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Bevan v. Valencia

United States District Court, D. New Mexico

November 2, 2017

AIMEE BEVAN, as Personal Representative of the Estate of Desiree Gonzales, deceased, Plaintiff,
GABRIEL VALENCIA, Youth Development Administrator, Individually, MATTHEW EDMUNDS, Corrections Officer, Individually, JOHN ORTEGA, Corrections Officer, Individually, MOLLY ARCHULETA, Corrections Nurse, Individually, ST. VINCENT HOSPITAL, and NATHAN PAUL UNKEFER, M.D., Defendants.


         This matter comes before the Court on Defendant Nathan Paul Unkefer, M.D.'s Motion for Partial Summary Judgment on the Issue of Punitive Damages and Supporting Memorandum (Motion for Partial Summary Judgment), filed April 15, 2016. (Doc. 165). Plaintiff filed a response on May 17, 2016, and filed her supporting exhibits on May 19, 2016. (Docs. 182 and 187). Defendant Nathan Paul Unkefer, M.D. (Dr. Unkefer) filed a reply on June 2, 2016. (Doc. 192). Having considered the Motion for Partial Summary Judgment, the accompanying briefs, and the relevant evidence, the Court grants the Motion for Partial Summary Judgment.

         A. Background

         This case involves, in part, whether Dr. Unkefer was negligent on May 7, 2014, by prematurely discharging Desiree Gonzales from St. Vincent Hospital after having treated her for a heroin overdose with both Narcan and Ativan.[1] Upon discharge from St. Vincent Hospital and having been medically cleared by Dr. Unkefer for incarceration, police took Gonzales from St. Vincent Hospital to the Santa Fe Youth Development Program (YDP) for incarceration. It is undisputed that no nurse was present at the YDP that night and that several hours later Gonzales stopped breathing. It is also undisputed that when Gonzales stopped breathing and became nonresponsive non-medical YDP staff performed CPR and called 911. Several hours later, Gonzales died at St. Vincent Hospital. The Office of the Medical Investigator determined that the cause of death was “Toxic effects of heroin.” (Doc. 145-4) at 1.

         1. Count Four of the Complaint for Wrongful Death (Complaint) (Doc. 1)

         Plaintiff brings negligence claims against Dr. Unkefer in Count Four of the Complaint. Plaintiff alleges that Dr. Unkefer prematurely discharged Gonzales from St. Vincent Hospital, failed to appropriately monitor her condition, failed to provide appropriate monitoring instructions to YDP staff and police, and failed to obtain informed consent for Gonzales' discharge. In addition, Plaintiff alleges that had Gonzales “been in the hospital when her condition worsened, she would have survived.” (Doc. 1) at 17, ¶ 95. Plaintiff further alleges that she is entitled to punitive damages based on Dr. Unkefer's “reckless, wanton or willful” conduct in discharging Gonzales considering what “was known to the medical providers” and considering “her fragile state was clear ….” Id. at 17, ¶ 98. Dr. Unkefer now moves for partial summary judgment on the punitive damages claim. Plaintiff opposes the Motion for Partial Summary Judgment.

         2. Facts Relevant to the Motion for Partial Summary Judgment[2]

a. Gonzales' Care and Treatment

         On May 7, 2014, at 7:34 p.m., emergency medical technicians (EMTs) arrived on scene to treat Gonzales for a heroin overdose.[3] (Doc. 165-2) at 1. The EMTs reported that Gonzales was unconscious and “not breathing, ” but a CAD Call Information sheet noted that Gonzales was breathing. Id. at 3; (Doc. 192-6) at 1. The EMTs initially administered Narcan nasally. (Doc. 165-2) at 2. When Gonzales did not respond to the initial Narcan dose, the EMTs administered Narcan intravenously at 7:38 p.m., after which Gonzales awoke within a minute. Id. at 3. When Gonzales awoke, she was alert and called her mother to inform her that she was going to the hospital. Id. at 2-3. The EMTs then transported Gonzales to St. Vincent Hospital.

         When Gonzales arrived at the emergency department of St. Vincent Hospital at 8:40 p.m., Gonzales was talking although “[s]he vomited quite a bit.” (Doc. 165-5) at 1; (Doc. 165-3) at 2, depo. at 32-33. While the initial triage nurse, Kerri Craddock, was triaging Gonzales, Gonzales “was very agitated, ” was “very tearful, ” “did not want to be there, ” “was uncooperative, and had ripped out her IV, ” and tried to get off the bed. (Doc. 165-3) at 3-4, depo. at 34-35, and 49. Dr. Unkefer was present during the triage and saw Gonzales yelling, crying, looking anxious, not wanting the blood pressure cuff on, and refusing to give her name. Id. at 3, depo. at 35; (Doc. 192-1) at 3-4, depo. at 48-49, 75. At 8:40 p.m., Dr. Unkefer ordered that Ativan be administered to Gonzales to calm her down. (Doc. 165-3) at 5, depo. at 50-52. Dr. Unkefer, in fact, noted in the Emergency Physician Record that he gave Gonzales Ativan because she was agitated. (Doc. 165-5) at 2. Dr. Unkefer also noted in the Emergency Physician Record that Gonzales was “slightly anxious.” Id. at 1. Additionally, Dr. Unkefer gave Gonzales Zofran for the vomiting. (Doc. 165-6) at 3, depo. at 84.

         At 8:48 p.m., Craddock recorded Gonzales' vital signs which included an oxygen saturation rate of 89% on room air and a pulse rate of 128 beats per minute (bpm). (Doc. 142-2) at 3. Dr. Unkefer believed that Gonzales did not need to be put on oxygen despite an 89% oxygen saturation level because her lung sounds were clear, her respiratory rate seemed normal, and she was not complaining that she could not breathe. (Doc. 192-1) at 3, depo. at 46. Gonzales was put on oxygen as a matter of course. Id. at 3, depo. at 46-47.

         At about 9:15 p.m., another nurse, Marie Munger, became involved in Gonzales' care as her primary nurse. (Doc. 165-8) at 2, depo. at 51-53. Craddock and another staff member reported to Munger that Gonzales was alert, oriented, and angry, but, otherwise, had no problems. Id. at 2, depo. at 52. Munger observed that Gonzales “was on and off the cell phone, and angry that she was going to jail….” Id. at 3, depo. at 57. Gonzales, otherwise, answered Munger's questions, was no longer vomiting, and was doing as Munger requested. Id. at 4, depo. at 58-60. At that point, Gonzales' mother was with Gonzales. Id. at 3, depo. at 57. Munger observed Gonzales yelling at her mother once or twice. Id.

         Gonzales' mother noted that at about 9:30 p.m. Gonzales stated that it hurt to breathe and that she was holding her chest. (Doc. 142-3) at 2, depo. at 31. Gonzales' mother also noted that Gonzales had a “hard time standing” and seemed “out of it.” Id. at 2, depo. at 31, 33. Only two police officers and Gonzales' mother were with Gonzales at that time. Id. at 2, depo. at 31. Despite her concerns, Gonzales' mother did not try to talk to a doctor or nurse about Gonzales' condition. (Doc. 192-5) at 3, depo. at 34.

         Munger removed Gonzales' nasal cannula at about 9:35 p.m. so that Gonzales could adjust to breathing room air. (Doc. 142-2) at 3; (Doc. 187-10) at 2, depo. at 33. Then, at 9:48 p.m., Munger recorded that Gonzales' oxygen saturation level at room air was 93% and that her pulse rate had lowered to 99 bpm. (Doc. 142-2) at 3.

         Prior to discharge at 9:52 p.m., Dr. Unkefer listened to Gonzales' lungs to check for any respiratory problems, found no problem with her breathing, and saw that her vital signs were normal. (Doc. 165-5) at 2; (Doc. 192-1) at 4, depo. at 76-7; (Doc. 192-2) at 1-2, depo. at 81-2. A 93% oxygen saturation level and 99 bpm pulse rate were recorded as Gonzales' discharge vital signs. (Doc. 142-2) at 4. Dr. Unkefer noted in the Emergency Physician Record that Gonzales was observed for two hours after the last dose of Narcan. (Doc. 165-5) at 2. Dr. Unkefer detected “[n]o [r]e-overdose” and that Gonzales was “wide awake, ...

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