffi c i e nt l y s e r i o us t o s up porthi s F ourt eenth A m endm ent c l ai m . Per haps a f actfi nd er cou ld reach th a t c o nc lusion. A s the district cou rt note d, pri son condi ti ons m ay b e uncom f or tabl e, ev en hars h, witho u t b ei ng i nhum ane. See Fa rm er, 51 1 U.S
. at 83 2, 1 14 S
. Ct
. a t 19 76
. But on th is r ec o r d, g r an ting th e E s t a t e t h e b en efitof all in fer en c es to w h ich it is en tit led on su m m ar y jud gm en t, a fa c tfin d er rea so n ab ly co ul d c o nc l ude tha t th e co ndi ti o ns o fRi ce ’ s confi nem en t ex c ee d e d m er e d isc om for t a n d w er e c on st itu tio n ally u n ac c ep ta b le. See, e . g. , Gillis , 46 8 F
. 3d at 493- 94 ( evi dence th at p ris on er w as st rip p ed n ak ed an d p lac ed in c e ll w ithou t, inter ali a, ad eq ua te san itation suffici en t to surviv e s u m m ar y jud gm en t); Vin ni ng- El v
. Lo ng, s u pra , 48 2 F. 3 d a t 9 2 4 ( ho l di ng de fe nd a nt s we r e no t e nt i t l e d to quali fi ed i m m unity o n E ighth A m endm ent c l ai m thatN os. 09

- 2804& 10

- 2389 29 i nm at e was s ubj ec te d t o uns an i ta r y a nd o th er wi se inhum an e c on fin em en t fo r p er iod of th re e t o s ix d ay s) (c oll. case s).

B. A DMI NI ST RA T I VE S EG RE GAT I ON The Es ta te ha s a se par at e co ndi ti o ns - o f

- co nfi ne m en t claim rel ating to R ice’s prolonged assignm en t t o W ard One , the a dm inistr at i ve s eg r eg at i o n un i t o fthe j ai l

. The re c or d ind i c a t e s t h at R ice w as h ou se d in t h at u n it f orapproxim ate l y s eve n m onths, fro m m i d-M ay, 20 04, unti l hi s death the f ol l owing Decem ber

. Ostensibl y, he was as sig n ed to th at u n it s o th a t h e c ou ld be m or e re ad ily m o ni to r ed an d b ec au se hi s be ha vi o r made hi s as si g nm en t el se wher e i n the j ai l pr oble m at i c. ( N o ne o fthe briefs in this cas e, un fortun ately, d iscus s w ith an y pa rti cu lar i ty the nature ofthi s j ai l ’ s a dm i ni str ati ve seg re gati on uni t an d w hat types ofi nm ate s were housed th er e. ) O ne ofthe Es ta te ’ s ex per ts , Dr
. J o e Gol den so n, op ined t h a t Rice sh ou ld h ave be en i n p laced i n th e j ail ’s m edi ca l war d, wher e he ha d b een pl ac ed o n pr ev i o us occa si ons, i nstea d ofadm i ni str ati ve seg re gat i on, bec au se “[i]tis a w ell es ta b l i s h e d fac t t h at ind ivid u als w ith p sych iatri c p roblem s d ecom p en sate w he n th ey are i n extr em e i sol ati on. ” R. 15 7- 2 a t 1 8 ¶ 7. W e m aymake s ho r t wor ko fthi s cl ai m b ec au se, as the di s t r i c tc o u r tn o t e d , th e E s t a t e h a s p r o v i d e d “ l i t t l e s up p ort” for it. 2 009 W L 17480 59, at * 12. Dr. G olden son ’s an al y si s ce r ta i nl y s ug g es ts tha t a p rolo ng ed pl ac ement i n s eg r eg at i o n mi g htha ve a dve r se e ffects on so m eo ne30 N os. 09

- 2804& 10

- 2389 i n Ri ce ’ s co ndi ti o n; a nd o ur ow n dec i si o n in Wal ke rv. Sh ans ky, 2 8 F
. 3 d 6 6 6 , 6 7 3 ( 7 th Ci r . 1 9 9 4 ) , r e c o g ni zes that prol onge d confin em ent in adm i ni str ati ve seg re gat i o n ma y c o n s t i t u t e a v i o l a t i o n o fth e E i g h th A me nd

m en t ( an d ther efo r e th e F o ur te en th ) , de pen di ngo n the du ra ti on a nd natur e o fthe seg re gat i on a nd wh ether th e r e w e r e fe a s ib l e a l t e r n a t i v e s t o th a tc o n fi n e me n t
. ( We n o t e , h o we v e r, th a tth e c l a i m i n Wa lk eral so i ncl ud ed alleg ati ons that the inm ate had bee n denie d w ate r f or per i o ds o fu p t o o ne we e k, h a d b e e n g i v e n i na dequ ate ti m e t o exer ci se, and had b een subj ect to physi cal ab u se .) B u t t h e E st at e h as n otd isc u ss ed in a n y d et ail w h at alt er n at i ve p lac em en ts w er e a va ilab le t o th e jail nor, m ore im p ortan tly, ha s it d ocu m en ted t h e d ifferences thos e pl acem ents w oul d have m ade i n t er m s of Ri ce ’ s so ci ali so l at i o n. W e ta k e i t as a g i ven th at th e E st at e d oe s n otbe liev e h e sh ou ld h av e b ee n p lac ed in th e g e n e r a l p o p u l a t i o n o fthe j a i l , a s i t s o th e r c l a i ms ar e pr em i sed o n the noti on that Ri ce s houl d have be en m o ni to r ed m o r e r athertha n l es s cl o se l y tha n h e w as

— and i t i s undis pu ted thathe was pl aced i n adm i ni str ati ve s egr ega ti on f orthatve rypurpose. Ri ce had be en pla ced i n the m ed i calward on pri oro ccasi ons, and presum abl y had he been ass i gned t o th at w ar d rather than to ad m i ni str ati ve seg re gat i on he w oul d have r ecei ved as m u c h if n otm or e m ed ica l at t e n t i o n t h an h e d id in seg re gat i on. But the re cor d sugges ts th at R i ce was not r etur ne d t o the me d ical war d a t th e r eque sto fthe j ai l ’ s m edi calst aff

. I t a l so i nd i cates that Ri ce had daily c ontac t with m edi calper sonneli n adm i nistr ati ve seg r eg at i o n. M o r e to the po i nt, the Es ta te do es no t ex -N os. 09

- 2804& 10

- 2389 31 pla i n w hy pl acem ent in th e m edi calward orany othe r unit of the j ai l w oul d hav e re du ced the l i kel ih oo d o f decom pensati on due to isol ati on. A l l we know is that Ric e had o ne hourea ch day t o m i ngl e with other pri sone rs wh i l e he w as housed i n adm i ni str ati ve seg regation ( w hich the record i nd icates h e often d eclined ); w e d o not know w hat a dd i ti onalo pp or tuni ti es f or so c ial in t e r a c t i on h e w ou ld h av e h ad in o th er fea sib le plac em ents w i thi n the j ai l

. I t i s no t t oo m uch to expect th e E st at e’s law ye rs , w h en co m p lain i n g a b ou t t h e d eb ilitating effects of th e j ail ’s hou sing d ecisions, to id e nt ify fea sibl e al te r na ti ve s an d t o t en dere vi den ce s uppo r ting the c onte nti on that Ri ce l i kel y would h av e fa re d bett er i n one oftho se al ternati ve p lacem ents. Thi s they ha ve not done.

C. E X CES SI VE F OR CE A s we note d i n ourf act u al sum m ar y, o n N ove m ber16 , 2003 , Ric e str uck hi s cel l m ate i n the eye . W h en co rr ecti onalo ffi cer s o rder ed hi m o ut o ft h e cel l, he di d not com plyand rem ai ned sta nd i ng in hi s ce l l

. Offi cerKoontz, at the di re cti on o fOffi cerS hel ton, sp ra yed pepper f oam i nto Ric e’s fac e i n an e ff or t t o secur e Ri ce’ s co m pli ance wi ththe i r orde r s. Ri ce was the n pl ac ed i n a r es tr aint ch a i r . Nur s i ngs t a ffh e l pe d r i ns e the p e pp e r f oam from R ice’s eyes. A fter som e p eriod of tim e, j ail st a ff at te m pte d t o releas e Ri ce fr o m the r es tr aintc ha i r, b ut R ice w as u n w illin g t o lea ve th e c h air an d u ltim at ely re m ai ned ther e fora tot alo fei ghtee n hours . T h e Esta te conte nd s that t he use ofthe pepp erf oam , al ong w i th32 N os. 09

- 2804& 10

- 2389

R ice w a s als o placed in a res tr aintchai r and left there f or a 2 s i m i l a r l y p r o l o n g e d p e r i o d o f t i me o n Au g u s t 2 , 2 0 0 4 , a ft e r he cut his n eck w ith a razor and rec ei ved tr eatm ent at Goshen G en era l H osp ital for the injury
. B u t the E state d oe s no t cite th i s i n c i d e n ti n c o n n e c t i o n w i th i t s e x c e s s i v e f o r c e c l a i m. his p rolonged confinem en t in the restrain t ch air, am ounted to exce ssi ve f or ce. 2 The use of f or ce qual i fi es as excess i ve f orthe pu rpos e ofEi ghth Am endm ent a nd due proc ess j uri sprudence w hen i t e ntai l s the “ ‘ unnecessary a nd wa n ton i nfl i cti on ofpai n. ’ ” Whit ley v . Alb ers , 4 7 5 U. S
. 3 1 2 , 3 1 9 , 1 0 6 S
. Ct. 1078 , 10 84 ( 1986 ) ( quoti ng Ingra ham v. Wr ight, 430 U
. S. 6 5 1 , 6 7 0 , 9 7S
. Ct
. 1 4 0 1 , 1 4 1 2 ( 1 9 7 7 ) )
. T ha tthe de gr ee off or ce use d a p p ears i n re tr ospectto have bee n unreasonab l e i s no t s uffi ci ent t o est abli sh a const i tuti onal vio lat i on . Id. at31 9, 10 6 S
. Ct. at10 84. W here , as her e, f or ce i s e m plo yed i n the cour se ofr eso l vi ng a disturba nc e , the p e r t i ne nti nqui r y i s “ ‘ whe ther f o r c e wa s a pp lied in a goo d fait h effo rtto m ain ta in or re s t o re d isc ip line or m ali ciously a nd sad isti cally for th e very p urpose of causi ng ha rm . ’ ” Id

. at32 0- 21, 10 6 S
. Ct. at10 85 ( quoti ng Johnson v
. Glick, 481 F. 2d 1028 , 1033 ( 2d Cir
. 19 73) ( F r i e nd l y, J
. ) )
. Fa c t o r s r e l e v a ntt o tha ti nqui r y i nc l ud e w hetherj ai l o ffi ci al s per cei ved a threatto thei r safety and the s afetyo fo theri nm ate s, wh ethe r th er e was a g en ui ne ne ed f o r the a p p l i ca ti o n o ff o r ce , whethe r the f or ce use d w as com m ensura te w i th the need f orf or ce, the e xtent o fany i nj ury i nfl i cted, and w hatev ereff or ts the o ffi cer s m ade to te m per th e s eve ri ty ofthe f or ceN os. 09

- 2804& 10

- 2389 33 th ey u se d

. Id. at32 1, 10 6 S . C t. at 10 85
. Se eal s o For r e s tv. Pri ne, 620 F.3d 73 9, 74 4-7 5 (7 th C ir. 20 10 ); Le wis v. D o w ney, 581 F.3d 46 7, 47 5-7 7 (7 th C ir. 20 09 ). The dis tr i ct c ourtchar acte ri zed the for ce e m plo yed by j ai l o ffi ci al s o n thi s o ccasi on notas exce ssi ve , b u t a s “ju stifi ed and re str ai ned, ” a pp l i ed i n go od f ai th, and re

sul ti ng i n no si gni fi cant inj ury to Ric e, 20 09 W L 17480 59, at *13 , an d th e E st at e’s cu rs or y t re at m en t o f th is c laim on a pp ealhas not convi nced us thatthe court e rr ed i n i ts anal ysi s. A l though the Estat e contends that Ri ce posed no thre at to anyo ne, i t doe s no t di spu te ei ther that Ric e had b ee n fighti ng with hi s ce l l m ate o r that he f ai l ed to c o m pl y wi ththe di r ec ti ve th athe s te p o ut ofhi s ce l l

. A fi ght a m ong tw o in m ates ce rt ai nl y pos es a d an ge r to t h e i n m at es inv olv ed as w ell as th e jail offi ci al s who m ust int er vene to sto p i t. Ri ce’ s m ental i l l ness m ay expla i n w hy h e stood unm oving wh en o r der ed o uto fthe c el l, a s th e Est at e su g g ests, butthe Est at e ci te s no ev idence s ho wi ngtha t th e o ffi ce r who spray ed Ri ce’ s f ace w i th pepper f oam ap p re c iate d that he was unabl e, a s o pp ose d to unw i l l i ng, to co m plywith th e ord er an d em p loy ed th e pe p p er sp r a y m alic iou sly r athe r tha n in a good faith e ff o r t to r es to r e o r der

. The sa m e i s true as to th e dec i si o n to pl ac e R ice i n a r es tr aint c h a i r . Th e E st at e c on te n d s in p as sin g t h at j ail offic ials vi ol ate d m ult i ple i nter nal ru les in deplo yi ng pepper spr ay, t r ea tingRi ce f o r the effec ts o ftha t spr ay, a nd the n l e a v i ng hi m in the r e s t r a i nt c ha i r f o r ho ur s o n en d, b u t fa ils to d isc u ss th e rele va n t ru les an d h ow sp ec ifica lly they w er e v i ol ate d. That Ri ce w as le ft in the chai r f or ei ghtee n hours does gi ve one pause. Y et , it is undisputed34 N os. 09

- 2804& 10

- 2389 that Ric e hi m sel f re fused to l eave the chair w h en i nvi ted to do so

. Thi s t oo m ay have been du e t o Ric e’ s m ental i l l ness, and to the extent j ai l o ffi ci al s a nd /o r CM S nurses r e c o g ni z e d th i s p o s s ib i l i t y, th e y ma y h a v e h a d s o me obli g at i o n n o t to l ea ve hi m i n the c ha i r . Butr emov i ng Ri ce fr om th e ch ai r a g ains t hi s wi l l i ts el fr equi r ed th e use o ff or ce (re c al l thatRi ce ul ti m ate l y had t o be dr agg ed f r o m t he c ha i r ) , s o the n ur s e s a l o ngwi th the g ua r ds w er e in a dam ned-i f

- you- do, dam ned-i f

- you- don’tsi tuat i o n. The Es t a t e do e s n o ti de nt i fy wh a ta l t e r na t i v e s t e ps j ai l o ffi c i a l s s h o u l d h a v e t a k e n, l e ta l o n e d i s c u s s wh y thei r acti ons w oul d enabl e a j ury to fin d that they a cted m alic io u s l y a n d sa d ist ica lly as op p os ed to n eg lige n tly or r eas onabl y. The di str i ct c ourtappropr i ate l y e nter ed s u mma r y j u d g me n ta g a i n s tth e E s t a t e o n th i s c l a i m.

D. F AI LUR E T O P RO T ECT T h e E st at e n ex t a rg u es th at th e d ist ric t c ou rterr ed in gr an tin g s u m m ar y jud gm en t a s t o its cla im th at th e jail f ai l ed to pr o te ctRi ce fr o m a ss au l ts b y o th er i nm at es . The cl ai m i s based o n two i nci dents: ( 1) the j ust- disc ussed N ove m ber16 , 20 03, incident in w hi ch Ri ce fought w i th h i s cel l m ate , and ( 2) the i nci dent on J une 25, 20 04 , i n w hi ch inm ate M onti e Geor ge poked a bro om sti ck thro ugh th e b ar s o f R ice ’s c ell an d rep ea te d ly st ru c k R ice in th e g r o i n a r ea, r esu lti ng i n v i sibl e wel ts o n h i s bo dy. The di st r i ctc o ur t i n i ts r ul i ngdi sc us se d o nl y the s ec o nd ofthe s e t wo i nc i de nt s , c o nc l ud i ngtha ts ummar y j ud gm ent was warranted bec ause ther e was no evi dence th at eitherthe j ai l o r f o r tha t m at te r Ri ce e xpe ct ed th eN os. 09

- 2804& 10

- 2389 35 att ack, wh i ch the cour t d escr ibed as a “ ra nd om ” o ne. 20 09 W L 17480 59, at* 14. J ai l o ffi ci al s hav e a duty t o prot ect i nm ate s fro m vio len t a ss au lts b y oth er inm at es . Far m e rv. Br e nna n , sup ra , 511 U
. S. at83 3, 11 4 S
. Ct. at19 76- 77. They in cur l i abi l i ty f orthe bre ach o fthatduty wh en the y were “a w ar e o f a su bs ta nt i alr i sko fs er i o us inj ur y t o [ ani nm at e] b ut never thel ess f ai l ed to ta ke appropri ate s tep s t o prot ect hi m fro m a known danger

. ” Guzm an v. Sh e ahan , 4 9 5 F. 3d 852, 85 7 ( 7th Ci r. 20 07) ( quoti ng B u t e r a v . C o ttey, 28 5 F
. 3d 60 1, 60 5 (7 th C ir.20 02 )); se e also S a n ti ago v. Walls , 59 9 F
. 3d 749, 758-59 (7th C ir. 2010). The e vi den ce i n thi s ca se woul d no t sup p ort a fi ndi ng th at j ail offic ials w er e a w ar e o f bu t d id n otap p ro p ria te ly re spond to a substanti alr i sk that Ric e m i ght b e a ssaul ted . W e know l i ttl e about the fi rs t inci dent i n 200 3 othe r than thatRi ce s tr u c k his cel l m ate
. The defendants r epr es en t th atRi ce a ctua l l y i ns ti g at ed th atfi g ht ; b ut eve n i fhe di d not, the Estate poi nts t o no e vi dence sugges ti ng tha t the j ai l was on no ti ce o fthe poss ibility th atRi ce was a t su bs ta nt i alr i sko fa n a ss au l t f r o m a no the r i nma t e a nd tha t j a i l o ffi c i a l s k ne w o f thi s r i sk. N or h a s t h e E st at e id en tifie d an y c on n ec tio n be tw ee n th is i nc i den t an d the s ec o nd o ne

— th eyo cc ur r ed i n di ffer en t un i t s o fthe j a i l a nd i nv o l v e d d i ffe r e nti nm ate s

— w hi ch m igh t s u gg es t t h at th e la te r in c id en t w as fore se ea b le in ligh t o f th e fo rm er . The Est at e subm i tte d an affi davi t fro m i nm ate Geor ge, w ho a ss aul ted Ri ce with the bro om sti ck, expl ai ni ng tha t he at tack ed Ri ce b ecause he h ad becom e fed up w i th36 N os. 09

- 2804& 10

- 2389

Col l ec t i vely, the affi davi t s an d dec l ar at i on f ro m the s e i n- 3 m a t e s r e i t e r a t e d S h a w’ s a c c o u n to fwh a th a p p e n e d th e n i ght thatRice died

— i. e., tha t th e y h e ard R ice’ s d istress and att e m pt e d wi tho uts uc c e s s to gai n the a t t e nt i ono fthe g ua r ds

— an d also a sserted tha t R ice’ s hea lth w as in a n o b v iou s state of d ecline during the fi nalm onths ofhi s l i fe, thatRi c e di d not alway s rec ei ve his m eal s, thathis ce ll w as f requentl y li tt ered w ith uneaten f ood , and that hi s hyg ie ne w as noti ceably poor. the s m el l em anati ng fro m R ice’ s ce l l

. But the dist ri ct co ur t ex cl ude d fr o m e vi den ce Ge o r g e’ s affi dav it, a l o ng wi t h a n o th e r a ffi d a v i ta n d a d e c l a r a t i o n fr o m t wo other in m ate s who w er e ho used i n the adm i ni str ati ve seg re gat i on uni t with Ri ce, bec ause the Esta te ha d not 3 disc l ose d these thre e in m ate s a s pro specti ve w i tness es as r equi r ed byF ede r alRule ofCi vi l Pr o ce dur e 26 ( a) a nd (e), an d th e c ou rtsu re ly d id n ota b u se its d isc re tio n in so rul i ng. A l though the Estate had obtained the na m es ofthes e ind i vi du al s fro m the defe nd ants d u ring dis

cove ry, the Estate did not disc l ose them as w itness es u n t i l r e s p o n d i n gt o th e d e fe n d a n t s ’ mo t i o n s f o r s u mm ar y j ud gm ent, and by that ti m e, d isc ov er y had cl ose d and the defendants co uld not depose them

. The o m i ssi on w as nei ther substa nti al l y j usti fi ed nor harm l ess , su ch th at it m ight be o v e rlooked p urs ua nt to Ru le 37(c) (1). A s t he di str i ct c ourtr i ghtl y obser ved, “The defendants ar en ’ t r e q u ire d to gu es s w h ich of th e m an y in d ivid u als i dent i fi ed duri ng di sco ver y the Estat e intends to use to s u p p o r ti t s c l a i ms

— that i s the sorto fi nd i re cti on th e d i s c l o s u r e r u l e s a r e d e s i g n e d t o a v o i d

. ” 2 0 0 9 WL 1748 059, at* 8.N os. 09

- 2804& 10

- 2389 37 W i thout Georg e’ s a ffi da vit, the seco nd at tacko n Ri ce i nd eed appear s t o have been ra nd om , j ust a s the di strict cour t char acte rized i t. But eve n w i th the expl anati on p ro vid ed by G eo rg e’s affid av it, t h er e w ou ld be n o b as is on wh i ch to co ncl ud e that the j ai l was aware o fa subst an tia l risk of inj u ry to R ice . Jail p er so n n el c er ta in ly w er e a w ar e that Ri ce had a hyg i ene pr obl em , b u t so f ar as the r eco rd r eve al s, theyhad no no ti ce t h at h e w as at ri sk ofas saul t be cause ofthatpro bl em , part i cu lar ly w i thi n the m or e s ec u re co nfines o fthe adm i ni str ati ve seg re gat i on uni t.

E. I S C EN I CER OS A S T AT E A CT OR ? T he Estat e’ s cl ai m ag ai nst Dr. Ceni cer os i s pri m ar ily foc u se d on h is re fu sa l to a d m it R ic e t o O ak law n in October20 04. Recal l thatDr. R ohr er, co ncer ned that Ric e was i n peri l o fdyi n g, had obta i ned a co urt or der author i zi ng Ri ce’ s invol untaryco m m i tm ent t o one of f our i npati en t f aci l i ti es, and Rohre r had atte m pted to ha ve Ri ce a dm i tt ed to El kh art Gen er alHos pi ta l

. But afte r El kh ar t Gen er alr efus ed to a dm i t Ri ce i n the m i sta ken b el i efthati t had no contractwith the j ai l, Ri ce w as i nstea d take n to Goshen, wh er e he w as see n by D r. M at h ew . A lth ou gh R ice w as d et er m in ed to be m ed ical l y s tabl e, Dr. M athew consul ted byte l epho n e w i th Dr
. Ce ni ce r o s as t o whethe r Ri ce mightne ed i npa ti en t psychi atr i c ca re , wh i ch Goshen was not equi pp ed to pr o vi de. ButCe niceros a l l eg edl y t o l d M athe w tha t he d id n ot beli eve R ice m e t th e criteri a for involun tary adm i ssi on a nd , b as ed on hi s pri oro bser vati ons ofRi ce,38 N os. 09

- 2804& 10

- 2389 that he was l i kel y m al i nger i ng. The E sta te conte nd s that Cenice ro s’ re fusal to adm i t Ric e si ght unseen, d es p i te f am i l i ar i ty w i th Ri ce’ s s chizo p hreni a, hi s t ro ubl ed hi st o r y a t th e j ai l, a s wel l a s hi s co ll ea g ue Ro hr er ’ s co ncl us i o n tha t Ri c e wa s i n ur g e nt ne e d o f i np a t i e ntcar e, amoun te d t o de l ibe r at e i ndi ffer en ce t o Ri ce ’ s co ndi ti o n. C en iceros’ em p loyer, Oa klaw n, had cont ractu a lly un d ertak en to pro vi de i npati ent psy chi atr i c se rv i ces to j ail i n ma t e s wh o n e e d e d i t, a n d s o , i n th e E s t a t e ’ s v i e w, C en iceros w as a state actor vis-à- vis the p sych iatri c care th athe pr o vi ded to (or wi thhe l d fr o m ) inm at es . In the E state ’s vi ew , then , i f C en iceros w as d eliberat ely ind if

fer en t t o R ice ’s p sy c h iat ric co n d itio n as alleg ed , he co u ld be lia b le as a state actor for his ind ifferenc e j us t as C M S’s nurses cou ld b e and, f orthatm att eri n the sam e way th at Cenice ro s’ co l l eague, Dr. Rohr er

— hi mse l fa n Oakl aw n physi ci an

— coul d be. The dis tr i ct c ourtdi spose d ofthe cl ai m ag ai nst C en iceros on th e grou n d that he w as no t a state ac tor, contr ar y t o the Esta te’ s co ntenti on. The co u rtf ocuse d on Ri ce’ s pri orco m m itm ents to Oakl aw n i n Octobe r 2003 and M ay 2004, r athert h an Ceni cer os’ r efusalto ad m it R i ce i n Oc tobe r 2 00 4. The r ec o r d, a s th e co urt und er sto od i t, i nd i cate d that Ceni cer os had accepted Ric e fortr eat m ent a t Oakl aw n on the two pri oro ccasion s not b y v ir tu e of O aklaw n’s con tract w ith C M S, b u tr a th e r p u r s u a n tt o th e c o u r to r d e r s w h i c h c o mm i tte d Rice i nvol unt ar il y t o Oakl aw n f oro bser vati on and tre atm ent. 2 009 W L 17480 59, at* 16. Pre sum abl y, al though the co urt did notaddress th e ev ents ofOctober 20 0 4 , the c o ur tl i k e wi s e wo ul d h a v e e mpha s i z edN os. 09

- 2804& 10

- 2389 39 th atRi ce ’ s co m m i tmentt o Oa kl awn was b eings o ug ht on that o ccasi on notpursuant to Oakl aw n’s co ntra ct w i th the j ai l but pu rs uant to t h e c ourt ’ s o rder author i zi ng Ri ce’ s invol untaryco m m i tm ent t o one of f o u r fa c ilitie s, in c lu d in g O ak law n . Th e c ou rtac kn ow ledg ed th atthe S upr eme Co urt ’s dec i si o n in We s tv. Atki ns , 48 7 U.S
. 42, 5 1, 10 8 S
. Ct. 22 50, 22 56 ( 1988 ) , r eco gni zes thatp riv ate physi ci ans m ay be dee m ed sta te act o r s wh e n the y p r o v i de me di c a l c a r e t o p r i s o ne r s at the pr i son. B ut the cour t co ncl ud ed that West ’s ra tio n ale do e s n o te xt e nd t o a p r i v a t e p s y c hi a t r i s twh o acc epts a n i n ma t e i n t o h i s ca r e p u r s u a n tt o a n e me r g e n c y c o mm i tm ent o rder. 2009 W L 17480 59, at* 16. Pro vi ding psych i at r i c ca r e to an i ndi vi dual who ha s be en i nvo l unta r i l y c o m m i tt ed f o r s uchc ar e i s no t a func ti o n t r adi ti o nal l y r ese rv ed to the sta te, the cour t r eas oned. Id. Because, i n th e c ou rt ’ s v i ew , Dr. Ceni cer os did notse rv e a publ i c functi on in caring forRi ce, hi s r ol e was notthat of a state actor. W e hav e our d ou bts as to w he th er the d istri ct cou rt w as c or re ct in cate gor i zi ng Ceni cer os as a pri vate r ather th an a st at e a c to r . R ice w as tre at ed by C en ice ro s in fu lfi l l m ent o fthe j ai l ’ s obl i gat i on t o provi de m edic alcar e, i ncl ud i ng nece ssa rypsychi atr i c ca re , to R i ce a s a n i nm ate o fthe j ai l

. The o rder s co m m i tting Ri ce t o a pri vate f aci l i ty si m plyr efl ect a j ud i ci aldeter m i nation, soli cited by Roh rer as the j ail ’s m en t a l he alth care p ro vid er , th at R ice req u ire d m or e in te n siv e p sy c h iat ric tr ea tmenttha n c o ul d b e pr o vi ded to hi m a t th e j ai l, a nd tr eat m ent that had to be provi ded witho ut his conse nt. A nd the r e c o r d s ug g e s t s tha ti twa s n o th a pp e ns t a nc e40 N os. 09

- 2804& 10

- 2389

W e note thatw hen R ohrer s oug ht Rice’ s adm is si on to Elkhart 4 G eneral i n O ct ober 2004, thathospit al refused to a ccept R ic e i n th e er ro ne ous be l i efthati tha d no c ont ra c t ual ar ra nge m en t with the j ai l

. Thi s s ugge s t s thatne i the r El kha rtno r any ofthe othe r thr ee faci l i t i es des i gna t ed i n the c our t ’ s c om m i t m en t or der wer e obl i gat ed to a cceptRi c e i n the abs en c e ofa c ontractu al rela tion ship w ith th e jail. orj ud i ci alfi at that re sul ted i n O ak l aw n’s se l ecti on a s th e f a c i l i t y t o wh i c h R i c e wo u l d b e c o mmi t t e d o n t he fi r stt wo o cc as ions i n Oc tobe r 2 00 3 an d M ay2 00 4 ( an d as one ofthe f our f aci l i ti es to w h ich h e co uld have bee n com m itted i n O ctob er 2004). R ath er, the facts sup p ort th e i n fe r e n c e tha tR i c e wa s c o mmi t t e d t o O a k l a wn be ca us e o f Oak l awn’ s vo l unt ar y, c o nt r ac tu alunde r ta k i ng to provi de psychi atr i c se rv i ces to the j ai l ’ s inm ate s. 4 The com m i tm en t o rder s di d not a l terRi ce’ s s tatus as a p re tr ial d et ain ee . B ec au se h e w as inc ar c er at e d , t h e jail had an obl i gat i on t o add re ss Ric e’ s ser i ous m edi calneeds. E st el lev. Ga m ble, 429 U
. S. 9 7, 1 0 3 , 97 S. Ct
. 285, 290 (1976 ). T h at o b liga tio n inc lu d ed a d u ty to p ro vid e p sy c h iat ric c ar e t o R ice as n ee d ed

. San vi l l ev. M cCaughtry, sup ra , 26 6 F.3 d at73 4; Wellm a n v . Fau lk ner, 715 F. 2d 269, 27 2 (7th C ir. 1983). I fRi ce had be en co m m i tte d to the sta te ’s ow n f aci l i ty for tre at m en t b y s ta te -em p loy ed p h ys icia n s, th er e w ou ld be no questi on that tho se physi ci ans would qual i fy a s state actors w ho cou ld be li able for an y d eliberat e ind if

fer en c e t o h is p sy c h iat ric n ee d s: “ ‘In st itu tio n al p h ys ic i a n s a s s u me a n o b l i g a t i o n t o th e mi s s i o n tha t th eN os. 09

- 2804& 10

- 2389 41 St ate , thr ough the i nsti tuti on, at tem pts to achi eve . ’ ” West, 48 7 U
. S. at51 , 10 8 S
. Ct. at22 56 ( quoti ng Pol k County v. D ods on , 454 U
. S. 312, 32 0 , 1 0 2 S. Ct
. 445, 451 (1981 ))
. This w oul d b e t rue w hetherRi ce were co m m i tte d to a p s y c h iat ric u n it w ith in th e jail, cf. Wa shin gto n v . Ha rper, 494 U
. S. 21 0, 110 S . C t. 10 28 ( 1990 ) ( pri sone r m edi cate d aga i nst hi s wil l atpri son m edi cal fac il i ty) , o r i nstea d tr an sfe rre d to a st at e-o w n ed fac ilit y o u ts id e o f th e jail, cf. Y o u n g b e rg v. R o m eo , 45 7 U.S
. 30 7, 10 2 S
. Ct. 24 52 (19 82 ) (rec og n izin g t h at st at e fa c ility for m en ta lly d isabled has d ut y to provid e, a m ong other th ings, safe condi ti ons ofco nfinem ent t o m ental l y di sabl ed ad u lt w h o w as inv olu n ta ri l y co m m itt ed to th at fac ility ); see also C o llignon v. M il w auk eeCo unty, sup ra , 16 3 F
. 3d at 987 ( “W hen a s tat e a cto r such as M i l w aukee County depri ves a per so n o fhi s ab i l i tyt o c ar e f o r hi m se l fb y i nc arcerat i ng h i m, d e t a i n i n gh i m, o r i n v o l u n t a r i l y c o mmi t t i n gh i m, i t a ssum es an o bl iga tion to provi de so m e m i ni m all eve l of w ell -being an d safety.”) ( coll

. cases). T ha t Rice w as instea d com m itted to the care of a pr i v a t e p s y c hi a t ri st

— or, i n the thi rd i nstance , was r e fus e d c a r e b y tha tp s y c hi a t r i st

— w hose em plo yer ha d cont racted to provid e p sych iatri c care to th e j ail ’s i nma t e s , a r g uab l y do e s n o ta l t e r the a na l y s i s ma t e r i al l y. The Suprem e Cour t h as not yetaddress ed w hether m edi calcar e pr ovi ded to a pri sone r i n a pr i vate f aci l i ty o u t s i d e o fth e p r i s o n wa l l s c o n s t i t u t e s s t a t e a c ti o n . Ho wever, i n West, the Court hel d that m edi calcar e pr ovi ded on the gr ounds ofthe pri son by a pri vate physi ci an under contr act w i th the st ate does co n st i tute sta te acti on: “Respondent, as a phys icia n em plo yed byN or th Caro l i na to42 N os. 09

- 2804& 10

- 2389 provi de m edi calse rv i ces to state pri son i nm ate s, act ed und er c o l o r o f s t a t e l a w f o r pu r po s e s o f § 1 9 8 3 wh en und er tak i ng hi s duti es i n tr eat i ng peti ti oner ’ s inj ury. S uch conduct i s f ai rl y att ributabl e to the St ate
. ” 487 U
. S. at 54, 108 S. Ct. at22 58. A l though the co urt ci ted th e lo cati on o fthe trea tmenta s o ne f ac to r s uppo r tingi ts c o nc l us i o n, i d. at56 n .15 , 108 S. C t. at 22 59 n .15 , no th in g in its an aly sis sugge sts that the re sul t necess ar i l y w oul d ha ve been differ ent had the car e be en pro vi ded at a pri vate f aci l i ty. Se eRodr iguez v. Ply m outh Am b ul anc eSe r v. , 57 7 F
. 3d 816, 827 ( 7th Ci r. 20 09) ( “The st ate cl ear l y d oes notr el i eve its elf of it s r e sp on sib ility to p ro vid e m ed ica l ca re so lely o n a cc o unto fthe v en ue wher e th o se s ervic es a r e r en dered. ”) ( ci ti ng C onner v. D onnelly, 42 F. 3d 220, 22 5- 26 ( 4th Cir
. 19 94) ( deem i ng pri vate physi ci an wh o tr eat ed pri soner ’ s inj ury i n p h ysic i an’ s o ffi ce o utsi de pri son to be sta te acto r)
. Instea d, centr alto the cour t’ s a nal ysi s was th atthe c ar e was pr o vi ded un d erc o nt r ac t wi ththe pri son i n ful fi l l m ent o fthe pri son’ s obl i gat i on t o provi de f orthe i nm ate ’ s m edi calneeds. Tha t i s ar gu ably j us t as t r ue he r e as i t was i n Wes t. One mighti nfertha t o n e ac h o fthe thre e o cc as i o ns w hen t h e co urt or dered Ri ce’ s invol untaryco m m i tm ent, Cenice ro s a nd Oakl aw n b ec am e invol ved notbec ause the cour t chose Oakl aw n f or i ts own re aso ns, orbe c au se O ak law n w as oth er w ise ob lige d t o p ro vid e p sy c h iat ric ca r e to al l who so ug ht i t, as an emer g en cyroom might b e, cf. R o drig uez , 57 7 F
. 3d at 827- 28, but ra therbec ause Oak l awn h ad vo l unt ar i l yagr ee d t o pr o vi de i npa ti en t p s y c h i a t r i c c a r e t o th e j a i l ’ s i n ma t e s wh e n n ee d e d

. As we o bs er ve d i n R o drig uez :N os. 09

- 2804& 10

- 2389 43 W h en a p ar ty en te rs int o a co n tr ac tu al re lat ion sh ip w ith th e s ta te ’s p en al in st itu tio n to p ro vid e s p ec if ic m edi calse rv i ces to i nm ate s, i t i s underta ki ng fre el y, an d fo r c o n sid er at ion, res p on sib ility for a sp ec ific po r t i o n o fthe s t a t e ’ s o v e r a l l obl i g a t i o n t o p r o v i de m ed ical care for inc arcerat ed pers ons . In s u c h a circumst an ce, th e pr o vi der ha s as su m ed f r ee ly th e sam e l i abi l i ty as the s tat e. S i m i l ar l y, wh en a perso n ac ce pts e m pl o y m en t wi tha pr i va te e nt i tytha t co ntr acts with the st ate , he unders tands thathe i s a accepting the r esponsibi l i ty to perf or m hi s duti es i n c o nf o r m i tywi ththe c o ns ti tu ti o n. Id. at82 7. H ad it been possibl e forRi ce t o re cei ve in p at ien t c ar e fro m C en ice ro s o n th e p re m ise s o f th e jail, th ere w ou ld be n o qu estion th at C en iceros w ou ld q ua li fy as a s ta te a ct o r unde r b o th Westa nd R o drigu ez. And the dist ri ct c ourt ’ s focus on the co urt- or dered natur e o f Ric e’ s co m m i tm ents i m pli ci tl y pr esu m es that had Rice been accepte d fo r adm i ssi on a t Oakl aw n i n the abse nce of s u c h an ord er , th e s a m e m igh t b e t ru e. C f. Ro drig uez , 577 F. 3d at 830 ( ass um i ng tha t cl ai m ag ai nst pr i vate am bul ance s er vi ce foral l ege d de liber ate i nd i ffer ence d u rin g i n m a te ’s t ra n sp or t fro m p ris on to h os p ita l w ou ld be v ia b le i f, i nt er ali a, tran sp ortation w as p rovide d pu rsu an t t o c on tr ac t w ith p ris on sy st em ); i d. at83 1- 32 ( pr i va te ho spi tal thata cc ept ed i nm at e f o r c ar e pur su an t to con tract co uld be li able as state actor). The cour t v i ew ed the j ud i ci alco m m i tm ent o rder s a s su per se di ngOa k l awn’ s vo l unt ar y a ss um pti o n o fthe j ai l ’ s dut y t o pr o vi d e p syc hi at r i c ca r e to i ts i nm at es . But44 N os. 09

- 2804& 10

- 2389 the r eco rd sugg est s tha t th e o rder s had m uch m or e t o d o w ith o v e rruling Rice’s w il l th an w ith O aklaw n’s wi l l i ng ne ss to tre atRi ce o n i ts pr emi se s. Ro hr ers o ug ht the c ourto rder s be cause Ric e, am on g ot her thi ngs, was r e fu s i n gt o t a k e h i s a n t i

- p s y c h o t i c me d i c a t i o n s . As we disc uss b elo w , pr ovi ded he di d not pos e a dangerto hi m sel fo r othe rs , Ri ce ha d that r i ght. H e was co m m i tte d i nvol untari l y fori npati ent t re atm ent s o that, i n part, he co uld be f orcib ly m edi cate d. One coul d i nfe r that Oak l awn’ s st atus di d no t ch an g e as a r esulto fthe c o urt orders

— i twa s s t i l l p r o v i di nge xa c t l y the s o r to f in p at ien t ps yc h iat ric c ar e th at it ha d c o n tr ac tu ally agr eed to p ro vi de. Ind eed, Oakl aw n and Cenice ro s r em ai ned fr ee to rej ect Ric e’ s a dm i ssion , a s e vi denced by Cenice ro s’ o utri gh t re fusalto adm i t Ri ce in Octobe r 20 0 4
. El k ha r tGe ne r a l i t s e l fr e fus e d R i c e ’ s a dmi s si on i n Oc tobe r 2 00 4 i n the m istak enb el i eftha t i t ha d no c o nt r a c tt o p r o v i de i np a t i e ntca r e to th e j a i l ’ s i nma t e s . On th e s e f a c t s , a f a c t fi n d e r mi g h tc o n c l u d e th a tO a k l a wn and C eni cer os w er e no t dra goon ed i nto tr eat i ng Ri ce as a r es ul t o fthe c ou r t’ s co m m i tmento r der s, b ut ra therhad voluntari l y a ssum ed t h at r ol e byvi rtue o f O ak l a w n ’s c on tr ac t w ith th e jail. C f. Ro drig uez , 57 7 F
. 3d at8 31 ( ho spi ta l whi chd ec l i ne d t o pr o vi de no nem er gencycar e t o pri sone r because i t l acke d con tr act w i th p ris on s yst em , and i nstea d provi ded o nl y s uch e m e r g e n c y c a r e a s i tw o u l d h a v e p r o v i d e d t o a n y m e mber of general pu bli c, d id n ot con stitut e state ac tor). W e nee d not ul ti m ate l y resol ve Cenice ro s’ st atus, h o we v e r, b e c a u s e a s we d i s c u s s l a t e r i n th i s o p i n i o n, we concl ud e that the f acts do nots u p p or t a fi nd i ng o fdel ib-N os. 09

- 2804& 10

- 2389 45

er ate i nd i ffer ence on C en ice ro s’ part
. W e hav e v oi ced our doubts about the di str i ct c ourt ’ s co ncl usi on that Cen i ce r o s was no t a st at e actorb ec au se tha t i s th e so l e b asi s o n whi chthe di st r i ctc o ur t r es o l ve d the Estate ’ s cl ai m ag ai nst Ceni cer os and beca use, gi ven the widespr ead prac ti c e of o utsour ci ng j ai l and pri son m ed ica l se rv ice s to p riv at e con tr ac to rs , it is c er ta in th a tth i s i ss u e wi l l r e c u r . We d o n o tc o n s i d e r wh a twe ha ve s ai d he r e to b e bindi ng, b utwe do wi sha ny futur e co ur t’ s ex pl o r at i o n o f th i s i ss ue to ta k e i nt o co nsi derat i on the ci rcum sta nces w e hav e hi gh l i ghted as r el ev an t to the s ta te
- ac to r de te r m i na ti o n.

F. O F F I CI AL P OLICY OR C US T OM C LAI MS The E st at e ha s su ed S he r i ffBo o k s, the k ee pero fthe j ai l, and tw o othe r offi ci al s of the j ai l ( Cap tai n R ogers , j ail c om m an d e r, an d L ieu te n an t C all, w ar d en ) in t h eir o ffi ci alc apa ci ti es , a l o ng w i thCM S a nd Oa k l awn, s ee k i ng to h old t hem l i abl e forcusto m s o r pol i ci es

— i nc l udi ng the f ai l ure to t ra i n thei r re specti ve sta ff s t o deal approp ri ate l y with m entali l l ness

— w hi ch the Estate bel i eve s co nt r ibut ed to Ri ce ’ s dea th

. T he Es ta te c i te s Bo o k s an d the j ai l f ora l aund ryl i st ofo m i ssi ons and fa il ures wh i ch it c on te n d s e v i n c es th e jail’s in d iffer en c e t o m en ta lly il l inm ates w ith self- d estru ctive ten d en cies. I n p articu lar, it crit ic iz es B ooks for (1) inad eq ua te training an d sup ervis ion of th e jail s t a f fge n er ally ; (2) n otad eq u at ely tr ain in g R og er s a n d C all a n d th e r e s t o f th e jail st aff in the a pp ro pri ate tr eat m ent o fm ental l y i l l inm at es ; ( 3) not ha ving ad eq ua te p oli cies i n p lace to de al w ith severe46 N os. 09

- 2804& 10

- 2389

m en tal i llne ss; (4) not ed uc ating R ogers as t o the j ail ’s sui ci de preve nti on pol i cy and no t ensuring that thi s pol i cy w as f ol l owed afte r R ice cut his neck ; ( 5) havi ng a pol i cy c on d itio n in g t h e t ra n sfe r of a n i n m a te to a p sy c h iat ric f aci l i ty on Oakl aw n’s approv al( w hi ch Ceni cer os rep eat
edl y r efus ed t o g i ve ) , a nd, kno wi ngo fRi ce ’ s co ndi ti o n, not exer ci si ng hi s o w n purport ed author i ty to tr ansfer Ric e t o such a f aci l i ty; ( 6) noten su ring co m pli ance with th e jail p olic y re q u irin g h ou rly ch ec ks on inm at e s in adm i ni str ati ve seg re gat i on, wh i ch the Es ta te al l ege s w er e no t m ade on the ni ght o fRi ce’ s death; and ( 7) i nadequate t ra i ni ng o fj ai l st affas to the u se o f fo rce o n m ental l y i l l i nm ate s, and/o r f aul ty pol i ci es as to the use of for c e o n su c h in m at es . A s t o C M S, w h ich w as res p on sibl e f o r the g en er almedi ca l c ar e o fthe j ai l ’ s i nm at es , the E st at e’ s th eo r y i s th ati na ct i o n o n the pa r t o fCM S’s n u rs in g sta ff at a m in im u m re flec ts a failu re to ad eq u at ely tr ai n i ts sta ffto pro perl y c ar e form ental l y i l l i nm ate s l i ke Ric e , i fn o ta p o l i c y a nd p r a c t i c e o fi g no r i ngthe me di cal ne ed s of su ch i nm ates. Th e E state rea s ons that Rice’s m en tal i llne s s w a s know n from the ou tset of his i nc arcer ati on, and by the c l ose o f20 03 h is ov er al l decl i ne was ap p arent i n h i s r efus alt o t ak e hi s m edi ca ti o n, wei g ht l o ss , r epe at ed st at e o fundr es s, and r ec o r ded o bs er va ti o ns th athe was ps y ch o ti c. Ye t, a cc o r di ngt o the Es ta te , the nur se s took no mean i ng fuls te ps to c o r r ec t Ri ce ’ s do wnwar d s piral

. The y r emai ne d pa ss i ve i n the e ns ui ng m o nths e ve n a s Ri ce ’ s phy si ca l a nd ment als ta tes c o nt i nue d t o de cl ine. B y w ayo fe xa m pl e, the Es ta te no te s th e l ack ofany affi rm ati ve e vi dence i n the j ai l ’ s s how erl og th atRi ce was s ho wer ed bet wee n Nov embe r 2 00 3 an dN os. 09

- 2804& 10

- 2389 47 A ugust 2 004, al ong w i th the nurse s’ purport ed f ai l ure to ta k e a p p r o p r i a t e s t e p s a ft e r R i c e c u t h i s n e c k wi th t he ra zor . Final l y, the E st ate co ntends thatOakl aw n to o i s r e s p o n s ib l e f o r R i c e ’ s d e mi s e th r o u g h th e a ct i o ns of Cen iceros, w hom i t ch aract er iz es as O aklaw n’s deci si onm ake r by vi rtue o fhi s unfett er ed dis cre ti on vi s- àvi s th e admi ss i o n o fi nm at es t o Oa klawn’ s f ac i l i ty
. The Estate al l ege s that Ceni cer os r eckl ess l y wrot e Ri ce o ffas a ma l i n g e r e r a n d r e fu s e d h i s a d mi s s i o n t o O a k l a wn i n Oc tobe r 2 00 4 des pi te hi s co l l ea g ue Ro hr er ’ s co nc lusi o n tha t Ri ce was in dan g ero fdy i ngfr o m mal no ur i sh

m ent a nd Dr. M athew’s consul tat i on w i th hi m as to th e po ss ibi l i tyo fps y ch i at r i c i nt er ve nt i o n. T he di str i ct c ourtf ound that the ev i dence d id not sup p ort the i m posi ti on o fm unici pal o r cor pora te l i ab i l i ty aga i ns t an y o fthe se de fen dan ts
. The c o ur t f o und that because the Sheriff was ent i tl ed gene ra l l y t o defe r to medi ca l pr o fes si o na l s as t o the a pp r o pr i at e tr ea tment of m ental l y i l l pri sone rs , ther e was nothi ng del iber ate l y ind i ffer ent about the j ai l ’ s pra cti ce o fl eaving to O aklaw n t h e d ecision w he th er or not to transfer a p arti cul ari nm ate to a f aci l i ty outsi de ofthe j ai l f ortr eat m ent. 20 09 W L 1 74 8 0 5 9 , a t* 1 8
. An d th e E s t a t e h a d c i t e d no au th or ity for its c o n te n tio n th at Sh er iff B oo ks co u ld h av e o rd er ed su c h a tr an sfe r on h is ow n . Id. As t o the ad eq ua cy of th e training an d sup ervision tha t the Sheriff ha d pr o vi ded to Ro g er s an d Ca l l a nd the r es t o fthe j ai l ’ s st aff, th e Est at e ha d no t sh o wn an y ca us all in k between the pu rpor ted def icienci es and any sho rt
com i ngs in the m edi caland psychol ogi c al car e pr ovi ded48 N os. 09

- 2804& 10

- 2389 to R ice
. Id. , at * 19. Books had in no w ay im p eded ori nter fer ed w i th Ri ce’ s t re atm ent b y the m edi cal profe s s i o na l s a nd w as en t i t l e d t o r e l y o n the m t o p r o v i de ad eq u at e c ar e t o R ice
. Id. F i na l l y, a ssum i ngtha t per so nnelh ad fa il ed to f ol l ow the j ai l ’ s s uic i de preve nti on p olic y a fte r R ice cu t h is n ec k, an d as su m in g t h at th is f ai l ure w as re fl ecti ve ofa pol i cy orprac ti ce r ather than be i ng a one- ti m e o m i ssi on, there w as no pro of th atthi s ha d a ny th i ngt o do wi thRi ce ’ s ev en tu alde ath: R ice d id n ot, a fte r all, co m m it s u icid e. Id. W i th r espect to CMS , the c o ur t s a w no e v i de nc e o f a c us tom o r p olic y re flec ti n g i n d iffer en c e t o th e n ee d s o f m en ta lly ill in m at es like R ice
. Id. , at* 20- * 21. CM S nurses had g e ne r a l l y s e e n Ri c e thr e e t i mes e v e ry d a ya nd h a d ma de effo rt s t o c ar e fo r h im
. Id. , at * 2 0 . D e c isions as to Rice’s p s y c h i a t r i c c a r e we r e r e s e r v e d t o R o h r e r a n d O a k l a wn pu rsua ntt o the c o nt r ac t be twe enCM S a nd Oa k l awn, and the r eco rd i nd i cate d that CM S p er sonnelr el i ed u p o n a n d c a r r i e d o u tR o h r e r ’ s i n s t r u c t i o n s a n d c o mm uni c a t e d wi th hi m r e g ul a r l y t o k e e p hi m a pp r i sed of R ice ’s c on d itio n . Id. F i n a l l y, t o th e e x t e n t th atthe nurses were re sp onsibl e forthe deci si on notto put Ri ce on s uic i de w atch fol l owing th e razori nci dent, ther e was no e vi dence thattheyexhibi ted del iber at e ind i ffer ence in m ak i n g t h at d ec isio n . Id. La st, a s to Oa k l awn, the cour t found the Estat e’s c l ai m defi ci ent in that i t was ba se d s o l el y on th e i ndi vi duala ct i o ns o fRo hr era nd C e n i c e r o s r a th e r th a n any c u s t o m o r p o l i c y o fO a k l a wn its elf. Id. , at* 21. Pri vate co rpor ati ons acting under c olo r ofst ate l aw m ay, l i ke m unici pal i ti es, be hel d l i ab le fori nj uri esN os. 09

- 2804& 10

- 2389 49

re su ltin g fro m th eir p olic ies an d p ra c tic es . M onell v. D ep’t o f So cia l Serv s. o

f C i ty o f N ew Yo rk, 43 6 U.S
. 65 8, 69 0- 91, 98 S. C t. 20 18 , 203 5-3 6 (1 97 8); Rodr iguez v. Ply m outh Am b ul anc eSe r v. , sup ra , 57 7 F
. 3d at 822 (M onell fra m e w o rk appli es to pri vate co rpor ati on a cti ng under co l oro fstate l a w) ( c i t i ng Jo h n s o n v. D o ssey, 515 F.3d 778 , 782 (7th C ir. 2008 ) )
. In or der t o re cove r aga i nst a m unici pal o r cor pora te defe nd an t u n der s ecti on 1 983, i t i s no t enough forthe pla i nti ffto s how thatan e m plo yee o f th e m uni ci pal i tyo r c o r po r at i o n v i o l at ed hi s co ns ti tu
tio n al rig h ts ; he m u st sh ow th at h is inj u ry w as th e re su lt ofthe m unici pal i ty’ s o r cor pora ti on’ s o ffi ci al poli cy or c u st om . SeePem baur v. C ity of Cincinnati, 47 5 U.S
. 469, 47 9- 80 , 106 S. C t. 12 9 2 , 1 29 8 (1 98 6) (p lu ra lity ); City of O klaho m a C ity v. Tuttl e, 47 1 U.S
. 80 8, 817, 10 5 S
. Ct. 24 27, 24 32 -33 (19 85 ); M onell, 43 6 U.S
. at69 0- 91, 98 S
. Ct. at20 35- 36. “[ M ]un ici p al l iab ili ty un d er § 1983 atta ch es w he re

— an d only w he re

— a del iber ate choi ce t o f ol l ow a co urse ofact i on i s m ade from am ong var i ous a l ternati ves” b y m u n icip al p olic ym ak er s. C ity o f C anton, O hio v. Harris , 48 9 U
. S. 3 78 , 3 89 , 1 09 S
. Ct
. 1 19 7, 1 20 5 ( 19 89 ) ( quo ting Pembaur, 47 5 U .S. at 48 3-8 4, 10 6 S. C t. at 13 00 -01 ) (p lu ra li ty) )
. A n offi ci alpol icy orcusto m m ay be e stabl i shed by me a ns o fa n e xp r e s s p o l i c y, a wi de s pr e a d p r a cti ce w h ich , alth ou g h u n w rit te n, i s s o e n tr en c h ed an d w ellk no wn as t o c ar r y the f o r ce o fpo l i cy, or th ro ug h the acti ons ofan ind i vi du alwh o posse sse s the autho rity t o m ake fi nal poli cy deci si ons on be hal fo fthe m unici pal i ty or co rp or at ion
. E.g
. , M ilesto ne v . C ityof M o nro e, Wis. , 66 5 F .3d 77 4, 78 0 ( 7 t h C i r . 2 01 1); Wat e rs v. Ci ty of Chi cago , 580 F.3 d 5 75, 58 1 ( 7th Ci r. 20 09)
. The pl ai nti ffm ust a l so50 N os. 09

- 2804& 10

- 2389 show a di re ct c ausalconnecti on be tw een the pol i cy or pract i ce a nd hi s inj ury, i n other w or ds that the pol i cy o r c us to m was the “ ‘ m o vingf o r ce [ be hi nd] the c o ns ti tu
ti onalvi ol ati on. ’ ” Harris , 489 U
. S. at 389, 109 S. C t. at 120 5 ( quoti ng M onell, 43 6 U. S
. at 69 4, 98 S
. Ct. at 20 38, and Po l k Co u n ty v . D ods on , sup ra , 45 4 U.S
. at32 6, 10 2 S
. Ct. at 4 5 4 )
. T h e f a i l u r e t o p r o v i de ad e q u a t e t r a i n i n gt o i t s e mp loy ee s m ay be a ba sis for im p os in g l iab ility on a m u n icipal i ty orpri vate co rp or ati on, but as w i th anyo ther p olic y or p ra c tic e fo r w h i c h t h e p lain tiff s ee ks to h old th e m un ici p al orcorp orate d efend an t li able, th e plaintiff m us t s ho w tha t th e f ai l ur e to t r ain r efl ec ts a c o ns ci o us ch oice am ong alternatives th at evinc es a d eliberat e ind if

fer ence to th e ri ghts ofthe i nd i vi du al s with w hom th os e e m p loy ee s w ill in te ra c t. Ib id

. W e a ffi rm the dist ri ct c ourt ’s j ud gm ent a s t o these claim s . T h e E state has n ot iden tified evid en ce su ffi ci en t f o r the f ac tfi nde r t o c o nc l ude tha t an y o fthe thre e s ets o fdefendants m ai n ta ined a pol i cy orcusto m ev in c in g d elib er at e in d iffer en c e t o th e n ee d s o fm en ta lly i l l pri sone rs thatr esul ted i n harm to Ri ce. Begi nning w i th S heri ffBook s a nd the j ai l superv i sor s, w e no te that m osto fthe er ro rs and om i ssi ons ci ted by the Esta te have to do w i th how R ice ’s m entali l l ness and the m ani fest ati ons ofthati l l ness w er e h an dle d by the j ailst aff

. The j ai l cer tai nl y has an obl i gat i on t o pr o vi de f o r the ps y ch i at r i c ca r e o fi ts i nm at es pur su an t to i ts c o ns ti tu ti o na l o bl i g at i o n t o a ddr es s t he i r s er i o us m ed ic a l ne ed s. See Sa nv ille v. M cC a ug htry, sup ra , 26 6 F
. 3d at 73 4; Wellm a n v . Fau lk ner, s upra , 7 15 F
. 2d at2 72
. ButtheN os. 09

- 2804& 10

- 2389 51 E state m akes n o all egat io n t ha t the j ailhad any sort o fp olic y or p ra c tic e t h at d ep riv ed inm at es of re as on ab le acc ess to m ed ica l a nd ps ych iatri c p rofessionals or interfer ed i n so m e wa y w i th the tr eat m ent pr escr ibed by th ose pro fess i onal s. The cl ose st to such an a l l ega ti on i s th e E sta te’ s char ge that the j ai l would not tr ansferan inm a t e to a psy ch iatri c facil ity w ithou t O aklaw n’s ap p ro va l an d th at Sh er iff B oo ks failed to ex er c ise h is own purport ed author i ty to tr ansferRi ce without s uch approval

. The E sta te’ s e xpert, Ken K ats ar i s, f or m er sher i ffo fLeon County, Fl or i da ( Tal l ahass ee) , o pined that Books had this author i ty and shoul d have e xerci sed it in R ice ’s c a s e . B u t a s t h e d ist ric t c ou rtn ot ed , j ail o ffi ci al s o r di na r i l y ar e en ti tl ed to defer to the j ud g m en t of m e d ica l p ro fes sio n als

. A rnett v . Webster, 65 8 F
. 3d 742, 75 5 (7 th C ir. 20 11 ); Johnson v. D ough ty, 43 3 F
. 3d 1001 , 10 10 (7t h C ir. 20 06 ); B row nell v . Figel , 95 0 F
. 2d 1285 , 12 91- 92 ( 7th Ci r . 1 99 1)
. Ce r ta i nl y j ai l o ffi ci al s m ayno t turn a bl i nd ey e t o an i nm ate i n dis tr ess o r to obvi ous incom pete nc e o n the par t o fthe phy si ci an s an d nur se s tr ea ting its inm at es . S ee A rn et t, 65 8 F
. 3d at 755- 56. H ow ever, alt h ou gh it ca n n otbe d en ied th at R ice f a r e d p oo rly wi th i n the c o nfi ne s o fthe jai l, no e vi den ce c i te d t o us w oul d perm i t a f actfin d er to co ncl ud e that Boo ks, Roger s, or C al l sho uld have se cond-guesse d the j ud gm ent o fDrs. Rohr ero r C eni cer os orany othe r m edi cal pr o fes si o na l a s to ho w Ri ce s ho ul d b e t re at ed an d s o ug ht car e forhi m el se w h er e. The Estat e, i n br oad st ro kes , cr i ti ci ze s th e tr aini ngof jai l s ta ffg en er al l y a nd th eir training in th e han d ling ofm e nt all y i llprison ers i n p ar ticular, but has no t e xplai ned how any parti cul ar52 N os. 09

- 2804& 10

- 2389

om iss ion in t h eir tra in in g h ar m ed R ice . I ts o n ly sp ec ific con ten tion is th at p erson ne l d id not fol low th e jail’ s sui ci de preven tio n pol i cy afterRi ce c ut hi s nec k with a r azo r. But ther e a re m ult i ple and o b vious fl aw s with thi s the o r y : ( 1 ) the Es t a t e do e s no t c o me t o g r i ps w i th th e f ac t t ha t a CM S nur se , Hes s, c o nc l ude d a fte r l o o k i ng i nto the inci dent th at it was not, i n f act, a sui ci de att e mpt

— a vie w shar ed by the physi ci an wh o saw Rice at Goshen General H ospi tal ; ( 2) ev en as sum i ng i t was a su i ci de at te m pt, no s ho wi ngha s be enm ad e t hat th e f ai l ure to f ol l ow the s u icid e pr eve nti on pol i cy w as som eth i ngo th er th ana n abe r r at i o n; ( 3) Ri ce ’ s su bs eque nt death, as th e di str i ct c ourtr i ghtl y e m phasi zed, was n otth e re s u l t o fsu icid e b u t ra th er as th e re su lt of h is psychog eni c pol ydi psi a; and ( 4) as sum i ng, as the Estate ev id en tly d o e s , t h at p lac in g R ice on su icid e w at c h w ou ld have m ade i t m or e l i kel y that hi s co m pu l si ve w ate r dri nki ng and i ts l ethaleffects would h av e been disc ove re d by j ai l per sonn el in ti m e t o save hi s l i fe, th e E s t a t e d oe s n otex p lain w h y t h e jail sh ou ld be h eld l i abl e forthe f ai l ure to fo l l ow a pol i cy that i s a i m ed at a d an ge r alt og et h er d ist in c t from th e on e t h a t a c tu ally ki l l ed R ice. The st aff’ s a l l ege d fa i l ure to conduct the r equi si te hourl y c hecks o fthe adm i ni str ati ve seg re gat i on un i t o n the ni ght Ri ce di ed ar guabl y has a m o r e di r ec t an d f o r es ee abl e co nne ct i o n t o hi s dea th, as su mi n g th a t s u c h c h e c k s a r e d e s i g n e d t o d e t e c tt he ver y s or t o f sud den and un expected o ccurr ence that ki l l ed Ri ce. But as w i th the f ailu re to o bser ve the di ctat es ofth e s ui c i de p r e v e nt i o n po l i c y, the Es t a t e h a s ma de no a tt empt t o a r g ue th at th e f ai l ur e to c o nduc t th eN os. 09

- 2804& 10

- 2389 53 hourl y c hecks o n the ni ght o f R i ce’ s death w as a co m m on and know n pract i ce at the j ai l ra ther than an isolat ed oc c u rre n c e. C

f. Wo o dw a rd v . Co rrectio na l M ed. Serv s of Ill., Inc. , 36 8 F
. 3d 917, 92 9 ( 7th Ci r. 20 04) (ev idence that CM S knew ofand condoned vi ol ati ons ofi ts w ri tte n p oli cies sup p orted i m p ositi o n of corp orate li abili ty). Finally, althou gh the E state c o m p lai ns that staff m embe r s wer e no t g i ve n a dequate i ns truct i o n a s to the p ro p er u se of forc e a ga in st m en ta lly ill pr iso n er s, it offe rs n o d et ail a s t o w h at sp ec ifica lly w as lac kin g in thei r tr ai ni ng and how bette r tr ai ni ng would have alte re d thei r conduct w hen Ri ce fought w i th hi s ce l l m ate o r when he r efus ed to r emov e hi m se l f from a r es tr aint ch air, for exa m p le. W e said earlier th at th e E state ’s cus to m o r pr acti ce a l l eg at i o ns a g ains t Bo o k s an d the j ai l am ounted to a lau nd ryl i st, and w e r ei ter ate that p oint he re: T he E state ha s m ad e a series ofc o n c lusory al l eg at i o ns wi th o uti n mos t instanc es makinge ve n a rudi m entary at tem pt to i denti fy a pol i cy orprac ti ce w hi ch w as the m oving f or ce b etwe en a const i tuti onal ha r m t ha tR i c e s uffe r e d. The case ag ai nst CM S f ar es l i ttl e b et ter. CM S’ s nurs es w er e a rguabl y b estsi tuate d to obs er ve Ric e’ s decl i ne not on ly b ec au se th ey sa w h im on a d aily ba sis , kn ew of h is d iag n os is, an d w itn es se d first h an d h is fre q u en t r e fu s als to be m edi cate d, to co m m unica te, and to ea t, but al so because as m edi calpro fess ion als they l i kel y would have ap p reciated the c onn ection betw een those beh aviors and Rice ’ s schi zophre ni a as w el l as the potenti alr am i fi cati ons ofhi s s ecl usi on, l ack ofse l f

- car e, and w ei ght l oss . The re cor d does no t s ugges t, as th e E sta te at poi nts doe s,54 N os. 09

- 2804& 10

- 2389 th at th e n u rs es sim p ly th re w u p th e i r h an d s w h ile Ric e ’ s he a l th de c l i ne d. Th e y di d mak e r e g ul a r e ff o r ts to convi nce hi m to e at and to tak e hi s pre scr ibed m edi catio n s; an d so far a s t h e re c or d r ev ea ls, th ey fait h fu lly rep orted his c ond iti on to th e ph ysicians w ho w ere charg ed w i th o ver see i ng hi s ca re. T h e Estate m ay have a poi nt wh en the y a sse rtthatthe n u rs es coul d have d one m o r e to ensu re that Rice w as clean ed up m ore re gul ar l y than the re cor d i nd i cate s that he w as. But eve n if w e a ss u m e t h at th e n u rs in g s ta fff a i l ed R ice in t h is or other r esp ects , the E state , beyon d criti cizing the suffi cienc y of th eir training, has on ce a g a in m ad e no effort to i denti fy a pol i cy orprac ti ce that would s up porta fin d ing that CM S i tse l fwas del iber ate l y ind i ffer ent t o th e pl i g hto fment al l y i l l pr i so ne r s l i k e Ri ce . Ins o f ara s th e nurses , to o, ar e cr i ti ci zed f orthe re sp on se to the ra zor i nc id en t, we re peat the poi nt thatther e i s no ev i dence l i nki ng thi s o ne i nci dent to s om e br oaderpol i cy or p ractice of CM S. As f o r Oa k l awn, the di st r i ctc o ur t r i g ht l y po i nt ed o ut that the Est ate ’ s cl ai m r est s e nti re l y o n the acts o f R ohr erand Cenic er os as opposed to so m e pol i cy or c u st om at tr ibu ta b le t o t h e h o s p ita l. T h e a c ts of an ind ivi du alwith pol i cym aking autho ri ty can be at tr ibuted to th e c or p or at ion th at em p loy s h im , Pemb a ur, 475 U
. S. at 480, 10 6 S
. Ct. at12 98- 99, and thi s i s the the or y that the Esta te press es on a pp ea l

. Ceni cer os, i t a rgues, had fi nal sa y o n w hetheran inm ate l i ke Ric e coul d be ad m itt ed to O ak law n, an d th u s h e w as a p olic ym ak er in th atr es pec t. Thi s is th e ex te nto fi ts abb r ev i at ed ar g um ent. The di str i ct c ourtdi d not ad dress thi s theor y in i tsN os. 09

- 2804& 10

- 2389 55 thor ough deci si on, and f orgood reas on: Itwas not ar gued b elo w . W e hav e r evi ew ed the w ri tte n m em or andu m that the Esta te subm itt ed in o pp osi ti on t o the defendants’ m o ti o ns f o r s um m ary j udg m en t, R. 2 76 , a nd a l so the tran script of th e oral argu m en t th at th e d istri ct cou rt he l d o n tho se mot i o ns , R
. 3 49, a nd no wher e di d we fi nd any a rgum ent, l et al one a deve l oped one, m ak in g a case that Cenice ro s s houl d be t re ate d as a pol i cym ake r f or O a k l a wn . E v e n i n t hi s c o u r t, th e a r g u me n ti s s o s u mm ar i l y m ade thatOakl aw n has ne i thernoti ced norr es po nd e d t o i t
. We the r e f o r e de e m t he argum e ntf o r fe i t e d, an d b ec au se thi s i s no t th e ex tr ao r dinaryc as e th atmight w ar rant o verlo ok in g t h e fo rfe itu re , see Shla hti ch m a n v . 1-800 C ontacts, Inc. , 61 5 F.3d 79 4, 80 3 (7th C ir. 20 10 ), w e w i ll not add re ss i t.

G. D EL I BE RA T E I NDIFF ERENCE OF J AI L O F F I CI ALS T he Es tate as serts th at tw o gro u p s of j ailpers onn el are l i ab l e f o r R i ce’ s de a th. T he s e i nc l ud e f o uro fthe g ua r ds w ho w ere on d ut y the night th a t R ic e d ied (officers S he l to n, S co tt Ei se nho ur, Ki m be r l y Ba xt er, a nd S amantha W er th ) as w ell as B oo ks , Ro ge rs , a n d C all, th is t im e in their i nd i vi du alcapaci ti es. The Estat e’ s theor y i s that the e nti re st affo fthe j ai l, from superv i sor s t o guar ds, w as aw ar e t h at R ice w as se ve re ly m e n t a l l y ill. E ve n if j ail p er so nne l wer e una war e o fthe po ss ibi l i tytha t he m i ght di e fro m water tox icity br ought on byco m pu l si ve w ate r dri nki ng, the Estate r eas ons, ther e we re fi ftee n m onths ofwa rni ng si gns pr i orto hi s death that R ice could not care f o r h im self an d suffered from self

-56 N os. 09

- 2804& 10

- 2389 destr ucti ve tendenci es, and a j ury coul d find that sta ffm em ber s were subj ecti vel y a w ar e o fthe substa n ti al ri sk that Rice m i ght ha rm hi m sel ff atal l y in so m e way. T h at kn ow led ge , th e E st at e a rg u es , com p e l led th e jail defe nd ants t o kee p Rice under cl ose watch i n or der t o preve nt hi m fro m hurting hi m sel f

. Cert ai nl y o nce Ri ce ha d c uthi s th r o at wi ththe r az o r i n Aug us t 20 04, he shoul d hav e been tr eat ed as a s uic i de ri sk, the Estate r e a s o ns : “ Ha d D e fe nd a nt s f o l l o we d the i r o wn s ui c i de preve nti on pol i ci es, the l i kel i hood o fN i chol as’ s death w oul d have be en gr eat l y di m i ni shed orpre vente d.” Estat e Br. 45
. Instea d, they ign or ed the ri sk, and thus incre ase d th e o dds that Ri ce mighti nj ur e hi m se l ft o the po i nt o fde a th b e f o r e a ny o ne c o ul d i nt e r v e ne . And the g ua r ds on d u ty t h e n igh t R ice d ied alleg ed ly d id n otco m p ly wi ththe j ail ’s s ta ndi ngr ul e th ati nm at es ho us ed i n the ad m in ist ra tiv e s eg re ga tio n u n it b e c h ec ke d u p on h ou rly and did not re spond to th e door

- ki cki ng o fi nm ate s w ho hea rd Ri ce’ s di str ess . T he di str i ct c ourtr ej ecte d the del iber ate i nd i ffer ence c laim s a ga in st th es e d efe n d an ts on th e g ro u n d th at j ail staff, even if th ey d id ap p reciate th e gravity of R ic e’s m en ta l i l l ne ss , ha d no war ni ngtha t Ri ce might ex p er ien c e t h e p sy c h og en ic p oly d ip sia th at ca u se d h is de a th. W i th r e s pe c t t o the g ua r ds , the c o urt a s s ume d, consi st en t with i nm ate S haw ’ s a ffi davi t, thattheyhad not m ade hour l y c hecks o fthe adm i ni str ati ve seg re gat i on unito n the ni ght Ri ce di ed. 20 09 W L 1748059 , a t *5 , * 22. St i l l, the court b elieved thatthe guar ds coul d not be ch ar ac te r i ze d a s d el ibe r at ely i ndi ffer en t to Ri ce ’ s pl i g ht bec au se th ere w as no eviden ce th at th ose gu a r d s in par-N os. 09

- 2804& 10

- 2389 57 ti cul arknew ofhi s s er i ous m ed ica l co nd i ti on a nd , ev en i f they did, they coul d no t have f or ese en hi s death fr om w ate r i ntoxi cation
. Id., at* 22. A nd as sum i ng tha t o ther in m at es in t h e u n it w ith R ice h ad ind ee d k i c ke d th eir door s when they hear d R i ce in dis tr ess , the evi dence di d no t su g g es t th atthe i r entr ea ti es i nc l ude d a ny w ar ni ng tha t Ri ce w as i n extr em i s a nd needed m edi cal at te n tio n . Id. In s ho r t, the g ua r ds wer e no t al er te d t o the need to r egul ar l y m on ito r Ric e t o preve nt an occur re nce of t h e k in d t h a t r es u lte d in h is d ea th

. Id. A s forBook s, R oger s , a nd Ca ll, the cou rt agreed that they w ere aw are ofRi ce’ s m edi calco nd i ti on . Id., at * 23. Bu t the y w ere entit led t o re l y o n the expert i se ofm edi calper sonnelas to the a pp ro pri ate car e o fRi ce, and t h ey gr anted Ri ce acce ss to m edi caltr eat m ent, di d not inter fer e with sai d tre atm ent, and did n ot w i thhol d rel evantinfo rm atio n from th e m ed ica l p ro fes si o n als

. Id. The r e was no evi dence thatj ai l m anage rs sho u ld h ave questi oned th e j ud gm en t of th ose p r o fe ssionals, esp eciall y w he re m edi calper sonnelhad acce ss to m edi calr ec ords that j ai l o ffi ci al s them sel ve s w er e forbi dd en under federa l law from se ein g. Id. A lthou gh w e d o not c onc ur w ith th e d istri ct cou rt’s r ea so ni ngi n a l l re spe ct s, w e no ne th el es s co nc l ude tha t th e dist ri ct c ourtco rr ectly g ra nted sum m ar y j ud gm ent t o th es e defen dan ts
. A fact fi nde rmightc o nc l ude tha t th e guar ds exhibi ted a gener al i zed r eckl ess ness w i th r espect to the s afetyo fthe i nm at es h ou sed o n W ar d On e by f ai l i ng to co nd uct hour l y ch ec ks ofthe adm i ni str ati ve se gre g at i o n un i t. Butthe r e i s no e vi den ce tha t th e guar ds w er e s ubj ecti vel y a w ar e o fthe possibi l i ty that58 N os. 09

- 2804& 10

- 2389 Ric e m i ght e ngage i n a b ehavior su ch as com pu l si ve w aterdr i nk i ngtha t woul d c au se hi m t o di e wi th i n a m att ero fhour s a n d thattheyco nsci ousl y di sr ega rded th at risk. N or i s the re eviden c e t h a t th e j ail ’s sup erv i s o r s we r e a wa r e o f s uc h a po s s ib i l i t y . On thi s r eco rd , a f actfi nd erco uld not r ea so nabl y c oncl ud e that a ny o f th e jail p er so n n el w er e d elib er at ely ind iffer en t t o th is sor t o fr i sk. A read ing of t h e r ecord f avorab le to th e E state certai nl y would s up porta fi nd i ng tha t the guar ds f ai l ed to conduct hourly c hecks o fthe adm i ni str ati ve seg rega tion uni t o n the ni gh t o fRi ce ’ s dea th

. Inm at e S ha w, who w as ho us ed i n th e cellnex t to Rice’s, averre d i n h is affi dav i t th ato ve r the c o ur se o fmul ti pl e ho ur s dur i ng wh i c h R i c e c o u l d b e h e a r d v o mi t i n g, n o g u a r d c a me to c he cko n inm at es i n the uni t, ev ena fte r S ha w and othe r i nm ate s be gan m ule

- ki cki ng the i r door s i n an unsuccess ful eff or t t o gain the guar ds’ att enti on. A l though the nam ed guar ds and the j ai li nsi st th at h ourly c hecks on th e u n it w er e m ad e, an d th at n ot h in g ou t o f th e o rd inarywas apparent, S h aw ’s affi davi t i s e nough to cr eat e a f actualdi spute o n thi s point, as the guar ds’ counsel rig h t l y co n c ed es . P a yn e v. P a uley, 33 7 F
. 3d 767, 77 2- 73 ( 7th Ci r. 20 03)
. I fn o c hecks were m ade, a f actfi nd er cer tai nl y c oul d concl ud e that the guar ds w ho w er e r equi r ed to make tho se c he ck s wer e i ndi ffer en t to the concerns underl yi ng the r ule m andati ng tho se checks

. Sur pri si ngl y, noto nl y do the b ri ef s f ai l to di scuss the p ur po s e a nd n a t ur e o fthe j a i l ’ s a dmi ni s t r a t i v e se gre gat i o n un i ta nd the ty pe s o fi nma t e s wh o a r e p l acedN os. 09

- 2804& 10

- 2389 59 i n tha t uni t, the y a l so o m i t an y di sc us si o n o fthe r eas o ns f orthe hourl y c heck rul e. A dm i ni str ati ve seg re gat i on i s o ften used to i sol ate fro m the gener alpopula ti on o f the pr i son i nm ate s who ei therpose a danger to othe r i nm a t e s o r wh o ma y b e e s pe c i a l l y v ulne r ab l e t o a s saul ts b y o the r i nma t e s . Bu twe do n o tkno w whe the r the a dm in ist ra tiv e s eg re ga tio n u n it in E lkh ar t’s c ou n ty j ail w as re gul ar l y use d (a nd w as k n ow n bythe guar ds to be used) as a pl ace to house pri sone rs wh o re quir ed f r eque nto bs er va ti o n b e ca use th ey w er e m ed ica lly fra gile orl i kel y t o harm them sel ves. Pro ofal ong th os e l i nes m i ght s up porta fin d in g that the guar ds appreci ate d th e r i skthe y wer e ta k i ngb y no t co ns ci en tious l y making th eir rou n d s. C

f. Arn ett v. Webster, sup ra , 6 58 F. 3d at 755 ( “Non

- m edi ca l defen dan ts s i m pl y c anno t i g no r e ani nm at e’s p ligh t.” ); Sa nv ille v. M cC a ug htry , sup ra , 26 6 F
. 3d at 739 ( “I fthe [ guar ds] w er e a w ar e o f t he al l ege d ri sk [ of s u i c i d e ] , f a i l i n g t o d e t e r mi n e wh a t wa s g o i n g o n i n [ th e i nm ate ’ s] ce l l co uld e asi l y b e co nd uct eg re gi ous t o ri se to the l evel o fdel iber ate i nd i ffer ence. ”)
. But no s uch evid en ce is ci ted to u s . R ice’s m en tal i llne ss ap p ears t o h a v e b e e n c o mmo n kn o wl e d g e a tt he j a i l, a n d s o we m ay assu m e f orthe sak e o far gum ent that e ach o f th e g ua r ds o n duty kne w ofhi s il lness. Yetthe r e i s no evi dence thatany ofthem , ev en i ftheywere aw ar e o f hi s fullhi sto ryat t h e j ai l ( i ncl ud i ng hi s wei ght l oss , i nabi l i ty to car e forhi m sel f, and fre q uent ca tat oni a) knew that he m ight engag e in behavi orl i ke com pu l si ve w ate r dri nki ng tha t co uld qui ckl y r esu l t in hi s death abs en t interven tion by th e j ailstaff.60 N os. 09

- 2804& 10

- 2389 The Es ta te ’ s r el i an ce o n the r az o r i nc i den t a s s uffi ci en t to p lace j ailsta ffo n n o tice of th e ri sk to Rice is un d erst an dab l e, a s t ha t i s th e o nl y pr i o r i nc i den t th atmight f al l i nto the c ate gory o fse l f

- des tr u cti ve behavi ornece ssi tat i ng im m edi ate i nter venti on. But the i nci dent w as i nvest i gat ed by nurse H ess and deem ed not to be a sui ci de att em pt. A s we have note d, her vi ew was shar ed by the physi ci an atGoshen Hospit alwh o tr eat ed Ri ce f o r h i s w o u n d

. And , ag a i n, R i c e u l t i ma t e l y d i d n o tc o mmi ts u i c i d e . R a th e r th a n d e l ib e r a t e l y h a r mi n gh i msel f, h e s uffe r e d a c o mpul s i o n t o dr i nke xc e s s i v e wa t er whi chr es ul te d i n a d rop in h i s bl o o d s o di um l ev el s an d a h e a r ta t t a c k

. Ca t e g o r i z i ngb o th i nc i de nt s a s ma ni f est ati o ns o f Ri ce ’ s se l f

- des truct i ve te nde nc i es , an d i ns i st i ng that the inci dent w i th the r azo r bl ade was enough t o m ak e t h e jail st a f fa w a re th at R ice m igh t h ar m h im se lf i nvol untari l y a nd i nadvert entl y, i gnor es the s ubstanti al di ffer en ce s be twe enthe t wo inc i den ts a nd the l ac ko fa ny w ar ni ng wh atsoe ver that Ri ce m i ght di e a s a r esul t o f a p h en om en on like p sy c h og en ic p oly d ip sia . So ev en if the gu ar ds re ckl ess l y f ai l ed to co nd uct hour l y c hecks as they w er e r equi re d to do, n o re aso nabl e f actfi nd er c ou ld fi n d t h at th ey kn ew of, an d w er e d elib er at ely i nd i ffer ent t o, a ri sk that Ric e m i ght c om e t o m edi cal harm l i ke car diacarr hythm i a br ought on bywater to x icit y w er e h e n otch ec ke d on reg u lar ly. Se eSt at eBank of St. C harle s v. C a m ic, 71 2 F
. 2d 1140 , 11 46 ( 7th Ci r. 19 83) ( eve n i fdefen dant pol i ce o ffi cer s di sr ega rded est abl i shed proc edures, such as co nd ucti ng hour l y c hecks o f detai nees, del iber ate i nd i ffer ence n ot sho w n i n abse nce ofev i de nc e tha tde fe nd a nt s we r e a c t ua l l y a wa r e thatN os. 09

- 2804& 10

- 2389 61 detai nee who ki l l ed hi m sel fwas a su icid e r i sk, and re asonab l e pr ecauti on s a gainst s uic i de had other w i se b ee n ta ke n ); see also Cagl ev. Su t he r l and, 334 F. 3d 980, 98 7- 88 (11 th C ir. 20 03 ) (p er cu ria m ) (fa ilu re to co n d u c t h ou rly che c k s o fde t a i ne e s a s r e qu i r e d b y p r i o r c o ns e ntde cre e i nsu ffi ci ent b y i tse l fto es tabl i sh del iber ate i nd i ffer ence to detai nee who com m i tte d sui ci de, absent e vi dence that defe nd a nt s h a d a c t ua l kno wl e dg e o fr i s ktha ta de t a i ne e w as like ly to c om m it su icid e); H ot tv. He nnepi n Coun ty, M i nn. , 260 F.3d 901 , 907 -0 8 ( 8 th Cir. 2001) (dep ut y’s al l ege d fa i l ure to conduct r equi si te hourl y c he c ks of speci alneeds sect i on o fdetent i on ce nterins u ffi ci ent t o sh o w d e l ib e r a t e i n d i ffe r e n c e t o n e e d s o fi n ma t e who kil led h im self, w he re eviden ce d id n ot show de p ut y’s awar en es s o fs ubs ta nt i alr i sktha t ani nm ate mi g ht c om m it s u icid e); Tim son v. Juvenil e & Jail Facility Mgm t. S e r vs . , Inc. , 35 5 F
. A pp ’ x 283 , 28 6 ( 11th Cir
. 20 09) ( per cu riam ) (non -prec ed en tia l d ecision) ( d eliberat e ind ifferen c e n otsh ow n d es p ite failu re of g u ar d s t o c h ec k jail in m at es ev er y t h irt y m in u te s a s re q u ire d by th e ir cor pora te em plo yer ’ s pol i cy, wh er e e vi dence di d not show guards had r eas on to be suspi ci ous th at i nm ate ha d suicid al tend en cies). Acce ptingthe Es ta te ’ s ve r si o n o fthe fact s a s true , the po ss ibi l i tytha t th e g ua r ds di d no t res p ond t o the kic kin g a n d sh ou tin g o fo t h er inm at es is p ar tic u lar ly di sturbing . W e do no t agree th ats i m pl y b ec au se the inm ate s di d no t so m eh o w expr es sly s i g na l tha t th ere w as a m edi calem er gency, t he guar ds w er e no t pl aced o n n o t i c e t h a ta n i n ma t e w a s i n me d i c a l d i s t r e s s . P r e s u mabl y that in form ati on would have bee n conve yed had62 N os. 09

- 2804& 10

- 2389

a nyg ua rd h e a r d the c o mm o t i o n a nd r e s po nd e d; an d m edi ca l di st r es s woul d be o ne po ss ibi l i tythat the i nm at es ’ ur g en t kicki ngwoul d c o nv ey . The who l e po i nt o f th e d o o r - k i c k i n g, o n e ma y i n fe r, wa s t o a l er t th e guar ds that so m ethi ng was am i ss and convi nce them to com e into the uni t s o that th ey c ou l d be t ol d j ust w ha t tha t w as. Either n one of th e nam ed guard s hea rd th e kick in g an d sh ou tin g, or on e or m or e o ft h e m d id heari t a nd si m plydi d not bo therto i nvest i gat e. N on et h ele ss th e r e a re atlea st tw o p ro b lem s w ith th is cl ai m tha t f o r ec l o se r el i eft o the E state
. F i r st, the r e i s no d i s c u s s i o n i n th e E s t a t e ’ s b r i e f a s t o wh i c h o ft he f o ur nam ed guar ds, i fany, would have been i n a pos i ti on t o h e a r th e d o o r - k i c k i n go fth e i n ma t e s o n Wa r d O n e . We know ver y l i ttl e about how the j ai l, and the adm i ni str ati ve s eg r eg at i o n un i t i n pa r ti cul ar, was moni to r ed i n the o ve r ni g htho ur s; n or do we kno w w he r e an y o fthe f o ur n am ed guar ds w as sta ti oned i n the j ai l o n the ni ght o f R ice’s deat h. W as th e j ailso sm allt h a t vigorous d oorkicking in W ard On e w ou ld h ave b e e n heard anyw he re on the pre m i ses ? Even i fnot, wou ld t h e a ssi gned ro und s o fa l l f o uro fthe n a med g ua r ds

— apartfro m c on d u c tin g h ou rly ch ec ks of W ar d O n e it se lf

— have at l ea stb r o ug htthe m w ithi n h ea r i ngr an g e o fthe a dm i ni st r at i ve segreg at i o n un i t ats o m e po i ntdur i ngthe hours i m m edi ate l y pr i orto Ri ce’ s death, such that th eywoul d h ave h ea r d the k i ck i ng ? S uchque st i o ns are left un ad d ressed by the brief s. Secon d , t h e Sheriff’s cou ns el, at oral argu m en t both before the d istri ct cou rt a n d th i s c o u r t, a n d wi th o u t c o n t r a d i c t i o n b y t he Est ate , not ed that the guard ( Bruno M ar ti nsky) wh o w asN os. 09

- 2804& 10

- 2389 63 sta ti oned i n the contr olr oo m ju st acr oss the hal l fro m th e a dm i ni str ati ve seg re gat i on uni t o n the ni ght o f Ric e’ s death

— an d w as th us i n a p ositi on to h ave h eard an y c o m m o ti o n o n W ar d One

— had been di sm i sse d fro m th e litig at ion by th e E st at e. See R. 34 9 a t 5 0. O u r d isc u ss i o n a s t o th e jail su p er vis or s (B oo ks , C all, Roger s) m ay be m uch m or e br i ef

. The E st ate does not co nt en d t hat an y o fthe se thr ee de fen dan ts was r es po nsibl e ( i n hi s ind i vi du alcapa c ity) f orthe f ai l ure to check on Ri ce the ni ght h e d ied

. I ts theo ryi nstea d i s that th ese d efend an ts w ere allaw are of R ice’s severe m en ta l i l l ne ss a nd hi s i nc r ea sing ly p i ti fulc o ndi ti o n a nd sh ou ld h av e, at th e le as t, ta ke n s t e p s to m on ito r h is c o nd i t i o n mor e c l o s e l y, a s b y p ut t i ng h i m o n s ui c i de wat ch, so th at hi s co m pul si ve wat er dr i nk i ng o n the ni g hto fh i s d e a th wo ul d n o th a v e g o ne u nn o t i c e d. W e h av e a l re ad y d isp os ed of th e n ot ion th at th e jail sh oul d have put Ri ce o n sui ci de w atch. I t a pp ear s that Ric e was put i n the adm in istr ati ve seg re gat i on uni t a t least in part to m onitor him m ore c lo s e ly, and w e are tol d that his a ss igned cel l ( 5A ) was the cel l m ost ea sily se en from th e c on tr ol roo m ac ro ss th e h all. It als o a p p ea rs t h a t as R ice ’s c on d itio n d et er iora te d , j ail adm i ni str ato rs m ade m or e o fan e ff or t t o kee p tr ack of h i s w e i g h t, s h o we r i n g, a n d so f o r th

. We ma y a s s u me tha tj a i l o ffi c i a l s , s ho r to ft r e a t i ngR i c e a s a s ui c i de ri sk, co uld have done m or e t o w atch R ice . (W e hav e al re ady o bser ved thata j ury coul d find j ai l per sonnel l i abl e fo r del iber ate i nd i ffer ence to hi s co nd i ti ons of confi nem ent. ) But w h at precl ud es the Esta te f ro m r eco ve r i nga g ains t th es e o ffi ci al s f o r R ice ’ s dea thi s th e64 N os. 09

- 2804& 10

- 2389 l a c ko fa nye v i de nc e tha tthe y we r e o n no t i ce o fthe ty pe ofr i sk that m ate ri al i zed wh en Ri ce unexpecte d l y b ega n to co n su m e e x c es s i v e a m ou n ts of w at er . Jail officia ls had no f or ew ar ni ng o fthatty p e of eve nt, o r ofthe ri sk tha th e mi g htdi e s ud de nl y wh e n i to c c ur r e d.

H. D EL I BE RA T E I NDIFF ERENCE OF C MS N UR SE S The Es ta te ’ s cl ai m s ag ains t th e i ndi vi dualnur se s who c a r e d f o r Rice at th e j ailf alli nt o three ca tegories: (1) a cl ai m b as ed o n the f ai l ur e to no te Ri ce ’ s d ist r es s o n the n igh t R ice d ied ; (2) a c laim ba s e d o n t h e in c id en t in w hi ch Ri ce was pepper- spray ed by a guard and then l eft f o r a pr o l o ng ed p er i o d i n the r es tr aintc ha i r ; a nd ( 3) a c l ai m bas ed on the adequacy ofthe car e Ri ce received from the n urs es over th e pe r io d o f his incarceration at the j ail. Th e claim as to the n ight of Rice’s d ea th i s focuse d on Lam bri ght. Because Lam bri ght was o n duty a t th e j ai l o n the n ighttha t Ri ce di ed, a nd because she w as aw ar e o fhi s co nd i ti on a nd hi sto ryat th e j ai l, the Es ta te a ppea r s to s ugg es t th atLa m br i g ht sh o ul d have b ee n c he ck i ngo n Ri ce he r se l fo ve r the c o ur s e o fthe e v e ning . R e l a t e dl y, the Es t a t e c o nt e nd s that Lam bri ght, be i ng aware ofthe ra zori nci dent, s ho ul d h a v e s e e n t o i ttha tR i c e wa s p l a c e d o n s ui c i de w atch , so that he w ou ld h a v e been m onitored m ore cl ose l y a nd so that the d i str ess associ ate d w i th hi s psyc hog en i c po l yd ipsi a woul d ha ve b ee n n o ti ce d. La m br i g ht is a lso cit ed for t h e re sp on s e to th e p ep p er -sp ra y in c iden t, a l o ngwi thBe l l

. The Es ta te ’ s co nt en ti on is tha t th e tw o nurses di spl aye d deliber ate i nd i fferen c e by notN os. 09

- 2804& 10

- 2389 65 doi ng m or e t o preve nt and /or r em edi ate the guar ds’ use o fpe ppers pr ayand b y l ea vingRi ce s ha ck l ed i n a re str ai nt chai r for ei ghtee n hours

. A s t o the t ota l i ty of Ric e’ s ca re atthe j ai l, H ess , L am b rig ht, Bel l, and J ones ar e na m ed al o ngwi thNurs e F l o renc e M ak o us k y a nd soc i alworke r M ar gar et M i l l er . The Estat e r eas ons that th eir d elib er at e in d iffer e n c e m ay be infe rre d from th eir al l ege d failu re to heed m ult i ple warni ng si gns that R ice’s m en tal i llne ss w as seve re and t o pu rsu e m ore proa cti ve i nter venti on r atherthan bl i nd l y defer ring to th e ph ysicians w hos e ow n con d uc t w as, in t he Es tate’s vie w , far t oo p as siv e. Se eBe r ry v . Pe t e r m an , 60 4 F
. 3d 435, 443 ( 7th Ci r. 20 10) ( a nurs e’ s deferen c e to physi ci an “m ay n otbe blin d or u n th in kin g , p a r tic u lar ly if it is ap p aren t tha t the p hy sician’s ord er w il l ha rm the p atient ”). T h e d i s t r i c tc o u r tga ve p r i ma r y e mph a s i s t o t wo p oints in r ej ectin g the Es tate’s claim against C M S’s nurses . Firs t, i t s tr ess ed that the nur ses were enti tl ed to defe r to the m edi calj ud gm ent o fOakl aw n, Ceni cer os, and Rohreras to th e ap propri ate tr eat m ent o fRi ce. 20 09 W L 1 7480 59, a t * 24
. S ec o nd, the c o ur t no te d tha t th e nursi ng st affvi si ted Ri ce m ult iple ti m es daily, m oni tor ed h i s wei ght, r egul ar l y m ade eff or ts to gethi m to ea t m o r e, a nd a l so e nc o uraged hi m t o t ak e th e m edi ca ti o ns p re sc rib ed by D r. R oh re r. Id. , a t * 24, * 26
. Al th ou gh the cour t a gr eed thatm or e co uld have b ee n done to m on ito r R ice ’s c on d itio n an d to tre at h i s i lln es s, it f ound the evi dence i nsuffi ci ent to supp or t an infer ence th at th e n urs es w ere d eliberat ely ind ifferent to R ice’s se riou s m ed ica l ne ed s. Id. , at* 26.66 N os. 09

- 2804& 10

- 2389 W e a gr ee w i th the di strict court that the r eco rd does not supp or t a fi nd i ng tha t an y ofthe CM S nurses i g no r ed a k no wn m edi ca l r i sk in c ar i ngf o r Ri ce . To begin w i th a poi nt we have m ade alr eady, Ri ce di ed not as a re sul t of any vol i ti onal sel f

- destr ucti ve tendenci es that w er e know n to the n u rs i ng st affbut ra therdue to a com pu l si on t o dri nk l ar ge am ounts ofwater that, so f ara s an yone knew, Ri ce had nev erexper i enced b efo re . M or eo ve r, as th e d ist ric t jud ge p o i n t e d ou t, d ec isi o ns a s to Ri ce ’ s tr ea tment

— i ncl ud i ng a deci si on t o m edi cate hi m ag ai nst hi s wil l, wh i ch m i ght ha ve re d u c ed th e like lih oo d of p sy c h og e n ic p oly d ip sia

— bel onge d to Ric e’ s physi ci ans r ather than hi s nurs es. N ur se La m br i g htwas o n duty the ni g ht R ice di ed, a nd th e Est at e appe ar s to f au l t he r f o r no t en su r i ngtha t he w as checke d on r egul ar l y a nd /o r f orf ail i ng to checko n Ric e her sel f

. But the E st ate poi nts us to no e vi dence that Lam bri ght was und eran obl i gat i on t o check on Ric e a nd the othe r i nm ate s in the adm i ni str ati ve seg r eg ati o n un i t ho ur l y, f o r e xa m pl e, no r do es i t ci te a ny evi d en c e that Lam bri ght was withi n hear i ng r ange of the uni t s uch that she would have h ea rd the ki cki ng o f the o theri nm ate s in that unit
. Insof aras i t m i ght ha ve be enwi th i n La m br i g ht ’ s pr o vinc e to admoni shthe guar ds to m ake thei r own hour l y c hecks o fW ar d On e, the no ti on th at she s houl d have e xerci sed thatautho ri ty i s p r e mi s e d o n L a mb r i g h t ’ s kn o wl e d g e o fth e i n c i den t i n whi ch R ic e ha d c uthi s ne ckwi ththe r az o r . Aga i n, how eve r, we rej ect the Esta te’ s co ntenti on that a n i nci den ttha tc o ul d h a v e b e e n un de r s t o o d a s a s ui c i de att em pt (a lthough CM S did notco nstr ue i t a s s uch) w asN os. 09

- 2804& 10

- 2389 67

A s the d istrict co u rt no ted , the E state d id no t effectiv ely 5 di s put e thi s f ac ti n r es pons e t o the defen dant s ’ s t at em en t ofm ater ial f act s below

. 2009 W L 1748059, at * 5 n. 4. su ffici en t to m ake L am b r ig h t or any oth er nu rse aw are th a t Ri c e wa s a t r i s k f o r a n e nt i r e l y di s t i nc t ha r m such as com pu l si ve w ate r dri nki ng. I t i s t rue that a nurs e m ay not unthinkingl y defer to p hy s ic ian s and i gn ore obvious ri sks to an i nm ate’s h e alt h, B erry, 6 0 4 F
. 3 d a t4 4 3 ; b u twi th o n e p o s s ib l e e xcepti on we m enti on be l ow (a nd wh i ch t h e Estate does no t pur su e) , the r e i s no ev ide nc e th ata ny nur se c o nsc iou sly d isr eg ar d ed R ice ’s s c h izo p h re n ia or its m an ifest ati ons. J ones ’ te sti m ony i nd ica te s that s he and her col l eagues s aw Ri ce three o r m or e t i m es d aily ( w hen they dist ributed pil l s a nd m ade thei r ro und s o fthe seg re ga tio n u n it), m on ito re d h is c on d itio n an d rep or te d it 5 to h is p h ys icia n s, at te m p te d to co n vin c e h im to ta ke h is m edi c a t i o ns , a nd t r i e d t o g e t hi m t o e a t mor e . They re double d thei r eff or ts i n the l att er r ega rd afterRi ce re turned t o the j ai l f ol l owing hi s br i efhos pit al i zati on at G osh en Ge ne ral H osp ital, w ith th e resu lt that R ice’s we i g htl o s s c e a s e d. W e h av e c on sid er ed w h e t h e r a fac tfin d er co u ld concl ud e that the nurse s were i nd i ffer ent t o th e s tat e o f Ric e’ s nutr i ti on, gi ven hi s wei ght l oss and the m i l d to m od erat e m alnu triti on d etec ted pos tm ortem
. Con trary to the defendant s, w e be l i eve thatRi ce’ s m al nutri ti on w oul d be a cti onabl e r ega rdl ess o fwh ether i t co ntributed to h is d ea th

. Se eFa r m e rv. Br e nna n , sup ra , 51 1 U .S. a t 8 32,68 N os. 09

- 2804& 10

- 2389 114 S. Ct. at19 76 ( ci ti ng pro vi si on o f“a dequ ate f oo d” as am on g p ris on offic ials ’ d u tie s); Wi l s on v. Seiter, sup ra , 50 1 U .S. at 3 03 , 111 S. C t. at 23 2 6

- 2 7 (c itin g foo d as a c on d itio n of co n fin em en t); Ree d v
. M cBr i de, 17 8 F
. 3d 849, 85 2, 853- 54 ( 7th Cir
. 1999 ) ( al l ege d depri vati on of f oo d st ate s Ei g hth Am en dm en t cl ai m depe ndi ngo n a m o unta nd d u ra tio n of d ep riv at ion ); Fre e m an v. Be rge, sup ra , 44 1 F.3 d at54 6 (p ri s o n h as d u ty to forc e-fe ed m en ta lly i l l p r i s o ne r i fn e c e s s a r y t o p r e v e nts t a r v a t i o n t o de g re e w hi ch m i ght s er i ously im pai r hi s hea l th)

. Per haps a f actfi nd erco uld fin d som e neg l i gence o n the part of th e nu rses in thi s rega rd , gi ven the ex ten t of R ice’s wei g htl o ss b efo r e hi s h ospi ta l i za ti o n a nd the i r e vi den t ab ility to h elp st op h is w eig h t los s a f t e r h e w as h os p ita li zed witho ut r eso rt i ng to extr aor dinar y m eas ures l i ke f or ced feedi ng. But w e see no e vi dence thatthe nurses ev er ign or ed t h e ris ks to R ice ’s h ea lth p os ed by h is failu re to ea t. T h ey w er e try in g to ge t Ric e to ea t w e ll before he w as ho sp it a li zed ; and i f th eir effor ts w ere m or e e ffecti ve after the ho spi tal i zati on, i t was not, so f ar as th e re c or d r ev ea ls, be c au se th ey w er e d elib er at ely ind ifferent to th e prob lem earli er. The i nd i vi du ali nci dents thatthe Estat e ci tes as ex ampl es o fi ndi ffer en ce b y the nur se s do no t al te r o ur con clusion th at th e nu rses w ere not d eliberat e ly i nd if

fer ent t o Ric e’ s con d ition. Fo r exam ple , i t f aul ts N urse s Lam bri ght a nd Bel l f orst andin g by wh i l e Offi cerS hel ton ord ered th at R ice be pep p er-spra yed fol low ing t h e alterc at ion w ith h is c ellm at e a n d t h en lea vin g R ice in the r est ra i nt chai r f orei ghtee n hours

. Thi s i s a n echo of th e E st at e’s ex c es siv e fo rc e c laim , an d it d o es n otca llN os. 09

- 2804& 10

- 2389 69 i nt o que s t i o n the nu r s e s ’ r e s po ns e t o R i c e ’ s me di c a l n e e ds (recalltha t th e nur se s he l ped cl ea ns e Ri ce ’ s f ac e o fthe peppe r s pr ay, a nd that R ice r efus ed to l ea ve the r es tr aint ch ai r wheni nv i te d t o do s o )
. The r az o r i nc i den t i s m en ti oned once ag ai n, but w e hav e al re ady address ed that. Final l y, N urse Bel l, as ev i denced by hero w n note s, once tol d Rice ( i n re sponse to his re fusalto ea t, ta ke hi s m edi cat ions, and com m unica te) that“a cti ng l i ke thi s won’tge t [ you] o ut o fj aill i ke bef or e. ” R. 19 8- 37 at 5. Bel l e vi den tly thoughttha t Ri ce was mal i ng er i ng, b ut sh e was no t al o ne i n tha t per ce pti o n, a nd e ve n i fs he was mis ta k en , the r emar kdo es no t su ppo r t th e co nc l usion th at s h e w a s d eliberat ely ind ifferent to R ice’s m en ta l he al tho r tha t sh e del ibe r at ely o r r ec k l essly wi th

he l d me di c a l c a r e tha tR i c e n e e de d. The r e ar g uabl y mightb e o ne r es pec t i n whi cha f actfi nd erm i ght c oncl ud e that the nurse s were del iber ate ly in d iffer ent, and that has t o do w i th the st ate o f Ric e’ s hyg i ene a nd se l f

- car e. W e no ted ea rl i erwith re spect to the c ondit i ons ofco nfinem ent claim ag ai nst the j a i l o ffi c i a l s a nd g ua r ds tha t the r e i s e v i de nc e t hat R i c e w e n tu n s h o we r e d f o r l o n ge n o u g h p e r i o d s o ft i me an d tha t hi s bo dy was v i sibl yfi l th y a nd s o mal o do rous th at oth er i nm ates co m p la in ed abou t the sm ell

. Th ere w as al so the one i nci dent i n w hi ch dead s kin sloughed offo f R ice’ s per son as guar ds l i fted hi m o ffhi s bunk. Bed sor es, o r the b eginnings o fsuch s or es, were al so note d on h is bod y at tim es . A s w e ha ve n ot ed , j a i l p e r s o n n el, i ncl ud i ng doctors and nurse s, have an obl i gat i on t o pr o te cta n inm at e fro m hi s o wn se l f

- des truct i ve t en d en c ies , in th is c as e R ice ’s fa ilu r e t o c l ea n h im se lf. A70 N os. 09

- 2804& 10

- 2389 f actfi nd erposs ibl y c oul d concl ud e that Ri c e’ s f ai l ure of se l f

- ca r e was a r es ul t o f hi s sc hi zo phr en i a an d th at the nur se s, who s aw Ri ce o n a da i l y b as i s when he was i n the admi ni st r at i ve s eg r eg at i o n un i t, a ppr ec i at ed as much. C e r t a i n l y th e r e i s e v i d e n c e th a tth e n u r s e s ma d e s o me eff o r ts t o a dd r es s th e pr o bl em: F o r e xa m pl e, J o ne s, the charg e nurs e, vo l unteer ed to co m e into the jail o n her o wn ti m e to s ho w er Ri ce . None th el es s, g i ve n the e v i dence tha tR i c e we ntu nb a the d fo r s i g ni fi c a ntp e r i o ds of t im e, w as d ev elo p in g b ed so r e s , an d h ad sk in slo ughi ng off hi s body w hen l i fted up off of hi s bed, i t is con ceivab le that a j ury w ou ld fi nd th a t t h e nu rsing staff ha d con s c iou sly disregard ed the con seq ue nc es of Rice’s f ai lu re t o car e forhi m sel fand thus depri ved hi m ( or he l p e d t o d e p r i v e h i m) o f h u ma n e c o n d i t i o n s o fc o nfi ne m en t. De pr i vingRi ce o fs an i ta r y c ond iti o ns o fc o nfi nem ent w oul d b e acti onabl e re gar dle ss ofwh ether th e d ep riv at ion p lay ed a ro le in h is d ea th

. Cf
. Vi n n i n g - El v. Lo ng, s u pra , 48 2 F
. 3d at 924 ( susta i ni ng vi abi l i ty of claim that i nm ate w as su bje c t e d to un san itary and otherw ise inh u m an e c on fin em en t fo r p er iod of th re e t o s ix d ays) (col l. cases). The Estate does notm ake such an a rg u m ent a s t o th e nur se s, ho wev er . W e th er efo r e pur su e th e i ss ue no furth er.

I. D EL I BE RA T E I NDIFF ERENCE OF D R . R OHRER The Estate co ntends thatDr. Rohr erknew that Ric e re q u ire d in p at ien t ps yc h iat ric c ar e an d w as d e l ibe ra te ly i nd i ffer ent t o Ric e’ s nee d fo r such car e in f ai l i ng toN os. 09

- 2804& 10

- 2389 71 obt ai n i t forhi m . Rohr erknew that Ric e’ s co nd i ti on w as dec l i ni ng : Hi s no te s r efl ec t hi s k no wl edg e o fRi ce’s w eig h t los s, R i c e’s refu sa l to t ak e h is m ed ica tio n s, h is unw i l l i ngness to com m unica te, and hi s o ther w i se psyc h ot ic b e h a v ior. O n th re e s ep ar at e o c c as ion s h e p et itio n ed for R ice ’s inv olu n ta ry c om m itm en t to a p sy c h iat ric f aci l i ty, o bser vi ng o n the thi rd o ccasi on in Octobe r 2004 that Ric e was i n peri l o fdyi ng. Y et , a fterDr. Ceni cer os atOa k l awn r eturned Ri ce t o the j ai l wi th i n t wenty - f o ur hou r s i n the fi r s tt wo i ns t a nc e s , c o nc l ud i ngtha tR i ce di d no t m ee t the c r i te r i a f o r inv o l unt ar y c o m m i tment and l i kel y was m al i nger i ng, Rohr ersi m p ly acceded to Cen i ce r o s’ a ss essm enta nd t o o kno fur th era ct i o n. In the th ird instan ce, Roh rer sough t Ri ce’s ad m issi on to a d if

fe r e ntf a c i l i t y ( El k ha r tGe ne r a l ) , wh i c h r e fus e d the a dm i ss i o n i n the mi s t a k e n b e l i e f tha t i t di d no t ha ve a contr act w i th the j ai l to tr eati nm ate s. R i ce was then t ake n to Goshen Hospit al, w h er e he w as decl ar ed m edi cal l y s tabl e a nd r etur ne d t o th e j ai l afterCeni cer os r efus ed hi s admi ss i o n t o Oa k l aw n. W he n, t wo months l ate r, Ri ce was f ound inco m petent to sta n d t ri al, he was d es ign at ed for a d m iss ion to L og an s p or t St at e H os p ita l, whi chpu t hi m o n a wai tingl i st
. In the v i ew o fo ne ofthe defe nse e xperts, D r. Dani elS cherb, ther e was a m er i to r i o us a r g um en t th atRo hr ers ho ul d ha ve c o nsi dered se curin g a c ourto rderautho ri zi ng Ri ce t o be f or cibl y m edi cate d and fe d by m ea n s of a feedi ng tube

. A l thou g h S c he rb di d no t b e l i e v e tha t Ri c e ’ s r e fus a l to eatand take m edi cati on f acto re d i nto hi s death, he a ckn ow led ge d th e p os sib ility th at h ad R ice be e n m ed ic at ed , he m igh t n oth av e e x p er ien c ed th e p sy c h o g e n ic72 N os. 09

- 2804& 10

- 2389 pol ydi psi a that ul ti m ate l y r esul ted i n hi s death. Estat e ex pe r t s o pi ne d mor e a ffi r mat i v e l y tha t ha d Ri c e bee n i nvol untari l y m ed i cate d, he would nothave di ed. Thus, i n the Estate ’ s v i ew , Rohr erm ay be found li able f or fa i l i ngt o pr es cr ibe a n e ffec ti ve c o ur se o ft r ea tment

— i nclu d in g invol untaryadm i ssi on t o a psyc hi atr i c f aci l i ty and/orf or ced m edi cati on

— to pr ev en t Ri ce ’ s dea th

. A s with the Estate ’ s cl ai m s a gains t the CM S nurses an d th e jail’s s ta ff, t h e d ist ric t c ou rtrejec te d th is c laim for w an t of p ro o f th at R ohrer w as d eliberat ely ind if

fe r e ntt o R i c e ’ s c o nd i t i o n. Ag a i n, the c o ur te mphasi zed th a tR i c e ’ s me di c a l n e e d s h a d n o tb e e n i g n o r e d

. 2 0 0 9 WL 1748 059, at * 26. Rohrer, l i ke the o therm edi caldefendants, w as aw ar e o fRi ce’s sc h izo phreni a a nd to ok ste ps to tr ea t it : H e v isit e d R ice reg u lar ly, m on ito re d h is c on d iti on be tw een v i si ts, pre scr ibed p sy chotr opi c m edi catio n su bj ec t t o R ice ’ s w illing n es s t o t ak e it, an d p et iti oned f orhi s co m m i tm ent t o i npat ient f aci l i ti es on three se p ar at e o c c as ion s. Id. , at* 25. A l though Rohr ersa w Ric e o nl y o nce i n l ate 20 04 f ol l owing Ric e’ s return t o the j a i l fr o m Go s he n Ho s pi t a l, h e di d ins t r uc tthe n urse s t o a s kR i c e we e k l y wh e the rh e woul d r e s ume h i s me di ca ti o n s ; h e kn e w th a tR i c e wa s e a t i n gs o me f o o d ; a nd the Esta te prese nted no e vidence that a ny par ti cul ar p sy c h iat ric ca re , oth er th an forc ed m ed ica tio n, w ou ld h av e im p ro ve d h is m ed ica l c o n d itio n . Id. S ec o nd, the cour t pointed out that Ric e e njoye d b oth a r i ght under I nd i ana s tatutor y l aw to re fuse m edi caltr eat m ent a s wel l a s a si g ni fi ca ntl ibe r tyi nt er es t r ec o g ni ze d b y the S upr eme Co ur t i n Wa shin gto n v . Ha rper, s upra , 494 U
. S. 21 0, 11 0 S . C t. 10 28 , in av oid in g u n w a n t e d an ti-p sy c h ot icN os. 09

- 2804& 10

- 2389 73 d ru gs . Id. Ri ce c o ul d no t be f orcibl y medi ca te d wi th o ut aff o r di nghi m pr o cedu r alpr o te ct i o ns , whi cha m o ng othe r thi ngs e ntaile d a pro ofo fan o ver ri ding j usti fi cati o n f o ri nv o l unt ar y medi ca ti o n a l o ngwi tha fi nd in g th at th e d ru g s w er e m ed ica lly ap p ro p ria te
. Id. W here , as in t h is c as e, a d oc to r’s ob liga ti o n t o a d d re ss h is pat i en t’ s se r i o us medi ca l ne eds c o nfl i ct s wi ththe pati ent’ s r i ght t o re fuse t re atm ent, the properr eso l uti on ofthe co nfl i ct i m pli cate s the physi ci an’ s m edi calj ud gm en t. Id. , at *2 5-*2 6. T h ird , bec au se R ice h ad n otex p er ie n c e d c o mpu l s i v e wa t e r d r i n k i n g p r i o r t o th e n i g ht he die d, hi s death as a r esul t o fpsycho geni c polyd ip sia, hyponatr em i a, and card i ac a rrhythm i a was notr easo n ab ly for es ee ab le t o R oh re r. Id. , at * 26. Fin ally, assu m ing, con sisten t w ith th e c r iticism s of R ice’s care ex p re ss ed by th e E st at e’s ex p er ts , th at R o h r er co u ld ha ve d one m ore t o trea t Rice’s sch izoph renia, a j ury sti l l l acke d any ba si s o n w hi ch to fi nd thatRohr er was g ui l tyo fde l ibe r at e i ndi ffer en ce t o Ri ce ’ s ser i o us m ed ica l ne ed s. Id. W e view i t a s a som ew ha t closer qu estion th an others w h et h er R oh re r w as en tit led to su m m ar y ju d g m e n t. In re sol vi ng the cl ai m s a gainst the j ai l st aff, we have st r es se d th at th ey co ul d j us ti fi ab l y r ely o n th e j ud g m en t of t h e m ed ica l p ro f es sio n als , an d w e h av e s im ilar ly o bs er ve d tha t th e nur ses w er e en ti tl ed to r ely o n the j ud gm ent of the physi ci ans. Rohrer w as the m edi cal pr o fes si o na l who was r es po ns ibl e f o r makingde ci si o ns as t o ho w R ice’s schi zo phr en i a sh o ul d b e tr ea te d. To the extent th at R i ce’ s co nd i ti on dem anded i npati ent c ar e, f o r ce d m edi cati o n, o r f o r ce d nut r i ti o n, Ro hr erwas the74 N os. 09

- 2804& 10

- 2389 p hy sician in a position t o p u r su e suc h ca re on R ice’s b e ha l f

. In f a c t, R o hr e r di d s e e kR i c e ’ s i nv o l un tar y a dm i ssi on t o Oakl aw n f orse vent y- tw o hours f orf or ced m ed ica tio n as w ell as ob se rv at i o n o n tw o oc c as ion s, on ly to ha ve Ce ni ce r o s con cl ude tha t Ri ce was mal i ng er i ng an d o r derhi m r etur ne d t o the j ailwi th i n t wenty - f o ur hours. Yet, i t i s undis pu ted thatRohr erhad the abi l i ty to have Ric e a dm i tte d to anothe r f aci l i ty, wh i ch i s what he t r ie d t o do in O ctob er 2004, only to run i nt o Elkh art Ge ne r a l ’ s mi s t a k e n b e l i e ftha ti th a d n o c o nt r a c twi th t h e j a i l a n d C e n i c e r o s ’ r e fu s a l t o a d mi th i m a tO a k l a wn wh e n D r . Ma th e w e xp l o r e d th a tp o s s ib i l i t y w i th h i m. Th e Es t a t e c o nt e nd s tha th a d R o hr er soug htR i c e ’ s a dm i ssi on t o anothe r f aci l i ty soonerthan he di d, oral ternativ ely so u gh t a u th or ity to m ed ica te R ice inv olu n t ar ily a tthe j a i l ( a s s umi ngtha twa s p o s s ib l e) , thenthe o dds o fRi ce e ng ag i ngi n c o m pul si ve wat erd rink i ng, a nd e xperien ci ng the f atalco m pli cati ons ofthatpol ydi psi a, m i ght ha ve been re du ced, as Dr. S cherb the or i zed. Granti ng i t the be nefi t o ftho se i nfe re nces, the Es tat e has sh o wn a p la us ibl e ne xus b etwee n Ro hr er ’ s tr ea tment dec i si o ns a nd Ri ce ’ s dea th

. Butul ti m atel y we a g r ee wi ththe di st r i ctc o ur t th atthe Est at e ha s m ade a t m o sta c ase f o r ne g l i g en ce o n the part ofDr. Rohr er . On thi s r eco rd, no reaso nabl e f actfi nde r c o ul d c ha r ac te r i ze Ro hr er ’ s tr ea tmentde ci si o ns as b eingde liber at ely i ndi ffer en t to Ri ce ’ s se r i o us m e d i c a l n e e d s , o r, p u ta n o th e r wa y, th a th i s d e ci si o ns re prese nted “ ‘ such a substa nti aldepartur e from acc e pt e d p r o fe s s i o na l j ud g men t, p r a c t i c e , o r s t a nd a r ds as t o de m o ns tr at e th at [he] a ctua l l y di d no t ba se theN os. 09

- 2804& 10

- 2389 75 deci si on[ s] o n such a j ud gm ent. ’ ” C o llig no n v . M ilw a uk ee C ounty, sup ra , 163 F. 3d at 989 ( quoti ng Yo un gb erg v. Ro m eo , sup ra , 457U .S. a t 32 3, 10 2 S . C t. at 24 62 ); s e eal s o i d. at98 8- 89 ( di sc us singpr o fes si o na l j udg m en t st an d ar d a s a va r i an t of Eighth A m en d m en t d elib erate ind ifferenc e stan d ard an d noting th ere is lit t le differenc e betw een the tw o). A s the district cou rt ri g h t ly n oted , Rice ha d a statu tory and a co nsti tuti onalr i ght, pro vi ded he di d not pos e a danger to hi m sel fo r othe rs , to r efuse the ve rym edi catio n s t h at m igh t h a ve m itig at ed th e s ym p to m s o f h is sc h izo p h re n ia a n d les se n e d t h e od d s o f h im ex p er ien c in g ps yc h og en ic p oly d ip sia
. See Ha rper, 494 U.S
. at22 1- 22, 11 0 S
. Ct. at 1036

- 37 ( 1990 ) ; Ind

. S tat
. 12

- 27- 5- 1, 12

- 27- 5- 2 (fo rm er ly In d . Sta t. 16 -14 -1.6 -7); In re M ent al Co m m it

me n to f M. P. , 5 1 0 N .E .2 d 64 5, 64 7-4 8 (In d . 198 7); see also Sa nv ille v. M cC a ug htry, s up ra , 26 6 F
. 3d at 736. Rohr er w as aw ar e that Ric e’ s unw i l l i ngness to tak e hi s pre scr ibed an ti-p sy c h ot ic m ed ica tio n s w as ad ve rs ely affe c tin g h is m en tala nd phy si ca l he al th, a nd f o r tha t ve r y r ea so n h e d id try , onth re e s ep ar at e o c c as ion s, to h av e R ice inv oluntari l y c om m i tte d fo r tr eat m ent. But as it turned o ut, Rohrer ’ s col l eague, Cenice ro s, concl ud ed that Ric e w as n otp sy c h ot ic a n d l i ke ly m alin ge rin g a n d h ad h im r et ur n e d t o th e j a i l o n th e fi r s t t wo o c c a s i o n s a nd re fused hi s ad m issi on o utri ght in the thi rd i nstance a fte r Elkha rt G en eral turn ed Rice aw ay an d Go sh en ’s D r. M at h ew s p ok e t o h im ab ou t t h e p os sib ility of h is adm i ssi on t o Oakl aw n. Ceni cer os, unl i ke Rohrer, was b oa rd -c er tifie d in p s y c h iat ry . E ve n if w e a ss u m e t h at it w as i m prudent forRohr erto acc ept Ceni cer os’ as ses sm ent, no evi dence supports an infe rence that Rohr er76 N os. 09

- 2804& 10

- 2389

w as consci ousl y di sr ega rdi ng a ri sk to Ric e’s well

-bei ng. Ro hr erb el i ev ed th ati nv o l unt ar y, i npa ti en t tr ea tment w as w ar ra nted , b u t hi s co l l eague f ound no need f ori t. B y Oc tober 200 4, w he n R ohrer con clud ed that Rice’s l i fe was i n danger, i t was o bvi ousl y c l earto R ohr erthat m edi ca l i nt er ve nt i o n was r equi r ed no twi th sta ndi ng whatCe ni ce r o s m ayha ve tho ug ht

— th u s R oh re r’s d ec isi on t o see k Ri ce’ s a dm i ssi on t o a f aci l i ty othe r than Oakl aw n. Despit e the f ai l ure of that eff or t, Rice w as decl ar ed m edi cal l y st ab l e bythe physi ci ans a t Goshe n H os pi t a l a nd r e t urne d t o the j a i lwi th a di r e c t i v e tha t hi s di et be s up ple m ented. A fterthat, his w ei ght l oss , whi chwas o ne o fthe maj o rr ea so ns Ro hr erha d s o ug ht h i s ho spi tal i zati on, cea sed. A nd o nce Ri ce was decl ar ed i ncom petent to sta nd tr i alin D ecem ber, he was o n a wai ting l i st f o r admi ss i o n to Lo g an spo r t. Gi ve n the st abili za ti o n o fRi ce ’ s wei g ht, the r e i s no th i ngi n the re cor d sugges ti ng tha t Rohrerwas aware o fa ser i ous r i sk to Ric e’ s l i fe, and cer tai nl y there was n o w ar ni ng tha t Ric e m i ght e xperi ence the psy choge nic p ol ydi psi a that l ed to h i s d eath. W e assum e, as the dis tr i ct c ourtdi d, that R oh re r an d th e o th er m ed ica l p ro fe s s i o n als atth e jail c ou ld h a v e d on e m or e g en er ally to m on ito r R ice ’s c on d itio n an d co u ld h av e t rie d s o on er an d m or e fo rc efu lly t o h a v e h i s s c hi z o ph r e ni a t r e a t e d inv o l un t a r i l y . P er ha ps a f actfi nd er c ou l d find thatRohr erbr eached the duty o f c ar e h e o w ed to R ice by failin g t o d o m or e t h an h e d id t o mo n i t o r a n d t r e a t R i c e ’ s me n t a l i l l n e s s . S o m e o ft he gap s in t im e b etw een Roh rer’s vi sits to Rice, an d i n p artic u lar th e fa c t t h a t R o h r er on ly sa w R ice on c e fo ll o wi nghi s r etur n to th e j ai l i n Oct o be r 20 04, a r e tr o ubl i ngN os. 09

- 2804& 10

- 2389 77 gi ven Rohr er ’ s o w n conce rn that Ri ce’ s co nd i ti on was decl i ni ng. But the Estate has not shown how any such om i ssi ons harm ed Ri ce, and w e ca nnot char acte ri ze any o m i ssi on o n hi s par t a s del iber ate i nd i ffer ence to Ric e’ s m edi calneeds. Earl i eri n thi s o p in ion, w e e xpresse d our doubts a s t o the di str i ct c ourt ’ s co ncl usi on that Cen i cer os did not quali fy a s a st ate act or . The di str i ct c ourtnev er pro ce ede d b ey o nd tha t th r es ho l d que st i on, b uta ss um i ng th atCe ni ce r o s was a s ta te a ct o r, we belie ve tha t he w oul d sti l l be enti tl ed to s u m m ar y j ud gm ent o n gr ounds si m i larto tho se w e hav e j ust a rt i cul ate d as t o Rohrer

. Ceni cer os w as obvi ousl y m uch m or e r em ove d from R i ce ’ s day

- to
- dayc o ndi ti o n tha n Ro hr erwas . Indee d, o n the o c c a s i o ns tha tCe ni c e r o s o b s e r v e d R i c e f i rs tha nd, Ri ce b eh av ed f ardi ffer en tly tha n h e di d a t the j a i l, wh i c h wa s wh a tl e d C e ni c e r o s t o c o nc l ud e that Ric e was noti n need of i npati ent t re atm ent a nd /o r f or ced m edi cati on. But eve n i fCeni cer os i s char ged with Rohrer ’ s know l edge, the cl ai m ag ai nst Cenice ros i s no t str ong enough t o survi ve sum m ar y j ud gm ent. The be st ar gum ent that ca n be m ade a ga in st Cenice ro s i s that, knowing ofthe concerns thattwice l ed Rohre r to see k Ric e’ s co m m i tm ent t o Oakl aw n, he s houl d not s o h a s t i l y h a v e d i s c h a r g e d R i c e f r o m O a k l a w n o n th e t wo occa si ons Ric e was se nt the re , and he s houl d not hav e refused R ic e’s ad m issi on in O ctob er 2004 w he n D r. M athew at Gos hen cons ult ed w i th hi m o n th e need f or i npatien t p sychi atr i c ca re . A l though we vi ew thi s questi o n t o o a s cl o se r tha n oth ers i n thi s ca se , g i ve n the no npsychotic be ha vi o r tha t Ri ce ha d di spl ay ed atOa k l awn,78 N os. 09

- 2804& 10

- 2389

w e d o n otbe liev e t h at a re as on ab le fa c tfin d er co u ld concl ud e that Ceni cer os w as del iber ate l y ind i ffer ent a s op p os ed to n eg lig e n t (a t w or st ) in d isc ou n tin g t h e p os sibi l i ty that Ric e was so se ri ouslym ental l y i l l as to need i npati ent c ar e a nd f or cibl e m edi cati on. There is evi dence th at th e m alin ge rin g C en ice ro s p e r c eiv ed its elf c ou ld have been due to Ri ce ’ s sc hi zo phr en i a ( Dr
. Yo der, the Oakl aw n psychol ogi st w ho evaluated Ric e’ s com petency i n A pri l 20 04, so o p ined), but ther e i s no r ealdi spute th at R ice did exh ib it s igns of m an ipu lative beha vior, and w hetherthi s behavi orwas due to Ric e’ s i l l ness or si m plyto hi s desire to ge t o ut o fj ai l was a m att ero n w hi ch r eas onable pro fess i onal s co uld ( and did) disa gr ee. Tha t po i nta si de, Ce ni ce r o s, l i ke R o hr er, ha d no war ni ng that Ric e m i ght e xperi ence c om p uls i ve w ate r dri nki ng, a n d th e r e f o r e d i d n o tc o n s c i o u s l y d i s r e g a r d th e c i r c u mst an ce s th atl ed to Ri ce ’ s dea th

. J. S T AT E C LAI MS A s w e note d e ar l i er i n our f actual sum m ar y, afte r gr anti ng sum m ar y j ud gm ent in f avo r ofthe defe nd an ts on a l l o fthe federa l cl ai m s, Jud ge M i l l err el i nquished j uri sdic ti on o verthe Estate ’ s s tat e- l aw cl ai m s for w ro ngful death ( w hi c h included cl ai m s o fnegl i gence , gr oss n egli gence , and w i l ful and w anton m i sco nd uct) on c e h e d et er m in ed th at th e E st at e h ad n otp ro p er ly al l ege d the e xi ste n c e of di ver si ty j uri sdic ti on o vertho se cl ai m s ( and conclu d ing that di ver si ty appeared t o be lack i ng )
. 20 09 W L 1748 05 9, at * 27
. The Est at e th ennarr o we d th e l i s t o f d e fe n d a n t s n a me d i n i t s s t a t e - l a w c l a i msN os. 09

- 2804& 10

- 2389 79 to c i ti ze ns o fs ta te s o th ertha n Mic hi g an( o fwhi chthe Estate i s a ci ti zen) and r e- fi l ed these cl ai m s against th e C M S d efe n d an ts al o n e in fed er al c ou rt, ex p re ss ly in vo kin g t h e c ou rt ’s d ive rs ity ju r i s d ict ion . Th e n ew su it was assigne d t o J udg e Lo za no , who di smi ss ed th e c laim s o n th e b as is of c olla te ra l es to p p el. The l i nchp i n ofthe col l ate ra l es toppelr uling was J ud ge M ill er ’ s fi nd i ng, i n dis posi ng o fthe del iber ate i nd i ffer ence cl ai m s, that“ ‘ i t wasn’tr eas onabl y for ese e ab l e tha tMr
. R i c e wo ul d s uffe r fr o m ca rdi ac arrhy th m ia du e t o hyp ona trem ia ari sing from M r. Rice’s ingestion of ex cess ive am ou nt s of w ater over a sh ort peri od ofti m e. ’ ” Est at eof Ri ceex re l
. Ri cev. Cor r e ct i onal M ed. Serv s. , N o. 09 C 319 , Order at 2- 3 ( N
. D . In d . M ay 17, 20 10 ) ( quo ting2 00 9 W L 1 74 8059, a t * 26 )
. J udg e Lo za no note d that in or der t o re cove r f orwron gfu l death under I nd i ana l aw , the Estate w ou ld have t o prove , i nteral i a, that a defendant br eached a du ty th at h e o r she o w ed to Rice, and that the bre a c h prox im ately cau sed an inj ury to R ice
. Id. at6. The f or ese eabi l i ty ofan inj ury i s a fund am ental tes t of proxi m ate ca u se . Id. at6. But J ud ge M i l l er ha d al r ea dy det er m i ne d, i n h i s su m m ar y j udg m en t ru lin g on t h e fe d er al c laim s, th at R ice ’s d ea th as a re su lt ofco m pu l si ve w ate r dri nki n g w as notr eas onabl y for ese eabl e. Al th o ug h the l eg althe o r y unde r l y i ngthe federa l cl ai m s ( del iber ate i nd i ffer ence) di ffer ed fro m th at u n d er lyin g t h e s ta te cla im s (n eg lige n c e), th e s p ec i f ic iss u e o f fore se ea b ilit y d i d n otd iffer

. Id. at7- 9. In or der to p re va il on its st at e c laim s, th e E st at e w ou ld ine vit ab ly h a v e t o p ro ve th at d ea th as a re su lt of p sy c h og en ic p o l y d i p s i a w a s a f o r e s e e ab l e r i s kt o R i c e th a tth e C MS80 N os. 09

- 2804& 10

- 2389 d efe n d an ts h ad a d u ty to g u a r d ag ain st
. Id. at9- 10. J ud ge M i l l er unequivo cal l y deter m i ned that Ric e’ s death b y wa t e r i ng e s t i o n w as n ot re as on ab ly for es ee ab le. Id. at 10 . G iv en that the p arties had sp en t three years li tigating th e case, i nc lud ing the f oreseea bil ity ofR ice ’s death, i n the lit i gat i on be f or e J ud ge M i l l er, the Estate had enj oye d a fulland f ai r op p or tu ni ty to l i ti gat e that iss u e. Id. a t 10

- 11
. J udg e M i l l er ’ s fi nd ing o n thi s po i nt was thus enti tl ed to c o l l at er ale st o ppele ffec t, b ar r i ng th e Est at e f r o m r el i ti g at ing the que st i o n in the c o nt ex t ofi ts sta te cl ai m s. The E st at e contends that i t i s inequit abl e t o gi ve Jud ge M il ler’ s fi nd ing as to th e foreseeabili ty of R ic e ’s de ath pr ecl usi ve effect as to the s tat e cl ai m s. Because th e federa l cl ai m s o fdel iber ate i nd i ffer ence ar e g ove rned by a di stinc t st an dard, and beca use J ud ge M i l l eri n re co g ni ti o n o fthe di ffe r e nc e e xp r e s s l y ab s t a i ne d fr o m a ddr es singthe po ss ibi l i tytha t an y o fthe de fen dan ts , i nc lu d in g t h e C M S d efe n d an ts , w er e n eg lige n t, it w ou ld be unf ai r to dispos e of t h e s tat e cl ai m s o n the basi s o f hi s for ese eabi l i ty fi nd i ng. W e a gr ee that J ud ge M i l l er ’ s fi nd i ng as to f or ese eabi l i ty shoul d n o tb e g i v e n pr e c l us i v e e ffe c t, b e c a us e i twas unnecessary forhi m to r eso l ve the i ssue off or ese eab ility i n or der t o dispos e o f the Estate ’ s del iber ate i nd i ffer ence cl ai m s. Because Ju d ge M i l l er ’ s deci si on was a federa l j u d gm en t, w e loo k t o fe d er al c om m on law for t h e c rit er ia go ve rn in g p re c lu sio n . Taylor v. Sturgell, 55 3 U
. S. 88 0, 89 1, 12 8 S. C t. 21 61 , 2 1 7 1 (2 00 8); Firish ch a kv. Ho lder, 63 6 F. 3d 305, 308 ( 7th Cir
. 20 11 ), c ert. den ied, 20 12 W L 53840 6N os. 09

- 2804& 10

- 2389 81 ( U. S
. F eb

. 2 1, 2 01 2)
. F o r a f ed eral c o ur t’ s r ul i ngo n a par ti cul ar i ss ue t o b e g i ve n pr ec l us i ve e ffec t, tha t i ss ue m u st h av e b e e n bo th ac tu ally an d n ec es sa rily d ec id ed in th e p rior ac tio n . Id. ; see also R EST A TE MENT (S EC OND ) OF J UDG MENTS § 27 & com m ent h ( 1982 ) ( pri ordeter m i nati on ofi ssue m ust hav e be en, i nteral i a, “e sse nti alto the j ud gm en t” ). N o o n e d isp u te s t h atJu d ge M iller a c tu ally d e c i d ed th at R ice ’s d ea th d u e t o p sy c h og en ic p oly d ip sia w as not re aso nabl y for ese eabl e t o the CM S defe nd ants (am on g ot h er s), b u t t h e p er tin en t q u es tio n is w h et h er it was ne ce ss ar y f o r hi m to de ci de th atque st i o n. The Est at e i s o n the r i gh t tr ac kwheni t emphas i ze s th e m aterial d ifferenc es betw een the fed eral cl aim s of d eliberate i nd i ffer ence and the s tat e cl ai m s o fnegl i gence . S uch differ ences d o n ot , i n and ofthem sel ves, pre vent an i nvocat i on o fc ol l ate ra l es toppel, as J ud ge Lozano quit e rig h tly p oin t e d o u t
. E.g
. , Taylo r, 55 3 U.S
. at89 2, 12 8 S
. Ct. at 2171 ( ci ti ng N e w Ham ps hi r ev. M ai ne, 5 3 2 U. S
. 742, 74 8- 49 , 1 21 S
. Ct. 1 80 8, 1 81 4 ( 20 01 ) )
. Buts uchdi st i nc ti o ns d o shed l ight o n w h e t he r i t w as ne cess ary for th e cou rt i n pri orli ti gat i on t o re ach a parti cul ari ssue. In or der f o r the Es t a t e t o s uc c e e d o n i t s c l ai m tha tthe me dical d efend an ts w ere d eliberat ely ind ifferent to R ice’s ser i ous m edi calneeds, i t was necessary t o show that the de fen d ants consci ousl y di sr ega rded a kn own r i sk, not m er ely a r ea so nabl y f o r es ee ab l e r i sk, t o R ice’s s afety a nd w ell-b ein g. Se eKnightv. Wi s e m an , 59 0 F
. 3d 458, 46 3 ( 7 th Ci r . 2 0 0 9 ) , a nd M a to s ex re l
. M at os v. O ’ Sul l i van , 33 5 F. 3d 553, 557 ( 7th Cir
. 2003 ) , both cit in g Prof f i t tv. Ridg way, 2 79 F
. 3d 50 3, 5 06 ( 7th Ci r . 2 00 2)
. A ltho ug h the p a r t i e s b e f o r e J u d g e Mi l l e r s p e n ta f a i r a mo u n to ft i me82 N os. 09

- 2804& 10

- 2389 tal ki ng ab out w hetheri t was fo re seeabl e t o the m edi cal d efe n d an ts th at R ice m igh t s u ffer a b ou t o f p sy c h o g en ic pol ydi psi a, the re l evantquesti on was w hetherthey kn ew R ice w as atrisk for p oly d ip sia ye t c on sc i ou sly disr ega rded the ri sk ( the subj ecti ve i nquir y cal l ed for by the del iber ate i nd i ffer ence sta nd ar d) ra th er than w hetherthe ri sk w as re aso nabl y forese eabl e t o them ( w hi ch i s the o bj ecti ve i nquiry that typi fies negl i gence case s). Se eKnight, 59 0 F
. 3d at 463. Thus, wh en Jud ge M i l l erc o nc l ude d tha t no ne o fthe medi ca lde fen d ants w er e del iber ate l y ind i ffer ent t o the pos sibi l i ty that Ric e m i ght e xperi ence psychog eni c pol ydip sia , he was n ec es sa rily fin d in g t h at th ey w er e n otsu bj ec tiv ely aw ar e o ft h i s risk an d in t u rn d id n otco n sc iou sly di s r e g a r d i t
. And tha twa s a l l tha th e n e e de d t o fi nd. H i s br oadero bser vati on that Ri ce’ s com pu l si ve w ate r d rin k i n g , an d in t u rn th e p os sib ility th at h e m igh t d ie f r o m i t, wer e no t r ea so nabl y f o r es ee ab l e to the se defen dants was unnecessa ryto hi s r uling o n the del iber ate in d iffer en c e c laim s. Inth e w or d s o f th e R es t a t e m en t, h is fi ndi nga s to f oresee ab i l i tywas “ no t es se nt i alt o the j u dgm ent. ” R ES TATE MENT (S EC OND ) OF J UDG MENTS§ 27 & co m m en t h

. See, e . g. , Ge orgeE. H of f m an & So ns, Inc . v. Int’l B roth erho o d o

f Team sters , 61 7 F
. 2d 1234, 12 46 n. 31 (7t h C ir. 19 8 0); Gen
. Conf e r e nc eCorp. of

Se ve nt h- D ay Adventists v. M cGill , 617F.3d 4 0 2, 41 3-1 4 (6 th C ir. 20 10 ), ce rt
. den ied, 131 S. C t. 20 97(2 01 1); A ss ’n of B it um inous Contract ors , Inc . v. Andr us , 581 F.2d 853 , 860 (D.C
. Cir. 1978). There ar e, at the sam e ti m e, unm i sta kabl e hin ts el sewher e i n J udg e M i l l er ’ s o pi ni o n tha t he di d no t i nt endN os. 09

- 2804& 10

- 2389 83 to m ake any rul i ng that w oul d precl ud e the Estat e’ s s tat el aw cl aim s. In part i cul ar, the j ud ge express l y s tat ed that he was not sp ea king to the pos sibi l i ty that the m edi cal defe nd ants ( i ncl ud i ng, o fco urse , the C M S defe nd ants) m ay ha ve be enne g l i g en t. 2 00 9 W L 1 74 80 59 , a t * 24 ( “the Estate ’ s st at e la w m al pract i ce c l ai m s r em ain, so no discu s sion is app rop riate as to w he th er the m ed ical care p ro vid ed b y th e d efe n d an ts fell b elo w th e a p p l i c ab le st an d ar d of ca re u n d er Ind ian a la w ”); id., at* 23 ( “Del ib e r a t e i nd i ffe r e nc e i s n o tme di c a l ma l pr a c t i c e . . . . ”) ( i n t e r n a l qu o t a t i o n ma r k s a n d c i t a t i o n s o mi t t e d )
. We ar e co nfi dent thath ad h e b ee n a sk ed wh ether he m eant to re nd era fi nd i ng o n the f or ese eabi l i ty of psychog en i c pol ydi psi a that would be pre cl usi ve as to th e Est at e’ s st at e- l aw c la i m s, the j udg e woul d ha ve a nsw er ed th at h e d id n ot
. Se ei d. , at* 27. W e there f or e co ncl ud e that J ud ge M i l l er ’ s fi nd i ng as to the for ese eabi l i ty ofRi ce’ s pol ydi psi a s hou ld n ot be a c c o r d e d p r e c l u s i v e e ffe cta s t o th e s t a t e - l a w c l a i ms . No o th e r ba s i s f o r a ffi r mi n gth e d i s mi s s a l o fth o s e c l a i ms h a s b e e n a r g u e d t o u s . Co n s e q u e n t l y, th o s e c l a i ms w i l l be re m anded to the dist ri ct c ourtf or furtherpro c ee d in gs. I t m ay m ake se nse t o conso l i date the l i ti gati on o vertho se cl ai m s wit h w h at r em ai ns o fthe federa l sui t be f or e J ud ge M i l l er . A s the subst ance of the st ate claim s h a s n o t ye t been ad d ressed by the district cou rt a n d h a s n o tb e e n a r g u e d i n th i s c o u r t, n o th i n gwe have sai d i n thi s o pini on s h ou ld be const rued as sp ea kin g t o th e m er its of th os e c laim s.84 N os. 09

- 2804& 10

- 2389 III. For th e foregoi ng reason s, in N o. 09-2804 , w e a ffirm in pa rt a n d rev erse in pa rt the d istri ct cou rt’s entry ofsum m ar y j ud gm ent in f avo r ofthe defe nd ants, an d in N o. 10 -23 89 , w e re ve rs e t h e d ist r i c t c o u rt ’s d ec isio n to d ism iss on th e ba sis of colla te ra l e st op p el. W e r em and both c ase s t o the di str i ct c ou rt forfurther pr o ce eding s co ns i st en t wi ththi s o pi ni o n.

3- 20- 12