United States District Court, E.D. Virginia, Richmond Division
JAMES R. SPENCER, Senior District Judge.
THIS MATTER is before the Court on a Motion to Dismiss ("RRJA Motion") (ECF No. 12) filed by Defendants Rappahannock Regional Jail Authority ("RRJA"), Joseph Higgs ("Higgs"), and Licensed Practical Nurses K. Diggins ("Diggins") and S. Canzon, as well as a Motion to Dismiss ("Dalberg Motion") (ECF No. 17) filed by Defendant Richard K. Dalberg ("Dr. Dalberg"). The three-count Complaint alleges constitutional violations pursuant to 42 U.S.C. § 1983 and common law negligence.
A. FACTUAL BACKGROUND
Cassandra Deavers was forty-eight years old on December 8, 2011, when she was sentenced to serve thirty days' incarceration in the Rappahannock Regional Jail ("Jail") for her conviction of Driving Under the Influence, second offense. At the time, Deavers was under the treatment of a physician for a prior pulmonary embolism and had been prescribed a daily dose of the blood thinner warfarin. On December 1, 2011, seven days prior to her sentencing, Deavers's primary care physician increased her dosage of warfarin to twelve milligrams per day and had ordered that her International Normalized Ratio and Prothrombin Time ("INR/PT") levels be checked on a weekly basis. An individual's INR/PT levels are indications of the time required for a patient's blood to clot and, therefore, are important 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 embolism.
After being sentenced on December 8, 2011, Deavers was transferred to the Jail to begin her incarceration. Deavers's personal property was inventoried, and the Jail medical staff performed a physical examination of Deavers. During these procedures, Deavers informed RRJA medical staff that she was prescribed warfarin, which was to be taken daily, and that her INR/PT levels were to be checked weekly. The RRJA medical staff also noted that Deavers was allergic to aspirin, but failed to refer her to a physician or to order an INR/PT test.
After her initial intake at the Jail, Deavers was placed in solitary confinement because of an assessed suicide risk. Deavers remained in solitary confinement until December 12, 2011, during which time she did not have access to a toilet or sink with which to clean herself. Two days after her incarceration, an unidentified nurse took Deavers's blood for an INR/PT test, but the results were never returned to Deavers despite multiple requests over the following thirty days. The results of this first test showed that Deavers's INR/PT levels were too high, putting her at risk for uncontrolled bleeding and indicating that her dose of warfarin should have been decreased. The Complaint alleges that the Jail, its medical staff, and Dr. Dalberg "failed to check on the test results, and failed to take the necessary therapeutic steps to correct" Deavers's out-of-range INR/PT levels. (Compl. ¶ 31.)
A Physician Orders sheet signed by an unidentified nurse indicates that on December 12, 2011, an unidentified physician ordered Deavers's INR/PT levels to be checked again in two weeks. That same day, Deavers was released into general population. She was assigned to a cell that was filthy and provided neither toilet nor sink facilities. Deavers requested the results of her first INR/PT test, but was given no information.
On December 21, 2011, Deavers completed a medical request form ("First Medical Request") complaining of a headache lasting for the previous three days. Such medical request forms were submitted by inmates to Jail medical staff in order to request medical evaluation and, when needed, treatment. Deavers alleges that the Jail medical staff responding to medical request forms have discretion to grant or deny a higher level of care. In her First Medical Request, Deavers indicated that medical request forms had not been available for the prior three days. The following day, on December 22, 2011, Deavers had a medical examination at which Defendant John Doe 1 or Defendant Nasmh diagnosed her with Methicillin-resistant Staphylococcus aureus ("MRSA") based on the presence of a hard, red bump that had appeared on her buttock two days prior. Deavers was prescribed an antibiotic for the infection and Tylenol for her headache. The treating Defendant did not check or note the results of Deavers's first INR/PT test and did not note that severe headaches are a symptom of warfarin toxicity.
On December 31, 2011, 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 same day, Deavers completed another medical 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 January 2, 2012, Deavers completed yet another medical request form ("Third Medical Request") complaining of a stomach ache lasting for two days and irregular bowel movements since her incarceration began. That same day, Deavers was given a physical exam by Diggins, possibly in response to both the Second Medical Request and the Third Medical Request. Despite knowing that Deavers was taking warfarin, Diggins took no action beyond prescribing Deavers Tylenol for her pain complaints. Diggins did not check the results of either of Deavers's INR/PT tests and did not refer Deavers for additional care.
On January 4, 2012, Deavers blood was redrawn for an INR/PT test. At 9:00 p.m. that evening, Deavers began bleeding profusely from the needle site. Between 11:00 p.m. and 1:00 a.m. the following morning, Deavers's cellmate twice hit the attention button, seeking medical care for Deavers's loss of blood. The guards who responded, Defendants John Doe 5 and John Doe 6, told Deavers that she could not be seen without first completing a medical request form. At approximately 3:00 a.m., a different guard, Defendant John Doe 7, came to Deavers's cell and, at her request, agreed to inform the Jail's medical staff about Deavers's continued bleeding. However, John Doe 7 either failed to inform them, or they declined to respond. Finally, at 5:00 a.m., when the cell doors were unlocked, Deavers attempted to leave, but immediately lost consciousness, fell, and hit her head, causing a one-centimeter laceration on the back of her head.
Deavers was transported to Mary Washington Hospital, where she was diagnosed with a large retroperitoneal hematoma "most likely secondary to Comadin [sic] toxicity, " acute blood loss, anemia, and dehydration secondary to blood loss. Deavers remained in the hospital for five days, receiving multiple blood transfusions and placement of an inferior vena cava filter. Deavers was released back to the Jail on January 12, 2012, and was released from the Jail on January 15, 2012.
B. PROCEDURAL BACKGROUND
On December 10, 2013, Deavers filed suit against the Defendants named above, as well as Jail LPN Nasmh, the Fredericksburg Emergency Medical Alliance, Incorporated ("FEMA"), three Jane Doe Defendants and eight John Doe Defendants. Notably, Defendant Nasmh has not appeared in the case, and FEMA has not joined either motion to dismiss. Count One of the Complaint-which relates generally to the Jail conditions and specifically to the events of January 4, 2011-raises a claim pursuant to 42 U.S.C. § 1983 ("Section 1983"), alleging a supervisory liability claim against Higgs-who is the Superintendent of the Jail-and a deliberate indifference claim against all other defendants. Count Two of the Complaint raises a Section 1983 claim against the nursing staff of the Jail, alleging that they were deliberately indifferent to Deavers's serious medical condition by failing to monitor her INR/PT test results or to identify the symptoms of warfarin toxicity. Count Three of the Complaint raises a common law negligence claim against Dr. Dalberg and FEMA for Dr. Dalberg's treatment of Deavers.
The RRJA Motion was filed on April 7, 2014, and the Dalberg Motion was filed on April 17, 2014. Notably, in her opposition to the RRJA Motion, Deavers indicates that she "is voluntarily withdrawing her claim against Defendant S. Canzon, LPN, with prejudice." (Mem. Opp'n RRJA Mot. 11.) The motions are ripe and a hearing was held on Monday, June 16, 2014.
II. LEGAL STANDARD
Rule 12 of the Federal Rules of Civil Procedure allows a defendant to raise a number of defenses to a complaint at the pleading stage, including failure to state a claim. A motion to dismiss 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); Goodman v. Praxair, Inc., 494 F.3d 458, 464 (4th Cir. 2007); Republican Party of N.C. v. Martin, 980 F.2d 943, 952 (4th Cir. 1992). A court ruling on a Rule 12(b)(6) motion must accept all of the factual allegations in the complaint as true, see Edwards v. City of Goldsboro, 178 F.3d 231, 244 (4th Cir. 1999); Warner v. Buck Creek Nursery, Inc., 149 F.Supp.2d 246, 254-55 (W.D. Va. 2001), in addition to any provable facts consistent with those allegations, Hishon v. King & Spalding, 467 U.S. 69, 73 (1984), and must view these facts in the light most favorable to the plaintiff, Christopher v. Harbury, 536 U.S. 403, 406 (2002).
To survive a motion to dismiss, a complaint must 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. Twombly, 550 U.S. 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47 (1957)). Rule 8(a)(2) requires the complaint to allege facts showing that the plaintiff's claim is plausible, and these "[f]actual allegations must be enough to raise a right to relief above the speculative level." Twombly, 550 U.S. at 555 & n.3. The Court need not accept legal conclusions that are presented as factual allegations, id. at ...