Ninth Circuit Finds Jail Nurses, San Diego Can’t Dodge Liability in Man’s Overdose Death

A trio of nurses and San Diego County can’t dodge liability for a man’s overdose death in jail, the Ninth Circuit found, in confirming a new standard of review for medical indifference to inmates.

The James R. Browning U.S. Courthouse in San Francisco, home of the Ninth Circuit Court of Appeals. (Ernest McGray/Associated Press)

SAN DIEGO (CN) — San Diego County, which has the highest rate of jail deaths in California, cannot dodge liability for the overdose death of a man left unmonitored for eight hours despite showing signs he was under medical distress, the Ninth Circuit found Wednesday.

In a 49-page order, U.S. Circuit Judge Kim McLane Wardlaw, a Bill Clinton appointee, reversed and remanded the wrongful death case where the wife and children of Ronnie Sandoval claimed three nurses and jail staff at the San Diego Central Jail failed to provide medical care to the father and husband, who had been arrested and booked for possession of a controlled substance, in violation of his parole.

Sandoval died from a methamphetamine overdose Feb. 22, 2014 after he had swallowed an amount of the drug estimated to be several hundred times the typical recreational dose to prevent its discovery during his arrest, Wardlaw wrote.

After he was brought to jail, medical staff left Sandoval unmonitored for eight hours and failed to promptly call paramedics when he was discovered unresponsive and having a seizure, according to the order.

U.S. District Judge Roger Benitez, a George W. Bush appointee, found in 2018 Sandoval’s family had failed to show there were triable issues of fact as to the individual nurses’ and county’s liability in their husband and father’s death.

He had rejected much of the evidence presented by the family including medical and police reports, after sustaining “boilerplate one-word objections” from the county Wardlaw found to be an abuse of discretion. As a result, the panel considered the evidence in making its decision Wednesday.

Wardlaw, writing on behalf of fellow Clinton appointee U.S. District Judge Joseph Bataillon, sitting with distinction from the District of Nebraska, found “a jury could conclude that Sandoval would not have died but for the defendants’ unreasonable response to his obvious signs of medical distress.”

“A jury could conclude that a reasonable nurse who was told that Sandoval was shaking, tired, and disoriented — and who was specifically directed by a deputy to evaluate Sandoval more thoroughly — would have understood that Sandoval faced a substantial risk of suffering serious harm,” Wardlaw wrote on behalf of the panel.

Based on that finding, she determined an objective standard should apply to constitutional claims of inadequate medical care brought by pretrial detainees.

Attorney Christopher Morris, who represents Ana Sandoval, Ronnie Sandoval’s widow, told Courthouse News the ruling is “a sea change for all of us that do jail litigation.”

“What this ruling does is set a new standard of review for the provision of health care in county jails where instead of looking at the subjective intent of the health care provider, a jury will review the actions of that provider as to whether or not they were objectively reasonable,” Morris said.

He added: “In light of the extremely high rate of jail deaths in the county of San Diego, this should increase the county’s motivation related to healthcare reforms in the jail.

“We don’t think for-profit health care is the appropriate provider in jails,” Morris said, acknowledging Supervisor Nathan Fletcher’s efforts to ensure trained county employees are tasked with providing medical care in sheriff’s department-run facilities.

Critically, Wardlaw also found the county must face Monell claims for its practice of using MOC1 “mixed use” jail cells as both holding cells for inmates requiring medical attention and general population holding cells “without adequate safeguards in place to ensure that jail staff were made aware of when individual was placed in MOC1 for medical, rather than correctional reasons.”

The system, which relied on verbal communication — rather than written nursing logs — in relying inmate’s medical information during staff changes, “created a substantial risk of turning MOC1 into a veritable no man’s land, where deputies believed the cell was being monitored by nurses, and nurses believed it was being monitored by deputies,” Wardlaw wrote.

In her order, Wardlaw found nurse Romeo de Guzman had been informed by a deputy “you need to look at him more thoroughly,” but only performed a duplicative, 10-second blood sugar test before clearing Sandoval for booking.

Despite sitting at the nurse’s station 20 feet from Sandoval’s cell, de Guzman did not check on him for the remaining six hours of his shift and failed to relay information about Sandoval’s condition to the nurses who replaced him.

“Sweating and being so disoriented that officers observe and comment about it are not everyday conditions. A jury could further conclude that de Guzman’s actions toward Sandoval — which were limited to administering a quick blood test and then ignoring Sandoval for the remaining six hours of his shift — were ‘akin to reckless disregard,’” Wardlaw wrote, finding he was not entitled to summary judgment.

As for nurses Dana Harris and Maria Llamado, Wardlaw also found they were not entitled to summary judgment on liability, as a jury could find their failure to promptly call paramedics — after incorrectly calling EMTs who could not transport unresponsive patients — was objectively unreasonable.

“There is ample evidence from which a jury could conclude that promptly calling paramedics was the only medically acceptable option,” Wardlaw wrote.

U.S. Circuit Judge Daniel Collins, a Donald Trump appointee, agreed with the majority’s conclusion nurses Dana Harris and Maria Llamado were not entitled to summary judgment, but in a 24-page dissent wrote he would affirm the district court’s ruling on summary judgment in favor of nurse Romeo de Guzman and the county of San Diego.

Collins found de Guzman was not subjectively aware of Sandoval’s medical needs and there was no evidence the county had an unconstitutional police practice or custom in its use of the MOC1 cell.

As for nurses Harris and Llamado, “the sharply conflicting evidence indicated that they subjectively knew that the paramedics needed to be called,” Collins wrote in the dissent.

A spokesman for the county did not immediately return a request for comment.

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