Opinion ID: 4387846
Heading Depth: 2
Heading Rank: 4

Heading: Other Intake Information

Text: Several of Cross’s other medical records, created by Kohl at the time of his intake, are specifically quoted or referred to in the deposition transcripts that the parties cite in support of their appellate briefing. The records include:
This assessment was in the form of a scoresheet broken up into 10 different categories, each scored on a scale beginning “0,” as the least severe. For instance, the first box concerned “[n]ausea and vomiting,” with the following questions: “Do you feel sick to the stomach? Have you vomited?” Kohl Dep., R. 109-3, Page ID # 823–25; 863–66 (citing LMDC Medical Record, R. 54-7, Page ID # 344). Depending upon the answer, the box included suggested scores. At the 5 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t bottom of the box was a line in which the assessor marked the score. Here, Cross scored a “0.” Id. The next box concerned “[t]actile disturbances,” with the following questions: “Have you any itching, pins and needles sensations, burning, numbness, or do you feel bugs crawling on or under your skin?” Id. Again, Kohl scored Cross a “0.” Id. Other boxes concerned “[t]remor[s],” “[a]uditory hallucinations,” “[p]aroxysmal sweats,” “[v]isual disturbances,” “[a]nxiety,” “[h]eadache, fullness in head,” “[a]gitation,” and “[o]rientation and clouding of sensorium.” Id. Kohl went through each section of the assessment with its various questions and scored Cross a zero for each section; thus, ultimately, Kohl determined that Cross’s total CIWA-Ar score was zero. The form stated, “< 10 points = Mild/at risk (Recheck as ordered).” Id. The other parts of the form stated, “10-15 points = Moderate (Notify provider)[.] Medication may be indicated” and “> 15 points = Severe (Notify provider immediately)[.] Medication may be [i]ndicated.” Id. Kohl signed the form at 5:06 PM.
This document listed alcohol detox, detox of opiates, hypertension, bipolar disorder, anxiety, and depression as the problems identified by Kohl during her intake. There is also a handwritten entry adding “20092 brain injury” to the problem list. Id. at Page ID # 325. Kohl signed the form. 3. Louisville Metro Dept. of Corrections Psychiatric Questions The form summarized Cross’s mental history, including his recent hospitalization for mental health reasons. One of the questions asked, “Are you currently being treated by an Out[p]atient Community Mental Health Center?” and next to it, there was a “Y.” Id. at Page ID # 338. Under the explanation, the entry stated that Cross “was not [forthcoming] with [i]nformation 2 It is unclear if the record stated “2009” or “2007” 6 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t [and] appeared [under] the [i]nfluence.” Id. Another question asked, “Have you recently taken or been prescribed medications for emotional problems?” and next to it, there was a “Y.” Id. For the explanation, the form stated that Cross “appears to be under the influence of a[n] unknown substance.” Id. Next to the question “Does subject talk or act in a strange manner?” there was a “Y.” Id. at Page ID # 339. For the explanation, the entry stated, “slurred speech nodding off during interview.” Id. Next to the question “Is subject apparently under the influence of alcohol or drugs?” there was a “Y” and “states he only had 1/2 beer.” Id. Next to the question “Does subject show signs of mental illness or withdrawal?” there was a “Y.” Id. The explanation stated “[p]ossible [h]ead [i]njury, developmentally delayed, substance use.” Id. 4. Louisville Metro Dept. of Corrections Medical Detox This record asked several questions regarding drug use. Next to the question “Have you taken potentially dangerous levels of drugs or alcohol?” there was a “N.” Id. at Page ID # 333. Next to “Do you drink alcohol?” there was a “Y,” and the entry stated that Cross consumed one beer “today.” Id. Next to the question “Do you use street drugs?” there was a “Y,” and the entry indicated that Cross used Xanax and Lortab. Id. Under “How Often,” the entry stated, “U[n]known appears to be under the influence” and “unknown” for the last time drugs were used. Id. Next to the question “Have you ever experienced . . . serious withdrawal from drugs or alcohol?” there was a “N” marked. Id. The form stated it was printed by Kohl. Kohl placed Cross “on detox” in the second floor, mental health observation section of the jail, based on her assessment, and given Cross’s level of functioning, including his slurred speech, difficulty remaining awake, and need for reorientation. Kohl 5:18 PM Note, R. 98-2, Page ID #608. Kohl gave instructions that Cross be assigned to a bottom bunk and observed every eight hours. She also telephoned her supervisor, RN Sloan, who was working on the second floor, to 7 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t inform Sloan of Cross’s transfer to that floor. As is typically the case for all inmates at the facility, the medical intake notes did not accompany Cross’s transfer. Instead, the records were to be brought up to the second floor at the end of the LPN’s shift. After Cross arrived on the second floor, LMDC corrections officer Kevin Lamkin secured Cross in Observation Cell 2. Soon thereafter, Sloan observed Cross talking with the other inmates, using hand gestures, and smiling. Sloan also saw Cross eating the meal provided by the jail. After meal time ended, Lamkin again observed Cross because several inmates complained that Cross was snoring loudly. Lamkin opened the door to the cell and “checked in on [Cross] and he was just sleeping and snoring . . . .” Lamkin Dep., R. 109-4, Page ID # 929. Sloan also heard Cross snoring loudly. Neither Sloan nor Lamkin woke up Cross. At 8:50 PM, an inmate work aide notified Lamkin that there was something wrong with Cross. Lamkin went to Cross’s cell and noticed first that Cross’s chest was not rising. Lamkin shook Cross, and when Cross did not wake up, Lamkin rolled Cross over, onto his back, and saw that Cross had blue lips. Lamkin “called for help and told medical on the radio to bring all lifesaving equipment.” Id. at Page ID # 936. Sloan, along with another nurse, responded to the distress call and attempted to revive Cross; however, their attempts were unsuccessful, as were the efforts of the Emergency Medical Technicians who transported Cross to the hospital. Cross died of a drug overdose at 9:33 PM. Meanwhile, before Cross was transported to the hospital, Kohl called Sloan to ask permission to take a break. Sloan notified Kohl that Cross was receiving CPR and asked Kohl to read her information from Cross’s chart relevant to his medical history. Kohl did so, and then began “making sure that [Cross’s medical] chart was together . . . .” Kohl Dep., R. 109-3, Page ID # 858. At that point, Kohl prepared a separate, second note describing her assessment of Cross. 8 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t Kohl handwrote the time as 9:49 PM on this second note. In her deposition, Kohl explained that it was impossible for her to edit or add to her first note (the 5:18 PM Note) because notes were printed immediately after they are completed and were not stored digitally. Unlike the 5:18 PM Note, the 9:49 PM Note did not state that Cross stumbled to the medical station, had a strong odor of alcohol, or fell asleep several times during the interview. In addition to other minor changes, the 9:49 PM Note also had an observation not included in the 5:18 PM Note: “Multiple times during this interview I questioned [Cross] if he had consumed any substance where [Cross] denied on multiple occasions only drinking one beer. [Cross] stated he was fine, he had been up all day and had not slept and wanted to lie down.” Kohl 9:49 PM Note, R. 103-5, Page ID # 674. According to Kohl at her deposition, she drafted the 9:49 PM Note “to make sure that as a nurse [she] had everything [she] needed” for Cross’s transfer to the hospital. Kohl Dep., R. 109- 3, Page ID # 803. She argues on appeal that she wrote the 9:49 PM Note to be sure that all the information relayed to her was memorialized in Cross’s chart. For instance, according to other parts of Cross’s medical record, Kohl asked Cross if he had “taken potentially dangerous levels of drugs or alcohol,” and the response in the record stated “N,” indicating that Cross answered in the negative. LMDC Medical Record, R. 54-7, Page ID # 333. And, at her deposition, Kohl maintained that she did not include her observations that Cross stumbled to the station, had an odor of alcohol, or feel asleep repeatedly during the intake “because [she] had already made mention to it in [her] 5:18 [PM] [N]ote.” Kohl Dep., R. 109-3, Page ID # 803. Blaine argues that Kohl’s 9:49 PM Note “can be interpreted as a fabricated justification for not doing more” to assess Cross because the 9:49 PM Note offered an explanation about why Cross was nodding off and mentioned that he denied taking drugs. Appellant’s Br. 19. The district court 9 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t took a more benign view, holding that the 9:49 PM Note appeared to be “a rather clumsy, transparent, manufactured attempt at ‘CYA.’” Summ. J. Mem., R. 112, Page ID # 1272 (quoting Pl.’s Br., R. 103, Page ID # 648). Regardless, the district court concluded that the 9:49 PM Note was not relevant to the deliberate-indifference analysis because the relevant inquiry was whether the Corizon Defendants were deliberately indifferent before Cross died, which occurred before the 9:49 PM Note.