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Lisa King, As Special Administrator For the Estate of John P. v. Sue Kramer

May 25, 2012


Appeal from the United States District Court for the Western District of Wisconsin. No. 3:10-cv-00123--William M. Conley, Chief Judge.

The opinion of the court was delivered by: Wood, Circuit Judge.


Before BAUER, POSNER, and WOOD, Circuit Judges.

John P. King died while incarcer- ated at the infirmary in the jail operated by La Crosse County, Wisconsin. King's widow, Lisa King, brought an action under 42 U.S.C. § 1983 against five defendants: Officer William Olson, Officer Jennifer Koby-Gobel, Nurse Sue Kramer, Nurse Karen Mondry-Anderson, and La Crosse County. For the reasons discussed below, we affirm in part and reverse in part the district court's grant of the defendants' motion for summary judgment.


Our account of the facts proceeds, as it must, in the light most favorable to King; as usual, we are not vouching for anything. Righi v. SMC Corp., 632 F.3d 404, 408 (7th Cir. 2011). On April 7, 2007, King was booked at the La Crosse County Jail to await trial. The County contracts with a private company, Health Professionals Ltd. (HPL), to provide medical care for the inmates. The 2007 contract makes HPL responsible for providing a physician to attend weekly sick call "for an estimated minimum of one hour and an estimated maximum of three hours except as is medically necessary." Dr. Erickson was the physician under contract with HPL to conduct on-site visits for at least two and no more than four hours a week; he typically came on Tuesdays. No other physician was physically present at the jail during the week. The contract also gave HPL the authority to develop a preferred drug list, the so-called formulary.

King suffered from serious medical problems, including severe anxiety, at the time of his incarceration. His doctor at the Tomah Veterans Hospital had prescribed for him a daily regimen of medications that included five milligrams of alprazolam, a benzodiazepine. King brought with him to the jail two grocery bags full of his medications, including a bottle with 115 one-milligram tablets of alprazolam. Nurse Karen Mondry-Anderson conducted his initial health screening. King told her that he had asthma, diabetes, a heart problem, high blood pressure, seizures, and mental health problems. He also said that he had mental health issues that would require attention while he was at the jail.

Mondry-Anderson contacted the on-call physician, Dr. Stephen Cullinan, who was based nearly 300 miles away in Peoria, Illinois. She informed him that King had a large bottle of alprazolam in his possession, but that she was not certain of his prescribed daily dosage. Obvi- ously unable to examine King, and not bothering to obtain the details about the VA prescription, Dr. Cullinan nevertheless scheduled him to be weaned off the alprazolam, a drug excluded from HPL's formulary, over a three-day period. This was a dangerously rapid reduction given King's existing prescription. Dr. Cullinan ordered King to be switched to a beta blocker, Inderal, that was on HPL's formulary, rather than another benzo- diazepine. Beta blockers may be used off-label to treat performance anxiety. They are often helpful to performers and public speakers because they block the physical symptoms of anxiety, notably tremors and short- ness of breath. Dr. Brian Brennan, What Are Beta Blockers, How Do They Work, and How Are Beta Blockers Used in the Treatment of Anxiety Disorders? ABC NEWS, story?id=4664801 (last visited May 22, 2012). They do little to reduce the feeling of anxiety, and are not rec- ommended for patients with heart conditions or asthma. Lundbeck Institute, Anxiety Disorders, Treatment.shtml (last visited May 22, 2012). Given that King was not seeking short-term performance anxiety relief and that he did suffer from a heart problem and asthma, it is not clear why Inderal was chosen for him. The jail medical staff failed to give King any alprazolam on his first day. On the second and third days, he received two doses, and he received one final dose on the fourth day, April 10.

Abrupt withdrawal from alprazolam can be life-threatening. Associated symptoms include agitation, elevated blood pressure, elevated pulse, tremors, delu- sions, hallucinations, and seizures. The severity of such symptoms requires medical providers to monitor the patient closely, preferably in a hospital. No member of the jail's medical staff prepared a plan to monitor King's withdrawal.

King was housed in Receiving Cell C with four other inmates: Michael Kleiber, John Gerke, Jesse Reid, and Clinton Stevens. King's health appeared to deteriorate in the days following his arrival at the jail. His shaking became more severe, and he became less and less coher- ent. King told Kleiber that he had been given a replacement medication that made him feel shaky and caused him to hallucinate.

On April 10, Nurse Deb Baker faxed a medical release to Tomah Veterans Hospital for a complete list of King's prescriptions. The Hospital provided the jail with the requested information later that day. The documentation stated that King was prescribed five milligrams of alprazolam daily. The list of medications was placed in King's medical file, where it remained available for the physician at his weekly on-site visit.

King submitted a health request the following day indicating that he wanted to be seen by a physician. He stated that he had not slept in at least 96 hours, among other concerns. He complained to jail staff that he was suffering from side effects of the medication, but they informed him that he needed to wait for the doctor. Again on April 13, King requested health care and was informed that he would meet with a physician at the next available appointment. He was seen by a social worker on April 13, who noted that King appeared anxious and was perspiring. King was not finally seen by a physician until April 17, ten days after he was admitted to the jail. The physician, Dr. Erickson, noted that King had pressured speech and flights of ideas with manic insomnia.

The critical events forming the basis of this action took place on April 18. In the morning, Officers Brian Olson and Jennifer Koby-Gobel conducted a cell check and saw King lying in his bed. He made eye contact with Olson and then closed his eyes and twitched his arm. At approximately 10:30 a.m., Gerke, one of King's cellmates, called for help. Olson and Koby-Gobel ...

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