By David M. Reutter

Granting qualified immunity (QI) to acting Kentucky Department of Corrections (DOC) Commissioner James Erwin on October 8, 2021, the U.S. Court of Appeals for the Sixth Circuit said he did not have supervisory liability for a state prisoner’s death allegedly caused by the negligence of privately contracted health care providers.

The dead man, Marc Crawford, was arrested for first-degree wanton endangerment and fleeing the scene of an accident and taken to the Madison County Detention Center (MCDC) on May 25, 2017. He had already butted heads with jail officials there after a September 2016 arrest, when they allegedly left him in a restraint chair so long he urinated on himself. His attempt to obtain video footage of the incident was met with threats of retaliatory arrest until the state Attorney General ultimately found the jail violated the state open records law in denying Crawford’s request.

Meanwhile Crawford developed lung cancer and a blood clot in his left leg before his next arrest. Though his wife, Dawn Crawford, informed arresting officers of his condition, MCDC staff—including employees of the jail’s privately contracted medical provider, Southern Health Partners (SHP)—allegedly provided Crawford with minimal medical care, according to the complaint she later filed. After removing his pain-medication patch and placing him on inappropriate psychoactive medications, she said they failed to provide him with his prescriptions that he needed. CCS also refused to honor his scheduled chemotherapy treatments while in custody, continuing not to provide Crawford care even when he began vomiting blood.

Six days later, on May 31, 2017, Crawford was transferred to Kentucky State Reformatory (KSR), where he was supposed to receive better care from DOC’s privately contracted provider, Correct Care Solutions (CCS), now Wellpath. Upon arrival there, he had an elevated heart rate, difficulty breathing, and swelling in his leg. A nurse practitioner prescribed breathing treatments. But Crawford died on June 24, 2017.

It was two days before his family was contacted. An autopsy revealed Crawford effectively drowned in over three liters of fluid accumulated in his lungs, a condition that would have been discovered if his prescribed medical treatments were administered.

His estate filed suit under 42 U.S.C. § 1983 in federal court for the Western District of Kentucky against Erwin and other DOC officials, as well as CCS and SHP, accusing them of negligent medical care in violation of Crawford’s civil rights. Erwin claimed QI, but the district court denied that claim. He appealed.

Taking up the case then, the Sixth Circuit said that for Erwin to be sued in his supervisory capacity requires a showing that he engaged in “active unconstitutional conduct” which “could be reasonably expected to give rise to just the sort of injuries that occurred.”

Plaintiff argued that by accepting Crawford’s transfer to KSR, Erwin was “made aware” of the prisoner’s medical conditions. She also argued that Erwin knew or should have known of CCS’s deficient policies and customs—i.e., failing to provide adequate medical and mental health to prisoners—as well as the firm’s over reliance on under-qualified licensed practical nurses to treat prisoners.

The Court found those claims were inadequate to overcome QI. First, it said that the claims about CCS’s practices at KSR were conclusory. Moreover, there was no showing Erwin knew of a problem nor that he was personally aware of Crawford’s medical conditions while he was at KSR.

“In appropriate circumstances, we have attributed knowledge of obvious risks to prison officials,” the Court said, pointing to Stoudemire v. Mich. Dep’t of Corrs., 614 F. App’x 798 (6th Cir. 2015). But there the defendant was a warden with “day-to-day obligations” at the institution, unlike Erwin, who “is responsible for twenty-seven subdivisions within [DOC].”

“We’ve never attributed knowledge of prison conditions so high up the chain of command with so little in the way of alleged exposure to those same conditions,” the Court said.

It also wasn’t going to start doing so in Crawford’s case.

“At most,” the Court concluded, “[Plaintiff’s] complaint alleges the following: Erwin accepted [Crawford’s] transfer to KSR. Through that process, Erwin was “made aware” of [Crawford’s] medical conditions. Erwin knew that [CCS’s] deficient policies and customs posed risks to [Crawford]. Erwin never tried to alleviate these risks. And the combination of these actions and inactions proximately caused [Crawford’s] injuries. That’s it. Even charitably construed, this is all the activity that [Plaintiff’s] amended complaint attributes to Erwin, and it is not enough.”

Thus the district court’s order was reversed and the case remanded with instructions to dismiss the complaint as to Erwin. See: Crawford v. Tilley, 15 F.4th 752 (6th Cir. 2021).

The case has now returned to the district court to proceed on Crawford’s claims against the remaining defendants. She is represented by attorney Jessica K. Winters of the Winters Law Group LLC in Lexington. See: Crawford v. Tilley, USDC (E.D. Ky.), Case No. 5:18-cv-00623.

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