Crowson v. Washington County State, Utah
983 F.3d 1166
10th Cir.2020Background
- Plaintiff Martin Crowson, a pretrial detainee at Washington County Jail, exhibited confusion, memory loss, and other neurocognitive symptoms while held in solitary and a medical observation cell.
- Nurse Michael Johnson evaluated Crowson (June 25 and June 28), placed him in observation, requested a psychological evaluation by the onsite PA, and later alerted Dr. Judd LaRowe by phone; some notes or referrals were not transmitted and nurses spent limited time with observation inmates.
- Dr. LaRowe (the Jail physician; on-site 1–2 days/week) ordered a chest x-ray and blood tests; blood was not obtained (unsuccessful draw) and testing was never completed; LaRowe prescribed benzodiazepines for presumed withdrawal.
- Crowson was transported to the hospital on July 1, diagnosed with metabolic encephalopathy, hospitalized, and later alleged worsened cognitive and medical sequelae.
- Crowson sued under 42 U.S.C. § 1983 asserting (1) deliberate indifference by Nurse Johnson and Dr. LaRowe (Eighth/Fourteenth Amendments) and (2) Monell claims against Washington County for failure to train and for systemic policy failures; the district court denied summary judgment/qualified immunity and denied County summary judgment; defendants appealed interlocutorily.
- The Tenth Circuit exercised collateral-order jurisdiction over the qualified-immunity issues, reversed denial of qualified immunity for Nurse Johnson and Dr. LaRowe (on distinct grounds), reversed summary judgment denial as to the County’s failure-to-train theory, and dismissed the County’s appeal of the systemic-policy theory for lack of jurisdiction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Nurse Johnson was deliberately indifferent (qualified immunity) | Johnson failed his gatekeeper duty by not ensuring physician evaluation/continuity; omissions were deliberate indifference | Johnson referred Crowson to the PA, documented concerns, and informed LaRowe; any omissions were negligent, not deliberate | Reversed denial of qualified immunity for Johnson: he fulfilled gatekeeper role (referral to PA and communication); omissions amounted at most to negligence, not deliberate indifference |
| Whether Dr. LaRowe violated clearly established rights by treating without completed blood tests (qualified immunity) | LaRowe refused to assess/diagnose properly by not ensuring diagnostic testing before treating, and Mata supports liability | No controlling precedent clearly established that treating for withdrawal without blood-test results violates Fourteenth Amendment; ambiguity means qualified immunity applies | Reversed denial of qualified immunity for LaRowe: assuming a violation, the law was not clearly established such that every reasonable doctor would know the conduct was unconstitutional |
| Whether County is liable for failure to train nurses (Monell) | County failed to train nurses and lacked written protocols; that failure caused Crowson’s injury | Failure-to-train claim depends on an underlying constitutional violation by the trained employee(s) (e.g., Nurse Johnson) | Reversed denial of summary judgment as to failure-to-train: because Nurse Johnson is not liable, the County’s failure-to-train claim based on him fails |
| Whether County is liable for systemic policy/practice failures (Monell) and whether appellate jurisdiction exists | County’s policies and practices (absentee physician, no written protocols, limited nurse time) create a systemic constitutional violation independent of individual liability | County argues resolution depends on individual-liability questions; appeals limited by collateral-order doctrine | Tenth Circuit lacked jurisdiction to decide systemic-policy Monell claim on interlocutory appeal; that claim remains for district court consideration (appeal dismissed in part and remanded) |
Key Cases Cited
- Mitchell v. Forsyth, 472 U.S. 511 (collateral-order doctrine permits immediate appeal of purely legal qualified-immunity questions)
- Pearson v. Callahan, 555 U.S. 223 (2009) (qualified-immunity two-prong framework and discretion to address prongs)
- Mullenix v. Luna, 577 U.S. 7 (2015) (qualified-immunity standard and admonition against defining clearly established law at high level of generality)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference standard: knowledge of and disregard of excessive risk)
- Estelle v. Gamble, 429 U.S. 97 (1976) (medical malpractice vs. constitutional deliberate indifference)
- Mata v. Saiz, 427 F.3d 745 (10th Cir. 2005) (medical personnel liability where they fail to assess/treat or deny access to treatment)
- Scott v. Harris, 550 U.S. 372 (2007) (record blatantly contradicting district-court facts — standard for de novo fact review in qualified-immunity appeals)
- Garcia v. Salt Lake County, 768 F.2d 303 (10th Cir. 1985) (municipal liability may exist where cumulative deficiencies in staffing/procedures effectively deny care)
- Trigalet v. City of Tulsa, 239 F.3d 1150 (10th Cir. 2001) (municipal liability generally requires an underlying constitutional violation by an officer)
- Collins v. City of Harker Heights, 503 U.S. 115 (1992) (separate inquiry whether municipal policy caused a constitutional violation)
- County of Sacramento v. Lewis, 523 U.S. 833 (1998) (substantive due process standard: conscience-shocking for certain executive action)