0.1. 9, 2004 12:52PM

CORRECTIONAL MEO/LEGAL

No,0675

P, 2

RODERIC GOTTULA MD
70421O:ECH WAY
CAS"J'LE Rocit, CO 80 f 08
1~1S0

RODG01TUL&@C:NLC.US

October 7, 2004
Alphonse Gerhardsfein
Laufman and Gerhardstein
617 Vine stJeet, Suite 1409

Cincinnati, OH 45202
RE:

Susan samples v. logan County Sheriffs Dept.
Case # 2:03CV647

Dear Mr_ Gemardstein,
These are my expert Witness opinions on the above named case. These opinions are based upon my 26 years
expe~nce as a FamilY Physician and my 13 years of CorrectionaJ Health Care el(per;ence, my knowledge of
Correctional Health Care standards through site surveys, as well as Interaction with Correctional Health Care
professlonals in my role as President of the SocIety of Correctional Physicians and the American Correctional
Health Services Association. I hold these opIniOns to a reasonable degree of medical certainty"
To formulate this opinion, I reviewed the following documents:
Documents from the Ohio Peace Office Training manuals. Section 5120: 1..s-09 of the Ohio Administrative Code of
Minimum Standards for Full Services Jails, Intake screening of Susan Samples at logan County Jail and
miscellaneous documents regarding training of offlcers, certificates and jail policies,

Dsposmons ot
1. Brent samples
2. Corporal Guy Knight
3. Amy Oakley
4. Charles Wirick
5. Heather MaxweU-Boone
6, FrancIS GalYk
7. David Stockwell
B. ScoH Cosbn
9. Brenda Shively
Interviews at the time oftha incki8nt of:
1. Beth Mathews
2, Charles Wirick
3, Oeborah Kindl.
4, Guy Knight
5. Heather Boone
6, Vera Holden

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Susan Samples was a 42 year-old woman, who was arrested by Officer Francis Galyk in the early morning of
September 17,2002 for disorder1y conduct. Galyk had been dispatched to the Samples' residence, following a call
by Brent Samples to the Sheriffs office. Upon arrMng at the house, Officer Galyk was met by Mr. Samples who
essentiany told him that Mrs. Samples appeared to out of control and he was concerned. According to his report,
Mr. Samples said Susan had a drinking problem and he was concerned for the welfare of himself and their children.
After several attempts to quiet Mrs, Samples down, OffICer Galyk finally arrested her and took her to the logan

County Jail,
The record~ indicate that they arriVed at the jail al around 3:00 am but she wasn't Oooked in untO 6",31 am, There
was no Specific explanation for this delay although there was speculation that the baoklng area might have been
busy, or that she was too intoxicated to cooperate and they let her ~ sleep it otr for a few hours_

When Officer Galyk tumed over custody of Mrs. Samples, he made a Xerox copy of his report and indicates in his
deposition that he put mUltiple X's at the bottom to indicate to the jail staff that she was quite intoxicated. Review at
Ofl'lcer Galyk's deposition seems to suggest that at some later date, marks were made over his X's to try and hide
them.
It appears that Officer Wirick oooked Mrs. Samples although, in his deposition, he stales that someOne else may
have finished her booking process,
Somelime in the morning around 9:00 am, Susan Samples was taken to court where she was sentenced to
approximately 7 days in jail. She was returned to the jail and assigned an upper bunk in one of the female dorms,
There appear to be no additional custody ofrlCer notes on her until the early hours of Sept 18,2002,
In the early hours of Sept. 18th, Corporal Knight, who was in the Control Center, received an intercom call from the
inmates In Susan Samples' dorm, stating that a woman had falten out altha upper bunk and struck her head on the
floor. The records reviewed give estimates of the custody officer's response time, from 15 seconds to 5 minutes.
Custody staff that entered the unit states they found a woman laying on the floor of the cellblock. partially on her
side and bleeding from the head. Initial evaluation by Officer Boone indicated that she flad a pulse but did not
respond to command. Officer Wirick thought she was brea~jng, but that it was Shallow. It appears that the majority
of inmates and officers refer to a gurgling sound or abnormal breathing.
A call was made to Corporal Knight tv summon the Rescue Squad. He placed thIs call after making a brief phone
call to the on-call nurse_ None of the officers attempted CPR, even though It appeared that Mrs, Samples' breathing
was deteriorating or stopping and that her pulse was weak or nonexistent. When Fire Rescue arrived, whic.h was
about 22 to 23 minutes after the inilial report of Susan Samples falling out bed, they Found her to be in fuJI code (not
breathing and no heart beat). They called for backup and began CPR. Eventually t she was intubated and given
defibrillation but to no avail. She was transported to the hospital where she was pronounced dead.
In reviewing these records, I find multiple instances of lack of care that constitute deliberate indifference to Mrs.
Samples' serious medical needs. The first of these is the woefully inadequate intake screening on her booking into
the Logan County Jail. She was obviously intoxicaled and the staff was alerted to this via Officer Galyk's report, but
nothing was done to assess her level 01 Jrrto:(ication. More specifICally, no questions were asked regarding her level
of drinking or her duration of drinking. This is not in conformance with the Ohio Administrative Code of Minimum
Standards for FUll Service Jails, whose policies state that when doing an intake on an arrestee this type of
information should be obtained. I attribute some of the blame for Mrs, SampleS' demise on the failure of the Logan
County Jail and ii's staff, to follow these rules promUlgated for fulf service jails [5120: 1~6-09J that are also reflective
of the accepted Standard of care in jails and prisons.
Second is the failure of the custody staff to foliow up on Susan Samples when she returned from Court, as
instructed by Corporal Knight when he finished h"ls shift on the morning of september 18,2002, Had they done so, I
believe that they would have seen the eany indications of Alcohol Withdrawal Syndrome and been able to either

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CORRECTIONAL MEG/LEGAL

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alert the nursing staff, or at least bring Susan Samples up to the bOoking area where she could have been
monitored more closely,
Third. in reViewing the depOsition of DL Scott Costin, if appears to me that he has very IiWe knowJedge of Alcohol
Withdrawal Syndrome. He seems to indicate in his deposition that treating alcohol wlthdrawal with benzodiazepines
only makes it more "tolerable" as opposed to being life saving. His responses also ,indicate that he dOes not
recognize that untreated alcohol withdrawal can frequently be life threatening, nor does he seem to be
knowfedgeable that the majortly of deaths related to alcohol withdrawal, occur in custody settings such as a jail. He
mentions that he used Harrison's and Cecirs Manuals of Medicine, as well as the American Academy of Family
Practice as his resources for practicing medIcine. He has never joined a CorrectIonal Health Care professional
group or ever attended a Correctional Health Care conference, where issues of de/ox would' have been a common
theme, This lack of common knowledge of what is a significant life threatening Illness in the correctional
environment. where it occurs frequently, I consider to be deliberately indifferent to the serious medical needs of
Susan Samples, as well as all inmates with serious alcohol problems booked into the logan County Jail. I note that
he acknowledges in hIs deposition, there are more indiylduals booked into the logan County Jail with alcohol
problems than are found in the general population. This indeed is most likely true, as alcoholics and those who are
intoXicated are much more hkely to run afoul of the law (as in Mrs. Samples' case) and be arrested.
This lack of know!edge and vigilance also allowed the nursing and custody start to nat be trained in recognizing
Alcohol Withdrawal Syndrome as a potentially lethal entity and allow it to go unrecogni(:ed. Or to be recognized
only after the individual was placed in housing and started to exhibit symptoms ofw·lthdra'Nal. In support of my
opinions, I have attached a bibliography of articles on the lethal/ty and treatment of Alcohol Withdrawal Syndrome.
as well as the National Commission on Correctional Health Care Standards on Intoxication and Withdrawal dated in
1996. AU of ltIese texts should have been available to Dr. Costin. If he had chosen to leam more about CorrectIonal
Medicine,
One of the articles is a chapter from Cljnical F'lract'rce in Correctional Medicine which discusses many of the iSsiJes
that are dealt with in correctional setting that are different then lhose experienced In private practice. One of those
differences relates to the frequency of alcohol and drug withdrawal In the correctional setting, This chapter, once
again. emphasizes the lethality of untreated alcohol Withdrawal,
According to Logan COl.mly Sheriffs Office, policy 72.75, Or, CostIn was to serve as the Medical Director of the jail.
As such, he has the overall responsibility for health care In that jail which would include development or oversight of
all medical and nursing policy and prncedlJre, as well as writing or signing off on all standing orders The records I
reviewed appear to indicate that medical policies and procedures were actually written by custody and not
medicaVnurslng staff, without input from Dr. costin, Such actions, if accurate, would constitute deliberate
indifference to the serious medical needs of the inmates of Log-an County Jail. inclUding Susan Samples.
Fourth, In reviewing Brenda Shively's deposWon, it appears that the nurse sees indiVIduals, who are identified as
having posSible alcohol Withdrawal. when the nurse is on site. The cuslody staff does not appear to have been
adequately trained to recognize Alcohol Wtthdrawal Syndrome. Therefore, even if there is a nurse on-eall for such
potential issues, If the custody staff can't recogn~ i~ this would still constitute deliberate indifference to the serious
medical needs of arrestees who either come Into the facility or start to have problems during those hours a nurse is
not on site (as was true in Susan Samples' case)_ Her deposition also Indicates to me that she, too. does not have
adequate knowledge of the lethality of Alcohol Withdrawal Syndrome. Such lack of knowledge In a jaW setting, in my
mind, constitutes deliberate indifference, as this IS the setting where it most likely to occur and at the same time the
person going through the withdrawal in unable to remedy the situation (i.e. drink some alcohol)
It haven't seen any evidence of education programs for the nursing or custody staff, not only in the lethality of
alcohol withdrawal, but also no training in the CIWA~r scale recommended by the American Society of Addiction
Medicine, the authors of "Clinical Practice in Correctional Medicine" and the articles in American Fam~v Physician.
Use of this scale, applies objectivity to monitoring the withdrawal process and allows someone to be safely
detoxified. There Is no evidence that this process was used and indeed. the detox protocols I reviewed are
extremely vague 10 the point that I can't even tell if Ihe nurse initiates them Without seeing the patient.

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It in fact, the nurses initiated the Detox process wfthout physician contact, without a specific: protocol and without
the use of the CIWA~r scale, I consider that to be detiberale indifference to the serious medical needs of the inmate.
To this point, the records indicate to me deliberate indlfferen'ce to the serious medical needs of SlJSan Samples by
not doing a proper intake regarding alcohol consumption as put forth by the Ohio Administrative Code of Minimum
Standards for Full Service Jails (Section 5120: 1-8-09). They failed to adequately re-evaluate Susan Samples as
requested by Corporal Knight when he finished his shift. They lacked the training to evaruate someone going
through potentially lethal alcohol withdrawal. Dr. Costin lacked the necessary training regarding alcohol withdrawal
and failed to impart its Importance to the nursing and custody staff at logan County Jail and Nurse Shively failed to
recognIze the potentlallethaltty of alcohol withdrawal and communicate that to her nursing staff via training and
proper protocols.

It appears from the records, that logan County Sheriffs Office poliCy 72. 73, page 5, Section II, G, states that the
physician will be on site three times a week. This is appropriate for a jail the size of Logan County and would meet
the National Commission on CotTeCtlonal Health Care standards were they to be accredited. However, the
testimony I reviewed indicates to me that Dr. Castin was on site only ance a week and that this was for about two
hours, WhiCh Were divided between the jail and the juvenile faclity, The expectation appears to have been that,
during this time. he would see all the sick call patients he needed 10 see, as weJJ as any necessary physical exams.
In my experience, performing all these services and providing quality care would be inconsistent in a jail setting.
Several documents allude also to a quarterly report on utiliZation. This was not contained in any of the records I
reviewed which might illuminate concerns about sick calf flow.

Fifth. defibarate indifference is also seen in the custody staffs behavior once they were alerted to Susan Samples
having fallen out of bed. Upon arriving at the scene, they assessed her for a pulse and breathing. Most of the
testimony seems to indicate that she was not breathing normally, at best, making what sounded like agonal breath
sounds and at worst, not breathing at all. In fact, in her testimony, Officer Boone states that she told Corporal
Knight that she thought Mrs. Samples had stopped breatt'ling. During that time, Officer Boone also checked Susan
Samples' pulse and initially found a good pulse. but later before she leaves the scene. found it weakening, All of
these signs are obvious indications that Susan Samples may be dying and in need of CPR. In spite of this. no CFlR
is started due to Officer Wirick's comment not to move her because of a possible head injury. In the face of
someone dying due to lack of cardiopulmonary circulation, you don't let them die because you are afraid to move
him!her. This to me indicates a lack of approprIate training of the logan County Shenff staff in regards to
Emergency Care and CPR, Had the custody staff initiated CPR instead ofwaiting for the Rescue Squad. Susan
Samples would more then likely than not, survived, as her head injuries were not that severs. Not initiating CPR 10
someone In cardiopulmonary arrest will usually assure his ar her demise.
In summary, I believe Dr. Costin exhibtted deliberate indifference to Susan Samples by not fulfilling hiS duties as
Medical Director of the logan County Jan, By not obtaining adequate knowfedge of the lethality of Alcohol
Wlthdrawal Syndrome, which is more common in the jail setting, and by not establishing polices and procedures
that would assure adequate training of the nursing and custody staff in this syndrome or how 10 manage it when
inmates began to show signs of it, also shows deliberate Indifference. It also appears that he was not adhering to
the policy of the Logan County Sheriffs Office with regard to the Urne spent on·sJte, norfu!fllling his duties in
developing porlCies and procedures as outlined in the Ohio Administrative Codes of Minimum Standards for a Full
Service Jail.

I believe Nurse Shively also demonstrated deliberate indifference to Susan SampleS' serious medical needs by not
being knowfedgeable of the potential lethality of Alcohol Withdrawal Syndrome, not ensurrng that her nursing staff
and the custody staff were educated on how to recognize it and what to do once it was recognized.
I believe that logan County and the logan County Sheriff exhibited deliberate indifference to Susan Samples'
serious medIcal need by not having an Intake Screen that was mandated by the Ohio Administrative Code of
Minimum Standards for a ~ull Service Jail, If such an Intake Screen had been in place at the time of Susan
SamplE!i enlry into their system, it would have revealed her to be at high risk for alcohol withdrawal and measures
could have been taken to ensure closer obsetVation and her safety. The lack of such a screen and attention to the
arresting officers reports allowed someone with a serious medical condition to enter the system unknown,

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Thl! response of the custody officers to Susan Samples aftsr sne ten from the bunk bed ensured that she would not
survive. At the time they reached her, she stU! had a heartbeat and possibly was still breathing. If CPR had been
initiated at that time, there Is a good possiblHty that she would have lived. However, the lack of oxygen to her brain
from the time the officers entered the room until the time that Rescue arrf\Ied 22-23 minutes later. allowed her fo
expire. I regard this as deliberate Indifference to her serious medical needs.
lastly, I regard those actions and omissions of Dr. Costin and Nurse Shively stated above. to demonstrate
deDberate indifference to Mrs. Samples' serious medical needs as well as demonstrating substanc@rdsere and
medicall1egligencs.
These opinions are based on my review of the records outlined at the beginning of this opinion letter. If additional
records or information is made available in the fUlure, J reserve the right to revise my opinion based on review of
this new information.

J;2UY'Ubm
Roderic Goltula MO

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Bibliography On Susan Samples v. Logan County
Kassel' C, Geller A, HolNllll E, Warlenberg A, Detoxilicalion: Principals and Protocols. Vol, 1, Number 2. Chevy
Chase. MD: Amelican SocIety of Addiction MedIcine, July 1997
Carison H. Konnedy J. The Trealmont 0/ Aloohol and OIlier Drug AbstInence Syndromes,
In: Puisls M, Clinlca' Practico in CorrecHonaI Madicine. Mosby.1998 Chspter 23.
Praler C, MUler K, Zylstra R. Outpatlent Deto>dfication ot U1e AdOlCIed Of Alooholic Palion!. Amelican Famtly
Physic/an 1999; 60: 1175-83.

_«Is for Health ServIc98 in JaUs. 2'" Printing. May, 1999. National CommISsion on Cotrectional Health Care.
Huffman G. Guido/ina for Management 0'Alcohol Wifhdiawaf. JAMA 1997k 278;144-51
Bayard M, Melnlyra J, Hill K, Woodside, Jr J. AIoohoI Withdrawal Syndroma. American Family PhysiCian 2004: Vol
69 Number61443-50