2022 UT App 51

THE UTAH COURT OF APPEALS

SPENCER CHRISTENSEN,

Appellant,

v.

SALT LAKE COUNTY, WELLCON INC., JAMES WINDER, AND 

TODD WILCOX,

Appellees.

Opinion

No. 20200220-CA

Filed April 14, 2022

Third District Court, Salt Lake Department

The Honorable Laura Scott

No. 170907640

Robert B. Sykes, C. Peter Sorensen, and Christina D.

Isom, Attorneys for Appellant

Simarjit S. Gill, Jacque M. Ramos, and Timothy A. 

Bodily, Attorneys for Appellees

JUDGE JILL M. POHLMAN authored this Opinion, in which JUDGES

DAVID N. MORTENSEN and DIANA HAGEN concurred.

POHLMAN, Judge:

¶1 Spencer Christensen’s daughter, Casie Christensen, was 

held in custody at the Salt Lake County Metro Jail while she was 

withdrawing from opiates. After about forty-eight hours in 

custody, Casie1 died by suicide. Alleging that Casie was not 

provided adequate medical care and supervision, Spencer 

brought a federal claim for cruel and unusual punishment and a 

1. Because Spencer and Casie Christensen share the same last 

name, we refer to them by their first names, with no disrespect 

intended by the apparent informality.
Christensen v. Salt Lake County

20200220-CA 2 2022 UT App 51

state law claim for wrongful death against Salt Lake County and 

others in federal district court. After the federal court granted 

judgment in favor of the defendants in that case, Spencer filed 

the current lawsuit in state court against Salt Lake County and 

others, bringing claims under the state constitution for 

unnecessary rigor and lack of due process. The state district 

court granted summary judgment in favor of the defendants. 

Spencer now appeals that decision, and we affirm. 

BACKGROUND2

¶2 On January 8, 2014, law enforcement arrested Casie on 

charges related to shoplifting. During a medical examination 

before being booked into the Salt Lake County Metro Jail, Casie 

reported that she had used heroin and cocaine that same day. 

After the examination, Casie was placed in a holding cell, and 

the jail began to monitor her for symptoms of withdrawal. Casie 

was also assessed for suicidal ideation, but even after she began 

experiencing withdrawal symptoms, Casie repeatedly denied 

any suicidal or self-harm thoughts. But on January 10, 2014, 

Casie died by suicide. We will discuss the undisputed facts 

surrounding these events in further detail below.

The Federal Lawsuit

¶3 Casie’s father, Spencer, commenced a lawsuit in federal 

district court against Salt Lake County, the Unified Police 

Department, and others. Based on his allegations that Casie was 

2. In reviewing a grant of summary judgment, “we view the facts 

and all reasonable inferences in a light most favorable to the 

party opposing the motion.” AKB Props. LLC v. Rubberball Prods. 

LLC, 2021 UT App 48, ¶ 12, 487 P.3d 465 (cleaned up); accord 

Kuchcinski v. Box Elder County, 2019 UT 21, ¶ 3 n.2, 450 P.3d 1056. 

We recite the facts with that standard in mind.
Christensen v. Salt Lake County

20200220-CA 3 2022 UT App 51

not provided adequate medical care and supervision, Spencer 

asserted a cause of action for cruel and unusual punishment 

under federal law and a cause of action for wrongful death 

under state law. It is undisputed that in the federal lawsuit,

Spencer did not assert a cause of action for unnecessary rigor in 

violation of Article I, Section 9 of the Utah Constitution or a 

cause of action for a denial of due process in violation of 

Article I, Section 7 of the Utah Constitution.

¶4 After discovery was completed, the defendants in the 

federal lawsuit moved for summary judgment, arguing that the 

undisputed facts did not support Spencer’s claims. Spencer 

responded by asserting that he did not intend to oppose the 

defendants’ motion “for a host of reasons.” Spencer specifically 

requested, however, that the federal court’s order “be narrowly 

tailored so as not to ‘dismiss all claims,’ but only those claims or 

causes of action raised in [his federal] Complaint.” Spencer 

explained, “For example, the Complaint did not allege a cause of 

action for any matters involving state civil rights violations, such 

as Article I, Sec. 9, or subjecting prisoners to unnecessary rigor. 

Such matters are still within the statute of limitations and may 

yet be filed in state court.”

¶5 Thereafter, the federal district court granted summary 

judgment to the defendants. The court’s order specified that 

Spencer’s action was dismissed “with prejudice only as to the 

exact claims brought in the Complaint at issue and addressed in 

the summary-judgment motion.”

The Present Lawsuit in State Court

¶6 Spencer then filed the present action in state court against 

Salt Lake County; Wellcon Inc., which contracted to provide 

medical services at the jail; Todd Wilcox, the responsible 

physician at the jail; and James Winder, the county sheriff 

(collectively, the County Defendants). In this lawsuit, Spencer 
Christensen v. Salt Lake County

20200220-CA 4 2022 UT App 51

asserted, for the first time, claims for unnecessary rigor and 

denial of due process in violation of the Utah Constitution.

¶7 The County Defendants eventually moved for summary 

judgment on the state constitutional claims. They sought 

judgment “on the grounds that the undisputed material facts 

alleged in the complaint and the undisputed material facts as 

established in the Federal Action preclude [Spencer’s] state 

constitutional violations as a matter of law.” (Cleaned up.) In 

other words, the County Defendants argued that “applying . . . 

those same undisputed facts to state constitutional law precludes 

[the] claims asserted in the state court action.” Indeed, they 

asserted that, as was “litigated and adjudicated” in the federal 

lawsuit, Casie had received appropriate medical treatment while 

incarcerated and that the County Defendants had employed 

proper protocols to assess her mental health status. The County 

Defendants thus contended that the “adjudicated facts the court 

found material and without dispute in the prior Federal Action 

are dispositive to [Spencer’s] ‘unnecessary rigor’ and due 

process claims” and that “on those adjudicated facts, [the] state 

constitutional claims against the County Defendants fail as a 

matter of law.”

¶8 In support of their motion, the County Defendants 

included a lengthy statement of material facts. These facts 

mirrored, nearly verbatim, those contained in the defendants’ 

summary judgment motion in the federal lawsuit. Importantly, 

in opposing summary judgment in the present case, Spencer 

contested only two facts. See infra ¶ 32. Consequently, the district 

court later determined that all but those two facts were deemed 

admitted under rule 56(a)(4) of the Utah Rules of Civil 

Procedure.3

3. In opposing summary judgment, Spencer also provided a 

separate statement of additional material facts in dispute in 

(continued...)
Christensen v. Salt Lake County

20200220-CA 5 2022 UT App 51

¶9 Still, Spencer insisted that he could bring his state 

constitutional claims because he never raised the claims in 

federal court and the federal court “said nothing about whether 

th[e] facts support a state civil rights claim.” He also stressed 

that the legal standards governing his state constitutional claims 

differed from the standards governing the claims he had raised 

in federal court. He further claimed that despite his admissions, 

questions of fact existed as to whether Casie was subjected to 

unnecessary rigor and deprived of due process when, in his 

view, the County Defendants failed to properly assess and treat 

Casie for opiate withdrawal.

The Facts

¶10 We now set forth the detailed facts of this case that are 

undisputed, unless otherwise indicated. 

¶11 Wednesday. In the late afternoon of January 8, 2014, Casie 

was taken into police custody, and afterward, she “acted as if

she was having a seizure.” She was taken to the hospital for 

evaluation, and while there, she reported that she had recently 

been raped and held against her will. After, a physician 

medically cleared Casie for transport to jail. When she arrived at 

jail, she underwent a nursing pre-screen examination—a routine 

procedure to obtain an overview of an inmate’s health.

¶12 During this examination at 10:06 p.m., Casie reported a 

history of anxiety and depression for which she had been 

prescribed medication; she also reported that she had used 

(...continued)

accordance with rule 56(a)(2) of the Utah Rules of Civil 

Procedure. The County Defendants did not contest those 

additional facts for purposes of their motion, asserting that the 

additional facts were “not relevant to nor dispositive to 

determining summary judgment.”
Christensen v. Salt Lake County

20200220-CA 6 2022 UT App 51

heroin and cocaine earlier that day. Casie’s vital signs were 

deemed to be in the normal range, and she appeared alert, calm, 

and appropriately oriented to the situation. Because of her recent 

drug use, Casie was placed in a holding cell in the screening area 

of the jail at approximately 10:35 p.m. The nursing staff also 

began to assess Casie for withdrawal symptoms from drugs at 

11:23 p.m.

¶13 Thursday. Casie was assessed again at 1:17 a.m., 3:08 a.m., 

and 5:00 a.m. on January 9, 2014. Within this same time period, 

officers also checked on Casie four additional times and saw no 

concerning behavior. During the nursing assessments, Casie had 

a slightly elevated heart rate, which the parties agree is not 

uncommon for individuals withdrawing from drugs or alcohol, 

but her vital signs were otherwise within the normal range. 

Based on these evaluations, Casie was encouraged to drink 

Gatorade to stay hydrated, and she was ultimately cleared for 

booking into the jail around 5:00 a.m.

¶14 Under the protocol used at the jail to assess an inmate’s 

symptoms of withdrawal, medical personnel are trained to track 

a variety of withdrawal symptoms, such as nausea, sweating, 

anxiety, headaches, and hallucinations. Each symptom is 

assigned a score ranging from zero to seven, and the numbers 

are added up as an inmate’s total score, known as a CIWA score. 

Generally, medical intervention is initiated once an inmate’s 

total score reaches twelve. Medical professionals at the jail are 

also trained to monitor inmates’ vital signs for withdrawal 

symptoms and to evaluate whether inmates experiencing

withdrawal have any suicidal or self-harm thoughts. 

¶15 At 10:00 a.m., a nurse recorded Casie’s CIWA score as 

one, with one point assessed for mild nausea with no vomiting. 

At this time, Casie’s vital signs were within normal range, and 

Casie denied having suicidal or self-harm thoughts, as noted on 

her withdrawal worksheet.
Christensen v. Salt Lake County

20200220-CA 7 2022 UT App 51

¶16 A nurse assessed Casie for withdrawal signs again at 2:00 

p.m. and recorded a score of zero on her withdrawal worksheet. 

Casie’s vital signs were still normal, and Casie again denied any 

suicidal or self-harm thoughts.

¶17 Around 3:15 p.m., Casie underwent a comprehensive 

nursing examination. During this evaluation, her vital signs 

remained within the normal range. She again reported her 

previous cocaine and heroin use, and she complained of bruising 

resulting from the rape. As part of this examination, she was 

assessed for her current risk of suicide; she was not considered 

to be at risk for suicide or in need of immediate mental health 

treatment. But based on her reports of drug use and 

victimization, she was referred to be seen by a mental health 

professional (MHP) in her housing unit on a non-emergent basis.

¶18 At around 8:58 p.m., Casie reported to a housing officer 

that she was “having difficulty breathing and has asthma.” 

Medical staff was contacted, and a nurse arrived to evaluate 

Casie at 9:14 p.m. The nurse assessed Casie’s vital signs as 

“good,” and Casie was cleared to stay in her normal housing 

unit. The nurse progress note reflects that Casie’s vital signs 

“were not concerning for an asthma attack” and instead were 

“reassuring and well within the range of normal.” The nurse 

urged Casie to rest, increase her fluids, and submit a sick call 

request if her symptoms worsened. Casie voiced her 

understanding.

¶19 Friday. Around 6:42 a.m. on January 10, 2014, an officer in 

the housing unit noticed that Casie refused to eat and exhibited

withdrawal symptoms. The parties agree that refusing to eat 

while withdrawing from drugs or alcohol is not uncommon for 

inmates and was not cause for concern. 

¶20 Casie had a CIWA score of three at 8:00 a.m. She was

nauseated, and her score reflected that she was somewhere 

between “mild nausea, no vomiting” and “intermittent nausea 
Christensen v. Salt Lake County

20200220-CA 8 2022 UT App 51

and dry heaves.” Again, the parties agree that such symptoms 

are not uncommon or cause for concern during withdrawal. 

Casie had a slightly elevated heart rate, but her vital signs were 

within normal range. A Gatorade was given to Casie to help her 

with her withdrawal symptoms. Additionally, Casie continued 

to deny having any suicidal or self-harm thoughts.

¶21 Casie was assessed again around 2:00 p.m. This time, her 

CIWA score was five, with two (out of seven) points for nausea 

and three (out of seven) points assessed for anxiety, meaning 

that she was somewhere between “mildly anxious” and 

“moderately anxious or guarded.” It is undisputed that neither 

the nausea nor the level of Casie’s anxiety is uncommon for 

individuals withdrawing from drugs or alcohol. She was 

prescribed another Gatorade to ease her withdrawal symptoms. 

Casie’s heart rate had lowered, and her other vital signs 

remained within normal ranges. Moreover, Casie continued to 

deny having suicidal or self-harm thoughts.

¶22 Around an hour later, Casie reported to a housing officer 

that she had been raped before coming to jail and that she had 

bruising, was having difficulty walking, and was “puking up 

blood.” She also stated that she had not yet had further medical 

evaluation, which she had been told at the time of booking that 

she would later receive. The housing officer “called Mental 

Health” at 2:50 p.m. and notified the on-duty sergeant of Casie’s 

complaints.

¶23 Mental Health responded within ten minutes, and an

MHP evaluated and spoke with Casie for thirty minutes. Casie 

reported to the MHP that she had been kidnapped and raped 

and that she was in a lot of pain with bruising all over her body 

and could not “get comfortable.” In response, the MHP referred 

Casie to be seen by a nurse again. Casie’s mental health progress 

note states that she “denies thoughts of self-harm but does want 

to be seen by medical.” Likewise, the MHP later testified that she 

saw no red flags to indicate that Casie was suicidal, and 
Christensen v. Salt Lake County

20200220-CA 9 2022 UT App 51

although the MHP noted that “the risk is higher when someone 

is going through withdrawal” and “when someone is in jail,” she 

testified that Casie “was adamant that she was not suicidal, but 

she was in pain and she wanted that addressed.”

¶24 At approximately 3:52 p.m., a nurse evaluated Casie. 

Casie complained of withdrawal symptoms and complications 

from her earlier rape. Casie also complained of increased 

abdominal pain, nausea, and vomiting. Other than a slightly 

elevated heart rate, Casie’s vital signs were still normal. But 

because of Casie’s reported heroin use and continuing 

withdrawal symptoms, the nurse called the on-call doctor. The 

on-call doctor ordered some blood tests, prescribed an antinausea medication and Gatorade, and referred Casie to be seen 

at the next women’s clinic to be held two days later. Casie voiced 

her understanding of this plan.

¶25 Two hours later, at 5:11 p.m., Casie asked to speak with 

Mental Health. She told the housing officer that she was “not 

thinking right,” but when asked if she was going to hurt herself, 

she said no. The MHP returned and spoke with Casie.4

¶26 At 5:47 p.m., an officer completed a regular watch tour, 

which involved walking by each cell and inmate in the housing 

unit to ensure the safety and security of the inmates and the unit. 

The officer saw nothing out of the ordinary or of concern on this 

watch tour.

¶27 A shift change occurred at 6:00 p.m. The new on-duty 

officer in Casie’s housing unit was briefed about the unit as a 

whole and about Casie specifically. The officers’ shift log 

indicates that Casie was experiencing withdrawal symptoms, 

4. The content of this conversation is not reflected in the 

undisputed facts.
Christensen v. Salt Lake County

20200220-CA 10 2022 UT App 51

had been seen by Mental Health, and was “cleared to stay in 

unit.” 

¶28 The on-duty officer conducted regular watch tours at 

6:22 p.m., 7:09 p.m., 7:57 p.m., 8:42 p.m., and 9:31 p.m. The 

officer noted nothing out of the ordinary or of concern on any of 

those watch tours.

¶29 But at 10:05 p.m., during clothing exchange, a prisoner 

reported to officers that Casie had hanged herself in her cell. An 

officer responded immediately and administered CPR until 

nurses arrived two minutes later and took over. At 

approximately 10:10 p.m., jail staff called for an ambulance while 

resuscitation efforts continued. The ambulance arrived about six 

minutes later and took Casie to the hospital, where she was 

declared dead at approximately 10:52 p.m.

¶30 Several important details about the County Defendants’ 

standard of care and treatment of Casie were undisputed for the 

purpose of summary judgment. Notably, the MHPs and nurses 

properly screened Casie for risk of suicide and self-harm during 

their encounters with her. Their care in this regard met the 

standard of care in correctional facilities. They also appropriately 

responded to Casie’s requests to speak with someone about her 

situation and concerns. Further, they properly identified Casie as 

at risk for withdrawal symptoms, and they conducted repetitive 

screenings to assess her and respond as necessary. This was 

consistent with their training and met the standard of care in 

correctional facilities. They likewise met the standard of care in 

responding to Casie’s complaints related to the reported rape. In 

short, it is undisputed that the staff at the jail “at all times 

monitored, assessed, and treated [Casie] utilizing their best 

clinical judgment and consistent with all applicable standards of 

care.”

¶31 The parties also agreed that there was no evidence of 

deliberate indifference to Casie’s serious medical needs. And 
Christensen v. Salt Lake County

20200220-CA 11 2022 UT App 51

there was no evidence that “any custom, policy, or practice of 

the County [Defendants] contributed to, let alone caused, 

[Casie’s] death.”

¶32 As mentioned, supra ¶ 8, Spencer disputed only two facts 

stated in the County Defendants’ motion for summary 

judgment. The two facts, along with Spencer’s responses, are as 

follows:

aa. One of the assessments for withdrawal from 

drugs or alcohol that is routinely used by medical 

personnel at the Jail and most other correctional 

facilities and hospitals in the United States is a 

“CIWA score,” which stands for “Clinical Institute 

Withdrawal Assessment.”

RESPONSE: Deny. CIWA stands for “Clinical 

Institute Withdrawal Assessment,” but it is used 

for alcohol withdrawal. . . . It is not appropriately 

used for “withdrawal from drugs.” 

bb. The CIWA score is an internationally validated 

assessment tool that has been in use for many years 

and is the gold standard for assessing patients 

experiencing signs and symptoms of withdrawal.

RESPONSE: Deny. The CIWA test is not 

appropriate for assessing withdrawal from opiate 

drugs. This was admitted by Dr. Wilcox in 2013, at 

least six months before Casie died.

(Cleaned up.) In other words, Spencer asserts that the CIWA 

protocol, which the County Defendants used in evaluating 

Casie, is appropriate only for assessing alcohol withdrawal but is 

not appropriate for assessing opiate withdrawal, the type of 

withdrawal that Casie was experiencing. 
Christensen v. Salt Lake County

20200220-CA 12 2022 UT App 51

The District Court’s Ruling

¶33 After briefing and oral argument, the district court 

granted summary judgment in favor of the County Defendants. 

The court first noted that Spencer had admitted all but the two 

disputed facts. See supra ¶¶ 8, 32. After laying out those two 

disputed facts, the court determined that “even if the Court 

assumes for purposes of the motion . . . [Spencer’s] position that 

there is a better or more accurate protocol that should have been 

used by [the County] Defendants to assess [Casie] during her 

incarceration, based on the remaining undisputed facts this 

Court cannot possibly conclude [the County] Defendants were 

deliberately indifferent or otherwise violated [Casie’s] 

constitutional rights to be free from ‘unnecessary rigor’ or due 

process under the Utah Constitution.” The court thus concluded 

that Spencer’s “inadequate medical care claims against [the 

County] Defendants fail as a matter of law.” 

¶34 Accordingly, the district court granted the County 

Defendants’ motion for summary judgment and dismissed 

Spencer’s claims with prejudice. Spencer appeals.

ISSUE AND STANDARD OF REVIEW

¶35 Spencer contends that the district court erred in granting 

summary judgment to the County Defendants on his state 

constitutional claims. Summary judgment is appropriately 

granted “if the moving party shows that there is no genuine 

dispute as to any material fact and the moving party is entitled 

to judgment as a matter of law.” Utah R. Civ. P. 56(a). “We 

review the trial court’s conclusions of law for correctness,” and 

“in doing so, we view the facts and all reasonable inferences in a 

light most favorable to the party opposing the motion.” AKB 

Props. LLC v. Rubberball Prods. LLC, 2021 UT App 48, ¶ 12, 487 

P.3d 465 (cleaned up).
Christensen v. Salt Lake County

20200220-CA 13 2022 UT App 51

ANALYSIS

¶36 Spencer challenges the district court’s decision granting 

summary judgment to the County Defendants. We begin by 

addressing whether material facts are in dispute. We then 

address Spencer’s arguments on appeal.

I. The Undisputed Facts

¶37 As an initial matter, we discuss whether Spencer is bound 

by certain facts. The district court recognized that, except for two 

facts, Spencer did not oppose the County Defendants’ statement 

of material facts in their motion for summary judgment in state 

court. Accordingly, the court deemed those facts admitted under

rule 56(a)(4) of the Utah Rules of Civil Procedure. Spencer does 

not challenge the court’s determination on this point, and we 

therefore proceed with our analysis of those undisputed facts.5

Supra ¶¶ 11–31. Further, as we explain, infra ¶ 56, the two 

disputed facts do not compel a different outcome here.

¶38 Spencer emphasizes that “[n]either unnecessary rigor 

[under the Utah Constitution] nor state due process were raised” 

in the federal action. This is true. The federal district court 

dismissed Spencer’s federal claim for cruel and unusual 

punishment and his state claim for wrongful death. Spencer’s 

state constitutional claims in the present action were not before 

the federal court. On appeal, Spencer emphasizes that the state 

constitutional claims are substantively different from his earlier 

claims in federal court, and he asserts that the established facts 

“give rise to state constitutional violations under state law” and 

5. Spencer is bound by these undisputed facts for the additional 

reason that he has conceded that he cannot relitigate the facts 

established by virtue of the federal action, which in all material 

respects are identical to the statement of material facts in the 

state action.
Christensen v. Salt Lake County

20200220-CA 14 2022 UT App 51

that the state district court erred in concluding otherwise. 

(Cleaned up.) Thus, our task is to determine whether Spencer 

has cognizable state constitutional claims in light of his 

admissions. Cf. Jensen ex rel. Jensen v. Cunningham, 2011 UT 17, 

¶ 49, 250 P.3d 465 (“Because the state and federal standards for 

determining whether a plaintiff is entitled to damages for a 

constitutional violation are different, a federal court 

determination that the material undisputed facts do not give rise 

to a federal constitutional violation does not preclude a state 

court from deciding whether those same facts will give rise to a 

state constitutional violation.”). We now turn to that task.

II. The State Constitutional Claims

¶39 Spencer contends that the district court erred in 

concluding that his state constitutional claim for unnecessary 

rigor failed as a matter of law. Spencer explains that this claim 

“deal[s] with the application of an alcohol withdrawal protocol 

to Casie” rather than an opiate withdrawal protocol. He asserts 

that the County Defendants failed to properly evaluate Casie for 

heroin withdrawal and unnecessarily exposed her to a risk of 

death by suicide, thereby subjecting her to unnecessary rigor in 

violation of Article I, Section 9 of the Utah Constitution. Spencer 

further argues that the district court “failed to appreciate that the 

same facts that might justify dismissal of a deliberate 

indifference claim in federal court do not preclude an 

unnecessary rigor claim in state court.” In his view, all he had to 

prove was “unnecessary abuse or unnecessary exposure to an 

increased risk of serious harm to establish unnecessary rigor.” 

(Cleaned up.) He also asserts that contested issues of fact 

precluded summary judgment in this regard. The County 

Defendants respond that the established facts show “all care and 

treatment [of Casie] was appropriate” and “within the standard 

of care” and that Spencer thus cannot show unnecessary rigor. 
Christensen v. Salt Lake County

20200220-CA 15 2022 UT App 51

¶40 We conclude that the district court correctly determined 

that Spencer’s unnecessary rigor claim fails as a matter of law.6

We first set forth the law involved when a party asserts a 

violation of the unnecessary rigor clause, and we then address 

its application to this case.

A

¶41 To recover monetary damages for a violation of the Utah 

Constitution, a plaintiff must establish (1) a violation of his or 

her constitutional rights, (2) that the constitutional provision the 

defendant violated was “self-executing,” and (3) that the 

Spackman test for tort liability, which requires a showing that the 

violation was flagrant, is satisfied. See Kuchcinski v. Box Elder 

County, 2019 UT 21, ¶ 37, 450 P.3d 1056; see also Spackman ex rel. 

Spackman v. Board of Educ. of Box Elder County School Dist., 2000 

UT 87, ¶¶ 22–25, 16 P.3d 553 (explaining that under the 

Spackman test, a plaintiff must establish “a ‘flagrant’ violation of 

his or her constitutional rights,” “that existing remedies do not 

redress his or her injuries,” and that equitable relief “is wholly 

inadequate to protect the plaintiff’s rights”). This framework 

applies to lawsuits against municipalities and their employees. 

See Kuchcinski, 2019 UT 21, ¶¶ 16, 24–25. Our analysis 

6. In addition to his unnecessary rigor claim, Spencer raised a 

due process claim under the Utah Constitution, arguing that 

Casie was denied due process. See Utah Const. art. I, § 7 (“No 

person shall be deprived of life, liberty or property, without due 

process of law.”). But on appeal Spencer focuses most of his 

attention on the unnecessary rigor claim, and he recognized at 

oral argument that his two state constitutional claims involve the 

“same law” and thus rise and fall together. Because we conclude 

that his unnecessary rigor claim fails as a matter of law, we 

likewise conclude that his due process claim fails as a matter of 

law.
Christensen v. Salt Lake County

20200220-CA 16 2022 UT App 51

concentrates primarily on the first element: whether Spencer has 

shown a violation of Casie’s constitutional rights.7

¶42 Article I, Section 9 of the Utah Constitution provides, 

“Excessive bail shall not be required; excessive fines shall not be 

imposed; nor shall cruel and unusual punishments be inflicted. 

Persons arrested or imprisoned shall not be treated with 

unnecessary rigor.” The first sentence of this section “closely 

approximates the language of the Eighth Amendment to the 

United States Constitution,” Dexter v. Bosko, 2008 UT 29, ¶ 7, 184 

P.3d 592, and it is “directed to the sentence imposed” on a 

criminal defendant, see id. ¶ 17. 

¶43 The second sentence of Article I, Section 9—the 

unnecessary rigor clause—is at issue here. It “has no federal 

counterpart,”8 id. ¶ 7, and its role is to “protect[] persons 

arrested or imprisoned from the imposition of circumstances on 

them during their confinement that demand more of the 

7. The second element is satisfied in this case. “A constitutional 

provision is self-executing if it articulates a rule sufficient to give 

effect to the underlying rights and duties intended by the 

framers of the constitution” or, “in other words, . . . if no 

ancillary legislation is necessary to the enjoyment of a right 

given, or the enforcement of a duty imposed.” Kuchcinski v. Box 

Elder County, 2019 UT 21, ¶ 17, 450 P.3d 1056 (cleaned up). The 

Utah Supreme Court has determined that the unnecessary rigor 

clause contained in Article I, Section 9 of the Utah Constitution 

“is a self-executing provision.” Bott v. DeLand, 922 P.2d 732, 737 

(Utah 1996), abrogated on other grounds by Spackman ex rel. 

Spackman v. Board of Educ. of Box Elder County School Dist., 2000 

UT 87, 16 P.3d 533; accord Dexter v. Bosko, 2008 UT 29, ¶ 21, 184 

P.3d 592.

8. In fact, “[n]early identical provisions . . . exist in only four 

other state constitutions.” Dexter, 2008 UT 29, ¶ 7 & n.8.
Christensen v. Salt Lake County

20200220-CA 17 2022 UT App 51

prisoner than society is entitled to require,” id. ¶ 17. It thus 

centers on “the circumstances and nature of the process and

conditions of confinement.” Id.

¶44 The Utah Supreme Court has explained that the 

unnecessary rigor clause protects prisoners and arrestees against 

“unnecessary abuse.” Bott v. DeLand, 922 P.2d 732, 737 (Utah 

1996), abrogated on other grounds by Spackman, 2000 UT 87. Abuse 

“focuses on needlessly harsh, degrading, or dehumanizing 

treatment of prisoners.” Id. at 740 (cleaned up). “[U]nnecessary 

rigor must be treatment that is clearly excessive or deficient and 

unjustified, not merely the frustrations, inconveniences, and 

irritations that are common to prison life.” Id. at 741. In other 

words, “[a] prisoner suffers from unnecessary rigor when subject 

to unreasonably harsh, strict, or severe treatment,” which “may 

include being unnecessarily exposed to an increased risk of 

serious harm.” Dexter, 2008 UT 29, ¶ 19. Accordingly, “[w]hen 

the claim of unnecessary rigor arises from an injury, a 

constitutional violation is made out only when the act 

complained of presented a substantial risk of serious injury for 

which there was no reasonable justification at the time.” Id. This 

standard is “difficult . . . to prove.” See Bott, 922 P.2d at 744. 

Further, to be a flagrant violation in satisfaction of the Spackman

test, “the conduct at issue [must] be more than negligent to be 

actionable.” Dexter, 2008 UT 29, ¶ 21.

B

¶45 Here, Spencer asserts that his claim is not about 

“inadequate or negligent care” or “deliberate indifference.” He 

acknowledges that he must prove unnecessary abuse or 

unnecessary exposure to an increased risk of serious harm to 

establish the unnecessary rigor claim. And Spencer’s theory is 

that the County Defendants’ “failure to assess and treat Casie 

with an opiate withdrawal standard (a) subjected her to 

unreasonably harsh, strict or severe treatment in her 

confinement; [and] (b) unnecessarily exposed her to an increased 
Christensen v. Salt Lake County

20200220-CA 18 2022 UT App 51

risk of serious harm, i.e., death by suicide.” (Cleaned up) (citing 

Dexter, 2008 UT 29, ¶ 19).

¶46 The district court concluded that even assuming “there is 

a better or more accurate protocol” that the County Defendants 

should have used to assess Casie during her incarceration, 

“based on the remaining undisputed facts [the court] cannot 

possibly conclude [the County] Defendants were deliberately 

indifferent or otherwise violated [Casie’s] constitutional right[] 

to be free from ‘unnecessary rigor’” under the Utah Constitution. 

The court then concluded that “the inadequate medical care 

claims . . . fail as a matter of law.” 

¶47 Spencer points to the district court’s use of the phrase 

“deliberately indifferent” and asserts that the court thereby 

mistakenly treated his claim as one for deliberate indifference 

under Article I, Section 9. But we are not persuaded that this 

reference demonstrates that the court treated his claim as limited 

to a deliberate indifference theory. We read the court’s 

statement, in context, as evidencing its understanding of the 

difference between deliberate indifference and unnecessary 

abuse, especially because the parties had addressed both in their 

briefing.9 See generally Bott, 922 P.2d at 740–41 (“The deliberate 

indifference standard protects prisoners from cruel and unusual 

punishments, and the unnecessary abuse standard protects 

prisoners from unnecessary rigor.”).

9. To the extent that Spencer suggests that perhaps the district 

court applied the deliberate indifference standard applicable to 

federal claims for cruel and unusual punishment under the 

Eighth Amendment, we disagree. The court’s decision 

demonstrates it understood that Spencer’s unsuccessful 

deliberate indifference claim under the Eighth Amendment in 

federal court did not necessarily foreclose an unnecessary rigor 

claim under Article 1, Section 9 of the Utah Constitution in state 

court.
Christensen v. Salt Lake County

20200220-CA 19 2022 UT App 51

¶48 Spencer further asserts that the district court “failed to 

appreciate that unnecessary rigor easily can arise out of the same 

facts that may fail to establish a federal claim for deliberate 

indifference under the Eighth Amendment” to the United States 

Constitution. (Cleaned up.) See generally Sealock v. Colorado, 218 

F.3d 1205, 1209 (10th Cir. 2000) (“A prison official’s deliberate 

indifference to an inmate’s serious medical needs violates the 

Eighth Amendment.” (citing Estelle v. Gamble, 429 U.S. 97, 102 

(1976))); Bott, 922 P.2d at 738 (noting that a prisoner may recover 

for “inadequate medical care only upon a showing of ‘deliberate 

indifference,’ as defined by the United States Supreme Court”).

Again, we are not persuaded. The court’s memorandum and 

earlier orders show that it understood that Spencer’s 

unnecessary rigor claim in this case arose solely under the Utah 

Constitution.

¶49 That leaves Spencer with his main argument on appeal—

that the district court erred in concluding that his state 

constitutional claim for unnecessary rigor failed as a matter of 

law. As he explains, “just because the ‘facts’ show some care for 

Casie (e.g., alcohol withdrawal) does not mean that a state claim 

for unnecessary rigor is precluded under those same facts.” And 

he asserts that the County Defendants violated the unnecessary 

rigor clause when they “unnecessarily exposed Casie to an 

increased risk of serious harm by suicide when they screened 

and treated her as an alcoholic instead of as a withdrawing 

heroin addict.”

¶50 The problem for Spencer is that even if the unnecessary 

rigor clause provides more protections than the Eighth 

Amendment,10 Spencer’s state constitutional claim is not viable 

10. Some federal courts appear to equate the state and federal 

standards. See Brown v. Larsen, 653 F. App’x 577, 579 (10th Cir. 

2016) (“The inquiry under the Eighth Amendment—whether the 

conditions objectively posed a substantial risk of serious harm—

(continued...)
Christensen v. Salt Lake County

20200220-CA 20 2022 UT App 51

considering his concessions. Specifically, it is undisputed that 

the staff at the jail “at all times monitored, assessed, and treated 

[Casie] utilizing their best clinical judgment and consistent with 

all applicable standards of care.” It is also undisputed that the 

MHPs and nurses properly screened Casie for risk of suicide and 

self-harm and met the standard of care in this regard. They also 

appropriately responded to Casie’s requests to speak with 

someone about her concerns, and they properly identified Casie 

as at risk for withdrawal symptoms, conducting repetitive 

screenings to assess her. This care was consistent with their 

training and met the standard of care in correctional facilities. 

Additionally, it is undisputed that no evidence showed that “any 

custom, policy, or practice of the County [Defendants] 

contributed to, let alone caused, [Casie’s] death.”

¶51 Spencer cannot sustain his unnecessary rigor claim in the 

face of these admissions. Because Spencer has conceded, among 

other things, that the County Defendants “at all times 

monitored, assessed, and treated” Casie for the risk of suicide 

and other conditions, we do not see how Spencer could prove 

that the County Defendants subjected Casie to “treatment that is 

clearly excessive or deficient and unjustified,” see Bott, 922 P.2d 

at 741, or to treatment that is “unreasonably harsh, strict, or 

severe,” see Dexter, 2008 UT 29, ¶ 19. For example, the County 

Defendants began monitoring Casie for withdrawal symptoms 

(...continued)

is the same as the inquiry under the unnecessary rigor clause—

whether the injurious act presented a substantial risk of serious 

injury.” (cleaned up)); Redmond v. Crowther, No. 2:13CV393DAK, 

2016 WL 3546292, at *7 (D. Utah June 23, 2016) (stating that “the 

protections of the Unnecessary Rigor Clause [are defined] in an 

identical way in medical treatment cases as the federal courts 

have defined protections of the Eighth Amendment”). Yet, for 

purposes of this appeal, we need not decide the exact contours of 

the relationship between the state and federal standards.
Christensen v. Salt Lake County

20200220-CA 21 2022 UT App 51

when she arrived at the jail, and the MHP responded to speak 

with Casie after Casie told a housing officer around 5:00 p.m. on 

January 10 (shortly before her death) that she was “not thinking 

right” but was not going to hurt herself. This treatment is not 

clearly deficient, and Spencer has not explained how he could 

still state a claim for unnecessary rigor given he admitted that 

the County Defendants used their best professional judgment 

and satisfied the applicable standard of care.

¶52 Under Utah law, “a constitutional violation [under the 

unnecessary rigor clause] is made out only when the act 

complained of presented a substantial risk of serious injury for 

which there was no reasonable justification at the time.” Id.

According to Spencer, Casie was unnecessarily exposed to “an 

increased risk of serious harm by suicide when [the County 

Defendants] screened and treated her as an alcoholic instead of 

as a withdrawing heroin addict.” But it is undisputed that under 

the protocol that the County Defendants did employ, they were

monitoring Casie for suicide and withdrawal symptoms. In fact, 

they were watching and assessing Casie for risk of suicide, and 

she repeatedly denied having any thoughts of self-harm.

¶53 Although the County Defendants sadly were unable to 

prevent Casie’s death from happening, their monitoring for 

suicide did not “expose[] [Casie] to an increased risk of harm” or 

“present[] a substantial risk” given the undisputed fact that 

those efforts were consistent with the appropriate standard of 

care. See id. Put differently, it is incompatible for Spencer to 

recognize that the County Defendants met the standard of care 

but also maintain that they simultaneously exposed Casie to a 

substantial risk of harm.

¶54 Our supreme court has also explained that to be a flagrant 

violation of the unnecessary rigor clause, “the conduct at issue 

[must] be more than negligent to be actionable.” Id. ¶ 21. Thus, 

the defendants’ conduct must be more culpable than mere 

negligence. See id. But Spencer asserts that he “is not arguing 
Christensen v. Salt Lake County

20200220-CA 22 2022 UT App 51

inadequate or negligent care,” and by admitting that the County 

Defendants complied with the standard of care, he has 

effectively conceded that the County Defendants’ conduct was 

not even negligent. Cf. Cope v. Utah Valley State College, 2014 UT 

53, ¶ 11, 342 P.3d 243 (explaining that negligence typically 

requires a breach of the applicable standard of care); Nguyen v. 

IHC Health Services, Inc., 2010 UT App 85, ¶ 15, 232 P.3d 529 

(stating that a party claiming negligence must “prove that the 

standard of care had been breached”). It follows that their 

conduct was not “more than negligent” and is not “actionable” 

under the unnecessary rigor clause. See Dexter, 2008 UT 29, ¶ 21; 

see also Richards v. State, 2003 UT App 68U, para. 6 (concluding 

that the plaintiff’s factual allegations “amount to a textbook 

example of simple employer negligence” and because 

“negligence is insufficient to constitute a violation” of Article I, 

Section 9, the trial court correctly dismissed the claim).

¶55 Spencer also has not explained how he could prevail 

when he has admitted that the County Defendants had no policy 

or practice that contributed to, let alone caused, Casie’s death. 

Where Spencer’s theory is predicated on the County Defendants’ 

use of an alcohol withdrawal protocol for Casie (who was 

withdrawing from opiates), Spencer would have to show that 

Casie’s “injury was caused by” the County Defendants’ allegedly 

flawed protocol. See Bott, 922 P.2d at 739–40 (emphasis added); 

see also id. (holding that a prisoner could recover damages under 

Article I, Section 9 if the prisoner “shows that his injury was 

caused by a prison employee who acted with deliberate 

indifference or inflicted unnecessary abuse upon him”). Because 

Spencer has conceded that there is no such causation, Spencer 

cannot prove an unnecessary rigor violation. See id.

¶56 Our view is unchanged even taking into consideration the 

two facts that Spencer disputed. In particular, Spencer asserts 

that the CIWA protocol used by the County Defendants is 

appropriate only for alcohol withdrawal, not withdrawal from 

opiates. Supra ¶ 32. But like the district court, we conclude that 
Christensen v. Salt Lake County

20200220-CA 23 2022 UT App 51

even assuming that “there is a better or more accurate protocol 

that should have been used by [the County] Defendants to assess 

[Casie] during her incarceration,” Spencer’s unnecessary rigor 

claim is still unavailing as a matter of law based on the 

remaining undisputed facts.

¶57 Finally, Spencer claims that factual disputes preclude 

summary judgment, arguing that “[a]t a bare minimum, there 

are substantial questions of fact about unnecessary rigor in this 

case.” But, again, Spencer cannot overcome his admissions. As 

discussed, Spencer cannot maintain this unnecessary rigor claim 

when he has effectively conceded, among other things, that he 

cannot show causation, a breach of the standard of care, or 

conduct that is more than negligent. For these reasons, the 

district court correctly granted summary judgment in favor of

the County Defendants.

CONCLUSION

¶58 We conclude that given Spencer’s admissions, his state 

constitutional claims fail as a matter of law. Accordingly, we 

affirm the district court’s grant of summary judgment to the 

County Defendants.