Opinion ID: 4567449
Heading Depth: 3
Heading Rank: 2

Heading: Detox Cell

Text: Griffith was placed in a “detox” cell at 11:10 p.m. so he could be monitored for the first forty-eight hours of his detention. During this time, FCRJ deputy jailers checked on his condition approximately every twenty minutes, and observed Griffith vomiting seven times between the time he was placed in the detox cell and 9 a.m. the next morning, when he was first seen by medical staff. The deputy jailers testified that this amount of vomiting was not uncommon for an inmate in detox. The deputy jailers recorded these observations in Griffith’s observation log. As indicated, Griffith had also been referred to the jail medical staff to be screened for potential medical observation. FCRJ provides medical care by contracting with SHP. The SHP medical staff at FCRJ falls into three general categories: a Medical Director, Dr. Robert Waldridge; two Advanced Practice Registered Nurses (“APRNs”); and three nurses, two of whom were Licensed Practical Nurses (“LPNs”) and one of whom was a Registered Nurse (“RN”). As Medical Director, Dr. Waldridge oversaw healthcare services at the jail during the operative time period. SHP’s original contract required Dr. Waldridge to conduct weekly visits to the jail, but he ultimately delegated this duty to APRNs Jane Bartram and Stacy Jensen. Dr. Waldridge remained available for telephone consultation. APRNs Bartram and Jensen therefore visited the facility once per week on a rotating basis, during which time they signed off on medical charts and visited specific inmates who were identified by the daily nursing staff as requiring additional care. Inmates who needed further attention from an APRN would be designated on a weekly list by the daily nursing staff. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 5 The nursing staff in turn provided daily care. During the work week, LPN Sabina Trivette and RN Heather Sherrow1 provided a combined sixteen hours of medical coverage per day. Weekend care was provided by RN Brittany Mundine, who worked six hours on both Saturdays and Sundays. Because RNs and LPNs cannot make diagnostic or treatment decisions, SHP employs policies and protocols to guide the nurses’ daily operations. Many of these policies and protocols require approval of an APRN or physician before an RN or LPN can take a specific course of action; for example, the FCRJ’s protocol for “intoxication and withdrawal” requires that a nurse call a physician or an APRN before the protocol is initiated. RNs and LPNs thus have various options to respond to medical situations. They can provide treatment that is within their standard of care (such as providing over-the-counter medication in certain circumstances), place the patient on the weekly list (so the patient will be seen by an APRN on the next visit), call an APRN to receive immediate guidance or initiate a certain protocol, or directly send the patient to the hospital for emergency care. RN Sherrow and LPN Trivette testified that they took the latter three steps with some regularity. Griffith first interacted with SHP medical staff at 7:42 a.m. on Monday, November 9th— after being in the facility for approximately eight hours—when Sherrow conducted a medical screening. Sherrow testified that she checked on him at this time because of his Kentucky Jail Mental Health Crisis Network designation as a moderate suicide risk.2 Sherrow met with Griffith while he was on his way to “pre-trial” and completed a Suicide Prevention Screening Guidelines Form. Sherrow indicated that Griffith was no longer showing signs of depression, did not appear overly anxious, and was otherwise behaving normally. She also indicated that he was experiencing nausea and vomiting. There is no indication that Sherrow did anything at this time to address his nausea or take his vital signs. The form cross-referenced the observation log recorded by the deputy officers indicating that Griffith had been vomiting regularly throughout the night, but RN Sherrow testified that she never reviewed the observation log herself. 1 The Franklin County Defendants refer to Sherrow as an LPN, but cite a deposition by Jailer Rodgers, who indicated that she was actually an RN. Sherrow also testified that she is an RN. 2 Similarly, RN Sherrow indicated on the form that Griffith had been placed on suicide watch by Kelly Ford because of “charge related risk.” Suicide Preventions Guidelines Form, R. 69-19 at PageID 813. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 6 After returning from pre-trial, Griffith completed a medical request form, referred to as a “sick call slip,” wherein he complained of stomach issues and vomiting. Trivette met with Griffith at approximately 10:00 a.m. to conduct his medical intake screening and to respond to his sick call slip. Trivette took Griffith’s vital signs and conducted a medical observation. Trivette stated that Griffith had reported vomiting and diarrhea, that she reviewed his hydration, and that his skin was warm, dry, “race appropriate & [that it had] good turgor,” Medical Staff Receiving Screening Form, R. 69-21 at PageID 815. To address Griffith’s reports of vomiting and diarrhea, Trivette provided Imodium and Mylanta. Griffith also indicated that he was not able to urinate, so Trivette put him on a list to provide a urine sample the following day. Trivette also indicated that Griffith reported some drug use—marijuana daily and Xanax on weekends— but further marked that he did not appear to be under the influence of or withdrawing from drugs or alcohol. Later Monday afternoon, LPN Trivette again observed Griffith when he came for medicine and recorded her observations on Griffith’s Suicide Prevention Form. At no time on Monday did any nurse attempt to identify the source of Griffith’s vomiting, determine the amount of the vomiting, or designate Griffith to be seen by an APRN. Because Trivette did not believe Griffith was experiencing significant drug withdrawals, she did not initiate the SHP drug withdrawal protocol, which would have required ongoing medical observation. The FCRJ staff continued to observe Griffith every twenty minutes pursuant to its own designation of him as a moderate risk, but those observation logs were never reviewed by Sherrow or Trivette. Deputy jailers also observed Griffith throwing up six times between his last medical evaluation on Monday afternoon and 5:00 a.m. Tuesday morning, when he filled out a second sick slip. Within that window, he did not eat any lunch and ate only 30% of his dinner. Griffith’s second sick slip—which he filled out, as mentioned above, on Tuesday, September 10th—contained complaints about his nausea. Trivette responded to the complaint and observed that he had warm and dry skin, a steady gait, soft abdomen, and good skin turgor. She also reported that she reviewed Griffith’s hydration and that Griffith mentioned he was again Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 7 unable to urinate. Because of his continued complaints of vomiting and diarrhea, LPN Trivette requested that Griffith be moved to a dry cell to further observe those symptoms.3 However, this move never occurred because no dry cells were available. Griffith was also seen on Tuesday by Sherrow at 7:50 a.m. and Trivette at 3:30 p.m. so the nurses could provide him medicine. Some time, on either Tuesday or Wednesday, Griffith’s mother attempted to visit him but was denied because she was told he was still in detox. Griffith was observed vomiting two more times that evening. On Wednesday, November 11th, Griffith was again seen by Sherrow and Trivette, and they performed the urinalysis that had been ordered the day before. Griffith was still complaining of vomiting, and Trivette provided him some Gatorade. Sherrow performed the urine dip test and observed that his urine contained an abnormal amount of blood and protein. According to Griffith’s liability expert, Madeline LaMarre, the volume of blood and protein in the sample were signs that he had an acute kidney injury, and the standard of care required that he be hospitalized. Sherrow did not send Griffith to the hospital, but instead added him to the list to be seen by an APRN on the next weekly visit. Trivette testified that this approach was taken because she and Sherrow “weren’t that alarmed by [their] evaluation [of the urine dip test], but [they] did want it reviewed.” Trivette Dep., R. 75-7 at PageID 2316. The urine sample was also a cloudy yellow, which Trivette thought could indicate the beginning of an infection. Consequently, Trivette prescribed an antibiotic Cipro, even though neither Sherrow nor Trivette was authorized to prescribe medicine without approval by an APRN or a physician. According to Griffith, prescribing Cipro before notifying an APRN was a violation of the nurses’ scope of care. Wednesday was also the end of Griffith’s forty-eight-hour monitoring period. He was therefore reevaluated by the Kentucky Jail Mental Health Crisis Network on that day. Griffith was downgraded from “moderate” to “low” risk, and he was recommended for release from observation into general population. The reevaluation form indicated that Griffith did not 3 A dry cell is a cell in which the plumbing has been cut off. This allows prison officials and medical staff to observe bodily discharge. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 8 present a risk for drug withdrawal, but that jail staff reported he was going through detox and was on detox observation. Griffith was then moved to a general population cell at 4:19 p.m. on Wednesday, with “out of detox” given as the reason.