Valerie McCann v. Ogle County, Illinois

In the

United States Court of Appeals

For the Seventh Circuit

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No. 17-3139

VALERIE MCCANN, Special Administrator

of the Estate of PATRICK J. MCCANN, deceased,

Plaintiff-Appellant,

v.

OGLE COUNTY, ILLINOIS, et al.,

Defendants-Appellees.

____________________

Appeal from the United States District Court for the

Northern District of Illinois, Western Division.

No. 3:11-cv-50125 — Frederick J. Kapala, Judge.

____________________

ARGUED SEPTEMBER 14, 2018 — DECIDED NOVEMBER 30, 2018

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Before BAUER, HAMILTON, and SCUDDER, Circuit Judges.

SCUDDER, Circuit Judge. Patrick McCann died from a doc-

tor’s over-prescription of methadone while detained and

awaiting trial at the Ogle County Correctional Center. His es-

tate brought suit under 42 U.S.C. § 1983 against Ogle County

and a host of county officials and other individuals, including

the doctor and nurse who cared for McCann while he was in-

carcerated, alleging deliberate indifference to McCann’s

2 No. 17-3139

severe burn wounds and related medical needs. After the

treating physician and his private employer settled the claims

against them, the district court entered summary judgment

for the remaining defendants, concluding that the evidence

did not show that any individual defendant acted with delib-

erate indifference in treating McCann.

Since the district court’s decision, this court decided

Miranda v. County of Lake, 900 F.3d 335 (7th Cir. 2018),

replacing deliberate indifference with a standard requiring a

showing of objective reasonableness for a claim challenging

the medical care provided to a pretrial detainee like McCann.

Measuring the record evidence under this new standard, we

affirm the district court’s award of summary judgment to the

individual defendants. So, too, do we affirm the district

court’s determination that the record evidence did not

support a claim for municipal liability against Ogle County

under Monell v. Dep’t of Social Services of New York, 436 U.S. 658

(1978).

I

A

On March 30, 2010, McCann assaulted and threatened to

kill his mother, only then to set fire to her house in the small

town of Polo, Illinois. McCann sustained substantial burn in-

juries and spent the next three weeks in the hospital. He was

released to police custody on April 20, charged with residen-

tial arson and aggravated battery, and transported first to the

Winnebago County jail and an hour later to the Ogle County

Correctional Center. McCann arrived at the Ogle County fa-

cility with his hospital discharge papers, a list of prescription

No. 17-3139 3

medications to be filled, and instructions for caring for his

burn wounds.

Although expressing initial surprise that someone in

McCann’s condition would not remain hospitalized, the Ogle

County correctional staff went to work to accommodate his

needs and monitor his condition. For her part, Cindy

Mongan, a licensed practical nurse, reviewed McCann’s hos-

pital discharge summary and called Dr. Stephan Cullinan, a

contract physician responsible for inmate care at the Ogle

County facility, to inform him of McCann’s admission and to

fill the prescriptions. Captain Cindy Kerwin of the Ogle

County Sheriff’s Office managed the correctional center and

took steps to order a hospital bed, air mattress, and extra

sheets to better accommodate McCann. Over the ensuing

days, Nurse Mongan and others checked and documented

McCann’s status every 5 to 15 minutes around the clock.

Dr. Cullinan examined McCann for the first time on April

27, finding normal vital signs and observing that McCann was

experiencing no difficulty breathing, moving, and eating or

drinking. That same day Dr. Cullinan decided to change

McCann’s pain medication to 60 mg of methadone twice per

day—an amount the district court recognized was “much too

high a dose.” Unaware of the dangers associated with this

dosage, Nurse Mongan provided the methadone to McCann

as directed by Dr. Cullinan.

Two days later, on April 29, Mongan informed Dr.

Cullinan that McCann had slept much of the previous day

and through the night with no complaints of pain. Her

morning status checks showed McCann alert and talkative,

with no lingering signs of fatigue. That evening, however,

other jail personnel noticed that McCann appeared sluggish,

4 No. 17-3139

and the next morning he struggled to stay awake during

breakfast.

During the early morning hours of April 30, Nurse

Mongan thought McCann looked tired, but otherwise saw

that he was able to eat, drink, and walk around his cell. Not

observing any trouble with McCann’s breathing, Mongan did

not check his vital signs. She conveyed McCann’s condition to

Dr. Cullinan at approximately 9:00 a.m. and, during the tele-

phone call, Dr. Cullinan reduced the methadone prescription

from 60 mg to 40 mg, twice daily. Another staff member

checked on McCann at least four times between 9:00 a.m. and

11:00 a.m. and observed him asleep in his cell.

Shortly after 11:00 a.m., Nurse Mongan and a colleague

entered McCann’s cell to serve him lunch and found him un-

responsive and not breathing. While waiting on an ambulance

to arrive, Mongan performed CPR, but was unable to resusci-

tate McCann. An autopsy showed that McCann died from an

over-prescription of methadone.

B

In May 2011, McCann’s estate brought this action under

42 U.S.C. § 1983 against numerous defendants. Two of those

defendants included Dr. Cullinan and his employer, Health

Professionals, Ltd. During the course of the litigation, Dr.

Cullinan and Health Professionals agreed to a settlement with

McCann’s estate. What remained were claims for money

damages against Nurse Mongan, Captain Kerwin, and Ogle

County Sheriff Gregory Beitel in their individual capacities as

well as separate claims, including against Sheriff Beitel, and

Captain Kerwin in their official capacities, which the district

No. 17-3139 5

court treated as claims for municipal liability against Ogle

County.

On the defendants’ motions for summary judgment, the

district court evaluated the claims against the individual de-

fendants under the deliberate indifference standard of Farmer

v. Brennan, 511 U.S. 825 (1994), and concluded that no reason-

able jury could find Nurse Mongan acted with such indiffer-

ence to McCann’s medical needs. Specifically, the district

court determined that Mongan neither was aware of the risks

associated with the dosage of methadone prescribed by Dr.

Cullinan nor at any point did she otherwise disregard clear

risks to McCann’s health. And more generally, the district

court emphasized that the record evidence showed that

“Mongan provided extensive care and treatment for McCann

and was anything but deliberately indifferent to his medical

needs.”

As for Sheriff Beitel and Captain Kerwin, the district court

concluded that there was no evidence showing that they

shouldered responsibility for McCann’s medical care or oth-

erwise learned of any risks associated with the methadone

dosage prescribed by Dr. Cullinan. Accordingly, the district

court entered summary judgment for each of the defendants

sued in their individual capacity.

On the Monell claim against Ogle County (and Sheriff

Beitel and Captain Kerwin in their official capacities), the

district court granted the defendants’ motions for summary

judgment. The court found no evidence that Ogle County had

a policy, formal or informal, that caused McCann to remain

incarcerated to save the County hospitalization costs and, by

extension, that led to his death. The decision that McCann did

not need to remain hospitalized, the district court

6 No. 17-3139

underscored, was the product of Dr. Cullinan’s medical

judgment. “By all accounts,” the district court added,

“McCann’s condition was being properly treated at the jail

and he was doing fine until Dr. Cullinan prescribed a dosage

of methadone that turned out to be toxic.”

II

A

After the district court ruled on the defendants’ motions

for summary judgment, we decided Miranda v. County of Lake,

900 F.3d 335 (7th Cir. 2018), holding that a standard of objec-

tive reasonableness, and not deliberate indifference, governs

claims under the Fourteenth Amendment’s Due Process

Clause for inadequate medical care provided to pretrial de-

tainees. Our decision in Miranda hewed closely to Kingsley v.

Hendrickson, where the Supreme Court held that the due pro-

cess standard for assessing a pretrial detainee’s claim of ex-

cessive force should be “objective not subjective.” 135 S. Ct.

2466, 2472 (2015). A pretrial detainee “needed only to show

that the defendant’s conduct was objectively unreasonable,”

without any accompanying requirement to demonstrate, as

would be the case in a claim brought under the Eighth

Amendment’s Cruel and Unusual Punishment Clause by an

inmate serving a sentence, “that the defendant was subjectively

aware that the amount of force being used was unreasonable.”

Miranda, 900 F.3d at 351 (citing Kingsley, 135 S. Ct. at 2472–73).

After Miranda, then, the controlling inquiry for assessing a

due process challenge to a pretrial detainee’s medical care

proceeds in two steps. The first step, which focuses on the in-

tentionality of the individual defendant’s conduct, remains

unchanged and “asks whether the medical defendants acted

No. 17-3139 7

purposefully, knowingly, or perhaps even recklessly when

they considered the consequences of their handling of [plain-

tiff’s] case.” Id. at 353. A showing of negligence or even gross

negligence will not suffice. See id.; accord Darnell v. Pineiro,

849 F.3d 17, 35–36 (2d Cir. 2017) (concluding that “[a]ny § 1983

claim for a violation of due process requires proof of a mens

rea greater than mere negligence”).

At the second step, and now aligned with Kingsley, we ask

whether the challenged conduct was objectively reasonable.

See Miranda, 900 F.3d at 354. This standard requires courts to

focus on the totality of facts and circumstances faced by the

individual alleged to have provided inadequate medical care

and to gauge objectively—without regard to any subjective

belief held by the individual—whether the response was rea-

sonable.

B

With this framework in place, we turn first to Nurse

Mongan’s care for McCann and then to the claims against

Ogle County officials Sheriff Beitel and Captain Kerwin. In

doing so, we review the summary judgment record de novo

and draw all inferences in McCann’s favor. See Ortiz v. City of

Chicago, 656 F.3d 523, 530 (7th Cir. 2011).

The record contains no evidence that Nurse Mongan pur-

posely, knowingly, or recklessly administered dangerous

dosages of methadone to McCann. To the contrary, she testi-

fied that she administered methadone to McCann in strict

compliance with Dr. Cullinan’s orders. And, while her efforts

in caring for McCann, including by administering the pre-

scribed dosages of methadone, were intentional and deliber-

ate, nothing shows that she foresaw or ignored the potential

8 No. 17-3139

consequences of her actions—McCann’s dying from the over-

prescription of methadone.

Nor is there any evidence that Nurse Mongan’s actions

were objectively unreasonable—the second part of the

requisite inquiry after Miranda. A licensed practical nurse like

Mongan was able to rely on Dr. Cullinan to determine the

proper dosage of methadone to treat the ongoing pain

McCann was experiencing from his burn wounds. Hers was

not the responsibility to second-guess Dr. Cullinan’s medical

judgment, especially when nothing about Dr. Cullinan’s

prescriptions or course of care more generally raised any

obvious risks of harm for McCann. See Berry v. Peterman, 604

F.3d 435, 443 (7th Cir. 2010) (“Although a medical care system

requires nurses to defer to treating physicians’ instructions

and orders in most situations, that deference may not be blind

or unthinking, particularly if it is apparent that the

physician’s order will likely harm the patient.”). Like the

district court, we cannot say on the record before us that

Nurse Mongan’s administration of the methadone dosages

prescribed by Dr. Cullinan was objectively unreasonable.

A broader look at the record shows that Mongan attended

diligently and conscientiously to McCann’s medical needs

from the moment he arrived at the Ogle County facility. To be

sure, Mongan harbored initial reservations as to the facility’s

ability to care for someone with severe burn wounds. Within

a few days of McCann’s arrival, however, those reservations

abated and Mongan became comfortable with McCann being

housed and cared for within the facility. The comfort came in

no small part from her own course of action. She checked and

documented McCann’s condition every 5 to 15 minutes, while

also regularly changing his bandages, bathing him, and

No. 17-3139 9

serving him meals. When off duty she asked her colleagues to

call her day or night if McCann’s condition worsened. She

even voluntarily came in on a weekend to assist McCann with

taking a shower. The district court stood on firm evidentiary

ground when concluding that Nurse Mongan went out of her

way to care for McCann.

McCann’s estate urges a contrary conclusion by focusing

more narrowly on Nurse Mongan’s failure to take McCann’s

vital signs during the early morning hours of April 30, 2010—

before she ultimately found him unresponsive and not

breathing. The allegation on this score, the district court

rightly recognized, sounds in negligence, which is insufficient

to support a claim for inadequate medical care under the

Fourteenth Amendment. See Miranda, 900 F.3d at 353; see also

Dixon v. County of Cook, 819 F.3d 343, 350 (7th Cir. 2016) (ex-

plaining that a plaintiff must “prove facts from which some-

thing more than negligence or even medical malpractice can

be inferred”). Even taking the allegation on its own terms,

however, we cannot conclude that any failure to check

McCann’s vital signs was objectively unreasonable. That

McCann appeared tired earlier that morning did not foretell

the onset of respiratory failure or some other downturn that

would end in his imminent death. Viewed objectively,

Mongan’s care for McCann was diligent and attentive—fall-

ing well short of violating McCann’s due process rights.

Applying the same analysis to the Ogle County defend-

ants, including the claims against Sheriff Beitel and Captain

Kerwin, we reach the same conclusion. Neither individual

was responsible for providing medical care to McCann. Ra-

ther, Sheriff Beitel and Captain Kerwin reasonably relied on

Dr. Cullinan to determine the proper course of care for

10 No. 17-3139

McCann and themselves took no steps to contribute to or de-

tract from the treatment McCann received. The law allowed

these officials to rely on Dr. Cullinan in this way. See Berry,

604 F.3d at 440 (underscoring that the law “encourages non-

medical security and administrative personnel … to defer to

the professional medical judgments of the physicians and

nurses treating the prisoners in their care without fear of lia-

bility for doing so”); see also Miranda, 900 F.3d at 343 (apply-

ing similar reasoning to reject allegations of inadequate med-

ical care brought against non-medical jail officials). The dis-

trict court, in short, was right to award summary judgment to

these individual defendants.

C

What remains is the Monell claim for municipal liability

against Ogle County. This claim includes the allegations

McCann’s estate advances against Sherriff Beitel and Captain

Kerwin in their official capacities. See Kentucky v. Graham, 473

U.S. 159, 166 (1985) (“[A]n official-capacity suit is, in all re-

spects other than name, to be treated as a suit against the [mu-

nicipal] entity … for the real party in interest is the entity.”).

A Monell claim subjects a local governing body like Ogle

County to liability when an “official policy, widespread cus-

tom, or action by an official with policy-making authority”

was the “‘moving force’ behind [a] constitutional injury.”

Dixon, 819 F.3d at 348 (quoting City of Canton v. Harris, 489

U.S. 378, 379 (1989)); see also Thomas v. Cook County Sheriff’s

Dep’t, 604 F.3d 293, 303 (7th Cir. 2010) (articulating same

standards for Monell liability).

McCann’s estate asserts that Ogle County’s decision to

house McCann instead of transferring him to a hospital

No. 17-3139 11

reflected a policy that elevated cost savings over necessary

medical care. This theory lacks support in the evidence ad-

duced at summary judgment. There was no testimony or doc-

umentary evidence pointing to any such custom, practice, or

policy—written or unwritten, formal or informal.

What the evidence shows is that Dr. Cullinan assessed

McCann’s condition and determined that the Ogle County fa-

cility had the capacity to attend to his ongoing medical needs.

Put differently, the decision to house McCann within the Ogle

County facility following his discharge from the local hospital

reflected Dr. Cullinan’s medical judgment, to which other

county officials reasonably deferred. And at no point during

McCann’s detention did Sherriff Beitel, Captain Kerwin, or

any other county official learn of deficiencies or concerns with

the adequacy of the medical care provided to McCann. See

Arnett v. Webster, 658 F.3d 742, 756 (7th Cir. 2011) (explaining

that “if a prisoner is under the care of medical experts, a non-

medical prison official will generally be justified in believing

that the prisoner is in capable hands”). With the record here

containing no such evidence, the district court properly con-

cluded the Monell claim cannot succeed.

A final observation is warranted. In rejecting the Monell

claim, the district court emphasized that McCann’s tragic

death resulted from Dr. Cullinan’s over-prescription of meth-

adone, not the decision to house him within the Ogle County

facility or, for that matter, the care he received from Nurse

Mongan and other staff members within the facility. This con-

clusion, too, finds sound support in the record.

For these reasons, we AFFIRM.