Steven Broughton v. Premier Health Care Serv, Inc., et al

Filing

OPINION filed : AFFIRMED. Decision not for publication. R. Guy Cole, Jr., Chief Judge (AUTHORING); David W. McKeague and Richard Allen Griffin, Circuit Judges.

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NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 16a0398n.06
Case No. 15-4150

FILED

UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT

STEVEN E. BROUGHTON,
Plaintiff-Appellant,
v.
PREMIER HEALTH CARE SERVICES, INC.;
WILLIAM COLE; CHERIE THOMAS; TOM
ARISS, Individually and as Warren County
Commissioner; PAT SOUTH, Individually and as
Warren County Commissioner; DAVID G.
YOUNG, Individually and as Warren County
Commissioner; CHRISTINA FINNEY
HUBBARD,
Defendants-Appellees.

BEFORE:

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Jul 15, 2016
DEBORAH S. HUNT, Clerk

ON APPEAL FROM THE
UNITED STATES DISTRICT
COURT FOR THE SOUTHERN
DISTRICT OF OHIO

OPINION

COLE, Chief Judge; McKEAGUE and GRIFFIN, Circuit Judges.

COLE, Chief Judge. Steven Broughton attempted to commit suicide while incarcerated
at the Warren County Jail in Lebanon, Ohio. Although he was rescued by corrections officers,
Broughton filed suit under 42 U.S.C. § 1983 claiming that Warren County, Premier Health Care
Services, Inc., and various officials violated his right to be free from cruel and unusual
punishment. See Estelle v. Gamble, 429 U.S. 97 (1976). The district court entered summary
judgment for the defendants. Because no reasonable jury could conclude that these defendants
were deliberately indifferent to Broughton’s risk of suicide, we affirm.

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I.
In November 2009, Broughton pleaded guilty to possession of child pornography, see
Ohio Rev. Code § 2907.323(A)(3), and was sentenced to 60 days’ imprisonment followed by
three years of probation.

While serving his 60-day sentence at the Warren County Jail,

Broughton notified corrections officials that he was “depressed” and “feeling suicidal.” He was
accordingly placed on “suicide watch,” which consisted of being isolated “in a cell with no
sheets . . . for 23 hours a day” and subjected to observation at 15-minute intervals. These
responsive measures worked: Broughton did not attempt to take his own life during his 2009
incarceration, and there is no indication that he felt suicidal during his three subsequent visits to
the Warren County Jail (all for probation violations).
Nearly two years later, in June 2011, Broughton was arrested for his fourth probation
violation stemming from that underlying conviction. He was again taken to the Warren County
Jail, where a booking officer conducted an initial medical screening and a nurse conducted a
medical evaluation.

Broughton represented that he had a general history of “psychiatric

disorders,” required several prescription medications, and had attempted suicide a “long time
ago” but was “not thinking about [it] now.” He also filled out an “inmate sick call” form,
requesting to speak with a “nurse about possible withdraw[al] from prescription med[ication].”
The next day, a nurse conducted a physical examination and determined that Broughton’s
respiration was “easy” and “even,” his speech was “clear,” his gait was “steady,” and that he was
in no “pain” or “discomfort.” Two days after that, medical personnel provided Broughton with
all of his prescriptions, other than Ambien.
Broughton was not entirely forthcoming. Though he disclaimed any current inclination
towards self-harm, one fact remained undisclosed: Broughton had attempted suicide by overdose

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a mere nine days before his 2011 arrest. As it happens, Broughton has attempted to overdose on
drugs “[o]ver a dozen” times since he was nine years old. None of this, however, was known to
the medical staff at the Warren County Jail. In fact, Broughton purposely withheld his history of
mental illness and attempted suicide because, in his words, he “didn’t want to be placed on
suicide watch.”
Broughton was ultimately admitted to the general population and, after getting into an
argument with his cellmate, placed in disciplinary segregation without any suicide prevention
protocols. About a day and a half later, on July 1, 2011, he attempted to kill himself while alone
in his cell. When corrections officers went to check on Broughton, they discovered him hanging
by a sheet. The corrections officers managed to cut him down, resuscitate him, and transport
him to a hospital, where he recovered.
Broughton later filed this § 1983 suit in the Southern District of Ohio against Warren
County (and its Commissioners Tom Ariss, Pat South, and David G. Young) and Premier Health
Care Services, Inc. (and its medical staff Dr. William Cole, Nurse Christina Finney Hubbard, and
Nurse Cherie Thomas). Broughton alleged that the defendants violated his right to be free from
cruel and unusual punishment because they were “deliberately indifferent” to his serious risk of
suicide. See Estelle, 429 U.S. at 104. He also included a supplemental medical malpractice
claim under Ohio law.
The defendants moved for summary judgment, arguing that Broughton could not marshal
any “subjective evidence” of deliberate indifference on the part of the municipality, the
healthcare contractor, or any named official. See Farmer v. Brennan, 511 U.S. 825, 837 (1994).
The district court agreed. After allowing time for discovery, the court concluded that “there was
no [apparent] manifestation of suicidal ideation from which [medical staff] could perceive a

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strong likelihood of suicide,” and thus, Broughton failed to show “that there is a genuine issue of
material fact as to whether the [defendants] acted with deliberate indifference.” The court then
granted summary judgment for the defendants, and declined to exercise supplemental jurisdiction
over Broughton’s state-law claims. This appeal followed.
II.
We review the district court’s grant of summary judgment de novo, drawing all
reasonable inferences in favor of the nonmoving party. Brown v. Chapman, 814 F.3d 447, 464
(6th Cir. 2016). Under Federal Rule of Civil Procedure 56(a), summary judgment is appropriate
when “there is no genuine dispute as to any material fact and the movant is entitled to judgment
as a matter of law.” Our inquiry is familiar: Did the evidence create “sufficient disagreement to
require submission to a jury,” or was it “so one-sided” that the defendants “must prevail as a
matter of law”? Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251–52 (1986).
A.
Broughton maintains that the district court erred in granting summary judgment. The
court, in his view, “gloss[ed] over several facts” upon which a reasonable jury could have
concluded that the defendants violated his Eighth and Fourteenth Amendment rights. To support
this claim, Broughton marshals a barrage of undifferentiated “circumstantial evidence” which, he
says, the district court overlooked. We disagree.
The Eighth Amendment prohibits the infliction of “cruel and unusual punishments.” The
government violates that right when, among other things, it acts with “deliberate indifference to
serious medical needs of prisoners.” Estelle, 429 U.S. at 104. Deliberate indifference claims
have two components—one objective and one subjective. Farmer, 511 U.S. at 834. The
objective component requires proof of a “sufficiently serious” medical need. Id. (quoting Wilson

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v. Seiter, 501 U.S. 294, 298 (1991)). In this case, the district court concluded that Broughton’s
“suicidal tendencies” amounted to an objectively serious medical condition. See Comstock v.
McCrary, 273 F.3d 693, 703–04 (6th Cir. 2001). All parties agree with that conclusion.
The determinative question here, rather, is subjective: Did the defendants “know[] that
[Broughton] face[d] a substantial risk of serious harm and disregard[] that risk by failing to take
reasonable measures to abate it”? Farmer, 511 U.S. at 847. At summary judgment, Broughton
was required to “make a showing sufficient to establish the existence” of deliberate indifference,
see Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986), because he shoulders “the onerous
burden of proving the [defendants’] subjective knowledge” at trial, see Comstock, 273 F.3d at
703.
To start, Broughton argues that medical staff “failed to follow the written protocols
regarding the screening of inmates.”

That fact, even if true, hardly establishes deliberate

indifference. We have long recognized that “the right to medical care for serious medical needs
does not encompass the right ‘to be screened correctly for suicidal tendencies.’” Id. at 702; see
also Taylor v. Barkes, 135 S. Ct. 2042, 2044 (2015) (per curiam) (“No decision of this Court
establishes a right to the proper implementation of adequate suicide prevention protocols.”).
Broughton next argues that the medical staff should have been alerted to his serious risk
of suicide. He bases this claim on his “complaints of withdrawal symptoms” and his “lack of
access to his insomnia medication.” As we have acknowledged, “[s]uicide is a difficult event to
predict and prevent and often occurs without warning.” Gray v. City of Detroit, 399 F.3d 612,
616 (6th Cir. 2005). Thus, in the suicide context, a plaintiff must show that there was a “strong,”
“obvious,” or “clearly foreseeable” likelihood “that he would attempt to take his own life in such

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a manner that failure to take adequate precautions amounted to deliberate indifference.” Id.
(quoting Barber v. City of Salem, 953 F.3d 232, 239–40 (6th Cir. 1992)).
Broughton’s symptoms and behaviors did not clearly indicate a risk of self-harm.
Rather, his complaints were primarily relevant to the physical indicators of withdrawal—
complaints that were promptly and appropriately addressed by the medical staff. See Grose v.
Corr. Med. Servs., Inc., 400 F. App’x 986, 988 (6th Cir. 2010) (noting there was “no proof that
[medical staff] perceived [plaintiff’s] ailment as anything other than [the physical symptoms of]
overuse syndrome”); Crocker ex rel. Estate of Tarzwell v. Cty. of Macomb, 119 F. App’x 718,
723 (6th Cir. 2005) (per curiam) (noting that there was no evidence that the decedent “exhibited
suicidal tendencies at any time between his arrest and his suicide”). The only prescription
medication Broughton did not receive was Ambien, which was reasonably withheld because he
admitted to abusing the drug by “snort[ing]” it.

Further, even if this treatment somehow

neglected Broughton’s risk of suicide, it is well-settled that ordinary negligence or medical
malpractice cannot satisfy the subjective component of deliberate indifference: “When a prison
doctor provides treatment, albeit carelessly or inefficaciously, to a prisoner, he has not displayed
a deliberate indifference to the prisoner’s needs, but merely a degree of incompetence which
does not rise to the level of a constitutional violation.” Comstock, 273 F.3d at 703.
Broughton goes on to argue that the defendants had general “knowledge” of his past
“mental health problems.” But there is no evidence to suggest these particular defendants had
actual knowledge of Broughton’s past suicidal thoughts—if anything, the record indicates that
the doctors and nurses were surprised by his attempted suicide. See Grabow v. Cty. of Macomb,
580 F. App’x 300, 304, 310 (6th Cir. 2014) (concluding that prison official’s failure to take note
of an electronic “alert” based on the inmate’s previous “suicide watch status” did not amount to

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subjective evidence of deliberate indifference). Moreover, Broughton’s three intervening and
uneventful stints in the Warren County Jail suggested that he was no longer suicidal. In the same
vein, Broughton makes much of an attempt by his step-father to notify the jail of his then-recent
drug overdose. But this does not change our analysis. Broughton’s step-father never actually
reached the jail’s medical staff, and deliberate indifference requires actual knowledge by the
particular official. See Gray, 399 F.3d at 616.
Finally, Broughton notes that he refused “recreation, medication, and a meal” for a day or
so while in disciplinary segregation. This behavior alone does not obviously indicate that
Broughton was contemplating suicide. See Soles v. Ingham Cty., 148 F. App’x 418, 419 (6th
Cir. 2005) (noting that “the deceased had not expressed suicidal thoughts for a period of
approximately two weeks” and “there was no glaring, new factor closely related to suicidal
thoughts” that defendants failed to investigate). Indeed, medical personnel had little reason to
suspect that Broughton would attempt suicide because he purposely misinformed them regarding
his medical history.
While Broughton’s disclaimer of suicidal ideation does not automatically insulate the
defendants from liability, it does undermine the claim that they willfully ignored his past medical
history and current symptomology. See, e.g., Grabow, 580 F. App’x at 304 (noting that the
plaintiff said that she “never attempted suicide and did not feel like she wanted to hurt herself at
that time”); Jerauld ex rel. Robinson v. Carl, 405 F. App’x 970, 978 (6th Cir. 2010) (noting that
the plaintiff “did not express suicidal ideations . . . to any . . . jail personnel”); Perez v. Oakland
Cty., 466 F.3d 416, 434–35 (6th Cir. 2006) (Griffin, J., concurring) (concluding that a plaintiff
who “appeared and claimed to be in a much-improved state of mind” could not establish

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deliberate indifference); Gray, 399 F.3d at 614 (noting that the defendant “had not expressed any
suicidal intent”).
Even taking all of this circumstantial evidence together, it cannot be said that these
defendants subjectively perceived facts from which to infer Broughton’s risk of suicide, that they
did in fact draw the inference, and that they then disregarded the risk. See Comstock, 273 F.3d at
703. In sum, the record indicates that these defendants were not alerted to Broughton’s serious
risk of self-harm, nor has there been any suggestion that the medical staff desired to bring about
Broughton’s suicide. To the contrary, they saved him. The medical staff took him at his word
when he said that he was “not thinking about” suicide, as confirmed by his mostly normal
behavior. Even if they were negligent, or committed medical malpractice, we have consistently
held that the constitutional standard of deliberate indifference “requires more.” See Mitchell v.
Hininger, 553 F. App’x 602, 604 (6th Cir. 2014) (explaining that deliberate indifference is
“something akin to criminal recklessness”).
B.
Broughton also contends that Warren County and Premier Health Care Services violated
his Eighth and Fourteenth Amendment rights by failing to properly train their employees on
“mental health and suicide prevention” protocols. See City of Canton v. Harris, 489 U.S. 378,
390 (1989). But, as discussed above, Broughton has not shown deliberate indifference on the
part of any individual official. He concedes that absent an underlying constitutional injury of
this sort, there can be no municipal liability for an alleged failure to train. See City of Los
Angeles v. Heller, 475 U.S. 796, 799 (1986); Robertson v. Lucas, 753 F.3d 606, 622 (6th Cir.
2014).

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III.
The district court’s judgment is affirmed.

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