Opinion ID: 4387846
Heading Depth: 2
Heading Rank: 1

Heading: Deliberate Indifference Against Kohl

Text: It may be that “there was a danger of which [Kohl] should objectively have been aware,” and there arguably may have been “facts from which the inference could be drawn that a substantial risk of serious harm [to Cross] exist[ed].” Watkins v. City of Battle Creek, 273 F.3d 682, 686 (6th Cir. 2001). But there is insufficient evidence from which a reasonable jury could find that Kohl in fact did “also draw the inference” that serious harm to Cross existed. Id. Because there is a lack of proof that Kohl drew the requisite inference, she could not have disregarded the substantial risk of harm to Cross. Accordingly, Kohl was entitled to summary judgment that she did not act with deliberate indifference when assessing Cross. Our holding in this regard is based on several factors. First, Blaine lacks enough evidence to demonstrate that Kohl even “subjectively perceived facts from which to infer substantial risk to” Cross. Rouster, 749 F.3d at 446. Kohl determined 3 We note that on appeal, neither party has briefed the objective component. While it may appear at first glance that this should be determinative of the outcome, as Blaine has not alleged one of the two necessary components to demonstrate cruel and unusual punishment upon appeal, our court has previously held that medical conditions resulting in death are sufficiently serious. See, e.g., Winkler, 893 F.3d at 890–91 (“There is no question that [the inmate’s] perforated duodenal ulcer, which ultimately caused his death, met this objective component.”) (citation omitted); Rouster, 749 F.3d at 446 (holding that “it is clear” the inmate suffered from a serious medical condition because the inmate died as a result of the medical condition). We need not determine at this juncture whether death resulting from a medical condition automatically meets the objective component, as Blaine cannot meet the subjective component. 14 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t that the facts available to her regarding Cross’s symptoms—the smell of alcohol on his person, his slurred speech, his admission that he drank that day, and his otherwise normal vital signs— indicated that he was under the influence of alcohol, not that he was under the influence of drugs and at a risk of drug overdose. Kohl thus took steps to admit Cross to the jail based upon the nonsevere alcohol intoxication condition she believed Cross had. Kohl “provided medication to address the condition that [Kohl] believed [Cross] was suffering from.” Winkler, 893 F.3d at 893. Though Blaine argues that a physician or other qualifying healthcare professional should have been called, Kohl’s assessment revealed that Cross’s condition did not appear sufficiently severe to warrant immediately calling a physician and administering treatment. For instance, his vital signs were normal and his score on the CIWA-Ar was below 10. These unrebutted facts show that Kohl did not subjectively perceive facts from which to infer a risk of drug overdose. “It is not enough that there was a danger of which an offic[ial] should objectively have been aware. ‘The official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and [s]he must also draw the inference.’” Watkins, 273 F.3d at 686 (quoting Farmer, 511 U.S. at 837)). Second, even if Kohl suspected that there was a risk of drug use (as Blaine argues Kohl did, based on to Kohl’s notes indicating that Cross may have been under the influence of an unknown substance and Kohl’s deposition testimony stating that when she assessed Cross, she suspected he may have been under the influence of drugs), Blaine has not shown that Kohl inferred (or even suspected) that Cross had overdosed on drugs. In other words, there is no evidence that Kohl inferred that Cross’s suspected drug use created a substantial risk of drug overdose. See Weaver v. Shadoan, 340 F.3d 398, 411 (6th Cir. 2003) (“Plaintiff’s contention that the [o]fficers ‘believed’ or ‘should have known’ that Weaver had swallowed drugs does not give rise to a 15 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t deliberate indifference claim.”). Certainly, Kohl identified some risk of harm because she assigned Cross to an observation cell and sought certain monitoring conditions. However, her 5:18 PM Note and the assessments she administered demonstrate that the risk of harm Kohl identified— alcohol intoxication (and perhaps potential drug use)—was not substantial or otherwise determinative of drug overdose. Kohl’s situation was similar to that in Rouster, where we held that a nurse was not deliberately indifferent when she suspected an inmate was suffering from alcohol withdrawal, administered a CIWA-Ar, and began to treat the inmate accordingly, even though the inmate was suffering from another medical condition. 749 F.3d at 451. Similarly, in Winkler, we found that a nurse was not deliberately indifferent when she suspected an inmate was suffering from opiate withdrawal and ordered treatment when in fact, the inmate suffered from a perforated duodenal ulcer. Winkler, 893 F.3d at 891. In both Winkler and Rouster, as here, there was insufficient evidence that the medical professional subjectively perceived and drew the inference of substantial risk. Why is it necessary that a medical professional subjectively perceive facts from which to infer a substantial risk of harm, and then also draw that inference? Because a medical professional who assesses a patient’s condition and takes steps to provide medical care, based upon the condition the professional has perceived, is not acting with indifference. Even if the professional’s assessment is ultimately incorrect, the professional acted to provide medical care. 4 A patient alleging deliberate indifference must show more than negligence or gross negligence, or the 4 To the extent that Blaine argues that Kohl was improperly trained to detect an overdose, Blaine has failed to present evidence regarding Kohl’s training, or alleged lack thereof. Thus, we have no basis upon which to review whether Kohl’s training resulted in an improper assessment. We discuss this point in detail later, in regard to Blaine’s claim against Corizon for its allegedly improper policies and practices. 16 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t misdiagnosis of an ailment. See Rouster, 749 F.3d at 446–47 (finding no deliberate indifference where jail nursing staff interpreted inmate’s stomach cramps, diarrhea, and bizarre behavior as alcohol withdrawal when inmate’s symptoms were actually caused by sepsis from a perforated duodenal ulcer); see also Jones, 625 F.3d at 947 (explaining that deliberate indifference “is a very high standard of culpability, exceeding gross negligence.”). Thus, even if Kohl acted with negligence or gross negligence, Kohl cannot be found to have acted with deliberate indifference: Kohl assessed Cross’s condition—as evidenced from the medical record detailing Cross’s vitals, Cross’s mental health history, and the results of the CIWAAr, among other intake records—and took steps to admit Cross to detox observation based upon the condition she believed Cross had. Third, Kohl’s assessment, while perhaps negligent or grossly negligent, is not transformed into “deliberate indifference” by the fact that Kohl falsely wrote on the Withdrawal Initial Screening and Treatment Plan that a provider had been notified and orders from the provider had been received when in fact, Kohl had not notified a provider. Kohl contends that she made the annotation concerning provider notification in anticipation of notifying the provider later in the evening because, though “the provider always has to be notified on any detox,” depending on the circumstances, Kohl could have contacted a physician or advanced practice registered nurse any time during her shift. Kohl Dep., R. 109-3, Page ID # 825, 788. Because Kohl determined, though an assessment, that Cross was not suffering from a condition of such severity as to require immediate provider notification, but rather should be placed in observation, Kohl did not act with deliberate indifference. Blaine argues that in order to prevail on a claim of § 1983 liability, she does not necessarily have to show that Cross’s signs and symptoms obviously demonstrated a substantial risk of harm. 17 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t Blaine is correct. Medical providers may “not escape liability if the evidence showed that [they] merely refused to verify underlying facts that [they] strongly suspected to be true, or declined to confirm inferences of risk that [they] strongly suspected to exist.” Farmer, 511 U.S. at 843 n.8. As we held in Rouster, “if [Cross’s] symptoms had been clearly inconsistent with alcohol withdrawal, [Kohl] might have been deliberately indifferent by failing to confirm that his symptoms were not indicative of a different and more serious condition.” 749 F.3d at 451. “However, the majority of [Cross’s] symptoms were entirely consistent with those experienced by patients suffering from alcohol withdrawal.” Id. at 451–52. In other words, “[n]one of these facts supports a conclusion that [Kohl] had reason to believe that [Cross] was suffering from anything else” other than alcohol withdrawal. Winkler, 893 F.3d at 893. Kohl “did not ignore [Cross’s] distress, but rather provided medication to address the condition that [Kohl] believed [Cross] was suffering from.” Id. Blaine cites Border v. Trumbull Cty. Bd. of Comm’rs, 414 F. App’x 831, 838 (6th Cir. 2011), where we reversed the district court’s determination of no deliberate indifference. Blaine argues that the factual similarities of Border to the case at hand similarly necessitates reversal in the instant case. In Border, the booking officer failed to assess Border’s obvious intoxication, and Border succumbed to drug overdose while in jail. Id. at 833. Blaine points out that, like Cross, Border nodded off in his cell and was breathing heavily while sleeping in the cell. Id. at 832–33. However, several additional facts were present in Border to demonstrate that the defendants were deliberately indifferent to Border’s medical needs. Border exited his vehicle with a pill bottle in his hand and showed signs of intoxication at the scene of his arrest; Border’s eyes were “red/glazed;” he lost control of his bladder while in his cell; an officer responded to these symptoms by saying “f— him;” and an officer deliberately altered several of Border’s health 18 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t records four months after his death. Id. at 831–35. In contrast, here, neither Kohl nor Sloan saw Cross with any pills, drugs, or other substances, or received information from the police that Cross was in possession of these substances when he was arrested. Instead, Kohl was made aware only that Cross took psychiatric drugs and that he drank alcohol that day. Moreover, the only change in Cross’s condition in his cell before he was found unresponsive was that he was snoring. There is no indication that Kohl or Sloan deliberately decided not to take part in, or to ignore, Cross’s medical care. The booking official in Border was not a medical professional conducting a health assessment; here, Kohl conducted the initial intake and assessed Cross, and Sloan observed him. Though Kohl created a second Note, she did not destroy or replace the 5:18 PM Note, and in fact, she timestamped the second Note. As the district court noted, the time of the second Note—9:49 PM—indicates the Note was written after Kohl assessed Cross and determined that his symptoms indicated alcohol consumption, assigned him to the second floor and bottom bunk, and provided instructions to observe him every eight hours. It may be that this second Note provides some indirect evidence as to whether Kohl had a “sufficiently culpable state of mind,” Farmer, 511 U.S. at 834. However, the contents of the Note ultimately do not “demonstrate that [Kohl] considered an alternative, more serious diagnosis but refused to verify that [Cross’s] symptoms were consistent with such a condition,” Rouster, 749 F.3d at 451–52, or that Kohl otherwise ignored Cross’s medical condition. Accordingly, we affirm the district court’s holding that Blaine has not presented sufficient evidence to demonstrate that Kohl was deliberately indifferent in her assessment of Cross. 19 Case No. 18-5224, Blaine v. Louisville Metro. Gov’t