The United States Court of Appeals for the Sixth Circuit (“Federal Appellate Court”) stated in its October 26, 2023 Opinion: “Bradley Grote died of acute methamphetamine intoxication three days after his arrest and detention at the Kenton County Detention Center in Covington, Kentucky. Although Grote was visibly in distress when put in a booking cell at the jail, the jail’s medical provider failed to render any treatment at all or seek further medical attention from a doctor on call or emergency medical services. Grote’s case exposes myriad failures by county and jail officials, including a lack of basic knowledge concerning overdoses and how to respond to them. Under the facts of this case, we hold that a jury could find that the medical provider was deliberately indifferent to Grote’s need for medical attention, but not that the jail deputies acted unconstitutionally.”
Deliberate Indifference
To make out a deliberate-indifference claim brought under the Fourteenth Amendment by a pretrial detainee, a plaintiff must demonstrate (1) an objectively serious medical need; and (2) that the defendants, analyzed individually, acted (or failed to act) intentionally and either ignored the serious medical need or recklessly failed to act reasonably to mitigate the risk the serious medical need posed. Stated differently, a pretrial detainee must have a serious medical need, and the defendant must act, whether through intentional action or omission, recklessly in response to the need and the risk it presented to the detainee.
The level of culpability with which a defendant must act to establish deliberate indifference to pretrial detainees is lower than that necessary for convicted incarcerated individuals. This is so because a pretrial detainee’s claims derive not from the Eighth Amendment, with its focus on punishment, but instead from the Fourteenth Amendment, which can be violated without respect to an official’s state of mind.
Contrary to deliberate-indifference claims brought under the Eighth Amendment, which requires both an official’s awareness of facts suggesting a likelihood of substantial harm to an incarcerated person and an official actually connecting such facts to an inference of harm, a pretrial detainee need only prove something akin to reckless disregard to satisfy the second element of a deliberate-indifference claim.
Serious Medical Need
A serious medical need is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention. “On numerous occasions we have held that drug or alcohol-related symptoms, like those associated with withdrawal or overdose, are sufficiently serious and obvious to laymen.”
In the case it was deciding, the Federal Appellate Court stated: “the district court erred when it found that Grote did not present an objectively serious medical need until he was found in his cell unconscious and foaming at the mouth. Although the Kenton County Defendants were not aware that Grote had ingested a lethal amount of methamphetamine, Grote manifested clear and undeniable signs of distress during the booking process shortly after arriving at KCDC. Nearly every corrections officer with whom Grote interacted noticed that Grote was experiencing some sort of medical issue, even if the cause was unknown … That Grote denied ingesting methamphetamine may factor into how we consider the defendants’ responses to Grote’s medical distress but is irrelevant when assessing whether Grote had a serious medical need, given the manifest signs of distress obvious to a layman … here Grote exhibited signs of serious medical issues, and Brand was the only medical provider to have examined Grote. Brown called for Nurse Brand to conduct a medical assessment, and officers witnessed Grote’s deterioration over time. Although Brand and the Kenton County Defendants were not aware of the cause of the medical distress, they could tell that Grote required extra observation, that he was shaking and twitching, and that he lacked basic motor control. At a minimum, disputes of material fact exist concerning the obviousness of the medical need prior to Grote’s seizure.”
Reckless Disregard
The Federal Appellate Court stated: “Grote does not need to prove that Brand was aware of the fact that Grote had ingested a lethal dose of methamphetamine to show that Brand recklessly disregarded his serious medical need. The need for medical attention based on Grote’s severe symptoms was obvious even to non-medical professionals, and Brand’s failure properly to appreciate that risk does not mean that she did not act recklessly … One need not be a doctor to know that placing Grote on cell checks by jailers amounted to treatment “so cursory as to amount to a conscious disregard” of his clear medical needs … a defendant need not diagnose the cause of the medical distress in order for such need to indicate medical issues beyond the defendant’s capability that require emergency care … This was the case for Brand, who could provide only the most basic medical care despite the obvious signs that Grote needed more … Brand did not need to know whether Grote ingested a lethal amount of methamphetamine to recklessly disregard his medical need; whether he was withdrawing or overdosing, there is nothing routine about Grote’s symptoms—uncontrollable shaking and hyperventilation, among others—that would suggest that no medical attention was necessary.”
“That Brand did not need to understand why Grote was experiencing medical distress, but instead simply see that he was in fact experiencing such distress, also differentiates this case from ones in which we have held that a misdiagnosis by a medical professional is not deliberate indifference. Generally, a mere misdiagnosis of a medical condition by a prison medical official, standing alone, will not constitute deliberate indifference … But we have not held that a misdiagnosis shields a medical provider from liability when the detainee was in clear medical distress of a magnitude requiring immediate emergency medical attention … even if Brand determined that Grote was detoxing from methamphetamine, as opposed to overdosing, Grote’s symptoms indicated that he needed medical attention that KCDC and SHP could not provide. A jury could find that placing Grote on deputy-supervised observation in these circumstances amounted to treatment “so cursory as to amount to no treatment at all”.”
However, “there are certain issues common to all of the Kenton County Defendants that cut against holding that they recklessly disregarded Grote’s medical need. Principally, Grote has not pointed to any record evidence to suggest that the Kenton County Defendants were aware of any information beyond that available to Brand during the approximately hour-and-a-half period between the time Grote entered KCDC and his seizure … Here, Grote has made no argument that the officers should have disregarded Brand’s assessment of Grote’s condition based on what they knew or observed.”
The Federal Appellate Court warned, however: “There is a certain risk that finding no municipal liability in a case such as this one may appear to condone a municipality’s practices. This should not be the message. This case lays bare myriad issues in our jails and prisons even if in this narrow instance they do not rise to a constitutional dimension for the Kenton County Defendants. Undoubtedly, people will continue to die or be seriously injured in our jails and prisons without better training and greater resources for staff. The municipal defendants in this case recognize that overdoses and other drug-related issues are rampant in our jails and prisons. But those same facilities appear woefully unprepared to handle such issues, at least to a degree that would prevent needless death. Under a different set of facts, a municipality may be constitutionally liable.”
Source Grote v. Kenton County, Kentucky. et al., No. 23-5133.
If you or a loved one were harmed due to the lack of appropriate medical care while a pretrial detainee in the United States, you should promptly seek the legal advice of a local medical malpractice lawyer in your state who handles pretrial detainee medical malpractice claims and may investigate your claim and represent you or your loved one, if appropriate.
Visit our website or call us toll-free in the United States at 800-295-3959 to be connected with prisoner rights lawyers in your state who may assist you.
Turn to us when you don’t know where to turn.