Failure to Monitor Medication States Claim

A Richmond U.S. District Court says a woman sentenced to 30 days in jail on a DUI charge, who alleged she informed defendant jail personnel that she was under treatment for a prior pulmonary embolism and required a daily dose of the blood thinner warfarin and weekly blood tests to monitor her medication level, may sue jail medical staff for negligence and deliberate indifference to her serious medical need, based on her hospitalization and treatment for warfarin toxicity.

Plaintiff’s complaint attempts to state two distinct bases for the supervisory liability of the Jail Authority and defendant Joseph Higgs. First, she argued Higgs implemented a series of policies that lead to conditions in the jail so likely to result in the jail medical staff’s deliberate indifference that it amounted to tacit authorization of such conduct. Second, she argues Higgs implemented a policy requiring inmates to complete a medical request form prior to any medical treatment being provided. Both of these claims fail the requirements for pleading a claim of supervisory liability under 42 U.S.C. § 1983.

Even assuming that LPNs functioned at the jail unsupervised and with complete discretion, plaintiff seems to rest her argument on a belief that LPNs are generally incompetent to function in the role allegedly assigned to them at the jail. In other words, plaintiff suggests any care from an LPN – rather than inadequate care from an LPN – posed a pervasive and unreasonable risk of constitutional injury. However, there is simply no factual allegation or citation of authority in the record that supports such a broad holding.

The complaint is similarly deficient when limited to an allegation that Higgs tacitly authorized inadequate medical care by LPNs at the jail. Because the complaint lacks factual allegations supporting a claim that inadequate medical care was widespread at the jail, plaintiff’s claim for supervisory liability based on conditions at the jail fails as a matter of law.

As to the claim alleging a policy of requiring a medical request form prior to treatment, the complaint identifies only a single occasion on which an inmate was denied medical care for this reason: the unnamed defendant guards’ denial of care to plaintiff on Jan. 4, 2012. Allegations of isolated conduct are insufficient to plausibly allege that a supervisor had knowledge of conduct creating a pervasive and unreasonable risk of constitutional injury.

Plaintiff’s allegations against defendant LPN Diggins are sufficient as a matter of law. The complaint alleges defendants failed to appropriately monitor plaintiff’s INR/PT levels and failed to check the results of INR/PT tests that were actually performed. Plaintiff has plausibly alleged the nurse defendants failed to monitor plaintiff’s INR/PT levels in disregard of a known risk that failure to monitor would create a substantial risk of serious injury to her.

However, she fails to state a claim of deliberate indifference for failure to diagnose warfarin toxicity or to refer plaintiff for higher levels of medical care. The court cannot read the complaint as alleging the nurse defendants ever concluded plaintiff was suffering from warfarin toxicity.

Plaintiff also has met her burden to plausibly allege that defendant Dr. Richard K. Dalberg had knowledge of plaintiff’s serious medical condition and that he owed plaintiff a continuing duty of care related to his treatment of her (for the negligence claim). The complaint states claims against Dalberg for deliberate indifference and negligence as a matter of law.

Deavers v. Rappahannock Regional Jail Authority (Spencer) No. 3:13cv821, July 3, 2014; USDC at Richmond, Va. VLW 014-3-346, 18 pp.