The Estate of Wilson v. Cnty. of San Diego

1

THE ESTATE OF MICHAEL WILSON, by and through its successor-in-interest, PHYLLIS JACKSON, and PHYLLIS JACKSON, Plaintiffs, v. COUNTY OF SAN DIEGO, et al., Defendants.

No. 3:20-cv-00457-RBM-DEB

United States District Court, S.D. California

December 1, 2023

ORDER GRANTING IN PART AND DENYING IN PART CCMG DEFENDANTS AND COUNTY DEFENDANTS' MOTIONS FOR SUMMARY JUDGMENT

[Docs. 96, 100]

HON RUTH BERMUDEZ MONTENEGRO, UNITED STATES DISTRICT JUDGE

This case concerns the death of 32-year-old Michael Wilson, who was serving a two-week flash incarceration at the San Diego Central Jail for a probation violation. Wilson had a history of suffering from hypertrophic cardiomyopathy (“HCM”) and congestive heart failure (“CHF”) and had an implanted heart pacer. Prior to his incarceration, he took four cardiac medications to manage his heart condition. Before his booking, the court warned medical staff at the jail in writing that Wilson had serious medical needs.

During the first six days of his incarceration, Wilson did not receive any of his cardiac medications. He missed 36 doses of those medications. Over the next three days, he received six doses of only some of his medications, but his prescriptions required 18 doses. On the morning of the tenth day, Wilson passed away due to sudden cardiac death arising from acute CHF and HCM.

Pending before the Court are Vincent Ronald Gatan, Peter Freedland Mark O'Brien, and Coast Correctional Medical Group's (collectively, the “CCMG Defendants”) motion for summary judgment (“CCMG's Motion”) (Doc. 96) and the County of San Diego, William Gore, Barbara Lee, Louis Gilleran, Laucet Garcia, Rizalin Bautista, Macy Germono, Marylene Ibanez, and Anil Kumar's (collectively, the “County Defendants”) motion for summary judgment (“County's Motion”) (Doc. 100). CCMG Defendant Mark O'Brien and County Defendants Barbara Lee, Louis Gilleran, Laucet Garcia, and Rizalin Bautista have been dismissed from this lawsuit with prejudice. (See Docs. 95, 124.) Accordingly, the Court will not address any arguments concerning Defendants O'Brien, Lee, Gilleran, Garcia, and Bautista.

The Estate of Michael Wilson (“Plaintiff”)^[1] filed a brief in opposition to CCMG and the County Defendants' Motions (“Opposition”). (Doc. 113.) The CCMG and County Defendants filed reply briefs. (Docs. 130, 132.) Plaintiff filed a sur-reply. (Doc. 138.)^[2]

The Court finds this matter suitable for determination without oral argument pursuant to Civil Local Rule 7.1(d)(1). For the reasons discussed below, CCMG's Motion and the County's Motion are GRANTED IN PART and DENIED IN PART.

I. BACKGROUND

At four to five months old, a pediatrician discovered Wilson had an enlarged heart and he was diagnosed with HCM and CHF. (Doc. 39-1 (Ex. 1), Declaration of Phyllis Jackson ¶ 4.) CHF occurs when there is fluid accumulation in the body, including the lungs. (Doc. 96-2 (Ex. S), Dr. Alon Steinberg's Expert Report (“Steinberg Report”) at 9.)

When fluid accumulates in the lungs, it causes shortness of breath, coughing, orthopnea (shortness of breath laying down), and paroxysmal nocturnal dyspnea (waking at night due to shortness of breath). (Id.) Failure to treat CHF can lead to respiratory failure and significant stress to the heart, which can lead to death. (Id.)

HCM, a disease in which the heart muscle becomes thickened, can make it harder for the heart to pump blood. Mayo Clinic, Hypertrophic cardiomyopathy, mayoclinic.org, availableathttps://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/symptoms-causes/syc-20350198 (last visited November 2, 2023). It can cause shortness of breath, chest pains, or changes in a heart's electrical system resulting in life-threatening heart rhythms or sudden death. Id.

A. Parole Revocation - February 5, 2019

On February 5, 2019, Wilson was sentenced to a two-week “flash incarceration” for a probation violation. (Doc. 131, Joint Statement of Undisputed Facts ¶ 1.)^[3] During the probation revocation hearing, the Court ordered “medical staff to be aware that this defendant has some serious medical issues.” (Id.)

B. Booking Procedure - February 5, 2019

a. Intake Medical Screening

Per County policy, procedure, and training, nurses conduct an intake medical screening to evaluate an inmate's physical, medical and psychological conditions based on their statements, responses to a lengthy questionnaire, appearance, behavior, presentation, and any hospital discharge paperwork. (Doc. 100-2, Declaration of Serina Rognlien-Hood (“Rognlien-Hood Decl.” ¶ 11.) A 3:50 p.m. note on Wilson's medical chart included his intake medical screening and was located electronically on the Jail Information Management System (“JIMS”).^[4] (Id. ¶ 13; Doc. 96-2 (Ex. B) CSD000001.)^[5] In the note, Wilson weighed 215 pounds. (CSD000002.) Wilson reported he had a history of CHF, HCM, and asthma. (CSD000013.) He was referred to a second stage assessment with Nurse Rizalina Bautista. (Doc. 131 at 1.)

b. Secondary Screening

Approximately one hour later, Wilson met with Bautista for an initial assessment of his reported CHF, HCM, and asthma. (Doc. 131 at 1.) Wilson told Bautista that he used an Albuterol inhaler for asthma, took 40 milligrams of Lasix daily for CHF, and took Invega for schizophrenia. (Id. at 2.) Bautista observed Wilson's respirations were even and unlabored and his lungs were clear to auscultation. (Id.) The note does not indicate how Bautista tested Wilson's lungs for auscultation. (CSD000022.)^[6] Bautista did not take Wilson's weight. (Id.)

Bautista initiated the Standard Nurse Protocol for asthma and gave Wilson an Albuterol inhaler. (Id.) Bautista obtained a release of information to acquire Wilson's medication list from Rite Aid Pharmacy. (Id.) Bautista scheduled Wilson for a medical doctor sick call, noting he was as a “Level 1”^[7] who claimed a history of CHF, taking 40 milligrams of Lasix daily, having HCM with “multiple meds,” and asthma. (CSD000023.) Bautista mentioned the court's warning regarding Wilson's serious medical needs. (Id.)

c. Chest x-ray

That evening, Wilson underwent a chest x-ray, which found no effusion (abnormal fluid), mild cardiomegaly (enlarged heart), no Tuberculosis, and reflected Wilson's “[l]eft-sided pacer” in his heart. (CSD000021.) This pacer provides electric shock to the heart in the event the heart switches into a dangerous or fatal rhythm. (Doc. 96-2 (Ex. R), Dr. Homer Venters' Expert Report (“Venters Report”) at 4.)

Wilson did not receive any cardiac medications on February 5, 2019. (Doc. 116-2 (Ex. 2) at 1-3.)

C. February 6, 2019

On February 6, 2019, a 10:32 a.m. note stated Wilson weighed 195 pounds. (CSD000023.) At 10:55 a.m., the Sheriff's Department received Wilson's list of prescription medications from Rite Aid Pharmacy. (Doc. 131 at 2.) The medications included Spironolactone (“1/2 tablet by mouth once daily”), Lisinopril (“take 1 tablet by mouth at bedtime”), Furosemide (“take 1 tablet by mouth twice a day”), and Metoprolol (“take ½ tablet by mouth twice a day”). (Id. at 2-3.)

Furosemide, the generic of Lasix, is a diuretic that treats congestion and fluid retention; many patients with CHF require diuretics to prevent fluid retention and accumulation in the body. (Steinberg Report at 10; Doc. 96-2 (Ex. C) Deposition of Arturo Leon (“Leon Dep.”) 46:15-17.) Spironolactone is also a diuretic. (Steinberg Report at 10.) Lisinopril is an ACE inhibitor that has been shown to reduce the work the heart does, helps the heart pump better, and prevents heart failure from worsening. (Id. at 10.) Spironolactone and Lisinopril have been shown to decrease morbidity and mortality in patients with weak hearts and CHF. (Id.) Metoprolol is a beta-blocker that is used to treat high blood pressure and patients with heart failure. Mayo Clinic, Metoprolol (Oral Route), mayoclinic.org, available at https://www.mayoclinic.org/drugs-supplements/metoprolol-oral-route/description/drg-20071141 (last visited November 11, 2023).

a. Dr. Leon Assessment

At 11:08 a.m., Dr. Arturo Leon, a CCMG physician,^[8] noted Wilson did not present in acute distress and had multiple medications for medical conditions including asthma and cardiac problems. (CSD000023.) He stated Wilson's vitals were normal and he had 100 percent oxygen saturation, clear lungs, and no rales or wheezing. (Id.) He noted Wilson's history of asthma and hypertension but not his CHF or HCM. (Id.) He noted Wilson would be placed on “metroprolo 5omg BIB” and “Lasix 40mg qd.” (Id.) In his deposition, Dr. Leon explained his “5omg” entry should have been 50 milligrams and his “BIB” entry should have been “BID,” the abbreviation for twice a day. (Doc. 96-2 (Ex. C) Leon Dep. 35:3-4; Doc. 116-11 (Ex. 11) Leon Dep. 44:13-17.) He planned to restart the rest of Wilson's medications once they received his pharmacy records. (Doc. 131 at 3.) A nurse noted Wilson's medications were reflected on Sapphire and they were awaiting his records. (CSD000023.) Physicians can order medications through JIMS, and those orders end up on Sapphire. (Doc. 96-2 (Ex. C) Leon Dep. 18:1-23, 39:10-15; Doc. 131 at 3.)

b. Sapphire

Sapphire shows a patient's list of medications and instructions for use. (Doc. 96-2 (Ex. H) Deposition of Vicente Ronald L Gatan (“Gatan Dep.”) 96:23-97:11.) Sapphire was used in conjunction with JIMS to track the jail's medication administration records (“MARs”). (Rognlien-Hood Decl. ¶ 14.) Sapphire and JIMS are intended to share and synchronize information regarding where patients are housed so that their prescribed medications can be added to their respective module's medication pass list. (Id. at ¶ 16.) On Sapphire, nurses document whether prescribed medication was given, marking it as administered or...