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Estate of Jensen v. Duchesne County

United States District Court, D. Utah

July 22, 2019




         This matter is before the court on Defendant Kennon Tubbs, M.D.'s Motion to Dismiss Plaintiff's Second Amended Complaint [ECF Docket No. 101] and Defendant Logan Clark's Motion for Judgment on the Pleadings [ECF Docket No. 104]. On July 11, 2019, the court held a hearing on the motion. At the hearing, Ryan B. Hancey represented Plaintiff Estate of Madison Jody Jensen, Cortney Kochevar represented Defendant Kennon Tubbs, and Kathleen Abke represented Defendant Logan Clark. Counsel for other Defendants were present and observed the proceedings. After hearing argument, the court took the matter under advisement. After carefully considering the memoranda and other materials submitted by the parties, as well as the law and facts relating to the motions, the court issues the following Memorandum Decision and Order.


         On Sunday, November 27, 2016, Jared Jensen called the Duchesne County Sheriff's Office after he observed his 21-year-old daughter, Madison, exhibiting erratic behavior and he found what he believed to be drug paraphernalia and residue in her room. Deputy Jared Harrison of the Duchesne County Sheriff's Office responded to the call and spoke to Madison. Madison told Harrison that she was “coming off” heroin, had last used four days earlier, and had disposed of her heroin supply that day. She also admitted to recently smoking marijuana and told Harrison she was taking Tramadol, Wellbutrin, and Clonidine as prescribed by her physician. Harrison arrested Madison for internal possession of drugs and possession of drug paraphernalia and took her to the Duchesne County Jail (the “Jail”). He also took her prescription medications.

         Madison was booked into the Jail at 1:34pm on November 27, 2016. During the booking process, Madison filled out an inmate mental health questionnaire where she disclosed that she suffered from anxiety and depression for which she had been prescribed and was taking Wellbutrin. Madison also noted that she was taking Tramadol for pain and Clonidine for high blood pressure. She also reported that she had a history of using heroin, pills, marijuana, and admitted that she had recently used heroin.

         According to Jail policy or custom, Deputy Elizabeth Richens, a booking officer, placed the intake questionnaire in a medical box designated for the jail nurse. At the time, Duchesne County employed a Jail nurse, Jana Clyde, who was responsible for overseeing the health and safety of the Jail inmates. In addition to the Jail nurse, Duchesne County contracted with an independent medical provider, Dr. Kennon Tubbs, M.D., to provide on-site medical care to sick inmates at the Jail one day a week and to be on call twenty-four hours a day, seven days a week to assist with medical issues as they arose. Dr. Tubbs subcontracted with physician assistant, Logan Clark, to perform some of Dr. Tubbs' medical care duties at the Jail. The specific details of their subcontract arrangement are unknown.

         Jail personnel placed Madison in a cell in the Jail's “H Block” with fellow inmate Maria Hardinger. Madison complained to Hardinger of feeling sick and vomited within ten minutes. She continued to vomit and suffer from diarrhea throughout the day and night. On Monday, November 28, 2016, Richens took Madison to visit Clyde in the Jail's medical office. Madison told Clyde she had been vomiting and believed she had a stomach bug. Clyde told Madison to save her vomit and diarrhea for Clyde to observe. Richens told Clyde that Madison had used heroin a few days before and had tested positive for opiates when she was booked into jail.

         Clyde took Madison's vital signs and observed that Madison's blood pressure was high. Clyde gave Madison a Gatorade and called Clark. Clyde informed Clark that Madison had been vomiting. Clyde claims she told Clark about all three of Madison's prescription medications and he only approved administration of the Clonidine. Clark, however, claims that Clyde only mentioned the Clonidine.

         The rest of that day, Madison continued to feel ill, stayed in her cell, and did not eat her meals. Jail staff knew she was not eating. When Madison attempted to drink water, she vomited. She and Hardinger used the call button in their cell several times to notify Jail staff that Madison was ill and vomiting. The Jail staff responded that they were aware Madison was ill but they did not provide any specific medical care for her symptoms. Around 6:00 p.m., Madison was able to leave her cell to take a shower but she continued to be ill.

         The following day, Monday, November 29, 2016, Madison continued to vomit, stayed in bed, and did not eat her meals. Richens took Madison to Clyde's office again that morning and noted that she looked noticeably weaker and paler than the previous day. Richens informed Clyde that Madison was still vomiting, but it is unclear what care was given. Later that day, Hardinger pushed the call button and informed the deputy in the control room that Madison was continuing to vomit so violently that it was causing a mess. The deputy told her she could leave her cell to retrieve cleaning supplies to clean up the mess but to stop pushing the call button. Clyde claims that no jail personnel ever informed her that Madison and Hardinger were pushing the call button or reporting anything.

         During the evening of Tuesday, November 29, 2019, Richens took Madison to see Detective Monty Nay. Madison was dizzy and having a hard time walking. Nay observed Madison and told Richens to watch her closely. Richens knew that Madison had not been eating. Richens moved Madison to a medical observation cell where jail staff could more easily observe her condition. Richens informed Clyde that Madison was being moved to an observation cell, and Clyde agreed to the move. Richens observed Madison lying in bed and vomiting several times. Richens requested that Clyde provide Madison with Gatorade.

         Clyde gave Richens a medical request form for Madison to fill out to see Clark on Thursday. Madison filled out the medical request form. She misdated the form and stated that she had been “puking for 4 days straight, runs, diarrhea, can't hold anything down not even water.” Richens gave the form to Clyde, who reviewed it. Neither Clyde nor Richens contacted Clark or Dr. Tubbs to inform them that Madison had been moved to a medical observation cell or that she filled out a medical request form.

         On Wednesday, November 30, 2019, Clyde attached Madison's medical request form to a medical file for Clark to review when he arrived at the Jail on December 1, 2019. Clyde visited Madison's cell once that day to pass her a Gatorade, but did not inquire as to her condition or take her vital signs. Deputy Caleb Bird took Madison's medication to her cell and she was unable to get out of bed to take it. Bird entered her room to give her the medication even though it was against jail policy. Bird told Clyde that Madison was too weak to get out of bed. Clyde told Bird that she knew Madison was vomiting and withdrawing from heroin. Again, no jail personnel contacted Clark or Dr. Tubbs about Madison's condition on November 30, 2019.

         On December 1, 2019, Jail employees reported that Madison had been vomiting through the night. Sergeant Purdy asked Clyde if she could give Madison a Gatorade, and Clyde agreed. Purdy put a Gatorade on the food pass of Madison's cell. When Lieutenant Jason Curry, the Jail Commander, arrived on his shift that day, he talked to Clyde about Madison. Curry asked Clyde if ...

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