Deavers v. Rappahannock Regional Jail Authority et al, No. 3:2013cv00821 - Document 38 (E.D. Va. 2014)
Court Description: MEMORANDUM OPINION. Signed by District Judge James R. Spencer on 10/6/14. (kyou, )
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Deavers v. Rappahannock Regional Jail Authority et al Doc. 38 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF VIRGINIA RICHMOND DIVISION CASSANDRA DEAVERS, Plaintiff, Civil Action No. 3:13-CV-821 v. KATHY DIGGINS, et al., Defendants. MEMORAN D U M OPIN ION THIS MATTER is before the Court on Defendant Kathy Diggins Motion to Dism iss Am ended Com plaint ( Motion ) (ECF No. 33), pursuant to Federal Rule of Civil Procedure 12(b)(6). Plaintiff did not file a Mem orandum in Opposition and neither party has requested a hearing on the m atter. For the reasons set forth below, the Motion is GRANTED with respect to paragraphs 47 and 48 of the Am ended Com plaint. I. BACKGROU N D a. Fa ct u a l Ba ck g r o u n d Cassandra Deavers was forty-eight years old on Decem ber 8, 20 11, when she was sentenced to serve thirty days incarceration in the Rappahannock Regional J ail ( J ail ) for her conviction of Driving Under the Influence, second offense. At the tim e, Deavers was under the treatm ent of a physician for a prior pulm onary em bolism and had been prescribed a daily dose of the blood thinner warfarin.1 On Decem ber 1, 20 11, seven days prior to her sentencing, Deavers prim ary care physician increased her dosage of warfarin to twelve m illigram s per day and had ordered that her International Norm alized Ratio and Prothrom bin Tim e ( INR/ PT ) 1 Warfarin is the generic name for the brand-name drug Coumadin. The Complaint and the documents attached thereto use warfarin and Coumadin interchangeably. For the sake of ease, the Court refers to the drug throughout this Memorandum Order by its generic name, warfarin. 1 Dockets.Justia.com levels be checked on a weekly basis. An individual s INR/ PT levels are indications of the tim e required for a patient s blood to clot and, therefore, are im portant indicators of whether the patient s warfarin dose is too high, putting her at risk for internal bleeding, or too low, putting her at risk for em bolism . After being sentenced on Decem ber 8, 20 11, Deavers was transferred to the J ail to begin her incarceration. Deavers personal property was inventoried, and the J ail m edical staff perform ed a physical exam ination of Deavers. During these procedures, Deavers inform ed RRJ A m edical staff that she was prescribed warfarin, which was to be taken daily, and that her INR/ PT levels were to be checked weekly. The RRJ A m edical staff also noted that Deavers was allergic to aspirin. On Decem ber 10 , 20 11, a nurse em ployed in the m edical staff took Plaintiff s blood for the intent of obtaining her INR/ PT levels. The results of this first test showed that Deavers INR/ PT levels were too high, putting her at risk for uncontrolled bleeding and indicating that her dose of warfarin should have been decreased.2 The Am ended Com plaint alleges that the Defendants failed to check on the test results, and failed to take the necessary therapeutic steps to correct Deavers out-of-range INR/ PT levels. (Am . Com pl. ¶ 25.) A Physician Orders sheet signed by an unidentified nurse indicates that on Decem ber 12, 20 11, an unidentified physician ordered Deavers INR/ PT levels to be checked again in two weeks. The sam e nurse never attem pted to follow up on the results of her first blood test. On that sam e day, Deavers subm itted a written inquiry to the RRJ staff inquiring about her test results, but was not given any inform ation. On Decem ber 21, 20 11, Deavers com pleted a m edical request form ( First Medical Request ) com plaining of a headache lasting for the previous three days. Deavers indicated that m edical request form s had not been available for the prior three days. The following day, on 2 The Complaint alleges that normal INR levels range from 0.8 to 1.2, but that Deavers INR level was 1.8; and that normal PT levels range from 9.1 and 12.0, but that Deavers PT level was 19.5. 2 Decem ber 22, 20 11, Deavers had a m edical exam ination at which tim e it was noted that a hard, red bum p had appeared on her buttock two days prior. Defendant Dahlberg, not having exam ined Deavers, signed off on a physician order sheet diagnosing her with Methicillinresistant Staphylococcus aureus ( MRSA ). No one addressed the fact that severe headaches are a sym ptom of warfarin toxicity, and failed to check on the results of her Decem ber 8 th blood test or otherwise address Deavers INR/ PT levels. Deavers was kept on the sam e dosage of Warfarin. On Decem ber 31, 20 11, Deavers had her blood drawn by Defendant Diggins for a second INR/ PT test. Deavers asked Diggins what the results of her first test were and Diggins responded, No news is good news. That sam e day, Deavers com pleted another m edical request form ( Second Medical Request ). The Second Medical Request indicated that Deavers had bruising on the backs of both legs and was experiencing significant pain as a result. On J anuary 1, 20 12, Deavers com pleted yet another m edical request form ( Third Medical Request ) com plaining of a stom ach ache lasting for two days and irregular bowel m ovem ents since her incarceration began. That sam e day, Deavers was given a physical exam by Diggins. Despite knowing that Deavers was taking warfarin, Diggins took no action beyond prescribing Deavers Tylenol for her pain com plaints. Diggins did not check the results of either of Deavers INR/ PT tests and did not refer Deavers for additional care. On J anuary 4, 20 12, Deavers blood was redrawn for an INR/ PT test. By this tim e, Deavers still had not learned the results of her initial lab work. At 9:0 0 p.m . that evening, Deavers began bleeding profusely from the needle site. Deavers continued to bleed out in her cell throughout the night. Finally, at 5:0 0 a.m ., when the cell doors were unlocked, Deavers attem pted to leave, but im m ediately lost consciousness, fell, and hit her head. Deavers was transported to Mary Washington Hospital, where she was diagnosed with a large retroperitoneal hem atom a m ost likely secondary to Coum adin (Warfarin) toxicity, acute blood loss, anem ia, and dehydration secondary to blood loss. Deavers rem ained in the hospital for five days, receiving m ultiple blood transfusions and placem ent of an inferior vena cava filter. 3 Deavers was released back to the J ail on J anuary 12, 20 12, and was released from the J ail on J anuary 15, 20 12. B. Pr o ce d u r a l Ba ck g r o u n d On Decem ber 10 , 20 13, Deavers filed suit against Defendants Rappahannock Regional J ail Authority ( RRJ A ), Superintendent J oseph Higgs, J ail Licensed Practical Nurses Nasm h, Diggins, and Canzon, as well as the Fredericksburg Em ergency Medical Alliance, Incorporated ( FEMA ), three J ane Doe Defendants and eight J ohn Doe Defendants. Count One of the Com plaint which relates generally to the J ail conditions and specifically to the events of J anuary 4, 20 12 raises a claim pursuant to 42 U.S.C. § 1983 ( Section 1983 ), alleging a supervisory liability claim against Higgs and a deliberate indifference claim against all other defendants. Count Two of the Com plaint raises a Section 1983 claim against the nursing staff of the J ail, alleging that they were deliberately indifferent to Deavers serious m edical condition by failing to m onitor her INR/ PT test results or to identify the sym ptom s of warfarin toxicity. Count Three of the Com plaint raises a com m on law negligence claim against Dr. Dalberg and FEMA for Dr. Dalberg s treatm ent of Deavers. Defendants RRJ A, Higgs, Diggins and Canzon filed a Motion to Dism iss on April 7, 20 14 ( RRJ A Motion ) (ECF No. 12) and Defendant Dalberg filed a Motion to Dism iss on April 17, 20 14 ( Dalberg Motion ) (ECF No. 17). A hearing was held on Monday, J une 16, 20 14 and a subsequent order and m em orandum opinion were issued, which GRANTED in part the RRJ A Motion with respect to RRJ A and Higgs, and DENIED in part as to Diggins (ECF No. 25). The Dalberg Motion was also DENIED. Additionally, the opinion GRANTED Deavers leave to am end her Com plaint as to RRJ A and Higgs. In accordance with the opinion, Deavers filed an am ended com plaint on August 25, 20 14 (ECF No. 32). The am ended two-count com plaint alleges a Section 1983 claim against Diggins, alleging that Diggins was deliberately indifferent to Deavers critical m edical needs, as well as a negligence claim against Defendants FEMA and Dalberg. Diggins subsequently filed a Motion to 4 Dism iss for Failure to State a Claim on Septem ber 25, 20 14 (ECF No. 33). In her present m otion, Diggins m oves the Court to dism iss Count I of the Am ended Com plaint to the extent that it alleges that Diggins failed to recognize sym ptom s of warfarin toxicity in the Plaintiff. II. LEGAL STAN D ARD Rule 12 of the Federal Rules of Civil Procedure allows a defendant to raise a num ber of defenses to a com plaint at the pleading stage, including failure to state a claim . A m otion to dism iss for failure to state a claim upon which relief can be granted challenges the legal sufficiency of a claim , rather than the facts supporting it. Fed. R. Civ. P. 12(b)(6); Goodm an v. Praxair, Inc., 494 F.3d 458, 464 (4th Cir. 20 0 7); Republican Party of N.C. v. Martin, 980 F.2d 943, 952 (4th Cir. 1992). A court ruling on a Rule 12(b)(6) m otion m ust accept all of the factual allegations in the com plaint as true, see Edw ards v. City of Goldsboro, 178 F.3d 231, 244 (4th Cir. 1999); W arner v. Buck Creek Nursery , Inc., 149 F. Supp. 2d 246, 254-55 (W.D. Va. 20 0 1), in addition to any provable facts consistent with those allegations, Hishon v. King & Spalding, 467 U.S. 69, 73 (1984), and m ust view these facts in the light m ost favorable to the plaintiff, Christopher v. Harbury , 536 U.S. 40 3, 40 6 (20 0 2). To survive a m otion to dism iss, a com plaint m ust contain factual allegations sufficient to provide the defendant with notice of what the . . . claim is and the grounds upon which it rests. Bell Atl. Corp. v. Tw om bly , 550 U.S. 544, 555 (20 0 7) (quoting Conley v. Gibson, 355 U.S. 41, 47 (1957)). Rule 8(a)(2) requires the com plaint to allege facts showing that the plaintiff s claim is plausible, and these [f]actual allegations m ust be enough to raise a right to relief above the speculative level. Tw om bly , 550 U.S. at 555 & n.3. The Court need not accept legal conclusions that are presented as factual allegations, id. at 555, or unwarranted inferences, unreasonable conclusions, or argum ents, E. Shore Mkts., Inc. v. J.D. Assocs. Ltd. P ship, 213 F.3d 175, 18 0 (4th Cir. 20 0 0 ). III. D ISCU SSION a. D ig g in s Ar g u m e n t 5 Diggins requests the Court to dism iss Count I of the Am ended Com plaint to the extent it alleges that she failed to recognize sym ptom s of warfarin toxicity in the Plaintiff, and also instruct Deavers to file a Second Am ended Com plaint striking the identified language. Diggins argues that the Court previously held that Deavers failed to state a claim on the warfarin toxicity claim s. However, Deavers Am ended Com plaint, specifically paragraphs 47 and 48, still reference several elem ents of the dism issed toxicity claim s. b. An a ly s is This Court s m em orandum opinion on J uly 3, 20 14 (ECF No. 25) denied the original Motion to Dism iss with respect to Diggins. However, the Court distinguished two separate claim s alleged by Deavers against Diggins, noting the fact that it was liberally construing the Com plaint for the sake of com pleteness. Mem . Op. 10 n.7, J uly 3, 20 14 (ECF No. 25). First, the Court found that the Com plaint alleges that Diggins and the unnam ed m edical staff defendants (collectively, Nurse Defendants ) failed to appropriately m onitor Deavers INR/ PT levels and failed to check the results of the INR/ PT tests that were actually perform ed. The Court held that this first claim was sufficient to survive a m otion to dism iss. Second, the Court found that the Com plaint alleged that the Nurse Defendants were deliberately indifferent for failing to diagnose warfarin toxicity or to refer Deavers for higher levels of m edical care. The Court treated the warfarin toxicity claim as a stand-alone claim . 3 Id. The Court held that this second claim fails to state a claim for deliberate indifference. Specifically, the Court held that the Com plaint does not allege that the Nurse Defendants ever realized the im port of Deavers sym ptom s; rather, the Com plaint only alleges constructive knowledge on the part of the Nurse Defendants. Id. at 12 13. Therefore, Deavers s claim based on the Nurse Defendants failure to diagnose Deavers s warfarin toxicity fails as a m atter of law. Id. at 13. Like the original Com plaint, the Court construes the Am ended Com plaint as alleging two 3 This claim is referenced in Paragraphs 67 and 68 of the original Complaint. These paragraphs are nearly identical to Paragraphs 47 and 48 in the Amended Complaint. 6 separate claim s, including the sam e claim for deliberate indifference in failing to diagnose warfarin toxicity. See Am . Com pl. ¶¶ 47, 48. A claim of deliberate indifferences requires that a defendant: (1) know facts indicating that a substantial risk to the inm ate existed; (2) conclude that the inm ate was at risk; and (3) fail to m ake efforts to m itigate that risk. See Farm er v. Brennan, 511 U.S. 825, 837 (1994). Under this standard, the Am ended Com plaint s allegation that Deavers sym ptom s should have alerted the Nurse Defendants to her plight or should undoubtedly have put Defendants on notice does not state a claim of deliberate indifference. See Am . Com pl. ¶¶ 30 , 33. Because of Deavers consistent use of constructive knowledge language, the Court cannot read the Am ended Com plaint as alleging that the Nurse Defendants ever concluded that Deavers was suffering from warfarin toxicity. Rather, like the original com plaint, the Am ended com plaint fails to state a claim of deliberate indifference. Therefore, Deavers claim based on Diggins failure to diagnose Deavers warfarin toxicity fails as a m atter of law. IV. CON CLU SION For the foregoing reasons, Diggins Motion is GRANTED with respect to paragraphs 47 and 48 of the Am ended Com plaint. Deavers is GRANTED leave to am end her Am ended Com plaint in order to strike the language in the identified paragraphs. Let the Clerk send a copy of this Mem orandum Opinion to all counsel of record. An appropriate Order will issue. _____________________/s/__________________ James R. Spencer Senior U. S. District Judge ENTERED this 6th_ _ _ day of October 20 14. 7
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