Rancourt v. Hillsborough County et al

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW HAMPSHIRE
Linda Rancourt
v. Case No. 20-cv-351-PB
Opinion No. 2022 DNH 067
Hillsborough County et al.
MEMORANDUM AND ORDER
The remaining defendants here seek reconsideration of my order
denying their motion for summary judgment on Linda Rancourt’s claims for
constitutionally inadequate medical care and negligence. At the motion
hearing, I allowed defendants to file supplemental briefing and evidence in
support of their motion, after I previously extended a similar courtesy to
Rancourt when she sought first to file a belated expert disclosure and later to
supplement that disclosure. After defendants’ filing, Rancourt submitted a
supplemental response. Because the record now before me establishes
defendants’ entitlement to summary judgment, I grant their motion for
reconsideration and dismiss all remaining claims.
I. BACKGROUND
Rancourt suffered a hypertensive event on the third day of her
incarceration at the Valley Street Jail. After settling her claims against the
jail’s outside medical providers, Rancourt sued three nurses who interacted
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with her on the first day of her incarceration, April 11, 2017.1 Nurse Flavia
Martin completed an intake mental health screening form with Rancourt at
4:20 a.m. The screening form recorded that Rancourt had a blood pressure
reading of 180/120, had complained of a headache, had suffered three strokes
in the prior two years, had active prescriptions for three hypertension
medications at Sam’s Club pharmacy, and had used one gram of heroin per
day—including the prior day. Nurse Martin’s only other involvement in
Rancourt’s care was conducting a detoxification watch check at 9:00 a.m., at
which time Rancourt’s condition remained unchanged. An hour later, Nurse
Martin finished her double shift and left.
After the screening form is completed, the jail’s practice is for the
nursing staff to contact the inmate’s pharmacy to verify any prescriptions.
Information obtained from the pharmacy is recorded in the medication
verification form. If the screening form is completed during the third shift,
when pharmacies usually are not open, a first shift nurse contacts the
pharmacy. Nurse Xina Barnes was the first shift nurse who called Sam’s
Club pharmacy that morning and verified that Rancourt had active
prescriptions for three hypertension medications. She recorded those
prescriptions in the medication verification form and signed it at 9:50 a.m.
1 I dismissed Rancourt’s claims against a fourth nurse in the summary judgment
order. I have not been asked to reconsider that ruling.
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After medications are verified, the next step is for the nursing staff to
request orders from the jail’s medical providers so that the prescriptions can
be ordered from the jail’s pharmacy and administered to the inmate. If no
provider is at the facility, the nurse obtains orders by telephone and records
them on the medication verification form as a telephonic order. If a provider
is at the facility, the nurse leaves a copy of the inmate’s screening form with
the medication verification form for the provider to review. The provider then
writes the orders directly on the medication verification form and signs it.
PA Christopher Schweiger, the on-duty provider that day, was at the
facility. He handwrote orders for the three hypertension medications on
Rancourt’s medication verification form, directed that her blood pressure be
checked three times per week for two weeks, and signed the form. Although
PA Schweiger did not include a date or time when he signed the form, he
would have done so between 9:50 a.m., when Nurse Barnes completed the
form, and 1:54 p.m., when another nurse ordered the medications from the
jail’s pharmacy.
Once the provider writes prescriptions on the medication verification
form, the nurses may administer those medications. The jail keeps a stock of
commonly prescribed medications so that they can be given to inmates before
prescriptions from the pharmacy arrive overnight. Two of the prescriptions
PA Schweiger ordered for Rancourt, Amlodipine and Carvedilol, are
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commonly prescribed hypertension medications that the jail typically keeps
in stock.
All medications given to an inmate are recorded on a chart called the
medication administration record. When a nurse administers a medication,
the nurse must initial one of the four boxes corresponding with the date and
time when the medication was given. The first box is used for the morning
medication pass (8:00 a.m.), the second for the noon medication pass (12:00
p.m.), the third for the afternoon medication pass (4:00 p.m.), and the fourth
for the evening medication pass (8:00 p.m.).
Rancourt’s medication administration record shows that, on April 11,
Nurse Barnes initialed the second box next to Amlodipine and Carvedilol.
Although she does not have a specific recollection of administering those
medications, Nurse Barnes stated in a sworn affidavit that she would not
have initialed those boxes unless she actually gave the two medications to
Rancourt on that day. She also stated that it was her practice to initial the
second box on the chart when she gave medications after 8:00 a.m. and before
4 p.m. In this case, Nurse Barnes would have administered the medications
sometime between 9:50 a.m., after PA Schweiger wrote the prescription
orders, and 2:42 p.m., when her shift ended. Because the pharmacy would not
deliver Rancourt’s medications until the following day, Nurse Barnes would
have used stock medications.
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The third nurse defendant, Katelyn Hrubiec, completed a medical
history form and a consent to treat form with Rancourt at 2:15 p.m. She
would have known that PA Schweiger had ordered Rancourt’s medications
because she referred to the medication verification form in her notes.
The medication administration record shows that the nursing staff
gave Rancourt a second dose of Carvedilol during the evening medication
pass on April 11. The next morning, a nurse wrote in Rancourt’s progress
notes, “Meds not in yet.” This notation would have referred to Rancourt’s
prescription medications on order from the pharmacy, which were expected to
arrive that day.
On April 13, two days after the nurse defendants treated Rancourt, she
was hospitalized in serious condition due to a hypertensive emergency. This
lawsuit followed.
II. STANDARD OF REVIEW
Defendants seek reconsideration of my interlocutory ruling denying
their motion for summary judgment. Because final judgment has not been
rendered, I consider defendants’ motion under Local Rule 7.2(d), which
requires a motion for reconsideration to “demonstrate that the order was
based on a manifest error of fact or law.” Reconsideration is “an
extraordinary remedy which should be used sparingly.” Fabrica de Muebles
J.J. Alvarez, Inc. v. Inversiones Mendoza, Inc., 682 F.3d 26, 31 (1st Cir. 2012)
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(cleaned up). Summary judgment is properly granted when “the movant
shows that there is no genuine dispute as to any material fact and the
movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a); see
Unibank for Sav. v. 999 Priv. Jet, LLC, 31 F.4th 1, 4-5 (1st Cir. 2022).
III. ANALYSIS
Defendants move for reconsideration of my order denying their motion
for summary judgment on Rancourt’s deliberate indifference and negligence
claims. As I explained in that order, Rancourt’s claims rest on the expert
disclosure of Dr. Robert Cohen, who has opined that defendants were
deliberately indifferent to Rancourt’s medical needs. Two key assumptions
underpin Dr. Cohen’s opinion: (1) that Rancourt was not given any blood
pressure medication on April 11, and (2) that the nurses did not consult a
medical provider to have Rancourt hospitalized. In their motion for summary
judgment, defendants argued that Rancourt’s claims fail because: (1) Nurse
Barnes administered two of the three medications on the day in question, and
(2) the nurses consulted PA Schweiger, who did not order hospitalization but
chose to treat Rancourt with prescription medications. I denied defendants’
motion because the record then before me was insufficiently developed to
demonstrate that no material facts were in genuine dispute. Specifically,
defendants had relied on medical records without adequately explaining
either their meaning or the jail’s relevant practices and procedures.
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After defendants moved for reconsideration, I let them supplement the
record with information that would fill the evidentiary gaps I identified in the
order. Ordinarily, a motion for reconsideration should not be used to marshal
evidence that could have been presented as part of the summary judgment
record. Considerations of fairness and judicial economy informed my
judgment to allow the record to be supplemented in this case. When
defendants first moved for summary judgment because plaintiff had failed to
disclose a necessary expert, I allowed Rancourt to belatedly disclose an expert
and later permitted her to supplement that disclosure. I also let Rancourt
respond to defendants’ supplemental filing, including by submitting
additional evidence to controvert defendants’ version of the facts.
Defendants’ supplemental filing has cured the defects that led me to
deny their motion for summary judgment, and plaintiff has not come forward
with any countervailing evidence. The record now shows that Rancourt
received two of the three medications between 9:50 a.m. and 2:42 p.m. on
April 11. Absent evidence to the contrary, I must accept Nurse Barnes’s
sworn statement that she would not have written her initials in the
corresponding boxes on Rancourt’s medication administration form unless
she gave her those two medications during that time. The record shows that
the medications came from the stock available at the jail for use before
inmates’ prescription orders can be filled. After Nurse Barnes left for the day,
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another nurse wrote in the chart that she gave Rancourt a second dose of one
of the two medications. Given the undisputed evidence that Rancourt’s
prescriptions would not arrive from the pharmacy until the next day, the
evidence of the second administration of medications on April 11 further
supports defendants’ position that, once PA Schweiger wrote the prescription
orders on or before 1:54 p.m. on April 11, the nursing staff began
administering stock medications to Rancourt.
The notation in Rancourt’s progress notes entered the following day
that Rancourt’s medications were “not in yet” does not validate Dr. Cohen’s
assumption that no medications were given on April 11. Construing the
record as a whole in the light most favorable to Rancourt, the only plausible
reading of that notation is that it referred to the receipt of prescriptions
ordered from the jail’s pharmacy. Again, that reading tracks the pharmacy
order fulfillment process and the nurses’ initials in the medication
administration record showing that Rancourt received two doses of Carvedilol
and one dose of Amlodipine on April 11.
Rather than offering evidence to support Dr. Cohen’s assumption that
she received no stock medications on April 11, Rancourt contends that
defendants cannot rely on self-serving affidavits to meet their burden. That is
not the law. “A party’s own affidavit, containing relevant information of
which he has first-hand knowledge, may be self-serving, but it is nonetheless
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competent to support or defeat summary judgment.” Santiago-Ramos v.
Centennial P.R. Wireless Corp., 217 F.3d 46, 53 (1st Cir. 2000) (cleaned up);
see also Harley-Davidson Credit Corp. v. Galvin, 807 F.3d 407, 413 (1st Cir.
2015). Once defendants met their evidentiary burden, the onus shifted to
Rancourt to present evidence that could salvage her claims. Dr. Cohen’s
opinion that no medications were given cannot satisfy that burden because
defendants have offered evidence showing that the sole basis for his opinion
does not withstand scrutiny. And Rancourt offered no other evidence.
It is also now undisputed that PA Schweiger was sufficiently informed
about Rancourt’s condition when he chose her course of treatment. Because
he was at the jail, he would have been given the intake screening form along
with the medication verification form he used to order her prescriptions. The
screening form listed Rancourt’s relevant medical history, including her prior
strokes. So informed, PA Schweiger did not order hospitalization and instead
directed the nursing staff to administer medications and monitor Rancourt’s
blood pressure.
Rancourt insists that the nurses still had a duty to disregard the
medical provider’s instructions and call 911 on Rancourt’s behalf. There is no
evidence, however, tending to show that PA Schweiger’s chosen treatment
was so inadequate that no reasonable nurse could have relied on it. Dr.
Cohen’s opinion that Rancourt’s condition should have been treated in an
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intensive care unit cannot close that evidentiary gap. At most, it shows a
disagreement about the proper course of treatment. But “substandard care,
malpractice, negligence, inadvertent failure to provide care, and
disagreement as to the appropriate course of treatment are all insufficient to
prove a constitutional violation.” Ruiz-Rosa v. Rullan, 485 F.3d 150, 156 (1st
Cir. 2007); see also Ramos v. Patnaude, 640 F.3d 485, 490 (1st Cir. 2011)
(“[M]isjudgment, even negligent misjudgment, is not deliberate
indifference.”). Rancourt cannot show that defendants were deliberately
indifferent to her medical needs because no reasonable factfinder reviewing
this record could find that the care provided was “so clearly inadequate as to
amount to a refusal to provide care.” Torraco v. Maloney, 923 F.2d 231, 234
(1st Cir. 1991) (cleaned up).2 Accordingly, Rancourt’s claims for
constitutionally inadequate medical care cannot stand.
The negligence claims likewise fail. Without evidence of reckless or
wanton conduct, defendants are entitled to official immunity under state law.
See N.H. Rev. Stat. Ann. § 507-B:4, IV; Farrelly v. City of Concord, 168 N.H.
430, 446 (2015). For the same reasons that Rancourt cannot show that
defendants were deliberately indifferent to her medical needs, she cannot
show that their conduct was wanton or reckless. See Murphy v. Strafford
Cnty., 2022 DNH 050, 2022 WL 1063829, at *5 (D.N.H.) (describing the
2 I described the applicable standard in detail in the summary judgment order.
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official immunity standard and finding it functionally equivalent to the
deliberate indifference standard).
In summary, the nurse defendants participated in Rancourt’s care only
at an early stage, well before her condition deteriorated. During that time,
they accurately recorded Rancourt’s medical history and blood pressure
reading, shared that information with PA Schweiger, and followed his chosen
course of treatment by administering stock medications. The record does not
support an inference that defendants were in any way culpable when, days
later, Rancourt was hospitalized due to a hypertensive emergency. Because
Rancourt has not marshaled evidence from which a reasonable factfinder
could conclude that defendants were deliberately indifferent to her medical
needs, her claims against them are not triable.
IV. CONCLUSION
Defendants’ motion for reconsideration (Doc. No. 33) is granted. Upon
reconsideration, I grant defendants’ motion for summary judgment (Doc. No.
29) in full. The clerk of court shall enter judgment and close the case.
SO ORDERED.
/s/ Paul J. Barbadoro
Paul J. Barbadoro
United States District Judge
May 26, 2022
cc: Counsel of record
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