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NaphCare Nurse Faces Liability in Ohio Detainee’s Death from Sickle Cell Disease

by David M. Reutter

On May 1, 2023, the U.S. Court of Appeals for the Sixth Circuit reversed the grant of summary judgment to a NaphCare nurse accused of deliberate indifference to a pretrial detainee’s sickle cell disease that resulted in his death at Ohio’s Hamilton County Justice Center. But the Court affirmed the grant of judgment to all other defendants.

The case involved the death of Cornelius Pierre Howell, 33, who was booked into the jail on December 2, 2018. That placed him under the care of NaphCare, Inc., the jail’s medical contractor. Over the first week of his incarceration, nurses screened Howell twice and placed him on the “chronic care list” because of his charted diagnosis of sickle cell disease. Howell also informed them that he typically took Oxycodone for his sickle cell pain, which he stated had worsened during his incarceration.

Howell uncharacteristically started a fight with his cellmate on December 9, 2018, and he was taken to the medical unit. On the way, Howell was seen on video falling to the ground twice because he could not walk. Arriving in a wheelchair at the medical unit, Howell exclaimed that he was in pain. He yelled, moaned and groaned, shouting he could not feel his legs and that his pain was at 10 out of 10. Video shows him sliding out of the wheelchair.

Nurse Christina Jordan observed the entire scene and evaluated Howell, finding he had an abnormal respiratory rate of just 22 breaths per minute. But she determined he was experiencing “a psych[iatric] issue more than sickle cell, because [with] sickle cell … you’re in too much pain to do anything” like moving or yelling, she said. Jordan ordered Howell placed in a restraint chair for observation. At the time she recorded Howell’s blood pressure as 90/56.

Under policy, Howell was to be checked every 10 minutes. Instead, guards made checks about every 20 minutes and falsified the record to indicate checks more often. They also failed to offer him water or to manipulate his limbs every two hours to prevent blood clots. Jordan never made a check on him despite believing Howell was in pain. About four hours after he was placed in the restraint chair, guards went to remove him from it and found Howell dead.

An expert for Howell’s Estate opined that a transfer to a hospital “would more likely than not have prevented Howell’s death.” The civil rights complaint the Estate then filed was dismissed by the federal court for the Southern District of Ohio, and the Estate appealed.

The Sixth Circuit began its analysis with the claim against Jordan for deliberate indifference to Howell’s serious medical need, in violation of his civil rights. It noted that Jordan had professional experience, academic and on-the-job training, in treating patients with sickle cell. She acknowledged that sickle cell crises can manifest in extreme pain and numbness in the arms and legs.

“A reasonable inference can be drawn that based on her review of Howell’s history in his medical chart, Jordan knew that Howell had been hospitalized during previous incarcerations due to sickle cell complications,” the Court wrote. So “a jury could find that Jordan acted recklessly by failing to treat Howell’s sickle cell disease when it was obvious that he faced an unjustifiably high risk of harm.”

That she made some diagnosis does not entirely insulate her from liability under 42 U.S.C. §1983, the Court wrote. “This record and our precedent do not support the conclusion that a diagnosis as generic as ‘psychiatric episode,’ which could cover almost any physiological symptom, can serve as blanket insulation from liability.”

The Court found that summary judgment was proper for all other defendants, who relied on Jordan’s diagnosis or did nothing other than fail to follow policies and procedures—which without more cannot constitute deliberate indifference. Thus, the district court’s order was affirmed as to them and reversed at to Jordan. The Estate was represented in its appeal by attorneys from the Roderick and Solange MacArthur Justice Center in Chicago and Washington, DC. See: Howell v. NaphCare, Inc., 67 F.4th 302 (6th Cir. 2023).

A petition for rehearing before the entire Sixth Circuit en banc was denied on June 2, 2023. See: Howell v. Naphcare, Inc., 2023 U.S. App. LEXIS 13821 (6th Cir.).

The case has now returned to the district court, where the Estate is represented by attorneys Konrad Kircher and Ryan J. McGraw with Rittgers & Rittgers in Lebanon. A dust-up over calling an additional medical expert—to bolster the Estate’s claim that Howell would have survived with a quicker transfer to a hospital—was resolved in Plaintiff’s favor on September 26, 2023. See: Howell v. Naphcare, Inc., 2023 U.S. Dist. LEXIS 171559 (S.D. Ohio).

Defendants have asked the Supreme Court of the U.S. to reverse the Sixth Circuit’s decision, but the high court has not yet decided to hear the case. No date has yet been set to try the Estate’s remaining claims, either, but PLN will update developments as they are available. See: Howell v. Naphcare, Inc., USDC (S.D. Ohio), Case No. 1:19-cv-00373.  

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Related legal cases

Howell v. NaphCare, Inc.

Howell v. Naphcare, Inc.