Parents of Late Schizophrenic Win Appeal

     CHICAGO (CN) – The 7th Circuit revived some of the claims of parents who blamed Indiana prison officials and medical staff for the death of their 21-year-old schizophrenic son, who died from drinking too much water while awaiting transfer to a psychiatric hospital.



     The three-judge panel ruled that Nicholas Rice’s parents are entitled to a jury trial on claims that their son suffered inhumane living conditions – because prison officials failed to clean his cell, which was caked with his own urine, feces, and uneaten food – as well as Indiana state law wrongful death claims.
     The prison saga and subsequent legal battle began on March 5, 2003, when Rice, of Stevensville, Mich., stole a neighbor’s car and drove to a KeyBank in Nappanee, Ind. Rice threatened to detonate a bomb if the teller refused to give him money. Then he walked out of the bank without explanation or money and returned home. He was arrested for auto theft and jailed in Berrien County, Mich.
     Rice had exhibited mental problems in high school and was diagnosed with undifferentiated schizophrenia. He was prescribed medications but did not always take them and stopped altogether when he was removed from his parents’ medical insurance.
     “It soon became apparent to the Michigan authorities that Rice had mental difficulties,” 7th Circuit Judge Ilana Rovner wrote in the 84-page opinion. Rice refused to eat, was often unresponsive, and was so dirty he was hospitalized shortly after arriving at the jail. Rice was found not competent to stand trial and was committed to Kalamazoo Psychiatric Hospital for 2 months.
     When he was discharged in August 2003, he was identified as a suspect in the failed Indiana bank robbery and was taken to Elkhart Jail in Indiana. He was booked in September 2003 and bail was set at $20,000, preventing his release.
     Elkhart’s healthcare services are contracted to Correctional Medical Services, a Missouri-based healthcare company, and the lead defendant in this case.
     CMS screened Rice upon arrival and noted his schizophrenia. Dr. Bryce Rohrer, who visited Elkhart Jail once a week, wrote Rice a prescription for the anti-psychotic Seroquel.
     When Rice refused to take the medication and was exhibiting troubling signs of psychosis, including refusal to eat and unresponsiveness, Rohrer petitioned the court to involuntarily commit Rice to a mental facility for 72 hours. The court grated his request and Rice was admitted to Oaklawn Psychiatric Center, which had a contract with CMS to serve inmates.
     But the treating physician at Oaklawn, Dr. Salvador Ceniceros, decided that there was no reason for Rice to be there. He concluded that the significant improvement he observed within hours of Rice’s arrival suggested malingering – faking psychotic symptoms. He discharged Rice within 24 hours and certified that Rice should be capable of standing trial.
     Rice was committed to Oaklawn again after he continued to exhibit schizophrenic behaviors at Elkhart. He lost 50 pounds due to refusal to eat, refused to take his medication or wear clothing, and had to be forcibly removed from his cell and showered.
     At one point, Rice struck a cellmate in the eye and had to be subdued with pepper spray when he refused to comply with guards’ orders to step out of his cell. After being placed in a restraint chair, Rice refused to leave and remained there for 18 hours. Guards had to drag him from the chair and return him to his cell.
     Rice was then sent to an administrative segregation unit where he could be more closely observed. In this unit, where Rice remained until his death 7 months later, he was allowed out of his cell for 1 hour a day and had no cellmate.
     Rice’s hygiene remained abysmal. “Joshua Shaw, an inmate who was housed in the cell next to Rice, indicated that Rice was ‘always naked, he had unbelievable odor due to his total lack of hygiene, feces on his body, urine throughout his cell, also rotting, uneaten food strewn throughout his cell,'” Rovner wrote.
     Shaw also indicated that Rice rarely spoke, except to mumble “go away” repeatedly.
     Rohrer again asked that Rice be committed to a psychiatric hospital, requesting Elkhart General rather than Oaklawn. But Elkhart General refused Rice admission under the mistaken belief that it did not have a contract with the jail.
     Rice was taken to Goshen General Hospital, which had no psychiatric unit, and was treated for dehydration and mild malnutrition. When he was stable, the hospital contacted Oaklawn for further psychiatric evaluation. But Ceniceros advised the Goshen doctors that Rice did not require psychiatric treatment and he was returned to Elkhart jail.
     In December 2004, Rice was found incompetent to stand trial and was committed to Logansport State Hospital.
     Ten days later, while Rice was still waiting in Elkhart jail for a bed to open up at Logansport, Shaw heard Rice gulping water and vomiting in his cell. Shaw and other inmates yelled and kicked their cell doors to get guards’ attention, but none came, despite the hourly check-up requirement in the prison unit. Rice was found dead at 4:30 a.m. on Dec. 18, 2004.
     An autopsy revealed that a lethal decline in the sodium levels of Rice’s blood had been caused by excessive water consumption.
     Between 6 and 20 percent of psychiatric patients experience compulsive water drinking, known as psychogenic polydipsia. There are no warning signs to predict the condition and only 10 to 20 percent of those who do experience psychogenic polydipsia drink enough for the condition to damage their health.
     Rice’s parents sued the prison, CMS, prison officials and doctors in Federal Court. They alleged inhumane conditions of confinement, excessive force, failure to protect from harm inflicted by other inmates, institutional indifference to adequate medical care for the mentally ill, and deliberate indifference.
     After two years of discovery, the defendants moved for summary judgment. South Bend Federal Judge Robert Miller Jr. granted the motion, finding that prison and medical personnel had not disregarded Rice’s needs and that his cause of death was unforeseeable.
     A second complaint, which focused on wrongful death under state law, was dismissed by U.S. District Judge Rudy Lozano, who ruled that Judge Miller’s foreseeability ruling precluded the claims. The Rice family appealed.
     The 7th Circuit proved more sympathetic to the Rice’s plight, reversing the rulings on the inhumane conditions of confinement and state law wrongful-death claims.
     Though the jail did not prevent Rice from showering or keeping his cell clean and did shower him and clean for him on occasion, the conditions of filth in which Rice lived warranted a jury determination, the court ruled.
     “We conclude, contrary to the district court, that whether jail officials were deliberately indifferent to Rice’s conditions of confinement presents a material dispute of fact that the fact finder must resolve at trial. That Rice himself created the unsanitary conditions of which his Estate complains certainly is a fact relevant to this claim … But given Rice’s mental condition, it by no means forecloses the claim, as the district court appears to have assumed,” Rovner wrote.
     Had the plaintiffs pled their case differently, the court indicated, deliberate indifference claims could have been brought against Rice’s nurses.
     “Given the evidence that Rice went unbathed for significant periods of time, was developing bedsores, and had skin sloughing off his body when lifted up off of his bed, it is conceivable that a jury would find that the nursing staff had consciously disregarded the consequences of Rice’s failure to care for himself and thus deprived him (or helped deprive him) of humane conditions of confinement,” Rovner wrote. “The Estate does not make such an argument as to the nurses, however. We therefore pursue the issue no further.”
     The court also reinstated the state law claims, finding that Judge Miller’s foreseeability finding had been unnecessary to resolve the federal deliberate indifference claims and should thus not be given preclusive effect.
     But the dismissal of the excessive force, failure to protect, official policy of indifference claims, and indifference to Rice’s declining medical condition on behalf of jail officials and doctors was affirmed.
     The Rice family will continue its suit in Federal Court in South Bend.

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