United States District Court, D. Colorado
JUSTIN KERNS, individual, as Personal Representative of the Estate of Amanda Christensen, and as parent and next friend of C.K., T.K., and B.K, ; ESTATE OF AMANDA CHRISTENSEN; C.K., a child of Amanda Christensen and Justin Kerns, by and through his/her father Justin Kerns; T.K., a child of Amanda Christensen and Justin Kerns, by and through his/her father Justin Kerns; and B.K., a child of Amanda Christensen and Justin Kerns, by and through his/her father Justin Kerns; Plaintiffs,
v.
SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC., d/b/a Axis Health System; BRIAN ENSIGN; ANN TREBELHORN; MORGAN WILLIAMS; DEBORAH QUAYLE; and ALFREDO CHAVARRIA; Defendants.
OMNIBUS ORDER ON MOTIONS TO DISMISS
WILLIAM J. MARTÍNEZ, UNITED STATES DISTRICT JUDGE
This
lawsuit alleges that Amanda Christensen
(“Christensen”) received constitutionally
deficient medical care while on an involuntary hold in the
Detox Unit at Crossroads at Grandview in Pagosa Springs,
Colorado (“Crossroads”), a healthcare facility
run by Defendant Southwest Colorado Mental Health Center,
Inc., d/b/a Axis Health System (“Axis”), which
resulted in Christensen taking her own life. (ECF No. 27.)
Justin Kerns (“Kerns”), personally, as personal
representative of the Estate of Amanda Christensen
(“the Christensen Estate”), and as parent and
next of friend of Kerns and Christensen's three minor
children; the Christensen Estate; and minor children C.K.,
T.K., and B.K. (together, “Plaintiffs”) sue five
individuals and one entity allegedly responsible in some way
for Christensen's death. Plaintiffs allege violations of
Christensen's federal substantive due process rights and
federal due process rights under 42 U.S.C. § 1983, as
well as state law claims for wrongful death, negligence, and
survival action, and a violation of the federal
Rehabilitation Act § 504.
Currently
before the Court are five motions to dismiss challenging the
Amended Complaint (ECF No. 27).[1] One motion is brought by
Defendants Ann Trebelhorn and Alfredo Chavarria, Axis staff
members in the Detox Unit at Crossroads at the time of
Christensen's death (“Staff Motion”). (ECF
No. 33.) Another motion is brought by Defendant Debra Quayle
(“Quayle Motion”). (ECF No. 45.) A third motion
is brought by Defendant Morgan Williams (“Williams
Motion”) and a fourth by Defendant Brian Ensign
(“Ensign Motion”). (ECF Nos. 32 & 36.) The
final motion is brought by Axis (“Axis Motion”).
(ECF No. 35.)[2] Axis, Williams, and Ensign also brought a
sixth motion to dismiss, which was struck by the Court
because the undersigned's Revised Practice Standard
III.D.2 requires that all requests for relief by a particular
defendant must be brought in a single Rule 12 motion. (ECF
No. 92.)
I.
BACKGROUND
The
Court assumes the truth of the following facts pled in the
First Amended Complaint for the purpose of resolving the
pending motions.
This
case arises from the tragic and untimely death of Christensen
while she was involuntarily detained at Crossroads in
November 2016. Crossroads is one of Axis's seven
facilities. (ECF No. 27 ¶ 10.) At the time of the events
that form the basis for this lawsuit, Ensign, Trebelhorn,
Williams, Quayle, and Chavarria (“Individual
Defendants”) were employees of Axis. (Id.
¶¶ 11-15.) Ensign was the Acute Treatment Unit
clinical team lead. (Id. ¶ 11.)
Christensen
suffered from borderline personality disorder and bipolar II
disorder, and struggled with substance abuse. (Id.
¶¶ 25-26.) On March 22, 2016, Christensen was
arrested and charged with criminal mischief, and subsequently
pled guilty to that charge and received one year of probation
under a deferred sentence. (Id. ¶¶ 27-28.)
The terms of her probation prohibited her from using alcohol,
and required her to submit to drug and alcohol testing.
(Id. ¶ 28.)
Christensen
sought professional help from Dr. Paul Mattox, a psychiatrist
in Durango, Colorado, and when Dr. Mattox was unavailable,
Christensen often called the Axis Health System crisis
hotline. (Id. ¶¶ 31-32.) In June 2016,
Christensen began seeing Josh Bramble
(“Bramble”), a licensed professional counselor.
(Id. ¶ 33.) He helped her through several acute
crises in the summer of 2016, and in the fall of 2016,
encouraged Christensen to enter a full-time treatment
program. (Id. ¶¶ 33-34.) Around October 1,
2016, Christensen attempted suicide by intentionally
overdosing on medication. (Id. ¶ 35.)
Around
November 13, 2016, Christensen violated the terms of her
probation by drinking heavily, and taking opiates for which
she did not have a prescription. (Id. ¶¶
36, 57, 59-60.) Kerns wrestled a knife away from Christensen
to prevent her from hurting herself. (Id. ¶
57.) Bramble called the police because he perceived
Christensen as a danger to herself and possibly others.
(Id. ¶ 58.) Police escorted Christensen in
handcuffs to the Pagosa Springs Medical Center for
evaluation. (Id. ¶ 59.) Instead of arresting
her, Archuleta County law enforcement officials agreed to
place Christensen in Axis's custody where she could
receive treatment. (Id. ¶¶ 37, 62.)
Plaintiffs allege that “Axis performed similar and
related services at the request and direction of Archuleta
County . . . although her detention was maintained at the
Crossroads facility rather than at either the Archuleta
County Detention Center or the La Plata County Jail.”
(Id. ¶ 46.)
During
Christensen's booking into Crossroads, the Intake
Admnistrator noted that Christensen had a blood alcohol
content level of 0.103 and was being admitted in part because
she made suicidal statements. (Id. ¶ 68.)
Christensen was placed in the Detox Unit. (Id.
¶ 70.)
On
November 14, 2016, Christensen met with Jamie Denier for a
crisis assessment. (Id. ¶ 72.) The ten-page
crisis assessment form detailed Christensen's high
suicide risk, mental health diagnosis and symptoms, and
history of depression, suicide attempts, self-harm, and
substance abuse. (Id. ¶¶ 72-74.) The form
was saved into the Axis patient database. (Id.
¶ 72.) Christensen ranked as “moderate or high
risk” in most categories of the suicide risk
assessment, but denied attempting to take her own life in
October 2016. (Id. ¶¶ 76, 80.)
Christensen's medical records also stated that
Christensen was “exhibiting a deteriorating course
leading toward danger to self or others.” (Id.
¶ 82.) The form also noted that Christensen had been
diagnosed with bipolar disorder, an unspecified personality
disorder, and alcohol dependence. (Id. ¶ 83.)
Defendant Ensign, the Acute Treatment Unit clinical team
lead, did not review or approve this initial screening form
until November 16, 2016.
When
Christensen was admitted to Crossroads, Kerns and Bramble
contacted the District Attorney's Office for the 6th
Judicial District and the Colorado Department of Human
Services to arrange for the filing of a petition for
Christensen's temporary involuntary commitment to an
intensive, 30-day inpatient alcohol treatment program.
(Id. ¶ 86.) On November 15, 2016, Bramble met
with Christensen and told her that he was pursuing
involuntary commitment. (Id. ¶ 87.) Christensen
was distraught upon hearing the news. (Id. ¶
90.) Defendant Williams performed a safety assessment and
noted that Christensen was “very escalated”
following her meeting with Bramble. (Id. ¶ 90.)
She did not want to be committed and planned to contest it.
(Id. ¶ 92.)
After
meeting with Christensen at Crossroads, Bramble told
Defendant Quayle that Christensen was “at an extremely
high risk for completing suicide” and that her October
2016 suicide attempt “was a serious one.”
(Id. ¶ 87.)
On
November 18, 2019, Deputy District Attorney Alexander Lowe
filed a petition for involuntary commitment for alcohol abuse
under Colo. Rev. Stat. § 27-81-112. (Id. ¶
93.) That same day, Christensen was taken to Mercy Medical
Center to refill her anti-anxiety medications. (Id.
¶ 94.) Defendant Chavarria spoke with Christensen when
she returned to Crossroads. (Id. ¶ 95.) His
notes from the meeting state “Patient returned from
Mercy ER with Librium and a prescription for Ativan.”
(Id.) Chavarria did not record Christensen's
emotional, physical, or psychological state at that time.
At
approximately 3:45 p.m. on November 18, 2019, Christensen
made a phone call supervised by Crossroads. (Id.
¶ 97.) To make a call, a patient must sit in front of a
window with an Axis staff member on the other side.
(Id.) Plaintiffs believe that Defendant Trebelhorn
was responsible for monitoring Christensen's call.
(Id.) During the call, Christensen moved out of the
chair and slumped to the floor, and was, according to
Plaintiffs, “visibly distraught.” (Id.
¶ 98.)
At
approximately 4:08 p.m., Christensen entered the women's
bathroom alone, carrying a tote bag and towel. (Id.
¶ 102.) She was in the line of sight of facility staff
responsible for monitoring Christensen, and in view of the
video surveillance system. (Id.) At 4:38 p.m., two
women tried to open the bathroom door, but could not because
it was locked. (Id. ¶ 103.) At 5:15 p.m.,
another woman unsuccessfully tried to open the door and
alerted staff that the door had been locked for over an hour.
(Id. ¶ 104.) Trebelhorn escorted the woman away
from the bathroom. Around 5:35 p.m., Trebelhorn tried to open
the door and found it locked. (Id. ¶ 106.)
Trebelhorn and a male staff member started looking for a key.
(Id. ¶ 107.) A janitor opened the door at
approximately 5:38 p.m. (Id.)
Inside
the bathroom, they found Christensen hanging by a towel.
(Id. ¶ 109.) Trebelhorn found scissors, and cut
Christensen down at approximately 5:39 p.m. (Id.
¶ 110.) Someone commenced CPR. (Id. ¶
111.) Emergency Medical Services (“EMS”) arrived
at 5:43 p.m. and found Christensen unresponsive and without a
pulse. (Id.) EMS intubated Christensen, gave her a
shot of epinephrine, and continued CPR. (Id. ¶
112.) Despite these efforts, Christensen died. Her cause of
death was asphyxia due to hanging. (Id. ¶ 113.)
II.
LEGAL STANDARD
Under
Federal Rule of Civil Procedure 12(b)(6), a party may move to
dismiss a claim in a complaint for “failure to state a
claim upon which relief can be granted.” The Rule
12(b)(6) standard requires the Court to “assume the
truth of the plaintiff's well-pleaded factual allegations
and view them in the light most favorable to the
plaintiff.” Ridge at Red Hawk, LLC v.
Schneider, 493 F.3d 1174, 1177 (10th Cir. 2007). In
ruling on such a motion, the dispositive inquiry is
“whether the complaint contains ‘enough facts to
state a claim to relief that is plausible on its
face.'” Id. (quoting Bell Atl. Corp.
v. Twombly, 550 U.S. 544, 570 (2007)). Granting a motion
to dismiss “is a harsh remedy which must be cautiously
studied, not only to effectuate the spirit of the liberal
rules of pleading but also to protect the interests of
justice.” Dias v. City & Cnty. of Denver,
567 F.3d 1169, 1178 (10th Cir. 2009) (internal quotation
marks omitted). “Thus, ‘a well-pleaded complaint
may proceed even if it strikes a savvy judge that actual
proof of those facts is improbable, and that a recovery is
very remote and unlikely.'” Id. (quoting
Twombly, 550 U.S. at 556).
III.
ANALYSIS
A.
Individual Defendants' Motions to Dismiss (ECF Nos. 32,
33, 36 & 45)
Plaintiffs
contend that the Individual Defendants were
“responsible for the monitoring, supervision, care and
treatment of Ms. Christensen during her detention at
Crossroads, and had an affirmative obligation to protect her
health and welfare and constitutional rights.” (ECF No.
27 ¶ 66.) Plaintiffs assert three separate claims under
42 U.S.C. § 1983 for alleged violations of
Christensen's constitutional rights. The Court will
address each claim in turn.
First,
the Court pauses to clarify that no defendant has challenged
his, her, or its status as a state actor under 42 U.S.C.
§ 1983. Indeed, Quayle is the only defendant to even
suggest that there may be an argument regarding her status as
a state actor: in a footnote, she states that she “does
not concede [that] she is a state actor or that she was
acting under color of law at any time relevant herein.”
(ECF No. 45 at 7 n.2.) Given that no Defendant squarely
raises, much less argues or analyzes the issue, the Court
will presume for present purposes that all Defendants were
state actors at the time of relevant events. See United
States v. Hunter, 739 F.3d 492, 495 (10th Cir. 2013)
(cursory argument not meaningfully developed by any analysis
or citation is deemed waived). The Court notes, however, that
there may be a question of whether Defendants are state
actors in light of the Tenth Circuit's decision in
Wittner v. Banner Health, 720 F.3d 770, 771 (10th
Cir. 2013).
1.
Violation of Substantive Due Process Under the Special
Relationship Doctrine (Claim 1)[3]
Generally,
state actors are liable under the Due Process Clause only for
their own direct actions, and are not responsible for the
actions of other private citizens. Uhlrig v. Harder,
64 F.3d 567, 572 (10th Cir. 1995). There are two exceptions
to this rule. State officials may be subject to
constitutional liability if they: (1) create a danger that
results in a harm to an individual, even if that harm is not
ultimately inflicted by a state official; or (2) if the state
has a “special relationship” with the individual
who then suffers harm. Id. Plaintiffs argue that the
special relationship doctrine applies here. (ECF No. 27
¶¶ 127-136.) “A special relationship exists
when the state assumes control over an individual sufficient
to trigger an affirmative duty to provide protection to that
individual (e.g. when the individual is a prisoner or
involuntarily committed mental patient).”
Uhlrig, 64 F.3d at 572 (citing DeShaney v.
Winnebago Cnty. Dep't of Soc. Servs., 489 U.S. 189,
199-200 (1989)). In other words, the state or its agents
become liable “under 42 U.S.C. § 1983 for failing
to protect people from harm if they have deprived those
people of liberty and made them completely dependent on the
state for their basic needs.” Dahn, v.
Amedei, 867 F.3d 1178, 1181 (10th Cir. 2017).
The
elements of a substantive due process claim based on the
special relationship doctrine are (1) a special relationship;
(2) the defendant knew the plaintiff was in danger or failed
to exercise processional judgment regarding that danger; (3)
the defendant's conduct caused the plaintiff's
injuries; and (4) the defendant's actions shock the
conscience. Id.
Individual
Defendants do not address the first two elements, and argue
solely that their actions do not shock the conscience and did
not cause Christensen's injuries.[4]Further, Ensign challenges
Plaintiffs' supervisory liability claim against him for
conduct undertaken by his staff. The Court will address these
arguments in turn.
a.
Conscience-shocking conduct
The
state actor's behavior must be sufficient to “shock
the conscience.” Johnson ex. rel. Estate of Cano v.
Holmes, 455 F.3d 1133, 1143 (10th Cir. 2006). To satisfy
this standard, “a plaintiff must do more than show that
the government actor intentionally or recklessly caused
injury to the plaintiff by abusing or misusing government
power.” Uhlrig, 64 F.3d at 574. The
defendant's conduct must be of a “degree of
outrageousness and a magnitude of potential or actual harm
that is truly conscience shocking.” Id. The
level of conduct required cannot be precisely defined and may
evolve over time. Id. Under the special relationship
doctrine, it is not sufficient to merely show that a
defendant abdicated a professional duty, a plaintiff must
instead show that such abdication is sufficient to shock the
conscience. Estate of Place v. Anderson, 398
F.Supp.3d 816, 833 (D. Colo. 2019). “To meet that
standard, the plaintiff must show more than merely negligent
conduct on the part of the defendant.” Id. at
833-34.
1.
Chavarria, Quayle, and Williams
Plaintiffs
contend that they have robustly supported, through their
factual allegations, that the actions or inactions of
Chavarria, Quayle, and Williams would shock the conscience of
a federal judge. On the facts pled, the Court disagrees.
Plaintiffs
posit that after brief, initial intake interactions with
Christensen or Bramble, Chavarria, Quayle, and Williams
failed to follow up to assure that protocols were put in
place and followed by fellow staff members. Specifically,
Plaintiffs allege that Chavarria conducted an assessment of
Christensen when she returned to Crossroads from obtaining a
prescription at Mercy Medical Center. (ECF No. 27
¶¶ 94-95.) That assessment did not include an
assessment of Christensen's emotional, physical, or
psychological state. (Id. ¶ 95.) Plaintiffs
allege that Williams performed a safety assessment of
Christensen and recognized that Christensen was “very
escalated.” (Id. ¶ 90.) Plaintiffs allege
that Bramble made Quayle aware that Christensen was at a high
risk for completing suicide. (Id. ¶ 87.)
Finally,
Plaintiffs allege that Chavarria, Quayle, and Williams failed
to follow “reasonable and professionally-appropriate
protocols” such as actively observing Christensen at
all times or ensuring that Christensen was under surveillance
at all times, and preventing Christensen from gaining access
to materials that could be used to inflict self-harm. (ECF
No. 51 at 9; ECF No. 63 at 5.) In essence, Plaintiffs allege
that these three Defendants were subsequently responsible for
overseeing each step of Christensen's ensuing care, and
that their failure to do so after their limited, initial
interactions with Christensen, is conscience shocking.
The
Court finds that even if Chavarria, Quayle, and
Williams's alleged conduct-failing to ensure that other
staff members at points later in time reasonably carried out
their jobs-was an abdication of their professional duties,
such conduct does not, on this record, shock the conscience.
Plaintiffs have failed to allege facts from which the Court
can conclude that after their brief interactions with
Christensen or Bramble at the intake phases of
Christensen's admission into Crossroads, Chavarria,
Quayle, and Williams had any continuing duty or
responsibility to monitor or ensure that appropriate
procedures were in place for other Crossroads staff to follow
during Christensen's subsequent treatment at the
facility. Without any factual context as to the scope of
these three Defendants' continuing duties,
responsibilities and decision-making authority beyond the
intake phase of Christensen's admission, the Court has no
basis from which to conclude that their alleged actions or
omissions shock its conscience.
For
these reasons the Court dismisses the substantive due process
claim against Chavarria, Quayle, and Williams. However,
because the Court cannot say with any degree of certainty
that Plaintiffs could never allege additional facts in an
amended complaint which would plausibly allege such a claim
based on an alleged special relationship between them and
these Defendants, this dismissal will be without prejudice.
2.
Ensign
Defendant
Ensign joins William's Motion, thus asserting that his
actions were also not conscience-shocking. (ECF No. 36 at 8.)
Ensign was the onsite supervisor at Crossroads at the time of
these events. (ECF No. 27 ¶ 85.) According to
Plaintiffs, Ensign did not review or approve
Christensen's initial screening form until two days after
her admission. (Id.) The import of this delay is
unclear. Plaintiffs do not suggest that the delay in review
in some manner limited staff access to the electronic medical
records. To the contrary, Plaintiffs allege that the
“Defendants were on notice regarding the content of
this extensive screening paperwork at all relevant
times.” (Id. ¶ 72.) Plaintiffs also
allege that Ensign was “responsible for the monitoring,
supervision, care and treatment of Ms. Christensen while she
was at Crossroads.” (Id. ¶ 66.)
Plaintiffs'
substantive due process claim against Ensign under a direct
liability claim fails for the same reasons that the claim
against Chavarria, Quayle, and Williams fails. Plaintiffs
fail to allege facts to demonstrate that Ensign abdicated his
professional responsibilities or unreasonably exercised or
failed to exercise his authority, much less did so in a way
that shocks the conscience. Instead, Plaintiffs merely allege
that Ensign did not timely review Christensen's
paperwork, but fail to present any additional facts material
to the issue of whether this purported delay had any impact
on her care, adverse or otherwise. Plaintiffs also do not
allege any facts to support their conclusory contention that
Ensign breached his professional ...