Opinion ID: 808047
Heading Depth: 3
Heading Rank: 1

Heading: mr. fields’ injury

Text: On July 6, 2007, Mr. Fields was being held in the Lee County jail after being convicted of two misdemeanors. At the time, Mr. Fields was an athletic 24-year-old man. He was by all accounts healthy, except for a bump about half the size of a tennis ball that swelled in his left arm. The bump resulted from a spider bite, and Mr. Fields had covered the bump and bite with gauze. As soon as he entered the jail, Mr. Fields was sent to a concrete room. There two corrections officers checked him for drugs and weapons. The officers forced Mr. Fields to remove the gauze and then sent him to a nurse. The nurses and medical staff at the jail all worked for Prison Health, a company that contracted with Lee County to provide medical services to prisoners in the County’s jails. Mr. Fields was seen by a nurse named Bettie Joyce Allen. Ms. Allen found Mr. Fields to be in good health. This was the first time Mr. Fields met Ms. Allen, but it would not be the last time, nor the most significant time. The jail’s medical staff sent Mr. Fields to an isolated part of the jail, where they 3 Case: 11-14594 Date Filed: 09/06/2012 Page: 4 of 28 treated him for a staphyloccocal infection, which is commonly known as a staph infection. The treatment did not work, however. The swollen arm remained swollen, and so on July 14th Mr. Fields complained about his open lesion. The reason for the treatment’s failure was simple. A staph infection is caused by bacteria, which is generally treated by a form of penicillin called methicillin. But Mr. Fields did not have the garden-variety bacteria that causes a staph infection. His infection was caused, rather, by methicillin-resistant Staphylococcus aureus, commonly known as MRSA. As its name implies, MRSA is resistant to treatment through methicillin. So Mr. Fields’ treatment did not work. Mr. Fields again requested treatment on July 24th. In a medical-request form, Mr. Fields wrote that “the meds that were given to” him were “not helping the open wound.” Trial Ex. 1 at 15. Apparently, the Prison Health medical staff eventually sent Mr. Fields to a medical block at the jail that dealt with MRSA infections. It appears that the Prison Health staff provided lax treatment, so that additional treatment also did not work. On August 6th Mr. Fields felt his back go sore and numb. At first, as the young and healthy are apt to do, Mr. Fields swiped all concerns away. He believed that the soreness resulted from a pinched nerve or something trivial. But his pain increased. On August 7th uncontrollable twitching affected his legs. For six hours, Mr. 4 Case: 11-14594 Date Filed: 09/06/2012 Page: 5 of 28 Fields dealt with the pain. By a little after midnight on August 8th Mr. Fields could no longer tolerate the pain. The cell had an emergency button, and Mr. Fields, as well as his roommate, began to thump the button. Mr. Fields testified that he hit the button hundreds of times. A Prison Health employee—a nurse—eventually showed up, and Mr. Fields explained the pain that he felt. The nurse did nothing, and told Mr. Fields that he would have to wait until the morning, when a doctor could examine him. His legs twitching uncontrollably, Mr. Fields continued to bang the emergency button to no avail. A corrections officer eventually ordered Mr. Fields and his roommate to stop pressing the button. On the morning of August 8th Mr. Fields dragged himself to the shower. As he tried to return to his cell, his legs gave out, and he collapsed. Using walls and tables to counterbalance gravity, Mr. Fields hoisted himself to his cell, where he again collapsed. By now, Mr. Fields could not walk and his lower body felt numb. Prisoners throughout screamed “man down,” a prisoner-created alarm that, in theory, informed the medical staff of an emergency. Some corrections officers and nurses thereafter appeared at Mr. Fields’ cell. They commanded Mr. Fields to get up, but he couldn’t. Mr. Fields stayed on the floor until an officer brought a wheelchair. The officers lifted 5 Case: 11-14594 Date Filed: 09/06/2012 Page: 6 of 28 Mr. Fields from the floor and placed him on the wheelchair. They then rolled him to the jail’s medical department. A nurse examined Mr. Fields at 8:55 a.m. In her notes, she wrote that Mr. Fields complained that he could not walk. See Trial Ex. 1 at 13. As soon as the nurse finished her examination, Mr. Fields met Joseph Richards, a physician’s assistant who worked for Prison Health. Now, August 8th was a Wednesday, and Mr. Richards did not normally examine inmates on Wednesdays. But Mr. Fields’ case constituted a medical emergency, Mr. Richards testified, and he therefore examined Mr. Fields. See R. Vol. 8:118 at 92–93. Mr. Fields recounted his symptoms, which included weakness, numbness, muscle spasms, and pain. He described his pain as a ten on a ten-point scale. Mr. Richards too wrote that Mr. Fields complained that he couldn’t walk. See Trial Ex. 1 at 13. Mr. Richards used a reflex hammer to test Mr. Fields’ patellar reflex, i.e., to test his knee-jerk reaction. Nothing happened; Mr. Fields had no reflex at all. Mr. Richards also scraped Mr. Fields’ feet with a pin. Although Mr. Fields could just feel the pin, he had no reaction whatsoever. Despite these warning signs, and his realization that there was a medical emergency, Mr. Richards gave Mr. Fields only Tylenol before he left. A nurse and a corrections officer took Mr. Fields back to his cell. It was now about 9:30 a.m. on 6 Case: 11-14594 Date Filed: 09/06/2012 Page: 7 of 28 August 8th, and a nurse recommend that Mr. Fields be housed in the medical block. After fifteen minutes, Mr. Fields was thrown into the back of a van. Corrections officers dragged him from the van, placed him in a wheelchair, and took him to the medical block. The officers placed Mr. Fields on the floor in a new cell and took the wheelchair. Still in pain and now exhausted from lack of sleep, Mr. Fields asked every Prison Health nurse that came by his cell that day—about ten by Mr. Fields’ calculation—for help. He informed them that he was exhausted, that his legs twitched without relent, that his lower body was numb, that his legs were weak. Like clockwork, or maybe as if by pact, all the nurses agreed on the same approach: they did nothing. A little after midnight on August 9th, Mr. Fields attempted to use the bathroom for the first time in days. He crawled to the toilet, but then he felt his intestines escaping from his rectum. Mr. Fields panicked, and the inmates in his cell begin to holler “man down.” Ms. Allen—the nurse who had checked Mr. Fields on his first day in jail—soon appeared. The inmates begged Ms. Allen to take Mr. Fields to the hospital. After corrections officers cleared the cell, Ms. Allen walked in. Mr. Fields explained that his intestines were coming out, and Ms. Allen demanded that Mr. Fields roll over. Mr. Fields, who was on the floor, explained that he couldn’t move the lower half of his body. Ms. Allen jerked Mr. Fields’ body, obtained some K-Y Jelly, and pushed the intestines back in. 7 Case: 11-14594 Date Filed: 09/06/2012 Page: 8 of 28 Once she finished, Ms. Allen pushed Mr. Fields’ legs back and forth. Mr. Fields, however, did not react. When she was done, Ms. Allen called Mr. Fields a liar. Ms. Allen stated that, if Mr. Fields had not gone to the bathroom for days, he would be in severe pain as she moved his legs. Mr. Fields explained that he could not feel anything below his stomach. By now it was nearing 3:00 a.m. On Ms. Allen’s orders, the corrections officers dragged Mr. Fields on top of a sheet and carried him on the sheet to an observation room. His pleas having been rejected by Ms. Allen, Mr. Fields dragged himself around the room, set up his bed, and tried to make himself comfortable. Ms. Allen, by her own deposition testimony, which was read to the jury, did not examine Mr. Fields further once he was placed in the observation room. In other words, there was no observation of Mr. Fields in the observation room. Mr. Fields lay in agony throughout the early hours of August 9th. While in the observation room, Mr. Fields begged six Prison Health employees for help. Again, none so much as lifted a finger. Dr. Noel Dominguez, a doctor who worked for Prison Health, arrived at work at the Lee County jail at 8:00 a.m. on August 9th—about 24 hours after Mr. Fields’ paralysis began. Incredibly, neither Ms. Allen nor the other six Prison Health employees with whom Mr. Fields spoke informed Dr. Dominguez about Mr. Fields, despite the 8 Case: 11-14594 Date Filed: 09/06/2012 Page: 9 of 28 fact that August 9th was a relatively light work day. Dr. Dominguez (who as noted was unaware of Mr. Fields’ condition) therefore did not see Mr. Fields until 10:30 a.m. There is no explanation in the record for the two-and-a-half–hour delay, but the jury certainly could have inferred that the delay was in part due to the Prison Health employees’ lack of concern about Mr. Fields and failure to tell Dr. Dominguez about Mr. Fields’ condition. Upon seeing Mr. Fields, Dr. Dominguez asked him what was wrong. Mr. Fields told him his symptoms. Dr. Dominguez then ran the same tests that Mr. Richards had performed. Immediately, he thought that there was something seriously wrong with Mr. Fields. Concluding that Mr. Fields needed an MRI, Dr. Dominguez commanded that Mr. Fields be sent to a hospital’s emergency room right away. Dr. Dominguez gave the command as soon as he finished his examination of Mr. Fields, but no one called an ambulance until 12:23 p.m. See Trial Ex. 2 at 3. The ambulance arrived within five minutes of being summoned. Doctors at the hospital took an MRI of Mr. Fields’ spine. The MRI showed that an abscess was compressing the spine. An abscess is a collection of pus that forms around tissue to protect other tissue from bacterial infection. Mr. Fields’ abscess, unfortunately, formed near his spine, and, as it grew, it damaged the nerves in his spinal cord. This compression of his spine and damage to his nerves caused Mr. Fields’ 9 Case: 11-14594 Date Filed: 09/06/2012 Page: 10 of 28 numbness and eventual paralysis. Within hours of Mr. Fields’ arrival at the emergency room, Dr. Jaime Alvarez operated on him to relieve the compression. Time is crucial where an abscess compresses the spine. According to Dr. Dominguez, as well as Mr. Fields’ medical expert, a patient who has the abscess removed within 24 hours of paralysis stands a good chance of recovery. That is, where a patient afflicted by spinal compression has an operation within 24 hours of his paralysis setting in, he or she is likely to walk again. But the odds plummet after those initial 24 hours. The record shows that paralysis (as compared to numbness) afflicted Mr. Fields sometime after 8:30 a.m. on August 8th. Therefore, had Mr. Fields received treatment around that time on August 9th—around 24 hours later—he could have averted permanent damage to his legs. But he did not receive that treatment because Prison Health delayed his treatment. Because of this delay, Mr. Fields missed the critical 24hour window. Though Mr. Fields can, after years of rehabilitation, now travel with a walker, he is still partially paralyzed from the waist down.