Court Opinion

ID: 9494315
Source: CourtListenerOpinion
Date Created: 2023-08-05 15:35:04.073032+00
Date Added: 2024-06-11T17:56:20.516141
License: Public Domain

RIPPLE, Circuit Judge,
dissenting.
1.
On June 7, 1993, Robert Johnson committed suicide by hanging himself from an overhead pipe using his bedsheet. The facts that led up to that tragedy are the basis of this lawsuit.
An understanding of the issue before us- and of the import of the majority’s conclusion — will be best understood if the circumstances surrounding Mr. Johnson’s suicide are placed in the broader factual context of the case.
Mr. Johnson was arrested and incarcerated at Metropolitan Correction Center (“MCC”) in Chicago while awaiting trial on extortion charges. During his incarceration, Mr. Johnson was first detained on the thirteenth floor, and later, was moved to the seventeenth. By all accounts, Mr. Johnson was not well on either floor. Mr. Johnson was described by inmates and guards alike as being a nervous and anxious person. Different inmates testified that Mr. Johnson did not eat or sleep well and that his emotional well-being was poor. Inmates alternately describe Mr. Johnson’s mood as very nervous, unstable, and worried. They testified that Mr. Johnson spent a great deal of time by himself and that he became less and less social as his incarceration progressed. Mr. Johnson’s last cellmate, Alvin McCar-ver, also testified that during the night, Mr. Johnson would be up alternately vomiting and brushing his teeth until his gums bled.1
Even more apparent than his general state of mind was a disturbing nervous habit that Mr. Johnson acquired. Mr. Johnson would scratch and pick at his skin, causing open sores that would bleed. Once he would cause these sores, Mr. Johnson would continue to pick at them with his fingers, manicure scissors, playing cards, or apparently anything else that was available. This continual scratching and picking caused the sores to fester and ooze blood; they never properly healed.2
*762Several inmates went out of their way to help Mr. Johnson. Thomas Johnson testified that, a few days prior to Mr. Johnson’s suicide, Johnson had told a guard that he thought Mr. Johnson was in need of psychiatric care. Jeffery Sorrenson, a former cellmate of Mr. Johnson, testified that he went to a female officer to complain about Mr. Johnson’s nervous habits and hygiene. Derrick Anderson encouraged Mr. Johnson to see a doctor and even accompanied him to sick call on the final morning of Mr. Johnson’s life.
The efforts of two inmates in particular are especially noteworthy. Richard Dover met Mr. Johnson while they both were on the thirteenth floor; Dover also was placed on the seventeenth floor with Mr. Johnson. Dover testified that two other inmates and he approached at least three guards in an attempt to get medical assistance for Mr. Johnson. Dover pointed out Mr. Johnson’s symptoms and said that Mr. Johnson needed to go to a hospital. Dover testified that nothing came of these conversations: “We always stayed up onto the guards, trying to get them to do something about it, and they never did.” Dover Dep. at 21.
Alvin McCarver, Mr. Johnson’s final cellmate, also sought help for Mr. Johnson. Even though McCarver shared a cell with Mr. Johnson for only a short time, McCar-ver already knew of Mr. Johnson’s problems just from living on the same floor. After becoming cellmates, however, his awareness of the problem increased. One day, while Mr. Johnson was at an attorney visit, McCarver brought a unit officer into their cell to see Mr. Johnson’s bloodstained sheets.3 McCarver told the officer that “[sjomething needs to be done about this. This guy needs some help. He has a nervous condition.” McCarver Dep. at 27. Because McCarver believed the unit officer had not done anything, McCarver then spoke to Mark Cunneen, a counselor assigned to the seventeenth floor. McCar-ver told Cunneen that Mr. Johnson needed psychiatric care and that perhaps antidepressant medication was in order. McCar-ver testified that this meeting happened only days before Mr. Johnson committed suicide.
The night before Mr. Johnson’s suicide, McCarver filled out a sick call sheet for Mr. Johnson. A sick call sheet was a request to see medical personnel. On the sheet, McCarver described Mr. Johnson’s complaint as open sores caused by nerves. In the box next to the question whether the complaint was serious, McCarver checked yes twice. However, when the physician’s assistant (“PA”) saw Mr. Johnson the next morning, she did not have the sick call sheet with her, in violation of prison policy.
Mr. Johnson told the PA that he was nervous and that he wanted something to calm him down. Again in violation of policy, the PA told Mr. Johnson to make an appointment with a psychologist rather than referring Mr. Johnson personally.
The compassionate attempts by inmates to help Mr. Johnson were to little avail. There is no evidence that any prison official attempted to get Mr. Johnson any type of medical attention. At least one prison official testified that he knew of Mr. Johnson’s problems. Officer James Young admitted that McCarver had confronted *763him about the blood-stained linens, but he nonetheless failed to seek assistance for Mr. Johnson. Other prison officials claimed to have no memory of Mr. Johnson. Cunneen, the counselor that McCar-ver testified he spoke to, claimed no recollection either of Mr. Johnson or of any conversation with McCarver regarding Mr. Johnson. The district court found that McCarver’s testimony was “adamant and precise” and that Cunneen’s testimony “strains credulity.” R.38 at 14.
Through their combined efforts, inmates were able to cajole Mr. Johnson into seeking help for his problems. After months of suffering alone, Mr. Johnson went to the PA in hopes of receiving help. When the PA failed to treat Mr. Johnson adequately, the last opportunity to help Mr. Johnson was lost. Twelve hours later, Mr. Johnson took his own life.
2.
The majority holds that the United States cannot be liable for Mr. Johnson’s death. Specifically, the majority reasons that Mr. Johnson’s suicide was not foreseeable and that the Government was not the proximate cause of Mr. Johnson’s death. I respectfully disagree.
“The district court’s determination of foreseeability is a factual determination reviewable only for clear error.” United States v. Bullis, 77 F.3d 1553, 1564 (7th Cir.1996). I do not believe that the district court clearly erred in its determination that Mr. Johnson’s suicide was foreseeable. The record offers ample evidence that demonstrates that prison officials should have known that Mr. Johnson was suffering severe emotional distress. As the district court noted,pretrial detainees like Mr. Johnson have a greater risk of suicide than the population in general. This reality should have alerted prison officials to scrutinize seriously the numerous reports they received concerning Mr. Johnson’s deteriorating psychiatric state.
Inmates testified that Mr. Johnson brushed his teeth until they bled, that he was up at nights vomiting, and that he scratched his skin until it bled. Mr. Johnson was described as a loner who had problems sleeping and eating. On more than one occasion, inmates such as Alvin McCarver brought these symptoms to the attention of prison officials. Prison officials chose to do nothing.
Undoubtedly, it is easier for officials to know that someone is having suicidal thoughts when that person says that he is having suicidal thoughts. However, having an inmate in custody creates a duty of care that must include enough attention to mental health concerns that inmates with obvious symptoms receive medical attention. Prison officials had numerous opportunities to meet their responsibilities to help Mr. Johnson, but no one did. One cannot avoid responsibility by putting one’s head in the sand.
3.
The court reviews factual findings, such as the existence of proximate cause, for clear error and will not reverse if the district court’s findings are plausible in light of the entire record. See Anderson v. Bessemer City, 470 U.S. 564, 573, 105 S.Ct. 1504, 84 L.Ed.2d 518 (1985); Wyletal v. United States, 907 F.2d 49, 50 (7th Cir.1990) (factual findings in Federal Tort Act cases reviewed under clearly erroneous standard); Susnis v. Radfar, 317 Ill.App.3d 817, 251 Ill.Dec. 27, 739 N.E.2d 960, 967 (Ill.App.Ct.2000) (under Illinois law, questions of proximate causation are questions of fact). “A factual determination is clearly erroneous only if, after considering all the evidence, the reviewing court is left with the definite and firm conviction that a mistake has been commit*764ted.” United States v. Charles, 238 F.3d 916, 918 (7th Cir.2001) (internal quotation marks and citations omitted). Additionally, “a district court’s choice between two permissible inferences from the evidence cannot be clearly erroneous.” See id. Under Illinois law, “proximate cause can only be established when there is a reasonable certainty that the defendant’s acts caused the injury” or the increased risk of future injury. Henderson v. Sheahan, 196 F.3d 839, 852 (7th.Cir.1999) (internal quotation marks and citations omitted).
I cannot join the majority view that the district court was clearly erroneous in its determination that the United States was the proximate cause of Mr. Johnson’s death. The majority correctly notes that suicide is generally viewed as a supervening cause breaking the chain of causation. However, there are circumstances that render this rule inapplicable. “As a general rule, absent some type of custodial relationship, one cannot be held liable for the suicide of another.” Wyke v. Polk County Sch. Bd., 129 F.3d 560, 574 (11th Cir.1997). By articulating the qualification “absent some type of custodial relationship,” our colleagues in the Eleventh Circuit acknowledged that the general rule makes no sense when a higher duty of care is required because “the State ‘takes a person into its custody and holds him there against his will,’ hence depriving him of liberty.” Butera v. Dist. of Columbia, 235 F.3d 637, 648 (D.C.Cir.2001) (quoting De-Shaney v. Winnebago County Dep’t of Soc. Servs., 489 U.S. 189, 199-200, 109 S.Ct. 998, 103 L.Ed.2d 249 (1989)); see also Bruzga v. PMR Architects, P.C., 141 N.H. 756, 693 A.2d 401, 403 (N.H.1997). “[Having stripped them [incarcerated persons] of virtually every means of self-protection and foreclosed their access to outside aid, the government and its officials are not free to let the state of nature take its course.” Farmer v. Brennan, 511 U.S. 825, 833, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994).
Here, prison officials knew that Mr. Johnson was suffering severe emotional distress. Given that knowledge, they had an affirmative duty to aid Mr. Johnson. Time and again, when presented with information that Mr. Johnson was suffering, officials failed to act. The combination of this inaction caused Mr. Johnson’s death.
I believe it to be entirely permissible for the district court to determine that the collective failure of prison officials to provide medical assistance for Mr. Johnson was the proximate cause of his death. Accordingly, the district court’s conclusion is not clearly erroneous and must be upheld.
4.
I also cannot join the majority’s discussion of the damage award in this. case. First, the point should be made that the majority concedes that “our analysis makes it unnecessary” to consider the damage award in this case. Maj. Op. at 757. Because the discussion of this issue is not necessary to determine the outcome of this case, it is “purely dicta” and “does not constitute the law of the case or any other binding precedent for our current consideration.” Thomas & Betts Corp. v. Panduit Corp., 138 F.3d 277, 289 n. 4 (7th Cir.1998). We have noted that:
Dicta are the parts of an opinion that are not binding on a subsequent court, whether as a matter of stare decisis or as a matter of law of the case.... They are non-binding for two reasons. First, not being integral elements of the analysis underlying the decision ... they may not express the judges’ most careful, focused thinking. Second, to give the inessential parts of an opinion the force of law would give judges too much power, and of an essentially legislative character; we could hardly consider ourselves judges in the Anglo American *765tradition were we to interrupt this opinion to offer our thoughts.
Wilder v. Apfel, 153 F.3d 799, 803 (7th Cir.1998).
The wisdom of this time-honored approach to dicta is well-justified by the majority’s expressed view that hanging deaths and death by drowning are comparable. Hanging is an excruciatingly painful and cruel way to die. Of the forty-eight states that once allowed executions by hanging, only two jurisdictions still do. More specifically:
In properly-performed hangings, the neck breaks immediately and unconsciousness is supposedly instantaneous. However, hanging has been called an “art,” and considerable skill is necessary to ensure that the neck breaks.... In most instances, however, this [break] does not result, and the condemned dies a violent and lingering death. If the drop is too long, the prisoner may be decapitated, causing great indignity to the body. If the drop is too short, the inmate may slowly strangle to death. In strangulation, extreme pain is evident: the eyeballs pop out, the tongue swells and protrudes, the rope can pull hunks of flesh off the face, and the, neck elongates and distorts. As it is so often improperly performed, the risk of either decapitation or slow strangulation is likely.
Kristina E. Beard, Comment, Five Under the Eighth: Methodology Review and the Cruel and Unusual Punishments Clause, 51 U. Miami L.Rev. 445, 464 (1997).
Given that a professional execution, in at least a semi-controlled environment, leads to an agonizing death, it seems apparent that a depressed man with only an overhead pipe and a bedsheet would suffer a great deal. Dr. Kern, an ear, nose, and throat surgeon, reviewed the documentation for Mr. Johnson’s case and testified as to his findings. Dr. Kern explained that death from a self-hanging is slower than a judicial hanging.. Like in Mr. Johnson’s case, the individual usually falls a short distance and uses a material that is looser on the neck than a rope. These circumstances combine to cause a slow suffocation. If a person succeeds in completely blocking his airway, that person may lose consciousness as quickly as in three minutes. However, Mr. Johnson “assuredly” could not achieve total airway blockage using the bedsheet. Tr.II at 140. While suffocating, Mr. Johnson experienced the phenomenon known as “air hunger” during which the body wants oxygen but cannot get it. Air hunger causes extreme anxiety and fear. Dr. Kern testified that it was very likely that Mr. Johnson was conscious longer than three minutes and may have suffered up to twenty.
Drowning is also clearly a traumatic experience. When a pérson in the water begins to take water in, the automatic physiological reaction is that the muscle at the entrance of the windpipe contracts, preventing water from entering the lungs. See Am. Med. Ass’n, Encyclopedia of Medicine 375 (1989). However, this contraction impairs breathing; without access to oxygen, the brain begins to be affected within thirty seconds, and the individual quickly loses consciousness. See id.; see also Roy W. Rafter, The Anatomy of Drowning, at http://www.airsearchres-eue.eom/drowning.h tm. Depending on the physical status of the victim, death often occurs in two minutes or less.
The differences between drowning and hanging are far too great to cabin the discretion of the trial court by making the court treat them as one and the same. The standard of review for damage awards is still an abuse of discretion.

. Admittedly, these individuals are not experts. However, when even a lay person recognizes that an individual needs help, it does not reflect well on the experts who remain oblivious to the situation.

. Although the defendants suggest that this *762scratching may have been caused by a skin condition, they offer no evidence to support that contention. Additionally, at least one inmate, Derrick Anderson, testified that Mr. Johnson told him that he scratched because he was nervous, not because of a skin problem.

. MCC policy requires blood-stained linens to be laundered in a particular manner to guard against blood-born pathogens. That policy was never followed in this case.