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Estate of John Patrick Walter v. Correctional Healthcare Companies, Inc.

United States District Court, D. Colorado

May 29, 2018

THE ESTATE OF JOHN PATRICK WALTER, by and through its personal representative, DESIREE' Y. KLODNICKI, Plaintiff,
CORRECTIONAL HEALTHCARE COMPANIES, INC.; CORRECTIONAL HEALTHCARE PHYSICIANS, P.C.; CHC COMPANIES, INC.; THE BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF FREMONT; JAMES BEICKER, individually and in his official capacity as Fremont County Sheriff; TY MARTIN, individually; RAYMOND HERR, M.D., individually; THE ESTATE OF ROY D. HAVENS, by and through its personal representative, Linda Havens; STEPHANIE REPSHIRE, LPN, individually; KATHLEEN MAESTAS, LPN, individually; SHARON ALLEN, M.D., individually; JOHN RANKIN, individually; JOHN DOES 1-10, individually; JANE DOES 1-10, individually; and DOE CORPORATIONS 1-10, Defendants.


          William J. Martinez United States District Judge

         By way of 42 U.S.C. § 1983, this lawsuit addresses whether John Patrick Walter (“Walter”) received unconstitutionally deficient medical care while in pretrial detention in Fremont County, Colorado, eventually causing his death. Specifically, Walter was deprived of a prescription anti-anxiety medication, allegedly creating severe withdrawal symptoms that eventually killed him. Walter's Estate, through its personal representative (“the Estate”), sues numerous individuals and entities that are allegedly responsible for Walter's death.

         Currently before the Court are two motions for summary judgment filed by various sets of Defendants. Fremont County and certain of its employees filed one of these motions. (ECF No. 167.) Two medical caregivers who interacted with Walter during his detention filed the other motion. (ECF No. 185.) For the reasons explained below, both motions are denied.


         Summary judgment is warranted under Federal Rule of Civil Procedure 56 “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a); see also 477 U.S. 242, 248-50 (1986). A fact is “material” if, under the relevant substantive law, it is essential to proper disposition of the claim. Wright Abbott Labs., Inc., 259 F.3d 1226, 1231-32 (10th Cir. 2001). An issue is “genuine” if the evidence is such that it might lead a reasonable trier of fact to return a verdict for the nonmoving party. Allen v. Muskogee, 119 F.3d 837, 839 (10th Cir. 1997).

         In analyzing a motion for summary judgment, a court must view the evidence and all reasonable inferences therefrom in the light most favorable to the nonmoving party. Adler v. Wal-Mart Stores, Inc., 144 F.3d 664, 670 (10th Cir. 1998) (citing Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)). In addition, the Court must resolve factual ambiguities against the moving party, thus favoring the right to a trial. See Houston v. Nat'l Gen. Ins. Co., 817 F.2d 83, 85 (10th Cir. 1987).

         II. FACTS

         For present purposes, the following facts are undisputed unless attributed to a party or a witness, or otherwise noted.

         A. Fremont County's Relationship with CHC

         At all times relevant to the Estate's allegations, Defendant Correctional Healthcare Companies, Inc. (“CHC”) was Fremont County's private contractor for healthcare services at the Fremont County Detention Center (“Detention Center”). (ECF No. 167 at 3, ¶¶ 8-9.) Through the contract between Fremont County and CHC, CHC “became a policymaker for Fremont County with the power to make and change [Detention Center] healthcare policies without [the Sheriff's] approval.” (ECF No. 187 at 6, ¶ 2.)

         In April 2014, CHC employed the following individuals, all of whom had some connection to CHC's contract services to the Detention Center:

• Defendant Raymond Herr, M.D., CHC's chief medical officer;
• Defendant Sharon Allen, M.D., a psychiatrist;
• Physician Assistant Roy Havens;[1] and
• Defendant Kathy Maestas, Defendant Stephanie Repshire, and non-party Monica Doughty, all of whom are licensed practical nurses.

(ECF No. 167 at 4-5, ¶¶ 11-14.) Dr. Allen and Nurse Repshire are the summary judgment movants in ECF No. 170. No. other CHC-affiliated defendant moves for summary judgment.

         B. Benzodiazepines

         This case revolves around a class of anti-anxiety drugs known as benzodiazepines, sometimes colloquially referred to as “benzos.” High doses of benzodiazepines over an extended time can create physical dependency, potentially leading to withdrawal symptoms when the medication is discontinued. (ECF No. 185 at 8-9, ¶¶ 6-7.)

         The parties and their experts are at odds over precisely what symptoms should be expected from benzodiazepine withdrawal, and just how dangerous such withdrawal can be. (See, e.g., id.; ECF No. 170 at 8, ¶ 21; Id. at 10, ¶ 35.) The parties agree, however, that the medical literature documents only two case studies of individuals dying from suspected benzodiazepine withdrawal, and neither study involved the benzodiazepine at issue here, clonazepam. (Id. at 8, ¶¶ 22-23.) The Estate nonetheless considers these statistics “highly misleading” because, it says, “very few deaths are the subject of ‘documented case studies.'” (ECF No. 185 at 5, ¶ 23 (emphasis removed).) Moreover, the Estate emphasizes Dr. Herr's purported agreement with the statement that “death is a well-recognized risk of acute benzo withdrawal.” (Id.)[2]

         The parties' experts also hotly dispute the potential dangers of a “cold turkey” approach to ending a benzodiazepine regimen. The Estate's experts assert that benzodiazepines “should never be abruptly discontinued, ” and “[a]ll reasonable jail medical personnel” understand as much. (ECF No. 170 at 12, ¶ 45.) Dr. Allen's and Nurse Repshire's expert counters that “the hazards of abrupt benzodiazepine discontinuation are greatly exaggerated.” (ECF No. 185 at 9, ¶ 11 (internal quotation marks omitted; alterations incorporated).)

         C. Walter's Confinement and Death at the Detention Center (April 3-20, 2014)

         1. April 3

         On the morning of Thursday, April 3, 2014, Walter was booked into the Detention Center on assault-related charges stemming from a fight the night before. (ECF No. 167 at 2, ¶¶ 1-3.) At booking, he completed a “Pre-Admission Medical Screen” form in which he declared that he was currently taking two prescribed medications: methadone and Klonopin, the latter being a brand name for clonazepam. (ECF No. 167-3 at 2.) Walter had a prescription bottle of Klonopin on his person, which Detention Center staff confiscated and-according to the Estate and the County Defendants-delivered to the CHC medical staff. (ECF No. 167 at 3, ¶ 7; ECF No. 185 at 10, ¶ 16.)

         Later that day, Physician Assistant (“PA”) Havens filled out a “provider order” to “start Benzo protocol to DC [i.e., discontinue] Benzodiazepines.” (ECF No. 173-2.) This brief notation apparently implies two policies or protocols. The first is an unwritten “no benzo” policy that, according to Nurse Maestas, CHC implemented and the Detention Center medical staff regularly followed. (ECF No. 185 at 11, ¶¶ 22-23; ECF No. 187 at 13, ¶ 31.) This meant that Walter was immediately and completely cut off from his Klonopin, without a chance for gradually tapering his dosage. (ECF No. 185 at 11, ¶ 21.) The second is a written policy known as the “L-06” protocol, which required CHC employees to “[m]onitor for withdrawal symptoms using [an attached] benzodiazepine withdrawal monitoring sheet. The Provider on-call [a doctor or physician assistant] should be notified immediately if there are any signs or symptoms of withdrawal.” (ECF No. 186-3 at 2.)

         Monitoring for withdrawal symptoms included measuring blood pressure, pulse, respiration, and temperature. (Id.) But CHC's on-site nurses, including Maestas and Repshire, did not initiate the L-06 protocol. (ECF No. 185 at 12, ¶ 27.) Nurse Maestas characterized this as a “significant oversight.” (ECF No. 201-1 at 51.)

         2. April 3-12

         Walter was initially housed with other inmates in an area of the Detention Center known as the “T-Pod.” (ECF No. 185 at 12, ¶ 28.) Two of Walter's fellow inmates in the T-Pod have submitted declarations in this case. (See ECF Nos. 185-5, 185-22.) They say that Walter arrived at the Detention Center in a normal, healthy condition, but gradually deteriorated over the next two weeks. (ECF No. 185 at 13-14, ¶¶ 29, 34-35.) They say that he also repeatedly asked nurses such as Maestas and Repshire for his Klonopin, but the nurses took no action. (Id. ¶¶ 30-32.) Eventually, Walter stopped eating or sleeping regularly, and he began trembling, pacing, talking nonsensically, and removing his clothes. (Id. ¶¶ 34-35.)

         3. April 13

         On April 13, former Defendant Charlene Combs (a Detention Center deputy) interacted with Walter and became concerned about him because of his mental confusion, tremors, and involuntarily eye twitching. (Id. at 14, ¶ 37.)

         On that same day, a nurse who is not a defendant here measured Walter's blood pressure and found it to be abnormally high. (Id. at 15, ¶ 39.) She ordered that Walter's blood pressure be checked daily for the next five days, but there is no record that anyone carried out this order. (Id.)

         4. April 14

         On April 14, a Detention Center corporal who is not a defendant here spoke with Walter and noted that he was confused and shaking during the entire interaction. (Id. ¶ 40.) That same day, Walter's cellmates submitted a complaint that Walter had been keeping them up all night by “talking to the wall.” (Id.)

         5. April 15

         In the early morning of April 15, Walter began kicking and banging on his cell door demanding to be let out. (ECF No. 167 at 6, ¶ 20.) Inmates began screaming at Walter to “knock it off.” (Id. ¶ 21.) Certain Detention Center officers who were formerly defendants in this case (Green, Cullen, and Cook) decided to move Walter to a holding cell away from other inmates. (Id. ¶ 25.) Walter, likely delusional at the time, did not go easily and the officers used a Taser and bodily force to gain his compliance. (ECF No. 185 at 15, ¶ 41.)

         Walter was then placed in “a small holding cell in the jail's booking area known as Holding Cell 2.” (Id. ¶ 42.) The holding cell had large windows through which anyone in the booking area could easily observe Walter. (Id. at 16, ¶ 43.)

         Detention Center officers used force on Walter twice more that day: once to put him in a restraining chair when he was punching the window of the holding cell, and once when he apparently tried to escape while being escorted to the showers. (ECF No. 167 at 7-10, ¶¶ 36-55.) The first use of force involved pepper spray and the second involved bodily force and a Taser. (See id.)

         The Estate's experts claim that the standard of care in the medical community dictated that someone with Walter's symptoms of mental distress should have been hospitalized by this point. (ECF No. 185 at 16, ¶ 46.) But no one called for an ambulance-that day or any other, until it was too late-because of a Sheriff's Department policy against such calls unless CHC's on-site supervisor (at that time, Nurse Maestas) approved the call or the inmate displayed “very obvious life-threatening injuries such as bleeding and unresponsiveness.” (ECF No. 187 at 27, ¶ 87 (internal quotation marks omitted).)

         6. April 16

         On the morning of April 16, Nurse Repshire saw Walter and noted that he was “acting very, very strange, talking to himself & ‘others' & trying to unlock his cell.” (ECF No. 167-18.) She gave him a dose of methadone, from which (unlike Klonopin) the medical staff was gradually weaning him. (Id.) As she handed the medicine to him through a hole in the cell door, she noticed that the cell “smelled.” (Id.) She chose not to check his blood pressure “due to his strange behavior.” (Id.)

         By this time, the commander of the Detention Center, Defendant Rankin, had seen for himself that Walter looked pale and thin; that he would not wear clothes and had stopped regularly eating or sleeping; that he seemed unaware of his surroundings; that he was speaking to people who were not there; and that he was otherwise frequently talking nonsensically, yelling, and screaming. (ECF No. 185 at 18, ¶¶ 55- 56.) Rankin's subordinates also expressed concern to him about Walter. Rankin then voiced his concerns to Nurse Repshire. (Id. at 19, ¶ 58.)

         According to Nurse Repshire's medical notes, Rankin “wondered if we should be weaning [Walter] off his meds due to him being on them for years. . . . He noticed [Walter] was fine before we started weaning him off & wondered if there was anything we could do.” (ECF No. 167-18.) Repshire finished this note by stating, “I will refer to the provider, ” meaning PA Havens. (Id.; ECF No. 170 at 5, ΒΆ 13) This ...

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