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Seventh Circuit: Summary Judgment Partially Reversed in Jail Death Caused by Medication Withdrawal

On May 25, 2012, the Seventh Circuit Court of Appeals reversed a grant of summary judgment to two defendants in a case involving a jail detainee who died after his prescribed medication was abruptly discontinued.

Wisconsin's La Crosse County Jail contracts with a private company, Health Professionals, Ltd. (HPL), to provide prisoner medical care. On-site doctor visits occurred only 2-4 hours, one day a week. The company's on-call physician, Dr. Stephen Cullinan, was based nearly 300 miles away in Peoria, Illinois.

John King suffered from serious health problems, including asthma, diabetes, a heart condition, high blood pressure, seizures, severe anxiety and other mental health issues when he was booked into the La Crosse County Jail on April 7, 2007.

King was taking "a daily regimen of medications that included five milligrams of alprazolam, a benzodiazepine." He entered the jail with "two grocery bags full of his medications, including a bottle with 115 one-milligram tablets of alprazolam."

Nurse Karen Mondry-Anderson called Dr. Cullinan because alprazolam was excluded from HPL's formulary of preferred drugs. "Obviously unable to examine King, and not bothering to obtain the details about [his] prescription," Dr. Cullinan ordered King to be weaned off the alprazolam in three days.

This was "a dangerously rapid reduction," given the dosage of medication that King was taking. "Abrupt withdrawal from alprazolam can be life-threatening. Associated symptoms include agitation, elevated blood pressure, elevated pulse, tremors, delusions, hallucinations, and seizures. The severity of such symptoms requires medical providers to monitor the patient closely, preferably in a hospital."

However, jail staff did not monitor King's withdrawal and his health quickly deteriorated. On April 11, 2007 he requested medical attention, but wasn't seen until six days later. A doctor "noted that King had pressured speech and flights of ideas with manic insomnia."

At about 10:30 a.m. on April 18, 2007, jail guards William Olson and Jennifer Koby-Gobel "found King convulsing on the floor, screaming and foaming at the mouth."

When Nurse Sue Kramer was notified, she told three nursing students who were with her at the time that prisoners fake seizures. King was shaking so badly that Kramer was unable to get a blood pressure reading. Consistent with seizures, he did not react to smelling salts and his face turned blue.

Nurse Kramer and the guards left King lying on the floor of his cell because they were convinced he was faking. They did not contact the on-call physician or summon an ambulance.

"Kramer was aware that King was being tapered off alprazolam and understood that alprazolam withdrawal can cause seizures, hallucination, and death." However, when another prisoner reported that King had another seizure an hour later, "Kramer again chose not to contact Dr. Cullinan or emergency medical services." Instead, she moved King to a single, padded cell and did nothing else.

Later that evening, Nurse Kramer told Mondry-Anderson that King had faked a seizure and responded to smelling salts. Neither was true.

At about 5:30 p.m., King called on his cell intercom but couldn't be understood. He was found unresponsive when Mondry-Anderson arrived to give him his medication two hours later, and was pronounced dead at 7:58 p.m.

King's widow, Lisa King, filed a wrongful death suit against Olson, Koby-Gobel, Kramer, Mondry-Anderson and La Crosse County, alleging deliberate indifference to King's serious medical needs. The district court granted summary judgment to all the defendants.

On appeal, the Seventh Circuit held that Olson, Koby-Gobel and Mondry-Anderson were entitled to summary judgment. Nurse Sue Kramer was not so entitled, however, because there was "a question of material fact whether Kramer's actions were so far afield from an appropriate medical response to King's seizures that they fell outside the bounds of her professional judgment." The Court of Appeals noted that "Kramer's statements to the nursing students suggest that she had already decided that King was faking seizures even before she saw him."

The appellate court also found that La Crosse County was not entitled to summary judgment because the plaintiff had "pointed to significant evidence that the County's policies violated [King's] constitutional rights." Therefore, the district court's grant of summary judgment was affirmed in part and reversed in part. See: King v. Kramer, 680 F.3d 1013 (7th Cir. 2012).

Following remand, the case went to trial in January 2013 and the jury entered a verdict for the defendants. The following month, La Crosse County filed a bill of costs seeking $30,397.17 from King's estate and Nurse Kramer sought $34,120.74 in costs. The district court has not yet ruled on their requests for costs.

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Related legal case

King v. Kramer