United States District Court, W.D. Missouri, St. Joseph Division
NANETTE K. LAUGHREY, UNITED STATES DISTRICT JUDGE
the Court is a motion for summary judgment by defendants Amy
Mowry, LPN, Alice Bergman, NP, and Karen Williams, LPN (Doc.
392), Frederick Covillo, D.O. (Doc. 382), Michelle Munger,
R.N. (Doc. 399), and their employer, Corizon, LLC (Doc. 394),
seeking, inter alia, summary judgment on Count IV of
Plaintiffs' complaint, which asserts civil rights claims
against them. For the reasons discussed below, the Court
grants Mowry's, Bergman's and Williams' motion
for summary judgment on Count IV, but denies in part the
motions by Covillo and Munger for summary judgment on Count
The Court also finds that Corizon cannot assert the defense
of qualified immunity to Count IV.
October 26, 2015, Justin Stufflebean, son of plaintiffs
Brenda Davis and Frederick Stufflebean, was sentenced for a
sex crime. Immediately following his sentencing, Stufflebean
was held at the Buchanan County Jail until he was transferred
on October 29, 2017 to the Western Reception Diagnostic and
Correctional Center (“WRDCC”), a receiving center
in St. Joseph, Missouri, for the Missouri Department of
Mowry, LPN, was working in receiving at the WRDCC on the date
of Stufflebean's transfer from the jail. She was the
intake LPN responsible for performing the intake assessment
for Stufflebean. She received Stufflebean at the WRDCC and
completed his Initial Receiving Screening. She was
responsible for gathering subjective current medical
information. Stufflebean told Mowry that he had Addison's
disease and hypoparathyroidism; Doc. 492-22 (Deposition of
Amy Mowry), 51:16-18; that he was experiencing vomiting,
weakness, and tachycardia (fast heart rate), id.,
51:8-15; that he had been hospitalized 16 times in the last
year for Addison's complications; and that he was on
various medications: fludrocortisone, NATPARA, vitamin D,
paroxetine, and prednisone. Doc. 492-1(Complete Medical
Record History), p. 1. Prednisone and fludrocortisone are
used to treat Addison's disease. Defendant Mowry's
“objective” assessment included Stufflebean's
being lethargic and having an unsteady gait from weakness.
Id., p. 3. Nonetheless, and despite the fact that
the records sent from the jail did not indicate when
Stufflebean last took his medications, Mowry did not inquire
of Stufflebean when he last received his medications.
See, generally, id. At intake, Stufflebean's
blood pressure was 121/89 and his pulse rate was 124.
Id., p. 3.
called Alice Bergman, APRN, the on-call provider, with regard
to Stufflebean. At 2:30 p.m. on October 29, 2015, Defendant
Mowry obtained a “verbal” order from Defendant
Bergman, Nurse Practitioner (NP), for a promethazine 50 mg
injection. Nurses' AF,  ¶ 30; Doc. 492-1, p. 5.
Promethazine is used for nausea and vomiting. Bergman claims
that Mowry did not tell her that Stufflebean was weak and
tachycardic, or that Stufflebean had been hospitalized 16
times in the prior year. Id., ¶¶ 33, 35.
Bergman could not recall whether Mowry told her that
Stufflebean had Addison's disease and hypoparathyroidism.
Id., ¶ 34. Bergman ordered that Stufflebean be
admitted to the Transitional Care Unit (“TCU”)
for observation and for evaluation by Dr. Covillo. Doc.
492-1, pp. 5-6.
Initial TCU Visit
took Stufflebean to the infirmary, known as the Transitional
Care Unit (“TCU”). There, still on October 29,
2015, at approximately 4:00 p.m., Stufflebean advised Nurse
Sybert that he had Addison's disease. Id., p. 8.
Stufflebean informed Sybert that he began vomiting that
morning while at the jail. Stufflebean told Sybert, “I
have Addison's and when I am stressed out I start
throwing up and hurting” (id.)-an indication
of an “impending Addisonian crisis” (Doc. 492-19
(Report of John P. Bilezikian, MD, PhD), p. 27). Sybert
charted that the reason for TCU admission was
“Observation for Addison's and
Hypoparathyroidism.” Doc. 492-1, p. 8. Sybert noted,
“Offender states that due to stress his Addison's
disease is ‘acting up' and causing ‘abd. pain
and vomiting.'” Doc. 492-1, p. 8.
Sybert took Stufflebean's vitals at 3:19 p.m. on October
29, 2015, charting a blood pressure of 121/89 and a heartrate
of 116 beats per minute. Id. The Corizon protocol
for Nausea/Vomiting states in bold, “Refer to
Practitioner Immediately” in the event of,
inter alia, “Signs of dehydration-dry mucus
membranes, poor skin turgor, skin cool to touch, recent 5%
weight loss, BP less than 100 systolic, pulse >90.”
Doc. 487-4, p. 2. Nonetheless, Stufflebean was
“escorted out of TCU” and “sent back to
wing . . . .” Doc. 492-1, p. 9.
the nurse who prescribed the promethazine, ordered a KUB
abdominal film for Stufflebean, noting “upper abdominal
pain x 1 day, nausea and vomiting, Addison's disease,
hypoparathyroidism.” Id. The results showed
“abundant stool.” Id. Stufflebean was
given a laxative, but none of the medications that his
treating physician had prescribed before his incarceration,
including those needed for his Addison's disease.
Id. Bergman did not review Stufflebean's
medications before prescribing new medications for him.
Nurses' AF, ¶ 49. Bergman ordered Stufflebean's
release to the wing, and she never saw him in person.
Id., ¶¶ 46, 48.
In the Wing
Millsap, an inmate whose bunk was located in the common area
into which Stufflebean's cell opened, could see
Stufflebean's cell from his bunk in the days leading up
to Stufflebean's cardiac arrest. Millsap testified that
Stufflebean was brought in to his cell “on a
wheelchair” and described his appearance as follows:
[T]here was, like, a lot of things wrong with him. We could
tell he was really shrunk. Like you could see cheekbones real
prominent. It looked like he had been, like, either really,
like, strung out at one point or he had some sort of, like,
condition like he had, like, cancer or AIDS or we didn't
know. At first we kind of made fun of him because of his name
and then we started to realize something was really wrong
with this guy, you know, because he kind of looked weird, you
know. . . . [W]e really didn't know how bad it was until
we went up to him. He wasn't going out to eat, and we
were trying to see if he was okay, and he wasn't.
Doc. 492-17 (Deposition of Trent Millsap), 16:3-25.
Stufflebean, according to Millsap, “was really
sick”-his hair “looked like it was falling out .
. . .” 17:16-24. Stufflebean was “just slouching
over . . . in the wheelchair when they brought him in,
” and “was really skinny.” Id.,
18:1-4. Millsap never saw Stufflebean standing or even
sitting erect. Id., 36:23-24. Millsap thought
perhaps Stufflebean was “deaf or maybe mute or
something because he wasn't responding to anything
anybody was saying, but he looked like he was trying to, but
nothing was making --he couldn't vocalize
anything.” Id., 35:20-24; see also
id., 35:13-19 (stating that Stufflebean “would
open his mouth like he was trying to vocalize - verbalize
something, but he wouldn't --no words would come
meal times, Millsap and other inmates noticed that
Stufflebean would not emerge from his open cell. Millsap
said, “And then we looked in the window and he's
just laying [sic] on his bed. We were like, hey,
man. You going to come eat? We kept on knocking on the
window. He wouldn't roll over. He looked like he was
already gone.” Id., 20:21-25; see also
id., 19:24-20:6 (“We were -- we were making fun at
first and then we're like, okay, why is he not coming out
to do anything, eat, shower, nothing. And we would look in
there and we were like, oh, my God. Is he -- is he alive? We
were joking. Oh, somebody go check his pulse. But then after
a while, we're like, no, really. Somebody needs to go in
there and probably check on him.”). Millsap claimed
that he told corrections officers more than once that
Stufflebean “was not looking good, ” and he heard
others ask for help for Stufflebean as well. Id.,
observed nurses checking on Stufflebean occasionally, but
“[t]hey weren't in there for more than two minutes.
It seems like they took his blood pressure and then just
left, and that was it.” Id., 23:10-24:4.
Millsap also remembered Stufflebean being taken in a
wheelchair “to medical, . . . but . . . it didn't
take them ten minutes to bring him right back down.”
was “dumbstruck” by how Stufflebean was treated.
Id., 21:19-22:4. Millsap suspected from the way
prison guards were treating Stufflebean that he might have
been a sex offender. See id., 44:25-45:6
(“When a person comes in, the first thing they do is
they want to check their face sheets. . . . And what that
will do is it will say whether or not you're a registered
sex offender.”); id., 46:16-48:9
(“[T]hen there was the ones that didn't do anything
and they, like, stayed to themselves all the time, and
certain COs would, you know, say degrading things at certain
times. And we're like, why did he deserve that? And then
we'd start thinking somebody probably should go check
that guy's paperwork. Because if he was just minding his
own business and the cops do that, you know, then, okay,
maybe there's a reason behind it. And that's what
would tip us off, and most of the time it was because the
person had that -- that charge. And that was one of the
things we thought maybe Justin had. We were like, okay, so
this guy is getting treated really poorly. He hasn't done
anything that we saw to deserve that . . . . We never checked
his paperwork. We didn't really care because he was so
bad that we didn't -- what were we going to do, you know.
There was -- we just knew that, okay, something is off here.
Either he's really faking it, he's got one of those
charges, or they just really don't care.”).
Covillo alleges that he performed a physical exam of
Stufflebean on October 30, 2015 at 9:00 a.m. Doc. 492-16
(Deposition of Frederick V. Covillo, D.O.), 76:5-77:6.
deposition, Dr. Covillo claimed that Stufflebean
“seemed very stable.” Id., 72:16-25. He
insisted that Stufflebean's reports of nausea, vomiting,
dizziness, and tachycardia (from just the previous day) were
from “the past” and did not represent his
condition at the time of the examination. Id.,
73:1-11. When asked where Stufflebean's condition at the
time of the examination was noted, Dr. Covillo stated simply,
“I examined him, ” and then claimed he
“would have written it in there if [Stufflebean] had a
problem.” Id., 73:12-16. Dr. Covillo noted
that Stufflebean's blood pressure was 121 over 89,
commenting, “That's pretty stable.”
Id., 73:20-74:6. Covillo then admitted that the
blood pressure listed in the record in connection with his
examination of Stufflebean in fact was taken by Nurse Mowry,
probably the day before Covillo purportedly examined
Stufflebean, and that Covillo did not actually know what
Stufflebean's blood pressure was on the day of the
examination. Id., 74:15-75:7.
Covillo did not try to determine when Stufflebean was last
given his medications, even though Dr. Covillo knew that
Stufflebean's condition was serious enough that he needed
his medication that day. Id., 71:19-72:6; 147:4-17.
Dr. Covillo purportedly called his supervisor to request
approval of medications from outside the formulary.
Id., 27:10-28:5. Dr. Covillo recalled Stufflebean
arriving with a bag of medications (although Covillo
acknowledged that the documentary evidence does not indicate
that Stufflebean arrived with medications), and with the
approval of his supervisor, Dr. Covillo ordered that
Stufflebean receive some of those medications that day
itself. Id., 79:14-82:13. However, Dr. Covillo could
not recall to whom he gave the verbal order regarding
medications, there is no record indicating that the
medications were dispensed, and there is no documentation of
Dr. Covillo's asking for permission to dispense
non-formulary medications or ordering that Stufflebean be
given the medications that accompanied him. Id. Dr.
Covillo maintains that he ordered calcium citrate,
fludrocortisone and Vitamin D for Stufflebean on October 30,
2015, but the time-stamp in the record shows that the
medications were not approved until October 31, 2015 at 5
a.m., after an emergency call had been placed with regard to
Stufflebean. Doc. 492-1, p. 6. Dr. Covillo acknowledged that
Stufflebean “did not get any medication . . . like he
was supposed to, ” but he claimed that the nurses had
“[a]pparently” not followed his order in that
regard. Doc. 492-16, 148:7-14.
First Code 16 - October 31, 2015 - 1:15 a.m. - No
October 31, 2015, at 1:15 a.m., the medical record shows that
somebody called a “Code 16, ” a medical
emergency, with respect to Stufflebean. Doc. 492-1, p. 13
(“10/31/2015 01:15 A ACCIDENT/CODE 16.”).
However, no one, including the nurses on duty, Munger and
Williams, documented why that Code 16 was called or what was
done at that time. Id.
Second Code 16 - October 31, 2015 - 4:30 a.m. - No
Documentation Until Nearly 24 Hours Later
second Code 16 was called at 4:30 a.m. that same day.
Id. The medical record entry, created “late,
” on November 1, 2015, at 1:07 a.m., notes that Nurse
Williams found Stufflebean lying on his abdomen on the floor
of his cell. Id. Stufflebean indicated that he had
fallen when he got up to get a drink because he felt weak.
Id. The notes reflect that “Sgt. Brown
mentioned that there was a towel with greenish liquid on it
close to his bunk and offender was asked if he was
nauseated.” Id. Stufflebean was placed in a
wheelchair and was taken to the TCU. Id. Williams
noted that, when asked about his diet, Stufflebean stated,
“I took a few bites of corn a couple days ago, because
I don't like the food.” Id. Stufflebean
was then given a carton of milk, which he “tolerated
well, ” and he “asked for another milk at this
time and stated that he was a little nauseated.”
Williams charted Stufflebean's blood pressure of 96/62
and heart rate of 96 beats per minute. Id. The
Corizon protocol for Nausea/Vomiting states in bold,
“Refer to Practitioner
Immediately” in the event of, inter
alia, “Signs of dehydration-dry mucus membranes,
poor skin turgor, skin cool to touch, recent 5% weight loss,
BP less than 100 systolic, pulse >90.” Doc. 487-4,
Return to TCU - October 31, 2015 -Before 5:30 a.m.
5:30 a.m. on October 31, 2015, Williams delivered Stufflebean
into Munger's care in the TCU for further observation.
His blood pressure was 100/64 and his heart rate was 91 beats
per minute. Doc. 492-1, p. 14. As soon as he was brought to
the TCU, Stufflebean stated that he needed to lie down.
Id. He advised Munger that he had “not eaten
in 3 days.” Id. Munger provided Stufflebean
with Promethazine at 5:30 a.m., after he had been given milk.
Id. Stufflebean advised Munger that he had
Addison's disease and had “been having this flare
up since he was sentenced to prison.” Id. He
also stated that “when this has happened before he
would just go to the hospital and he would receive IV
fluids.” Id. In her note, which was written
after Stufflebean was taken to the hospital, Munger wrote,
“He fully understands how and what is causing his
condition to flare up and gets worse by not eating. . . .
Encouraged offender that he needed to drink and eat, put an
MSR [(medical service request)] into mental health to help
with his stress, and if he felt he needed to see Dr. Covillo
again to put in an MSR for the doctor.” Id.
Munger released Stufflebean to his cell without ever
contacting a doctor. See id.
Stufflebean Returned to His Cell - October 31, 2015 -
Approximately 7 a.m.
“Late Entry” in Stufflebean's chart says the
following about Stufflebean's return to his cell on the
morning of October 31, 2015:
When offender was released from TCU at 7AM with CO1
Huddleston, offender got as far as the telephone and the
offender became wobbly and layed [sic] on to the
floor. This was during shift change and witnessed by several
of the day shift nurses as well as the night shift nurses and
CO1 Huddleston and CO1 Williams. My self and CO1 Huddleston
helped offender walk back to his room and he walked fine with
assistance. SGT Brown was called and notified. SGT Brown, CO1
Huddleston, and CO1 Green came to TCU to escort offender back
Id., pp. 14-15.
CO Huddleston described Stufflebean during this incident as
“weak and incoherent.” Munger AF,  ¶ 91. He
looked “dazed like he was sick.” Id.
Huddleston recalled Stufflebean “stumbling” and
then falling down after ten to twenty steps. Id. He
described Stufflebean's falling as “kind of slow.
He fell down on his knees, and then he just kind of fell
over. I mean it wasn't -- it didn't seem like it was
that hard. He fell really slow to the ground.”
Stufflebean fell on his face. Id. Huddleston said
Stufflebean did not say anything, instead, “[h]e just
made grunting noises . . . .” Id. Huddleston
believes he then got a wheelchair, and they placed
Stufflebean in it. Id. Stufflebean was slumped over.
Id. Huddleston wheeled Stufflebean to his cell and
helped him to his bunk. Id.
reading Munger's description of Stufflebean's
becoming “wobbly” and lying down on the floor,
Dr. Covillo said, “Now that's a true Addison
crisis, ” and he agreed that proper procedure would
“definitely” have been for the nurse to
immediately call the on-call physician. Doc. 492-16,
125:7-128:8. Dr. Covillo also thought Stufflebean should have
remained in the TCU for monitoring. He said, “I
don't know why they're in such a rush to kick him out
of TCU. It doesn't make any sense.” Id.,
127:4-10. He thought sending Stufflebean to his cell after
his collapse on his way out of the TCU was
“crazy.” Id., 127:11-15.
did not report Stufflebean's condition to the oncoming
nurse, Nurse Euler, or call for a doctor. 493-13 (Deposition
of Michelle L. Munger), 36:9-21.
Third Code 16 - October 31, 2015 - 10:45 a.m.
10:45 a.m. on October 31, 2015, less than three hours after
Munger sent Stufflebean back to his cell, a third Code 16 was
called. Doc. 492-1, p. 16. Stufflebean's fellow inmate
Millsap testified that when officers came to
Stufflebean's cell, they found Stufflebean on the ground,
unmoving. Doc. 492-17, 25:1-3. Stufflebean was wrapped in his
sheets, as though he had fallen out of bed. Id.,
25:16-23. Millsap, who later moved into the cell Stufflebean
was in, testified that there was roughly 16 ounces of green
vomit on the floor and sheets after Stufflebean was removed.
Baker Smith was the medical nurse working in the area
next to the TCU at the time of the third Code 16. Baker Smith
went to Stufflebean's cell. She noted later that
Stufflebean's skin was “warm and dry” and
“a little greenish in color” at that time. Doc.
492-1, p. 16. Although she did not make note of it in the
medical record, at her deposition, Smith testified that
Stufflebean vomited green liquid when they started CPR. Doc.
493-31 (Deposition of Janet Baker Smith), 17:8-19. Despite
Stufflebean's condition, during the eight or ten minutes
it took for a wheelchair to arrive, Baker Smith did not
attempt to take Stufflebean's vitals. Id.,
testified that when Baker Smith and a correctional officer
took Stufflebean out, they dragged him out instead of
bringing a wheelchair to him, despite the fact that the cell
was meant for handicapped inmates and therefore was wide
enough to accommodate a wheelchair. Doc. 492-17, 25:24-26:13;
see also id., 29:9-14 (identifying the nurse at
issue as Baker Smith).
of the cell, the corrections officer put Stufflebean into the
wheelchair roughly, and Baker Smith walked with him to the
TCU at a “[l]eisurely” pace. Id.,
30:4-32:23. According to Baker Smith, “on the way to
TCU, offender had his head back, went limp.” Doc.
492-1, p. 16.
Smith could not recall receiving any report from Nurse
Williams, and she testified that, had she been told to
monitor Stufflebean, she would have included that direction
in her chart documentation. Doc. 493-31, Doc. 15:6-18:16.
Baker Smith could not recall-and she did not document-anyone
telling her that Stufflebean was having an Addison's
flare-up, or that he had two serious medical issues.
Fourth Code 16 - October 31, 2015 - 11:30 p.m.
TCU, Stufflebean's pulse was 67 and Baker Smith was
unable to get his blood pressure. Doc. 492-1, p. 16.
Stufflebean became “unresponsive.” Id. A
fourth Code 16 was called in relation to Stufflebean.
Id. Baker Smith wrote that “CRP [sic]
was performed till the ambulance crew arrived.”