Fifth Circuit Upholds Qualified Immunity in Medical Neglect Death of Texas Detainee

by Matt Clarke

In a case involving the death of a pretrial detainee due to lack of medical treatment, the Fifth Circuit Court of Appeals upheld a district court’s order granting qualified immunity to a contract doctor at a county jail and to the county itself.

When Jason Ray Brown, 26, was booked into jail in Wichita County, Texas in July 2004, he told the booking officer that he suffered from autoimmune chronic hepatitis, enlarged veins in the lower esophagus, anemia, jaundice and an enlarged spleen, and that he was under the care of a medical specialist. An hour later he complained of vomiting a small amount of blood.

Licensed vocational nurse (LVN) Michelle George obtained a list of Brown’s medications from his pharmacist, but was told by her supervisor, LVN Rose Ingram, not to order any medication until Brown was seen by the jail’s contract physician, Daniel Bolin.

Just before midnight the next day, Brown vomited a large amount of blood. He told a jailer that he had gastric ulcers and had received 27 units of blood due to internal bleeding within the previous six months. The jailer called LVN Kay Krajca, who told him to give Brown a dose of liquid antacid per Dr. Bolin’s standing orders.

Soon afterwards, other prisoners told the jailer that Brown was complaining he was in a great deal of pain. Called at home, Krajca said Brown should receive a phenergan suppository for his nausea, per the standing orders. Jailers who arrived to administer the suppository around 2:25 a.m. discovered Brown “moaning and incoherent.” This time when they called Krajca she agreed to return to the jail.

After Krajca arrived, she had Brown transferred to a medical cell where he was allegedly monitored from time to time through a slot in the door. He was later discovered without a pulse; responding emergency medical technicians said he had been dead quite some time. An autopsy reported his death was due to a massive gastrointestinal hemorrhage.

Brown’s parents filed suit against the county, sheriff, jailers, medical staff and Dr. Bolin under 42 U.S.C. § 1983, with pendant state negligence claims. They alleged the defendants were deliberately indifferent to Brown’s serious medical needs in violation of his due process rights. The district court granted qualified immunity to the sheriff, which was affirmed on appeal. See: Brown v. Callahan, 623 F.3d 249 (5th Cir. 2010).

Dr. Bolin and Wichita County then moved for reconsideration of their summary judgment motions based on qualified immunity, citing the Court of Appeals’ decision in favor of the sheriff. The district court granted their motions for qualified immunity, and the plaintiffs appealed.

The Fifth Circuit noted that Krajca “undoubtedly acted with deliberate indifference to Brown’s medical needs,” and that “[a]s a pretrial detainee, Brown had a clearly established Fourteenth Amendment right not to be denied medical care as a result of deliberate indifference.”

Brown’s parents alleged that Dr. Bolin was “allowing the LVNs to medicate detainees from the standing orders requiring them to perform medical care beyond their professional training,” and intimidated nurses who either called him for medical assistance at night or had prisoners transported to a hospital for emergency care, making him responsible under the theory of supervisory liability.

The appellate court held that Bolin had not directly observed Brown’s condition and had no indication that his standing orders or intimidation of the nurses put prisoners’ health at risk prior to Brown’s death. Thus, he was entitled to qualified immunity. The county was also entitled to qualified immunity as there was no proof it had established an unconstitutional policy at the jail that was a “moving force” in the violation of Brown’s rights.

“Although we reach these conclusions based on the facts available to Dr. Bolin and the County at the time of Brown’s incarceration, this holding is not approval of the medical care provided by Dr. Bolin or the Wichita County Jail,” the Fifth Circuit wrote. “As pointed out by the plaintiffs, there have been two documented cases of improper assessment by the nursing staff at the jail since Brown’s death which could be viewed as evidence that the nurses do not have the proper training to recognize critical medical situations.... However, based on the record in this case, we affirm the judgment of the district court granting qualified immunity to these defendants.”

One appellate judge dissented and would have denied qualified immunity to Bolin. The plaintiffs filed a petition for writ of certiorari with the Supreme Court, which was denied on June 17, 2013. See: Brown v. Bolin, 500 Fed.Appx. 309 (5th Cir. 2012), cert. denied.

Apparently, medical care at the jail hasn’t improved much. On May 21, 2014, former Wichita County Jail prisoner Nicole Guerrero filed suit in federal court after she delivered a baby in a solitary confinement cell in 2012, without medical assistance, resulting in her baby’s death. The lawsuit names the county, sheriff, registered nurse Ladonna Anderson and Correctional Healthcare Management as defendants.

Guerrero said she was denied medical care when she began to experience labor, even though she was “in obvious distress, [and] began to moan, scream and cry.” Anderson’s nursing license is listed as “delinquent” by the Texas Board of Nursing. The lawsuit remains pending. See: Guerrero v. Wichita County, U.S.D.C. (N.D. Tex.), Case No. 7:14-cv-00058-O.

Additional source: Times Record News

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