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United States Court of Appeals, Ninth Circuit.
Decided: December 10, 2004
Hiroshi TOGUCHI, on behalf of himself and as Special Administrator of the Estate of Keane Toguchi, Plaintiffs-Appellants, v. SOON HWANG CHUNG, Defendant-Appellee. No. 03-15378.
Before: FARRIS, NOONAN, and RAWLINSON, Circuit Judges. Carl M. Varady, Honolulu, HI, for the plaintiffs-appellants. Girard D. Lau, Deputy Attorney General, Honolulu, HI, for the defendant-appellee.
We sympathize with the Toguchis on the loss of their son, Keane. However, we agree with the district court that Keane’s death was not the result of Dr. Soon Hwang Chung’s deliberate indifference to his serious medical needs. Accordingly, we affirm the district court’s judgment in favor of Dr. Chung.
Keane Toguchi (Keane) was incarcerated for most of the period between 1993 and 1998.
He was treated by Dr. Chung during his incarceration at the Halawa Correctional Facility (Halawa) in 1997 and 1998. Keane had a lengthy history of mental illness and had been clinically diagnosed with bi-polar disorder, panic disorder, organic brain syndrome, depression, and Wolff-Parkinson-White Syndrome. Keane also had an extensive history of illicit drug use, including cocaine, crystal methamphetamine (ice), and heroin. Keane was paroled in April of 1998, but returned to Halawa eight months later, after he violated his parole by testing positive for ice. In fact, Keane had taken ice two days prior to his readmission and had not taken his prescribed medications, including Seroquel, Klonopine, Tranxene, and Zoloft, for five days. Keane was placed under the direct care of Dr. Chung, who kept him in therapeutic lockdown for two weeks in an attempt to stabilize his condition. Dr. Chung prescribed Seroquel, Zoloft, Haldol, and Benadryl, and by December 16, Keane had been stabilized and released into the general population.
Five days later, he began to display irrational behaviors, including urinating on the floor. Discontinuing the use of Seroquel and Haldol, Dr. Chung transferred Keane to the mental health module of the prison, and prescribed Trilafon (an antipsychotic) and Congentin to deal with his irrational behaviors.Two days later, Keane was brought to Dr. Chung after he had been shaking, talking loudly, and moving around throughout the previous night. Dr. Chung reported her observations of Keane at 9:15 a.m. and treated him with Haldol, Cogentin, Benadryl, and Artane. At around 1:20 p.m., Dr. Chung observed Keane acting in a bizarre manner, including walking into walls and rocking on the toilet bowl. Dr. Chung ascribed Keane’s irrational behaviors to a likely ice flashback. Dr. Chung considered Keane an imminent threat to himself and ordered him placed in restraints.Dr. Chung observed Keane for about fifteen minutes after he was restrained and returned every fifteen minutes thereafter. At 2:30 p.m., the doctor noted that Keane had fallen asleep, and was still sleeping at 2:45 p.m. However, at 3:00 p.m., a nurse notified Dr. Chung that Keane had stopped breathing. Attempts to revive Keane failed, and he died shortly thereafter.
The medical examiner described the cause of death as follows:[T]his 37-year-old man died as a result of combined toxic effects of sertraline and diphenhydramine. The blood level of sertraline is in the lethal level and the blood level of diphenhydramine is in the toxic level. These blood levels are attained by ingestion of multiple tablets of the medications. It is not known whether the medications were taken with suicidal intentions or accidentally ingested because of the altered mental status of the decedent.Keane’s parents (the Toguchis) brought a 42 U.S.C. § 1983 action against prison physicians Dr. Sisar Paderes and Dr. Chung alleging that they were deliberately indifferent to Keane’s serious medical needs. Dr. Robert C. Marvit and Dr. Wayne R. Snodgrass served as experts on behalf of Dr. Chung.
Dr. Marvit concluded that “it would be unrealistic to state that the levels [of Benadryl and Zoloft] in the blood were from the prescribed medications.” 1 He also opined that “the care and treatment provided to [Keane] by Dr. Soon Hyung Chung was appropriate and met the standard of care for psychiatrists ․” Dr. Snodgrass similarly concluded that “[t]he clinical symptoms and signs exhibited by [Keane] were appropriately interpreted by Dr. Chung to be consistent with withdrawal from methamphetamine” and that the “drug therapy ordered by SH Chung, M.D. was appropriate and indicated.”Dr. Bruce Victor and Dr. Randall Tackett served as experts on behalf of the Toguchis. Dr. Victor concluded that:Dr. Chung’s failure to evaluate [Keane’s] actual condition, to conduct a differential diagnosis that would rule out disease or conditions other than ‘ice flashbacks,’ led her to disregard the known risks of harm from the medications she was administering to him in high doses which, in turn, were superimposed upon probable benzodiazipine withdrawal syndrome and WPW [Wolff-Parkinson-White Syndrome].
Her failure to consider these risks directly and proximately precluded proper treatment of [Keane] and, thereby, eliminated any chance of determining the seriousness of his condition or taking appropriate measures that would have prevented his death.Dr. Tackett concluded that “[Keane] died from the combined effects of sertarline [sic] and diphenhydramine administered to him by Dr. Chung.” Dr. Tackett expressed the view that these drugs, along with Cogentin, were prescribed “without any assessment by Dr. Chung of [Keane’s] actual medical condition and without regard for possible withdrawal symptoms that would be affecting his heart rate or potential for arrhythmia.”After considering the evidence submitted by the parties, the district court granted the defendants’ summary judgment motion, concluding that there was no triable issue of material fact on the question of whether Keane’s death resulted from Dr. Chung’s deliberate indifference to his medical needs.2