Stephen E. Carswell, Cross-Appellant v. Bay County, Lavelle Pitts, William Grigsby, Graham Belz, Thomas G. Merrill, Cross-Appellees
Docket: 87-3710
Court: Court of Appeals for the Eleventh Circuit; September 7, 1988; Federal Appellate Court
Stephen E. Carswell brought a lawsuit under 42 U.S.C. Sec. 1983 against Bay County and several officials, alleging failure to provide adequate medical treatment while he was a pre-trial detainee at Bay County Jail. Carswell entered the jail on August 21, 1984, without a physical examination, indicating he had no medical issues. Over the next eleven weeks, he made multiple requests for medical care due to a rash, constipation, and significant weight loss, but many requests were ignored. Although he received some treatment, including a cream for a rash and medication for tonsillitis, his health continued to deteriorate.
On November 5, 1984, a public defender noted Carswell's emaciated condition during an arraignment and urged jail administrator William Grigsby to arrange medical care. Grigsby only made a vague request for medical attention upon returning to the jail. Two days later, Carswell was examined again and had lost about fifty-three pounds, weighing only ninety-two pounds. He was subsequently hospitalized and diagnosed as a diabetic, remaining there for two months before recovering.
The jury found in favor of Sheriff Pitts but against Grigsby, Belz, and Dr. Merrill on the constitutional claim of deliberate indifference, awarding $10,000 in compensatory damages on that claim. They held Sheriff Pitts negligent, ordering an additional $10,000 in damages, and found Belz and Merrill negligent, resulting in $40,000 in damages. No punitive damages were awarded. The district court entered judgments against the defendants for the amounts determined by the jury.
Appellants raise three key issues on appeal: 1) the applicability of section 1983 liability to a physician contracted to provide medical services to inmates, 2) the sufficiency of evidence supporting a jury's finding of "deliberate indifference" by Grigsby and Belz regarding Carswell's medical needs, and 3) whether the judgment should be vacated due to an inconsistent jury verdict.
To establish liability under section 1983, a plaintiff must show the defendant acted under color of state law. Appellant Merrill argues he does not meet this criterion, as he was a private physician with no supervisory duties and did not treat Carswell. However, the district court ruled that state action was present, citing relevant case law, including Ancata v. Prison Health Servs. Inc. and Morrison v. Washington County, which support the notion that a private physician under contract to provide medical services to inmates acts under color of state law. This position was reaffirmed by the Supreme Court in West v. Atkins, which clarified that the nature of a physician's duties while working for the state determines their status under section 1983. Consequently, Merrill is deemed to have acted under color of state law and is liable.
Regarding the second issue, the appellants argue there was insufficient evidence for the jury's finding of deliberate indifference against Grigsby and Belz, who provided care to Carswell and addressed his requests for medication. They contend that the failure to correctly diagnose Carswell's condition does not equate to deliberate indifference, given their efforts to respond to his medical needs.
The jury could reasonably conclude that Grigsby and Belz exhibited deliberate indifference regarding Carswell's medical needs. Evidence showed that both had awareness of Carswell's urgent medical condition, with EMT Monroe and Officer Eldridge alerting Belz to the situation, which he ignored. Grigsby also acknowledged Carswell's deteriorating state during his rounds and received requests for medical assistance, yet he took no effective action. Under section 1983, the combination of knowledge of medical needs and intentional refusal to provide care surpasses mere negligence, thereby establishing deliberate indifference.
The jury found Grigsby, Merrill, and Belz liable for $10,000 in compensatory damages due to deliberate indifference, while Merrill and Belz were also found negligent, resulting in $40,000 in damages on state law claims. Appellants contended the verdicts were inconsistent and attributed confusion to the jury instructions and verdict form, claiming they raised this issue thrice during the trial. However, the court noted that no formal objection was made to the jury instructions, which is necessary to preserve the issue for appeal.
Upon review, the court found no inconsistency in the jury's findings. The Seventh Amendment requires the acceptance of any interpretation of the case that aligns the jury's answers. The appellee provided a coherent rationale for the verdict, suggesting that while initial negligence by Merrill and Belz primarily caused Carswell's injuries, their later inaction, along with Grigsby's, constituted deliberate indifference. The jury's determination regarding Sheriff Pitts' negligence likely stemmed from his general failure to ensure proper medical care at the jail. Given this logical explanation for the jury's conclusions, the court upheld the verdict without disturbance.
Carswell's appeal centers on the application of Florida's collateral source rule regarding his claim for medical expenses against Grigsby and Bay County. Prior to trial, Carswell and Bay County settled, leading to the dismissal of Carswell's claim against Bay County and Bay County's counterclaim for medical expenses under Fla.Stat. Sec. 951.032. Despite this settlement, Carswell continued to pursue damages from Sheriff Pitts and Grigsby. The district court ruled that Bay County's payment of Carswell's medical expenses would reduce any damage award against Pitts and Grigsby.
Carswell contends that the collateral source rule allows recovery from both Grigsby and Bay County, arguing they should be treated as independent tortfeasors. However, Florida law restricts the collateral source rule to prevent plaintiffs from receiving undeserved windfalls. The district court found that Bay County's payment was not an earned benefit, as the county was statutorily entitled to recover these costs. Consequently, the court ruled that the medical expenses paid by Bay County would reduce the damages awarded to Carswell from Grigsby.
The district court's application of the collateral source rule was deemed appropriate, affirming that even if Grigsby and Bay County are not joint tortfeasors, the limitation of the rule prevents Carswell from recovering the sought damages. The conclusion of the district court was therefore affirmed. Additionally, while there were issues related to defaults against other defendants, these were not addressed on appeal as neither party discussed their implications.
The jury determined that Merrill was liable to Carswell under Section 1983 based on specific criteria: Merrill had to either personally participate in the deprivation of Carswell's constitutional rights, have actual knowledge and acquiesce to the wrongful conduct, instigate actions by his subordinate Belz leading to constitutional harm, or create a policy allowing Belz to violate constitutional rights. The court clarified that Merrill could not be held liable under the respondeat superior doctrine for Belz's actions, as Section 1983 does not permit such liability. Furthermore, the district court ruled that medical payments made by Bay County were considered a settlement by a joint tortfeasor, which, according to Florida Statute Section 768.31, necessitated a reduction of damages against Grigsby by the amount of the settlement, as established in relevant case law.
