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Florida Jail Liable in Medical Neglect Death by PHS

Carol Ancata, personal representative of Anthony Ancata, deceased, and
natural guardian of Tara Ancata, filed a lawsuit against Prison Health
Services, Inc. (PHS), the Broward County Jail and the Sheriff of Broward
County (defendants) for violating Anthony Ancata's Fourteenth and Eighth
Amendment rights to be free from cruel and unusual punishment, and to
receive adequate medical care.

Anthony Ancata was placed in the Broward County Jail in pre-trial
detention on August 20, 1982. Approximately one week later he began
suffering from several symptoms including swelling of the ankle, inability
to sleep, chills, back pain, numbness of the hands, hyperventilation and
double vision. Despite these serious symptoms, PHS did nothing to evaluate
his medical condition, instead giving him Ben Gay and Tylenol II. PHS
also suggested an orthopedic or psychiatric evaluation but never followed
through with that suggestion. Instead, PHS told Ancata and his family that
they would not let him see a specialist without a court order, and that
Ancata would have to agree to pay for the visit to the specialist even
though he had already been declared indigent.

Ancata's public defender obtained a court order forcing PHS to provide an
evaluation by an orthopedic specialist, who recommended a neurological
evaluation after seeing Ancata. PHS again refused to agree to the
specialist's recommendation without another court order. Ancata's attorney
obtained another court order and Ancata was hospitalized and diagnosed as
having leukemia. After the diagnosis Ancata died in the hospital from
respiratory failure on December 30, 1982. Carol Ancata filed suit in
August 1984 in the U.S. District Court, Southern District of Florida. PHS
and the other defendants filed motions to dismiss the complaint. The
district court dismissed the complaint against all of the defendants on
November 19, 1984.

The U.S. Court of Appeals, Eleventh Circuit, held that the complaint
sufficiently alleged a claim of deliberate indifference to Ancata's
serious medical needs. The appellate court also held that the county had
an obligation to provide prisoners with adequate medial care, and that the
county was not absolved of its duty by contracting to PHS. The county
remained liable for any constitutional deprivations caused by their or
PHS's policies or customs. Further, a lack of funds cannot justify an
unconstitutional lack of medical care and treatment for prisoners. The
court also held that if the county instituted or practiced a policy or
custom or requiring prisoners who need medical care to obtain court orders
to get medical assistance, and as a result a prisoner's treatment is
delayed, then the county, sheriff and/or contracted health officials who
practice that policy may be liable. Finally, the court held that the
plaintiff had adequately alleged a federal claim and the district court's
dismissal of the pendent state law claims was premature. The appeals court
reversed the district court's decision and remanded the case for further
proceedings. See: Ancata v. Prison Health Services, Inc., 769 F.2d 700
(11th Cir. 1985).

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Related legal case

Ancata v. Prison Health Services, Inc.

Ancata v. Prison Health Services Inc., 769 F.2d 700 (11th Cir. 08/26/1985)

[1] U.S. Court of Appeals, Eleventh Circuit

[2] No. 84-5923

[3] 769 F.2d 700, 1985

[4] August 26, 1985


[6] Appeal from the United States District Court for the Southern District of Florida.

[7] Peter M. Siegel; Randall C. Berg, Jr., Miami, Florida, for Appellant.

[8] Bruce W. Jolly, Ft. Lauderdale, Floridas.

[9] Deborah Mann; Robert Klein, West Palm Beach, Florida.

[10] Edward R. Nicklaus, Miami, Florida.

[11] Alexander Cocalis, Ft. Lauderdale, Florida.

[12] Christopher R. Fertig; Lawrence J. Marraffino, Fertig & Gamble, Ft. Lauuderdale, Florida, for Appellee.

[13] Henderson and Clark, Circuit Judges and Tuttle, Senior Circuit Judge. Henderson, Circuit Judge, concurring in part and dissenting in part.

[14] Author: Clark

[15] CLARK, Circuit Judge:

[16] I. FACTS

[17] A. Procedural History

[18] This is an appeal from an order of the district court dismissing all counts of plaintiff's first amended complaint based upon 42 U.S.C. §1983.

[19] Plaintiff is the personal representative of the deceased's, Anthony Ancata's, estate and the guardian of his minor child Tara Ancata. Defendant Prison Health Services is and was the entity responsible for providing medical care to those housed at the Broward County Jail. Defendants Colligan, Sutton, Hargrove and Blady were all medical personnel employed by Prison Health Services, Inc. Robert Butterworth was sued in his official capacity as the sheriff of Broward County at the time of the incidents forming the basis of this lawsuit. Sheriff Brescher was sued in his official capacity as the current sheriff of Broward County. Broward County was sued for its alleged failure to provide adequate funding to address the medical needs of individuals incarcerated there.

[20] Plaintiff's original complaint was filed in August of 1984. Each defendant, other that Prison Health Services, filed a motion to dismiss.*fn1 Before the court ruled on the motions to dismiss, the defendants consented to the filing of an amended complaint. This took place in October of 1984. Counts 1 and 2 of the complaint alleged that all the defendants violated plaintiff's decedent's right to be free from cruel and unusual punishment by the deliberate indifference to his serious medical needs. The remaining counts raised pendent state law claims. After the amended complaint was filed, defendant Broward County and defendant Blady filed motions to dismiss. The district court entered an order on November 19, 1984 dismissing all counts of the complaint against all defendants.*fn2 The district court determined that counts 1 and 2 of the complaint as amended, alleging the constitutional violations, alleged at most, only medical malpractice. Thus, the court determined that dismissal as to all medical defendants was proper. With respect to the non-medical defendants, the district court found that the allegations against them were grounded on notions of respondeat superior and therefore were subject to dismissal. The district court dismissed the pendent state law claims as it had found no valid federal claim.

[21] B. The Facts as Alleged in Plaintiff's Complaint

[22] The facts, as alleged in the plaintiff's complaint, indicate the following. Anthony Ancata was arrested and placed in pre-trial detention at the Broward County Jail on August 20, 1982. On August 29, 1982, he began to suffer from a variety of medical symptoms including swelling of the ankle, inability to sleep, chills, lower back pain, tingling and numbness of his hands, hyperventilation, severe pain in his back and right leg, double vision, and other serious problems. Despite his complaints, Prison Health Services and its employees, defendants Blady, Colligan, Sutton and Hargrove did little or nothing to evaluate the medical needs of Mr. Ancata.*fn3

[23] The defendants did administer such non-prescription drugs as Ben Gay and Tylenol II and suggested an orthopedic or psychiatric evaluation. However, they took no steps to have Ancata examined by either an orthopedic specialist or a psychiatrist. Rather, they informed Ancata and his family that he would not be referred to a non-staff specialist without a court order. Furthermore, they refused to acquiesce in the entry of a court order unless plaintiff agreed to bear the costs of the recommended diagnostic evaluation. Mr. Ancata, however, had already been declared indigent.

[24] Ancata's appointed public defender successfully obtained a court order compelling an evaluation by an orthopedic specialist. The orthopedist recommended a neurological evaluation. However, Prison Health Services would again not agree to a medical evaluation by a neurologist without a court order. The second court order was again obtained by the public defender representing Mr. Ancata. After the neurological examination was conducted, Anthony Ancata was hospitalized. He was soon diagnosed as having leukemia. He died in the hospital on December 30, 1982 from respiratory failure.*fn4

[25] The appellant raises the following issues on appeal: (1) whether the complaint sufficiently alleged a case of deliberate indifference to serious medical needs thus rendering dismissal improper; (2) whether the federal claims asserted against the sheriff of Broward County and Broward County itself were premised solely on notions of respondeat superior; and (3) whether the dismissal of the pendent state law claims, if the federal claims are found to state a cause of action, was premature.


[27] When reviewing an order granting a motion to dismiss for failure to state a claim, this court must accept the facts as pleaded to be true and resolve them in the light most favorable to the plaintiff. The motion to dismiss should not be granted unless it appears to a certainty, "that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Milburn v. United States,734 F.2d 762, 765 (11th Cir.1984). The threshold of sufficiency that a complaint must meet to survive a motion to dismiss for failure to state a claim is, as we have stated previously, "exceedingly low." Quality Foods de Centro America, S.A. v. Latin American Agribusiness Devel.,711 F.2d 989, 995 (11th Cir.1983).

[28] It should also be noted at the outset in this case that the defendants fall into several different groups. Prison Health Services, as was noted previously, is the entity responsible, pursuant to an agreement between it and the county, for providing medical care to those housed at the Broward County Jail. Defendants Colligan, Sutton, Hargrove and Blady were all medical personnel employed by Prison Health Services. The issue to be resolved as to Prison Health Services and its employees, i.e. the medical defendants, is whether plaintiff's allegations sufficiently stated a constitutional tort of deliberate indifference to serious medical needs.

[29] The county and the current sheriff are sued as public bodies ultimately responsible for providing medical care to those incarcerated in Broward County. Mr. Butterworth was the sheriff at the time of Ancata's death. The issue to be resolved as to these defendants, i.e., the non-medical defendants, is whether the district court properly dismissed the claims against them when it determined that any liability they may be exposed to was based solely upon notions of respondeat superior.

[30] A. Medical Defendants and the Deliberate Indifference to Serious Medical Needs Claim

[31] The question before us is whether the allegations of plaintiff's complaint are sufficient to permit a jury to find that the medical defendants' conduct amounted to a deliberate indifference to serious medical needs. See Estelle v. Gamble, 429 U.S. 97, 97 S. Ct. 285, 50 L. Ed. 2d 251 (1976).*fn5

[32] The medical defendants do not contest, and there can be no serious dispute, that if their actions resulted in a deprivation of Ancata's constitutional rights, they would be subject to liability pursuant to 42 U.S.C. §1983. Although Prison Health Services and its employees are not strictly speaking public employees, state action is clearly present. Where a function which is traditionally the exclusive prerogative of the state (or here, county) is performed by a private entity, state action is present. Jackson v. Metropolitan Edison Co., 419 U.S. 345, 95 S. Ct. 449, 42 L. Ed. 2d 477 (1974); see also Lawyer v. Kernodle, 721 F.2d 632 (8th Cir.1983) (private physician hired by county to perform autopsies was acting under color of state law); Morrison v. Washington County, Alabama,700 F.2d 678 (11th Cir.1983) (refusing to dismiss physician employed by county from § 1983 action); Perez v. Sugarman, 499 F.2d 761 (2d Cir.1974) (holding that state action was present for private institution's acts where the City of New York removed a child from the mother's custody and placed the child in a private child care institution).

[33] If the complaint is sufficient, then dismissal for failure to state a claim is improper. Accepting plaintiff's allegations as true, and giving the plaintiff the benefit of all legitimate inferences from the complaint as we must, we conclude that the complaint sufficiently alleges a claim of deliberate indifference to serious medical needs.

[34] There are at least three separate although somewhat overlapping aspects to plaintiff's claim of deliberate indifference. The first is plaintiff's allegation that the defendants failed to provide even that level of diagnostic care that they themselves believed necessary. The knowledge of the need for medical care and intentional refusal to provide that care has consistently been held to surpass negligence and constitute deliberate indifference. See Robinson v. Moreland,655 F.2d 887 (8th Cir.1981). In Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir.1980), cert. denied, 450 U.S. 1041, 101 S. Ct. 1759, 68 L. Ed. 2d 239 (1981) the court said:

[35] Deliberate indifference to serious medical needs is shown when prison officials have prevented an inmate from receiving recommended treatment or when an inmate is denied access to medical personnel capable of evaluating the need for treatment.

[36] In this case the plaintiff alleged that the defendants knew that medical care was necessary but simply refused to provide it. The complaint maintains that the defendants concluded that Ancata required a psychiatric or orthopedic evaluation and refused to take the steps to see that he was properly evaluated. Instead, they placed the burden on decedent to obtain a court order for the very examination they believed necessary. Intentional failure to provide service acknowledged to be necessary is the deliberate indifference proscribed by the Constitution. See Woodall v. Foti,648 F.2d 268, 272-73 (5th Cir.1981).

[37] Second, plaintiff alleges that the defendants failed to secure medical care for Ancata because he would not pay. Delay in medical treatment cannot be justified as a means to coerce payment. See City of Revere v. Massachusetts General Hospital, supra. Furthermore, if necessary medical treatment has been delayed for non-medical reasons, a case of deliberate indifference has been made out. See Archer v. Dutcher,733 F.2d 14, 17 (2d Cir.1984). Plaintiff alleged that Ancata was indigent and that the defendants put the financial interest of Prison Health Services ahead of the serious medical needs of Ancata.