Since its September 2021 ruling in Brawner v. Scott Cty., the U.S. Court of Appeals for the Sixth Circuit has held that pretrial detainees challenging their medical care in jail are not fully held to the “deliberate indifference” standard laid out by the Supreme Court of the U.S. (SCOTUS) in Farmer v. Brennan, 511 U.S. 825 (1994). 

Under that ruling, a prisoner making an Eighth Amendment claim for “cruel and unusual punishment” must show that officials both ignored an objectively obvious risk and also were subjectively aware that it was posed to a specific plaintiff. But then SCOTUS held in Kingsley v. Hendrickson, 576 U.S. 389 (2015), that pretrial detainees may make a claim under the Fourteenth Amendment that they were “punished” without due process, so they need not show that it was “cruel and unusual.” As PLN reported, the Sixth Circuit then found in Brawner that those incarcerated but not yet convicted of a crime need prove only that they suffered an objectively obvious serious medical need which went ignored, without also having to prove that defendant jailers subjectively knew of the risk to their health, too. [See: PLN, Mar. 2022, p.52.] 

Yet when adjudicating the claim that officials at Kentucky’s Lewis County Detention Center (LCDC) neglected a pretrial detainee’s symptoms of drug withdrawal from which he then died, the federal court for the Eastern District of Kentucky ruled against Plaintiff Julie Helphenstine, the surviving wife of Christopher Dale Helphenstine. Though not convicted of a crime when he succumbed at the jail to those untreated drug withdrawal symptoms in April 2017, the district court refused to hold jailers liable because “[a]wareness of withdrawal is not tantamount to deliberate indifference.”

Why was that standard used, one that Brawner had refuted for people like Helphenstine? Probably because, since that case was decided, a different panel of the Sixth Circuit appeared to revive the deliberate indifference standard for claims by a pretrial detainee; in its ruling in Trozzi v. Lake Cty., 29 F.4th 745 (6th Cir. 2022), that panel of the appellate court said it didn’t matter that defendant jailers ignored an objectively serious medical need, absent a showing that they did so intentionally. “The post-Brawner deliberate indifference inquiry still requires consideration of an official’s actual knowledge of the relevant circumstances,” the Court declared.

It was onto this murky legal terrain that Julie Helphenstine wandered. But first came her husband’s arrest on April 14, 2017, when outstanding warrants were discovered during a traffic stop for a misdemeanor drug possession charge and a felony count of trafficking in a controlled substance. Christopher Helphenstine was booked into the LCDC. 

Two days later, on Sunday, April 16, 2017, he vomited and told a guard that he was “dope sick.” He was placed in a single-man “detox cell.” But LCDC guards and employees lacked medical training beyond first aid and CPR. All other medical services were contracted from Dr. Tommy von Luhtre, an elderly osteopath whose medical license had been revoked in Ohio and suspended (though later reinstated) in Kentucky for sexual misconduct with three patients. His contract obligated von Luthre to weekly jail visits, “but he did not always do so if the jail did not report any (detainees) were sick,” as the Sixth Circuit later recalled. 

Helphenstine was checked by guards every 20 minutes to record his activity or lack thereof. By midnight on Monday, April 17, 2017, his condition had deteriorated so far that a guard faxed to Von Luthre’s office a non-emergency but “urgent” request for Helphenstine to be seen, noting that he was vomiting and soiling himself, refusing to eat or drink, and had not gotten out of bed in 24 hours.

The fax came to the doctor’s attention around mid-morning on Tuesday, Von Luthre’s normal visit day. At this point, his testimony and that of guards sharply diverged. Von Luthre testified that he called the LCDC and directed that Helphenstine be taken to a hospital to receive “IV fluids,” after which jailers reported that Helphenstine refused to go. But LCDC records failed to show that any such call occurred, and no guards recalled Helphenstine ever refusing any medical care. Jailers testified that they had sent a sick call to the doctor from three detainees needing care, but von Luthre denied ever receiving that. Yet even after learning that Helphenstine was in dire need of care, he failed to visit the jail that day.

Guards meanwhile attempted to get fluids into Helphenstine, but no one took any further action. Video from just after midnight on April 19, 2017, showed Helphenstine lying face-down and largely motionless, only “occasionally twitching and raising or shaking his feet.” At around 3:30 p.m., guards entered the cell and found him unresponsive. Emergency responders were finally called, but Helphenstine was declared dead on the way to the hospital. Experts testified that Helphenstine died either from withdrawal or severe dehydration from withdrawal.

Legal Saga Begins

With the aid of Louisville attorney Greg Belzley, Julie Helphenstine filed suit for her husband’s Estate against Lewis County, several guards and Von Luthre. The district court granted Defendants summary judgment, and the Estate appealed. At the Sixth Circuit, Belzley asked the Court to clarify whether a pretrial detainee making a medical neglect claim against a jail needs to prove both prongs of the “deliberate indifference” standard from Farmer, or the lower standard announced in Brawner. 

In its ruling on February 9, 2023, the Court noted that its sister circuits “are all over the map on the issue”; the Fifth, Eighth, Tenth, and Eleventh Circuits refused to do what the Sixth Circuit did in Brawner—extend Kingsley’s protection from the full deliberate indifference standard for a pretrial detainee’s excessive-force claims to also include claims of medical neglect. The Second, Seventh, and Ninth Circuits had done so, though each asked different questions to reach that conclusion. In the First, Third and Fourth Circuits, the question was still not entirely settled. 

Quoting its opinion in Brawner, the Sixth Circuit reiterated that a pretrial detainee “must prove more than negligence but less than subjective intent—something akin to reckless disregard.” More to the point, the Court said that its panel’s decision in Trozzi “is irreconcilable with Brawner.”

“Simply put,” the Court said, “Kingsley required us to lower the subjective … component from actual knowledge to recklessness” for a pretrial detainee’s civil rights claims. The district court’s order was therefore reversed. A request for rehearing before the entire Sixth Circuit en banc was denied on April 18, 2023, and SCOTUS denied a petition for a writ of certiorari to hear an appeal on January 22, 2024. See: Helphenstine v. Lewis Cty., 60 F.4th 305 (6th Cir. 2023); 65 F.4th 794 (6th Cir. 2023); and 144 S. Ct. 692 (2024).

The victory prompted the normally temperate Belzley to indulge a “two beer night,” he recalled. But the celebration provided only a temporary respite. Back at the district court, Von Luthre filed for a stay in November 2024 while he pursued separated litigation in state court over an apparent lapse in his malpractice insurance coverage. The case remains pending for resolution of that dispute, and PLN will continue to update developments as they are available. See: Helphenstine v. Lewis Cty., USDC (E.D. Ky.), Case No. 0:18-cv-00093.  

Additional source: The Marshall Project

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