United States District Court, D. New Mexico
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.
MEMORANDUM OPINION AND ORDER
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.
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. 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.
Count Four of the Complaint for Wrongful Death (Complaint)
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
Facts Relevant to the Motion for Partial Summary
a. Gonzales' Care and Treatment
7, 2014, at 7:34 p.m., emergency medical technicians (EMTs)
arrived on scene to treat Gonzales for a heroin
overdose. (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.
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.
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.
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.
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.
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.
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,