by David M. Reutter

In a lawsuit alleging officials at Oklahoma’s Carter County Jail (CCJ) failed to provide any medical attention in the days leading up to a pretrial detainee’s death, the U.S. Court of Appeals for the Tenth Circuit overruled a lower court’s grant of qualified immunity (QI) to the jail’s nurse and reversed a grant of summary judgment for Defendants on March 14, 2022.

The detainee, Wayne Bowker, 41, was booked into CCJ for possession of cocaine on March 23, 2016. At intake, he informed jail officials that he suffered from asthma, congestive heart failure, high blood pressure, bipolar disorder, anxiety disorder, seizures, shortness of breath and thyroid problems. He was also taking medications for high cholesterol and blood pressure.

But “[i]n the days and weeks preceding his death, Bowker did not receive several of his prescribed medications,” according to the complaint filed by his estate. He also began to experience fecal incontinence and catatonia, leaving him “able to communicate with jail staff only by using strange repetitive phrases.”

Between May 18 and June 11, 2016, Bowker made three trips from the jail to the hospital. On each occasion, doctors at discharge recommended follow-up care. On the second discharge, the doctor said that if Bowker did not receive prompt follow-up, he “may suffer permanent disability, pain, and possibly death.” The third discharge recommend follow-up neurology care and continuation of a course of medications.

But no follow-up care was ever sought for Bowker. The last time he received any medication was on June 12, 2016. After that, his condition continued to deteriorate until he was found unresponsive in his cell on June 30, 2016, when was transported to an emergency room and pronounced dead.

Aided by attorneys Byron D. Helm, Daniel Smolen and Robert M. Blakemore of Smolen, Smolen & Roytman in Tulsa, Judy Lynn Prince, Bowker’s mother and the administrator of his estate, filed suit in federal court for the Eastern District of Oklahoma against CCJ nurse Kimberly Miller and former Sheriff Milton Anthony, as well as his replacement, Chris Bryant, accusing them of deliberate indifference to Bowker’s serious medical need, in violation of his due-process rights under the Fourteenth Amendment.

The district court granted Defendants summary judgement, reasoning that Miller was entitled to QI because it wasn’t clear Bowker was at risk of death and that the Sheriff was therefore also not liable for failing to properly train and supervise her. Prince appealed to the Tenth Circuit.

District Court Asked
the Wrong Question

Taking up the case, the Court said that whether Miller knew Bowker faced death was the wrong question. Instead, were Bowker’s alleged symptoms—psychosis, fecal incontinence and catatonia—sufficiently serious that Miller shouldn’t have ignored them? In answering that affirmatively, the Court said that “[a] medical condition is ‘sufficiently serious’ when ‘the condition has been diagnosed by a physician as mandating treatment or is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention,’” quoting Al-Turki v. Robinson, 762 F.3d 1188 (10th Cir. 2014). 

Presented with Bowker’s symptoms, a jury might very well see them as evidence of an “immediate harm” that ultimately resulted in one much more serious, namely his death. Part of the legal burden on Plaintiff to overcome Miller’s claim of QI was to make just such a showing of objective harm, the Court noted, citing Mata v. Saiz, 427 F.3d 745 (10th Cir. 2005) to hold that
“[a]s long as the resulting harm is sufficiently serious and prison officials ignored the intermediate symptoms, the objective prong is satisfied.”

But in the Tenth Circuit, overcoming QI in a neglect claim also requires a showing that Defendants were subjectively aware of the specific risk to Bowker. So the Court again turned to the evidence, which showed that Miller consulted with Bowker when he was communicating only in incoherent phrases and had been moved to an isolated cell due to his fecal incontinence. She’d also been put on notice by hospital doctors that follow-up treatment was urgent.

Moreover, Miller knew that just seven months earlier, another detainee, Michael Manos, had died at CCJ after exhibiting similar symptoms. Yet, the nurse made no effort to get Bowker to a hospital. Citing four rulings in similar circumstances—Al-Turki, as well as Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000); Olsen v. Layton Hills Mall, 312 F.3d 1304 (10th Cir. 2002); and McCowan v. Morales, 945 F.3d 1276 (10th Cir. 2019)—the Court concluded that a reasonable jury could find this constituted evidence of deliberate indifference by the nurse.

Having dispensed with Miller’s QI claim, the Court turned to the Sheriff and decided that a “jury could find that Carter County had unofficial policies or customs of failing to medically train jail employees, inadequately staffing the jail, and delaying inmate medical attention.”

Despite policy requiring a doctor on staff, the jail did not employ one. Miller was the only CCJ employee with any medical training, and she admitted having no mental health training and being unqualified to diagnose medical conditions. When she went home on evenings and weekends, there were no medical personnel present at all, and Miller was reportedly so hostile when phoned after hours that guards were reluctant to do so.

Worse, because Bowker didn’t arrive at the jail with his medications in unopened containers, they were withheld from him under CCJ policy, which also required him to pay $100 for a trip to a hospital emergency room to get new prescriptions. As a result, Bowker was denied necessary medications for close to two months after his arrival at the jail.

Since testimony showed that the Sheriff was aware of these conditions, the Court said, a jury could find him liable for acting “with deliberate indifference to the consequences,” as laid out in Bryson v. City of Oklahoma City, 627 F.3d 784 (10th Cir. 2010). So the district court’s entire order was reversed and the case remanded. See: Prince v. Sheriff of Carter Cty., 28 F.4th 1033 (10th Cir. 2022).

The case has now returned to the district court, where the parties failed to reach an agreement at a settlement conference on July 26, 2022, leaving the case to proceed to trial in December 2022. PLN will report further developments as they become available. See: Prince v. Sheriff of Carter Cty., USDC (E.D. Okla.), Case No. 6:18-cv-00201.

PLN has also reported the outcome in one of the earlier jail-death cases upon which the Court relied in its decision, filed by the estate of 44-year-old Michael Manos after he was found unresponsive in his CCJ cell in November 2015. It proceeded to trial in August 2019 on conflicting claims as to whether the diabetic detainee was denied insulin. Then jail logs suddenly surfaced showing Manos never received the medication, and the case was quickly settled for $3.2 million. [See: PLN, Feb. 2020, p.61.] 

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