Case 2:12-cv-05343-JS-SIL Document 123 Filed 01/10/18 Page 1 of 42 PageID #: 6362
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`MEMORANDUM & ORDER
`12-CV-5343(JS)(SIL)
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`UNITED STATES DISTRICT COURT
`EASTERN DISTRICT OF NEW YORK
`-----------------------------------X
`LILYANN RYAN, Individually and as
`Administrator of the Estate of
`BARTHOLOMEW RYAN, deceased,
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`
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`Plaintiff,
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`-against-
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`COUNTY OF NASSAU, COUNTY OF
`NASSAU CORRECTIONAL CENTER,
`NASSAU COUNTY SHERIFF’S
`DEPARTMENT, ARMOR CORRECTIONAL
`HEALTH SERVICES, INC., and
`ARMOR CORRECTIONAL HEALTH
`SERVICES OF NEW YORK, INC.,
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`
`
`
`Defendants.
`-----------------------------------X
`APPEARANCES
`For Plaintiff:
`Nicholas E. Warywoda, Esq.
`
`Parker Waichman
`
`6 Harbor Park Drive
`
`Port Washington, NY 11050
`For the County
`Defendants:
`
`
`
`For the Armor
`John J. Doody, Esq.
`Defendants:
`Sana Suhail, Esq.
`
`Lewis Brisbois Bisgaard & Smith, LLP
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`199 Water Street, 25th Floor
`
`New York, NY 10038
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`SEYBERT, District Judge:
`Plaintiff Lilyann Ryan (“Plaintiff”), individually and
`as administrator of the Estate of Bartholomew Ryan (“Ryan”),
`commenced this action against the County of Nassau, the Nassau
`
`James R. Scott, Esq.
`Nassau County Attorney’s Office
`1 West Street
`Mineola, NY 11501
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`MEMORANDUM & ORDER
`12-CV-5343(JS)(SIL)
`
`
`UNITED STATES DISTRICT COURT
`EASTERN DISTRICT OF NEW YORK
`-----------------------------------X
`LILYANN RYAN, Individually and as
`Administrator of the Estate of
`BARTHOLOMEW RYAN, deceased,
`
`
`
`
`Plaintiff,
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`
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`
`
`
`
`-against-
`
`
`COUNTY OF NASSAU, COUNTY OF
`NASSAU CORRECTIONAL CENTER,
`NASSAU COUNTY SHERIFF’S
`DEPARTMENT, ARMOR CORRECTIONAL
`HEALTH SERVICES, INC., and
`ARMOR CORRECTIONAL HEALTH
`SERVICES OF NEW YORK, INC.,
`
`
`
`
`Defendants.
`-----------------------------------X
`APPEARANCES
`For Plaintiff:
`Nicholas E. Warywoda, Esq.
`
`Parker Waichman
`
`6 Harbor Park Drive
`
`Port Washington, NY 11050
`For the County
`Defendants:
`
`
`
`For the Armor
`John J. Doody, Esq.
`Defendants:
`Sana Suhail, Esq.
`
`Lewis Brisbois Bisgaard & Smith, LLP
`
`199 Water Street, 25th Floor
`
`New York, NY 10038
`
`SEYBERT, District Judge:
`Plaintiff Lilyann Ryan (“Plaintiff”), individually and
`as administrator of the Estate of Bartholomew Ryan (“Ryan”),
`commenced this action against the County of Nassau, the Nassau
`
`James R. Scott, Esq.
`Nassau County Attorney’s Office
`1 West Street
`Mineola, NY 11501
`
`
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`Case 2:12-cv-05343-JS-SIL Document 123 Filed 01/10/18 Page 2 of 42 PageID #: 6363
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`County Correctional Center, the Nassau County Sheriff’s Department
`(together, the “County Defendants”), Armor Correctional Health
`Services, Inc., and Armor Correctional Health Services of New York,
`Inc. (together, the “Armor Defendants” or “Armor,” and
`collectively, “Defendants”) on October 22, 2012. (Compl., Docket
`Entry 1.) On November 14, 2012, Plaintiff filed an Amended
`Complaint asserting claims under 42 U.S.C. §§ 1981, 1983, and 1985
`and state law claims for negligence and wrongful death. (Am.
`Compl., Docket Entry 7, ¶¶ 108-180.)
`After the Court dismissed the claims under Sections 1981
`and 1985, and the Section 1983 claim against the County Defendants,
`the remaining claims proceeded to trial. (See March 2016 Order,
`Docket Entry 62, at 25.) The case was tried from April 3, 2017 to
`April 12, 2017, and the following claims were submitted to the
`jury: (1) a Section 1983 claim for deliberate indifference to
`medical needs against the Armor Defendants, and (2) negligence and
`wrongful death claims against the Armor Defendants and the County
`Defendants. (Verdict Sheet, Court Ex. 3, Docket Entry 108, at 2-
`9.) On April 12, 2017, the jury reached a verdict in Plaintiff’s
`favor on both claims and awarded $370,000 for pain and suffering
`on the negligence claim, and $520,000 for pain and suffering and
`$7,000,000 in punitive damages on the Section 1983 claim. (Verdict
`Sheet 6(A)-(G).) As to the negligence pain and suffering award,
`the jury apportioned the fault as follows: twenty-five percent
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`(25%) to the County of Nassau, fifty-five percent (55%) to Armor,
`and twenty percent (20%) to Ryan. (Verdict Sheet 6(D).)
`Currently pending before the Court is the Armor
`Defendants’ motion for judgment as a matter of law pursuant to
`Federal Rule of Civil Procedure 50(b), or alternatively, for a new
`trial pursuant to Federal Rule of Civil Procedure 59(a)(A). (Armor
`Mot., Docket Entry 115.) The County Defendants have not moved for
`any post-trial relief. For the reasons that follow, the Armor
`Defendants’ motion is GRANTED.
`DISCUSSION
`The Court assumes familiarity with its March 2016 Order
`resolving the parties’ motions for summary judgment and will
`discuss the evidence presented at trial as necessary in its
`analysis. (See generally March 2016 Order.) Briefly, Ryan was
`remanded to the Nassau County Correctional Center (“NCCC”) on
`February 23, 2012. (March 2016 Order at 4.) After his arrival,
`he was assessed by a corrections officer, two nurses employed by
`Armor, and Dr. Vincent Manetti (“Dr. Manetti”), a psychiatrist
`employed by Armor. (March 2016 Order at 5-8.) While Ryan relayed
`that he had a history of drug abuse and psychological disorders,
`he did not indicate that he was experiencing suicidal ideations or
`that he had previously attempted suicide. (March 2016 Order at 5-
`7.) However, he did indicate to Dr. Manetti that he had used
`heroin immediately prior to his arrival at NCCC. (March 2016 Order
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`at 7-8.) As a result, Dr. Manetti referred Ryan to the medical
`department for monitoring on an urgent basis, which according to
`Armor’s guidelines, meant that Ryan would be seen within twenty-
`four hours. (March 2016 Order at 8, 21.) Unfortunately, just
`hours after his visit with Dr. Manetti, Ryan committed suicide.
`(March 2016 Order at 2, 9.)
`I.
`The Armor Defendants’ Motion for Judgment as a Matter of Law
`A. Rule 50(b) Standard
`If a party believes that “a reasonable jury would not
`have a legally sufficient evidentiary basis” to find for its
`adversary on a particular issue, it may move for judgment as a
`matter of law during trial under Federal Rule of Civil Procedure
`50(a), and renew the motion after trial under Rule 50(b). FED. R.
`CIV. P. 50(a)-(b). In an order determining a Rule 50(b) motion,
`the district court may: “(1) allow judgment on the verdict, if the
`jury returned a verdict; (2) order a new trial; or (3) direct the
`entry of judgment as a matter of law.” FED. R. CIV. P. 50(b).
`The district court may only grant a Rule 50(b) motion
`when “‘there exists such a complete absence of evidence supporting
`the verdict that the jury’s findings could only have been the
`result of sheer surmise and conjecture, or the evidence in favor
`of the movant is so overwhelming that reasonable and fair-minded
`[persons] could not arrive at a verdict against [it].’”
`Protostorm, LLC v. Antonelli, Terry, Stout & Krauss, LLP, No. 08-
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`CV-0931, 2015 WL 3605143, at *2 (E.D.N.Y. June 5, 2015) (quoting
`Kinneary v. City of N.Y., 601 F.3d 151, 155 (2d Cir. 2010))
`(alterations in original). In other words, judgment as a matter
`of law is appropriate only when “‘a reasonable juror would have
`been compelled to accept the view of the moving party.’” Id. at
`*2 (quoting This is Me, Inc. v. Taylor, 157 F.3d 139, 142 (2d Cir.
`1998)). “When considering the evidence associated with a Rule
`50(b) motion, the trial court may not weigh evidence, assess
`credibility, or substitute its opinion of the facts for that of
`the jury,” Rosioreanu v. City of N.Y., 526 F. App’x 118, 119 (2d
`Cir. 2013) (internal quotation marks and citation omitted), and
`must view the evidence “in the light most favorable to the
`nonmoving party,” Houston v. Cotter, No. 07-CV-3256, 2016 WL
`1253391, at *1 (E.D.N.Y. Mar. 30, 2016) (internal quotation marks
`and citation omitted).
`B. Section 1983 Deliberate Indifference to Medical Needs
`To establish a Section 1983 claim, a plaintiff must
`demonstrate that the defendant violated a “right, privilege, or
`immunity secured by the Constitution or laws of the United
`States . . . by a person acting under the color of state law.”
`Charles v. Cty. of Orange, N.Y., No. 16-CV-5527, 2017 WL 4402576,
`at *6 (S.D.N.Y. Sept. 29, 2017); 42 U.S.C. § 1983. To establish
`a claim for deliberate indifference to medical needs under the Due
`Process Clause of the Fourteenth Amendment, a pre-trial detainee
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`must establish two elements: (1) that the “deprivation of medical
`care . . . [was] ‘sufficiently serious,’” and (2) that the
`defendant “acted or failed to act with ‘a sufficiently culpable
`state of mind.’” See Smith v. Outlaw, No. 15-CV-9961, 2017 WL
`4417699, at *2 (S.D.N.Y. Sept. 30, 2017) (quoting Salahuddin v.
`Goord, 467 F.3d 263, 279 (2d Cir. 2006); Farmer v. Brennan, 511
`U.S. 825, 834, 114 S. Ct. 1970, 1977, 128 L. Ed. 2d 811 (1994));
`see also Grimmett v. Corizon Med. Assocs. of N.Y., No. 15-CV-7351,
`2017 WL 2274485, at *3 (S.D.N.Y. May 24, 2017).
`The first element requires that the Court assess the
`seriousness of the deprivation of medical care objectively,
`including whether “the medical care was inadequate, and if
`so, . . . how the offending conduct is inadequate and what harm,
`if any, the inadequacy has caused or will likely cause the
`prisoner.” Smith, 2017 WL 4417699 (internal quotations marks and
`citation omitted). Further, while courts should tailor the
`analysis “to the specific circumstances of each case[,] . . . .
`the inmate must show that the conditions, either alone or in
`combination, pose an unreasonable risk of serious damage to his
`health.” Id. (internal quotation marks and citations omitted).
`Generally, the condition must be “‘a condition of urgency’ that
`may result in ‘degeneration’ or ‘extreme pain.’” Grimmett, 2017
`WL 2274485, at *3 (quoting Chance v. Armstrong, 143 F.3d 698, 702
`(2d Cir. 1998)). If the plaintiff alleges that medical care was
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`delayed or interrupted, the appropriate inquiry is whether “the
`challenged delay or interruption in treatment . . . is, in
`objective terms, sufficiently serious,” to support a claim. Id.
`(internal quotation marks, citation, and emphasis omitted).
`Prior to the Second Circuit’s decision in Darnell v.
`Pineiro, 849 F.3d 17 (2d Cir. 2017), the second element--whether
`the defendant acted with a sufficiently culpable state of mind--
`was evaluated subjectively. See Grimmett, 2017 WL 2274485, at *4.
`However, in Darnell, in light of the Supreme Court’s decision in
`Kingsley v. Henderickson, 135 S. Ct. 2466 (2015), the Second
`Circuit held that the standard for deliberate indifference depends
`on whether the plaintiff is a pre-trial detainee, in which case
`the claim arises under the Fourteenth Amendment, or a convicted
`prisoner, in which case the claim arises under the Eighth
`Amendment. Darnell, 849 F.3d at 32-36. The Second Circuit further
`held that when a claim arises under the Fourteenth Amendment, “the
`pre-trial detainee must prove that the defendant-official acted
`intentionally . . . or recklessly failed to act with reasonable
`care . . . even though the defendant-official knew, or should have
`known that the condition posed an excessive risk to health or
`safety.” Id. at 35; see also Charles, 2017 WL 4402576, at *10.
`In other words, the second element of a deliberate indifference
`claim under the Fourteenth Amendment “is defined objectively,” and
`a plaintiff is not required to show subjective awareness by the
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`defendant that “[his] acts (or omissions) have subjected the pre-
`trial detainee to a substantial risk of harm.”1 Darnell, 849 F.3d
`at 35. Despite the slightly lower standard articulated in Darnell,
`which is akin to objective recklessness, “‘any § 1983 claim or a
`violation of due process requires proof of a mens rea greater than
`mere negligence.’” Smith, 2017 WL 4417699, at *3 (quoting Darnell,
`849 F.3d at 36); see also Grimmett, 2017 WL 2274485, at *4.
`In order for a municipality or a corporation such as
`Armor2 to be liable for deliberate indifference to medical needs
`under Monell v. Department of Social Services, 436 U.S. 658, 694,
`98 S. Ct. 2018, 56 L. Ed. 2d 611 (1978), the plaintiff must “show
`that the action that caused the constitutional violation was
`undertaken pursuant to an official policy.” (March 2016 Order at
`20.) Specifically, the plaintiff “must ‘demonstrate that, through
`its deliberate conduct, the [entity] [itself] was the moving force
`
`1 While Darnell involved claims of unconstitutional conditions of
`confinement, several courts in this Circuit have extended
`Darnell’s holding to claims of deficient medical treatment. See
`Grimett, 2017 WL 2274485, at *4 n.2; Smith, 2017 WL 4417699, at
`*3; see also Charles, 2017 WL 4402576, at *10 (“This standard
`for deliberate indifference applies to any underlying violation
`of the due process clause, such as for maintaining
`unconstitutional conditions of confinement or failing to provide
`adequate medical care to a person in state custody, ‘because
`deliberate indifference means the same thing for each type of
`claim under the Fourteenth Amendment.’”) (quoting Darnell, 849
`F.3d at 33, n.9.)
`2 The Court previously found that Armor was a state actor for
`purposes of Section 1983. (March 2016 Order at 19.)
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`behind the alleged injury.’” Simms v. City of N.Y., 480 F. App’x
`627, 629 (2d Cir. 2012) (quoting Roe v. City of Waterbury, 542
`F.3d 31, 37 (2d Cir. 2008)) (second alteration in original).
`However, “‘[a] policy or custom need not be memorialized in a
`specific rule or regulation;’” “‘persistent and widespread’”
`constitutional violations “can be ‘so permanent and well settled
`as to constitute a custom or usage with the force of law,’” and
`lead to the imposition of liability. Houston, 2016 WL 1253391, at
`*7 (quoting Kern v. City of Rochester, 93 F.3d 38, 44 (2d Cir.
`1996); Sorlucco v. N.Y.C. Police Dep’t, 971 F.2d 864, 870 (2d Cir.
`1992)).
`C. Analysis
`The Armor Defendants argue that they are entitled to
`judgment as a matter of law on Plaintiff’s Section 1983 claim
`because the evidence at trial did not establish either element of
`a deliberate indifference claim. (Armor Br., Docket Entry 117, at
`4-5.)
`
`1. The Objective Prong
`As to the first element, the Armor Defendants maintain
`that Plaintiff failed to show that Ryan received inadequate medical
`care. (Armor Br. at 6-9.) Specifically, they contend that “Armor
`and its staff followed protocol in processing and evaluating the
`plaintiff upon his arrival to NCCC . . . and there was simply no
`notice of Ryan’s purported suicidal tendencies prior to and at the
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`time of his detention.” (Armor Br. at 6.) They point out that
`there were no signs that Ryan was experiencing symptoms of
`withdrawal or mental illness when he arrived at NCCC. (Armor Br.
`at 6; see also NCCC Records, Doody Decl., Ex. B, Docket Entry 116-
`2, at 2.) However, because Ryan indicated that he had taken
`medication for a psychological condition, he was placed on constant
`observation until he could be assessed by the mental health
`department.3 (Armor Br. at 6.)
`Afterward, he was seen by a Licensed Practical Nurse,
`Joe Mathews (“Nurse Mathews”), and a Registered Nurse, Tanya
`Tinglin (“Nurse Tinglin”). (Armor Br. at 7; see also Armor
`Records, Doody Decl., Ex. C, Docket Entry 116-3, at 1-16.)
`According to the Armor Defendants, the evidence reflects that Ryan
`told Nurse Mathews that he was previously diagnosed with Post
`Traumatic Stress Disorder (“PTSD”) and was taking medication, and
`indicated that although he used heroin in the past, he was not
`currently using drugs. (Armor Br. at 7; Armor Records at 12-13,
`16.) After assessing him, Nurse Mathews referred Ryan to the
`mental health department on a routine basis. (Armor Records at
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`3 The suicide prevention screening form (the “Screening Form”),
`completed by Officer Michael Archer (“Officer Archer”),
`indicates that Ryan failed the suicide screening because he
`indicated that he had previously taken medication for a
`psychological condition. (Screening Form, Doody Decl., Ex. C,
`Docket Entry 116-3, at 6-7.) The Screening Form indicated that
`he answered “no” to questions regarding suicidal thoughts and
`prior suicide attempts. (Screening Form at 6.)
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`17.) Next, the Armor Defendants assert that when Ryan saw Nurse
`Tinglin, he reported a history of PTSD, bipolar disorder and
`anxiety, and denied using drugs. (Armor Br. at 7; Armor Records
`at 14.) His only complaint was lower back pain, and Nurse Tinglin
`noted elevated blood pressure during her exam. (Armor Br. at 7;
`Armor Records at 14.) He denied having any suicidal thoughts or
`prior suicide attempts. (Armor Br. at 8; Armor Records at 15.)
`The next morning, Ryan saw Dr. Manetti and reported that
`he used heroin two days prior to being remanded to NCCC. (Armor
`Br. at 8; Armor Records at 20.) He continued to deny suicidal
`thoughts and prior suicide attempts. (Armor Records at 20.) Dr.
`Manetti’s diagnosis was opiate dependence, and he put in an urgent
`referral to the medical department to monitor Ryan for symptoms of
`withdrawal. (Armor Br. at 8; Armor Records at 18, 21.) Dr.
`Manetti testified at trial that Ryan was not exhibiting any
`symptoms of withdrawal when he evaluated him, and that he believed
`that Ryan had actually used heroin more recently than reported.
`(Trial Tr. (Manetti), Doody Decl., Ex. A, Docket Entry 116-1,
`312:13-18.) He declined to continue Ryan’s psychotropic
`medication and recommended that Ryan be housed with the general
`population. (Armor Records at 19-21.) The Armor Defendants
`maintain that all of this evidence shows that Ryan received
`adequate care, and as a result, Plaintiff failed to meet her burden
`of proof on the first element of her deliberate indifference claim.
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`Plaintiff argues that the evidence established “an
`intentional denial or delay of access to medical care.” (Pl.’s
`Opp., Docket Entry 119, at 13.) She contends that Dr. Manetti,
`following Armor’s referral protocol, referred Ryan to the medical
`department on an urgent basis, even when he knew that it could
`take as long as twenty-four hours for Ryan to been seen and despite
`his concerns that Ryan was not being monitored for signs of drug
`withdrawal. (Pl.’s Opp. at 13; Trial Tr. (Manetti) 346:17-348:10
`(testifying regarding his concerns and agreeing that Ryan could
`wait up to twenty-four hours before he was monitored for withdrawal
`symptoms).) Further, she points out that Dr. Manetti failed to
`forward the referral form to the medical department until an hour
`and a half after his visit with Ryan. (Pl.’s Opp. at 13; Trial
`Tr. (Manetti) 350:21-351:2.) As a result, Plaintiff argues, Ryan
`was not being monitored after his visit with Dr. Manetti until he
`committed suicide. (Pl.’s Opp. at 13.) Plaintiff maintains that,
`among other things, the evidence established that Dr. Manetti (1)
`should have sought additional information regarding Ryan’s prior
`treatment for psychological disorders based on his assessment that
`Ryan was a poor historian, (Trial Tr. (Manetti) 308:2-13
`(discussing his characterization of Ryan as a poor historian),
`310:4-9 (testifying that the fact that Ryan was a poor historian
`would be a reason to contact a treating physician or family)), and
`(2) should have alerted corrections officers that Ryan could
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`experience withdrawal, (Trial Tr. (Manetti) 302:11-24 (agreeing
`that it was good psychiatric practice to notify corrections
`officers of imminent withdrawal), 355:23-356:3 (testifying that he
`did not tell any corrections officer about Ryan’s possible
`withdrawal).)
`On reply, the Armor Defendants argue that because
`Plaintiff’s claim is based on a delay or interruption in care, the
`Court should evaluate the seriousness of the delay or interruption
`rather than the seriousness of Ryan’s condition alone. (Armor
`Reply, Docket Entry 121, at 2.) They argue that the evidence shows
`that Dr. Manetti did not believe that obtaining Ryan’s medical
`records was necessary after his initial evaluation, and that he
`understood that by referring him to medical, he would be seen
`within twenty-four hours, which he felt was appropriate based on
`the fact that Ryan was not exhibiting symptoms during his visit.
`(Armor Reply at 2; Trial Tr. (Manetti) 337:17-338:7 (testifying
`that Ryan did not “present in a manner in which I was
`concerned . . . that I needed that history right away”), 393:8-
`394:7 (testifying that Ryan was not showing any symptoms of
`withdrawal, but to be cautious, he put in an urgent referral, which
`in practice, meant Ryan would seen by the end of the day).)
`Therefore, the Armor Defendants argue, there was no delay in
`treatment to support a deliberate indifference claim, and even if
`there was a delay that could be considered the result of negligence
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`by Dr. Manetti or other staff, negligence is not sufficient to
`prove a constitutional violation. (Armor Reply at 2.)
`The Court previously concluded that “Ryan’s withdrawal,
`combined with his numerous psychological problems amounted to a
`‘sufficiently serious’ medical problem.” (March 2016 Order at
`16.) See, e.g., Iacovangelo v. Corr. Med. Care, Inc., 624 F. App’x
`10, 13 (2d Cir. 2015) (“Although there is no per se rule that drug
`or alcohol withdrawal constitutes an objectively serious medical
`condition, courts in this Circuit have found many such instances
`to satisfy the objective prong.”). Turning to the adequacy of
`care, the Armor Defendants maintain that their staff assessed Ryan
`appropriately, and Dr. Manetti testified that he believed an urgent
`referral was adequate based on his assessment that Ryan was not
`experiencing symptoms of withdrawal. (Trial Tr. (Manetti) 393:12-
`19.) However, Dr. Ziv Cohen (“Dr. Cohen”), a psychiatry expert,
`testified that Ryan’s care was not adequate because Dr. Manetti
`failed to: (1) treat the situation as a psychiatric emergency, (2)
`place Ryan under constant observation, (3) continue his
`psychiatric medication, (4) treat Ryan’s withdrawal from heroin,
`(5) properly diagnose Ryan with PTSD, bipolar disorder, or any
`other mental health condition, (6) conduct a proper examination
`for PTSD, (7) order appropriate follow-up care, and (8) seek
`information from family members or other doctors. (Trial Tr.
`(Cohen) 675:19-677:6, 682:8-683:3, 698:5-699:1, 699:7-700:10,
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`702:7-703:11.) Viewing the evidence in the light most favorable
`to Plaintiff, the Court concludes that there was sufficient
`evidence for the jury to conclude that the deprivation of care was
`sufficiently serious.
`2. The Mens Rea Prong4
`Alternatively, the Armor Defendants argue that the
`evidence at trial did not establish that any Armor personnel
`recklessly disregarded a risk to Ryan’s health. (Armor Br. at 9-
`13.) They contend that “the evidence demonstrated that even if
`Armor were aware that Ryan might be experiencing signs of
`withdrawal, they were equally aware that he was subject to ongoing
`continuous observation patrols as well as 15-minute observations
`by correctional officers who were trained to recognize the signs
`and symptoms of withdrawal and advised to notify medical should
`the inmate appear to be in any distress.” (Armor Br. at 10; Trial
`Tr. (Manetti) 282:18-285:7 (testifying that he participated in
`suicide prevention training of corrections officers and advised
`them to call him if any inmate exhibited any suicidal behavior);
`Trial Tr. (Manetti) 372:14-21 (testifying that corrections
`officers alerted him to vomiting, cramping, sweating, and signs of
`agitation by inmates in the past); Trial Tr. (Smith) 235:13-236:19
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`4 In Darnell, the Second Circuit indicated that this prong should
`be referred to the mens rea prong, rather than the subjective
`prong, to prevent confusion. See Darnell, 849 F.3d at 29.
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`(testifying that corrections officers were trained to look for
`signs of withdrawal and would immediately send the inmate to the
`medical department).)
`Further, the Armor Defendants argue that it was
`reasonable to rely on the corrections officers to notify the mental
`health or medical departments based on the testimony of several
`corrections officers who were assigned to Ryan’s housing area on
`the day of his suicide. (Armor Br. at 10; Trial Tr. (Brown) at
`435:22-436:4 (testifying that if he determined that an inmate
`needed medical care, he would alert his supervisor, who would
`contact the medical department), 442:18-444:8 (testifying that
`while on the mental health housing tier, he was looking for
`behavior that would indicate an inmate was depressed and would
`notice if an inmate was vomiting, sweating profusely, and shaking
`and would ask the inmate if he needed to go to the medical
`department); Trial Tr. (Vogt) 482:25-484:6 (testifying that he was
`trained on signs of suicidal behavior and if an inmate indicated
`that he planned to hurt himself, the inmate was taken out of his
`cell and placed in a separate area until mental health department
`arrived).) Finally, the Armor Defendants point to testimony of
`several corrections officers that Ryan did not exhibit any unusual
`behavior that day. (See Trial Tr. (Brown) 448:21-449:7 (testifying
`that when he conducted a tour of the housing unit, he observed
`Ryan lying on his bunk); Trial Tr. (Killeen) 533:12-534:4
`
`16
`
`
`
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`
`(testifying that he observed Ryan lying on his bunk). Officer
`Vogt specifically testified that he did not observe Ryan suffering
`any symptoms of withdrawal. (Trial Tr. (Vogt) 486:18-487:6.)
`Plaintiff contends that the appropriate inquiry after
`the Darnell decision is whether, aware of Ryan’s withdrawal, Armor
`was reasonable in relying on the observations and patrols by
`corrections officers who were trained to recognize symptoms of
`withdrawal and patrolled the housing area every fifteen minutes.
`(Pl.’s Opp. at 15.) Plaintiff maintains that there was sufficient
`evidence to support the jury’s finding that Armor’s reliance was
`not reasonable, including Dr. Manetti’s testimony that he was
`concerned that Ryan would begin to experience withdrawal and that
`he was not being monitored for withdrawal. (Trial Tr. (Manetti)
`329:23-25 (Q: “At that point you became very, very concerned he
`was going to begin going through withdrawal; is that correct? A:
`“I thought that was a possibility, yes.”), 330:4-6.) Plaintiff
`also appears to argue that Dr. Manetti should have seen Ryan sooner
`in light of the assessments of Officer Archer, Nurse Mathews, and
`Nurse Tinglin, each of whom noted a history of mental health
`disorders and drug use. (Pl.’s Opp. at 15-16.)
`Additionally, relying on Dr. Manetti’s own testimony,
`Plaintiff contends that Dr. Manetti acted recklessly by: (1)
`failing to contact other physicians or family members regarding
`Ryan’s prior treatment and diagnoses, (Trial Tr. (Manetti) 310:4-
`
`17
`
`
`
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`
`9 (testifying that it would be good practice to contact family or
`treating physicians if patient was a poor historian)); (2) failing
`to tell corrections officers that Ryan was at risk for withdrawal
`symptoms, (Trial Tr. (Manetti) 302:11-24 (agreeing that it was
`good psychiatric practice to notify corrections officers of
`imminent withdrawal), 355:23-356:3 (testifying that he did not
`tell any corrections officer about Ryan’s possible withdrawal));
`and (3) despite his concerns, referring Ryan to the medical
`department for monitoring knowing that he could wait twenty-four
`hours to be seen, (Trial Tr. (Manetti) 346:17-348:10 (testifying
`regarding his concerns and agreeing that Ryan could wait up to
`twenty-four hours before he was monitored for withdrawal
`symptoms)). (See Pl.’s Opp. at 16-17.) Moreover, Plaintiff
`maintains that Armor’s argument that it reasonably relied on the
`corrections officers, even if it was believed by the jury, is
`irrelevant in light of Dr. Manetti’s admission that he never told
`the officers about his concerns. (Pl.’s Opp. at 17.) In light of
`this evidence, Plaintiff maintains that there was sufficient
`evidence to conclude that Dr. Manetti “knew or should have known”
`that his conduct “posed an excessive risk” to Ryan’s health and
`safety. (Pl.’s Opp. at 18 (internal quotation marks omitted).)
`The Court finds that no reasonable juror could conclude
`that Dr. Manetti acted with a state of mind sufficient to support
`a deliberate indifference claim. Focusing on the Darnell standard,
`
`18
`
`
`
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`
`there is no evidence that Dr. Manetti intentionally deprived Ryan
`of adequate medical care. See Darnell, 849 F.3d at 35 (holding
`that “the pre-trial detainee must prove that the defendant-
`official acted intentionally . . . or recklessly failed to act
`with reasonable care . . . even though the defendant-official knew,
`or should have known that the condition posed an excessive risk to
`health or safety”). Further, the evidence does not support a
`finding that Dr. Manetti “‘knew or should have known’ that his
`actions or omissions . . . ‘posed an excessive risk to [Ryan’s]
`health or safety.’” Lloyd v. City of N.Y., 246 F. Supp. 3d 704,
`720 (S.D.N.Y. 2017) (quoting Darnell, 849 F.3d at 35). Dr. Manetti
`assessed Ryan, and based on his assessment that Ryan was not
`experiencing symptoms of withdrawal at that time, he determined
`that the appropriate treatment plan was to refer Ryan to the
`medical department on an urgent basis. (Trial Tr. (Manetti) 313:3-
`20.) In other words, he recognized the risk that withdrawal posed
`to Ryan’s health but exercising his medical judgment, concluded
`that Ryan did not need treatment immediately.5
`
`5 The Court previously denied summary judgment on the deliberate
`indifference claim on the basis that “[i]f [Dr.] Manetti blindly
`adhered to Armor’s policy and ignored his medical judgment with
`respect to Ryan’s needs, a jury could find that [Dr.] Manetti
`acted with deliberate indifference and that his action was
`undertaken pursuant to Armor’s policy.” (March 2016 Order at
`22.) No evidence to that effect was presented at trial.
`
`19
`
`
`
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`
`The evidence also does not support a finding that Dr.
`Manetti was, or should have been, aware of a substantial risk of
`suicide because Ryan did not indicate to him, Nurse Mathews, Nurse
`Tinglin, or Officer Archer that he was thinking about suicide or
`had attempted suicide in the past. (Screening Form at 6; Armor
`Records at 15-16, 20-21.) Ryan was initially deemed a suicide
`risk after indicating to Officer Archer that he was prescribed
`psychiatric medication in the past, but he explicitly denied
`suicidal thoughts or prior suicide attempts. (Screening Form at
`6.) Ryan was then housed in the mental health unit and observed
`every fifteen minutes until he could be assessed by Dr. Manetti.
`(Screening Form at 6-7.) Thereafter, he was assessed by Nurse
`Tinglin and Nurse Mathews, to whom he again denied suicidal
`thoughts or prior suicide attempts. (Armor Records at 15-16.) He
`also denied suicide thoughts or attempts during his visit with Dr.
`Manetti. (Armor Records at 20-21.) Viewing the evidence in
`Plaintiff’s favor, Dr. Manetti may have misjudged the risk of
`suicide or misdiagnosed Ryan. However, that is not enough to
`establish objective recklessness.
`Plaintiff contends that Dr. Manetti’s decision to refer
`Ryan to the medical department on an urgent basis put him in
`jeopardy because the referral “meant that an inmate in the throes
`of withdrawal could be sitting in his cell for up to 24 hours
`before being monitored or receiving treatment for drug
`
`20
`
`
`
`Case 2:12-cv-05343-JS-SIL Document 123 Filed 01/10/18 Page 21 of 42 PageID #: 6382
`
`withdrawal.” (Pl.’s Opp. at 8.) However, Dr. Manetti’s referral
`would not have prevented Ryan from receiving treatment if he needed
`it. Dr. Manetti testified that if an inmate needed medical
`attention for an acute condition, the medical department would see
`the inmate on an expedited basis. (Trial Tr. (Manetti) 395:24-
`396:9 (testifying that an inmate could alert a correction
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