Tenth Circuit Affirms Denial of Qualified Immunity to Utah Jailers After Detainee’s Withdrawal Death
by David M. Reutter
On September 7, 2022, the U.S. Court of Appeals for the Tenth Circuit affirmed denial of qualified immunity (QI) to officials at Utah’s Unitah County Jail in a lawsuit accusing them of deliberate indifference in a detainee’s death from complications related to alcohol withdrawal.
Coby Lee Paugh had long suffered from chronic alcoholism when he pleaded guilty in March 2015 to an alcohol-related offense and was placed on supervised probation. One condition of that supervision: He must abstain from alcohol for six months.
Of course, for someone suffering alcohol addiction, this was an impossible assignment. Paugh utterly failed, going on a multi-day drinking binge. But realizing he needed help, Paugh turned himself into police on July 24, 2014, for violating his probation. At the time, he had a blood alcohol content of .324, “dangerously” close to “alcohol overdose levels,” according to the complaint later filed on his behalf.
Arresting deputies immediately took Paugh to a hospital for medical clearance to admit him to the jail. There Dr. Aaron Bradbury examined Paugh and diagnosed chronic alcoholism and alcohol withdrawal. After prescribing Librium to mitigate the alcohol-withdrawal symptoms, Bradbury found Paugh was “currently stable and safe for incarceration.” But his discharge instructions required jail officials to administer Librium to Paugh “[a]s needed” and advised that if Paugh’s “alcohol withdrawal condition got any worse [jail officials would] have to bring him back to” the hospital, the complaint recalled.
Guard Dan Bunnell and nurse Kori Anderson interacted with Paugh when he arrived at the jail at around 2:20 a.m. Bunnell was night-shift supervisor and Anderson the designated medical official. They placed Paugh in a “detox” cell, but they did not get the Librium prescription filled and administered.
Moreover, they failed to advise the following day shift of Paugh’s condition and medical needs. Still, when they arrived to take over the next shift, Kyle Fuller, Tyler Conley and Richard Gowen “reviewed at least part of Paugh’s medical file or otherwise learned” that he was experiencing alcohol withdrawal, the complaint alleged.
Throughout the day, Fuller and Gowen observed Paugh’s withdrawal symptoms. After Fuller had the Librium prescription filled, he noted the instructions to administer “as needed” conflicted with the jail’s scheduled three-times-daily medication hand-outs. To resolve the discrepancy, Fuller called Physician Assistant Logan Clark.
Fuller allegedly knew then that Paugh had refused breakfast. But he told Clark the detainee had been eating. Fuller also allegedly knew Paugh had developed the shakes and had vomited several times. Yet he told Clark that Paugh hadn’t vomited, was moving around well, and seemed to be doing fine. Based on what he was told, Clark instructed Paugh be given one Librium capsule three times daily.
When dinner was served, Paugh told Gowen that he was “feeling sick and nauseous.” His hands and forearms were visibly shaking. Gowen noted that Paugh appeared sick and that he had vomited and not eaten much through the day. Conley was instructed at 5 p.m. to administer Librium to Laugh, but he never did so.
About an hour after the night shift returned on duty at 6 p.m., Paugh informed Bunnell and Anderson that he had not received any Librium during dinner and that he was feeling sick from withdrawal symptoms. They then allegedly gave Paugh a second dose at 8:00 p.m.
He reported almost two hours later that he was having hot and cold flashes. Paugh was last checked at 2 a.m. About 6:10 a.m., he was found dead in his cell. It was determined that he died of alcohol withdrawal complications.
With the aid of Salt Lake City attorney William P. Morrison, along with attorneys Michael A. Worel, Paul M. Simmons and Richard E. Shelton of Dewsnup King Olsen Worel Havas Mortensen, also in Salt Lake City, Paugh’s estate filed suit in federal court for the District of Utah. Proceeding under 42 U.S.C. § 1983, they accused the county and its jail staff of deliberate indifference to Paugh’s serious medical need, in violation of his Eighth Amendment guarantee of freedom from cruel and unusual punishment.
Defendants claimed QI and moved for summary judgment. But the district court denied that motion as to Anderson, Bunnell, Fuller, Conley and Gowen. They filed an interlocutory appeal, which the County joined.
Taking up the case, the Tenth Circuit began by noting that each of the individual defendants was aware of the alcohol withdrawal diagnosis and Dr. Bradley’s directions. They also witnessed Paugh’s withdrawal symptoms, but they delayed or took no action to administer Librium. Nor did they return Paugh to the hospital. The Court noted that no Librium was found in Paugh’s blood during autopsy, so maybe he was never administered the medication.
Affirming denial of QI, the Court emphasized the hospital directions, which mandated that Defendants take action in the face of Paugh’s worsening symptoms. But it found no jurisdiction to hear the County’s appeal, since it was not an individual and therefore not entitled to QI. The Court also said it was premature to consider the estate’s claim against the county – that it so poorly trained its jailers as to create a de facto policy of deliberate indifference to detainees like Paugh, giving rise to liability under Monell v. Dep’t of Soc. Servs., 436 U.S. 658 (1978); that determination would require more fact-finding by the district court. Thus the district court’s order was affirmed. See: Paugh v. Uintah Cty., 47 F.4th 1139 (10th Cir. 2022).
The case remains pending in the district court, where trial is currently scheduled for August 2023; PLN will update developments as they are available. See: Paugh v. Ashley Valley Med. Ctr., USDC (D. Utah), Case No. 2:17-cv-01249.
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