by Chuck Sharman

On June 5, 2025, the U.S. Court of Appeals for the Ninth Circuit vacated a $24 million punitive damages award against NaphCare for a Washington jail death, remanding the case to the U.S. District Court for the Eastern District of Washington to make a new punitive damages award that was not more than four times the $2.75 million in compensatory damages awarded to the Estate of Cindy Lou Hill. But the firm was not off the hook entirely; only weeks earlier, another massive jury verdict was returned against NaphCare for costing another Washington jail prisoner his leg, as reported elsewhere in this issue. [See: PLN, Jan. 2026, p.25.]

In Hill’s case, the firm was hit with a July 2022 verdict awarding $26.75 million to the surviving daughter of Cindy Lou Hill, 55, for NaphCare’s denial of medical care to her for a ruptured intestine. As PLN also reported, that led to her death in 2018 at the Spokane County Jail. [See: PLN, Oct. 2023, p.27.]

NaphCare appealed that verdict, and the Ninth Circuit provided considerable relief. However, the Court found sufficient evidence to uphold the jury’s finding that NaphCare was liable for maintaining a “policy or custom” that both demonstrated deliberate indifference to Hill’s serious need and was the “moving force” in causing that constitutional injury, as laid out first in Monell v. Dep’t of Soc. Servs. of City of N.Y., 436 U.S. 658 (1978).

It wasn’t disputed that Hill was deprived of her constitutional right to adequate health care, when a nurse who had already heard Hill screaming in pain that day then stood outside her cell later that afternoon and recorded no signs of medical distress. In fact, Hill was likely already unconscious. But it was almost two-­and-­a-­half hours before a guard noticed her condition and began administering CPR. She was later transferred to a hospital and pronounced dead.

That NaphCare had a custom or policy of “using medically untrained jail guards to monitor NaphCare patients in need of medical monitoring by medical professionals,” was also established, the Court continued. Hill died in a “medical watch” cell where it was up to guards to observe detainees briefly through a window in the door and record signs of life. Importantly, the Estate provided an expert witness who testified that this “deviated significantly from … correctional healthcare standards,” the Court recalled.

Jurors were not instructed to find deliberate indifference in order to assign Monell liablity on NaphCare, the firm objected. But since that objection to the lack of a more a specific instruction wasn’t raised at trial, the Court was obliged only to review the record for plain error. Determining that jurors made clear from their punitive damages award that they had, in fact, found NaphCare deliberately indifferent to Hill’s need, the Court found no such error.

However, the ratio of punitive damages to compensatory damages was 8.7:1, which the Court agreed was excessive. Under Ninth Circuit precedent, the ratio should not exceed 4:1, unless a Defendant’s conduct is found to be “egregious,” as held in Planned Parenthood of Columbia/Willamette Inc. v. Am. Coal. of Life Activists, 422 F.3d 949 (9th Cir. 2005).

To determine whether this was the case, the Court considered five factors from Hardeman v. Monsanto Co., 997 F.3d 941 (9th Cir. 2021): whether “[1] the harm caused was physical as opposed to economic”; whether “[2] the tortious conduct evinced an indifference to or a reckless disregard of the health or safety of others”; whether “[3] the target of the conduct had financial vulnerability”; whether “[4] the conduct involved repeated actions or was an isolated incident”; and whether “[5] the harm was the result of intentional malice, trickery, or deceit, or mere accident.” Only the first two factors could be found in Hill’s death, the Court said, agreeing therefore that the punitive damages award was excessive.

Judge Daniel Collins dissented and wrote that he would reverse the lower court’s denial of NaphCare’s motion for Judgment as a Matter of Law, finding nothing in the record to support the contention that NaphCare’s reliance on guards to perform medical duties that they were not trained to perform was sufficiently “widespread” or “permanent”—especially since Plaintiff pointed to no other instance in which referral to “medical watch” resulted in “the provision of inadequate medical care.”

The majority was persuaded otherwise and limited its concern to this ratio of punitive to compensatory damages, remanding the case to the district court with instructions to recalculate the punitive damages using the lower ratio. Before the Court, the Estate was represented by attorneys with Budge & Heipt in Seattle as well as Berkeley attorney Megha Ram. See: Est. of Hill v. NaphCare, Inc., 2025 U.S. App. LEXIS 13773 (9th Cir.).

The case returned to the district court, which granted the parties’ stipulated motion for dismissal on June 18, 2025. PLN will request a copy of any settlement agreement reached and update its details. See: Est. of Hill v. NaphCare, Inc., USDC (E.D. Wash.), Case No. 2:20-­cv-­00410.  

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