Psychotic Break May Cost County Contractor

     (CN) - A home health care worker who peed on the head of one of his elderly clients may show that a doctor for the county erred in not having him committed, the 6th Circuit ruled.
     Officers in Muskegon County, Mich., arrested Timothy Carl in March 2008 after he suffered a psychotic episode and peed on the head of an elderly client for whom he provided in-home health care services. Carl tried to dispense liquid soap on another client's head.
     Facing a charge of vulnerable-adult abuse, Carl continued to behave strangely during the booking process.
     Community Mental Health Services, the agency that provides psychiatric services to Muskegon County Jail inmates, had Carl examined by two of its employees, Steve Weinert and Julie McLaughlin. These CMH workers concluded that Carl was "floridly psychotic" and paranoid, saying the pretrial detainee described to them a "glowing light in his cell that [was] tugging at his brain," the ruling states.
     Dr. Katherine Jawor, a CMH independent contractor, examined Carl a few days later to find out if he needed involuntarily hospitalization.
     "During Dr. Jawor's evaluation, Carl denied feeling depressed, denied suicidal and homicidal ideations, and denied experiencing paranoid delusions and auditory hallucinations," the ruling states. "This marked a dramatic change from the delusional state Weinert and McLaughlin reported merely two days before."
     Carl said he was just "messing with" Weinert and McLaughlin, and agreed to take his medication, according to the ruling. Jawor decided that Carl did not meet the criteria for involuntary hospitalization.
     Carl later sued the county and Jawor, saying his psychotic state worsened because he did not get the mental health services he needed because he was not hospitalized against his will.
     Most of the defendants settled, however, and only the claims against Jawor advanced to summary judgment. In ruling for the doctor, a federal judge in Grand Rapids held that "Jawor was not a state actor because Carl had not demonstrated the performing an involuntarily commitment determination is a public function," the ruling states.
     A three-judge panel with the 6th Circuit reversed Friday, finding otherwise.
     "True enough, Dr. Jawor did not have a direct employment relationship with Muskegon County Jail to provide psychiatric services to detainees," Chief Judge R. Guy Cole Jr. wrote for the court in Cincinnati. "She was, however, under contract with the county, through its agency CMH, to administer services to pretrial detainees held at the jail."
     The eight-page ruling cites the 1988 U.S. Supreme Court case West v. Atkins, which dealt with private contractors in prisons.
     Granting Jawor summary judgment "would incentivize the state to contract out, piece by piece, features of its prison healthcare system," and contractors could avoid liability, the court found/
     "In the face of today's expansion to healthcare outsourcing and prison privatization, these activities, many of which are necessary and well-intentioned, do not absolve a state from adhering to constitutional precepts," Cole wrote.