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Davis v. Buchanan County Missouri

United States District Court, W.D. Missouri, St. Joseph Division

December 23, 2019

BRENDA DAVIS, et al., Plaintiffs,



         Before 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.[1] 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 IV.[2] The Court also finds that Corizon cannot assert the defense of qualified immunity to Count IV.

         I. Background[3]

         On 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 Corrections (“MODOC”).

         a. Intake

         Amy 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.

         Mowry 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, [4] ¶ 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.

         b. Initial TCU Visit

         Mowry 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.

         Nurse 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.

         Bergman, 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.

         c. In the Wing

         Trent 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 out”).

         During 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., 36:11-22.

         Millsap 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.” Id., 32:25-33:3.

         Millsap 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.”).

         d. Doctor's Examination

         Dr. 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.

         At his 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.

         Dr. 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.

         e. First Code 16 - October 31, 2015 - 1:15 a.m. - No Documentation

         On 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.

         f. Second Code 16 - October 31, 2015 - 4:30 a.m. - No Documentation Until Nearly 24 Hours Later

         A 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.” Id.

         Defendant 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, p. 2.

         g. Return to TCU - October 31, 2015 -Before 5:30 a.m.

         Before 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.

         h. Stufflebean Returned to His Cell - October 31, 2015 - Approximately 7 a.m.

         Munger's “Late Entry”[5] 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 to cell.

Id., pp. 14-15.

         However, CO Huddleston described Stufflebean during this incident as “weak and incoherent.” Munger AF, [6] ¶ 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.[7]

         After 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.

         Munger 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.

         i. Third Code 16 - October 31, 2015 - 10:45 a.m.

         At 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. Id., 91:11-92:16.

         Nurse Baker Smith[8] 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., 35:4-5.

         Millsap 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).

         Outside 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.

         Baker 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. Id., 20:1-9.

         j. Fourth Code 16 - October 31, 2015 - 11:30 p.m.

         At the 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.” Id. ...

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