Opinion ID: 806090
Heading Depth: 3
Heading Rank: 1

Heading: Pausits

Text: A reasonable jury could conclude that Pausits was aware of the substantial risk to Parsons and failed to provide him with Dilantin at any point during his time at Standish. Because this conduct would rise to the level of deliberate indifference, we reverse the grant of summary judgment to Pausits. Pausits recognized that Parsons did not have his anti-seizure medication, but she testified that she did not view it as an emergency situation: Q: Now, is - - is that an emergency to you? If that guy showed up and didn’t have . . . some of these Dilantin pills with him? Pausits: No, it wouldn’t be an emergency to me. I wouldn’t jump into my car and run to the pharmacy and get him some, no. Q: You wouldn’t call an ambulance and have them come up to pick him up? Pausits: No, no. No, I would not. Q: People can go without the stuff and they can live to see the next day? Pausits: Yes, they can. The district court relied on this testimony and concluded that “[e]ven if [Pausits] should have known it was an emergency situation, unless she actually knew it was such a situation (which she did not), she committed no constitutional violation.” The deliberate indifference standard, however, does not require a plaintiff to show that a defendant knew of an “emergency situation.” Instead, Parsons must demonstrate that Pausits subjectively perceived facts from which to infer substantial risk to Parsons and that she did in fact draw the inference. See Comstock, 273 F.3d at 703. Common sense dictates that certain situations can present a substantial risk to a prisoner without being an emergency. In Farmer, which explained -9- No. 10-1584 and 11-1992 Parsons v. Caruso the subjective component of deliberate indifference, the Court held that prison officials could be liable for placing a transsexual prisoner in the general population when there existed a substantial risk of harm to that prisoner. Farmer, 511 U.S. at 847-49. The prisoner claimed to have been beaten and raped two weeks after being placed with the other inmates. Id. at 830. The initial placement of the prisoner with the general population did not create an emergency situation, but it did “expose [the] prisoner to a sufficiently substantial ‘risk of serious damage to his future health.’” Id. at 843 (quoting Helling v. McKinney, 509 U.S. 25, 35 (1993)) (emphasis added). Parsons is required to show actual knowledge of this substantial risk of harm, not actual knowledge of an emergency situation. Subjective knowledge of a substantial risk can be “demonstrat[ed] in the usual ways, including inference from circumstantial evidence.” Farmer, 511 U.S. at 842. This prevents a defendant from avoiding liability by simply denying knowledge after the fact. See id. In this case, Parsons points to the testimony of Dr. McCarthy as circumstantial evidence of Pausits’s knowledge of the substantial risk. Dr. McCarthy stated that, when a patient arrives at the facility without his medications, “this creates a rather urgent–in our view, a somewhat urgent situation.” Although this statement was in reference to all of Parsons’s medications and not just his Dilantin, it is still circumstantial evidence that a medical professional at Standish like Pausits would have recognized the substantial risk.1 1 In Parsons v. Heebsh, No. 11-1992, Plaintiff submitted the deposition of Dr. Gerald Sheiner. Dr. Sheiner testified: [W]hen a patient is taking [anti-seizure] medication regularly and stopped abruptly, the possibility or likelihood of a rebound event, in this case the emergence of a - 10 - No. 10-1584 and 11-1992 Parsons v. Caruso Also, the risk to Parsons in this case should have been obvious. See Farmer, 511 U.S. at 842. “If the risk is obvious, so that a reasonable man would realize it, we might well infer that the defendant did in fact realize it . . . .” Id. (internal quotation marks and alterations omitted). Parsons suffered from a seizure disorder, was regularly taking Dilantin to control his seizures, and did not have his Dilantin upon arriving at Standish. Pausits was aware of each of these facts when she conducted intake. Even if it is not obvious whether these facts present an emergency situation, “a reasonable man would realize” that there exists a substantial risk to a seizure disorder sufferer who does not have his anti-seizure medication. See id. Although “it remains open to the officials to prove that they were unaware even of an obvious risk to inmate health or safety,” this determination would fall to the trier of fact. Id. at 844. Parsons has presented sufficient evidence that Pausits was aware of a substantial risk to Parsons. Under the relevant standard, however, Parsons must also show that Pausits was deliberately indifferent by “disregard[ing] that risk.” Comstock, 273 F.3d at 703. A jury could conclude that Pausits was aware of the obvious risk to a seizure disorder sufferer who has not taken Dilantin for a number of hours. There is evidence that Pausits could have obtained Dilantin for Parsons immediately, as her own testimony demonstrates that Dilantin was seizure disorder which the drug is designed to suppress, that possibility increases hour by hour. When does it become clinically significant? A concern, 6 hours after missing a dose; a serious concern 12 hours after missing a dose, a dire condition 24 hours after missing a dose. This would be further circumstantial evidence that the risk to Parsons would have been obvious to a medical professional. However, the transcript of this deposition was only submitted in Parsons v. Heebsh and was not in front of the district court in Parsons v. Caruso, so it can only be considered with regard to defendants Heebsh and CMS. - 11 - No. 10-1584 and 11-1992 Parsons v. Caruso available in the “stock meds,” and she stated that she could have obtained the medication if she viewed the situation as an emergency. Pausits’s actions demonstrate a conscious choice to let Parsons linger yet longer without his anti-seizure medication. Moreover, Parsons has submitted evidence of the general prison practice of ordering medications from PharmaCorr, a process which could sometimes take several days. Pausits disputes that her decision to delay Parsons’s receipt of Dilantin was the proximate cause of Parsons’s injury. She notes that Heebsh saw Parsons the next morning, and there is no evidence that the interim delay caused Parsons’s death. Even if Pausits’s alleged indifference was not the “sole cause” of Parsons’s death, it would still be “‘a proximate cause if it [was] a substantial factor in the sequence of responsible causation.’” See Trollinger v. Tyson Foods, Inc., 370 F.3d 602, 620 (6th Cir. 2004) (quoting Cox v. Admin. U.S. Steel & Carnegie, 17 F.3d 1386, 1399 (11th Cir. 1994)). Given the risk involved in delaying providing anti-seizure medication to a seizure sufferer for over 24 hours, Pausits’s decision could reasonably be considered a substantial factor in Parsons’s death. Finally, Parsons can recover against Pausits so long as Pausits’s inaction increased the risk of injury—no matter whether Pausits actually contributed to Parsons’s death. See Blackmore, 390 F.3d at 899. Moreover, in Pausits’s case, evidence of deliberate indifference extends to August 27. There is conflicting evidence regarding Parsons’s medication while he was at Standish. According to Pausits and Parsons’s MAR, Pausits administered 100 mg of Dilantin to Parsons at 6:00 p.m. on August 27. The toxicology report after Parsons’s death, however, did not discover any Dilantin in his system, suggesting that he did not receive this medication for at least three days prior to his death - 12 - No. 10-1584 and 11-1992 Parsons v. Caruso on August 28. The toxicology results also showed the presence of Wellbutrin, which can exacerbate a seizure disorder. Also, there is a discrepancy in who was the nurse to dispense medications to Parsons on August 27–although Pausits signed Parsons’s MAR, the prison unit log states that Alexander performed the medication round on August 27. Viewing this evidence in the light most favorable to Plaintiff, a jury could reasonably determine that: (1) Pausits was aware of the substantial risk to Parsons and (2) Pausits did not administer Dilantin.2 These determinations are reasonable because a jury could place more importance on the toxicology report rather than Pausits’s testimony and the MAR. Furthermore, as indicated by the MAR, nurses are supposed to circle their initials if there were any problems administering the medication; Pausits’s initials for 6:00 p.m. on August 27 were not circled, and a jury could conclude that this demonstrates that Parsons ingested whatever medication was given to him. Although the district court notes that there is no evidence “that Nurse Pausits willfully committed a medications error,” Farmer makes clear that “deliberate indifference is satisfied by something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result.” Farmer, 511 U.S. at 835. Viewing the facts and drawing all reasonable inferences in favor of Parsons, Pausits’s failure to administer Dilantin, even if she lacked intent or knowledge 2 Based on the toxicology report, a third conclusion could be that Pausits in fact administered Wellbutrin to Parsons on August 27. This conclusion, however, may be too speculative–while a reasonable jury could conclude that Parsons could only have received Wellbutrin from a prison official dispensing the medication, a jury would have to connect additional dots to conclude that the official was Pausits. The determination that Pausits recklessly disregarded the risk to Parsons by failing to administer Dilantin when she had the opportunity requires only that the jury credit the toxicology report and the MAR, which shows that it was Pausits’s duty to dispense medication, and is much less speculative than the conclusion that she actually administered Wellbutrin. - 13 - No. 10-1584 and 11-1992 Parsons v. Caruso that harm would actually result, would exceed negligence and rise to the level of “recklessness” as required under the deliberate indifference standard. See id. at 836-37. Pausits’s conduct, if true, would be especially reckless because of her familiarity with Parsons through the medical intake and her failure to initially provide Dilantin on August 25. Plaintiff has presented sufficient evidence to create a genuine issue as to whether Pausits acted with deliberate indifference in failing to administer Dilantin to Parsons.