Samuel McGaw, Jr. v. Sevier County, Tenn.

NOT RECOMMENDED FOR PUBLICATION
File Name: 17a0599n.06
No. 16-6729
UNITED STATES COURT OF APPEALS FILED
FOR THE SIXTH CIRCUIT Oct 31, 2017
DEBORAH S. HUNT, Clerk
SAMUEL MCGAW, JR., et al., )
)
Plaintiff-Appellees, )
)
v. ) ON APPEAL FROM THE
) UNITED STATES DISTRICT
SEVIER COUNTY, TENNESSEE, et al., ) COURT FOR THE EASTERN
) DISTRICT OF TENNESSEE
Defendants-Appellants. )
)
)
BEFORE: CLAY, ROGERS and SUTTON, Circuit Judges.
ROGERS, Circuit Judge. Samuel M. McGaw, IV, arrived at the Sevier County Jail,
having consumed enough alcohol and opiates to leave him visibly intoxicated. Defendant jail
officers summoned a nurse to examine McGaw, and the nurse informed them that McGaw could
safely be left in a holding cell to sleep off his intoxication. However, during the night, McGaw
suffered a heart attack caused by the combination of alcohol and drugs, and later died at the
hospital. Plaintiffs in this 42 U.S.C. § 1983 action allege deliberate indifference by the officers
to McGaw’s medical needs, and failure on the part of the county to train its officers to recognize
medical emergencies. The district court denied defendants’ summary judgment motions, and
defendants appeal. Because the officers relied on what they reasonably believed to be
appropriate treatment advice by the jail nurse, they did not act with deliberate indifference and
were accordingly entitled to qualified immunity. With respect to the county, however, we lack
No. 16-6729, McGaw, et al. v. Sevier County, Tenn., et al.
pendent jurisdiction to review the interlocutory denial of summary judgment, where resolution of
the suit against the officers does not resolve all of the issues in the suit against the county.
On March 25, 2014, at around 10:30 p.m., Samuel M. McGaw, IV, turned himself in to
the Sevier County Jail on a capias warrant for a previous failure to appear in court on charges of
misdemeanor assault and public intoxication. At the time of his arrival at the jail, McGaw was
visibly intoxicated. He could not state what time it was, lacked the ability to sit up by himself,
and was flummoxed by questioning. McGaw did maintain enough presence of mind to state the
reason for his condition. He told his booking officers that he had consumed an unspecified
amount of vodka and three “roxys”—slang for roxicodone, a prescription opiate.
Defendant officers—Bradley Mount, Hayden Whaley, and Joshua McKinzie—
summoned a jailhouse nurse, Judy Sims, to examine McGaw. Sims was a licensed practical
nurse (LPN), employed by First Med, Inc., a contractor to Sevier County. Neither Sims nor First
Med is a party to this appeal. Officer McKinzie informed Nurse Sims that McGaw had reported
consuming alcohol and three “roxys.” Nurse Sims proceeded to examine McGaw, finding that
his pupils were pinpoint and nonreactive to light and his speech was slurred, but his blood
pressure, heart-rate, and blood-oxygen percentages were all within what Sims considered to be
normal limits. After conferring with her supervisor, Jessie Timbrook, another LPN, Nurse Sims
informed the officers that McGaw did not need to see a doctor or be taken to a hospital, but could
be left in a cell overnight for “monitoring.” Following that advice, the officers brought McGaw
to a holding cell. Throughout the night, the officers periodically observed McGaw through a
window and occasionally heard him snoring. They did not, however, physically enter the cell to
examine McGaw or otherwise reassess his condition.
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At around 1:09 a.m., jail staff observed McGaw in his cell and noticed he was
unresponsive and not breathing. The officers transported McGaw from the jail to a hospital,
where doctors diagnosed McGaw as having suffered full cardiac arrest. McGaw remained in a
coma until his death on April 6. The autopsy report stated that McGaw had died from “a
combination of alcohol and oxycodone toxicity” caused by McGaw’s consumption of those
substances.
McGaw’s estate and next-of-kin brought suit against the defendant officers and Sevier
County in the district court below, alleging a violation of McGaw’s civil rights pursuant to 42
U.S.C. § 1983. Plaintiffs claimed that McGaw possessed a clearly established right to medical
treatment and that defendants violated this right: the officers by failure to recognize the
seriousness of McGaw’s condition or transport him to a hospital, and Sevier County by failure to
supervise defendant officers, failure to properly train them, and failure to have adequate
procedures in place to prevent mistreatment. Defendants moved for summary judgment on the
grounds that the officers were entitled to qualified immunity, and that no county policy or
procedure caused any violation of McGaw’s rights. The district court denied qualified immunity
to the officers on the grounds that McGaw had a clearly established right to medical treatment
and the officers were deliberately indifferent to that right when they left McGaw in an
observation cell, despite knowing of his intoxication. The district court also denied summary
judgment to Sevier County on the grounds that material disputes of fact existed as to whether any
inadequacies in Sevier County’s training programs and policies caused McGaw’s death.
Both defendant officers and Sevier County now appeal.
Defendant officers were entitled to qualified immunity because they did not act with
deliberate indifference to McGaw’s medical needs when they relied on what they reasonably
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believed to be appropriate advice from Nurse Sims. Here, the officers placed McGaw in the
observation cell because they reasonably believed, based on Nurse Sims’s assessment, that this
was the medically appropriate thing to do, and are thus entitled to qualified immunity for acting
pursuant to that assessment. None of the officers had medical training, and there is no evidence
that they knew or believed that Nurse Sims’s diagnosis was anything but correct. As the Third
Circuit has reasoned, where “a prisoner is under the care of medical experts . . . a non-medical
prison official will generally be justified in believing that the prisoner is in capable hands.”
Spruill v. Gillis, 372 F.3d 218, 236 (3d Cir. 2004). The record does not show any evidence that
the officers were or should have been aware that their lay understandings of this situation were
superior to Nurse Sims’s trained assessment. In retrospect, it appears clear that Nurse Sims’s
recommendation should have been for McGaw to be taken to the hospital, but the question of
whether the officers acted with deliberate indifference is based on what the officers themselves
knew at the time. See Spears v. Ruth, 589 F.3d 249, 255 (6th Cir. 2009). Without any indication
that the officers could or should have assessed any deficiency in Nurse Sims’s diagnosis at the
time she made it, the officers are entitled to qualified immunity when they acted on her counsel.
Recovery under the Eighth Amendment in this context requires the plaintiff to show that
the defendant was acting with “deliberate indifference to serious medical needs of prisoners.”
Estelle v. Gamble, 429 U.S. 97, 104 (1976). In demonstrating a violation of this right,
“[a] constitutional claim for denial of medical care has objective and subjective components,”
Blackmore v. Kalamazoo Cty., 390 F.3d 890, 895 (6th Cir. 2004) (citing Farmer v. Brennan,
511 U.S. 825, 834 (1994)), and the subjective component of such a showing is clearly not met
here. The officers did not act with subjective deliberate indifference when they left an
intoxicated McGaw in an observation cell and did not transport him to a hospital or provide
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additional medical care, because they were following Nurse Sims’s indication that this was an
appropriate response to McGaw’s condition. When officers are not “subjectively aware of a
substantial risk of serious harm,” it “cannot be shown that they acted with deliberate
indifference.” Ruiz-Bueno v. Scott, 639 F. App'x 354, 361 (6th Cir. 2016). Defendant officers in
this case were therefore entitled to qualified immunity.
Cases in this and other circuits demonstrate that a non-medically trained officer does not
act with deliberate indifference to an inmate’s medical needs when he “reasonably deferred to
the medical professionals’ opinions.” Johnson v. Doughty, 433 F.3d 1001, 1010 (7th Cir. 2006).
For example, this court has held that a police officer was entitled to qualified immunity in a case
where medical professionals had failed to recognize an arrestee’s cocaine overdose because the
officer “was entitled to rely on the EMTs’ and the jail nurse’s medical assessments that [the
arrestee] did not need to be transported to the hospital.” Spears 589 F.3d at 255. In Spears, this
court recognized the fact that the EMTs and a jail nurse who had improperly diagnosed the
arrestee in that case “presumably had a greater facility than the average layperson to recognize
an individual’s medical need,” and thus the police officer did not err in deferring to what
appeared to be their more capable judgment. Id.Plaintiffs argue that the officers remain subject to a denial of qualified immunity because
they knew or should have known that a combination of alcohol and opiates can be toxic to a
person like McGaw. This argument fails on these facts because the officers did not ignore the
risks that those drugs posed to McGaw. Indeed, the officers recognized McGaw’s condition,
summoned a person they believed capable of assessing those risks, and followed the guidance
that Nurse Sims provided. As the Third Circuit has explained, in a situation where a non-trained
officer defers to a medical professional’s judgment, “absent a reason to believe (or actual
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knowledge) that prison doctors or their assistants are mistreating (or not treating) a prisoner, a
non-medical prison official . . . will not be chargeable with the Eighth Amendment scienter
requirement of deliberate indifference.” Spruill, 372 F.3d at 236. Here, the officers had no
reason to know or believe that Nurse Sims’s recommendation was inappropriate, and thus did not
act with subjective deliberate indifference when they followed it.
Plaintiffs also object that Nurse Sims, as an LPN, was not sufficiently trained to formally
diagnose McGaw, but this contention does not change the outcome here. It is true, as the district
court found, that Nurse Sims’s judgments were not medically binding and the officers had the
general authority to override Nurse Sims’s recommendations if they so chose. However, an
officer does not act with subjective deliberate indifference when he does not override a medical
recommendation that he reasonably believes to be appropriate, even if in retrospect that
recommendation was inappropriate. See Spruill, 372 F.3d at 236. Nor has this court ever
recognized the status of an LPN as precluding an officer from relying on that LPN’s judgment.
By analogy, in Spears we held that there was no constitutional violation in an officer following
the recommendations of a jail nurse and EMTs. See Spears, 589 F.3d at 255. Instead, the test
for deliberate indifference requires a more general failure by an officer: that an officer “was
aware of facts from which the inference could be drawn that a substantial risk of serious harm
existed, that he drew that inference and chose to disregard the risk.” Id. Where, as here, an
officer responds to a substantial risk of serious harm by asking for and following the advice of a
professional the officer believes to be capable of assessing and addressing that risk, then the
officer commits no act of deliberate indifference in adhering to that advice.
Although defendant officers are thus entitled to qualified immunity, this court lacks
jurisdiction to hear Sevier County’s appeal, and so Sevier County’s appeal must be dismissed. A
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court of appeals has jurisdiction generally only over the final decisions of a district court. See
28 U.S.C. § 1291. Because denial of a motion for summary judgment is not such a final
decision, “denial of a motion for summary judgment is not an appealable order.” Kindl v. City of
Berkley, 798 F.3d 391, 405 (6th Cir. 2015).
It is true that, in narrow circumstances, a court of appeals may review the denial of a
motion for summary judgment through the court’s pendent jurisdiction, but Sevier County’s
appeal does not qualify for this exception. A court hearing an appeal may in its discretion
exercise pendent jurisdiction “where the appealable and non-appealable issues are ‘inextricably
intertwined,’ meaning that ‘the appealable issue at hand cannot be resolved without addressing
the nonappealable collateral issue.’” Id. (quoting Chambers v. Ohio Dep’t of Human Servs.,
145 F.3d 793, 797 (6th Cir.1998)). Thus, where the question of a municipality’s liability is
coterminous with a determination of an officer’s qualified immunity, a court may exercise
pendent jurisdiction over the former claim in the course of an appeal of the latter. See id.Here, however, this court lacks jurisdiction over Sevier County’s claim because the
county’s liability is not foreclosed by our determination that the officers were entitled to
qualified immunity. The district court denied the county’s motion for summary judgment
because it held that there were genuine issues of material fact as to whether the county had
properly trained its officers to recognize inmates’ medical needs. The fact that these officers did
not act with deliberate indifference because they reasonably relied on Nurse Sims’s diagnosis of
McGaw’s needs does not resolve the disputes over whether the county’s training procedures
were adequate or appropriate as a whole. Lack of training could conceivably have affected
Nurse Sims’s action, and that would not at all intertwine with the officers’ immunity claims.
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Without such intertwining, pendent appellate jurisdiction is lacking, and it is not appropriate for
us to exercise it here.
For these reasons, the judgment of the district court is reversed with respect to the officer
defendants, and Sevier County’s appeal is dismissed for lack of jurisdiction.
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