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Qualified Immunity Denied to Nurses who Ignored Prisoner's Symptoms of Active TB; $2.28 Million in Damages, Fees and Costs on Remand

The Eighth Circuit Court of Appeals held on July 12, 2012 that a former prisoner had presented sufficient evidence against three nurses to overcome qualified immunity in a lawsuit that claimed he was denied necessary medical treatment for an active tuberculosis (TB) infection. Following remand, a jury entered a verdict of $590,600 against one of the nurses and the defendants agreed to pay $1.69 million in attorney fees and costs.

The appeal concerned a Minnesota federal district court's denial of summary judgment on qualified immunity grounds to five nurses employed at the Ramsey County Correctional Facility (RCCF), in a lawsuit filed by Marchello McCaster. McCaster had entered RCCF on April 17, 2008 to serve a 56-day sentence on an assault charge.

Upon his arrival at RCCF, Nurse Nancy Mattson conducted an intake exam that noted McCaster had lost a significant amount of weight and had an elevated pulse rate, which in combination can be a sign of active TB. Mattson then administered a Mantoux test, which involves injecting a derivative of TB under the skin of the forearm; she did not have any further interaction with McCaster.

Two days later, McCaster saw Nurse Audrey Darling for a reading of the Mantoux test. She read the results between 32.5 and 43.5 hours after the injection, although the facility's health services supervisor and Darling were aware that tests read before 48 hours or 72 hours after the injection are invalid. Darling noticed an induration, or bump, on McCaster's forearm, which if over 10 millimeters indicates a positive result for TB. She did not measure the induration but noted in McCaster's chart that it was zero millimeters, which she later changed to five millimeters.

Between April 19 and May 21, 2008, McCaster had no interaction with nursing staff. Guards who saw him within several days of his admission described him as visibly ill and a "very sick inmate." Recordings of his phone calls from the jail indicated that McCaster was coughing regularly.

Other prisoners described McCaster as barely able to walk and routinely coughing up blood. Both guards and prisoners attempted to seek medical attention on McCaster's behalf. The guards called the nurses' station and prisoners repeatedly submitted medical requests to RCCF nurses Mary Clausen and Julie Nelson. They acknowledged receiving the requests but did not act on them because they were not signed by McCaster; Nelson said they would not respond unless a prisoner had signed the medical request himself.

Clausen treated McCaster on May 21, 2008 for a "grossly swollen" jaw and on May 28 for problems with his feet. She did not check him for other medical conditions. Nurses Nelson and Patti Vodinelich saw McCaster daily to administer penicillin for his jaw infection, but also disregarded his symptoms of active TB.

The same day that McCaster was finally transported to a hospital in late June 2008, a guard informed Nurse Vodinelich that McCaster was "incoherent, moved slowly, and appeared very sick." She responded that he was "going to get out in a couple of days; he can go see his own doctor." Upon McCaster's arrival at the emergency room, the admission records indicated he was "chronically sick looking" and "emaciated."

Following his recovery from the TB infection, which included a 3½-month hospital stay, McCaster filed a civil rights complaint in federal court against the county, the RCCF nurses who had denied him medical care and several RCCF administrators and guards. He had spent 54 days at the jail without receiving treatment for his active TB.

McCaster submitted expert testimony from Dr. Michael Iseman that TB "evolves over weeks and in some cases months," thus it was "improbable" that a trained health professional who saw McCaster in late May would have failed to notice he was extremely sick. Dr. Iseman described McCaster as "near death" when he was finally taken to a hospital.

The district court dismissed Ramsey County and the jail administrators from the suit but denied summary judgment as to the nurses, rejecting their qualified immunity defense. The defendants appealed.

The Eighth Circuit reversed the denial of qualified immunity to Nurses Mattson and Darling because the record did not indicate that they knew McCaster had a serious medical condition due to their brief encounters with him. As to Nurses Clausen, Nelson and Vodinelich, the Court of Appeals found the record showed they had sufficient interaction and notice from others at the jail to alert them to McCaster's increasingly symptomatic condition and need for medical care. Vodinelich's remark the same day that McCaster was hospitalized – that he could see his own doctor after he was released – supported a finding of deliberate indifference.

The district court's summary judgment order was therefore affirmed in part and reversed in part. See: McCaster v. Clausen, 684 F.3d 740 (8th Cir. 2012).

Following remand the case went to trial. On December 10, 2012, a federal jury found that Clausen was deliberately indifferent to McCaster's serious medical needs, and awarded him $295,300 in compensatory damages and $295,300 in punitive damages. The jury entered verdicts in favor of nurses Nelson and Vodinelich. McCaster then moved for attorney fees and costs; according to one of McCaster's attorneys, Robert Bennett with Gaskins Bennett Birrell Schupp, LLP, the defendants settled the fees and costs for $1,690,000 in February 2013.

Meanwhile, McCaster had infected at least 108 other prisoners with TB as well as 42 jail employees when he was incarcerated at RCCF without medical care.

The prisoners filed a separate class-action lawsuit, which settled in September 2010. Pursuant to the settlement agreement with Ramsey County, current and former prisoners with active TB received $250,000 each and an annual medical examination "related to the monitoring or assessment of TB," plus reimbursement for medical costs and treatment should they re-develop TB in the future.

Prisoners with latent (non-active) TB received from $44,347.83 to $54,347.83 each, depending on whether they had completed drug treatment for their condition, plus an annual medical check-up. Should those with latent TB develop the active form of the disease, they will receive an additional payment of $200,000.

For prisoners with active TB who require treatment for "significant symptoms such as hepatitis, renal disease, neuropathy or other comparably serious side-effects," or who die as a result of their TB infection, they or their estate may claim additional compensation up to $250,000. The district court approved attorney fees and costs for class counsel of $2.6 million. See: Robinson v. Ramsey County, U.S.D.C. (D. Minn.), Case No. 0:08-cv-05779-RHK-AJB.

Thus, the failure of RCCF nurses to diagnose and treat McCaster's active TB infection cost the county an estimated minimum of $11 million, not including workers' compensation payments to jail employees who contracted TB.

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Related legal case

Robinson v. Ramsey County