Opinion ID: 808047
Heading Depth: 3
Heading Rank: 2

Heading: prison health’s policies

Text: Remarkably, neither side introduced Prison Health’s policy manual at trial. Instead, the parties introduced evidence of Prison Health’s medical policies through the testimony of Ms. Allen and Prison Health’s corporate representative. Prison Health’s 10 Case: 11-14594 Date Filed: 09/06/2012 Page: 11 of 28 corporate representative testified that nurses and physicians could send inmates to hospitals only in emergencies. See R. Vol. 8:118 at 187. Prison Health’s corporate representative defined an emergency as a critical injury or life-threatening “injury or illness,” but she never testified that this definition was communicated to the medical staff. R. Vol. 8:118 at 187. Ms. Allen corroborated part of this testimony. Nurses, Ms. Allen said, “weren’t trained to designate whether somebody” had “to go to the ER;” to the contrary, “that’s a doctor’s job to do.” R. Vol. 8:118 at 71. Hence, Prison Health allowed nurses to send inmates to the hospital only in an emergency, but then left them to figure out what an emergency was. To Ms. Allen, an emergency was narrowly defined as when someone is “dying any minute.” R. Vol. 8:118 at 71. Ms. Allen elaborated on her definition by giving examples of “emergencies.” She, for instance, had called ambulances where a man was beaten half to death and where a man had no pulse, but had placed inmates with partial paralysis in an observation room. See R. Vol. 8:118 at 79–80, 86–87. Prison Health enforced its restrictive policy against sending inmates to the hospital. Ms. Allen testified that, at monthly nurses’ meetings, medical supervisors “yelled a lot about nurses” sending inmates to hospitals. See Vol. 8:118 at 65. Repeatedly, Prison Health instructed nurses to be sure that the inmate had an emergency because it cost money to send inmates to the hospital. See Vol. 8:118 at 71. In fact, 11 Case: 11-14594 Date Filed: 09/06/2012 Page: 12 of 28 Ms. Allen remembered three separate supervisors who emphasized the policy to her.3 As noted above, the abscess presented life-changing consequences for Mr. Fields if left untreated for more than 24 hours. It thus constituted an objective medical emergency. In fact, Mr. Richards—one of Prison Health’s own employees—saw Mr. Fields because the situation was a medical emergency. Both Dr. Dominguez and Mr. Fields’ medical expert also testified that Mr. Fields had a medical emergency. After he tapped Mr. Fields with the reflex hammer and saw no response, Dr. Dominguez believed that Mr. Fields “needed to be sent to the emergency room right away.” R. Vol. 8:118 at 161. And Mr. Fields’ medical expert testified that there was no medical justification for refusing to send Mr. Fields to a hospital once he could no longer walk. See R. Vol. 7:117 at 111. Dr. Alvarez, the surgeon, agreed with the other two doctors. “[A]ny discovery of weakness in the legs,” he said, “warrants immediate attention, immediate 3 Because Prison Health’s policy manual was not introduced at trial, the jury never heard evidence as to which definition of emergency—that provided by Prison Health’s corporate representative or the more narrow one used by Ms. Allen and/or other Prison Health staff—was the operative one. Prison Health introduced a written policy at the summary judgment stage and now argues that we must consider it, even though it chose not to introduce that evidence at trial. This argument is frivolous. The legal standard for a motion for judgment as a matter of law requires courts to determine whether evidence introduced at trial supports the jury’s conclusion. See Bill John’s Rests., Inc. v. NLRB, 461 U.S. 731, 745 n.11 (1983). It is incoherent to say that evidence that a jury never saw somehow supports (or undermines) that jury’s conclusion. See Porter v. Am. Optical Corp., 641 F.2d 1128, 1137 (5th Cir. Apr. 1981) (noting that in deciding a motion for judgment as a matter of law courts look at the evidence introduced at trial). 12 Case: 11-14594 Date Filed: 09/06/2012 Page: 13 of 28 action, to find out what’s causing it.” R. Vol. 8:118 at 13. He bluntly said that it is an emergency to find the cause of the legs’ weakness. See R. Vol. 8:118 at 14. Finally, like Mr. Fields’ medical expert, Dr. Alvarez testified that, with Mr. Fields’ symptoms, no medical justification existed for not taking an MRI. See R. Vol. 8:118 at 24. “[I]f the paralysis is obvious, any nurse or physician’s assistant, any health-care personnel with some training, would be able to recognize that.” R. Vol. 8:118 at 34. Even Mr. Richards recognized that partial paralysis would result from tumors, trauma to the spinal cord, or spinal compression. See R. Vol. 8:118 at 129. Significantly, there was no contrary testimony from Prison Health: Prison Health’s medical expert testified that back pain was not a dire emergency but did not opine that paralysis is not a medical emergency. Although these doctors testified that weakness in the legs requires, at the least, an MRI, Ms. Allen incredibly testified that she would not send someone with paralysis to the hospital. Prison Health had no MRI available in Lee County jails, but, when Ms. Allen had encountered inmates with symptoms of partial paralysis, she had simply “put them in an observation cell and put them down to see a doctor.” R. Vol. 8:118 at 86. This was, Ms. Allen assured the jury, the norm. See R. Vol. 8:118 at 87. In light of this testimony by Ms. Allen, the jury was entitled to reject the testimony of Prison Health’s corporate representative as to what constituted an emergency and find that 13 Case: 11-14594 Date Filed: 09/06/2012 Page: 14 of 28 Prison Health had a custom or policy of not sending inmates with paralysis to the hospital unless they were near death.