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Private Medical Contractors in Kentucky Not Entitled to Qualified Immunity

The Kentucky Court of Appeals held that a trial court improperly granted summary judgment to the defendants in a civil action alleging a prisoner received negligent medical care at the Hardin County Detention Center (HCDC).

HCDC contracts with Southern Health Partners, Inc. (SHP), a for-profit company, to provide medical care to its prisoners. SHP provides nursing and medical services to almost 200 jails nationwide. To fulfill its contract at HCDC, the company contracted with Dr. John Adams, who employed Elizabeth Walkup, an advanced registered nurse practitioner, to assist him. SHP employed nurses and other medical personnel at HCDC.

Mark Sietsema was booked into the jail in the fall of 2009. He advised medical staff that he suffered from diverticulitis and previously had 16 inches of his colon removed due to the disease.

On April 24, 2010, Sietsema filed a medical request indicating he had been vomiting and feverish for the last two days. The next day, a nurse documented abdominal pain, nausea, vomiting, fever and constipation; she gave him nausea medication and prescribed a liquid diet. Nurse Heather Kennedy examined Sietsema on May 8, recording complaints of nausea and vomiting. Kennedy and Nurse Brenda Brown had him placed in observation and continued the treatment provided the previous day.

Sietsema alleged that he received “no care from May 8 to May 13,” which is when he was examined by Walkup. His complaints of vomiting and no bowel movement for six days were attributed to diverticulitis and mild dehydration, and Walkup prescribed ice chips so he could stay hydrated, nausea medication, suppositories, antibiotics and a note to send him to a hospital if he did not stabilize or become able to tolerate fluids.

Over the next several days Sietsema refused his medication. He collapsed in his cell at 4 a.m. on May 17, 2010, but Brown delayed a hospital transport until she could examine him at 10 a.m. the same day.

Once at a hospital, Sietsema was placed in ICU due to severe dehydration, a bowel obstruction and a possible ruptured esophagus. He also developed respiratory failure and had to be intubated. Further examination the next day “revealed multiple adhesions to the small bowel which caused an obstruction.” They were repaired and Sietsema was released from the hospital on May 26.

After he filed suit for damages in state court claiming negligence by SHP, Dr. Adams, Walkup, Brown, Kennedy and nurses Christina Fulk and Georgeann Williams, the defendants moved for summary judgment. The court granted the motion, finding Adams and Walkup could not be liable due to insufficient expert testimony with respect to their roles. As for SHP and the nurses, the court held they were entitled to qualified immunity.

The Court of Appeals, however, found that the res ipsa loquitur exception could apply to the case, and medical expert testimony against Dr. Adams and Walkup was unnecessary. Adams, as HCDC’s medical director, was required to visit the jail weekly but only did so monthly. Instead, he delegated his weekly visits to Walkup. Both were Sietsema’s primary caregivers, though between May 8 and 13, 2010, Walkup did not examine him. Dr. Adams did not know about Sietsema until he was taken to the hospital.

“A layman could conclude Adams and Nurse Walkup did not effectively communicate with SHP staff and HCDC in this instance,” the appellate court wrote. Further, it could be found that “they did not properly oversee this patient’s care.”

In addition, Kentucky case law provides that “independent contractors who perform services for the government, and are not merely an alter ego, are not immune from suit.” As such, the defendants were not entitled to qualified immunity. The trial court’s order was reversed; however, the Kentucky Supreme Court granted discretionary review on August 17, 2016, and the case remains pending a decision by the state Supreme Court. See: Sietsema v. Adams, 2015 Ky. App. Unpub. LEXIS 882 (Ky. App. Unpub. 2015). 

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Related legal case

Sietsema v. Adams