Opinion ID: 2982638
Heading Depth: 2
Heading Rank: 2

Heading: Claims against Nurse Allison

Text: The first component of a § 1983 claim is objective: Plaintiff must show that the alleged deprivation by Allison was sufficient to pose a “substantial risk of serious harm” to Sours’s health. Garretson, 407 F.3d at 796-97. As the district court correctly concluded and Defendants concede, the denial of insulin and medical care to an insulin-dependent diabetic satisfies the objective component. Id. at 797. The test also includes a subjective component. Watkins, 273 F.3d at 686. “[T]he official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he [or she] must also draw the inference.” Farmer, 511 U.S. at 837. The question of whether an official actually perceived, inferred, or disregarded a risk is a question of fact for the jury “subject to demonstration in the usual ways, including inference 9 Case No. 13-6370, Sours v. Big Sandy Reg’l Jail Auth. from circumstantial evidence.” Farmer, 511 U.S. at 842; Clark-Murphy v. Foreback, 439 F.3d 280, 290 (6th Cir. 2006). Yet a court must also consider other factors—such as the obviousness of the risk, the information available to the official, the observable symptoms, and the expected level of knowledge of the particular official. Farmer, 511 U.S. at 842-43; LeMarbe, 266 F.3d at 436-39. If a risk is obvious or if it is well-documented and circumstances suggest that the official has been exposed to information such that she must have known of the risk, the evidence is sufficient for a jury to find that the official had knowledge. Farmer, 511 U.S. at 842-43. In Phillips v. Roane County, Tennessee, we held that there was sufficient evidence for a jury to infer that the guards knew of a substantial risk of serious harm where a diabetic inmate in a medical observation cell exhibited symptoms of nausea, vomiting, and chest pains. 534 F.3d 532, 540-41 (6th Cir. 2008). Likewise, in LeMarbe, this court found that a jury could infer that the prison surgeon had knowledge of the serious risk posed by a bile leak where there was evidence that the surgeon knew of the bile leak and that “any general surgeon would have known” that it was serious and needed to be stopped immediately. 266 F.3d at 434, 436-39. An inmate’s own statements can also be relevant to whether an official could have drawn an inference of a serious risk. In Garretson, for example, an insulin-dependent diabetic with no observable symptoms went into diabetic ketoacidosis after she spent a day in pretrial detention with no insulin. 407 F.3d at 794. For the official who had no prior notice of the detainee’s condition and who obtained emergency care after learning of her condition, we held that a jury could not infer deliberate indifference. Id. at 797. For the two officers that the detainee had informed of her condition, however, we held that “[b]oth officers were allegedly aware of facts from which the inference of substantial risk of harm could be drawn.” Id. at 798. 10 Case No. 13-6370, Sours v. Big Sandy Reg’l Jail Auth. When viewed in the light most favorable to Sours, facts in this record show that Allison inferred a substantial risk of serious harm. These facts include: 1) Allison knew that Sours had diabetes and took insulin; 2) Allison’s own notes about whether Sours had recently taken insulin are contradictory, and she reported that Sours said he had not taken insulin for over a month and had run out of insulin; 3) ketoacidosis is a well-recognized but preventable complication of insulin-dependent diabetes that can lead to death; 4) Allison knew that observable symptoms of ketoacidosis include nausea, vomiting, chest pains, and confusion; 5) Allison was aware that Sours had symptoms of nausea, vomiting, confusion, and a rising blood sugar level; 6) Allison herself is diabetic; 7) Allison knew that no insulin had been ordered for Sours and that there would be no medical staff at the jail for 5 days; 8) Allison knew Sours was in a “critical situation” because of his refusal to cooperate; and 9) a nursing expert testified that Allison “should have known” of potential significant changes in a patient with diabetes and hypertension who was detoxing and that failing to arrange medical care would put Sours’s health at risk. Allison’s own statement of her lack of knowledge regarding Sours’s diabetes is not dispositive where the record includes significant documentary and/or circumstantial evidence to the contrary. Farmer, 511 U.S. at 842. While the district court focused much of its analysis on Nurse Allison’s statement of her knowledge, a court must also consider other factors, including the obviousness of the risk. Id. In light of the record—Sours’s assertion that he was diabetic and had recently been treated for diabetes, his knowledge regarding diabetes coupled with his ability to test his own blood sugar with the jail’s monitor, his high blood sugar levels, and Dr. Belhasen’s diagnosis of Sours as diabetic upon reviewing Allison’s notes on his condition—a jury could find that Allison’s statements suggesting doubt that Sours was in fact diabetic are instead an indication that Allison knew her failure to act was unreasonable under the 11 Case No. 13-6370, Sours v. Big Sandy Reg’l Jail Auth. circumstances. Nor does the fact that Sours himself did not identify the blood sugar levels as the cause of his problem change the analysis. As the jail’s nurse, Allison should have been aware that Sours was at risk: she had been told by Sours himself that he “gets confused at times” and was incapable of caring for himself; she knew that his blood sugar was high; and she had observed objective symptoms of ketoacidosis. The two components of deliberate indifference at met. Allison concedes the objective component: Sours’s medical need was sufficiently serious. Based on the record viewed in the light most favorable to plaintiff, a jury could find that Nurse Allison also had subjective knowledge of a substantial risk of serious harm to Sours. We therefore ask the second question—whether a jury could find that Allison acted unreasonably in response to that risk. Id. at 844-45. If so, summary judgment for Nurse Allison is precluded. This record includes facts that, when viewed in the light most favorable to Sours, reveal that Allison consciously acted unreasonably in response to the known risk. These facts include that Allison did nothing to obtain insulin for Sours or administer insulin to him, even though 1) Dr. Belhasen had previously prepared a sliding scale so that Allison would be able to administer insulin to new inmates until they could establish regular maintenance; and 2) Allison knew that during her absence Sours would be without insulin for five days after not having any for at least the two previous days and likely longer. Other facts evidencing an unreasonable response include that: 3) Allison did not ensure that Sours was under the care of medical staff while she was away for the weekend; 4) Allison did not leave instructions for the guards on how to respond to high blood sugar levels or Sours’s refusals to check his own blood sugar; 5) Allison knew that Sours had been initially uncooperative; and 6) Allison knew that there would be no medical staff at the jail for 5 days and she did not expect the guards to know the symptoms of 12 Case No. 13-6370, Sours v. Big Sandy Reg’l Jail Auth. ketoacidosis. Finally, expert testimony indicated that: 7) Allison’s actions were not reasonable within the bounds of standard nursing practice; and 8) reasonable care would have included insuring that Sours was under the care of medical staff. The district court held that Allison did not act unreasonably because she took some actions in response to Sours’s condition, including placing him in a medical observation cell and instructing the guards to monitor his blood sugar. But the provision of some treatment by a medical professional does not immunize that official from liability. LeMarbe, 266 F.3d at 43839. “A government doctor has a duty to do more than simply provide some treatment to a prisoner who has serious medical needs; instead, the doctor must provide medical treatment to the patient without consciously exposing the patient to an excessive risk of serious harm.” Id. at 439. The same is true for other medical staff. Moreover, our holding that medical care that “is so cursory as to amount to no treatment at all” constitutes deliberate indifference does not support the district court’s conclusion that there is no deliberate indifference unless the treatment amounted to no treatment at all. Terrance v. Northville Reg’l Psychiatric Hosp., 286 F.3d 834, 843-44 (6th Cir. 2002). A jury could find that Allison consciously exposed Sours to an excessive risk of serious harm by failing to arrange for insulin injections or medical care. See also Natale v. Camden Cnty. Correctional Facility, 318 F.3d 575, 580 (3d Cir. 2003) (stating that even a layperson would have the common sense to know that medical personnel should determine how often a diabetic needs insulin). Therefore, we reverse the district court’s grant of summary judgment to Nurse Allison regarding the § 1983 claim against her. 13 Case No. 13-6370, Sours v. Big Sandy Reg’l Jail Auth.
In addition to his constitutional claim, plaintiff also alleges that Allison was negligent and grossly negligent in her conduct toward Sours. Allison asserts qualified official immunity as a defense to these claims. “Official qualified immunity” protects Kentucky public employees sued in their individual capacity from damages liability for “good faith judgment calls made in a legally uncertain environment.” Yanero v. Davis, 65 S.W.3d 510, 522 (Ky. 2001). It applies to negligent performance of 1) discretionary acts or functions, 2) made in good faith, 3) that are within the scope of the employee’s authority. Id. In this case, Allison is ineligible for qualified immunity not only because her actions amounted to “ministerial” duties but also because her actions could be construed as the product of bad faith. Qualified official immunity is defeated if the negligent actions alleged by any defendant amounted to “ministerial” duties rather than discretionary duties. “An act is ministerial if the duty is absolute, certain, and imperative, involving mere execution of a specific act based on fixed and designated facts.” Autry v. W. Ky. Univ., 219 S.W.3d 713, 717 (Ky. 2007). A discretionary act, in contrast, involves the exercise of “personal deliberation, decisions, and judgment.” Id. However, “[a]n act is not necessarily ‘discretionary’ just because the officer performing it has some discretion with respect to the means or method to be employed.” Yanero, 65 S.W.3d at 522. In Kentucky, “[t]he administration of medical care is a ministerial function” and “compliance with the applicable standard of care does not involve a discretionary governmental function.” Gould v. O’Bannon, 770 S.W.2d 220, 222 (Ky. 1989). Viewed in a light most favorable to Sours, the record reflects that Allison did not satisfy the applicable standard of care when she failed to procure insulin or administer insulin to Sours, who had been 14 Case No. 13-6370, Sours v. Big Sandy Reg’l Jail Auth. diagnosed as a diabetic by Dr. Belhasen, had increasingly high blood sugar levels and evidenced symptoms of ketoacidosis. Allison’s defense also fails on the “good faith” prong of the analysis. The Kentucky Supreme Court has recognized that good faith is not present, and qualified immunity is defeated, if the official “‘knew or reasonably should have known that the action he took . . . would violate the constitutional rights of the plaintiff.’” Yanero, 65 S.W.3d at 523 (quoting Harlow v. Fitzgerald, 457 U.S. 800, 815 (1982)). “‘[B]ad faith’ can be predicated on a violation of a constitutional, statutory, or other clearly established right which a person in the public employee’s position presumptively would have known was afforded to a person in the plaintiff’s position, i.e., objective unreasonableness.” Id.; see also Autry v. W. Ky. Univ., 219 S.W.3d 713, 717 (Ky. 2007) (“[T]here is no immunity if [the discretionary function] violates constitutional, statutory, or other clearly established rights.”). In a case like this one, where there is no question the right at issue was clearly established, “bad faith” occurred under Kentucky law if a jury could find that Defendants violated the constitutional right. We have already determined that a jury could find that Allison violated Sours’s constitutional rights, therefore, a jury could find that she acted in bad faith and is similarly not entitled to qualified official immunity under state law.