Opinion ID: 4567449
Heading Depth: 4
Heading Rank: 1

Heading: Nurse Sherrow

Text: Griffith argues that Sherrow was deliberately indifferent because she did not put Griffith on the list to be seen by an APRN before Wednesday, when she performed the urine dip test. He contends that at that time, Sherrow should have called Dr. Waldridge or an APRN rather than place him on the weekly list, and he further faults Sherrow for not initiating SHP’s drug withdrawal policy or nausea/vomiting protocol at some point during his detention. He also asserts that Sherrow was deliberately indifferent when she removed him from detox monitoring and allowed him to return to general population. Sherrow interacted with Griffith three times during his period of detention, each of which occurred while he was being held in the detox cell. She first interacted with him on Monday, November 9th at 7:42 a.m. to complete the Suicide Prevention Screening Guidelines Form when he was on his way to pretrial. She assessed his mental health and indicated that he was no longer showing signs of depression or anxiety. She recorded that he was experiencing nausea, but apparently did not take any action to follow up on his complaint. She indicated on the form that the deputy jailers had been conducting monitoring, but she did not herself review the observation log. To be sure, it may have been preferable for Sherrow to have taken a more aggressive course of action at this time in response to Griffith’s complaint of nausea and vomiting. Perhaps initiating the detox protocol would have given the medical staff a better opportunity to monitor Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 20 Griffith’s condition and allow them to intervene before he suffered a seizure several days later. But, when she conducted the screening, Sherrow made a decision that Griffith’s condition did not warrant elevation to medical observation. Sherrow testified that regardless of whether jail staff designates an inmate for observation, the medical staff makes an independent evaluation as to whether to place the inmate on medical observation. Based on the signs and symptoms that Griffith exhibited, Sherrow made the decision that further observation by medical was not necessary. Specifically, she indicated that observation would be appropriate for an inmate who was “hallucinat[ing], sweating, can’t [sic] get up.” Sherrow Dep., R. 75-5 at PageID 2013. She further testified that she would make the decision to place an inmate in medical observation based on their vital signs and other visible symptoms. There is no evidence that Sherrow “knew, or should have known,” that Griffith was suffering severe withdrawal symptoms that would lead to a series of seizures several days later or otherwise “posed an excessive risk to health or safety.” Bruno v. City of Schenectady, 727 F. App’x 717, 720 (2d Cir. 2018). To the contrary, Griffith has not introduced any evidence that his vomiting was caused by drug withdrawal, or that he was suffering drug withdrawal at all. Instead, he testified that he had been vomiting because of nerves. Even putting aside the issue of drug withdrawal, there is no evidence that Sherrow knew or should have known that Griffith’s vomiting evinced a substantial risk to his health. Griffith now contends that his vomiting caused him to experience dehydration, which in turn led to his seizures. But again, there is no medical evidence to support his theory. The UK Hospital discharge report said “his seizure was most likely due to PRES . . . . The cause of PRES was either due to his acute renal failure or possible intoxication.” UK Discharge Summary, R. 69-33. And the FRMC report, the document upon which Griffith relies, does not say that his renal failure was caused by dehydration. Instead, it says: “[Griffith’s] presentation is complex. Differential [diagnosis] is broad.” FRMC Physician Record, R. 101-18 at PageID 3892. It then discusses potential causes for his renal failure and seizures (including rhabdomyolysis, HUS, toxic ingestion, serotonin syndrome, encephalitis, or meningitis) without reaching any resolution. Moreover, Griffith’s expert testified that she did not think that dehydration was the primary source of his kidney failure, and she declined to testify definitively that he suffered dehydration Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 21 (rather than simply being dehydrated). Accordingly, there is no evidence that Sherrow should have known, based on Griffith’s report of vomiting on Monday, November 9th, that he was at risk of dehydration leading to kidney failure and multiple seizures.7 There is also no evidence that Sherrow “recklessly failed to act with reasonable care to mitigate [that] risk.” Bruno, 727 F. App’x at 720. Based on her assessment, Sherrow did not consider Griffith to be at a high risk requiring medical observation. She testified that this was in part because of the signs and symptoms that she witnessed, and in part because Griffith or the deputy jailers could fill out a sick call slip if his conditioned worsened. “[C]ourts are generally reluctant to second guess the medical judgment of prison medical officials.” Rouster v. County of Saginaw, 749 F.3d 437, 448 (6th Cir. 2014) (alteration in original) (quoting Jones v. Muskegon County, 625 F.3d 935, 944 (6th Cir. 2010)). Even if Sherrow was negligent in failing to take more aggressive steps in monitoring Griffith, that would only constitute a claim of medical malpractice that lies beyond the Constitution’s reach. “When a prison doctor provides treatment, albeit carelessly or inefficaciously, to a prisoner, he has not displayed a deliberate indifference to the prisoner’s needs, but merely a degree of incompetence which does not rise to the level of a constitutional violation.” Winkler v. Madison County, 893 F.3d 877, 891 (6th Cir. 2018) (quoting Comstock v. McCrary, 273 F.3d 693, 703 (6th Cir. 2001)). For example, we have held that a prison doctor was not deliberately indifferent when he misdiagnosed the plaintiff’s cancer and attempted to treat the condition with over-the-counter medications. See Jones, 625 F.3d at 945–46. Similarly, we have twice held that prison medical officials were not deliberately indifferent when they misdiagnosed two severe ulcers—both of which were lethal—as symptoms of drug or alcohol withdrawal. See Winkler, 893 F.3d at 892–93; Rouster, 749 F.3d at 448–51. In Rouster, the prison nursing staff had misdiagnosed 7 For this reason, Griffith’s reliance on Clark-Murphy v. Foreback is unpersuasive. See 439 F.3d 280 (6th Cir. 2006). There, the inmate died of dehydration after being held in an observation cell for multiple days in 90degree heat without access to water. He also repeatedly asked for water and was seen drinking out of the toilet. The court held that collectively, this evidence was sufficient for a jury to infer that the jailers were subjectively aware that he was suffering dehydration. See id. at 289–90. By contrast, Griffith’s reports of vomiting to Trivette and Sherrow do not suggest that they knew, or should have known, that Griffith was at a risk of extreme dehydration that would cause acute renal failure which would, in turn, lead to a seizure. As discussed, there is no evidence that Griffith suffered dehydration. Moreover, the unrebutted evidence, discussed infra, demonstrates that Trivette took several measures to monitor for the possibility of dehydration in response to his complaints of vomiting and diarrhea. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 22 ulcers as potential alcohol withdrawal, even though the plaintiff was seen eating food off the ground, drinking out of the toilet, and otherwise behaving erratically in ways not consistent with alcohol withdrawal. See 749 F.3d at 449. But, we explained, the medical staff did not know he had previously been treated for a perforated ulcer and therefore did not have the information necessary to make the appropriate diagnosis. See id. at 448.8 Accordingly, the nursing staff did not violate the Constitution by attempting to treat the plaintiff, even though the treatment ultimately was unsuccessful. See id.; see also Winkler, 893 F.3d at 892–93 (“Although [the defendant’s] assessment and treatment of [the detainee] might not represent the best of medical practices, her actions do not suggest deliberate indifference to a known risk to [the detainee’s] health.”). When Sherrow interacted with Griffith on the morning of Monday, November 9th, she completed the screening for potential suicide risk or mental health, which was the main reason Griffith was held by jail staff for observation. She recorded that he no longer presented such a risk based on her evaluation. She also noted his report of nausea, but she did not believe further action was needed based on his symptoms at that time and on her judgment and experience. She testified that Griffith would be able to submit a sick slip if he was experiencing further symptoms, and he in fact did submit such a slip and was treated by Trivette later that day during his full medical intake. The failure to take further steps based only on his statement that he was experiencing vomiting and nausea cannot rise to a level above negligence. 8 The evidence suggests that, as in Rouster and Winkler, Griffith’s medical emergency arose from a latent issue that existed prior to his detention. He was already vomiting before he was admitted to the jail, beginning when he was struck with a baseball bat during the failed robbery. However, there is no evidence that Griffith informed the medical staff that he had been in a violent confrontation and had been vomiting ever since. Thus, Griffith would also not prevail on a theory that the medical staff failed to discover an underlying medical issue originating at the burglary because the medical staff did not have the “critical piece of information” that he had been in a violent incident. See Rouster, 749 F.3d at 448. The dissent suggests that we are overemphasizing the uncertainty about the cause of Griffith’s medical condition. See Dissent at 13 n.2. We disagree because, even accepting the dissent’s formulation, the test requires that we determine what a reasonable nurse “would have known, or should have known,” about Griffith’s condition. See id. at 10. That medical professionals were unable to identify what happened to Griffith, even with the benefit of hindsight, weighs strongly against a finding that a reasonable nurse “would have known, or should have known,” the extent of his condition at the time of treatment. Accord LeMarbe, 266 F.3d at 436 (“[A] factfinder may conclude that a prison official knew of a substantial risk from the fact that the risk was obvious.” (quoting Farmer, 511 U.S. at 842)). Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 23 Sherrow next saw Griffith the following day, Tuesday, November 10th, at 7:50 a.m. to administer medicine. Sherrow could not recall the length of this interaction, but indicated that based on her notes, Griffith did not make any other complaints at that time. There is no evidence from this interaction that she was or should have been aware that Griffith was suffering from a serious medical issue or that his condition had worsened. Finally, Sherrow saw Griffith on Wednesday, November 11th, and provided treatment along with Trivette. Sherrow performed the urine dip test while Trivette provided Imodium, Mylanta, and Gatorade. Consistent with the instructions on the urine dip test, Sherrow added Griffith to the list to be seen by an APRN on the next weekly visit to review the results of the urine test. Again, it would have been preferable if Sherrow had immediately elevated Griffith’s test results to an APRN rather than putting him on a list to be seen on the next weekly visit. Perhaps that was even what the standard of care dictated. But Griffith acknowledges that Sherrow did administer the urine test, review the results, and elevate those results to the APRN. Moreover, Sherrow witnessed Trivette provide over-the-counter treatment for his symptoms as well as Gatorade. Sherrow also witnessed that Griffith was able to drink the Gatorade without vomiting or other negative reaction, a fact that, in her experience, indicated that his medical status was stable. The decision to elevate Griffith’s results via the weekly list rather call an APRN directly may be evidence that Sherrow underestimated the severity of Griffith’s condition, but it does not demonstrate that she “recklessly failed to act with reasonable care to mitigate [the] risk,” Bruno, 727 F. App’x at 720, or that she should have known that his medical condition was declining.9 9 The dissent suggests that we are ignoring the “context” of Sherrow’s decision to elevate Griffith’s condition to an APRN by placing him on the weekly list rather than immediately placing a phone call or transferring him to the emergency room. See Dissent at 13. But it is the dissent that ignores the context of Griffith’s period of detention by focusing exclusively on this single interaction between Griffith and Nurse Sherrow. This meeting occurred only because Nurse Trivette was taking affirmative steps to monitor Griffith’s condition, not in response to a sick call slip. Indeed, Griffith only requested medical attention on two occasions—on September 9th and September 10th. The unrebutted evidence demonstrates that Nurse Sherrow and Nurse Trivette provided treatment to Griffith on September 11th, and Griffith never indicated that the treatment provided was insufficient or that his condition was not improving. Further, it is undisputed that Griffith’s condition was elevated to an APRN when he Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 24 There is also no evidence that by placing him on the weekly list rather than calling an APRN, Sherrow “consciously expos[ed] [Griffith] to an excessive risk of serious harm,” Richmond v. Huq, 885 F.3d 928, 940 (6th Cir. 2018) (quoting LeMarbe v. Wisneski, 266 F.3d 429, 439 (6th Cir. 2001)), or provided care “so woefully inadequate as to amount to no treatment at all,” id. (quoting Asplaugh v. McConnell, 643 F.3d 162, 169 (6th Cir. 2011)). Griffith and the dissent rely on LeMarbe, but that reliance is misplaced. There, a surgeon conducting exploratory surgery visually observed five liters of bile that had leaked into the plaintiff’s abdomen. See 266 F.3d at 433. But the surgeon was unable to determine the source of the leak and simply drained the fluid and closed the surgical incision. Id. Even though he knew that bile was leaking into the plaintiff’s abdomen, knew that he had not identified or remedied the leak, and knew the continuing bile leakage required immediate medical attention, the surgeon discharged the plaintiff several days later without taking any further action. Id. We held that this was evidence of deliberate indifference. See id. at 439. That case is distinguishable in two important respects. The first involves what the defendant knew or should have known. There, the surgeon personally saw five liters of bile that had leaked into the plaintiff’s abdomen, which exposed a risk of harm that was “extreme and obvious to anyone with a medical education and to most lay people.” Id. at 437. In contrast, Nurse Sherrow saw the results of a urine test that indicated a potential abnormality. Even Griffith’s expert report does not speak in the unequivocal language used in LeMarbe: Griffith’s expert stated only that the urinalysis shows “a potentially serious medical condition which required immediate medical evaluation and treatment.” Report of Madeline LaMarre, R. 101-26 at PageID 4065. Second, and more importantly, LeMarbe differs from this case because of the evidence there indicating the surgeon “disregarded” the risk. LeMarbe, 266 F.3d at 438. The surgeon in LeMarbe took no further steps to address the leaking bile; he simply ended surgery and discharged the patient. Id. at 433. In contrast, Nurse Sherrow elevated Griffith’s condition to an APRN by placing him on the weekly list. It is therefore undisputed that Griffith’s medical condition was still under review and that he would have received further treatment. Even if was placed on the weekly list. The dissent also ignores the three full days Griffith spent in general population, during which time Nurse Sherrow had no information about his condition. Nos. 19-5378/5438/5439/5440 Griffith v. Franklin County, Ky., et al. Page 25 Sherrow’s chosen approach was negligent, that is not enough to satisfy Griffith’s evidentiary burdens, either under Farmer or Kingsley: “Whatever Kingsley requires, it is more than negligence.” Martin v. Warren County, 799 F. App’x 329, 338 n.4 (6th Cir. 2020). Finally, for two reasons there is no merit to Griffith’s contention that Sherrow’s deliberate indifference is demonstrated because Griffith was released into the general population or because she did not follow up with Griffith after that time. First, Griffith had been held for observation by jail staff and the Kentucky Jail Mental Health Crisis Network, not medical staff. Accordingly, the recommendation to release him into general population came not from the nurses but from Clinician Thompson with the Kentucky Jail Mental Health Crisis Network. There is no evidence to suggest that the nursing staff was responsible for releasing Griffith into general population. Second, there is no evidence that the nursing staff should have affirmatively followed up with Griffith for continued monitoring. To the contrary, the expectation was that either Griffith or a deputy jailer would submit a sick slip if he needed further attention. There is no evidence that the nurses should have expected that Griffith’s condition was deteriorating or that they could have known that their attempts to treat his condition had been unsuccessful. In sum, Sherrow had three brief interactions with Griffith over the course of his time in detox. During that period, she conducted a urine sample that contained information about his condition and elevated the test results to an APRN. Griffith made no effort to obtain further care other than the two sick call slips he filled out in detox, and there is no evidence that Sherrow would have expected that he had not responded to the treatment provided by herself and Trivette. Sherrow’s treatment may have been suboptimal, but it does not rise to the level of a constitutional violation. We therefore affirm the grant of summary judgment in favor of Sherrow.