On August 20, 2013, the Seventh Circuit affirmed a district court’s denial of qualified immunity in a case concerning an Illinois pretrial detainee’s death due to medical neglect.

Phillip Okoro, 23, was arrested for a misdemeanor property offense in October 2008 and held at the Williamson County Jail. Although Gerstein v. Pugh, 420 U.S. 103 (1975) requires a probable cause hearing to be held within 48 hours, Okoro was incarcerated for 69 days without such a hearing.

As a teenager, Okoro was diagnosed with Type I diabetes, which he controlled by carefully monitoring his blood sugar levels. In college, however, Okoro’s health deteriorated when he suffered from schizophrenia and stopped monitoring his diabetes.

Williamson County contracts with Health Professionals, Ltd. (HPL) to provide medical care at the county jail. Immediately after his arrest, Okoro’s family alerted jail and medical staff about his mental illness and diabetes.

While incarcerated, Okoro was confined in an isolation cell under the care of HPL employees Dr. Jogendra Chhabra and Nurse Marilyn Ann Reynolds. He was dependent on jail and medical staff to monitor his blood sugar levels, provide insulin shots and deliver other necessary medical treatment.

On December 23, 2008, Okoro collapsed in his cell and died from diabetic ketoacidosis, a buildup of acidic ketones in the bloodstream that occurs when the body runs out of insulin.

Okoro’s sister, Jaclyn Currie, filed a federal lawsuit against jail officials, HPL, Dr. Chhabra, Nurse Reynolds and others. She alleged the defendants were deliberately indifferent to Okoro’s medical needs and his death was “completely preventable” with adequate medical care, regular blood sugar monitoring and sufficient insulin.

Currie initially claimed violations of the Eighth and Fourteenth Amendments. “At the close of discovery, however, in response to the defendants’ motion for summary judgment, Currie argued for the first time that the Fourth Amendment’s ‘objectively unreasonable’ standard should govern,” since Okoro was a pretrial detainee. The district court granted Currie leave to amend her complaint to allege a Fourth Amendment violation.

Shortly after that ruling the county and jail officials settled with Currie, leaving HPL and its employees, Chhabra and Reynolds, as the only remaining defendants.

The HPL defendants then moved to dismiss, claiming they were entitled to qualified immunity because the Fourth Amendment has not been applied to medical professional subcontractors. When the district court denied their motion, Chhabra and Reynolds filed an interlocutory appeal.

“A jailer might violate an arrestee’s Fourth Amendment rights by unreasonably denying the arrestee access to insulin,” they argued, “but a health care professional who unreasonably withholds insulin does not.”

The Seventh Circuit found their argument lacked “support in law or logic,” noting that “from the perspective of the arrestee, it matters not a whit whether it is the jailer or the doctor whose conduct deprives him of life-saving medical care.”

Following the Sixth Circuit’s reasoning in McCullum v. Tepe, 693 F.3d 696 (6th Cir. 2012), the appellate court found “the contours of Okoro’s Fourth Amendment rights were ‘sufficiently clear that a reasonable official would understand that what he is doing violates that right’ throughout the period of Okoro’s detention.”

The Court of Appeals also rejected the defendants’ argument that they were entitled to qualified immunity because they were unaware of Okoro’s legal status as a pretrial detainee.

Such an argument “assumes that health care providers calibrate the level of medical care they provide to a jail inmate based on their assessment of the inmate’s legal status, taking advantage of the right to be sloppy where the standard is lower,” the Seventh Circuit observed. “We sincerely hope that this is not how Chhabra, Reynolds, and Health Professionals, Ltd. go about caring for those in the State’s custody.” The appellate court concluded that “if the defendants truly tailor their care (or lack thereof) in this fashion, then their failure to ascertain Okoro’s correct status cannot be characterized as a ‘reasonable’ mistake, and their qualified immunity claim still fails.” See: Currie v. Chhabra, 728 F.3d 626 (7th Cir. 2013).

Following remand, Dr. Chhabra agreed to settle the case in December 2013 for $775,000, resolving claims related to the remaining HPL defendants. Okoro’s sister was represented by the Chicago law firm of Loevy & Loevy.

(Published by Prison Legal News; used by permission)

About Christopher Zoukis, MBA

Christopher Zoukis, MBA, is the Managing Director of the Zoukis Consulting Group, a federal prison consultancy that assists attorneys, federal criminal defendants, and federal prisoners with prison preparation, in-prison matters, and reentry. His books include Directory of Federal Prisons (Middle Street Publishing, 2020), Federal Prison Handbook (Middle Street Publishing, 2017), Prison Education Guide (PLN Publishing, 2016), and College for Convicts: The Case for Higher Education in American Prisons (McFarland & Company, 2014).

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