A federal judge ruled last month that a jury will decide whether medical personnel at the Colorado Territorial Correctional Facility were negligent or deliberately indifferent to an incarcerated man whose deteriorating condition culminated in his 2017 death.

Lorenzo Gabriel Flores had recently been transferred to the prison in Cañon City when he collapsed in his cell and died of a blood clot. Flores’ surviving child sued multiple prison employees, medical contractor Supplemental Health Care, Inc. and nursing personnel over his death. The state settled its claims, leaving only medical defendants as parties.

In a Dec. 8 order, Judge Timothy M. Tymkovich, who sits on the Denver-based U.S. Court of Appeals for the 10th Circuit, green-lit the lawsuit for trial. He concluded there was a valid dispute over whether nurse Anita Normandy knew of a serious risk to Flores’ health and disregarded it, and whether Normandy and nurse practitioner Celia Rife responded unreasonably to signs of medical distress.

Reports by expert witnesses concluded “both nurses failed to monitor Mr. Flores’s lack of eating and drinking and clear signs of distress,” wrote Tymkovich, who occasionally handles cases in the trial court despite his status as an appellate judge. “Since there remain material factual disputes as to whether Ms. Normandy and Ms. Rife were negligent, the defendants’ motion for summary judgment is denied both with respect to them and with respect to their employer, SHC.”

Flores was housed at multiple institutions prior to Colorado Territorial Correctional Facility. There were records of Flores experiencing “some leg pain” and that he had not eaten or drunk anything for long periods. At the same time, medical personnel also documented that nothing was amiss except a potential “hunger strike.”

The lawyers for Flores’ child, however, argued Flores’ longstanding mental health problems, specifically schizophrenia, rendered him incapable of caring for himself, to the point where it was obvious to a layperson. His attorneys submitted a statement from Flores’ cellmate who attested:

• Flores was not on a hunger strike, and only drank “once or twice” in the time they lived together

• Flores did not shower or “take care of his personal hygiene in any way”

• The cellmate repeatedly told nurses Flores was not eating or drinking, but “they didn’t do anything about it”

• Whenever Flores got up, he “grabbed his chest and winced like it was hurting”

On Aug. 3, 2017, Normandy asked Flores if he needed anything, such as water. Flores indicated he did not and Normandy left him. Ten minutes later, security informed her Flores was on the ground, and Normandy responded to an apparent seizure. Although Flores momentarily improved, he began to seize again and did not recover despite attention from medical personnel. He died that day.

The lawsuit alleged Normandy violated Flores’ constitutional rights through deliberate indifference, meaning she was aware of a serious risk of harm and disregarded it. Lawyers for Flores’ child also claimed Normandy, Rife and Supplemental Health Care were negligent in providing care leading up to his death.

“Mr. Flores’s severe dehydration and immobility (and related potentially profoundly serious effects) presented medical needs that were so obvious and urgent that Normandy and Rife had a constitutional obligation to immediately personally treat them. They could have done this simply by making sure that he consumed adequate water and providing him with Gatorade and the like,” the plaintiffs’ lawyers wrote. “Normandy and Rife did nothing whatsoever to attempt to ameliorate Flores’s obviously serious medical concern.”

The defendants countered that Flores did not exhibit any obvious signs of distress until he collapsed.

“Mr. Flores chose to lay in bed for hours at a time,” wrote lawyer Joseph P. Sanchez. “Although his obesity may have contributed to the development of blood clots in the legs (a risk factor not under the control of the SHC Defendants), a more likely reason for having developed blood clots was his lack of activity, which he made by his own choosing.”

In August, U.S. Magistrate Judge N. Reid Neureiter recommended against resolving the case in the defendants’ favor without a trial. While it was possible the defendants did not know Flores was in crisis, the statements of Flores’ cellmate and the expert opinions of a nurse and an emergency physician suggested medical staff acted unreasonably in treating or monitoring Flores.

“The SHC Defendants concede that Mr. Flores would ‘lay in bed for hours at a time,’ although they appear to attribute this to laziness rather than a medical condition. Whether his lack of mobility was a choice, or a symptom of a larger problem is question best left to a jury,” Neureiter observed.

Tymkovich adopted Neureiter’s recommendation and set the case for a jury trial. The parties have since indicated they will try mediating the claims with retired U.S. Magistrate Judge Kristen L. Mix next month.

The case is Estate of Flores et al. v. Supplemental Health Care, Inc. et al.