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Medical Provider On the Hook for Inmate’s Death

(CN) - A private health care provider accused of reckless indifference after a 25-year-old man died in jail of a staph infection is not entitled to immunity, the Sixth Circuit ruled.

Tyler Butler arrived at the Hopkins County Detention Center in Madisonville, Ky., on April 8, 2010, to serve a short sentence for a misdemeanor, according to court records.

At intake, he told medical staff, provided by private for-profit company Southern Health Partners, that he had an antibiotic-resistant staph infection. He reportedly appeared to be under the influence, but told staff that he had not been drinking.

While changing into a prison uniform, Butler vomited twice and had difficulty standing up. Staff said his skin was almost gray in color and he appeared bloated, court records show.

Butler pulled down his pants slightly to show the intake nurse that he had open sores all over his groin area.

Despite his serious condition, the intake nurse decided to admit Butler. She did not contact the medical director to request orders for Butler's care, although the jail's policy provides for medical supervision with physician overview, according to the Sixth Circuit ruling.

Butler's blood pressure was taken once a day, and each reading showed a decrease in blood pressure, but he was never treated for the condition. No nurse ever examined his infection despite written policy guidelines instructing staff to keep a close watch on drug-resistant infections.

On the second day of Butler's incarceration, he was unable to get up from the floor of his cell to receive his medication, so a nurse came into the cell to give it to him. This nurse did not medically assess his situation, according to court records.

Butler defecated on himself on the morning of his third day in jail and he was in too much pain to move. Deputies helped him shower and change into a new uniform, but he did not receive medical attention.

In the afternoon, Butler asked a deputy for a cup of water because he could not get up. The deputy told him to get water from his cell faucet.

Less than an hour later, the same deputy found Butler dead in his cell, court records show.

An autopsy found that Butler died of a cardiac arrhythmia due to sepsis, a complication of his staph infection.

Butler's mother, Cindy Shadrick, sued Hopkins County and Southern Health Partners, or SHP, for allegedly violating her son's constitutional right to adequate medical care.

A federal judge ruled that both defendants were entitled to immunity, but the Sixth Circuit reversed 2-1 on Friday with respect to SHP.

"A reasonable jury could find that the potential risk of the commission of constitutional torts by LPN [licensed practical nurse] nurses who lack the essential knowledge, tools, preparation, and authority to respond to the recurring medical needs of prisoners in the jail setting is so obvious that SHP's failure to provide adequate training and supervision to those nurses constitutes deliberate indifference to the risk," Judge Jane Stranch wrote for the majority.

All of the nurses who worked at the jail during the three days of Butler's stay testified that SHP did not provide them with any training on its medical policies, and didn't supervise their work to be sure they were following protocol, according to the ruling.

The court said an administrator with SHP did not ask to review Butler's file after his death, and no one reprimanded the nurses for failing to follow policy.

"None of the administrators within SHP's organizational hierarchy ... took responsibility to train LPN nurses at [the jail] or to provide them with appropriate supervisory oversight to avoid violation of the constitutional rights of confined inmates to adequate medical treatment for their serious medical needs," Stranch said. "As a result, the nurses engaged in a custom and practice of requiring seriously ill inmates to request medical care before any services would be provided, even if the circumstances called for emergency medical treatment."

Evidence suggests that Butler obviously needed medical attention the moment he walked into the jail, but that the nursing staff showed reckless disregard for his needs, likely causing his death, according to the ruling.

Stranch said SHP's status as a contractor performing work typically performed by government employees does not make it an arm of the state eligible for governmental immunity.

Judge Richard Griffin dissented, saying he would find private entities that contract with a state county eligible for immunity.

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